The impact of the Great Recession on California domestic violence events, and related hospitalizations and emergency service visits.

OBJECTIVE: Explore the impact of the Great Recession on domestic violence (DV) related hospitalizations and emergency department (ED) visits in California. METHODS: Hospital and ED data were drawn from California's Office of Statewide Health Planning and Development (OSHPD). DV-related hospitalizations and ED visits in California were analyzed between January 2000 and September 2015 (53,596), along with total medical costs. Time series were divided into pre-recession (Jan 2000-Nov 2007) and recession/post-recession (Dec 2007-Sept 2015) periods. RESULTS: The medical cost of DV-related hospitalizations alone was estimated as $1,136,165,861. A dramatic increase in DV episodes was found potentially associated with the Great Recession. The number of ED visits per month tripled from pre- to post-recession (104.9 vs. 290.6), along with an increased number of hospitalizations (77.1 vs. 95.6); African Americans and Native Americans were disproportionally impacted. In addition, psychiatric comorbidities, severe DV episodes, in-hospital mortality and charge per hospitalization escalated. The rise in DV hospitalizations and ED visits beginning in December 2007 was mainly attributable to physical abuse episodes in adults; minors had no change in DV trends. DISCUSSION: Recessions are frequent in modern economies and are repeated cyclically. Our study provides critical information on the effects of the 2007 financial crisis on DV-related healthcare service utilization in California. Given the current financial crisis associated with COVID-19, which expert predict could extend for years, the results from this study shine a spotlight on the importance of DV-related screening, prevention and response.

The impact of the 2008 economic crisis on the increasing number of young psychiatric inpatients. / Impacto de la crisis económica del 2008 en el número de jóvenes hospitalizados por patología psiquiátrica.

BACKGROUND: Little is published about the impact of the 2008 economic crisis on mental health services in Spain. METHOD: An interrupted time series analysis was conducted to investigate a potential short-term association between the 2008 economic crisis and the number of psychiatric hospital admissions. The timing of the intervention (April 2008) was based on observed changes in Gross Domestic Product (GDP). Data on 1,152,880 psychiatric inpatients from the national Hospital Morbidity Survey, 69 months before and after the onset of the economic crisis (April 2008), were analyzed. RESULTS: Age-adjusted psychiatric (ICD9 290-319) hospital discharge rates significantly increased from April 2008, matching the onset of the crisis, especially for inpatients aged 15-24 years old and to a less extend for inpatients aged 25-34 years old. Other age groups were not affected. There was a significant increase in diagnoses for disturbance of conduct and emotions, depression, neurotic and personality disorders and alcohol and drug disorders; however, diagnoses for mental retardation and organic psychosis for 15-34 years old inpatients were unaffected. CONCLUSIONS: Psychiatric hospital admissions abruptly increased in April 2008, coinciding with the onset of the economic crisis. We identified age groups and diagnoses affected. Increased hospitalizations were found only at the age-ranges most affected by the rise in unemployment. The diagnoses affected were those most sensitive to environmental changes.

Tuberculosis Prevalence Among US Crop-Workers, 2000 to 2012: Trends and Contributing Factors.

OBJECTIVE: We intend to study tuberculosis (TB) in one of the poorest communities in the US, hired agriculture workers, for most recent years (2000 to 2012) including the last recession period. METHODS: Time-chart, simple mean differences, and logistic regressions were used to describe TB-prevalence and risk factors among US crop-workers. Data were drawn from the National Agricultural Workers Survey (NAWS). RESULTS: A high TB-prevalence was found among crop-workers with a dramatically increasing trend in recent years. Hispanic ethnicity, having farmworker family members, the presence of health insurance, and good spoken English were associated with an increased TB-prevalence. CONCLUSION: We found risk factors related to ethnicity and poor access to health care, a strong association between agriculture activity and TB, and an increase of TB-cases due to the 2008 downturn in this underserved population. We urge the health authorities to control this epidemic.

Changing SNAP-Participation Trends Among Farmworker Households in the U.S., 2003-2012.

We investigated Supplemental Nutrition Assistance Program (SNAP) participation among citizen, documented and undocumented immigrant hired crop farmworkers for ten recent years. We analyzed population representative data from the National Agricultural Workers Survey for 2003-2012 (N = 18,243 households). Time-chart, simple mean differences, and logistic regressions described farmworker household participation in SNAP. The 2008 financial crisis almost doubled SNAP-participation by agriculture households (6.5% in 2003-2007 vs. 11.3% in 2008-2012). The increasing SNAP-participation was found for citizen, documented and undocumented immigrant households. We found low participation among documented (OR 0.67, 95% CI 0.56-0.8) and undocumented immigrants (OR 0.63, 95% CI 0.54-0.74) compared to citizens. Low odds ratios (OR 0.70, 95% CI 0.55-0.89) were found for Hispanic-citizens as compared with non-Hispanic white-citizens. Our results may help inform the debate surrounding the effects of the financial crisis on SNAP-participation and on differences in participation among citizens, immigrants, Hispanics and non-Hispanics, the latter suggesting ethnic farmworker disparities in SNAP-participation.

Participation in the Women, Infants, and Children (WIC) Program as Reported by Documented and Undocumented Farm Worker Adults in the Households.

Debate surrounds the provision of Women, Infants, and Children (WIC) benefits to undocumented immigrants. Few studies are available to estimate use of WIC services by documented and undocumented households using nationally representative data. The authors analyzed data from the National Agricultural Workers Survey (NAWS) annual cross-sections from 1993 through 2009 (N = 40,896 person-years). Household documentation status is defined by the status of the adults in the household, not children. Simple mean differences, logistic regressions, and time charts described household participation in WIC over 2-year intervals. Without adjustments for covariates, 10.7% of undocumented farm workers' households and 12.4% of documented households received WIC benefits, yielding an odds ratio of 0.84 (95% confidence interval [CI]: 0.76-0.94). Logistic regressions revealed that for the same number of children in the household, participation by undocumented persons was higher than participation by documented persons. Time charts and logistic regressions with interaction terms showed a stronger correspondence between participation in WIC and number of children <6 years old in undocumented households than documented households. Undocumented farm workers' households were only a little less likely to participate in WIC than documented farm workers' households, and undocumented households' participation was especially responsive to the presence of children. These results are consistent with the legal requirements for WIC participation, which do not distinguish between documented and undocumented households. These results may be helpful in the debate surrounding the effects of undocumented workers on WIC participation and costs.

Changing trends in hospitalization rates associated with psychosis: Spain, 1980-2009.

PURPOSE: To analyze the prevalence of hospitalization attributable to psychosis in Spain over the last three decades. METHODS: Longitudinal analysis (1980-2009) of age-adjusted hospital discharges rates associated with psychosis (ICD9 290-8) in all Spanish hospitals. DATA SOURCE: Spanish Hospital Morbidity Survey. RESULTS: The hospitalization rate associated with psychotic episodes had been gradually increasing since 1980 until 2004; an abrupt turnaround observed in 2004 marks the beginning of a steady decline in the rate. The turning point described is not observed for each of the psychotic diagnoses separately analyzed. However, it is clearly seen when data are grouped in diagnosis-related groups (organic-psychosis, functional psychosis and substance-induced psychosis) since the time course of the diseases within the major diagnostic groups are interrelated as evidenced by shared turning points which collectively display a common time course pattern. Main hospital indicators and antipsychotic drug prescriptions were analyzed for any possible turning point in mid-2000s. Psychiatric hospital beds and length of stays remained stable by 2004; the hospitalizations associated with non-psychotic psychiatric pathologies show no turning point in 2004. However, an abrupt change on antipsychotic drug prescriptions is precisely observed in 2004. CONCLUSIONS: After decades of linear growth, hospitalizations for psychotic patients begin to decline in 2004, coinciding with the start of last generation atypical antipsychotic drug consumption in Spain. Some of the psychotic diagnostic rates evolve in an interrelated manner which calls into question the diagnosis and nosological boundaries between some of these pathologies.