Disparities In Mental Health Outcomes Research Articles

The Correlates of Collective and Individual Trauma on Mental Health Outcomes Among Afghan Refugees: A Study of Sociodemographic Differences.

Following the U.S. military's departure from Afghanistan, a significant number of Afghan refugees have resettled in the United States, presenting complex mental health challenges exacerbated by extensive traumatic exposure. This demographic is particularly affected by collective trauma due to war, genocide, and the loss of homeland. However, detailed investigations into the correlations between collective trauma and mental health outcomes among Afghan refugees are limited. This study sought to explore the relationship between collective trauma and mental health outcomes within the Afghan refugee population in the United States, paying particular attention to the influence of sociodemographic factors. Identifying subgroups at greater risk allows for the development of more targeted mental health interventions. The study surveyed 173 Afghan refugees employing snowball sampling, utilizing a cross-sectional design. Data collection was facilitated through online and in-person surveys in English, Dari, and Pashto. Key measures included the Harvard Trauma Questionnaire for individual trauma experiences, the Historical Loss Scale for collective trauma, the Historical Loss Associated Symptoms Scale for collective trauma symptoms, the Afghan Symptom Checklist-22 for mental health symptoms, and the Post-Migration Living Difficulties Scale for post-migration stressors. Statistical analyses involved Pearson's correlation for variable associations, with nonparametric Mann-Whitney U and Kruskal-Wallis tests conducted to assess sociodemographic impacts due to data's non-normal distribution. The analysis revealed significant variations in collective trauma and mental health outcomes across subgroups. Afghan women, minoritized ethnic groups, those who experienced extended displacement, and refugees with uncertain visa statuses reported higher collective trauma levels and worse mental health outcomes. Statistical significance was noted in the correlations between collective trauma and mental health symptoms (r = .53, p < .01) and between post-migration difficulties and mental health (r = .33, p < .01). The disparities in mental health outcomes based on sociodemographic characteristics were significant, with nonparametric tests showing clear distinctions across different groups (Kruskal-Wallis H = 14.76, p < .05 for trauma experience by visa status). This study emphasizes the critical need for mental health interventions that account for the complex experiences of collective trauma among Afghan refugees, especially among identified subgroups. Tailoring mental health services to address the specific needs highlighted through disaggregated data can enhance support for Afghan refugees in the United States. This research contributes to a deeper understanding of the relationship between collective trauma and refugee mental health, advocating for nuanced care strategies in resettlement environments.

The Prevalence of Depression Among Medical Staff During The COVID-19 Pandemic

Background: Medical professionals' psychological health has been significantly damaged by the COVID-19 pandemic, with nurses being a particularly susceptible group. The purpose of this study is to assess the prevalence of depression among healthcare professionals during the pandemic, investigate risk variables, and provide suitable supportive treatments. Objective: This research combines data from 11 studies involving 424 healthcare professionals, including doctors, nurses, and others. The prevalence of depression and associated variables in these professions during the COVID-19 outbreak are examined. Methods: Data were gathered from many study initiatives that covered the 2020 to 2023 time period. In these research, the Impact of Events Scale Revised (IES-R), the Patient Health Questionnaire (PHQ-9), and the Perceived Stress Scale (PSS-10) were used to assess post-traumatic stress, depression, and stress levels. The study looked into demographic variables, individuals' mental health backgrounds, and aspects connected to their jobs in the healthcare industry. Results: COVID-19 pandemic led to 19% severe depression symptoms in healthcare professionals, with females, younger workers, and nursing professionals more susceptible. Social support strongly influences the results of mental health. Conclusion: Medical staff's mental health has been severely impacted by the COVID-19 epidemic, with nurses experiencing increased levels of despair and anxiety. Gender disparities in mental health outcomes highlight the need for targeted support for female healthcare workers. Improving working conditions and strengthening social support networks are essential steps in addressing these mental health challenges. To fully understand the long-term consequences on the mental health of healthcare workers, taking into consideration cultural and socioeconomic factors, further longitudinal study is needed. Offering culturally sensitive mental health support is pivotal for the welfare of healthcare workers.

Vicarious Racism, Direct Racism, and Mental Health Among Racialized Minority Healthcare Workers.

Racism-related stress is a root cause of racial and ethnic disparities in mental health outcomes. An individual may be exposed to racism directly or vicariously by hearing about or observing people of the same racial and/or ethnic group experience racism. Although the healthcare setting is a venue by which healthcare workers experience both direct and vicarious racism, few studies have assessed the associations between direct and vicarious racism and mental health outcomes among healthcare workers. In this cross-sectional study, we assessed the relationships between direct and vicarious racism and symptoms of posttraumatic stress, depression, and anxiety among healthcare workers in the USA in 2022. Our sample consisted of 259 healthcare workers identifying as a racialized minority, including 68 (26.3%) who identified as mixed-race, 61 (23.6%) East Asian, 36 (13.9%) Black, 33 (12.7%) South Asian, 22 (8.5%) Southeast Asian, 21 (8.1%) Middle Eastern/North African, and 18 (6.9%) another race. The mean age was 37.9years (SD 10.1). In multivariable linear regression models that adjusted for demographics, work stressors, and social stressors, we found that increased reporting of vicarious racism was associated with greater symptoms of anxiety (B = 0.066, standard error = 0.034, p = .049). We did not identify significant relationships between vicarious and direct racism and symptoms of posttraumatic stress or depression in the fully adjusted models. Our findings should be considered by academic health systems to mitigate the negative impact of racism on healthcare workers' mental health.

Trends and Factors Associated With the Mortality Rate of Depressive Episodes: An Analysis of the CDC Wide-Ranging Online Data for Epidemiological Research (WONDER) Database.

Background Depressive episodes are associated with increased mortality rates across the United States. Recognizing the relationship between depression and physical health, understanding the contributing factors, and addressing disparities are critical in reducing mortality rates and improving the overall well-being of individuals experiencing depressive episodes. Continued research, public health efforts, and collaborative approaches are essential to tackle this complex public health concern effectively. Studying the mortality rate trends of depressive episodes along with other related factors will help enhance the understanding of the condition, which, in turn, will assist in reducing mortality rates in the vulnerable population. Methodology Data from the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) database on the Underlying Cause of Death were examined to identify individuals who experienced fatal outcomes related to depressive episodes from 1999 to 2020. The WONDER database refers to the online system used by the CDC to make its various resources accessible to the public and public health experts. CDC WONDER offers access to a broader range of information on public health. Results A total of 13,290 individuals who died from depressive episodes between 1999 and 2020 were identified. Data analysis revealed an overall mortality rate of 0.20 per 100,000 individuals during the specified period. The highest mortality rates were observed in the years 2003 (0.28), 2001 (0.27), and 1999 (0.27). The analysis revealed significant disparities in mortality rates among different demographic groups. Older adults, females, specific racial groups, including Whites and African Americans, and specific geographic areas, including the Midwest, Northeast, South, and West, exhibited higher mortality rates associated with depressive episodes. Conclusions The study identified that older individuals, females, Whites, and African Americans, as well as certain geographic regions, exhibited an increased likelihood of mortality related to depressive episodes. These findings highlight the importance of understanding the complex interplay between mental health and mortality. The findings emphasize the importance of addressing disparities in mental health outcomes among different demographic groups. Identifying vulnerable populations can inform targeted interventions and resources to address the elevated mortality risk.

Racial Disparities in Mental Health Disorders in Youth with Chronic Medical Conditions

To evaluate the association between race/ethnicity, poverty, and mental health in youth with chronic conditions. A cross-sectional comparative study was performed using the records of a tertiary care center from 2011 to 2015. children aged 4-17years with ≥1 hospitalization or emergency department visit. Exclusion criteria were those with arrhythmias or treatment with clonidine/benzodiazepines. The primary outcome variable was diagnosis or medication for anxiety, depression, or attention deficit hyperactivity disorder. The primary predictor variable was diagnosis of cystic fibrosis (CF), sickle cell disease (SCD), or congenital heart disease (CHD). We identified 112 313 patients, 0.2% with CF, 0.4% with SCD, and 1.0% with CHD. Patients with CF had the highest prevalence (23%) and odds (OR, 4.21; 95% CI, 3.07-5.77) of anxiety or depression, whereas patients with SCD had the lowest prevalence (7%) and odds (OR, 1.54; 95% CI, 1.11-2.14). Those with CHD had a prevalence of up to 17%, with 3-4 times higher odds of anxiety or depression (OR, 3.70; 95% CI, 2.98-4.61). All non-White participants were less likely to be diagnosed or treated for anxiety or depression and attention deficit hyperactivity disorder. Although poverty increased the probability of anxiety or depression in patients with CHD, this finding was not seen in patients with CF or SCD. Children with CF, SCD, and CHD are at increased risk of anxiety or depression; however non-White patients are likely being underdiagnosed and undertreated. Increased screening and recognition in minority children are needed to decrease disparities in mental health outcomes.

Associations between Socioeconomic Status and Psychological Distress: An Analysis of Disaggregated Latinx Subgroups Using Data from the National Health Interview Survey

Differences in socioeconomic status (SES), including income, education, and employment, continue to be significant contributors to health disparities in the United States (US), including disparities in mental health outcomes. Despite the size and diversity of the Latinx population, there is a lack of literature describing differences in mental health outcomes, including psychological distress, for Latinx subgroups (e.g., Dominican, Puerto Rican, Cuban). Therefore, we used pooled data from the 2014-2018 National Health Interview Survey to examine variations in psychological distress among Latinx subgroups as compared to other Latinx subgroups and non-Latinx whites. Additionally, we conducted regression analyses and tested whether race/ethnicity modified the relationship between SES indicators and psychological distress. Findings indicate that individuals categorized as Dominican and Puerto Rican were among the Latinx subgroups with the highest levels of psychological distress when compared to other Latinx subgroups and non-Latinx whites. Additionally, results demonstrate that SES indicators, such as higher levels of income and education, were not necessarily significantly associated with lower levels of psychological distress for all Latinx subgroups when compared to non-Latinx whites. Our findings discourage the practice of making broad generalizations about psychological distress or its associations with SES indicators to all Latinx subgroups using results garnered from the aggregate Latinx category.

Depression, anxiety, and burnout among hospital workers during the COVID-19 pandemic: A cross-sectional study.

Healthcare personnel have faced unprecedented mental health challenges during the COVID-19 pandemic. The study objective is to assess differences in depression, anxiety, and burnout among healthcare personnel with various occupational roles and whether financial and job strain were associated with these mental health outcomes. We employed an anonymous survey between July and August 2020 at an urban county hospital in California, USA. We assessed depression, anxiety, and burnout using validated scales, and asked questions on financial strain and job strain. We performed logistic and linear regression analyses. Nurses (aOR 1.93, 95% CIs 1.12, 3.46), social workers (aOR 2.61, 95% CIs 1.35, 5.17), service workers (aOR 2.55, 95% CIs 1.20, 5.48), and administrative workers (aOR 2.93, 95% CIs 1.57, 5.61) were more likely than physicians to screen positive for depression. The odds of screening positive for anxiety were significantly lower for ancillary workers (aOR 0.32, 95% CIs 0.13-0.72) compared with physicians. Ancillary (aB = -1.77, 95% CIs -1.88, -0.47) and laboratory and pharmacy workers (aB -0.70, 95% CI -1.34, -0.06) reported lower levels of burnout compared with physicians. Financial strain partially accounted for differences in mental health outcomes across job categories. Lack of time to complete tasks and lack of supervisory support were associated with higher odds of screening positive for depression. Less job autonomy was associated with higher odds of screening positive for anxiety and higher burnout levels. We found significant disparities in mental health outcomes across occupational roles. Policies to mitigate the adverse impact of COVID-19 on health workers' mental health should include non-clinical staff and address financial support and job characteristics for all occupational roles.

Inflammation and depression symptoms are most strongly associated for Black adults

Although race/ethnicity is associated with substantial differences in risk for depression and other diseases of aging in the United States, the processes underlying these health disparities remain poorly understood. We addressed this issue by examining how levels of a robust marker of inflammatory activity, C-reactive protein (CRP), and depression symptoms varied across racial/ethnic groups. Additionally, we tested whether the inflammation-depression association differed across groups. Data were drawn from the Chicago Community Adult Health Survey, an epidemiological survey examining biopsychosocial factors affecting health and well-being. Participants were 3105 Chicago community adults, of which 610 provided blood samples and were included in analyses. C-reactive protein was assayed from blood samples, and depression symptoms were assessed using the 11-item Center for Epidemiologic Studies-Depression scale. Race/ethnicity was self-reported and consisted of Black, Hispanic, White, and other racial/ethnic groups. Results revealed that these racial/ethnic groups differed in terms of both their CRP and depression levels. Specifically, Black Americans exhibited higher levels of CRP as compared to White and other race/ethnicity Americans. Moreover, Black Americans exhibited more depression symptoms than Hispanic Americans. Finally, we found that inflammatory levels were strongly related to depression symptoms but only for Black Americans, with CRP alone accounting for 8% of the variance in depression symptoms in this subgroup. These data thus point to a biological process that may help to explain disparities in mental health outcomes across race/ethnicity in the United States. At the same time, additional research is needed to understand the social and structural factors driving these effects.

Same-Sex Marriage and Common Mental Health Diagnoses: A Sibling Comparison and Adoption Approach

ABSTRACT We aimed to test whether the association between same-sex marriage and common mental health diagnoses was explained by shared genetic and environmental familial influences using sibling comparison and adoption analyses. For the sibling comparison analysis, participants (1,177,712 men and 1,266,917 women) were individuals born in Sweden between 1932 and 1994 and had ever been recorded as married (in opposite-sex or same-sex marriages). For the adoption analysis, participants were 147,164 and 1,298 female–female full sibling and adoptive sibling pairs, respectively. Based on medical records, prescribed medication, and death certificates, depression, substance abuse, and suicide (completed and attempted) from age 18 years were identified. For both sexes, being in a same-sex marriage was associated with greater risk of depression, substance abuse, and suicide, compared with being in an opposite-sex marriage. Controlling for shared familial confounding reduced this difference by less than 20% in magnitude, but overall mental health disparities for individuals in same-sex marriages remained statistically significant. Among women, only the genetic correlation between same-sex marriage and depression was statistically significant (r = .33). Same-sex marriage, as a proxy for sexual orientation, was associated with increased risk of certain mental health diagnoses and shared familial confounding explained a small component of this association, depending on the diagnosis. The findings indicate that sexual orientation disparities in mental health outcomes may involve unmeasured factors, and a relatively small proportion should be considered that may be due to shared familial confounding relevant to both sexual orientation and psychopathology.

Psychoactive Substance Effect on Mental Health and Well-Being Focusing on Student-Aged Lithuanian Cohort of Sexual Minorities

Mental health refers to cognitive, behavioral, and emotional well-being. However, significant research gaps are still found in disclosing the disparities in mental health outcomes between heterosexual and sexual minority (SM) individuals during the period of 20–24 years of age. Therefore, the aim of this study was to assess the association between the prevalence of psychoactive substance use and the severity of anxiety or depressive symptoms, and well-being across SM and non-SM student-aged populations (N = 1330). This cross-sectional study was conducted in Lithuania over the period of fifteen months following the beginning of the COVID-19 pandemic. This study concentrated on the mental health symptomatology, well-being status, and the prevalence of the psychoactive substance use, which were measured by three screening instruments. In terms of negative well-being, mental health problems, and health-risk behaviors, it was found that the SMs were potentially more exposed than the non-SMs. The current study also revealed a significant impact of substance use (alcohol consumption, cigarette smoking) on the symptoms of anxiety (adjusted odds ratios (AOR) 1.6 (95% confidence interval (CI): 1.0–2.6), AOR 1.5 (95% CI: 1.0–2.2)), and negative well-being (AOR 1.7 (95% CI: 1.0–2.8), AOR 1.7 (95% CI: 1.1–2.5)) across the SM student-aged group. The association between the increased self-administration of cannabis and positive mental health outcomes appertained to milder anxiety symptoms amid SMs has been identified (AOR 0.5 (95% CI: 0.2–0.9)). Given that minority stressors could play an important part in mediating between the sexual orientation and negative outcomes of mental and behavioral health in student-aged populations, health strategies should focus on the development of effective substance abuse and drug prevention programs, both student-centered and SMs-centered, aimed to reduce health-risk behaviors in emerging adulthood.

Supportive interactions with primary care doctors are associated with better mental health among transgender people: results of a nationwide survey in Aotearoa/New Zealand.

BackgroundPast research has established that transgender people experience significant disparities in mental health outcomes and healthcare dissatisfaction compared with cisgender people, but more research is needed on how supportive healthcare interactions relate to the mental health of transgender people.ObjectivesThe 2 main aims of our analyses were: (i) to establish the most common negative experiences in healthcare and the most common supportive experiences specifically with primary care doctors for transgender people; and (ii) to examine the association of supportive experiences with mental health variables after controlling for demographic factors.MethodsData from the 2018 Counting Ourselves nationwide survey of transgender people were analysed using regression modelling. The 948 participants with a primary care doctor or general practitioner were included in analyses. Participants were aged 14–83 years old (mean 30.20).ResultsThe most common supportive experiences involved primary care doctors treating transgender people equitably, with competence, and with respect. Participants with more negative healthcare experiences had higher psychological distress as well as higher likelihood of reporting nonsuicidal self-injury and suicidality. Conversely, participants with more experiences of supportive primary care doctors had lower psychological distress and were less likely to have attempted suicide in the past 12 months.ConclusionWhen transgender people receive supportive care from their primary care providers they experience better mental health, despite ongoing negative healthcare experiences. Future research is needed to confirm ways of supporting positive trajectories of mental health for transgender people but these findings demonstrate the importance of positive aspects of care.

Mental Health of Sexual and Gender Minority Oncology Patients: Synthesis of Recommendations for Advancing Health Equity

Sexual and gender minority (SGM) individuals are at increased risk for several health concerns, including those related to mental health. This increased risk, combined with the unique psychosocial challenges faced by SGM cancer patients, leads to disparities in mental health outcomes across the cancer care continuum. Despite these disparities, little to no resources (e.g. SGM groups, SGM cancer-related literature) exist within most cancer institutes to target SGM populations for appropriate cancer care, such as cancer prevention, accessible treatment, end-of-life, and survivorship concerns, which all may impact psychological wellbeing. This paper synthesizes existing recommendations, both general and cancer-specific, pertaining to the mental health concerns of SGM individuals with hope to provide a valuable resource for cancer institutes and providers on how to better address the unique mental health outcomes of SGM cancer patients. Additional input was obtained from stakeholders from a large, Midwestern, NCI-designated cancer center in an effort to expand our understanding of SGM cancer patients' needs. Through review of relevant guidelines and recommendations and feedback from stakeholder meetings, five broad areas of recommendation for improving SGM cancer care were identified: welcoming environment, patient education and support, community connections, standard approach to care, and research. Rooted in pertinent psychological constructs, each recommendation provides suggestions for increasing attention to SGM patients' psychosocial oncological needs. These recommendations seek to establish culturally inclusive and responsive climates where all SGM cancer patients feel valued and respected.

Smartphone non-users experience disproportionately higher psychological distress than their counterparts: Mediations via psychosocial resources in a large sample of college students in China

BackgroundDespite growing adoption of digital technologies, the gap between users and non-users (aka digital divide) persists. It is imperative to determine whether and how such a gap can lead to disparities in mental health outcomes among populations. However, few empirical studies have explored the effect of smartphone non-use on psychological well-being. MethodsA large-scale cross-sectional survey was conducted among 26,951 college students in Shaanxi Province, China. Levels of depression and loneliness were first compared between smartphone non-users and their user counterparts. Based on the Conservation of Resources theory, structural equation modeling was then used to test the mediating roles of social support, quality of peer relationship, and self-esteem. ResultsAround 56.8% of smartphone non-users had probable depression and they reported significantly higher depressive symptoms (Cohen's d = 0.52) and loneliness (Cohen's d = 0.30) than users. The hypothesized mediation model was well supported with good model fit. Lower levels of social support, quality of peer relationship, and self-esteem fully mediated the total effect of smartphone non-use status on loneliness and explained 69.4% of the total effect on depression. LimitationsFindings might be subject to self-reporting bias and limitations due to a cross-sectional design. ConclusionsThe study adds new evidence that the minority group of smartphone non-users exhibited disproportionately greater psychological distress than users resulting from lower supportive social relationships and positive sense of self. The findings inform the future investigation into digital divide in smartphone use/access and its negative impact on population's psychological well-being.

Self-control and Mental Health? Exploring Perceptions of Control from the Experiences of Black and Minority Communities

Although the disparities in mental health outcomes for ethnic minorities are well-documented, very little is known regarding service user perspectives and experiences from locus of control ambit. The aim of this qualitative study was to investigate the experiences of African and Caribbean service users, from the context of their Locus of Control (LOC). Informed by an Interpretivist approach, this study was conducted via in-depth interviews (N=10) and two focus groups (N=14). Purposive sampling methods were used to recruit mental health service users from a South London Borough to participate in the study. Data was collected through a semi-structured interview schedule and a focus group guide. Data analysis was informed by an Interpretive Phenomenology Analysis approach in the examination of the LOC profiles and service user perspectives. The study found that the drivers of LOC for the respondents were: perceived racism; perceived loss of control due to challenges pertaining to accessing employment, work stressors, lack of career advancement, socio-economic challenges; discrimination at work, identity challenges and entry to and exit pathways from mental health services, all of which promotes LOC externality. The findings suggest that mental health services need to take an active interest in factors that constitute externality in the LOC in assessment of the needs of A &amp; C groups in clinical and community interventions. A holistic approach to psycho-social and socio-cultural issues are highly needed to improve the mental health outcomes for members of African and Caribbean communities with experience of mental health challenges.

Racial Disparities in Mental Health Outcomes Among Women With Early Pregnancy Loss

(Abstracted from Obstet Gynecol 2021;137:156–163) It is estimated that 1 in 4 women will experience a pregnancy loss in her lifetime. The emotional impact of a pregnancy loss in many women is devastating.

Improving Mental Health Outcomes for Black and Minority Ethnic Communities: A Quantitative Study into Perception of Control

Background: Although the disparities in mental health outcomes for ethnic minorities in the United Kingdom are well-documented, little is known about the role perception of control plays in the experiences of service users and its role in perpetuating or improving health inequalities. This quantitative methods study investigated the perspectives of the members of these communities from the Locus of Control domain. Methods: A small-scale survey (N=50), applied a purposive sampling method to recruit mental health service users of African and Caribbean origin from a South London Borough to complete two structured questionnaires. Data were analysed using SPSS in the examination of the scores, various demographic variables, linear relationships, and other reliability tests. Results: Key findings indicate a moderate to high externality in LOC scores for participants, in general and mental health milieus, with some remarkable differences in ethnicity, gender, and age. Conclusion: The results present some implications and opportunities for mental health services, policy, and professionals in engaging with clients from this target group towards addressing the inequality of outcomes.

Racial Disparities in Mental Health Outcomes Among Women With Early Pregnancy Loss.

To explore the relationship between race and depression symptoms among participants in an early pregnancy loss clinical trial. We performed a planned secondary analysis of a randomized trial by comparing treatments for medical management of early pregnancy loss. We hypothesized that Black participants would have higher odds of risk for major depression (measured with the CES-D [Center for Epidemiological Studies-Depression] scale) 30 days after early pregnancy loss treatment when compared with non-Black participants. We analyzed the data as a cohort, with the primary exposure being race and secondary exposure being high adverse childhood experience scores (measured with the Adverse Childhood Experience scale). Our primary outcome was risk for major depression (score of 21 or higher on the CES-D scale) 30 days after early pregnancy loss treatment. Three hundred participants diagnosed with a nonviable intrauterine pregnancy from 5 to 12 weeks of gestation were randomized as part of the original trial from May 2014 to April 2017. Of 275 respondents included in this analysis, 120 [44%] self-identified as Black and 155 [56%] self-identified as non-Black. After early pregnancy loss treatment, 65 [24%] participants were at risk for major depression. Black participants had an increased risk for major depression (57%) after early pregnancy loss treatment compared with non-Black participants (43%; odds ratio [OR] 2.02; 95% CI 1.15-3.55). After adjustment for risk for baseline depression, adverse childhood experience score, and parity, the odds of risk for major depression 30 days after pregnancy loss treatment remained higher for Black participants when compared with non-Black participants (OR 2.02; 95% CI 1.15-3.55; adjusted OR 2.48; 95% CI 1.28-4.81). Overall, approximately one quarter of women who experience an early pregnancy loss are at an increased risk for major depression 30 days after treatment. This risk is about twice as high for Black women compared with non-Black women. There is a need for appropriate mental health resources for women undergoing early pregnancy loss care. ClinicalTrials.gov, NCT02012491.

P38 Racial disparities in mental health outcomes among women with early pregnancy loss

Objectives: To examine the relationship between race and psychometric variables among participants in an early pregnancy loss (EPL) clinical trial.

A call to action to address rural mental health disparities.

Rural residents in the USA experience significant disparities in mental health outcomes even though the prevalence of mental illness in rural and metropolitan areas is similar. This is a persistent problem that requires innovative approaches to resolve. Adopting and appropriately modifying the National Institute on Minority Health and Health Disparities research framework are the potential approaches to understanding how these disparities might be addressed through research. Using this research framework can facilitate interrogation of multiple levels of influence, encompassing complex domains of influence and consideration of the entire life course trajectory, which is consistent with several National Institute of Mental Health priorities.

Health Disparities Among Transgender Adults in South Korea.

This study aims to identify health disparities among transgender adults in South Korea (hereafter Korea), where they widely experience social stigma. We assessed prevalence of nine health indicators using a nationwide cross-sectional survey of 255 Korean transgender adults in 2017. Standardized prevalence ratios of these indicators were estimated using four nationally representative surveys in Korea that included the same health measures. Overall, transgender adults had a significantly higher risk of adverse health outcomes than the general population in Korea. Specifically, disparities in mental health outcomes between transgender adults and the general population were statistically significant. The prevalence of depressive symptoms was 6.44 and 9.71 times higher among transgender adults than women and men in the general population, respectively. For suicidal ideation, transgender adults reported 6.49 and 18.83 times greater risk than women and men in the general population, respectively. Our findings indicate that Korean transgender adults are at a higher risk of negative health outcomes than the general population.