The mental health of the United States' Latino population significantly deteriorated during the SARS-CoV-2 (COVID-19) pandemic, and Latino immigrants living in rural areas faced unique vulnerabilities. However, few studies have specifically examined the mental health burden and experiences of rural Latino immigrants during the COVID pandemic. To understand the mental health experiences of first- and second-generation Latinos in rural areas, we conducted semi-structured interviews with 35 Latino residents of rural California counties during July 2020-February 2021 and screened all respondents for major depression and generalized anxiety symptoms using the Patient Health Questionnaire [PHQ]-2 and Generalized Anxiety Disorder [GAD]-2 screeners. We explored the prevalence of symptoms of depression and anxiety in our sample, iteratively analyzed participants' narratives regarding the mental health impact of the pandemic, and used their mental health screener status to contextualize these narratives. Results indicated that nearly all respondents viewed mental health as a major concern, and 34% (n = 12) of respondents screened positive for major depression or generalized anxiety disorder. Respondents connected their mental health concerns to experiences of financial precarity, fear of contracting COVID-19, social isolation, and the challenges of remote schooling. Additional themes emerged around problems accessing the mental health care system, the utility of pre-pandemic mental health services, and using healthy coping mechanisms to alleviate psychological problems. Respondents' narratives tended to focus on the mental health challenges facing their family members, particularly their children. Our findings suggest that mental health intervention models that engage with multiple family members, policies that support infrastructure for encouraging exercise and outdoor activity, and ensuring access to culturally and linguistically appropriate mental health care for Latino communities may be important for protecting population mental health.
Publications
2023
2022
Rural Latinx immigrants experienced disproportionately negative health and economic impacts during the COVID-19 pandemic. They contended with the pandemic at the intersection of legal status exclusions from the safety net and long-standing barriers to health care in rural regions. Yet, little is known about how rural Latinx immigrants navigated such exclusions. In this qualitative study, we examined how legal status stratification in rural contexts influenced Latinx immigrant families' access to the safety net. We conducted interviews with first- and second-generation Latinx immigrants (n = 39) and service providers (n = 20) in four rural California communities between July 2020 and April 2021. We examined personal and organizational strategies used to obtain economic, health, and other forms of support. We found that Latinx families navigated a limited safety net with significant exclusions. In response, they enacted short-term strategies and practices - workarounds - that met immediate, short-term needs. Workarounds, however, were enacted through individual efforts, allowing little recourse beyond immediate personal agency. Some took the form of strategic practices within the safety net, such as leveraging resources that did not require legal status verification; in other cases, they took the form of families opting to avoid the safety net altogether.
The suicide rate among adolescents and young adults in the United States increased 57% between 2007 and 2018, from 6.8 to 10.7 deaths per 100 000 individuals. Recent research characterized as alarming the increases in overall suicide rates among young Black and other racial/ethnic minority populations. To assess the temporal trends in overall suicide and firearm suicide mortality rates among non-Hispanic Black young adults, we conducted a sex-specific Joinpoint regression analysis to identify changing trends in these rates between 1999 and 2019. Data were obtained from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System. Results showed an 84.5% increase in the firearm suicide rate among young Black men and a 76.9% increase among young Black women between 2013 and 2019. Additional research is needed to investigate potential population-level exposures during or before 2013 that may have influenced suicide and firearm suicide risk.
CONTEXT: Segregation has been linked to unequal life chances. Individuals from marginalized communities experience more crime, higher levels of poverty, poor health, and less civic engagement; and segregated metropolitan regions witness inequality in access to basic services. This paper builds on this previous work by linking segregation to infection and deaths from COVID-19.
METHODS: Using Census data matched to COVID infection and death statistics at the county level, we offer a theoretical basis for our choice of segregation measures and predictions for different racial groups. We analyze the relationship between two dimensions of segregation, racial isolation and racial unevenness, and COVID outcomes for different racial and ethnic groups.
FINDINGS: We find that in counties where Black and Latino residents live in more isolated neighborhoods, they were much more likely to contract COVID-19. This pattern was exacerbated in counties with a high proportion of front-line workers. We also find that racial segregation increased COVID-19 death rates for Black, Latino, and white residents.
CONCLUSIONS: Our findings suggest that devastating outcomes of the coronavirus pandemic were linked to a long history of racial marginalization and entrenched discrimination produced by structural inequalities embedded in our geographies and should inform public health planning going forward.
PURPOSE: This study examined the epidemiology of self-harm emergency department (ED) visits among Asian American and Pacific Islander (AAPI) youth, and associated factors.
METHODS: We used California ED visit records in 2010 and 2011 to calculate incidence rates of self-harm ED visits for AAPI versus non-Hispanic White (NHW) patients aged 10-29 years. Demographic and clinical characteristics were compared for AAPI versus NHW patients presenting with self-harm. We used modified Poisson regression models to estimate the relative risk of recurrent ED self-harm visits for AAPI versus NHW patients and examined the association of insurance type and gender with recurrent self-harm among AAPIs.
RESULTS: Rates of self-harm ED visits for young AAPI patients were 38 and 26 per 100,000 among females and males, respectively. Although AAPI patients presenting with self-harm were equally or less likely than NHW patients to have comorbid psychological and substance use diagnoses at their index visit, they were 25% more likely to be admitted to hospital. However, they were 40% less likely to have a recurrent ED self-harm visit. Among AAPI patients, those who used Medicaid were significantly more likely than those with other insurance to be admitted as inpatients.
DISCUSSION: Young AAPI patients presenting to EDs with deliberate self-harm have different sociodemographic and clinical profiles compared to NHW patients. Our study also demonstrates significant heterogeneity in risk of recurrent self-harm by gender and insurance type among AAPI patients. This information may be useful for future intervention programs among self-harming AAPI youth.
OBJECTIVE: Patient presentations to the emergency department (ED) for alcohol-involved injury represent a growing public health burden, but their characteristics and sequelae remain understudied. This study examined mortality rates among ED patients presenting with alcohol-involved injuries and assessed how mortality varied by injury intent and other characteristics.
METHOD: This retrospective cohort study used statewide, longitudinally linked ED patient record and mortality data from California. Participants comprised all residents presenting to a licensed ED in 2009-2012 with a nonfatal injury that involved comorbid diagnosis of alcohol use disorder (AUD; n = 261,222; 59.3% male). Injury intent was defined using International Classification of Diseases, 9th Revision, Clinical Modification external cause-of-injury codes. Cox regression was used to investigate factors associated with 12-month all-cause mortality rates. Age-, sex-, and race/ethnicity-adjusted standardized mortality ratios (SMRs) were calculated using statewide mortality data.
RESULTS: Most ED injury visits involving an AUD diagnosis were coded as unintentional (75.9%). Following the index ED visit, all-cause mortality among AUD-involved injury patients was 5,205 per 100,000 person-years, five times higher than the demographically matched population (SMR = 5.3; 95% confidence interval [5.2, 5.4]). Adjusted Cox regression models indicated that patients whose index injury was unintentional, and whose AUD was for acute intoxication, had significantly higher mortality. Most deaths among unintentionally injured patients were from natural causes, whereas external-cause deaths were relatively more common in the other patient groups.
CONCLUSIONS: AUD-involved injury presentations to the ED in California are common and associated with high patient mortality burden, which varies by injury intent. Interventions are needed to reduce excess mortality in these patients.