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Why Do US Latinos Underuse Mental Health Services?

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Why Do US Latinos Underuse Mental Health Services? VOLUME 2 • ISSUE 2 APRIL 2011 NEWS FROM THE DEPARTMENT OF EPIDEMIOLOGY MAILMAN SCHOOL OF PUBLIC HEALTH COLUMBIA UNIVERSITY 2 UPCOMING 3 PUBLICATION HIGHLIGHTS 5 CONFERENCES Page 15 6 AWARDS & GRANTS International Engagement, 7 IN THE NEWS 8 PROFILES Why Do US Latinos 11 BRIEF MENTIONS 12 GIANTS AMONG US Underuse Mental 24 USEFUL RESOURCES 31 FACULTY ARTICLE Health Services? BIBLIOGRAPHY Latinos in the US access mental health services at a lower rate than non-Hispanic whites, and a new study led by Dr. Katherine Keyes, Instructor in Epidemiology, indicates that language barriers and stronger cultural ties to Hispanic heritage predict this pattern. Dr. Deborah Hasin, Professor of Clinical Epidemiology (in Psychiatry), was the senior investigator on the study, and Dr. Lisa Bates, Assistant Professor of Epidemiology was a co-investigator. Latinos are the fastest growing minority group in the US, with the expectation they will comprise 20% of the population by 2020. However, disparities between their use of health services and those of non-Latino whites have been on the rise and are only partially explained by differences in fi nancial means and health insurance status. To further understand the causes, the study, which was published in Social Psychiatry and Psychiatric Epidemiology, examined the degree to which markers of immigrant adaptation, such as exclusively The investigators found few differences between subgroups speaking Spanish and stronger ties to ethnic of Latinos (such as Puerto Ricans, Mexicans, and Cubans) after identity, play a role in Latino experience with controlling for economic and practical barriers, though Mexican mental health services. individuals with a mood/anxiety disorder were less likely to seek Using data from 6,359 Latino participants treatment than Puerto Rican individuals. in the National Epidemiologic Survey on The results suggest that strategies to improve mental health Alcohol and Related Conditions (NESARC), care should focus on ethnic/cultural factors that are unique to a nationally representative face-to-face Latino immigrants and on the specifi c disorder, even among survey of US residents, the investigators Latinos who speak English. found that greater levels of Latino ethnic “Although increasing the fi nancial acces- identity, use of Spanish language, and Latinos are more likely sibility of mental health service use is a pri- less time living in the US predicted lower ority, programs to improve access to care and usage of mental health services for mood to distrust the medical management of illness should recognize the disorders, even after controlling for factors important role of language, cultural values such as insurance, income, and the severity community and the and beliefs, and more explicitly address ac- of symptoms. cess to care for specifi c psychiatric disorders The authors also note that Latinos are health care system due across diverse populations,” the authors say. more likely to distrust the medical commu- nity and the health care system due to past to past experiences of Keyes KM, Martins SS, Hatzenbuehler ML, Blanco C, Bates experiences of discriminatory treatment or LM, Hasin DS. Mental health service utilization for psychi- ineffective care, and cultural stigmas and discriminatory treatment atric disorders among Latinos living in the United States: attitudes toward psychiatric disorders and the role of ethnic subgroup, ethnic identity, and language/ social preferences. Soc Psychiatry Psychiatr Epidemiol. mental health services. or ineffective care 2011 Feb 3. [Epub ahead of print] 1 MESSAGE FROM THE CHAIR Dear colleagues, Welcome to the April 2011 issue of Two by Two, the Department of Epidemiology newsletter. In this issue, we shine a light on International Engagement among our faculty and students. We include a sampling of international research projects led by Department faculty. We profi le the Epidemiology faculty who make up the core of the International Center for AIDS Care and Treatment Programs (ICAP). Also, we feature the Epidemiology students engaged in the school-wide Global Health Track program. Psychiatric epidemiology also fi gures prominently this month, in three ways: our Giants Among Us profi le of Dr. Bruce Dohrenwend’s seminal contributions to the fi eld; the multiple psychiatric epidemiology awards garnered by our faculty; and the arrival of Dr. Karestan Koenen, an alumna of our Psychiatric Epidemiology Training program who joined the faculty in March. In recognition of International Women’s Day in March, we highlight the career of Epidemiology alumna Dr. Roberta Ness, whose work focuses on women’s health. Our thanks to the senior cluster administrators, faculty, and students who provided material for this international issue. And fi nally, my very best wishes to the students who are winding up their spring semester, especially those preparing to graduate in May. Look for a special June issue focused on our award winning students and graduates. Warm regards, CLUSTER SEMINARS LATE MARCH/APRIL — MAY SOCIAL EPIDEMIOLOGY TUESDAY, MARCH 29 4:00-5:30 PM THURSDAY, MARCH 31 10:00-11:30 AM THURSDAY, APRIL 7 4:00-5:30 PM UPCOMING APRIL — MAY THURSDAY, APRIL 28 10:00-11:30 AM PSYCH / NEURO EPIDEMIOLOGY THURSDAY, APRIL 7 12:30-2:00 PM WEDNESDAY, APRIL 6, 2011 ALAN BERKMAN MEMORIAL LECTURE: GERALD FRIEDLAND, MD THURSDAY, MAY 5 12:30-2:00 PM FRIDAY, APRIL 8, 2011 DEPARTMENT SEMINAR: JERI NIEVES, PhD TUESDAY, APRIL 12, 2011 SPECIAL LECTURE: ROBERT KAPLAN, PhD LIFECOURSE EPIDEMIOLOGY FRIDAY, APRIL 15, 2011 FACULTY MEETING TUESDAY, APRIL 12 1:00-2:30 PM TUESDAY, APRIL 26, 2011 SPECIAL LECTURE: KARL KELSEY, MD, MOH TUESDAY, MAY 10 1:00-2:30 PM WEDNESDAY, APRIL 27, 2011 CUEGR: ALBERT HOFMAN, MD, PhD EPIDEMIOLOGY INNOVATION FRIDAY, MAY 13, 2011 DEPARTMENT SEMINAR: MITCHELL ELKIND, MD, MS WEDNESDAY, APRIL 20 8:30-10:00 AM FRIDAY, MAY 20, 2011 FACULTY MEETING WEDNESDAY, MAY 18 8:30-10:00 AM WEDNESDAY, MAY 25, 2011 CUEGR: GRAHAM THORNICROFT, MBBS, PhD CHRONIC DISEASE EPIDEMIOLOGY FRIDAY, APRIL 8 12:00-1:00 PM FRIDAY, MAY 13 12:00-1:00 PM INFECTIOUS DISEASE EPIDEMIOLOGY FRIDAY, APRIL 29 3:00-4:30 PM FRIDAY, MAY 20 3:00-4:30 PM APRIL 2011 INTERNATIONAL ENGAGEMENT 2 PUBLICATION HIGHLIGHTS Drugs play a role in aviation accidents, study fi nds Aviation employees who test positive for illicit drugs are almost three times as likely to be involved in an accident as those who test negative, according to a new study by faculty and students of the Department of Epidemi- ology. “We wanted to see whether drug violations by employees are associated with their risk of being in an aviation accident,” Dr. Guohua Li, Professor of Epidemi- ology, says. “Our case-control analysis of nearly 5,000 employees who were involved in aviation accidents and over one million employees who were not indicates that the answer is a very clear yes.” The investigators found that 1.8% of the employees involved in accidents tested positive for drugs (marijuana, cocaine, amphetamines, opiates, or phencyclidine) compared with 0.6% of their randomly selected counterparts. Aviation employees with safety-sensitive functions are subject to mandatory random drug testing as well as post-accident testing. This study is part of an ongoing NIH-funded project aimed at assessing the effectiveness of mandatory alcohol and drug testing programs in reducing occupational accidents and injuries. Coauthors include Dr. Charles DiMaggio, Associate Clinical Professor of Epidemiology; Dr. Qi Zhao, an MPH student; and Ms. Joanne Brady, a PhD student. Li G, Baker SP, Zhao Q, Brady JE, Lang BH, Rebok GW, DiMaggio C. Drug Violations and Aviation Accidents: Findings from the U.S. Mandatory Drug Testing Programs. Addiction. 2011 Feb 10. [Epub ahead of print] In 2008, Dr. William Friedewald, Vice Chair (NEJM), fi nds that despite having switched Aggressive of the Department of Epidemiology and to the standard therapy approach, the partic- Professor of Clinical Epidemiology, Clinical ipants still have as high a rate of mortality as diabetes Biostatistics, and Clinical Medicine, and his they did before. In order to fi nd out whether co-investigators in the Action to Control the rate of mortality decreases the longer treatment Cardiovascular Risk in Diabetes (ACCORD) patients are off the intensive therapy, the study reported the surprising fi nding that an ACCORD group will continue to monitor the associated with intensive blood sugar lowering strategy that participants for the next 4 years. Because was hoped to reduce the risk of cardiovas- of the clinical and scientifi c importance of risk of death cular disease (CVD) for people with type 2 the fi ndings from this large complex clinical diabetes actually posed an increased risk of trial, 3 related papers have been published death for participants, compared to a control in the NEJM over the last 9 months. group on a standard therapy approach. After the investigators learned of those results, ACCORD Study Group, Gerstein HC, Miller ME, Genuth S, they ceased the intensive therapy strategy. Ismail-Beigi F, Buse JB, Goff DC Jr, Probstfi eld JL, Cushman The most recent ACCORD publication, senior WC, Ginsberg HN, Bigger JT, Grimm RH Jr, Byington RP, Rosenberg YD, Friedewald WT. Long-term effects of intensive authored by Dr. Friedewald and published glucose lowering on cardiovascular outcomes. N Engl J Med. in the New England Journal of Medicine 2011;364(9): 818-28. APRIL 2011 INTERNATIONAL ENGAGEMENT 3 Measuring and monitoring health care Toward a workers’ compliance with hand hygiene rules has become one of the primary strategies for standard for eliminating infections acquired at hospitals, but there is not yet a consensus around one hand hygiene particular method to assess compliance. In order to come up with a good measure, compliance Dr. Elaine Larson, Professor of Pharmacology and Therapeutic Research (in Nursing) & Epidemiology, and co-investigators recorded the number of “hand hygiene opportunities,” or HHOs, (for example, right before touching a patient) that health care workers in large teaching hospitals and small community hospitals come across every day, using standards set by the World Health Organization.
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