Examining Suicidality in Youth With Disabilities: 2021-2023 National Survey on Drug Use and Health

Journal of Adolescent Health · 2026-05-01

Exploring the association between supportive school policy and youth tobacco use

Public Health · 2025-12-10

Protocol for socioecological study of autism, suicide risk, and mental health care: Integrating machine learning and community consultation for suicide prevention

PLoS ONE · 2025-03-19 · 2 citations

INTRODUCTION: Autistic people experience higher risk of suicidal ideation (SI) and suicide attempts (SA) compared to non-autistic people, yet there is limited understanding of complex, multilevel factors that drive this disparity. Further, determinants of mental health service receipt among this population are unknown. This study will identify socioecological factors associated with increased risk of SI and SA for autistic people and evaluate determinants of mental health care receipt. METHODS: This study will link information for individuals aged 12-64 years in healthcare claims data (IBM® MarketScan® Research Database and CMS Medicaid) to publicly available databases containing community and policy factors, thereby creating a unique, multilevel dataset that includes health, demographic, community, and policy information. Machine learning data reduction methods will be applied to reduce the dimensionality prior to nested, multilevel empirical estimation. These techniques will allow for robust identification of clusters of socioecological factors associated with 1) risk of SI and SA and 2) receipt of mental health services (type, dose, delivery modality). Throughout, the research team will partner with an established group of autistic partners to promote community relevance, as well as receive input and guidance from a council of policy and practice advisors. DISCUSSION: We hypothesize that nested individual (co-occurring conditions, age, sex), community (healthcare availability, social vulnerabilities), and policy factors (state mental health legislation, state Medicaid expansion) will be associated with heightened risk of SI and SA, and that receipt, dose, and delivery of mental health services will be associated with interdependent factors at all three levels. The approach will lead to identification of multilevel clusters of risk and factors that facilitate or impede mental health service delivery. The study team will then engage the community partners, and policy and practice advisors to inform development of recommendations to reduce risk and improve mental health for the autistic population.

Pain Progression and Functional Decline in Pre-Frail Older Adults: A Survival Analysis

SSRN Electronic Journal · 2025-01-01

Association of disability with COVID-19 outcomes in older adults: a prospective analysis of the US health and retirement study

BMJ Public Health · 2025-07-01

Introduction: The COVID-19 pandemic disproportionately impacted the ageing population and persons with disability. Previous studies have used cross-sectional or descriptive designs, limiting the establishment of robust associations. Our objective was to examine prospective associations between functional disability and COVID-19 outcomes in ageing US adults. Methods: This study included 9390 Health and Retirement Study participants from the 2018 wave, representing 64 044 633 adults aged 50 years or older, who completed the 2021 Pandemic Mail-in Survey. Baseline functional disability comprised activities of daily living (ADL) and instrumental ADL. COVID-19 outcomes included infection, emergency room utilisation, hospitalisation, length of hospital stay and post-COVID conditions (PCC). Multivariate regression and propensity-score weighting were applied to assess prospective associations between baseline functional disability, vaccination and COVID-19 outcomes. Targeted learning was applied to assess the association between functional disability and COVID-19 within each vaccination stratum. Mediation analysis was used to quantify the proportion of effects of functional disability on COVID-19 infection and PCC, mediated through vaccination. Results: 1460 (16.2%) participants reported infection, 7985 (86.1%) were vaccinated and 178 (11.4%) of COVID-19 infected had PCC. Functional disability was associated with increased risk of infection (OR: 1.28, 95% CI 1.01 to 1.64) and PCC (OR: 2.24, 95% CI 1.05 to 4.47), while vaccination was protective against infection (OR: 0.53, 95% CI 0.42 to 0.67). Vaccination mediated a small portion of the effect of functional disability on infection and PCC, while showing no effect modification. Conclusions: Comprehensive strategies beyond vaccination are needed to decrease infections and prevent PCC for vulnerable ageing adults with functional disability. As the first study to prospectively investigate associations between functional disability, vaccination status and COVID-19 outcomes using nationally representative data, these findings provide a robust foundation for future research and policy decisions to protect vulnerable populations during public health emergencies.

679-P: Behavioral Health Care Utilization amongst Patients with Insulin-Requiring Diabetes Receiving Care at Federally Qualified Health Centers

Diabetes · 2025-06-13

Introduction and Objective: Behavioral health comorbidities significantly impact diabetes outcomes. Federally Qualified Health Centers (FQHCs), serving as medical homes for over 30 million underserved individuals, are uniquely positioned to integrate behavioral and physical health care. However, research characterizing behavioral health care utilization in diabetes has not included FQHC populations. This study aimed to describe behavioral health care utilization in a national cohort of FQHC patients with T1D/T2D on MDI/CSII. Methods: A large data platform from 40 FQHCs in 17 states was leveraged to identify and describe documented utilization of behavioral health care for adults with T1D/T2D. Data was analyzed descriptively according to race and ethnicity, Federal Poverty Level (FPL), and insurance type. Results: A cohort of n=16,267 was identified: 2,249 with T1D and 14,018 with T2D; 53.8% below the poverty line (FPL<100); 23.4% Non-Hispanic White (NHW), 28.0% Non-Hispanic Black (NHB), 0.4% American Indian/Alaska Native (AIAN), 2.0%, Native Hawaiian/Pacific Islander (NHPI), 1.2% Non-Hispanic Asian (NHA), 39.0% Hispanic, and 5.9% Other/Multiracial; 47.6% publicly insured, 22.1% uninsured, and 30.3% privately insured. Among T1D, NHPI had the highest utilization rate (28.6%), while NHA had no utilization (0.0%). Among T2D, NHW had the highest utilization rate (24.7%), followed by NHB (22.6%). AIAN consistently showed lower utilization across T1D/T2D. Patients with FPL<100 had lower utilization (19.2% T1D, 23.7% T2D) despite comprising over half the cohort. Conclusion: This is the first known study to describe utilization of and disparities within behavioral health care in diabetes at FQHCs. Given behavioral health comorbidities may compromise treatment engagement and increase risk for complications, descriptive research and future interventions to increase behavioral health equity must include FQHC populations. Disclosure S. Westen: None. B. Churba: None. K.G. Malden: None. T. Long: None. W. Esmond: None. Y. Hong: Consultant; Weight Watchers International. C. Walker: None. N. Marlow: None. M. Gurka: None. K. VanDoren: None. S. Downs: None. S.T. Martinez: None. L. Siman: None. A. Hamilton: None. M.J. Haller: Advisory Panel; SAB Biotherapeutics, Inc, MannKind Corporation. Consultant; Sanofi. A.F. Walker: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

A machine learning analysis of suicidal ideation and suicide attempt among U.S. youth and young adults from multilevel, longitudinal survey data

Frontiers in Psychiatry · 2025-02-24 · 4 citations

Objectives: To investigate individual, interpersonal, health system, and community factors associated with suicidal ideation (SI) and attempts (SA). Methods: graders in 1994-95 followed >20 years until 2016-18, N=18,375), least absolute shrinkage selector operator (LASSO) regression determined multilevel predictors of SA and SI. Models comprised full and diagnosis subgroups (ADD/ADHD, depression, PTSD, anxiety, learning disabilities [LD]). Results: Approximately 2.48% and 8.97% reported SA and SI, respectively. Over 25% had depression, and 20.98% anxiety, 6.42% PTSD, 4.55% ADD/ADHD, and 2.50% LD. LASSO regression identified 20 and 21 factors associated with SA and SI. Individual-level factors associated with SI and SA included educational attainment, substance use, ADD/ADHD, depression, anxiety, and PTSD. Interpersonal-level factors included social support, household size, and parental education, while health system-level factors comprised health care receipt, health insurance, and counseling. The strongest associations were among individual-level factors followed by interpersonal and health system factors. Conclusions: The distinct factors associated with SI and SA across diagnostic subgroups highlight the importance of targeted, subgroup-specific suicide prevention interventions. These findings emphasize the value of precise, data-driven approaches for suicide prevention among diverse populations and individuals with disabilities across the life-course.

Comparative effectiveness of dual vs. single-action antidepressants on HIV clinical outcomes in HIV-infected people with depression

UNC Libraries · 2024-03-16

Objective: Depression is highly prevalent among people living with HIV/AIDS (PLWHA) and has deleterious effects on HIV clinical outcomes. We examined changes in depression symptoms, viral suppression, and CD4 + T cells/μl among PLWHA diagnosed with depression who initiated antidepressant treatment during routine care, and compared the effectiveness of dual-action and single-action antidepressants for improving those outcomes. Design: Comparative effectiveness study of new user dual-action or single-action antidepressant treatment episodes occurring from 2004 to 2014 obtained from the Center for AIDS Research Network of Integrated Clinical Systems. Methods: We identified new user treatment episodes with no antidepressant use in the preceding 90 days. We completed intent-to-treat and per protocol evaluations for the main analysis. Primary outcomes, were viral suppression (HIV viral load <200 copies/ml) and CD4 + T cells/μl. In a secondary analysis, we used the Patient Health Questionnaire-9 (PHQ-9) to evaluate changes in depression symptoms and remission (PHQ <5). Generalized estimating equations with inverse probability of treatment weights were fitted to estimate treatment effects. Results: In weighted intent-to-treat analyses, the probability of viral suppression increased 16% after initiating antidepressants [95% confidence interval=(1.12, 1.20)]. We observed an increase of 39 CD4 + T cells/μl after initiating antidepressants (30, 48). Both the frequency of remission from depression and PHQ-9 scores improved after antidepressant initiation. Comparative effectiveness estimates were null in all models. Conclusion: Initiating antidepressant treatment was associated with improvements in depression, viral suppression, and CD4 + T cells/μl, highlighting the health benefits of treating depression in PLWHA. Dual and single-action antidepressants had comparable effectiveness.

Hearing Impairment, Mental Health Services Use, and Perceived Unmet Needs Among Adults With Serious Mental Illness: A Cross-Sectional Study

Journal of Speech Language and Hearing Research · 2023-05-31 · 5 citations

Purpose: Individuals with hearing impairment have higher risks of mental illnesses. We sought to develop a richer understanding of how the presence of any hearing impairment affects three types (prescription medication, outpatient services, and inpatient services) of mental health services utilization (MHSU) and perceived unmet needs for mental health care; also, we aimed to identify sociodemographic factors associated with outpatient mental health services use among those with hearing impairment and discuss potential implications under the U.S. health care system. Method: Using secondary data from the 2015–2019 National Survey on Drug Use and Health, our study included U.S. adults aged ≥ 18 years who reported serious mental illnesses (SMIs) in the past year. Multivariable logistic regression was used to examine associations of hearing impairment with MHSU and perceived unmet mental health care needs. Results: The study sample comprised 12,541 adults with SMIs. Prevalence of MHSU (medication: 55.5% vs. 57.5%; outpatient: 37.1% vs. 44.2%; inpatient: 6.6% vs.7.1%) and unmet needs for mental health care (47.5% vs. 43.3%) were estimated among survey respondents who reported hearing impairment and those who did not, respectively. Those with hearing impairment were significantly less likely to report outpatient MHSU ( OR = 0.73, 95% CI [0.60, 0.90]). Conclusions: MHSU was low while perceived unmet needs for mental health care were high among individuals with SMIs, regardless of hearing status. In addition, patients with hearing impairment were significantly less likely to report outpatient MHSU than their counterparts. Enhancing communication is essential to improve access to mental health care for those with hearing impairment.

Marijuana use disorder among adults with functional disabilities—A US population‐based cross‐sectional study

American Journal on Addictions · 2023-10-11 · 4 citations

BACKGROUND AND OBJECTIVES: Recent studies suggest a growing trend in marijuana use, compared to a stable prevalence of marijuana use disorder among US adults over the first 15 years of the 21st century. This study investigated the recent patterns of marijuana use disorder among people with disabilities (PWD). METHODS: We extracted a nationally representative sample (N = 209,058) from the 2015-2019 National Survey on Drug Use and Health data set and examined associations by functional disability status (any disability, disability by type, and number of disabling limitations) with marijuana use disorder using a series of independent multivariable logistic regression models. We also performed trend analyses during the study period. RESULTS: The prevalence of marijuana use disorder (from 1.7% to 2.3%) increased significantly among PWD between 2015 and 2019 (p-trend < .001). PWD were significantly more likely to report marijuana use disorder (odds ratio [OR], 1.37, 95% confidence interval [CI], 1.24-1.52) than people without disability (PWoD). Those with cognitive limitation only (OR, 1.78, 95% CI, 1.53-2.06) and ≥2 limitations (OR, 1.29, 95% CI, 1.10-1.51) were more likely to report marijuana use disorder than PWoD. DISCUSSION AND CONCLUSIONS: PWD had a consistently higher prevalence of marijuana use disorder than PWoD. Additionally, the level of risk for marijuana use disorder varied by disability type and number of disabling limitations. SCIENTIFIC SIGNIFICANCE: Our study provided new nuance on disparities in marijuana use disorder between PWD and PWoD and further revealed the varied risks for marijuana use disorder across different disability statuses.