How people get into mental health services: stories of choice, coercion and "muddling through" from "first-timers"

Treatment Readiness in Psychiatric Residential Care for Adolescents

There are many factors to consider when treating adolescents with psychiatric challenges, including whether they are willing and interested in participating in treatment. This study aimed to explore how treatment readiness impacts treatment experience for adolescents in psychiatric residential care who came into treatment with moderate to severe depression. All participants (N = 1,624; Mage = 15.58, SD = 1.46) were admitted to a large, multi-state psychiatric residential system between January 2020 and March 2022. Patients were 95.6% White, 99% non-Hispanic, and 64.7% identified as female. At intake, all patients were administered an assessment which includes the multi-dimensional Behavioral Health Screen (BHS) that assesses psychopathology and risk factors, a working alliance scale, depression, and well-being measures. Patients were also asked how they were admitted to the program, using a single item, multiple choice question as an informal treatment readiness measure, yielding three readiness groups: precontemplation, contemplation, or preparation. Regression analysis results indicated that patients' readiness level was associated with different baseline characteristics (e.g., age, gender, psychopathology symptoms, risk factors) and week 3 outcomes (e.g., decreased symptoms, well-being, alliance, satisfaction). The clinical implications, as well as limitations and future directions, will be discussed.

Mixed Methods for Research on Support Networks of People Experiencing Chronic Illness and Social Marginalization

Substantial research has focused on how social networks help individuals navigate the illness experience. Sociologists have begun to theorize beyond the binary of strong and weak social network ties (e.g., compartmental, elastic, and disposable ties), citing the social, economic, and health conditions that shape their formation. However, limited research has employed mixed social network methods, which we argue is especially critical for examining the "non-traditional" social support networks of marginalized individuals. We employ quantitative social network methods (i.e., the egocentric network approach) in addition to in-depth interviews and observations, with a novel tool for capturing network data about social groups, to surface these kinds of supportive relationships. Using the case of "nameless ties"-non-kin, non-provider ties who were unidentifiable by given name or were grouped by context or activity rather than individually distinguished-we show how mixed social network methods can illuminate supporters who are commonly overlooked when only using traditional social network analysis. We conclude with a proposal for mixed methods and group alter approaches to successfully observe liminal support ties that is ideal for research about individuals experiencing chronic disability, poverty, housing insecurity, and other forms of social marginalization.

Who has mental health problems? Comparing individual, social and psychiatric constructions of mental health

PURPOSE

The persistent gap between population indicators of poor mental health and the uptake of services raises questions about similarities and differences between social and medical/psychiatric constructions. Rarely do studies have assessments from different perspectives to examine whether and how lay individuals and professionals diverge.

METHODS

Data from the Person-to-Person Health Interview Study (P2P), a representative U.S. state sample (N ~ 2700) are used to examine the overlap and correlates of three diverse perspectives-self-reported mental health, a self/other problem recognition, and the CAT-MH™ a validated, computer adaptive test for psychopathology screening. Descriptive and multinominal logit analyses compare the presence of mental health problems across stakeholders and their association with respondents' sociodemographic characteristics.

RESULTS

Analyses reveal a set of socially constructed patterns. Two convergent patterns indicate whether there is (6.9%, The "Sick") or is not (64.6%, The "Well") a problem. The "Unmet Needers" (8.7%) indicates that neither respondents nor those around them recognize a problem identified by the screener. Two patterns indicate clinical need where either respondents (The "Self Deniers", 2.9%) or others (The "Network Deniers", 6.0%) do not. Patterns where the diagnostic indicator does not suggest a problem include The "Worried Well" (4.9%) where only the respondent does, The "Network Coerced" (4.6%) where only others do, and The "Prodromal" (1.4%) where both self and others do. Education, gender, race, and age are associated with social constructions of mental health problems.

CONCLUSIONS

The implications of these results hold the potential to improve our understanding of unmet need, mental health literacy, stigma, and treatment resistance.

Social pathways to care: how community-based network ties shape the health care response of individuals with mental health problems

PURPOSE

Mental health research has powerfully documented inequities related to characteristics, such as ethnicity and gender. Yet how and where disparities like unmet need occur have been more elusive. Drawing from a now modest body of research that deployed the Network Episode Model (NEM), we examine how individuals create patterns of response to mental health problems, influenced by the culture and resources embedded in their social networks.

METHODS

The Person-to-Person Health Interview Study (P2P; N ~ 2,700, 2018-2021) provides representative, community-based, NEM-tailored data. Both descriptive, latent class and multinomial regression analyses mark mental health care-seeking patterns, including individuals consulted and activities used, as well as the influence of the structure and cultural content of social networks.

RESULTS

Latent class analysis detected five pathways with good fit statistics. The Networked General Care Path (37.0%) and The Kin General Care Path (14.5%) differ only in whether friends are activated in using the general care sector. The Networked Multi-Sector Care Path (32.5%) and The Saturated Path (12.6%) involve family, friends, and both general and specialty care with only the latter expanding consultation to coworkers and clergy. The Null Path (3.3%), or no contacts, is not used as perceived problem severity increases. Network size and strength are associated with the more complex pathways that activate ties, respectively. Trust in doctors is associated with pathways that include specialty providers but not others at work or church. Race, age, and rural residence have specific pathway effects, while gender has no significant impact.

CONCLUSIONS

Social networks propel individuals with mental health problems into action. Tie strength and trust produce care responses that are fuller and more targeted. Considering the nature of homophily, results also suggest that majority status and college education are clearly implicated in networked pathways. Overall, findings support community-targeted rather than individually based efforts to increase service use.

Organizational access points and substance use disorder treatment utilization among Black women: a longitudinal cohort study

INTRODUCTION

Health and social service organizations, including the emergency department (ED) and public assistance programs, constitute a social safety net that may serve as an "access point" for substance use treatment utilization. Racialization of substance use disorder (SUD) and gender disparities in access to treatment contribute to differences in health and social service utilization, including substance use treatment for Black women. We therefore explored the role of various access points in facilitating the use of substance use treatment among Black women with substance use and involvement in the criminal justice system.

METHODS

We used data from the Black Women in the Study of Epidemics (B-WISE) project (2008-2011), which recruited Black women who use drugs from community, probation, and prison recruitment settings in Kentucky. B-WISE is a three-wave panel survey collected on a six-month interval. We estimated dynamic panel models to understand whether time-varying use of services influenced women's substance use treatment utilization over 18-months, adjusting for time-invariant characteristics. We stratified the analysis based on where women were recruited (i.e., community, prison, and probation).

RESULTS

The sample included 310 persons and 930 person-waves. For the community and prison samples, the use of an ED in the 6 months prior decreased women's likelihood of subsequent substance use treatment use (Coef: -0.21 (95% CI: -0.40, -0.01); -0.33 (95% CI: -0.60, -0.06), respectively). For the probation sample, receiving support from public assistance (i.e., food stamps, housing, cash assistance) increased the likelihood of subsequent substance use treatment use (0.27 (95% CI: 0.08, 0.46)).

CONCLUSION

Interactions with health and social service organizations predicted Black women's use of substance use treatment services and varied based on their involvement in the criminal justice system. Public assistance venues for Black women on probation may be a point of intervention to increase their access to and use of substance use treatment.

Exploring the use of social network interventions for adults with mental health difficulties: a systematic review and narrative synthesis

BACKGROUND

People with mental health difficulties often experience social isolation. The importance of interventions to enhance social networks and reduce this isolation is increasingly being recognised. However, the literature has not yet been systematically reviewed with regards to how these are best used. This narrative synthesis aimed to investigate the role of social network interventions for people with mental health difficulties and identify barriers and facilitators to effective delivery. This was undertaken with a view to understanding how social network interventions might work best in the mental health field.

METHODS

Systematic searches using combinations of synonyms for mental health difficulties and social network interventions were undertaken across 7 databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science) and 2 grey literature databases (EThoS and OpenGrey) from their inception to October 2021. We included studies reporting primary qualitative and quantitative data from all study types relating to the use of social network interventions for people with mental health difficulties. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Data were extracted and synthesised narratively.

RESULTS

The review included 54 studies, reporting data from 6,249 participants. Social network interventions were generally beneficial for people with mental health difficulties but heterogeneity in intervention type, implementation and evaluation made it difficult to draw definitive conclusions. Interventions worked best when they (1) were personalised to individual needs, interests and health, (2) were delivered outside formal health services and (3) provided the opportunity to engage in authentic valued activities. Several barriers to access were identified which, without careful consideration could exacerbate existing health inequalities. Further research is required to fully understand condition-specific barriers which may limit access to, and efficacy of, interventions.

CONCLUSIONS

Strategies for improving social networks for people with mental health difficulties should focus on supporting engagement with personalised and supported social activities outside of formal mental health services. To optimise access and uptake, accessibility barriers should be carefully considered within implementation contexts and equality, diversity and inclusion should be prioritised in intervention design, delivery and evaluation and in future research.

Help-Seeking and Help-Related Experiences of Commercially Sexually Exploited Youth: A Qualitative Meta-Synthesis

This interpretive qualitative meta-synthesis (QMS) aims to systematically review what we know about the help-seeking and help-related experiences of commercially sexually exploited youth (CSEY). A comprehensive search of the relevant databases was conducted to identify published qualitative peer-reviewed papers and research reports about the experiences and perceptions of CSEY. A corpus of 34 qualitative studies was compiled and synthesized, using the conceptual framework of help-seeking and QMS guidelines. The QMS reveals that although help-seeking of CSEY are rarely the focus of the inquiry, the reviewed studies include meaningful information about help-related experiences of CSEY. Thus, the synthesis of the available data yields novel insights about how CSEY perceive their involvement in CSE, define the problems they deal with, decide to seek help, choose the proper help, and engage in helping relations. Particularly, the QMS underscores that CSEY do not always perceive their involvement in CSE as problematic, nor do they identify themselves as victims of exploitation. The findings highlight the significance of developing social services that specialize in helping CSEY, the importance of actively identifying CSEY and reaching out to them, and the need to enable CSEY to be involved in decisions about the extent and type of support they are provided.

Trajectories of Preventive Health Care Utilization Among Older Koreans: The Role of Social Relationships

Background

Receiving timely health screening is associated with important public health benefits among older adults. By focusing on the role of social relationships, the present study was aimed at examining longitudinal trajectories of health screening use among older adults in Korea, whose universal health care system provides free-of-charge health screening.

Methods

A nationally representative sample of 3,575 individuals aged 65 or older from wave one of the Korean Longitudinal Study of Aging (2006) was followed for 10 years (up to Wave 6, 2016). Mixed-effect logit models were used to investigate how an older adult’s social relationship characteristics (i.e., household composition, financial support from family, social group participation, and the frequency of contact with friends or relatives) were associated with their trajectories of participation in the national health screening program.

Results

Despite the low financial burden, only 49.7% of older adults in Korea reported receiving the recommended health screening at the baseline. Although the probability of receiving recommended health screening increased over the 10-year study period, the trajectories were significantly different by an older adult’s social relationship characteristics. All four social relationship characteristics were significantly associated with receiving health screening. However, those with more frequent social contacts and those who participated in social groups showed steeper increases in the probability of receiving health screening (i.e., significant interaction with time).

Conclusions

This study highlights the importance of social relationships and intervention approaches that accommodate socially isolated older adults to facilitate their timely receipt of recommended preventive care.

Persuasion or coercion? An empirical ethics analysis about the use of influence strategies in mental health community care

Background

Influence strategies such as persuasion and interpersonal leverage are used in mental health care to influence patient behaviour and improve treatment adherence. One ethical concern about using such strategies is that they may constitute coercive behaviour ("informal coercion") and negatively impact patient satisfaction and the quality of care. However, some influence strategies may affect patients' perceptions, so an umbrella definition of “informal coercion” may be unsatisfactory. Furthermore, previous research indicates that professionals also perceive dissonance between theoretical explanations of informal coercion and their behaviours in clinical practice. This study analysed mental health professionals’ (MHPs) views and the perceived ethical implications of influence strategies in community care.

Methods

Qualitative secondary data analysis of a focus group study was used to explore the conflict between theoretical definitions and MHPs’ experiences concerning the coerciveness of influence strategies. Thirty-six focus groups were conducted in the main study, with 227 MHPs from nine countries participating.

Results

The findings indicate that not all the influence strategies discussed with participants can be defined as “informal coercion”, but they become coercive when they imply the use of a lever, have the format of a conditional offer and when the therapeutic proposal is not a patient’s free choice but is driven by professionals. MHPs are rarely aware of these tensions within their everyday practice; consequently, it is possible that coercive practices are inadvertently being used, with no standard regarding their application. Our findings suggest that levers and the type of leverage used in communications with the patient are also relevant to differentiating leveraged and non-leveraged influence.

Conclusion

Our findings may help mental health professionals working in community care to identify and discuss influence strategies that may lead to unintended coercive practices.

Behind the screen of voluntary psychiatric hospital admissions: A qualitative exploration of treatment pressures and informal coercion in experiences of patients in Italy, Poland and the United Kingdom

BACKGROUND

Despite the extensive research and intense debate on coercion in psychiatry we have seen in recent years, little is still known about formally voluntarily admitted patients, who experience high levels of perceived coercion during their admission to a psychiatric hospital.

AIMS

The purpose of the present research was to explore forms of treatment pressure put on patients, not only by clinicians, but also by patients' relatives, during admission to psychiatric hospitals in Italy, Poland and the United Kingdom.

METHODS

Data were obtained via in-depth, semi-structured interviews with patients (N = 108) diagnosed with various mental disorders (ICD-10: F20-F49) hospitalised in psychiatric inpatient wards. Maximum variation sampling was applied to ensure the inclusion of patients with different socio-demographic and clinical characteristics. The study applied a common methodology to secure comparability and consistency across participating countries. The qualitative data from each country were transcribed verbatim, coded and subjected to theoretical thematic analysis.

RESULTS

The results of the analysis confirm that the legal classifications of involuntary and voluntary hospitalisation do not capture the fundamental distinctions between patients who are and are not coerced into treatment. Our findings show that the level of perceived coercion in voluntary patients ranges from 'persuasion' and 'interpersonal leverage' (categorised as treatment pressures) to 'threat', 'someone else's decisions' and 'violence' (categorised as informal coercion).

CONCLUSION

We suggest that the term 'treatment pressures' be applied to techniques for convincing patients to follow a suggested course of treatment by offering advice and support in getting professional help, as well as using emotional arguments based on the personal relationship with the patient. In turn, we propose to reserve the term 'informal coercion' to describe practices for pressuring patients into treatment by threatening them, by making them believe that they have no choice, and by taking away their power to make autonomous decisions.

Law Enforcement Pathways to Mental Health: Secondary Traumatic Stress, Social Support, and Social Pressure

The mental health of law enforcement officers (LEO) is critical to the safety and well-being of the officers and the public they serve. However, LEO face significant on-the-job stressors that undermine mental health, and there is a lot to be learned about when and how LEO seek and enter mental health services. The present study sought to explore variables related to mental health seeking behavior, the role of social engagement and social pressure in the decision to seek mental health services, and the most common pathways into mental health utilized by LEO. A small sample of 86 LEO were recruited from the social media page of a law enforcement nonprofit support organization to take several self-report measures on past mental health service usage and intentions to seek future services, the Inventory of Attitudes Toward Seeking Mental Health Services, the Professional Quality of Life Survey, and a measure of social engagement on mental health topics. Results indicate that while a number of factors are associated with intentions to seek future services, the primary factor in past mental health seeking behavior was secondary traumatic stress. Those who sought mental health services reported higher social engagement and social pressure to seek help. LEO entered mental health services for a variety of reasons and through a variety of provider options, such that no one provider source was preferred. Though the present study was limited by a small sample size, reliance on self-report measures, and occurred during a time of civil unrest that sparked the "defund the police" movement, the results serve as a starting point for understanding the pathways into mental health services for LEO and the roles of secondary trauma and prior mental health service experience.

Health decisions amidst controversy: Prenatal alcohol consumption and the unequal experience of influence and control in networks

Individuals avoid stigma by looking to members of their networks for guidance on how to behave. Health controversies complicate this process by exposing people to inconsistent norms, influence, and control within their networks. To understand this process, we meld perspectives on networks and social psychology. Using the case of light/moderate drinking during pregnancy, we examine how people make health decisions in the face of controversy. Through in-depth interviews with first-time pregnant individuals and their health care providers, we reveal that individuals' decisions about controversial health behaviors depend on 1) the consistency of the influence and control they encounter, 2) their status relative to enforcers, and 3) the strength of their ties to enforcers. These processes give people from higher social positions more power to resist influence and control. These findings illuminate how medical recommendations and public health interventions should account for the unequal experience of influence and control within networks.

Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review

Worldwide, growing concern with young people's mental health is spurring service reform efforts. Such reform requires a full understanding of the experiences of young people and their carers when seeking mental health help. To generate such an understanding, we conducted a meta-synthesis of qualitative literature on the perspectives of youths and their carers on navigating mental health systems. Five electronic databases were searched (Medline, PsycINFO, EMBASE, CINAHL, HealthSTAR). Studies were included if they explored the experiences of pathways to mental health services of persons aged 11-30 years and/or their carers; were published in English or French; and used qualitative methodology. Quality appraisal was conducted using the CASP tool. The synthesis of 31 included studies yielded three themes-initiating contact with mental health services; characteristics of services' response; and youths' and carers' appraisal of services. Themes about initiating contact included mental health literacy, structural barriers, and social support. Service response-related themes included complex pathways, waitlists, eligibility, and fragmented care. In terms of service appraisal, positive encounters featured providers who were accessible and perceived as caring. Negative appraisals resulted from feeling misunderstood and excluded and being ill-informed about treatment. Across diagnoses and settings, youths and carers had difficult experiences accessing mental healthcare. While individual, social, and healthcare factors shaping pathways to care varied, systemic complexities were a common inhibitor. This synthesis informs recommendations for improving mental health services and youths' pathways to them. It underlines the need for grounding reform in youths' and carers' perspectives and needs.

My Whole World Changed: A Qualitative Exploration of the Coping Experiences of Transgender Women After an HIV Diagnosis

The aim of this study was to generate a theoretical stage model that describes transgender women's coping strategies and responses after a new HIV diagnosis. The sample included 18 transgender women living with HIV in a large metropolitan city in central Indiana. Semi-structured interviews were conducted, digitally recorded, transcribed verbatim, and analyzed using grounded theory methods. Participants commonly described the experience of being newly diagnosed with HIV as, having the world change. Four stages through which attempts at coping occurred were identified: having the world come crashing down; shutting out the world; living in a dark world; and reconstructing the world. This model advances our understanding of the social and behavioral factors that influence how transgender women cope with a new HIV diagnosis and how their coping responses influence entry and engagement in the HIV care continuum.

Relational body image: Preliminary evidence that body image varies within a person from one specific relationship to another

Although social factors influence body image, it remains unknown whether a given individual's body image varies from one specific relationship to another. The present study examined this novel concept of relational body image by investigating the extent to which individuals' body image differs across their relationships with specific others. These differences were expected to arise in part due to differences in how an individual perceives others' personal body preoccupation, others' acceptance of her body, and others' body size relative to her own. Eighty-seven female undergraduates reported on their typical levels of body appreciation, appearance orientation, and intuitive eating with 10 people in their lives, and reported on the characteristics of these others. Intraclass correlations revealed that participants' body image and eating varied across their different relationships. Furthermore, participants perceived differences in others' acceptance of the participant's body, body preoccupation, and body size. Multilevel modelling showed that participants reported more adaptive body image and eating patterns in relationships with others whom they perceived to be relatively more accepting of their body, less body preoccupied, and more similar in size to them. Findings provide initial support for the concept of relational body image.

Change in Housing Status among Homeless and Formerly Homeless Individuals in Quebec, Canada: A Profile Study

Housing stability is a key outcome in studies evaluating housing services for the homeless population. Housing stability has typically been defined dichotomously and based on a fixed duration of maintenance in housing accommodations, which does not fully capture change in housing status among homeless individuals. Moreover, few typologies have examined housing trajectories across different housing types. Cluster analysis was used to develop a typology of housing status change for 270 currently or formerly homeless individuals in Quebec (Canada) residing in shelters and temporary and permanent housing. Participants were interviewed at baseline (T0) and 12 months later (T1). The Gelberg–Andersen Model was used to organize housing-related variables into predisposing, needs and enabling factors. Comparison analyses were conducted to assess group differences. Three groups (Groups 1, 3 and 4) had more favorable and two (Groups 2 and 5) less favorable, housing status at T1. Findings suggest that maintenance or improvement of housing status requires suitable types and frequencies of service use (enabling factors) that are well adapted to the nature and complexity of health problems (needs factors) among homeless individuals. Specific interventions, such as outreach programs and case management, should be prioritized for individuals at higher risk for returning to homelessness.

Older Adults' Narratives of Seeking Mental Health Treatment: Making Sense of Mental Health Challenges and "Muddling Through" to Care

Older adults who experience challenges related to mental health are unlikely to seek professional help. The voices of older adults who have navigated through mental health issues and systems of care to arrive at psychological treatment are less well understood. We conducted individual interviews with 15 adults aged 61 to 86 who sought psychological treatment. Interviews were audio-recorded, transcribed, and analyzed using narrative methods. We identified several main storylines that describe the meaning-making and treatment-seeking journeys of older adults: resistance to being labeled with mental health problems (telling stories of resistance, defining mental health issues in mysterious and uncontrollable terms, and experiencing internal role conflict); muddling through the help-seeking process (manifestations of chaos and system-level barriers); and emotional reactions to psychological treatment (hope, fear, and mistrust). Findings add to the literature base in the area of narrative gerontology, and highlight the complex experiences that older adults face when seeking psychological treatment.

Barriers to Mental Health Service Use and Predictors of Treatment Drop Out: Racial/Ethnic Variation in a Population-Based Study

This study examines racial/ethnic differences in perceived need for mental health treatment, barriers to treatment receipt, and reasons for dropout. Data are from the Collaborative Psychiatric Epidemiology Studies, a pooled dataset from three U.S. nationally-representative adult samples. Among respondents with a 12-month psychiatric disorder who received no treatment (N = 1417), Asians and Latinos reported lower perceived need than Blacks and Whites, and Latinos reported the fewest attitudinal barriers. Among those with a 12-month disorder who dropped out of treatment, Asians and Latinos gave more reasons for dropping out. Significant interactions of race/ethnicity with other characteristics identified subpopulations with high unmet need.

Choice, coercion, and/or muddling through: Older adults' experiences in seeking psychological treatment

Help-seeking related to mental health concerns has been found to decrease as age increases . Despite extensive literature devoted to barriers to accessing mental health services, the reasons why older adults are especially unlikely to seek treatment are not well understood. The present study had two objectives concerning the experiences of older adults accessing outpatient psychological treatment: 1) classifying pathways into treatment using the Network Episode Model (NEM; Pescosolido et al., 1998), and 2) critically examining whether these pathways effectively captured the process of seeking treatment for older adults. Utilizing secondary qualitative data from three studies (N = 35), we met our first objective of classifying pathways according to the NEM with directed content analysis. The majority (n = 21, 60%) of older adults willingly accessed treatment (choice) and 42.9% of those involved 'others' in their help-seeking by way of referrals or support. The remaining participants' (n = 14, 40%) pathways into treatment reflected a process of muddling through (being unsure of their need for mental health services and where to access support, or bouncing around the treatment system). No participants' pathways were categorized as coercive. To meet our second objective, we used conventional content analysis to explore how best to categorize pathways to treatment. Findings demonstrated that a minority of participants (n = 10, 28.6%) had a help-seeking journey that represented only one of the three pathways. Instead, most participants described a lengthy period of muddling through, eventually followed by a willingness to seek help. These findings highlight the complex process of seeking treatment, and suggest a need to implement more direct mental health literacy interventions to reduce the amount of time spent muddling through, while improving the experience of mental health help-seeking for older adults.

The dual contingencies of ethnoraciality: Status-context disparities in health information sources among sexual minorities

Researchers often explore health (care) beliefs as a function of individual characteristics; yet, few consider the role of context in shaping both beliefs and the behaviors that are informed by them. As a sociopolitical construct, ethnoraciality provides a concerning source of bias in studies of health (care) beliefs because it inhabits both individual and contextual forms. This study examines whether the ethnoracial context of the residential area where sexual minorities live is associated with a particular health (care) belief - sources of trustworthy health information - and considers how ethnoracial group membership status differentiates these ecological associations drawing on mediation and moderation models. Using data from the 2010 Social Justice Sexuality Project, our analysis shows that sexual minorities who live with high concentrations of Latinos and Whites are less likely to rely exclusively on medical professionals for trustworthy health information than those who live with high concentrations of Blacks. Moreover, exclusive reliance on medical professionals for health information among Black and Latino sexual minorities is stronger in co-ethnic communities (predominately Black and Latino areas, respectively). The analysis also documents status and contextual differentials and status-context contingencies of reliance on the Internet, social networks, and multiple agents ("triangulation") as sources of health information. Findings suggest that place-based co-ethnic networks may facilitate disease prevention among Black and Latino sexual minorities by improving the quality of their relationships with sick role gatekeepers and breaking down the silos of the medical complex. The study concludes by considering the value of a place-based approach to alleviating health disparities among sexual minorities vis-à-vis the health care system.

Negotiating support from relationships and resources: a longitudinal study examining the role of personal support networks in the management of severe and enduring mental health problems

BACKGROUND

Personal communities or personal support networks comprise a variety of social ties considered important to individuals in their everyday lives. This set of active and significant ties influence the capacity to manage mental health problems because of the potential to access social support. However, little is known in the context of people's everyday management of mental health about how relationships with people, places, objects and activities are navigated and negotiated. This study aimed to explore the nature and negotiation of support from personal communities in the everyday management of severe and enduring mental health problems.

METHODS

A longitudinal qualitative study undertaken in the UK incorporating 79 interviews with 29 participants based on personal network mapping. 29 users of mental health services with a diagnosis of severe and enduring mental illness were interviewed at three time points. Data was analysed using an inductive thematic approach underpinned by the Network Episode Model.

RESULTS

The presence and maintenance of interpersonal trust was a fundamental condition of the relational work required to develop, undertake and sustain relationships with others. Whilst relationships with spouses, family members and friends were generally viewed positively, the work required to engage human others was contingent, vicarious and overlain with felt and enacted stigma. Developing relationships with others was hindered by a lack of confidence fuelled by the experience of mental illness and a fear of rejection or failure. By contrast, weaker ties and inanimate objects and places offered and provided a sense of reliability and security. Strategies employed by participants in order to garner sufficient support for condition management in the light of these particular challenges are illuminated by the discussion of who and what is relevant and valued in personal support networks.

CONCLUSIONS

Access to valued activities, hobbies and things should be considered alongside human relationships in providing a means of ongoing support and resource for the everyday management of life for those experiencing severe and enduring mental health problems.

Falling between two systems of care: Engaging families, behavioral health and the justice systems to increase uptake of substance use treatment in youth on probation

Justice-involved youth (JIY) in the US have high rates of substance use (SU) problems, yet 50%-80% of these youth do not receive necessary services. There has been no systematic exploration of the use of treatment services for JIY that examines viewpoints across stakeholders in justice- and treatment-systems as well as the families. We conducted qualitative interviews and focus groups with n = 58, youth, their caregivers, SU treatment providers and probation officers in a Northeastern state. Interviews explored how families, staff- and system-level factors influence uptake of and retention in SU treatment services in youth on probation. We conducted a thematic analysis of all interview texts. Caregiver engagement is essential for youth treatment uptake and retention. Difficulties achieving caregiver engagement and agreement that treatment was necessary stemmed from distrust in the "system"; denial or minimization of youth's SU problem; relational barriers; and overburden and chaos within the family system. Structural barriers to service uptake were lack of available treatment options, SU agency practices and policies, and interagency collaboration between SU treatment agencies and probation. Enhancing family engagement at the point of referral to SU treatment is essential. Improvements in interagency collaboration and communication between SU treatment and probation agencies are necessary. Implications for policy and intervention are discussed.

Psychiatric advance directives for people living with schizophrenia, bipolar I disorders, or schizoaffective disorders: Study protocol for a randomized controlled trial - DAiP study

BACKGROUND

Compulsory admission to psychiatric hospital is rising despite serious ethical concerns. Among measures to reduce compulsory admissions, Psychiatric Advance Directives (PAD) are the most promising, with intensive PAD (i.e. facilitated and shared) being the most effective. The aim of the study is to experiment Psychiatric Advance Directives in France.

METHODS

A multicentre randomized controlled trial and qualitative approach conducted from January 2019 to January 2021 with intent-to-treat analysis.

SETTING

Seven hospitals in three French cities: Lyon, Marseille, and Paris. Research assistants meet each participant at baseline, 6 months and 12 months after inclusion for face-to-face interviews.

PARTICIPANTS

400 persons with a DSM-5 diagnosis of bipolar I disorder (BP1), schizophrenia (SCZ), or schizoaffective disorders (SCZaff), compulsorily admitted to hospital within the last 12 months, with capacity to consent (MacCAT-CR), over 18 years old, and able to understand French.

INTERVENTIONS

The experimental group (PAD) (expected n = 200) is invited to fill in a document describing their crisis plan and their wishes in case of loss of mental capacity. Participants meet a facilitator, who is a peer support worker specially trained to help them. They are invited to nominate a healthcare agent, and to share the document with them, as well as with their psychiatrist. The Usual Care (UC) group (expected n = 200) receives routine care.

MAIN OUTCOMES AND MEASURES

The primary outcome is the rate of compulsory admissions to hospital during the 12-month follow-up. Secondary outcomes include quality of life (S-QoL18), satisfaction (CSQ8), therapeutic alliance (4-PAS), mental health symptoms (MCSI), awareness of disorders (SUMD), severity of disease (ICG), empowerment (ES), recovery (RAS), and overall costs.

DISCUSSION

Implication of peer support workers in PAD, potential barriers of supported-decision making, methodological issues of evaluating complex interventions, evidence-based policy making, and the importance of qualitative evaluation in the context of constraint are discussed.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03630822. Registered 14th August 2018.

HUMAN RIGHTS OF MENTALLY ILL PATIENTS

Introduction: Mental health is the development of a person's healthy view ofthemselves and the environment in which they live, so that they can achieve thehighest degree of self-fulfillment. Purpose: The purpose of the present work is toinvestigate and highlight the rights of the mentally ill and to promote and promotethe health of these patients. Methodology: The study material consisted of articleson the topic found in Greek and international databases such as: Google Scholar,Mednet, Pubmed, Medline and the Hellenic Academic Libraries Association(HEAL-Link), using keywords: mental illness, patient rights, health professionals. Results: The rights of mental patients and their exercise in a meaningful andeffective manner is a dynamic process that encompasses the corresponding rightsand obligations of mental health professionals. An important legal effort to protectthe rights of the mentally ill is Resolution 46/119 of the United Nations GeneralAssembly on the Protection of Persons with Mental Illness and Improving MentalHealth Care, adopted on 17 December 1991. Conclusions: The exercise of therights of the mentally ill requires their encouragement from mental healthprofessionals, who are essentially obliged to refrain from restrictive practices.

Gender, Depression, and Blue-collar Work: A Retrospective Cohort Study of US Aluminum Manufacturers

BACKGROUND

Industrial blue-collar workers face multiple work-related stressors, but evidence regarding the burden of mental illness among today's blue-collar men and women remains limited.

METHODS

In this retrospective cohort study, we examined health and employment records for 37,183 blue- and white-collar workers employed by a single US aluminum manufacturer from 2003 to 2013. Using Cox proportional hazards regression, we modeled time to first episode of treated depression by gender and occupational class. Among cases, we modeled rates of depression-related service utilization with generalized gamma regression.

RESULTS

Compared with their white-collar counterparts, blue-collar men were more likely to be treated for depression (hazard ratio [HR] = 1.3; 95% confidence interval [CI] = 1.1, 1.4) as were blue-collar women (HR = 1.4; 1.2, 1.6). Blue-collar women were most likely to be treated for depression as compared with white-collar men (HR = 3.2; 95% CI = 2.1, 5.0). However, blue-collar workers used depression-related services less frequently than their white-collar counterparts among both men (rate ratio = 0.91; 95% CI = 0.84, 0.98) and women (rate ratio = 0.82; 95% CI = 0.77, 0.88).

CONCLUSIONS

Blue-collar women were more likely to be treated for depression than white-collar workers, and blue-collar women were most likely to be treated for depression compared with white-collar men. However, blue-collar men and women used depression-related healthcare services less frequently than white-collar workers. These findings underscore that blue-collar women may be uniquely susceptible to depression, and suggest that blue-collar workers may encounter barriers to care-seeking related mental illness other than their insurance status.

Self-Determination and Choice in Mental Health: Qualitative Insights From a Study of Self-Directed Care

SELF-DETERMINATION AND CHOICE IN MENTAL HEALTH.

Social Networks and the Emergence of Health Inequalities Following a Medical Advance: Examining Prenatal H1N1 Vaccination Decisions

Health inequalities persist, in part, because people in socioeconomically advantageous positions possess resources to avoid new health risks when medicine advances. Although these health decisions rarely occur in isolation, we know less about the specific role of networks. We examine whether social capital mediates the relationship between individual educational attainment and decisions about a medical advance: H1N1 vaccination during pregnancy. Building on prior work that defines social capital as the resources of network members, we examine two mechanisms through which social capital may affect health decisions, facilitating information flow and exerting influence. Using egocentric network data collected from 225 pregnant women during the 2009-10 H1N1 pandemic, we measure social capital as the proportion of networks that are college-educated H1N1 discussants (information flow) and the proportion of college-educated H1N1 supporters (influence). Findings reveal that college-educated women knew more college-educated H1N1 discussants and supporters. Further, both measures of social capital predicted higher probabilities of vaccination, with the latter mechanism emerging as a particularly strong predictor. Our findings provide evidence that health decisions are shaped by individual resources as well as social capital available through network ties, offering a unique perspective of the ways that social networks contribute to producing, and potentially reproducing, unequal health.

Negotiating the boundaries of psychosis: A qualitative study of the service provider perspective on treatment delay in community mental health

AIM

Evidence shows that many patients are detected and treated late in their course of illness, and that substantial delay occurs even after entry to mental health services. Although several studies have examined the service user and carer perspectives on treatment delay, few have explored the issue from the service provider perspective. The aim of this study was to broaden our understanding of treatment delay by exploring the service provider perspective on reasons for treatment delay in community mental health services.

METHODS

A qualitative study using data from focus group interviews with 33 healthcare professionals in community mental health care. Interview data were digitally recorded and transcribed verbatim, and analysed using a grounded theory approach.

RESULTS

Service providers perceived divergent or conflicting perspectives as the main challenge in early psychosis. Clinical negotiation was chosen as the main term describing the interactions between patients and healthcare professionals: This was observed in 3 overlapping areas: (1) Negotiating the patients status as help-seeker; (2) Negotiating the place and conditions of treatment and (3) Negotiating the meaning of distressing experiences and the timing of treatment options.

CONCLUSIONS

This study suggests that delay in initiation of treatment for psychosis in community mental health is related to clinical challenges of early disengagement from services and diagnostic uncertainty. Service providers found negotiating the therapeutic relationship and patient-centred flexibility more useful in ensuring engagement than an assertive outreach approach. Diagnostic uncertainty was resolved through watchful waiting using a distress-overload conceptualization in assessing changes in mental state and service needs.

Decision Making About Pathways Through Care for Racially and Ethnically Diverse Young Adults With Early Psychosis

OBJECTIVE

This study elicited factors that shaped treatment decision making for young adults and their key supporters after an initial hospitalization for psychosis to generate hypotheses about how to improve service engagement.

METHODS

This prospective, longitudinal, ethnographic study (using home visits, interviews, and hospital-based fieldwork) asked what mattered to 18 young adults primarily from racial-ethnic minority groups and 19 of their self-identified key supporters (N=37) as they made decisions about treatment during the 12-week critical period after an initial hospitalization for psychosis. The analytical approach used inductive coding and constructivist grounded theory methods to analyze interview transcripts and field notes from home visits and generate hypotheses about key factors that seemed to affect treatment decision making. Factors were ranked in order of frequency across all participants (overall, young adults only, and key supporters only).

RESULTS

Among the 37 total participants (young adults and key supporters), more than two-thirds were concerned with getting back to normal, the insufficient mental health care on offer, police involvement in their pathway to care, feeling worse, and needing help with repairing strained relationships. More than one-half were concerned with how young adults would be able to live independently in the future, paying for mental health care, distrusting mental health diagnoses, managing social pressure to use substances, feeling disempowered by hospitalization experiences, and managing transportation challenges.

CONCLUSIONS

To better engage young adults with early psychosis in care, including those from racial-ethnic minority groups, there is a need to design services that address the specific concerns of their everyday lives in the context of the initial hospitalization and posthospitalization period.

Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation

PURPOSE

Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user- and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels.

METHODS

A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically.

RESULTS

The process evaluation demonstrated that despite buy-in from those delivering care planning in mental health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention.

CONCLUSIONS

Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of health care relationships and include elements which seek to address these directly.

Modeling Health Disparities and Outcomes in Disenfranchised Populations

The Health Disparities and Outcomes (HDO) model originally created to explain the complexity of obtaining healthcare in rural settings has been revised and updated using emerging theoretical models of adversity and inequity and two decades of empirical work by the authors. With a strong orientation to explaining population-based health inequities, the HDO is applied to individuals with Serious Mental Illness (SMI), to explain their high rates of morbidity and mortality compared to the general population. Individual-, community-, and system-level factors that reflect an understanding of life-long risk, accrued hazards associated with multiple and intersecting disadvantages, and difficulty obtaining healthcare that meets accepted standards are described. The revised HDO can be applied to populations with disproportionate health challenges to identify multi-level factors that affect illness trajectory and overall health outcomes.

Agency, activation and compatriots: the influence of social networks on health-seeking behaviours among Sri Lankan migrants and Anglo-Australians with depression

The nexus between social networks and illness behaviours is important in uptake of health care, however scant research has explored this relationship in South Asian migrants living with mental illness. We explored the interplay between culture, social networks and health seeking in Sri Lankan migrants and Anglo-Australians living with depression. Forty-eight in-depth interviews were conducted and data were analysed through the theoretical prism of the network episode model. Results showed that social networks were important in negotiating care. Decisions to initiate care occurred along a continuum of choice and agency; some took charge of their care, others were coerced into care, however some Sri Lankan migrants were led through various informal channels of care. Selective activation of compatriots - those perceived to understand mental illness-became increasingly important to participants through their illness careers. Compatriots were considered of greater benefit as participants progressed through depression than otherwise meaningful social networks based on ethnicity, culture and kinship. We argue that the role of social networks is pivotal in uptake of formal care, and engaging with communities to improve responses of social networks to mental illnesses may provide a bottom-up avenue for improving uptake of mental health services in migrant communities.

Supported Decision-Making: The Expectations Held by People With Experience of Mental Illness

Supported decision-making (SDM) is a principle guiding mental health service provision, which aims to improve people's ability to make informed decisions about their care. Understanding diverse individual needs is vital to its success. Based on 29 narrative interviews with people diagnosed with mental illness in Australia, we examine how participants reflected on their own experiences of SDM. We find that participants' conceptualization of mental health expertise, their own experiences and sense of agency, and their varying needs for dependence and independence influenced their relationships with mental health practitioners. These factors in turn shaped their expectations about SDM. Four narrative positions emerged: the "Inward Expert," the "Outward Entrustor," the "Self-Aware Observer," and the "Social Integrator." These positionings influenced the type or style of support that participants expected and considered most useful. Our findings are relevant to developing effective approaches to SDM that take into account service users' needs and preferences.

Loneliness is closely associated with depression outcomes and suicidal ideation among military veterans in primary care

BACKGROUND

Although the substantial influence of social relationships on health is well-known, studies that concurrently examine the influence of varying dimensions of social connectedness on major depression are more limited. This study's aim was to determine to what degree several facets of social connectedness (number of confidants, social support, interpersonal conflict, social norms, and loneliness) are correlated with depression-related outcomes.

METHODS

Participants were primary care patients (n = 301) with probable major depression at a Veterans Health Administration hospital and its satellite clinics. Social connectedness was primarily measured using multi-item instruments from the NIH Toolbox of Adult Social Relationship Scales. Primary outcomes were clinical symptoms (depression and suicidal ideation) and secondary outcomes were self-reported health-related behaviors (medication adherence, patient activation, and help-seeking intentions).

RESULTS

In multivariate models adjusting for potential confounders and other facets of connectedness, loneliness was associated with higher levels of depression and suicidal ideation, as well as lower patient activation and help-seeking intentions. Social support and social norms about depression treatment were each associated with higher patient activation and help-seeking intentions. Social connectedness was not associated with medication adherence.

LIMITATIONS

The limitations of this study are primarily related to its cross-sectional survey design and study population.

CONCLUSIONS

Multiple aspects of social connectedness are associated with depression outcomes among military veterans with depression. Loneliness may represent the most important component of connectedness, as it is associated with depression severity, suicidality, and health-related behaviors.

Perceived Need for Mental Health Care: The Intersection of Race, Ethnicity, Gender, and Socioeconomic Status

Racial/ethnic minority populations underutilize mental health services, even in the presence of psychiatric disorder, and differences in perceived need may contribute to these disparities. Using the Collaborative Psychiatric Epidemiology Surveys, we assessed how the intersections of race/ethnicity, gender, and socioeconomic status affect perceived need. We analyzed a nationally representative sample of U.S. adults (18 years or older; N=14,906), including non-Latino whites, Asian Americans, Latinos, African Americans, and Afro-Caribbeans. Logistic regressions were estimated for the total sample, a clinical need subsample (meets lifetime diagnostic criteria), and a no disorder subsample. Perceived need varies by gender and nativity, but these patterns are conditional on race/ethnicity. Men are less likely than women to have a perceived need but only among non-Latino whites and African Americans. Foreign-born immigrants have lower perceived need than U.S.-born persons, only among Asian Americans. Intersectional approaches to understanding perceived need may help uncover social processes that lead to disparities in mental health care.

Racial/ethnic differences in perceived need for mental health care and disparities in use of care among those with perceived need in 1990-1992 and 2001-2003

OBJECTIVES

This study examines whether there are racial/ethnic differences in perceived need for mental health care among those with a mood and/or anxiety disorder in 1990-1992 and 2001-2003 in the US. Then among those with perceived need, we examine whether racial/ethnic disparities in use of mental health care existed in both time periods.

DESIGN

Using data from the 1990-1992 National Comorbidity Survey (NCS) and 2001-2003 National Comorbidity Survey - Replication (NCS-R), the study analyzes whether whites differed from blacks and Latinos in rates of perceived need among those with a mood and/or anxiety disorder in 1990-1992 and 2001-2003. Then among those with a disorder and perceived need, rates of mental health care use for whites are compared to black rates and Latino rates in within the 1990-1992 cohort and then within the 2001-2003 cohort.

RESULTS

There were no statistical racial/ethnic differences in perceived need in both time periods. Among those with perceived need in 1990-1992, there were no statistical racial/ethnic disparities in the use of mental health care. However, in 2001-2003, disparities in mental health care use existed among those with perceived need.

CONCLUSIONS

The emergence of racial/ethnic disparities in use of mental health care among those with a perceived need for care in 2001-2003 suggests that personal/cultural belief along with issues concerning access and quality of mental health care may create barriers to receiving perceived needed care. More research is needed to understand why these disparities emerged among those with perceived need in the latter time period and whether these disparities continue to exist in more recent years.

End-of-Life Caregiver Social Support Activation: The Roles of Hospice Clinicians and Professionals

Caregivers of those with life-limiting illness face many complicated tasks, including providing direct patient care, communicating with professionals, and managing the logistical demands of daily activities. To assist with caregiving responsibilities, caregivers require social support from social network members at all points in the illness process. This study analyzes themes from interviews with 61 caregivers of patients enrolled in hospice services to identify the types of support caregivers mobilize from new social network members for social support during the end-of-life care process. Themes indicate that caregivers receive accessible, immediate, caregiver-centered emotional support from hospice health care professionals, and situationally tailored, understandable informational support from other types of professionals. In addition, caregivers received overlapping emotional and informational support from hospice health care professionals. Findings enhance the understanding of how caregivers receive tailored emotional and informational support.

Parental Action and Referral Patterns in Spatial Clusters of Childhood Autism Spectrum Disorder

Sociodemographic factors have long been associated with disparities in autism spectrum disorder (ASD) diagnosis. Studies that identified spatial clustering of cases have suggested the importance of information about ASD moving through social networks of parents. Yet there is no direct evidence of this mechanism. This study explores the help-seeking behaviors and referral pathways of parents of diagnosed children in Costa Rica, one of two countries in which spatial clusters of cases have been identified. We interviewed the parents of 54 diagnosed children and focused on social network connections that influenced parents' help seeking and referral pathways that led to assessment. Spatial clusters of cases appear to be a result of seeking private rather than public care, and private clinics are more likely to refer cases to the diagnosing hospital. The referring clinic rather than information spread appears to explain the disparities.

Integrated Primary Medical-Behavioral Health Care for Adolescent and Young Adult Depression: Predictors of Service Use in the Youth Partners in Care Trial

Objectives

Depression, a chronic and disabling condition, frequently has its first onset during adolescence, underscoring the value of early effective treatment and prevention. Integrated medical-behavioral health care provides one strategy for improving treatment access for adolescents and young adults (AYA).

Methods

This study examined predictors of accessing treatment in a multisite randomized controlled trial evaluating an integrated collaborative care intervention aimed at improving access to evidence-based depression treatment through primary health care, compared with usual care.

Results

The integrated care intervention was able to overcome barriers to care associated with an initial reluctance to pursue active treatment and older age. Service use was low in both conditions among less acculturated/non-English-speaking families.

Conclusions

Results support the value of integrated medical-behavioral health care for improving rates of care. Findings highlight mechanisms by which integrated care may lead to improved rates of care and outcomes for AYA, an underserved and understudied group.

Korean immigrants don't buy health insurance: The influences of culture on self-employed Korean immigrants focusing on structure and functions of social networks

Culture has been pinpointed as a culprit of disparities in health insurance coverage between Korean immigrants and other ethnic groups. This study explored specific mechanisms by which culture influences a decision to buy health insurance among self-employed Korean immigrants living in ethnic enclaves by focusing on the structure and functions of social networks. Between March and June 2015, we recruited 24 Korean immigrant adults (aged 18 or older) who identified as self-employed and being uninsured for substantial periods before 2014 in Southern California. Interviews were conducted in Korean, and Korean transcripts were translated into English by two bilingual interpreters. Using constant comparative analysis, we explored why participants didn't purchase health insurance after migrating to the United States and how their social networks influenced their decisions whether to purchase health insurance. Results indicate Korean immigrants sought health information from dense and homogeneous social networks whose members are mostly Korean immigrants embedded in similar social contexts. Social learning was frequently observed when people sought health care while uninsured. However, respondents often noted social ties do not provide helpful information about benefits, costs, and ways to use health insurance. "Koreans don't buy health insurance" was a dominant social norm reported by most respondents. Findings indicate that social learning and normative influence occur inside social networks and these mechanisms seemingly prevent purchasing of health insurance. In addition to the individual mandate in the Patient Protection and Affordable Care Act, more targeted approaches that consider the structure and functions of social networks could improve the public health of Korean immigrants.

Disadvantaged Status and Health Matters Networks among Low-Income African American Women

A significant gap in current network research relates to understanding the factors that shape the health matters (HM) networks of marginalized, socially disadvantaged populations. This is noteworthy, given that these networks represent a critical resource for mitigating the adverse health effects of both acute and chronic strains associated with marginalized status. Further, research has suggested that the networks of such populations—especially low-income African American women—are unique, and may operate in substantively different ways than those of other groups. Using two waves of data from a sample of low-income African American women, this research identifies the demographic, health status, and health behavior measures at time one that correspond to HM network characteristics at time two, six months later. This study offers preliminary insights on the relationship between key sociodemographic and health status characteristics of low-income African American women and their HM networks, including criminal justice involvement. Findings reveal that though poorer health status and criminal justice involvement correspond to smaller health matters networks, they also correspond to more active and supportive networks.

"Si Dios Quiere": Fatalismo and use of mental health services among Latinos with a history of depression

Latinos are less likely to seek professional mental health care than other groups in the United States. While fatalismo has long been hypothesized to be responsible for this behavior, there is little evidence on this assumption. Using an adapted version of the Behavioral Model of Health Service Use (BMHSU), and a nationally representative sample, this study examined the association between fatalismo and mental health service use among Latinos with a history of depression. Participants (n = 703) were drawn from the 2007 Pew Hispanic Healthcare survey. Results showed that fatalismo was significantly associated with the use of psychiatric care, even after controlling for traditional deterrents of health care access and utilization. The findings underscore the importance of fatalismo in predicting Latinos' use of psychiatric care. Implications for practice are discussed.

HIV Testing and Entry to Care Among Trans Women in Indiana

Trans women in the United States are disproportionately affected by HIV infection. To improve HIV services for this population, more information is needed about their experiences in early stages of the HIV Care Continuum. Trans women in states such as Indiana, which has moderate HIV incidence but little public health investment in HIV prevention and treatment, experience special challenges. Our qualitative descriptive study describes the circumstances influencing HIV testing and entry to care by 18 trans women living with HIV in Central Indiana. In-depth interviews regarding participants' HIV care experiences were analyzed using standard content analysis. Participants discussed three main topics: (a) HIV testing circumstances, (b) facilitators and barriers to entering care, and (c) motivators for entering care after a delay. Findings indicate that social relationships play a significant role in trans women's care experiences and that stigma, discrimination, and adverse life circumstance are powerful deterrents to care. Practice and policy implications are discussed.

Interactions between patients' experiences in mental health treatment and lay social network attitudes toward doctors in recovery from mental illness

Research in the area of social networks and health has demonstrated that lay social network members play a critical role in the early stages of the illness career, influencing key decisions and pathways to formal care. Here, we revisit and extend this body of work, examining how the lay social network context can moderate the influence of treatment experiences on recovery outcomes as the illness career unfolds. To achieve this goal, we address two research questions, drawing on a longitudinal sample of people making their initial contact with the mental health treatment system: First, we explore how treatment experiences, lay social network characteristics, and recovery outcomes change over 2 years, beginning with the point of entry into treatment. Second, we examine whether the relationship between perceived treatment experiences and recovery outcomes is contingent on characteristics of the lay network context in which clients are socially embedded, focusing on the network's cultural orientation toward medical professionals. We find that positive treatment interactions facilitate improved self-esteem, mastery, role functioning, recovery optimism, and global functioning when the lay network culture is pro-medical, but largely have null effects on the recovery process when the lay network is more hostile to medical professionals.

Exploring Professional Help-Seeking for Mental Disorders

Only a third of people with mental disorders seek professional help. In this study, we aimed to investigate attitudes toward help-seeking among non-help-seekers drawn from a community survey in South London. We conducted qualitative interviews with 24 participants with symptoms of mental disorders. We analyzed data using thematic analysis. Participants' reasons for not seeking professional help included perceiving their problems as normal or unsuitable for professional help, negative expectations of professional help, believing informal strategies were sufficient, fearing being stigmatized for having a mental disorder and help-seeking, and self-perceptions of being strong and/or self-reliant. A small number (n = 4) had resolved their problems. Participants with unresolved mental disorders (n = 20) had more chronic stressors, particularly about finances and family relationships, and greater concerns about professional help and stigma than other participants. Potential targets for interventions to encourage help-seeking could be focused around stigma about help-seeking as well as the self-perception of being strong.