Unmet Health Care Need Research Articles

Unmet Health Care Needs of the Older Population in European Countries Based on Indicators Available in the Eurostat Database.

Access to healthcare may affect the health of the population, especially older people. The aim of this study is to analyze the reasons and factors influencing the unmet healthcare needs (UHCN) of the older population in the context of differences between age groups for 28 European countries. A self-reported UHCN indicator obtained from Eurostat database was used. The share of people with healthcare needs reporting distance/transportation issues was significantly different in the younger and older groups, as well as in age groups within the older population. The differences in other reasons were not so considerable. Problems with UHCN were observed more often in the older population with lower rather than with higher income and with more severe activity limitations rather than with none/moderate limitations (differences statistically significant, except for income for 75+). In most countries, the UHCN dependence on income/activity limitation is higher in the age group of 15-64 than for the older population. To plan/introduce/monitor appropriate, tailored actions for improving healthcare access for the older population, a detailed analysis of the UHCN prevalence, reasons, and determinants in this age group is needed; it is insufficient to analyze only the population as a whole. Additionally, the group of older people is not homogeneous in terms of UHCN.

류마티스 관절염 여성 환자의 미충족 의료 경험 및 자살충동에 관한 연구

류마티스 관절염 여성 환자의 미충족 의료 경험 및 자살충동에 관한 연구

Predictors of Unmet Healthcare Needs during Economic and Health Crisis in Greece.

(1) Background: The aim of this study was to identify predictors of the unmet healthcare needs during the financial and recent health crisis in Greece. (2) Methods: Time series analysis was performed for the years 2008 through 2022 using the Eurostat database. The dependent variable was the percentage of people who reported unmet need for medical care. Demographic, socioeconomic, and health data, as well as health expenditures, were used as independent variables. Correlation analysis and simple linear regression models were conducted to analyze the results. (3) Results: Unmet health needs in Greece increased from the start of the crisis until 2016, as a gradual de-escalation of the crisis was observed. However, in 2019 the country recorded the second highest level of unmet needs for medical care before the health crisis. Limitations in usual activities, reporting bad/very bad health status, being unemployed, and having low income increased the likelihood of unmet needs. Health expenditures (public or private) were also significant determinants of unmet healthcare needs. (4) Conclusions: The increased unmet health needs widen inequalities in health and healthcare access. Therefore, health policies should eliminate barriers which restrict the access to health and enhance healthcare services, developing conditions for citizens' well-being.

Predicting Unmet Healthcare Needs in Post-Disaster: A Machine Learning Approach.

Unmet healthcare needs in the aftermath of disasters can significantly impede recovery efforts and exacerbate health disparities among the affected communities. This study aims to assess and predict such needs, develop an accurate predictive model, and identify the key influencing factors. Data from the 2017 Long-term Survey on the Change of Life of Disaster Victims in South Korea were analyzed using machine learning techniques, including logistic regression, C5.0 tree-based model, and random forest. The features were selected based on Andersen's health behavior model and disaster-related factors. Among 1659 participants, 31.5% experienced unmet healthcare needs after a disaster. The random forest algorithm exhibited the best performance in terms of precision, accuracy, Under the Receiver Operating Characteristic (AUC-ROC), and F-1 scores. Subjective health status, disaster-related diseases or injuries, and residential area have emerged as crucial factors predicting unmet healthcare needs. These findings emphasize the vulnerability of disaster-affected populations and highlight the value of machine learning in post-disaster management policies for decision-making.

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.

Prevalence of unmet health care need in older adults in 83 countries: measuring progressing towards universal health coverage in the context of global population ageing

Current measures for monitoring progress towards universal health coverage (UHC) do not adequately account for populations that do not have the same level of access to quality care services and/or financial protection to cover health expenses for when care is accessed. This gap in accounting for unmet health care needs may contribute to underutilization of needed services or widening inequalities. Asking people whether or not their needs for health care have been met, as part of a household survey, is a pragmatic way of capturing this information. This analysis examined responses to self-reported questions about unmet need asked as part of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. Noting the large variation in questions and response categories, the results point to low levels (less than 2%) of unmet need reported in adults aged 60+ years in countries like Andorra, Qatar, Republic of Korea, Slovenia, Thailand and Viet Nam to rates of over 50% in Georgia, Haiti, Morocco, Rwanda, and Zimbabwe. While unique, these estimates are likely underestimates, and do not begin to address issues of poor quality of care as a barrier or contributing to unmet need in those who were able to access care. Monitoring progress towards UHC will need to incorporate estimates of unmet need if we are to reach universality and reduce health inequalities in older populations.

The impact of the covid-19 outbreak on unmet health care needs in istanbul

Background & aimCOVID-19 pandemic caused significant barriers to maintain health services. Our study determines the frequency and significant determinants of unmet health needs in Istanbul both in 2019, a pre-pandemic year, and in 2021, a pandemic year and compares the results COVID-19 era to a prior to pandemic year. MethodsAs our study is the first questing Istanbul experience, we estimate the frequencies and determinants of unmet healthcare need among +15 population using TurkStat’s Income and Living Conditions Survey Data via Generalized Linear Models (GLMs). ResultsWe found that the most prominent barriers were late appointment dates and financial difficulty both before and during the pandemic. According to our findings, women and those having any chronic disease become significantly more likely to have unmet health needs during the pandemic compared to pre-pandemic period. Indeed, the ones belonging to the lowest income group and having lower level perceived health were disadvantaged with higher change of unmet needs both prior to and during the pandemic. Furthermore, the frequency of the Istanbulers who had unmet healthcare needs increased more than 1.5 time during the COVID-19 pandemic. ConclusionsAs unmet healthcare needs due to COVID-19 jeopardizing the healthcare systems, it is important to comprehend the causes of unmet healthcare demands during infectious disease outbreaks in order to prioritize the right policies and protection strategies for the most vulnerable ones.

Taking Charge of Men’s Health: Need for More Comprehensive Care Beyond the Prostate Cancer Diagnosis

Introduction: In this study, we aim to characterize diagnosed and undiagnosed comorbid conditions as well as the sufficiency of their management in order to demonstrate the opportunity available to improve the overall health in men presenting with a new prostate cancer diagnosis. Methods: A retrospective chart review was performed on patients presenting with a new prostate cancer diagnosis from January 2020 to March 2022 to determine undiagnosed conditions and adequacy of the management of comorbidities. Results: Of the included patients, 24.9% had prediabetes, 19.3% diabetes mellitus (DM), 68.5% hypertension (HTN), 70.2% hyperlipidemia (HLD), and 43.1% metabolic syndrome. For DM, HTN, and HLD, 10.5%, 18.8%, and 18.8% of patients were screened but inadequately treated, respectively; 5.5%, 13.8%, and 8.3% were not diagnosed; 2.8%, 0, and 5.5% were not screened. The average 10-year ASCVD risk in patients with metabolic syndrome was 25.6% vs 15.1% in those without ( P &lt; .001), and 21.8% vs 15.1% in patients who were incompletely screened for chronic disease compared with those who were screened per guidelines ( P &lt; .001). Conclusion: The study population has high rates of comorbidities, and undermanaged chronic diseases. This significant unmet health care need represents an opportunity for urologists to champion men’s health in new prostate cancer patients.

What are the factors affecting older adults’ experience of unmet healthcare needs amid the COVID-19 pandemic in Korea?

BackgroundUnmet healthcare need is a critical indicator, showing a plausible picture of how the healthcare system works in the unprecedented pandemic situation. It is important to understand what factors affect healthcare services of older adults in the midst of the outbreak, as this could help identify service- and performance-related challenges and barriers to the healthcare system. This study aimed to identify factors associated with unmet healthcare needs among the older Korean population amid the COVID-19 pandemic.MethodsCross-sectional data were used from the Experience Survey on Healthcare Use of Older Adults during the COVID-19 (COVID-19 Survey) in Korea (n = 1,917). Our main outcome, unmet healthcare need, was measured based on self-reported experience of overall, regular, and irregular outpatient care services-related unmet healthcare needs. Independent variables were selected based on previous studies on determinants of unmet healthcare need during the COVID-19 pandemic and Andersen’s expanded behavioural model, which theorizes that healthcare-seeking behaviours are driven by psychosocial, enabling, and need factors.ResultsUsing multiple logistic regression models, we identified a good understanding of the nation’s health system was associated with lower likelihood of all types of unmet healthcare needs among older Korean adults (OR: 0.39, 95%CI: 0.25–0.61; OR: 0.36, 95%CI: 0.20–0.63; OR: 0.41, 95%CI: 0.23–0.75). Decreased social activities (i.e., shopping and visiting family members) and worsened psychological health issues (i.e., increased anxiety & nervousness and greater difficulty sleeping) were also factors affecting overall and irregular outpatient services-related unmet needs.ConclusionsTo ensure timely access to necessary healthcare services for older adults in the era of the COVID-19 outbreak, improving older adult’s understanding on how the healthcare system works is necessary. Moreover, changes in psychological condition and daily activities due to COVID-19 should be considered as possible barriers to healthcare services among older adults during the global pandemic.

Unmet Healthcare Needs among the Elderly Korean Population: Before and during the COVID-19 Pandemic

Unmet healthcare needs (UHN) are an important indicator in healthcare management and require sustainable healthcare systems. This cross-sectional descriptive study aimed to identify differences in UHN among the elderly Korean population before and during the first year of the COVID-19 pandemic. Data (N = 3371) from the 8th Korea National Health and Nutrition Examination Survey (2019–2020), specifically focusing on adults aged 65 years and older, were analyzed. The overall prevalence of UHN decreased from 8.2% in 2019 to 7.6% in 2020, but there was no statistical significance (p &gt; 0.05). The leading reasons for UHN were cost burden and mild symptoms in 2020 and cost burden in 2019 (p &lt; 0.05). Compared to 2019, the cost burden in 2020 was lower in men than in women (odds ratio [OR] = 0.287, 95% confidence interval [CI]: 0.113–0.726, p &lt; 0.05), and in the economically active group than in the non-economically active one as to mild symptoms (OR = 0.161, 95% CI: 0.054–0.478, p &lt; 0.05) in multiple logistic regression analyses. In conclusion, these findings imply that sustainable healthcare policies and systems should be tailored to address the targeted population’s healthcare needs, even beyond the COVID-19 era.

Impact of the First Year of the COVID-19 on Unmet Healthcare Need among New York City Adults: a Universal Healthcare Experiment.

We examined the impact of the first year of the COVID-19 pandemic on unmet healthcare need among New Yorkers and potential differences by race/ethnicity and health insurance. Data from the Community Health Survey, collected in 2018, 2019, and 2020, were merged to compare unmet healthcare need within the past 12 months during the pandemic versus the 2 years prior to 2020. Univariate and multivariable logistic regression models evaluated change in unmet healthcare need overall, and we assessed whether race/ethnicity or health insurance status modified the association. Overall, 12% of New Yorkers (N = 27,660) experienced unmet healthcare during the 3-year period. In univariate and multivariable models, the first year of the pandemic (2020) was not associated with change in unmet healthcare need compared with 2018-2019 (OR = 1.04, p = 0.548; OR = 1.03, p = 0.699, respectively). There was no statistically significant interaction between calendar year and race/ethnicity, but there was significant interaction with health insurance status (interaction p = 0.009). Stratifying on health insurance status, those uninsured had borderline significant lower odds of experiencingunmet healthcare need during 2020 compared to the 2 years prior (OR = 0.72, p = 0.051) while those with insurance had a slight increase that was not significant (OR = 1.12, p = 0.143). Unmet healthcare need among New Yorkers during the first year of the pandemic did not differ significantly from 2018-2019. Federal pandemic relief funding, which offered no-cost COVID-19 testing and care to all, irrespective of health insurance or legal status, may have helped equalized access to healthcare.

Trends, Prevalence, and Risk Factors of Food Insecurity Among Pregnant and Postpartum Women in the United States: Findings from the 2019-2021 National Health Interview Survey.

Background: Despite the widespread food insecurity in the United States, there is limited research investigating its prevalence among pregnant women and the potential impact it has on maternal and child health outcomes. This study examined trends in the prevalence of, and investigated risk factors for, food insecurity among peripartum women, using a nationally representative sample in the United States. Materials and Methods: This cross-sectional study included pregnant and postpartum women aged 18-49 years who reported being currently pregnant or pregnant in the past 12 months and who participated in the National Health Interview Survey from 2019 to 2021. Weighted multivariable logistic regression analysis was used to estimate associations with food insecurity. Results: A total of 1,527 pregnant women, weighted to represent 5,588,192 women in the United States, were included in the analysis. Overall, from 2019 to 2021, 10.8% of peripartum women were food insecure. The prevalence of food insecurity changed substantially between 2019 and 2021 (2019: 10.6% confidence interval [95% CI: 8.7-13.5], 2020: 16.0% [95% CI: 10.9-22.8], 2021: 6.2% [95% CI: 4.2-9.1]). The adjusted odds of food insecurity were significantly higher among pregnant and postpartum women in 2020 (aOR 2.15), who had a health insurance coverage (aOR 2.98) and who had an unmet health care need in the preceding 12 months (aOR 6.52). Conclusion: We found that food insecurity was common among peripartum women between 2019 and 2021 and was exacerbated by the COVID-19 pandemic. Identifying the factors that predispose peripartum women to the risk of food insecurity can guide the development and implementation of targeted interventions aimed at reducing the adverse impact of food insecurity on perinatal and infant health.

Association of social isolation with health status among community-dwelling Chinese older adults living with homecare services: a cross-sectional survey in Hong Kong.

Defined as having few social relationships or infrequent social contact with family, friends, and the community, social isolation is a public health crisis. We aimed to evaluate the prevalence of social isolation and explore the association between social isolation and health status among community-dwelling Chinese Older Adults living with homecare services. This is a cross-sectional survey with a structured questionnaire conducted among older adults aged ≥60 in the Central Kowloon District of Hong Kong during 2017-2018. Social isolation was assessed by the Lubben Social Network Scale-6 and a score less than 12 was defined as socially isolated. Six aspects of health status including fall risk, cognitive function, depression, activities of daily living (ADL), instrumental activities of daily living (IADL), and functional mobility were measured by standardized instruments. Multi-criteria decision analysis (MCDA) was applied to estimate an index to represent the overall health status of the respondents. Multivariate logistic/linear regression models were applied to examine the associations between social isolation and health status after adjusting the sociodemographic characteristics. Among the 1,616 participants included in this analysis, the mean age was 80.9 years, 66.3% were female and 41.4% were identified as socially isolated. Compared with the non-isolated group, the socially isolated group had higher proportions of males, divorced or unmarried, ever smoking and drinking, living alone, and living in public housing without religion. After adjusting for confounders, the odds ratios (OR) comparing the socially isolated vs. non-isolated groups were 2.52 (95%CI: 1.79, 3.56) for high fall risk, 1.51 (1.17, 1.94) for cognitive impairment, and 1.78 (1.31, 2.43) for depression. The socially isolated group increased the odds of abnormal ADL, IADL, and functional mobility by 105-150%, and decreased the overall health score by 5.30 (3.42, 7.18). We demonstrated the association of social isolation with poorer physical function and mental health and overall health status among the community-dwelling Chinese older adults living with homecare services. These findings provided new knowledge about the association of social isolation with both physical and mental function for daily living even for those receiving an integrated homecare service in the community. It implies that an unmet healthcare need existed when comparing the service scope of the current homecare services in the community. It also highlighted the need for targeted prevention and intervention initiatives among community-dwelling old adults to alleviate social isolation for better health and good functioning in the community.

Assessing the Feasibility of Rural Residency Training for Licensed Naturopathic Physicians in the Northwest: A Qualitative Study.

Naturopathic physicians (ND) are uniquely situated to address areas of unmet health care need as primary care providers (PCPs). In several states, NDs have a broad scope of practice and are licensed as independent practitioners regardless of residency training. However, with a larger role in the health care system, the need for post-graduate medical training becomes more important for clinical success and patient safety. Our study aimed at assessing the feasibility of developing residencies for licensed NDs in rural federally qualified health centers (FQHCs) of Oregon and Washington. We conducted interviews with leadership from a convenience sample of eight FQHCs. Six centers were rural, two of which already employed NDs. Two urban centers that employed NDs as PCPs were included for their valuable insights related to study design. Two investigators independently reviewed and coded site visit notes for prominent themes through inductive reasoning analysis. Consensus was met identifying the following themes: onboarding and mentorship; diversity of clinical training; financial structure; length of residency; and addressing health care needs in the community. We identified several opportunities for the development of primary care residencies for NDs, including the need for PCPs in rural communities, the ability of NDs to manage chronic pain with prescription drugs, and the prevention of morbidity from complex conditions such as diabetes and cardiovascular disease. Potential barriers to residency development include lack of Medicare reimbursement, mixed awareness of the ND scope of practice, and scarcity of dedicated mentors. These results may serve as guideposts for the future development of naturopathic residencies in rural community health centers.

(030) Mental Health and Unmet Healthcare Needs of Female Sex Workers in Baltimore, Maryland

Abstract Introduction Female sex workers (FSW) experience unique mental health and well-being challenges that intersect with their sex work and sexual health. Further, they often experience discrimination and stigma within healthcare settings, leading to delayed or forgone healthcare. Throughout the COVID-19 pandemic, FSW faced unique limitations on their ability to gain financial compensation, which can amplify existing social inequities and morbidities (i.e. poor mental health) among this marginalized population. Objective As poor mental health is associated with increased risk of acquiring HIV and other sexually transmitted infections (STI), it is critical to understand the unique mental health strains of FSW in order to improve their engagement in and quality of mental and sexual healthcare. Methods Participants were purposively sampled for in-depth qualitative interviews to ensure a diversity of experience from an existing cohort study of COVID-19 testing in Baltimore, Maryland. The semi-structured interview includes questions about aspects of sex work most salient for mental health (and their changes during COVID) including: their relationship with street-based sex work, police interactions, violence, safety, substance use and overdose. Two independent coders conducted a thematic analysis using inductive and deductive codes. Results Preliminary results from qualitative interviews (n=14) with FSWs demonstrate a diversity of experience throughout the COVID-19 pandemic and its impact on mental health, self-management practices, stigmatizing and unsafe experiences, and barriers to healthcare. Despite many having a primary care physician, many participants did not report receiving care that was respectful or culturally sensitive to their sex work; participants who did not report having a primary care physician had a harder time seeking care. Multiple FSWs described formal psychiatric diagnoses but often noted that they were not on consistent medication due to financial instability and prescription side-effects. Moreover, self-medication through drugs was a prevalent theme, as barriers to accessing treatment for mental illness required that they find alternate means to address their symptoms. Cultivating self-management strategies (e.g., getting high, writing in a journal, finding a place to release emotions, focusing on work) that serve as alternatives to primary care treatment was common. Themes also included isolation during COVID, and a lack of a strong support system to discuss feelings of stress, depression, and anxiety. Conclusions Results show that FSW have a unique constellation of factors that negatively impact their mental health, but often lack access to culturally sensitive and non-stigmatizing care. Healthcare providers must be educated on the healthcare concerns of FSWs and their intersections with the unique social determinants they face. Disclosure No

The Unmet Healthcare Needs of Female Adolescent and Related Factors During Menstruation Period

Amaç: Bu araştırmanın amacı, adölesanların menstruasyon döneminde karşılanmamış sağlık hizmeti gereksinimlerini ve ilişkili faktörleri incelemektir.&#x0D; Yöntem: Araştırma kesitsel tiptedir. Araştırmanın evrenini, Türkiye’nin farklı bölgelerinde yaşayan ve 12-19 yaş arasındaki kadın adölesanlar oluşturmuştur. Araştırmanın örneklemi bilgisayar ortamında 0.2 etki büyüklüğü, %80 güç ve %95 güven düzeyinde 202 olarak hesaplanmıştır. Araştırmanın verileri literatürden yararlanılarak hazırlanan anket formu ile toplanmıştır. Veriler sosyal medya hesapları üzerinden gönderilen link yoluyla 27 Eylül-6 Kasım 2021 tarihleri arasında toplanmıştır. &#x0D; Bulgular: Adölesanların %16.3’ünün menstruasyon döneminde karşılanmamış en az bir sağlık hizmeti gereksinimi vardır. Adölesanların en çok acil durumlarda sağlık hizmetine erişemediği, yaklaşık beşte birinin de hijyenik pede erişemediği belirlenmiştir. Karşılanmamış sağlık hizmeti gereksiniminin en sık rastlanan nedenleri; sosyal güvencenin olmaması ve doktor korkusudur. Geniş ailede yaşayan, menstruasyonun en yoğun gününde ped değiştirme sıklığı az olan, pedi evde kendi kendine yapan, menstruasyon nedeniyle okula devamsızlık yapanlarda karşılanmamış sağlık hizmeti gereksiniminin daha fazla olduğu belirlenmiştir (p

Effectiveness and implementation of a text messaging intervention to reduce depression and anxiety symptoms among Latinx and Non-Latinx white users during the COVID-19 pandemic

Text messaging interventions are increasingly used to help people manage depression and anxiety. However, little is known about the effectiveness and implementation of these interventions among U.S. Latinxs, who often face barriers to using mental health tools. The StayWell at Home (StayWell) intervention, a 60-day text messaging program based on cognitive behavioral therapy (CBT), was developed to help adults cope with depressive and anxiety symptoms during the COVID-19 pandemic. StayWell users (n = 398) received daily mood inquiries and automated skills-based text messages delivering CBT-informed coping strategies from an investigator-generated message bank. We conduct a Hybrid Type 1 mixed-methods study to compare the effectiveness and implementation of StayWell for Latinx and Non-Latinx White (NLW) adults using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Effectiveness was measured using the PHQ-8 depression and GAD-7 anxiety scales, assessed before starting and after completing StayWell. Guided by RE-AIM, we conducted a thematic text analysis of responses to an open-ended question about user experiences to help contextualize quantitative findings. Approximately 65.8% (n = 262) of StayWell users completed pre-and-post surveys. On average, depressive (−1.48, p = 0.001) and anxiety (−1.38, p = 0.001) symptoms decreased from pre-to-post StayWell. Compared to NLW users (n = 192), Latinx users (n = 70) reported an additional −1.45 point (p < 0.05) decline in depressive symptoms, adjusting for demographics. Although Latinxs reported StayWell as relatively less useable (76.8 vs. 83.9, p = 0.001) than NLWs, they were more interested in continuing the program (7.5 vs. 6.2 out of 10, p = 0.001) and recommending it to a family member/friend (7.8 vs. 7.0 out of 10, p = 0.01). Based on the thematic analysis, both Latinx and NLW users enjoyed responding to mood inquiries and sought bi-directional, personalized text messages and texts with links to more information to resources. Only NLW users stated that StayWell provided no new information than they already knew from therapy or other sources. In contrast, Latinx users suggested that engagement with a behavioral provider through text or support groups would be beneficial, highlighting this group's unmet need for behavioral health care. mHealth interventions like StayWell are well-positioned to address population-level disparities by serving those with the greatest unmet needs if they are culturally adapted and actively disseminated to marginalized groups. Trial registrationClinicalTrials.gov Identifier: NCT04473599.

Impact of the COVID-19 pandemic on perceived access and quality of care in German people with parkinsonism.

Due to the heterogeneous clinical presentation, people with Parkinsonism (PwP) develop individual healthcare needs as their disease progresses. However, because of limited health resources during the COVID-19 pandemic, many patients were put at risk of inadequate care. All this occurred in the context of inequitable healthcare provision within societies, especially for such vulnerable populations. This study aimed to investigate factors influencing satisfaction and unmet need for healthcare among PwP during the COVID-19 pandemic in Germany. Analyses relied on an anonymous online survey with a 49-item questionnaire. We aimed at describing access to health services before and during the early stages of the pandemic. To this end, a generalized linear model was used to derive significant predictors and a stepwise regression to subsummarize the main factors of perceived inadequate care. In total, 551 questionnaires showed that satisfaction with Parkinsonism-related care decreased significantly during the pandemic (p < 0.001). In particular, factors such as lower educational level, lower perceived expertise of healthcare providers, less confidence in remote care, difficulties in obtaining healthcare, and restricted access to care before the pandemic but also lower densities of neurologists at residence and less ability to overcome barriers were indicative of higher odds to perceive unmet needs (p < 0.05). The results unveil obstacles contributing to reduced access to healthcare during the COVID-19 pandemic for PwP. These findings enable considerations for improved provision of healthcare services to PwP.

Understanding Inequality of Mental Health of US Adults during the Covid19 Pandemic

US adults experienced significant mental health shocks during the Covid-19 pandemic. Various factors, including quarantine and segregation from family members, anxiously waiting for test results, illness or even death of family members, loss of job or income, and social and economic disruptions, exacerbated mental health problems in the US. Using the Household Pulse Survey conducted by the U.S Census Bureau from April 2020 to October 2021, this study finds that more than half of U.S adults experienced symptoms of anxiety (61.48%) and depression (52.11%), doubled the 2019 level. Second, 21.11% took prescription medication and less than 10% received professional counseling or therapy (9.96%) for mental health, on a par with the 2019 level (15.8% and 9.5%). many people had an unmet need for mental health care (10.83%). Third, inequality of mental health was pronounced. Female, younger age cohorts, and low-income adults were more likely to experience mental health shocks, receive mental health services, and have an unmet need of mental health care. Compared with non-Hispanic white adults, Hispanic and non-Hispanic black adults had a higher probability of experiencing mental health problems and having an unmet need of mental health care, but they were less likely to receive mental health service.

Access to mental health support, unmet need and preferences among adolescents during the first year of the COVID-19 pandemic.

The COVID-19 pandemic has had widespread effects on adolescent mental health. However, little is known about support-seeking, unmet need and preferences for mental health care among adolescents. The Youth Development Instrument (YDI) is a school-administered survey of adolescents (N = 1928, mean age = 17.1, SD = 0.3) across British Columbia, Canada. In this cohort, we assessed the characteristics of accessed mental health supports, prevalence of unmet need and preferences for in-person versus internet-based services. Overall, 40% of adolescents obtained support for mental health, while 41% experienced unmet need. The most commonly accessed supports were family doctors or pediatricians (23.1%) and adults at school (20.6%). The most preferred mode of mental health care was in-person counselling (72.4%), followed by chat-based services (15.0%), phone call (8.1%) and video call (4.4%). The adjusted prevalence of accessing support was elevated among adolescents with anxiety (adjusted prevalence ratio [aPR] = 1.29, 95% CI: 1.10-1.51), those who used alcohol (1.14, 1.01-1.29), gender minorities (1.28, 1.03-1.58) and sexual minorities (1.28, 1.03-1.45). The adjusted prevalence of unmet need was elevated among adolescents with depression (1.90, 1.67-2.18), those with anxiety (1.78, 1.56-2.03), females (1.43, 1.31-1.58), gender minorities (1.45, 1.23-1.70) and sexual minorities (1.15, 1.07-1.23). Adolescents of gender or sexual minority status and those with anxiety were more likely than others to have discussed mental health concerns and also to have reported unmet need. The most common sources of support were primary health care providers and adults at school, while the most and least preferred modes of support were in-person and video call services, respectively.