Espiritismo and Santeria: a gateway to child mental health services among Puerto Rican families?

Background Barriers to mental health care access among Latinx children contribute to mental health disparities. It is unclear whether traditional spiritual guides in Latinx communities may function more as gateway providers or in some instances as deterrents to mental health treatment. This study assesses whether family involvement in Espiritismo and/or Santeria, two forefront non-Christian spiritual traditions among Latinx families, is associated with mental health care utilization among Puerto Rican children in two contexts. Methods Data are from Waves 1–3 (2000–2004) of the Boricua Youth Study, a population-based longitudinal cohort study of Puerto Rican children from San Juan and Caguas, Puerto Rico (PR), and the South Bronx, New York (SBx), 5 to 17 years of age (N = 2491). Results At baseline, 5.02% (n = 58) of the families reported involvement with Espiritismo and/or Santeria in the SBx and 3.64% (n = 52) in PR. Logistic regression models predicting mental health service use found, after adjusting for multiple risk and protective factors, that families involved with Espiritismo and/or Santeria were 2.41 times more likely (p = 0.0034) to use mental health services over the course of 3 years than children with no family involvement in these practices in the SBx. The same association was not found in PR. Conclusions The findings among PR families in the SBx lend support to the gateway provider model in which spiritual guides open doors to mental health treatment. Forming community connections between mental health providers and traditional spiritual groups may be a culturally considerate, fruitful approach to reducing barriers to mental health treatment among Latinx families.

Racial segregation and mental health service use by older adults

Older adults living in racially segregated neighborhoods often lack access to mental health care. This study assessed the role of racial segregation in mental health service use and examined whether the relationship between segregation and mental health service use differs by race/ethnicity. We linked residential segregation data from the National Neighborhood Change Database to the 2015 Medical Expenditure Panel Survey. The sample included 4,023 adults aged 65 and older. We measured mental health service use as visit(s) to a mental health professional and/or use of prescribed medication for mental health (1=yes, 0=no) during the past year. Residential segregation was assessed using a combined measure of isolation (level of interaction with the same racial and ethnic group members) and dissimilarity (evenness of distribution of racial groups). Indices ranged from 0 (integrated) to 1 (segregated). We adjusted for age, sex, race/ethnicity, marital status, education, income, attitude toward health care, health insurance, and mental health status. Multiple logistic regression analyses showed that older adults living in more segregated counties were less likely to use a mental health service than those living in more integrated counties (OR=0.77, p=.04). The relationship did not differ by race/ethnicity. As expected, Blacks and Hispanics underused mental health services compared to Whites. The findings highlight that racial segregation limits access to mental health care. Practitioners and policy-makers should identify mental health needs and service use patterns to target services effectively and efficiently. Future research should explore the intersection of income and mental health care resources in segregated neighborhoods.

Disparities of Mental Health Service Needs and Utilization Among Older Adults

Prior studies have examined mental health disparities, however, without adequate attention to the older adult population. Framed by the Andersen Behavioral Model of Health Service Use, this study was to examine the prevalence of depression and anxiety and the mental health service use among older adults of different race/ethnicity; and to investigate factors associated with mental health services use(counseling and psychotropic medication). Data from the National Health Interview Survey 2019 were analyzed by bivariate tests and logistic regression analyses. Hispanic older adults have the highest rates of depressive and anxious symptoms, followed by Whites, Blacks, and Asians. Non-Hispanic Asians and Blacks reported significantly lower rates of taking medication. The severity of depression and anxiety was consistently associated with mental health service use across all groups. Education was positively associated with counseling use in white and black groups. For older whites, better general health, male and foreign-born were significantly predicting less medication use. Older blacks with better general health were significantly less likely to use medication. For Hispanic older adults, female and being single were associated with anxiety medication use. Results suggest that older adults, despite different perceptions and cultural understandings of mental health, use mental health services for severe conditions. This study also highlights the important role that education and health literacy could have played in the use of counseling services. For the medication use, the result—that general health status was important for both black and white older adults, but not Hispanics—could suggest a few directions for further exploration.

Mental Health Effects of COVID-19 in Older Adults Are Moderated by Existing Mental Health Needs and Emotional Support

Mitigating mental health consequences is one of the priorities for the society to advance, and the aim of this study is to investigate the mental health effects of COVID-19 in older adults and to explore risk and protective factors. Social workers recruited 722 older adults living in the community (mean age 73.6±8.4) from January 2020 to February 2021 in Hong Kong, and interviewed them for basic demographics (age, gender, education, and living status), mental health service use in recent three months (proxy for existing needs), number of people to talk to when feeling down (proxy for emotional support network), and assessed their depression using Patient Health Questionnaire-9 (PHQ-9). Impacts of COVID-19 were indicated by local daily effective reproductive number (Rt) and Nth wave since the start of the pandemic. Generalized linear models (GLM) were applied. Basic demographics were not associated with depression, existing mental health needs (β=2.99, p<.001), Rt (β=1.08, p<.05) and Nth wave (β=0.49, p<.05) were positively associated with depression, while emotional support network was negatively associated with depression (β=-2.47, p<.001). There was also a significant interaction between Rt and Nth wave on depression (β=0.69, p<.05), suggesting ongoing COVID-19 took a toll on older adults’ mental health. Three-way interactions between COVID-19 Rt, Nth wave and existing mental health needs (β=0.25, p<.05) and emotional support network (β=-0.12, p=.07) on depression further indicated that older adults with existing mental health needs warrant more attention, and wider emotional support network may buffer the impact of the pandemic on mental health.

The Influence of Social Support, Help-Seeking Attitudes and Help-Seeking Intentions on Older Australians’ use of Mental Health Services for Depression and Anxiety Symptoms

This study investigated the influence of predisposing factors (social support, help-seeking attitudes and help-seeking intentions) on older Australian adults’ use of mental health services for depression and/or anxiety symptoms. Participants were 214 older Australian adults (61% female; aged between 60 and 96 years; M = 75.15 years, SD = 8.40 years) who completed a self-report questionnaire that measured predisposing factors and lifetime mental health service use for depression and/or anxiety symptoms. Higher levels of social support predicted non-use of mental health services. When this relationship was serially mediated by help-seeking attitudes and help-seeking intentions, it predicted mental health service use for depression and/or anxiety. Older adults are less likely to seek help for depression and/or anxiety symptoms unless members of their social support network encourage positive help-seeking attitudes, which lead to positive help-seeking intentions and the subsequent use of mental health services.

Gendering Neighbourhood Marginalization Metrics in Mental Health Services Research: A Cross-Sectional Exploration of a Rural and Small Urban Population

Background: Little is known about the extent to which socioenvironmental characteristics may influence mental health outcomes in smaller population centres or differently among women and men. This study used a gender-based analysis approach to explore individual- and neighbourhood-level sex differences in mental health service use in a context of uniquely smaller urban and rural settlements. Methods: This cross-sectional analysis leveraged multiple person-based administrative health datasets linked with geospatial datasets among the population aged 1 and over in the province of New Brunswick, Canada. We used multinomial logistic regression to examine associations between neighbourhood characteristics with risk of service contacts for mood and anxiety disorders in 2015/2016, characterizing the areal measures among all residents (gender neutral) and by males and females separately (gender specific), and controlling for age group. Results: Among the province’s 707,575 eligible residents, 10.7% (females: 14.0%; males: 7.3%) used mental health services in the year of observation. In models adjusted for gender-neutral neighbourhood characteristics, service contacts were significantly more likely among persons residing in the most materially deprived areas compared with the least (OR = 1.09 [95% CI: 1.05–1.12]); when stratified by individuals’ sex, the risk pattern held for females (OR = 1.13 [95% CI: 1.09–1.17]) but not males (OR = 1.00 [95% CI: 0.96–1.05]). Residence in the most female-specific materially deprived neighbourhoods was independently associated with higher risk of mental health service use among individual females (OR = 1.08 [95% CI: 1.02–1.14]) but not among males (OR = 1.02 [95% CI: 0.95–1.10]). Conclusion: These findings emphasize that research needs to better integrate sex and gender in contextual measures aiming to inform community interventions and neighbourhood designs, notably in small urban and rural settings, to reduce socioeconomic inequalities in the burden of mental disorders.

Effects of the Mental Health and Welfare Law revision on schizophrenia patients in Korea: an interrupted time series analysis

Background High rates of involuntary hospitalization and long lengths of stay have been problematic in Korea. To address these problems, the Mental Health and Welfare Law was revised in 2016, mainly to protect patient rights by managing involuntary admissions. The aim of this study was to evaluate the impact of the revised Mental Health and Welfare Law on deinstitutionalization by using routinely collected data from hospital admissions and continuity of mental health service use after hospital discharge as proxy measures of deinstitutionalization. Methods We used monthly-aggregated claims-based data with a principal or secondary diagnosis of schizophrenia from 2012 to 2019, collected by the National Health Insurance Service. Outcome variables included rates of first admission; discharges; re-admissions within 7, 30, and 90 days; outpatient visits after discharge within 7 and 30 days; and continuity of visits, at least once a month for 6 months after discharge. Using interrupted time series analysis, we estimated the change in levels and trends of the rates after revision, controlling for baseline level and trend. Results There was no significant change in first admission and discharge rates after the revision. Immediately after the revision, however, the rates of re-admission within 7 and 30 days dropped significantly, by 2.24% and 1.99%, respectively. The slopes of the re-admission rate decreased significantly, by 0.10% and 0.14%, respectively. The slopes of the re-admission rate within 90 days decreased (0.001%). The rates of outpatient visits within 7 and 30 days increased by 1.98% and 2.72%, respectively. The rate of continuous care showed an immediate 4.0% increase. Conclusions The revision had slight but significant effects on deinstitutionalization, especially decreasing short-term re-admission and increasing immediate outpatient service utilization.