Disparities In Mental Health Care Research Articles

The 30,000 Foot View: Using Big Data to Address Complex Clinical Questions in the Most Vulnerable Older Adults

Older people of color, those who are socially isolated, veterans, and incarcerated older adults experience disparities in mental healthcare and high levels of psychiatric and physical comorbidity, including increased risk of suicide. The identification of risk factors and understanding the culture and context that impact risk are major public health challenges. Effective approaches to address these challenges are likely to involve using national databases and applying advanced methodologies to address complex clinical questions in older adults. By leveraging extensive epidemiological datasets, we can effectively pinpoint risk factors and consequences associated with mental health disorders in later stages of life. Moreover, these datasets allow us to disaggregate heterogeneous groups which are often treated as homogeneous (e.g. people of color, veterans, etc.). This disaggregation may reveal significant within group differences and provide important contextual information regarding these groups which can be used to deliver precision mental healthcare in an efficient manner and reduce the burden of mental illness in late life. In this session, we will explore innovative methodologies of utilizing national datasets to discern the cultural and contextual elements that impact the mental health and well-being of four high-risk, older adult populations. Emphasis will be placed on identifying patterns in mental healthcare disparities and comprehending how factors such as race, ethnicity, sex, gender, and incarceration contribute to feelings of loneliness, suicide rates, and dementia. Furthermore, we will also discuss the potential application of this data in developing precise risk assessment tools and targeted prevention and treatment strategies. interventions for late-life mental health issues.

The Effects of COVID-19 on the Mental Health of Children and Adolescents: A Review.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has profoundly affected global health and well-being. As part of the Coronaviridae family, SARS-CoV-2 joins a diverse group of viruses found in both humans and various animal species, including bats, camels, and cats. The pandemic has led to widespread social isolation, reduced physical activity, and significant lifestyle changes, posing potential risks to individuals' mental and emotional health. This review aims to explore the implications of COVID-19 on the mental health of children and adolescents, given the limited attention this population has received in the medical literature. Multiple research studies in several countries have found that the COVID-19 pandemic is associated with greater stress levels, depression, anxiety, insomnia, drug misuse, and other mental health challenges among young individuals. Understanding the long-term effects of the pandemic on mental health is crucial for developing effective interventions and support systems to promote resilience and well-being in children and adolescents. Even after the pandemic ends,it is crucial to prioritize understanding the long-term impacts of the pandemic on mental health, integrating findings into public health strategies, addressing mental healthcare disparities, and fostering resilience in children and adolescents. Achieving these objectives requires collaborative efforts across various sectors to ensure equitable access to mental health resources and the implementation of sustainable solutions for the well-being of young people in the aftermath of the pandemic.

Leveraging Measurement-Based Care to Reduce Mental Health Treatment Disparities for Populations of Color.

Disparities in mental health treatment have consistently been documented for clients of color as compared to White clients. Most mental health care disparities literature focuses on access to care at the point of initial engagement to treatment, resulting in a dearth of viable solutions being explored to retain clients in care once they begin. Measurement-based care (MBC) is a person-centered practice that has been shown to improve the therapeutic relationship, make treatment more personalized, and empower the client to have an active role in their care. Problems with therapeutic alliance and treatment relevance are associated with early termination for communities of color in mental health services. However, MBC has not been explored as a clinical practice to address therapeutic alliance and continual engagement for people of color seeking mental health care. This Point of View describes several MBC features that may be able to impact current sources of disparity in mental health treatment quality and provides a rationale for each. Our hope is that the field of MBC and progress feedback will more explicitly consider the potential of MBC practices to promote equity and parity in mental health services of color and will start to explore these associations empirically. We also discuss whether MBC should be culturally adapted to optimize its relevance and effectiveness for communities of color and other groups experiencing marginalization. We propose that MBC has promise to promote equitable mental health service quality and outcomes for communities of color.

Access to interventional psychiatric treatments in the United States: Disparities and proposed solutions

Interventional psychiatric treatments are a group of mental health procedures and monitored pharmacological interventions that are implemented when first-line therapies, such as psychotherapy and traditional pharmacotherapy, are ineffective or when there is a need for rapid symptom relief. Interventional treatments such as repetitive transcranial magnetic stimulation, esketamine, and electroconvulsive therapy are the United States Food and Drug Administration -approved treatments for major depressive disorder that has gained increased use and shows promise for improvement in efficacy and greater adoption. Despite the immense value and potential of interventional therapies, there are disparities in access to these treatments owing to economic, cultural, and geographical factors. When compounded with existing disparities in mental health care for racial and ethnic minorities, this interaction worsens inequities in access and may exacerbate the severity of disease in underserved groups. This review describes the factors contributing to these disparities, suggests strategies to ameliorate inequities, and broadens the impact of interventional therapies.

Common practices for sociodemographic data reporting in digital mental health intervention research: a scoping review

BackgroundThe ability of digital mental health interventions (DMHIs) to reduce mental health disparities relies on the recruitment of research participants with diverse sociodemographic and self-identity characteristics. Despite its importance, sociodemographic...

A Retrospective Analysis of Early 20th Century Asylum Records of Patients with Dementia Praecox

Mental illness definitions and classifications are to a certain extent intrinsically tied to social factors. To empirically examine the impact of sociodemographic factors on patients institutionalized with dementia praecox in the early 20th century, we examined records from Dorothea Dix Hospital (DDH), an asylum in Southeastern United States. Data was extracted from digitally archived handwritten admission ledgers and general casebooks. Of those institutionalized at DDH between 1896-1917, 190 patients were diagnosed with dementia praecox. Clinical characteristics of patients are described using descriptive text analysis. We used regression models to examine the influence of sociodemographic factors on length of stay and release condition from the asylum. Race was not recorded for any patient and presumed White since DDH was not racially integrated until 1960s. Women had a significantly increased odds (OR = 3.8, p = 0.016) of dying in the facility than getting discharged; being single significantly increased the odds of dying in the facility (OR = 6.8, p = 0.002). Marital status predicted length of stay—being single increased the length of stay (b = 5.97, t (159) = 2.43, p = 0.016) adjusting for the effects of gender, age, and education. We report the impact of gender and marital status on patient release condition and length of stay in an asylum in the early 20th century. Results from the historical data we empirically examined are relevant today as women continue to experience disparities in mental health care. Family support was crucial to better outcomes then, as it is today.

Racial and ethnic trends in mental health service utilisation and perceived unmet need in the USA

BackgroundTwo decades ago, the Surgeon General issued a report highlighting concerning disparities in mental healthcare among racial and ethnic minority populations. The present study characterised national trends in mental health...

Falling on deaf ears: interpreters as cultural brokers in mental healthcare.

Communication is the cornerstone of mental healthcare. In the UK, many people who will need access to mental health services do not possess English as their first language. In this editorial, we seek to examine current policy and guidance with respect to interpreting in mental healthcare, and explore the benefits and challenges of interpretation and the ethical implications to consider. We focus on how mental health services could better engage with interpreters as cultural brokers to understand cultural expressions of distress. We conclude by suggesting an education and research agenda which could decrease ethnic disparities in mental healthcare.

Roaming

There are significant disparities in mental health care between First Nations and non-Indigenous people in settler-colonial nations. This paper, authored by a crosscultural and interdisciplinary team, argues that settler-colonial legislation, the tools and technologies of architecture, and the clinical practice of psychiatry are all implicated. Taking inspiration from Tanganekald, Meintangk-Bunganditj legal scholar Irene Watson, who yearns for freedom to roam across Country and connect with the land of her ancestors, we propose tactics for ‘roaming’ from the conventions of architecture and psychiatry to decolonize our practices. These include yarning, walking Country, and representing these itinerant practices through wandering lines. The outcomes are processes for developing new therapeutic places and practices for mental health care.

Cultural and Ethnic Factors in Mental Health Care Disparities amongst Asian Americans

Cultural and Ethnic Factors in Mental Health Care Disparities amongst Asian Americans

3.55 Impact of Mental Health Care Disparities on the Patterns of Pharmacotherapy and Psychotherapy Uses Among Young Children: A Retrospective Examination

3.55 Impact of Mental Health Care Disparities on the Patterns of Pharmacotherapy and Psychotherapy Uses Among Young Children: A Retrospective Examination

Racial and ethnic disparities in unmet need for mental health care among children: A nationally representative study.

There is a dearth of large, nationally representative studies that examine racial/ethnic disparities in self-reported unmet need for mental health care among children and youth. This study assessed racial/ethnic disparities in unmet need for mental health care, use of psychotropic medication, and reasons for forgone care among children and youth. This nationally representative cross-sectional study analyzed data from the combined 2016-2020 National Survey of Children's Health (n = 151,876). Bivariate statistics and multivariable logistic regression models assessed the association between race/ethnicity, unmet need for mental health care, and use of psychotropic medication. Reasons for forgone care were also examined. Black non-Hispanic children and youth had approximately twice the odds of unmet mental health care needs (AOR, 1.97; 95% CI 1.53-2.55) as White non-Hispanic children and youth. The likelihood of reporting that it was not possible to see a mental health professional was higher for Black non-Hispanic (AOR, 3.39; 95% CI 1.64-7.01) and Multi-racial/Other non-Hispanic children and youth (AOR, 2.96; 95% CI 1.40-6.25) compared with White non-Hispanic peers. Black non-Hispanic, Hispanic, and Multi-racial/Other non-Hispanic children and youth were also less likely to use psychotropic medication (p < 0.001). Common reasons for forgoing care included cost, problems getting an appointment, and lack of transportation or childcare. This study found significant racial/ethnic disparities in unmet mental health care, psychotropic medication use, and barriers in accessing mental health care. Data from this study suggest that eliminating these disparities requires policy interventions that address medical and societal barriers to health care access and quality.

Racial and Ethnic Disparities in Physical and Mental Health Care and Clinical Trials.

Historically, in the United States, scientific racism has been used to justify differential treatment of Black, Indigenous, People of Color (BIPOC) populations compared with the White population. Discrimination toward BIPOC populations by the medical community has contributed to racial and ethnic disparities in health care that persist to this day. At the 2022 American Society of Clinical Psychopharmacology Annual Meeting, a panel of 5 experts from the areas of academia, advocacy, and clinical research discussed racial and ethnic disparities in mental health care. This Academic Highlights summarizes and expands on that discussion by tracing the history of scientific racism from the colonization of the US to present-day health inequities, illustrating the ongoing problem of low diversity in clinical trials, and outlining solutions through community engagement.

Clinical significance of psychotic-like experiences across U.S. ethnoracial groups.

Prevalence of psychotic-like experiences (PLEs) - reports of hallucinations and delusional thinking not meeting criteria for psychotic disorder - varies substantially across ethnoracial groups. What explains this range of PLE prevalence? Despite extensive research, the clinical significance of PLEs remains unclear. Are PLE prevalence and clinical severity differentially associated across ethnoracial groups? We examined the lifetime prevalence and clinical significance of PLEs across ethnoracial groups in the Collaborative Psychiatric Epidemiology Surveys (N = 11 139) using the Composite International Diagnostic Interview (CIDI) psychosis symptom screener. Outcomes included mental healthcare use (inpatient, outpatient), mental health morbidity (self-perceived poor/fair mental health, suicidal ideation or attempts), and impairment (role interference). Individuals with outcome onsets prior to PLE onset were excluded. We also examined associations of PLEs with CIDI diagnoses. Cox proportional-hazards regression and logistic regression modeling identified associations of interest. Contrary to previous reports, only Asian Americans differed significantly from other U.S. ethnoracial groups, reporting lower lifetime prevalence (6.7% v. 8.0-11.9%) and mean number (0.09 v. 0.11-0.18) of PLEs. In multivariate analyses, PLE clinical significance showed limited ethnoracial variation among Asian Americans, non-Caribbean Latinos, and Afro-Caribbeans. In other groups, mental health outcomes showed significant ethnoracial clustering by outcome (e.g. hospitalization and role interference with Caribbean-Latino origin), possibly due to underlying differences in psychiatric disorder chronicity or treatment barriers. While there is limited ethnoracial variation in U.S. PLE prevalence, PLE clinical significance varies across U.S. ethnoracial groups. Clinicians should consider this variation when assessing PLEs to avoid exaggerating their clinical significance, contributing to mental healthcare disparities.

Mental Health Care Disparities After Implementation of a Perinatal Depression Intervention [ID: 1377829

INTRODUCTION: Perinatal depression affects upward of 1:7 childbearing individuals and is associated with significant negative intergenerational outcomes, especially when unrecognized and untreated. Our study examined provider perinatal depression screening, assessment, treatment, and follow-up by race and ethnicity, as a proxy for implicit bias or systemic racism, after a perinatal depression intervention was implemented. METHODS: The Program In Support of Moms (PRISM), an obstetric practice intervention, was implemented in November 2017 at the UMass ob-gyn resident clinic. PRISM aims to improve the detection, assessment, treatment, and follow-up of patients with perinatal depression. With IRB approval, we abstracted data from charts of patients having one or greater prenatal or postpartum visits with an Edinburgh Postnatal Depression Screen (EPDS) score equal to or greater than 10 between October 2017 and May 2020. Descriptive statistics were used for comparisons. RESULTS: Seven hundred ninety individuals were included (White n=369, Black n=84, Hispanic n=264, other n=73). There were significant differences by race and ethnicity in the assessment of prior mental health history, interest in treatment engagement, therapy referrals, and medication treatment offered (all P≤.001) with White patients having significantly higher rates than patients who were Black or another race. There were no differences by race and ethnicity in provider positive screen acknowledgement, provision of psychoeducation, or repeat screening after a positive screen. CONCLUSION: Racial disparities in assessment, referral, and medication treatment offerings exist after a perinatal depression intervention. Implementation of PRISM intervention with an anti-racist lens is needed to improve equitable access to mental health care for those marginalized by racism.

Racial/Ethnic Disparities in Mental Healthcare in Youth With Incarcerated Parents

Youth with incarcerated parents experience more adverse childhood experiences than other youth, placing them at higher risk for mental health and substance use disorders. Despite their increased risk, these youth may be less likely to access mental health services, particularly given their racial and ethnic makeup. Therefore, this study aimed to assess racial and ethnic disparities in access to mental health services for youth with incarcerated parents. This secondary data analysis used longitudinal data from 2016 to 2019 from the Adolescent Brain Cognitive Development Study. Logistic regression models assessed the relationships among incarceration, cumulative childhood experiences, DSM-5 diagnoses, and mental health services. Additional analyses stratified these models by race and ethnicity. All analyses were performed in 2022. Youth with incarcerated parents were more likely to report 4 or more childhood experiences (51% vs 14%; AOR=3.92; 95% CI=3.3, 4.65; p<0.001) and to have received mental health services (25% vs 15%; AOR=1.89; 95% CI=1.6, 2.21; p<0.001) than unexposed youth. However, Black youth with incarcerated parents (19% vs 34%; AOR=0.38; 95% CI=0.27, 0.52; p<0.001) and Latinx youth with incarcerated parents (10% vs 17%; AOR=0.5; 95% CI=0.33, 0.76; p<0.001) were significantly less likely to report receiving mental health services than White youth with incarcerated parents and non-Latinx youth with incarcerated parents, respectively. Youth with incarcerated parents were more likely to report utilization of mental health services, but significant racial and ethnic disparities exist between Black and Latinx youth with incarcerated parents compared with that among White and non-Latinx youth with incarcerated parents. There is a continued need to expand mental health services to youth with incarcerated parents and to address racial and ethnic disparities in access to care.

Racial-Ethnic Disparities in Outpatient Mental Health Care in the United States.

The authors aimed to compare national rates and patterns of use of outpatient mental health care among Hispanic, non-Hispanic Black, and non-Hispanic White individuals. Data from the 2018-2019 Medical Expenditure Panel Survey, a nationally representative survey of U.S. households, were analyzed, focusing on use of any outpatient mental health care service by non-Hispanic White (N=29,126), non-Hispanic Black (N=7,965), and Hispanic (N=12,640) individuals ages ≥4 years (N=49,731). Among individuals using any mental health care, analyses focused on those using psychotropic medications, psychotherapy, or both and on receipt of minimally adequate mental health care. The annual rate per 100 persons of any outpatient mental health service use was more than twice as high for White (25.3) individuals as for Black (12.2) or Hispanic (11.4) individuals. Among those receiving outpatient mental health care, Black (69.9%) and Hispanic (68.4%) patients were significantly less likely than White (83.4%) patients to receive psychotropic medications, but Black (47.7%) and Hispanic (42.6%) patients were significantly more likely than White (33.3%) patients to receive psychotherapy. Among those treated for depression, anxiety, attention-deficit hyperactivity disorder, or disruptive behavior disorders, no significant differences were found in the proportions of White, Black, or Hispanic patients who received minimally adequate treatment. Large racial-ethnic gaps in any mental health service use and smaller differences in patterns of treatment suggest that achieving racial-ethnic equity in outpatient mental health care delivery will require dedicated efforts to promote greater mental health service access for Black and Hispanic persons in need.

Developing culturally-adapted mobile mental health interventions: a mixed methods approach.

Black young adults suffer from psychological distress at either similar or greater rates than that of White Americans, yet they are seven times less likely to have access to or receive effective treatments. Fortunately, mobile-health (mHealth) technology may transform mental health services and address disparities in mental healthcare. The current study utilized focus groups of Black young adults to inform the development of culturally-adapted mHealth using quantitative and qualitative approaches. The study utilized a mixed-methods approach, in that qualitative (i.e., mini focus groups, n=11) and quantitative methods (i.e., self-report surveys) were used to explore the research questions. Participants included African American young adults (n=38, Mage =21). Participants completed self-report questionnaires prior to focus group facilitation. Correlational analyses were used to answer the quantitative research questions, and thematic analysis was used to answer the qualitative research questions. The qualitative findings highlighted that sociocultural experiences impact mental health and treatment seeking attitudes. Despite these findings, participants highlighted a variety of desired features and content that should be incorporated into future culturally-adapted mHealth interventions. Participants also highlighted both positive and negative aspects of current mHealth technologies for mental health. Finally, the study found that on average, participants had positive attitudes towards mental health, mental health treatments, and utilizing mHealth for mental health. Participants also had strong desires for culturally-adapted mHealth interventions. Bivariate correlations also revealed significant associations between vicarious online racial discrimination and mHealth attitudes, as well as racial identity and mHealth attitudes. In summary, the current study highlights that there is an urgent need for mHealth technology for mental health symptoms for African American young adults and presents a variety of features, content, and design/development considerations for future researchers.

Coverage Parity And Racial And Ethnic Disparities In Mental Health And Substance Use Care Among Medicare Beneficiaries.

Many older Americans do not receive needed care for mental health and substance use disorders (MHSUD), and there are substantial racial and ethnic disparities in receipt of this care across the lifespan. Medicare introduced cost-sharing parity for outpatient MHSUD care during the period 2010-14, reducing beneficiaries' out-of-pocket share of MHSUD spending from 50percent to 20percent. Among traditional Medicare beneficiaries ages sixty-five and older, we examined changes in MHSUD use and spending during the period 2008-18 for low-income beneficiaries with the cost-sharing reduction versus a control group of beneficiaries with free care throughout the study period among Black, Hispanic, Asian, and American Indian/Alaska Native versus White beneficiaries. Among older Medicare beneficiaries, overall use of MHSUD services increased during this period. For White beneficiaries, MHSUD cost-sharing parity was associated with an increased likelihood of having specialty MHSUD visits and medication use and a reduced likelihood of having unmonitored MHSUD medication use and MHSUD emergency department visits and hospitalizations. However, cost-sharing parity was associated with smaller or no gains in MHSUD services use for racial and ethnic minority beneficiaries compared with White beneficiaries, thus widening racial and ethnic disparities in MHSUD care.

Othering refugees: Psychotherapists’ attitudes toward patients with and without a refugee background

ABSTRACT Objective: A large proportion of refugees present with psychological disorders that require psychotherapy as first-line treatment. However, even in countries with well-established psychotherapy system, refugees continue to face barriers to care. Psychotherapists’ attitudes toward refugees may also impede access to psychotherapy, as it is evident that stereotypes of health professionals contribute to health care disparities. However, little is known about psychotherapists’ attitudes toward refugees. Methods: In a cross-sectional online study of N = 2002 outpatient psychotherapists in Germany (M age = 54.48 years, 73.1% female), a vignette experiment was applied to examine differences in therapists’ attitudes toward refugee patients from the Middle East and non-refugee patients. Subsequently, associations between attitudes and psychotherapists’ characteristics (e.g., provision of treatment for refugees) were analyzed. Results: Results showed significant differences between therapists’ attitudes toward refugee and non-refugee patients ( = .23), with more therapy-hindering attitudes toward refugee patients. Higher therapy-hindering attitudes were significantly associated with less frequent provision of psychotherapy for refugees. Conclusion: Our findings provide initial evidence that psychotherapists perceive refugee patients as deviant from the norm and that these divergent attitudes may relate to disparities in mental health care. To avoid such a process of othering, training for psychotherapists should question stereotypes toward refugees.