COVID-19, social determinants, and African American-White disparities: policy response and pathways forward.

COVID-19 translated African Americans' greater social, economic, and health-related risk, reflecting adverse Social Determinants of Health (SDOH), into greater COVID morbidity, hospitalization, and mortality, and it threatened to enlarge the very risks causing greater COVID suffering. However, following a federal policy response injecting trillions of dollars into the US economy, longstanding African American-White disparities in economic well-being, insurance coverage, vaccination rates, and evictions declined. On the other hand, troubling and consequential disparities in k-12 academic achievement and college attendance disparities widened.

Predictors of Outpatient and Inpatient Service Utilization Among Publicly-Insured Youth With Eating Disorders.

Introduction: Although eating disorders (EDs) affect youth from all socioeconomic backgrounds, little is known about the treatment experiences of under-resourced youth with EDs. To address this gap, we examined patterns of outpatient and inpatient service utilization among publicly-insured youth with EDs in California and potential disparities for youth with additional marginalized identities.

Method: Participants were identified from the full sample of California Medicaid/Medi-Cal beneficiaries aged 7-18 with ≥ 1 service episode between January 1, 2014 and December 31, 2016.

Characterizing Medical Complications in Publicly Insured Youth With Eating Disorders.

Purpose: The present study describes the occurrence of eating disorder (ED)-related medical diagnoses in a publicly insured sample of youth with EDs. The study also compares ED medical diagnoses with other psychiatric disorders and identifies high-risk demographic groups. Improved screening practices are needed in public mental health systems where treatment is critical for youth with EDs.

Exploring Demographic and Clinical Characteristics of Racially and Ethnically Diverse Youth With Eating Disorders Using California Medicaid Claims Data.

Objective: To explore the scope of diagnosed eating disorders among Medicaid-insured youth in California, and to describe the demographic characteristics of this population in a repeated annual cross-sectional study design.

Method: California Medicaid claims data were extracted for youth aged 7 to 18 years between January 2014 and December 2016. Participants included all youth who received an eating disorder diagnosis at any point in the study period (N = 8,075).

States' racial resentment correlates with administrative distancing and lower rates of health plan selection in affordable care act marketplaces: a cross sectional analysis.

Background: In the United States, the Affordable Care Act (ACA) pursued equity in healthcare access and treatment, but ACA implementation varied, especially limiting African Americans' gains. Marketplaces for subsidized purchase of coverage were sometimes implemented with limited outreach and enrollment assistance efforts. Reflecting state's ACA receptivity or reluctance, state's implementation may rest on sociopolitical stances and racial sentiments.

Patterns of Social Determinants of Health and Child Mental Health, Cognition, and Physical Health.

Importance: Social determinants of health (SDOH) influence child health. However, most previous studies have used individual, small-set, or cherry-picked SDOH variables without examining unbiased computed SDOH patterns from high-dimensional SDOH factors to investigate associations with child mental health, cognition, and physical health.

Objective: To identify SDOH patterns and estimate their associations with children's mental, cognitive, and physical developmental outcomes.

COVID-19 Policies, Pandemic Disruptions, and Changes in Child Mental Health and Sleep in the United States.

Importance: The adverse effects of COVID-19 containment policies disrupting child mental health and sleep have been debated. However, few current estimates correct biases of these potential effects.

Objectives: To determine whether financial and school disruptions related to COVID-19 containment policies and unemployment rates were separately associated with perceived stress, sadness, positive affect, COVID-19-related worry, and sleep.

Racial and Ethnic Disparities in Health Status and Community Functioning Among Persons with Untreated Mental Illness.

Using  6 years of data from the National Survey of Drug Use and Health, the present study investigated ethnic minority-White disparities in self-rated health and community functioning for persons with untreated mental illness. Comparing minority and White persons with untreated severe mental illness (SMI) and mild and moderate mental illness (MMMI), the study sought evidence of "double jeopardy": that minority persons with mental illness suffer an added burden from being members of ethnic minority groups. For African Americans with SMI and MMMI, results indicated that the odds were greater of living in poverty, being unemployed, and being arrested in the past year, and for African Americans with SMI, the odds were greater of reporting fair/poor health.

Subsidized Marketplace Purchases Reduced Racial Disparities in Private Coverage Under the Affordable Care Act.

The Affordable Care Act's Marketplaces, by allowing subsidized purchase of insurance coverage by persons with incomes from the poverty line to middle income, and through active outreach and enrollment assistance efforts, are well situated to reduce large African American-white private coverage disparities. Using data from the National Health Interview Survey for multiyear periods before and after Affordable Care Act implementation, from 2011-2013 to 2015-2018, this study assessed how much disparity reduction occurred when Marketplaces were implemented. Analysis compared private coverage take-up by African Americans and whites for persons with incomes between 100 and 400% of the Federal Poverty Line (FPL), controlling for African American-white income differences and other covariates.

Racial Bias Correlates with States Having Fewer Health Professional Shortage Areas and Fewer Federally Qualified Community Health Center Sites.

Federally Qualified Community Health Centers (FQHCs), serving Health Professional Shortage Areas (HPSAs), are fixtures of the healthcare safety net and are central to healthcare delivery for African Americans and other marginalized Americans. Anti-African American bias, tied to anti- "welfare" sentiment and to a belief in African Americans' supposed safety net dependency, can suppress states' willingness to identify HPSAs and to apply for and operate FQHCs. Drawing on data from n = 1,084,553 non-Hispanic White Project Implicit respondents from 2013-2018, we investigated associations between state-level implicit and explicit racial bias and availability of FQHCs and with HPSA designations.

COVID-19, Social Determinants Past, Present, and Future, and African Americans' Health.

As the COVID-19 pandemic progresses, more African Americans than whites are falling ill and dying from the virus and more are losing livelihoods from the accompanying recession. The virus thereby exploits structural disadvantages, rooted partly in historical and contemporary anti-Black sentiments, working against African Americans. These include higher rates of comorbid illness and more limited health care access, higher rates of disadvantageous labor market positioning and community and housing conditions, greater exposure to long-term care residence, and higher incarceration rates.

African American/white disparities in psychiatric emergencies among youth following rapid expansion of Federally Qualified Health Centers.

Objective: To test whether rapid expansion of mental health services in Federally Qualified Health Centers (FQHCs) reduces African American/white disparities in youth psychiatric emergency department (ED) visits.

Data Sources: Secondary ED data for psychiatric care for 3.3 million African American and white youth in nine states, 2006-2011.

Rapid Growth of Mental Health Services at Community Health Centers.

Community Health Centers (CHCs) target medically underserved communities and expanded by 70% in the last decade. We know little, however, about mental health services at CHCs. We analyzed data from 2006 to 2015 and determined county-level drivers of these services.

African Americans and Caribbean Blacks: Perceived neighborhood disadvantage and depression.

The purpose of this study was to advance a theoretical understanding of the effects of impoverished neighborhoods on mental health and to inform policy measures encouraging residents to leave such neighborhoods. To do this, we investigated whether individuals' perceived neighborhood disadvantage served as a risk factor for clinical depression in a nationally representative sample of African Americans and Caribbean Blacks. We performed logistic regression analysis on stratified socioeconomic status (SES) subsamples from the National Survey of American Life sample of 5,019 African Americans and Caribbean Blacks.

Mental health treatment and work among African American and Caribbean Black welfare recipients.

Objective: Untreated depression among Temporary Assistance for Needy Families (TANF) participants greatly reduces chances of securing and holding gainful employment.

Method: Logistic regression models were estimated on data describing 1,000 African American and Caribbean Black TANF recipients and 2,123 African American and Caribbean Black non-TANF recipients obtained from the National Survey of American Life (NSAL).

Results: Black TANF participants were more likely than Black non-TANF participants to be depressed and treated.

Mainstreaming Mental Health Care in 42 Countries.

Abstract-Global consensus and national policies have emphasized deinstitutionalization, or a shift in providing mental health care from institutional to community settings. Yet, psychiatric hospitals and asylums receive the majority of mental health funding in many countries, at odds with research evidence that suggests that services should be delivered in the community. Our aim is to investigate the norms, actors, and strategies that influence the uptake of deinstitutionalization internationally.

States higher in racial bias spend less on disabled medicaid enrollees.

Background: While there is considerable state-by-state variation in Medicaid disability expenditure, little is known about the factors that contribution to this variation.

Objective: Since Blacks disproportionately benefit from Medicaid disability programs, we aimed to gain insight into whether racial bias towards Blacks is one factor that explains state-by-state variation in Medicaid disability expenditures.

Method: We compiled 1,764,927 responses of explicit and implicit racial bias from all 50 states and Washington D.

Examining the reliability and validity of the Clinical Assessment Interview for Negative Symptoms within the Management of Schizophrenia in Clinical Practice (MOSAIC) multisite national study.

The current study sought to expand on prior reports of the validity and reliability of the CAINS (CAINS) by examining its performance across diverse non-academic clinical settings as employed by raters not affiliated with the scale's developers and across a longer test-retest follow-up period. The properties of the CAINS were examined within the Management of Schizophrenia in Clinical Practice (MOSAIC) schizophrenia registry. A total of 501 participants with a schizophrenia spectrum diagnosis who were receiving usual care were recruited across 15 national Patient Assessment Centers and evaluated with the CAINS, other negative symptom measures, and assessments of functioning, quality of life and cognition.

Increased Medicaid Financing and Equalization of African Americans' and Whites' Outpatient and Emergency Treatment Expenditures.

Objective: We investigated whether a new funding opportunity to finance mental health treatment, provided to autonomous county-level mental health systems without customary cost sharing requirements, equalized African American and White children's outpatient and emergency treatment expenditure inequalities. Using Whites as a benchmark, we considered expenditure patterns favoring Whites over African Americans ("disparities") and favoring African Americans over Whites ("reverse disparities").

Methods: Settlement-mandated Early Periodic Screening Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995.

Medicaid Spending Differences for Child/Youth Community-Based Care in California's Decentralized Public Mental Health System.

This study evaluated spending differences across counties during the decade after California decentralized its public mental health system. Medicaid data for 0-25 year olds using mental health services were collapsed to the county-year level (n = 627). Multivariate models with county fixed effects were used to predict per capita spending for community-based mental health care.