Browsing by Author "Jimenez, Daniel E."
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Item Impact of comorbid mental health needs on racial/ethnic disparities in general medical care utilization among older adults(Wiley, 2017) Jimenez, Daniel E.; Schmidt, Andrew C.; Kim, Giyeon; Le Cook, Benjamin; University of Miami; University of Alabama Tuscaloosa; Harvard University; Cambridge Health AllianceObjectiveThe objective is to apply the Institute of Medicine definition of healthcare disparities in order to compare (1) racial/ethnic disparities in general medical care use among older adults with and without comorbid mental health need and (2) racial/ethnic disparities in general medical care use within the group with comorbid mental health need. MethodsData were obtained from the Medical Expenditure Panel Survey (years 2004-2012). The sample included 21,263 participants aged 65+years (14,973 non-Latino Caucasians, 3530 African-Americans, and 2760 Latinos). Physical illness was determined by having one of the 11 priority chronic health illnesses. Comorbid mental health need was defined as having one of the chronic illnesses plus a Kessler-6 Scale >12, or two-item Patient Health Questionnaire >2. General medical care use refers to receipt of non-mental health specialty care. Two-part generalized linear models were used to estimate and compare general medical care use and expenditures among older adults with and without a comorbid mental health need. ResultsRacial/ethnic disparities in general medical care expenditures were greater among those with comorbid mental health need compared with those without. Among those with comorbid mental health need, non-Latino Caucasians had significantly greater expenditures on prescription drug use than African-Americans and Latinos. ConclusionsExpenditure disparities reflect differences in the amount of resources provided to African-Americans and Latinos compared with non-Latino Caucasians. This is not equivalent to disparities in quality of care. Interventions and policies are needed to ensure that racial/ethnic minority older adults receive equitable services that enable them to manage effectively their comorbid mental and physical health needs. Copyright (c) 2016 John Wiley & Sons, Ltd.Item Limited English Proficiency and Trajectories of Depressive Symptoms Among Mexican American Older Adults(Oxford University Press, 2019) Kim, Giyeon; Kim, Minjung; Park, Soohyun; Jimenez, Daniel E.; Chiriboga, David A.; Chung Ang University; Ohio State University; University of Alabama Tuscaloosa; University of Miami; University of South FloridaBackground and Objectives: This study examined the effect of limited English proficiency (LEP) on trajectories of depressive symptoms among Mexican American older adults in the United States. Research Design and Methods: The sample was drawn from Waves 1 to 6 (1993-2007) of the Hispanic Established Population for Epidemiological Studies of the Elderly (H-EPESE). A total of 2,945 Mexican American older adults were included in the analyses. A latent growth curve modeling was conducted. Results: After adjusting for covariates, results show that Mexican American older adults with LEP had higher levels of depressive symptoms than those with English proficiency (EP) at baseline as well as over a 14-year period. Differential trajectories were observed between those with LEP and EP over time, indicating that those with LEP had a significantly steeper curve of depressive symptom trajectories over time than those with EP. Discussion and Implications: These results suggest that LEP is a risk factor not merely for greater depressive symptomatology at each time point, but for an accelerated trajectory of depressive symptoms over time among Mexican American older adults. Overall, the findings emphasize the need to assist not only the informal support system of Mexican American older adults with LEP, but also the formal system.Item Relationship Between General Illness and Mental Health Service Use and Expenditures Among Racially-Ethnically Diverse Adults >= 65 Years(American Psychiatric Publishing, 2015) Jimenez, Daniel E.; Le Cook, Benjamin; Kim, Giyeon; Reynolds, Charles F., III; Alegria, Margarita; Coe-Odess, Sarah; Bartels, Stephen J.; University of Miami; Harvard University; University of Alabama Tuscaloosa; University of Pittsburgh; Cambridge Health Alliance; Swarthmore College; Dartmouth CollegeObjectives: The association of general medical illness and mental health service use among older adults from racial-ethnic minority groups is an important area of study given the disparities in mental health and general medical services and the low use of mental health services in this population. The purpose of this report is to describe the impact of comorbid general medical illness on mental health service use and expenditures among older adults and to evaluate disparities in mental health service use and expenditures in a racially-ethnically diverse sample of older adults with and without comorbid general medical illness. Methods: Data were obtained from the Medical Expenditure Panel Survey (years 2004-2011). The sample included 1,563 whites, 519 African Americans, and 642 Latinos (N = 2,724) age >= 65 with probable mental illness. Two-part generalized linear models were used to estimate and compare mental health service use among adults with and without a comorbid general medical illness. Results: Mental health service use was more likely for older adults with comorbid general medical illness than for those without it. Once mental health services were accessed, no differences in mental health expenditures were found. Comorbid general medical illness increased the likelihood of mental health service use by older whites and Latinos. However, the presence of comorbidity did not affect racial-ethnic disparities in mental health service use. Conclusions: This study highlighted the important role of comorbid general medical illness as a potential contributor to using mental health services and suggests intervention strategies to enhance engagement in mental health services by older adults from racial-ethnic minority groups.