Racial and Ethnic Disparity in Major Depressive Disorder.

Major depressive disorder (MDD) is one of the most common and disabling psychiatric disorders in the USA. Early diagnosis and appropriate treatment are extremely important to prevent disability and improve quality of life. Recent studies have demonstrated racial and ethnic disparities in the diagnosis and treatment of MDD. African Americans (AA), Hispanics, and Asian Americans were significantly less likely to receive a depression diagnosis from a health-care provider than were non-Hispanic whites. The underdiagnosis of MDD in minority groups may be due to differences in socioeconomic status (SES), care affordability, cultural beliefs about depression, help-seeking patterns, access to culturally and linguistically appropriate care, patient-physician relationship, clinical presentation of depression, etc. Meanwhile, the likelihood of both having access to and receiving adequate care for depression was significantly low for AA, Hispanics, and Asian Americans, in contrast to whites. Similar disparities also exist in treatment outcomes. Besides the reasons for MDD underdiagnosis, additional contributing factors include access barriers to preferred mode of treatment, cultural concerns about antidepressants and different metabolism of antidepressants, etc. There are many ways to address these disparities and improve MDD care in minority populations, including universal depression screening, public financial incentives to ensure access to care in low-income and minority neighborhoods, quality improvement programs, cultural competency of mental health professionals, collaborative care management, community engagement and planning, and enhanced participation of minorities in clinical research.

Remaking the American health care system: a positive reflection on the Affordable Care Act with emphasis on mental health care.

Health care reform under the Patient Protection and Affordable Care Act (PPACA, ACA) of 2010 may be the most significant health care-related legislation enacted since the establishment of Medicare and Medicaid several decades ago. Over two years ago the U.S. Supreme Court upheld the constitutionality of the individual mandate of the Patient Protection and Affordable Care Act. This legislation has emerged as a significant and ambitious undertaking for all levels of the U.S. government. With the need to accommodate the estimated 30 million people projected over time to become newly insured it is increasingly important to understand the necessity of reform, how the legislation has been interpreted and implemented to fit the goals of the federal, state, and local governments, and what the potential benefits and consequences of changing the system are, in particular, as it relates to mental health care.

Misconceptions of depression in african americans.

Major depression is a very common disabling disorder. Although the relationship between race and depression is complex, depression affects all races, all ethnic and geographic locations as well as all age groups. The prevalence of depression in African Americans is controversial, due to the paucity of research. The deficit in the knowledge and skills in treating depression in African Americans have not been adequately addressed so far. Inadequate and insufficient data on African Americans contributes to the problems of under diagnoses, misdiagnosis, and under treatment of depression. This article will highlight the existing problem of depression in Afro American with a focus on diagnostic and treatment issues.

The potential of neural stem cell transplantation for the treatment of fetal alcohol spectrum disorder.

Fetal alcohol spectrum disorder (FASD) is caused by intrauterine exposure to alcohol and can cause a full range of abnormalities to brain development, as well as long-term sequelae of cognitive, sensory and motor impairments. The incidence is estimated to be as high as 2% to 5% in children born within the US, however the prevalence is even higher in low socioeconomic populations. Despite the various mechanisms thought to explain the etiology of FASD, molecular targets of ethanol toxicity during development are not completely understood. More recent findings explore the role of GABA-A and GABA-B mechanisms, as well as cell death, cell signaling and gene expression malfunctions. Stem cell based therapies have grown exponentially over the last decade, which have lead to novel clinical interventions across many disciplines. Thus, early detailed understanding of the therapeutic potential of stem cell research has provided promising applications across a wide range of illnesses. Consequently, these potential benefits may ultimately lead to a reduced incidence and severity of this highly preventable and prevalent birth defect. It is recognized that stem cell derivations provide unique difficulties and limitations of therapeutic applications. This review will outline the current knowledge, along with the benefits and challenges of stem cell therapy for FASD.

Depression and chronic diseases: it is time for a synergistic mental health and primary care approach.

OBJECTIVE: To identify the growing significance of depression as a global leading cause of years lost to disability and its role as a major independent risk factor in many chronic illnesses. The distinct effects of depression on morbidity and mortality in cancer, diabetes, heart disease, and stroke are investigated, including behavioral factors and plausible biological mechanisms (psychoneuroimmunology of depression). DATA SOURCES: PubMed articles in English were searched from 1992 to 2012 (20-year span) using the following search criteria: psychoneuroimmunology of depression, immune-mediated inflammation, depression treatment recommendations, depression screening, years lost to disability, underserved populations and depression, chronic illnesses and depression, and selective serotonin reuptake inhibitors and immune system. DATA SYNTHESIS: Evidence of the robust bidirectional relationship between depression and individual chronic diseases is presented and discussed. A brief overview of currently recommended psychotherapeutic and psychopharmacologic treatment approaches in regard to depression in chronic diseases is provided. RESULTS: Discordance between mental health and primary care within the US public health system is a systematic problem that must be addressed. This situation leads to a potentially high hidden prevalence of underdiagnosed and undertreated depression, especially in the underserved populations. CONCLUSION: Measures must be implemented across the communities of mental health and primary care practitioners in order to achieve a synergistic approach to depression.

How to evaluate disability.

A disability assessment for non-therapeutic reasons is the most common evaluation requested of treating psychiatrists. Mental disorders affect approximately 20 percent of Americans each year. People who are unable to work need some financial assistance. As part of the system, it's our goal to assist them in this process. When a disability claim is filed, psychiatrists take into account the individual's impairments and disabilities. A psychiatrist's evaluation of disability involves knowledge and experience. There are many ethics related challenges, especially when performing disability evaluation of their own patients. Disability training should therefore be part of residency curriculum for training of psychiatry residents.

Overview of substance use disorders and incarceration of african american males.

Incarceration affects the lives of many African American men and often leads to poverty, ill health, violence, and a decreased quality of life. There has been an unprecedented increase in incarceration among African American males since 1970. In 2009, the incarceration rate among black males was 6.7 times that of white males and 2.6 times of Hispanic males. Substance abuse in African American males leads to higher mortality rates, high rates of alcohol-related problems, more likely to be victims of crimes, and HIV/AIDS. African Americans comprised only 14% of the U.S. population but comprised 38% of the jail population. The cost of incarcerating persons involved in substance related crimes has increased considerably over the past two decades in the U.S. A reduction in the incarceration rate for non-violent offences would save an estimated $17 billion per year. Substance use disorder makes the individual more prone to polysubstance use and leads to impulse control problems, selling drugs, and other crimes. The high rate of incarceration in U.S. may adversely affect health care, the economy of the country, and will become a burden on society. Implementation of good mental health care, treatment of addiction during and after incarceration will help to decrease the chances of reoffending. Therapeutic community programs with prison-based and specialized treatment facilities, cognitive behavioral therapy treatment for 91-180 days, and 12-step orientation with staff specialized in substance abuse can be helpful. It is essential for health care professionals to increase public awareness of substance abuse and find ways to decrease the high rates of incarceration.