Daniel Rosen

Mental Health Treatment Seeking Among Older Adults with Depression: The Impact of Stigma and Race

OBJECTIVE Stigma associated with mental illness continues to be a significant barrier to help seeking, leading to negative attitudes about mental health treatment and deterring individuals who need services from seeking care. This study examined the impact of public stigma (negative attitudes held by the public) and internalized stigma (negative attitudes held by stigmatized individuals about themselves) on racial differences in treatment-seeking attitudes and behaviors among older adults with depression. METHOD Random digit dialing was utilized to identify a representative sample of 248 African American and white older adults (older than 60 years) with depression (symptoms assessed by the Patient Health Questionnaire-9). Telephone-based surveys were conducted to assess their treatment-seeking attitudes and behaviors and the factors that impacted these behaviors. RESULTS Depressed older adult participants endorsed a high level of public stigma and were not likely to be currently engaged in or did they intend to seek mental health treatment. Results also suggested that African American older adults were more likely to internalize stigma and endorsed less positive attitudes toward seeking mental health treatment than their white counterparts. Multiple regression analysis indicated that internalized stigma partially mediated the relationship between race and attitudes toward treatment. CONCLUSION Stigma associated with having a mental illness has a negative influence on attitudes and intentions toward seeking mental health services among older adults with depression, particularly African American elders. Interventions to target internalized stigma are needed to help engage this population in psychosocial mental health treatments.

The Prevalence of Mental and Physical Health Disorders Among Older Methadone Patients

OBJECTIVES The aging opioid-addicted cohort from the 1970s has begun to alter the demographic characteristics of individuals in need of services for heroin addiction. Yet, despite clear trends that indicate the population of older methadone patients is increasing, little is known about their well-being and service needs. The goal of this study was to assess the physical and mental health status of older methadone patients. DESIGN Face-to-face interviews were conducted with study participants. SETTING This study was conducted at a free-standing methadone clinic in a Midwestern industrial city. PARTICIPANTS A clinic sample of 140 adult methadone patients over the age of 50 was recruited for face-to-face interviews. MEASURES Mental health status was assessed by the Composite International Diagnostic Interview. The SF-12v2 was administered to measure a range of physical health issues. Participants were also asked about a variety of chronic conditions. In addition, respondents provided access to their drug screen results from monthly urine tests for illegal drug use for 1 year before and 1 year after the interview. RESULTS Findings revealed that over half (57.1%) of respondents had at least one mental health disorder in the past year. In the year before the interview, the most prevalent mental health disorder experienced by older adult patients was major depressive episode (32.9%). The most prevalent anxiety disorders were posttraumatic stress disorder (27.8%) and generalized anxiety disorder (29.7%). Additionally, women experienced significantly higher levels of depression than males (43.8% versus 27.2%), and nearly twice the prevalence rate of agoraphobia and panic disorders. Regarding physical health, respondents reported high rates of health problems in the past year, including arthritis (54.3%) and hypertension (44.9%). The majority of respondents reported having fair to poor physical health (57.7%). When examining the entire 24-month period during which urine data were collected, three quarters (76.4%) of the respondents had at least 1 month where the urine screen detected illegal drug use. CONCLUSIONS In the next decade, the growing and aging substance abusing population will require clinicians trained in both geriatrics and substance abuse. Health and mental health professionals have the opportunity to address the specialized needs of this population and prepare for the shifting service needs these older patients will require.

Intimate Partner Violence, Depression, and Posttraumatic Stress Disorder as Additional Predictors of Low Birth Weight Infants Among Low-Income Mothers

Estimates of intimate partner violence (IPV) during pregnancy vary by population being studied, measures, and other methodological limitations, hindering the ability to gauge the relationship between IPV and negative birth outcomes. The authors report aggregated data from a subsample (n = 148) of the first three waves of the Womens Employment Study. The authors compared groups of women who did and did not give birth to low birth weight infants on demographic, material deprivation, risk behavior, mental health, and IPV factors. The prevalence of domestic violence was more than twice as high for women with low birth weight infants as those women who had a normal weight infant. When considering additional risk factors, including food insufficiency, substance dependence, and depression and/or posttraumatic stress disorder, IPV remained a significant indicator, but it was most strongly associated with low birth weight among women also experiencing depression and/or posttraumatic stress disorder.

Barriers to treatment and culturally endorsed coping strategies among depressed African-American older adults

Objective: Older adults are particularly vulnerable to the effects of depression, however, they are less likely to seek and engage in mental health treatment. African-American older adults are even less likely than their White counterparts to seek and engage in mental health treatment. This qualitative study examined the experience of being depressed among African-American elders and their perceptions of barriers confronted when contemplating seeking mental health services. In addition, we examined how coping strategies are utilized by African-American elders who choose not to seek professional mental health services. Method: A total of 37 interviews were conducted with African-American elders endorsing at least mild symptoms of depression. Interviews were audiotaped and subsequently transcribed. Content analysis was utilized to analyze the qualitative data. Results: Thematic analysis of the interviews with African-American older adults is presented within three areas: (1) Beliefs about Depression Among Older African-Americans; (2) Barriers to Seeking Treatment for Older African-Americans; and (3) Cultural Coping Strategies for Depressed African-American Older Adults. Conclusion: Older African-Americans in this study identified a number of experiences living in the Black community that impacted their treatment seeking attitudes and behaviors, which led to identification and utilization of more culturally endorsed coping strategies to deal with their depression. Findings from this study provide a greater understanding of the stigma associated with having a mental illness and its influence on attitudes toward mental health services.

Low-Income Women's Use of Substance Abuse and Mental Health Services

This paper examines the utilization of mental health, alcohol, and drug treatment in a sample of low-income women. We analyze data from the Womens Employments Study, a study examining the barriers to employment for welfare recipients, and compare prevalence rates of mental health disorders and service utilization with the National Comorbidity Survey. Fewer than one in five of the respondents with a current mental health and/or substance dependence problem in the Womens Employment Study (WES) received treatment in the past 12 months. A logistic regression model of the association among demographic variables, risk factors, and service utilization in the WES found that having a co-occurring substance dependence and mental health disorder was significantly associated with receiving treatment. Those respondents with an increased number of barriers were significantly less likely to receive treatment. The authors argue that the success of welfare reform may hinge on low-income womens access to and utilization of appropriate services.

“You're Nothing But a Junkie”: Multiple Experiences of Stigma in an Aging Methadone Maintenance Population

ABSTRACT Whereas research has addressed the impact of mental illness stigma on treatment-seeking attitudes and behaviors, the effects of other stigmas such as age, race, drug addiction, and poverty have received far less attention. In addition, research has not sufficiently addressed the potential additive effect of stigma on individuals who are experiencing multiple stigmas simultaneously. In an attempt to explore the impact of experiencing multiple stigmas, this qualitative study examined the existence and experiences of stigma in a sample of older adult methadone maintenance clients. Semistructured interviews with 24 older adults in a methadone program were conducted and analyzed using an inductive content analysis approach. Results reveal 8 distinct stigmas experienced by this sample. Additionally, respondents who reported more stigmas were more likely to identify stigma as a barrier to substance abuse and mental health treatment. These findings reinforce the importance of recognizing the ways in which the burden of multiple stigmas impacts our most vulnerable populations. Implications for clinical practice and future research are discussed.

Characteristics and consequences of heroin use among older adults in the United States: A review of the literature, treatment implications, and recommendations for further research

This review reports on the results of a comprehensive literature search of studies examining the physical and mental health characteristics of older adults in the United States who use heroin. Multiple databases were searched for papers meeting the inclusion criteria of heroin users who were age 50 years or older. A total of 14 articles covering 9 different studies met the review inclusion criteria. All of the studies were convenience samples, and seven of the nine studies (77.8%) were entirely drawn from substance abuse treatment programs, primarily methadone maintenance programs. Findings from the qualitative studies suggest that the marginalization of older heroin users was a predominant experience that impacted the intent to seek treatment as well as treatment retention. While articles reported high levels of physical and psychological/psychiatric comorbidities with substance misuse, research on heroin use and methadone treatment among older adults is scant and the quantitative findings are inconsistent. The articles reviewed in this study demonstrate that the needs of this population will be significant, yet the development of appropriate interventions and treatment for older adult heroin users will be contingent on empirical research that adequately describes mental and physical health problems.

I Just Let Him Have His Way

This study explores the relationship between teenage pregnancy and male partner violence by examining the prevalence and effect of partner violence in a sample of new adolescent mothers. Data for this study are drawn from in-depth interviews with 35 new teenage mothers who had never been in, were currently involved in, or had recently exited from abusive partner relationships. The effect of partner violence on contraceptive use and pregnancy resolution are discussed as important variables in order to understand adolescent pregnancy. The role of social support is discussed as an important buffer for many of the adolescent mothers.

Mistrust and Self-Isolation: Barriers to Social Support for Older Adult Methadone Clients

Objectives: The purpose of this study is to explore barriers to the use, maintenance, and expansion of social supports in older adult methadone clients. Methods: The data for this analysis were derived from a qualitative study of the needs of aging methadone clients. Data were collected through face-to-face interviews with 24 methadone clients over the age of 50. Results: A lack of trust was identified as a principal barrier to the use, maintenance, and expansion of the social supports of older adult methadone clients. Causes of this mistrust include issues associated with aging, past traumatic experiences, and difficult personal relationships. Implications: These findings imply that addressing the issue of self isolation and recognizing the reason older adult methadone clients engage in this behavior is a key element in getting this specific population to use, maintain, and foster healthy social supports. A common phrase echoed throughout the interviews is that a person cannot trust anybody. Because of this mistrust, some clients keep to themselves by electing to self-isolate and decline to use, maintain, or foster new relationships. As a result, these individuals are less likely foster and/or engage in healthy social relationships, which are a key component of substance abuse treatment and abstinence maintenance.

Social Media Use and Perceived Social Isolation Among Young Adults in the U.S

INTRODUCTION Perceived social isolation (PSI) is associated with substantial morbidity and mortality. Social media platforms, commonly used by young adults, may offer an opportunity to ameliorate social isolation. This study assessed associations between social media use (SMU) and PSI among U.S. young adults. METHODS Participants were a nationally representative sample of 1,787 U.S. adults aged 19-32 years. They were recruited in October-November 2014 for a cross-sectional survey using a sampling frame that represented 97% of the U.S. POPULATION SMU was assessed using both time and frequency associated with use of 11 social media platforms, including Facebook, Twitter, Google+, YouTube, LinkedIn, Instagram, Pinterest, Tumblr, Vine, Snapchat, and Reddit. PSI was measured using the Patient-Reported Outcomes Measurement Information System scale. In 2015, ordered logistic regression was used to assess associations between SMU and SI while controlling for eight covariates. RESULTS In fully adjusted multivariable models that included survey weights, compared with those in the lowest quartile for SMU time, participants in the highest quartile had twice the odds of having greater PSI (AOR=2.0, 95% CI=1.4, 2.8). Similarly, compared with those in the lowest quartile, those in the highest quartile of SMU frequency had more than three times the odds of having greater PSI (AOR=3.4, 95% CI=2.3, 5.1). Associations were linear (p<0.001 for all), and results were robust to all sensitivity analyses. CONCLUSIONS Young adults with high SMU seem to feel more socially isolated than their counterparts with lower SMU. Future research should focus on determining directionality and elucidating reasons for these associations.