Medicaid Policy Changes in Mental Health Care and Their Effect on Mental Health Outcomes

Abstract Aims Mental disorders in children are a significant and growing cause of morbidity worldwide. Although interventions to help overcome barriers along the pathway to accessing health care for children with mental disorders exist, there is no overview of randomised controlled trials (RCTs) on these interventions as yet. This study aimed to systematically identify RCTs of interventions to improve access to mental health care for children and synthesise them using a conceptual framework of access to health care. Methods This systematic review was performed following a predefined protocol registered with PROSPERO (ID: CRD42018081714). We searched the databases MEDLINE, EMBASE, PsycINFO and CENTRAL for RCTs up to 15 May 2019 using terms related to the concepts ‘young people,’ ‘mental disorders’ and ‘help-seeking interventions’ and scanned reference lists from relevant studies. Two reviewers independently screened all identified articles in a two-stage process, extracted results on outcomes of interest (knowledge, attitudes, intentions, help-seeking, accessing care, mental health outcomes and satisfaction), assessed the risk of bias and conducted meta-analyses where deemed appropriate. Results After screening 5641 identified articles, 34 RCTs were eligible for inclusion. Eighty per cent of universal school-based interventions measuring knowledge (n = 5) and 67% measuring attitudes (n = 6) reported significantly better results compared with controls on those outcomes, whereas 20% measuring access to care (n = 5) and none measuring mental health outcomes (n = 7) did. In contrast, 71% of interventions targeting at-risk individuals (n = 21) reported better access to care compared with controls, while just 33% (n = 6) did for mental health outcomes. For satisfaction with care, this proportion was 80% (n = 5). Meta-analyses of interventions measuring initial appointment attendance yielded combined odds ratios of 3.11 (2.07–4.67) for appointment reminder interventions and 3.51 (2.02–6.11) for treatment engagement interventions. The outcomes for universal school-based interventions were heterogeneous and could not be summarised quantitatively through meta-analysis. Conclusions To have a population-level effect on improving children's access to mental health care, two-stage interventions that identify those in need and then engage them in the health-care system may be necessary. We need more evidence on interventions to target contextual factors such as affordability and infrastructural barriers.

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Mental Health Inequities and Disparities among African American Adults in the United States: The Role of Race

Research in Health Science ◽

10.22158/rhs.v5n3p23 ◽

2020 ◽

Vol 5 (3) ◽

pp. p23

Author(s):

Elizabeth Armstrong-Mensah ◽

Harshita Patel ◽

Priyanka Parekh ◽

Crystal Lee

Keyword(s):

Mental Health ◽

United States ◽

Health Care ◽

African Americans ◽

Mental Health Care ◽

Health Outcomes ◽

Economic Status ◽

The United States ◽

Poor Quality ◽

Mental Health Outcomes

Although the rate of mental illness among African Americans and Whites in the United Sates are similar, African Americans tend to have the worst mental health outcomes in the country. This is due to several inequities, particularly those associated with race such as discrimination, provider bias, stereotyping, weak socio-economic status, limited access to health insurance, poor quality mental health care, treatment gaps, culture, and stigma related to mental health care. Recognizing that the differences in mental health outcomes among minority populations in the United States is also driven by race and not just by brain chemistry, or environmental exposures, and developing strategies that target the issue of race, will not only lead to increased access to mental health services among African Americans, but will generally improve upon their mental health status. This article discusses mental health disparities among African Americans, the inequities that cause them, and strategies for addressing the disparities with a focus on race.

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Mental Health Outcomes Associated with COVID-19 Pandemic in a Group of Health Care Professionals

The Journal of Behavioral Health Services & Research ◽

10.1007/s11414-021-09761-5 ◽

2021 ◽

Author(s):

Michał Ziarko ◽

Aleksandra Jasielska ◽

Maia Stanisławska-Kubiak ◽

Przemysław Daroszewski ◽

Włodzimierz Samborski ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Health Outcomes ◽

Health Care Professionals ◽

Mental Health Outcomes

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A Longitudinal Study of Health Care Resources, Family Support, and Mental Health Outcomes Among Suicidal Adolescents

Analyses of Social Issues and Public Policy ◽

10.1111/asap.12139 ◽

2017 ◽

Vol 17 (1) ◽

pp. 319-338 ◽

Cited By ~ 3

Author(s):

Mary LeCloux ◽

Peter Maramaldi ◽

Kristie A. Thomas ◽

Peter Maramaldi ◽

Kristie A. Thomas ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Longitudinal Study ◽

Health Outcomes ◽

Family Support ◽

Mental Health Outcomes ◽

Health Care Resources

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Mental health of health care workers during the COVID-19 pandemic and evidence-based frameworks for mitigation: A rapid review

10.1101/2021.01.03.21249166 ◽

2021 ◽

Author(s):

Ajay Major ◽

Fay J Hlubocky

Keyword(s):

Mental Health ◽

Risk Factors ◽

Health Care ◽

Health Outcomes ◽

Health Care Workers ◽

Mental Health Outcomes ◽

Rapid Review ◽

Evidence Based ◽

Care Workers ◽

Pubmed Database

Background: The ongoing COVID-19 pandemic has profoundly affected the mental health of health care workers (HCWs), and optimal strategies to provide psychological support for HCWs are not currently established. Aims: To rapidly review recently-published literature on the mental health of HCWs during the COVID-19 pandemic. Methods: Query of all quantitative research through the PubMed database on the mental health of HCWs during the COVID-19 pandemic which utilized validated mental health instruments. 723 articles were screened and 87 articles were included. Results: Nearly all included studies were cross-sectional, survey-based assessments of the prevalence of and risk factors for mental illness. Only one interventional study was identified. Prevalence of mental health outcomes varied widely: 7.0-97.3% anxiety, 10.6-62.1% depression, 2.2-93.8% stress, 3.8-56.6% post traumatic stress, 8.3-88.4% insomnia, and 21.8-46.3% burnout. Risk and protective factors were identified in personal and professional domains, including degree of COVID-19 exposure, adequacy of protective equipment, and perception of organizational support. Conclusions: The myriad risk factors for poor mental health among HCWs suggests that a comprehensive psychosocial support model with individual- and organization-level interventions is necessary. Further longitudinal research on specific evidence-based interventions to mitigate adverse mental health outcomes among HCWs is urgently needed as the pandemic continues.

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Factors Associated with Mental Health Outcomes in Oman during COVID19: Frontline vs Non-frontline Healthcare Workers

10.1101/2020.06.23.20138032 ◽

2020 ◽

Author(s):

Muna Alshekaili ◽

Walid Hassan ◽

Nazik Al Said ◽

Fatima Alsulaimani ◽

Sathish Kumar Jayapal ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Health Outcomes ◽

Online Survey ◽

Psychosocial Interventions ◽

Severity Index ◽

Cross Sectional Study ◽

Mental Health Outcomes ◽

Chi Square ◽

Cross Sectional

OBJECTIVE: This study aims to assess and compare demographic and psychological factors and sleep status of frontline HCWs in relation to non-frontline HCWs DESIGN, SETTINGS, AND PARTICIPANTS This cross-sectional study was conducted using an online survey from the 8th to the 17th of April 2020 across varied health care settings in Oman accruing 1139 HCWS. MAIN OUTCOMES AND MEASURES Mental health status was assessed using Depression, Anxiety, and Stress Scales (DASS-21), and insomnia was evaluated by the Insomnia Severity Index (ISI). Samples were categorized into the frontline and non-frontline groups. Chi-square, odds ratio, and independent t-tests were used to compare groups by demographic and mental health outcomes. Results This study included 1139 HCWs working in Oman. There was a total of 368 (32.3%), 388 (34.1%), 271 (23.8%), and 211 (18.5%) respondents reported to have depression, anxiety, stress, and insomnia, respectively while working during the pandemic period. HCWs in the frontline group were 1.4 times more likely to have anxiety (OR=1.401, p=0.007) and stress (OR=1.404, p=0.015) as compared to those working in the non-frontline group. On indices of sleep-wake cycles, HCWs in the frontline group were 1.37 times more likely to report insomnia (OR=1.377, p=0.037) when compared to those working in the non-frontline group. No significant differences in depression status between workers in the frontline and non-frontline groups were found (p=0.181). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first study to explore the differential impacts of the COVID-19 pandemic on different grades of HCWs. This study suggests that frontline HCWs are disproportionally affected compared to non-frontline HCWs. The problem with managing sleep-wake cycles and anxiety symptoms were highly endorsed among frontline HCWs. As psychosocial interventions are likely to be constrained owing to the pandemic, mental health care must first be directed to frontline HCWs.

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