Exploring Socioeconomic Disparities in Posttraumatic Stress in an Urban Population.

Although studies have shown that persons with low socioeconomic position (SEP) are more likely to develop posttraumatic stress disorder (PTSD) than those with high SEP, there has been no systematic attempt to explain this observation. We used data from the Detroit Neighborhood Health Study (DNHS), a longitudinal population-based study of Detroit residents, to explore the relation between SEP and posttraumatic stress (PTS). Our first goal was to assess whether low SEP persons are more likely to develop PTSD than those with high SEP because they are more likely to experience a traumatic event or because they are more vulnerable to psychopathology after the traumatic experience. We then examined additional SEP differences in PTS symptomatology that cannot be evaluated using categorical measures of PTS. Finally, given that social support is one of the strongest predictor of PTS and is thought to buffer against the psychological consequences of stressful events, we investigated the potential modifying role of social support in the relation between SEP and PTS. We found that although low SEP persons were more likely to have experienced assaultive violence than those with high SEP, this did not explain their greater risk of PTSD. Instead, it was the greater burden of concomitant stressful life events among low SEP persons that explained their vulnerability to PTS. An examination of SEP differences in PTS as a continuous variable yielded additional information about PTS symptomatology. We found that differences in PTS score distribution between low and high SEP groups were not only more pronounced in the highest range of scores but also in the middle range of scores, which may be overlooked in categorical conceptualizations of PTS but may also be accompanied by substantial functional impairment. Though not conclusive, there was some evidence that social support reduced socioeconomic vulnerability to PTS. Differences in PTS severity between low and high SEP persons were smaller among those with high social support than among those with low social support. Our findings may inform interventions to reduce socioeconomic disparities in mental health and improve well-being among the most disadvantaged.Ph.D.Epidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/89717/1/goldmann_1.pd

Epidemiology

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61302/1/goldmann galea epidemiology 2008.pd

The time-course of a scrapie outbreak

BACKGROUND: Because the incubation period of scrapie has a strong host genetic component and a dose-response relationship, it is possible that changes will occur during an outbreak, especially in the genotypes of cases, age-at-onset of disease and, perhaps, the clinical signs displayed. We investigated these factors for a large outbreak of natural scrapie, which yielded sufficient data to detect temporal trends. RESULTS: Cases occurred mostly in two genotypes, VRQ/VRQ and VRQ/ARQ, with those early in the outbreak more likely to be of the VRQ/VRQ genotype. As the epidemic progressed, the age-at-onset of disease increased, which reflected changes in the genotypes of cases rather than changes in the age-at-onset within genotypes. Clinical signs of cases changed over the course of the outbreak. As the epidemic progressed VRQ/VRQ and VRQ/ARQ sheep were more likely to be reported with behavioural changes, while VRQ/VRQ sheep only were less likely to be reported with loss of condition. CONCLUSION: This study of one of the largest scrapie outbreaks in the UK allowed investigation of the effect of PrP genotype on other epidemiological parameters. Our analysis indicated that, although age-at-onset and clinical signs changed over time, the observed changes were largely, but not exclusively, driven by the time course of the PrP genotypes of cases

Association Between Anxiety, Depression, and Post-traumatic Stress Disorder and Outcomes After Ischemic Stroke

Background: Stroke patients are known to be at risk of developing anxiety, depression, and post-traumatic stress disorder (PTSD).Objective: To determine the overlap between anxiety, depression, and PTSD in patients after stroke and to determine the association between these disorders and quality of life, functional status, healthcare utilization, and return to work.Methods: A cross-sectional telephone survey was conducted to assess for depression, anxiety, PTSD, and health-related outcomes 6–12 months after first ischemic stroke in patients without prior psychiatric disease at a single stroke center.Results: Of 352 eligible subjects, 55 (16%) completed surveys. Seven subjects (13%) met criteria for probable anxiety, 6 (11%) for PTSD, and 11 for depression (20%). Of the 13 subjects (24%) who met criteria for any of these disorders, 6 (46%) met criteria for more than one, and 5 (39%) met criteria for all three. There were no significant differences in baseline characteristics, including stroke severity or neurologic symptoms, between those with or without any of these disorders. Those who had any of these disorders were less likely to be independent in their activities of daily living (ADLs) (54 vs. 95%, p < 0.001) and reported significantly worse quality of life (score of 0–100, median score of 50 vs. 80, p < 0.001) compared to those with none of these disorders.Conclusions: Anxiety, depression, and PTSD are common after stroke, have a high degree of co-occurrence, and are associated with worse outcomes, including quality of life and functional status

Addressing the climate challenge

In 2021, colleagues from across the University of Birmingham community were invited to write articles about topics relevant to the COP26 climate change summit. In this series of articles, experts from across many different disciplines provide new insight and evidence on how we might all understand and tackle climate change

Pre-pandemic mental health and coping strategy usage during the COVID-19 pandemic: a cross-sectional analysis of the Southern Cities Study

Abstract Background Little is known about the usage of coping strategies recommended by the World Health Organization and the Centers for Disease Control and Prevention during the COVID-19 pandemic and whether coping strategy usage varies by pre-pandemic mental health. This study examined the prevalence of different coping strategies and associations of their usage with pre-pandemic mental health. Methods Data were collected from adults residing in metropolitan areas of the U.S. South in May/June 2020 using random-digit-dialing and web-based surveys (n = 1,644). We estimated the prevalence of each coping strategy: (1) keeping up-to-date about COVID-19; (2) taking breaks from the news or social media; (3) taking care of physical health; (4) engaging in relaxing activities; (5) reaching out to and spending time with others; and (6) trying to find comfort in religious or spiritual beliefs. We examined the association between the use of each strategy and pre-pandemic mental health using modified Poisson regression, adjusting for covariates. We also analyzed the association between pre-pandemic mental health and the number of coping strategies employed using ordered logistic regression. Results The most prevalent strategies were: “keeping up-to-date about COVID-19” (53%), “taking care of physical health” (52%), and “reaching out to and spending time with others” (52%). Good pre-pandemic mental health was associated with an increased prevalence of “reaching out to and spending time with others” (adjusted prevalence ratio, 1.43; 95% confidence interval, 1.07–1.91). The use of other coping strategies and the number of coping strategies used during the pandemic did not vary by pre-pandemic mental health. Conclusions Our findings suggest that people who had good pre-pandemic mental health were more likely to connect with other people during the COVID-19 pandemic. Given the well-documented impact of social support on mental health in disaster contexts, efforts to promote safe social connections for those with pre-existing mental health concerns are needed

City Living and Mental Health in History

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63448/1/Galea_City MH in history_2009.pd

Borrowing And Selling To Pay For Health Care In Low-And Middle-Income Countries

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63445/1/Kruk_Borrowing health care_2009.pd

Race/ethnic Differences in Post-stroke Depression (PSD): Findings from the Stroke Warning Information and Faster Treatment (SWIFT) Study.

OBJECTIVE: Post-stroke depression (PSD) is common and associated with poor stroke outcomes, but few studies have examined race/ethnic disparities in PSD. Given the paucity of work and inconsistent findings in this important area of research, our study aimed to examine race/ethnic differences in depression in a multi-ethnic cohort of stroke patients. DESIGN: Longitudinal. SETTING: Prospective trial of a post-stroke educational intervention. PARTICIPANTS: 1,193 mild/moderate ischemic stroke/transient ischemic attack (TIA) patients. MAIN OUTCOME MEASURES: We used the Center for Epidemiologic Studies Depression (CES-D) Scale to assess subthreshold (CES-D score 8-15) and full (CES-D score ≥ 16) depression at one month (early) and 12 months (late) following stroke. Multinomial logistic regression analyses examined the association between race/ethnicity and early and late PSD separately. RESULTS: The prevalence of subthreshold and full PSD was 22.5% and 32.6% in the early period and 22.0% and 27.4% in the late period, respectively. Hispanics had 60% lower odds of early full PSD compared with non-Hispanic Whites after adjusting for other covariates (OR=.4, 95% CI: .2, .8). Race/ethnicity was not significantly associated with late PSD. CONCLUSIONS: Hispanic stroke patients had half the odds of PSD in early period compared with Whites, but no difference was found in the later period. Further studies comparing trajectories of PSD between race/ethnic groups may further our understanding of race/ethnic disparities in PSD and help identify effective interventions

Age-Related Differences in Antihypertensive Medication Adherence in Hispanics: A Cross-Sectional Community-Based Survey in New York City, 2011-2012.

INTRODUCTION: US Hispanics, particularly younger adults in this population, have a higher prevalence of uncontrolled hypertension than do people of other racial/ethnic groups. Little is known about the prevalence and predictors of antihypertensive medication adherence, a major determinant of hypertension control and cardiovascular disease, and differences between age groups in this fast-growing population. METHODS: The cross-sectional study included 1,043 community-dwelling Hispanic adults with hypertension living in 3 northern Manhattan neighborhoods from 2011 through 2012. Age-stratified analyses assessed the prevalence and predictors of high medication adherence (score of 8 on the Morisky Medication Adherence Scale [MMAS-8]) among younger (<60 y) and older (≥60 y) Hispanic adults. RESULTS: Prevalence of high adherence was significantly lower in younger versus older adults (24.5% vs 34.0%, P = .001). In younger adults, heavy alcohol consumption, a longer duration of hypertension, and recent poor physical health were negatively associated with high adherence, but poor self-rated general health was positively associated with high adherence. In older adults, advancing age, higher education level, high knowledge of hypertension control, and private insurance or Medicare versus Medicaid were positively associated with high adherence, whereas recent poor physical health and health-related activity limitations were negatively associated with high adherence. CONCLUSION: Equitable achievement of national hypertension control goals will require attention to suboptimal antihypertensive medication adherence found in this study and other samples of US Hispanics, particularly in younger adults. Age differences in predictors of high adherence highlight the need to tailor efforts to the life stage of people with hypertension