Tag: equity

Reading of the Week: Tailoring CBT for Black Women – the New JAMA Psych Paper; Also, Meds & Transgender Individuals

From the Editor

The story is too familiar: Black women are more likely to have insomnia, and yet less likely to receive the needed care. What can be done? That question speaks to the larger issue of equity.

In the first selection from JAMA Psychiatry, Eric S. Zhou (of Harvard University) and his co-authors offer a culturally tailored form of CBT-insomnia for Black women. They designed an elegant, three-armed RCT, working with several people, including – yes – a Black woman with insomnia. They find: “Participants were more likely to complete the full intervention if they received the tailored program, with intervention completion associated with greater insomnia improvement.” We consider the paper and its implications.

CBT-I aims to help everyone sleep like lambs

In the second selection, we look at a new paper by Dr. Jack L. Turban (of Stanford University) and his co-authors. In JAMA Psychiatry, they write: “Transgender and gender diverse (TGD) people unfortunately experience high rates of psychiatric morbidity, and their psychopharmacologic needs can be unique when compared with those of cisgender people.” They offer practical suggestions.

DG

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Reading of the Week: Equity & Mental Health Care – Post-Partum Follow Up After ED Visits (Lancet Psych) and Race and Prescribing (Psych Services)

From the Editor

We often speak of the challenges patients face in accessing mental health care. But, of course, such challenges may vary greatly, depending on demographics – think rural versus urban, young versus older, White versus non-White. How equitable is care? This week, we look at two new papers; one draws on Canadian data while the other on American. And though the studies are different, they point in a similar direction: unique populations face significant challenges accessing care.

In the first selection, Dr. Lucy C. Barker (of the University of Toronto) and her co-authors consider follow-up after an ED visit for patients in the post-partum period. In a new Lancet Psychiatry paper, they drew on Ontario databases, with more than 12 000 visits analyzed. They write: “Fewer than half of emergency department visits for a psychiatric reason in the post-partum period were followed by timely outpatient care, with social-determinants-of-health-based disparities in access to care.” We consider the paper and its implications.

In the second selection, Jocelyn E. Remmert (of the U.S. Department of Veterans Affairs) and her co-authors consider depression care and race. In a new Psychiatric Services paper, they look at antidepressant prescribing, finding big differences between White and Black veterans. “Among veterans, Black patients were almost two times less likely than White patients to have an antidepressant prescription, even after the analyses controlled for depression symptoms, demographic characteristics, psychosocial variables, and other clinical symptoms.”

DG

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Reading of the Week: Clozapine Prescribing & Demographics; Also, HBR on Equity in Telemedicine, and Eichler on Her Uncle & His Disappearances

From the Editor

Is clozapine prescribing effected by demographics?

In the first selection, from Psychiatric Services, Natalie Bareis (of Columbia University) and her co-authors consider medication prescriptions for those with psychotic disorders, drawing on US Medicaid data. “Our results indicate significant variation across states and among racial-ethnic groups in prescription patterns of six types of psychotropic medications, even after we had adjusted for multiple patient factors.” Indeed, they find that clozapine is much more commonly prescribed for those who are White. We consider the paper and its implications.

unknownClozapine: a simple molecule but complicated availability in the US?

In the second selection, Dr. Jonathan Rogg (of the University of Texas) and his co-authors consider equity and telemedicine. In a paper for the Harvard Business Review, they describe the services offered in a low-income area of Texas, and the lessons learned. “The Covid-19 pandemic has forced a rapid evolution in technology with the potential to help the most disadvantaged patients. Our experience during the pandemic has demonstrated that telemedicine can overcome access-related challenges faced by indigent populations. By allowing them to access care in their homes or even their jobs, it can help them address health issues expeditiously with minimal disruption to their lives.”

Finally, in the third selection from The Globe and Mail, writer Leah Eichler writes about her uncle, who probably had an undiagnosed mental illness. She writes about his disappearances and erratic behaviour. “We like to believe our relationships are solid, that love is somehow inextricably linked to permanence. Missing our loved ones, if anything, highlights how impermanent even our closest relationships can be.”

Please note that there will be no Reading next week.

DG

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