School of Public Health

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The collections in this community comprise faculty research works, as well as graduate theses and dissertations.

Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.

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Start date: 2010Subject: search.filters.subject.Mental health

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Now showing 1 - 10 of 43
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    DISPARITIES IN ADOLESCENT MENTAL HEALTH SERVICES UTILIZATION AND HELP-SEEKING
    (2024) Truong, Michelle L; Sehgal, Neil J; Boudreaux, Michel; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Inequities in access to and utilization of mental and behavioral health care for adolescents have persisted for numerous decades. Adolescents from racial and ethnic minority backgrounds, as well as those in underserved geographic regions, are disproportionately impacted. As the youth mental health crisis escalates, it is critical to study the mechanisms driving these disparities to inform effective and targeted interventions and policies. Divided into three studies, this dissertation explored the influence of individual, cultural, and contextual factors on adolescent help-seeking behaviors using data from the 2009 and 2011 to 2019 California Health Interview Survey (CHIS).The first study employed mediation analyses to assess the extent to which having a subjective or perceived need for mental health care, conditional on objective need, contributes to racial and ethnic disparities in mental health services utilization. I found significant racial and ethnic differences in subjective needs for mental health services and that these differences partially explain the racial and ethnic disparities in service utilization. The second study explored differences in mental health service utilization among subgroups of non-Hispanic (NH) Asian and Latino/Hispanic adolescents compared to NH white adolescents. I found that Vietnamese and Mexican adolescents were significantly less likely to utilize mental health services relative to their NH white counterparts. The third study merged the adolescent data with provider data from the National Plan and Provider Enumeration System (NPPES), facility data from the National Substance Use and Mental Health Services Survey (N-SUMHSS), and population data from the US Decennial Census Redistricting Data Summary Files to assess the moderating effects of distance to the nearest pediatric mental health facility and provider-to-population densities on the relationship between subjective mental health care needs and service utilization. I discovered that provider density and subjective needs interact, resulting in a diminished effect of subjective needs on service utilization among adolescents residing in areas with lower primary care provider density. I did not find that distance to the nearest pediatric mental health facility had a significant impact on service utilization. This dissertation examined racial, ethnic, and geographic mental health care disparities among a diverse adolescent population in California. Findings from this work contribute to the understanding of adolescent help-seeking behaviors and provide insights for targeted interventions and policies to advance mental health care equity.
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    Distress and Deaths of Despair in the U.S. Healthcare Delivery System: Understanding Patterns in Healthcare among Distressed Americans
    (2024) Spencer, Merianne Rose Tiglao; Chen, Jie; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    The United States has experienced rising mortality rates for the past several decades. Drug poisonings have increased nearly five-fold, suicide rates by nearly 40%, and by nearly 30% percent for alcohol-induced deaths between 1999 and 2021. This collection of drug-, alcohol- and suicide deaths are oftentimes referred to as “deaths of despair”, first coined by economists Anne Case and Angus Deaton who cited health and socioeconomic disparities driving Americans into mental distress, depression, and anxiety. The impact on the mental health of Americans was further exacerbated by the COVID-19 pandemic; this exposed vulnerabilities in the mental healthcare system as well as the various stressors that negatively impacted individuals across the globe. Using nationally representative data, this dissertation delves into the deaths of despair phenomenon using a multidisciplinary health services research lens. Access, utilization, and risk from deaths of despair are examined by using psychological distress (which is treated as a proxy for despair in the first two aims). Using the Kessler-6 scale, a well-accepted and clinically valid tool for non-specific mental distress, this dissertation explores patterns of healthcare spending among those with varying severity levels of psychological distress over a two-decade period; delves into patterns of healthcare utilization among young adults aged 18-30 (a population disproportionately impacted by stressors during the COVID-19 pandemic) by psychological distress; and quantifies the risk of death among those with varying severity levels of psychological distress.
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    LGBTQ+ Youth Therapeutic Engagement and Experiences: Associations with LGBTQ+ Family Environment
    (2024) Zheng, Azure; Fish, Jessica N,; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    LGBTQ+ youth experience unique stressors that increase the risk for poor mental health. LGBTQ+ youth’s family environment, often measured as parental acceptance and rejection of youth’s LGBTQ+ status, is associated with youth mental health; less often studied is how the family environment may be linked to LGBTQ+ youth’s access to therapy and, more importantly, experiences with LGBTQ+ affirmative and competent providers. Using a contemporary non-probability national sample of LGBTQ+ youth ages 13-17, our study examined the association among LGBTQ+ youth’s reports of caregiver supportive and rejection behaviors related to their LGBTQ+ identity and youth’s engagement and experiences in therapy. Using a step-wise logistic regression method, results tell a clear story. There is a consistent positive association between parent’s LGBTQ+ support behaviors and (1) youth access to therapy and (2) their therapists' LGBTQ+ competency. In the absence of controls, we found that parents’ rejecting behaviors were also positively associated with the youth’s access to therapy, but this relationship was mediated by the youth’s depression and anxiety symptoms. For youth who did not access therapy in the last year, those who reported more parental support were inversely related, and parental rejection positively related to wanting therapy but not receiving it. Youth who reported more rejecting behaviors from parents were less likely to perceive their therapists as LGBTQ+ competent. Findings point to varied pathways and experiences in therapy engagement for LGBTQ+ youth based on parents' support of their LGBTQ+ identity.
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    Mental health among black lesbian, gay, and bisexual people: Examining patterns of risk, treatment utilization, and mental health management strategies
    (2023) Williams, Natasha Diamond; Fish, Jessica N; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Empirically, a Black-White “double paradox” exists whereby 1) despite living in a society plagued by anti-Black racism, Black individuals in the United States are no more likely to experience depression than their White counterparts and 2) Black individuals are more likely to report severe psychological distress, a construct that is correlated with depression. Further, intersectional theory suggests that Black lesbian, gay, and bisexual, transgender, and queer (LGBTQ+) young adults may experience elevated risk for mental health issues due to overlapping systems of oppression (i.e., racism, heterosexism). Lastly, Black LGBTQ+ persons’ utilization of professional mental health services (PMHS; e.g. therapy, medication) may be impacted by these same forces, but quantitative research has yet to explore utilization disparities at this intersection. Therefore, Studies 1 & 2 of this investigation documented disparities in major depressive episodes (MDE) and severe psychological distress (SPD), as well as differences in the utilization of outpatient PMHS. Study 3 involved semi-structured interviews with Black LGBTQ+ young adults that explored participants’ (i) experiences of intersectional minority stress; (ii) perceptions of the relationship between these experiences and their mental health; and (iii) strategies for managing their mental health. In Study 1 covariate-adjusted models, compared to White heterosexual individuals, Black LGB males and females evidenced similar or reduced odds of an MDE; there were no statistical differences between these groups for SPD. Compared to their White LGB peers, Black LGB males and females were less likely to report an MDE or SPD. However, compared to their Black heterosexual counterparts, Black LGB males and females had higher odds of an MDE and SPD. Bisexual identity (as opposed to lesbian/gay identity), age, and education were associated with MDE or SPD among the subsample of Black LGB adults. In Study 2 unadjusted models, compared to White heterosexual females, Black LGB females were less likely to use PMHS. This relationship was not significant in models adjusted for covariates. In models that accounted for mental health need, Black LGB females were less likely to use PMHS than White heterosexual females in unadjusted and adjusted models. The association for Black LGB males, relative to White heterosexual males, was not significant in unadjusted or adjusted models, regardless of mental health need. Still, predicted probabilities illustrated disparities among Black LGB adults, with and without accounting for mental health need, in PMHS utilization relative to White LGB adults and Black heterosexual adults. Age, income, and education were also associated with PMHS utilization among Black LGB individuals. Participants in Study 3 generally did not describe their identities or attribute their bias experiences in intersectional terms. Rather, most described themselves as “Black first” and discussed instances of anti-Black or, separately, anti-queer discrimination. Almost all shared periods of poor mental health and discussed myriad strategies for managing their mental health, including seeking PMHS, as well as social supports and self-care strategies. Together, these studies illustrate differences in risk for depression and psychological distress, disparities in utilization of PMHS, and mental health experiences of Black [LGB]TQ+ young people. Based on all three studies, it appears that the experience of being a sexual minority in Black contexts may have different, and potentially more deleterious, mental health consequences than being Black in queer contexts. In aggregate, this investigation’s findings have implications for health policy and mental health practice related to bias/discrimination, barriers to care, and PMHS quality. Directions for future research are also discussed.
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    Exploring Young Bi+ Women's Intersecting Mental Health and Sexual and Reproductive Health Experiences in Context: A Multi-Analytic Method Qualitative Study
    (2023) Robinson, Jennifer Lynn; Aparicio, Elizabeth M; Butler, James; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Young bi+ women report worse mental health and sexual and reproductive health (SRH) outcomes compared to gay, lesbian, and straight young adults. They experience intersecting threats to their health and well-being due to their sexuality, gender, and stage of development. There is a lack of research on bi+ women’s unique mental health and SRH experiences, and often bi+ women are overlooked due to bi-erasure and biphobia. Regressive policies related to LGBTQ+ and women’s rights, including increased restrictions to reproductive healthcare after the Dobbs v. Jackson Women’s Health Organization decision overturning abortion protections, further threaten bisexual women’s health. This dissertation used a multi-analytic method qualitative approach to explore the intersecting mental health and SRH experiences of young bisexual women in the current socio-political context. Semi-structured in-depth interviews were conducted over Zoom with 16 young bi+ women from across the U.S. A narrative inquiry approach was used to explore young bi+ women’s mental health experiences and coping strategies. In addition, thematic analysis was used to investigate how young bi+ women describe their mental health as intersecting with their SRH in the current socio-political context. The study yielded rich and nuanced information about challenges these young bi+ women experienced throughout their lives that affected their mental health and SRH. Experiencing trauma had far-reaching negative effects on their mental health. Participants discussed the challenges of forming their identity within the social context, particularly as bi+ women in a society that often invalidates bisexual identities and subjugates women. They also discussed the joys along with difficulties of navigating young adulthood. They further described coping with challenges in a variety of adaptive (e.g., therapy, exercise) and maladaptive (e.g., substance use, self-injury) ways. They discussed relying on social support such as partners, friends, family, therapists, and teachers. Participants desired more support with sexuality-related issues, particularly in early adolescence. These bi+ women described their mental health and SRH as intertwined and discussed how bodily autonomy and agency were essential to their well-being. The socio-political context, including social norms, rhetoric, and federal- and state-level policies, influenced participants’ well-being. The current study shows that young bi+ women face unique threats to their mental health and SRH. Practice implications include improving access to affordable and LGBTQ+-affirming healthcare and developing interventions attuned to the needs of young bi+ women. Policies are needed that uphold the choice and agency of young women in their reproductive health decision-making. Future research should continue to explore the needs and experiences of young bi+ women concerning their mental health and SRH including demographic differences along with potential mechanisms resulting in poorer health.
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    Associations between Classical Music, Physical Activity and Symptoms of Depression in Older Adults during the COVID-19 Pandemic
    (2023) Arnold-Nedimala, Naomi A; Smith, J Carson; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Background: The initial lockdown in March 2020 due to COVID-19 rattled the residents of North America as normalcy came to a standstill, freedom was stripped away, and people were forced to adapt to new restrictions and regulations, simply to survive. The elderly population was greatly affected by the lockdown as it prohibited those living in assisted living facilities to physically interact with family and friends highlighting the need to identify protective behaviors against mental health and depression. The neurological benefits of listening to classical music is an emerging area of research. A few studies suggest the positive outcomes of listening to classical music in reducing symptoms of depression. Additionally, while the cardiovascular benefits of exercise are well known, the impact of exercise on affect continues to be an emerging area of research. Purpose: The purpose of this study is to understand the efficacy of listening to classical music in attenuating symptoms of depression in older adults (50 – 90+) utilizing data collected from 3 separate time points during the COVID-19 pandemic, and to determine if physical activity is associated with providing additional benefit to lowering symptoms of depression Methods: A survey including the Geriatric Depression Scale (GDS), the Physical Activity Scale for the Elderly (PASE), and questions about listening to music (classical, Broadway, Christian music), and the frequency of listening to music was generated and distributed to people living in the United States and Canada immediately following the initial COVID-19 lockdown in April 2020. Informed consent was obtained prior to completing the survey, and participants who were interested in receiving a follow-up survey were asked to provide their email addresses. The follow-up surveys were generated 4-months (August 2020) and one year (April 2021) after the initial survey. Results: At the initial onset of the COVID-19 lockdown in April 2020, significant associations were observed between classical music listening (CML) and lower symptoms of depression, physical activity (PA) and lower symptoms of depression, music listening frequency, and lower symptoms of depression. In August 2020 and April 2021, significant associations were found between physical activity and lower symptoms of depression. However, no associations were observed between classical music listening and lower symptoms of depression, and music listening frequency and lower symptoms Additionally, significant associations were observed between age and lower symptoms of depression, sex, and lower symptoms of depression at all three time points. Conclusion: The results from our study suggest that there is an association between classical music listening and symptoms of depression, physical activity and symptoms of depression, music listening frequency and symptoms of depression in older adults (50+) during the early stages of the COVID-19 pandemic (April 2020). Additionally, the association between physical activity and symptoms of depression was maintained throughout the first year of the pandemic as supported by the data collected in August 2020 (4 months) and April 2021 (12-months).
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    EXAMINING THE ASSOCIATION BETWEEN INTERPREGNANCY INTERVAL AND MATERNAL HEALTH IN THE POSTPARTUM PERIOD
    (2023) Barber, Gabriela A; Thoma, Marie E; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Interpregnancy interval (IPI) is defined as the period of time between a previous birth and a subsequent conception, usually measured in months. While recommendations issued by the World Health Organization and the American College of Obstetricians and Gynecologists provide guidance for ideal birth spacing, many births occur after non-optimal IPIs – either too short (<18 months) or too long (60+ months). These recommendations were motivated by the body of research on a host of adverse infant and maternal health outcomes associated with non-optimal IPIs. To date, the literature has focused heavily on the association between IPI and adverse infant health outcomes, with limited attention in comparison being given to IPI and maternal health. Within the research on IPI and maternal health, there is a narrow focus on physical health outcomes related to pregnancy/delivery complications, with few studies looking at health outcomes in the postpartum and beyond. In order to fill this gap, this research investigated the association between IPI and several postpartum maternal health outcomes/indicators, including 1) postpartum depression (PPD), 2) attendance at a postpartum checkup, and 3) postpartum contraceptive use (any and type). One of the perennial difficulties in studying IPI is parsing out whether IPI has an independent association with a health outcome or behavior or is exerting its effects through pregnancy intention, therefore, for each aim, pregnancy intention was tested as a moderator. For each aim, unique cut-offs for IPI were determined after examination of the association between more detailed IPI categories and the outcome of interest. Categories were collapsed into broader IPI classifications when the associations were similar in order to maximize precision of the estimates and in order to allow us to characterize the most clinically relevant exposure for specific health outcomes. In fully adjusted models, individuals who had IPIs less than 18 months were significantly more likely to experience elevated PPD symptoms (aOR: 1.19, 95% CI: 1.02 – 1.39, p=0.024) when compared to individuals with long IPIs, and individuals who had IPIs less than 12 months were significantly less likely to attend their postpartum checkup (aOR: 0.78, 95% CI: 0.66 – 0.93, p=0.006) when compared to those with long IPIs. Pregnancy intention was not found to significantly moderate either of these associations. For the third aim, pregnancy intention was found to moderate the association between IPI and any use of postpartum contraception. Stratified analyses show that it is among unintended pregnancies that there is an association between short IPI and increased use of any contraception in the postpartum. Among unintended pregnancies, those with IPIs less than 6 months (aOR: 2.31, 95% CI: 1.37 – 3.90, p=0.002) and those with IPIs of 6-11 months (aOR: 2.15, 95% CI: 1.48 – 3.10, p=0.001) were more likely to be using any contraception in the postpartum than those with long IPIs, and the magnitude of this association exceeded that of other IPI intervals and pregnancy intention categories. Among those who were using contraception in the postpartum, individuals with IPIs less than 6 months were more likely to be using highly-effective methods (aOR: 1.59, 95% CI: 1.22 – 2.10, p=0.001) than least-effective methods of contraception. Pregnancy intention did not significantly moderate the association between IPI and type of contraception. Future research should continue to explore the association between IPI and a broader range of maternal health outcomes and work to identify the mechanisms through which IPI may be impacting these outcomes. Recent changes in reproductive policies in the U.S. may also soon change the proportion of individuals who experience short IPIs, therefore making it even more important to understand how this shift may impact a broad range of maternal health behaviors and outcomes. This research highlights how an increase in births occurring after a short IPI would likely increase rates of PPD and increase demand for certain family planning services.
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    Intersectional stigma, self-efficacy, depression, and resilience: a Rasch analysis
    (2022) Reuben, Jacqueline; Liu, Hongjie; Turpin, Rodman; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Background: Black men who have sex with men (BMSM) are disproportionally affected by negative health outcomes associated with stigma related to both their racial and sexual minority status. Foundational to understanding stigma is the ability to correctly measure this latent construct. The Rasch model is a probabilistic model for analyzing categorical data that was developed to improve the measurement of latent traits. This study, grounded in intersectional minority stress theory, reviewed the application of Rasch analysis in the HIV/AIDS literature (Aim 1) and used the Rasch model to calibrate person measures to assess the interrelationships among internalized stigma, resilience, self-efficacy, and psychologic well-being among BMSM (Aims 2 and 3). Methods: For Aim 1, we conducted a systematic review of the literature following PRISMA guidelines. Aims 2 and 3 used data from a cross-sectional online survey of 151 HIV-negative BMSM in 2020. For Aim 2, we conducted Rasch analysis to assess the psychometric properties of the internalized racism (IR), internalized homophobia (IH), self-efficacy, and resilience scales. For Aim 3, we used linear regression and path analysis of the Rasch-calibrated person measures to examine the mediating and modifying effects of self-efficacy and resilience on the relationship between intersectional stigma and depressive symptoms. Results: For Aim 1, after screening 183 articles, 45 articles were included in the analysis. Strengths and weaknesses of using the Rasch approach were summarized. For Aim 2, the final IR scale had a person reliability and separation of 0.91 and 3.13, respectively, and an item reliability and separation of 0.94 and 4.01, respectively. The final IH scale had a person reliability and separation of 0.88 and 2.72, respectively, and an item reliability and separation of 0.79 and 1.95, respectively. For Aim 3, IR (β=0.296, 95% CI [0.133, 0.458]) and IH (β=0.414, 95% CI [0.204,0.623]) were independently and positively associated with depression in multivariable models controlling for age, income, and relationship status. Resilience and self-efficacy modified the relationship between IH and depression (βIHxRES=-0.034, 95% CI [-0.060, -0.008] and βIHxSE=-.056, 95% CI [-0.113, 0.00], respectively), but there was no evidence of effect modification by resilience or self-efficacy on the association between IR and depression. Public health implications: Our findings suggest that interventions targeting multiply marginalized groups such as BMSM that address co-occurring forms of stigma and foster positive self-evaluation and coping skills may reduce the negative consequences of internalized stigma on mental health outcomes.
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    Understanding the informal help-seeking process of Korean emerging adults living in the U.S.: Influence of the family context
    (2022) Yoo, Jee Hun; Curbow, Barbara; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Korean Americans are a major Asian subgroup in the U.S., and epidemiological data demonstrate that rates of mental health symptoms are higher among Korean American emerging adults compared to other Asian American counterparts. Seeking and receiving appropriate support are important ways to cope with mental health burden, but there is a dearth of literature on how Asian Americans seek help from friends and family members. Available studies suggest that various sociocultural factors influence the informal help-seeking process among Asian Americans. As family context has a significant impact on children’s sociocultural development, examining such contextual factors can help understand some of the mechanisms and correlates of informal help-seeking. In this dissertation study, I explored the characteristics and associations among family communication patterns, relevant sociocultural factors (i.e., perceived parental support, emotional self-control, relational concerns, face loss concerns), and informal help-seeking intentions using a sample of 201 Korean American emerging adults (ages 18 – 29) drawn from an online survey. In paper 1, factor analysis showed that different help sources can be grouped into three domains (i.e., formal sources, family members, and partner and friends), with intention to seek help being the highest towards partner and friends, followed by family members and formal sources. Characteristics of higher acculturation were positively associated with help-seeking intention towards partner and friends. In paper 2, mediation analyses revealed that participants with parents fostering unrestrained communications perceived receiving more informational support from parents, which in turn was associated with higher intention to seek parental support. Participants with parents emphasizing conformity in beliefs and values perceived receiving less emotional and implicit support from parents, which in turn was associated with lower intention to seek parental support. The negative association between conformity orientation and perceived emotional support was only significant among participants identifying as American or bi-cultural. In paper 3, bivariate analyses showed that conversation orientation was positively associated with informal help-seeking intention, while conformity orientation, emotional self-control, relational concerns, and face loss concerns were negatively associated. Mediation analyses indicated that participants with parents stressing conformity in beliefs and values were more likely to endorse suppression of emotional expression and be concerned with potential loss of face from help-seeking, which in turn were associated with lower intention to seek help from family and friends. Findings from this dissertation study point to the utility of examining family contextual factors to better understand the informal help-seeking process among Korean American emerging adults. More studies on Asian Americans’ informal help-seeking are needed to find more culturally appropriate ways to address the mental health needs of this population.
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    YO SOY PAZ (I AM PEACE): PILOT STUDY OF A TRAUMA-INFORMED, COMMUNITY AND MINDFULNESS-BASED PROGRAM FOR LATINO IMMIGRANTS IN MARYLAND.
    (2022) Munoz, Juliana; Green, Kerry M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Background: One in three Latinos in the US is an immigrant. Immigrants face particular stressors that are heightened by previous traumatic experiences before, during, and after migration. Latino populations report the highest level of stress of all racial/ethnic groups in the US and the second-highest prevalence of mental health illness. Mindfulness-Based Interventions (MBIs) have shown to be successful at reducing stress and strengthening mental health in diverse populations, yet little is known about the effects of these interventions on this particular population.Methods: The pilot study tested the Yo Soy Paz (I am Peace) online synchronous program, an evidence and trauma-informed mindfulness-based intervention that was adapted for immigrant Latina mothers and the community staff members that work with them in a community setting. The eight session pilot intervention was delivered to three cohorts for a total of 41 participants, including staff and parents of youth receiving services at a local community-based organization that serves Latino immigrants. The study used the Consolidated Framework for Implementation Research (CFIR) to examine the feasibility, acceptability, appropriateness, and fidelity of the Yo Soy Paz online program. The study also examined the initial effects of the program on stress, mindfulness, mind-body connection, and subjective well-being. Qualitative and quantitative data were collected through self-reported pre-post questionnaire, fidelity checklists, and focus groups with parents and staff. Results: Acceptability, feasibility, fidelity and appropriateness scored high on the quantitative measures. Inner compatibility with the organization’s mission and vision, clients’ needs and the organization’s receptivity to implement the intervention scored in the medium range. Mothers’ and promotoras’ self-reported mean scores for subjective wellbeing and perceived physical and mental health increased significantly from baseline- to post-test. No significant changes were observed in surveys completed by the staff, even though focus group participants reported meaningful improvement. Discussion: Overall the pilot feasibility study was well received and relevant for the organization and the population they serve. MBIs for Latino immigrants and the staff that works with them have the potential to improve well-being and overall mental and physical health. The study’s findings provide guidance to others in implementing online mindfulness practices with Latino immigrants and the staff that works with them.