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The purpose of this chapter is to examine geographic variations in utilization and need for mental health services. Data for this study were obtained from the 2002 National Survey of American Families. The total sample size was 23,327 adults of aged 18 years and older. Both logistic and linear regression were used to test the possibility of geographical variations. Disparities were found among the 13 U.S. states examined in this study. Results also showed that the percentage of African Americans, state mental health budgets, and mean length of stay in psychiatric hospitals in the state are important predictors of variations in mental health utilization and need variables. These findings suggest that although individual sociodemographic characteristics are important in examining mental health utilization, state characteristics (especially percentage of African Americans, state mental health laws, and mean length of stay in psychiatric hospitals) are also important predictors of variation in utilization of mental health services.

To investigate the role of social factors, health status, and psychiatric disorders (DSM-III-R) on mental health services use, we utilized the National Comorbidity Survey (NCS), a nationally representative household survey (1990–1992) of the US (n=5877). Multivariate logistic regression allowed estimation of the adjusted odds ratios and 95% confidence intervals on the likelihood of visiting the health or the specialty mental/addictive service sectors. Significant determinants included: gender, race, household income, work status, and quality of community-level health care resources. Those with greater socioeconomic resources or comorbid psychiatric disorders were more likely to visit the specialty mental health sector.

This chapter explores how primary care physicians deliver mental health treatment for Medicaid patients in one county in the United States, and how treatment may have changed after HMO enrollment with a mental health carve-out. We utilize Lipsky's theory of street-level bureaucracy to better understand how primary care physicians treat Medicaid patients for depression and what types of insurance arrangements support or inhibit that treatment. Exploratory interviews with 20 physicians revealed that the patient's status as a non-voluntary client, service system barriers and physicians’ commitment to treatment caused them to bear primary responsibility for the majority of depression care. Physicians were willing to act as advocates for their clients and viewed such advocacy as ethical given the lack of mental health parity. In general, primary care physicians were not familiar with new policies dictating mental health carve-outs for Medicaid patients, nor were they concerned with how mental health care was reimbursed for their patients. However, they were willing to provide mental health care even if they were not reimbursed. Physicians rely upon medication management to treat depression, and reimbursement plays a role in the amount of time spent with patients and in the coding used for the visit. Lipsky's (1980) theory of street-level bureaucracy provides a useful framework for understanding how physicians will act as advocates for their clients in the face of structural as well as resource constraints on health care.

The role of gender in psychiatric disorders is not well understood, but several broad trends are known: while men and women experience psychiatric symptoms at roughly the same rate, women are more likely to experience depressive symptoms (Kessler et al., 1993) and men are more likely to experience substance use disorders (DHHS, 1999). However, women are more likely to use primary care services for mental health care than are men (Wells et al., 1986). Equally controversial and not well understood has been the differential responses to treatment interventions by gender (Kornstein, 1997). One recent study found that a depression intervention was more cost-effective for women than for men (Pyne et al., in press). Indeed, the study found that the intervention was essentially cost and outcome neutral for men, while women were found to have a cost-effectiveness ratio of over $5000 for each QALY saved.

Since health behaviors of elderly Asian Americans are often underreported, the study, based on the health behavioral model (Andersen’s model), was to examine if there is a reciprocal relationship between healthcare utilization and health outcomes, and how social characteristics play their role in this relationship between US-born and foreign-born elderly Asian Americans.

Using structural equation modeling, this research examined the proposed hypotheses which consisted of direct and indirect effects among health outcomes, healthcare utilization and social characteristics, as well as the disparities of the effects between US-born and foreign-born elderly Asian Americans (65 + ). A sample size of elderly Asian Americans was divided into a US-born group (N = 1,305) and a foreign-born group (N = 4,902) from the National Health Interview Survey (NHIS) 1998–2012. Health outcomes consisted of current health status and health change. Healthcare utilization included general doctor visit, ER, and mental health professional visit. Social characteristics of population included predisposing characteristics (such as age, sex, marital status, and region of residency) and enabling resources (such as education, family size, and family income).

Results from the study indicated that first, there was a reciprocal relationship between health outcomes and healthcare utilization for both groups. Second, predisposing characteristics had a direct effect on health outcomes, and enabling resources had an indirect effect on health outcomes via healthcare utilization. In addition, living in the West had both direct and indirect effects on health outcomes. Third, regarding disparities of the effects between both groups, the US-born elderly are more likely to attain health benefits from healthcare utilization and their social characteristics than the foreign-born. As a result, the interactive relationship between health outcomes, healthcare utilization, and social characteristics, as well as disparities of healthcare outcomes through health utilization and social characteristics for elderly Asian Americans is highlighted.

First, due to the design of NHIS, this research was limited to fully present the needs and more characteristics of elderly Asian Americans. This shows the great need for a large scale, representative study for health behaviors of elderly Asian Americans. Second, in the dataset, the study was limited to explore health behaviors of elderly Asian Americans into each Asian ethnic subgroup. Since the culture of Asian Americans is heterogeneous, it is recommended that future research can explore differences and commonalities of the health behaviors between Asian subgroups. Third, based on the health behavioral model and the design of the dataset, this study was limited to illustrate variations of life experiences between both groups. These differences regarding their needs and desires for healthcare services and health outcomes can become an important foundation for service providers and policy makers to provide appropriate services that improve the quality of the later lives of elderly Asian Americans.

First, the study applied the health behavioral model and proved that the effect of healthcare utilization and social characteristics on health outcomes is greater for the US-born elderly Asian Americans than for the foreign-born. Second, this study confirmed that the healthcare services in US society are still beneficial for the health outcomes of elderly Asian Americans. Third, the study found that when family is used to explain the social behaviors of elderly Asian Americans, researchers need to be more careful to identify various family factors in accordance to its dynamics, such as interpersonal relationship, material supply, and emotional support.

The purpose of this chapter is to propose a theory which may lead to a holistic description of the mechanism of touristic phenomena. In so doing, the central discussion is to provide descriptive answers to basic questions. It will not be a sociological or anthropological discourse. Instead, it will use perspectives from environmental psychology, genetics, and a theory of information energy in elementary particle physics. The study of tourism, though it is not a distinct disciplinary field, must provide a grand theory. In this chapter, the discussions mainly focus on the concept of tourist to provide several ideas to amend its definition, which may directly correspond to an overall view of touristic phenomena.

Existing descriptions of trust in health care largely assume a straightforward association between a patient’s relationship with a regular provider and his or her trust in health care. I extend status characteristics theory (SCT) and social identity theory (SIT) to suggest greater variability in this association by investigating the role of social differences between patients and their regular providers. Whereas the SIT extension predicts lower trust in dissimilar than similar dyads, the predictions from the SCT extension depend on status in dissimilar dyads. Further, research examining how social differences in patient–provider dyads shape trust largely emphasizes racial differences, but the theories implicate gender differences too.

I analyze a longitudinal dataset of patient–provider dyads offering a conservative test of the extensions.

Results generally support predictions from the SCT extension. Specifically, patients’ status based on differences in either race or gender: (1) is inversely related to their trust in health care and (2) influences the resiliency of their trust, whereby the degree health care met prior expectations matters less (more) for the trust of low (high) status patients than equal status patients.

When patients and providers differ on both race and gender, findings sometimes depart from predictions. This indicates differences in two social categories is a unique situation where the contributions of each category are distinct from that of the other.

This research extends SCT to explain greater variability in the connection between patient–provider dyads and trust in health care, while also showing how gender compares to race.

The purpose of the present study is to investigate whether family caregivers with a stronger sense of coherence (SOC) who are caring for community dwelling older adults with cognitive impairment are less likely to use mental health services. An adaptation of the Anderson behavioral model of access to health care was employed as a conceptual framework. Data were collected for 304 impaired older adult/family caregiver dyads. Caregiver mental health service use and sense of coherence were measures as well as predisposing factors (age, gender, race, education, type of familial relationship, family size, and co-residence with impaired family member), enabling factors (self-reported awareness of services, travel times to mental health services, social support, and insurance), and need factors (chronic health conditions and distress). The impaired elder’s age, level of physical impairment, and level of memory impairment were also examined. Logistic regression results indicated that caregivers who have a stronger SOC were less likely to use mental health services (OR=0.91, p=0.006). Other significant independent predictors of mental health service use were social support (OR=0.34, p=0.032) and caregivers aiding family members with higher levels of physical impairment (OR=1.14, p=0.033). The results of this study support clinicians and planners developing mental health services that use SOC to mitigate the detrimental effects of caregiving. Future research is needed to target effective measures to positively manipulate this variable.

The COVID-19 pandemic imposed significant and abrupt lifestyle changes on the pediatric population. Major lifestyle changes that occur during children’s and adolescents’ vital developmental years have the potential to introduce stressors, which have both immediate and long-term effects on physical and mental health. The aspects of the COVID-19 pandemic that impacted pediatric mental health included school closures, quarantine, increases in screen time, changes to Labor & Delivery unit COVID-19 policies, and changes to the delivery of clinical mental health care, including telehealth. In addition, pediatric mental health was deeply impacted by the ongoing challenges to health equity associated with health disparities and racism as a health crisis. Pediatric mental health declined since the start of the pandemic, school closures and quarantine affected rates of food insecurity and physical activity levels, and the COVID-19 pandemic exacerbated pre-existing health disparities and mental health conditions among the pediatric population. Recommendations for building more resilient public health systems are explored.