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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.

  Background Psychosocial stress has been implicated as a risk factor for overweight and obesity. However, research on psychosocial stressors and overweight and obesity has typically focused on single stressors in isolation, which may overestimate the impact of a specific stressor and fail to describe the role of cumulative stress on overweight and obesity risk. Purpose This study explores the association between overweight/obesity and cumulative exposure to a wide range of psychosocial stressors, among a multiracial/ethnic sample of adults. Methods Using secondary data from the Chicago Community Adult Health Study (n = 2,983), we conducted multinomial logistic regression analyses to quantify associations between eight psychosocial stressors, individually and in combination, and measured overweight and obesity, adjusted for sociodemographic factors, alcohol use and smoking. Results In separated covariate-adjusted models, childhood adversities (odds ratio [OR] = 1.16; confidence interval [CI] = [1.03, 1.30]), acute life events (OR = 1.18; CI = [1.04, 1.34]), financial strain (OR = 1.30; CI = [1.15, 1.47]), and relationship stressors (OR = 1.18; CI = [1.04, 1.35]) were associated with increased odds of obesity. In a model adjusted for all stressors simultaneously, financial strain was the only stressor independently associated with overweight (OR = 1.17; CI = [1.00, 1.36]) and obesity (OR = 1.21; CI = [1.05, 1.39]). Participants with stress exposure in the highest quintile across 2, 3, or ≥4 (compared to no) types of stressors had significantly higher odds of obesity. Conclusions Multiple types of stressors may be risk factors for obesity, and cumulative exposure to these stressors may increase the odds of obesity. Reducing exposure to stressors at the population level may have the potential to contribute to reducing the burden of obesity.  

  BACKGROUND: The significance of the timing and chronicity of childhood adversity for depression outcomes later in life is unclear. Identifying trajectories of adversity throughout childhood would allow classification of children according to the accumulation, timing, and persistence of adversity, and may provide unique insights into the risk of subsequent depression. METHODS: Using data from the Avon Longitudinal Study of Parents and Children, we created a composite adversity score comprised of 10 prospectively assessed domains (e.g., violent victimization, inter-parental conflict, and financial hardship) for each of eight time points from birth through age 11.5 years. We used semiparametric group-based trajectory modeling to derive childhood adversity trajectories and examined the association between childhood adversity and depression outcomes at the age of 18 years. RESULTS: Among 9,665 participants, five adversity trajectories were identified, representing stable-low levels (46.3%), stable-mild levels (37.1%), decreasing levels (8.9%), increasing levels (5.3%), and stable-high levels of adversity (2.5%) from birth through late childhood. Approximately 8% of the sample met criteria for probable depression at 18 years and the mean depression severity score was 3.20 (standard deviation = 3.95, range 0-21). The risk of depression in young adulthood was elevated in the decreasing (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.19-2.48), increasing (OR = 1.81, 95% CI = 1.15-2.86), and stable-high (OR = 1.80, 95% CI = 1.00-3.23) adversity groups, compared to those with stable-low adversity, when adjusting for potential confounders. CONCLUSIONS: Children in trajectory groups characterized by moderate or high levels of adversity at some point in childhood exhibited consistently greater depression risk and depression severity, regardless of the timing of adversity.

Jie Chen and colleagues will publish a study examining the behavioral health treatment among individuals with co-occurring opioid use disorder and mental illness

Purpose Psychosocial stress has been associated with susceptibility to many infectious pathogens. We evaluated the association between perceived stress and incident sexually transmitted infections (STIs;  Chlamydia trachomatis ,  Neisseria gonorrhoeae , and  Trichomonas vaginalis  genital infections) in a prospective study of women. Stress may increase vulnerability to STIs by suppressing immune function and altering the protective vaginal microbiota. Methods Using the 1999 Longitudinal Study of Vaginal Flora (n  = 2439), a primarily African American cohort of women, we fitted Cox proportional hazards models to examine the association between perceived stress and incident STIs. We tested  bacterial vaginosis  (measured by Nugent Score) and sexual behaviors (condom use, number of partners, and partner concurrence) as mediators using VanderWeele's difference method. Results Baseline perceived stress was associated with incident STIs both before and after adjusting for confounders (adjusted hazard ratio = 1.015; 95% confidence interval, 1.005–1.026). Nugent score and sexual behaviors significantly mediated 21% and 65% of this adjusted association, respectively, and 78% when included together in the adjusted model. Conclusions This study advances understanding of the relationship between perceived stress and STIs and identifies high-risk sexual behaviors and development of bacterial vaginosis—both known risk factors for STIs—as mechanisms underlying this association.

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.

The developmental origins of disparities in common mental disorders

Meaning Making on the Margins: Partnering with Undocumented Immigrants to Understand and Promote Mental Health in Context

Drawing on data from the National Longitudinal Study of Adolescent Health (Add Health), we examine the association between incarceration and depressive symptoms among a sample of 13,131 young adults. We find that a history of incarceration is associated with a higher expected rate of depressive symptoms and that this relationship operates most strongly through material hardship. We find no differences in the main effect of incarceration across groups, but we find that the role of certain mediating variables may vary, with marital and employment status being a stronger mediator for males than females, and marriage being a stronger mediator for whites compared to blacks and Hispanics. Our results suggest that incarceration constitutes a potent stressor, but that the pathways to depressive symptoms may differ.

Julia Steinberg will use an NICHD K01 grant to investigate the impact of depression throughout the reproductive cycle