Hsiang Huang

• MD, MPH
• Consultant at Cambridge Health Alliance

Requests for the evaluation of potential adult attention-deficit/hyperactivity disorder (ADHD) is on the rise across primary care clinics. Many health care providers, however, may feel ill equipped to diagnose and manage adults presenting with inattention and impulsivity. The diagnosis of ADHD is often complicated by medical and psychiatric conditi...

The COVID-19 pandemic has been expected to lead to substantial increases in need for behavioral health care. A population health framework can facilitate the development of interventions and policies to promote the equitable distribution of care across the population. This column describes the application of population behavioral health principles...

Untreated depression presents a distinct set of risks for pregnancy complications. Past studies have connected antenatal depression with adverse birth outcomes. The purpose of this study was to conduct an updated systematic review and meta-analysis examining the relationship between depression during pregnancy and associated adverse birth outcomes...

Background and Implementation: Novel coronavirus disease 2019 (COVID-19) has presented unique challenges for patients and health care systems, including a surge in behavioral health (BH) needs. A community teaching public hospital system in Massachusetts (MA) whose 13 primary care (PC) clinics serve a diverse patient population, has developed a mod...

There is inadequate availability and access to behavioral health services to meet demand, and this issue amplified during the pandemic, creating a mental health crisis. Group therapy is an effective way to meet this need. The rapid implementation of telehealth group psychotherapy as part of a Primary Care Behavioral Health Integration program in a...

Insomnia, including insomnia disorder, is a common but often overlooked complaint in primary care settings. It is a risk factor for various medical and psychiatric diagnoses and is associated with substantial health care costs. While cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia disorder, access to CBT-I...

Food insecurity and perinatal depression are significant public health concerns for perinatal services, however descriptive research examining their association is limited. The purpose of this study was to examine the views and perspectives of staff from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program on the...

Borderline personality disorder (BPD) is a common mental health diagnosis observed in the primary care population and is associated with a variety of psychological and physical symptoms. BPD is a challenging disorder to recognize due to the limitations of accurate diagnosis and identification in primary care settings. It is also difficult to treat...

Importance Suicide prevention implementation in primary care is needed due to the increasing rate of suicide in the past few decades, particularly for young and marginalized people. Primary care is the most likely point of contact for suicidal patients in the healthcare system. Attention to the level of medical integration with behavioral health is...

Objective Maternal mental health disorders are a leading complication of childbirth. While few systems are adequately able to identify and treat depression, people experiencing perinatal depression may benefit from the intervention of home visiting. The intent of home visiting interventions is to alleviate stressors of parenthood for people facing...

Background Comorbidity of psychiatric and medical illnesses among older adult populations is highly prevalent and associated with adverse outcomes. Care management is a common form of outpatient support for both psychiatric and medical conditions in which assessment, care planning, and care coordination are provided. Although care management is oft...

Bipolar disorder is a chronic mental illness associated with early mortality, elevated risk of comorbid cardiovascular disease, enormous burden of disability, and large societal costs. Patients often seek treatment for symptoms of bipolar disorder in the primary care setting but are frequently misdiagnosed. This article provides primary care provid...

Maternal depression affects 10 percent to 17 percent of mothers in the United States. Women of color, particularly Latina women, may be at an elevated risk for adverse consequences of maternal depression. However, scant research addresses cultural experiences and perceptions of maternal depressive feelings. This study included interviews with 30 La...

Background Racial/ethnic minorities experience a greater burden of mental health outcomes compared to White adults in the United States. The Collaborative Care model is increasingly being adopted to improve access to services and to promote diagnosis and treatment of psychiatric diseases. This systematic review seeks to summarize what is known abou...

Background: Perinatal tobacco smoking remains a public health concern and is associated with smoking related morbidity and mortality. This study aims to report the prevalence and correlates of smoking during pregnancy among low-income women. Methods: The study sample comprised 729 pregnant women who were enrolled in a perinatal depression regist...

This report describes the implementation of a primary care behavioral health integration program for anxiety management at Cambridge Health Alliance (CHA), a safety-net health care system. Using a staged implementation process, CHA built upon existing capacities to create a comprehensive infrastructure for managing behavioral health conditions in p...

Background: Suicidal ideation (SI) during pregnancy is a major maternal health concern, however few examinations report findings on the burden of SI among low-income women. The aim of this study is to estimate the prevalence and correlates of suicidal ideation among a sample of low-income women. Methods: A cross-sectional analysis of 736 low-inc...

Disparities in maternal mental health outcomes persist despite the myriad of existing evidencebased treatments and recent public health prevention policy efforts. Integrated health care delivery models suchas Collaborative Care and patient medical home models have the potential to reduce health disparities in clinicsettings. These evidence-based ap...

Posttraumatic stress disorder (PTSD) occurs following acute threatening events in approximately 12.5% of the primary care population. Objective: The aim of this article is to advance evidence-based clinical practice and collaborative care approaches to PTSD by summarizing targeted-care guidelines. Method: This narrative literature review addres...

Background: Integrating behavioral health (BH) services into primary care is an evidence-based intervention that can increase access to care, improve patient outcomes, and decrease costs. Digital technology, including smartphone apps, has the potential to augment and extend the reach of these integrated behavioral health services through self-manag...

Purpose: Although variations in breastfeeding initiation are well documented, the contributing role of maternal race remains poorly understood, especially among the multiracial—two or more races—population. The purpose of this study is to examine differences in breastfeeding initiation among a racially and ethnically diverse population of low-incom...

OBJECTIVES:Assessing the burden of maternal mortality is important for tracking progress and identifying public health gaps. This paper provides an overview of the burden of maternal mortality in the Eastern Mediterranean Region (EMR) by underlying cause and age from 1990 to 2015. METHODS:We used the results of the Global Burden of Disease 2015 stu...

OBJECTIVES:Mental disorders are among the leading causes of nonfatal burden of disease globally. METHODS:We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and st...

Introduction Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state. Objective To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016. Des...

Eleven South Asian women were recruited from three domestic violence agencies in the United States and interviewed to examine their experiences with intimate partner violence (IPV). The interviews were analyzed using a grounded theory approach. Themes included detailed barriers and facilitators to disclosure of the abuse and leaving the abusive rel...

Objective Diabetes is a major global health concern. People with diabetes have worse mental health outcomes than those without diabetes. Researchers have recently sought to examine the relationship between diabetes and suicidal ideation. The aim of this study is to determine the burden of suicidal ideation among adults with type II diabetes from ex...

Objective: This letter to the editor describes how psychiatry residents' confidence in delivering population based care improved after working within a collaborative care system. Methods: An anonymous online survey was delivered to 24 psychiatry residents who matriculated through Cambridge Health Alliance residency from 2012 to 2014 and particip...

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the impo...

Background: The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016...

This is a duplicate entry for DOI: 10.1016/S0140-6736(17)31833-0 (ResearchGate staff: Please remove this entry.)

Background: As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years l...

The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of add...

Results Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.7. Out of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with Sou...

Background: Heart transplantation in children has revolutionized the care of young patients with congenital and acquired heart disease, with considerable improvements in survival and quality of life. Heart transplantation is now being offered as a potentially life-saving option to pediatric patients with many cardiac conditions, and yet the major l...

Objective: The multiracial adult population is one of the fastest growing segments of the U.S. population, yet much remains to be learned about multiracial health. Considerable research finds racial/ethnic disparities in self-rated health, however subgroups within the multiracial population have not been consistently described. Design: We use data...

Objective: Determine the prevalence of clinician-diagnosed PTSD and questionnaire-ascertained PTSD symptoms in primary care patients. Methods: A systematic review of the literature using the PRISMA method, searching MEDLINE, CINAHL, Cochrane Database, PsycINFO, EMBASE, Google Scholar, and relevant book chapter bibliographies. Studies that report...

Background: Although intimate partner violence (IPV) during perinatal period is more common than during other maternal health conditions, it receives less attention within research on maternal mortality rates. Given the risks for maternal mortality because of suicidality, the purpose of this investigation is to examine the risk of suicidal ideatio...

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological...

Background: Integrating behavioral health care into the primary care setting is increasingly recognized as an effective way to manage mental illness and substance use disorders on a population level in the United States. The term "integrated care," however, is used in many ways and encompasses several different models. Objectives: The aim of thi...

Adolescent pregnancy has social, economic, and educational consequences and is also linked to adverse perinatal outcomes. However, studies show a positive relationship between pregnancy and increased social status among low-income adolescents. This study aims to assess the association between planned pregnancy and years of schooling among low-incom...

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow a...

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow a...

Addressing disparities in health services utilization remains critical for improving minority health; however, most studies do not report on the health service use of multiracial young adults (age 22-34). This study compares past year health service use of self-identified multiracial (two or more races) young adults with monoracial White young adul...

Background: Collaborative care is an evidence-based approach for improving quality mental health access in primary care settings. Although job opportunities will grow over the next decade, few psychiatry residencies have established curricula to train the next generation of psychiatrists to work in this expanding model of care. Objective: In thi...

Background: Antipsychotic medications are widely used to treat behavioral symptoms of dementia. However, studies have shown that antipsychotic use in patients with dementia is associated with risk of side effects. Aims: The aim of this study is to examine antipsychotic prescribing patterns for beneficiaries with dementia enrolled in a Medicare Adva...

BACKGROUND: In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). ME...

Progress towards the Sustainable Development Goals.

The supplementary results offer additional results tables and figures, as well as more detailed methodological figures.

This methods appendix provides further methodological detail for the health-related Sustainable Development Goals (SDGs). The appendix is organized into broad sections following the structure of the main paper. The supplementary results offer additional results tables and figures, as well as more detailed methodological figures.

Background: Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potent...

Background: Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Developmen...

Background: Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2...

Background: In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying...

Background: Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Inj...

This is a duplicate entry.

This appendix provides methodological detail, supplemental figures, and more detailed results for disability‐adjusted life years and healthy life expectancy. The appendix is organized into broad sections following the structure of the main paper.

Supplementary appendix.

Supplementary appendix.

Supplementary appendix.

Background: The collaborative care model has been found to be effective for depression management in various primary care populations; however, no review has synthesized trials tailored to treat women. Objective: The purpose of this systematic review is to evaluate the current evidence for collaborative depression care for women. Methodology:...

Background: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and...

This appendix provides methodological detail, supplemental figures and more detailed results for HIV estimation.

This study investigates three domains of public stigma (perceived negative reactions, perceived discrimination, and dangerousness) against older adults with depression. The sample comprised of older adults registered with primary care clinics (n = 1,291) and primary health care professionals (n = 469) from São Paulo and Manaus, Brazil. Participants...

São Paulo-Manaus Study–Elderly Data. (DTA)

São Paulo-Manaus Study–Health Care Professionals Data. (DTA)

Background: The prevalence of depression has been widely studied in high-income countries and in large cities of low-income countries; however, little is known about the prevalence and treatment gap of depression in remote areas of the Amazonian region in Brazil. Objectives: The objectives of this study are to estimate the prevalence of depressi...

Dataset of this study. (DTA)

Background: Common mental disorder (CMD) and sleep disturbance are two common conditions among women in late pregnancy, affecting up to 20% and 63% of women, respectively, and may adversely affect their quality of life. Aim: The aim of this study is to examine the relationship between sleep disturbance in pregnancy and persistent CMD among low-i...

Introduction: This study examines patient experiences with shared medical appointments for buprenorphine treatment at a safety net primary care clinic. Methods: This is a cross-sectional observational study of 28 participants in a primary care buprenorphine shared medical appointments program. Results: Participants reported appreciating the gr...

Depression, diabetes and hypertension are major contributors to the global burden of disease; however, the majority of research on depression and co-morbid conditions originates in high-income countries. This study examines the depression identification rate and compares treatment rates of depression with those of diabetes and hypertension among el...

Cannabis is the most commonly used illicit drug during the perinatal period and has potential risks to the fetus. The purpose of this study is to estimate the 1-year prevalence of cannabis use and identify associated factors for a population of low-income pregnant women in Brazil. We performed a cross-sectional analysis of 831 women surveyed using...