American Journal of Preventive Medicine最新文献_第2页

Age Profiles of Suicide Attempt Among Sexual Minority Adolescents 性少数群体青少年自杀未遂的年龄特征。

IF 4.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Preventive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amepre.2024.10.021

Samuel J. Mann PhD , Jamie L. Ryan PhD , Harry Barbee PhD

引用次数: 0

Projected Impact of Replacing Juice With Whole Fruit in Early Care and Education 在早期保育和教育中用全水果取代果汁的影响预测。

IF 4.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Preventive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amepre.2024.10.017

Daniel A. Zaltz PhD, MPH , Brian W. Weir PhD, MHS, MPH , Roni A. Neff PhD, ScM , Sara E. Benjamin-Neelon PhD, JD, RD

Introduction

The purpose of this study was to simulate potential changes in dietary intake and food costs by replacing juice with whole fruit among children ages 1–5 years attending U.S. early care and education settings between 2008 and 2020.

Methods

Estimated mean changes in daily intake of calories, sugar, fiber, calcium, vitamin C and overall food costs under plausible scenarios of replacing juice with whole fruit. Researchers fit hierarchical regression with children nested within early care and education nested within studies, adjusting for potential confounders.

Results

The sample consisted of 6,304 days of direct observation (90% aged 2 years or older, 51% female, 38% Black/African American) in 846 early care and education facilities (73% centers, 75% Child and Adult Care Food Program participants). Replacing juice with whole fruit would reduce energy intake by 8.2–27.3 kcal/day, reduce sugar by 3.4–5.6 g/d, increase fiber by 0.5–1.3 g/d, and have negligible impact on vitamin C and calcium. Replacing juice with whole fruit in early care and education would increase per-child daily food costs between $0.44 and 0.49, representing an increase from 3.8% for juice to approximately 9.8%–10.7% for whole fruit as a percent of total food costs.

Conclusions

Replacing juice with whole fruit in early care and education would result in increased fiber intake and decreased sugar and calories. A policy to replace juice with whole fruit in early care and education would likely cause an increased daily food cost and given the potential broad benefit of this dietary intervention, there may be reason to expand funding within nutrition assistance programs in early care and education.

简介：本研究的目的是模拟 2008-2020 年间在美国早期保育和教育（ECE）机构就读的 1-5 岁儿童以全水果取代果汁后，膳食摄入量和食品成本可能发生的变化：方法：估算在用全果取代果汁的合理方案下，每日摄入的卡路里、糖、纤维、钙、维生素 C 的平均变化量以及总体食品成本。研究人员将儿童嵌套在研究中的幼儿教育中，并对潜在的混杂因素进行调整，从而拟合出分层回归：样本包括对 846 家幼教机构（73% 为中心，75% 为儿童和成人护理食品计划 (CACFP) 参与者）的 6304 天直接观察（90% 为 2 岁或以上儿童，51% 为女性，38% 为黑人/非裔美国人）。用全水果取代果汁将使能量摄入量每天减少 8.2 - 27.3 千卡，糖分每天减少 3.4 - 5.6 克，纤维每天增加 0.5 - 1.3 克，对维生素 C 和钙的影响可以忽略不计。在幼儿教育中用全果取代果汁会使每个儿童每天的食品成本增加 0.44 - 0.49 美元，占食品总成本的比例从果汁的 3.8%增加到全果的约 9.8% - 10.7%：结论：在幼儿教育中用全果取代果汁可增加纤维摄入量，减少糖分和热量。在幼儿教育中用全果取代果汁的政策很可能会导致每日食品成本的增加，鉴于这种饮食干预措施的潜在广泛益处，可能有理由在幼儿教育营养援助计划中扩大资金投入。

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引用次数: 0

Hypertensive Blood Pressure in Adolescent Females With Polycystic Ovary Syndrome 多囊卵巢综合征青少年女性的高血压：青少年多囊卵巢综合症与高血压。

IF 4.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Preventive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amepre.2024.10.009

Sherry Zhang MD , Jeanne A. Darbinian MPH , Louise C. Greenspan MD , Sahar Naderi MD , Nirmala D. Ramalingam MPP , Joan C. Lo MD

Introduction

Polycystic ovary syndrome is associated with hypertension in women, but few population studies have examined findings among adolescents. This retrospective study examines PCOS and hypertensive blood pressure in a large adolescent population receiving routine healthcare.

Methods

Among females aged 13–17 years who had a well-child visit with systolic/diastolic blood pressure measured in a Northern California healthcare system (2013–2019), the outcome of hypertensive blood pressure (≥130/80 mmHg) was examined. Polycystic ovary syndrome was based on clinical diagnosis (ICD-9/10 256.4/E28.2) within 1 year of the visit. Overweight and obesity were defined by BMI 85th to <95th percentile and ≥95th percentile, respectively; 1.7% with underweight (<5th percentile) were excluded. Multivariable logistic regression was used to examine the association of polycystic ovary syndrome and hypertensive blood pressure, adjusting for age, race/ethnicity, BMI category, and estimated neighborhood deprivation index. Analyses were conducted in 2023–2024.

Results

The cohort included 224,418 females (mean age 14.9±1.4 years; 34.3% non-Hispanic White, 30.1% Hispanic, 19.5% Asian/Pacific Islander, and 9.7% Black). Overall, 18.7% had overweight and 15.8% had obesity. The prevalence of hypertensive blood pressure was 7.2%, much higher for those with polycystic ovary syndrome (18.2%) versus no polycystic ovary syndrome (7.1%, p<0.001). In adjusted analyses, polycystic ovary syndrome was associated with 1.25-fold greater odds of hypertensive blood pressure (95% CI=1.10, 1.42). Similar findings were seen among the subset with obesity (OR=1.23 [95% CI=1.06, 1.42]).

Conclusions

Nearly 1 in 5 adolescents with polycystic ovary syndrome had hypertensive blood pressure. Polycystic ovary syndrome was associated with 25% increased adjusted odds of hypertensive blood pressure, emphasizing the importance of blood pressure surveillance in this population with higher cardiometabolic risk.

导言：多囊卵巢综合征（PCOS）与女性高血压有关，但很少有人群研究对青少年进行调查。这项回顾性研究调查了接受常规医疗保健服务的大量青少年群体中多囊卵巢综合征与高血压（BP）的关系：方法：在北加州医疗保健系统（2013-2019 年）中，13-17 岁的女性在接受儿童健康检查并测量收缩压/舒张压后，对高血压（≥130/80 mmHg）的结果进行了研究。多囊卵巢综合征基于就诊一年内的临床诊断（ICD-9/10 256.4/E28.2）。超重和肥胖的定义分别为体重指数第85百分位至第th百分位和≥第95百分位；1.7%体重不足（第th百分位）者被排除在外。多变量逻辑回归用于检验多囊卵巢综合症与高血压之间的关系，并对年龄、种族/人种、体重指数类别和估计的邻里贫困指数进行了调整。分析于 2023-2024 年进行：队列包括 224 418 名女性（平均年龄为 14.9±1.4 岁；34.3% 为非西班牙裔白人，30.1% 为西班牙裔，19.5% 为亚太裔，9.7% 为黑人）。总体而言，18.7%的人超重，15.8%的人肥胖。高血压患病率为 7.2%，患有多囊卵巢综合症的青少年（18.2%）远高于未患有多囊卵巢综合症的青少年（7.1%）：近五分之一患有多囊卵巢综合症的青少年患有高血压。多囊卵巢综合症导致高血压的调整几率增加了 25%，这强调了对这一具有较高心脏代谢风险的人群进行血压监测的重要性。

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引用次数: 0

Health Insurance and Self-Rated Health From Adolescence to Early Midlife in the U.S. 美国从青春期到中年早期的医疗保险和自评健康状况

IF 4.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Preventive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amepre.2024.10.002

Xing Zhang PhD , Tiffany L. Lemon PhD

Introduction

Although health insurance is a critical tool for well-being across the life course, few studies have explored the long-term health implications of shifts in insurance coverage. This study examined whether changes in insurance types from adolescence to early midlife were associated with early midlife self-rated health.

Methods

This study used data from Wave I (1994–1995; average age 15.7 years), Wave IV (2008–2009; average age 28.7 years), and Wave V (2016–2018; average age 37.6 years) of Add Health, including 6,765 respondents from 1994 to 2018. Logistic regression was used to examine the association between health insurance status from adolescence to early midlife and early midlife self-rated health. The analyses were conducted from March to August 2024.

Results

Relative to having private insurance in adolescence and early midlife, the following health insurance statuses in adolescence and early midlife were significantly associated with poorer early midlife self-rated health: public in adolescence and early midlife (AOR=3.34; 95% CI=1.89, 5.91); uninsured in adolescence to public at early midlife (AOR=3.29; 95% CI=1.85, 5.85); private in adolescence to public at early midlife (AOR=3.36; 95% CI=2.46, 4.58), and private in adolescence to uninsured at early midlife (AOR=1.68; 95% CI=1.10, 2.55).

Conclusions

Health insurance statuses from adolescence to early midlife, specifically having or switching into public insurance, may be associated with poorer health in early midlife among individuals who were adolescents in the early 1990s. More research is needed to explore how insurance reform such as the Children's Health Insurance Program may have mitigated this association in future cohorts.

导言：虽然医疗保险是整个生命过程中保障健康的重要工具，但很少有研究探讨保险范围变化对健康的长期影响。本研究探讨了从青少年时期到中年早期，保险类型的变化是否与中年早期的自我健康评价有关：本研究使用了《Add Health》第一波（1994-1995 年；平均年龄 15.7 岁）、第四波（2008-2009 年；平均年龄 28.7 岁）和第五波（2016-2018 年；平均年龄 37.6 岁）的数据，包括 1994-2018 年期间的 6765 名受访者。采用逻辑回归法研究了从青春期到中年早期的医疗保险状况与中年早期自评健康状况之间的关联。分析时间为 2024 年 3 月至 8 月：与青春期和中年早期拥有私人保险相比，青春期和中年早期的以下医疗保险状况与中年早期较差的自评健康状况显著相关：青春期和中年早期拥有公共保险（AOR=3.34；95% CI=1.89，5.91）；青春期无保险到中年早期有保险（AOR=3.29；95% CI=1.85，5.85）；青春期有私人保险到中年早期有保险（AOR=3.36；95% CI=2.46，4.58），以及青春期有私人保险到中年早期无保险（AOR=1.68；95% CI=1.10，2.55）：从青少年时期到中年早期的医疗保险状况，特别是拥有或转入公共保险的状况，可能与 20 世纪 90 年代初青少年时期的中年早期健康状况较差有关。还需要更多的研究来探讨儿童健康保险计划等保险改革如何在未来的队列中缓解这种关联。

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引用次数: 0

Clinician Response to the 2021 USPSTF Recommendation for Colorectal Cancer Screening in Average Risk Adults Aged 45–49 Years 临床医生对 2021 年 USPSTF 关于 45-49 岁平均风险成人结直肠癌筛查建议的回应。

IF 4.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Preventive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amepre.2024.10.003

Joseph Carter Powers BA , Michael B. Rothberg MD, MPH , Jeffrey D. Kovach MS , Nicholas J. Casacchia PharmD, MS , Elizabeth Stanley MPH , Kathryn A. Martinez PhD, MPH

Introduction

In 2021, the USPSTF lowered the recommended age of colorectal cancer (CRC) screening initiation from 50 to 45 years. This study assessed clinician response to the updated guideline in a major health system.

Methods

This was a retrospective cohort study of average-risk, CRC screening–naïve adults aged 45–50 years with a primary care appointment between July 2018 and February 2023. The authors defined the pre–guideline change period as July 2018–February 2020 (pre-period) and the post–guideline change period as July 2021–February 2023 (post-period). Clinician ordering of any CRC screening type was assessed. Mixed effects Poisson regression was used to model the incidence rate ratio (IRR) of a patient receiving a screening order, including an interaction between age (45–49 years versus 50 years) and time period (pre- versus post-guideline change.) Variation in screening orders were also described by calendar quarter and clinician.

Results

There were 28,114 patients in the pre-period and 22,509 in the post-period. Compared to patients aged 40–49 years in the pre-period, those in the post-period were more likely to have screening ordered (IRR=12.1; 95% CI=11.3–13.0). The screening ordering rate increased for patients aged 50 years from the pre- to the post-period (IRR=1.08; 95% CI=1.01, 1.16) and was slightly higher than that of patients aged 45–49 years in the post-period (IRR=1.08; 95% CI=1.02, 1.14). All clinicians increased their ordering rate for patients aged 45–49 years. Within 5 months of the guideline change, the ordering rate for patients aged 45–49 years and 50 years was nearly the same.

Conclusions

Rapidly following the guideline change, clinicians increased their screening ordering rate for patients aged 45–49 years, indicating almost complete uptake of the recommendation.

导言：2021 年，USPSTF 将结肠直肠癌 (CRC) 筛查的建议开始年龄从 50 岁降至 45 岁。我们评估了一家大型医疗系统的临床医生对更新指南的反应：这是一项回顾性队列研究，研究对象为 2018 年 7 月至 2023 年 2 月期间接受初级保健预约的 45-50 岁平均风险、未接受过 CRC 筛查的成年人。我们将指南变更前时期定义为 2018 年 7 月至 2020 年 2 月（前时期），指南变更后时期定义为 2021 年 7 月至 2023 年 2 月（后时期）。对临床医生订购的任何一种 CRC 筛查类型进行了评估。混合效应泊松回归用于模拟患者接受筛查指令的发病率比（IRR），包括年龄（45-49 岁与 50 岁）和时间段（指南变更前与变更后）之间的交互作用：结果：前一时期有 28,114 名患者，后一时期有 22,509 名患者。与前期的 40-49 岁患者相比，后期的患者更有可能接受筛查（IRR：12.1；95%CI：11.3-13.0）。从前期到后期，50 岁人群的筛查下单率有所上升（IRR:1.08; 95%CI:1.01-1.16），后期略高于 45-49 岁人群（IRR:1.08; 95%CI:1.02-1.14）。所有临床医生都提高了 45-49 岁患者的下单率。在指南变更后的五个月内，45-49 岁患者和 50 岁患者的下单率几乎相同：结论：指南变更后，临床医生迅速提高了 45-49 岁患者的筛查下单率，表明该建议几乎已被完全采纳。

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引用次数: 0

ACPM Member Spotlight—Clarence Lam, MD, MPH, FACPM

IF 4.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Preventive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amepre.2024.10.022

引用次数: 0

Letter to the Editor in Response to “Psychedelic Use by Sexual Minority Adults in the United States, 2022”

IF 4.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Preventive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amepre.2024.09.018

Nicholas A. Carlisle JD, Melissa Bradley MPH, Peter S. Hendricks PhD, Sarah MacCarthy ScD

引用次数: 0

Incentivizing Tobacco Helpline Engagement in Persistent Poverty Counties: A Randomized Trial 激励持续贫困县参与烟草帮助热线：随机试验。

IF 4.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Preventive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amepre.2024.10.014

Darla E. Kendzor PhD , Morgan Davie BS , Meng Chen PhD , Jonathan Hart PhD , Summer G. Frank-Pearce PhD , Mark P. Doescher MD , Adam C. Alexander PhD , Michael S. Businelle PhD , Motolani E. Ogunsanya DPh, PhD , Munjireen S. Sifat PhD , Laili Kharazi Boozary PhD

Introduction

Persistent poverty counties (PPCs) are U.S. counties where ≥20% of residents have lived in poverty for ≥30 years. Cancer mortality rates in PPCs are exceptionally high due, in part, to elevated smoking rates.

Study Design

The study used a parallel 2-group randomized controlled trial design.

Setting/participants

Participants were Oklahoma Tobacco Helpline (OTH) callers from PPCs who smoked daily (N=165). Data were collected in 2022–2023.

Intervention

Participants were randomized to received OTH treatment (coaching calls plus nicotine replacement therapy [NRT]) or OTH treatment + financial incentives (OTH+FI) for completing coaching calls.

Main Outcome Measures

Outcome measures included the number of coaching calls completed, call-contingent incentives earned, past 7-day self-reported abstinence rates, and study retention at 8- and 12-weeks post-enrollment.

Results

Participants (N=165) were predominantly female (63.6%), 24.2% were racially/ethnically minoritized (18.2% single- or multi-race American Indian), and they smoked an average of 21.01 (SD=11.67) cigarettes per day. Adjusted analyses indicated that participants assigned to OTH+FI were significantly more likely than those assigned to OTH to report past 7-day abstinence at the 8-week (AOR=2.28; 95% CI=1.18, 4.48) and 12-week (AOR=2.00; 95% CI=1.03, 3.96) follow-ups when missing outcomes were considered smoking. Participants assigned to OTH+FI were more likely to complete ≥3 coaching calls (AOR=3.64; 95% CI=1.84, 7.43), and they completed more total calls (aRR=1.53; 95% CI,=1.24, 1.90) than those assigned to OTH. The number of coaching calls completed significantly mediated the relationship between treatment group assignment and abstinence at the 8- and 12-week follow-ups. Overall, study retention was >83% at the 8- and 12-week follow-ups and did not differ between groups. Statistical analyses were conducted in 2024.

Conclusions

Findings support the feasibility and efficacy of offering small FI for completing OTH coaching calls to increase treatment engagement and smoking cessation in PPCs.

导言：持续贫困县（PPCs）是指美国有≥20%的居民在贫困中生活≥30年的县。持续贫困县的癌症死亡率特别高，部分原因是吸烟率较高：研究采用平行 2 组随机对照试验设计：参与者是俄克拉荷马州烟草帮助热线（OTH）的来电者，他们每天都吸烟（N=165）。数据收集于2022-2023年：参与者被随机分配接受OTH治疗（辅导电话加尼古丁替代疗法[NRT]）或OTH治疗+完成辅导电话的经济激励（OTH+FI）：主要结果测量指标包括完成辅导电话的次数、获得的与电话相关的奖励、过去7天自我报告的戒断率，以及加入后8周和12周的研究保持率：参与者（N=165）主要为女性（63.6%），24.2%为少数种族/族裔（18.2%为单一或多种族美国印第安人），平均每天吸烟21.01支（SD=11.67）。调整后的分析表明，如果将缺失结果视为吸烟，则被分配到OTH+FI的参与者在8周（aOR=2.28 [95% CI, 1.18, 4.48]）和12周（aOR=2.00 [95% CI, 1.03, 3.96]）的随访中报告过去7天戒烟的可能性明显高于被分配到OTH的参与者。与被分配到OTH的参与者相比，被分配到OTH+FI的参与者更有可能完成≥3次通话（aOR=3.64 [95% CI, 1.84, 7.43]），完成的辅导通话总数也更多（aRR=1.53 [95% CI, 1.24, 1.90]）。在 8 周和 12 周的随访中，完成的辅导电话次数对治疗组分配与戒断之间的关系有明显的中介作用。总体而言，在 8 周和 12 周的随访中，研究保留率大于 83%，且各组之间没有差异。统计分析于 2024 年进行：研究结果表明，为完成OTH辅导电话提供小额FI以提高PPCs的治疗参与度和戒烟率是可行且有效的。

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引用次数: 0

Hormones, Stress, and Heart Disease in Transgender Women with HIV in LITE Plus LITE Plus 中感染艾滋病毒的变性妇女的荷尔蒙、压力和心脏病。

IF 4.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Preventive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amepre.2024.10.001

Tonia C. Poteat PhD, PA-C , Molly Ehrig MB , Hedyeh Ahmadi PhD , Mannat Malik MHS , Sari L. Reisner ScD , Asa E. Radix MD, PhD , Jowanna Malone PhD , Christopher Cannon MPH , Carl G. Streed Jr. MD, MPH , Mabel Toribio MD , Christopher Cortina MS , Ashleigh Rich PhD , Kenneth H. Mayer MD , L. Zachary DuBois PhD , Robert-Paul Juster PhD , Andrea L. Wirtz PhD , Krista M. Perreira PhD

Introduction

Cardiovascular disease (CVD) is a leading cause of death among transgender women and people with HIV. Exogenous estrogen and psychosocial stressors are known risk factors for CVD. Yet, few studies have used biomarkers to examine the role of stress in CVD risk among transgender women with HIV (TWHIV). This analysis examined whether stress moderates relationships between gender-affirming hormone therapy (GAHT) duration and CVD risk among TWHIV.

Methods

This cross-sectional analysis of baseline data from an observational cohort of 108 Black and Latina TWHIV in Boston, New York, and Washington, DC, enrolled December 2020 to June 2022, measured sociodemographics, medical diagnoses, medications, smoking history, and perceived stress via interviewer-administered surveys. Physiological stress was measured with 14 biomarkers to calculate allostatic load indices (ALI). Forty participants provided saliva samples used to calculate cortisol awakening response and cortisol daily decline. The 2018 American College of Cardiology Revised Pooled Cohort Equation estimated 10-year CVD risk. Data were analyzed in 2024.

Results

GAHT duration was positively associated with CVD risk scores in bivariate regression. In multivariable linear regression models (adjusting for age, income, education), only age and ALI remained significantly associated with CVD risk scores (β 1.13, CI: 1.05, 1.21). No stress measure significantly interacted with GAHT duration to affect CVD risk scores. In visual plots, GAHT duration increased CVD risk scores only for TWHIV experiencing the highest ALI.

Conclusions

Stress plays an important role in CVD in TWHIV. More research is needed on non-GAHT factors, which influence CVD health among transgender women.

导言：心血管疾病（CVD）是变性女性和 HIV 感染者的主要死因。外源性雌激素和社会心理压力是心血管疾病的已知风险因素。然而，很少有研究使用生物标志物来检测压力在感染 HIV 的变性女性（TWHIV）中心血管疾病风险中的作用。这项分析研究了压力是否会调节性别确认激素疗法（GAHT）持续时间与跨性别女性艾滋病病毒感染者心血管疾病风险之间的关系：这项横断面分析是对波士顿、纽约和华盛顿特区 108 名黑人和拉丁裔 TWHIV 的基线数据进行的观察性队列分析，这些 TWHIV 于 2020 年 12 月至 2022 年 6 月入组，通过访谈者主持的调查测量了社会人口统计学、医疗诊断、药物、吸烟史和感知压力。生理压力通过 14 种生物标志物进行测量，以计算代谢负荷指数（ALI）。40 名参与者提供了唾液样本，用于计算皮质醇觉醒反应和皮质醇日下降率。2018年美国心脏病学会修订的集合队列方程估算了10年心血管疾病风险。对 2024 年的数据进行了分析：在二元回归中，GAHT持续时间与心血管疾病风险评分呈正相关。在多变量线性回归模型中（调整年龄、收入、教育程度），只有年龄和 ALI 仍与心血管疾病风险评分显著相关 [β 1.13, CI: 1.05, 1.21]。没有任何一项压力指标与 GAHT 持续时间有明显的相互作用，从而影响心血管疾病风险评分。在直观图中，GAHT持续时间仅增加了ALI最高的TWHIV的心血管疾病风险得分：结论：压力对 TWHIV 的心血管疾病有重要影响。还需要对影响变性女性心血管疾病健康的非GAHT因素进行更多研究。

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引用次数: 0

Factors Associated With Mental Healthcare Utilization Among United States Military Personnel With Posttraumatic Stress Disorder or Depression Symptoms 与有创伤后应激障碍或抑郁症状的美国军人使用精神保健服务有关的因素。

IF 4.3 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

American Journal of Preventive Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.amepre.2024.10.006

Neika Sharifian PhD , Cynthia A. LeardMann MPH , Claire A. Kolaja MPH , Anna Baccetti MPH , Felicia R. Carey PhD , Sheila F. Castañeda PhD , Charles W. Hoge MD , Rudolph P. Rull PhD , Millennium Cohort Study Team

Introduction

Although posttraumatic stress disorder (PTSD) and depression are prominent mental health conditions affecting United States service members, only a subset of individuals with these conditions utilize mental healthcare services. Identifying factors associated with mental healthcare utilization may elucidate military subgroups with unmet mental healthcare needs.

Methods

Cross-sectional survey data from the 2019–2021 Millennium Cohort Study assessment were used to examine correlates of unmet mental healthcare needs among military personnel who screened positive for PTSD or depression symptoms (n=18,420) using modified Poisson regression models. Data analyses for this study were conducted between 2023 and 2024.

Results

Approximately 32%–43% of service members reported receiving any mental health care in the past 12 months. Hispanic and Asian or Pacific Islander personnel and those with certain service characteristics (higher pay grade, recent deployment, experienced discrimination) had a lower likelihood of mental healthcare utilization. Female sex, greater symptom severity, experiencing bullying, and other psychosocial factors were associated with greater likelihood of mental healthcare utilization.

Conclusions

One third of service members with PTSD or depression symptoms reported any mental healthcare use, highlighting the need to identify factors that may impede or delay treatment. Racial and ethnic disparities in treatment utilization persist, as do differences in utilization by military characteristics. Further research and initiatives are necessary to identify potential service-specific or cultural barriers and provide equitable quality and access to needed mental health services within the Military Health System.

导言：尽管创伤后应激障碍（PTSD）和抑郁症是影响美国军人的主要心理健康问题，但只有一部分患有这些疾病的人利用心理保健服务。确定与心理保健利用率相关的因素可能会揭示出那些心理保健需求未得到满足的军人亚群：利用 2019-2021 年千年队列研究（Millennium Cohort Study）评估的横截面调查数据，使用修正的泊松回归模型，对筛查出创伤后应激障碍或抑郁症状阳性的军人（人数=18,420）中未得到满足的心理保健需求的相关因素进行研究。本研究的数据分析在 2023 年至 2024 年期间进行：大约 32-43% 的军人表示在过去 12 个月中接受过任何心理保健服务。西班牙裔、亚洲或太平洋岛民以及具有某些服役特征（薪资级别较高、近期部署、经历过歧视）的人员使用心理保健服务的可能性较低。女性性别、更严重的症状、遭受欺凌以及其他社会心理因素与更有可能使用心理保健服务有关：结论：三分之一有创伤后应激障碍或抑郁症状的服役人员表示使用过任何心理保健服务，这突出表明有必要识别可能阻碍或延迟治疗的因素。治疗利用率方面的种族和民族差异依然存在，军事特征导致的利用率差异也是如此。有必要开展进一步的研究和行动，以确定潜在的特定服务或文化障碍，并在军事卫生系统内提供公平的质量和获得所需心理健康服务的机会。

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