Background: Stroke remains a major public health burden. Few studies have focused on the age differences in the associations of behavioral and psychosocial factors with stroke while no study focusing on the effect of severe psychological distress (SPD) on stroke has been conducted. The aim of this study was to examine the age differences in these risk factors for stroke as young (18-44 years), middle aged (45-64 years), and elderly (65 years or older). Methods: A total of 1,258 adults with stroke and 39,985 controls were selected from the 2005 California Health Interview Survey. Multiple logistic regression analyses were used to estimate the associations of the factors with stroke at different ages. Results: The prevalence of SPD was 10% in cases and 3.6% in controls, respectively. Overall, current smoking, lack of physical activity, alcohol consumption, SPD, type II diabetes, male, older age, and unemployment were all associated with a higher prevalence of stroke. Practically, we found that smoking and SPD were associated with the prevalence of stroke in young adults, lack of physical activity was associated with the prevalence of stroke in middle-aged adults, and lack of physical activity and SPD were associated with the prevalence of stroke in the elderly. Conclusions: Appropriate intervention for reducing stroke and eliminating its disparities may be developed separately at each age.

No description available.

Objective: To estimate the prevalence of mental health service use among US adults, examine the associations of mental health service use with health insurance coverage, mental health problems and drug use, and detect health disparities. Methods: This was a cross-sectional study with 5,434 adults receiving mental health service out of 37,424 adult respondents from the 2013 National Survey on Drug Use and Health. Weighted univariate and multiple logistic regression analyses were used to estimate the associations of potential factors with mental health service use. Results: The overall prevalence of mental health services use was 14.7%. Our results showed that being female, aging, having a major depressive episode, serious psychological distress, and illicit drug or alcohol abuse/dependence were positively associated with mental health service use; whereas being African American, Asian or Hispanic ethnicity, married, and having any form of insurance were negatively associated with mental health service use. Stratified analysis by insurance types showed that Medicaid/CHIP, CHAMPUS, and other insurance were positively associated with mental health service use. Conclusions: Health insurance coverage, mental health problems, and drug abuse or dependence were associated with mental health service use in US adults. Furthermore, adults with different insurances had disparities in access of mental health service.

No description available.

In Colorado in 2014, suicidal ideation or suicide attempts occurred up to 10 times more frequently among transgender persons than the general population. This reality occurred within a milieu of stigma that included transgender persons' negative perceptions of healthcare, a higher incidence of psychological distress, and an uncertain role for social isolation in their well-being. The purpose of this quantitative study was to explore the interactions between social isolation, supportive medical care, and psychological distress within the framework of Meyer's minority stress theory. Data were acquired from the 2014 Colorado Transgender Health Survey conducted by the One Colorado Education Fund (n = 417). These survey data were analyzed using multivariate techniques and structural equation modeling. Key findings were that psychological health and social integration were positively related (p < .001), supportive medical care and psychological health were positively related (p = .016) and influenced by race and gender identity (p = .05), and, social integration and supportive medical care were not significantly associated. Access to medical care and disease history influenced these relationships (p < .001), and 5 distinct gender identity/race groups emerged. The positive social change implications stemming from this study include recommendations for healthcare and policy-making bodies to improve understanding regarding gender and racial disparities in medical and psychological healthcare, to expand collection of gender identity and victimization data, to improve availability of adequate insurance coverage, and, to foster employment and housing equity. Implementation of these recommendations may improve the lives of transgender Coloradans.

No description available.

The goal of this thesis is to explore the mechanisms underlying the association between women's experiences of child sexual abuse (CSA) and substance use in adulthood. Specifically, I evaluated the role of CSA, adult sexual victimization (ASA), and psychological distress including symptoms of depression, perceived stress, and PTSD on substance use. Research has shown that individuals who experience CSA are more likely to experience ASA, which results in psychological distress. Individuals may engage in substance use to cope with psychological distress from CSA and ASA, consistent with the self-medication hypothesis. Women (N = 225) were recruited from Mechanical Turk (MTurk) and completed an online survey. Results indicate positive correlations between CSA, ASA, psychological distress, problem drinking, and drug use. Further, there was an indirect effect of CSA on substance use through ASA, but not psychological distress. Results highlight the importance of trauma informed care for women's psychological distress and problem substance use.

Stigma is a multi-facetted construct that permeates the daily lives of sexual minorities including perceptions of self and social interactions. While research findings are ubiquitous on the negative mental health outcomes of living with a stigmatized identity (Link & Phelan, 2001), little is known about how perceived stigma may influence relationship satisfaction among sexual minorities. The present study investigated the relationship between perceived stigma and relationship satisfaction and whether psychological distress served as a mediating mechanism. Furthermore, a unique aspect of this study is its examination of multiple domains of stigma. Results indicated that sexual minorities experienced more perceived discrimination, public stigma, and self-stigma than heterosexuals as well as were less out about their sexuality. Main results did not support psychological distress as mediator but did reveal that self-stigma was significantly related to decreased relationship satisfaction among sexual minorities. Future research should focus on further elucidating the relationship between self-stigma and relationship satisfaction.

Since European settlers arrived to the United States (U.S.), American Indians (AI) have been separate and unequal members of society. After a long history of discrimination, ethnocide, genocide, and distrust, the AI have become a population with severe disparities, having the highest rates of diabetes, depression, suicide, tuberculosis, and alcoholism than any other minority or majority population in the U.S. The author's purpose for conducting this study was to explore a possible relationship between depression or psychological distress and diabetes in AI women. AI women are the most under studied group in the country; therefore, a secondary analysis of the large established California Health Interview Survey (CHIS) was done. The sample used 1,110 self-identified AI women's data. Even though the literature shows that the AI have the highest rates of diabetes and depression of any population, this analysis revealed no statistically significant relationship between the two diseases. It did reveal many limitations and implications associated with the use of such large databases for the AI woman. Among the limitations were the survey itself, its administration to the AI population, guidelines for self-identifying as AI, and the researcher's limited access to the data. The implications of this study are significant. Large databases provide the basis for social and political decisions such as allocation of federal dollars for health care. Healthcare and health care services are designed according to the health burden of specific populations. If these databases are in error, or not representative of the true population, healthcare decisions will not reflect the true health care needs of the population. The inadequacies of large databases results in less funding, leading to less quality health care, and an increase in AI health disparities. Further research is needed to determine the actual health burden depression and diabetes place on the AI woman.

A gap in the literature exists on the connection between an individual's career and non-career domains. Even less research exists on the topic of career development and how it relates to an individual's mental health. Accordingly, this study sought to investigate the connection between career issues and mental health by exploring the psychological distress levels of students enrolled in a career exploration course. During the course, students completed a bi-weekly online survey, the Outcome Questionnaire (OQ-45). Results support the possible connection between career issues and mental health and also show that for certain populations, career guidance interventions may decrease an individual's psychological distress.