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Difficulty in Access to Outpatient Mental Health Care in Boston Has National Implications

A new study finds that access to outpatient psychiatric care in the greater Boston area is severely limited, even for people with reputedly excellent private health insurance. Given that the federal health law is modeled after the Massachusetts health reform, the findings have national implications, the researchers say.

Study personnel posed as patients insured by Blue Cross Blue Shield of Massachusetts PPO, the largest insurer in Massachusetts. They called every Blue Cross-contracted mental health facility within a 10-mile radius of downtown Boston, stating they had been evaluated in an emergency department for depression and discharged with instructions to obtain a psychiatric appointment within two weeks, signaling that they needed urgent care.

Only eight of the 64 facilities (12.5 percent) listed by Blue Cross as preferred providers offered appointments; only four (6.2 percent) offered an appointment within two weeks. 

According to the study, 23 percent of phone calls seeking appointments were never returned, even after a second attempt. Another common reason appointments were unavailable was that 23 percent of psychiatric providers required that the patient already be enrolled with a primary-care doctor affiliated with their psychiatric facility.

“People with mental health problems often can’t advocate for themselves—especially in a crisis,” said lead author Dr. J. Wesley Boyd, an attending psychiatrist at the Harvard-affiliated Cambridge Health Alliance. “Health insurers know this and yet, thanks to their restrictive provider networks and their low reimbursement rates for psychiatric services, they’ve created a situation where a patient with a potentially life-threatening disorder, such as the severe depression portrayed in our callers’ scenario, is essentially abandoned at a time of great need.”

Source. Article citation: “The crisis in mental health care: A preliminary study of access to psychiatric care in Boston,” J. Wesley Boyd, MD, PhD, et. al, Annals of Emergency Medicine, July 21, 2011.

Public Pressure Affects Accuracy of Suicide Reporting

Medical examiners and appointed coroners are less likely to underreport suicides than are elected coroners, according to a new study from Temple University.

Suicides are commonly explained by the mental and emotional health of the individual. However, because suicides tend to cluster in specific populations and places, sociologists are interested in how social contexts can affect a person’s propensity to commit suicide.

To examine those social contexts, researched set out to answer the question: “Does the type of office responsible for reporting on deaths impact the suicide rates, potentially biasing estimates of the social causes of suicide, such as income or divorce rates?”

To answer that question, researchers analyzed reported suicide rates in counties with elected coroners, appointed coroners, and appointed medical examiners. They found that elected coroners report slightly lower official suicide rates than medical examiners (all of whom are appointed) and appointed coroners.

“Medical examiners and appointed coroners demonstrate less suicide underreporting due to their insulation from public pressure,” the researchers conclude.


World Suicide Prevention Day …

… is Sept. 10, as it is every year. Events and activities held on Sept. 10 raise awareness that suicide is a major preventable cause of premature death. World Suicide Prevention Day also promotes worldwide action to prevent suicides.

High Social Rank Comes at a Price, Researchers Find

Being at the very top of a social hierarchy has its rewards, but the elevated position may also come with higher stress. A new study has found that in wild baboon populations, the highest-ranking, or alpha, males have higher stress-hormone levels than the highly ranked males below them, known as beta males—even during periods of stability. 

The findings have implications for the study of social hierarchies as well as on the impact of social dominance on health and well-being, in both human and other animal populations.

Researchers measured levels of a stress hormone called glucocorticoid and testosterone in fecal samples over a period of nine years. The data collected in the study is five to 10 times greater in duration, number of groups, and number of individual males than any data previously available for any non-human primate. This allowed researchers to control for important variables that might have affected stress hormones, said Laurence Gesquiere, an associate research scholar in Princeton’s Department of Ecology and Evolutionary Biology. 

Gesquiere also noted “Baboons are not only genetically closely related to humans, but like humans they live in highly complex societies.”

The researchers pointed out that the baboons’ heightened stress levels are most likely based on the energy they must expend to maintain their social position, rather than on psychological factors. 

For instance, alpha males are involved in a higher rate of fighting and mate-guarding than beta males. They do not differ, however, in the rate of challenges to their status, which is considered a psychological stressor, or in the amount of grooming they receive from adult and juvenile females, which is a measure of psychological support.

Source: Excerpted from a July 14 article by Nick DiUlio. The article about the study, “Life at the Top: Rank and Stress in Wild Male Baboons,” was published in the July 15 issue of Science, (Vol. 333 no. 6040, pp. 357-360).

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