ANSWER
Beliefs about the causes of mental illness may help explain the significant disparities in formal mental health service use rates between racial/ethnic minority elderly and Caucasian elderly. The Cultural Influences on Mental Health framework are used in this study to identify the relationship between race/ethnicity and differences in: (1) beliefs about the cause of mental illness and treatment preferences; and (3) provider characteristics.

The Cultural Attitudes toward Healthcare and Mental Illness Questionnaire was developed for the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) study, a multisite randomized trial for older adults (65+) with depression, Anxiety, or at-risk alcohol consumption. The final sample included 1257 non-Latino Whites, 536 African-Americans, 112 Asian-Americans, and 303 Latinos.

Results
Compared to non-Latino Whites, African-Americans, Asian Americans, and Latinos held different beliefs about the causes of mental illness. Race/ethnicity was also linked to who makes healthcare decisions, treatment preferences, and preferred healthcare provider characteristics.

Conclusions
This study examines the relationship between race/ethnicity and health beliefs, treatment preferences, healthcare decisions, and the characteristics of healthcare providers that consumers prefer. Individual values and preferences can help engage racial/ethnic minority patients in mental health services.
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Keywords: race/ethnicity, health beliefs, senior citizens
Minority racial/ethnic groups are the fastest-growing segment of the elderly population. According to projections for the year 2050, approximately 40% of the elderly population will be a racial or ethnic minority (1). Regardless of age, racial/ethnic minorities have higher rates of mental disorders than non-Latino Whites (2) and receive lower-quality care (3). As a result, racial/ethnic minorities bear a disproportionate share of the burden of unmet mental health needs (4), owing to the patient, provider, and healthcare system barriers (5-8, 4).

An array of evidence-based mental health services have been developed to address some of the barriers that older adults face (9, 10, 11); however, racial/ethnic minorities continue to be underserved and drop out at a higher rate than non-Latino White elderly (12). These disparities in mental health care persist even after controlling for individual (e.g., language) and macro-level factors (e.g., poverty, education), indicating the presence of additional psychological barriers to mental health service use (12-15).

Culturally associated health beliefs may shed light on why these disparities exist and how to provide culturally appropriate services to racial/ethnic minority older adults. Cultural beliefs about mental illness may influence the type of treatment sought as well as how mental illness is addressed and managed. This research aims to discover cultural beliefs about the causes of mental illness and treatment preferences among four different racial/ethnic groups.

The Cultural Influences on Mental Health (CIMH) framework helps characterize cultural factors in the relationship between the patient-mental the health care system (2). According to this model, various cultural influences contribute to the etiology and development of mental illness and influence how one defines symptoms and illness. Cultural differences, for example, may contribute to the prevalence of mental disorders, influence beliefs about the causes of mental illness, and thus influence treatments and interventions. Before receiving mental health care, preferences regarding the type and role of the health care clinician or alternative provider addressing mental health issues are formed. Minorities of color may have treatment preferences that influence how they seek help.

The current study employs the CIMH model to identify cultural attitudes toward healthcare and mental illness among various racial/ethnic minority older adults suffering from common mental health issues such as depression, anxiety disorders, or risky alcohol use. This study investigates explicitly the extent to which race/ethnicity is associated with differences in (1) beliefs about the cause of mental illness; (2) treatment preferences; and (3) provider characteristics. Compared to non-Latino Whites, it is hypothesized that African-Americans, Asian Americans, and Latinos will have different beliefs about the causes of mental illness. Furthermore, race/ethnicity will influence who makes healthcare decisions, treatment preferences, and preferred characteristics of healthcare providers.

Visit: Methods
The Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) trial is a multisite randomized trial that compared two specific interventions for older people with depression, Anxiety, or at-risk alcohol consumption: an integrated care model and an enhanced referral model (16, 17). In the PRISM-E study, all patients 65 and older were initially seen or referred to the study by their primary care clinician. Those who qualified were then randomized to either the integrated or the enhanced referral model. A mental health provider provided mental health/substance abuse services in the primary care clinic under the integrated model. The enhanced referral model provided mental health/substance abuse services in a specialty setting designated as a mental health/substance abuse clinic. A total of 24,930 older adults aged 65 and up were screened across the United States at primary care clinics or practices. Excluded participants did not meet the criteria for a target diagnosis, were ineligible for the study due to incomplete data, or had hypomania or psychosis.

A total of 6430 patients tested positive for one of the three target conditions (depression, Anxiety, or at-risk alcohol use). Three thousand two hundred twenty-five refused to participate in the baseline assessment interview. Those who did not participate were more likely to be Caucasian males with a lower mean General Health Questionnaire score (indicating less severe distress) and a higher weekly alcohol consumption (18). The final study sample included 2,244 people who completed the baseline diagnostic interviews, agreed to participate and were enrolled.

Patients were recruited from six VA Medical Centers, three community health centers, and two hospital networks, representing a wide range of clinical settings and patient demographics. A detailed description of the research methods can be found elsewhere (19). At predetermined intervals, data from a variety of psychological instruments were collected.

Participants
In this study, the PRISM-E baseline sample was used. Only those who completed the Cultural Attitudes toward Healthcare and Mental Illness measure at baseline (before participation in any of the interventions being evaluated) were included in these analyses (N = 2208) of those who screened eligible for the PRISM-E study. The analyses included 1257 non-Latino Whites, 536 African-Americans, 112 Asian-Americans, and 303 Latinos in the final sample. Interviews were conducted in Spanish and Chinese to accommodate participants who did not speak English.

Measures
A sociodemographic questionnaire, diagnostic assessments, a service use questionnaire, a stigma questionnaire, and a cultural beliefs and preferences questionnaire were all part of the baseline assessment. Only baseline data are presented because the current study seeks to identify cultural attitudes toward healthcare and mental illness, as well as cultural sensitivity desired from the healthcare system, from a cross-sectional perspective.

Characteristics of the Sociodemographic Group The following sociodemographic data were gathered for the current study: age; country of birth (whether in the United States or elsewhere); years in the United States; years of formal education; and marital status (married or unmarried).
Questionnaire on Cultural Attitudes Toward Healthcare and Mental Illness A measure was developed specifically for PRISM-E to assess cultural sensitivity desired from the healthcare system and to measure cultural attitudes toward healthcare and mental illness. The questionnaire was created by PRISM-E researchers interested in multicultural mental health. Because this is the first study to use the measure, its psychometric properties have yet to be investigated. The measure, however, has been translated into Spanish and Chinese. The authors went through a translation and back-translation process to ensure linguistic validity. A consensus process was used to develop and review each item. Four questions are asked in this questionnaire: (1) “No one knows for certain what causes mental health problems such as depression, but people have many different theories about what the causes might be. “What do you believe is the cause of depression?” (2) “What do you think would help you get better if you had a mental health problem?” (3) “Who would you contact if you have a mental illness?” (4) “Who makes the majority of healthcare decisions?”
The responses to these questions are categorical (see tables 2–6) 6, and respondents were allowed to select more than one response for each question. The questionnaire also asked respondents to rate the importance of specific characteristics in their healthcare provider (for example, speaking the same language, being of the same racial/ethnic group, being the same gender, being the same age, being open to different treatment options, and understanding the respondent’s culture). The responses to this set of questions were graded on a 5-point Likert scale ranging from 0 (Not at all important) to 4. (Very Important).

Table 2: Mental Illness Causes by Ethnicity
Item Percentage Endorsing the Product
Significant Distinction
White non-Latino (N = 1257)
(N = 536) African-Americans
(N = 112) Asian-Americans
Hispanic (N = 303)
% (n) % (n) % (n) % (n) (n)
χ2 p
Mental Illness Causes
Stress/Loss
Loss (e.g., family, friends) (e.g., family, friends)
34.9% (439) (439)
41.6% (223)* 18.8% (21)* 44% (133)* 29.7 <.01 a loss or a lack of enjoyable activities 27.4% (344) (344) 25.7% (138) (138) 9.8% (11)* 25.7% (78) (78) 17.1.01 Family problems 29% (364) (364) 30.2% (162) (162) 45.5% (51)* 47.2% (143) (143) * 45.6.01 Financial concerns 29.9% (376) (376) 37.1% (199)* 35.7% (40) (40) 30.4% (92) (92) 9.6.05 Political tension 5.3% (66) (66) 5.8% (31) .9 (1)* 2.3% (7) (7) * 10.4.03 Concerns about safety 6% (76) (76) 6.9% (37) (37) 2.7% (3) (3) 7.3% (22) (22) 3.4.50 Anxiety or stress 33.1% (416) (416) 43.7% (234)* 36.6% (41) (41) 22.4% (68)* 41.0.01 Medical Medical Illness 35.4% (445) (445) 37.3% (200) (200) Infectious disease 56.3% (63)* 63.7% (193)* 96.1.01 8% (100) (100) 7.3% (39) .9% (1)* 7.9% (24) (24) 7.7.10 Nutrient deficiency 7.7% (97) (97) 5.8% (31) (31) 2.7% (3) (3) * 5% (15) (15) 7.5.11 Chemical discord 14.4% (181) (181) 7.5% (40) (40) * .9% (1)* 5.6% (17) (17) * 43.0.01 Genetic 13.5% (170) 8.2% (44)* 3.6% (4)* 3.6% (11) (11) * 37.5 <.01 \sSpirit/Psyche Body, mind, and spirit disturbance 9% (113) (113) 9.7% (52) (52) 3.6% (4) (4) * 16.5% (50) (50) * 20.8.01 Something you did incorrectly in the past 7.2% (90) (90) 8.4% (45) (45) 0% (0)* 1.7% (5)* 55.2.01 Supernatural (such as witchcraft and hexes). 95% (12) (12) 3.5% (19)* 0% (0) (0) 1.3% (4) (4) 20.7 <.01 \sEnvironment/Culture Moving to a new location 9.1% (115) (115) 8% (43) 8% (9) (9) 203.2.01 Cultural differences 38.3% (116)* 6.5% (82) (82) 6.5% (35) (35) 21.4% (24)* 3.3% (10)* 43.3.01 Adapting to a new culture 6.6% (83) (83) 4.7% (25) (25) 9.8% (11) (11) 6.3% (19) (19) 5.9 .20 Launch in a new window It should be noted that Chi-Square was used to detect differences in response patterns. 3 degrees of freedom *Denotes a distinction with non-Latino whites. Table 6: Preferred Health Care Provider Characteristics by Ethnicity Item Percentage Endorsing the Product Significant Distinction White non-Latino (N = 1257) (N = 536) African-Americans (N = 112) Asian-Americans Hispanic (N = 303) M (SD) M (SD) M (SD) (SD) F p The significance of a health care provider: Using the same language 4.24 (1.35) (1.35) 4.69 (.93)* 4.78 (.86)* 4.23 (1.34) (1.34) 16.5 <.01 Being from the same racial/ethnic group 1.56 (1.12) (1.12) 1.52 (1.19) (1.19) 3.70 (1.65)* 1.79 (1.39)* 80.7 <.01 Being of the same gender 1.47 (1.02) (1.02) 1.62 (1.26)* 1.30 (.90)* 1.51 (1.10) (1.10) 3.2.01 Being the same age 1.36 (.83) (.83) 1.38 (.98) (.98) 1.25 (.72) (.72) 1.3 (.87) (.87) .71 .58 Being open to new treatments (acupuncture, massage, etc.) 2.47 (1.44) (1.44) 2.66 (1.56)* 2.13 (1.38)* 1.93 (1.33)* 14.2.01 Cultural understanding 2.81 (1.53) (1.53) 3.57 (1.60)* 3.38 (1.39)* 3.34 (1.62)* 25.5 <.01 Launch in a new window ANOVA was used to demonstrate mean differences. 3 degrees of freedom = 2204 degrees of freedom *Indicates a statistical difference with Non-Latino Whites. Racial/ethnic group differences in sociodemographic variables were examined using one-way ANOVA for continuous variables and chi-square analyses for categorical variables. A Fisher's exact test was used for the "Years in the US" variable because there were too many cells with expected frequencies less than 5 to make a chi-square reasonable. Chi-square and pairwise comparisons were used to answer each of the four questions in the Cultural Attitudes toward Healthcare and Mental Illness questionnaire for the primary outcomes. The responses of non-Latino Whites were compared to those of each ethnic minority group because they were the referent group. ANOVA was used to compare group means for each item on preferred healthcare provider characteristics (dependent variable) and racial/ethnic group affiliation (independent variable). Because there were significant overall group differences for race/ethnicity, pairwise comparisons were performed between non-Latino Whites and each race/ethnicity. Because of the multiple comparisons, only results with p values less than or equal to.01 were considered. Navigate to: Results Characteristics of Sociodemography and Immigration Table 1 examines sociodemographic and immigration characteristics of PRISM-E participants who are non-Latino white, African-American, Asian-American, or Latino. Asian Americans tended to be younger than non-Latino Whites. Compared to non-Latino whites, a higher proportion of Latinos and Asian Americans reported having less than 12 years of education. Most Latinos and Asian Americans reported having lived in the United States for ten years or more. African-Americans, Asians, and Latinos suffered from depression at significantly higher rates than non-Latino Whites. Anxiety levels did not differ by ethnicity. Non-Latino Whites had higher rates of at-risk drinking than the other ethnic groups. The dual diagnosis was significantly more common among African-Americans than among non-Latino Whites. Table 1: Sociodemographic Factors Sociodemographic Factors Significant Ethnic Difference White non-Latino (n = 1257) (n = 536) African-Americans (n = 112) Asian-Americans Hispanic (n = 303) M SD M SD M SD M SD F p Age 74.1 6.2 72.9 6.0 70.5* 5.0 72.7 5.8 13.2.01 N % N % N % N % N % N % 2 p Years of Education 779.8.01 Less than 8th grade 73 5.8% 111 20.7%* 60 53.6%* 204 67.3%* Below 12th grade 262 20.8% 339 27% 183 34.1%* 14 12.5%* 30 9.9%* High School Graduate/GED 339 27% 119 22.2% Some College 300 23.9% 94 17.5% 13 11.6% 32 10.5% 2 1.8%* 24 7.9%* College Graduate 144 11.4% 17 3.2%* 21 18.8% 8 2.6%* Graduate School 120 9.5% 11 2.1%* 2 1.8%* 4 1.3%* Marital Status 183.4.01 Married 732 58.2% 190 35.4%* 75 67%* 108 35.6%* Separated 22 1.8% 53 9.9%* 2 1.8% 36 11.9%* \s Divorced 168 13.4% 104 19.4% 4 3.6%* 52 17.2% Widowed 262 20.8% 149 27.8% 29 25.9% 84 27.7% Never Married 61.9% 39.3% 2 1.8% 21 6.9% Location of Birthb 1684.3.01 US 1188 94.5% 533 99.4% 3 2.7%* 29.6%* Outside of the United States 52 4.1% 3 0.6% 106 94.6%* 274 90.4%* Years in the United States 81.7.01 Less than one year 0 0% 0 0% 0 0% 3 .01% 1-5 years 0 0% 0 0% 18 16.1%* 7 2.3% 6-9 years 2 .16% 0 0% 26 23.2%* 8 2.6% 10+ years 48 3.8% 3 .56% Psychiatric Illness Depression: 63 56.3%* 235 77.6%* 825 (65.6%) 433 (80.8%) 105 (93.8%) 286 (94.4%) 143.5.01 Anxiety Disorder 325 25.9% 132 24.6% 29 25.9% 64 21.1% 3.5.48 Risky Drinking 458 36.4% 142 26.5%* 4 3.6%* 20 6.6%* 148.7.01 Dual Diagnosis 88 7.0% 49 9.1%* 3 2.7% 7 2.3%* 19.1.01 Open in a new window ANOVA was used to calculate age differences (DF= 3, 2204). Chi-Square was used to calculate differences in Years of Education (DF = 15), Marital Status (DF = 12), Place of Birth (DF = 3), and Rates of Psychiatric Illness (DF = 9). Fisher's Exact Test was used to calculate differences in years in the United States (DF = 9). Degrees of freedom (DF) SD stands for standard deviation. A total of 21 participants (19 non-Latino Whites, 1 African-American, and 1 Latino) still need to report their formal education years. b20 participants (17 non-Latino Whites, 3 Asian-Americans) needed to provide information about their birth country. Because diagnostic categories were not mutually exclusive, totals may not add up to 100%. The term "dual diagnosis" refers to a diagnosis of at-risk drinking combined with depression and Anxiety. Indicates a difference in cultural attitudes toward healthcare and mental illness among non-Latino whites. Nobody knows what causes mental health problems, such as depression, but different people have different theories. What do you believe is the root cause of depression? African-Americans tended to blame mental illness on stress and loss. They regarded the loss of family, and friends, financial stress, and general stress or worry as more likely causes of mental illness than non-Latino Whites. Asian Americans were likelier than non-Latino Whites to believe that family issues, medical illness, and cultural differences caused mental illness. Compared to non-Latino Whites, Latinos stated that the loss of family and friends, family issues, and moving to a different location were the causes of mental illness. Table 2 contains more information. What would help you get better if you had a mental health problem? As shown in Table 3, a higher proportion of African-Americans said they would seek spiritual advice to help them with mental health problems than non-Latino Whites. No single treatment modality was preferred by Asian Americans over non-Latino Whites. Latinos, on the other hand, were more likely to prefer medications. Table 3: Ethnic Treatment Preferences Item Percentage Endorsing the Product Significant Distinction White non-Latino (N = 1257) (N = 536) African-Americans (N = 112) Asian-Americans Hispanic (N = 303) % (n) % (n) % (n) % (n) (n) χ2 p What do you believe is better for you? Medication or pills 35% (440) (440) 39.6% (212) (212) Herbal remedies 23.2% (26)* 45.5% (138)* 22.6.01 9.4% (118) (118) 12.5% (67) (67) 6.3% (7) (7) 5.6% (17) (17) * 12.8.01 Individual counseling 48.8% (614) (614) 50.9% (273) (273) 21.4% (24)* 45.5% (138) (138) 35.5.01 Group psychotherapy 30.8% (387) (387) 31.7% (170) (170) 3.6% (4) (4) * 16.2% (49) (49) * 66.0.01 Alternative treatments (acupuncture, massage, etc.) 13.1% (165) (165) 13.6% (73) (73) 3.6% (4)* 4% (12) (12) * 31.3.01 Spiritual counsel 25.4% (319) (319) 32.5% (174)* 1.8% (2)* 9.6% (29) (29) * 88.3 <.01 Launch in a new window It should be noted that Chi-Square was used to detect differences in response patterns. 3 degrees of freedom *Denotes a distinction with non-Latino whites. Who would you turn to if you had a mental illness? Table 4 shows that compared to non-Latino Whites, African-Americans were likelier to speak to a family member living with them (non-spouse) but less willing to speak to psychiatrists or psychologists. Compared to non-Latino Whites, Asian Americans were more reluctant to speak to anyone. Latinos were more likely than non-Latino Whites to consult a psychologist and less likely to consult a medical doctor. Table 4 shows which you would talk to about mental health depending on your ethnicity. Item Percentage Endorsing the Product Significant Distinction White non-Latino (N = 1257) (N = 536) African-Americans (N = 112) Asian-Americans Hispanic (N = 303) % (n) % (n) % (n) % (n) χ2 p Who would you approach about mental health or substance abuse concerns? Spouse or significant other 27.1% (341) (341) 20% (107)* 33% (37) (37) 15.5% (47) (47) * 31.4.01 Living with a family member 6.4% (81) (81) 12.3% (66)* 10.7% (12) 18.2% (55) (55) * 43.4.01 Family member who does not live with you 20.2% (255) (255) 21.5% (115) (115) 13.4% (15) (15) 24.8% (75) (75) Friend 14.2% 7.5.11 (178) 18.1% (97)* 15.2% (17) (17) 8.9% (27) (27) * 15.6 <.01 Healer. 95% (12) .93% (5) (5) 0% (0) .7% (2) (2) 1.4 <.01 \s Psychiatrist 12.7% (160) (160) 9.5% (51)* 3.6%(4)* 12.5% (38) (38) 11.7 <.01 49.5% of doctors are doctors (622) 53.9% (289) (289) 3.6% (4)* 34.3% (104)* 121.5 <.01 Worker in Social Services 5.6% (70) (70) 5.4% (29) (29) .9% (1) (1) 6.6% (20) (20) 8.5% Psychologist 7.7.10 (107) 4.9% (26)* 1.8% (2)* 13.2% (40)* 24.9 <.01 12 step procedure 4.2% (53) (53) 3.4% (18) (18) 0% (0)* 1.7% (5)* 14.6 <.01 Someone from the congregation 6.7% (84) (84) 11.6% (62)* 0% (0)* 4% (12) (12) Religious/spiritual leader 30.3.01 1.8% (23) (23) 3% (16) 0% (0) (0) 1% (3) (3) 7.2.127 Provider of alternative care (massage, acupuncture, etc.). 87% (11) (11) 1.3% (7) (7) 0% (0) (0) 0% (0) (0) 11.9 .02  No one 5.2% (65) 5.8% (31) (31) 29.5% (33)* 6.6% (20) (20) 98.2 <.01 Launch in a new window It should be noted that Chi-Square was used to detect differences in response patterns. 3 degrees of freedom *Denotes a distinction with non-Latino whites. Who makes the majority of your medical decisions? As shown in Table 5, most participants across all racial/ethnic groups stated that they (as individuals) make the majority of health care decisions. Because respondents were given more than one response option, most African-Americans also stated that their doctors were the most likely to make healthcare decisions. Asian Americans and Latinos were less likely to report that their doctors made healthcare decisions for them than non-Latino Whites. Table 5 shows who makes healthcare decisions based on ethnicity. Item Percentage Endorsing the Product Significant Distinction White non-Latino (N = 1257) (N = 536) African-Americans (N = 112) Asian-Americans Hispanic (N = 303) % (n) % (n) % (n) % (n) χ2 p Who makes medical decisions? You 73.8% (928) (928) 79.3% (425) (425) 71.4% (80) (80) 77.6% (235) (235) 5.4.25 Spouse or signatory other 20% (251) 7.8% (42)* 13.4% (15) (15) 11.2% (34) (34) * 49.8.01 Dr. 44.9% (565) 56% (300) * 17.9% (20)* 15.2% (46)* 166.6.01 Other family member than spouse 5.6% (71) (71) 8.2% (44)* 7.1% (8) (8) 12.9% (39) (39) * 19.0 <.01 \s Someone else . 72% (9) (9) 1.7% (9) 0% (0) (0) 1% (3) 4.9 .30 Launch in a new window It should be noted that Chi-Square was used to detect differences in response patterns. 3 degrees of freedom *Denotes a distinction with non-Latino whites. Preferred characteristics of health care provider Table 6 shows that African-Americans expressed a greater degree of preference for their health care providers to understand their culture compared to non-Latino Whites. Asian Americans indicated a greater preference for their healthcare providers to be of the same racial/ethnic group compared to non-Latino Whites. QUESTION
For this , you will take on the role of a clinician who is building a health history for one of the following cases.:

SUBJECTIVE DATA:

Chief Complaint
(CC)“I came for my annual physical, but do not want to be a burden to my daughter.”

History of Present Illness (HPI)At-risk 86-year-old Asian male – who is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs.

PMH (Previous medical history) Hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis

PSH S/P cholecystectomy

Drug HxCurrent Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and Cipro 100mg daily.

Allergies : none

Family history: none

REVIEW OF SYSTEMS (ROS)

General+ weight loss of 25 lbs over the past year; no recent fatigue, fever, or chills.

Head, Eyes, Ears, Nose & Throat (HEENT)No changes in vision or hearing, no difficulty chewing or swallowing.

NeckNo pain or injury

Respiratory: none

CV, GI: None

GUno urinary hesitancy or change in urine stream

Integumentmultiple bruises on his upper arms and back.

MS/Neuro+ falls x 2 within the last 6 months; no syncopal episodes or dizziness

OBJECTIVE DATA:

PE B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8

HEENTAtraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.

LungsCTA AP&L

CardS1S2 without rub or gallop

Abd benign, normoactive bowel sounds x 4

Ext no cyanosis, clubbing or edema

Integumentary multiple bruises in different stages of healing – on his upper arms and back.

NeuroNo obvious deformities, CN grossly intact II-XII

REQUIREMENTS:

Discuss the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
Utilizing the five assessment domains, which ones would you utilize on your patients in conducting a comprehensive nutritional assessment.
Discuss the functional anatomy and physiology of a psychiatric mental health patient. Which key concepts must a nurse know in order to assess specific functions?

Submision:

at least 500 words ( 2 complete pages of content) formatted and cited in current APA style 7 ed with support from at least 3 academic sources which need to be journal articles or books from 2019 up to now. NO WEBSITES allowed for reference entry. Include doi, page numbers, etc. Plagiarism must be less than 10%.