Jessica Isom - Academia.edu (original) (raw)

Papers by Jessica Isom

Psychiatric Services, Nov 30, 2023

PLOS global public health, Apr 24, 2024

Race is a sociopolitical construct that results in a classification of people determined by a com... more Race is a sociopolitical construct that results in a classification of people determined by a combination of physical traits, rather than biology. Racism, a hierarchical system based on race, in which those with power and privilege are advantaged and given more opportunities (White), while others are systematically disadvantaged others (racial/ethnic minorities). For racial/ethnic minorities with opioid use disorder (OUD), it is important to understand how these hierarchies can result in decreased access to treatment, including initiation, engagement, and adherence. Social dominance theory provides a framework for understanding how social hierarchies are maintained, and resources such as health status, are distributed among socially constructed groups. Consistently employing a racial equity framework that explicitly inserts race and power into the decision-making process and promotes active engagement of stakeholders is often a key component missing in the decision-making process impacting racial/ethnic minorities with OUD. Given the exclusion of racial/ethnic minorities with OUD from the broader public health opioid crisis discussion, promotion of health equity must include deliberate attention to the unique challenges of racial/ethnic minorities with OUD. These challenges include the use of other substances in addition to opioids, the impact of residing in geographic locations with higher opioid overdose death rates, prevalence of common medical comorbidities with OUD, and vulnerabilities in the social determinants of health. Providing instruction on how to elicit this information using the structural vulnerability tool is one model to improve health outcomes, in addition to expert application of the stages of equity and empowerment lens. Finally, understanding cultural norms as protective factors can help in developing integrated treatment plans in partnership with racial/ethnic minorities with OUD for promotion of health and a collaboration toward health equity.

Psychiatric Services, Feb 1, 2021

Psychiatric Clinics of North America, Sep 1, 2020

Despite available treatment options for addiction, there remains an abysmal uptake of treatment i... more Despite available treatment options for addiction, there remains an abysmal uptake of treatment initiation and engagement among varying communities. The existing treatment gap is based on historical occurrences, including discriminatory drug policies that have targeted communities of color with addiction. The current opioid epidemic and differential treatment therein exemplifies the severity of the existing disparity in addiction treatment, highlighting barriers such as institutionalized racism and vulnerabilities in the social determinants of health. To mitigate the disparity, an array of solutions to address these inequities are discussed, thereby providing a pathway forward to eliminating this treatment gap.

The tender moments that call for true empathy are often failed by the demands of the traditional ... more The tender moments that call for true empathy are often failed by the demands of the traditional physician-patient relationship.

American Journal of Psychiatry, Jul 1, 2021

The Lancet Psychiatry, Mar 1, 2021

Academic Medicine, Jun 23, 2020

Health inequities stem from systematic, pervasive social and structural forces. These forces marg... more Health inequities stem from systematic, pervasive social and structural forces. These forces marginalize populations and create the circumstances that disadvantage these groups, as reflected in differences in outcomes like life expectancy and infant mortality and in inequitable access to and delivery of health care resources. To help eradicate these inequities, physicians must understand racism, sexism, oppression, historical marginalization, power, privilege, and other sociopolitical and economic forces that sustain and create inequities. A new educational paradigm emphasizing the knowledge, skills, and attitudes to achieve health equity is needed. Systems-based practice is the graduate medical education core competency that focuses on complex systems and physicians’ roles within them; it includes topics like multidisciplinary team-based care, patient safety, cost containment, end-of-life goals, and quality improvement. This competency, however, is largely health care centric and does not train physicians to engage with the complexities of the social and structural determinants of health or to partner with systems and communities that are outside health care. The authors propose a new core competency centered on health equity, social responsibility, and structural competency to address this gap in graduate medical education. For the development of this new competency, the authors draw on existing, innovative undergraduate and graduate medical pedagogy and public health, health services research, and social medicine frameworks. They describe how this new competency would inform graduate medical education and clinical care and encourage future physicians to engage in the work of health equity.

Journal of Medical Systems, Apr 8, 2022

In this editorial, we further discuss the effects that health equity tourism has had on Black, Na... more In this editorial, we further discuss the effects that health equity tourism has had on Black, Native, and Latinx marginalized communities. We identify the consequences of the resulting medical mistrust within these communities as well as implications for data collection in research. Throughout, solutions are proposed that may eventually empower these communities to become actively engaged with the research and initiatives that influence their health outcomes, as well as improve the quality and quantity of data extracted from these communities.

Academic Psychiatry, Jan 29, 2021

It is critical that physicians understand the societal forces that drive illness and unequal trea... more It is critical that physicians understand the societal forces that drive illness and unequal treatment in the USA [1]. Efforts to arm physicians in training with the skills necessary to identify, name, and eliminatemental health inequities must be a clinicianeducator goal [1–3]. It is essential that graduate medical educators develop curricula to prepare residents to address mental health and health care disparities throughout and after training. In response, the Yale Department of Psychiatry has developed a 4-year longitudinal Social Justice and Health Equity Curriculum (SJHEC), consisting of four tracks: Structural Competency [4, 5], Advocacy [6], History of Psychiatry, and the Human Experience. As part of the core residency curriculum, trainees attend sessions in all four tracks with a collective mission of creating a generation of psychiatrists equipped to eradicate mental health disparities. This manuscript will describe the Human Experience (HE) Track, which aims to illuminate systems of power and oppression within ourselves and society and teach trainees clinical practice interventions to mitigate inequities caused by these systems. The HE Track draws on the social sciences, humanities, and psychological theories; residents are taught how to see and respond to societal, institutional, and individual manifestations of oppression (such as racism, sexism, heterosexism, ableism, classism, ageism, and anti-Semitism) and understand how they contribute to disparities. To our knowledge, there are very few similar curricula within psychiatry training programs [2, 6, 7]. This manuscript aims to first outline the development and implementation of the pilot HE Track within the SJHEC and second, to describe critical feedback from residents and facilitators used to inform subsequent iterations of the curriculum. We will outline our resident feedback and how it was incorporated to improve the curriculum in six lessons learned and aspire to support others in developing and revising similar curricula.

Journal of the American Academy of Child and Adolescent Psychiatry, Nov 1, 2020

The general transcription factor IIE (TFIIE) is essential for transcription initiation by RNA pol... more The general transcription factor IIE (TFIIE) is essential for transcription initiation by RNA polymerase II (RNA pol II) via direct interaction with the basal transcription/DNA repair factor IIH (TFIIH). TFIIH harbors mutations in two rare genetic disorders, the cancer-prone xeroderma pigmentosum (XP) and the cancer-free, multisystem developmental disorder trichothiodystrophy (TTD). The phenotypic complexity resulting from mutations affecting TFIIH has been attributed to the nucleotide excision repair (NER) defect as well as to impaired transcription. Here, we report two unrelated children showing clinical features typical of TTD who harbor different homozygous missense mutations in GTF2E2 (c.448G>C [p.Ala150Pro] and c.559G>T [p.Asp187Tyr]) encoding the beta subunit of transcription factor IIE (TFIIEb). Repair of ultraviolet-induced DNA damage was normal in the GTF2E2 mutated cells, indicating that TFIIE was not involved in NER. We found decreased protein levels of the two TFIIE subunits (TFIIEa and TFIIEb) as well as decreased phosphorylation of TFIIEa in cells from both children. Interestingly, decreased phosphorylation of TFIIEa was also seen in TTD cells with mutations in ERCC2, which encodes the XPD subunit of TFIIH, but not in XP cells with ERCC2 mutations. Our findings support the theory that TTD is caused by transcriptional impairments that are distinct from the NER disorder XP.

Academic Psychiatry, Oct 14, 2020

Harvard Review of Psychiatry, 2023

The overdiagnosis and misdiagnosis of racially minoritized groups as having a primary psychotic d... more The overdiagnosis and misdiagnosis of racially minoritized groups as having a primary psychotic disorder is one of psychiatry’s longest-standing inequities born of real-time clinician racial bias. Evidence suggests that providers assign a diagnosis of schizophrenia and/or schizoaffective disorder according to race more than any other demographic variable, and this inequity persists even in the absence of differences in clinician symptom ratings. This case report describes the journey of one young Black woman through her racialized misdiagnosis of schizophrenia and the process by which interdisciplinary, health equity-minded providers across the spectrum of medical education and practice joined together to provide a culturally informed, systematic rediagnosis of major depressive disorder and post-traumatic stress disorder. Expert discussion is provided by three Black academic psychiatrists with expertise in social justice and health equity. We provide an evidence-based exploration of mechanisms of clinician racial bias and detail how the psychosis misdiagnosis of racially minoritized groups fails medical ethics and perpetuates iatrogenic harm to patients who truly need help with primary mood, trauma, and substance use disorders.

New England Journal of Medicine

Harvard Review of Psychiatry

Psychiatric Services, Nov 30, 2023

PLOS global public health, Apr 24, 2024

Race is a sociopolitical construct that results in a classification of people determined by a com... more Race is a sociopolitical construct that results in a classification of people determined by a combination of physical traits, rather than biology. Racism, a hierarchical system based on race, in which those with power and privilege are advantaged and given more opportunities (White), while others are systematically disadvantaged others (racial/ethnic minorities). For racial/ethnic minorities with opioid use disorder (OUD), it is important to understand how these hierarchies can result in decreased access to treatment, including initiation, engagement, and adherence. Social dominance theory provides a framework for understanding how social hierarchies are maintained, and resources such as health status, are distributed among socially constructed groups. Consistently employing a racial equity framework that explicitly inserts race and power into the decision-making process and promotes active engagement of stakeholders is often a key component missing in the decision-making process impacting racial/ethnic minorities with OUD. Given the exclusion of racial/ethnic minorities with OUD from the broader public health opioid crisis discussion, promotion of health equity must include deliberate attention to the unique challenges of racial/ethnic minorities with OUD. These challenges include the use of other substances in addition to opioids, the impact of residing in geographic locations with higher opioid overdose death rates, prevalence of common medical comorbidities with OUD, and vulnerabilities in the social determinants of health. Providing instruction on how to elicit this information using the structural vulnerability tool is one model to improve health outcomes, in addition to expert application of the stages of equity and empowerment lens. Finally, understanding cultural norms as protective factors can help in developing integrated treatment plans in partnership with racial/ethnic minorities with OUD for promotion of health and a collaboration toward health equity.

Psychiatric Services, Feb 1, 2021

Psychiatric Clinics of North America, Sep 1, 2020

Despite available treatment options for addiction, there remains an abysmal uptake of treatment i... more Despite available treatment options for addiction, there remains an abysmal uptake of treatment initiation and engagement among varying communities. The existing treatment gap is based on historical occurrences, including discriminatory drug policies that have targeted communities of color with addiction. The current opioid epidemic and differential treatment therein exemplifies the severity of the existing disparity in addiction treatment, highlighting barriers such as institutionalized racism and vulnerabilities in the social determinants of health. To mitigate the disparity, an array of solutions to address these inequities are discussed, thereby providing a pathway forward to eliminating this treatment gap.

The tender moments that call for true empathy are often failed by the demands of the traditional ... more The tender moments that call for true empathy are often failed by the demands of the traditional physician-patient relationship.

American Journal of Psychiatry, Jul 1, 2021

The Lancet Psychiatry, Mar 1, 2021

Academic Medicine, Jun 23, 2020

Health inequities stem from systematic, pervasive social and structural forces. These forces marg... more Health inequities stem from systematic, pervasive social and structural forces. These forces marginalize populations and create the circumstances that disadvantage these groups, as reflected in differences in outcomes like life expectancy and infant mortality and in inequitable access to and delivery of health care resources. To help eradicate these inequities, physicians must understand racism, sexism, oppression, historical marginalization, power, privilege, and other sociopolitical and economic forces that sustain and create inequities. A new educational paradigm emphasizing the knowledge, skills, and attitudes to achieve health equity is needed. Systems-based practice is the graduate medical education core competency that focuses on complex systems and physicians’ roles within them; it includes topics like multidisciplinary team-based care, patient safety, cost containment, end-of-life goals, and quality improvement. This competency, however, is largely health care centric and does not train physicians to engage with the complexities of the social and structural determinants of health or to partner with systems and communities that are outside health care. The authors propose a new core competency centered on health equity, social responsibility, and structural competency to address this gap in graduate medical education. For the development of this new competency, the authors draw on existing, innovative undergraduate and graduate medical pedagogy and public health, health services research, and social medicine frameworks. They describe how this new competency would inform graduate medical education and clinical care and encourage future physicians to engage in the work of health equity.

Journal of Medical Systems, Apr 8, 2022

In this editorial, we further discuss the effects that health equity tourism has had on Black, Na... more In this editorial, we further discuss the effects that health equity tourism has had on Black, Native, and Latinx marginalized communities. We identify the consequences of the resulting medical mistrust within these communities as well as implications for data collection in research. Throughout, solutions are proposed that may eventually empower these communities to become actively engaged with the research and initiatives that influence their health outcomes, as well as improve the quality and quantity of data extracted from these communities.

Academic Psychiatry, Jan 29, 2021

It is critical that physicians understand the societal forces that drive illness and unequal trea... more It is critical that physicians understand the societal forces that drive illness and unequal treatment in the USA [1]. Efforts to arm physicians in training with the skills necessary to identify, name, and eliminatemental health inequities must be a clinicianeducator goal [1–3]. It is essential that graduate medical educators develop curricula to prepare residents to address mental health and health care disparities throughout and after training. In response, the Yale Department of Psychiatry has developed a 4-year longitudinal Social Justice and Health Equity Curriculum (SJHEC), consisting of four tracks: Structural Competency [4, 5], Advocacy [6], History of Psychiatry, and the Human Experience. As part of the core residency curriculum, trainees attend sessions in all four tracks with a collective mission of creating a generation of psychiatrists equipped to eradicate mental health disparities. This manuscript will describe the Human Experience (HE) Track, which aims to illuminate systems of power and oppression within ourselves and society and teach trainees clinical practice interventions to mitigate inequities caused by these systems. The HE Track draws on the social sciences, humanities, and psychological theories; residents are taught how to see and respond to societal, institutional, and individual manifestations of oppression (such as racism, sexism, heterosexism, ableism, classism, ageism, and anti-Semitism) and understand how they contribute to disparities. To our knowledge, there are very few similar curricula within psychiatry training programs [2, 6, 7]. This manuscript aims to first outline the development and implementation of the pilot HE Track within the SJHEC and second, to describe critical feedback from residents and facilitators used to inform subsequent iterations of the curriculum. We will outline our resident feedback and how it was incorporated to improve the curriculum in six lessons learned and aspire to support others in developing and revising similar curricula.

Journal of the American Academy of Child and Adolescent Psychiatry, Nov 1, 2020

The general transcription factor IIE (TFIIE) is essential for transcription initiation by RNA pol... more The general transcription factor IIE (TFIIE) is essential for transcription initiation by RNA polymerase II (RNA pol II) via direct interaction with the basal transcription/DNA repair factor IIH (TFIIH). TFIIH harbors mutations in two rare genetic disorders, the cancer-prone xeroderma pigmentosum (XP) and the cancer-free, multisystem developmental disorder trichothiodystrophy (TTD). The phenotypic complexity resulting from mutations affecting TFIIH has been attributed to the nucleotide excision repair (NER) defect as well as to impaired transcription. Here, we report two unrelated children showing clinical features typical of TTD who harbor different homozygous missense mutations in GTF2E2 (c.448G>C [p.Ala150Pro] and c.559G>T [p.Asp187Tyr]) encoding the beta subunit of transcription factor IIE (TFIIEb). Repair of ultraviolet-induced DNA damage was normal in the GTF2E2 mutated cells, indicating that TFIIE was not involved in NER. We found decreased protein levels of the two TFIIE subunits (TFIIEa and TFIIEb) as well as decreased phosphorylation of TFIIEa in cells from both children. Interestingly, decreased phosphorylation of TFIIEa was also seen in TTD cells with mutations in ERCC2, which encodes the XPD subunit of TFIIH, but not in XP cells with ERCC2 mutations. Our findings support the theory that TTD is caused by transcriptional impairments that are distinct from the NER disorder XP.

Academic Psychiatry, Oct 14, 2020

Harvard Review of Psychiatry, 2023

The overdiagnosis and misdiagnosis of racially minoritized groups as having a primary psychotic d... more The overdiagnosis and misdiagnosis of racially minoritized groups as having a primary psychotic disorder is one of psychiatry’s longest-standing inequities born of real-time clinician racial bias. Evidence suggests that providers assign a diagnosis of schizophrenia and/or schizoaffective disorder according to race more than any other demographic variable, and this inequity persists even in the absence of differences in clinician symptom ratings. This case report describes the journey of one young Black woman through her racialized misdiagnosis of schizophrenia and the process by which interdisciplinary, health equity-minded providers across the spectrum of medical education and practice joined together to provide a culturally informed, systematic rediagnosis of major depressive disorder and post-traumatic stress disorder. Expert discussion is provided by three Black academic psychiatrists with expertise in social justice and health equity. We provide an evidence-based exploration of mechanisms of clinician racial bias and detail how the psychosis misdiagnosis of racially minoritized groups fails medical ethics and perpetuates iatrogenic harm to patients who truly need help with primary mood, trauma, and substance use disorders.

New England Journal of Medicine

Harvard Review of Psychiatry