The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort
•Socioeconomic status (SES) is associated with psychiatric symptoms and likelihood of self-reported symptom recovery after receiving mental health treatment in multiple sclerosis (MS).•Race, ethnicity, and individual and neighborhood-level SES are important to consider when delivering mental health...
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| Veröffentlicht in: | Multiple sclerosis and related disorders 2022-02, Vol.58, p.103451-103451, Article 103451 |
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| creator | Pimentel Maldonado, Daniela A. Eusebio, Justin R. Amezcua, Lilyana Vasileiou, Eleni S. Mowry, Ellen M. Hemond, Christopher C. Umeton (Pizzolato), Raffaella Berrios Morales, Idanis Radu, Irina Ionete, Carolina Fitzgerald, Kathryn C. |
| description | •Socioeconomic status (SES) is associated with psychiatric symptoms and likelihood of self-reported symptom recovery after receiving mental health treatment in multiple sclerosis (MS).•Race, ethnicity, and individual and neighborhood-level SES are important to consider when delivering mental health care for persons with MS.•Attitudes regarding mental health care delivery in MS vary according to racial and ethnic background.
Psychiatric symptoms are common in multiple sclerosis (MS) and may contribute to worse MS outcomes. Previous studies suggest the burden of symptoms may vary by race, ethnicity and socioeconomic status (SES). Our objective was to expand upon this previous work and explore the associations between SES, race, and ethnicity, as predictors of psychiatric symptoms, mental health attitudes, and health-seeking behavior in patients with MS.
Persons with MS answered a national web-based survey including demographic characteristics (including race, ethnicity and measures of SES), mental health attitudes, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Modified Fatigue Impact Scale 5-item version (MFIS-5), and the Alcohol Use Disorders Identification Test (AUDIT). The survey also queried mental health availability and perceptions of care. We measured neighborhood-level SES (nSES) of each participant using the Agency for Healthcare Research and Quality (AHRQ) index that was calculated from 5-digit postal codes. Other indicators of participant-level SES included education level and self-reported household income. We assessed the association between race, ethnicity, and neighborhood/participant-level SES indicators and affective symptom burden using generalized linear models that were adjusted for age, sex, and MS characteristics.
2095 participants answered the survey (mean AHRQ index 54.6 ± 5.4, age 51.3 ± 12.2 years, 7% Black/African American, 5.4% Hispanic/Latino, and 81.8% female). Those in the lowest quartile of nSES (most disadvantaged) were more likely to be either Black/African American or Hispanic/Latino as compared to those in highest quartile (least disadvantaged). Those in the lowest quartile of nSES had higher mean MFIS-5 (1.02 points; 95% CI: 0.39, 1.43), PHQ-9 (1.24 points; 95% CI: 0.49, 1.98), and GAD-7 (0.69 points; 95% CI: -0.01, 1.38) scores relative to those in the highest quartile. Of those who consumed alcohol (n = 1489), participants in the lowest AHRQ quartile had lower mea |
| doi_str_mv | 10.1016/j.msard.2021.103451 |
| format | Article |
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Psychiatric symptoms are common in multiple sclerosis (MS) and may contribute to worse MS outcomes. Previous studies suggest the burden of symptoms may vary by race, ethnicity and socioeconomic status (SES). Our objective was to expand upon this previous work and explore the associations between SES, race, and ethnicity, as predictors of psychiatric symptoms, mental health attitudes, and health-seeking behavior in patients with MS.
Persons with MS answered a national web-based survey including demographic characteristics (including race, ethnicity and measures of SES), mental health attitudes, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Modified Fatigue Impact Scale 5-item version (MFIS-5), and the Alcohol Use Disorders Identification Test (AUDIT). The survey also queried mental health availability and perceptions of care. We measured neighborhood-level SES (nSES) of each participant using the Agency for Healthcare Research and Quality (AHRQ) index that was calculated from 5-digit postal codes. Other indicators of participant-level SES included education level and self-reported household income. We assessed the association between race, ethnicity, and neighborhood/participant-level SES indicators and affective symptom burden using generalized linear models that were adjusted for age, sex, and MS characteristics.
2095 participants answered the survey (mean AHRQ index 54.6 ± 5.4, age 51.3 ± 12.2 years, 7% Black/African American, 5.4% Hispanic/Latino, and 81.8% female). Those in the lowest quartile of nSES (most disadvantaged) were more likely to be either Black/African American or Hispanic/Latino as compared to those in highest quartile (least disadvantaged). Those in the lowest quartile of nSES had higher mean MFIS-5 (1.02 points; 95% CI: 0.39, 1.43), PHQ-9 (1.24 points; 95% CI: 0.49, 1.98), and GAD-7 (0.69 points; 95% CI: -0.01, 1.38) scores relative to those in the highest quartile. Of those who consumed alcohol (n = 1489), participants in the lowest AHRQ quartile had lower mean AUDIT scores (-0.73 points; 95% CI: -1.18, -0.29) as compared to those in higher quartiles. Race and ethnicity were not associated with self-reported psychiatric symptom burden in this cohort. SES was also associated with self-reported improvement of symptoms after receiving mental health care. A higher proportion of Black/African American (44.1% vs 30.2%, p = 0.003) and Hispanic/Latino (49.1% vs 30.6%, p<0.001) participants were more likely to report they would “definitely go” receive mental health care if services were co-located with their MS care as compared to white and Non-Hispanic/Latino participants, respectively.
Higher SES was associated with a lower burden of psychiatric symptoms and with a higher likelihood of self-reported symptom recovery after receiving mental health treatment. Attitudes regarding mental health care delivery in MS varied according to racial and ethnic background. Future longitudinal studies in more diverse populations should assess whether co-location of mental health services with MS care helps to reduce the gap between access and need of mental health care in MS.</description><identifier>ISSN: 2211-0348</identifier><identifier>EISSN: 2211-0356</identifier><identifier>DOI: 10.1016/j.msard.2021.103451</identifier><identifier>PMID: 34953410</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adult ; Alcoholism ; Ethnicity ; Female ; Healthcare disparities ; Humans ; Male ; Mental Health ; Middle Aged ; Multiple sclerosis ; Multiple Sclerosis - epidemiology ; Patient Acceptance of Health Care ; Race ; Social Class ; Socioeconomic status</subject><ispartof>Multiple sclerosis and related disorders, 2022-02, Vol.58, p.103451-103451, Article 103451</ispartof><rights>2021</rights><rights>Copyright © 2021. Published by Elsevier B.V.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-3e0678c227abc8e33f8977f83a3f9446031ed014122cbbb6dfb0689e7214f8003</citedby><cites>FETCH-LOGICAL-c459t-3e0678c227abc8e33f8977f83a3f9446031ed014122cbbb6dfb0689e7214f8003</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,778,782,883,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34953410$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pimentel Maldonado, Daniela A.</creatorcontrib><creatorcontrib>Eusebio, Justin R.</creatorcontrib><creatorcontrib>Amezcua, Lilyana</creatorcontrib><creatorcontrib>Vasileiou, Eleni S.</creatorcontrib><creatorcontrib>Mowry, Ellen M.</creatorcontrib><creatorcontrib>Hemond, Christopher C.</creatorcontrib><creatorcontrib>Umeton (Pizzolato), Raffaella</creatorcontrib><creatorcontrib>Berrios Morales, Idanis</creatorcontrib><creatorcontrib>Radu, Irina</creatorcontrib><creatorcontrib>Ionete, Carolina</creatorcontrib><creatorcontrib>Fitzgerald, Kathryn C.</creatorcontrib><title>The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort</title><title>Multiple sclerosis and related disorders</title><addtitle>Mult Scler Relat Disord</addtitle><description>•Socioeconomic status (SES) is associated with psychiatric symptoms and likelihood of self-reported symptom recovery after receiving mental health treatment in multiple sclerosis (MS).•Race, ethnicity, and individual and neighborhood-level SES are important to consider when delivering mental health care for persons with MS.•Attitudes regarding mental health care delivery in MS vary according to racial and ethnic background.
Psychiatric symptoms are common in multiple sclerosis (MS) and may contribute to worse MS outcomes. Previous studies suggest the burden of symptoms may vary by race, ethnicity and socioeconomic status (SES). Our objective was to expand upon this previous work and explore the associations between SES, race, and ethnicity, as predictors of psychiatric symptoms, mental health attitudes, and health-seeking behavior in patients with MS.
Persons with MS answered a national web-based survey including demographic characteristics (including race, ethnicity and measures of SES), mental health attitudes, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Modified Fatigue Impact Scale 5-item version (MFIS-5), and the Alcohol Use Disorders Identification Test (AUDIT). The survey also queried mental health availability and perceptions of care. We measured neighborhood-level SES (nSES) of each participant using the Agency for Healthcare Research and Quality (AHRQ) index that was calculated from 5-digit postal codes. Other indicators of participant-level SES included education level and self-reported household income. We assessed the association between race, ethnicity, and neighborhood/participant-level SES indicators and affective symptom burden using generalized linear models that were adjusted for age, sex, and MS characteristics.
2095 participants answered the survey (mean AHRQ index 54.6 ± 5.4, age 51.3 ± 12.2 years, 7% Black/African American, 5.4% Hispanic/Latino, and 81.8% female). Those in the lowest quartile of nSES (most disadvantaged) were more likely to be either Black/African American or Hispanic/Latino as compared to those in highest quartile (least disadvantaged). Those in the lowest quartile of nSES had higher mean MFIS-5 (1.02 points; 95% CI: 0.39, 1.43), PHQ-9 (1.24 points; 95% CI: 0.49, 1.98), and GAD-7 (0.69 points; 95% CI: -0.01, 1.38) scores relative to those in the highest quartile. Of those who consumed alcohol (n = 1489), participants in the lowest AHRQ quartile had lower mean AUDIT scores (-0.73 points; 95% CI: -1.18, -0.29) as compared to those in higher quartiles. Race and ethnicity were not associated with self-reported psychiatric symptom burden in this cohort. SES was also associated with self-reported improvement of symptoms after receiving mental health care. A higher proportion of Black/African American (44.1% vs 30.2%, p = 0.003) and Hispanic/Latino (49.1% vs 30.6%, p<0.001) participants were more likely to report they would “definitely go” receive mental health care if services were co-located with their MS care as compared to white and Non-Hispanic/Latino participants, respectively.
Higher SES was associated with a lower burden of psychiatric symptoms and with a higher likelihood of self-reported symptom recovery after receiving mental health treatment. Attitudes regarding mental health care delivery in MS varied according to racial and ethnic background. Future longitudinal studies in more diverse populations should assess whether co-location of mental health services with MS care helps to reduce the gap between access and need of mental health care in MS.</description><subject>Adult</subject><subject>Alcoholism</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Healthcare disparities</subject><subject>Humans</subject><subject>Male</subject><subject>Mental Health</subject><subject>Middle Aged</subject><subject>Multiple sclerosis</subject><subject>Multiple Sclerosis - epidemiology</subject><subject>Patient Acceptance of Health Care</subject><subject>Race</subject><subject>Social Class</subject><subject>Socioeconomic status</subject><issn>2211-0348</issn><issn>2211-0356</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1q4zAUhUWZMi1pn2Cg3BdwRn-W7UUHhjI_hUI37VrI8nWs1JaCpAT6EvPMdZM2TDfVRhfpnHM5fIR8Y3TJKFPf18spmdgtOeVsfhGyZCfknHPGCipK9eU4y_qMXKa0pvNRJZOKfSVnQjalkIyek38PA4KbNsZmCD2kYF1AG3yYnIWUTd4mCB4m9NmMMKAZ8wDGd29jkRCfnF9Bi4PZuRDB2BhSgmgs7nWYB--sy8_gPBgYTVwhTNsxu82IkOyIs94lsGEIMV-Q096MCS_f7gV5_P3r4eZvcXf_5_bm511hZdnkQiBVVW05r0xraxSir5uq6mthRN9Iqahg2FEmGee2bVvV9S1VdYMVZ7KvKRUL8uOQu9m2E3Z2rhfNqDfRTSY-62Cc_vjj3aBXYacbQWtG1RwgDgH7uhH7o5dR_UpIr_WekH4lpA-EZtfV_2uPnnces-D6IMC5_M5h1Mk69BY7F9Fm3QX36YIXnNSmfA</recordid><startdate>20220201</startdate><enddate>20220201</enddate><creator>Pimentel Maldonado, Daniela A.</creator><creator>Eusebio, Justin R.</creator><creator>Amezcua, Lilyana</creator><creator>Vasileiou, Eleni S.</creator><creator>Mowry, Ellen M.</creator><creator>Hemond, Christopher C.</creator><creator>Umeton (Pizzolato), Raffaella</creator><creator>Berrios Morales, Idanis</creator><creator>Radu, Irina</creator><creator>Ionete, Carolina</creator><creator>Fitzgerald, Kathryn C.</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20220201</creationdate><title>The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort</title><author>Pimentel Maldonado, Daniela A. ; Eusebio, Justin R. ; Amezcua, Lilyana ; Vasileiou, Eleni S. ; Mowry, Ellen M. ; Hemond, Christopher C. ; Umeton (Pizzolato), Raffaella ; Berrios Morales, Idanis ; Radu, Irina ; Ionete, Carolina ; Fitzgerald, Kathryn C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-3e0678c227abc8e33f8977f83a3f9446031ed014122cbbb6dfb0689e7214f8003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Alcoholism</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Healthcare disparities</topic><topic>Humans</topic><topic>Male</topic><topic>Mental Health</topic><topic>Middle Aged</topic><topic>Multiple sclerosis</topic><topic>Multiple Sclerosis - epidemiology</topic><topic>Patient Acceptance of Health Care</topic><topic>Race</topic><topic>Social Class</topic><topic>Socioeconomic status</topic><toplevel>online_resources</toplevel><creatorcontrib>Pimentel Maldonado, Daniela A.</creatorcontrib><creatorcontrib>Eusebio, Justin R.</creatorcontrib><creatorcontrib>Amezcua, Lilyana</creatorcontrib><creatorcontrib>Vasileiou, Eleni S.</creatorcontrib><creatorcontrib>Mowry, Ellen M.</creatorcontrib><creatorcontrib>Hemond, Christopher C.</creatorcontrib><creatorcontrib>Umeton (Pizzolato), Raffaella</creatorcontrib><creatorcontrib>Berrios Morales, Idanis</creatorcontrib><creatorcontrib>Radu, Irina</creatorcontrib><creatorcontrib>Ionete, Carolina</creatorcontrib><creatorcontrib>Fitzgerald, Kathryn C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Multiple sclerosis and related disorders</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pimentel Maldonado, Daniela A.</au><au>Eusebio, Justin R.</au><au>Amezcua, Lilyana</au><au>Vasileiou, Eleni S.</au><au>Mowry, Ellen M.</au><au>Hemond, Christopher C.</au><au>Umeton (Pizzolato), Raffaella</au><au>Berrios Morales, Idanis</au><au>Radu, Irina</au><au>Ionete, Carolina</au><au>Fitzgerald, Kathryn C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort</atitle><jtitle>Multiple sclerosis and related disorders</jtitle><addtitle>Mult Scler Relat Disord</addtitle><date>2022-02-01</date><risdate>2022</risdate><volume>58</volume><spage>103451</spage><epage>103451</epage><pages>103451-103451</pages><artnum>103451</artnum><issn>2211-0348</issn><eissn>2211-0356</eissn><abstract>•Socioeconomic status (SES) is associated with psychiatric symptoms and likelihood of self-reported symptom recovery after receiving mental health treatment in multiple sclerosis (MS).•Race, ethnicity, and individual and neighborhood-level SES are important to consider when delivering mental health care for persons with MS.•Attitudes regarding mental health care delivery in MS vary according to racial and ethnic background.
Psychiatric symptoms are common in multiple sclerosis (MS) and may contribute to worse MS outcomes. Previous studies suggest the burden of symptoms may vary by race, ethnicity and socioeconomic status (SES). Our objective was to expand upon this previous work and explore the associations between SES, race, and ethnicity, as predictors of psychiatric symptoms, mental health attitudes, and health-seeking behavior in patients with MS.
Persons with MS answered a national web-based survey including demographic characteristics (including race, ethnicity and measures of SES), mental health attitudes, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Modified Fatigue Impact Scale 5-item version (MFIS-5), and the Alcohol Use Disorders Identification Test (AUDIT). The survey also queried mental health availability and perceptions of care. We measured neighborhood-level SES (nSES) of each participant using the Agency for Healthcare Research and Quality (AHRQ) index that was calculated from 5-digit postal codes. Other indicators of participant-level SES included education level and self-reported household income. We assessed the association between race, ethnicity, and neighborhood/participant-level SES indicators and affective symptom burden using generalized linear models that were adjusted for age, sex, and MS characteristics.
2095 participants answered the survey (mean AHRQ index 54.6 ± 5.4, age 51.3 ± 12.2 years, 7% Black/African American, 5.4% Hispanic/Latino, and 81.8% female). Those in the lowest quartile of nSES (most disadvantaged) were more likely to be either Black/African American or Hispanic/Latino as compared to those in highest quartile (least disadvantaged). Those in the lowest quartile of nSES had higher mean MFIS-5 (1.02 points; 95% CI: 0.39, 1.43), PHQ-9 (1.24 points; 95% CI: 0.49, 1.98), and GAD-7 (0.69 points; 95% CI: -0.01, 1.38) scores relative to those in the highest quartile. Of those who consumed alcohol (n = 1489), participants in the lowest AHRQ quartile had lower mean AUDIT scores (-0.73 points; 95% CI: -1.18, -0.29) as compared to those in higher quartiles. Race and ethnicity were not associated with self-reported psychiatric symptom burden in this cohort. SES was also associated with self-reported improvement of symptoms after receiving mental health care. A higher proportion of Black/African American (44.1% vs 30.2%, p = 0.003) and Hispanic/Latino (49.1% vs 30.6%, p<0.001) participants were more likely to report they would “definitely go” receive mental health care if services were co-located with their MS care as compared to white and Non-Hispanic/Latino participants, respectively.
Higher SES was associated with a lower burden of psychiatric symptoms and with a higher likelihood of self-reported symptom recovery after receiving mental health treatment. Attitudes regarding mental health care delivery in MS varied according to racial and ethnic background. Future longitudinal studies in more diverse populations should assess whether co-location of mental health services with MS care helps to reduce the gap between access and need of mental health care in MS.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>34953410</pmid><doi>10.1016/j.msard.2021.103451</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Multiple sclerosis and related disorders, 2022-02, Vol.58, p.103451-103451, Article 103451 |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Adult Alcoholism Ethnicity Female Healthcare disparities Humans Male Mental Health Middle Aged Multiple sclerosis Multiple Sclerosis - epidemiology Patient Acceptance of Health Care Race Social Class Socioeconomic status |
| title | The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort |
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