Stigma for Common Mental Disorders in Racial Minorities and Majorities A Systematic Review and Meta-Analysis

Eylem, Özlem; Wit, Leonore de; Straten, Annemieke van; Steubl, Lena; Melissourgaki, Zaneta; Danışman, Gözde Topgüloğlu; Vries, Ralph de; Kerkhof, A.J.F.M.; Bhui, Kamaldeep; Cuijpers, Pim

doi:10.21203/rs.3.rs-15675/v1

Cited by 16 publications

(18 citation statements)

References 34 publications

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“…Wireless penetration and digital literacy have been suggested as potential explanations, although widespread telemedicine adoption during the pandemic may improve acceptability and comfort over time. [57][58][59] Prior telemedicine studies in mental health have been limited to a single payer, a particular institution or practice, or certain populations, such as veterans, rural beneficiaries, or incarcerated individuals. 56,[60][61][62][63][64] These have established the non-inferiority in outcomes and patient satisfaction of more common provider-driven telemental health models, such as clinic-basedvideoconferencing, electronic consultation, or collaborative models in the assessment or treatment of specific behavioral health conditions, as compared to inperson visits.…”

Section: Discussionmentioning

confidence: 99%

Use of Direct-to-Consumer Telemedicine to Access Mental Health Services

et al. 2022

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Background The coronavirus disease 2019 pandemic has contributed to growing demand for mental health services, but patients face significant barriers to accessing care. Direct-to-consumer(DTC) telemedicine has been proposed as one way to increase access, yet little is known about its pre-pandemic use for mental healthcare. Objective To characterize patients, providers, and their use of a large nationwide DTC telemedicine platform for mental healthcare. Design Retrospective cross-sectional study. Setting Mental health encounters conducted on the American Well DTC telemedicine platform from 2016 to 2018. Participants Patients and physicians. Main Measures Patient measures included demographics, insurance report, and number of visits. Provider characteristics included specialty, region, and number of encounters. Encounter measures included wait time, visit length and timing, out-of-pocket payment, coupon use, prescription outcome, referral receipt, where care otherwise would have been sought, and patient satisfaction. Factors associated with five-star physician ratings and prescription receipt were assessed using logistic regression. Key Results We analyzed 19,270 mental health encounters between 6708 patients and 1045 providers. Visits were most frequently for anxiety (39.1%) or depression (32.5%), with high satisfaction (4.9/5) across conditions. Patients had a median 2.0 visits for psychiatry (IQR 1.0–3.0) and therapy (IQR 1.0–5.0), compared to 1.0 visit (IQR 1.0–1.0) for urgent care. High satisfaction was positively correlated with prescription receipt (OR 1.89, 95% CI 1.54–2.32) and after-hours timing (aOR 1.18, 95% CI 1.02–1.36). Prescription rates ranged from 79.6% for depression to 32.2% for substance use disorders. Prescription receipt was associated with increased visit frequency (aOR 1.95, 95% CI 1.57–2.42 for ≥ 3 visits). Conclusions As the burden of psychiatric disease grows, DTC telemedicine offers one solution for extending access to mental healthcare. While most encounters were one-off, evidence of some continuity in psychiatry and therapy visits—as well as overall high patient satisfaction—suggests potential for broader DTC telemental health use. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07326-y.

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Section: Discussionmentioning

confidence: 99%

Use of Direct-to-Consumer Telemedicine to Access Mental Health Services

et al. 2022

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“…As members of minority groups, MARs and SGM also have in common that they are susceptible to differential treatment in the societies in which they live [ 82 , 83 ] and are often confronted with stigmatization, prejudice, and discrimination [ 83 , 84 , 85 , 86 , 87 , 88 ]. Stigma, discrimination, and prejudice emerge when individuals and groups are ‘othered’.…”

Section: Introductionmentioning

confidence: 99%

Minority Identity, Othering-Based Stress, and Sexual Violence

Schrijver

Fomenko

Krahé

et al. 2022

IJERPH

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Background: Some (minority) groups (MGs) are more vulnerable to sexual violence (SV) exposure than others. Othering-based stress (OBS) may mediate the relationship between minority identification and SV. This study aims to assess the prevalence of SV in different MGs to explore the relationship between minority identification and SV, to investigate whether belonging to multiple MGs moderates this relationship, and to explore OBS SV moderation for different MGs. Method: Through an online survey administered to a nationally representative sample in Belgium, data was collected from 4632 persons, of whom 21.01% self-identified as belonging to a MG (SI-Minority). SV prevalence was measured using behaviorally specific questions based on the WHO definition of SV. SI-Minority participants received an additional scale on OBS. Results: SI-Minority participants reported more SV victimization compared to the non-minorities. However, this increased risk was not moderated by minority identification but linked to the socio-demographic SV risk markers common to minority individuals. Multiple-minority participants were found more at risk of SV compared to single-minority respondents. Lesbian, gay, bisexual, pan-/omnisexual, asexual, and other non-heterosexual (LGB+) participants were found more at risk than heterosexual participants. OBS was found to be significantly correlated to SV in sexual and gender minorities and in cultural minorities. Conclusions: This study contributes to our understanding of the relationship between minority identification, OBS, and SV. Studying both specific and common SV vulnerabilities and outcomes within specific societal subgroups and the general population may inform policy makers when allocating resources to those interventions with the largest societal impact.

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“… 15 Stigma is another factor that affects patients’ likelihood of seeking out treatment. 16 A meta-analysis performed in 2020 concluded that minorities have a significantly increased stigma toward mental health illness compared to White communities. 16 It is important to note that the studies reviewed in this paper have examined both depressive and anxiety disorders together while our study focuses only on treatment of anxiety disorders.…”

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confidence: 99%

Disparities in Offered Anxiety Treatments Among Minorities

Samander

Harman

2022

J Prim Care Community Health

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Purpose The primary purpose of this article was to determine if race and ethnicity played a role in if primary care physicians offered anxiety treatment in office visits by adult patients who were diagnosed with an anxiety disorder(s). Methods This study pooled data from the 2011 to 2018 National Ambulatory Medical Care Survey (NAMCS) that included adult patients with an anxiety disorder and the type of treatment offered to them. Logistic regressions were performed to examine the odds of offered anxiety treatment in office visits by non-Hispanic Black, Hispanic, and other race/ethnicity patients compared to office visits by non-Hispanic White patients. Results Physicians offered anxiety treatment in more than half of office visits where the patient was diagnosed with an anxiety disorder. Providers offered counseling or talk therapy in less than 13% of all office visits. Office visits by non-Hispanic Black patients had half the odds of being offered counseling/talk therapy ( P = .068) compared to those by non-Hispanic White patients. Conclusions These findings suggest that statistically significant differences in the offering of any anxiety treatments in office visits to minorities compared to non-Hispanic White patients do not exist; however, there are still differences in the rates of counseling/talk therapy offered in office visits by minorities versus non-minorities. Future studies may want to examine reasons for lower rates of counseling/talk therapy offered to minority and majority patients and the specific pharmacological or therapeutic treatments offered to different races.

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Stigma for Common Mental Disorders in Racial Minorities and Majorities A Systematic Review and Meta-Analysis

Cited by 16 publications

References 34 publications

Use of Direct-to-Consumer Telemedicine to Access Mental Health Services

Use of Direct-to-Consumer Telemedicine to Access Mental Health Services

Minority Identity, Othering-Based Stress, and Sexual Violence

Disparities in Offered Anxiety Treatments Among Minorities

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