Racial and ethnic minority groups are less likely to seek or have access to mental health support services. Despite an increase in the quantity of mental health services nationwide, disparities in usage across racial and ethnic minority groups still exist, leaving resources underutilized and many individuals with unmet needs. Previous studies highlight both structural and non-structural barriers, such as income and stigma, which prevent certain racial groups from fully utilizing health care services. Studies often overlook health outcomes associated with immigrant status and overgeneralize findings to all populations. While scholars have studied the structural barriers to accessing mental health care services, there is a need to understand the cultural contexts preventing racial and ethnic groups from reaching out to these services. Using data from the National Health Interview Survey (NHIS), this study examines differences in access to and utilization of mental health care services of U.S born and immigrant populations from the years 2010-2020. The NHIS allows for the control and determination of effects of both structural and cultural factors such as health insurance coverage, financial instability, racial and ethnic characteristics, and migrant status to further understand the dynamics of access to and use of mental health care services. Foreign-born individuals are expected to show lower access to health care resources with varying levels of moderate mental distress. These differences are expected to vary for those who have spent more time in the U.S with more access to resources and higher levels of mental distress. Understanding trends related to mental health care can help develop better public policy responses and improve the promotion of health care services. This study will help address why services are underutilized and how to minimize health service inequalities among racial and ethnic populations. 

Negative life events play an etiological role in posttraumatic stress disorder (PTSD) and depression. Social support and disclosure are associated with resilience following negative events. This secondary analysis examined the relationship between disclosure to specific individuals following negative events and current depression and PTSD symptom severity. Female-identifying undergraduate students (N = 101) were asked to describe "the most negative event" they experienced in the past year and identify individuals to whom they disclosed (e.g. friend, partner, parent, therapist, law enforcement, teacher, and university employee). Using path analyses, I examined whether: 1) for female-identifying undergraduates (n = 89), the identity of the individual to whom participants disclosed their negative memory was correlated with current severity of depression symptoms (Quick Inventory of Depressive Symptoms) and 2) for those who experienced a DSM Criterion A trauma (n = 12), identity of the individual to whom participants disclosed the event was correlated with current PTSD symptom severity (Posttraumatic Diagnostic Scale). Disclosure of negative events to professionals (law enforcement, teachers, university employees, and therapists) were associated, at a trend level, with higher depression severity (B = .56, p = .07); driven by an effect of disclosing to a therapist (B = .96, p = .04), while no strong association was found for disclosure to personal confidantes (friends, parents, and partners). Disclosure of Criterion A traumatic events to partners was associated with higher depression (B = 1.33, p = .07). These findings complicate literature on the mental health correlates of disclosure, which may be associated with increased depression and PTSD symptom severity following negative events, and emphasize the need for trauma-informed care for mandated reporters and others working with individuals who may disclose negative events. 

 Historical discourse has dangerously misrepresented and normalized the positioning of Black women in various states of vulnerability. Such discourses have then been embodied by society and further perpetuated within institutions- shaping the realities of Black women. This study explored how social services at a Seattle-based women’s shelter affect the experiences of Black women utilizing social services, while also understanding how Black women thrive utilizing such services. In this community-based qualitative research project, I used ethnographic methods to conduct semi-structured interviews with Black women utilizing social services at a Seattle-based womens shelter. I also conducted participant-observation methods to collect data on the shelter’s environment and the dynamic between Black women seeking services and employees providing services. Finally, I reviewed relevant theoretical frameworks such as intersectionality, the criminalization of poverty, and racial capitalism to assist in my analysis of how Black women seeking services at a Seattle women’s shelter have been positioned to experience vulnerability. Key findings include 1) social services have been socially constructed to sustain the experience of vulnerability within the Black community, specifically by Black women utilizing services; and 2) through various levels of gratitude, Black women find spiritual peace and grow new resiliences to systemic challenges. These findings draw awareness to the ways social services have deepened Black women’s dependency to them. Such awareness could serve as a critical framework for reshaping the way social services within the greater Seattle area assist Black women to promote prosperity, dismantle racist rhetoric, and aim to eradicate, not perpetuate, homelessness.

Research suggests disparities exist in cardiac arrest outcomes between men and women. Our objective was to evaluate differences in automated external defibrillator (AED) use and time from arrival on-scene to initial emergency medical services (EMS) defibrillation for men and women suffering from out-of-hospital cardiac arrest (OHCA). I abstracted data from non-traumatic OHCA cases not witnessed by EMS from 2018 to 2021 treated by EMS agencies participating in the four-county Portland Cardiac Arrest Epidemiologic Registry. Dr. Lupton, helped run unpaired t-tests with unequal variances for unadjusted comparisons, adjusted for potential confounders, and accounted for clustering by county. 3,187 OHCAs not witnessed by EMS had all variables for analysis. Rates of any bystander AED application, regardless of ultimate arrest rhythm, were higher for men (12.0%) compared to women (7.9%, p<0.001). Among patients with shockable initial rhythms (n=754), the percentage receiving an AED shock before EMS arrival was higher for men (14.1%) compared to women (7.0%, p=0.005). For patients still in shockable rhythms at initial EMS contact (n=677), the average time from arrival to first EMS shock was longer for women (5.6 minutes) compared to men (4.5 minutes, p=0.005). After adjustment, the odds ratio (aOR [95% CI]) for AED application (1.56 [1.15-2.11]) and AED shock for patients with shockable initial rhythms (2.30 [1.03-5.14]) remained significantly higher for men, and men were shocked significantly sooner after EMS arrival than women (-0.91 minutes [-1.51 to -0.31]). Women with OHCA receive lower rates of bystander AED use than men and initial defibrillation from EMS nearly one-minute later when both have shockable rhythms on initial EMS contact. The impact of these disparities on survival and neurologic outcomes requires further study.

Implicit bias refers to unconscious attitudes and stereotypes in patient-provider communication that can lead to discrimination based on race, sexual orientation, gender, or other characteristics. This disproportionately impacts historically marginalized communities, including Black, Indigenous, and People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender, Queer, and/or Questioning people (LGBTQ+). Although interventions have been developed to improve provider awareness of implicit bias, there has been little exploration of patient perspectives. With the help of my team, I conducted an analysis of 7 previously conducted co-design workshops with 32 BIPOC and LGBTQ+ people to understand patient perspectives on interventions to mitigate the impact of provider implicit bias in healthcare interactions. These workshops included group discussions about personal experiences with healthcare discrimination and a storyboarding activity to envision solutions for improving patient-provider interactions. Across workshops, participants created 13 storyboards that depict solutions in a primary care setting, several of which focus on improving patient-provider communication and promoting self-advocacy and empowerment. Through our collaborative qualitative analysis, my team and I identified two prominent themes from the workshops: communication tools and patient advocates. Participants shared experiences of feeling dismissed and unheard during healthcare visits, leading to storyboard proposals of communication tools, such as "smart boards" that allow patients to describe their symptoms in a nuanced manner. Another storyboard proposed a "panic button" that helps patients ask for help or request a different provider. Other storyboards focus on strategies to hold providers accountable, such as a "patient advocate" who approaches the provider about the patient's experience of discrimination and recommends a communication training intervention that raises awareness of bias. These findings can inform future research on interventions to address implicit bias in provider-patient communication. By prioritizing patient perspectives, we can create a healthcare system that is equitable and inclusive for all.

Emergency medical services (EMS) are an essential part of the healthcare system in the United States. However, there are many barriers to EMS use among racial and ethnic minorities, which can lead to poorer health outcomes. Language discordance is a crucial barrier that needs to be addressed. My project addresses the interactions between patients with limited English Proficiency skills (LEP) and emergency services in King County. We have partnered with Puget Sound, Bellevue Fire Department, and Renton Regional Fire Authorities to identify patient care data in LEP Spanish-speaking patients. To better understand the experiences and future needs of non-English speaking patrons of these services, we have developed a multi-model survey to collect data and assess communication satisfaction with EMS providers. We also provide a letter explaining the purpose of the project we have designed to inform participants why we are collecting this data and what we hope to accomplish. Data is being collected via an English or Spanish mailed/online survey. The survey includes topics related to the language spoken at home, English proficiency, and questions related to emergency services received in the last six months. From preliminary data collection, we have found that a recurring barrier was diminished access to interpreter services. With increased access to interpreter services, patient experiences will improve. From these pieces of data, our next steps are to introduce phase two, which includes partnering with other fire departments in the area, the Vulnerable Populations Strategic Initiative (VPSI), and sending surveys to LEP Chinese and Somali-speaking patients to obtain a more extensive scope of data. We plan to implement informational workshops in King County fire departments to explain the impacts of language barriers and provide solutions to address these inequities.