Educational inequalities in hypothermia mortality in the Baltic countries and Finland in 2000-15.

BACKGROUND: Despite an increased focus on cold-related mortality in recent years, there has been comparatively little research specifically on hypothermia mortality and its associated factors. METHODS: Educational inequalities in hypothermia mortality among individuals aged 30-74 in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in 2000-15 were examined using data from longitudinal mortality follow-up studies of population censuses (the Baltics) and from a longitudinal register-based population data file (Finland). RESULTS: Age-standardized mortality rates (ASMRs) were much higher in the Baltic countries than in Finland across the study period. From 2000-07 to 2008-15, overall ASMRs declined in all countries except among Finnish women. Although a strong educational gradient was observed in hypothermia mortality in all countries in 2000-07, inequalities were larger in the Baltic countries. Between 2000-07 and 2008-15, ASMRs declined in all educational groups except for high-educated women in Finland and low-educated women in Lithuania; the changes however were not always statistically significant. The absolute mortality decline was often larger among the low educated resulting in narrowing absolute inequalities (excepting Lithuania), whereas a larger relative decline among the high educated (excepting Finnish women) resulted in a considerable widening of relative inequalities in hypothermia mortality by 2008-15. CONCLUSION: Although some reduction was observed in absolute educational inequalities in hypothermia mortality in 2000-15, substantial and widening relative inequalities highlight the need for further action in combatting factors behind deaths from excessive cold in socioeconomically disadvantaged groups, including risky alcohol consumption and homelessness.

Perceived colorism and lifetime psychiatric disorders among Black American adults: findings from the National Survey of American Life.

Colorism has been propagated across the globe, and skin tone discrimination may partly explain social stratification and health disparities within the Black American population. Using data from a large probability sample of Black American adults (National Survey of American Life; 2001-2003), we examined the relations between perceived colorism and psychiatric disorders. In multivariable logistic regression models, in-group colorism was associated with greater odds of having any lifetime psychiatric disorder (aOR: 1.20; 95% CI: 1.08-1.32; p = 0.00); however, out-group colorism was not significantly associated, net of sociodemographic characteristics and in-group colorism (aOR: 1.08; 95% CI: 0.99-1.18; p = 0.08). When looking at specific disorders, in-group colorism was significantly associated with greater odds of alcohol use disorder, substance use disorder, anxiety disorder, and eating disorder, but was not associated with post-traumatic stress disorder or mood disorder. Out-group colorism was not significantly associated with any psychiatric disorder except anxiety disorder. Our findings show that colorism predicts psychiatric disorders, though more research is needed to understand why the effects of in-group and out-group colorism are related to certain psychiatric disorders but not others.

Psychotic experiences and suicidal behavior: testing the influence of psycho-socioenvironmental factors.

PURPOSE: Research has produced inconsistent results with respect to whether the association between psychotic experiences and suicidal behavior is independent of co-occurring clinical and socioenvironmental factors, despite substantial evidence linking the two phenomena. This study tests whether a comprehensive set of demographic, socioenvironmental, and clinical variables account for the statistical association between psychotic experiences and suicidal behaviors. METHODS: We utilized blocked multivariable logistic regression models to analyze the association between 12-month psychotic experiences and 12-month suicide behaviors (ideation, plan, and attempt) on a subsample (N = 2307) of the National Comorbidity Survey Replication. The models adjusted for socio-demographic characteristics, environmental factors in the form of childhood adversity, mental health service utilization, and psychiatric and substance abuse disorders. RESULTS: Psychotic experiences were significantly associated with suicidal ideation, even after adjusting for socio-demographics, childhood adversity. However, the significant association between psychotic experiences and suicidal ideation was not robust to the inclusion of mental health service utilization and psychiatric disorders. There was no significant association between psychotic experiences and suicide plan. Psychotic experiences were associated with a significantly increased risk of reporting suicide attempts (OR 6.52; 95% CI 1.36-31.11), even after adjusting for the full set of variables. CONCLUSIONS: Although psychotic experiences were not associated with suicidal ideation after statistical adjustments, psychotic experiences were associated with a significantly increased risk of suicide attempts after the inclusion of common risk factors and co-morbidities. Thus, psychotic experiences should be included in routine psychiatric assessments to identify the individuals most at risk for attempting suicide.

Psychiatric problems among returned migrants in Mexico: updated findings from the Mexican Migration Project.

PURPOSE: Migration is often a stressful process that can have deleterious effects on health. We study the potential mental health consequences of migration by comparing Mexican migrants to the United States who have since returned to Mexico with Mexicans who have never migrated. METHODS: Data from the Mexican Migration Project were used to compare returned migrants and non-migrants in Mexico for the years 2007-2016 (N = 7716). Random intercept logistic regression models were used to estimate the associations between characteristics of migration and psychiatric problems. Coarsened exact matching was implemented to account for the selection bias inherent to migration. RESULTS: Relatively healthier Mexicans were more likely to migrate to the United States, regardless of their documentation status. Returned migrants in Mexico who traveled to the United States while undocumented were significantly more likely to report that they experienced psychiatric problems when compared with non-migrant Mexicans, even after adjusting for demographic, socioeconomic, pre-migration health, and community-level factors. CONCLUSIONS: Undocumented return migrants in Mexico are at-risk of developing psychiatric problems, despite evidence that suggests migrants tend to be healthier than non-migrants before they travel to the United States. Mental health services should encompass strategies for migrants on both sides of the border.

Acculturative stress, disability, and health treatment utilization among Asian and Latin American immigrants in the United States.

PURPOSE: Empirical research has largely ignored the potential links between immigration-related stress and disability as well as immigration-related stress and health service utilization despite increasing scholarship on the association between acculturative stress and health. This study examined the associations between acculturative stress, disability, and health treatment utilization among Asian and Latin American immigrants in the United States. METHODS: Data were from the National Latino and Asian American Study (NLAAS), a nationally representative survey of Asians and Latinos living in the United States. The analytic sample contained 2653 immigrants. We utilized multivariable logistic regression and negative binomial regression analyses to examine the associations between acculturative stress and disability domains. We also examined the association between acculturative stress and treatment utilization, as this may have implications for how to best intervene to address any functional disability related to acculturative stress. RESULTS: Acculturative stress was significantly associated with self-reported disability across five domains: self-care, cognition, mobility, time out of role, and social interaction. Additionally, acculturative stress was significantly associated with a greater frequency of disability domains. Acculturative stress was not significantly associated with utilization of services from mental health or general health sectors, but was significantly and positively associated with utilization of non-health care services. The findings were robust regarding the inclusion of everyday discrimination as well as demographic and socioeconomic covariates. CONCLUSIONS: Acculturative stress may be an important yet overlooked correlate of disability among immigrants in the United States. Non-health care services may provide an effective pathway for intervening for these individuals.

Racial discrimination and disability among Asian and Latinx populations in the United States.

PURPOSE: This study examined the association between perceived racial discrimination and disability among Asian and Latinx residents of the United States, as the link between discrimination and disability has gone largely ignored in analyses of these populations. MATERIALS AND METHODS: Nationally representative samples included 2046 Asian Americans and 2515 Latinx Americans from the National Latino and Asian American Study (NLAAS). We used multivariable logistic regression and multivariable negative binomial regression to analyze the association between racial discrimination and five different disability domains as well as racial discrimination and a count of simultaneous functional limitations, respectively. The disability domains included: self-care, cognition, mobility, time out of role, and social interaction. RESULTS AND CONCLUSIONS: Perceived racial discrimination positively and significantly predicted impairments across a variety of disability domains for both Asian and Latinx populations. The estimated associations between racial discrimination and disability were heterogeneous across Asian and Latinx ethnicities. Racial discrimination may contribute to stress for Asians and Latinxs in the United States, potentially increasing the possibility these populations develop disabilities. Rehabilitation efforts should consider the social contexts in which people of color live, recognizing that discrimination may differentially affect risk profiles for disabilities across racial and ethnic groups.IMPLICATIONS FOR REHABILITATIONAcross Asian and Latinx populations, racial discrimination is associated with impairments in self-care, cognition, mobility, time out of role, and social interaction.Future translational research can explore the utility of brief racial discrimination screens in clinical settings to assess risk for disability in various domains.Professionals should attend to the stress and overall impact of racial discrimination, as it is conceivable that racial discrimination may result in the exclusion or hindrance of people of color who are pursuing meaningful participation in places of work, public spaces, and civic life.Society bears the collective obligation to reduce discrimination against Asian and Latinx populations, particularly against those who experience disability.

Educational inequalities in epilepsy mortality in the Baltic countries and Finland in 2000-2015.

Little is known about socioeconomic differences in epilepsy mortality. This study examined educational inequalities in epilepsy mortality in the general population in the Baltic countries and Finland in 2000-2015. Education-specific mortality estimates for individuals aged 30-74 in Estonia, Latvia and Lithuania were obtained from census-linked mortality datasets while data for Finland came from the register-based population and death data file of Statistics Finland. Trends and educational inequalities in epilepsy mortality were assessed using age-standardised mortality rates (ASMRs) per 100,000 person years and age-adjusted mortality rate ratios (RRs) calculated using Poisson regression. ASMRs were higher in men than women in all countries. ASMRs reduced in 2000-2015 among all men and women except for Finnish women. Among men, an inverse educational gradient in epilepsy mortality in 2000-2007 widened in 2008-2015 with ASMRs falling among high and mid educated men in all countries but increasing among low educated men in three countries. An inverse educational gradient in female mortality remained in all countries throughout 2000-2015. Although epilepsy mortality fell in the Baltic countries and Finland (men only) in 2000-2015, this masked a clear inverse educational gradient in mortality that became steeper across the period.

Childhood physical neglect and psychotic experiences: Findings from the National Comorbidity Survey Replication.

AIM: Childhood adversities have been linked to an increased risk for psychosis. However, as yet, there has been comparatively little research on the effects of neglect. This study examined the association between childhood physical neglect and psychotic experiences (PEs) in a general population sample. METHODS: Data were analysed from 2308 individuals collected during the National Comorbidity Survey Replication (NCS-R). Information on lifetime PEs was collected with the WHO-CIDI Psychosis Screen. Respondents also reported on five forms of childhood neglect (went hungry, went without necessities, went unsupervised, lacked medical care, chores too difficult/dangerous). Multivariable logistic regression analysis was used to examine associations. RESULTS: In models adjusted for sociodemographic and psychiatric disorder variables, aggregated physical neglect scores (continuous/dichotomized) were associated with significantly increased odds for any lifetime PEs. All individual forms of neglect except went without necessities (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 0.98-1.50) were significantly associated with PEs with ORs ranging from 1.28 (95% CI: 1.08-1.51, went unsupervised) to 1.53 (95% CI: 1.19-1.97, went without medical care). In models that were further adjusted for co-occurring forms of neglect and childhood physical abuse, doing chores that were too difficult/dangerous continued to be associated with significantly increased odds for PEs (OR: 1.29, 95% CI: 1.03-1.61). CONCLUSIONS: Childhood physical neglect is associated with significantly increased odds for PEs in the general population. Screening for childhood adversities and PEs among potential patients may be important for the early detection of individuals at high risk for psychosis, as well as for formulating comprehensive and effective treatment plans.

Disability and loneliness in nine countries of the former Soviet Union.

BACKGROUND: People with disabilities (PWD) often face structural and other barriers to community involvement and may therefore be at risk of loneliness. Yet, so far, this issue has received little attention. OBJECTIVE: This cross-sectional study aimed to examine the association between disability and loneliness in nine countries of the former Soviet Union (FSU). METHODS: Data were analyzed from 18000 respondents aged ≥18 that came from the Health in Times of Transition (HITT) survey that was undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine in 2010/11. Respondents reported on whether they had a disability (no/yes) and its severity. A single-item question was used to assess loneliness. Logistic regression analysis was used to examine the associations. RESULTS: Across the countries, 6.8% of respondents reported being disabled. In a fully adjusted combined country analysis, disability was associated with higher odds for loneliness (odds ratio: 1.30, 95% confidence interval: 1.06-1.60). In an analysis restricted to PWD, individuals in the most severe disability category (Group 1) had over two times higher odds for loneliness when compared to those in the least severe disability category (Group 3). CONCLUSIONS: Disability is associated with higher odds for reporting loneliness in the FSU countries and this association is especially strong among those who are more severely disabled. An increased focus on the relationship between disability and loneliness is now warranted given the increasing recognition of loneliness as a serious public health problem that is associated with a number of detrimental outcomes.

Disability and psychological distress in nine countries of the former Soviet Union.

BACKGROUND: People with disabilities (PWD) are at increased risk of poor mental health. However, this association and the pathways involved remain under-researched in many parts of the world. This study examined the association between disability and psychological distress in nine countries of the former Soviet Union (FSU). METHODS: Data were analysed from 18,000 adults aged ≥18 years collected during the Health in Times of Transition (HITT) survey undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine in 2010 and 2011. Information was obtained on disability status, the severity of the disability and psychological distress. Logistic regression analysis was used to estimate associations. RESULTS: In a fully adjusted combined country analysis, disability was associated with over two times higher odds for psychological distress (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.86-2.58). The strength of the association varied across the individual countries. Among PWD more severe disability was associated with significantly higher odds for psychological distress (OR: 2.12, 95%CI: 1.26-3.55). LIMITATIONS: The data were cross-sectional and disability status was self-reported, possibly resulting in underreporting. CONCLUSIONS: Disability is associated with worse psychological health in FSU countries, especially among those with more severe disabilities. As poor mental health may also increase the risk of negative outcomes in PWD, this finding highlights the importance of the early detection and treatment of mental disorders in PWD in these countries.

Major discriminatory events and suicidal thoughts and behaviors amongst Black Americans: Findings from the National Survey of American Life.

BACKGROUND: Risk for suicide is growing among certain groups of Black Americans, yet the topic remains understudied. Discrimination appears to increase risk for suicidal thoughts and behaviors, but the evidence has been mixed for Black Americans. This study aimed to examine the association between major discriminatory events and suicidal thoughts and behaviors among Black American adults. METHODS: We drew data from the National Survey of American Life, a representative sample of Black Americans, and used multivariable logistic regression to examine the associations between nine major discriminatory events and suicidal thoughts and behaviors (ideation, plan, attempt), adjusting for sociodemographic characteristics and psychiatric disorders. RESULTS: We found that some major discriminatory events increased odds of reporting suicidal thoughts and behaviors, while others did not. Further, findings suggest the mediating role of psychiatric disorders. LIMITATIONS: The study drew from cross-sectional data and did not allow for causal inferences. CONCLUSIONS: Major discriminatory events have important implications for clinical practice, as well as diagnostic criteria when considering race-related stressors as a precipitator of suicidal thoughts and behaviors.

Physical multimorbidity and suicidal behavior in the general population in the United States.

BACKGROUND: As yet, there has been little research on the association between physical multimorbidity (the co-occurrence of two or more physical illnesses) and suicide, and results have been mixed. This study examined if physical multimorbidity is associated with suicidal behavior in the general population in the United States. METHOD: Data were analyzed from 15,311 adults that were obtained from the Collaborative Psychiatric Epidemiology Surveys (CPES). Information was obtained on nine self-reported physical health conditions and lifetime suicidal behavior (suicidal ideation, plan, and attempts). Logistic regression analysis was used to examine associations. RESULTS: An increasing number of physical health conditions was associated with higher odds for suicidal behavior. Compared to those with no physical conditions, individuals with ≥ 4 physical illnesses had 2.99, 4.82, and 4.39 times higher odds for reporting suicidal ideation, a suicide plan, and suicide attempts, respectively. An interaction analysis showed that for suicide attempts the association was stronger in younger rather than older adults. LIMITATIONS: The data were cross-sectional and information on physical conditions and suicidal behavior was self-reported and may have been subject to reporting bias. CONCLUSIONS: As multimorbidity has increased in recent decades in the United States, alerting medical practitioners to the increased risk of suicidal behavior in adults who have multiple medical conditions as well as screening for suicidality in this group may be important preventive measures to help reduce suicidal behavior in the general population.

Childhood neglect and suicidal behavior: Findings from the National Comorbidity Survey Replication.

BACKGROUND: Although child neglect is common, there has been comparatively little research on it or its specific forms and their effects on mental health in adulthood. OBJECTIVE: This study aimed to examine the association between exposure to different forms of childhood neglect and lifetime suicidal behavior among a nationally representative sample of adults in the U.S. general population. METHODS: Data were analyzed from 5665 adults that were drawn from the National Comorbidity Survey Replication (NCS-R). Information was obtained on 'care', 'supervisory' and 'medical' neglect in childhood and lifetime suicidal behavior (ideation, plan, attempt). Lifetime psychiatric disorders were based on the World Mental Health - Composite International Diagnostic Interview. Logistic regression analysis was used to examine the associations. RESULTS: In fully adjusted models, any neglect was associated with significantly increased odds for all forms of suicidal behavior (suicidal ideation, odds ratio [OR]: 1.80, 95 % confidence interval [CI]: 1.42-2.29; plan, OR: 2.27, 95 % CI: 1.78-2.91; attempt, OR: 2.05, 95 % CI: 1.63-2.59, all p < 0.001). In unadjusted analyses all individual forms of neglect were significantly associated with all forms of suicidal behavior. However, when all forms of neglect were included together in the fully adjusted models, care neglect was no longer significantly associated with any form of suicidal behavior. CONCLUSION: Different forms of childhood neglect are associated with suicidal behavior in adults independent of common mental disorders. Future studies should focus on childhood neglect subtypes in order to better understand the effects of neglect on adult mental health.

Church-Based Sleep Screenings to Detect Mental Health Problems Among Korean-Americans.

Korean-American mental health is poorly understood, and screening for sleep disturbances may be an effective means of identifying at-risk individuals. In partnership with a Korean-American church in Los Angeles, an online survey was administered. The study was conducted at a Korean-American church in Los Angeles, California. The sample consisted of 137 Korean-Americans drawn from the church congregation. Sleep disturbances were measured using a single ordinal variable, and mental health outcomes included nonspecific psychological distress, perceived stress, loneliness, suicidal ideation, hazardous drinking, treatment seeking behaviors, and perceived need for help. Multivariable logistic regression was used to estimate the associations between sleep disturbances and mental health outcomes, adjusting for age and sex. Results are presented as odds ratios (OR) and 95% confidence intervals. Almost a third of the sample reported moderate or severe sleep disturbances. After adjusting for age and sex, sleep disturbances were associated with greater odds of reporting probable mental illness, perceived need for treatment, and treatment-seeking behaviors. Sleep disturbances were also associated with higher levels of perceived stress and loneliness, but were not significantly associated with suicidal ideation or hazardous drinking. Sleep disturbances are associated with mental health problems and may be an important idiom of distress for Korean-Americans. Primary care providers and informal providers in the community (specifically churches) should work together to screen for sleep problems and refer at-risk individuals to appropriate levels of care.

Psychotic experiences in the context of mood and anxiety disorders and their associations with health outcomes among people of color in the United States.

BACKGROUND: Psychotic experiences appear to increase risk for health outcomes above and beyond mood/anxiety disorders. However, existing studies that have found this association were conducted mostly in low- and middle-income countries, calling for more studies to explore the association in other contexts, such as the U.S., where people of color face considerable health disparities. MATERIALS/METHODS: Data from the National Latino and Asian American Survey, and the National Survey of American Life were analyzed. After restricting the analytic sample to individuals with at least one mood or anxiety disorder (N = 2929), multivariable logistic regression was used to examine the associations between psychotic experiences and health outcomes, disabilities, and help-seeking behaviors, adjusting for socio-demographic characteristics and psychiatric disorders. RESULTS: Among people of color with mood/anxiety disorders, 16.58% (n = 519) of the weighted analytic sample reported psychotic experiences. Psychotic experiences were associated with 1.75 times greater odds (95% CI: 1.24-2.47) for reporting a lifetime health condition, with varying odds depending on the specific conditions (e.g. arthritis, heart disease, ulcers, and asthma), and specific disabilities (e.g. cognition, mobility, social interaction, and time out of role). Psychotic experiences were associated with 1.66 times the odds of seeking any treatment (95% CI: 1.20-2.29), and the perceived need for help among people who did not seek treatment (e.g. feeling the need for treatment, being encouraged to seek treatment by others). CONCLUSIONS: Mental health practitioners serving people of color who have mood/anxiety disorders should routinely screen for psychotic experiences, which may suggest health problems and disabilities that warrant integrated healthcare.

Perceived discrimination and psychotic experiences in the English general population.

BACKGROUND: Perceived discrimination has been linked to psychotic experiences (PEs). However, as yet, information is lacking on the relationship between different forms of discrimination and PEs. This study examined this association in the English general population. METHODS: Nationally representative, cross-sectional data were analyzed from 7363 adults aged 16 and above that came from the Adult Psychiatric Morbidity Survey, 2007. Self-reported information was obtained on six forms of discrimination (ethnicity, sex, religious beliefs, age, physical health problems/disability, sexual orientation), while PEs were assessed with the Psychosis Screening Questionnaire (PSQ). Multivariable logistic regression analysis was used to assess associations. RESULTS: In a fully adjusted logistic regression analysis, any discrimination was significantly associated with PEs (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.75-3.48). All individual forms of discrimination were significantly associated with PEs except sexual orientation. Multiple forms of discrimination were associated with higher odds for PEs in a monotonic fashion with those experiencing ≥ 3 forms of discrimination having over 5 times higher odds for any PE. In addition, experiencing any discrimination was associated with significantly increased odds for all individual forms of PE with ORs ranging from 2.16 (95%CI: 1.40-3.35) for strange experience to 3.36 (95%CI: 1.47-7.76) for auditory hallucination. CONCLUSION: Different forms of discrimination are associated with PEs in the general population. As discrimination is common at the societal level, this highlights the importance of public policy and evidence-based interventions to reduce discrimination and improve population mental health.

Psychotic experiences and accidents, injuries, and poisonings among adults in the United States.

Psychotic experiences (PEs) have been linked to an increased risk for accidents and injuries. However, this association remains little researched in many countries. To address this research gap, the current study used cross-sectional data from the United States to examine the association between PEs and accidents, injuries, and poisoning in a general population sample. Data were analyzed from 2274 individuals who completed the psychosis screen as part of the National Comorbidity Survey Replication (NCS-R). Information was obtained on PEs (hallucinations and delusions) and the experience of past 12-month accidents, injuries, and poisoning. Logistic regression analysis was used to examine the association while adjusting for demographic variables and common mental disorders (CMDs). In a fully adjusted model past 12-month PEs were associated with almost three times higher odds for reporting accidents, injuries, and poisoning (odds ratio [OR]: 2.97, 95% confidence interval [CI]: 1.13-7.74). The results of this study indicate that PEs are associated with higher odds for accidents and injuries among adults in the United States. Research is now needed to determine the direction of this association and the factors linked to it.