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Hospital and Public Health InterdisciPlinarY Research (HAPPY) Laboratory Annual Aging Symposium

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

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.

This study examines the effect of inconsistent  Medicaid coverage  on  parenting stress , maternal depression, and child behavior in a sample of teen mothers and their children. The majority (54%) of mothers experienced inconsistent coverage. After 24 months, mothers experiencing inconsistent coverage had significantly higher  parenting stress  and depressive symptoms, and their children had more internalizing behaviors than families with consistent Medicaid. These differences existed despite no initial differences and controlling for numerous covariates. Policies and practices that stabilize  Medicaid coverage  for teen parent families may reduce unnecessary stress, depressive symptoms, and early childhood behavior problems.

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.

Theoretical and empirical integration of the rejection sensitivity (RS) model to sexual minority people is one of the few attempts to extend existing theoretical frameworks that explain mental health disparities for this population, namely the minority stress framework (Meyer,  2003 ) and its extensions (Hatzenbuehler,  2009 ; Testa, Habarth, Peta, Balsam, & Bockting,  2015 ). Theoretical origins of RS are rooted in the desire to understand how rejection from significant others affects subsequent other close relationships (Downey & Feldman,  1996 ). This was later extended to conceptualize rejection based on membership of a stigmatized group and modified to understand sexual orientation-related RS among sexual minorities (Dyar, Feinstein, Eaton, & London,  2016 ; Pachankis, Goldfried, & Ramrattan,  2008 ). Feinstein ( 2019 ) brings new life to this adapted application by grounding and integrating the basic tenets of sexual orientation-related RS alongside a critical health compromising process of minority stress: vigilance. Meyer theorized vigilance as a core form of proximal minority stressors and explains that “LGB people learn to anticipate—indeed, expect—negative regard from members of the dominant culture. To ward off potential negative regard, discrimination, and violence, they must be vigilant” and this vigilance is “related to feared possible (even if imagined) negative events” (Meyer,  2003 , p. 680–681). Feinstein explains that existing theoretical frameworks (Hatzenbuehler,  2009 ; Meyer,  2003 ) mention vigilance and RS as important processes, but lack a comprehensive integration of these concepts. Given that schemas for RS are formed early in the life course, we focus on the applicability to sexual minority adolescents, and other marginalized groups.

  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.

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.

Sexual and gender minority (SGM) youth experience high rates of victimization leading to health disparities. Community size and community climate are associated with health outcomes among SGM youth; however, we lack studies that include them as covariates alongside victimization to understand their collective impact on health. This study utilized minority stress theory to understand how community context shapes experiences of victimization and health among SGM youth. SGM youth in one Midwestern U.S. state completed an online survey ( n  = 201) with measures of physical health, mental health, community context, and victimization. Data were analyzed via multiple regression using a path analysis framework. Results indicate that perceived climate was associated with mental, but not physical, health; Community size was unrelated to health outcomes. Victimization mediated the association between community climate and mental health. Findings are discussed in light of current literature and implications for research and practice are shared.

Police Contact, Mental Health, and Health Disparities among Urban Teens