Association between nonspecific severe psychological distress as an indicator of serious mental illness and increasing levels of medical multimorbidity.

OBJECTIVES: We sought to determine whether severe psychological distress (SPD) and serious mental illnesses (SMIs) are associated with a specific set of chronic medical conditions (CMCs) and the association between SPD-SMIs and increasing levels of medical multimorbidity and complexity (i.e., from 1 to 3 or more CMCs). METHODS: We used data from 3 administrations (2008-2010) of the National Survey on Drug Use and Health collected from 110 455 adult participants. We used binary and ordinal logistic regressions adjusting for sociodemographics and substance abuse to examine the associations between SPD-SMIs and increasing levels of multimorbidity. RESULTS: SPD-SMI was associated with higher probabilities for many CMCs generally, but we found no specific pattern for any class of conditions for SPD-SMIs and multimorbidity. The association between SPD-SMIs and multimorbidity strengthened as the number of CMCs increased. CONCLUSIONS: The finding of no discernible risk pattern for any specific CMC grouping supports broad medical assessment strategies and closely coordinated primary and behavioral health care for those with SPD-SMIs, as called for in the Patient Protection and Affordable Care Act.

MSM and drug use: A latent class analysis of drug use and related sexual risk behaviors.

This study examined patterns of drug use among gay men and other men who have sex with men (MSM) to identify sub-categories of men whose drug use and sexual behavior place them at especially high risk for HIV. A latent class analysis of a sample of MSM yielded a four-class model with two distinct high drug use sub-groups: one whose drug use concentrated on "sex-drugs" (SDU); and a distinct polydrug use class that showed higher probabilities of using all other drugs assessed. Comparative follow-up analyses indicated the SDU group was also more likely to engage in particular potentially high-risk sexual behaviors, be older, and to be HIV positive. Implications of distinguishing between patterns of drug use for HIV-risk prevention efforts with MSM are discussed.

Substitute care entry: the relationship between race or ethnicity and levels of county organization.

OBJECTIVE: Past studies demonstrate a relationship between race and the likelihood of children entering state custody subsequent to a maltreatment investigation. Research also shows that community structural characteristics such as poverty and residential mobility are correlated with entry rates. The combined effect, however, of race and community characteristics on substitute care entry is unclear. We analyzed 3 years of Illinois child welfare administrative and county-level structural data to assess the combined effect of child characteristics and level of community organization on substitute care entry. METHODS: Based on county indicators of crime, socioeconomic status, residential mobility, and child care burden, a latent profile analysis classified Illinois counties into three levels of social organization (high, moderate, and low). To test the relationship between community and child level predictors of substitute care entry, a dichotomous variable representing substitute care entry was regressed onto county level and individual covariates (child age, race or ethnicity, gender, and allegation). To test the combined relationship of community and individual level characteristics, interactions between county level of organization and race were explored. RESULTS: Like previous studies, results showed that individual factors of race, age, and allegation were associated with the decision to place children in substitute care. Also consistent with past research, they revealed a general trend in which decreasing levels of social organization were associated with relatively higher odds of entry to care. The magnitude of this effect at each level of social organization, however, varied by race, with African American children in disorganized communities experiencing the greatest risk of removal. CONCLUSIONS: These findings suggest that efforts to understand the decision to place a child in substitute care may need to be community specific. In particular the level of community organization may influence the response of the system to maltreatment investigations. In communities with different characteristics and across racial groups, child welfare systems may need to examine decision making processes regarding children's removal from parental care.