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1.
J Nerv Ment Dis ; 212(1): 43-51, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37874988

RESUMO

ABSTRACT: Limited empirical data have been available on the adult sequelae of childhood homelessness. Using nationally representative data from the National Epidemiologic Survey of Alcohol and Related Conditions-III, we compared a hierarchy of adults who were never homeless, those who were only homeless as children, and those who were homeless both as children and adults, hypothesizing greater adversity as one moved up the three-level hierarchy on sociodemographic, behavioral, and lifetime mental health diagnostic characteristics. As a further evaluation of the status of adults who were homeless as both children and adults, we compared this highest risk group to those who had been homeless only as adults. Individuals who experienced childhood homelessness were 46.9 times more likely than others to also experience adult homelessness. Testing the hierarchical hypothesis, compared with those who were never homeless, individuals who experienced homelessness only as children reported numerous associated disadvantages, including childhood sexual abuse/neglect, parental adversities, adult incarceration, psychiatric disorders, and low academic achievement/employment. Those reporting both child and adult homelessness, in contrast to childhood homelessness alone, additionally met the criteria for multiple substance use disorders, confirming our hierarchical hypothesis. Those reporting both child and adult homelessness also showed more numerous social and psychiatric problems when compared with those experiencing homelessness for the first time as adults. This study demonstrates how homelessness in childhood is associated with extensive social and psychiatric adversities in both childhood and adulthood.


Assuntos
Maus-Tratos Infantis , Pessoas Mal Alojadas , Transtornos Relacionados ao Uso de Substâncias , Adulto , Humanos , Criança , Problemas Sociais , Saúde Mental , Maus-Tratos Infantis/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia
2.
Psychol Med ; 53(12): 5592-5602, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-36106374

RESUMO

BACKGROUND: While suicide rates have recently declined for White individuals, rates among Black and Hispanic individuals have increased. Yet, little is known about racial/ethnic differences in precursors to suicide, including suicidal ideation (SI) and suicide attempts (SA). METHODS: Data from 2009-2020 National Survey of Drug Use and Health (NSDUH) consisted of non-institutionalized US civilians aged ⩾18 (n = 426 008). We compared proportions of White, Black, and Hispanics among adults reporting no past-year suicidal thoughts/behavior, SI, and SA. Multivariable-adjusted analyses were used to evaluate the independence of observed racial/ethnic differences in past-year SI, SA, and mental health service use. RESULTS: In the entire sample, 20 791 (4.9%) reported past-year SI only and 3661 (0.9%) reported a SA. Compared to White individuals, Black and Hispanic individuals were significantly less likely to report past-year SI [OR 0.73 (95% CI 0.69-0.77); OR 0.75 (95% CI 0.71-0.79), respectively], but more likely to report a past-year SA [OR 1.45 (95% CI 1.28-1.64); OR 1.19 (95% CI 1.04-1.37), respectively] even after multivariable adjustment. Black and Hispanic individuals were significantly less likely to use mental health services, but the lack of significant interactions between race/ethnicity and SI/SA in association with service use suggests differences in service use do not account for differences in SI or SA. CONCLUSIONS: Black and Hispanic individuals are significantly less likely than White individuals to report SI but more likely to report SAs, suggesting differences in suicidal behavior across race/ethnicity that may be impacted by socio-culturally acceptable expressions of distress and structural racism in the healthcare system.


Assuntos
Serviços de Saúde Mental , Ideação Suicida , Tentativa de Suicídio , Adulto , Idoso , Humanos , Etnicidade , Hispânico ou Latino/psicologia , Grupos Raciais , Aceitação pelo Paciente de Cuidados de Saúde , Brancos , Negro ou Afro-Americano
3.
JAMA ; 329(17): 1469-1477, 2023 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-37129655

RESUMO

Importance: There has been increasing concern about the burden of mental health problems among youth, especially since the COVID-19 pandemic. Trends in mental health-related emergency department (ED) visits are an important indicator of unmet outpatient mental health needs. Objective: To estimate annual trends in mental health-related ED visits among US children, adolescents, and young adults between 2011 and 2020. Design, Setting, and Participants: Data from 2011 to 2020 in the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of EDs, was used to examine mental health-related visits for youths aged 6 to 24 years (unweighted = 49 515). Main Outcomes and Measures: Mental health-related ED visits included visits associated with psychiatric or substance use disorders and were identified by International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) and ICD-10-CM (2016-2020) discharge diagnosis codes or by reason-for-visit (RFV) codes. We estimated the annual proportion of mental health-related pediatric ED visits from 2011 to 2020. Subgroup analyses were performed by demographics and broad psychiatric diagnoses. Multivariable-adjusted logistic regression analyses estimated factors independently associated with mental health-related ED visits controlling for period effects. Results: From 2011 to 2020, the weighted number of pediatric mental health-related visits increased from 4.8 million (7.7% of all pediatric ED visits) to 7.5 million (13.1% of all ED visits) with an average annual percent change of 8.0% (95% CI, 6.1%-10.1%; P < .001). Significant linearly increasing trends were seen among children, adolescents, and young adults, with the greatest increase among adolescents and across sex and race and ethnicity. While all types of mental health-related visits significantly increased, suicide-related visits demonstrated the greatest increase from 0.9% to 4.2% of all pediatric ED visits (average annual percent change, 23.1% [95% CI, 19.0%-27.5%]; P < .001). Conclusions and Relevance: Over the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. These findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people, especially for children experiencing suicidal symptoms.


Assuntos
Serviço Hospitalar de Emergência , Necessidades e Demandas de Serviços de Saúde , Transtornos Mentais , Saúde Mental , Suicídio , Adolescente , Criança , Humanos , Adulto Jovem , COVID-19/epidemiologia , COVID-19/psicologia , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/tendências , Saúde Mental/estatística & dados numéricos , Saúde Mental/tendências , Pandemias , Estados Unidos/epidemiologia , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Suicídio/psicologia , Suicídio/estatística & dados numéricos
4.
J Nerv Ment Dis ; 209(1): 65-70, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33141782

RESUMO

Epidemiologic data on first-episode psychosis is limited due to the infrequency of cases in the general population. This study uses the National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36,309) to examine population-based estimates of early psychosis based on adults who report a first-time diagnosis of schizophrenia from a doctor in the past year and compares them with those receiving diagnoses in previous years. Altogether, 60 respondents reported past-year schizophrenia (170 per 100,000) or 6.7% of 901 with any reported schizophrenia. Mean age was 41.4 ± 2.1, and they reported significantly higher rates of any past-year substance use disorder (44.7%) than individuals diagnosed in previous years (27.7%), specifically alcohol use disorder. Compared with other samples (many of which excluded older adults), this study suggests that early psychosis may affect older populations more than previously recognized, but comorbidity with substance use disorders showed similar elevations.


Assuntos
Comorbidade , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Alcoolismo/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários , Estados Unidos
5.
Psychiatr Q ; 92(3): 1079-1092, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33575954

RESUMO

While COVID-19 has had widespread impact on the way behavioral health services are delivered, very little research exists characterizing how providers have perceived these changes. This study used mixed-methods to understand the complex and varied experiences of staff of a psychiatric service line at a large tertiary medical center with high community spread of COVID-19. A brief convenience survey was sent to all staff of the service line and thematic analysis generated brief themes and their frequency. Qualitative focus groups were then held to elucidate greater detail on survey responses. In total, 99 individuals responded to the survey and 17 individuals attended two focus groups in which theoretical saturation was achieved. While brief survey responses generated three broad themes, including operations, telehealth and technology, and communication, focus group data provided nuanced information about these themes, including reasons underlying heightened stress and fatigue felt by staff, inadequacy of technology while finding innovative approaches for its use, and appreciation for the benefits of telehealth while expressing concern for patients not served well by it. These mixed-methods findings highlight the complexities of implementing widespread changes during COVID-19 and demonstrate how survey and focus group data can be used to evaluate rapid care transformations driven by COVID-19.


Assuntos
Atitude do Pessoal de Saúde , COVID-19 , Pesquisas sobre Atenção à Saúde , Pessoal de Saúde/psicologia , Serviços de Saúde Mental , Telemedicina , Adulto , Idoso , COVID-19/epidemiologia , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Centros de Atenção Terciária
6.
Community Ment Health J ; 56(8): 1429-1435, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32062717

RESUMO

Despite the availability and effectiveness of medication-assisted treatment (MAT) for substance use disorders (SUDs), utilization of these medications remains suboptimal, especially in public sector settings. A key limitation is clinicians' reluctance to include MAT in their routine practice due, in part, to low confidence about managing SUDs and limited awareness of the disease model of addiction. This study evaluates the impact of a 1-day MAT training for community mental health clinicians using a 30-item pre- and post-training questionnaire. Of the 109 clinicians who attended the training, 107 completed the pre- and post-training questionnaires. Factor analysis of the questionnaire identified two domains: readiness to address SUDs among patients (factor 1) and understanding SUDs as diseases (factor 2). Post training, there was a significant change in both factor 1 (p = .00001) and factor 2 (p = .00003), indicating that a brief MAT training can increase clinicians' confidence and readiness to address SUDs and improve their understanding of the disease model of addiction.


Assuntos
Saúde Mental , Transtornos Relacionados ao Uso de Substâncias , Intervenção em Crise , Humanos , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Inquéritos e Questionários
7.
Am J Public Health ; 108(10): 1334-1340, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30138073

RESUMO

The rise of the opioid epidemic and the increasing rate of suicides have drawn attention to mental health and addiction and have highlighted the need for collaboration between public health and behavioral health. However, these 2 fields have had limited engagement with one another. The introduction of Public Health 3.0 and population-based financing models that promote prevention and value in health care have created opportunities and incentives for local health departments and behavioral health agencies and providers to work together. New undertakings include the creation of accountable care organizations, community health needs assessment requirements for all non-profit hospitals, local health department requirements to conduct community Health Assessments (CHA), and increasing numbers of public health departments that are pursing accreditation. We argue that by taking advantage of these opportunities and others, local health departments can play a vital role in addressing critical challenges in mental health and addiction facing their communities.


Assuntos
Acreditação , Comportamento Cooperativo , Saúde Mental , Administração em Saúde Pública/normas , Humanos , Estados Unidos
8.
Acad Psychiatry ; 45(2): 232-233, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32170591

Assuntos
Autoimagem , Humanos
9.
J Pediatr ; 167(1): 148-54.e1, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25799193

RESUMO

OBJECTIVE: To determine whether children with calcium-deficiency rickets respond better to treatment with calcium as limestone or as ground fish. STUDY DESIGN: Nigerian children with active rickets (n = 96) were randomized to receive calcium as powdered limestone (920 mg of elemental calcium) or ground fish (952 mg of elemental calcium) daily for 24 weeks. Radiographic healing was defined as achieving a score of 1.5 or less on a 10-point scale. RESULTS: The median (range) age of enrolled children was 35 (6-151) months. Of the 88 children who completed the study, 29 (66%) in the ground fish group and 24 (55%) in the limestone group achieved the primary outcome of a radiographic score of 1.5 or less within 6 months (P = .39). The mean radiographic score improved from 6.2 ± 2.4 to 1.8 ± 2.2 in the ground fish group and from 6.3 ± 2.2 to 2.1 ± 2.4 in the limestone group (P = .68 for group comparison). In an intention to treat analysis adjusted for baseline radiographic score, age, milk calcium intake, and serum 25-hydroxyvitamin D concentration, the response to treatment did not differ between the 2 groups (P = .39). Younger age was associated with more complete radiographic healing in the adjusted model (aOR 0.74 [95% CI 0.57-0.92]). After 24 weeks of treatment, serum alkaline phosphatase had decreased, calcium and 25-hydroxyvitamin D increased, and bone mineral density increased in both groups, without significant differences between treatment groups. CONCLUSION: In children with calcium-deficiency rickets, treatment with calcium as either ground fish or limestone for 6 months healed rickets in the majority of children.


Assuntos
Carbonato de Cálcio/administração & dosagem , Suplementos Nutricionais , Produtos Pesqueiros , Raquitismo/terapia , Fatores Etários , Fosfatase Alcalina/sangue , Densidade Óssea , Cálcio/sangue , Cálcio/deficiência , Criança , Pré-Escolar , Dessecação , Feminino , Humanos , Lactente , Masculino , Nigéria , Pós , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Raquitismo/diagnóstico por imagem , Ulna/diagnóstico por imagem , Vitamina D/análogos & derivados , Vitamina D/sangue
10.
Am J Psychiatry ; : appiajp20230397, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38831705

RESUMO

OBJECTIVE: This study estimated national annual trends and characteristics of emergency department visits for suicide attempts and intentional self-harm in the United States from 2011 to 2020. METHODS: Data were from the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national sample survey of emergency departments. Visits for suicide attempts and intentional self-harm were identified using discharge diagnosis codes (ICD-9-CM for 2011-2015; ICD-10-CM for 2016-2020) or reason-for-visit codes. The annual proportion of emergency department visits for suicide attempts and intentional self-harm was estimated. RESULTS: The weighted number of emergency department visits for suicide attempts and intentional self-harm increased from 1.43 million, or 0.6% of total emergency department visits, in 2011-2012 to 5.37 million, or 2.1% of total emergency department visits in 2019-2020 (average annual percent change, 19.5%, 95% CI=16.9, 22.2). Visits per capita increased from 261 to 871 visits per 100,000 persons (average annual percent change, 18.8%, 95% CI=17.6, 20.0). The increase in visits was widely distributed across sociodemographic groups. While suicide attempt and intentional self-harm visits were most common among adolescents, adults age 65 or older demonstrated the largest increase (average annual percent change, 30.2%, 95% CI=28.5, 32.0). Drug-related diagnoses were the most common co-occurring diagnosis among suicide attempt and intentional self-harm visits. Despite the rise in emergency department visits for suicide attempts and intentional self-harm, less than 16% included an evaluation by a mental health professional. CONCLUSIONS: A significant national increase in emergency department visits for suicide attempts and intentional self-harm occurred from 2011 to 2020, as a proportion of total emergency department visits and as visits per capita. These trends underscore an urgent need to improve the continuum of mental health care for individuals with suicidal symptoms.

11.
J Affect Disord ; 358: 342-349, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38734245

RESUMO

OBJECTIVE: To examine recent 12-year trends in prevalence of suicidal ideation and behaviors (SIBs) among US adults experiencing a past-year treatment-resistant depression (TRD). METHODS: Using data from the National Survey of Drug Use and Health, we estimated the annual percentage of individuals aged ≥18 with TRD who reported past-year SIBs, and estimated linear trends adjusting for potentially confounding factors from 2009 to 2020. RESULTS: Of estimated 237.5 million US adults, 7.1 % met diagnostic criteria for a past-year major depressive episode (MDE) between 2009 and 2020. Of these, 9.7 % met criteria for TRD. The proportion reporting past-year suicidal ideation in TRD ranged from 39.5 % (95 % confidence interval [CI], 32.1-47.3 %) in 2009-2010 to 43.4 % (95 % CI, 36.7-503 %) in 2019-2020, with an average annual percent change (AAPC) of 1.3 % (95 % CI, -0.7 % to 3.3 %). The prevalence of past-year suicide attempts in TRD was 7.3 % across the study period (AAPC, 0.1 %; 95 % CI, -4.3 % to 4.7 %). Past-year SIBs were significantly associated with an increased likelihood of meeting criteria for TRD among adults with MDE (adjusted odds ratio [AOR], 1.53; 95 % CI, 1.35-1.75 for suicidal ideation; AOR, 2.17; 95 % CI, 1.79-2.62 for suicide attempts). No significant differences were observed between 2019 and 2020, reflecting the COVID-19 pandemic. CONCLUSION: Among individuals with TRD, proportions of SIBs are high. These findings underscore an urgent need for suicide prevention efforts in this high-risk population, including preventive services across diverse settings and accessibility to evidence-based pharmacological and non-pharmacological interventions.


Assuntos
Transtorno Depressivo Maior , Transtorno Depressivo Resistente a Tratamento , Ideação Suicida , Tentativa de Suicídio , Humanos , Adulto , Estados Unidos/epidemiologia , Feminino , Masculino , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Resistente a Tratamento/epidemiologia , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Pessoa de Meia-Idade , Tentativa de Suicídio/estatística & dados numéricos , Adulto Jovem , Prevalência , Adolescente , COVID-19/epidemiologia , COVID-19/psicologia , Idoso , Inquéritos Epidemiológicos
12.
J Clin Psychiatry ; 84(2)2023 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-36856537

RESUMO

Background: Suicide prevention is a major public health priority. The effectiveness of suicide prevention initiatives is typically assessed by reductions in incidents of suicidal behavior. However, the association of suicide attempts with changes in measures of overall health-related quality of life (HRQOL) has been understudied.Methods: Nationally representative data from 36,309 adults from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III) were used to compare 3 groups: individuals with any suicide attempt in the past 3 years, individuals with a suicide attempt prior to the past 3 years, and those with no prior attempts. Using the 12-item Short Form (SF-12) items, standard measures of mental component score (MCS) and physical component score (PCS) of HRQOL and of quality-adjusted life-years (QALYs) were constructed and compared across these groups. Multivariable regression analyses adjusted scores for sociodemographic, diagnostic, and behavioral covariates.Results: Overall, 1.0% (n = 355) reported an attempt in the last 3 years, 4.3% (n = 1,569) reported an attempt prior to the past 3 years, and 94.7% (n = 34,385) had no prior attempt. In unadjusted analysis, individuals with recent attempts reported much lower MCS scores compared to individuals with no prior attempts (-13.5 points; 95% confidence interval [CI], -15.4 to -11.6) as well as those with past attempts (-7.7 points; 95% CI, -8.5 to -7.0). QALYs were also much lower (-0.13; 95% CI, -0.14 to -0.11 for those with recent attempts and -0.09; 95% CI, -0.10 to -0.08 for those with past attempts, respectively). Adjustment for correlated factors, especially psychiatric disorders and substance use disorders, accounted for 75%-86% of the association of recent and past suicide attempts with MCS-HRQOL and 89%-91% of QALYs; ie, these factors were largely incorporated in these measures of HRQOL.Conclusions: Individuals with relatively recent suicide attempts report significantly lower MCS-HRQOL and QALYs compared to both individuals with no prior attempts and individuals with more remote attempts. Psychiatric and substance use comorbidities account for most but not all of the group differences in these measures and thus provide a brief approach to assessing suicide prevention initiatives encompassing multiple aspects of well-being and providing a basis for future cost-benefit analysis.


Assuntos
Transtornos Relacionados ao Uso de Álcool , Tentativa de Suicídio , Adulto , Humanos , Qualidade de Vida , Análise Custo-Benefício , Saúde Mental
13.
Mayo Clin Proc ; 98(7): 969-984, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37419587

RESUMO

OBJECTIVE: To examine recent 12-year trends in the incidence of suicidal ideation (SI) and suicide attempts (SAs) and receipt of mental health treatment among individuals experiencing a past-year major depressive episode (MDE). PATIENTS AND METHODS: Using data from the National Survey of Drug Use and Health, we estimated the annual percentage of individuals with MDE who reported past-year SI or SAs and their use of mental health services from 2009 to 2020 and calculated odds ratios (ORs) for longitudinal change adjusting for potentially confounding factors. RESULTS: During our study period, the weighted unadjusted proportion of patients with a past-year MDE who reported SI increased from 26.2% (668,690 of 2,550,641) to 32.5% (1,068,504 of 3,285,986; OR, 1.38; 95% CI, 1.25 to 1.51) and remained significant in the multivariable-adjusted analysis (P<.001). The greatest increase in SI was seen among Hispanic patients, young adults, and individuals with alcohol use disorder. Similar trends were seen for past-year SAs, increasing from 2.7% (69,548 of 2,550,641) to 3.3% (108,135 of 3,285,986; OR, 1.29; 95% CI, 1.04 to 1.61), especially among Black individuals, patients with incomes greater than $75,000, and those with substance use disorders. In multivariable-adjusted analyses, the temporal trend of increasing SI and SAs remained significant (P<.001 and P=0.04, respectively). Among individuals with past-year SI or SAs, there was no notable change in the mental health service use, and over 50% of individuals with MDE and SI (2,472,401 of 4,861,298) reported unmet treatment needs. No notable differences were observed between 2019 and 2020, reflecting the coronavirus disease 2019 pandemic. CONCLUSION: Among individuals with MDE, rates of SI and SAs have increased, especially among racial minorities and individuals with substance use disorders, without a corresponding change in mental health service use.


Assuntos
COVID-19 , Transtorno Depressivo Maior , Transtornos Relacionados ao Uso de Substâncias , Adulto Jovem , Humanos , Ideação Suicida , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/terapia , Tentativa de Suicídio/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia
14.
Schizophr Res ; 253: 22-29, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-34088549

RESUMO

BACKGROUND: While there is increasing recognition of disparities in healthcare for Black Americans, there have been no comparisons in a nationally representative U.S. sample of Black and White adults with clinical diagnoses of schizophrenia. METHODS: Using nationally representative survey data from the National Epidemiologic Survey on Alcohol and Related Conditions-III, we compared Black (n = 240, 36.2%) and White (n = 423, 63.8%) adults who report having been told by a physician that they have schizophrenia. Due to the large sample size, effect sizes (risk ratios and Cohen's d), rather than p-values, were used to identify the magnitude of differences in sociodemographic and clinical characteristics, including experiences of discrimination and service use. Multivariate analyses were used to identify independent factors. RESULTS: Black individuals with diagnoses of schizophrenia reported multiple sociodemographic disadvantages, including lower rates of employment, educational attainment, income, marriage, and social support, with little difference in incarceration, violent behavior, and quality of life. They reported much higher scores on a general lifetime discrimination scale (Cohen's d = 0.75) and subscales representing job discrimination (d = 0.85), health system discrimination (d = 0.70), and public race-based abuse (d = 0.55) along with higher rates of past year alcohol and drug use disorders, but lower rates of co-morbid psychiatric disorders. Multivariable-adjusted regression analyses highlighted the independent association of Black race with measures of discrimination and religious service attendance; less likelihood of receiving psychiatric treatment (p = 0.02) but no difference in substance use treatment. CONCLUSION: Black adults with schizophrenia report numerous social disadvantages, especially discrimination, but religious service attendance may be an important social asset.


Assuntos
Discriminação Percebida , Esquizofrenia , Determinantes Sociais da Saúde , Adulto , Humanos , Qualidade de Vida , Esquizofrenia/diagnóstico , Esquizofrenia/etnologia , Esquizofrenia/terapia , Transtornos Relacionados ao Uso de Substâncias , Brancos , Negro ou Afro-Americano , Estados Unidos
15.
Psychiatry Res ; 321: 115106, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36791593

RESUMO

Black children face more numerous socio-economic disadvantages than White children, but whether they have more adverse mental health problems remains understudied. Using nationally-representative data from the 2018-2019 National Survey of Children's Health, we examined differences in mental health problems between non-Hispanic Black (n = 2,890) and White (n = 30,015) children aged 6-17. Multivariate analyses were used to determine whether differences in mental health conditions could be accounted for by other factors. We found Black children were significantly less likely than White children to have clinically-identified internalizing conditions (especially anxiety) and more likely to be identified with conduct problems. Black children were also substantially more likely to have greater exposure to adverse childhood experiences (ACEs), to be uninsured, experience poverty, and less likely to receive needed mental health services. After adjusting for these potential confounders, Black children remained half as likely to have clinically-recognized internalizing conditions, but were no longer more likely to have clinically-identified conduct problems. Differences in ACEs alone fully accounted for the racial difference in conduct problems. These results point to the potential impact of assessment bias by clinicians and underscore the potential benefit of routine screening for depression/anxiety in racial/ethnic minority children, especially in light of rising suicide rates among Black youth.


Assuntos
Etnicidade , Saúde Mental , Adolescente , Criança , Humanos , Saúde Mental/etnologia , Grupos Minoritários , Brancos , Negro ou Afro-Americano
16.
Int J Drug Policy ; 112: 103931, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36563489

RESUMO

BACKGROUND: The majority of patients with opioid use disorder do not receive medications for opioid use disorder (MOUD), especially in rural areas. The patient-centered access to healthcare framework posits access as a multidimensional phenomenon impacted by five healthcare system and five patient ability dimensions. Interventions to improve local MOUD treatment outcomes require an understanding of how these dimensions differ across urban and rural communities. This scoping review sought to systematically appraise the literature on MOUD access across urban and rural communities (i.e., rurality) in the US using the patient-centered access framework. METHODS: We performed a scoping review of 1) electronic databases, 2) grey literature, and 3) correspondence with content experts (March 2021). We included articles specifying the study sample by rurality and examining at least one dimension of access to MOUD. The analysis and qualitative synthesis of study results examined study characteristics and categorized key findings by access dimensions. RESULTS: The search produced 3963 unique articles, of which 147 met inclusion criteria. Among included studies, 96% (142/147) examined healthcare system dimensions of access while less than 20% (25/147) examined any of the five dimensions of patient ability. Additionally, 49% (72/147) of studies compared access dimensions by rurality. Across studies, increasing rurality was associated with fewer available MOUD services, but little was known about geographic variation in other critical dimensions of access. CONCLUSIONS: The vast majority of studies examined healthcare system dimensions of MOUD access and few studies made comparisons by rurality or prioritized the patient's perspective, limiting our understanding of how access differs by rurality in the US. As COVID-19 spurs novel changes in MOUD delivery, this inadequate multidimensional understanding of MOUD access may impede the tailoring of interventions to local needs. There is an urgent need for mixed-methods and community-engaged research prioritizing the patient's perspective of MOUD access by rurality. REGISTRATION: Open Science Framework (https://osf.io/wk6b9/).


Assuntos
Buprenorfina , COVID-19 , Transtornos Relacionados ao Uso de Opioides , Humanos , População Rural , Acessibilidade aos Serviços de Saúde , Bases de Dados Factuais , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Tratamento de Substituição de Opiáceos
17.
J Clin Psychiatry ; 84(6)2023 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-37870368

RESUMO

Objective: Research on reactive attachment disorder (RAD) has focused on institutionalized samples, and long-term outcomes have not been described. This study examines the natural history of RAD into adulthood in a US community sample.Methods: The electronic medical record of a tertiary care center was reviewed for individuals who received an ICD-9 or ICD-10 diagnosis of RAD between 3-12 years old and were ≥ 18 years old at the start of the study; data were collected between February and June 2018. Children with RAD (n = 49) were identified and psychiatric, social, and medical outcomes were collected in childhood and adulthood. A subset of the RAD cohort with comorbid attention-deficit/hyperactivity disorder (ADHD) based on ICD codes (n = 34) was compared with age-matched controls with ADHD and without attachment disorders (n = 102).Results: Children with RAD had high rates of adult psychiatric diagnoses (73.5%), substance use (42.9%), suicide attempts (28.6%), and psychiatric hospitalizations (71.4%). They also demonstrated poor psychosocial outcomes, including low high school (34.7%) and college (2.0%) graduation, high unemployment (26.5%), state-funded health insurance (65.3%), and legal issues (34.7%). Compared to children with ADHD alone, children with RAD and ADHD had higher rates of comorbid adult psychiatric diagnoses (OR 3.0, P = .02), suicide attempts (OR 7.5, P < .01), and hospitalizations (OR 6.4, P < .01).Conclusions: This study describes the natural history of RAD into adulthood in a non-institutionalized sample. The findings suggest that children with RAD have a high burden of psychiatric comorbidities and reduced psychosocial functioning into adulthood that extend beyond the impairment associated with ADHD, a common comorbidity in RAD. These findings highlight the continuous impact of early attachment difficulties on the developmental trajectory of children.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno Reativo de Vinculação na Infância , Humanos , Criança , Adulto , Pré-Escolar , Adolescente , Transtorno Reativo de Vinculação na Infância/diagnóstico , Transtorno Reativo de Vinculação na Infância/epidemiologia , Transtorno Reativo de Vinculação na Infância/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Comorbidade , Tentativa de Suicídio
18.
JAMA Psychiatry ; 79(3): 219-231, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-35044428

RESUMO

IMPORTANCE: Although suicide attempts remain the strongest risk factor for future suicide, little is known about recent trends in the prevalence of and risk factors for suicide attempts and past-year use of services among adults who attempted suicide. OBJECTIVE: To estimate annual rates of suicide attempts and use of mental health services among US adults from 2008 to 2019. DESIGN, SETTING, AND PARTICIPANTS: This US nationally representative cross-sectional study used the National Survey of Drug Use and Health (NSDUH) from 2008 through 2019. Participants included noninstitutionalized US civilians 18 years or older (n = 484 732). The overall annual rates of suicide attempts per 100 000 adults in the general population and national trends from 2008 to 2019 were estimated, with suicide attempts defined as self-reported efforts to kill one's self in the past 12 months. Subgroup analyses were also performed by demographic characteristics and clinical conditions. The trends in past-year use of mental health services among those who reported past-year suicide attempts were then examined. Data were analyzed from October to December 2021. MAIN OUTCOMES AND MEASURES: Rate of suicide attempts from 2008 to 2019. Multivariate-adjusted logistic regression analyses were used to determine whether adjusting for sociodemographic and clinical factors associated with past-year suicide attempts could account for the change within the study period. RESULTS: Of 484 732 survey participants, most were 35 years or younger (69.8%), women (51.8%), and non-Hispanic White individuals (65.7%). From 2008 to 2019, the weighted unadjusted suicide attempt rate per 100 000 population increased from 481.2 to 563.9 (odds ratio [OR], 1.17 [95% CI, 1.01-1.36]; P = .04) and remained significant after controlling for sociodemographic characteristics (adjusted OR [aOR], 1.23 [95% CI, 1.05-1.44]; P = .01). Rates of suicide attempt increased particularly among young adults aged 18 to 25 years (aOR, 1.81 [95% CI, 1.52-2.16]; P < .001), women (aOR, 1.33 [95% CI, 1.09-1.62]; P = .005), those who were unemployed (aOR, 2.22 [95% CI, 1.58-3.12]; P < .001) or never married (aOR, 1.60 [95% CI, 1.31-1.96]; P < .001), and individuals who used substances (aOR, 1.44 [95% CI, 1.19-1.75]; P < .001). In multivariate analyses, the temporal trend of increasing suicide attempts remained significant even after controlling for other significant sociodemographic and clinical factors (aOR, 1.36 [95% CI, 1.16-1.60]; P < .001). Several sociodemographic and clinical subgroups remained independently associated with suicide attempts, especially those with serious psychological distress (aOR, 7.51 [95% CI, 6.49-8.68]; P < .001), major depressive episodes (aOR, 2.90 [95% CI, 2.57-3.27]; P < .001), and alcohol use disorder (aOR, 1.81 [95%CI, 1.61-2.04]; P< .001) as well as individuals who reported being divorced or separated (aOR, 1.65 [95% CI, 1.35-2.02]; P < .001) or being unemployed (aOR, 1.47 [95% CI, 1.27-1.70]; P< .001) and those who identified as Black (aOR, 1.41 [95% CI, 1.24-1.60]; P < .001) or American Indian or Alaska Native, Asian, or Native Hawaiian or Other Pacific Islander (aOR, 1.56 [95% CI, 1.26-1.93]; P < .001). Among adults with a suicide attempt, there was no significant change in the likelihood of receiving past-year mental health or substance-related services. During the study period, 34.8% to 45.5% reported needing services but did not receive them, with no significant change from 2008 to 2019. CONCLUSIONS AND RELEVANCE: Although suicide attempts appear to be increasing, use of services among those who attempted suicide has not increased, suggesting a need to expand service accessibility and/or acceptability, as well as population-wide prevention efforts.


Assuntos
Transtorno Depressivo Maior , Tentativa de Suicídio , Estudos Transversais , Feminino , Humanos , Saúde Mental , Fatores de Risco , Adulto Jovem
19.
J Am Acad Child Adolesc Psychiatry ; 61(9): 1141-1154, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35367608

RESUMO

OBJECTIVE: While the psychological effects of military service on the children of active-duty personnel have been studied extensively, little is known about the potential effects of military service for children of veterans after service has ended. METHOD: Using nationally representative data from the 2018-2019 National Survey of Children's Health, school-age children of veteran families (n = 4,028) were compared with children of nonveteran families (n = 38,228). Owing to large sample sizes, effect sizes (relative risk and Cohen's d), rather than p values, were used to identify substantial differences in caregiver-reported sociodemographic, clinical, and school performance factors between children and caregivers in families with and without a veteran caregiver. Multivariate analyses were used to adjust for socioeconomic factors that could increase health service use. RESULTS: Children of veteran families were more likely to have higher family incomes, health insurance, and married caregivers, but were also reported to have higher rates of clinically recognized externalizing behavioral conditions (attention-deficit disorder/attention-deficit/hyperactivity disorder or conduct disorder) (17.6% vs 12.7%; relative risk 1.42; 95% CI 1.21-1.66) and adverse childhood experiences; no substantial differences were reported in clinically recognized anxiety or depression. After adjustment for potentially confounding factors, children in veteran families were still more likely to be reported to have externalizing problems (odds ratio 1.34; 95% CI 1.02-1.77). CONCLUSION: After adjustment for socioeconomic advantages that may increase health service use, children of veteran families demonstrate substantially higher rates of clinically recognized externalizing problems. While explanations for this require further study, service systems working with veterans may consider integrating child-focused screening/services.


Assuntos
Veteranos , Ansiedade , Cuidadores/psicologia , Família/psicologia , Humanos , Fatores Socioeconômicos , Veteranos/psicologia
20.
J Clin Psychiatry ; 84(1)2022 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-36479956

RESUMO

Objective: Poor social support is a robust predictor of suicidal thoughts and behaviors (STB). However, little is known about which components of social support (ie, diversity of social networks and perceived strength of social support) may play a protective role for STB.Methods: We analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions Wave III to examine whether diversity of social networks or perceived strength of social support was inversely associated with lifetime STB (ie, suicidal ideation and suicide attempts). Multivariable-adjusted analyses examined the independent association between components of social support and STB, while accounting for sociodemographic, clinical, and behavioral covariates.Results: Among adults with a history of suicide attempt, the majority reported low diversity/high perceived support (48.5%), followed by high diversity/high perceived support (36.0%). Similar patterns were found among adults with lifetime suicidal ideation. In multivariable-adjusted analyses, greater social network diversity was associated with a lower relative risk (RR) of suicidal ideation (RR = 0.83; 95% confidence interval [CI], 0.75-0.83) and attempt (RR = 0.79; 95% CI, 0.67-0.94). While greater perceived strength of social support was linked to a lower risk of suicide attempt (RR = 0.81; 95% CI, 0.68-0.97), such an association was not observed for ideation.Conclusions: Greater diversity of social networks was more strongly associated with lower risks of suicidal ideation and attempt than perceived strength of social support. Psychosocial interventions to enhance the diversity of social networks may be a source to mitigate risks for STB, but further research is warranted.


Assuntos
Apoio Social , Ideação Suicida , Humanos , Tentativa de Suicídio/prevenção & controle , Rede Social , Integração Social
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