Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St., New York City, NY, 10021, USA.
Department of Orthopaedic Surgery, University of New Mexico, Albuquerque, NM, USA.
Clin Rheumatol. 2022 Jul;41(7):2205-2211. doi: 10.1007/s10067-022-06074-6. Epub 2022 Mar 9.
Patients with rheumatologic disease experience higher rates of comorbid mental health diseases than those without. Although mental health services (MHS) can improve musculoskeletal functional outcomes, access to MHS has been limited among vulnerable populations in the United States (US). The purpose of this study was to investigate contemporary patterns of severe psychological distress and receipt of MHS among immigrant populations with rheumatologic disease in the US.
The National Health Interview Survey was queried for patients with rheumatologic disease from 2009 to 2018. Patient demographics, severe psychological distress, and receipt of MHS were collected and/or calculated. Multivariable logistic regressions assessed for factors associated with decreased receipt of MHS and severe psychological distress.
Immigrant patients with rheumatologic disease had higher rates of severe psychological distress than US-born patients (7.7% vs. 6.5%, p < 0.001), but were less likely to access MHS (8.3% vs. 11.0%, p < 0.001). Among immigrant patients, factors associated with lower MHS receipt included being Black (AOR 0.50, 95% CI 0.32-0.77, p = 0.002), Hispanic (AOR 0.80, 95% CI 0.30-1.00, p = 0.050), Asian (AOR 0.44, 95% CI 0.31-0.63, p < 0.001), older (p < 0.001), uninsured (p < 0.001), and having self-reported poor health (p < 0.001).
Immigrant patients with rheumatologic disease in the US had higher rates of severe psychological distress yet were less likely to receive MHS compared to US-born patients. Immigrants with rheumatologic illness were less likely to receive MHS if they were male, Black, Hispanic, Asian, older, lower income, or uninsured. This lack of MHS receipt may contribute to disparities in functional outcomes seen in immigrant minorities with musculoskeletal disease. Key Points • Immigrant patients with rheumatologic disease in the US had higher rates of severe psychological distress yet were less likely to receive MHS compared to US-born patients between 2009 and 2018 • Immigrants with rheumatologic illness were less likely to receive MHS if they were Black, Hispanic, Asian, older, lower income, or uninsured • Future efforts to carefully screen for mental health diseases in these vulnerable patient populations should be made while exploring patient-specific cultural considerations of MHS receipt.
患有风湿性疾病的患者比没有此类疾病的患者更容易出现合并精神健康疾病。尽管精神健康服务（MHS）可以改善肌肉骨骼功能的预后，但在美国弱势群体中，MHS 的获取受到限制。本研究的目的是调查美国风湿性疾病移民人群中严重心理困扰和接受 MHS 的当代模式。
2009 年至 2018 年，对全国健康访谈调查中的风湿性疾病患者进行了查询。收集并/或计算了患者的人口统计学资料、严重心理困扰和接受 MHS 的情况。多变量逻辑回归评估了与 MHS 接受率下降和严重心理困扰相关的因素。
与美国出生的患者相比，患有风湿性疾病的移民患者的严重心理困扰发生率更高（7.7%比 6.5%，p<0.001），但接受 MHS 的可能性更低（8.3%比 11.0%，p<0.001）。在移民患者中，与 MHS 接受率较低相关的因素包括为黑人（AOR 0.50，95%CI 0.32-0.77，p=0.002）、西班牙裔（AOR 0.80，95%CI 0.30-1.00，p=0.050）、亚裔（AOR 0.44，95%CI 0.31-0.63，p<0.001）、年龄较大（p<0.001）、没有保险（p<0.001）和自我报告健康状况较差（p<0.001）。
与美国出生的患者相比，美国风湿性疾病移民患者的严重心理困扰发生率更高，但接受 MHS 的可能性更低。患有风湿性疾病的移民如果是男性、黑人、西班牙裔、亚裔、年龄较大、收入较低或没有保险，他们接受 MHS 的可能性就较低。这种 MHS 接受率低可能导致患有肌肉骨骼疾病的移民少数族裔在功能预后方面存在差异。要点 • 2009 年至 2018 年间，与美国出生的患者相比，美国风湿性疾病移民患者的严重心理困扰发生率更高，但接受 MHS 的可能性更低。• 患有风湿性疾病的移民如果是黑人、西班牙裔、亚裔、年龄较大、收入较低或没有保险，他们接受 MHS 的可能性就较低。• 未来应在探索 MHS 接受情况的患者特定文化因素的同时，认真筛查这些弱势群体中的精神健康疾病。
