Racism, Healthcare Provider Trust, and Medication Adherence among Black Patients in Safety-Net Primary Care: A Strength-Based Approach

Integrated primary care has been incorporated into a variety of healthcare settings. The benefits of these services are empirically supported by a plethora of studies, which highlight the integration of behavioral and physical healthcare to be beneficial for both patient and healthcare providers. Integrated care models are typically incorporated in Veterans Affairs hospitals, general primary care facilities, and community clinics. Community-based clinics, such as safety-net clinics, typically serve underrepresented populations, and research has shown several mental and physical health disparities to exist among minority populations. Further, the minority stress model posits that distal and proximal minority-based stress processes can result in a cascade of negative health outcomes, such as increased symptomology or poor health-management behaviors. Although minority stressors can lead to this series of consequences, several community and personal strengths may serve as protective factors for marginalized individuals. These processes may occur within safety-net primary care, considering that the populations of interest are underserved. Black patient populations face numerous barriers to healthcare, such as racism, discrimination, and provider bias. Prior literature has shown that prior experiences of racism result in poorer mental and physical health outcomes for Black patient populations. Further, these outcomes have been shown to negatively impact healthcare attitudes and behaviors. The current study aimed to examine how aspects of the minority stress model may operate within safety-net primary care services for Black patient populations. It was hypothesized that racism would predict poorer mental health, which would negatively impact provider trust, and therefore predict lower medication adherence. Using a strengths-based approach, grit and social support were hypothesized to serve as personal and collective buffers to this series of relationship. A path analysis showed that racism significantly predicted mental health, which predicted poorer provider trust; however, the last path of this model, provider trust to medication adherence, was not found to be statistically significant. Thus, the path analysis was broken up into a series of mediations, which explored the relationship between racism and both provider trust and medication adherence through mental health. Mental health was found to mediate the relationship from racism to provider trust and from racism to medication adherence. The moderated mediation effect of social support was found to be non-significant for all mediations, except that grit was moderated the mediation between racism to medication adherence through mental health. These results showed grit served as a personal strength to dampen the associated effects of racism, which may suggest improving intrinsic attitudes and motivation towards long-term health related goals may increase treatment adherence behaviors. Results from this study also confirm the importance of integrated primary care services, as the data suggested high rates of mental health problems, which typically go underreported among Black patients in healthcare settings

Racial/Ethnic Disparities In Longitudinal Trajectories Of Arrest Probability After Traumatic Brain Injury

Traumatic Brain Injury (TBI) is one of the leading causes of disability across the globe, and epidemiological studies have documented a rise in this condition over the recent years. Post-TBI functional impairments can persist beyond the acute phase of the injury, and specific psychosocial and injury-related factors have predicted variability in these outcomes. Previous literature has documented profound racial/ethnic disparities in TBI risk, cause, treatment, and rehabilitation. Prior investigation has revealed an overlap between incarceration and TBI, which showed that incarcerated persons typically endorsed a history of TBI. Criminal justice literature has shown stark racial/ethnic differences in incarceration rates, which are consistent among TBI populations. The current study included participants from the national TBI Model System’s study. An aim of the current study was to evaluate whether racial/ethnic disparities in traumatic brain injury acquisition and rehabilitation, which have been supported by previous literature, occurred within the current study sample. An additional aim of this research was to examine racial/ethnic disparities in arrest probability trajectories and whether injury and sociodemographic characteristics contributed to these longitudinal arrest trajectories. This study utilized a series of hierarchical linear models (HLMs) to assess longitudinal trajectories of arrest probability over the span of ten years post-injury, racial/ethnic disparities longitudinal arrest trajectories, and socio-demographic and injury-related predictors of these identified disparities. Preliminary study results supported previous literature which has shown racial/ethnic disparities in TBI cause and rehabilitation. Arrest probability trajectories generally decreased over the course of ten years post-discharge. White persons with TBI had lower arrest probability trajectories than Black and Native American persons, and Asian individuals with TBI had lower arrest probability trajectories than White, Black, Latinx, and Native American persons. When sociodemographic and injury related characteristics were entered in the models, the racial/ethnic differences in longitudinal arrest probability trajectories were no longer significant for the White vs. Black, Latinx vs. Asian, White vs. Native American, and Latinx vs. Native American comparisons. However, disparities remained in the White vs. Asian, Black vs. Asian, and Asian vs. Native American comparisons. These findings suggest that arrest probability trajectories occur differentially as a function of racial/ethnic group membership, though these differences can only in part be accounted for by injury and sociodemographic considerations. As such, the current study findings yield clinical, public health, and criminal justice implications, aimed to lessen arrest probability outcomes for persons with TBI who possess certain sociodemographic features in addition to racial/ethnic minority group membership

Health Conditions, Access to Care, Mental Health, and Wellness Behaviors in Lesbian, Gay, Bisexual, and Transgender Adults

This study examined relationships among wellness behaviors, physical health conditions, mental health, health insurance, and access to care among a sample of 317 lesbian, gay, bisexual, and transgender (LGBT) adults. Participants completed a web-administered survey from May 2013 to April 2014. Of the sample, 41.6% of the participants reported having one or more health conditions. Most participants (92.1%) reported access to a health care facility and current health insurance coverage (84.9%), though 24.9% of those with health insurance reported being incapable of paying the copayments. Physical health conditions, age, and self-esteem explained 24% of the variance in engagement in wellness behaviors; older age, a greater number of health conditions, higher self-esteem, possession of health insurance, and ability to access to care were associated with increased wellness behaviors. Providing affordable insurance coverage, improving access to care, and properly treating mental health in LGBT individuals could improve wellness behaviors

Is Helping Really Helping? Health-Related Quality of Life after TBI Predicting Caregiver Depression Longitudinally in Latin America

Objective: Studies have shown that functional and psychosocial sequelae of traumatic brain injury (TBI) predict emotional well-being of caregivers (Harris, 2000). Previous research examining the mental health of caregivers and the health-related quality of life (HRQoL) of people with TBI have primarily been in the US (Sander, 2012). Very little research has been conducted to uncover the unique relationships between HRQoL of people with TBI and caregiver mental health longitudinally, or in low-middle income Latin American countries. The aim of this study was to evaluate how HRQoL after TBI predict caregiver depression longitudinally in two countries and three data collection sites in Latin America. Design: Multi-site, multinational longitudinal study. Setting: Three hospitals in Neiva and Cali, Colombia, and Mexico City, Mexico (before hospital discharge), as well as in the homes of individuals with TBI and caregivers in these regions (before discharge, at 2 and 4 months after discharge). Participants: A sample of 109 TBI caregiver-patient dyads (n = 218) was included in the study. Main Outcome Measure(s): Caregiver depression (Patient Health Questionnaire-9) and HRQoL in the person with TBI (Short Form-36). Results: Three multiple regressions were conducted to examine which aspects of patient HRQoL at baseline predicted caregiver depression at baseline, 2 months, and 4 months post-discharge. Eight aspects of patient HRQoL were simultaneously entered into each model as predictors: physical functioning, role limitations (physical and emotional), vitality, mental health, social functioning, pain, and general health. At baseline, the overall model significantly predicted caregiver depression, F(8, 105) = 2.62, p = .012, R 2 = .18. Patient mental health was the only significant unique predictor of caregiver depression at baseline, p = .021, β = -.34. The overall model predicting 2-month caregiver depression was significant, F(8, 101) = 3.21, p = .003, R 2 = .22. Only mental health, p = .016, β = -.36, was a significant unique predictor. The overall model predicting 4-month caregiver depression was significant, F(8, 98) = 2.70, p = .010, R 2 = .19, and no factors uniquely predicted caregiver depression, all ps\u3e.05. Conclusions: Results suggest that TBI patient HRQoL can predict caregiver depression among Latin American caregivers before and during the first 4 months after hospital discharge. Across all three time points (baseline, 2 months, and 4 months), caregiver depression was significantly predicted by patient HRQoL. At baseline, patient mental health was the only domain that uniquely predicted caregiver depression. At 2 months, only physical role limitations uniquely predicted caregiver depression, and no unique predictors were detected at 4 months. These findings suggest that within the cultural framework in Latin America, there is a strong relationship between functional and psychological impairments after TBI and depression outcomes in Latin American caregivers. The results highlight the importance of uncovering these relational distinctions and may infer early detection of mental health needs and psychological intervention considerations for Latin American caregivers.https://scholarscompass.vcu.edu/gradposters/1052/thumbnail.jp

Predicting Caregiver Burden Over the First 4 Months After TBI in Latin America: A Multi-site, Multi-Country Study

Disparities in TBI exist between developed and developing regions, and this neurological condition typically requires caregivers to provide aid and functional support for those with TBI (Hyder, Wunderlich, Puvanachandra, Gururaj, & Kobusingye, 2007). Latin America, among these global regions, has elevated risks of both sustaining TBI and poorer post-TBI functioning (Bonow et al., 2018). Previous literature has shown the poor cognitive, mental health, and social functional outcomes following the injury (Deloche, Dellatolas, & Christensen, 2000), but research has minimally explored both longitudinal trends of these outcomes, and if functional outcomes of the injury differentially predict caregiver burden. The aim of the current study was to examine if deficits in cognitive/executive functioning, depression, and social disadaptation among individuals with TBI in Latin America predict longitudinal trajectories of caregiver burden. A sample of 109 Latin American caregivers of individuals with a newly sustained TBI, from three hospitals were included in the study. In order to evaluate this series of relationships, Hierarchal Linear Modeling (HLM) assessed whether key features of TBI (e.g, depression, cognitive dysfunction, and social disadaptation), at baseline, predicted longitudinal outcomes of caregiver burden. Study findings showed that social disadaptation significantly predicted caregiver burden trajectory. Further, results showed that caregiver burden trajectories generally decreased over time, and men reported greater caregiver burden compared to women. These findings highlight unique trends among post-TBI caregivers in Latin America and suggest that future research should assess mechanisms that influence these trends.https://scholarscompass.vcu.edu/gradposters/1090/thumbnail.jp

Spinal Cord Injury/Disorder Function, Affiliate Stigma, and Caregiver Burden in Turkey

BackgroundThe association among spinal cord injury and disorder (SCI/D) function, caregiver affiliate stigma, and caregiver depression and burden has not been adequately studied. In Turkey, a region with a developing healthcare infrastructure, SCI/D caregivers may have a higher responsibility of care given limited resources and may experience greater psychological distress associated with caregiving than in more developed healthcare systems.ObjectiveTo examine whether SCI/D function, caregiver affiliate stigma, and caregiver burden and depression in Turkey are associated with each other.DesignCross‐sectional survey design.SettingParticipants were recruited from the Turkish Spinal Cord Injury Foundation and from the SCI/D service at Istanbul Physical Rehabilitation Hospital.ParticipantsA total of 82 SCI/D caregivers in Turkey.InterventionsNot applicable.Main Outcome MeasuresBarthel Index, Affiliate Stigma Scale, Zarit Burden Interview, and Patient Health Questionnaire‐9.ResultsIn an initial path model using bootstrapping, SCI/D function did not predict affiliate stigma, and once this path was trimmed, a final path model suggested that SCI/D function and affiliate stigma predicted caregiver burden, which in turn predicted caregiver depression. Burden partially mediated the effects of both SCI/D function and affiliate stigma on caregiver depression. All paths in the final model were statistically significant, and the fit indices suggested good fit.ConclusionsBecause affiliate SCI/D function and stigma exerted a cascade of statistical effects across caregiver burden and depression, interventions should be developed and tested to help caregivers cope with low SCI/D function and combat affiliate stigma, preventing it from exerting harmful effects. Previously developed caregiver interventions should be translated and culturally adapted for a Turkish context, given that the burden and depression outcomes these interventions target are highly relevant for Turkish SCI/D caregivers.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171108/1/pmrj12548_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171108/2/pmrj12548.pd

Health Conditions, Access to Care, Mental Health, and Wellness Behaviors in Lesbian, Gay, Bisexual, and Transgender Adults

This study examined relationships among wellness behaviors, physical health conditions, mental health, health insurance, and access to care among a sample of 317 lesbian, gay, bisexual, and transgender (LGBT) adults. Participants completed a web-administered survey from May 2013 to April 2014. Of the sample, 41.6% of the participants reported having one or more health conditions. Most participants (92.1%) reported access to a health care facility and current health insurance coverage (84.9%), though 24.9% of those with health insurance reported being incapable of paying the copayments. Physical health conditions, age, and self-esteem explained 24% of the variance in engagement in wellness behaviors; older age, a greater number of health conditions, higher self-esteem, possession of health insurance, and ability to access to care were associated with increased wellness behaviors. Providing affordable insurance coverage, improving access to care, and properly treating mental health in LGBT individuals could improve wellness behaviors

Racial/Ethnic Differences in Arrest Probability Trajectories after Traumatic Brain Injury: A Model Systems Study

Background: Previous literature has documented racial/ethnic differences in traumatic brain injury (TBI) risk, cause, treatment, and rehabilitation. The purpose of the current study was to investigate potential racial/ethnic differences in arrest probability trajectories over the first 10 years after TBI and whether injury and sociodemographic characteristics accounted for these differences. Methods: The current study included 13,195 participants with moderate-to-severe TBI in the TBI Model Systems National Database who had arrest data from at least one follow-up time point (Years 1, 2, 5, and/or 10). A series of hierarchical linear models assessed racial/ethnic differences in trajectories of arrest probability over these 10 years post-injury and then included socio-demographic and injury-related covariates. Results: White individuals with TBI had lower arrest probability trajectories than Black and Native American individuals, and Asian individuals with TBI had lower arrest probability trajectories than White, Black, Latinx, and Native American persons. In many cases, racial/ethnic disparities persisted even when injury and sociodemographic characteristics were covaried. Conclusion: These results suggest that rehabilitation clinicians should assess for post-injury arrest risk factors such as age, sex, education, pre-injury unemployment, arrest history, and substance abuse, particularly in Black, Latinx, and Native American groups, and integrate programming to lessen post-injury arrest probability and improve overall rehabilitation outcomes

Suicidal Ideation After Acute Traumatic Brain Injury:A Longitudinal Actor-Partner Interdependence Model of Patients and Caregivers in Latin America

Traumatic brain injury (TBI) is associated with depression, anxiety, and even suicidality in individuals with TBI and in caregivers. Moreover, emotional functioning in individuals with TBI is linked with caregiver functioning. However, no known studies to date have examined linkages in suicidal ideation in individuals with TBI and family caregivers. This is especially important in Latin America, where TBI rates are high, and where cultural norms influence family caregiving. This study examined associations among self-reported suicidal ideation in individuals with TBI and their primary caregivers over time in Mexico and Colombia. Research Method/Design: A total of 109 individuals and their primary caregivers completed measures during hospitalization for TBI and at 2 and 4-months posthospitalization. The primary outcome was Item 9 from the Spanish version of the Patient Health Questionnaire-9, assessing for thoughts of death or suicide in the previous 2 weeks. Results: Patients and caregivers reported high levels of suicidal ideation (18.3%–22.4% and 12.4%–15.7%, respectively) at each time point, and suicidal ideation at one time point strongly predicted ideation at the next. When patients endorsed suicidal ideation in the hospital, their caregivers tended to endorse suicidal ideation 2 months later. Although unaccounted for variables could be driving these relationships, they may also provide possible evidence of causal preponderance between patient and caregiver suicidal ideation post-TBI. Conclusions/Implications: Clinicians and rehabilitation specialists can use these findings to inform suicide risk assessment by expanding these practices to caregivers of patients who endorsed suicidal ideation. Interventions after TBI should incorporate caregivers given this study showed significant interdependence of suicidality between patients and caregiver