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Article Reference Troff document (with manpage macros)Accountable Care Organizations and Preventable Hospitalizations Among Patients With Depression
Introduction Accountable care organizations have been successful in improving quality of care, but little is known about who is benefiting from accountable care organizations and through what mechanism. This study examined variation of potentially preventable hospitalizations for chronic conditions with coexisting depression in adults by hospital accountable care organization affiliation and care coordination strategies by race/ethnicity. Methods Data  files of 11 states from 2015 State Inpatient Databases were used to identify potentially preventable hospitalizations for chronic conditions with coexisting depression by race/ethnicity; the 2015 American Hospital Association's Annual Survey was used to identify hospital accountable care organization affiliation; and American Hospital Association's Survey of Care Systems and Payment (collected from January to August 2016) was used to identify hospital Accountable care organizations affiliation and hospital-based care coordination strategies, such as telephonic outreach, and chronic care management. In 2019, multiple logistic regressions was used to test the probability of potentially preventable hospitalization by accountable care organization affiliation and race/ethnicity. The test was repeated on a subsample analysis of accountable care organization–affiliated hospitals by care coordination strategy. Results Preventable hospitalizations were significantly lower among accountable care organization–affiliated hospitals than accountable care organization–unaffiliated hospitals. Lower preventable hospitalization rates were observed among white, African American, Native American, and Hispanic patients. Effective care coordination strategies varied by patients’ race. Results also showed variation of the adoption of specific care coordination strategies among accountable care organization–affiliated hospitals. Analysis further indicated effective care coordination strategies varied by patients’ race. Conclusions Accountable care organizations and specifically designed care coordination strategies can potentially improve preventable hospitalization rates and racial disparities among patients with depression. Findings support the integration of mental and physical health services and provide insights for Centers for Medicare and Medicaid Services risk adjustment efforts across race/ethnicity and socioeconomic status.
Located in MPRC People / Jie Chen, Ph.D. / Jie Chen Publications
Amanda Geller, New York University
Police Contact, Mental Health, and Health Disparities among Urban Teens
Located in Coming Up
Article Reference Troff document (with manpage macros)Barriers to health care access among US adults with chronic conditions and co-occurring serious psychological distress between 2011-2015
Importance: Nearly 34 million adults – 17 percent of all American adults – have co-occurring mental and physical health conditions. However, the extent to which increased health insurance coverage has facilitated access to needed health care services among this population remains unclear. Objective: Prior research suggests that people with serious psychological distress (SPD) and cancer, heart disease, diabetes, asthma, or hypertension report worse access to care than people with the same physical conditions but no SPD. While the recent expansion in health insurance coverage was expected to improve access to care for people with SPD, access barriers that people with SPD report remain underexplored. Setting: Using the cross-sectional data from the National Health Interview Survey 2011-2015, we examined self-reported health care access barriers among adults (between ages 18 to 64) with SPD and co-occurring physical health conditions. Results: Our sample included 45,294 individuals with chronic conditions (heart disease, high blood pressure, diabetes, cancer, or asthma). Among them, 3,639 also had SPD. After controlling for demographic and socioeconomic factors, results of multivariate logistic regressions showed that individuals with co-occurring SPD and a physical health condition were significantly more likely to report that they had worse health insurance coverage compared to the prior year (OR=1.32, p<0.01), that doctor's office informed that they were not accepting new patients (OR=2.09, p<0.001), that the doctor's office stated they did not accept the particular health insurance they have (OR=1.98, p<0.001), that they couldn't get an appointment soon enough (OR=2.42, p<0.001), they had no transportation to get to the doctor (OR=3.23, p<0.001), and that overall they had trouble finding a doctor/provider (OR=2.12, p<0.001). Conclusions: Our results suggest that despite an increase in health insurance coverage between 2011 and 2015, barriers to access remain a significant concern for individuals with co-occurring SPD and physical health conditions.
Located in MPRC People / Jie Chen, Ph.D. / Jie Chen Publications
Article Reference Troff document (with manpage macros)Behavioral health treatment utilization among individuals with co-occurring opioid use disorder and mental illness: Evidence from a national survey
BACKGROUND: Past research shows that among individuals with substance use disorders, the presence of a co-occurring mental illness can influence the initiation, course, and success of behavioral health treatment, but little research has examined people with opioid use disorder (OUD) specifically. METHODS: Using the 2008-2014 National Survey on Drug Use and Health, this study examines the utilization of substance use disorder and mental health treatment among individuals with OUD and different degrees of mental illness severity. The study also examined types of treatment, perceived unmet need for treatment, and barriers to care. RESULTS: 47% of individuals with OUD and co-occurring mild/moderate mental illness did not receive any behavioral health treatment, and 21% of those with co-occurring serious mental illnesses did not receive any behavioral health treatment. Among those with OUD and co-occurring mild/moderate mental illness, 16% reported receiving both substance use disorder and mental health treatment; among those with co-occurring serious mental illness the rate was 32%. The most common form of treatment was prescription medication for mental health, and this was true regardless of whether or not the individual had any mental illness. More than 50% of the study population reported financial difficulties as a barrier to treatment. CONCLUSION: A high proportion of individuals with OUD and co-occurring mental illness are not receiving needed care. However, nearly one in five of those with OUD but no diagnosed mental illness is receiving prescription medication for mental illness. These findings suggest that there is a need to better facilitate access to and coordinate behavioral health care across settings for individuals with OUD. Published by Elsevier Inc.
Located in MPRC People / Jie Chen, Ph.D. / Jie Chen Publications
Black men’s mental health: Healing from complex trauma and toxic environments
Department of Behavioral and Community Health Research and Learning Seminar Series hosts: Black men’s mental health: Healing from complex trauma and toxic environments Presented by: Dr. Craig Fryer, Dr. Joseph B Richardson, and Dr. Kevin Roy
Located in Coming Up
Effects of Depression on Contraceptive Behavior
Julia Steinberg will use an NICHD K01 grant to investigate the impact of depression throughout the reproductive cycle
Located in Research / Selected Research
Article Reference Troff document (with manpage macros)Externalizing trajectories predict elevated inflammation among adolescents exposed to early institutional rearing: A randomized clinical trial
  BACKGROUND: There has been mounting interest in the pathophysiological relation between inflammation and psychopathology. In this paper, we examined associations between internalizing and externalizing psychopathology and inflammation in adolescents with a history of severe psychosocial deprivation and children reared in typical family contexts. METHOD: The Bucharest Early Intervention Project is a longitudinal randomized trial of high-quality foster care as an alternative to institutional care. This report is based on 56 institutionalized children randomized to care as usual, 59 institutionalized children randomized to foster care, and 101 never institutionalized children who were recruited as an in-country comparison sample. Externalizing and internalizing behaviors were reported by parents and teachers at ages 8, 12, and 16. At age 16, C-reactive protein (CRP) was derived from blood spots in a subset of participants (n = 127). Multiple-group latent growth curve models were used to examine externalizing and internalizing trajectories and their associations with CRP. RESULTS: Among children assigned to care as usual, higher levels of externalizing behaviors at age 8, as well as smaller decreases in these behaviors from 8 to 16 years predicted higher levels of CRP at age 16. In the same group of children, higher internalizing behaviors at age 8, but not the rate of change in these behaviors, also predicted higher levels of CRP. In contrast, these relations were not observed in the children assigned to foster care and never institutionalized controls. CONCLUSIONS: Early institutional rearing is associated with a coupling of psychopathology and inflammation, whereas early placement into foster care buffers against these risks. These findings have implications for promoting healthy mental and physical development amongst institutionalized children.
Located in Retired Persons / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)How Early Is Too Early? Identification of Elevated, Persistent Problem Behavior in Childhood
We inquire how early in childhood children most at risk for problematic patterns of internalizing and externalizing behaviors can be accurately classified. Yearly measures of anxiety/depressive symptoms and aggressive behaviors (ages 6–13;  n  = 334), respectively, are used to identify behavioral trajectories. We then assess the degree to which limited spans of yearly information allow for the correct classification into the elevated, persistent pattern of the problem behavior, identified theoretically and empirically as high-risk and most in need of intervention. The true positive rate (sensitivity) is below 70% for anxiety/depressive symptoms and aggressive behaviors using behavioral information through ages 6 and 7. Conversely, by age 9, over 90% of the high-risk individuals are correctly classified (i.e., sensitivity) for anxiety/depressive symptoms, but this threshold is not met until age 12 for aggressive behaviors. Notably, the false positive rate of classification for both high-risk problem behaviors is consistently low using each limited age span of data (< 5%). These results suggest that correct classification into highest risk groups of childhood problem behavior is limited using behavioral information observed at early ages. Prevention programming targeting those who will display persistent, elevated levels of problem behavior should be cognizant of the degree of misclassification and how this varies with the accumulation of behavioral information. Continuous assessment of problem behaviors is needed throughout childhood in order to continually identify high-risk individuals most in need of intervention as behavior patterns are sufficiently realized.
Located in MPRC People / Terence Thornberry, Ph.D. / Terence Thornberry Publications
Article ReferenceLGBTQ Youth-Serving Community-Based Organizations: Who Participates and What Difference Does it Make?
LGBTQ youth are at greater risk for compromised health, yet large-scale health promotion programs for LGBTQ young people have been slow to develop. LGBTQ community-based organizations—which provide LGBTQ-focused support and services—have existed for decades, but have not been a focus of the LGBTQ youth health literature. The current study used a contemporary sample of LGBTQ youth (age 15–21;  M  = 18.81;  n  = 1045) to examine who participates in LGBTQ community-based organizations, and the association between participation and self-reported mental health and substance use. Youth who participated in LGBTQ community-based organizations were more likely to be assigned male at birth, transgender, youth of color, and accessing free-or-reduced lunch. Participation was associated with concurrent and longitudinal reports of mental health and substance use. LGBTQ community-based organizations may be an underutilized resource for promoting LGBTQ youth health.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article ReferenceMaternal postpartum depressive symptoms and infant externalizing and internalizing behaviors
Maternal postpartum depression has been shown to be one of the main predictors of externalizing and internalizing behaviors in toddlers and adolescents. Research suggests that presence of such behaviors can be observed as early as infancy. The current study uses longitudinal data from 247 mothers to examine the relationship between postpartum depressive symptoms at 8 weeks and the infant's externalizing and internalizing behaviors at 12 months. In unadjusted linear regression models, there were associations between postpartum depressive symptoms and infant externalizing behaviors (β=0.082, SE=0.032, p=0.012) and internalizing behaviors (β=0.111, SE=0.037, p=0.003). After controlling for potential confounding factors, including maternal age, race, education, home ownership, smoking status in the postpartum period, marital status, parenting stress, and happiness from becoming a parent, the associations between postpartum depressive symptoms and infant externalizing (β=0.051, SE=0.034, p=0.138) and internalizing behaviors (β=0.077, SE=0.040, p=0.057) were reduced and became non-significant. Furthermore, in these models the total amount of variance explained was 17.2% (p<0.0001) for externalizing behaviors and 10.5% (p<0.01) for internalizing behaviors; the only significant predictor of externalizing behaviors was maternal age (β=-0.074, SE=0.030, p=0.014), and of internalizing behaviors was white non-Hispanic ethnicity (β=-1.33, SE=0.378, p=0.0005). A combined effect of the confounding factors seems to explain the finding of no significant independent association between postpartum depressive symptoms and infant externalizing and internalizing behaviors.
Located in MPRC People / Edmond Shenassa, Ph.D. / Edmond Shenassa Publications