The role of pharmaceutical side-effects in depression among immigrants.

OBJECTIVES: This study explores the role of pharmaceuticals with depression or suicidality as a side-effect in explaining the immigrant depression paradox. Immigrants generally report less depression than their native-born peers, despite the socio environments that are less conducive to well-being. This immigrant advantage in mental health tends to recede with time in the US and more acculturation. To date, an explanation for this pattern has remained elusive, partly because acculturation is also associated with many desirable outcomes, suggesting less depression with more acculturation. DESIGN: Data came from seven two-year waves (2005-2006 to 2017-2018) of the National Health and Nutrition Examination Survey (NHANES). Depression was measured using the Patient Health Questionnaire (PHQ-9). Linear and logistic regressions were used to estimate the immigrant differences in depression, while controlling for sociodemographic characteristics, healthcare access, health conditions, and the use of medications with depression or suicidality as a side-effect. RESULTS: 30.3% and 22.7% of US-born adults used at least one medication with depression or suicidality as a side-effect, compared to 16.4% and 9.2% of foreign-born adults. Access to healthcare improved with time in the US and with acculturation, and both of these factors were also positively associated with the use of medications with depression or suicidality as a side-effect. The magnitude of the mediation associated with medication side-effects was significant, in many cases sufficient to eliminate the relationship between acculturation - whether expressed in terms of time in the US, English-language use, or nativity - and depression. CONCLUSION: Exposure to medications with depression or suicidality as a side-effect helped explain part of the relative mental health advantage of foreign-born residents, as well as the diminishing advantage associated with time in the US and with acculturation.

Determinants of stigma among patients with hepatitis C virus infection.

Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV treatment and elimination. The determinants of HCV-related stigma, including the impacts of stage of HCV treatment (ie spontaneously cleared; diagnosed, untreated; previously treated, not cured; currently being treated; and treated, cured) and coinfection with human immunodeficiency virus (HIV), remain unknown. To address these gaps, we conducted a cross-sectional study among patients with a history of HCV infection (n = 270) at outpatient clinics in Philadelphia from July 2018 to May 2019. We evaluated stigma using the validated HCV Stigma Scale, adapted from the Berger HIV Stigma Scale. Associations among HCV-related stigma and hypothesized demographic, behavioural, and clinical risk factors were evaluated by multivariable linear regression. Most participants (95.5%) experienced HCV-related stigma. Mean stigma scores did not differ significantly between HCV-monoinfected and HIV/HCV-coinfected participants (P = .574). However, we observed significant interactions between HIV status and multiple determinants; therefore, we stratified analyses by HIV status. Among HIV/HCV-coinfected participants, previous HCV treatment without cure, female gender, Hispanic/Latinx ethnicity and some college education were significantly associated with higher HCV-stigma scores. An annual income of $10 000-$40 000 was associated with significantly lower stigma scores. No significant associations were observed among HCV-monoinfected participants. We found that most participants experienced stigma associated with HCV diagnosis. While stigma scores were similar between HCV-monoinfected and HIV/HCV-coinfected participants, the determinants associated with HCV stigma differed by HIV status. Understanding how experiences of stigma differ between HCV-monoinfected and HIV/HCV-coinfected patients may aid in the development of targeted interventions to address the HCV epidemic.

The Growth, Scope, and Spatial Distribution of People With Felony Records in the United States, 1948-2010.

The steep rise in U.S. criminal punishment in recent decades has spurred scholarship on the collateral consequences of imprisonment for individuals, families, and communities. Several excellent studies have estimated the number of people who have been incarcerated and the collateral consequences they face, but far less is known about the size and scope of the total U.S. population with felony convictions beyond prison walls, including those who serve their sentences on probation or in jail. This article develops state-level estimates based on demographic life tables and extends previous national estimates of the number of people with felony convictions to 2010. We estimate that 3 % of the total U.S. adult population and 15 % of the African American adult male population has ever been to prison; people with felony convictions account for 8 % of all adults and 33 % of the African American adult male population. We discuss the far-reaching consequences of the spatial concentration and immense growth of these groups since 1980.

The Institutional Effects of Incarceration: Spillovers From Criminal Justice to Health Care.

POLICY POINTS: The steady increase in incarceration is related to the quality and functioning of the health care system. US states that incarcerate a larger number of people show declines in overall access to and quality of care, rooted in high levels of uninsurance and relatively poor health of former inmates. Providing health care to former inmates would ease the difficulties of inmates and their families. It might also prevent broader adverse spillovers to the health care system. The health care system and the criminal justice system are related in real but underappreciated ways. CONTEXT: This study examines the spillover effects of growth in state-level incarceration rates on the functioning and quality of the US health care system. METHODS: Our multilevel approach first explored cross-sectional individual-level data on health care behavior merged to aggregate state-level data regarding incarceration. We then conducted an entirely aggregate-level analysis to address between-state heterogeneity and trends over time in health care access and utilization. FINDINGS: We found that individuals residing in states with a larger number of former prison inmates have diminished access to care, less access to specialists, less trust in physicians, and less satisfaction with the care they receive. These spillover effects are deep in that they affect even those least likely to be personally affected by incarceration, including the insured, those over 50, women, non-Hispanic whites, and those with incomes far exceeding the federal poverty threshold. These patterns likely reflect the burden of uncompensated care among former inmates, who have both a greater than average need for care and higher than average levels of uninsurance. State-level analyses solidify these claims. Increases in the number of former inmates are associated simultaneously with increases in the percentage of uninsured within a state and increases in emergency room use per capita, both net of controls for between-state heterogeneity. CONCLUSIONS: Our analyses establish an intersection between systems of care and corrections, linked by inadequate financial and administrative mechanisms for delivering services to former inmates.

Cultural reflexivity in health research and practice.

Recent public health movements have invoked cultural change to improve health and reduce health disparities. We argue that these cultural discourses have sometimes justified and maintained health inequalities when those with power and authority designated their own social practices as legitimate and healthy while labeling the practices of marginalized groups as illegitimate or unhealthy. This "misrecognition," which creates seemingly objective knowledge without understanding historical and social conditions, sustains unequal power dynamics and obscures the fact that what is deemed legitimate and healthy can be temporally, geographically, and socially relative. We use examples from research across multiple disciplines to illustrate the potential consequences of cultural misrecognition, highlight instances in which culture was invoked in ways that overcame misrecognition, and discuss how cultural reflexivity can be used to improve health research and practice.

The relationship between incarceration and premature adult mortality: gender specific evidence.

We examine the relationship between incarceration and premature mortality for men and women. Analyses using the National Longitudinal Survey of Youth (NLSY79) reveal strong gender differences. Using two different analytic procedures the results show that women with a history of incarceration are more likely to die than women without such a history, even after controlling for health status and criminal behavior prior to incarceration, the availability of health insurance, and other socio-demographic factors. In contrast, there is no relationship between incarceration and mortality for men after accounting for these factors. The results point to the importance of examining gender differences in the collateral consequences of incarceration. The results also contribute to a rapidly emerging literature linking incarceration to various health hazards. Although men constitute the bulk of inmates, future research should not neglect the special circumstances of female former inmates and their rapidly growing numbers.

The contingent effect of incarceration on state health outcomes.

Introduction: This study examines how growth in the population of former prisoners affects rates of communicable diseases such as tuberculosis, syphilis, chlamydia, and HIV. Methods: We estimate state-level fixed effects count models showing how the former prisoner population affected communicable disease in U.S. states from 1987 to 2010, a period of dramatic growth in incarceration. Results: We find contingent effects, based on how specific diseases are recognized, tested, and treated in prisons. The rate of former prisoners increases diseases that are poorly addressed in the prison health care system (e.g., chlamydia), but decreases diseases that are routinely tested and treated (e.g., tuberculosis). For HIV, the relationship has shifted in response to specific treatment mandates and protocols. Data on prison healthcare spending tracks these contingencies. Discussion: Improving the health of prisoners can improve the health of the communities to which they return. We consider these results in light of the relative quality of detection and treatment available to underserved populations within and outside prisons.

Learning to do well or learning to do good? Estimating the effects of schooling on civic engagement, social cohesion, and labor market outcomes in the presence of endowments.

Although some point to the large effects of schooling on civic engagement (usually measured in terms of volunteering and participation in civic organizations) and social cohesion (usually measured in terms of social networks and relationship quality), the effects of schooling on social outcomes have not been estimated with the same rigor as the effects of schooling on labor-market outcomes, such as earnings. In particular, previous research has failed to consider (i) the many potential and often unobserved confounding factors ("endowments") influencing both schooling and social outcomes, including family upbringing, innate characteristics, and personality, and (ii) the ways in which schooling pushes individuals in multiple directions simultaneously, including toward greater social engagement, but also toward more independent and market-driven pursuits. Using samples of unrelated persons, ordinary siblings, and identical twins, this study explores the effects of schooling on measures of civic engagement and social relationships, as well as labor-force earnings and labor-force participation. The siblings models reveal a more complex picture than typically suggested by standard individual estimates. On one hand, the results reveal a robust positive effect of schooling on earnings: well-schooled persons work more and earn more, albeit not as much as associations without control for endowments suggest. On the other hand, the results reveal more tenuous and occasionally negative effects of schooling on social outcomes. The effects of schooling on volunteering and membership in civic organizations, for example, disappear almost entirely with control for endowments. Also, within-identical-twins models reverse the positive effects of schooling on reports of support from friends, family, and coworkers. These results may reflect the tension schooling creates between market and non-market commitments, as well as between independence and interpersonal reliability. Schooling may, indeed, induce some pro-social behaviors, but schooling allows individuals choices of whether to pursue more personal interests as well.

Pharmaceutical Side Effects and the Sex Differences in Depression and Distress.

INTRODUCTION: Women suffer from depression at higher rates than men. This difference is well established, although a consolidated explanation remains elusive. This study examines the role played by medications with depression or suicidality as a potential side effect in explaining the sex difference in depression. METHODS: Data were analyzed for 224,810 U.S. adults aged ≥18 years from the 2008-2018 Medical Expenditure Panel Survey. Linear and logistic regressions were used to assess the sex differences in distress and depression while controlling for sociodemographic characteristics, healthcare access, health conditions, and the use of medications with depression or suicidality as a side effect. RESULTS: 41% and 28% of women used ≥1 medication with depression and suicidality as a side effect compared with 27% and 17% of men, respectively. When controlling for sociodemographic characteristics, healthcare access, and health conditions, women were more likely to report significant distress (OR=1.16, 95% CI=1.10, 1.24) and major depression (OR=1.12, 95% CI=1.07, 1.18) than men. In models that further adjusted for the use of medications with depression or suicidality as a side effect, the sex differences became statistically nonsignificant for both distress (OR=0.97, 95% CI=0.91, 1.03) and depression (OR=0.97, 95% CI=0.92, 1.02). Nonhormone medications (rather than hormone medications) with such side effects helped explain the sex differences in distress and depression. CONCLUSIONS: Findings suggest a significant sex difference in pharmaceutical treatment and the potential consequences of pharmaceutical side effects on distress and depression. These results highlight the importance of pharmaceutical side effects in understanding health and health disparities.

The Nexus of Physical and Psychological Pain: Consequences for Mortality and Implications for Medical Sociology.

Although physical pain lies at the intersection of biology and social conditions, a sociology of pain is still in its infancy. We seek to show how physical and psychological pain are jointly parts of a common expression of despair, particularly in relation to mortality. Using the 2002-2014 National Health Interview Survey Linked Mortality Files (N = 228,098), we explore sociodemographic differences in the intersection of physical and psychological pain (referred to as the "pain-distress nexus") and its relationship to mortality among adults ages 25 to 64. Results from regression and event history models reveal that differences are large for the combination of the two, pointing to an overlooked aspect of health disparities. The combination of both high distress and high pain is most prevalent and most strongly predictive of mortality among socioeconomically disadvantaged, non-Hispanic whites. These patterns have several implications that medical sociology is well positioned to address.

The impact of disease-related knowledge on perceptions of stigma among patients with Hepatitis C Virus (HCV) infection.

Most patients with hepatitis C virus (HCV) infection perceive some degree of disease-related stigma. Misunderstandings about diseases may contribute to disease-related stigma. The objective of this study was to evaluate patient-level knowledge about HCV infection transmission and natural history and its association with HCV-related stigma among HCV-infected patients. We conducted a cross-sectional survey study among 265 patients with HCV in Philadelphia using the HCV Stigma Scale and the National Health and Nutrition Examination Survey (NHANES) Hepatitis C Follow-up Survey (2001-2008). The association between HCV knowledge and HCV-related stigma was evaluated via linear regression. Overall knowledge about HCV transmission and natural history was high, with >80% of participants answering ≥9 of 11 items correctly (median number of correct responses, 9 [82%]), HCV-related knowledge was similar between HIV/HCV-coinfected and HCV-monoinfected participants (p = 0.30). A higher level of HCV-related knowledge was associated with greater perceived HCV-related stigma (ß, 2.34 ([95% CI, 0.51-4.17]; p = 0.013). Results were similar after adjusting for age, race, ethnicity, HIV status, education level, stage of HCV management, time since diagnosis, and history of injection drug use. In this study, increased HCV-related knowledge was associated with greater perceptions of HCV stigma. Clinicians may consider allotting time to address common misconceptions about HCV when educating patients about HCV infection, which may counterbalance the stigmatizing impact of greater HCV-related knowledge.

Gene-environment correlations in the stress-depression relationship.

A critical feature of the social stress model is the apparent relationship between stress and depression. Although many studies have demonstrated a connection between the two, the relationship may be contaminated by genes affecting both stress and depression. Using a sample of identical and fraternal twins, this study explores genetic influences on depression and assorted sources of stress while explicitly estimating, and thereby controlling for, gene-environment correlations. I consider both stress and depression in a fine-grained fashion. For the former, the study explores assorted sources of stress, including health and disability, family, unemployment, discrimination, and perceived neighborhood safety, as gene-environment correlations may be stronger for some forms of stress than others. For the latter, the study explores both depressive symptoms and major depressive disorders, as each may entail a different epidemiological process, especially with respect to genes. The results reveal that most, but not all, measures of stress have moderate heritabilities, suggesting that genes influence exposure to the environment in a broad fashion. Yet, despite this, the relationship between stress and depression is generally robust to gene-environment correlations. There are some notable exceptions. For example, allowing for gene-environment correlations, marital conflict is generally unrelated to depression. Moreover, gene-environment correlations are generally stronger for major depression than for depressive symptoms, encouraging further elaboration of the distinction between the onset of depression and its recurrence, especially in the context of genes. These exceptions do not put limits on environmental influence, but do suggest that genes operate in a complex life-course fashion.

Religion, social integration, and depression in Europe: Evidence from the European Social Survey.

Western Europe's growing Muslim population has occasioned considerable debate regarding cultural integration, immigration, and social isolation. In this study I explore the relationship between religious identification and depression in European countries, focusing in particular on the situation of Muslims, but comparing across other religious groups, as well as those who are unaffiliated with any religion. The analysis is based on countries sampled in the sixth round of the European Social Survey, conducted in 2012. The results reveal the dueling effects of religious identity: religious involvement involves social integration among like-minded friends, but can also invite discrimination from others. This dueling effect implies significant differences between groups. Among Protestants and Catholics greater religious identification is associated with progressively lower depression, relative to those with no affiliation. Among Muslims lower levels of identification are associated with significantly more depression. Muslims of the highest level of identification are statistically indistinguishable from those with no religious affiliation. These patterns among Muslims are not born of poor social integration, but rather reflect more experiences with discrimination. Overall differences among religious groups are very strong: the difference in depression between Muslims and Protestants, for instance, exceeds the difference between men and women.

In-utero determinants of adult depression: evidence from the 1918 flu pandemic.

Social scientists have dealt only glancing with potential in-utero determinants of mental health. This study looks at the enduring consequences of gestational exposure to the 1918 flu pandemic for adult depression. It does so using data collected in the first wave of the National Health and Nutrition Examination Survey (1971-1975), corresponding to when those exposed in-utero were in their early to mid-50s. The results indicate very strong effects of in-utero exposure on depression. These effects are only found, however, among men. The effects are sufficiently large to eliminate sex differences in major depression within a cohort: among those born in 1919, the prevalence of major depression is about 1 in 5 for both men and women. Additional analyses further clarify the relationship, showing effects of in-utero exposure across the full spectrum and syndrome of depressive symptoms. In addition, the effects are stronger for symptoms related to depression than for symptoms related to schizophrenia. Additional analyses show that the effect of exposure is reduced somewhat when adjusting for later socioeconomic disadvantages. In addition, the effect is reduced when controlling for broader dimensions of physical health. Yet neither of these relationships explains the effects of exposure altogether.

Pharmaceutical Side Effects and Mental Health Paradoxes among Racial-Ethnic Minorities.

Sociologists have long struggled to explain the minority mental health paradox: that racial-ethnic minorities often report better mental health than non-Hispanic whites despite social environments that seem less conducive to well-being. Using data from the 2008-2013 Medical Expenditure Panel Survey (MEPS), this study provides a partial explanation for the paradox rooted in a very different disparity. Evidence from MEPS indicates that non-Hispanic whites consume more pharmaceuticals than racial-ethnic minorities for a wide variety of medical conditions. Moreover, non-Hispanic whites consume more pharmaceuticals that although effective in treating their focal indication, include depression or suicide as a side effect. In models that adjust for the use of such medications, the minority advantage in significant distress is reduced, in some instances to statistical nonsignificance. Although a significant black and Hispanic advantage in a continuous measure of distress remains, the magnitude of the difference is reduced considerably. The relationship between the use of medications with suicide as a side effect and significant distress is especially large, exceeding, for instance, the relationship between poverty and significant distress. For some minority groups, the less frequent use of such medications is driven by better health (as in the case of Asians), whereas for others, it reflects a treatment disparity (as in the case of blacks), although the consequences for the mental health paradox are the same. The implications of the results are discussed, especially with respect to the neglect of psychological side effects in the treatment of physical disease as well as the problem of multiple morbidities.

Utilization of Medications With Cognitive Impairment Side Effects and the Implications for Older Adults' Cognitive Function.

Objectives: Many medications have cognitive impairment, memory loss, amnesia, or dementia as side effects ("cognitive side effects" hereafter), but little is known about trends in the prevalence of these medications or their implications for population-level cognitive impairment. Method: We use data from the National Health and Nutrition Examination Survey (1999-2016) to describe trends in the use of medications with cognitive side effects among adults aged 60+ (N = 16,937) and their implications for cognitive functioning (measured using word learning and recall, animal fluency, and digit symbol substitution assessments). Results: Between 1999 to 2000 and 2015 to 2016, the prevalence of older adults taking one, two, and at least three medications with cognitive side effects increased by 10.2%, 57.3%, and 298.7%, respectively. Compared to non-users, respondents who simultaneously used three or more medications with cognitive side effects scored 0.22 to 0.27 standard deviations lower in word learning and recall (p = .02), digit symbol substitution (p < .01), and the average standardized score of the three assessments (p < .001). Limitation: Dosage of medications associated with cognitive side effects was not measured. Discussion: Concurrent use of medications with cognitive side effects among older adults has increased dramatically over the past two decades. The use of such medications is associated with cognitive impairment and may explain for disparities in cognitive function across subgroups. These findings highlight the need for cognitive screenings among patients who consume medications with cognitive side effects. They also highlight the synergic effects of polypharmacy and potential drug-drug interactions that result in cognitive deficits.

Neither mad nor bad? The classification of antisocial personality disorder among formerly incarcerated adults.

Using the National Comorbidity Survey, this study explores the presence and symptoms of antisocial personality disorder (ASPD) among people with varying degrees of contact with the criminal justice system. The study finds an elevated prevalence of ASPD among formerly incarcerated persons, but also that ASPD is not a simple linear function of actual or potential contact with the criminal justice system. For example, among people who have been arrested the prevalence of ASPD is not much greater than among those who committed a crime but were never arrested. Furthermore, the difference in prevalence between those who were incarcerated and those who were arrested but not incarcerated is small. Moreover, the prevalence is highly sensitive to the elimination of one particular symptom among seven: failure to conform to social norms, as indicated by having been arrested. Eliminating this single symptom reduces the prevalence of ASPD by more than 50%, even among formerly incarcerated persons. Additional analyses reveal that, among formerly incarcerated persons who meet the diagnostic threshold for ASPD, their set of symptoms is perhaps driven more by their circumstance than their personality. For example, while formerly incarcerated persons frequently report failing to fulfill their promises, fewer than one in ten report a lack of remorse for having mistreated others. These findings suggest the need to further contextualize ASPD symptomatology, particularly among populations with frequent contact with the criminal justice system.

Validation of a modified Berger HIV stigma scale for use among patients with hepatitis C virus (HCV) infection.

BACKGROUND: Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV prevention, treatment, and elimination. To date, no validated instrument exists to measure patients' experiences of HCV stigma. This study aimed to revise the Berger (2001) HIV stigma scale and evaluate its psychometric properties among patients with HCV infection. METHODS: The Berger HIV stigma scale was revised to ask about HCV and administered to patients with HCV (n = 270) in Philadelphia, Pennsylvania. Scale reliability was evaluated as internal consistency by calculating Cronbach's alpha. Exploratory factor analysis was performed to evaluate construct validity by comparing item clustering to the Berger HIV stigma scale subscales. Item response theory was employed to further evaluate individual items and to calibrate items for simulated computer adaptive testing sessions in order to identify potential shortened instruments. RESULTS: The revised HCV Stigma Scale was found to have good reliability (α = 0.957). After excluding items for low loadings, the exploratory factor analysis indicated good construct validity with 85% of items loading on pre-defined factors. Analyses strongly suggested the predominance of an underlying unidimensional factor solution, which yielded a 33-item scale after items were removed for low loading and differential item functioning. Adaptive simulations indicated that the scale could be substantially shortened without detectable information loss. CONCLUSIONS: The 33-item HCV Stigma Scale showed sufficient reliability and construct validity. We also conducted computer adaptive testing simulations and identified shortened six- and three-item scale alternatives that performed comparably to the original 40-item scale.

An uncertain revolution: why the rise of a genetic model of mental illness has not increased tolerance.

This study uses the 2006 replication of the 1996 General Social Survey Mental Health Module to explore trends in public beliefs about mental illness in the USA. Drawing on three models related to the framing of genetic arguments in popular media, the study attempts to address why tolerance of the mentally ill has not increased, despite the growing popularity of a biomedical view. The key to resolving this paradox lies in understanding how genetic arguments interact with other beliefs about mental illness, as well as the complex ideational implications of genetic frameworks. Genetic arguments have contingent relationships with tolerance. When applied to schizophrenia, genetic arguments are positively associated with fears regarding violence. Indeed, in this regard, attributing schizophrenia to genes is no different from attributing schizophrenia to bad character. However, when applied to depression, genetic arguments are positively associated with social acceptance. In addition to these contingencies, genetic explanations have discontinuous relationships with beliefs regarding treatment. Although genetic arguments are positively associated with recommending medical treatment, they are not associated with the perceived likelihood of improvement. The net result of these assorted relationships is little change in overall levels of tolerance over time. Because of the blunt nature of the forces propelling a biomedical view--including the growing popularity of psychiatric medications--altering beliefs about the etiology of mental illness is unlikely, on its own, to increase tolerance.