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文化中心视角下的精神健康:有色人种老年人在诊断、治疗和获得护理方面的差异。

Centering Culture in Mental Health: Differences in Diagnosis, Treatment, and Access to Care Among Older People of Color.

机构信息

Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY.

Department of Psychiatry and Behavioral Sciences (DEJ, DMG), University of Miami Miller School of Medicine, Miami, FL; Department of Family Health Care Nursing (MP), University of California San Francisco School of Nursing, San Francisco, CA; School of Social Work (DR), University of Pittsburgh, Pittsburgh, PA; Department of Psychiatry (JHJ, OO), Harvard Medical School, Boston, MA; Department of Psychology (ERW), University of Miami, Miami, FL; Department of Mental Health Law and Policy (KC), College of Behavioral and Community Sciences University of South Florida, Tampa, FL; Department of Psychiatry (CS), University of Rochester Medical Center, Rochester, NY.

出版信息

Am J Geriatr Psychiatry. 2022 Nov;30(11):1234-1251. doi: 10.1016/j.jagp.2022.07.001. Epub 2022 Jul 8.

Abstract

Mental healthcare disparities are routinely documented, yet they remain wider than in most other areas of healthcare services and common mental disorders (depression and anxiety) continue to be one of the highest health burdens for older people of color. To address disparities in mental health services for older people of color, the narrative must move beyond simply documenting these inequities and attain a better understanding of the internalized, interpersonal, systemic, and medical racism that have harmed these communities and excluded them from its services in the first place. It is imperative that researchers, clinicians, and policymakers acknowledge the realities of racism and discrimination as leading causes of mental healthcare disparities. Therefore, this review is a call-to-action. Authors adopt an antiracist and health equity lens in evaluating the differing needs of Blacks/African-Americans, Asian Americans, and Latinos by exploring psychiatric comorbidity, experiences with seeking, accessing, and engaging in treatment, and the unique cultural and psychosocial factors that affect treatment outcomes for these diverse groups. Further, authors offer researchers and practitioners tangible tools for developing and implementing culturally-sensitive, mental health focused interventions for older people of color with special attention placed on cultural adaptations, models of care, prevention, and practical strategies that can be implemented to reduce disparities and increase equity in mental healthcare.

摘要

精神卫生保健方面的差距是经常被记录在案的,但它们仍然比医疗服务的大多数其他领域更为严重,而常见的精神障碍(抑郁症和焦虑症)仍然是有色人种老年人面临的最高健康负担之一。为了解决有色人种老年人精神卫生保健方面的差距,叙述必须超越简单地记录这些不平等现象,并更好地了解导致这些社区受到伤害和最初被排除在服务之外的内化的、人际的、系统的和医疗的种族主义。研究人员、临床医生和政策制定者必须承认种族主义和歧视是精神卫生保健差距的主要原因,这一点至关重要。因此,这篇综述是一个行动呼吁。作者通过探讨精神共病、寻求、获得和参与治疗的经历,以及影响这些不同群体治疗结果的独特文化和心理社会因素,从反种族主义和健康公平的角度来评估黑人和非裔美国人、亚裔美国人和拉丁裔的不同需求。此外,作者为研究人员和从业者提供了切实可行的工具,用于为有色人种老年人制定和实施文化敏感的、以精神健康为重点的干预措施,特别关注文化适应、护理模式、预防以及可以实施的实用策略,以减少精神卫生保健方面的差距并增加公平性。

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