Assigment 6 modules reflexion 2-3 pages.Apa seven . All instructions attached.

Foundations of Population Health

Introduction to Case Reports

Case reports were designed to provide you with an opportunity to consider how the population health strategies you learned during the training module can be applied to different population health issues. Two case reports were created: 1) Depression and Suicide in LGBTQI Populations and 2) Infant Mortality. The depression and suicide in LGBTQI populations module is split into different sections so that you can review each section after you complete the corresponding training module. After completing all 6 training modules, you can review the second case report on infant mortality, to help solidify how the different population health strategies can be applied.

Each section of the case report is structured the same way. The section first provides pertinent background information followed by a reflection question. The reflection question asks you to consider, based on the background information, how you could apply the content you learned in the corresponding population health module. All sections conclude by providing considerations (possible answers to the reflection question) to help you solidify knowledge about how the content can be applied. Each section builds upon prior sections; you can always go back to access previous content if you want to review.

Please note that though the cases are fictional and not based on any existing state, county or community, the background information highlighting the scope of the problem is based on evidence. Citations are provided after the final case report section to designate the evidence.

Population Health Training

Module

1

Case Report #1: Depression and Suicide in LGBTQI Populations

Module 1. Social Determinants of Health

1A) Background:

Depression is a mood disorder that is characterized by feelings of sadness, hopelessness, loss of interest in activities that were previously

enjoyable, and physical symptoms including fatigue, headaches, and other pains

Foundations of Population Health

Module 1: Case Report | 2

(CDC, 2021). According to the Diagnostic and Statistical Manual of Mental Disorders, Version 5 (DSM-5), to make a diagnosis of depression, an individual must experience a depressed mood or loss of interest or pleasure, in addition to at least four of the following symptoms within a two-week period: significant changes in weight (either weight loss or weight gain) or appetite; significant sleep changes; fatigue or loss of energy; feelings of excessive or inappropriate guilt or worthlessness; a slowing down of thoughts and physical movements observable by others; concentration difficulty; or recurrent thoughts of death or feelings of hopelessness ( American Psychiatric Association, 2013).

In 2016, 23% of adults in the United States had a diagnosis of depression, the highest amount compared to ten other high-income countries around the world (The Commonwealth Fund, 2020). In 2017, 7.1% of American adults, or 17.3 million adults, experienced at least one major depressive episode, with 8.7% of adult females experiencing a major depressive episode compared to 5.3% of males (see Figure 1; National Institute of Mental Health [NIMH], n.d.-

a). The highest prevalence of a major depressive episode was in adults aged 18-25, and for adults who reported identifying with two or more races (NIMH, n.d.-a). Race is a social construct that should not be considered a causal factor in explaining depression rate variability. Racism, perpetuated by institutional, political, and societal factors, drives the differential rates of depression.

Figure 1. The highest prevalence of depression observed in adult females, those aged 18-25 years, and those identifying with two or more races.

Source: NIMH, n.d.-a.

Suicidal thoughts, plans, or attempts are the most serious and lethal consequences of major depressive disorder. Suicide is defined as death by self-inflicted injury with the intent to die and was the tenth-leading cause of death in the United States in 2019 (NIMH, n.d.-b). Suicide rates have increased across the nation in the last 20 years (Office of Disease Prevention and Health Promotion [ODPHP], n.d.-c). In 2018, 14.2 suicides occurred per 100,000 individuals, and in 2019, 4.8% of adults aged 18 years or older reported serious thoughts about suicide (NIMH, n.d.-b).

Figure 2. Suicidal thoughts were highest among those aged 18-

25 years and

those 18 years or older reporting backgrounds of two or more races.

Source: NIMH, n.d.-b.

Rates of major depression and suicidal thoughts are particularly high among LGBTQI (lesbian, gay, bisexual, transgender, queer/questioning, intersex) populations living in urban areas (Haas et al., 2011). In 2015, one in three LGBTQI adults experienced a mental illness compared to only one in five of their heterosexual counterparts (Human Rights Campaign, n.d.). In 2017, 58.5% of sexual minorities in 9th to 12th grade reported experiencing suicidal ideation in the last 12 months (ODPHP, n.d.-b). In a national study of US adults, 40% of transgender adults reported attempting suicide, with 92% of those attempting before the age of 25 (The Trevor Project, n.d.). Individuals in the LGBTQI community were 75% were more likely to plan suicide, 92% more likely to contemplate suicide, and 88% were

Use of LGBTQI

LGBTQI is an umbrella term referring to sexual and gender identities. Each letter represents a unique sexual or gender identity. Use of this umbrella term should not be construed as equating all minoritized sexual and gender identity individuals, since there is variability in experiences, both across and within different sexual and gender identities.

more likely to attempt suicide compared to heterosexual individuals (The Williams Institute, 2020).

Since the onset of the COVID-19 pandemic in 2020, rates of depressive symptoms have increased significantly (Ettman et al., 2020), with rates of suicide largely remaining the same (Appleby, 2021). Physical distancing restrictions that were implemented during the COVID-19

pandemic limited physical movement and connections for both pleasure and work, resulting in a significant mental health crisis.

The rise in the mental health crisis further overloads the already insufficient infrastructure that exists to connect LGBTQI populations to mental health services in urban areas. The current healthcare system lacks robust referral processes across healthcare settings for LGBTQI populations, resulting in a lack of appropriate referrals and difficulties accessing mental health treatment. Primary care visits make up approximately 54.5% of physician office visits each year (National Center for Health Statistics, 202 1) and offer an opportunity for individuals to receive referrals to specialty care. In 2016, approximately, 8.5% of primary care offices regularly screened for depressive symptoms in individuals 12 years of age and older (ODPHP, n.d.-a).

Healthy People 2030 aims to increase the proportion of primary care office visits where adults are screened for depression, as research suggests that depression symptoms may improve in adults if they are screened during their primary care office visits (ODPHP, n.d.-a). Healthy People 2030’s target is to increase depression screenings from 8.5% to 13.5%. In conjunction with this, Healthy People 2030 aims to increase the proportion of adults with major depressive episodes who receive treatment through medication and/or talk therapy (e.g., cognitive behavioral therapy) from 64.8%, as of 2018, to 69.5% (ODPHP, n.d.-a). Specific to LGBTQI populations, Healthy People 2030 also aims to reduce suicide rates and suicidal thoughts among LGBTQI high school students from 58.2% to 52.1% (ODPHP, n.d.-b).

1B) Reflection Question:

City C, a large city in the Midwest, reported depression rates at 20% among LGBTQI adults in 2017, higher than the national average, and they reported suicide rates at 25 suicides per 100,000 adults. What social determinants of health might contribute to an LGBTQI individual’s ability to gain access to mental health services in City C, given the challenges that exist with seeking healthcare as a member of this population? Consider social determinants connected to the six main categories reviewed in Module 1: economic stability, neighborhood/physical environment, education, food, community/social content, and the healthcare system.

1C) Considerations:

Consider the following social determinants of health that could contribute to the LGBTQI health disparities observed in City C.

Economic stability

· In City C, those who identify as LGBTQI are less likely to have health insurance compared to those who do not identify as LGBTQI.

Neighborhood/physical environment

· The public transportation in City C is underdeveloped and unreliable, making it difficult to attend appointments.

· Rent prices and the cost of owning a home is high in City C, resulting in economic stress that may further exacerbate symptoms of depression (e.g., helplessness, hopelessness).

Education

· City C does not have money allocated in their budget for risk assessment and crisis management training for first responders and law enforcement, unlike other large cities in the Midwest. Because City C lacks a budget to provide risk assessment training for first responders and law enforcement, they lack the necessary skills and education to appropriately handle cases where individuals have suicidal thoughts.

· Training in providing LGBTQI affirming care is limited at the local health professions universities.

Food

· The cost of food in City C has risen in the last 10 years, resulting in consumption of less nutritious food that can impact risk of developing a physical health condition, which could increase risk for depression, or worsen depressive symptoms like fatigue/lack of energy.

· Grocery stores are located in wealthier parts of City C. Food deserts are highly prevalent, forcing many residents living in poorer neighborhoods to rely on liquor and convenience stores for their groceries.

Community/social context

· Not all neighborhoods in City C are welcoming towards LGBTQI individuals. Some religious institutions have been vocal about not welcoming LGBTQI individuals in their places of worship.

· There are limited community spaces where LGBTQI individuals can gather together comfortably.

Healthcare system

· Mental health clinics in City C are concentrated in a few locations in the city, making it difficult to access mental health care depending on where patients live.

· Mental health clinics have been experiencing an influx in referrals given the COVID-19 pandemic and waitlists continue to grow, further exacerbating access to mental health care.

· Some of the major healthcare systems in City C do not provide routine training in LGBTQI affirming care. Without proper training, the care of those who identify as LGBTQI may suffer and ultimately limit their access to the healthcare system.

· In a recent survey conducted by one of the city’s health systems, 50% of LGBTQI individuals reported mentioning mental health symptoms (e.g., low mood, sadness, passive thoughts of suicide) to their primary care physician. However, only 12% of patients reported leaving with a referral to a mental health provider. Primary care providers lack the knowledge and resources to make appropriate referrals in City C.

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