News & Announcements
Recovery from Psychological Distress among Low-income African American Mothers
Posted: January 25, 2012
Survivors of Hurricane Katrina have struggled for years with poor mental health, a study of low-income mothers in the New Orleans area titled Five years later: Recovery from post traumatic stress and psychological distress among low-income mothers affected by Hurricane Katrina, finds. Launched in 2003, the project began as a study of low-income adults enrolled in community colleges around the country, including three in New Orleans. After Katrina struck the Gulf Coast in 2005, researchers decided to continue to track the New Orleans-based participants. The sample includes 532 low-income mothers, most of them African American and whose average age was 26, spread across twenty-three states; participants were interviewed eleven months and nearly five years after the storm.
The study found that even after four years, roughly a third of participants still exhibited symptoms of post-traumatic stress, while 30 percent exhibited psychological distress. Though levels for both conditions were down from the first follow-up eleven months after the storm, they had not fallen back to pre-hurricane levels.
"On average, people were not back to baseline mental health and they were showing pretty high levels of post-traumatic stress symptoms. There aren't many studies that trace people for this long, but the very few that there are suggest faster recovery than what we're finding here," said Christina Paxson, a professor of economics and public affairs at Princeton and lead author on the study. "I think the lesson for treatment of mental health conditions is don't think it's over after a year. It isn't." Due to the makeup of the sample, Paxson cautioned that the study's results cannot be assumed to apply to the population as a whole, but they shed light on natural disasters' effects on a particularly vulnerable group.
The surveys helped rate the women on two signs of poor mental health: psychological distress and post-traumatic stress symptoms (PTSS). Researchers measured psychological distress using a series of questions (also in the initial questionnaire) typically used to screen for anxiety and mood disorders, asking about feelings such as sadness, hopelessness and nervousness experienced over the last 30 days. They measured PTSS using a test used to identify individuals at a high risk of meeting the criteria for post-traumatic stress disorder; for example, the women in the study were asked how often they thought about the hurricane in the last seven days and whether they had thoughts about the storm that they could not suppress.
The researchers found that even after four years, about 33 percent of the participants still had PTSS, and 30 percent had psychological distress. Though levels for both conditions had declined from the first follow-up 11 months after the hurricane, they were not back to pre-hurricane levels.
Integrated Care for Asian American, Native Hawaiian and Pacific Islander Communities
Posted: January 24, 2012
On April 8, 2011 the U.S. Department of Health and Human Services (US DHHS) issued an action plan to reduce racial and ethnic health disparities. As part of its ongoing commitment to enhance health equity and eliminate disparities in behavioral health for racial and ethnic minority populations, the US DHHS Office of Minority Health (OMH) partnered with the National Asian American Pacific Islander Mental Health Association (NAAPIMH) to convene an historic summit titled Integrated Care for Asian American, Native Hawaiian and Pacific Islander Communities: A Blueprint for Action. The August 15-16, 2011 meeting in San Francisco, California brought together more than 40 key stakeholders— all committed to improving the quality of life for Asian American, Native Hawaiian, Pacific Islander (AANHPI) communities. For the first time, providers, consumers, policy makers, evaluators and administrators from the areas of primary healthcare, integrated care, mental health, substance use and disabilities came together to develop a national agenda to examine the benefits integrated care for AANHPIs. Participants identified core components most relevant to AANHPI overall health and healthcare. Recommendations were designed to inform both governmental and non-governmental partners on best approaches and models of care that take into account the unique cultural and language needs of this diverse AANHPI population.
The four break-out sessions were designed to work as think tanks and were selected based on best evidence and practices available; and resulted in the following: 1) develop strategies to implement integrated care; 2) workforce training and development; 3) use of health information technology; and 4) community based participatory research and evaluation. Although each group made independent recommendations, they collectively agreed to the following:
Read the report (pdf).
Homeless Heavy Drinkers Imbibe Less when Housing Allows Alcohol
Posted: January 22, 2012
A study of a controversial housing project that allows chronically homeless people with severe alcohol problems to drink in their apartments found that during their first two years in the building residents cut their heavy drinking by 35 percent. For every three months during the study, participants drank an average of 8 percent fewer drinks on their heaviest drinking days. They also had fewer instances of delirium tremens, a life-threatening form of alcohol withdrawal. The study titled Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories was published in the American Journal of Public Health.
Housing for chronically homeless people usually comes with many conditions, including abstinence from drugs and alcohol and compliance with psychiatric and substance abuse treatment. But such requirements can become barriers to staying in housing. "These individuals have multiple medical, psychiatric and substance abuse problems, and housing that requires them to give up their belongings, adhere to curfews, stop drinking and commit to treatment all at once is setting them up to fail. The result is that we are relegating some of the most vulnerable people in our community to a life on the streets," said Susan Collins, lead author and University of Washington research assistant professor of psychiatry and behavioral sciences. Because they are unable to cope with the rules, they often do not qualify for housing or are asked to leave. Once back on the street, they cost taxpayers' money through use of emergency room visits, shelter and sobering center stays, arrests and jail bookings.
In response, an approach called project-based Housing First has been developed by the Downtown Emergency Service Center, a Seattle-based housing agency. Project-based Housing First provides immediate, permanent and supportive housing to chronically homeless people within a single housing project. It is considered "low-barrier" because it removes some of the traditional barriers to housing, such as abstinence from alcohol. The idea behind it is that if chronically homeless people are provided with stable, permanent housing, then their medical, psychiatric and substance abuse problems will become more manageable.
"A lot of people believe in the 'enabling hypothesis' – that allowing homeless, alcohol-dependent individuals to drink in their homes will enable them to drink more, and their drinking will spiral out of control," Collins said. "But instead what we found are across-the-board decreases in alcohol consumption and problems." Health also improved. Residents reporting recent bouts of delirium tremens dropped by more than half over the two-year study, from 65 percent to 23 percent. In the study:
Binge Drinking: Nationwide Problem, Local Solutions
Posted: January 20, 2012
Binge drinking accounts for more than half of the estimated 80,000 average annual deaths and three quarters of $223.5 billion in economic costs resulting from excessive alcohol consumption in the United States. CDC analyzed data collected in 2010 on the prevalence of binge drinking (defined as four or more drinks for women and five or more drinks for men on an occasion during the past 30 days) among U.S. adults aged ≥18 years in 48 states and the District of Columbia; and on the frequency (average number of episodes per month) and intensity (average largest number of drinks consumed on occasion) among binge drinkers.
Everyone can help prevent binge drinking.
States and communities can:
Doctors, nurses, and other providers can:
Download the CDC factsheet on Binge Drinking (pdf). Read the CDC Report Vital Signs: Binge Drinking Prevalence, Frequency, and Intensity Among Adults — United States, 2010.
Geographic & Sociodemographic Patterns in Prevalence of Mental Health Conditions Among Children
Posted: January 19, 2012
In a study titled Mental Health Conditions Among School-Aged Children: Geographic and Sociodemographic Patterns in Prevalence and Treatment the authors have provided state-level estimates of the prevalence of diagnosed pediatric emotional and behavioral mental health conditions and treatment received by children and adolescents ages 6-17 with these diagnoses. "Our results show significant variation in the prevalence of diagnosed mental health conditions among children and youth by state of residence in addition to documented sociodemographic and health-related factors. In contrast, receipt of treatment was more strongly related to socioeconomic and health-related factors," write the authors of an article published in the January 2012 issue of the Journal of Developmental and Behavioral Pediatrics. The prevalence of mental health conditions and potential for both long-term and widespread negative impacts underscore the importance of early identification and treatment. Identifying variations in the prevalence of diagnosed mental health conditions and the receipt of treatment among this population may help to illustrate disparities and to highlight examples where policies and systems could better support both identification and treatment of children and adolescents with mental health problems.
Data for the study came from the 2007 National Survey of Children's Health. Mental health conditions were identified using parents' responses to three questions about whether a doctor or health professional had ever told them that their child had depression, anxiety problems, or behavioral or conduct problems. Receipt of treatment was determined by parents' report of whether their child had received any treatment or counseling from a mental health professional in the past 12 months. Although state of residence was the primary covariate of interest, seven sociodemographic and health-related variables shown to be associated with mental health conditions and access to treatment in previous research were also assessed: child's or adolescent's sex, age, race and ethnicity, poverty status, insurance type, health status, and maternal health status.
The authors found that
The authors conclude that "further research at both the state and national levels is needed to determine how different approaches to the provision and financing of mental health services may affect both the prevalence of diagnosis and access to treatment for these conditions."
Read the abstract of the study.