Background-Epidemiological studies have found lower than expected prevalence of psychiatric disorders among disadvantaged race-ethnic minority groups in the United States. Recent research shows that this is due entirely to reduced lifetime risk of disorders, as opposed to persistence. Specification of race-ethnic differences with respect to clinical and social characteristics can help identify the protective factors that lead to lower lifetime risk among disadvantaged minority groups.

Members of disadvantaged ethnic groups in the United States do not have an increased risk for psychiatric disorders. Members of these groups, however, do tend to have more persistent disorders. Future research should focus on explanations for these findings, including the possibility that these comparisons are biased, and on potential means of reducing the disparity in persistence of disorders across ethnic groups.

Background-Studies find lower lifetime risk for psychiatric disorder among immigrants than among the US-born population, but we do not know how these differences arise over time.

Findings indicate that customized, proactive telephone calls have good potential to improve long-term adherence behavior and clinical outcomes.

Objectives-We examined migration to the United States as a risk factor for suicidal behavior among people of Mexican origin.Methods-We pooled data from 2 nationally representative surveys in the United States (2001-2003; n=1284) and Mexico (2001Mexico ( -2002 n=5782). We used discrete time survival models to account for time-varying and time-invariant characteristics, including psychiatric disorders. Results-Risk for suicidal ideation was higher among Mexicans with a family member in the UnitedStates (odds ratio [OR]=1.50; 95% confidence interval [CI]=1.06, 2.11), Mexican-born immigrants who arrived in the United States at 12 years or younger (OR=1.84; 95% CI=1.09, 3.09), and USborn Mexican Americans (OR=1.56; 95% CI=1.03, 2.38) than among Mexicans with neither a history of migration to the United States nor a family member currently living there. Risk for suicide attempts was also higher among Mexicans with a family member in the United States (OR=1.68; 95% CI=1.13, 2.52) and US-born Mexican Americans (OR=1.97; 95% CI=1.06, 3.65). Selection bias caused by differential migration or differential return migration of persons at higher risk of suicidal ideation or attempt did not account for these findings.Conclusions-Public health efforts should focus on the impact of Mexico-US migration on family members of migrants and on US-born Mexican Americans.Transnational migration shapes the lives of people of Mexican origin on both sides of the Mexico-US border. The 11 million Mexican-born individuals in the United States comprise Requests for reprints should be sent to Guilherme Borges, ScD, Instituto Nacional de Psiquiatria & Universidad Autonoma Metropolitana, Calzada Mexico Xochimilco No. 101-Col. San Lorenzo Huipulco C.P. 10610, Mexico DF, Mexico (e-mail: guibor@imp.edu.mx). Contributors G. Borges collected data in Mexico, analyzed the data, and wrote the initial draft and the final version of the article. J. Breslau participated in planning and data analyses, wrote drafts, and reviewed the final version of the article. M. Su performed statistical coding and analyses and reviewed the final version of the article. M. Miller wrote drafts and reviewed the final version of the article. M. E. Medina-Mora collected data in Mexico and reviewed the final version of the article. S. Aguilar-Gaxiola reviewed the final version of the article. All authors helped to conceptualize the study. Human Participant ProtectionThe institutional review board of the National Institute of Psychiatry (Mexico City) approved this project, and the institutional review boards of the Cambridge Health Alliance, the University of Washington, and the University of Michigan approved all recruitment, consent, and interviewing procedures for the National Latino and Asian-American Survey. The recruitment, consent, and field procedures in the National Comorbidity Survey Replication were approved by the human subjects committees of both Harvard Medical School and the University of Michigan. NIH Public Access Author ManuscriptAm J Public Health. Aut...

Our understanding of the relationship between immigration and mental health can be advanced by comparing immigrants pre-and post-immigration with residents of the immigrants' home countries. DSM-IV anxiety and mood disorders were assessed using identical methods in representative samples of English-speaking Mexican immigrants to the US, a subsample of the US National Comorbidity Survey Replication (NCSR), and Mexicans, the Mexican National Comorbidity Survey (MNCS). Retrospective reports of age of onset of disorders and, in the immigrant sample, age of immigration were analyzed to study the associations of pre-existing mental disorders with immigration and of immigration with the subsequent onset and persistence of mental disorders. Preexisting anxiety disorders predicted immigration (OR=3.0; 95% CI 1.2-7.4). Immigration predicted subsequent onset of anxiety (OR=1.9; 95% CI 0.9-3.9) and mood (OR=2.3; 95% CI 1.3-4.0) disorders and persistence of anxiety (OR=3.7 95% CI 1.2-11.2) disorders. The results are inconsistent with the "healthy immigrant" hypothesis (that mentally healthy people immigrate) and partly consistent with the "acculturation stress" hypothesis (i.e., that stresses of living in a foreign culture promote mental disorder). Replication and extension of these results in a larger bi-national sample using a single field staff are needed.

Background: Effective and easy to implement interventions to improve adherence to antiretroviral therapy are needed. Objective: To compare a site-nurse initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretroviral therapy compare to the study site’s standard of care. Methods: A randomized controlled trial of site-nurse initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretrovirals. Subjects were randomized to receive site-nurse initiated telephone calls (intervention) or no additional calls above the site’s standard of care (control). Subjects received calls 1-3 days after initiating antiretrovirals, weeks 1, 2, 3, 6, 10, 14, 18, 22, 26, and every 8 weeks thereafter. Self-reported adherence was captured during study visits. Results: A total of 333 subjects starting antiretrovirals as part of ACTG 384 were co-enrolled into ACTG 5031. Subjects were followed for up to 160 weeks and were contacted for 74% of scheduled calls. There was no significant difference in proportion of patients with >95% mean Total Adherence, 87.9% and 91.2% (p=0.34) and mean self-reported Total Adherence, 97.9% and 98.4% in the intervention and control, respectively, or in symptom distress and clinical endpoints. Conclusions: In the context of a clinical trial, where self-reported adherence was exceptionally high, the site-nurse initiated telephone calls did not further improve self-reported adherence, symptom distress or clinical outcomes.

Context:In patients with diabetes, intraday glucose variability might predict health outcomes independently from glycosylated hemoglobin (HbA 1c ).Objective: Our objective was to evaluate patient satisfaction (PS), quality of life (QoL), glycemic control, and variability during insulin intensification to HbA 1c below 7.0%.Patients, Design, and Setting: Eighty-two type 1 and 306 insulin-treated type 2 diabetes patients (47% male; age 54 Ϯ 11 yr; HbA 1c ϭ 7.8 Ϯ 0.7%) participated in this multicenter, randomized, crossover trial at 52 U.S. centers. Interventions:Interventions included insulin glargine plus premeal glulisine (n ϭ 192) vs. twice-daily premix 75/25 or 70/30 analog insulin (n ϭ 196) for 12 wk and crossed to the alternate arm for 12 wk. Main Outcome Measures:Main outcome measures included PS and QoL questionnaires, 3-d continuous glucose monitoring (CGM), and HbA 1c every 4 -8 wk.Results: Mean Ϯ SE HbA 1c change was Ϫ0.39 Ϯ 0.09% for glargine-glulisine and Ϫ0.05 Ϯ 0.09% for premix (P Ͻ 0.0001). The PS net benefit scale (0 -100) improved from 51.1 to 60.5 Ϯ 1.2 for glargineglulisine and worsened to 45.4 Ϯ 1.2 for premix (P Ͻ 0.0001). The PS regimen acceptance scale was comparable (P ϭ 0.33). Overall QoL favored glargine-glulisine (P Ͻ 0.001), as did perceived health (P Ͻ 0.0001), symptom distress (P Ͻ 0.0001), general health perceptions (P Ͻ 0.01), and psychosocial (P Ͻ 0.02). CGM daily glucose mean, daily glucose SD (glycemic variability), and percent time over 140 mg/dl were lower for glargine-glulisine by 13.1 Ϯ 2.7 mg/dl, 5.9 Ϯ 1.4 mg/dl, and 7.3 Ϯ 1.6%, respectively (all P Ͻ 0.0001), with no difference in CGM percent time below 70 mg/dl (P ϭ 0.09). Symptomatic hypoglycemia rates were comparable. HbA 1c , mean CGM daily glucose, and glycemic variability were independent predictors of PS net benefit. Conclusions:Patient satisfaction was impacted more positively by improved QoL, reduced glucose variability, and better glycemic control with a basal-bolus regimen than negatively by the burden of additional injections, thereby facilitating insulin intensification and the ability to achieve HbA 1c below 7.0%.