Addressing Oral Health Disparities in Individuals with Mental Health Problems

描述（由申请人提供）：本K23指导患者导向研究职业发展奖的提案将为候选人提供五年的持续指导支持和额外培训，以调查导致口腔健康状况不佳与心理健康问题之间复杂关系的风险因素。候选人的长期目标是通过了解社会心理因素影响个人如何参与口腔自我保健和寻求牙科治疗的方式，成为减少口腔健康差距的主要独立研究者。候选人在肯塔基大学获得临床心理学博士学位，在佛罗里达大学完成了一年的健康心理学博士前实习培训，并在华盛顿大学牙科公共卫生科学系完成了三年的NRSA博士后培训。该奖项将使候选人能够发展成为一名独立的研究者，并为候选人在口腔健康差异研究方面成功指导硕士和博士候选人做好准备。培训计划包括两个阶段：强调流行病学课程的教学部分；生物统计学;研究方法;卫生服务研究，以及一个研究阶段，涉及调查导致心理健康问题与口腔健康状况不佳之间复杂关系的因素，如避免预防保健和延误必要的牙科治疗。在此培训申请中提出了四个具体目标。具体目标1将通过对国家卫生服务利用调查的回顾性分析，审查非机构个人的心理健康问题与未满足的牙科需求之间的关系。具体目标2将通过与非牙科保健提供者的个别访谈，调查他们目前向有精神健康问题的患者提供的口腔健康建议，以及他们干预患者口腔健康的意愿。具体目标3将通过对有精神健康问题的个人进行调查，确定这一服务不足人群中个人的口腔健康状况和获得口腔保健的障碍。最后，具体目标4将确定一个基于药房的口腔健康试点计划的可行性，个人服用精神药物。Peter Milgrom， DDS，牙科公共卫生科学教授，将主持一个多学科指导委员会，该委员会由来自华盛顿大学药学院、卫生服务研究学院、生物统计学学院、牙科公共卫生科学学院和口腔颌面外科学院的教师组成。完成拟议的研究计划将提供有关心理健康问题和口腔健康不良之间复杂的多因素关系的宝贵信息。精神药物会直接导致口干症状，对口腔健康有害。间接地，情绪和焦虑障碍会干扰保持口腔卫生的动机和寻求预防性牙科治疗的意愿。许多患有慢性精神健康问题的人来自弱势家庭或残疾人，在购买牙科保健方面面临经济障碍。然而，目前尚不清楚的是，有精神健康问题的人对自己的口腔健康风险了解多少，以及他们从牙科和非牙科卫生保健提供者那里得到了哪些关于这些风险的建议（如果有的话）。这项工作预计将表明，虽然有精神健康问题的人口腔健康状况不佳的风险增加，但这些人并没有得到关于口腔健康的一致建议，特别是在缺乏常规牙科保健来源的情况下。最终，这项工作将导致R01应用程序的重点是非牙科卫生保健提供者在减少这一服务不足人群的健康差距中的作用。

DESCRIPTION (provided by applicant): This proposal for a K23 Mentored Patient-Oriented Research Career Development Award will provide the candidate with five years of continuous mentored support and additional training in the investigation of risk factors that contribute to the complex relationship between poor oral health outcomes and mental health problems. The long-term goal is for the candidate to become a leading independent investigator in reducing oral health disparities by understanding the ways in which psychosocial factors impact how individuals engage in oral self-care and dental treatment seeking. The candidate received her PhD in Clinical Psychology at the University of Kentucky, completed one year of predoctoral Health Psychology internship training at the University of Florida, and completed three years of NRSA postdoctoral training in the Department of Dental Public Health Sciences at the University of Washington. This award would allow the candidate to evolve into an independent investigator and would prepare the candidate to successfully mentor MS and PhD candidates in oral health disparities research. The training program consists of two phases: a didactic component emphasizing courses in epidemiology; biostatistics; research methods; and health services research, and a research phase involving the investigation of factors contributing to the complex relationship between mental health problems and poor oral health outcomes, such as avoidance of preventive care and delays in necessary dental treatment. Four specific aims are proposed in this training application. Specific Aim 1 will examine the relationship between mental health problems and unmet dental needs in non-institutionalized individuals through a retrospective analysis of a national health services utilization survey. Specific Aim 2 will examine, through individual interviews with non-dental health care providers, what oral health recommendations they currently give to patients with mental health problems and their willingness to intervene in patients' oral health. Specific Aim 3 will determine, through surveys with individuals with mental health problems, the oral health status of and barriers to oral health care faced by individuals in this underserved population. Finally, Specific Aim 4 will determine the feasibility of a pharmacy- based oral health pilot program with individuals taking psychotropic medications. Peter Milgrom, DDS, Professor of Dental Public Health Sciences, will chair a multidisciplinary Mentoring Committee consisting of faculty members from the University of Washington Departments of Pharmacy, Health Services Research, Biostatistics, Dental Public Health Sciences, and Department of Oral and Maxillofacial Surgery. Completion of the proposed Research Plan will provide valuable information regarding the complex, multifactorial relationship between mental health problems and poor oral health. Directly, psychotropic medications can cause dry mouth symptoms harmful to oral health. Indirectly, mood and anxiety disorders can interfere with motivation for adequate oral hygiene and willingness to seek preventive dental treatment. Many individuals with chronic mental health problems come from disadvantaged backgrounds or are disabled and face financial barriers to purchasing dental care. What is not known, however, is what individuals with mental health problems know about their oral health risks and what recommendations, if any, they receive from dental and non-dental health care providers about these risks. This work is expected to show that while people with mental health problems are at an increased risk for poor oral health outcomes, these individuals do not receive consistent recommendations about their oral health, particularly in the absence of a regular source of dental care. Ultimately, this work will result in an R01 application focusing on the role of non- dental health care providers in reducing health disparities in this underserved population. Public Health Relevance: The public health relevance of the proposed Research Plan relates to the use of non-dental health care providers in the delivery of oral health counseling to individuals who lack access to regular dental care. Completion of the studies in this proposal will lay the groundwork for future interventions to increase access to oral health resources for individuals in underserved populations.