Display options
Cite
Pimentel Maldonado DA, Eusebio JR, Amezcua L, et al. The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort. Mult Scler Relat Disord. 2021;58:103451doi: 10.1016/j.msard.2021.103451.
Pimentel Maldonado, D. A., Eusebio, J. R., Amezcua, L., Vasileiou, E. S., Mowry, E. M., Hemond, C. C., Umeton Pizzolato, R., Berrios Morales, I., Radu, I., Ionete, C., & Fitzgerald, K. C. (2021). The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort. Multiple sclerosis and related disorders, 58103451. https://doi.org/10.1016/j.msard.2021.103451
Pimentel Maldonado, Daniela A, et al. "The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort." Multiple sclerosis and related disorders vol. 58 (2021): 103451. doi: https://doi.org/10.1016/j.msard.2021.103451
Pimentel Maldonado DA, Eusebio JR, Amezcua L, Vasileiou ES, Mowry EM, Hemond CC, Umeton Pizzolato R, Berrios Morales I, Radu I, Ionete C, Fitzgerald KC. The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort. Mult Scler Relat Disord. 2021 Dec 05;58:103451. doi: 10.1016/j.msard.2021.103451. Epub 2021 Dec 05. PMID: 34953410.
Copy Download .nbib Format: NLM
Share it on

Mult Scler Relat Disord. 2021 Dec 05;58:103451. doi: 10.1016/j.msard.2021.103451. Epub 2021 Dec 05.

The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort.

Multiple sclerosis and related disorders

Daniela A Pimentel Maldonado, Justin R Eusebio, Lilyana Amezcua, Eleni S Vasileiou, Ellen M Mowry, Christopher C Hemond, Raffaella Umeton Pizzolato, Idanis Berrios Morales, Irina Radu, Carolina Ionete, Kathryn C Fitzgerald

Affiliations

  1. Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States. Electronic address: [email protected].
  2. Department of Behavioral Medicine, Edward M. Kennedy Community Health Center, Worcester, MA, United States.
  3. Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA, United States.
  4. Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
  5. Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
  6. Department of Neurology, University of Massachusetts Medical School, Worcester, MA, United States.

PMID: 34953410 DOI: 10.1016/j.msard.2021.103451

Abstract

BACKGROUND: Psychiatric symptoms are common in multiple sclerosis (MS) and may contribute to worse MS outcomes. Previous studies suggest the burden of symptoms may vary by race, ethnicity and socioeconomic status (SES). Our objective was to expand upon this previous work and explore the associations between SES, race, and ethnicity, as predictors of psychiatric symptoms, mental health attitudes, and health-seeking behavior in patients with MS.

METHODS: Persons with MS answered a national web-based survey including demographic characteristics (including race, ethnicity and measures of SES), mental health attitudes, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Modified Fatigue Impact Scale 5-item version (MFIS-5), and the Alcohol Use Disorders Identification Test (AUDIT). The survey also queried mental health availability and perceptions of care. We measured neighborhood-level SES (nSES) of each participant using the Agency for Healthcare Research and Quality (AHRQ) index that was calculated from 5-digit postal codes. Other indicators of participant-level SES included education level and self-reported household income. We assessed the association between race, ethnicity, and neighborhood/participant-level SES indicators and affective symptom burden using generalized linear models that were adjusted for age, sex, and MS characteristics.

RESULTS: 2095 participants answered the survey (mean AHRQ index 54.6 ± 5.4, age 51.3 ± 12.2 years, 7% Black/African American, 5.4% Hispanic/Latino, and 81.8% female). Those in the lowest quartile of nSES (most disadvantaged) were more likely to be either Black/African American or Hispanic/Latino as compared to those in highest quartile (least disadvantaged). Those in the lowest quartile of nSES had higher mean MFIS-5 (1.02 points; 95% CI: 0.39, 1.43), PHQ-9 (1.24 points; 95% CI: 0.49, 1.98), and GAD-7 (0.69 points; 95% CI: -0.01, 1.38) scores relative to those in the highest quartile. Of those who consumed alcohol (n = 1489), participants in the lowest AHRQ quartile had lower mean AUDIT scores (-0.73 points; 95% CI: -1.18, -0.29) as compared to those in higher quartiles. Race and ethnicity were not associated with self-reported psychiatric symptom burden in this cohort. SES was also associated with self-reported improvement of symptoms after receiving mental health care. A higher proportion of Black/African American (44.1% vs 30.2%, p = 0.003) and Hispanic/Latino (49.1% vs 30.6%, p<0.001) participants were more likely to report they would "definitely go" receive mental health care if services were co-located with their MS care as compared to white and Non-Hispanic/Latino participants, respectively.

CONCLUSION: Higher SES was associated with a lower burden of psychiatric symptoms and with a higher likelihood of self-reported symptom recovery after receiving mental health treatment. Attitudes regarding mental health care delivery in MS varied according to racial and ethnic background. Future longitudinal studies in more diverse populations should assess whether co-location of mental health services with MS care helps to reduce the gap between access and need of mental health care in MS.

Copyright © 2021. Published by Elsevier B.V.

Keywords: Ethnicity; Healthcare disparities; Mental health; Multiple sclerosis; Race; Socioeconomic status

Publication Types