Gender and Ethnic Medicine Project: Mental Health

Video 3: Click the picture above to see Drs Schindler and Yeh discuss Mental Health issues related to Gender, Ethnicity, and more...

NEW: You might subscribe to the GEM discussions in iTunes, and listen to them on your iPod

I. Explain sex, gender and ethnic differences in normal development & pathophysio-logy as they apply to the prevention & management of diseases

Objectives

References

Integration-what & where

What we currently cover

Compare and contrast adolescent sexuality in females and males. Compare and contrast differences in ethnic groups, where appropriate.

MD

Describe the physical and psychological causes of sexual dysfunctions. Describe any ethnic differences in this area.

MD, GME

Compare sexual attitudes and behaviors in women and men across the lifespan, including any ethnic differences.

MD, GME

Discuss sex and gender differences in the etiology and presentation of mood disorders, including bipolar disorder and depression. Also address any ethnic differences or disparities

MD, GME, CME

Describe sex and gender differences in the incidence and presentation of personality disorders. Also address any ethnic differences or disparities.

MD, GME, CME

Specify sex differences in the etiology, symptoms, signs, and treatment of alcohol and substance abuse.  Also specify any ethnic differences or disparities.

MD, GME, CME

Contrast sex differences in the vulnerability to nicotine addiction. Also contrast any ethnic differences.

MD, GME, CME

Describe sex and gender differences in the etiology and presentation of somatoform disorders. Also describe any ethnic differences

MD, GME, CME

Describe the differential diagnosis and management of depression during pregnancy. Describe any differences between ethnic groups.

MD, GME, CME

List risk factors for postpartum depression and psychosis.  Describe any differences between ethnic groups.

MD, GME, CME

Describe the differential diagnosis and management of postpartum depression and psychosis. Describe any differences between ethnic groups.

MD, GME, CME

II. Effectively communicate with patients demonstrating awareness of gender, ethnic and cultural issues. 

Objectives

References

Integration-what & where

What we currently cover

Describe how the patient's ideas, feelings, beliefs, expectations, and experience of illness affect health outcomes. 

MD

Describe the correlation between specific culturally based communication skills and clinical outcomes. 

MD

Describe how gender, sociocultural differences such as SES and living environment affect the power differential and the formation of a therapeutic relationship between the clinician and patient. (Keep in mind dominant culture vs. minority culture)

GME, CME

Integrate appropriate screening questions for the identification of substance abuse, high-risk sexual activity, and interpersonal violence or abuse in a manner that demonstrates empathy, respect, and cultural sensitivity. 

MD, GME

Demonstrate the ability to perform a culturally competent danger assessment in a woman who discloses violence or abuse. 

MD,GME

Demonstrate skills that build trust by addressing contextual factors, such as culture, ethnicity, gender, language/literacy, socioeconomic class, spirituality/religion, age, sexual orientation, disability, and care-giving responsibilities. 

GME, CME

Respond to patients' emotions using nonverbal and verbal skills, including reflecting, legitimizing/validating, expressing support, expressing partnership, and expressing respect. 

MD

Demonstrate how to share control of the interview by using facilitative culturally competent nonverbal behavior, using language the patient can understand, eliciting the patient's concerns and expectations for the encounter, and negotiating a consensual agenda for the encounter. 

GME, CME

Demonstrate shared responsibility for health decisions by identifying and negotiating areas of agreement and disagreement, and by identifying gender and cultural barriers and enablers to adherence. 

GME, CME

Propose a plan to explain both normal and abnormal results in a culturally sensitive manner, and to educate the patient about the follow-up process using words and written information the patient can understand, including translation to the patient’s language if they are non-English speaking.. 

MD, GME

III & VIII.

Objectives

References

Integration-what & where

What we currently cover

Describe the essentials of comprehensive mental health care

MD, GME

Compare and contrast 2 different organizational models for psychiatric care for women and minority patients

Anderson RT, Weisman CS, Scholle SH, Henderson JT, Oldendick R, Camacho F. Evaluation of the quality of care in the clinical care centers of the National Centers of Excellence in Women's Health. Womens Health Issues. 2002 Nov-Dec;12(6):309-26.

Weisman CS. The trends in health care delivery for women: challenges for medical education. Acad Med. 2000;75:1107-13.

http://www.ncqa.org/index.htm. 

GME

Name 3 organizations that provide mental health care safety net for women and minority patients

http://www.dpw.state.pa.us/LowInc/BehaveMentalHealth/

GME, CME

Describe types of mental health care insurance coverage available in Philadelphia for women and minority patients

http://www.phlp.org/New%20Website%20Pages%20Spring%2004/Mental%20Health.asp
Rosenbaum S. Medicaid. N Engl J Med. 2002 Feb 21;346(8):635-40.
Moon M. Medicare. N Engl J Med. 2001 Mar 22;344(12):928-31.
Institute of Medicine (U.S.); Committee on the Consequences of Uninsurance. Coverage matters: insurance and health care. Washington, DC: National Academies Press, 2001. 

GME

Describe financial and non-financial barriers to access to mental health care

http://www.surgeongeneral.gov/library/mentalhealth/home.html

http://www.mcgill.ca/files/tcpsych/Report6.pdf

http://www.cdc.gov/omh/AMH/factsheets/mental.htm

http://www.mentalhealth.samhsa.gov/cre/execsummary-2.asp

Institute of Medicine (U.S.); Committee on the Consequences of Uninsurance. Coverage matters: insurance and health care. Washington, DC: National Academies Press, 2001.
National Women's Law Center; Oregon Health & Science University. Making the grade on women's health: a national and state-by-state report card. Washington, DC; Portland: National Women's Law Center; Oregon Health & Science University, 2004.

MD, GME, CME

Name mental health quality measurement instruments that my be used in women and minority patients

http://www.cqaimh.org/quality.html
Hermann RC, Leff HS, Palmer RH, Yang D, Teller T, Provost S, Jakubiak C, Chan J. Quality measures for mental health care: results from a national inventory. Med Care Res Rev. 2000;57 Suppl 2:136-54.
Agency for Healthcare Research and Quality. Quality Assessment [homepage on the Internet]. Rockville, MD: Agency for Healthcare Research and Quality [cited 2004 Oct 19]. Available from: http://www.ahrq.gov/qual/.  
National Committee for Quality Assurance [homepage on the Internet]. Washington, DC: National Committee for Quality Assurance [cited 2004 Oct 19]. Available from: http://www.ncqa.org.

GME

Identify 2 major mental health policy issues for women and minority patients

The Jacobs Institute for Women's Health [homepage on the Internet]. Washington, DC: The Jacobs Institute for Women's Health [cited 2004 Oct 19]. Available from: http://www.jiwh.org/.

The Society for Women's Health Research [homepage on the Internet]. Washington, DC: The Society for Women's Health Research [cited 2004 Oct 19]. Available from: http://www.womens-health.org/.

The Alan Guttmacher Institute [homepage on the Internet]. New York; Washington, DC: The Alan Guttmacher Institute [cited 2004 Oct 19]. Available from: http://www.guttmacher.org/.

Agency for Healthcare Research and Quality. Women's Health [homepage on the Internet]. Rockville, MD: Agency for Healthcare Research and Quality [cited 2004 Oct 19]. Available from: http://www.ahrq.gov/research/womenix.htm. 

MD, GME

Identify how these are being addressed

http://www.hhs.gov/news/factsheet/womenshealth.html
http://www.womanshealth.gov/owh/pub/minority/activities.htm
http://www.surgeongeneral.gov/library/mentalhealth/cre/execsummary-6.html

Institute of Medicine (U.S.); Committee on Understanding the Biology of Sex and Gender Differences. Exploring the biological contributions to human health: does sex matter? Wizemann TM, Pardue ML, editors. Washington, DC: National Academies Press, 2001.

MD, GME

IV. Discuss the impact of gender-based societal and cultural roles, and context on health care and on women.

Objectives

References

Integration-what & where

What we currently cover

Discuss how gender and cultural bias has influenced roles in the health care professions.

MD, GME

Describe the health consequences of sex or gender discrimination.

MD, GME

Discuss the impact of poverty on key public health indicators used to track health care quality. 

MD, GME,CME

Compare behaviors and conditions that affect health risks for women of various ethnicities above and below the poverty level. 

MD,  GME

Discuss the effects of discrimination on the health status of special populations. (lesbians, persons with co-occurring disabilities). 

MD, GME

Identify risk factors and disease profiles associated with changing lifestyles after imimigration.

MD, GME

Describe the impact of differing belief systems between patient and provider on care for women or patients with cultural diversity. 

MD, GME

Discuss the effect of patient choice of provider gender or ethnicity. 

GME

Describe how religion, spirituality and country of origin influence provider practice and patient decision making. 

MD, GME,CME

V. Identify and assist victims of physical, emotional, and sexual violence and abuse

Objectives

References

Integration-what & where

What we currently cover

Define intimate partner violence, elder mistreatment, and sexual violence. 

MD,GME

Describe characteristics of abusive relationships, including intimate partner violence, elder mistreatment, and sexual violence. 

MD, GME

Describe culturally competent guiding principles of care for victims of violence and abuse.

MD,GME

Summarize the incidence and prevalence of violence against and abuse of women using available national/local data sources and published literature. 

GME

Describe the personal and health care system challenges that health care providers may face when caring for patients who are victims of violence and abuse.

GME

Describe the signs and symptoms of violence and abuse with regard to physical trauma, psychological manifestations, obstetrical complications, and medical problems. 

MD,GME

Describe common behaviors of the abused and the abuser in a clinical encounter.

MD, GME

Discuss the long-term sequelae of violence and abuse on a woman's health within the context of cultural factors 

GME

Describe the components and process of routine screening and “red flag” indicators for violence and abuse across the lifespan. 

MD, GME

Discuss patient barriers to disclosure of violence and abuse. 

MD.GME

VI: Assess & counsel women for sex and gender-appropriate reduction of risk, etc

Objectives

References

Integration-what & where

What we currently cover

a.

List risk factors for depression/mood disorders in women & ethnic minorities

b.

Assess for indicators of current mood disturbance, using established diagnostic

c.

Describe recommended management strategies for mood disorders-both pharmacologic & non-pharmacologic interventions

d.

List the types & presentations of anxiety disorders (including panic and obsessive compulsive disorder) in women

e.

Describe recommended management strategies for anxiety disorders, including pharmacologic & non-pharmacologic interventions

f.

Demonstrate how to effectively counsel women and ethnic minorities regarding stress management

g.

List the prevalence of eating disorders in women, including presentation and complications

h.

List factors that differentiate eating disorders from dietary habits

i.

Describe recommended management options for eating disorders, including pharmacologic and non pharmacologic interventions

j.

List risk factors that make it more difficult for women to quit smoking than men & list resources to help women quit

k.

List the known adverse effects of tobacco use by women and girls

l.

Describe factors predictive of successful smoking cessation during pregnancy& other times in the life cycle.

M

Describe risk factors for the development of co-morbid mental health and addiction problems in women and minorities

n.

Describe sex, gender and ethnicity differences in the epidemiology & presentation of alcohol abuse

o.

Demonstrate how to effectively  use screening questionnaire e.g. CAGE,  in assessing alcohol abuse in women and minorities

p.

List the know consequences of drug & alcohol abuse during the reproductive years including the impact on the developing fetus.

q.

Describe the impact of alcohol and other substance abuse in women with children on behaviors, including child neglect, child abuse, sexual promiscuity, prostitution, and criminal activity