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Ehntholt A, Rodgers IT, Lekas HM, Lewis-Fernández R, Samaranayake D, Anderson A, Capobianco L, Cohen DE, Feeney S, Leckman-Westin E, Marinovic S, Pritam R, Chen S, Smith TE, Dixon LB, Saake A. Disparities in COVID-19-Related Psychological Distress Among Recipients of a State's Public Mental Health Services. Psychiatr Serv 2024; 75:444-450. [PMID: 37960865 DOI: 10.1176/appi.ps.20230025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The authors examined changes in perceived anxiety, stress, and mental health symptoms (i.e., psychological distress) reported by recipients of New York State public mental health services during the early months of the COVID-19 pandemic, as well as whether these changes varied by demographic characteristics or pandemic-related socioeconomic challenges. METHODS A statewide survey of service recipients (N=3,483) was conducted (May 8-June 22, 2020). Descriptive analyses were summarized, and logistic regression was used to evaluate associations between increases in reported psychological distress and age, gender, region of residence, race and ethnicity, socioeconomic challenges, and alcohol or drug use. RESULTS Fifty-five percent of respondents (N=1,933) reported a slight or moderate increase in COVID-19-related psychological distress, and 15% (N=520) reported a substantial increase. In adjusted models, substantial elevations in psychological distress were associated with identifying as female (AOR=1.83, 95% CI=1.50-2.25), experiencing three or more pandemic-related socioeconomic challenges (AOR=2.41, 95% CI=1.91-3.03), and reporting increased use of alcohol or drugs (AOR=1.81, 95% CI=1.34-2.44). Compared with non-Hispanic/Latinx White service recipients, non-Hispanic/Latinx Black individuals had lower odds of reporting substantially increased psychological distress (AOR=0.59, 95% CI=0.45-0.76), as did non-Hispanic/Latinx Asian-descent individuals (AOR=0.28, 95% CI=0.12-0.64). CONCLUSIONS In this large sample of recipients of New York State public mental health services, the COVID-19 pandemic's impact on psychological well-being was widespread and varied by gender, race and ethnicity, and socioeconomic vulnerability. These relationships must be considered in ongoing efforts to provide optimal care for this population.
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Affiliation(s)
- Amy Ehntholt
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Ian T Rodgers
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Helen-Maria Lekas
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Roberto Lewis-Fernández
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Dhanushki Samaranayake
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Adrienne Anderson
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Linda Capobianco
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Dana E Cohen
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Suzanne Feeney
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Emily Leckman-Westin
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Sonia Marinovic
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Riti Pritam
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Shuo Chen
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Thomas E Smith
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Lisa B Dixon
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Amanda Saake
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
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Zhang C, Zhang H, Zhang B. Prevalence trends and racial-ethnic disparities of diabetes and prediabetes among children and adolescents in the United States from 2019 to 2021. Prev Med Rep 2024; 41:102688. [PMID: 38533394 PMCID: PMC10963308 DOI: 10.1016/j.pmedr.2024.102688] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
Objective This study investigated disparities in diabetes and prediabetes prevalence among US children and adolescents using 2019-2021 National Health Interview Survey (NHIS) data. With rising trends in diabetes, understanding prevalence rates and associated disparities is crucial for targeted interventions. Methods Analyzing a cross-sectional sample of 19,490 participants aged 3-17, we employed NHIS data to calculate prevalence rates. Stratification by sociodemographic factors, race/ethnicity, and family income allowed for in-depth analyses. Results Between 2019 and 2021, overall diabetes prevalence was 1.18%, comprising 0.87% prediabetes and 0.46% diabetes rates. Disparities were evident, with higher prediabetes rates in non-Hispanic black and Hispanic children and elevated diabetes rates in non-Hispanic white and Hispanic children. Subgroup analyses revealed associations within age, gender, education, and income strata. Conclusions The study highlighted potential increases in diabetes prevalence from 2017 to 2021 and persistent racial/ethnic disparities. The 12-17 age subgroup exhibited significant disparities, emphasizing the need for early intervention. Targeted strategies were imperative to mitigate diabetes and prediabetes prevalence in vulnerable populations, particularly non-Hispanic black and Hispanic children. This study underscored the urgency of addressing health disparities for improved overall well-being and healthcare outcomes.
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Affiliation(s)
- Cancan Zhang
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hui Zhang
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Woodward EN, Cornwell BL, Wray LO, Pomerantz AS, Kirchner JE, McCarthy JF, Kearney LK. Impact of Primary Care-Mental Health Care Integration on Mental Health Care Engagement Across Racial and Ethnic Groups. Psychiatr Serv 2024; 75:369-377. [PMID: 38321918 DOI: 10.1176/appi.ps.20220631] [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: 02/08/2024]
Abstract
OBJECTIVE Receiving mental health services as part of primary care in the Veterans Health Administration (VHA) might increase engagement in specialty mental health care. The authors reexamined the association between primary care-mental health integration (PCMHI) and continued engagement in specialty mental health care for VHA patients and assessed differences by race and ethnicity. METHODS The study included 437,051 primary care patients with a first in-person specialty mental health encounter in 2015-2016 (no specialty mental health encounters in prior 12 months), including 46,417 patients with new PCMHI encounters in the year before the first specialty mental health encounter. Multivariable logistic regression assessed odds of follow-up specialty mental health care within 3 months of the first specialty mental health encounter. The dependent variable was care engagement (attending a second specialty mental health appointment); independent variables were whether patients were seen by PCMHI on the same day as the primary care appointment ("same-day access"), the time between PCMHI and first specialty mental health appointments, and race and ethnicity. RESULTS PCMHI was associated with increased engagement in specialty mental health care for all patients, with a greater likelihood of engagement among non-Hispanic White patients. Same-day access to PCMHI was positively associated with care engagement, with no significant differences by race or ethnicity. PCMHI care within 3 months before a first specialty mental health encounter was associated with greater care engagement. CONCLUSIONS PCMHI, especially same-day access to PCMHI care, may boost engagement in mental health care, although the study design precluded conclusions regarding causal relationships.
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Affiliation(s)
- Eva N Woodward
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, U.S. Department of Veterans Affairs (VA), and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Woodward); Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Ann Arbor (Cornwell); VA Center for Integrated Healthcare and Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, D.C., and Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Pomerantz); VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Kirchner); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Office of Mental Health and Suicide Prevention, VA, Washington, D.C., and University of Texas Health Science Center at San Antonio, San Antonio, Texas (Kearney)
| | - Brittany L Cornwell
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, U.S. Department of Veterans Affairs (VA), and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Woodward); Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Ann Arbor (Cornwell); VA Center for Integrated Healthcare and Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, D.C., and Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Pomerantz); VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Kirchner); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Office of Mental Health and Suicide Prevention, VA, Washington, D.C., and University of Texas Health Science Center at San Antonio, San Antonio, Texas (Kearney)
| | - Laura O Wray
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, U.S. Department of Veterans Affairs (VA), and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Woodward); Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Ann Arbor (Cornwell); VA Center for Integrated Healthcare and Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, D.C., and Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Pomerantz); VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Kirchner); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Office of Mental Health and Suicide Prevention, VA, Washington, D.C., and University of Texas Health Science Center at San Antonio, San Antonio, Texas (Kearney)
| | - Andrew S Pomerantz
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, U.S. Department of Veterans Affairs (VA), and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Woodward); Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Ann Arbor (Cornwell); VA Center for Integrated Healthcare and Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, D.C., and Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Pomerantz); VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Kirchner); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Office of Mental Health and Suicide Prevention, VA, Washington, D.C., and University of Texas Health Science Center at San Antonio, San Antonio, Texas (Kearney)
| | - JoAnn E Kirchner
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, U.S. Department of Veterans Affairs (VA), and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Woodward); Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Ann Arbor (Cornwell); VA Center for Integrated Healthcare and Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, D.C., and Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Pomerantz); VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Kirchner); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Office of Mental Health and Suicide Prevention, VA, Washington, D.C., and University of Texas Health Science Center at San Antonio, San Antonio, Texas (Kearney)
| | - John F McCarthy
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, U.S. Department of Veterans Affairs (VA), and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Woodward); Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Ann Arbor (Cornwell); VA Center for Integrated Healthcare and Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, D.C., and Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Pomerantz); VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Kirchner); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Office of Mental Health and Suicide Prevention, VA, Washington, D.C., and University of Texas Health Science Center at San Antonio, San Antonio, Texas (Kearney)
| | - Lisa K Kearney
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, U.S. Department of Veterans Affairs (VA), and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Woodward); Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Ann Arbor (Cornwell); VA Center for Integrated Healthcare and Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo (Wray); Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, D.C., and Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire (Pomerantz); VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Kirchner); Center for Clinical Management Research, VA, and Department of Psychiatry, University of Michigan, Ann Arbor (McCarthy); Office of Mental Health and Suicide Prevention, VA, Washington, D.C., and University of Texas Health Science Center at San Antonio, San Antonio, Texas (Kearney)
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Byhoff E, Dinh DH, Lucas JA, Marino M, Heintzman J. Mental Health Care Use by Ethnicity and Preferred Language in a National Cohort of Community Health Center Patients. Psychiatr Serv 2024; 75:363-368. [PMID: 37880967 PMCID: PMC10984775 DOI: 10.1176/appi.ps.20220585] [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: 10/27/2023]
Abstract
OBJECTIVE Disparities in U.S. mental health care by race and ethnicity have long been documented. The authors sought to compare specialty mental health service use among non-Hispanic White, English-preferring Hispanic, and Spanish-preferring Hispanic patients who accessed care in community health centers (CHCs). METHODS Retrospective electronic medical records data were extracted for patients ages ≥18 years who received care in 2012-2020 at a national CHC network. Zero-inflated Poisson regression models were used to estimate the likelihood of receiving mental health services, which was compared with expected annual rates of mental health service use. RESULTS Of the 1,498,655 patients who received care at a CHC during the study, 14.4% (N=215,098) received any specialty mental health services. English- and Spanish-preferring Hispanic patients were less likely to have had a mental health visit (OR=0.69, 95% CI=0.61-0.77, and OR=0.65, 95% CI=0.54-0.78, respectively). Compared with non-Hispanic White patients, Spanish-preferring Hispanic patients had an estimated annualized rate of 0.59 (95% CI=0.46-0.76) mental health visits. CONCLUSIONS Among patients who were likely to receive specialty mental health services, Spanish-preferring patients had a significantly lower rate of mental health care use. Although overall access to mental health care is improving, unequal access to recurring specialty mental health care remains among patients who do not prefer to use English.
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Affiliation(s)
- Elena Byhoff
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
| | - Dang H Dinh
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
| | - Jennifer A Lucas
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
| | - Miguel Marino
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
| | - John Heintzman
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester (Byhoff); Department of Family Medicine, Oregon Health & Science University, Portland (Dinh, Lucas, Marino, Heintzman); Department of Research, OCHIN, Portland, Oregon (Heintzman)
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Barry S, Jarskog LF, Xia K, Torpunuri RS, Wu X, Zeng X. Racial Disparities in Clozapine Prescription Patterns Among Patients With Schizophrenia. Psychiatr Serv 2024:appips20230226. [PMID: 38500451 DOI: 10.1176/appi.ps.20230226] [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: 03/20/2024]
Abstract
OBJECTIVE Previous research has suggested that demographic factors affect the likelihood of a patient with schizophrenia receiving a clozapine prescription. The authors aimed to determine the impact of race, social determinants of health, gender, rurality, and care patterns on clozapine prescription rates. METHODS This cross-sectional observational study used structured electronic health records data from 3,160 adult patients diagnosed as having schizophrenia between October 1, 2015, and November 30, 2021, in a multifacility health system. The social vulnerability index (SVI) was used to quantify social determinants of health. Descriptive data analysis, logistic regression, and sensitivity analysis were conducted to identify differences between patients with schizophrenia who received a clozapine prescription and those who received antipsychotic medications other than clozapine. RESULTS Overall, 401 patients with schizophrenia were given a clozapine prescription during the study period, and 2,456 received antipsychotics other than clozapine. Results of the logistic regression indicated that White race (OR=1.71, compared with Black race), community minority status and language SVI score (OR=2.97), and increased treatment duration (OR=1.36) were significantly associated with a higher likelihood of clozapine prescription; gender, rurality, age at first diagnosis, and ethnicity did not influence the likelihood of receiving clozapine. CONCLUSIONS Black patients with schizophrenia had a lower likelihood of receiving a clozapine prescription compared with White patients, even after analyses accounted for demographic variables, social determinants of health, and care access patterns. Given the effectiveness of clozapine in managing treatment-resistant schizophrenia, it is crucial for future research to better understand the factors contributing to this treatment disparity.
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Affiliation(s)
- Spenser Barry
- Department of Psychology, University of North Carolina Wilmington, Wilmington (Barry); Carolina Health Informatics Program (Torpunuri) and Department of Biostatistics (Wu), University of North Carolina at Chapel Hill, Chapel Hill; North Carolina Psychiatric Research Center (Jarskog, Zeng) and Mental Health Informatics and Analytics Core (Xia, Zeng), Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
| | - L Fredrik Jarskog
- Department of Psychology, University of North Carolina Wilmington, Wilmington (Barry); Carolina Health Informatics Program (Torpunuri) and Department of Biostatistics (Wu), University of North Carolina at Chapel Hill, Chapel Hill; North Carolina Psychiatric Research Center (Jarskog, Zeng) and Mental Health Informatics and Analytics Core (Xia, Zeng), Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kai Xia
- Department of Psychology, University of North Carolina Wilmington, Wilmington (Barry); Carolina Health Informatics Program (Torpunuri) and Department of Biostatistics (Wu), University of North Carolina at Chapel Hill, Chapel Hill; North Carolina Psychiatric Research Center (Jarskog, Zeng) and Mental Health Informatics and Analytics Core (Xia, Zeng), Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
| | - Rohit Simha Torpunuri
- Department of Psychology, University of North Carolina Wilmington, Wilmington (Barry); Carolina Health Informatics Program (Torpunuri) and Department of Biostatistics (Wu), University of North Carolina at Chapel Hill, Chapel Hill; North Carolina Psychiatric Research Center (Jarskog, Zeng) and Mental Health Informatics and Analytics Core (Xia, Zeng), Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
| | - Xiaoyu Wu
- Department of Psychology, University of North Carolina Wilmington, Wilmington (Barry); Carolina Health Informatics Program (Torpunuri) and Department of Biostatistics (Wu), University of North Carolina at Chapel Hill, Chapel Hill; North Carolina Psychiatric Research Center (Jarskog, Zeng) and Mental Health Informatics and Analytics Core (Xia, Zeng), Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
| | - Xiaoming Zeng
- Department of Psychology, University of North Carolina Wilmington, Wilmington (Barry); Carolina Health Informatics Program (Torpunuri) and Department of Biostatistics (Wu), University of North Carolina at Chapel Hill, Chapel Hill; North Carolina Psychiatric Research Center (Jarskog, Zeng) and Mental Health Informatics and Analytics Core (Xia, Zeng), Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill
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6
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Miller-Matero LR, Yeh HH, Maffett A, Mooney JT, Sala-Hamrick K, Frank CB, Simon GE, Rossom R, Owen-Smith AA, Lynch FL, Beck A, Waring S, Daida YG, Lu CY, Ahmedani BK. Racial-Ethnic Differences in Receipt of Past-Year Health Care Services Among Suicide Decedents: A Case-Control Study. Psychiatr Serv 2024; 75:124-130. [PMID: 37554000 PMCID: PMC10840630 DOI: 10.1176/appi.ps.20220578] [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: 08/10/2023]
Abstract
OBJECTIVE Suicide remains an urgent public health crisis. Although some sociodemographic characteristics are associated with greater suicide risk in the general population, it is unclear whether individuals utilizing health care in the United States have similar suicide incidence patterns. The authors examined whether race-ethnicity is associated with suicide death among patients seeking health care and investigated health care utilization patterns. METHODS Data were collected from electronic health records and government mortality records for patients seeking health care across nine health care systems in the United States. Patients who died by suicide (N=1,935) were matched with patients in a control group (N=19,350) within each health care system. RESULTS Patients who died by suicide were significantly more likely to be White, older, male, living in low-education areas, living in rural areas, or diagnosed as having mental health conditions or were significantly less likely to have commercial insurance (p<0.05). Among most racial-ethnic groups, those who died by suicide had a higher number of past-year mental health, primary care, and total health care visits; for American Indian/Alaska Native patients, the number of health care visits tended to be lower among suicide decedents. CONCLUSIONS These findings suggest that higher past-year health care utilization was associated with increased likelihood of suicide death across several racial-ethnic groups. This observation underscores the need for identifying and managing suicide risk in health care settings, including outside of mental health visits, among most racial-ethnic groups.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Hsueh-Han Yeh
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Anissa Maffett
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Jan T Mooney
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Kelsey Sala-Hamrick
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Cathrine B Frank
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Gregory E Simon
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Rebecca Rossom
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Ashli A Owen-Smith
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Frances L Lynch
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Arne Beck
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Stephen Waring
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Yihe G Daida
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Christine Y Lu
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Brian K Ahmedani
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
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7
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Pei J, Amanvermez Y, Vigo D, Puyat J, Kessler RC, Mortier P, Bruffaerts R, Rankin O, Chua SN, Martínez V, Rapsey C, Fodor LA, David OA, Garcia C, Cuijpers P. Sociodemographic Correlates of Mental Health Treatment Seeking Among College Students: A Systematic Review and Meta-Analysis. Psychiatr Serv 2024:appips20230414. [PMID: 38291886 DOI: 10.1176/appi.ps.20230414] [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: 02/01/2024]
Abstract
OBJECTIVE College students have high rates of mental health problems and low rates of treatment. Although sociodemographic disparities in student mental health treatment seeking have been reported, findings have not been synthesized and quantified. The extent to which differences in perceived need for treatment contribute to overall disparities remains unclear. METHODS A systematic search of PubMed, PsycInfo, and Embase was conducted. Studies published between 2007 and 2022 were included if they reported treatment rates among college students with mental health problems, stratified by sex, gender, race-ethnicity, sexual orientation, student type, student year, or student status. Random-effects models were used to calculate pooled prevalence ratios (PRs) of having a perceived need for treatment and of receiving treatment for each sociodemographic subgroup. RESULTS Twenty-one studies qualified for inclusion. Among students experiencing mental health problems, consistent and significant sociodemographic differences were identified in perceived need for treatment and treatment receipt. Students from racial-ethnic minority groups (in particular, Asian students [PR=0.49]) and international students (PR=0.63) reported lower rates of treatment receipt than White students and domestic students, respectively. Students identifying as female (sex) or as women (gender) (combined PR=1.33) reported higher rates of treatment receipt than students identifying as male or as men. Differences in perceived need appeared to contribute to some disparities; in particular, students identifying as male or as men reported considerably lower rates of perceived need than students identifying as female or as women. CONCLUSIONS Findings highlight the need for policy makers to address barriers throughout the treatment-seeking pathway and to tailor efforts to student subgroups to reduce treatment disparities.
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Affiliation(s)
- Julia Pei
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Yagmur Amanvermez
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Daniel Vigo
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Joseph Puyat
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Ronald C Kessler
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Philippe Mortier
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Ronny Bruffaerts
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Osiris Rankin
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Sook Ning Chua
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Vania Martínez
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Charlene Rapsey
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Liviu A Fodor
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Oana A David
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Claudia Garcia
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
| | - Pim Cuijpers
- Department of Psychiatry (Pei, Vigo) and School of Population and Public Health (Pei, Vigo, Puyat), University of British Columbia, Vancouver; Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Amanvermez, Cuijpers); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Health Services Research Unit, Hospital del Mar Research Institute, Barcelona, Spain, and Consorcio Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Madrid (Mortier); Center for Public Health Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium (Bruffaerts); Department of Psychology, Harvard University, Cambridge, Massachusetts (Rankin); Relate Mental Health Malaysia, Kuala Lumpur, and School of Biological Sciences, Nanyang Technological University, Singapore (Chua); Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente, Facultad de Medicina, Universidad de Chile, and Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile (Martínez); Department of Psychological Medicine (Rapsey) and Department of Psychology (Garcia), University of Otago, Dunedin, New Zealand; International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania (Fodor, David, Cuijpers)
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Norris DM, Primm A. Burnout and Moral Injury Among Black Psychiatrists and Other Black Mental Health Professionals. Psychiatr Serv 2024; 75:83-86. [PMID: 37287228 DOI: 10.1176/appi.ps.20220522] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This column discusses burnout and moral injury among Black psychiatrists and other Black mental health professionals and highlights the contribution of racism to these outcomes. In the United States, the COVID-19 pandemic and racial turmoil have revealed stark inequities in health care and social justice, and demand for mental health services has increased. To meet the mental health needs of communities, racism must be recognized as a factor in burnout and moral injury. The authors offer preventive strategies to support the mental health, well-being, and longevity of Black mental health professionals.
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Affiliation(s)
- Donna M Norris
- Harvard Medical School, Boston (Norris); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore (Primm)
| | - Annelle Primm
- Harvard Medical School, Boston (Norris); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore (Primm)
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Abstract
Black adults in the United States are more likely to be diagnosed as having schizophrenia spectrum disorders and to report experiences of paranoia than are White adults. Cultural mistrust, or marginalized groups' adaptive skepticism toward dominant historically White institutions, is associated with paranoia among Black individuals, suggesting that experiences of paranoia may be culturally mediated. The authors aimed to explore thematic differences between Black and White adults with schizophrenia spectrum disorders in their experiences of paranoia, including potential differences in persecutory content, cultural mistrust, and related themes. The authors conducted a thematic content analysis of archival qualitative data on experiences of paranoia reported by Black and White adults with schizophrenia spectrum disorders (N=21) in a structured clinical interview. Distinct themes related to cultural mistrust and persecutory paranoia emerged among the participants, suggesting that lived experiences of persecution and discrimination may affect how Black adults with schizophrenia spectrum disorders interpret threat and express paranoia. These findings highlight the importance of culturally responsive approaches in assessment and conceptualization of clinical paranoia versus cultural mistrust.
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Affiliation(s)
- Shari Gordon
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Chestnut Hill, Massachusetts (Gordon); Department of Occupational Therapy, Sargent College at Boston University, Boston (Mote, Fulford); Department of Psychological and Brain Sciences, Boston University, Boston (Fulford)
| | - Jasmine Mote
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Chestnut Hill, Massachusetts (Gordon); Department of Occupational Therapy, Sargent College at Boston University, Boston (Mote, Fulford); Department of Psychological and Brain Sciences, Boston University, Boston (Fulford)
| | - Daniel Fulford
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Chestnut Hill, Massachusetts (Gordon); Department of Occupational Therapy, Sargent College at Boston University, Boston (Mote, Fulford); Department of Psychological and Brain Sciences, Boston University, Boston (Fulford)
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Young AS, Findling RL, Riehm KE, Seegan P, Crum RM, Mojtabai R, Chiappini EA, Youngstrom EA, Fristad MA, Arnold LE, Birmaher B, Horwitz SM. Adequacy of Children's Psychopharmacology Services: Variations by Race and Clinical Characteristics. Psychiatr Serv 2023; 74:1218-1226. [PMID: 37287230 PMCID: PMC10983772 DOI: 10.1176/appi.ps.20220375] [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: 06/09/2023]
Abstract
OBJECTIVE An expert consensus approach was used to determine the adequacy of children's psychopharmacology and to examine whether adequacy varied by demographic or clinical characteristics. METHODS Data were from the baseline interview of 601 children, ages 6-12 years, who had visited one of nine outpatient mental health clinics and participated in the Longitudinal Assessment of Manic Symptoms study. Children and parents were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia and the Service Assessment for Children and Adolescents to assess the child's psychiatric symptoms and lifetime mental health services use, respectively. An expert consensus approach informed by published treatment guidelines was used to determine the adequacy of children's psychotropic medication treatment. RESULTS Black children (compared with White children; OR=1.84, 95% CI=1.53-2.23) and those with anxiety disorders (vs. no anxiety disorder; OR=1.55, 95% CI=1.08-2.20) were more likely to receive inadequate pharmacotherapy; those whose caregivers had a bachelor's degree or more education (vs. those who had a high school education, general equivalency diploma, or less than high school education; OR=0.74, 95% CI=0.61-0.89) were less likely to receive inadequate pharmacotherapy. CONCLUSIONS The consensus rater approach permitted use of published treatment efficacy data and patient characteristics (e.g., age, diagnoses, history of recent hospitalizations, and psychotherapy) to assess adequacy of pharmacotherapy. These results replicate findings of racial disparities reported in previous research using traditional methods to determine treatment adequacy (e.g., with a minimum number of treatment sessions) and highlight the continued need for research on racial disparities and strategies to improve access to high-quality care.
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Affiliation(s)
- Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Robert L Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Kira E Riehm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Paige Seegan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Rosa M Crum
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Ramin Mojtabai
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Erika A Chiappini
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Eric A Youngstrom
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Mary A Fristad
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Boris Birmaher
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Sarah M Horwitz
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
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Lekas HM, Lewis C, Bradley MV, Pahl K. The Color of Autonomy: Examining Racial Inequity in Coercive Institutional Practices. Psychiatr Serv 2023; 74:1189-1191. [PMID: 37143336 DOI: 10.1176/appi.ps.20220595] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Two articles recently published in this journal identified racial inequities in routine psychiatric practice. This Open Forum discusses the need for a paradigm shift in inequities research. The two articles reviewed here, one by Shea and colleagues on racial-ethnic inequities in inpatient psychiatric civil commitment and one by Garrett and colleagues on racial-ethnic disparities in psychiatric decisional capacity consultations, are examples of the new research gaze. Four topics are identified for enhancing understanding of racism and other forms of structural exclusion in psychiatric practice: medical authority and power imbalance between providers and patients, involuntary psychiatric commitment and requests for decisional capacity consultations as strategic research events, limited use of theory, and limitations of the literature on psychiatric inequities.
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Affiliation(s)
- Helen-Maria Lekas
- Division of Social Solutions and Services Research, Center for Research on Cultural and Structural Equity in Behavioral Health, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Lewis, Pahl); Department of Psychiatry, Grossman School of Medicine, New York University, New York City (all authors); Veterans Affairs New York Harbor Healthcare System-Brooklyn, New York (Bradley)
| | - Crystal Lewis
- Division of Social Solutions and Services Research, Center for Research on Cultural and Structural Equity in Behavioral Health, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Lewis, Pahl); Department of Psychiatry, Grossman School of Medicine, New York University, New York City (all authors); Veterans Affairs New York Harbor Healthcare System-Brooklyn, New York (Bradley)
| | - Mark V Bradley
- Division of Social Solutions and Services Research, Center for Research on Cultural and Structural Equity in Behavioral Health, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Lewis, Pahl); Department of Psychiatry, Grossman School of Medicine, New York University, New York City (all authors); Veterans Affairs New York Harbor Healthcare System-Brooklyn, New York (Bradley)
| | - Kerstin Pahl
- Division of Social Solutions and Services Research, Center for Research on Cultural and Structural Equity in Behavioral Health, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Lewis, Pahl); Department of Psychiatry, Grossman School of Medicine, New York University, New York City (all authors); Veterans Affairs New York Harbor Healthcare System-Brooklyn, New York (Bradley)
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12
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Smith CM, Daley LA, Lea C, Daniel K, Tweedy DS, Thielman NM, Staplefoote-Boynton BL, Aimone E, Gagliardi JP. Experiences of Black Adults Evaluated in a Locked Psychiatric Emergency Unit: A Qualitative Study. Psychiatr Serv 2023; 74:1063-1071. [PMID: 37042104 PMCID: PMC10732806 DOI: 10.1176/appi.ps.20220533] [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: 04/13/2023]
Abstract
OBJECTIVE Evidence shows that Black individuals have higher rates of coercive emergency psychiatric interventions than other racialized groups, yet no studies have elevated the voices of Black patients undergoing emergency psychiatric evaluation. This qualitative study sought to explore the experiences of Black individuals who had been evaluated in a locked psychiatric emergency unit (PEU). METHODS Electronic health records were used to identify and recruit adult patients (ages ≥18 years) who self-identified as Black and who had undergone evaluation in a locked PEU at a large academic medical center. In total, 11 semistructured, one-on-one interviews were conducted by telephone, exploring experiences during psychiatric evaluation. Transcripts were analyzed with thematic analysis. RESULTS Participants shared experiences of criminalization, stigma, and vulnerability before and during their evaluation. Although participants described insight into their desire and need for treatment and identified helpful aspects of the care they received, they noted a mismatch between their expectations of treatment and the treatment received. CONCLUSIONS This study reveals six major patient-identified themes that supplement a growing body of quantitative evidence demonstrating that racialized minority groups endure disproportionate rates of coercive interventions during emergency psychiatric evaluation. Interdisciplinary systemic changes are urgently needed to address structural barriers to equitable psychiatric care.
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Affiliation(s)
- Colin M Smith
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Lori-Ann Daley
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Chris Lea
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Keith Daniel
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Damon S Tweedy
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Nathan M Thielman
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - B Lynette Staplefoote-Boynton
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Elizabeth Aimone
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
| | - Jane P Gagliardi
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina (Smith); Department of Psychiatry and Behavioral Sciences (Daley, Tweedy, Staplefoote-Boynton, Gagliardi) and Department of Medicine (Thielman, Staplefoote-Boynton, Gagliardi), School of Medicine, Duke University, Durham, North Carolina; School of Medicine (Lea), Duke University, Durham, North Carolina; Duke Divinity School, Duke University, Durham, North Carolina (Daniel); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (Aimone)
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Han S, Lee HS, Kataoka S. "It's Taboo to Talk About It": Korean American Clergy Members' Views of Mental Health. Psychiatr Serv 2023; 74:1096-1099. [PMID: 37042111 DOI: 10.1176/appi.ps.20220252] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Korean Americans are more likely to seek guidance from church leaders than to use traditional mental health services. Through semistructured key informant interviews with 16 Christian clergy members serving later-generation Korean Americans, the authors explored clergy members' perceptions of the mental health needs of their congregants. Insights from the study suggested that communication and collaboration between mental health professionals and church leaders may be helpful in addressing the Korean American community's emotional and mental health needs.
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Affiliation(s)
- Stephanie Han
- Department of Psychiatry, Semel Institute (Han, Kataoka), and Center for Autism Research and Treatment (Lee), University of California, Los Angeles, Los Angeles
| | - Hyon Soo Lee
- Department of Psychiatry, Semel Institute (Han, Kataoka), and Center for Autism Research and Treatment (Lee), University of California, Los Angeles, Los Angeles
| | - Sheryl Kataoka
- Department of Psychiatry, Semel Institute (Han, Kataoka), and Center for Autism Research and Treatment (Lee), University of California, Los Angeles, Los Angeles
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Li Verdugo J, Oh HY, Jang Y. Mental Health of Asian American Caregivers of Family Members With Severe Mental Illness. Psychiatr Serv 2023; 74:1100-1103. [PMID: 36935622 DOI: 10.1176/appi.ps.20220535] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Within the general population, caregivers of individuals with severe mental illness experience considerable mental health burdens. Less is known about these burdens among Asian Americans, who frequently serve as primary caregivers of family members in accordance with cultural values of familism and interdependence. Asian American caregivers experience severe stigma regarding mental health issues as well as other barriers to care, often resulting in decreased help-seeking behaviors and poorer mental health. Given a paucity of research, the authors systematically reviewed the literature on mental health outcomes among Asian American caregivers. This column offers policy and practice suggestions for supporting the mental health of Asian American families affected by severe mental illness.
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Affiliation(s)
- Juliann Li Verdugo
- School of Social Work, University of Michigan, Ann Arbor (Li Verdugo); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Oh, Jang); Department of Social Welfare, Ewha Womans University, Seoul, South Korea (Jang)
| | - Hans Y Oh
- School of Social Work, University of Michigan, Ann Arbor (Li Verdugo); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Oh, Jang); Department of Social Welfare, Ewha Womans University, Seoul, South Korea (Jang)
| | - Yuri Jang
- School of Social Work, University of Michigan, Ann Arbor (Li Verdugo); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Oh, Jang); Department of Social Welfare, Ewha Womans University, Seoul, South Korea (Jang)
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Haro-Ramos AY, Bacong AM. Disparities in unmet needed paid leave across race, ethnicity and citizenship status among employed Californians: a cross-sectional study. Public Health 2023; 221:97-105. [PMID: 37441997 DOI: 10.1016/j.puhe.2023.06.013] [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: 02/02/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Paid leave is essential for public health in order to prevent presenteeism (i.e., working while sick), provide an economic safety net for workers when ill, and promote family well-being through parental leave. While racial and ethnic disparities in unmet paid leave (or needing but not being able to take paid leave) are well documented, little evidence of the intersecting role of citizenship status exists. This study examined disparities in unmet paid leave across race, ethnicity and citizenship status. STUDY DESIGN This was a cross-sectional study of employed adults in California, USA. METHODS Weighted, multivariable logistic regressions were used to assess disparities in unmet needed paid leave across race, ethnicity and citizenship status categories, including non-citizen, naturalised, and citizen Latinx and Asian respondents, and naturalised and non-citizen White respondents, relative to US-born White respondents, controlling for demographic, familial, health-related and work-related covariates. This study examined a representative sample of Californian adults using the 2021 California Health Interview Survey (CHIS). A total of 24,453 people completed the CHIS from March to October 2021. This analysis was restricted to individuals who had complete data, were employed at the time of the survey and were part of the study race and ethnic groups of interest, leading to an analytical sample of 12,485 respondents. RESULTS While 16.9% of employed Californians reported forgoing needed paid leave, disparities across race, ethnicity and citizenship status were evident. Specifically, 31.8% of non-citizen Latinx respondents, compared to 11% of US-born White respondents, did not use paid leave when they needed it due to fear of job loss, fear of negative impacts on job advancement, employers denying it, lack of information or knowledge regarding the process or ineligibility. In the fully adjusted analyses, respondents identifying as non-citizen Latinx (adjusted odds ratio [aOR] = 2.57, 95% confidence interval [CI] = 1.94-3.40), naturalised Latinx (aOR = 1.90, 95% CI = 1.46-2.48), US-born Latinx (OR = 1.30, 95% CI = 1.06-1.60), non-citizen Asian (aOR = 2.34, 95% CI = 1.69-3.23) and naturalised Asian (aOR = 1.78, 95% CI = 1.35-2.34) had a statistically significantly higher likelihood of experiencing unmet needed paid leave compared to US-born White respondents. CONCLUSIONS Despite its importance for health, disparities across race, ethnicity and citizenship status exist in those who experience unmet paid leave. It is recommended that the administrative and enforcement agencies in California further communicate eligibility, facilitate the application process and enforce equitable access to paid leave for all workers.
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Affiliation(s)
- A Y Haro-Ramos
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
| | - A M Bacong
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Samaranayake DP, Feeney SB, Baker T, Hans JJ, Jacobs D, Compton MT. Overrepresentation of In-Home, Natural Deaths Among Individuals Treated for Mental Illnesses in New York State. Psychiatr Serv 2023; 74:885-888. [PMID: 36820522 DOI: 10.1176/appi.ps.202100732] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE The authors compared rates of in-home, natural death among individuals receiving treatment for mental illnesses with those in the general population. METHODS Two data sets were used to determine the prevalence of in-home, natural deaths in the general population and among those receiving treatment for mental illnesses in New York State, outside New York City, for the period 2016-2018. RESULTS Overall, 37% of natural deaths among individuals receiving mental health treatment occurred in the home, compared with 26% in the general population. Earlier death was also apparent; for example, 26.4% of in-home deaths among those receiving mental health treatment were among those ages 45-54 years, compared with 5.5% in the general population. In-home, natural deaths were also higher among non-Hispanic Black and Hispanic subpopulations. CONCLUSIONS These findings suggest a need for programmatic and policy advances to reduce disparities in general health care for those living with mental illnesses. Additional analyses are warranted.
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Affiliation(s)
- Dhanushki P Samaranayake
- New York State Office of Mental Health, Albany, New York (Samaranayake, Feeney, Baker, Hans, Jacobs); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton)
| | - Suzanne B Feeney
- New York State Office of Mental Health, Albany, New York (Samaranayake, Feeney, Baker, Hans, Jacobs); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton)
| | - Tami Baker
- New York State Office of Mental Health, Albany, New York (Samaranayake, Feeney, Baker, Hans, Jacobs); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton)
| | - John J Hans
- New York State Office of Mental Health, Albany, New York (Samaranayake, Feeney, Baker, Hans, Jacobs); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton)
| | - Deanna Jacobs
- New York State Office of Mental Health, Albany, New York (Samaranayake, Feeney, Baker, Hans, Jacobs); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton)
| | - Michael T Compton
- New York State Office of Mental Health, Albany, New York (Samaranayake, Feeney, Baker, Hans, Jacobs); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton)
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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.
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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)
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18
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Wen M, Shi L, Zhang D, Li Y, Chen Z, Chen B, Chen L, Zhang L, Li H, Li J, Han X, Su D. Racial-ethnic disparities in psychological distress during the COVID-19 pandemic in the United States: the role of experienced discrimination and perceived racial bias. BMC Public Health 2023; 23:957. [PMID: 37231401 DOI: 10.1186/s12889-023-15912-4] [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] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Research on mental health disparities by race-ethnicity in the United States (US) during COVID-19 is limited and has generated mixed results. Few studies have included Asian Americans as a whole or by subgroups in the analysis. METHODS Data came from the 2020 Health, Ethnicity, and Pandemic Study, based on a nationally representative sample of 2,709 community-dwelling adults in the US with minorities oversampled. The outcome was psychological distress. The exposure variable was race-ethnicity, including four major racial-ethnic groups and several Asian ethnic subgroups in the US. The mediators included experienced discrimination and perceived racial bias toward one's racial-ethnic group. Weighted linear regressions and mediation analyses were performed. RESULTS Among the four major racial-ethnic groups, Hispanics (22%) had the highest prevalence of severe distress, followed by Asians (18%) and Blacks (16%), with Whites (14%) having the lowest prevalence. Hispanics' poorer mental health was largely due to their socioeconomic disadvantages. Within Asians, Southeast Asians (29%), Koreans (27%), and South Asians (22%) exhibited the highest prevalence of severe distress. Their worse mental health was mainly mediated by experienced discrimination and perceived racial bias. CONCLUSIONS Purposefully tackling racial prejudice and discrimination is necessary to alleviate the disproportionate psychological distress burden in racial-ethnic minority groups.
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Affiliation(s)
- Ming Wen
- Faculty of Social Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
- Department of Sociology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA
| | - Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY, 11501, USA
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, 30602, USA
| | - Baojiang Chen
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, 1616 Guadalupe, Suite 6.300, Austin, TX, 78701, USA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA
| | - Hongmei Li
- Department of Media, Journalism and Film, Miami University, Oxford, OH, 45056, USA
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, 30303, USA
| | - Dejun Su
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
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Abstract
Research safety protocols are ubiquitous in mental health research involving human subjects and have the potential to harm research participants from racial-ethnic minority populations. For mental health emergencies, such protocols commonly rely on law enforcement for crisis intervention. The authors review inequities experienced by individuals with mental illness in law enforcement encounters, especially Black, Latinx, and other minoritized populations. They then describe the development of a research safety protocol that uses community-based crisis intervention programs as alternatives to law enforcement and provide a roadmap for researchers and institutional review boards to revisit and revise their human subjects safety protocols.
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Affiliation(s)
- Esther Anene
- Department of Psychology, Yale University, New Haven, Connecticut (Anene); Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Nallajerla); Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bath, Castillo)
| | - Meghana Nallajerla
- Department of Psychology, Yale University, New Haven, Connecticut (Anene); Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Nallajerla); Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bath, Castillo)
| | - Eraka P J Bath
- Department of Psychology, Yale University, New Haven, Connecticut (Anene); Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Nallajerla); Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bath, Castillo)
| | - Enrico G Castillo
- Department of Psychology, Yale University, New Haven, Connecticut (Anene); Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Nallajerla); Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bath, Castillo)
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Smith TE, Corbeil T, Wall MM, Tang F, Essock SM, Frimpong E, Goldman ML, Mascayano F, Radigan M, Wang R, Rodgers I, Dixon LB, Olfson M, Lewis-Fernández R. Community, Hospital, and Patient Factors Contributing to Ethnoracial Disparities in Follow-Up After Psychiatric Hospitalization. Psychiatr Serv 2023:appips20220110. [PMID: 36651116 DOI: 10.1176/appi.ps.20220110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/19/2023]
Abstract
OBJECTIVE This study used an ecosocial perspective to examine ethnoracial disparities in timely outpatient follow-up care after psychiatric hospitalization in a cohort of Medicaid recipients. METHODS This retrospective analysis used 2012-2013 New York State Medicaid claims data for 17,488 patients ages <65 years who were treated in hospital psychiatric units and discharged to the community. Claims data were linked to other administrative data sets capturing key social conditions and determinants of mental health for non-Latinx White (White hereafter), non-Latinx Black (Black), Latinx, non-Latinx Asian/Pacific Islander (Asian/Pacific Islander), non-Latinx American Indian or Native Alaskan (American Indian or Native Alaskan), and other ethnoracial groups. Regression models were used to estimate the variations in disparities in timely follow-up care that were attributable to community, organization (i.e., hospital), and individual patient characteristics. RESULTS Overall, 60.1% of patients attended an outpatient mental health visit within 30 days of discharge. Compared with the rate for White patients, the attendance rates were 9.5 percentage points lower for Black patients and 7.8 percentage points higher for Asian/Pacific Islander patients. No significant difference in attendance rates was found between Latinx and White patients. Community factors, specifically urban versus rural classification and county poverty status, accounted for the greatest variation in timely follow-up care in all comparisons. CONCLUSIONS Efforts to increase connection to outpatient mental health follow-up care after psychiatric hospitalization should incorporate cultural and structural competencies to address social conditions and determinants of mental health that underly ethnoracial disparities.
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Affiliation(s)
- Thomas E Smith
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Tom Corbeil
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Fei Tang
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Susan M Essock
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Eric Frimpong
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Matthew L Goldman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Franco Mascayano
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Marleen Radigan
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Rui Wang
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Ian Rodgers
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Mark Olfson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
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21
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Soutullo OR, Duncan F, Coleman L, Mitchell SJ, Godoy L, Tyson C, Long M. Factors Associated With Psychiatric Readmission of Youths in a Racially Diverse and Urban Hospital Setting. Psychiatr Serv 2023; 74:66-69. [PMID: 36004435 DOI: 10.1176/appi.ps.202100389] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study examined predictors of readmission to a psychiatric inpatient unit of an urban children's hospital within 1 year of discharge among a racially diverse sample of youths. METHODS The authors retrospectively analyzed 2 years of electronic health record data of inpatient psychiatric unit admissions (N=1,604). Multivariate logistic regression and random-effects multinomial logistic regression were used for analyses. RESULTS The estimated odds ratios for any readmission within 1 year of discharge were significantly higher for Black youths, youths insured by Medicaid, and youths with a length of stay longer than 7 days. Factors remained strongly predictive when examining multiple readmissions versus no readmissions. CONCLUSIONS Black youths, youths insured by Medicaid, and youths with longer stays were more likely than other youths to be readmitted. Findings suggest the need for interventions such as care coordination to target predictors of readmission and the need to examine inequities in the health care system.
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Affiliation(s)
- Olivia R Soutullo
- Children's National Hospital, Washington, D.C. (all authors); Department of Pediatrics (Soutullo, Godoy, Tyson, Long) and Department of Psychiatry and Behavioral Sciences (Soutullo, Godoy, Tyson), School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Folami Duncan
- Children's National Hospital, Washington, D.C. (all authors); Department of Pediatrics (Soutullo, Godoy, Tyson, Long) and Department of Psychiatry and Behavioral Sciences (Soutullo, Godoy, Tyson), School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Lael Coleman
- Children's National Hospital, Washington, D.C. (all authors); Department of Pediatrics (Soutullo, Godoy, Tyson, Long) and Department of Psychiatry and Behavioral Sciences (Soutullo, Godoy, Tyson), School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Stephanie J Mitchell
- Children's National Hospital, Washington, D.C. (all authors); Department of Pediatrics (Soutullo, Godoy, Tyson, Long) and Department of Psychiatry and Behavioral Sciences (Soutullo, Godoy, Tyson), School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Leandra Godoy
- Children's National Hospital, Washington, D.C. (all authors); Department of Pediatrics (Soutullo, Godoy, Tyson, Long) and Department of Psychiatry and Behavioral Sciences (Soutullo, Godoy, Tyson), School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Colby Tyson
- Children's National Hospital, Washington, D.C. (all authors); Department of Pediatrics (Soutullo, Godoy, Tyson, Long) and Department of Psychiatry and Behavioral Sciences (Soutullo, Godoy, Tyson), School of Medicine and Health Sciences, George Washington University, Washington, D.C
| | - Melissa Long
- Children's National Hospital, Washington, D.C. (all authors); Department of Pediatrics (Soutullo, Godoy, Tyson, Long) and Department of Psychiatry and Behavioral Sciences (Soutullo, Godoy, Tyson), School of Medicine and Health Sciences, George Washington University, Washington, D.C
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22
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Abstract
OBJECTIVE In this study, the authors examined potential disparities and biases in the placement and outcomes of decisional capacity evaluations across races, controlling for patient characteristics. METHODS The authors reviewed 181 patient decisional capacity consultations requested for the consultation-liaison psychiatry service at a tertiary care medical center from 2018 to 2019. The racial distribution of patients in these consultations was compared with the racial distribution of hospital inpatient admissions from 2018 to 2019. The authors analyzed patient outcomes by using logistic regression that controlled for race, gender, age, education, primary insurance, type of capacity assessment, and psychiatric diagnosis. RESULTS Decisional capacity consultations were placed disproportionately for Black (43% of consultations vs. 18% of total admissions) and Hispanic patients (26% of consultations vs. 21% of admissions) compared with White and Asian patients. Among 130 patients with a capacity determination, 95 (53% of total sample) were determined not to have capacity, an outcome that did not differ by race but was more likely to occur among patients diagnosed as having delirium. Sixty-seven patients with no capacity (37% of total sample) experienced a change in treatment, an outcome that was less likely to occur among Hispanic patients in the univariable analysis. CONCLUSIONS Significant racial disparities were observed during the placement of a decisional capacity consultation. These findings reveal the potential biases introduced with both the initial challenge to a patient's capacity and the subsequent outcomes of the consultation. As such, the balance of risk versus benefit or utility of these consultations in certain populations must be carefully considered.
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Affiliation(s)
- William S Garrett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (all authors) and Department of Psychiatry, NYC Health + Hospitals/Harlem (Mirza), New York City; Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore (Thomas)
| | - Anita Verma
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (all authors) and Department of Psychiatry, NYC Health + Hospitals/Harlem (Mirza), New York City; Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore (Thomas)
| | - Daniel Thomas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (all authors) and Department of Psychiatry, NYC Health + Hospitals/Harlem (Mirza), New York City; Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore (Thomas)
| | - Jacob M Appel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (all authors) and Department of Psychiatry, NYC Health + Hospitals/Harlem (Mirza), New York City; Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore (Thomas)
| | - Omar Mirza
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (all authors) and Department of Psychiatry, NYC Health + Hospitals/Harlem (Mirza), New York City; Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore (Thomas)
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23
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Daley TC, George P, Goldman HH, Krenzke T, Zhu X, Ren W, Giangrande M, Ghose S, Rosenblatt A. Client Racial Composition in First-Episode Psychosis Programs Compared With Compositions in Program Service Areas. Psychiatr Serv 2022; 73:1373-1379. [PMID: 35652193 DOI: 10.1176/appi.ps.202100587] [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: 11/30/2022]
Abstract
OBJECTIVE The authors examined the extent to which clients served by first-episode psychosis programs reflected the racial composition of the surrounding service area and, to the extent that they did not, explored possible explanatory factors. METHODS As part of a national study of coordinated specialty care (CSC) sites in the United States, 35 programs documented race for 772 clients. Programs identified a geographic service area for their clients. Using Census data, the authors identified the proportion of clients in this service area who were Black and then examined the extent of disproportionality, calculated as a risk ratio and as a relative difference in racial composition between CSC programs and their service areas. RESULTS Overall, 71% of CSC programs had a disproportionately greater proportion of Black clients than Black residents within the service area. This disproportionality was still evident after conducting sensitivity analyses that included adjusting for sampling error in the service area population estimates; however, smaller study sites displayed greater fluctuations in disproportionality in the sensitivity analyses. CONCLUSIONS Using data from diverse CSC programs, the authors illustrate that the odds of Blacks receiving services through a CSC program are much higher than would be expected on the basis of the population living in the area being served by the program. Multiple reasons may explain this finding, but in the absence of clear explanatory factors, this result may be ripe for discussion and further investigation.
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Affiliation(s)
- Tamara C Daley
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Preethy George
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Howard H Goldman
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Tom Krenzke
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Xiaoshu Zhu
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Weijia Ren
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Michael Giangrande
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Shoma Ghose
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Abram Rosenblatt
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
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24
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Abstract
OBJECTIVE The study examined racial-ethnic disparities in access to and utilization of treatment for attention-deficit hyperactivity disorder (ADHD) and other psychiatric diagnoses among children with ADHD. METHODS Nationally representative, cross-sectional data from the Household Component of the Medical Expenditure Panel Survey 2011-2019 were used to examine racial-ethnic disparities in access to and utilization of treatment by children ages 5-17 with ADHD (N=5,838). Logistic regression models were estimated for access outcomes, and generalized linear models were estimated for utilization outcomes. Multivariable regression models adjusted for race-ethnicity, age, sex, and treatment need in accordance with the Institute of Medicine definition of health care disparities. RESULTS In adjusted analyses, compared with White children with ADHD, Black, Hispanic, and Asian children with ADHD had significantly lower rates of any past-year treatment visit for ADHD or for other psychiatric diagnoses. They also had lower rates of having accessed ADHD medication. Compared with White children, Black and Asian children with ADHD used fewer ADHD medications, and Black and Hispanic children with ADHD had lower overall mental health treatment expenditures. CONCLUSIONS Disparities in ADHD treatment among children from racial-ethnic minority populations may be driven primarily by disparities in access rather than in utilization. Once treatment had been accessed, disparities in utilization were largely accounted for by differences in socioeconomic status. These findings suggest that interventions targeting access to treatment among children from racial-ethnic minority populations may help close existing care gaps.
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Affiliation(s)
- Kelly Guanhua Yang
- Prime Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York City (Yang); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Flores, Carson, Cook); Department of Psychiatry, Harvard Medical School, Boston (Flores, Cook)
| | - Michael William Flores
- Prime Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York City (Yang); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Flores, Carson, Cook); Department of Psychiatry, Harvard Medical School, Boston (Flores, Cook)
| | - Nicholas J Carson
- Prime Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York City (Yang); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Flores, Carson, Cook); Department of Psychiatry, Harvard Medical School, Boston (Flores, Cook)
| | - Benjamin Lê Cook
- Prime Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York City (Yang); Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Boston (Flores, Carson, Cook); Department of Psychiatry, Harvard Medical School, Boston (Flores, Cook)
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25
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Abstract
OBJECTIVE Involuntary psychiatric treatment may parallel ethnoracial inequities present in the larger society. Prior studies have focused on restraint and seclusion, but less attention has been paid to the civil commitment system because of its diversity across jurisdictions. Using a generalizable framework, this study investigated inequities in psychiatric commitment. METHODS A prospective cohort was assembled of all patients admitted to an inpatient psychiatric unit over 6 years (2012-2018). Patients were followed longitudinally throughout their admission; raters recorded legal status each day. Sociodemographic and clinical data were collected to adjust for confounding variables by using multivariate logistic regression. RESULTS Of the 4,393 patients with an initial admission during the study period, 73% self-identified as White, 11% as Black, 10% as primarily Hispanic or Latinx, 4% as Asian, and 3% as another race or multiracial. In the sample, 28% were involuntarily admitted, and court commitment petitions were filed for 7%. Compared with White patients, all non-White groups were more likely to be involuntarily admitted, and Black and Asian patients were more likely to have court commitment petitions filed. After adjustment for confounding variables, Black patients remained more likely than White patients to be admitted involuntarily (adjusted odds ratio [aOR]=1.57, 95% confidence interval [CI]=1.26-1.95), as were patients who identified as other race or multiracial (aOR=2.12, 95% CI=1.44-3.11). CONCLUSIONS Patients of color were significantly more likely than White patients to be subjected to involuntary psychiatric hospitalization, and Black patients and patients who identified as other race or multiracial were particularly vulnerable, even after adjustment for confounding variables.
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Affiliation(s)
- Timothy Shea
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Samuel Dotson
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Griffin Tyree
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Lucy Ogbu-Nwobodo
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Stuart Beck
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
| | - Derri Shtasel
- Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston
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26
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Richmond J, Adams LB, Annis IE, Ellis AR, Perryman T, Sikich L, Thomas KC. Rapid and Deferred Help Seeking Among African American Parents of Children With Emotional and Behavioral Difficulties. Psychiatr Serv 2022; 73:1359-1366. [PMID: 35678082 PMCID: PMC9722499 DOI: 10.1176/appi.ps.202100553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/30/2022]
Abstract
OBJECTIVE Little is known about the factors African American parents consider when seeking care for their child after emotional and behavioral difficulties emerge. This study aimed to examine factors associated with seeking professional care within 30 days after identifying a child's need (i.e., rapid care seeking) and with deferring care for ≥1 year. METHODS This cross-sectional study surveyed African American parents raising a child with emotional or developmental challenges (N=289). Logistic regression was used to examine associations of parent activation, medical mistrust, and care-seeking barriers with two outcomes: rapidly seeking care and deferring care seeking. RESULTS About 22% of parents rapidly sought care, and 49% deferred care for 1 year or longer. Parents were more likely to rapidly seek care if they had higher parent activation scores; lived with other adults with mental health challenges; or, contrary to the authors' hypothesis, mistrusted doctors. Parents were less likely to rapidly seek care if the challenge did not initially bother them much or if their health insurance would not cover the service. Parents were more likely to defer care if they feared involuntary hospitalization for their child or if their health insurance would not cover the service. Parents were less likely to defer care if they had at least some college education or lived with other adults with mental health challenges. CONCLUSIONS Community-based pediatric and child welfare professionals should be informed about facilitators and barriers to mental health care seeking as part of efforts to develop interventions that support African American families.
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Affiliation(s)
- Jennifer Richmond
- Department of Medicine, Vanderbilt University Medical
Center, Nashville, TN
| | - Leslie B. Adams
- Mental Health, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD
| | - Izabela E. Annis
- Division of Pharmaceutical Outcomes and Policy, University
of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Alan R. Ellis
- Department of Social Work, North Carolina State University,
Raleigh, NC
| | - Twyla Perryman
- Department of Counseling, Higher Education, and
Speech-Language Pathology, University of West Georgia, Carrollton, GA
| | - Linmarie Sikich
- Department of Psychiatry and Behavioral Sciences, Duke
University, Durham, NC
| | - Kathleen C. Thomas
- Division of Pharmaceutical Outcomes and Policy, University
of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
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27
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Fortuna KL, Kadakia A, Cosco TD, Rotondi A, Nicholson J, Mois G, Myers AL, Hamilton J, Brewer LC, Collins-Pisano C, Barr P, Hudson MF, Joseph K, Mullaly C, Booth M, Lebby S, Walker R. Guidelines to Establish an Equitable Mobile Health Ecosystem. Psychiatr Serv 2022; 74:393-400. [PMID: 36377370 DOI: 10.1176/appi.ps.202200011] [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: 11/16/2022]
Abstract
Mobile health (mHealth)-that is, use of mobile devices, such as mobile phones, monitoring devices, personal digital assistants, and other wireless devices, in medical care-is a promising approach to the provision of support services. mHealth may aid in facilitating monitoring of mental health conditions, offering peer support, providing psychoeducation (i.e., information about mental health conditions), and delivering evidence-based practices. However, some groups may fail to benefit from mHealth despite a high need for mental health services, including people from racially and ethnically disadvantaged groups, rural residents, individuals who are socioeconomically disadvantaged, and people with disabilities. A well-designed mHealth ecosystem that considers multiple elements of design, development, and implementation can afford disadvantaged populations the opportunity to address inequities and facilitate access to and uptake of mHealth. This article proposes inclusion of the following principles and standards in the development of an mHealth ecosystem of equity: use a human-centered design, reduce bias in machine-learning analytical techniques, promote inclusivity via mHealth design features, facilitate informed decision making in technology selection, embrace adaptive technology, promote digital literacy through mHealth by teaching patients how to use the technology, and facilitate access to mHealth to improve health outcomes.
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Affiliation(s)
- Karen L Fortuna
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Arya Kadakia
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Theodore D Cosco
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Armando Rotondi
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Joanne Nicholson
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - George Mois
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Amanda L Myers
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Jennifer Hamilton
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - LaPrincess C Brewer
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Caroline Collins-Pisano
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Paul Barr
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Matthew F Hudson
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Kalisa Joseph
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Christa Mullaly
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Mark Booth
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Stephanie Lebby
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
| | - Robert Walker
- Department of Psychiatry (Fortuna) and Center for Technology and Behavioral Health (Barr), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; BRITE Center, University of Washington, Seattle (Kadakia); Gerontology Research Centre, Simon Fraser University, Vancouver, and Oxford Institute of Population Ageing, University of Oxford, Oxford (Cosco); Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Health Care System, and Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh (Rotondi); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Nicholson, Myers); School of Social Work, University of Illinois, Urbana (Mois); College of Applied Health Sciences Human Factors and Aging Laboratory, University of Illinois, Champaign (Mois); College of Social Work, University of Kentucky, Lexington (Hamilton); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Brewer); Psychology Department, University of Colorado, Colorado Springs (Collins-Pisano); Department of Medicine, University of South Carolina School of Medicine, and Prisma Health, Greenville (Hudson); Centre for Mental Health, University of Rwanda, Kigali (Joseph); Psychiatric Rehabilitation Division, Vinfen, Cambridge, Massachusetts (Mullaly); Clarity Health, Nashua, New Hampshire (Booth); College of Nursing and Health Sciences, University of Vermont, Burlington (Lebby); Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston (Walker)
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Olfson M, Mauro C, Wall MM, Barry CL, Choi CJ, Mojtabai R. Medicaid Expansion and Racial-Ethnic Health Care Coverage Disparities Among Low-Income Adults With Substance Use Disorders. Psychiatr Serv 2022:appips20220155. [PMID: 36321322 DOI: 10.1176/appi.ps.20220155] [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: 03/08/2023]
Abstract
OBJECTIVE In light of historical racial-ethnic disparities in health care coverage, the authors assessed changes in coverage in nationally representative samples of Black, White, and Hispanic low-income adults with substance use disorders after the 2014 Affordable Care Act Medicaid expansion. METHODS Data from 12 years of the annual National Survey on Drug Use and Health (2008-2019) identified low-income adults ages 18-64 years with alcohol, cannabis, cocaine, or heroin use disorder (N=749,033). Trends in coverage focused on non-Hispanic Black, non-Hispanic White, and Hispanic individuals. Age- and sex-adjusted difference-in-differences analysis assessed effects of expansion state residence on insurance coverage for the three groups. RESULTS Before Medicaid expansion (2008-2013), 38.5% of Black, 37.6% of White, and 51.2% of Hispanic low-income adults with substance use disorders were uninsured. After expansion (2014-2019), these proportions significantly declined for Black (24.2%), White (22.0%), and Hispanic (34.5%) groups. Decreases in rates of individuals without insurance and increases in Medicaid coverage tended to be more pronounced for those in expansion states than for those in nonexpansion states. In nonexpansion states, the proportions of those without insurance significantly decreased among Black and White individuals but not among Hispanic individuals. Proportions receiving past-year substance use treatment did not significantly change and remained low postexpansion: Black, 10.7%; White, 14.6%; and Hispanic, 9.0%. CONCLUSIONS After Medicaid expansion, coverage increased for low-income Black, White, and Hispanic adults with substance use disorders. For all three groups, Medicaid coverage disproportionately increased among those living in expansion states. However, coverage remained far from universal, especially for Hispanic adults with substance use disorders.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson, Wall), and Mailman School of Public Health (Olfson, Mauro, Wall), Columbia University, New York City; Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (Barry); Division of Mental Health Data Science, New York State Psychiatric Institute, New York City (Choi); Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry, Johns Hopkins University, Baltimore (Mojtabai)
| | - Christine Mauro
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson, Wall), and Mailman School of Public Health (Olfson, Mauro, Wall), Columbia University, New York City; Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (Barry); Division of Mental Health Data Science, New York State Psychiatric Institute, New York City (Choi); Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry, Johns Hopkins University, Baltimore (Mojtabai)
| | - Melanie M Wall
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson, Wall), and Mailman School of Public Health (Olfson, Mauro, Wall), Columbia University, New York City; Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (Barry); Division of Mental Health Data Science, New York State Psychiatric Institute, New York City (Choi); Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry, Johns Hopkins University, Baltimore (Mojtabai)
| | - Colleen L Barry
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson, Wall), and Mailman School of Public Health (Olfson, Mauro, Wall), Columbia University, New York City; Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (Barry); Division of Mental Health Data Science, New York State Psychiatric Institute, New York City (Choi); Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry, Johns Hopkins University, Baltimore (Mojtabai)
| | - C Jean Choi
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson, Wall), and Mailman School of Public Health (Olfson, Mauro, Wall), Columbia University, New York City; Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (Barry); Division of Mental Health Data Science, New York State Psychiatric Institute, New York City (Choi); Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry, Johns Hopkins University, Baltimore (Mojtabai)
| | - Ramin Mojtabai
- Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson, Wall), and Mailman School of Public Health (Olfson, Mauro, Wall), Columbia University, New York City; Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York (Barry); Division of Mental Health Data Science, New York State Psychiatric Institute, New York City (Choi); Department of Mental Health, Bloomberg School of Public Health, and Department of Psychiatry, Johns Hopkins University, Baltimore (Mojtabai)
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Ehntholt A, Frimpong EY, Compton MT, Rowan GA, Ferdousi W, Swetnam H, Chaudhry S, Radigan M, Smith TE, Rotter M. Prevalence and Correlates of Four Social Determinants in a Statewide Survey of Licensed Mental Health Services. Psychiatr Serv 2022; 73:1282-1285. [PMID: 35538747 DOI: 10.1176/appi.ps.202100380] [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: 11/30/2022]
Abstract
OBJECTIVE This analysis examined the distribution of four social determinants of health among recipients of state-licensed mental health services and analyzed relationships between determinants and individuals' clinical and demographic characteristics. METHODS With data from the New York State Office of Mental Health 2017 Patient Characteristics Survey (N=103,416), prevalences of four social determinants (education, employment, housing, and criminal legal involvement) among mental health service recipients were described. Results were stratified to explore differences by diagnosis, gender, race and ethnicity, and region of residence. RESULTS High proportions had low education (20.9%), unemployment (79.1%), homelessness (8.2%), and criminal legal involvement (12.2%), surpassing statistics for the general state population. Prevalences of alcohol-related, drug-related, and psychotic disorders were higher among these groups than were prevalences of other diagnoses. People of color and male recipients were overrepresented among those with adverse social determinants. CONCLUSIONS Results highlight the magnitude of social adversity among those receiving mental health services, as well as potential inequities.
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Affiliation(s)
- Amy Ehntholt
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Eric Y Frimpong
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Michael T Compton
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Grace A Rowan
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Wahida Ferdousi
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Hannah Swetnam
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Sahil Chaudhry
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Marleen Radigan
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Thomas E Smith
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Merrill Rotter
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
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Liu FF, McRee E, Coifman J, Stone J, Lai CK, Yu CL, Lyon AR. School Mental Health Professionals' Knowledge of Stereotypes and Implicit Bias Toward Black and Latinx Youths. Psychiatr Serv 2022; 73:1308-1311. [PMID: 35855619 PMCID: PMC9633346 DOI: 10.1176/appi.ps.202100253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/01/2022]
Abstract
Clinician bias is a contributor to health care inequities, but research on racial-ethnic bias among mental health professionals, especially toward minoritized youths, is limited. This column describes two studies involving mental health clinicians in schools, where most youths access mental health services. Study 1 used a mixed-methods approach to identify stereotypes about Black and Latinx youths salient to clinicians (e.g., academic failure; anger and aggression). In study 2, the authors developed four Implicit Association Tests to assess clinicians' implicit prejudice and stereotyping of Black and Latinx youths and found pro-White and anti-Black/Latinx bias at levels similar to those of other health care providers and the general population.
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Affiliation(s)
- Freda F. Liu
- University of Washington School of Medicine, Department of
Psychiatry and Behavioral Sciences
| | - Erin McRee
- University of Washington School of Medicine, Department of
Psychiatry and Behavioral Sciences
| | - Jessica Coifman
- University of Washington School of Medicine, Department of
Psychiatry and Behavioral Sciences
| | - Jeff Stone
- University of Arizona, Department of Psychology
| | - Calvin K. Lai
- Washington University in St. Louis, Department of
Psychological and Brain Sciences
| | - Chia-li Yu
- Pennsylvania State University, Department of
Psychology
| | - Aaron R. Lyon
- University of Washington School of Medicine, Department of
Psychiatry and Behavioral Sciences
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Goldstein EV, Bailey EV, Wilson FA. Discrimination and Suicidality Among Hispanic Mental Health Patients, 2010-2020: A Natural Language Processing Approach. Psychiatr Serv 2022; 73:1313-1314. [PMID: 36346105 DOI: 10.1176/appi.ps.20220240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Evan V Goldstein
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine (all authors), College of Social and Behavioral Science (Bailey), and Matheson Center for Health Care Studies (Wilson), University of Utah, Salt Lake City
| | - Elise V Bailey
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine (all authors), College of Social and Behavioral Science (Bailey), and Matheson Center for Health Care Studies (Wilson), University of Utah, Salt Lake City
| | - Fernando A Wilson
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine (all authors), College of Social and Behavioral Science (Bailey), and Matheson Center for Health Care Studies (Wilson), University of Utah, Salt Lake City
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He CX, Saunders R. The Crypto-Apartheid of Race, Class, and Safety Arbitration on the Inpatient Psychiatric Unit. Psychiatr Serv 2022; 73:1304-1307. [PMID: 35440160 DOI: 10.1176/appi.ps.202100286] [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: 11/30/2022]
Abstract
Inpatient psychiatric treatment and violence assessment are strongly influenced by a patient's race and class identity. The authors argue that psychiatrists enact a crypto-apartheid wherein they recognize and condemn the structural racism and classism disadvantaging many patients, but through violence risk assessments and dispositional decisions, psychiatrists also function as arbiters of public safety and repeatedly disadvantage less-privileged patients to further symptomatic decline or even subsequent incarceration.
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Affiliation(s)
- Cynthia X He
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco
| | - Ramotse Saunders
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco
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Farquharson W, Schwartz JE, Klein DN, Carlson GA. Factors Associated With Police Bringing Children to a Psychiatric Emergency Room. Psychiatr Serv 2022; 74:488-496. [PMID: 36300282 DOI: 10.1176/appi.ps.202200028] [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: 11/30/2022]
Abstract
OBJECTIVE Sensational headlines describing police entanglements with young children have prompted questions about how often these incidents occur and why. The authors of this cross-sectional study examined the factors associated with police versus nonpolice arrivals to the psychiatric emergency room and those predicting subsequent police arrivals. METHODS Electronic medical records of children ages 5.0-12.9 years brought to a comprehensive psychiatric emergency program (CPEP) at a university hospital were reviewed to determine whether a child was brought by police ("police arrival") in response to a 911 call by school personnel, a mental health or other medical professional, or a caregiver. Extracted data included the child's age, sex, race-ethnicity, family makeup, insurance status, arrival status, referral source, diagnosis, disposition, treatment, number of CPEP and police encounters, and occurrences of aggression and suicidality. Multilevel and ordinary logistic regression models were used to identify factors associated with a first and subsequent police arrival. RESULTS Of 339 children with CPEP encounters from September 2017 to April 2018, 103 (30%) had had at least one police arrival. Children brought by police were more likely than peers brought by caregivers to be Black or Latinx, have Medicaid, come from families without two parents, and have aggressive outbursts or suicidal behavior. Results from multilevel logistic regression indicated that aggressive outbursts and suicidality were most significantly and consistently associated with experiencing both a first and subsequent police arrival. CONCLUSIONS Clinical and sociodemographic differences in police arrivals highlight the need for a comprehensive systems approach for children, especially marginalized youths, who need psychiatric emergency care.
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Affiliation(s)
- Wilfred Farquharson
- Renaissance School of Medicine (Farquharson, Schwartz, Carlson) and Department of Psychology (Klein), Stony Brook University, Stony Brook, New York
| | - Joseph E Schwartz
- Renaissance School of Medicine (Farquharson, Schwartz, Carlson) and Department of Psychology (Klein), Stony Brook University, Stony Brook, New York
| | - Daniel N Klein
- Renaissance School of Medicine (Farquharson, Schwartz, Carlson) and Department of Psychology (Klein), Stony Brook University, Stony Brook, New York
| | - Gabrielle A Carlson
- Renaissance School of Medicine (Farquharson, Schwartz, Carlson) and Department of Psychology (Klein), Stony Brook University, Stony Brook, New York
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Archibald ME, Behrman P, Yakoby J. Racial-ethnic disparities across substance use disorder treatment settings: Sources of treatment insurance, socioeconomic correlates and clinical features. J Ethn Subst Abuse 2022:1-25. [PMID: 36208872 DOI: 10.1080/15332640.2022.2129537] [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] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Aim: Contrary to expectations, studies of racial-ethnic disparities in substance use disorder (SUD) treatment frequently uncover minority-majority parity in access and utilization of services. What accounts for the anomaly? To answer the question, this study explores racial-ethnic differences in the odds of utilization of SUD treatment in varied settings (e.g., the criminal justice system, private doctor's office, etc.), adjusting for sources of treatment insurance, socioeconomic correlates of treatment (e.g., employment, income, education), as well as clients' clinical features (e.g., type of substance abuse/dependence, co-morbidities, health status). Methods: Data were compiled from the National Survey of Drug Use and Health (NSDUH) dataset, 2002-2014. The sample consisted of respondents with a past year diagnosis of a substance use disorder, who also reported having received treatment (n = 6,207). Data were pooled to maximize subgroup analyses. Weight- and design- adjusted logistic regressions were use to analyze factors predicting SUD treatment source. Results: Blacks were more likely than Whites to receive treatment through the criminal justice system and Whites more likely than Blacks and Latinx to receive treatment at a doctor's office. Blacks were also more likely than Whites to receive treatment through inpatient/outpatient rehabilitation, before adjustments but not afterwards. Discussion: In this study we show that even after adjusting for mechanisms expected to shape pathways from race-ethnicity to SUD treatment sites, significant racial-ethnic disparities persist. This fills an important gap in the literature in that disparities research has not explicitly modeled racial-ethnic variation across the full range of SUD treatment sites.
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Kodish T, Lau AS, Belin TR, Berk MS, Asarnow JR. Improving Care Linkage for Racial-Ethnic Minority Youths Receiving Emergency Department Treatment for Suicidality: SAFETY-A. Psychiatr Serv 2022; 74:419-422. [PMID: 36128694 DOI: 10.1176/appi.ps.20220129] [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: 11/30/2022]
Abstract
OBJECTIVE This study evaluated the effects of Safe Alternatives for Teens and Youths-Acute (SAFETY-A), a brief strengths-based, cognitive-behavioral family intervention, on racial-ethnic minority youths receiving emergency department (ED) treatment for suicidal episodes. METHODS Participants were 105 racial-ethnic minority youths enrolled in a randomized controlled trial evaluating SAFETY-A versus enhanced usual care for youths receiving ED treatment for suicidal episodes. Analyses examined group effects on care linkage after discharge and adequate treatment dose. A sample of 55 White youths was included for comparison. RESULTS Racial-ethnic minority youths who received SAFETY-A had higher treatment linkage rates than those receiving usual care. Adequate treatment dose rates did not differ by group. CONCLUSIONS Racial-ethnic minority youths receiving SAFETY-A had higher treatment linkage rates after discharge than those receiving usual care. SAFETY-A is a promising approach to enhance care continuity and mental health equity for racial-ethnic minority youths at risk for suicide.
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Affiliation(s)
- Tamar Kodish
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
| | - Anna S Lau
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
| | - Thomas R Belin
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
| | - Michele S Berk
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
| | - Joan R Asarnow
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
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Callejas LM, Jones N. Meaningful Participatory Research in a Multistakeholder Collaboration on Youth Pathways to Care: Implementation and Reflections. Psychiatr Serv 2022; 73:1077-1080. [PMID: 35172596 DOI: 10.1176/appi.ps.202100567] [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: 11/30/2022]
Abstract
The authors of this column describe and reflect on challenges and successes encountered during implementation of a participatory research collaborative focused on the pathways to mental health care for youths and young adults. The collaborative centered development of stakeholder partner-led, small-scale research projects, supported by the academic research team. The column calls for greater investment in research projects that are selected and designed by community stakeholders.
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Affiliation(s)
- Linda M Callejas
- Child and Family Studies Department, University of South Florida, Tampa (Callejas); School of Social Work, University of Pittsburgh, Pittsburgh (Jones). Nev Jones, Ph.D., and Keris Jän Myrick, M.B.A., M.S., are editors of this column
| | - Nev Jones
- Child and Family Studies Department, University of South Florida, Tampa (Callejas); School of Social Work, University of Pittsburgh, Pittsburgh (Jones). Nev Jones, Ph.D., and Keris Jän Myrick, M.B.A., M.S., are editors of this column
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Díaz E, Nava LA, Parke S, Silva M, Lu FG, Davidson L, Restrepo-Toro M, Jordan A, Vassallo MG, Mendiola A, Steiner J, Dike C. Addressing Health Equity and Racism Through a Hispanic Psychiatry Fellowship. Psychiatr Serv 2022; 73:1061-1064. [PMID: 35414187 DOI: 10.1176/appi.ps.202100220] [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: 11/30/2022]
Abstract
The scarcity of bilingual psychiatrists, as well as appropriate mental health services for populations with limited English proficiency, has led to inequitable health outcomes. A fellowship program was developed, which draws from a clinical model staffed by bilingual (Spanish-English) professionals from racial-ethnic minority groups, to address access to care and the structural determinants of health. This new Hispanic Psychiatry Fellowship focuses on health inequality and racism in policy and leadership, clinical care for Spanish-speaking patients, cultural psychiatry, recovery, forensics, substance use, and education. This column describes the program's development, first 2 years of implementation, and feasibility indicators for use in creating similar programs.
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Affiliation(s)
- Esperanza Díaz
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Díaz, Nava, Parke, Silva, Davidson, Restrepo-Toro, Vassallo, Mendiola, Steiner, Dike); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu); Department of Psychiatry, New York University, New York City (Jordan). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Luis Añez Nava
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Díaz, Nava, Parke, Silva, Davidson, Restrepo-Toro, Vassallo, Mendiola, Steiner, Dike); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu); Department of Psychiatry, New York University, New York City (Jordan). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Susan Parke
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Díaz, Nava, Parke, Silva, Davidson, Restrepo-Toro, Vassallo, Mendiola, Steiner, Dike); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu); Department of Psychiatry, New York University, New York City (Jordan). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Michelle Silva
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Díaz, Nava, Parke, Silva, Davidson, Restrepo-Toro, Vassallo, Mendiola, Steiner, Dike); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu); Department of Psychiatry, New York University, New York City (Jordan). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Francis G Lu
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Díaz, Nava, Parke, Silva, Davidson, Restrepo-Toro, Vassallo, Mendiola, Steiner, Dike); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu); Department of Psychiatry, New York University, New York City (Jordan). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Larry Davidson
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Díaz, Nava, Parke, Silva, Davidson, Restrepo-Toro, Vassallo, Mendiola, Steiner, Dike); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu); Department of Psychiatry, New York University, New York City (Jordan). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Maria Restrepo-Toro
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Díaz, Nava, Parke, Silva, Davidson, Restrepo-Toro, Vassallo, Mendiola, Steiner, Dike); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu); Department of Psychiatry, New York University, New York City (Jordan). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Ayana Jordan
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Díaz, Nava, Parke, Silva, Davidson, Restrepo-Toro, Vassallo, Mendiola, Steiner, Dike); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu); Department of Psychiatry, New York University, New York City (Jordan). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Maria Garcia Vassallo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Díaz, Nava, Parke, Silva, Davidson, Restrepo-Toro, Vassallo, Mendiola, Steiner, Dike); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu); Department of Psychiatry, New York University, New York City (Jordan). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Andrea Mendiola
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Díaz, Nava, Parke, Silva, Davidson, Restrepo-Toro, Vassallo, Mendiola, Steiner, Dike); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu); Department of Psychiatry, New York University, New York City (Jordan). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Jeanne Steiner
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Díaz, Nava, Parke, Silva, Davidson, Restrepo-Toro, Vassallo, Mendiola, Steiner, Dike); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu); Department of Psychiatry, New York University, New York City (Jordan). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Charles Dike
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Díaz, Nava, Parke, Silva, Davidson, Restrepo-Toro, Vassallo, Mendiola, Steiner, Dike); Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento (Lu); Department of Psychiatry, New York University, New York City (Jordan). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
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Savill M, Nguyen T, Shim RS, Loewy RL. Online Psychosis Screening: Characterizing an Underexamined Population to Improve Access and Equity. Psychiatr Serv 2022; 73:1005-1012. [PMID: 35172594 DOI: 10.1176/appi.ps.202100257] [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: 11/30/2022]
Abstract
OBJECTIVE Online resources represent an important avenue to identify and support individuals who may be experiencing symptoms of psychosis but have yet to engage in care. Understanding the experiences and needs of this group is critical to inform outreach for early psychosis and improve outcomes by addressing barriers to early treatment. METHODS The authors conducted a retrospective, explorative, cross-sectional analysis by using data collected by Mental Health America as part of their online psychosis screening and support program. Data included scores from the Prodromal Questionnaire-Brief, basic demographic information, and respondents' plans for next steps. RESULTS Of 120,937 respondents, most (82.1%) reported distressing psychosis-like experiences at levels sufficient to merit a referral to specialty care for additional evaluation. However, only 17.1% planned to seek treatment as a next step, with most (53.6%) wanting instead more information. Higher distress was only weakly associated with the plan to seek treatment. In the multivariable analysis, respondents who were younger; lesbian, gay, bisexual, transgender, or queer; or Native American or who had lower income reported the greatest symptom-related distress. Younger and higher-income respondents were less likely to plan to seek treatment next. Across race-ethnicity, African Americans were most likely to plan to seek treatment. CONCLUSIONS Most respondents reported that psychosis-like experiences caused significant distress, but they did not plan to seek treatment next. Addressing this treatment gap requires careful consideration regarding what services individuals want, how services should be presented, and what barriers may limit help seeking. These steps are critical to improve access to early intervention for individuals with psychosis spectrum disorders.
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Affiliation(s)
- Mark Savill
- Department of Psychiatry and Behavioral Sciences, University of California, Davis (Savill, Shim); Mental Health America, Alexandria, Virginia (Nguyen); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Loewy)
| | - Theresa Nguyen
- Department of Psychiatry and Behavioral Sciences, University of California, Davis (Savill, Shim); Mental Health America, Alexandria, Virginia (Nguyen); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Loewy)
| | - Ruth S Shim
- Department of Psychiatry and Behavioral Sciences, University of California, Davis (Savill, Shim); Mental Health America, Alexandria, Virginia (Nguyen); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Loewy)
| | - Rachel L Loewy
- Department of Psychiatry and Behavioral Sciences, University of California, Davis (Savill, Shim); Mental Health America, Alexandria, Virginia (Nguyen); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Loewy)
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Abstract
OBJECTIVE Antidepressants are often prescribed in primary care to treat veterans who have depression. An evaluation of current racial disparities in integrated primary care is warranted. This study examined the association between race and prescription of antidepressants among veterans in primary care. METHODS Veterans in primary care (Black, N=4,120; White, N=4,372) who were referred from primary care to a collaborative care program completed an assessment of demographic characteristics and clinical symptoms, including of current antidepressant prescription before the referral, verified by chart review. Patient data were collected from January 1, 2015, to December 22, 2020. Logistic regression analyses were conducted to examine the relationships between patient race and both depression symptoms and antidepressant prescription. Analyses were also stratified by severity of depression symptoms to understand the results in the context of clinical guidelines. RESULTS White patients were almost two times (odds ratio=1.96, 95% confidence interval [CI]=1.75–2.19, p<0.001) more likely than Black patients to receive an antidepressant prescription, after the analysis was controlled for depression symptoms, demographic characteristics, and other clinical symptoms. Among patients with severe depression, for whom prescription of antidepressants is clinically indicated, White patients were 1.87 times more likely than Black patients to receive an antidepressant prescription (95% CI=1.40–2.50, p<0.001). CONCLUSIONS The findings reveal racial disparities in antidepressant prescription for veterans in primary care. Regular clinical review of antidepressant prescription is recommended to identify disparities in individual clinics. Future research should aim to identify drivers of racial disparities and provide recommendations for health care systems, providers, and patients.
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Affiliation(s)
- Jocelyn E Remmert
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center (MIRECC) (Remmert, Mavandadi, Oslin) and Psychology Department (Guzman), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia; Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey (Guzman); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Oslin)
| | - Gabriella Guzman
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center (MIRECC) (Remmert, Mavandadi, Oslin) and Psychology Department (Guzman), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia; Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey (Guzman); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Oslin)
| | - Shahrzad Mavandadi
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center (MIRECC) (Remmert, Mavandadi, Oslin) and Psychology Department (Guzman), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia; Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey (Guzman); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Oslin)
| | - Dave Oslin
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center (MIRECC) (Remmert, Mavandadi, Oslin) and Psychology Department (Guzman), Corporal Michael J. Crescenz Department of Veterans Affairs (VA) Medical Center, Philadelphia; Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey (Guzman); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Mavandadi, Oslin)
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Smith CM, Turner NA, Thielman NM, Tweedy DS, Egger J, Gagliardi JP. Association of Black Race With Physical and Chemical Restraint Use Among Patients Undergoing Emergency Psychiatric Evaluation. Psychiatr Serv 2022; 73:730-736. [PMID: 34932385 DOI: 10.1176/appi.ps.202100474] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 12/01/2022]
Abstract
OBJECTIVE Few studies have examined the disproportionate use of restraints for Black adults receiving emergency psychiatric care. This study sought to determine whether the odds of physical and chemical restraint use were higher for Black patients undergoing emergency psychiatric care compared with their White counterparts. METHODS This single-center retrospective cohort study examined 12,977 unique encounters of adults receiving an emergency psychiatric evaluation between January 1, 2014, and September 18, 2020, at a large academic medical center in Durham, North Carolina. Self-reported race categories were extracted from the electronic medical record. Primary outcomes were the presence of a behavioral physical restraint order or chemical restraint administration during the emergency department encounter. Covariates included age, sex, ethnicity, height, time of arrival, positive urine drug screen results, peak blood alcohol concentration, and diagnosis of a bipolar or psychotic disorder. RESULTS A total of 961 (7.4%) encounters involved physical restraint, and 2,047 (15.8%) involved chemical restraint. Models with and without a race covariate were compared by using quasi-likelihood information criterion scores; in each instance, the model with race performed better than the model without. Black patients were more likely to be physically (adjusted odds ratio [AOR]=1.35; 95% confidence interval [CI]=1.07-1.72) and chemically (AOR=1.33; 95% CI=1.15-1.55) restrained than White patients. CONCLUSIONS After analyses were adjusted for measured confounders, Black patients undergoing psychiatric evaluation were at higher odds of experiencing physical or chemical restraint compared with White patients, which is consistent with the growing body of evidence revealing racial disparities in psychiatric care.
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Affiliation(s)
- Colin M Smith
- Department of Medicine (Smith, Turner, Thielman, Gagliardi), Department of Psychiatry and Behavioral Sciences (Smith, Tweedy, Gagliardi), and Duke Global Health Institute (Thielman, Egger), Duke University School of Medicine, Durham, North Carolina
| | - Nicholas A Turner
- Department of Medicine (Smith, Turner, Thielman, Gagliardi), Department of Psychiatry and Behavioral Sciences (Smith, Tweedy, Gagliardi), and Duke Global Health Institute (Thielman, Egger), Duke University School of Medicine, Durham, North Carolina
| | - Nathan M Thielman
- Department of Medicine (Smith, Turner, Thielman, Gagliardi), Department of Psychiatry and Behavioral Sciences (Smith, Tweedy, Gagliardi), and Duke Global Health Institute (Thielman, Egger), Duke University School of Medicine, Durham, North Carolina
| | - Damon S Tweedy
- Department of Medicine (Smith, Turner, Thielman, Gagliardi), Department of Psychiatry and Behavioral Sciences (Smith, Tweedy, Gagliardi), and Duke Global Health Institute (Thielman, Egger), Duke University School of Medicine, Durham, North Carolina
| | - Joseph Egger
- Department of Medicine (Smith, Turner, Thielman, Gagliardi), Department of Psychiatry and Behavioral Sciences (Smith, Tweedy, Gagliardi), and Duke Global Health Institute (Thielman, Egger), Duke University School of Medicine, Durham, North Carolina
| | - Jane P Gagliardi
- Department of Medicine (Smith, Turner, Thielman, Gagliardi), Department of Psychiatry and Behavioral Sciences (Smith, Tweedy, Gagliardi), and Duke Global Health Institute (Thielman, Egger), Duke University School of Medicine, Durham, North Carolina
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Abstract
Efforts that destigmatize mental health, especially media campaigns, have not fully penetrated Latinx and Spanish-language media and have not reached consumers. This lack of reach conceivably contributes to high stigma and low use of mental health care services among young, diverse, and growing Latinx populations. Latinx and Spanish-language media have been historically excluded from media-related research examining stigmatizing content and help-seeking resources. Moreover, Latinx populations are rarely included in antistigma efficacy trials. Such exclusion has plausibly restricted mental health service utilization for Latinx communities, thereby perpetuating mental health inequities. Addressing these inequities can help support effective future antistigma efforts that leverage Latinx and Spanish-language mass media to rapidly reach Latinx audiences and narrow treatment gaps.
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Affiliation(s)
- Melissa J DuPont-Reyes
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas. Roberto Lewis-Fernández, M.D., and Jessica Isom, M.D., M.P.H., are editors of this column
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Stenersen MR, Kelly A, Bracey J, Marshall T, Cummins M, Clark K, Kaufman JS. Understanding Racial-Ethnic Disparities in Wraparound Care for Youths With Emotional and Behavioral Disorders. Psychiatr Serv 2022; 73:526-532. [PMID: 34470504 PMCID: PMC8888774 DOI: 10.1176/appi.ps.202100086] [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: 11/30/2022]
Abstract
OBJECTIVE Systems of care (SOCs) were developed to increase access to and quality of care for children with emotional and behavioral difficulties and their families through the provision of coordinated, community-based, culturally competent, family-driven services. SOCs focus on wraparound care that is individualized to meet each family's needs. Previous research has illustrated significant disparities in outcomes of nonwraparound care on the basis of youths' race-ethnicity. This study aimed to fill a research gap by examining disparities in outcomes for families receiving wraparound care coordination within an SOC. METHODS This exploratory study examined racial-ethnic disparities in outcomes observed at intake, during service provision, and at 6-month follow-up among 1,138 youths and their caregivers who participated in wraparound care coordination as part of a statewide SOC between 2016 and 2020. Analyses of variance and regression analyses were executed to investigate whether receiving services and/or the youths' racial-ethnic identity predicted differences in behavioral health outcomes and characteristics of or satisfaction with care. Caregiver-reported outcomes were assessed with the Ohio Scales for Youth, the Child Trauma Screen, and the Caregiver Strain Questionnaire. RESULTS Results revealed few racial-ethnic disparities in the characteristics and outcomes of care coordination among participants at intake or in family involvement in the wraparound process. Participants across groups reported similar and significant improvement in outcomes. However, the results indicated some disparities in satisfaction with care. CONCLUSIONS Results revealed the positive impact of care coordination on the health and well-being of youths and caregivers across racial-ethnic groups.
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Affiliation(s)
- Madeline R Stenersen
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Aleece Kelly
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Jeana Bracey
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Tim Marshall
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Mary Cummins
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Kathryn Clark
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
| | - Joy S Kaufman
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, Connecticut (Stenersen, Clark, Kaufman); Child Health and Development Institute of Connecticut, Farmington (Kelly, Bracey); Office of Community Mental Health, Connecticut Department of Children and Families, Hartford (Marshall, Cummins)
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Aggarwal NK. Diversity and Inclusion Training in Health Care: What the Evidence Suggests. Psychiatr Serv 2022; 73:472-475. [PMID: 34235944 DOI: 10.1176/appi.ps.202000805] [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: 11/30/2022]
Abstract
On September 22, 2020, then-President Donald Trump signed Executive Order 13950, titled "Combating Race and Sex Stereotyping." This order restricted the types of diversity and inclusion (DI) training that federal agencies and contractors could offer with federal funding. In this column, the author denounces that order, uses this critique to examine DI training sessions in their current forms, and suggests evidence-based solutions for organizations that are committed to dismantling racism. Mental health organizations must move beyond single, standalone DI training sessions that target individual providers and initiate institution-wide activities that embrace antiracism and structural competence.
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Affiliation(s)
- Neil Krishan Aggarwal
- Department of Psychiatry, Columbia University Irving Medical Center, New York City. Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
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Abstract
Individually, the COVID-19 pandemic and opioid epidemic have each been responsible for hundreds of thousands of deaths. Systemic racism, including public perceptions about people who use opioids, inadequate substance abuse prevention and treatment efforts, heightened risks for COVID-19 exposure, and inadequate access to testing and health care, has contributed to the ongoing disparities underlying these health crises. Thus, the authors propose an integrative framework for conceptualizing the COVID-19, opioid use, and racism (COR) syndemic, with traumatic stress as a critical underpinning of this model. Action is needed to address trauma and the COR syndemic. Implications for research, practice, and policy are discussed.
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Affiliation(s)
- Denise Nguyen Hien
- Rutgers Center of Alcohol & Substance Use Studies (Hien, Bauer) and Graduate School of Applied and Professional Psychology (Hien, Franklin, Lalwani, Pean), Rutgers University, Piscataway, New Jersey. Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
| | - Alexandria G Bauer
- Rutgers Center of Alcohol & Substance Use Studies (Hien, Bauer) and Graduate School of Applied and Professional Psychology (Hien, Franklin, Lalwani, Pean), Rutgers University, Piscataway, New Jersey. Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
| | - Liza Franklin
- Rutgers Center of Alcohol & Substance Use Studies (Hien, Bauer) and Graduate School of Applied and Professional Psychology (Hien, Franklin, Lalwani, Pean), Rutgers University, Piscataway, New Jersey. Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
| | - Tanya Lalwani
- Rutgers Center of Alcohol & Substance Use Studies (Hien, Bauer) and Graduate School of Applied and Professional Psychology (Hien, Franklin, Lalwani, Pean), Rutgers University, Piscataway, New Jersey. Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
| | - Kierra Pean
- Rutgers Center of Alcohol & Substance Use Studies (Hien, Bauer) and Graduate School of Applied and Professional Psychology (Hien, Franklin, Lalwani, Pean), Rutgers University, Piscataway, New Jersey. Ruth S. Shim, M.D., M.P.H., and Michael T. Compton, M.D., M.P.H., are editors of this column
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Amonoo HL, Levy-Carrick NC, Nadkarni A, Grossman SJ, Green DW, Longley RM, Silbersweig DA, AhnAllen CG. Diversity, Equity, and Inclusion Committee: An Instrument to Champion Diversity Efforts Within a Large Academic Psychiatry Department. Psychiatr Serv 2022; 73:223-226. [PMID: 34157855 DOI: 10.1176/appi.ps.202000934] [Citation(s) in RCA: 3] [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] [Indexed: 11/30/2022]
Abstract
Diversity, equity, and inclusion (DEI) have become increasingly recognized as essential to the practice of high-quality patient care delivery and the support of members of the clinical environment. A solid understanding of DEI contributes to a better grasp of what drives health care disparities and yields improved clinical outcomes for minority populations. This column discusses how individuals can practically promote DEI by describing the design and implementation of DEI in an academic psychiatry department. The authors highlight the powerful role of departmental initiatives in establishing best practices for DEI and lessons learned through the work of the psychiatry department's DEI committee.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychiatry, Brigham and Women's Hospital, Boston (all authors); Department of Psychiatry, Harvard Medical School, Boston (Amonoo, Levy-Carrick, Nadkarni, Grossman, Green, Silbersweig, AhnAllen). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Nomi C Levy-Carrick
- Department of Psychiatry, Brigham and Women's Hospital, Boston (all authors); Department of Psychiatry, Harvard Medical School, Boston (Amonoo, Levy-Carrick, Nadkarni, Grossman, Green, Silbersweig, AhnAllen). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Ashwini Nadkarni
- Department of Psychiatry, Brigham and Women's Hospital, Boston (all authors); Department of Psychiatry, Harvard Medical School, Boston (Amonoo, Levy-Carrick, Nadkarni, Grossman, Green, Silbersweig, AhnAllen). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Samara J Grossman
- Department of Psychiatry, Brigham and Women's Hospital, Boston (all authors); Department of Psychiatry, Harvard Medical School, Boston (Amonoo, Levy-Carrick, Nadkarni, Grossman, Green, Silbersweig, AhnAllen). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - David W Green
- Department of Psychiatry, Brigham and Women's Hospital, Boston (all authors); Department of Psychiatry, Harvard Medical School, Boston (Amonoo, Levy-Carrick, Nadkarni, Grossman, Green, Silbersweig, AhnAllen). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Regina M Longley
- Department of Psychiatry, Brigham and Women's Hospital, Boston (all authors); Department of Psychiatry, Harvard Medical School, Boston (Amonoo, Levy-Carrick, Nadkarni, Grossman, Green, Silbersweig, AhnAllen). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - David A Silbersweig
- Department of Psychiatry, Brigham and Women's Hospital, Boston (all authors); Department of Psychiatry, Harvard Medical School, Boston (Amonoo, Levy-Carrick, Nadkarni, Grossman, Green, Silbersweig, AhnAllen). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
| | - Christopher G AhnAllen
- Department of Psychiatry, Brigham and Women's Hospital, Boston (all authors); Department of Psychiatry, Harvard Medical School, Boston (Amonoo, Levy-Carrick, Nadkarni, Grossman, Green, Silbersweig, AhnAllen). Michael Mensah, M.D., M.P.H., Lucy Ogbu-Nwobodo, M.D., M.S., and Ruth S. Shim, M.D., M.P.H., are editors of this column
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Hunt AD, Adams LM. Health Care Access Alone Falling Short of Health Care Equity. Psychiatr Serv 2022; 73:210-211. [PMID: 34470503 DOI: 10.1176/appi.ps.202100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aaron D Hunt
- Department of Psychology (Hunt, Adams) and Women and Gender Studies Program (Adams), George Mason University, Fairfax, Virginia
| | - Leah M Adams
- Department of Psychology (Hunt, Adams) and Women and Gender Studies Program (Adams), George Mason University, Fairfax, Virginia
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Abstract
As the debate within the United States about reforming its militarized police force continues, psychiatrists need to critically reflect on their profession's role in perpetuating structural violence. Research shows that the now well-documented disproportionate use of force against people of color in many communities is also mirrored in the hospital setting. The authors of this Open Forum provide a structurally informed perspective on the use of restraints in their practice, highlight the persistence of police weaponry in hospitals despite recommendations to abolish it, and call on regulatory authorities and clinicians to make changes that address these health inequities.
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Affiliation(s)
- Samuel Dotson
- Department of Psychiatry, Massachusetts General Hospital, and Department of Psychiatry, Harvard Medical School, Boston
| | - Lucy Ogbu-Nwobodo
- Department of Psychiatry, Massachusetts General Hospital, and Department of Psychiatry, Harvard Medical School, Boston
| | - Derri Shtasel
- Department of Psychiatry, Massachusetts General Hospital, and Department of Psychiatry, Harvard Medical School, Boston
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Abstract
OBJECTIVE Using a retrospective sample, the authors sought to determine whether Black patients with first-episode psychosis (FEP) in Canada were at a higher risk for coercive referral and coercive intervention than non-Black patients with FEP. METHODS Retrospective data from patients referred to an FEP program in 2008-2018 were collected via chart review (N=208). The authors used chi-square and logistic regression analyses to explore the relationships among race-ethnicity, diagnosis of psychosis, and coercive referral and intervention. RESULTS Results showed that Black persons of Caribbean or African descent with FEP were significantly more likely to be coercively referred (χ2=9.24, df=2, p=0.010) and coercively treated (χ2=9.21, df=2, p=0.010) than were non-Black individuals with FEP. Age and violent or threatening behavior were predictors of coercive referral. Ethnoracial status, age, and violent or threatening behavior were predictors of coercive intervention. CONCLUSIONS This study contributes to the dearth of research on Black Canadians and offers insight into factors that may place patients with FEP at risk for coercive treatment. More research is needed to explore the role that ethnoracial status may play in hospital admissions and to uncover the role of racial prejudices in the assessment of danger.
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Affiliation(s)
- Sommer Knight
- Department of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal (all authors); First Episode Psychosis Program (FEPP), Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal (Jarvis); Department of Psychology, Faculty of Arts and Science, Concordia University, Montreal (Ryder)
| | - G Eric Jarvis
- Department of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal (all authors); First Episode Psychosis Program (FEPP), Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal (Jarvis); Department of Psychology, Faculty of Arts and Science, Concordia University, Montreal (Ryder)
| | - Andrew G Ryder
- Department of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal (all authors); First Episode Psychosis Program (FEPP), Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal (Jarvis); Department of Psychology, Faculty of Arts and Science, Concordia University, Montreal (Ryder)
| | - Myrna Lashley
- Department of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal (all authors); First Episode Psychosis Program (FEPP), Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal (Jarvis); Department of Psychology, Faculty of Arts and Science, Concordia University, Montreal (Ryder)
| | - Cécile Rousseau
- Department of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal (all authors); First Episode Psychosis Program (FEPP), Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal (Jarvis); Department of Psychology, Faculty of Arts and Science, Concordia University, Montreal (Ryder)
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Coombs A, Joshua A, Flowers M, Wisdom J, Crayton LS, Frazier K, Hankerson SH. Mental Health Perspectives Among Black Americans Receiving Services From a Church-Affiliated Mental Health Clinic. Psychiatr Serv 2022; 73:77-82. [PMID: 34235947 DOI: 10.1176/appi.ps.202000766] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/30/2022]
Abstract
Black Americans face substantial barriers to mental health services that are due, in part, to historical and contemporary issues of anti-Black racism. Identifying novel models of care that increase access and engagement in mental health services is important. One such model was developed by a predominantly Black church in Harlem, New York City, which built a free mental health clinic to serve the surrounding community. However, treatment barriers and facilitators of this care model have not been reported. Therefore, the authors conducted a qualitative study to identify Black Americans' (N=15) perspectives of their experiences seeking and receiving care from this church-affiliated mental health clinic and the role of the church in promoting mental health service utilization. Treatment facilitators included health care that was free of charge, services affiliated with a trusted institution, and access to culturally competent care that integrated their faith perspectives. Participants perceived the churches as having the potential to provide psychoeducation, destigmatization, and connection to mental health services. The perspectives shared suggest that this novel model of care may address several barriers to mental health care faced by some Black American populations.
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Affiliation(s)
- Angela Coombs
- Department of Psychiatry, Columbia University Irving Medical Center, New York City (Coombs, Hankerson); New York State Psychiatric Institute, New York City (Coombs, Joshua, Flowers, Hankerson); Wisdom Consulting, New York City (Wisdom); Graduate School of Social Service, Fordham University, New York City (Crayton); KYND Consulting, Inc., New York City (Frazier)
| | - Amita Joshua
- Department of Psychiatry, Columbia University Irving Medical Center, New York City (Coombs, Hankerson); New York State Psychiatric Institute, New York City (Coombs, Joshua, Flowers, Hankerson); Wisdom Consulting, New York City (Wisdom); Graduate School of Social Service, Fordham University, New York City (Crayton); KYND Consulting, Inc., New York City (Frazier)
| | - Mavis Flowers
- Department of Psychiatry, Columbia University Irving Medical Center, New York City (Coombs, Hankerson); New York State Psychiatric Institute, New York City (Coombs, Joshua, Flowers, Hankerson); Wisdom Consulting, New York City (Wisdom); Graduate School of Social Service, Fordham University, New York City (Crayton); KYND Consulting, Inc., New York City (Frazier)
| | - Jennifer Wisdom
- Department of Psychiatry, Columbia University Irving Medical Center, New York City (Coombs, Hankerson); New York State Psychiatric Institute, New York City (Coombs, Joshua, Flowers, Hankerson); Wisdom Consulting, New York City (Wisdom); Graduate School of Social Service, Fordham University, New York City (Crayton); KYND Consulting, Inc., New York City (Frazier)
| | - La'Shay S Crayton
- Department of Psychiatry, Columbia University Irving Medical Center, New York City (Coombs, Hankerson); New York State Psychiatric Institute, New York City (Coombs, Joshua, Flowers, Hankerson); Wisdom Consulting, New York City (Wisdom); Graduate School of Social Service, Fordham University, New York City (Crayton); KYND Consulting, Inc., New York City (Frazier)
| | - Kyndra Frazier
- Department of Psychiatry, Columbia University Irving Medical Center, New York City (Coombs, Hankerson); New York State Psychiatric Institute, New York City (Coombs, Joshua, Flowers, Hankerson); Wisdom Consulting, New York City (Wisdom); Graduate School of Social Service, Fordham University, New York City (Crayton); KYND Consulting, Inc., New York City (Frazier)
| | - Sidney H Hankerson
- Department of Psychiatry, Columbia University Irving Medical Center, New York City (Coombs, Hankerson); New York State Psychiatric Institute, New York City (Coombs, Joshua, Flowers, Hankerson); Wisdom Consulting, New York City (Wisdom); Graduate School of Social Service, Fordham University, New York City (Crayton); KYND Consulting, Inc., New York City (Frazier)
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Friedman BR, Durán DK, Nestsiarovich A, Tohen M, Lenroot RK, Bustillo JR, Crisanti AS. Characteristics of Hispanics Referred to Coordinated Specialty Care for First-Episode Psychosis and Factors Associated With Enrollment. Psychiatr Serv 2021; 72:1407-1414. [PMID: 34074143 DOI: 10.1176/appi.ps.202000798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The primary objectives of this study were to examine referral sources and demographic, clinical, and socioenvironmental characteristics of Hispanics referred to and enrolled in a program of coordinated specialty care (Early CSC program) for first-episode psychosis, to compare them with characteristics of other referred and enrolled racial-ethnic groups, and to identify factors associated with enrollment in the program. METHODS A retrospective review was conducted for all individuals referred to and enrolled in the Early CSC program over a 2-year period. Extracted data included referral sources and demographic and clinical characteristics. Zip code-level data from publicly available sources were cross-referenced with individual records. Nonparametric tests and appropriate secondary analysis were used to determine significant differences across racial-ethnic groups referred to (N=180) or enrolled in (N=75) the Early CSC program. A random forest model was used to determine which factors or interacting factors were associated with enrollment among the eligible referrals (N=114). RESULTS Hispanic individuals were more likely to be referred from inpatient or outpatient mental health providers and not from other community sources. Among eligible Hispanic referrals, those who lived in areas with a lower percentage of Spanish speaking in the home were more likely to enroll in services, compared with those who lived in areas with a higher percentage of Spanish speaking. CONCLUSIONS Continued exploration of factors associated with referral and enrollment in CSC programs for the growing Hispanic ethnic group in the United States can help determine best steps for developing these programs.
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Affiliation(s)
- Bess Rose Friedman
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Danielle K Durán
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | | | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Rhoshel K Lenroot
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Juan R Bustillo
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Annette S Crisanti
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
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