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Williams AJ, Townsend E, Naeche N, Chapman-Nisar A, Hollis C, Slovak P. Investigating the Feasibility, Acceptability, and Appropriation of a Socially Assistive Robot Among Minority Youth at Risk of Self-Harm: Results of 2 Mixed Methods Pilot Studies. JMIR Form Res 2023; 7:e52336. [PMID: 37991838 PMCID: PMC10701649 DOI: 10.2196/52336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Minority youth are at an increased risk of experiencing self-harmful thoughts and behaviors. However, there is limited evidence of successful interventions to support young people in the moment of their distress. Digital interventions are considered a potential solution for providing in-the-moment support for those at risk of adverse mental health and self-harm. OBJECTIVE These pilot studies aim to investigate the feasibility and acceptability of a new in situ intervention tool, Purrble, among two broad groups of minority youth: (1) lesbian, gay, bisexual, transgender, queer, and similar minority (LGBTQ+) youth and (2) racial and ethnic minority youth. Purrble was designed to support in-situ emotion regulation (ER) support when individuals are facing emotionally challenging situations. METHODS This study consisted of 2 mixed methods pilot studies that followed the same mixed methods design, including 3 weeks of daily and weekly surveys and optional follow-up interviews. Inclusion criteria were (1) aged between 16 and 25 years, (2) part of a minority group, (3) had experiences of self-harmful thoughts or behaviors or elevated symptoms of depression or anxiety, and (4) living in the United Kingdom at the time of the study. The primary outcomes were (1) the feasibility of Purrble as an intervention among pilot samples (analyzed by consent rate, retention rate, adherence to surveys, and engagement with the device) and (2) the acceptability and appropriation of Purrble across pilot studies as a tool to support ER in situ (thematically analyzed qualitative open-ended questions and interview data). The secondary outcomes were descriptive pilot data concerning the mental health outcomes in each sample. RESULTS In total, 21 LGBTQ+ young people participated in pilot study 1, with 86% (n=18) completing the baseline and 3 weeks of daily surveys. These young people maintained engagement with Purrble across deployment, across which period there was a decrease in self-harmful thoughts and anxiety symptoms. A total of 19 ethnic and racial minority youths participated in pilot study 2, and 84% (n=16) completed the study. Although pilot study 2 participants also maintained engagement with Purrble across deployment, this was to a lesser degree than participants of pilot study 1, and perceived mental health outcomes did not indicate potential change associated with the device. The thematic analysis indicated three superordinate themes: (1) stopping the self-harm cycle, (2) adopting ER strategies, and (3) stages of change. CONCLUSIONS These were the first pilot studies of a novel intervention that aimed to provide in situ ER support for young people at risk of self-harm. Both quantitative and qualitative findings indicate that young people found Purrble to be a feasible and acceptable intervention, as they effectively incorporated the device into their ER practices. These engagements with Purrble were described as interrupting the cycle of self-harmful ideation and behavior.
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Affiliation(s)
- A Jess Williams
- Department of Informatics, King's College London, London, United Kingdom
| | - Ellen Townsend
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Nkem Naeche
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Amelia Chapman-Nisar
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Chris Hollis
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Petr Slovak
- Department of Informatics, King's College London, London, United Kingdom
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Thoma BC, Hone E, Roig A, Goodfriend E, Jardas EJ, Brummitt B, Riston S, Sakolsky D, Zelazny J, Marsland AL, Chen K, Douaihy AB, Brent DA, Melhem NM. Risk for Suicidal Behavior After Psychiatric Hospitalization Among Sexual and Gender Minority Patients. JAMA Netw Open 2023; 6:e2333060. [PMID: 37682570 PMCID: PMC10492186 DOI: 10.1001/jamanetworkopen.2023.33060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/22/2023] [Indexed: 09/09/2023] Open
Abstract
Importance The months following inpatient psychiatric hospitalization are a period of high risk for suicidal behavior. Sexual and gender minority (SGM) individuals have elevated risk for suicidal behavior, but no prior research has examined whether SGM inpatients have disproportionate risk for suicidal behavior following discharge from psychiatric hospitalization. Objectives To evaluate whether SGM patients have elevated risk for suicidal behavior following discharge from psychiatric hospitalization compared with heterosexual and cisgender patients and to examine whether differences in risk across groups were accounted for by demographic characteristics and clinical factors known to be associated with suicidal behavior. Design, Setting, and Participants This prospective cohort study was conducted from August 2017 to July 2021 among inpatients aged 18 to 30 years who were voluntarily enrolled during psychiatric hospitalization. The study was conducted at an inpatient psychiatric hospital, with prospective data collected via follow-up visits and electronic health records. Main Outcomes and Measures Onset and/or recurrence of suicidal behavior following discharge from psychiatric hospitalization, assessed at follow-up visits and through electronic health records. Results A total of 160 patients were included, with 56 sexual minority (SM) and 15 gender minority (GM) patients. The median (IQR) age of the patients was 23.5 (20.4-27.6) years, 77 (48%) reported male sex assigned at birth, and 114 (71%) identified their race as White. During the follow-up period, 33 suicidal behavior events occurred (among 21% of patients). SM (hazard ratio [HR], 2.02; 95% CI, CI, 1.02-4.00; log-rank P = .04) and GM (HR, 4.27; 95% CI, 1.75-10.40; log-rank P < .001) patients had significantly higher risk for suicidal behavior compared with their heterosexual and cisgender counterparts, respectively, in bivariable analyses. Risk between SM and heterosexual patients was not different after controlling for demographic characteristics and clinical factors associated with suicidal behavior. GM patients exhibited elevated risk during the 100 days following discharge even after controlling for demographic and clinical characteristics (HR, 3.80; 95% CI, 1.18-11.19; P = .03). Conclusions and Relevance Within this cohort study of psychiatric patients, SGM patients had higher risk for suicidal behavior than non-SGM patients following discharge. While SM patients' risk was accounted for by clinical characteristics, GM patients' risk for suicidal behavior was not accounted for by their acute psychiatric state on admission. Future studies with larger subsamples of GM individuals are needed, and inpatient clinicians must attend to the unique needs of SGM individuals to ensure they receive affirming services.
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Affiliation(s)
- Brian C. Thoma
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Emily Hone
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alyssa Roig
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - EJ Jardas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Bradley Brummitt
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sarah Riston
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jamie Zelazny
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Anna L. Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kehui Chen
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Antoine B. Douaihy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nadine M. Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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O'Brien M, Hirschtritt ME, Tahir P, Kalapatapu RK. Experiences of transgender and gender diverse patients in emergency psychiatric settings: A scoping review. J Am Coll Emerg Physicians Open 2023; 4:e13018. [PMID: 37547378 PMCID: PMC10399137 DOI: 10.1002/emp2.13018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023] Open
Abstract
Objective This scoping review aims to characterize what is known about transgender and gender diverse (TGD) individuals in emergency psychiatric settings and identify what gaps persist in this literature. Methods A search of 4 electronic databases (PubMed, Web of Science, GenderWatch, and PsycINFO) was used for data collection. Included were studies that looked at TGD individuals presenting to a psychiatric emergency department (ED) or ED with a primary mental health concern. Study screening progress was documented in a Preferred Reporting Items for Systematic reviews and Meta-Analyses flow chart. A total of 232 titles and abstracts were screened, 38 full texts were evaluated for eligibility, and 10 studies were included. Results The studies reviewed identified mental health vulnerabilities unique to the TGD population, including service denial in health care settings, gender dysphoria, increased rates of non-suicidal self-injury, and in some studies an increase in suicidality. Societal inequities, including the risk of discrimination and residential instability, were also revealed. A subset of the studies identified best practices in caring for this population, including the use of non-judgmental, affirmative, and inclusive language, and on a structural level creating emergency environments that are confidential, inclusive, and therapeutic for these individuals. Conclusions There is limited information on TGD individuals in emergency psychiatric settings, and thus it is difficult to form strong conclusions. However, the current evidence available suggests possible inequities in this population. Three major themes with regards to TGD individuals in emergency psychiatric settings were identified: mental health vulnerabilities, societal inequities, and best practices in caring for this population. Overall, there is a scarcity of literature in this field, and further research on the experiences of this population is needed to inform clinical practice.
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Affiliation(s)
- Megan O'Brien
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoUSA
| | - Matthew E. Hirschtritt
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoUSA
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
- Department of PsychiatryKaiser Permanente Oakland Medical CenterOaklandCaliforniaUSA
| | - Peggy Tahir
- Department of Library SciencesUniversity of CaliforniaSan FranciscoUSA
| | - Raj K. Kalapatapu
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoUSA
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Lillemoe J, Holmstrom SE, Sojar SH. Emergency care considerations for transgender and gender diverse youth: a review to improve health trajectories. Curr Opin Pediatr 2023; 35:331-336. [PMID: 36876657 DOI: 10.1097/mop.0000000000001239] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
PURPOSE OF REVIEW Transgender and Gender Diverse (TGD) youth represent a growing subset of pediatric patients who are at increased risk for harmful health outcomes. Consideration of these risks during emergency encounters may decrease these undesired, sometimes fatal, adverse events. RECENT FINDINGS Gender affirmative care of TGD youth is considered a basic healthcare right as noted by several academic societies including the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the American Psychological Association [1-3] ( Table 1 ). Withholding gender affirmative care can lead to undesired health outcomes including but not limited to an increased incidence of mood disorders, self-injurious behavior, suicidal ideation, sexually transmitted diseases, and delayed presentations of treatable illness. TGD youth often access acute care settings, yet many feel apprehensive due to prior negative experiences or fear of discrimination. Practitioners are also often unaware as to how to effectively provide this type of healthcare. SUMMARY Acute care settings provide a unique and impactful environment to provide evidence-based, gender-affirming care that can make patients feel validated, mitigate future care avoidance, and minimize negative downstream health effects. In this review, we have consolidated high yield health considerations regarding TGD youth for acute care and emergency providers to deliver optimal care for this population.
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Affiliation(s)
- Jenna Lillemoe
- Department of Emergency Medicine
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sara E Holmstrom
- Department of Emergency Medicine
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sakina H Sojar
- Department of Emergency Medicine
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Jimenez N, Harner V, Oliva MA, Lozano L, Fuentes M. The role of social determinants of health in the receipt of school services after\\ traumatic brain injury: A focus review on underserved pediatric populations. NeuroRehabilitation 2023:NRE220210. [PMID: 37125571 DOI: 10.3233/nre-220210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Return to school is key for community re-integration after a traumatic brain injury (TBI). School support facilitates and ensure a successful transition back to school. However, access to school services is not uniform among U.S. children. OBJECTIVE To describe school services for children with TBI from minoritized backgrounds and highlight population-specific risk factors and facilitators for accessing services. METHODS Narrative review of the literature including studies on return to school after a mild-complicated, moderate, or severe TBI, among children enrolled in the U.S. school system. We describe receipt of services, enabling and risk factors, and outcomes, for minority children. RESULTS There is a gap in knowledge regarding return to school among minoritized children with TBIs. Studies have few participants from racial and ethnic minority backgrounds, or low income or rural communities. Transgender and non-binary youth are not represented in present research efforts. Studies highlight larger barriers to receipt of school services among minority children and additional barriers associated with their minority status. CONCLUSION Diversity in the U.S pediatric population is increasing. Minoritized populations are at increased risk for TBI and poor outcomes. Research focused on the needs of these populations is required to optimize school return after TBI hospitalization and overall post-discharge care.
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Affiliation(s)
- Nathalia Jimenez
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Vern Harner
- School of Social Work and Criminal Justice, University of Washington-Tacoma, Tacoma, WI, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
| | - Maria Andrea Oliva
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Lorena Lozano
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Molly Fuentes
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Haroz EE, Sarapik LM, Adams LB, Nestadt PS, Athey A, Alvarez K, Slade EP, Cwik M, Berman AL, Wilcox HC. A Cascade of Care Model for Suicide Prevention. Am J Prev Med 2023; 64:599-603. [PMID: 36402646 PMCID: PMC10166000 DOI: 10.1016/j.amepre.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/31/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Emily E Haroz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Liina M Sarapik
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leslie B Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Paul S Nestadt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alison Athey
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kiara Alvarez
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric P Slade
- Johns Hopkins School of Nursing, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alan L Berman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
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Hunsicker M, Maloul E, Amanda K. G, Gilady D, Brownstone LM. Filling a gap: virtual clinician-led support groups for disordered eating. COUNSELLING PSYCHOLOGY QUARTERLY 2023. [DOI: 10.1080/09515070.2023.2192461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Schultz TR, Zoucha R, Sekula K, Abrams BAD. Emergency care for youth who experience suicidality and identify as LGBTQ. Public Health Nurs 2023; 40:243-249. [PMID: 36519928 DOI: 10.1111/phn.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/01/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Suicide is a leading cause of death in children; youth who identify as LGBTQ+ are at an exponentially higher risk of suicide. The purpose of this study was to explore the lived experiences of youth who identify as LGBTQ+ and sought emergency care for suicidality as adolescents. METHODS Hermeneutics phenomenology is the research method used in this study. Youth who identify as LGBTQ+ and sought emergency treatment for suicidality when they were adolescents were recruited; fifteen youth enrolled. Individuals ranged in age from 20 to 25 years. Participants described their gender identity as male, female, non-binary, transgender female, and their sexual orientation as: female, demisexual, bisexual, gay, homosexual, lesbian, queer, asexual, and transgender. RESULTS This study establishes that youth who identify as LGBTQ+ seeking emergency care for suicidality value: coping and control, acceptance from others and self, communicating with me about me, and moving beyond danger and distress. Lack of psychological safety-from the emic perspective-emerged as a critical finding. CONCLUSION This research has strong implications for public health, policy, and research. Future research must seek to understand ways in which psychological safety is assessed in healthcare if we are to more deeply understand and effectively address the impact on health equity.
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Affiliation(s)
- Theresa Ryan Schultz
- Children's National Hospital, Director of Nursing, Emergency Medicine and Trauma Center, Washington, DC
| | - Rick Zoucha
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania
| | - Kathleen Sekula
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania
| | - Bishop Allyson D Abrams
- Pastor of Empowerment Liberation Cathedral, President of Empowerment Justice Center, Bowie, Maryland
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Jacobson SV, Gilbert AC, O'Loughlin CM, Widman C, Law KC, Ammerman BA. Effects of sexual orientation and NSSI severity on suicide risk. J Psychiatr Res 2023; 157:174-179. [PMID: 36470199 DOI: 10.1016/j.jpsychires.2022.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/17/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION People who identify as sexual minorities are at increased risk for suicide. Non-suicidal self-injury (NSSI) is also a risk factor for suicide and NSSI severity may contribute to development of capability for lethal self-injury. Further research is needed to understand how NSSI severity increases suicide risk, specifically in high-risk populations like sexual minorities. The current study seeks to examine whether sexual minority adults exhibit greater NSSI severity and suicide risk than heterosexuals, and if NSSI severity moderates the relationship between sexual orientation and suicide risk. METHODS Undergraduate students (N = 1,994) who reported five or more acts of NSSI in their lifetime completed online self-report questionnaires including sexual orientation, NSSI severity, and suicide risk. RESULTS A factorial ANOVA demonstrated main effects of sexual orientation and NSSI severity on suicide risk. DISCUSSION The lack of significant interaction effect indicates NSSI severity does not amplify the effect of on sexual orientation on suicide risk; rather, it predicts the same level of increased risk across orientations. Therefore, suicidality related to both sexual orientation and NSSI severity are equally important treatment targets.
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Affiliation(s)
- Samantha V Jacobson
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA.
| | - Anna C Gilbert
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | | | - Cammy Widman
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA
| | - Keyne C Law
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA, USA.
| | - Brooke A Ammerman
- Department If Psychology, University of Notre Dame, Notre Dame, IN, USA
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10
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Hoge MA, Vanderploeg J, Paris M, Lang JM, Olezeski C. Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda. Community Ment Health J 2022; 58:1225-1239. [PMID: 35038073 PMCID: PMC8762987 DOI: 10.1007/s10597-022-00937-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022]
Abstract
There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors' interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.
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Affiliation(s)
- Michael A. Hoge
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jeffrey Vanderploeg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- Child Health and Development Institute, Farmington, CT USA
- Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Manuel Paris
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jason M. Lang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- Child Health and Development Institute, Farmington, CT USA
- Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Christy Olezeski
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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Marraccini ME, Pittleman C, Griffard M, Tow AC, Vanderburg JL, Cruz CM. Adolescent, parent, and provider perspectives on school-related influences of mental health in adolescents with suicide-related thoughts and behaviors. J Sch Psychol 2022; 93:98-118. [PMID: 35934453 PMCID: PMC9516717 DOI: 10.1016/j.jsp.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/04/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
Abstract
Previous research supports a link between school-related factors, such as bullying and school connectedness, and suicidal thoughts and behaviors. To deepen understanding of how school experiences may function as both protective and risk factors for youth struggling with suicidal thoughts and behaviors, this qualitative study explored multiple perspectives. Specifically, in-depth interviews were conducted with adolescents previously hospitalized for a suicidal crisis (n = 19), their parents (n = 19), and the professionals they may interact with in schools and hospitals (i.e., school professionals [n = 19] and hospital providers [n = 7]). Data were analyzed using applied thematic analysis revealing three main themes related to perceptions of how school experiences can positively or negatively impact mental health, including (a) school activities, (b) school social experiences, and (c) school interventions. An emergent theme related to the complexity of suicide-related risk identified the ways in which school experiences may intersect with other environmental, biological, and psychological factors. Findings underscore the need for school-based approaches to address the unique academic, social, and emotional needs of students with suicide-related risk that complement the supports and services provided in their home and community.
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Affiliation(s)
- Marisa E Marraccini
- School of Education, University of North Carolina at Chapel Hill, Campus Box 3500, Peabody Hall, Chapel Hill, NC 27599, United States.
| | - Cari Pittleman
- School of Education, University of North Carolina at Chapel Hill, Campus Box 3500, Peabody Hall, Chapel Hill, NC 27599, United States
| | - Megan Griffard
- School of Education, University of North Carolina at Chapel Hill, Campus Box 3500, Peabody Hall, Chapel Hill, NC 27599, United States
| | - Amanda C Tow
- School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27599, United States
| | - Juliana L Vanderburg
- School of Education, University of North Carolina at Chapel Hill, Campus Box 3500, Peabody Hall, Chapel Hill, NC 27599, United States; School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27599, United States
| | - Christina M Cruz
- School of Education, University of North Carolina at Chapel Hill, Campus Box 3500, Peabody Hall, Chapel Hill, NC 27599, United States; School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27599, United States
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Marchi M, Arcolin E, Fiore G, Travascio A, Uberti D, Amaddeo F, Converti M, Fiorillo A, Mirandola M, Pinna F, Ventriglio A, Galeazzi GM. Self-harm and suicidality among LGBTIQ people: a systematic review and meta-analysis. Int Rev Psychiatry 2022; 34:240-256. [PMID: 36151841 DOI: 10.1080/09540261.2022.2053070] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Research evidence has consistently documented a higher risk of suicidality in the Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ) population. This systematic review and meta-analysis aimed to report a detailed description of research data regarding the risk of Attempted Suicide (SA), Suicide Ideation (SI), and Non-Suicidal Self-Injury (NSSI) behaviours for LGBTIQ people and their subgroups. Medline, Scopus, PsycINFO, and EMBASE were searched for studies reporting a comparative estimation of SA, SI, and NSSI rates among LGBTIQ population and the general population (i.e. heterosexual/cisgender), without restrictions on participants' age and setting for the enrolment. Pooled analyses were based on odds ratios (ORs, with 95% CIs), estimated through inverse variance models with random effects. Fifty studies were selected for the quantitative synthesis and included fifty samples involving 3.735.601 controls and 87.252 LGBTIQ people. LGBTIQ people reported an increased risk of SA (OR:4.36[95%CI:3.32;5.71]), SI (OR:3.76[95%CI:3.02;4.69]), and NSSI (OR:4.24[95%CI:3.23;5.55]). Among LGBTIQ subgroups, the Bisexual group has shown the highest risk of suicidality (SA, OR:6.71; SI, OR:5.04; NSSI, OR: 5.03), followed by the Lesbian-Gay for attempted suicide (SA, OR:6.03), and the Transgender-Intersex-Queer for suicide ideation and non-suicidal self-injury (SI and NSSI, OR:3.42). The quality of the evidence ranged from low to moderate. Our findings have shown that LGBTIQ people report a higher risk of suicidality compared with their cisgender/heterosexual peers. This evidence may contribute to the public awareness on LGBTQI mental health needs and suggest supportive strategies as well as preventive interventions (e.g. supportive programs, counselling, and destigmatizing efforts) as parts of a tailored health-care planning aimed to reduce psychiatric morbidity and mortality in this at-risk population.
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Affiliation(s)
- Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Arcolin
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluca Fiore
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Travascio
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniele Uberti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Health Sciences, University of Brighton, Brighton, UK
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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13
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Marraccini ME, Ingram KM, Naser SC, Grapin SL, Toole EN, O'Neill JC, Chin AJ, Martinez RR, Griffin D. The roles of school in supporting LGBTQ+ youth: A systematic review and ecological framework for understanding risk for suicide-related thoughts and behaviors. J Sch Psychol 2022; 91:27-49. [PMID: 35190078 PMCID: PMC8906061 DOI: 10.1016/j.jsp.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/25/2021] [Accepted: 11/30/2021] [Indexed: 01/20/2023]
Abstract
The extant literature on suicide-related thoughts and behaviors (STB) has highlighted increased patterns of risk among specific minoritized populations, including lesbian, gay, bisexual, transgender, questioning, intersex, two spirit, and queer (LGBTQ+) youth. Compared to their heterosexual and cisgender peers, LGBTQ+ youth are at increased risk for having STB. Identity-specific stressors such as homonegativity and anti-queerness are among the unique factors posited to contribute to this risk and inhibit factors that protect against suicide. The school setting has been a focal point for suicide prevention and intervention and may also play a key role in linking students to care; however, schools also hold the potential to provide supports and experiences that may buffer against risk factors for STB in LGBTQ+ students. This systematic literature review presents findings from 44 studies examining school-related correlates of STB in LGBTQ+ students, informing an ecological approach to suicide prevention for school settings. Findings underscore the importance of school context for preventing STB in LGBTQ+ youth. Approaches that prioritize safety and acceptance of LGBTQ+ youth should span multiple layers of a student's ecology, including district and state level policies and school programs and interventions, such as Gender and Sexuality Alliances and universal bullying prevention programs. Beyond their role as a primary access point for behavioral health services, schools offer a unique opportunity to support suicide prevention by combating minority stressors through promoting positive social relationships and a safe community for LGBTQ+ students.
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Affiliation(s)
- Marisa E Marraccini
- School of Education, University of North Carolina at Chapel Hill, United States of America.
| | - Katherine M Ingram
- School of Education, University of North Carolina at Chapel Hill, United States of America
| | - Shereen C Naser
- College of Sciences and Health Professions, Cleveland State University, United States of America
| | - Sally L Grapin
- Psychology Department, Montclair State University, United States of America
| | - Emily N Toole
- School of Education, University of North Carolina at Chapel Hill, United States of America
| | - J Conor O'Neill
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, United States of America
| | - Andrew J Chin
- School of Education, University of North Carolina at Chapel Hill, United States of America
| | - Robert R Martinez
- School of Education, University of North Carolina at Chapel Hill, United States of America
| | - Dana Griffin
- School of Education, University of North Carolina at Chapel Hill, United States of America
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14
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Schultz TR, Zoucha R, Sekula LK. The intersection between youth who identify as LGBTQ+ and emergency care for suicidality: an integrative review. J Pediatr Nurs 2022; 63:e82-e94. [PMID: 34756491 DOI: 10.1016/j.pedn.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
PROBLEM Suicide is a leading cause of death in children. Sexual minority youth are greater than three times more likely to attempt suicide than their cisgender heterosexual peers. ELIGIBILITY CRITERIA Empirical and theoretical literature were evaluated through the integrative review process using the Whittemore-Knafl integrative review model (2005). Studies were included when they addressed LGBTQ+ youth seeking emergency care for suicidality. SAMPLE The final sample included a mix of 13 qualitative, quantitative, and mixed methods studies published in peer-review journals between 2011 and 2020. These articles were located in journals found through a database search, including Medline EBSCO, Health Source/Nursing Academic Education, SportDiscus, ERIC EBSCO, Academic Search Elite, Social Services Abstracts, Sociological Abstracts, APA Psych Info, Embase, and CINAHL. RESULTS Thirteen studies included individuals 5 to 26 years of age; ten studies included individuals > 11 years old. The analysis and synthesis of coded and grouped data resulted in four themes: 1) affirmation/acceptance, 2) strength, 3) approach/intervention, and 4) safety/psychological distress. CONCLUSIONS Research study methods, design, setting, and quality varied. This integrative review has established that youth who identify as LGBTQ+ and are seeking emergency care for suicidality, value: acceptance, safety, strength, and approach/intervention. IMPLICATIONS There are strong implications for research, healthcare policy, and pediatric nursing practice. Future research is needed to explore the unique values, beliefs, and experiences of youth who identify as LGBTQ+ seeking emergency/crisis care for suicidality.
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Affiliation(s)
| | - Rick Zoucha
- Duquesne University, 600 Forbes Avenue, 527 Fisher Hall, Pittsburgh, PA 15202, USA
| | - L Kathleen Sekula
- Duquesne University, 600 Forbes Avenue, 527 Fisher Hall, Pittsburgh, PA 15202, USA
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15
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Williams AJ, Arcelus J, Townsend E, Michail M. Feasibility and acceptability of experience sampling among LGBTQ+ young people with self-harmful thoughts and behaviours. Front Psychiatry 2022; 13:916164. [PMID: 36061288 PMCID: PMC9428709 DOI: 10.3389/fpsyt.2022.916164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
This study was the first to determine whether it was feasible and acceptable to use experience sampling methods (ESM) among LGBTQ+ young people, who had current experiences of self-harm. Sixteen LGBTQ+ young people (16-25 years old) took part in the experience sampling study. This included a baseline assessment, a 7-day ESM assessment (participants were sampled six times a day using a phone app), and the option of an interview at the end of the 7-day ESM assessment. Feasibility data was descriptively analysed, with pilot ESM data presented. Qualitative data was thematically analysed to determine the acceptability (barriers and facilitators) of taking part in this study. Study feasibility was assessed by enrolment rate (55.2%), participant retention across assessment period (100%), ESM app feasibility (87.5%), and good adherence to total number of ESM surveys (67.6%). Individual study adherence ranged between 43 and 95.2%. Study acceptability was assessed by participant interviews. Thematic analysis indicated four superordinate themes; (i) Self-reflection and awareness; (ii) Practicalities of ESM surveys; (iii) Daily timeframes; and (iv) Suggestions for future studies. Pilot ESM data demonstrates that there was fluctuation of depressive and anxiety symptoms within- and between- participants over the course of the study, however, greater sample power is needed for full analysis. This study demonstrated that ESM designs are feasible and acceptable among LGBTQ+ young people with current experiences of self-harm. Pilot data indicated that specific experiences and moods are likely to be important to self-harm. These potentially have a temporal influence on self-harm behaviour or ideation, and therefore should be examined in a fully powered sample.
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Affiliation(s)
- A J Williams
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom.,Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, United Kingdom.,Informatics, Faculty of Natural, Mathematical and Engineering Sciences, King's College London, London, United Kingdom
| | - Jon Arcelus
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
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16
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de Graaf NM, Steensma TD, Carmichael P, VanderLaan DP, Aitken M, Cohen-Kettenis PT, de Vries ALC, Kreukels BPC, Wasserman L, Wood H, Zucker KJ. Suicidality in clinic-referred transgender adolescents. Eur Child Adolesc Psychiatry 2022; 31:67-83. [PMID: 33165650 DOI: 10.1007/s00787-020-01663-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/11/2020] [Indexed: 12/20/2022]
Abstract
Gender and sexually diverse adolescents have been reported to be at an elevated risk for suicidal thoughts and behaviors. For transgender adolescents, there has been variation in source of ascertainment and how suicidality was measured, including the time-frame (e.g., past 6 months, lifetime). In studies of clinic-referred samples of transgender adolescents, none utilized any type of comparison or control group. The present study examined suicidality in transgender adolescents (M age, 15.99 years) seen at specialty clinics in Toronto, Canada, Amsterdam, the Netherlands, and London, UK (total N = 2771). Suicidality was measured using two items from the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). The CBCL/YSR referred and non-referred standardization samples from both the U.S. and the Netherlands were used for comparative purposes. Multiple linear regression analyses showed that there was significant between-clinic variation in suicidality on both the CBCL and the YSR; in addition, suicidality was consistently higher among birth-assigned females and strongly associated with degree of general behavioral and emotional problems. Compared to the U.S. and Dutch CBCL/YSR standardization samples, the relative risk of suicidality was somewhat higher than referred adolescents but substantially higher than non-referred adolescents. The results were discussed in relation to both gender identity specific and more general risk factors for suicidality.
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Affiliation(s)
- Nastasja M de Graaf
- Gender Identity Development Service, The Tavistock and Portman NHS Trust, London, England
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Thomas D Steensma
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Polly Carmichael
- Gender Identity Development Service, The Tavistock and Portman NHS Trust, London, England
| | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Madison Aitken
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peggy T Cohen-Kettenis
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Annelou L C de Vries
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Lori Wasserman
- Reproductive Life Stages Program, Women's College Hospital, Toronto, ON, Canada
| | - Hayley Wood
- Psychological Services, Toronto Board of Education, Toronto, ON, Canada
| | - Kenneth J Zucker
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON, M5T 1R8, Canada.
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17
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Wang Y, Feng Y, Han M, Duan Z, Wilson A, Fish J, Sun S, Chen R. Methods of attempted suicide and risk factors in LGBTQ+ youth. CHILD ABUSE & NEGLECT 2021; 122:105352. [PMID: 34655994 DOI: 10.1016/j.chiabu.2021.105352] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study aimed to identify patterns of attempted suicide methods and risk factors in lesbian, gay, bisexual, transgender, queer and other gender/sexual minority (LGBTQ+) youth by comparing them to non-LGBTQ+ youth. METHODS A total of 9281 Chinese college students completed the study, 8313 participants were included in the analysis of which 1032 were LGBTQ+ youth and 7281 were non-LGBTQ+ youth. Sociodemographic information was collected along with several scales and self-report items. This included anxiety scores using the Generalized Anxiety Disorder (GAD)-7, depression scores using the Patient Health Questionnaire (PHQ)-9, mania score using the Altman Self-Rating Mania (ASRM), Childhood Trauma Questionnaire (CTQ), and Intimate Partner Violence (IPV) victimization using the World Health Organization's definition. Self-report items were used to further collect history of non-fatal self-injurious behaviors, parents' related risk factors, history of suicide attempts, and methods of attempted suicide. RESULTS The prevalence of attempted suicide in LGBTQ+ youth was 4.2%, which in comparison was more than four times higher than non-LGBTQ+ youth. LGBTQ+ youth 19-22 years old were at a significantly higher risk of attempting suicide than non-LGBTQ+ youth. The most common method of attempted suicide was cutting of the wrist, followed by jumping from a high height. There were some common suicide risk factors that were similar between LGBTQ+ and non-LGBTQ+ youth, such as living in a rural area, having a history of a psychiatric disorder, and having a history of non-fatal self-injurious behaviors. The associated increased risk factors for LGBTQ+ youth were having a higher score for CTQ-emotional abuse and CTQ-sexual abuse. LIMITATION The causality of risk factors to attempted suicide cannot be assumed due to the cross-sectional nature of the survey. Also, due to the relatively small sample size within the subgroups, we did not assess LGBTQ+ youth separately according to the different sexuality groups. CONCLUSION LGBTQ+ youth showed a higher prevalence of attempted suicide when compared to their heterosexual peers. Emotional and sexual abuse showed higher rates among LGBTQ+ youth, the cumulative effects of childhood trauma might explain the difficulties in developing healthy coping styles.
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Affiliation(s)
- Yuanyuan Wang
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China; School of Psychology, Beijing Normal University, Beijing, China
| | - Meng Han
- Department of Medical Psychology, The School of Health Humanities, Peking University, Beijing, China; Vanke School of Public Health, Tsinghua University, Beijing, China.
| | - Zhizhou Duan
- Preventive health service, Jiangxi Provincial People's Hospital, Affiliated People's Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Julie Fish
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Shufang Sun
- Brown University School of Public Health, Department of Behavioral and Social Sciences, International Health Institute, US
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China.
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18
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Kruse MI, Voloshin D, Wan M, Clarizio A, Bigham BL, Upadhye S. Care of Sexual and Gender Minorities in the Emergency Department: A Scoping Review. Ann Emerg Med 2021; 79:196-212. [PMID: 34785088 DOI: 10.1016/j.annemergmed.2021.09.422] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE This scoping review was conducted to collate and summarize the published research literature addressing sexual and gender minority care in the emergency department (ED). METHODS Using PRISMA-ScR criteria, an electronic search was conducted of CINAHL, Embase, Ovid Medline, and Web of Science for all studies that were published after 1995 involving sexual and gender minorities, throughout all life stages, presenting to an ED. We excluded non-US and Canadian studies and editorials. Titles and abstracts were screened, and full-text review was performed independently with 4 reviewers. Abstraction focused on study design, demographics, and outcomes, and the resulting data were analyzed using an ad hoc iterative thematic analysis. RESULTS We found 972 unique articles and excluded 743 after title and abstract screening. The remaining 229 articles underwent full-text review, and 160 articles were included. Themes identified were HIV in sexual and gender minorities (n=61), population health (n=46), provider training (n=29), ED avoidance or barriers (n=23), ED use (n=21), and sexual orientation/gender identity information collection (n=9). CONCLUSION The current literature encompassing ED sexual and gender minority care cluster into 6 themes. There are considerable gaps to be addressed in optimizing culturally competent and equitable care in the ED for this population. Future research to address these gaps should include substantial patient stakeholder engagement in all aspects of the research process to ensure patient-focused outcomes congruent with sexual and gender minority values and preferences.
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Affiliation(s)
- Michael I Kruse
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Daniel Voloshin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Wan
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexandra Clarizio
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Blair L Bigham
- Division of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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19
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Berona J, Whitton S, Newcomb ME, Mustanski B, Gibbons R. Predicting the Transition From Suicidal Ideation to Suicide Attempt Among Sexual and Gender Minority Youths. Psychiatr Serv 2021; 72:1261-1267. [PMID: 34346732 PMCID: PMC8570968 DOI: 10.1176/appi.ps.202000497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sexual and gender minority youths are more likely to consider, attempt, and die by suicide than are heterosexual and cisgender youths, yet little is known about how to predict future attempts or transitions from suicidal thoughts to behaviors. Additionally, adaptive measurement of psychopathology is a promising approach that may help characterize risk in this population. This study examined the validity of the Computerized Adaptive Test for Suicide Scale (CAT-SS) in predicting suicide attempts and the transition from suicidal ideation to attempt. METHODS The CAT-SS was administered to participants of two ongoing cohort studies of sexual and gender minority adolescents and young adults (N=1,006). Survival analyses examined longitudinal associations between CAT-SS scores and time to suicide attempt. Analyses were conducted for the full sample and stratified by those with and without a history of suicidal ideation, with comparisons between adaptive and static measures of depressive symptoms. RESULTS The CAT-SS predicted future suicide attempts in the overall sample (hazard ratio [HR]=1.34, 95% confidence interval [CI]=1.03-1.74). Among youths without a history of suicidal ideation, social support reduced the risk for attempts (HR=0.66, 95% CI=0.45-0.96). Among youths with a history of ideation, predictors of the transition from suicidal thoughts to attempts included baseline CAT-SS score (HR=1.51, 95% CI=1.06-2.15) and victimization (HR=2.48, 95% CI=1.10-5.59). CONCLUSIONS Risk and protective factors for suicide attempts differed between youths with and without a history of suicidal thoughts. The CAT-SS had validity in predicting future risk of the sample overall and of youths with suicidal ideation.
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Affiliation(s)
- Johnny Berona
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
| | - Sarah Whitton
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
| | - Michael E Newcomb
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
| | - Robert Gibbons
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
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20
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Dorrell K, Berona J, Hipwell AE, Keenan K. Longitudinal associations between peer factors and suicidal thoughts and behaviors among sexual minority women. J Psychiatr Res 2021; 141:111-115. [PMID: 34186272 PMCID: PMC8675878 DOI: 10.1016/j.jpsychires.2021.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/27/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Sexual minority young women endorse higher rates of suicidal thoughts and behaviors than heterosexual women, but the reasons for these disparities remain unclear. One hypothesis is that the two groups of women share peer-related risk factors, but the magnitude of effect is stronger for sexual minority women. METHOD We utilized 6 years of data drawn from a community sample of women (N = 2078; 26% sexual minority) to examine rates of suicidality in early adulthood, adolescent peer influences on later suicidal ideation and behavior, and whether sexual minority status moderated the impact of peer influences on suicidality. RESULTS Across the study period, rates of suicidality were higher among sexual minority women compared to heterosexual women. In prospective analyses, peer victimization increased risk for future suicidality whereas peer connectedness attenuated risk for the entire sample. Additionally, sexual minority status moderated the magnitude of these relationships for suicidal ideation and behavior. Specifically, the effect of peer connectedness on suicidal ideation was stronger for heterosexual women than sexual minority women, whereas the effect of peer connectedness on suicidal attempts was stronger for sexual minority than for heterosexual women. In addition, peer victimization increased risk for suicide attempts among sexual minority women. CONCLUSIONS This study highlights the importance of peer experiences in late adolescence for suicidality during the transition to young adulthood, and how such relations vary by sexual minority status.
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Affiliation(s)
- Kate Dorrell
- Department of Psychiatry, University of Pittsburgh School of Medicine, USA; Department of Psychology, Rosalind Franklin University of Medicine and Science, USA.
| | - Johnny Berona
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Psychology, University of Pittsburgh
| | - Kate Keenan
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Psychiatry and Behavioral Neuroscience, University of Chicago
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21
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Williams AJ, Jones C, Arcelus J, Townsend E, Lazaridou A, Michail M. A systematic review and meta-analysis of victimisation and mental health prevalence among LGBTQ+ young people with experiences of self-harm and suicide. PLoS One 2021; 16:e0245268. [PMID: 33481862 PMCID: PMC7822285 DOI: 10.1371/journal.pone.0245268] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND LGBTQ+ youth have higher rates of self-harm and suicide than cisgender, heterosexual peers. Less is known about prevalence of risks within these populations. OBJECTIVES The first systematic review and meta-analysis to investigate the prevalence of risks among young people throughout the LGBTQ+ umbrella with experiences across the dimension of self-harm, suicidal ideation and suicide behaviour; and how they may differ between LGBTQ+ umbrella groups. DATA SOURCES MEDLINE, Scopus, EMBASE, PsycINFO, and Web of Science searches were run to identify quantitative research papers (database inception to 31st January, 2020). STUDY ELIGIBILITY CRITERIA Articles included were empirical quantitative studies, which examined risks associated with self-harm, suicidal ideation or suicidal behaviour in LGBTQ+ young people (12-25 years). SYNTHESIS METHODS 2457 articles were identified for screening which was completed by two independent reviewers. 104 studies met inclusion criteria of which 40 had data which could be meta-analysed in a meaningful way. This analysis represents victimisation and mental health difficulties as risks among LGBTQ+ youth with self-harm and suicide experiences. Random-effects modelling was used for the main analyses with planned subgroup analyses. RESULTS Victimisation and mental health were key risk factors across the dimension self-harm and suicide identified through all analyses. A pooled prevalence of 0.36 was indicated for victimisation and 0.39 for mental health difficulties within LGBTQ+ young people with experiences of self-harm or suicide. Odds ratios were calculated which demonstrated particularly high levels of victimisation (3.74) and mental health difficulties (2.67) when compared to cisgender, heterosexual counterparts who also had these experiences. CONCLUSIONS Victimisation and mental health difficulties are highly prevalent among LGBTQ+ youth with experiences of self-harm and suicide. Due to inconsistency of reporting, further risk synthesis is limited. Given the global inclusion of studies, these results can be considered across countries and inform policy and suicide prevention initiatives. PROSPERO REGISTRATION NUMBER CRD42019130037.
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Affiliation(s)
- A. Jess Williams
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- School of Psychology, Self-Harm Research Group, University of Nottingham, Nottingham, United Kingdom
| | - Christopher Jones
- School of Psychology, Centre for Applied Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Jon Arcelus
- School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ellen Townsend
- School of Psychology, Self-Harm Research Group, University of Nottingham, Nottingham, United Kingdom
| | - Aikaterini Lazaridou
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
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22
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Schmidt M, Uman T. Experiences of acute care by persons with mental health problems: An integrative literature review. J Psychiatr Ment Health Nurs 2020; 27:789-806. [PMID: 32083776 DOI: 10.1111/jpm.12624] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 01/31/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Understanding experiences of acute care by persons with mental health problems is vital for improving these experiences through the development of different parts of the care delivery and its facilities. Literature has extensively addressed experiences of persons with mental health problems in acute care settings. Yet, there is a paucity of studies that aggregate and organize these findings in presenting development-oriented solutions for the improvements of these experiences. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Acute care can be understood through patients' experiences of structure (such as setting, staff and resources); process (such as communication and interpersonal relations); and outcome (such as satisfaction and post-discharge well-being and health) and suggests improvements in these domains. The paper illuminates that previous literature has mainly captured negative experiences of acute care by persons with mental health problems, and suggests diverting the focus to the best practices and to seek inspiration from other fields of research. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Attending to the improvement and development of different parts of the acute care might be an important step in improving experiences of persons with mental health problems. For example, improving resource allocation systems and facilities, emphasizing professionalism in encounters with these patients and systematically assessing patient satisfaction during and after visits are important areas that require attention. ABSTRACT: Aim The provision of acute care to persons with mental health problems is challenging due to difficulties in encountering this group and the vulnerability of these persons. Understanding this group's experiences with acute care is thus an important endeavour. The purpose of this review was to critically and systematically identify and assess previous research on experiences of acute care by persons with mental health problems, guided by Donabedian's structure-process-outcome framework (Prospero ID: CRD42019116652). Method and results An integrative literature review was performed, resulting in the identification of 43 studies. The search was conducted using five electronic databases: Web of Science Core, PubMed, MEDLINE, CINAHL and PsycINFO. Discussion The review revealed that patients experienced structure components such as setting, staff and resources in a predominantly negative way. A predominately negative picture also emerged of the process components, where, for example, communication and interpersonal relations were represented by negative experiences, with limited positive experiences reported. The outcome components, related to patients' satisfaction and their well-being after discharge, were also predominantly experienced negatively. Implications for practice Using Donabedian's framework of structure, process and outcome allowed us to systematize the literature reviewed, to identify the research gaps and to suggest ways forward for the field's development.
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Affiliation(s)
- Manuela Schmidt
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Timur Uman
- Jönköping International Business School, Jönköping University, Jönköping, Sweden
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Fulginiti A, Rhoades H, Mamey MR, Klemmer C, Srivastava A, Weskamp G, Goldbach JT. Sexual Minority Stress, Mental Health Symptoms, and Suicidality among LGBTQ Youth Accessing Crisis Services. J Youth Adolesc 2020; 50:893-905. [PMID: 33206318 DOI: 10.1007/s10964-020-01354-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022]
Abstract
Sexual and gender minority youth are at elevated risk for suicide. Studies have separately established the relation between minority stress and mental health symptoms, as well as minority stress and suicidality. However, no known research has simultaneously examined different mental health mechanisms whereby minority stress may be associated with different suicidal experiences (e.g., suicidal ideation, suicide attempts). The present study used data from a national sample of 572 sexual and gender minority youth aged 12 to 24 (mean age = 17.59; SD = 3.13) recruited from an LGBTQ youth-focused suicide crisis prevention provider. Nearly one-third of the sample (30.2%) identified as transgender, genderqueer, or questioning. Nearly one quarter of the sample (24.3%) identified as gay, 17.1% as pansexual, 16.8% as bisexual, and 15.2% as lesbian. Structural equation modeling was used for mediation analyses to explain suicidal ideation and suicide attempts. Serial mediation models were determined to be the best fit for both suicide-related outcomes. Minority stress was associated with depressive and PTSD symptoms, which were linked with suicidal ideation and attempt through hopelessness. The findings supported the hypotheses that minority stress would be associated with suicidality not just directly, but also indirectly through multiple mental health symptom pathways.
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Affiliation(s)
- Anthony Fulginiti
- Graduate School of Social Work, University of Denver, 2148S. High St., Denver, CO, 80208, USA.
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 663W. 34th St., Los Angeles, CA, 90089, USA
| | - Mary Rose Mamey
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 663W. 34th St., Los Angeles, CA, 90089, USA
| | - Cary Klemmer
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 663W. 34th St., Los Angeles, CA, 90089, USA
| | - Ankur Srivastava
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 663W. 34th St., Los Angeles, CA, 90089, USA
| | - Garrett Weskamp
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 663W. 34th St., Los Angeles, CA, 90089, USA
| | - Jeremy T Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 663W. 34th St., Los Angeles, CA, 90089, USA
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24
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Horwitz AG, McGuire T, Busby DR, Eisenberg D, Zheng K, Pistorello J, Albucher R, Coryell W, King CA. Sociodemographic differences in barriers to mental health care among college students at elevated suicide risk. J Affect Disord 2020; 271:123-130. [PMID: 32479307 PMCID: PMC7266827 DOI: 10.1016/j.jad.2020.03.115] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/04/2020] [Accepted: 03/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND College student mental health (MH) problems and suicide risk have steadily increased over the past decade and a significant number of students with MH problems do not seek treatment. While some barriers to mental health care service utilization (MHSU) have been identified, very little is known regarding how these barriers differ among sociodemographic subgroups of students. METHOD Participants were 3,358 college students from four US universities who screened positive for elevated suicide risk (defined as 2 or more of: depression, alcohol misuse, suicidal ideation, suicide attempt) and were not actively receiving MH services. Reported barriers to MHSU were categorized into: Low perceived need, privacy/stigma concerns, questioning helpfulness of treatment, logistics, time constraints, finances, and cultural issues. RESULTS Adjusted odds ratios indicated that finances were a greater barrier for women, sexual and gender minority students, and Black and Hispanic students. Privacy/stigma concerns were more prominent for men and young undergraduate students. White students and older undergraduate and graduate students were more likely to report a lack of time, and cultural sensitivity issues were significant barriers for sexual and gender minority, and racial/ethnic minority, students. LIMITATIONS Participating sites were not nationally representative. The barriers assessment did not examine the degree to which a specific barrier contributed to lack of MHSU relative to others. CONCLUSIONS In light of the significant variation in barriers based on age, gender identity, race/ethnicity, and sexual orientation, efforts to increase MHSU should be tailored to meet the unique needs of specific sociodemographic student subgroups.
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Affiliation(s)
- Adam G Horwitz
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, United States.
| | - Taylor McGuire
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, United States
| | - Danielle R Busby
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, United States
| | - Daniel Eisenberg
- School of Public Health, Institute for Social Research, University of Michigan, United States
| | - Kai Zheng
- School of Information and Computer Sciences, University of California, Irvine, United States
| | | | - Ronald Albucher
- Counseling and Psychological Services, Stanford University, United States
| | | | - Cheryl A King
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI 48109, United States
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