• Behavioral Health among Foreign-Born and U.S.-Born Emerging Adults: Barriers to Seeking Services, College Enrollment Status, and Service Utilization

      Bessaha, Melissa; Cornelius, Llewellyn Joseph, 1959-; Unick, George Jay (2016)
      Behavioral health problems are a leading cause of disability and a major public health issue in the United States. Compared to other adult age groups, emerging adults aged 18 to 29 experience more behavioral health problems. Although transitioning to adulthood may provide growth opportunities, it can also be a time of increased vulnerability and risk as emerging adults often face challenges in emotional, educational, and professional transitions. The United States has also seen rapid growth in the foreign-born emerging adult population as well as growing health disparities among immigrant and minority groups; however, prior research investigating behavioral health service use of emerging adults has largely been limited to homogeneous samples of college students. Using the Behavioral Model for Vulnerable Populations, this study explored factors associated with patterns of behavioral health service use across a diverse national sample of emerging adults by nativity status (foreign-born, U.S.-born) and college enrollment status (college student, non- student). A subsample of 6,696 emerging adults from the 2012 Agency for Healthcare Research and Quality Medical Expansion Panel Study was used for this study. Multiple hierarchical binomial logistic regression analyses were performed to determine which factors predicted patterns of behavioral health service use among emerging adult groups. Employed (foreign-born) and Black (all groups except foreign-born) emerging adults were less likely to use services compared to unemployed and White emerging adults, respectively. Preference for English language (non-college students), shorter duration in the United States (college students), and having insurance (all groups except foreign-born) was associated with service use. Those with middle and high income backgrounds (college students) were less likely to use services compared to poor students. Having higher perceived mental health status (all groups except college students) and higher general mental health status (all groups) predicted less service use. Although certain factors were consistently predictive of service use among emerging adult groups, there were differences that necessitate further research. Findings clearly portray the need for greater awareness and consideration of factors related to service use on healthcare policy and higher education program initiatives especially as they relate to promoting health equity and successful transition to adulthood.
    • Differential item functioning of pathological gambling criteria: an examination of gender, race/ethnicity, and age

      Sacco, Paul; Unick, George Jay; Torres, Luis R., Ph.D.; Cunningham-Williams, Renee M.; Woods, Carol M. (2011-06)
      This study tested for the presence of differential item functioning (DIF) in DSM-IV Pathological Gambling Disorder (PGD) criteria based on gender, race/ethnicity and age. Using a nationally representative sample of adults from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), indicating current gambling (n = 10,899), Multiple Indicator-Multiple Cause (MIMIC) models tested for DIF, controlling for income, education, and marital status. Compared to the reference groups (i.e., Male, Caucasian, and ages 25-59 years), women (OR = 0.62; P < .001) and Asian Americans (OR = 0.33; P < .001) were less likely to endorse preoccupation (Criterion 1). Women were more likely to endorse gambling to escape (Criterion 5) (OR = 2.22; P < .001) but young adults (OR = 0.62; P < .05) were less likely to endorse it. African Americans (OR = 2.50; P < .001) and Hispanics were more likely to endorse trying to cut back (Criterion 3) (OR = 2.01; P < .01). African Americans were more likely to endorse the suffering losses (OR = 2.27; P < .01) criterion. Young adults were more likely to endorse chasing losses (Criterion 9) (OR = 1.81; P < .01) while older adults were less likely to endorse this criterion (OR = 0.76; P < .05). Further research is needed to identify factors contributing to DIF, address criteria level bias, and examine differential test functioning.
    • Factors affecting psychiatric inpatient hospitalization from a psychiatric emergency service

      Unick, George Jay; Kessell, Eric; Woodard, Eric K.; Leary, Mark, 1955-; Dilley, James W., 1951-; Shumway, Martha (2011-11)
      OBJECTIVE: As a gateway to the mental health system, psychiatric emergency services (PES) are charged with assessing a heterogeneous array of short-term and long-term psychiatric crises. However, few studies have examined factors associated with inpatient psychiatric hospitalization following PES in a racially diverse sample. We examine the demographic, service use and clinical factors associated with inpatient hospitalization and differences in predisposing factors by race and ethnicity. METHOD: Three months of consecutive admissions to San Francisco's only 24-h PES (N = 1,305) were reviewed. Logistic regression was used to estimate the associations between demographic, service use, and clinical factors and inpatient psychiatric hospitalization. We then estimated separate models for Asians, Blacks, Latinos and Whites. RESULTS: Clinical severity was a consistent predictor of hospitalization. However, age, gender, race/ethnicity, homelessness and employment status were all significant related to hospitalization. Alcohol and drug use were associated with lower probability of inpatient admission, however specific substances appear particularly salient for different racial/ethnic groups. DISCUSSION: While clinical characteristics played an essential role in disposition decisions, these results point to the importance of factors external to PES. Individual and community factors that affect use of psychiatric emergency services merit additional focused attention.
    • Heterogeneity in Comorbidity between Major Depressive Disorder and Generalized Anxiety Disorder and its Clinical Consequences

      Unick, George Jay; Snowden, Lonnie R., 1947-; Hastings, Julia, Ph.D. (2009-04)
      Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are highly comorbid and, as diagnoses, problematic because they are heterogeneous, may impair functioning even in subclinical manifestations, and may not predict important external criteria as well as empirically-derived classifications. The present study employed a latent class analysis using data from National Comorbidity Survey (1990-1992) and focused on respondents who endorsed at least 1 screening question for MDD and 1 for GAD (N = 1009). Results revealed 4 symptom domains (somatic anxiety, somatic depression, psychological anxiety, and psychological depression) reflecting the heterogeneity of MDD and GAD, and 7 respondent classes. Analysis revealed that people in classes with a high prevalence of either somatic anxiety or somatic depression symptoms presented with the highest levels of disability, distress, and service utilization. Evidence also was found for clinically meaningful subthreshold comorbid conditions. Anxiety-related and depression-related symptoms can be meaningfully differentiated, but differentiating between somatic and psychological symptoms has the greatest practical significance.
    • Impact of South American heroin on the US heroin market 1993-2004

      Ciccarone, Daniel; Unick, George Jay; Kraus, Allison (2009-09)
      BACKGROUND: The past two decades have seen an increase in heroin-related morbidity and mortality in the United States. We report on trends in US heroin retail price and purity, including the effect of entry of Colombian-sourced heroin on the US heroin market. METHODS: The average standardized price ($/mg-pure) and purity (% by weight) of heroin from 1993 to 2004 was from obtained from US Drug Enforcement Agency retail purchase data for 20 metropolitan statistical areas. Univariate statistics, robust Ordinary Least Squares regression and mixed fixed and random effect growth curve models were used to predict the price and purity data in each metropolitan statistical area over time. RESULTS: Over the 12 study years, heroin price decreased 62%. The median percentage of all heroin samples that are of South American origin increased an absolute 7% per year. Multivariate models suggest percent South American heroin is a significant predictor of lower heroin price and higher purity adjusting for time and demographics. CONCLUSION: These analyses reveal trends to historically low-cost heroin in many US cities. These changes correspond to the entrance into and rapid domination of the US heroin market by Colombian-sourced heroin. The implications of these changes are discussed.
    • Linking Heroin Price and Heroin Overdose

      Unick, George Jay; Ciccarone, Daniel; Rosenblum, Dan (2012)
      PowerPoint presentation of a study to determine the relationship between the changing price of heroin and the number of heroin overdoses in the United States.
    • Longitudinal Outcomes for Community Mental Health System Clients Diagnosed with Schizophrenia

      Unick, George Jay; Madoff, Debrah; Santoni, Tim; Harring, Jeffrey, 1964- (2012)
      PowerPoint presentation hightlighting the results of a study of Maryland community mental health services outcomes for clients diagnosed with schizophrenia.
    • Maryland's First Unaccompanied Homeless Youth & Young Adult Count: Findings from Youth REACH MD Phase 2

      Shannahan, Ryan; Harburger, Deborah Sarah; Unick, George Jay; Greeno, Elizabeth J.; Shaw, Terry V. (University of Maryland, Baltimore. School of Social Work. Institute for Innovation & Implementation, 2016-05)
      Every night in Maryland, thousands of youth and young adults living on their own turn to their a friend's couch, a stranger's house, a vacant building, the street, or some other tenuous or unsuitable location for a place to sleep. These are unaccompanied homeless youth - youth or young adults under 25 years old who are not in the care of their parents or guardians and lack access to safe, adequate, and reliable housing. We know these youth are individuals with their own stories and experiences and that they are not defined by their housing status. This report—and all of the work of Youth REACH MD—is designed to identify the common challenges and barriers that result in youth and young adults experiencing homelessness in order to end youth homelessness. No finding, statement, or analysis in this report should be taken to diminish the importance of the voices of youth and young adults or to minimize the individual experiences, preferences, and vision for the future that each youth and young adult has for themselves. This report reflects the aggregate findings regarding a diverse population of youth and young adults who were willing share of themselves by participating in this survey, and we are grateful to them for sharing their stories and experiences with us and for helping us to gain new and deeper understanding of what it means to experience homelessness.
    • Multilevel Analysis of the Relationship between Maternal Depression and Medication Adherence in Urban, African-American Children with High-Risk Asthma

      Margolis, Rachel H.F.; Bellin, Melissa; Tsoukleris, Mona; Unick, George Jay; Kub, Joan E.; Butz, Arlene (2019-11)
    • Trends in Opiate-Related Overdose Admissions in a Nationally Representative Sample of US Hospitals: 1993-2007

      Unick, George Jay; Rosenblum, Dan; Tseng, Wendy; Ciccarone, Daniel (2011)
      PowerPoint presentation highlighting changes in demographics for opiate overdoses from 1993 through 2007. Included are data on age, gender, race, rural versus urban hospital admissions, and heroin versus prescription opiate use.