Psychiatric Treatment Needs Among the Medically Underserved: A Study of Black and White Primary Care Patients Residing in a Racial Minority Neighborhood

Method: A systematic sample of black (n = 345) and white (n = 57) patients from a primary care clinic in a racial minority neighborhood in northern Manhattan, New York, was analyzed. Logistic regression models were utilized to assess the effect of race on psychiatric treatment. The study was conducted during 1998-1999 and 2001-2003. Results: Blacks were less likely than whites to have a lifetime psychiatric disorder (OR = 0.17; 95% Cl, 0.06—0.53). Among patients with a current psychiatric disorder, there were no significant black-white differences in psychiatric treatment (OR = 0.72; 95% Cl, 0.21-2.49). Yet, there were significant and substantial differences among patients without a current psychiatric disorder, with blacks less likely to receive psychiatric treatment than whites (OR = 0.09; 95% Cl, 0.04-0.21). Conclusions: The study findings suggest that neighborhood residence moderates the relationship between race and psychiatric treatment. Black and white primary care patients with a current disorder residing in this racial minority neighborhood had similar rates of psychiatric treatment. Yet, whites, who were the minority in the clinic and the neighborhood from which the clinic draws patients, appear to have more chronic psychiatric problems for which they are receiving treatment. Primary care clinics can serve as a vital tool in addressing the persistent disparities in psychiatric treatment and the psychiatric conditions among whites residing in racial minority neighborhoods

Short-term binge drinking, marijuana, and recreational drug use trajectories in a prospective cohort of people living with HIV at the start of COVID-19 mitigation efforts in the United States.

BackgroundAt the start of the COVID-19 pandemic, HIV experts suggested that an increase in mental health diagnoses and substance use among people living with HIV (PLHIV) may be an unintended consequence of COVID-19 mitigation efforts (e.g., limiting social contact). We evaluated short-term trajectories in binge drinking, marijuana, and recreational drug use in a prospective cohort of PLHIV.MethodsData (N = 2121 PLHIV) consist of survey responses on substance use behaviors from two pre-COVID-19 (October 2018-September 2019) and one COVID-19-era (April 2020-September 2020) timepoints within the MACS/WIHS Combined Cohort Study (MWCCS). We conducted group-based trajectory models, triangulated with generalized linear mixed models, to assess changes in binge drinking, daily marijuana use, and recreational drug use at the start of the pandemic. Controlling for age and race/ethnicity, we tested whether trajectories differed by sex and early-pandemic depressive symptoms, loneliness, and social support.ResultsGroup-based trajectory models yielded two trajectory groups for binge drinking (none vs. any), marijuana (none/infrequent vs. daily), and recreational drug use (none vs. any). Binge drinking and recreational drug use decreased at the beginning of the pandemic. Generalized linear mixed model supported these trends. Consistent with prior research, male sex and having depressive symptoms early pandemic were positively associated with each substance use outcomes. Social support was inversely associated with recreational drug use.ConclusionsContrary to hypotheses, problematic substance use behaviors decreased from pre-pandemic to the post-pandemic follow-up in our sample of PLHIV. Ongoing surveillance is needed to assess whether this pattern persists as the pandemic continues