Help-seeking behaviors for serious psychological distress among individuals with diabetes mellitus: The California Health Interview Survey, 2011-2012.

AIM: To investigate patterns of and factors associated with help-seeking behaviors among individuals with diabetes mellitus (DM) and/or serious psychological distress (SPD). METHODS: The analysis was conducted with the California Health Interview Survey (CHIS) 2011-2012 of 40,803 adults. Logistic regression was used to examine the associations between the multiple facilitating/preventing factors and outcome, guided by the Andersen's Health Care Utilization Model. RESULTS: The prevalence of DM and SPD were 10.9% and 3.4%, respectively, among participants in the survey. The participants with DM were more likely to experience SPD than those without DM (OR 1.46, 95% CI=1.11-1.91, p=0.006). Participants with combined DM and SPD, the most underserved, were less likely to perceive the need for mental health services and less likely to seek help, compared to those with only SPD. Need factors (SPD status and perceived need) were significantly associated with help-seeking behaviors for mental health, along with predisposing factors (age, gender, obesity, race, and employment), and enabling factors (insurance, English proficiency). CONCLUSIONS: Perceptions about need for seeking help seem to play an important role in receiving mental health services in addition to other predisposing or enabling factors. Identification of these factors may improve clinical outcomes related to DM and SPD.

Screening for type 2 diabetes mellitus in patients with mental illness: application of a self-assessment score for diabetes mellitus risk.

Various methods for diabetes risk assessment have been developed over a decade, but they were not evaluated in patients with mental illness. This study examined the feasibility and utility of a self-assessment score for type 2 diabetes mellitus (DM2) risk among patients with mental illness. DM2 risk was assessed by patients with mental illness as well as clinicians via a self-assessment questionnaire, and the resulting scores were compared to each other as well as with actual diagnosis. Of 100 patients, nine patients were newly revealed to have DM2 and 34 patients have pre-DM2. Patients tended to underreport risk factors - obesity and physical activity - so perceived to have lower risk. Sensitivity of the self-assessment score was different when used by patients and by clinicians despite correlation coefficient of 0.82. Based on positive predictive values, we may expect one out of two patients who have high scores actually have DM2 or pre-DM2. Also, the discrimination capability was reasonably high (AUC=0.79), comparable to its performance observed in general populations. The self-assessment score has potential as a simple and adjunct tool to identify a high risk group of DM2/pre-DM2 among persons with mental illness, especially, when used together with health care providers.

Factors associated with mental health service utilization among Korean American immigrants.

This study adapted Andersen's Health Belief Model to examine the predictors of mental health services utilization among Korean American (KA) immigrants. A cross-sectional survey was used to gather data on 363 KA immigrants 18 years and older residing in New York City. Predisposing factors included gender, age, marital status, education, length of stay in the US, and religion; the need factor was depression; and enabling factors included health insurance, English proficiency, income, and perceived need for help. Approximately 8.5 % of participants reported having utilized mental health services, while 23 % reported having depressive symptoms. Shorter duration of residence in the US, lower income, and the presence of perceived need for help were significantly related to use of mental health services. The perceived need for help mediated the relationship between depression and mental health service utilization. Failure to perceive the need for psychological help continues to be a major reason that KA immigrants do not use mental health services.

Weight changes and characteristics of patients associated with weight gain during inpatient psychiatric treatment.

This study investigated weight changes and patient characteristics associated with weight gain in a public psychiatric hospital. A retrospective chart review was conducted on a multi-racial population admitted for psychiatric inpatient treatment. Patients gained an average of 5.41 pounds during psychiatric hospitalization. Patients with normal weight at admission were significantly more likely to gain weight compared to overweight or obese patients. Black patients showed the greatest weight gain, while Asian patients showed the smallest weight gain. This study suggests that it may be possible to identify specific demographic characteristics that warrant more intensive clinical evaluation, although additional research is necessary.

Serious psychological distress, health risk behaviors, and diabetes care among adults with type 2 diabetes: the California Health Interview Survey 2007.

AIMS: To examine the association between type 2 diabetes and serious psychological distress (SPD) and to assess if SPD was an independent risk factor for health risk behaviors and diabetes care among adults with diabetes. METHODS: Cross-sectional analysis was performed using the 2007 California Health Interview Survey with adults in California. Multiple logistic models were used to examine the associations between the multiple risk and outcome factors. RESULTS: Of the participants, 6.9% of adults had diagnoses of type 2 diabetes. SPD was present in 7.0% of adults with diabetes but only in 3.5% of adults without diabetes. Multiple logistic regression analysis revealed that participants with diabetes were significantly more likely than those without diabetes to experience SPD (OR=1.81; 95% CI=[1.3-2.5], p=0.0002), adjusting for other factors. In addition, participants with diabetes and SPD were more likely to report insufficient physical activity and more current cigarette smoking than participants without SPD. SPD among participants with diabetes, however, did not significantly affect good diabetes care. CONCLUSIONS: The findings suggest that adults with diabetes are more likely to experience SPD than adults without diabetes. Further research is needed to explore the underlying mechanisms for this association among adults with both diabetes and SPD.

Understanding the experience and manifestation of depression among Korean immigrants in New York City.

Depression among immigrant groups, especially Korean immigrants, has often lacked a comprehensive understanding by the providers of Western health care. This study aims to explore the subjective experience of Korean immigrants suffering from depression during resettlement in the United States. A series of focus groups and in-depth interviews were conducted with Korean immigrants in New York City who identified themselves as depressed. Participants described their depression as manifested through the feeling of an "unbalanced self " and tended to express dysphoric symptoms in somatic terms. These differences need to be reflected in the assessment and treatment of depression in Korean immigrants.

Inpatient stays of Asian patients with psychiatric diagnoses in New York City.

This study examines whether race, specifically Asian, contributes to longer inpatient stays for patients with psychiatric diagnoses in a large American city. Secondary data analyses were conducted using Statewide Planning and Research Cooperative System data sets for 983,584 inpatient discharges with psychiatric diagnoses in New York City between 1995 and 1999. Asians were admitted more often through the emergency room and showed a higher incidence of emergency admission than non-Asians. Greater percentages of Asians were diagnosed with schizophrenic disorders and affective psychoses compared to non-Asians. Furthermore, Asians were about 70% less likely to utilize inpatient services but stayed considerably longer than non-Asians when hospitalized. Study findings will assist in development of policy to improve service utilization for this vulnerable population.

Help-seeking behaviors by Korean immigrants for depression.

Underutilization of mental health services by Asian immigrants has been an ongoing concern for those attempting to provide accessible care for people suffering from mental illness. The author investigated Korean immigrants' help-seeking behaviors for depression to understand their underutilization of mental health services. The study involved 6 focus group discussions and 24 in-depth interviews with 70 Korean immigrants in New York City. Prolonged care within family and traditional Asian practices led to a delay in seeking mental health services, keeping many Korean immigrants with depression out of the delivery system. The lack of interface between formal service providers and psychiatric service providers also caused delayed treatment. This study suggests the need for a comprehensive care model based on community education, linking mental health care with other services, and cultural brokering, as ways to connect population needs with mental health service delivery.

Quality of care measurement in nursing home AIDS care: a pilot study.

A pilot study was conducted to identify which, if any, demographic or quality indicators differentiate HIV-positive patients from other long-term care patients. This study used the Minimum Data Set files for all New York state nursing homes submitted in 1997. Chi-square tests were used to assess difference in proportions of demographics and quality indicators between HIV-positive and HIV-negative patients. The HIV-positive patients tended to be between 40 and 59 years of age and male and were more likely to be Black or Hispanic. HIV-positive patients had a significantly higher prevalence of diagnosis or symptoms of depression without any treatment compared to HIV-negative patients. HIV-positive patients had significantly higher prevalence of weight loss, antipsychotic use, antianxiety/hypnotic use, and incontinence of bladder and bowel compared to HIV-negative patients. This study paves the way for the development of a more appropriate quality indicator system tailored to the AIDS population and allows facilities to make necessary improvements in the quality of care offered to this vulnerable population.