Graduate School of Social Service doctoral candidate Leslie Ince, GSS ‘25, sees stories within data. Her job as a researcher is to communicate those stories to ignite action.
“They’re not just numbers; I see a story,” she said. “I want to know what story can I tell if I look at data, run my analyses, and then look at the deeper meaning behind [it].”
Racial health disparities are a well-documented issue, but few studies have explored these inequities specifically within the population of adults with serious mental illness. Ince’s doctoral dissertation—successfully defended on October 15—explored this topic between non-Hispanic Black and non-Hispanic white individuals, analyzing data from the 2018 National Survey on Drug Use and Health.
A Compounding Negative Impact
Ince’s research revealed stark disparities in risk factors such as diabetes, high blood pressure, and obesity between non-Hispanic Black and non-Hispanic white individuals. The findings illustrate what Ince called a “double jeopardy” effect, where systemic inequities compound existing health challenges faced by those with serious mental illness.
What’s driving these outcomes? Access to care, type of health insurance, and systemic barriers such as racism and socioeconomic instability, Ince said, are likely contributing factors.
However, like every interesting story, there were unforeseen events. Asthma outcomes in Ince’s research ran counter to trends typically seen in the general population: non-Hispanic whites in the study reported worse asthma outcomes than non-Hispanic Blacks. Similarly, there was no significant racial disparity in heart conditions, a result Ince found unexpected given the broader disparities in cardiovascular risk factors throughout the study.
“That was surprising,” she said.
In addition—Ince’s research noted differences in emergency room usage. Non-Hispanic Black study participants reported visiting the emergency room far more often than non-Hispanic white counterparts. Ince attributed this, in part at least, to medical insurance and insufficient primary care options for underinsured persons.
Regular health screenings can prevent serious sickness and disease. So, when someone doesn’t have health insurance that covers these screenings, it’s harder to catch sickness before it escalates, she said. When they eventually notice the illness, it’s far too late—and they must rush to the emergency room.
So, if there are good data available, and clearly things that still need to be uncovered, why have researchers historically underexplored this population? Ince thinks they may feel like they don’t need to.
Many studies dive deep into racial and serious mental illness inequities as separate populations. It’s possible that researchers believe this is “good enough,” and that, in doing this, everyone is represented. However, Ince said they aren’t considering the compounding implications of one person experiencing both inequities.
“There’s this kind of feeling that [the research]is being done [by studying the two groups separately],” Ince said. “People aren’t necessarily thinking about putting the two together.”
Ince’s findings show just how necessary it is.
A Personal and Professional Journey
Before pursuing her doctorate, Ince worked at a day treatment program where mental and physical health care were co-located—meaning, the services were provided in the same building. Service providers like Ince helped clients ensure they were keeping up with their holistic health—and the convenience of colocation made it much easier to receive quality care. Ince said she saw it improve outcomes.
“That kind of sparked my interest in health outcomes for people with serious mental illness,” she said.
Ince added that her experience in Fordham’s Master of Social Work (M.S.W.) program also contributed to her interest in research. She chose the research domain for her master’s studies and quickly learned she had a knack for numbers. She attributed part of her success to mentorship from faculty members like Cathy Berkman, Ph.D., (Ince’s dissertation chair), whose guidance was both practical and compassionate.
“Her feedback wasn’t just about the dissertation—it was about navigating life challenges, too,” Ince said. “I wouldn’t have made it through without her.”
Berkman said Ince was an “outstanding student,” and her dissertation research was “groundbreaking.”
“Leslie has made an important contribution to our understanding of social determinants of health in this population,” Berkman said. “[She] is to be commended for choosing to do this research that was methodologically rigorous and involved advanced statistics. I want to thank dissertation committee members Dana Marlowe and Eri Noguchi for their considerable contributions to this dissertation.”
Looking Ahead
Ince aims to publish her findings and advocate for collaborative care models, which integrate physical and behavioral health services.
“Teaching and publishing are my next big steps,” she said, emphasizing the need for better outreach to individuals with serious mental illness who may not prioritize physical health due to their mental health challenges.
Interested in Fordham’s Ph.D. in Social Work program? Read more here.
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