Publications by authors named "Inger Burnett-Zeigler"

24 Publications

  • Page 1 of 1

Integrating Cultural Humility into the Medical Education Curriculum: Strategies for Educators.

Teach Learn Med 2021 Feb 11:1-7. Epub 2021 Feb 11.

Center for Global Health Education, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

Issue: The framework of cultural humility, which emphasizes curiosity and self-reflection over mastery, was identified over 20 years ago as a way to address implicit bias in health care, an important factor in health disparities. Despite growing interest from researchers and educators, as well as the urgent call to adopt these values, the foundational elements of cultural humility remain challenging to teach in medical education and have not yet been widely adopted.

Evidence: Health disparities persist throughout the United States among a growing population of diverse patients. The cultural humility framework undermines power imbalances by encouraging the clinician to view their patient as an expert of their own experience. This approach strengthens relationships within the community, illuminates racial and historical injustices, and contributes to equitable care. However, recent reviews have shown that humility-based principles have yet to be widely integrated into cultural curricula. Based on available evidence, this article introduces the foundational concepts of cultural humility with the aim of helping medical educators better understand and implement the principles of cultural humility into undergraduate medical education.

Implications: Cultural humility is a powerful and feasible adjunct to help student physicians cultivate effective tools to provide the best patient care possible to an increasingly diverse patient population. However, there is little known about how best to implement the principles of cultural humility into existing undergraduate medical education curricula. The analyses and strategies presented provide educators with the background, instructional and curricular methods to enable learners to cultivate cultural humility. Future systematic research will need to focus on investigating design, implementation and impact.
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http://dx.doi.org/10.1080/10401334.2021.1877711DOI Listing
February 2021

Mental Health in Women Living With HIV: The Unique and Unmet Needs.

J Int Assoc Provid AIDS Care 2021 Jan-Dec;20:2325958220985665

Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA.

Women living with HIV (WLWH) experience depression, anxiety, and posttraumatic stress symptoms at higher rates than their male counterparts and more often than HIV-unaffected women. These mental health issues affect not only the well-being and quality of life of WLWH, but have implications for HIV management and transmission prevention. Despite these ramifications, WLWH are under-treated for mental health concerns and they are underrepresented in the mental health treatment literature. In this review, we illustrate the unique mental health issues faced by WLWH such as a high prevalence of physical and sexual abuse histories, caregiving stress, and elevated internalized stigma as well as myriad barriers to care. We examine the feasibility and outcomes of mental health interventions that have been tested in WLWH including cognitive behavioral therapy, mindfulness-based interventions, and supportive counseling. Future research is required to address individual and systemic barriers to mental health care for WLWH.
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http://dx.doi.org/10.1177/2325958220985665DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829520PMC
January 2021

Mental health stigma among university health care students in Nigeria: a cross-sectional observational study.

Pan Afr Med J 2020 2;37. Epub 2020 Sep 2.

Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria.

Introduction: stigma is a key barrier to access and utilization of mental health services, particularly in low- and middle- income countries. The authors explore the specific content of mental health stigma among Nigerian university health care students at a national teaching hospital. These students are key stakeholders and represent a vital demographic to engage in stigma reduction initiatives. We evaluated the extent to which demographic characteristics, mood symptoms and utilization of resources are associated with stigma.

Methods: the authors examined data obtained from surveys completed by university health care students (N = 82) at Lagos University teaching hospital. Surveys assessed demographic background, mood symptoms and use of mental health services. Simple linear regression was used to model the unadjusted association between each component variable and overall stigma score. All analyses were conducted using R (version 3.5.3, 2019, The R Foundation) and assumed a two-sided, 5% level of significance.

Results: being a member of the minority ethnic group within our study population was associated with increased stigma. Individuals having greater need for mental health services (due to mood symptoms) were associated with increased stigma. Willingness to use medical services and community support from family and friends was associated with lower stigma. Religious themes were prominent among the majority of respondents.

Conclusion: consideration of the content details of stigma among university health care students in Nigeria is essential to inform interventions and strategies to reduce stigma within this subgroup. Those students who have symptoms of depression or anxiety may have lower utilization of mental health services.
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http://dx.doi.org/10.11604/pamj.2020.37.5.24898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501753PMC
January 2021

Acceptability of a mindfulness intervention for depressive symptoms among African-American women in a community health center: A qualitative study.

Complement Ther Med 2019 Aug 10;45:19-24. Epub 2019 May 10.

Northwestern University, Feinberg School of Medicine, Medical Social Sciences, Chicago, IL, United States.

Introduction: In this study we examined the acceptability and feasibility of a mindfulness based group intervention for socio-economically disadvantaged women in an urban community health center (M-Body).

Method: Women ages 18-65 with depressive symptoms who participated in an 8-week mindfulness based group intervention were invited to attend follow up focus groups about their experience. Inductive content analysis was used to identify themes from transcripts.

Results: All participants were African-American (N = 27). Participants had limited past experience with mindfulness. They reported benefits included anger management, increased control of thoughts, emotions and behaviors, enhanced awareness/focus and feeling calm and relaxed. Barriers to session attendance included transportation, employment, family responsibilities and child care. Participants suggested modifications such as providing the audio in multiple formats, increasing time spent doing yoga, modifying yoga postures and providing an orientation session. They stated that the content and delivery format of the group was acceptable.

Discussion: The mindfulness based intervention for depression was acceptable, reduced stress and improved coping and functioning among women in a community health center.
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http://dx.doi.org/10.1016/j.ctim.2019.05.012DOI Listing
August 2019

A Mindfulness-Based Intervention for Low-Income African American Women with Depressive Symptoms Delivered by an Experienced Instructor Versus a Novice Instructor.

J Altern Complement Med 2019 Jul 26;25(7):699-708. Epub 2019 Mar 26.

2Department of Medical Social Sciences, and Feinberg School of Medicine, Northwestern University, Chicago, IL.

In the present study, the authors pilot a streamlined mindfulness teacher training protocol for Federally Qualified Health Center (FQHC) staff and examine the distribution and variability of psychologic outcomes for participants in groups led by an experienced instructor compared to a FQHC staff instructor who received the streamlined training. Seventy-four adult women aged 18-65 with depressive symptoms enrolled to participate in the 8-week group mindfulness intervention led by an experienced instructor ( = 33) or a novice instructor ( = 41). The effect of instructor on the outcomes depression, stress, mindfulness, functioning, well-being, and depression stigma was assessed at baseline, 8, and 16 weeks. Depressive symptoms and stress significantly decreased, and mindfulness significantly increased in the experienced and novice instructor groups. In the novice instructor group, there was also a significant increase in well-being and functioning. The change in depressive symptoms, stress, functioning, and well-being was significantly greater in the novice instructor group than the experienced instructor groups. Preliminary data suggest that health care staff who receive streamlined training to deliver mindfulness-based interventions have comparable outcomes as experienced instructors.
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http://dx.doi.org/10.1089/acm.2018.0393DOI Listing
July 2019

Implementation Research Methodologies for Achieving Scientific Equity and Health Equity.

Ethn Dis 2019 21;29(Suppl 1):83-92. Epub 2019 Feb 21.

Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.

Implementation science has great potential to improve the health of communities and individuals who are not achieving health equity. However, implementation science can exacerbate health disparities if its use is biased toward entities that already have the highest capacities for delivering evidence-based interventions. In this article, we examine several methodologic approaches for conducting implementation research to advance equity both in our understanding of what historically disadvantaged populations would need-what we call scientific equity-and how this knowledge can be applied to produce health equity. We focus on rapid ways to gain knowledge on how to engage, design research, act, share, and sustain successes in partnership with communities. We begin by describing a principle-driven partnership process between community members and implementation researchers to overcome disparities. We then review three innovative implementation method paradigms to improve scientific and health equity and provide examples of each. The first paradigm involves making efficient use of existing data by applying epidemiologic and simulation modeling to understand what drives disparities and how they can be overcome. The second paradigm involves designing new research studies that include, but do not focus exclusively on, populations experiencing disparities in health domains such as cardiovascular disease and co-occurring mental health conditions. The third paradigm involves implementation research that focuses exclusively on populations who have experienced high levels of disparities. To date, our scientific enterprise has invested disproportionately in research that fails to eliminate health disparities. The implementation research methods discussed here hold promise for overcoming barriers and achieving health equity.
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http://dx.doi.org/10.18865/ed.29.S1.83DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428169PMC
July 2020

Accessibility and feasibility of using technology to support mindfulness practice, reduce stress and promote long term mental health.

Complement Ther Clin Pract 2018 Nov 8;33:93-99. Epub 2018 Sep 8.

Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.

Background And Purpose: We evaluated the feasibility of using an activity monitor to support mindfulness practice, reduce self-reported stress and physiological indicators of stress.

Materials And Methods: Adult women (N = 19) who previously participated in a mindfulness intervention wore an activity monitor for eight-weeks. The activity monitor notified them when they were stressed (based on standard deviation pulse pressure). Heart rate and pulse pressure were continuously collected via the activity monitor. Mindfulness, stress, depression and trauma symptoms were collected via self-report surveys.

Results: There were no significant changes in self-reported stress, depression, post-traumatic stress and mindfulness from baseline to eight-weeks. Pulse pressure and standard deviation of pulse pressure increased over time. Those who were high on the non-judge mindfulness subscale had a lower standard deviation pulse pressure and spent less time stressed.

Conclusion: Those who are more mindful are less likely to have physiological signs of stress.
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http://dx.doi.org/10.1016/j.ctcp.2018.09.001DOI Listing
November 2018

Ethnic Identity, Acculturation, and 12-Month Psychiatric Service Utilization Among Black and Hispanic Adults in the U.S.

J Behav Health Serv Res 2018 Jan;45(1):13-30

Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.

A cross-sectional study design was used to examine the associations of ethnic identity, acculturation, and psychiatric service utilization among Wave 2 respondents of the National Epidemiologic Survey on Alcohol Related Conditions with 12-month psychiatric disorders who self-identified as Black (6587, 19%) and Hispanic (6359, 18%). Weighted multivariable regression analyses were conducted to examine the relationships between ethnic identity, acculturation, and 12-month psychiatric service utilization. Stronger ethnic identity was associated with decreased odds of using psychiatric services among Black (AOR = 0.956; CI = 0.923-0.991) and Hispanic individuals (AOR = 0.967; CI = 0.945-0.990). Greater acculturation was associated with an increased odds of psychiatric service utilization for Hispanic individuals (AOR = 1.025; CI = 1.000-1.050). These findings suggest that a sense of pride, belonging, and attachment to one's racial/ethnic group and participating in ethnic behaviors is associated with lower rates of participation in psychiatric services; alternatively, acquiring key elements of the U.S. culture is associated with greater participation in psychiatric services.
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http://dx.doi.org/10.1007/s11414-017-9557-8DOI Listing
January 2018

The Frequency of PTSD and Subthreshold PTSD among African-American Women with Depressive Symptoms in a Disadvantaged Urban Neighborhood: Pilot Study.

J Racial Ethn Health Disparities 2017 Dec 6;4(6):1069-1073. Epub 2016 Dec 6.

Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Claire, Suite 1000, Chicago, IL, 60611, USA.

Racial/ethnic minority women in a disadvantaged urban neighborhood may experience a high rate of post-traumatic stress disorder (PTSD) and depression. This brief report examined the frequency of a PTSD diagnosis and subthreshold PTSD among 72 female participants with depressive symptoms in a mindfulness-based intervention for depression at an urban federally qualified health center (FQHC). The MINI International Neuropsychiatric Interview was used to assess PTSD diagnosis or subthreshold PTSD, and the Inventory of Depressive Symptomatology-Self-Report (IDS-SR) was used to assess depressive symptoms. We conducted a descriptive analysis of trauma experiences and explored the neighborhood context of the participants. Fifty-one percent of women self-reported that they experienced a traumatic event. Twenty-nine percent of women met PTSD diagnosis and 7% had subthreshold PTSD; women with a PTSD diagnosis or subthreshold PTSD had significantly worse depressive symptoms. Commonly reported traumas included witnessing a murder, experiencing abuse, and domestic violence. This brief report highlights the high frequency of PTSD diagnosis and subthreshold PTSD among underserved women with depressive symptoms. This may be associated with trauma events linked to residing in a disadvantaged neighborhood.
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http://dx.doi.org/10.1007/s40615-016-0311-3DOI Listing
December 2017

Mindfulness based stress reduction adapted for depressed disadvantaged women in an urban Federally Qualified Health Center.

Complement Ther Clin Pract 2016 Nov 13;25:59-67. Epub 2016 Aug 13.

Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA.

Background: In this study we examine the feasibility and preliminary effectiveness of mindfulness based stress reduction adapted for delivery in an urban Federally Qualified Health Center (FQHC).

Methods: Thirty-one African- American adult women ages 18-65 with depressive symptoms enrolled to participate in an 8-week mindfulness group intervention. The primary outcome (depression) and secondary outcomes (stress, mindfulness, functioning, well-being, and depression stigma) were assessed at baseline, 8 and 16-weeks.

Results: Depressive symptoms significantly decreased from baseline to 16 weeks. A significant decrease in stress and significant increase in mindfulness was found from baseline to 8 weeks and baseline to 16 weeks. Additionally, aspects of well-being-self-acceptance and growth-significantly increased from baseline to 8-weeks. Stigma significantly increased from baseline to 8 weeks and significantly decreased from 8 to 16 weeks (all p's < 0.05).

Conclusions: Mindfulness-based interventions implemented in FQHCs may increase access to effective treatments for mental health symptoms.
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http://dx.doi.org/10.1016/j.ctcp.2016.08.007DOI Listing
November 2016

Mind-Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review.

J Altern Complement Med 2016 Feb 5;22(2):115-24. Epub 2015 Nov 5.

1 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL.

Mind-body approaches are commonly used to treat a variety of chronic health conditions, including depression and anxiety. A substantial proportion of individuals with depression and anxiety disorders do not receive conventional treatment; disadvantaged individuals are especially unlikely to receive treatment. Mind-body approaches offer a potentially more accessible and acceptable alternative to conventional mental health treatment for disadvantaged individuals, who may not otherwise receive mental health treatment. This review examines evidence for the efficacy of mind-body interventions for mental health symptoms among disadvantaged populations. While rates of utilization were relatively lower for racial/ethnic minorities, evidence suggests that significant proportions of racial/ethnic minorities are using complementary health approaches as health treatments, especially prayer/healers and natural or herbal remedies. This review of studies on the efficacy of mind-body interventions among disadvantaged populations found evidence for the efficacy of mind-body approaches for several mental and physical health symptoms, functioning, self-care, and overall quality of life.
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http://dx.doi.org/10.1089/acm.2015.0038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761814PMC
February 2016

Mental Health-Related Healthcare Use Following Bilateral Deep Brain Stimulation For Parkinson's Disease.

J Parkinsons Dis 2015 ;5(3):497-504

Loyola University Stritch School of Medicine, Maywood, IL, USA.

Background: The subthalamic nucleus (STN) and the globus pallidus internus (GPi) are both effective targets for deep brain stimulation (DBS) to relieve motor symptoms of Parkinson's disease. However, studies have reported varied effects on mental health-related adverse events and depressed mood following DBS.

Objective: The current observational study sought to compare mental health healthcare utilization and costs for three years following STN or GPi DBS.

Methods: For a cohort of Veterans (n = 161) with Parkinson's disease who participated in a larger multi-site randomized trial, we compared mental health outpatient visits, medication use, inpatient admissions, and associated costs by DBS target site (STN vs. GPi).

Results: Neither group nor time differences were significant for mental health outpatient or inpatient utilization following DBS. Overall costs associated with mental health visits and medications did not differ by time or by group. However, the percentage of patients with mental health medication use increased in the 6-month and 6 to 12 month periods post-surgery. The STN group had significantly greater increase in medication use at 6 to 12 months post-surgery compared to the GPi group (p <  0.05).

Conclusion: Despite a brief increase in medication use following surgery, this study suggests that mental health healthcare use and costs are stable over time and similar between DBS targets. Prior research findings of mental health-related adverse events and mood following DBS did not translate to greater mental health service utilization in our cohort. The changes seen in the year following surgery may reflect temporary adjustments with stabilization over time.
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http://dx.doi.org/10.3233/JPD-140512DOI Listing
July 2016

Cost of deep brain stimulation for the treatment of Parkinson's disease by surgical stimulation sites.

Mov Disord 2014 Nov 15;29(13):1666-74. Epub 2014 Sep 15.

Hines VA Hospital, Center for Management of Complex Chronic Healthcare, Hines, Illinois, USA; Loyola University Stritch School of Medicine, Maywood, Illinois, USA.

Objective: To assess costs and effectiveness of deep brain stimulation (DBS) of the internal globus pallidum (GPi) versus subthalamic nucleus (STN) from the provider and societal perspectives for Parkinson's disease (PD) patients in a multicenter randomized trial.

Methods: All costs from randomization to 36 months were included. Costs were from Department of Veterans Affairs (VA) and Medicare databases and clinical trial data. Quality adjusted life years (QALYs) were from Quality of Well Being questionnaires.

Results: Provider costs were similar for the 144 GPi and 130 STN patients (GPi: $138,044 vs. STN: $131,822; difference = $6,222, 95% confidence interval [CI]: -$42,125 to $45,343). Societal costs were also similar (GPi: $171,061 vs. STN: $167,706; difference = $3,356, 95% CI: -$57,371 to $60,294). The GPi patients had nonsignificantly more QALYs.

Conclusions: The QALYs and costs were similar; the level of uncertainty given the sample size suggests that these factors should not direct treatment or resource allocation decisions in selecting or making available either procedure for eligible PD patients.
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http://dx.doi.org/10.1002/mds.26029DOI Listing
November 2014

The association between race and gender, treatment attitudes, and antidepressant treatment adherence.

Int J Geriatr Psychiatry 2014 Feb 25;29(2):169-77. Epub 2013 Jun 25.

Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Objectives: We examined the associations between treatment attitudes and beliefs with race-gender differences in antidepressant adherence.

Methods: Subjects (n = 186) were African-American and White subjects aged ≥60 years, diagnosed with clinically significant depression, and had a new outpatient primary care recommendation for antidepressant treatment. Antidepressant adherence was assessed using the Brief Medication Questionnaire. Attitudes and beliefs were assessed using the Patients Attitudes Toward and Ratings of Care for Depression, two items rating perceived medication importance, and a modified version of the Stigma Scale for Receiving Psychological Help.

Results: African-American men and women had significantly greater concerns about antidepressants and significantly less understanding about treatment than White women. African-American men had significantly more negative attitudes toward healthcare providers than African-American and White women. African-American women were more likely than White men and women to endorse a medication other than their antidepressant as most important. Whereas some race-gender differences were found in personal spirituality, no group differences were found in perceived stigma. In a logistic regression model adjusted for key baseline variables, White women were significantly more adherent to antidepressants than African-American women (OR = 3.05, 95% CI = 1.06-8.81). Fewer concerns about antidepressants and indicating the antidepressant as the most important medication were both significantly associated with adherence. After including either of these two variables, the adherence difference between White women and African-American women was no longer significant (OR = 2.56, 95% CI = 0.84-7.80).

Conclusions: Concerns about antidepressants and the importance of antidepressant medication are associated with adherence and are potentially modifiable through improved patient-provider communication, psycho-education, and therapeutic interventions.
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http://dx.doi.org/10.1002/gps.3984DOI Listing
February 2014

Ethnic identity, acculturation and the prevalence of lifetime psychiatric disorders among black, Hispanic, and Asian adults in the U.S.

J Psychiatr Res 2013 Jan 9;47(1):56-63. Epub 2012 Oct 9.

VA Ann Arbor Healthcare System, VA Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, USA.

Background: Past research has asserted that racial/ethnic minorities are more likely to develop psychiatric disorders due to their increased exposure to stressors; however most large epidemiologic studies have found that individuals who are Black or Hispanic are less likely to have most psychiatric disorders than those who are White. This study examines the associations between ethnic identity, acculturation, and major psychiatric disorders among Black, Hispanic, and Asian adults in the U.S.

Methods: The sample included Wave 2 respondents to the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), a large population-based survey, who self-identified as Black (N = 6219), Asian/Native Hawaiian/Other pacific islander (N = 880), and Hispanic (N = 5963). Multivariable regression analyses were conducted examining the relationships between ethnic identity, acculturation, and the prevalence of psychiatric disorders.

Results: Higher scores on the ethnic identity measure were associated with decreased odds of having any lifetime psychiatric diagnoses for those who were Black (AOR = 0.978; CI = 0.967-0.989), Hispanic (AOR = 0.974; CI = 0.963-0.985), or Asian (AOR = 0.96; CI = 0.936-0.984). Higher levels of acculturation were associated with an increased odds of having any lifetime psychiatric diagnosis for those who were Black (AOR = 1.027; CI = 1.009-1.046), Hispanic (AOR = 1.033; CI = 1.024-1.042), and Asian (AOR = 1.029; CI = 1.011-1.048).

Conclusion: These findings suggest that a sense of pride, belonging, and attachment to one's racial/ethnic group and participating in ethnic behaviors may protect against psychopathology; alternatively, losing important aspects of one's ethnic background through fewer opportunities to use one's native language and socialize with people of their ethnic group other may be a risk factor for psychopathology.
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http://dx.doi.org/10.1016/j.jpsychires.2012.08.029DOI Listing
January 2013

Prevalence and correlates of mental health problems and treatment among adolescents seen in primary care.

J Adolesc Health 2012 Jun 4;50(6):559-64. Epub 2012 Feb 4.

Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.

Purpose: In this study, we describe the characteristics of adolescents with mental health problems among those presenting to primary care clinics in urban areas.

Methods: The sample included 1,076 adolescents aged 12-18 years who presented to federally qualified community health clinics in urban cities in the Midwest. Bivariate and multivariate logistic regression analyses were conducted to examine the associations between having a mental health problem with demographic characteristics, health-related variables, and other risk and promotive factors. We also examined the use of health services and involvement in activities among those with mental health problems.

Results: Approximately 14% of adolescents screened positive for a mental health problem; among those with a mental health problem, 42.8% received mental health services in the past 3 months. In the multivariate logistic regression analysis, adolescents who were female, with poorer grades, fair to poor self-reported health, using drugs, and lower parental monitoring were more likely to have a mental health problem. In bivariate analyses, adolescents with mental health problems were less likely to participate in school activities and community activities and more likely to use emergency room services.

Conclusions: Adolescents with mental health problems were more likely to have several other difficulties including poor grades, poor self-rated health, drug/alcohol use, and sexual activity. This study highlights the importance of screening youth with multidimensional needs and referring them to the appropriate services.
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http://dx.doi.org/10.1016/j.jadohealth.2011.10.005DOI Listing
June 2012

Psychotherapy utilization for acute depression within the Veterans Affairs health care system.

Psychol Serv 2012 Nov 7;9(4):325-35. Epub 2012 May 7.

VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.

This study examined the demographic characteristics and psychiatric comorbidities associated with the receipt of psychotherapy. The sample included 217,816 VA patients with a new depression diagnosis. Multinomial logistic regression analyses examined the relationships between the independent variables and the initiation of individual, group, or both individual and group psychotherapy within 90 days of a new diagnosis. Eighteen percent of VA patients received some form of psychotherapy. Veterans received a greater mean number of group therapy than individual therapy visits. Veterans who were female, younger than 35, unmarried, and with substance use, anxiety, or personality disorders were more likely to receive individual therapy only. Veterans who were male, 35-49 years old, Black, Other, or Hispanic, and with substance-use or anxiety disorders were more likely to receive group therapy only than no psychotherapy. Veterans who were male, 35-49 years old, Black, or Other race and with substance-use or anxiety disorders were more likely to receive both individual and group psychotherapy. Increased efforts are needed to encourage early initiation of psychotherapy treatment among depressed veterans.
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http://dx.doi.org/10.1037/a0027957DOI Listing
November 2012

The impact of psychiatric disorders on employment: results from a national survey (NESARC).

Community Ment Health J 2013 Jun 27;49(3):303-10. Epub 2012 Mar 27.

VA Ann Arbor Healthcare System, VA Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI 48105, USA.

In this study we examine the longitudinal effects of psychiatric and substance use disorders on employment, in an employed population. The sample included respondents to the National epidemiologic survey on alcohol related conditions (NESARC) who were employed at Wave 1 (N=22,407). Bivariate and multivariable analyses were conducted examining the associations between 12-month and new onset 12-month psychiatric diagnoses at Wave 1 and employment status at Wave 2. Past year and new onset 12-month depression, 12-month bipolar, new onset 12-month drug abuse, and 12-month and new onset 12-month drug dependence were associated with a decreased odds of being employed at Wave 2. This study suggests that it would be beneficial for employers to support their employees in participating in mental health treatment. Additionally, understanding how psychiatric disorders influence employment over the life course might inform the development of preemptive interventions to treat mental health symptoms.
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http://dx.doi.org/10.1007/s10597-012-9510-5DOI Listing
June 2013

Depression treatment in older adult veterans.

Am J Geriatr Psychiatry 2012 Mar;20(3):228-38

VA Ann Arbor Healthcare System, VA Serious Mental Illness Treatment Research and Evaluation Center (SMITREC)/Health Services Research and Development (HSR&D), Ann Arbor, MI 48105, USA.

Objectives: : Older adults in the VA Healthcare System may have an increased risk for depression than those in the general population. These factors may also be associated with the likelihood of receiving depression treatment. This study examined the associations between sociodemographic characteristics, psychiatric comorbidities, and medical comorbidities and the receipt of depression treatment among depressed older adults in the VA.

Design: : Secondary analysis of data obtained from the VA's National Registry for Depression, a linkage of several administrative data sources with detailed services and pharmacy data for all VA patients diagnosed with depression.

Setting: : VA healthcare system.

Participants: : The sample included 147,631 VA patients who were at least 50 years old and received a new diagnosis of depression in FY08.

Measurements: : The associations between the depression treatment conditions (antidepressants, psychotherapy, both, and none) as outcome variables and sociodemographic characteristics, psychiatric comorbidities, and medical comorbidities as independent variables were assessed using χ tests and multinomial logistic regression analysis.

Results: : Approximately one-third (35.9%) of the depressed older adults did not receive any treatment. The odds receiving depression treatment decreased with increasing age. Those who were white, female and married were more likely to receive antidepressants, while those who were male of minority race/ethnicity, and unmarried were more likely to receive psychotherapy. Medical comorbidities and psychiatric comorbidities were also associated with the type of depression treatment received.

Conclusions: : Many depressed older adults may have limited or no treatment. Future outreach and intervention efforts should be targeted toward this vulnerable population.
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http://dx.doi.org/10.1097/JGP.0b013e3181ff6655DOI Listing
March 2012

Longitudinal predictors of first time depression treatment utilization among adults with depressive disorders.

Soc Psychiatry Psychiatr Epidemiol 2012 Oct 5;47(10):1617-25. Epub 2012 Jan 5.

VA Ann Arbor Healthcare System, VA Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), 2215 Fuller Road (11H), Ann Arbor, MI 48105, USA.

Purpose: Depressive disorders are a growing public health concern, however, a substantial number of depressed individuals do not receive treatment. This study examined the longitudinal predictors of receiving depression treatment among adults with persistent depressive disorders and no lifetime history of treatment.

Methods: The sample included respondents to the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), a large population-based survey, who met criteria for a 12-month major depressive disorder (MDD) or dysthymia (DYS) and had no prior depression treatment. Bivariate and multivariate analyses were conducted examining which socio-demographic and clinical predictors among individuals with depressive disorders and no prior treatment at Wave 1 were associated with receiving depression treatment at Wave 2 (N = 337).

Results: Only 47.2% of those with MDD or DYS and no prior treatment at Wave 1 had received depression treatment at Wave 2. Females were more likely to have received treatment at Wave 2: those of Hispanic ethnicity, other race, unmarried, 12 years of education, self-rated health of good/very good/excellent and anxiety disorders were less likely to have received treatment at Wave 2. Those with substance use disorders were more likely to have received treatment at Wave 2.

Conclusions: This study highlights individuals who would likely benefit from increased efforts to enhance depression treatment utilization.
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http://dx.doi.org/10.1007/s00127-011-0465-6DOI Listing
October 2012

Perceptions of quality of health care among veterans with psychiatric disorders.

Psychiatr Serv 2011 Sep;62(9):1054-9

Health Services Research and Development, Veterans AffairsAnn Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, USA.

Objective: An estimated 37% to 40% of veterans treated by the U.S. Department of Veterans Affairs (VA) have a psychiatric disorder, and many of them have comorbid general medical problems. This study examined the impact of demographic and clinical characteristics on perceptions of outpatient health care experiences among veterans with psychiatric disorders.

Methods: Responses from the Survey of Health Care Experiences (SHEP) administered by the Veterans Health Administration (VHA) and administrative data from the VA were collected for 55,578 patients aged 18 and older with a psychiatric disorder surveyed in fiscal year 2005. Bivariate and multivariable analyses were used to examine the associations between demographic and clinical characteristics and patients' responses about providers' attentiveness, collaboration in health care decisions, confidence in providers, and overall quality of care.

Results: Most veterans with psychiatric disorders perceived their health care experiences positively. However, those who were younger, were nonwhite, had lower incomes, had a service-connected disability, and had been diagnosed as having PTSD or a substance use disorder were less likely to perceive their health care experiences positively.

Conclusions: An opportunity exists to improve clinical practice and design health care services to better serve certain groups of patients at VHA facilities. Areas of improvement may include rapport building and developing ways to include patients in decisions about their health care.
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http://dx.doi.org/10.1176/ps.62.9.pss6209_1054DOI Listing
September 2011

Civilian employment among recently returning Afghanistan and Iraq National Guard veterans.

Mil Med 2011 Jun;176(6):639-46

VA Ann Arbor Healthcare System, Health Services Research and Development (HSR&D), 2215 Fuller Road, Ann Arbor, MI 48105, USA.

Objective: National Guard service members face deactivation from active duty soon after they return to the United States and rapid entry into the civilian workforce; therefore, it is important to examine employment among these Veterans.

Methods: The sample included 585 National Guard service members. Bivariate and multivariable analyses were conducted examining the associations between mental health symptoms, alcohol use, number of deployments, and combat exposure with employment status and full-time versus part-time employment as outcomes.

Results: Forty-one percent of National Guard service members were employed 45 to 60 days following demobilization. Among those who were employed, 79% were employed full-time. Age, family income, and combat exposure were associated with employment; income and health status were associated with part-time versus full-time employment.

Conclusions: Mental health status may not be strongly associated with initiating civilian employment among National Guard service members; however, better mental health status is associated with being employed full-time versus part-time.
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http://dx.doi.org/10.7205/milmed-d-10-00450DOI Listing
June 2011

Prevalence and correlates of alcohol misuse among returning Afghanistan and Iraq veterans.

Addict Behav 2011 Aug 13;36(8):801-6. Epub 2011 Jan 13.

VA Ann Arbor Healthcare System, VA Serious Mental Illness Treatment Research and Evaluation Center/Health Services Research and Development, Ann Arbor, MI 48105, USA.

Objective: Several studies have reported high rates of alcohol misuse and low rates of substance use treatment among OEF/OIF military service members. This study assessed the prevalence and correlates of alcohol misuse and the factors associated with treatment utilization among recently returned National Guard service members.

Methods: The sample included 585 members of the National Guard who volunteered to complete an anonymous survey assessing mental health and substance use problems, functional status, and past treatment experiences. Bivariate and multivariate logistic regression analyses were performed examining the significance of associations between alcohol misuse and mental health service use as outcomes and demographic variables, mental health symptoms, and military service characteristics as predictors. Barriers to treatment and factors facilitating treatment were also examined.

Results: Thirty-six percent of the service members met criteria for alcohol misuse. Of those misusing alcohol, 31% reported receiving any mental health treatment and 2.5% reported receiving specific substance use treatment in the past year. The barrier to treatment most commonly endorsed by those misusing alcohol was concern that the information about treatment would appear in their records. Among those misusing alcohol who had received services, spouses were most commonly endorsed as facilitating the pursuit of care.

Conclusions: Rates of alcohol misuse are high and rates of substance use treatment are low among National Guard service members. Additional research is needed to identify means of overcoming barriers to care and establish more effective approaches to facilitate linkage to care and receipt of appropriate interventions.
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http://dx.doi.org/10.1016/j.addbeh.2010.12.032DOI Listing
August 2011

Longitudinal predictors of addictions treatment utilization in treatment-naïve adults with alcohol use disorders.

Drug Alcohol Depend 2011 Jan 15;113(2-3):215-21. Epub 2010 Sep 15.

Department of Veterans Affairs, Health Services Research & Development, 2215 Fuller Road 11H, Ann Arbor, MI 48105, United States.

Background: Despite the substantial prevalence of alcohol use disorders (AUDs), prior research indicates that most people with AUDs never utilize either formal or informal treatment services. Several prior studies have examined the characteristics of individuals with AUDs who receive treatment; however, limited longitudinal data are available on the predictors of receiving AUD services in treatment-naive individuals with AUDs.

Methods: This study utilized data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) to identify adults in Wave 1 who met criteria for an AUD within the last 12 months and reported no prior lifetime alcohol treatment (N = 2760). These individuals were surveyed again at Wave 2, approximately 3-4 years later (N = 2170). This study examined the Wave 1 demographic and psychiatric conditions that were associated with receipt of AUD treatment services between Waves 1 and 2.

Results: In multivariable analyses, use of AUD treatment services between Waves 1 and 2 was significantly more likely among those who were male, non-Caucasian, younger, had lower income, and who had health insurance. Additionally, those who met criteria for a baseline drug use disorder, anxiety disorder or a personality disorder were more likely to receive AUD treatment.

Conclusions: Treatment was more often utilized in those who had more severe baseline psychopathology and in those with fewer economic resources. These findings highlight the need to broaden the types of care available to individuals with AUDs to increase the appeal of AUD services.
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http://dx.doi.org/10.1016/j.drugalcdep.2010.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005968PMC
January 2011