Try a new search

Format these results:

Searched for:

person:lewisc12

in-biosketch:yes

Total Results:

107


Impact of Telemedicine on Utilization of Psychiatric Resources in New York City during the COVID-19 Pandemic

Ricklan, Sarah J; Sohler, Nancy; Ezie, C E Chiemeka; Avalone, Lynsey; Dinsell, Victoria; Lewis, Crystal; Fattal, Omar; Balan, Sabish; McQuistion, Hunter; Pastore, Frank; Sarcevic, Nermica; Swift, Ronnie; Espejo, Gemma; Lorenz, Carina
This study sought to evaluate the impact of telepsychiatry during the COVID-19 pandemic among patients discharged from psychiatric inpatient units in the New York City Health and Hospitals Corporation system. We compared patients discharged to telepsychiatry (April 2020, n = 739) and in-person follow-up (May 2019, n = 527); we collected number, timing and attendance for follow-up appointments and number and timing of emergency room (ER) visits and readmissions. We used logistic regression to evaluate the odds of having these encounters and Kaplan-Meier analyses to compare time to these encounters. Patients discharged in 2020 were more likely to have a follow-up (29.4 vs. 19.9%, p < 0.001) and an ER visit or readmission (40.5 vs. 28.7%, p < 0.001). Kaplan-Meier analyses showed shorter time to first follow-up (chi-square = 14.69, d.f.=1, p < 0.0001, follow-ups = 322) and ER visit or readmission (chi-square = 19.57, d.f.=1, p < 0.0001, ER visits or admissions = 450) in the 2020 cohort. In multivariable analyses, patients discharged in 2020 were more likely to have a follow-up visit (adjusted OR 1.85, 95% confidence interval 1.40, 2.45, p < 0.0001). We found an increase in psychiatric service utilization during the pandemic, with an increase in and shorter time until outpatient visits and ER visits or readmissions. Although increased use of psychiatric services during the height of the COVID-19 pandemic is encouraging, it also points to the depth of the crisis among vulnerable populations; this pattern warrants further exploration and intervention.
PMID: 38105337
ISSN: 1573-2789
CID: 5612592

The Color of Autonomy: Examining Racial Inequity in Coercive Institutional Practices

Lekas, Helen-Maria; Lewis, Crystal; Bradley, Mark V; Pahl, Kerstin
Two articles recently published in this journal identified racial inequities in routine psychiatric practice. This Open Forum discusses the need for a paradigm shift in inequities research. The two articles reviewed here, one by Shea and colleagues on racial-ethnic inequities in inpatient psychiatric civil commitment and one by Garrett and colleagues on racial-ethnic disparities in psychiatric decisional capacity consultations, are examples of the new research gaze. Four topics are identified for enhancing understanding of racism and other forms of structural exclusion in psychiatric practice: medical authority and power imbalance between providers and patients, involuntary psychiatric commitment and requests for decisional capacity consultations as strategic research events, limited use of theory, and limitations of the literature on psychiatric inequities.
PMID: 37143336
ISSN: 1557-9700
CID: 5521572

Explanations Underlying the Lack of Utility of Diagnostic Depression Scales in Black Americans

Jones, Gerald; Drake, Christin; Lewis, Crystal Fuller
Major depression disorder is one of the most common mental disorders in the United States. However, Black Americans are often underdiagnosed, misdiagnosed, or not treated for depression. Limited research has been conducted on the utility of diagnostic tools in identifying depression in the Black community and could explain lack of research and public health attention to mental illness in this population. Other explanations discussed include greater ability to cope with stressful situations and the myth of the "˜resiliency expectation,"™ social activism and positive health outcomes, and lack of trust in institutions due to structural and interpersonal racism. Further research that provides contextualized results is warranted to better understand and recognize symptoms of depression, and development of more effective treatment modalities. [Psychiatr Ann. 2022;52(12):504-508.].
SCOPUS:85146135254
ISSN: 0048-5713
CID: 5408492

Self-reported anxiety and depression problems and suicide ideation among black and latinx adults and the moderating role of social support

Williams, Sharifa Z; Lewis, Crystal Fuller; Muennig, Peter; Martino, Daniele; Pahl, Kerstin
Suicide is a critical public health problem. Over the past decade, suicide rates have increased among Black and Latinx adults in the U.S. Though depression is the most prevalent psychiatric contributor to suicide risk, Black and Latinx Americans uniquely experience distress and stress (e.g., structural adversity) that can independently operate to worsen suicide risk. This makes it important to investigate non-clinical, subjective assessment of mental health as a predictor of suicide ideation. We also investigate whether social support can buffer the deleterious impact of poor mental health on suicide ideation.We analyzed data from 1,503 Black and Latinx participants of the Washington Heights Community Survey, a 2015 survey of residents of a NYC neighborhood. Multivariable logistic regression was conducted to examine the effect of subjectively experienced problems with anxiety and depression on suicide ideation independent of depression diagnosis, and the role of social support as a moderator.Estimated prevalence of past two-week suicide ideation was 5.8%. Regression estimates showed significantly increased odds of suicide ideation among participants reporting moderate (OR = 8.54,95% CI = 2.44-29.93) and severe (OR = 16.84,95% CI = 2.88-98.46) versus no problems with anxiety and depression, after adjustment for depression diagnosis. Informational support, i.e., having someone to provide good advice in a crisis, reduced the negative impact of moderate levels of anxiety and depression problems on suicide ideation.Findings suggest that among Black and Latinx Americans, subjective feelings of anxiety and depression account for a significant portion of the suicide ideation risk related to poor mental health. Further, social support, particularly informational support, may provide protection against suicide ideation.
PMID: 35921053
ISSN: 1573-3610
CID: 5288082

Examining the Multilevel Barriers to Pharmacy-Based HIV Prevention and Treatment Services

Crawford, Natalie D; Lewis, Crystal F; Moore, Ronnie; Pietradoni, Glen; Weidle, Paul
PMCID:9560970
PMID: 35550478
ISSN: 1537-4521
CID: 5350862

Reckoning with Racism in the Match Process [Editorial]

Drake, Christin; Lewis, Crystal F; Lekas, Helen-Maria
PMCID:9243903
PMID: 35768748
ISSN: 1545-7230
CID: 5281222

A longitudinal pathway from ethnic-racial discrimination to sexual risk behaviors among Black women and Latinas: Ethnic-racial identity exploration as a protective factor

Pahl, Kerstin; Williams, Sharifa Z; Capasso, Ariadna; Lewis, Crystal Fuller; Lekas, Helen Maria
BACKGROUND:Black women and Latinas in their thirties continue to be at risk for HIV transmission via heterosexual intercourse. METHODS:Informed by the Theory of Gender and Power, this study investigated a longitudinal path model linking experiences of ethnic-racial discrimination in late adolescence to sexual risk behaviors in adulthood among 492 Black women and Latinas. We also tested whether ethnic-racial identity exploration served as a resilience asset protecting women against the psychological impact of ethnic-racial discrimination. Survey data from female participants in the Harlem Longitudinal Development Study, which has followed a cohort of New York City Black and Latinx youth since 1990, were analyzed. Data for this analysis were collected at four time points when participants were on average 19, 24, 29, and 32 years of age. Structural equation modeling was used to examine a hypothesized pathway from earlier ethnic-racial discrimination to later sexual risk behaviors and the protective role of ethnic-racial identity exploration. RESULTS:Results confirmed that ethnic-racial discrimination in late adolescence was linked with sexual risk behaviors in the early thirties via increased levels of affective distress in emerging adulthood, experiences of victimization in young adulthood, and substance use in the early thirties among women low in ethnic-racial identity exploration. We also found that ethnic-racial identity served as a resilience asset, as the association between discrimination in late adolescence and affective distress in emerging adulthood was not significant among women with higher levels of ethnic-racial identity exploration. CONCLUSIONS:The results provide important preliminary evidence that ethnic-racial identity exploration may serve as a resilience asset among Black women and Latinas confronting racial discrimination. Further, we suggest that ethnic-racial identity exploration may constitute an important facet of critical consciousness.
PMID: 35637046
ISSN: 1873-5347
CID: 5283392

#BlackLivesMatter to C-L Psychiatrists: Examining Racial Bias in Clinical Management of Behavioral Emergencies in the Inpatient Medical Setting [Meeting Abstract]

Caravella, R A; Ying, P; Ackerman, M; Deutch, A; Siegel, C; Lin, Z; Vaughn, R; Madanes, S; Caroff, A; Storto, M; Polychroniou, P; Lewis, C; Kozikowski, A
Background: CL psychiatrists are uniquely positioned to combat structural racism in medicine Currently, there are no published papers examining racial bias in the management of psychiatric emergencies in the general medical hospital. Given the potential for restrictive clinical interventions that directly challenge a patient's autonomy (including intramuscular injections and restraints), our group embarked on a long-term, quality improvement project to detect and address racial bias affecting the clinical management of these psychiatric emergencies.
Method(s): Our institution has a multidisciplinary behavioral code team known as the Behavioral Emergency Response Team (BERT) that responds to behavioral emergencies throughout the medical hospital. Secondary BERT event data occurring from 2017 to 2020 was combined with demographic data from the electronic medical record. Race and ethnic data were collapsed into unique, phenotypic categories. BERT events were coded based on the most restrictive intervention utilized. Descriptive statistics were used to describe the sample and examine whether race / ethnicity correlated with BERT intervention utilized, diagnostic impression, reason for BERT activation, or recurrent BERTs.
Result(s): Our sample included 1532 BERT events representing N = 902 unique patients. The main interaction of BERT intervention by Race / Ethnic category reached statistical significance (p=0.04). Though most BERTs only required verbal de-escalation (n=419, 46.45%), 3% of BERTs (n = 29) escalated to 4-pt restraints (most restrictive intervention). Though reaching level 5 was rare, Black patients had a statistically significant higher likelihood of receiving this intervention compared with White patients (6% v 2%, p=0.027) and compared with all other non-Black patients (6% v 2%, p=0.040). Although the overall comparison for Race/Ethnicity and the diagnostic impression "Psychosis" did not reach significance (p=0.086), targeted analysis showed that Black patients were significantly more likely to have "Psychosis" listed as a contributing factor compared with White patients (p=0.009) and all other non-Black patients (p=0.016). Several other comparisons with Race / Ethnic category reached statistical significance: Age (p=0.048), and need for interpreter yes/no (p<0.001). Closer examination of the interaction of Race/Ethnicity x Need for Interpreter revealed that half of events involving Asian patients (n=22, 53.66%) and a third of events involving Hispanic patients (n=29, 30.53%) required interpreter services.
Discussion(s): This study demonstrates the feasibility of investigating racial bias in behavioral emergency management. The results of this preliminary analysis suggest multiple areas for enhanced education, self-awareness development, and programmatic improvement to target systemic racism, decrease racial bias, and improve patient care. These areas include bias in restraints use, the role of language in behavioral emergencies, and the influence of race on perception of underlying diagnosis.
Copyright
EMBASE:2019334423
ISSN: 2667-2960
CID: 5291782

Scaling opioid overdose prevention and naloxone dispensation among rural and small metro area pharmacists: findings from a qualitative study

Tofighi, Babak; Martino, Daniele; Lekas, Helen Maria; Williams, Sharifa Z.; Blau, Chloe; Lewis, Crystal F.
Background: Community pharmacies offer a population-wide approach to scale opioid overdose prevention programs (OOPP). This qualitative study identified factors influencing implementation of New York State"™s OOPP to inform the uptake of naloxone dispensation in rural and small metro area pharmacies. Methods: In-person interviews were conducted among licensed retail, independent, or supermarket pharmacists (n = 60) in the mid-Hudson valley area of New York in high- and medium-overdose regions. The semi-structured 29-item survey captured attitudes and experiences related to pharmacy participation in naloxone dispensation. Results: Data revealed pharmacist support for naloxone dispensation. Barriers to OOPP success included: (1) Insufficient retail pharmacy leadership support for administrative and clinical tasks for OOPP tasks; (2) excessive opioid analgesic prescribing by physicians; (3) limited uptake of naloxone by prescribers and patients; (4) out-of-pocket costs for patients to obtain naloxone; (5) lack of time, staffing, and space to provide opioid overdose prevention counseling; (6) concern for increased overdose fatalities and injection drug use in the pharmacy premises if pharmacists dispensed sterile syringes, naloxone, and/or Buprenorphine-naloxone; and (7) stigmatizing attitudes toward persons who use opioids. Conclusion: Multi-level intervention efforts that include pharmacist-prescriber communication and training, and stigma-reducing efforts in rural and small metro area regions are needed.
SCOPUS:85132650555
ISSN: 1465-9891
CID: 5315292

Internet use and uptake of a web-based prevention and risk reduction intervention for persons who use drugs in New York City - WebHealth4Us study (2013-2016)

Lewis, Crystal Fuller; Williams, Sharifa Z; Tofighi, Babak; Lekas, Helen-Maria; Joseph, Adriana; Rivera, Alexis; Amesty, Silvia C
PMID: 35499405
ISSN: 1547-0164
CID: 5215862