Structural Disadvantage and Culture, Race, and Ethnicity in Early Psychosis Services: International Provider Survey.
Ontology highlight
ABSTRACT: Objective
Little is known about provider perspectives on programmatic responses to structural disadvantage and cultural differences within early intervention in psychosis (EIP) services, programs, and models. The primary objective of this study was to investigate providers' perspectives on the impacts of disadvantage and minority race, ethnicity, and culture and to describe current practices and perceived gaps and concerns.Methods
An online survey of specialized EIP providers was disseminated in the United Kingdom, United States, Canada, Australia, and Chile. A total of 164 providers, representing 110 unique sites, completed the survey. Closed-ended questions gathered demographic and program data, including information on formal assessment of trauma or adversity, integration of trauma-informed care, integration of formal cultural assessment tools, training focused on culture, programmatic changes to address culture-related issues, and consultation with cultural insiders. Open-ended questions addressed the demographic mix of the program's client population; the perceived role and influence of trauma, structural disadvantage, and cultural differences; and concerns and needs related to these topics. Frequencies were examined for closed-ended items; open-ended responses were systematically coded.Results
Overall, survey findings suggested low levels of implementation of a variety of assessment and support practices related to cultural diversity in EIP programs. Coding of open-ended responses revealed numerous concerns regarding the impacts of disadvantage and cultural difference on clients and perceived gaps in policy and implementation.Conclusions
An expansion of research and service development aimed at better meeting the disadvantage- and culture-related needs of young people with early psychosis and their families should be a priority for the field.
SUBMITTER: Jones N
PROVIDER: S-EPMC9119303 | biostudies-literature | 2021 Mar
REPOSITORIES: biostudies-literature
Publications
Structural Disadvantage and Culture, Race, and Ethnicity in Early Psychosis Services: International Provider Survey.
Jones Nev N Kamens Sarah S Oluwoye Oladunni O Mascayano Franco F Perry Chris C Manseau Marc M Compton Michael T MT
Psychiatric services (Washington, D.C.) 20210112 3
<h4>Objective</h4>Little is known about provider perspectives on programmatic responses to structural disadvantage and cultural differences within early intervention in psychosis (EIP) services, programs, and models. The primary objective of this study was to investigate providers' perspectives on the impacts of disadvantage and minority race, ethnicity, and culture and to describe current practices and perceived gaps and concerns.<h4>Methods</h4>An online survey of specialized EIP providers was ...[more]
Similar Datasets
Project description:ImportancePostpartum depression (PPD) is a debilitating condition with higher rates among Black individuals. Increasingly, neighborhood disadvantage is being recognized as a contributor to poor health and may be associated with adverse postpartum mental health; however, associations between neighborhood disadvantage, race and ethnicity, and PPD have not been examined.ObjectiveTo investigate the association between neighborhood disadvantage and PPD and evaluate the extent to which these associations may differ by race and ethnicity.Design, setting, and participantsThis population-based cross-sectional study included 122 995 postpartum Kaiser Permanente Northern California members 15 years or older with a live birth between October 7, 2012, and May 31, 2017, and an address in the electronic health record. Analyses were conducted from June 1, 2022, through June 30, 2023.ExposuresNeighborhood disadvantage defined using quartiles of the Neighborhood Deprivation Index (NDI), a validated census-based socioeconomic status measure; self-reported race and ethnicity ascertained from Kaiser Permanente Northern California electronic health records.Main outcomes and measuresMultivariable Poisson regression was conducted to assess associations between neighborhood disadvantage, race and ethnicity, and a diagnosis of PPD.ResultsOf 122 995 included postpartum individuals, 17 554 (14.3%) were younger than 25 years, 29 933 (24.3%) were Asian, 8125 (6.6%) were Black, 31 968 (26.0%) were Hispanic, 47 527 (38.6%) were White, 5442 (4.4%) were of other race and ethnicity, and 15 436 (12.6%) had PPD. Higher neighborhood disadvantage and race and ethnicity were associated with PPD after covariate adjustment. Compared with White individuals, Black individuals were more likely to have PPD (adjusted relative risk [ARR], 1.30; 95% CI, 1.24-1.37), whereas Asian (ARR, 0.48; 95% CI, 0.46-0.50), and Hispanic (ARR, 0.92; 95% CI, 0.89-0.96) individuals and those identified as having other race and ethnicity (ARR, 95% CI, 0.90; 0.85-0.98) were less likely to have PPD. Associations between NDI and PPD differed by race and ethnicity (likelihood ratio test for interaction, χ212 = 41.36; P < .001). Among Black individuals, the risk of PPD was the greatest overall and increased with neighborhood disadvantage in a dose-response manner (quartile [Q] 2 ARR, 1.39 [95% CI, 1.13-1.71]; Q3 ARR, 1.50 [95% CI, 1.23-1.83]; Q4 ARR, 1.60 [95% CI, 1.32-1.93]; Cochrane-Armitage test for trend, P < .001). Neighborhood disadvantage was associated with PPD among Asian (Q2 ARR, 1.17 [95% CI, 1.04-1.31]; Q3 ARR, 1.20 [95% CI, 1.06-1.35]) and White (Q3 ARR, 1.14 [95% CI, 1.07-1.21]; Q4 ARR, 1.17 [95% CI, 1.09-1.26]) individuals and those of other race and ethnicity (Q3 ARR, 1.34 [95% CI, 1.09-1.63]; Q4 ARR, 1.28 [95% CI, 1.03-1.58]), but the magnitude of risk was lower. Neighborhood disadvantage was not associated with PPD among Hispanic individuals (eg, Q2 ARR, 1.04 [95% CI, 0.94-1.14]; Q3 ARR, 1.00 [95% CI, 0.91-1.10]; Q4 ARR, 0.98 [95% CI, 0.90-1.08]).Conclusions and relevanceIn this cross-sectional study of postpartum individuals, residing in more disadvantaged neighborhoods was associated with PPD, except among Hispanic individuals. Neighborhood disadvantage may be associated with racial and ethnic differences in postpartum mental health. Geographic targeting of mental health interventions may decrease postpartum mental health inequities.
| S-EPMC10644210 | biostudies-literature
Project description:ObjectivePsychosocial factors likely contribute to racial and ethnic inequalities in cardiovascular diseases (CVDs). However, precise social, psychological, and physiological pathways linking race and ethnicity to the development of CVDs are not well understood. Systemic inflammation, commonly indexed by C-reactive protein (CRP), is a biomarker for CVD risk and progression. The objective of this study was to identify mediating pathways from race and ethnicity to CRP through social, psychological, and behavioral variables.MethodsUsing data from 12,382 participants aged 51 and older in the Health and Retirement Study, structural equation models tested for direct and indirect effects of race and ethnicity on CRP measured over four years through educational disadvantage, everyday discrimination, depressive symptoms, external locus of control, and smoking.ResultsEducational disadvantage mediated Black-White and Hispanic-White disparities in baseline CRP directly, as well as indirectly through elevated depressive symptoms, higher external locus of control, and smoking. Educational disadvantage also mediated Black-White and Hispanic-White disparities in CRP change directly, as well as indirectly through higher external locus of control and smoking. Independent of education, discrimination mediated Black-White differences in baseline CRP via elevated depressive symptoms, higher external locus of control, and smoking. Discrimination also mediated Black-White disparities in CRP change via external locus of control.ConclusionsResults from this population-based, longitudinal study support the view that racially patterned social disadvantage is prospectively associated with longitudinal inflammatory processes, and some of these effects are independently mediated by psychological and behavioral factors. Biopsychosocial pathways to health disparities also differ between minority groups.
| S-EPMC6520605 | biostudies-literature
Project description:Objective We determine whether racial concordance between postpartum patients and obstetric providers (dyads) impacts the perception of quality of care among people undergoing intrapartum obstetrical procedures.Study design This is a prospective cohort study of postpartum people who underwent operative vaginal or cesarean deliveries in the second stage of labor. Participants were asked to identify the race of their primary provider and complete the Interpersonal Processes of Care (IPC) survey, which assesses communication, patient-centered decision-making, and interpersonal style. The association of participant-identified patient-provider racial concordance with IPC scores was determined. The primary outcome was the IPC subdomain related to discrimination, and secondary outcomes included other IPC subdomains and IPC results by participant racial identity (Black, LatinX vs. White). Sociodemographic and biomedical data were extracted from the medical record. Bivariable analyses were performed.Results Of 168 patients who were approached, 107 (63.6%) agreed to participate and 87 (81.3%) completed the survey. The majority (n=49) identified a racially discordant provider. Participants in racially concordant dyads were more likely to be older, White, use English as a primary language, complete a higher degree of education, and have a higher household income when compared with racially discordant dyads. Intrapartum outcomes were not significantly different between groups. Median IPC subtest scores were not significantly different between groups or between racial/ethnic identities.Conclusion There were no significant differences in perceptions of IPC between racially concordant versus discordant dyads. However, there is an ongoing need to further clarify measures of quality of care in high-acuity obstetrical situations to remediate ongoing racial and ethnic disparities in adverse health outcomes.Key points· Racial concordance between patient and clinician has been associated with improved quality of care.. · There are limited data on racial concordance and perceptions of operative obstetrical care (e.g., operative vaginal delivery).. · Racial concordance was not associated with differences in patient-perceived quality of care associated with operative obstetrics..
| S-EPMC10323858 | biostudies-literature
Project description:Experiences within one's social environment shape neural sensitivity to threatening and rewarding social cues. However, in racialized societies like the USA, youth from minoritized racial/ethnic backgrounds can have different experiences and perceptions within neighborhoods that share similar characteristics. The current study examined how neighborhood disadvantage intersects with racial/ethnic background in relation to neural sensitivity to social cues. A racially diverse (59 Hispanic/Latine, 48 White, 37 Black/African American, 15 multi-racial and 6 other) and primarily low to middle socioeconomic status sample of 165 adolescents (88 female; Mage = 12.89) completed a social incentive delay task while undergoing functional magnetic resonance imaging (fMRI) scanning. We tested for differences in the association between neighborhood disadvantage and neural responses to social threat and reward cues across racial/ethnic groups. For threat processing, compared to White youth, neighborhood disadvantage was related to greater neural activation in regions involved in salience detection (e.g. anterior cingulate cortex) for Black youth and regions involved in mentalizing (e.g. temporoparietal junction) for Latine youth. For reward processing, neighborhood disadvantage was related to greater brain activation in reward, salience and mentalizing regions for Black youth only. This study offers a novel exploration of diversity within adolescent neural development and important insights into our understanding of how social environments may 'get under the skull' differentially across racial/ethnic groups.
| S-EPMC9949505 | biostudies-literature
Project description:ImportanceThe global prevalence of autism spectrum disorder (ASD) has been reported to be between 1% and 2% of the population, with little research in Black, Asian, and other racial/ethnic minority groups. Accurate estimates of ASD prevalence are vital to planning diagnostic, educational, health, and social care services and may detect possible access barriers to diagnostic pathways and services and inequalities based on social determinants of health.ObjectiveTo evaluate whether socioeconomic disadvantage is associated with ASD prevalence and the likelihood of accessing ASD services in racial/ethnic minority and disadvantaged groups in England.Design, setting, and participantsThis case-control prevalence cohort study used the Spring School Census 2017 from the Pupil Level Annual Schools Census of the National Pupil Database, which is a total population sample that includes all English children, adolescents, and young adults aged 2 to 21 years in state-funded education. Data were collected on January 17, 2017, and analyzed from August 2, 2018, to January 28, 2020.ExposuresAge and sex were treated as a priori confounders while assessing correlates of ASD status according to (1) race/ethnicity, (2) social disadvantage, (3) first language spoken, (4) Education, Health and Care Plan or ASD Special Educational Needs and Disability support status, and (5) mediation analysis to assess how social disadvantage and language might affect ASD status.Main outcomes and measuresSex- and age-standardized ASD prevalence by race/ethnicity and 326 English local authority districts in pupils aged 5 to 19 years.ResultsThe final population sample consisted of 7 047 238 pupils (50.99% male; mean [SD] age, 10.18 [3.47] years) and included 119 821 pupils with ASD, of whom 21 660 also had learning difficulties (18.08%). The standardized prevalence of ASD was 1.76% (95% CI, 1.75%-1.77%), with male pupils showing a prevalence of 2.81% (95% CI, 2.79%-2.83%) and female pupils a prevalence of 0.65% (95% CI, 0.64%-0.66%), for a male-to-female ratio (MFR) of 4.32:1. Standardized prevalence was highest in Black pupils (2.11% [95% CI, 2.06%-2.16%]; MFR, 4.68:1) and lowest in Roma/Irish Travelers (0.85% [95% CI, 0.67%-1.03%]; MFR, 2.84:1). Pupils with ASD were more likely to face social disadvantage (adjusted prevalence ratio, 1.61; 95% CI, 1.59-1.63) and to speak English as an additional language (adjusted prevalence ratio, 0.64; 95% CI, 0.63-0.65). The effect of race/ethnicity on ASD status was mediated mostly through social disadvantage, with Black pupils having the largest effect (standardized mediation coefficient, 0.018; P < .001) and 12.41% of indirect effects through this way.Conclusions and relevanceThese findings suggest that significant differences in ASD prevalence exist across racial/ethnic groups and geographic areas and local authority districts, indicating possible differential phenotypic prevalence or differences in detection or referral for racial/ethnic minority groups.
| S-EPMC8008434 | biostudies-literature
Project description:ImportanceThere are substantial disparities in breastfeeding rates by race and ethnicity. Telelactation services that connect parents to lactation consultants via video are increasingly available and may reduce inequities in breastfeeding support; however, there is limited evidence on effectiveness.ObjectiveTo assess the impact of video telelactation services on breastfeeding duration and exclusivity across a racially and ethnically diverse population of parents.Design, setting, and participantsThis digital randomized clinical trial was conducted across 39 states. Eligible participants were aged 18 years or older, were in their third trimester of pregnancy with their first child, and intended to breastfeed. Participants were recruited through pregnancy apps from July 2021 to December 2022 and followed up through 24 weeks post partum. Analyses were completed from December 2023 to June 2024.InterventionPregnant individuals were randomized 1:1 to the treatment arm, which received access to a smartphone app with on-demand access to lactation consultants 24 hours a day via video visits, or to the control arm, which received an infant care e-book.Main outcomes and measuresAny breastfeeding and any infant formula use at 24 weeks post partum and time to breastfeeding cessation. The intention-to-treat analysis used regression models to estimate unadjusted effects and effects adjusted for baseline characteristics.ResultsA total of 2108 participants were randomized, and 1911 were analyzed for primary outcomes. The mean (SD) age at the time of recruitment was 29.61 (5.37) years, and 707 participants (37.0%) had a household income of less than $55 000. In all, 611 participants (32.0%) identified as Black, 678 (35.5%) as Latinx, and 622 (32.5%) as races and/or ethnicities other than Black or Latinx. Among treatment arm participants, 466 (48.8%) used telelactation services. In intention-to-treat analyses, the proportion of all participants who reported any breastfeeding at 24 weeks was 674 (70.6%) in the treatment group and 639 (66.8%) in the control group (adjusted difference, 3.6 percentage points; 95% CI, -0.5 to 7.6 percentage points; P = .08), and the proportion with exclusive breastfeeding at 24 weeks was 447 (46.9%) in the treatment arm and 421 (44.1%) in the control arm (adjusted difference, 2.4 percentage points; 95% CI, -1.9 to 6.8 percentage points; P = .28). Differences were significant among Black participants. The proportion of Black participants who reported any breastfeeding at 24 weeks was 196 of 301 (65.1%) in the treatment arm and 178 of 310 (57.4%) in the control arm (adjusted difference, 7.5 percentage points; 95% CI, 0.2-14.8 percentage points; P = .045) and who reported breastfeeding exclusively at 24 weeks was 128 of 300 (42.7%) in the treatment arm and 105 of 310 (33.9%) in the control arm (adjusted difference, 9.2 percentage points; 95% CI, 1.4-16.9 percentage points; P = .02).Conclusions and relevanceIn this randomized clinical trial, telelactation services had no significant effect on breastfeeding rates among participants overall, but significant improvements were found among Black individuals. The results suggest that telelactation services could be a component of a comprehensive strategy to reduce racial disparities in breastfeeding rates.Trial registrationClinicalTrials.gov Identifier: NCT04856163.
| S-EPMC11868977 | biostudies-literature
Project description:ImportanceEvidence from national studies indicates systematic differences in hospitals in which racial/ethnic minorities receive care, with most care obtained in a small proportion of hospitals. Little is known about the source of these differences.ObjectivesTo examine the patterns of emergency department (ED) destination of emergency medical services (EMS) transport according to patient race/ethnicity, and to compare the patterns between those transported by EMS and those who did not use EMS.Design, setting, and participantsThis cohort study of US EMS and EDs used Medicare claims data from January 1, 2006, to December 31, 2012. Enrollees aged 66 years or older with continuous fee-for-service Medicare coverage (N = 864 750) were selected for the sample. Zip codes with a sizable count (>10) of Hispanic, non-Hispanic black, and non-Hispanic white enrollees were used for comparison of EMS use across racial/ethnic subgroups. Data on all ED visits, with and without EMS use, were obtained. Data analysis was performed from December 18, 2018, to July 7, 2019.Main outcomes and measuresThe main outcome measure was whether an EMS transport destination was the most frequent ED destination among white patients (reference ED). The secondary outcomes were (1) whether the ED destination was a safety-net hospital and (2) the distance of EMS transport from the ED destination.ResultsThe study cohort comprised 864 750 Medicare enrollees from 4175 selected zip codes who had 458 701 ED visits using EMS transport. Of these EMS-transported enrollees, 26.1% (127 555) were younger than 75 years, and most were women (302 430 [66.8%]). Overall, the proportion of white patients transported to the reference ED was 61.3% (95% CI, 61.0% to 61.7%); this rate was lower among black enrollees (difference of -5.3%; 95% CI, -6.0% to -4.6%) and Hispanic enrollees (difference of -2.5%; 95% CI, -3.2% to -1.7%). A similar pattern was found among patients with high-risk acute conditions; the proportion transported to the reference ED was 61.5% (95% CI, 60.7% to 62.2%) among white enrollees, whereas this proportion was lower among black enrollees (difference of -6.7%; 95% CI, -8.3% to -5.0%) and Hispanic enrollees (difference of -2.6%; 95% CI, -4.5% to -0.7%). In major US cities, a larger black-white discordance in ED destination was observed (-9.3%; 95% CI, -10.9% to -7.7%). Black and Hispanic patients were more likely to be transported to a safety-net ED compared with their white counterparts; the proportion transported to a safety-net ED among white enrollees (18.5%; 95% CI, 18.1% to 18.7%) was lower compared with that among black enrollees (difference of 2.7%; 95% CI, 2.2% to 3.2%) and Hispanic enrollees (difference of 1.9%; 95% CI, 1.3% to 2.4%). Concordance rates of non-EMS-transported ED visits were statistically significantly lower than for EMS-transported ED visits; the concordance rate among white enrollees of 52.9% (95% CI, 52.1% to 53.6%) was higher compared with that among black enrollees (difference of -4.8%; 95% CI, -6.4% to -3.3%) and Hispanic enrollees (difference of -3.0%; 95% CI, -4.7% to -1.3%).Conclusions and relevanceThis study found race/ethnicity variation in ED destination for patients using EMS transport, with black and Hispanic patients more likely to be transported to a safety-net hospital ED compared with white patients living in the same zip code.
| S-EPMC6735492 | biostudies-literature
Project description:ObjectiveTo determine the association of socioeconomic status at the census block group level with chronic conditions and to determine whether the associations differ by age, sex, race, or ethnicity.MethodsAdults aged 20 years and older on April 1, 2015, from 7 counties in southern Minnesota were identified using the Rochester Epidemiology Project records-linkage system. We estimated the prevalence of 19 chronic conditions (7 cardiometabolic, 7 other somatic, and 5 mental health conditions) at the individual level and a composite measure of neighborhood socioeconomic disadvantage (the area deprivation index [ADI]) at the census block group level (n=249).ResultsAmong the 197,578 persons in our study, 46.7% (92,373) were male, 49.5% (97,801) were aged 50 years and older, 12.3% (24,316) were of non-White race, and 5.3% (10,546) were Hispanic. The risk of most chronic conditions increased with increasing ADI. For each cardiometabolic condition and most other somatic and mental health conditions, the pattern of increasing risk across ADI quintiles was attenuated, or there was no association across quintiles of ADI in the oldest age group (aged ≥70 years). Stronger associations between ADI and several cardiometabolic, other somatic, and mental health conditions were observed in women.ConclusionHigher ADI was associated with increased risk of most chronic conditions, with more pronounced associations in younger persons. For some chronic conditions, the associations were stronger in women. Our findings underscore the importance of recognizing the overall and potentially differential impact of area-level deprivation on chronic disease outcomes for diverse populations.
| S-EPMC8775356 | biostudies-literature
Project description:IntroductionUnderstanding how contextual socioeconomic factors are associated with psychosocial distress among different ethnoracial groups is important for addressing health disparities in individuals at risk for Alzheimer's disease.MethodsUsing Health and Aging Brain Study-Health Disparities (HABS-HD) data collected between 2017 and 2023, we examined the association of neighborhood disadvantage with psychosocial distress using demographically adjusted linear regression models, stratified by ethnoracial group and cognitive status.ResultsWe included 630 non-Hispanic Black, 1109 Hispanic, and 1068 non-Hispanic White older adults deemed cognitively normal (CN) or diagnosed with mild cognitive impairment (MCI). Residing in areas of greater neighborhood disadvantage was associated with increased chronic stress (CS) among CN White participants, but this relationship was attenuated among White participants with MCI. Regardless of cognitive status, severe levels of disadvantage were associated with increased CS and depression among Black participants.DiscussionAging in more disadvantaged neighborhoods was associated with greater CS and depression for Black and White participants.HighlightsGreater neighborhood disadvantage was associated with increased depression and chronic stress for White and Black individuals. Individuals with mild cognitive impairment reported greater levels of psychosocial distress. These findings are relevant for addressing mental health inequity in aging populations.
| S-EPMC11772701 | biostudies-literature
Project description:ObjectiveTo improve an existing method, Medicare Bayesian Improved Surname Geocoding (MBISG) 1.0 that augments the Centers for Medicare & Medicaid Services' (CMS) administrative measure of race/ethnicity with surname and geographic data to estimate race/ethnicity.Data sources/study settingData from 284 627 respondents to the 2014 Medicare CAHPS survey.Study designWe compared performance (cross-validated Pearson correlation of estimates and self-reported race/ethnicity) for several alternative models predicting self-reported race/ethnicity in cross-sectional observational data to assess accuracy of estimates, resulting in MBISG 2.0. MBISG 2.0 adds to MBISG 1.0 first name, demographic, and coverage predictors of race/ethnicity and uses a more flexible data aggregation framework.Data collection/extraction methodsWe linked survey-reported race/ethnicity to CMS administrative and US census data.Principal findingsMBISG 2.0 removed 25-39 percent of the remaining MBISG 1.0 error for Hispanics, Whites, and Asian/Pacific Islanders (API), and 9 percent for Blacks, resulting in correlations of 0.88 to 0.95 with self-reported race/ethnicity for these groups.ConclusionsMBISG 2.0 represents a substantial improvement over MBISG 1.0 and the use of CMS administrative data on race/ethnicity alone. MBISG 2.0 is used in CMS' public reporting of Medicare Advantage contract HEDIS measures stratified by race/ethnicity for Hispanics, Whites, API, and Blacks.
| S-EPMC6338295 | biostudies-literature