Factors Associated With, and Mitigation Strategies for, Health Care Disparities Faced by Patients With Headache Disorders.

OBJECTIVE: To review contemporary issues of health care disparities in headache medicine with regard to race/ethnicity, socioeconomic status (SES), and geography and propose solutions for addressing these disparities. METHODS: An Internet and PubMed search was performed and literature was reviewed for key concepts underpinning disparities in headache medicine. Content was refined to areas most salient to our goal of informing the provision of equitable care in headache treatment through discussions with a group of 16 experts from a range of headache subspecialties. RESULTS: Taken together, a multitude of factors, including racism, SES, insurance status, and geographical disparities, contribute to the inequities that exist within the health care system when treating headache disorders. Interventions such as improving public education, advocacy, optimizing telemedicine, engaging in community outreach to educate primary care providers, training providers in cultural sensitivity and competence and implicit bias, addressing health literacy, and developing recruitment strategies to increase representation of underserved groups within headache research are proposed as solutions to ameliorate disparities. CONCLUSION: Neurologists have a responsibility to provide and deliver equitable care to all. It is important that disparities in the management of headache disorders are identified and addressed.

Diversity in randomized clinical trials of depression: A 36-year review.

Historically, authors reporting the results of randomized clinical trials (RCTs) to address mental health problems have insufficiently described sample characteristics pertaining to the ethnic/racial, linguistic, socioeconomic, and immigrant backgrounds of participants. RCTs have also had inadequate representation of participants from diverse backgrounds. This study reports on the trends in the reporting and representation of various sample demographic characteristics in RCTs of psychotherapy and other psychosocial interventions for depression over a 36-year period, and on the extent to which ethnicity, in particular, is considered in the analyses of treatment effects. A total of 342 trials (85.1% comprised of adult samples), representing 61,283 participants, are summarized in the review. Reporting for ethnicity and socioeconomic indicators improved over time, and RCTs for depression have also increasingly included significant numbers of ethnic minority and low-income groups. However, trials are far more likely to exclude, rather than include, linguistic minorities, and have not enrolled a meaningful number of Asian American, Native Hawaiian/Pacific Islander, Native American/Native Alaskan and multi-ethnic participants. Finally, treatment effects are almost never presented separately across racial/ethnic groups and ethnicity moderation analyses are only sporadically conducted. These findings have implications for generalizability, policy, journal reporting guidelines, and dissemination and implementation.

Depressive symptoms in young, urban schoolchildren: environmental, social, and cognitive risk.

This study examined relations among stressors, perceived social competence, attributional style, and depressive symptoms in young urban schoolchildren. Data were collected from 85 5- to 11-year-olds, mostly African American, who attended a public elementary school in a low-income urban area. Social competence was examined as a potential mediator, and attributional style was examined as a potential moderator of the relation between stressful life events and depressive symptoms. Separate analyses were conducted by age and gender. For older children and girls, main effects were found for stressful life events as predictors of depressive symptoms. Mediational analyses indicated that perceived peer acceptance served as a mediator of the relation between stressful life events and depressive symptoms for girls. In addition, attributional style moderated the relation between stressors and depressive symptoms in the older children. Together, findings suggest that significant relations exist among stressful life events, social and cognitive processes, and depressive symptoms in young urban children and that these relations are influenced by gender and development.

Stressful life experiences and peer externalizing behaviors mediate the relation between reduced family support and externalizing symptoms in low-income urban youth.

Family support, urban stressors, and peer behavior were examined in relation to externalizing symptoms in 605 predominantly low-income urban sixth through eighth grade adolescents. Mother and father support were each associated with lower levels of externalizing symptoms in both males and females. For males, father absence was associated with increased peer externalizing behavior and heightened rates of youth externalizing symptoms. Stress (in the form of major life events, daily hassles, and exposure to violence) and peer externalizing behavior were examined as mediators of the relation between parent support and youth externalizing symptoms. Increased stress exposure mediated the relation between weak mother and father support and youth externalizing symptoms. Additionally, for females, peer externalizing behavior mediated the relation between weak mother support and youth externalizing symptoms.

Electrophysiological evidence of enhanced performance monitoring in recently abstinent alcoholic men.

RATIONALE: Chronic alcoholism is associated with mild to moderate cognitive impairment. Under certain conditions, impairment can be ameliorated by invoking compensatory processes. OBJECTIVE: To identify electrophysiological mechanisms of such compensation that would be required to resolve response conflict. METHODS: 14 abstinent alcoholic men and 14 similarly aged control men performed a variation of the Eriksen flanker task during an electroencephalography (EEG) recording to examine whether alcoholics could achieve and maintain control-level performance and whether EEG markers could identify evidence for the action of compensatory processes in the alcoholics. Monitoring processes engaged following a response were indexed by the correct related negativity (CRN) and error related negativity (ERN), two medial-frontal negative event-related potentials. RESULTS: The alcoholics were able to perform at control levels on accuracy and reaction time (RT). Alcoholics generated larger ERN amplitudes following incorrect responses and larger CRNs following correct responses than controls. Both groups showed evidence of post-error slowing. Larger CRN amplitudes in the alcoholics were related to longer RTs. Also observed in the alcoholics was an association between smaller CRN amplitudes and length of sobriety, suggesting a normalization of monitoring activity with extended abstinence. CONCLUSIONS: To the extent that greater amplitude of these electrophysiological markers of performance monitoring indexes greater resource allocation and performance compensation, the larger amplitudes observed in the alcoholic than control group support the view that elevated performance monitoring enables abstinent alcoholics to overcome response conflict, as was evident in their control-level performance.