Purpose This study examined receipt of services for mental health conditions and non-opioid substance use disorders (SUDs) among privately insured adolescents and young adults (ie, youth) with subsequent clinically diagnosed opioid use disorder (OUD) or opioid poisoning. Methods Among individuals aged 12 to 25 years (N = 4926), healthcare service utilization claims for the 2 years before a newly clinically diagnosed OUD or opioid poisoning were assessed for mental health and nonopioid SUD service visits. Results Over half (60.6%) of the youth with clinically diagnosed OUD or opioid poisoning received mental health or nonopioid SUD services in the 2 years before the opioid poisoning or OUD diagnosis. Conclusion Many adolescents and young adults with clinically diagnosed OUD or opioid poisoning interacted with the healthcare system to receive services for mental health conditions and nonopioid SUDs before the OUD or opioid poisoning being diagnosed. Opportunities exist to design better intervention strategies to prevent OUD or opioid poisoning among adolescents and young adults.
Introduction: Area-level residential instability (ARI), an index of social fragmentation, has been shown to explain the association between urbanicity and psychosis. Urban upbringing has been shown to be associated with reduced gray matter volumes (GMV)s of brain regions corresponding to the right caudal middle frontal gyrus (CMFG) and rostral anterior cingulate cortex (rACC). We hypothesize that greater ARI will be associated with reduced right CMFG and rACC GMVs. Methods: Data were collected at baseline as part of the North American Prodrome Longitudinal Study Phase 2. Counties where participants resided during childhood were geographically coded using the US Census to area-level factors. ARI was defined as the percentage of residents living in a different house 5 years ago. Generalized linear mixed models tested associations between ARI and GMVs. Results: This study included 29 healthy controls (HC)s and 64 clinical high risk for psychosis (CHR-P) individuals who were aged 12 to 24 years, had remained in their baseline residential area, and had magnetic resonance imaging scans. ARI was associated with reduced right CMFG (adjusted β = −0.258; 95% CI = −0.502 to −0.015) and right rACC volumes (adjusted β = −0.318; 95% CI = −0.612 to −0.023). The interaction term (ARI-by-diagnostic group) in the prediction of both brain regions was not significant, indicating that the relationships between ARI and regional brain volumes held for both CHR-P and HCs. Conclusions: ARI may adversely impact similar brain regions as urban upbringing. Further investigation into the potential mechanisms of the relationship between ARI and neurobiology, including social stress, is needed.
Objective: Racial/ethnic differences in the course of treatment for a major depressive episode (MDE) among adolescents may arise, in part, from variation in the perceived rationale for treatment. We examined racial/ethnic differences in the perceived reasons for receiving mental health (MH) treatment among adolescents with an MDE.
Method: A total of 2,789 adolescent participants who experienced an MDE and received MH treatment in the past year were drawn from the 2005 to 2008 National Survey on Drug Use and Health. Adolescents reported the settings in which they received care and reasons for their most recent visit to each setting. Distributions of specific depressive symptoms were compared across racial/ethnic groups. Racial/ethnic differences in endorsing each of 11 possible reasons for receiving treatment were examined using weighted probit regressions adjusted for sociodemographic characteristics, health and mental health status, treatment setting, and survey year.
Results: Despite similar depressive symptom profiles, Hispanic adolescents were more likely than whites to endorse "breaking rules" or getting into physical fights as reasons for MH treatment. Black adolescents were more likely than white adolescents to endorse "problems at school" but less likely to endorse "felt very afraid or tense" or "eating problems" as reasons for treatment. Asian adolescents were more likely to endorse "problems with people other than friends or family" but less likely than whites to endorse "suicidal thoughts/attempt" and "felt depressed" as reasons for treatment.
Conclusion: Racial/ethnic minority participants were more likely than white participants to endorse externalizing or interpersonal problems and less likely to endorse internalizing problems as reasons for MH treatment. Understanding racial/ethnic differences in the patient's perceived treatment rationale can offer opportunities to enhance outcomes for depression among diverse populations.
Objective: The study examined the association between private health insurance and the receipt of specialty substance use disorder treatment.
Methods: Weighted logistic regressions were estimated to examine the association between health insurance and the receipt of any specialty substance use disorder treatment in national samples of nonelderly adults with alcohol abuse or dependence (N522,778), alcohol dependence (N510,104), drug abuse or dependence (N59,427), and drug dependence (N56,736). Receipt of any specialty substance abuse treatment was compared among the uninsured and privately insured persons who reported known coverage, no coverage, or unknown coverage for alcohol and drug abuse treatment. Regressions adjusted for sociodemographic characteristics, treatment need, criminal justice involvement, and year of survey.
Results: Compared with being uninsured, private insurance was associated with greater use of any specialty substance use disorder treatment only among those with alcohol dependence with known coverage for alcohol treatment (p<.05).
Conclusions: Private insurance was associated with increased use of specialty treatment among persons with severe alcohol use disorders who knew they had coverage for alcohol abuse treatment.
IMPORTANCE: The passage of the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act incorporated parity for substance use disorder (SUD) treatment into federal legislation. However, prior research provides us with scant evidence as to whether federal parity legislation will hold the potential for improving access to SUD treatment. OBJECTIVE: To examine the effect of state-level SUD parity laws on state-aggregate SUD treatment rates and to shed light on the impact of the recent federal SUD parity legislation.
DESIGN, SETTING, AND PARTICIPANTS: We conducted a quasi-experimental study using a 2-way (state and year) fixed-effect method. We included all known specialty SUD treatment facilities in the United States and examined treatment rates from October 1, 2000, through March 31, 2008. Our main sourceof data was the National Survey of Substance Abuse Treatment Services, which provides facility-level information on specialty SUD treatment.
INTERVENTIONS: State-level SUD parity laws during the study period.
MAIN OUTCOMES AND MEASURES: State-aggregate SUD treatment rates in (1) all specialty SUD treatment facilities and (2) specialty SUD treatment facilities accepting private insurance. RESULTS: The implementation of any SUD parity law increased the treatment rate by 9% (P <.001) in all specialty SUD treatment facilities and by 15% (P =.02) in facilities accepting private insurance. Full parity and parity only if SUD coverage is offered increased the SUD treatment rate by 13% (P =.02) and 8% (P =.04), respectively, in all facilities and by 21% (P =.03) and 10% (P =.04), respectively, in facilities accepting private insurance.
CONCLUSIONS AND RELEVANCE: We found a positive effect of the implementation of state SUD parity legislation on access to specialty SUD treatment. Furthermore, the positive association is more pronounced in states with more comprehensive parity laws. Our findings suggest that federal parity legislation holds the potential to improve access to SUD treatment.
Objective: Individuals with serious mental illnesses are at risk of receiving inadequate outpatient mental health services, increasing the likelihood of medication non-adherence, readmission, and self-harm. The purpose of this study was to identify individual- and neighborhood-level factors associated with outpatient mental health visits. Methods: This study included 418 participants from two randomized trials of patients with comorbid medical conditions and serious mental illnesses across two study sites between 2011 and 2017. On the basis of individual addresses, data were collected about participants’ distance to the nearest mental health facility and 13 neighborhood characteristics from the American Community Survey. Three neighborhood-level factors were derived from factor analysis. Poisson regression was used to assess associations between individual- and neighborhood-level characteristics and the number of visits to mental health providers. Known individual-level risk factors for outpatient follow-up were mutually adjusted in a model with neighborhood covariates added. Results: Male gender, older age, unemployment, and lower education level were associated with less outpatient mental health service utilization. Neighborhood-level residential mobility, defined as the combination of percentage of residents living in a different house in the past year and percentage of non-owner-occupied housing, was significantly associated with fewer mental health service visits even after controlling for other neighborhood- and individual-level factors. Conclusions: Among individuals with comorbid medical conditions and serious mental illnesses, living in neighborhoods with higher residential mobility was associated with fewer visits to outpatient mental health providers. This finding suggests the importance of recognizing social conditions that may shape clinical interactions.
Background: Depression is associated with a higher risk for experiencing barriers to care, unmet social needs, and poorer economic and mental health outcomes. Objective: To determine the impact of COVID-19 on ability to access care, social and economic needs, and mental health among Medicare beneficiaries with and without depression. Design and Participants: Cross-sectional study using data from the 2020 Medicare Current Beneficiary Survey COVID-19 Summer Supplement Public Use File. Main Measures: Access to medical care, inability to access food, medications, household supplies, pay rent or mortgage, feelings of economic security, and mental health effects since COVID-19, risk-adjusted for sociodemographic and clinical characteristics. Key Results: Participants were 11,080 Medicare beneficiaries (nationally representative of 55,960,783 beneficiaries), 27.0% with and 73.0% without a self-reported history of depression. As compared to those without a history of depression, Medicare beneficiaries with a self-reported history of depression were more likely to report inability to get care because of COVID-19 (aOR = 1.28, 95% CI, 1.09, 1.51; P = 0.003), to get household supplies such as toilet paper (aOR = 1.32, 95% CI, 1.10, 1.58; P = 0.003), and to pay rent or mortgage (aOR = 1.64, 95% CI, 1.07, 2.52; P = 0.02). Medicare beneficiaries with a self-reported history of depression were more likely to report feeling less financially secure (aOR = 1.43, 95% CI, 1.22, 1.68; P < 0.001), more stressed or anxious (aOR = 1.68, 95% CI, 1.49, 1.90; P < 0.001), more lonely or sad (aOR = 1.97, 95% CI, 1.68, 2.31; P < 0.001), and less socially connected (aOR = 1.27, 95% CI, 1.10, 1.47; P = 0.001). Conclusion: A self-reported history of depression was associated with greater inability to access care, more unmet social needs, and poorer economic and mental health outcomes, suggesting greater risk for adverse health outcomes during COVID-19.
Objective: Behavioral health homes, which provide onsite primary medical care in mental health clinics, face challenges in integrating information across multiple health records. This study tested whether a mobile personal health record application improved quality of medical care for individuals treated in these settings. Methods: This randomized study enrolled 311 participants with a serious mental illness and one ormore cardiometabolic risk factors across two behavioral health homes to receive a mobile personal health record application (N=156) or usual care (N=155). A securemobile personal health record (mPHR) app provided participants in the intervention group with key information about diagnoses,medications, and laboratory test values and allowed them to track health goals. The primary study outcome was a chart-derived composite measure of quality of cardiometabolic and preventive services. Results: At 12-month follow-up, participants in the mPHR group maintained high quality of care (70% of indicated services at baseline and at 12-month follow-up), in contrast to a decline in quality for the usual-care group (71%at baseline and 67% at follow-up), resulting in a statistically significant but clinically modest differential impact between the groups. No differences between the study groups were found in secondary self-reported outcomes, including delivery of chronic illness care, patient activation, and quality of life related to mental or general medical health. Conclusions: Use of a mPHR app was associated with a statistically significant but clinically modest differential benefit for quality of medical care among individuals with serious mental illness and comorbid cardiometabolic conditions.
Background
High incidence and prevalence of sexually transmitted infection (STI) in African Americans have been attributed to multiple factors. However, few articles have discussed spatial access to healthcare as a driver of disparities. The objective of this analysis was to evaluate the relationship between travel time to a healthcare provider and the likelihood of testing positive for one of three STIs in a sample of adults living in public housing.
Methods
One hundred and eight African-American adults in Atlanta, Georgia from November 2008 – June 2009, completed a survey that queried sexual behavior and healthcare utilization and had urine tested for, C. trachomatis, N. gonorrhoeae, and T. vaginalis by molecular methods. Travel time was a continuous variable capturing the number of minutes it took to reach the place where participants received most of their care. Multivariate analyses tested the hypothesis that individuals reporting longer travel times would be more likely to test positive for an STI. Travel time was squared to linearize its relationship to the outcome.
Results
Thirty six residents (37.5%) tested positive for ≥1 STI. A curvilinear relationship existed between travel time and STI status. When travel time was <48 minutes, a positive relationship existed between travel time and the odds of testing positive for an STI. An inverse relationship existed when travel time was ≥48 minutes.
Conclusion
Residents of impoverished communities experience a curvilinear relationship between travel time and STI status. We discuss possible factors that might have created this curvilinear relationship including voluntary social isolation.
This analysis investigates changes in spatial access to safety-net primary care in a sample of US public housing residents relocating via the HOPE VI initiative from public housing complexes to voucher-subsidized rental units; substance misusers were oversampled. We used gravity-based models to measure spatial access to care, and used mixed models to assess pre-/post-relocation changes in access. Half the sample experienced declines in spatial access of ≥79.83%; declines did not vary by substance misuse status. Results suggest that future public housing relocation initiatives should partner with relocaters, particularly those in poor health, to help them find housing near safety-net clinics.