Literature Collection

Social workers play an important role in assessing social determinants of health (SDH) and providing behavioral health services in integrated care settings. Evidence suggests that integrated care interventions improve quality of life and other patient outcomes. However, the ambiguous role of social workers on the interdisciplinary team, the lack of protocol in SDH screening and intervention, and restrictions due to healthcare reimbursement limit social workers' ability to intervene. Future directions include standardizing integrated care models, evaluating integrated care's efficacy to address SDH, incorporating SDH into interprofessional training including role clarification and reimbursing for SDH assessment and intervention.

BACKGROUND: Depression is highly prevalent among people with HIV (PWH), and treatment is critical. We examined associations between sociodemographic and clinical characteristics, focusing on alcohol use and smoking, with use of depression treatment. METHODS: Electronic health record data from an integrated healthcare system in Northern California were used to identify PWH who had a primary care visit (index) between 1/1/2014-12/31/2020 and a depression diagnosis within 6 months of the index date. Outcomes included separate indicators for outpatient mental health (MH) encounters and antidepressant prescription fills in the year post index. RESULTS: Among 3078 PWH, 24.7 % (761) had a depression diagnosis; of those, 52.6 % were aged 50+, 10.5 % female, 56.1 % White, 36.4 % reported alcohol use in the past 3 months and 18.7 % reported current smoking. Seventy-six percent used depression treatment services (antidepressants [68 %] and outpatient MH [35 %]). Patients aged 50-59 years (OR = 0.52, CI = 0.34, 0.80) and 60+ years (OR = 0.27, CI = 0.14, 0.50) were less likely to have outpatient MH encounters compared to patients ≤40 years. Compared to White patients, Black (OR = 0.37, CI = 0.23, 0.59) and Hispanic (OR = 0.48, CI = 0.31, 0.75) patients were less likely to have antidepressant prescription fills, and Black (OR = 0.47, CI = 0.28, 0.77), Hispanic (OR = 0.58, CI = 0.35, 0.94) and Asian (OR = 0.48, CI = 0.25, 0.93) patients were less likely to use any depression treatment. Neither alcohol use nor smoking were associated with depression treatment. CONCLUSIONS: We found substantial demographic disparities in use of depression treatment services among PWH and depression. Facilitating access to mental health care for older and racial and ethnic minority patients should be prioritized.

OBJECTIVE: We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic. METHODS: This population-based repeated cross-sectional study of children and adolescents (3-17 years; N = 2.5 million) used linked health and demographic administrative data in Ontario, Canada (2017-2021). Multivariable Poisson regressions with generalized estimating equations compared rates of outpatient physician-based mental healthcare use during the first year of the COVID-19 pandemic with expected rates based on pre-COVID patterns. Analyses were conducted by socioeconomic status (material deprivation quintiles of the Ontario Marginalization index), urban/rural region of residence, and immigration status. RESULTS: Overall, pediatric physician-based mental healthcare visits were 5% lower than expected (rate ratio [RR] = 0.95, 95% confidence interval [CI], 0.92 to 0.98) among those living in the most deprived areas in the first year of the pandemic, compared with the least deprived with 4% higher than expected rates (RR = 1.04, 95% CI, 1.02 to 1.06). There were no differences in overall observed and expected visit rates by region of residence. Immigrants had 14% to 26% higher visit rates compared with expected from July 2020 to February 2021, whereas refugees had similarly observed and expected rates. Virtual care use was approximately 65% among refugees, compared with 70% for all strata. CONCLUSION: During the first year of the pandemic, pediatric physician-based mental healthcare utilization was higher among immigrants and lower than expected among those with lower socioeconomic status. Refugees had the lowest use of virtual care. Further work is needed to understand whether these differences reflect issues in access to care or the need to help inform ongoing pandemic recovery planning.