RESUMO
As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino (n = 4), non-Hispanic/Latino Black (n = 8), or non-Hispanic/Latino White (n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient-provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.
Assuntos
Atenção à Saúde , Depressão , Racismo , Adulto , Negro ou Afro-Americano , Depressão/terapia , Etnicidade , Hispânico ou Latino , Humanos , Aceitação pelo Paciente de Cuidados de SaúdeRESUMO
BACKGROUND: The Food and Drug Administration's 2004 antidepressant warning was followed by decreases in antidepressant prescribing for youth. This was due to declines in all types of depression treatment, not just the intended changes in antidepressant prescribing patterns. Little is known about how these patterns varied by race/ethnicity. METHOD: Data are Medicaid claims from four U.S. states (2002-2009) for youth ages 5-17. Interrupted time series analyses measured changes due to the warning in levels and trends, by race/ethnicity, of three outcomes: antidepressant prescription fills, depression treatment visits, and incident fluoxetine prescription fills. RESULTS: Prewarning, antidepressant fills were increasing across all racial/ethnic groups, fastest for White youth. Postwarning, there was an immediate drop and continued decline in the rate of fills among White youth, more than double the decline in the rate among Black and Latino youth. Prewarning, depression treatment visits were increasing for White and Latino youth. Postwarning, depression treatment stabilized among Latinos, but declined among White youth. Prewarning, incident fluoxetine fills were increasing for all groups. Postwarning, immediate increases and increasing trends of fluoxetine fills were identified for all groups. CONCLUSIONS: Antidepressant prescription fills declined most postwarning for White youth, suggesting that risk information may have diffused less rapidly to prescribers or caregivers of minorities. Decreases in depression treatment visits help to explain the declines in antidepressant prescribing and were largest for White youth. An increase in incident fluoxetine fills, the only medication indicated for pediatric depression at the time, suggests that the warning may have shifted prescribing practices.
Assuntos
Antidepressivos/uso terapêutico , Negro ou Afro-Americano/estatística & dados numéricos , Depressão/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Fluoxetina/uso terapêutico , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Guias de Prática Clínica como Assunto , United States Food and Drug Administration , População Branca/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estados UnidosRESUMO
The Internet's permeation into daily life has profoundly changed the practice of psychiatry with adolescents, who mobilize online social media and related technologies in their efforts to develop identity and "hang out" with peers. Technology offers both challenges and opportunities to mental health professionals working with teens. Practitioners will need a new skill-set, including keeping abreast of technological developments; professionally incorporating technology into clinical assessment and practice; identifying the negative impacts of technology on teens' physical and mental health and the particular vulnerabilities of at-risk patients in a digital world; and guiding patients and parents about interventions. Particular patient factors related to race/ethnicity, gender and sexual orientation, mental health and trauma history, family culture, parenting style, and personality traits will need to be considered. This article provides an overview of the literature on adolescents and the Internet focusing on recent research on Internet and digital technologies used for social communication among youth.
Assuntos
Comportamento do Adolescente/psicologia , Internet , Transtornos Mentais/etiologia , Adolescente , Humanos , Internet/estatística & dados numéricos , Fatores de Risco , Mídias SociaisRESUMO
BACKGROUND: The objective was to develop and assess performance of an algorithm predicting suicide-related ICD codes within three months of psychiatric discharge. METHODS: This prognostic study used a retrospective cohort of EHR data from 2789 youth (12 to 20 years old) hospitalized in a safety net institution in the Northeastern United States. The dataset combined structured data with unstructured data obtained through natural language processing of clinical notes. Machine learning approaches compared gradient boosting to random forest analyses. RESULTS: Area under the ROC and precision-recall curve were 0.88 and 0.17, respectively, for the final Gradient Boosting model. The cutoff point of the model-generated predicted probabilities of suicide that optimally classified the individual as high risk or not was 0.009. When applying the chosen cutoff (0.009) to the hold-out testing set, the model correctly identified 8 positive cases out of 10, and 418 negative cases out 548. The corresponding performance metrics showed 80 % sensitivity, 76 % specificity, 6 % PPV, 99 % NPV, F-1 score of 0.11, and an accuracy of 76 %. LIMITATIONS: The data in this study comes from a single health system, possibly introducing bias in the model's algorithm. Thus, the model may have underestimated the incidence of suicidal behavior in the study population. Further research should include multiple system EHRs. CONCLUSIONS: These performance metrics suggest a benefit to including both unstructured and structured data in design of predictive algorithms for suicidal behavior, which can be integrated into psychiatric services to help assess risk.
Assuntos
Alta do Paciente , Ideação Suicida , Adolescente , Criança , Humanos , Adulto Jovem , Algoritmos , Pacientes Internados , Estudos RetrospectivosRESUMO
Importance: The COVID-19 pandemic has contributed to poorer mental health and a greater need for treatment. Nationally representative estimates of major depressive disorder (MDD) and mental health treatment among US adolescents during the pandemic are needed. Objective: To estimate MDD prevalence among adolescents, evaluate mental health treatment use among adolescents with MDD, and assess differences by race and ethnicity. Design, Setting, and Participants: This cross-sectional analysis of the nationally representative 2021 National Survey on Drug Use and Health included noninstitutionalized US adolescents between the ages of 12 and 17 years (n = 10â¯743). Analytic weights were applied to all rates and model estimates to be nationally representative and account for sample design and survey nonresponse. Data were collected from January 14 to December 20, 2021, and analyzed from February 11 to April 3, 2023. Exposures: Self-reported race and ethnicity. Main Outcomes and Measures: Dichotomous outcomes of MDD as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), MDD-specific mental health treatment, any type of mental health treatment, telehealth visits, and delays in mental health treatment. Results: The sample included 10â¯743 adolescents (51.1% male). Self-reported race and ethnicity included 5.1% Asian, 14.1% Black, 23.3% Latinx, 51.2% White, and 6.3% more than 1 race. Ages were evenly distributed: 34.0% aged 12 to 13 years; 33.3% aged 14 to 15 years; and 32.7% aged 16 to 17 years. Adolescents of more than 1 race or ethnicity had the highest MDD rate (26.5%). Compared with White adolescents, the lowest rates of any MDD treatment overall were found among Latinx adolescents (29.2% [95% CI, 22.2%-36.2%]) and those of more than 1 race or ethnicity (21.1% [95% CI, 11.6%-30.7%]). Similar results were found for treatment by any clinician (Latinx, 25.6% [95% CI, 18.8%-32.4%]; >1 race or ethnicity, 19.1% [95% CI, 9.7%-28.6%]), treatment by a mental health specialist (Latinx, 22.9% [95% CI, 16.9%-28.9%]; >1 race or ethnicity, 16.7% [95% CI, 7.1%-26.3%]), treatment by a nonspecialist clinician (Latinx, 7.3% [95% CI, 3.3%-11.3%]; >1 race or ethnicity, 4.8% [95% CI, 1.9%-7.7%]), and use of any psychotropic medication prescription (Latinx, 11.6% [95% CI, 7.3%-15.9%]; >1 race or ethnicity, 8.3% [95% CI, 2.8%-13.7]). Compared with White adolescents, Black adolescents had lower rates of MDD treatment by any clinician (31.7% [95% CI, 23.7%-39.8%]) and by nonspecialist clinicians (8.4% [95% CI, 3.8%-13.2%]) and experienced lower prescription rates for any psychotropic medication (12.6 [95% CI, 4.6%-20.6%]). Asian (16.0% [95% CI, 5.0%-27.2%]) and Latinx (17.8% [95% CI, 12.6%-23.0%]) adolescents had lower rates of virtual mental health treatment compared with White adolescents. Black (19.1% [95% CI, 14.1%-24.2%]) and Latinx (17.9% [95% CI, 15.0%-21.1%]) adolescents had lower rates of appointments transition to telehealth, while Black adolescents (14.1% [95% CI, 10.7%-17.4%]) experienced delays getting their prescriptions. Conclusions and Relevance: During the first full calendar year of the pandemic, approximately 1 in 5 adolescents had MDD, and less than half of adolescents who needed treatment had any mental health treatment. Adolescents in racial and ethnic minority groups, particularly Latinx, experienced the lowest treatment rates. Federal policy should target adolescents as a whole, and minority populations in particular, to ensure equitable treatment access. Efforts should consider the social, racial, ethnic, and cultural determinants of health.
Assuntos
Transtorno Depressivo Maior , Etnicidade , Humanos , Masculino , Adolescente , Criança , Feminino , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/terapia , Estudos Transversais , Pandemias , Grupos MinoritáriosRESUMO
OBJECTIVE: The study examined racial-ethnic disparities in access to and utilization of treatment for attention-deficit hyperactivity disorder (ADHD) and other psychiatric diagnoses among children with ADHD. METHODS: Nationally representative, cross-sectional data from the Household Component of the Medical Expenditure Panel Survey 2011-2019 were used to examine racial-ethnic disparities in access to and utilization of treatment by children ages 5-17 with ADHD (N=5,838). Logistic regression models were estimated for access outcomes, and generalized linear models were estimated for utilization outcomes. Multivariable regression models adjusted for race-ethnicity, age, sex, and treatment need in accordance with the Institute of Medicine definition of health care disparities. RESULTS: In adjusted analyses, compared with White children with ADHD, Black, Hispanic, and Asian children with ADHD had significantly lower rates of any past-year treatment visit for ADHD or for other psychiatric diagnoses. They also had lower rates of having accessed ADHD medication. Compared with White children, Black and Asian children with ADHD used fewer ADHD medications, and Black and Hispanic children with ADHD had lower overall mental health treatment expenditures. CONCLUSIONS: Disparities in ADHD treatment among children from racial-ethnic minority populations may be driven primarily by disparities in access rather than in utilization. Once treatment had been accessed, disparities in utilization were largely accounted for by differences in socioeconomic status. These findings suggest that interventions targeting access to treatment among children from racial-ethnic minority populations may help close existing care gaps.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Etnicidade , Criança , Humanos , Estados Unidos , Pré-Escolar , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Estudos Transversais , Grupos Minoritários , Disparidades em Assistência à SaúdeRESUMO
OBJECTIVE: To describe the mental health service use of Haitian, African-American, and non-Latino White youth in a community mental health setting. Groups are compared on adherence to treatment guidelines for attention-deficit/hyperactivity disorder (ADHD) and depressive disorders. DESIGN: Retrospective review of outpatient mental health charts (n = 252) from five community sites in an urban area of the Northeastern United States. We recorded the total number and treatment type of sessions during the first six months of treatment. Guideline-adherent treatments were compared and predicted after controlling for clinical need. RESULTS: Most Haitian and African-American youth stopped treatment by six months, with the majority attending less than eight sessions. One third of Haitian and African-American patients attended just one session. Haitian patients who presented with less severe symptoms and dysfunction were more likely to have single-session treatments. Guideline-adherent treatment for ADHD and depression was less likely for Haitians. Older patients were more likely to receive adequate depression treatment. Haitian youth were relatively underinsured, had more family separations documented, and received Adjustment Disorder diagnoses more often. CONCLUSIONS: Haitian youth use outpatient mental health services in similar proportion to African-American youth and at lower rates than White youth. Guideline-adherent treatment for ADHD and depression is limited by low retention in care for Black youth. Low insurance coverage is likely an important contributor to reduced use of services, especially for Haitians. These findings are discussed in the context of providing culturally sensitive mental health care to diverse communities.
Assuntos
Transtornos de Adaptação/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Serviços de Saúde Mental/estatística & dados numéricos , Qualidade da Assistência à Saúde , Adolescente , Negro ou Afro-Americano/etnologia , Negro ou Afro-Americano/estatística & dados numéricos , Fatores Etários , Criança , Pré-Escolar , Diversidade Cultural , Feminino , Fidelidade a Diretrizes , Haiti/etnologia , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Serviços de Saúde Mental/provisão & distribuição , Modelos Psicológicos , Pacientes Ambulatoriais , Guias de Prática Clínica como Assunto , Psicometria , Estudos Retrospectivos , Estados Unidos , População Urbana , População Branca/etnologia , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
The COVID-19 pandemic has been expected to lead to substantial increases in need for behavioral health care. A population health framework can facilitate the development of interventions and policies to promote the equitable distribution of care across the population. This column describes the application of population behavioral health principles in a safety-net health system during the pandemic. The approach includes stepped models of care, interventions to target individuals at high behavioral health risk, and measurement-based care. Early data suggest that these strategies have resulted in expanded behavioral health care capacity.
Assuntos
COVID-19 , Saúde da População , Programas Governamentais , Humanos , Pandemias , SARS-CoV-2RESUMO
OBJECTIVE: The rapid proliferation of machine learning research using electronic health records to classify healthcare outcomes offers an opportunity to address the pressing public health problem of adolescent suicidal behavior. We describe the development and evaluation of a machine learning algorithm using natural language processing of electronic health records to identify suicidal behavior among psychiatrically hospitalized adolescents. METHODS: Adolescents hospitalized on a psychiatric inpatient unit in a community health system in the northeastern United States were surveyed for history of suicide attempt in the past 12 months. A total of 73 respondents had electronic health records available prior to the index psychiatric admission. Unstructured clinical notes were downloaded from the year preceding the index inpatient admission. Natural language processing identified phrases from the notes associated with the suicide attempt outcome. We enriched this group of phrases with a clinically focused list of terms representing known risk and protective factors for suicide attempt in adolescents. We then applied the random forest machine learning algorithm to develop a classification model. The model performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. RESULTS: The final model had a sensitivity of 0.83, specificity of 0.22, AUC of 0.68, a PPV of 0.42, NPV of 0.67, and an accuracy of 0.47. The terms mostly highly associated with suicide attempt clustered around terms related to suicide, family members, psychiatric disorders, and psychotropic medications. CONCLUSION: This analysis demonstrates modest success of a natural language processing and machine learning approach to identifying suicide attempt among a small sample of hospitalized adolescents in a psychiatric setting.
Assuntos
Comportamento do Adolescente , Adolescente Hospitalizado/psicologia , Aprendizado de Máquina , Processamento de Linguagem Natural , Ideação Suicida , Adolescente , Algoritmos , Criança , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Massachusetts , Unidade Hospitalar de Psiquiatria , Psicologia do Adolescente , Tentativa de Suicídio/psicologia , Adulto JovemRESUMO
Digital media (also called "new media") have become an important ecosystem in which adolescents develop biologically, psychologically, and socially. When assessing adolescents in the psychiatric interview, a nuanced understanding of digital media use can inform a more accurate formulation. However, there are few published resources to help the psychiatrist assess the impact of digital media during the initial adolescent interview. The authors propose an innovation on the traditional psychiatric assessment that addresses teen Internet use and digital media habits. Through this enhanced assessment, mental health clinicians can improve upon current interviewing practices of twenty-first century adolescents.
Assuntos
Comportamento do Adolescente , Internet , Entrevista Psicológica , Transtornos Mentais/diagnóstico , Mídias Sociais , Adolescente , HumanosRESUMO
OBJECTIVE: Clinical practice guidelines underscore the need for careful evaluation of the risk-benefit ratio of psychotropic medications treating mental health disorders among youth. While it is well known that racial/ethnic disparities exist in psychotropic medication use, little is known about whether these differences are driven by over-prescribing among white youth, under-prescribing among minority youth, or both. To build evidence in this area, this study examined racial/ethnic differences in the prescription of psychotropic medications among youth with and without psychological impairment. METHODS: Secondary data on two-year medication use from the 2004-2011 Medical Expenditure Panel Surveys were analyzed. We capitalized on two-year panel data, creating variables that allow for differential sequencing of psychological impairment and medication prescription (e.g., impairment in year 1 or year 2, and a psychotropic medication fill in year 2). Statistical differences were determined using unadjusted rate comparisons and logistic regression models, after adjustment for socio-contextual and health status characteristics. RESULTS: Compared to Black and Latino youth with psychological impairment, White youth were more likely to be prescribed psychotropic medications when impaired. Among youth never having psychological impairment, White youth were also more likely to be prescribed medications compared to their racial/ethnic minority counterparts. CONCLUSIONS: Differences in rates of medication use among youth with and without impairment suggest poor medication targeting across racial/ethnic groups. These results, combined with recent psychotropic medication risk warnings and concerns over increases in psychotropic medication use among youth, suggest that a continued emphasis on accurate targeting of prescribing patterns is needed across racial/ethnic groups.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/etnologia , Psicotrópicos/uso terapêutico , População Branca/estatística & dados numéricos , Adolescente , Negro ou Afro-Americano/etnologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estados Unidos/etnologia , População Branca/etnologiaRESUMO
Clinicians in community mental health settings frequently evaluate individuals suffering from physical health problems. How patients make meaning of such "comorbidity" can affect mental health in ways that may be influenced by cultural expectations and by the responses of clinicians, with implications for delivering culturally sensitive care. A sample of 30 adult mental health intakes exemplifying physical illness assessment was identified from a larger study of patient-provider communication. The recordings of patient-provider interactions were coded using an information checklist containing 21 physical illness items. Intakes were analyzed for themes of meaning making by patients and responses by clinicians. Post-diagnostic interviews with these patients and clinicians were analyzed in similar fashion. Clinicians facilitated disclosures of physical suffering to varying degrees and formulated them in the context of the culture of mental health services. Patients discussed their perceptions of what was at stake in their experience of physical illness: existential loss, embodiment, and limits on the capacity to work and on their sense of agency. The experiences of physical illness, mental health difficulties, and social stressors were described as mutually reinforcing. In mental health intakes, patients attributed meaning to the negative effects of physical health problems in relation to mental health functioning and social stressors. Decreased capacity to work was a particularly salient concern. The complexity of these patient-provider interactions may best be captured by a sociosomatic formulation that addresses the meaning of physical and mental illness in relation to social stressors.
Assuntos
Serviços Comunitários de Saúde Mental , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Dor/diagnóstico , Adolescente , Adulto , Idoso , Comorbidade , Feminino , Nível de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Medicina Psicossomática , Pesquisa Qualitativa , Adulto JovemRESUMO
OBJECTIVE: Outpatient follow-up after hospitalization for mental health reasons is an important indicator of quality of health systems. Differences among racial-ethnic minority groups in the quality of service use during this period are understudied. This study assessed the quality of outpatient treatment episodes following inpatient psychiatric treatment among blacks, whites, and Latinos in the United States. METHODS: The Medical Expenditure Panel Survey (2004-2010) was used to identify adults with any inpatient psychiatric treatment (N=339). Logistic regression models were used to estimate predictors of any outpatient follow-up or the beginning of adequate outpatient follow-up within seven or 30 days following discharge. Predicted disparities were calculated after adjustment for clinical need variables but not for socioeconomic characteristics, consistent with the Institute of Medicine definition of health care disparities as differences that are unrelated to clinical appropriateness, need, or patient preference. RESULTS: Rates of follow-up were generally low, particularly rates of adequate treatment (<26%). Outpatient treatment prior to inpatient care was a strong predictor of all measures of follow-up. After adjustment for need and socioeconomic status, the analyses showed that blacks were less likely than whites to receive any treatment or begin adequate follow-up within 30 days of discharge. CONCLUSIONS: Poor integration of follow-up treatment in the continuum of psychiatric care leaves many individuals, particularly blacks, with poor-quality treatment. Culturally appropriate interventions that link individuals in inpatient settings to outpatient follow-up are needed to reduce racial-ethnic disparities in outpatient mental health treatment following acute treatment.
Assuntos
População Negra/estatística & dados numéricos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Transtornos Mentais/terapia , Grupos Minoritários/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Humanos , Estados UnidosRESUMO
OBJECTIVES: Past literature documents many individual predictors of treatment engagement among mental health clients in community settings, but few studies have examined clinic characteristics that may be associated with treatment engagement. With data from a patient activation and self-management trial, this study examined the variation in demographic and clinic characteristics across community mental health clinics and whether this variation predicted differences in treatment engagement in mental health services. METHODS: Chart reviews were conducted for 638 clients of 12 community mental health clinics. Client attendance records were collected for a one-year period to examine engagement (defined as the ratio of kept versus scheduled appointments). Adjusting for client variability, the investigators examined which clinic-level characteristics were associated with treatment engagement. RESULTS: Clinics varied significantly in their clients' demographic characteristics and engagement in mental health care. Providing case management and offering transportation vouchers or free parking at the clinic were associated with lower engagement. However, offering outreach was associated with greater engagement. CONCLUSIONS: The results of this study suggest that certain clinic characteristics are associated with engagement in mental health services. These results demonstrate the difficulties faced by community mental health clinics in reducing no-show rates even in the face of strong efforts to improve engagement.
Assuntos
Centros Comunitários de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Children's psychological adjustment following parental separation or divorce is a function of the characteristics of the custodial parent, as well as the degree of postdivorce parental cooperation. Over time, custody has shifted from fathers to mothers and currently to joint arrangements. In this retrospective chart review of family court clinic records we examined predictors of custody and visitation. Our work improves on previous studies by assessing a greater number of predictor variables. The results suggest that parental emotional instability, antisocial behavior, and low income all decrease chances of gaining custody. The findings also show that income predicts whether a father is recommended for visitation rights and access to his child or children. Furthermore, joint custody is not being awarded as a function of parental postdivorce cooperation. At issue is whether parental emotional stability, antisocial behavior, and income are appropriate markers for parenting capacity and whether visitation rights and joint custody are being decided in a way that serves the child's best interests.
Assuntos
Custódia da Criança/legislação & jurisprudência , Divórcio/legislação & jurisprudência , Conflito Familiar/legislação & jurisprudência , Relações Pais-Filho/legislação & jurisprudência , Pais/psicologia , Adaptação Psicológica , Adolescente , Sintomas Afetivos/diagnóstico , Sintomas Afetivos/psicologia , Transtorno da Personalidade Antissocial/diagnóstico , Transtorno da Personalidade Antissocial/psicologia , Criança , Comportamento Cooperativo , Escolaridade , Conflito Familiar/psicologia , Feminino , Humanos , Masculino , Pobreza/legislação & jurisprudência , Pobreza/psicologia , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVE: To review the literature on racial and ethnic disparities in behavioral health services and present recent data, focusing on services for substance use disorders (SUD) and comorbid mental health disorders for children and adolescents. METHOD: A literature review was conducted of behavioral health services for minority youth. Articles were included if specific comparisons in receipt of SUD services for youth were made by race or ethnicity. The review was organized according to a sociocultural framework. RESULTS: Compared with non-Latino Whites with SUD, Black adolescents with SUD reported receiving less specialty and informal care, and Latinos with SUD reported less informal services. Potential mechanisms of racial and ethnic disparities were identified in federal and economic health care policies and regulations, the operation of the health care system and provider organization, provider level factors, the environmental context, the operation of the community system, and patient level factors. Significant disparity decreases could be achieved by adoption of certain state policies and regulations that increase eligibility in public insurance. There is also a need to study how the organization of treatment services might lead to service disparities, particularly problems in treatment completion. Institutional and family characteristics linked to better quality of care should be explored. Because treatments appear to work well independent of race/ethnicity, translational research to bring evidence-based care in diverse communities can bolster their effectiveness. CONCLUSIONS: This review suggests promising venues to decrease ethnic and racial disparities in behavioral health services for ethnic and racial minority youth.
Assuntos
Terapia Cognitivo-Comportamental/organização & administração , Prática Clínica Baseada em Evidências/métodos , Disparidades nos Níveis de Saúde , Transtornos Mentais/epidemiologia , Serviços de Saúde Escolar/organização & administração , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Criança , Serviços Comunitários de Saúde Mental/legislação & jurisprudência , Serviços Comunitários de Saúde Mental/métodos , Comorbidade , Diversidade Cultural , Etnicidade/psicologia , Prática Clínica Baseada em Evidências/legislação & jurisprudência , Características da Família/etnologia , Necessidades e Demandas de Serviços de Saúde , Humanos , Política Organizacional , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Estados UnidosRESUMO
BACKGROUND: Media exposure has been found to impact adolescent smoking, although the mechanisms of this relationship have not been thoroughly investigated. Drive for thinness and tobacco advertising receptivity, both shown to be associated with smoking, are two potential mediators. METHODS: 967 twelfth grade students completed a self-report survey as part of a longitudinal study of biobehavioral predictors of smoking. Exposure to magazines and television, drive for thinness, tobacco advertisement receptivity, and twelfth grade smoking level were the primary variables of interest. Effects of gender, race, BMI, smoking exposure, and perceived physical appearance were controlled for in the model. RESULTS: Exposure to fashion, entertainment, and gossip magazines had indirect effects on smoking via drive for thinness and tobacco advertisement receptivity. There was a direct effect of health, fitness, and sports magazine reading on smoking. Television watching had no significant effects on smoking. CONCLUSIONS: Adolescents who read fashion, entertainment, and gossip magazines may be more likely to smoke, in part, because of a higher drive for thinness and greater receptivity to cigarette advertisements. Conversely, adolescents reading Health and Fitness magazines may be less likely to smoke. Drive for thinness and tobacco advertising receptivity are thus potential targets for adolescent smoking intervention.