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Non-Hispanic American Indian and Native American (AI/AN) adults and children are at greater risk than all other racial groups of experiencing poor mental health outcomes and unmet medical and mental healthcare needs. For instance, suicide rates for AI/AN adults and youth are higher than the national average.

For native people, cultural differences play a crucial role in this gap as well as in the misdiagnosis. An accurate assessment is not possible without intimate knowledge of another culture; such knowledge cannot always be learned in the present educational systems, many of which do not share the same historical accounts or knowledge tribal systems have been teaching for thousands of years.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) states that understanding a culture means comprehending and applying that culture’s beliefs, ceremonial rituals, and customs. With the Native American culture, this would not be possible without the actual time and tutelage of an American Indian or First Nations Healer and Spiritual Person, who would be most qualified to provide the appropriate expertise. In order for native-serving providers to meet the standards set forth in the DSM-5, they must learn from outside of the Western medical education system.

Few mental health diagnostic tools, assessments, or treatments have been studied in AI/AN communities. For instance, few mental health treatment models apply spiritual phenomena—such as spirits, ghosts, or healing—but this is an area common within Native American tribes.

Read more on NPA-RHEC.org.

More than one-third of U.S. Army soldiers who attempt suicide don’t have a history of mental health problems, a recent study suggests.

Attempted suicides have become more common among enlisted soldiers since the start of the wars in Afghanistan and Iraq, researchers note in JAMA Psychiatry. While a history of mental illness has long been linked to an increased risk of suicide among military service members and civilians alike, less is known about the risk among soldiers who haven’t been diagnosed with psychiatric disorders.

For the current study, researchers examined data on 9,650 active-duty Army soldiers who attempted suicide between 2004 and 2009 as well as a control group of more than 153,000 soldiers who didn’t attempt suicide.

Overall, 3,507, or 36 percent, of the soldiers who attempted suicide had no previous diagnosis of mental illness, the study found.

“Soldiers without a mental health diagnosis may have had mental health problems but had not reported them to their medical care teams,” said lead author Dr. Robert Ursano, director of the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

“This can be because they do not think they have a problem, they are concerned about stigma associated with mental health care – which is true in both military and civilian settings – or they felt even if they reported their problems to their physicians that nothing would help,” Ursano said by email.

Some factors unique to military service did appear to influence the odds of a soldier with no prior mental illness diagnosis attempting suicide.

For example, even without a history of mental illness, soldiers in their first year of military service were six times more likely to attempt suicide than people in the Army for longer.

And soldiers without a prior mental health diagnosis who had previous deployments were 2.4 times more likely to attempt suicide than those without prior deployments.

Work stress might also play a role.

Soldiers with no history of psychiatric problems who had a promotion delayed for up to two months were twice as likely to attempt suicide as those who didn’t experience delayed promotions. And they were 60 percent more likely to attempt suicide if they were demoted in the previous year.

Previous combat injuries were also associated with a 60 percent higher risk of suicide attempts among soldiers without a history of mental illness.

The study wasn’t designed to prove whether or how a prior mental health diagnosis might directly impact the risk of suicide, and it’s impossible to know what proportion of people without a prior diagnosis might have been suffering from untreated mental illness.

Women soldiers were also 2.6 times more likely than men to attempt suicide, and soldiers treated in the past month for a physical injury were 3 times more likely than those not recently treated for an injury to make a suicide attempt.

Army suicide rates were lower in the 2000s than in the general population, Mark Reger of the Veterans Affairs Puget Sound Health Care System in Seattle and colleagues point out in an accompanying editorial. Mental health care for soldiers has also shifted from being provided primarily in mental health clinics to being offered in other settings, Reger and colleagues note.

“Since soldiers without a mental health diagnosis are unlikely to be seen in mental health clinics by definition, a focus on prevention in other settings appears warranted,” they write.

Behavioral health services are more widely available today, and mental health clinicians may deploy with units or be available within walking distance of barracks to make it easier for soldiers to access care, they write.

Read more on Reuters.com.

The Evidence-based Practice Center (EPC) Program at the Agency for Healthcare Research and Quality (AHRQ) has posted the protocol for Achieving Health Equity in Preventive Services. The protocol describes the purpose and scope of the review, the key questions, and inclusion/exclusion criteria about what types of studies will be included.

In addition, if there is unpublished scientific information relevant to this topic, AHRQ encourages you to submit it via the Supplemental Evidence and Data for Systematic Reviews (SEADS) portal. The deadline for submissions is October 1. Materials submitted cannot be confidential; they may be made public. This is a voluntary request for information.

The purpose of the review is to summarize the state of the evidence on achieving health equity in preventive services by identifying the effects of impediments and barriers that can create disparities in prevention services, and the effectiveness of strategies and interventions to reduce health disparities in preventive services.

AHRQ is a government agency tasked with producing evidence to improve the quality of healthcare while working with partners to ensure that the evidence is understood and used.

Learn more and submit SEADs for systematic review at EffectiveHealthcare.AHRQ.gov.

Can a person look hard to understand?

The answer, Northern Arizona University researcher Okim Kangfound, is yes. And that expectation of listeners—that the person standing in front of them will be less intelligible because English is likely their second language, before the speaker opens their mouth—is harmful both to speakers and to listeners and the ability of all us to effectively communicate.

With that in mind, Kang, an associate professor of applied linguistics, has spent her career figuring out why listeners are biased against people they perceive will be harder to understand and what interventions both speakers and listeners can take to improve understanding and communication. Her research started with a study that brought her to international prominence in the field of linguistics—demonstrating that students reported more trouble understanding a speaker they thought was Asian than they did a speaker they thought was Caucasian, when the same man was speaking both times and the students were looking at different pictures.

This phenomenon, known as reverse linguistic stereotyping, indicates attributions of a speaker’s group membership create distorted evaluation of the speaker’s speech pattern even before he or she said a word.

This research was recently highlighted on the “Talk American” episode of Code Switch, an NPR podcast about race in the United States. (Code switching refers to when a speaker talks one way to one group and in a different way to other groups, such as when multilingual speakers speak Spanish at home and English at work.) It is, however, just one piece of the larger communication question to which Kang has applied her research.

“For successful communication, we need not only a clear, intelligible speaker but also responsive, unbiased listeners,” Kang said. “Conversation is a two-way street.”

Read more on NAU.edu.

The mental health of new fathers is being overlooked despite evidence suggesting men might experience similar rates of depression to mothers after the birth of a child, experts have warned.

It is thought at least 10% of new mothers experience postnatal depression,  figures could be higher as surveys have shown many women do not seek help or are not asked about their mental health after having a baby.

But recent studies have suggested that new fathers might experience depression at similar rates, and that such depression might affect various developmental outcomes for children as is thought to be the case for new mothers with postnatal depression.

New fathers, however, are generally not screened for mental health problems, and a survey of  last year suggested the scale used to assess mothers for postpartum depression was not necessarily as accurate for men.

Speaking at the American Psychological Association convention, psychologists in the US have said that new fathers should be screened, as new mothers are supposed to be, for mental health problems.

“Fathers need to be seen as the partners that they are, and the family system is what needs to be assessed and treated any time there is a newborn coming into the home,” said Dr Sara Rosenquist, a psychologist based in North Carolina, adding that adoptive parents can also experience postnatal depression. Rosenquist added that men need access to suitable treatment if they have postnatal depression.

Read more on TheGuardian.com

In the late 1990s, Mary Jo Trepka, M.D., M.S.P.H., was the epidemiologist for Miami-Dade County in southern Florida. At the time, HIV/AIDS was more common there than anywhere else in the country. Looking at maps of the area, she noticed a pattern: The poorer neighborhoods had higher rates of HIV/AIDS, as well as other sexually transmitted diseases and tuberculosis, and African Americans were more likely to die from AIDS than their White counterparts were.

Dr. Trepka, now a professor of epidemiology at Florida International University in Miami, has spent the last 7 years trying to understand why HIV-positive African Americans and other non-Hispanic Blacks remain more likely than Whites to die from AIDS even though effective HIV medications are available. Inspired by her experience at the health department, Dr. Trepka has focused on determining what features of a neighborhood, such as segregation, poverty, and whether it is rural or urban, affect how likely a resident is to die from AIDS. Through careful study of Florida health records, she has started to identify exactly how things go wrong for people of color with HIV.

One question to address was whether non-Hispanic Blacks were not getting care for HIV because they were more likely to be poor or to live in rural areas. In a study published this year in the Annals of Epidemiology, Dr. Trepka showed that non-Hispanic Blacks were still more likely than Whites to die from HIV, even when she controlled for factors such as poverty and whether people lived in a rural or urban area.

However, Dr. Trepka’s research suggests that segregation could play a role. After being controlled for poverty, the data show that non-Hispanic Blacks with HIV are more likely to die if they live in highly segregated areas.

African Americans living in highly segregated areas often have fewer opportunities, face significant discrimination, and experience neighborhood violence. People in segregated areas may have poorer nutrition or live farther from high-quality hospitals. The stress associated with these segregated neighborhoods can also affect how likely people are to be consistent about treatment: HIV medications have unpleasant side effects and must be taken several times a day, so people who do not have symptoms are sometimes less motivated to take their medications. “That’s a barrier for everybody, but I think it’s a greater barrier for people that have a lot of other stressors in their life,” Dr. Trepka says.

Now Dr. Trepka is trying to find where in the healthcare system HIV-positive African Americans face problems. She has looked at how long it takes people to see a doctor after being diagnosed with HIV. Her study, yet to be published, found that non-Hispanic Black people were less likely than White people to see a doctor 3 or even 6 months after they were diagnosed. She speculates that stigma in the community might prevent some people from seeking medical care.

“Our work so far has led to a hundred more questions than what we had when we started,” says Dr. Trepka. But her findings have started to point to specific barriers, such as stigma and segregation, that public health professionals can begin to address. It is especially important to target these barriers, considering that racial disparities in HIV/AIDS persist even though effective therapy has been available for almost 20 years, she says.

Not only are non-Hispanic Blacks more likely to die from AIDS than White people, but Dr. Trepka’s research shows they are dying younger. “The racial disparities in terms of years of potential life lost are really quite large,” she says. “It really highlighted how much is lost in the community by these people getting HIV infections and dying.”

Read more on NIMHD.NIH.gov.