Gender-aware mental healthcare: counteracting sex and gender disparities in diagnosis and treatment for women

To determine the relations between obstructive sleep apnea (OSA) diagnosis, the likelihood of being diagnosed with a psychological condition, among obese veterans, after accounting for severity of obesity and the correlated nature of patients within facility. We hypothesized that (1) individuals with a diagnosis of OSA would be more likely to receive a diagnosis of a (a) mood disorder and (b) anxiety disorder, but not (c) substance use disorder. Cross-sectional retrospective database review of outpatient medical records between October 2009 and September 2010, conducted across all 140 Veterans Health Administration (VHA) facilities. The entire VA Health Care System. Population-based sample of veterans with obesity (N = 2,485,658). Physician- or psychologist-determined diagnosis of psychological conditions including mood, anxiety, and substance use disorders. Using generalized linear mixed modeling, after accounting for the correlated nature of patients within facility and the severity of obesity, individuals with a diagnosis of sleep apnea had increased odds of receiving a mood disorder diagnosis (OR = 1.85; CI = 1.71-1.72; p < 0.001), anxiety disorder diagnosis (OR = 1.82; CI = 1.77-1.84; p < 0.001), but not a diagnosis of substance use disorder. Among obese veterans within VA, OSA is associated with increased risk for having a mood and anxiety disorder, but not substance use disorder, with the strongest associations observed for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). In addition, this relation remained after accounting for severity of BMI.

BackgroundCompassion is a vital component to the achievement of positive health outcomes, particularly in mental health care. The rise of digital technologies may influence the delivery of compassionate care, and thus this relationship between compassion and digital health care needs to be better understood.ObjectiveThis scoping review aimed to identify existing digital technologies being used by patients and health professionals in the delivery of mental health care, understand how digital technologies are being used in the delivery of compassionate mental health care, and determine the facilitators of and barriers to digital technology use among patients and health professionals in the delivery of compassionate mental health care.MethodsWe conducted this scoping review through a search of Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process and EPub Ahead of Print, PsycINFO, and Web of Science for articles published from 1990 to 2019.ResultsOf the 4472 articles screened, 37 articles were included for data extraction. Telemedicine was the most widely used technology by mental health professionals. Digital technologies were described as facilitating compassionate care and were classified using a conceptual model to identify each digital intersection with compassionate care. Facilitators of and barriers to providing compassionate care through digital technology were identified, including increased safety for providers, health care professional perceptions and abilities, and the use of picture-in-picture feedback to evaluate social cues.ConclusionsImplementing digital technology into mental health care can improve the current delivery of compassionate care and create novel ways to provide compassion. However, as this is a new area of study, mental health professionals and organizations alike should be mindful that compassionate human-centered care is maintained in the delivery of digital health care. Future research could develop tools to facilitate and evaluate the enactment of compassion within digital health care.

To obtain descriptions of how family physicians detect and manage mental health problems commonly encountered in their practices and how they function in their role as mental health care providers. Also, to elicit their perceptions of barriers to the delivery of optimal mental health care. Focus groups with standardized questions were used to elicit descriptive data, opinions, attitudes, and terminology. Convenience samples of 10 to 12 physicians were chosen in each of Ontario's 7 health care planning regions, with a mixture of rural, urban, and university settings. Discussions were audiotaped, transcribed, analyzed, and recurring themes were extracted. Family physicians' descriptions of the range of problems commonly encountered and their detection and management highlight the unique nature of mental health care in the primary care setting. The realities of family medicine, the undifferentiated nature of presenting problems, the long-term physician-patient relationship, and the frequent overlap of physical and mental health problems dictate an approach to diagnosis and treatment that differs from mental health care delivery in other settings. Difficulties in the relationship with local psychiatric services--accessing psychiatric care (especially for emergencies), poor communication with mental health care providers, and cumbersome intake procedures of many mental health services--were consistently identified as barriers to the delivery of optimal mental health care. This study confirms the importance of the family physician in the detection and management of mental health problems. It offers insights into how family physicians function in their role as mental health care providers and how they deal with diagnostic and management challenges that are specific to primary care. It also identifies barriers to the optimal delivery of mental health care in the primary care setting, including difficulties at the clinical interface between psychiatry and family medicine. Further studies are needed to explore these issues in greater depth.

Back to table of contents Next article Taking IssueFull AccessHealth Care Reform and Mental Health Care DeliveryVidhya Alakeson M.Sc.,Richard G. Frank Ph.D.,Vidhya Alakeson M.Sc.Search for more papers by this author,Richard G. Frank Ph.D.Search for more papers by this author,Published Online:1 Nov 2010AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Three articles in this issue of the journal review economic and policy implications for mental health delivery of the Patient Protection and Affordable Care Act, referred to as the ACA. The authors highlight opportunities for great improvement, as well as challenges, in the financing and delivery of mental health care in the United States. The ACA incrementally expands existing insurance, and it also creates and encourages the development and diffusion of important new institutions and organizational forms that will govern insurance markets and service provision. Garfield and colleagues describe these expansions. McGuire and Sinaiko explain the role of health insurance exchanges in restructuring the individual and small-group markets. Druss and Mauer explain the potential of new organizational forms to promote integration of mental health and other medical care, along with improved approaches to specialty care delivery.In each case, important potential gains in social welfare are noted, with an emphasis on key choices that must be made by those implementing the blueprint set out in the ACA. Gains in coverage among people with mental and substance use disorders are intertwined with the problems of poverty, illiteracy, and social isolation. Special efforts will be required to engage and enroll this deprived and frequently costly population. McGuire and Sinaiko explain that competitive insurance markets have functioned especially poorly in providing coverage to people at elevated risk of mental health and substance use problems. They review measures that might be adopted by new health insurance exchanges to mitigate historical failures in private insurance. The analysis presented by Garfield and colleagues highlights that gaps in services will remain despite coverage expansion, particularly for social supports that are not likely to be covered by private health insurance. Funding for wraparound services will continue to be important. Finally, Druss and Mauer suggest improvements in the infrastructure to promote improved mental health care within newly created medical homes and accountable care organizations. They call for development of a broader range of quality measures in mental health and the use of information technology by specialty providers.The ACA reinforces the place of mental health and substance use disorder care in the health care mainstream, building on the 2010 implementation of parity requirements for coverage of behavioral health care in private health insurance. Even though the field may have entered the mainstream of health care reform, it is still important to recognize and address the unique challenges to the health care system posed by individuals with mental and substance use disorders. The government and other stakeholders must redouble their commitments to craft policies that account for the sometimes exceptional circumstances presented by mental health care delivery.Nuffield TrustOffice of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services FiguresReferencesCited byDetailsCited ByNavigating a Complex Health System: the Perceptions of Psychiatric Residents in Addressing Sexual and Reproductive Health of Women with Severe Mental Illness21 February 2020 | Academic Psychiatry, Vol. 44, No. 4Behavioral Health's Integration Within a Care Network and Health Care Utilization30 May 2018 | Health Services Research, Vol. 53, No. 6The Role of Health Plans in Supporting Behavioral Health Integration23 June 2017 | Administration and Policy in Mental Health and Mental Health Services Research, Vol. 44, No. 6How Health Reform is Recasting Public PsychiatryPsychiatric Clinics of North America, Vol. 38, No. 3Administration and Policy in Mental Health and Mental Health Services Research, Vol. 42, No. 3 Volume 61Issue 11 November, 2010Pages 1063-1063PSYCHIATRIC SERVICES November 2010 Volume 61 Number 11 Metrics PDF download History Published online 1 November 2010 Published in print 1 November 2010

Back to table of contents Next article Taking IssueFull AccessHealth Care Reform and Mental Health Care DeliveryVidhya Alakeson M.Sc.,Richard G. Frank Ph.D.,Vidhya Alakeson M.Sc.Search for more papers by this author,Richard G. Frank Ph.D.Search for more papers by this author,Published Online:1 Nov 2010AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Three articles in this issue of the journal review economic and policy implications for mental health delivery of the Patient Protection and Affordable Care Act, referred to as the ACA. The authors highlight opportunities for great improvement, as well as challenges, in the financing and delivery of mental health care in the United States. The ACA incrementally expands existing insurance, and it also creates and encourages the development and diffusion of important new institutions and organizational forms that will govern insurance markets and service provision. Garfield and colleagues describe these expansions. McGuire and Sinaiko explain the role of health insurance exchanges in restructuring the individual and small-group markets. Druss and Mauer explain the potential of new organizational forms to promote integration of mental health and other medical care, along with improved approaches to specialty care delivery.In each case, important potential gains in social welfare are noted, with an emphasis on key choices that must be made by those implementing the blueprint set out in the ACA. Gains in coverage among people with mental and substance use disorders are intertwined with the problems of poverty, illiteracy, and social isolation. Special efforts will be required to engage and enroll this deprived and frequently costly population. McGuire and Sinaiko explain that competitive insurance markets have functioned especially poorly in providing coverage to people at elevated risk of mental health and substance use problems. They review measures that might be adopted by new health insurance exchanges to mitigate historical failures in private insurance. The analysis presented by Garfield and colleagues highlights that gaps in services will remain despite coverage expansion, particularly for social supports that are not likely to be covered by private health insurance. Funding for wraparound services will continue to be important. Finally, Druss and Mauer suggest improvements in the infrastructure to promote improved mental health care within newly created medical homes and accountable care organizations. They call for development of a broader range of quality measures in mental health and the use of information technology by specialty providers.The ACA reinforces the place of mental health and substance use disorder care in the health care mainstream, building on the 2010 implementation of parity requirements for coverage of behavioral health care in private health insurance. Even though the field may have entered the mainstream of health care reform, it is still important to recognize and address the unique challenges to the health care system posed by individuals with mental and substance use disorders. The government and other stakeholders must redouble their commitments to craft policies that account for the sometimes exceptional circumstances presented by mental health care delivery.Nuffield TrustOffice of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services FiguresReferencesCited byDetailsCited byNavigating a Complex Health System: the Perceptions of Psychiatric Residents in Addressing Sexual and Reproductive Health of Women with Severe Mental Illness21 February 2020 | Academic Psychiatry, Vol. 44, No. 4Behavioral Health's Integration Within a Care Network and Health Care Utilization30 May 2018 | Health Services Research, Vol. 53, No. 6The Role of Health Plans in Supporting Behavioral Health Integration23 June 2017 | Administration and Policy in Mental Health and Mental Health Services Research, Vol. 44, No. 6How Health Reform is Recasting Public PsychiatryPsychiatric Clinics of North America, Vol. 38, No. 3Administration and Policy in Mental Health and Mental Health Services Research, Vol. 42, No. 3 Volume 61Issue 11 November, 2010Pages 1063-1063PSYCHIATRIC SERVICES November 2010 Volume 61 Number 11 Metrics PDF download History Published online 1 November 2010 Published in print 1 November 2010

Various definitions of health and mental health exist, however there is a generally persistent inclusion and acknowledgement of the importance of holistic elements such as environment and relationships. Integration of the physical, social, and mental aspects of an individual, through the social determinants of health is an important component in establishing the effective delivery of optimal mental health care. With increasing numbers of collaborative care teams, and mental health promotion strategies, primary health care is increasingly building its capacity to help respond to these holistic mental health care needs, with increased and more purposeful attention to the social determinants of health. Despite these steps in the right direction, a gap continues to exist in the delivery of mental health care and many people continue to struggle in accessing adequate treatment. In order to determine how best to proceed, it is important to understand what mental health is, what mental health care in primary health care looks like, what the existing challenges to the delivery of mental health care in primary health care are, and what other models have been successful in integrating the social determinants of health and mental health into the primary health care system.

IntroductionAs digital technologies become an integral part of mental health care delivery, concerns have risen regarding how this technology may detract from health professionals’ ability to provide compassionate care. To...

Mood disorders in the emergency department: the challenge of linking patients to appropriate services

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Accelerating the Growth of Evidence-Based Care for Women and Men Veterans.

Use of Psychoactive Substances and Health Care in Response to Anxiety and Depressive Disorders

The volume-outcome relationship in lung cancer surgery: The impact of the social determinants of health care delivery.

Addressing Maternal Mental Health: Progress, Challenges, and Potential Solutions

Little is known about the prevalence of neurodevelopmental, mental, or behavioral disorders among CSEC survivors, and the experiences of CSEC survivors with these disorders with health care. We conducted a self-report survey study with N = 269 youths between the ages of 13 and 24 years old who disclosed that they had experienced CSEC prior to age 18 in the United States. The vast majority, 82%, reported that they had ever been diagnosed with a neurodevelopmental disorder or neurological impairment (i.e. ADHD, autism, intellectual disability, or learning disorder), a serious mental illness (i.e. schizophrenia, schizoaffective disorder, or bipolar disorder), a mood disorder (i.e. PTSD, depression, or anxiety), or a behavioral disorder (substance use, eating, or conduct disorder). Approximately 26% reported seeking healthcare while being exploited. Those with Serious mental illness (SMI) or behavioral disorder were more likely than other subsets of CSEC survivors to report poor mental and physical health, and negative experiences in the healthcare setting. Our findings have direct implications for efforts that align with the UN's Sustainable Development Goal of “promoting just, peaceful and inclusive societies,” in that they provide support for the idea that health care providers will benefit from training in supporting human trafficking survivors with neurodevelopmental, mental, and behavioral disorders.

Previous analyses demonstrated an elevated occurrence of perceived unmet need for mental health care among persons with co-occurring mental and substance use disorders in comparison with those with either disorder. This study built on previous work to examine these associations and underlying reasons in more detail. Secondary data analyses were performed on a subset of respondents to the 2002 Canadian Community Health Survey (unweighted N=4,052). Diagnostic algorithms classified respondents by past-year substance dependence and selected mood and anxiety disorders. Logistic regressions examined the associations between diagnoses and unmet need in the previous year, accounting for recent service use and potential predisposing, enabling, and need factors often associated with help seeking. Self-reported reasons underlying unmet need were also tabulated across diagnostic groups. Of persons with a disorder, 22% reported a 12-month unmet need for care. With controls for service use and other potential confounders, the odds of unmet need were significantly elevated among persons with co-occurring disorders (adjusted odds ratio=3.25; 95% confidence interval=1.96-5.37). Most commonly, the underlying reason involved a preference to self-manage symptoms or not getting around to seeking care, with some variation by diagnosis. The findings highlight potential problems for individuals with mental and substance use disorders in accessing services. The elevated occurrence of perceived unmet need appeared to be relatively less affected by contact with the health care system than by generalized distress and problem severity. Issues such as stigma, motivation, and satisfaction with past services may influence help-seeking patterns and perceptions of unmet need and should be examined in future work.