Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes

Exploring Disparities in Behavioral Health Service Use in the Early Stages of the COVID-19 Pandemic

BACKGROUND

Previous studies examined the impact of the COVID-19 pandemic on mental health, but few studies looked at associations between the pandemic and state-funded behavioral health service utilization. We aimed to examine behavioral health service utilization during the early phase of COVID-19 among individuals with psychiatric disorders (PD), substance use disorders (SUD), and co-occurring disorders (COD).

METHODS

Using the last Adult Needs and Strengths Assessment (ANSA) completed in 2019 and 2020 in a Midwestern state, a column proportion test and Poisson regression model examined the associations of the pandemic year, age, gender, race/ethnicity, diagnostic type, and behavioral health needs.

RESULTS

Between 2019 and 2020, the number of adults newly involved in behavioral health services increased from 11,882 to 17,385. The number of total actionable items (TAI) differed by gender and age group. Adults who were Black or American Indian were more likely to have a significantly higher number of needs that interfered with functioning (β = 0.08; CI [0.06, 0.09]), (β = 0.16; CI [0.08, 0.23]), respectively, than White peers. Individuals with COD showed the highest number of needs (β = 0.27; CI [0.26, 0.28]) when compared to the needs of individuals with psychiatric disorders, after controlling for year, age, gender, and race/ethnicity.

CONCLUSIONS

Additional research is needed to better understand the intersections of age, gender identity, race/ethnicity, the complexity of needs, and useful strengths. The involvement of practitioners, service organizations, researchers, and policymakers will be required to provide accessible, effective behavioral health services with cultural and developmental adaptations to support recovery.

The clinical effectiveness of the Mind/Body Program for Infertility on wellbeing and assisted reproduction outcomes: a randomized controlled trial in search for active ingredients

STUDY QUESTION

Does the Mind/Body Program for Infertility (MBPI) perform better, due to certain distinctive elements, than a partly matched support group in improving the wellbeing and medically assisted reproduction (MAR) outcomes of women with elevated distress levels in a clinical setting?

SUMMARY ANSWER

While robust enhancements occurred in the wellbeing overall, the cognitive behavioural and formalized stress management elements of the MBPI allowed a significantly stronger improvement in trait anxiety, but not in other mental health and MAR outcomes, compared with a support group.

WHAT IS KNOWN ALREADY

Mind-body psychological programmes adjacent to MAR have been found to improve women's mental states and possibly increase chances of pregnancy. However, not enough is known about the programme's effectiveness among patients with elevated distress levels in routine clinical settings, nor is it clear which of its particular ingredients are specifically effective.

STUDY DESIGN, SIZE, DURATION

A pre-post design, single-centre, randomized controlled trial was performed between December 2019 and October 2022 (start and end of recruitment, respectively). The sample size (n = 168) was calculated to detect superiority of the MBPI in improving fertility-related quality of life. Randomization was computer-based, with random numbers concealing identities of patients until after allocation.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The trial was conducted at a large university teaching hospital. A total of 168 patients were randomly assigned to the mind-body (MBPI) group (n = 84) and the fertility support (FS) control group (n = 84). Patients received a 10-week, 135-min/week group intervention, with the FS group following the same format as the MBPI group, but with a less restricted and systematic content, and without the presumed effective factors. The number of patients analysed was n = 74 (MBPI) and n = 68 (FS) for post-intervention psychological outcomes, and n = 54 (MBPI) and n = 56 (FS) for pregnancy outcomes at a 30-month follow-up.

MAIN RESULTS AND THE ROLE OF CHANCE

Significant improvements occurred in both groups in all psychological domains (adjusted P < 0.001), except for treatment-related quality of life. Linear mixed-model regression analysis did not reveal significantly greater pre-post improvements in the MBPI group than in the FS group in fertility-related quality of life (difference in differences (DD) = 4.11 [0.42, 7.80], d = 0.32, adjusted P = 0.124), treatment-related quality of life (DD = -3.08 [-7.72, 1.55], d = -0.20, adjusted P = 0.582), infertility-specific stress (DD = -2.54 [-4.68, 0.41], d = -0.36, adjusted P = 0.105), depression (DD = -1.16 [3.61, 1.29], d = -0.13, adjusted P = 0.708), and general stress (DD = -0.62 [-1.91, 0.68], d = -0.13, adjusted P = 0.708), but it did show a significantly larger improvement in trait anxiety (DD = -3.60 [-6.16, -1.04], d = -0.32, adjusted P = 0.042). Logistic regression showed no group effect on MAR pregnancies, spontaneous pregnancies, or live births.

LIMITATIONS, REASONS FOR CAUTION

The follow-up only covered MAR-related medical outcomes and no psychological variables, and their rates were not equal in the two groups. Biological factors other than age, aetiology, and duration of infertility may have confounded the study results. Loss to follow-up was between 5% and 10%, which may have led to some bias.

WIDER IMPLICATIONS OF THE FINDINGS

The psychologically and medically heterogeneous sample, the normal clinical setting and the low attrition rate all raise the external validity and generalizability of our study. The MBPI works not only in controlled conditions, but also in routine MAR practice, where it can be introduced as a cost-effective, low-intensity psychological intervention, within the framework of stepped care. More studies are needed to further identify its active ingredients.

STUDY FUNDING/COMPETING INTEREST(S)

The authors received no financial support for the research, authorship, and/or publication of this article. The authors have no conflict of interest to disclose.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT04151485.

TRIAL REGISTRATION DATE

5 November 2019.

DATE OF FIRST PATIENT’S ENROLMENT

15 December 2019.

Intention to receive Latent Tuberculosis Infection (LTBI) treatment and its associated factors among healthcare workers in a Malaysian teaching university hospital

The acceptability of latent tuberculosis infection (LTBI) therapy remains low among healthcare workers (HCWs). Up to 10% of LTBI cases can reactivate into active tuberculosis, posing risks to HCWs and patients. Understanding HCWs' intention to undergo LTBI treatment is crucial for designing effective management policies, especially where no LTBI policy exists. This cross-sectional study investigated the intention to receive LTBI therapy and its associated factors among HCWs in a Malaysian teaching hospital. The study was conducted from 5th to 30th May 2023, in a hospital without an LTBI screening program. Stratified random sampling was used to select HCWs, excluding those undergoing TB or LTBI therapy. Respondents completed a questionnaire measuring intention to receive LTBI treatment, LTBI knowledge, attitude, perceived norm, and perceived behavioral control. Of the 256 respondents, the majority were female (63.7%), under 35 years old (64.45%), had no comorbidities (82.0%), and worked in clinical settings (70.3%). However, 60.5% of respondents had low LTBI knowledge and 60.5% held unfavorable attitudes toward LTBI treatment. Despite this, 53.5% of respondents intended to undergo LTBI therapy if diagnosed. Factors positively associated with this intention included being female [aOR: 2.033, 95% CI: 1.080-3.823], having high LTBI knowledge [aOR 1.926, 95% CI: 1.093-3.397], had favorable attitude [aOR 3.771, 95% CI: 1.759-8.084], and strongly perceiving social norms supportive of LTBI treatment [aOR 4.593, 95% CI: 2.104-10.023]. These findings emphasize the need for an LTBI management policy in the teaching hospital. To boost HCWs' intention and acceptance of LTBI treatment, a focused program improving knowledge, attitude, and perception of social norms could be introduced.

Pilot implementation of an evidence-based online cognitive behavioural therapy for perfectionism in university students: Lessons learnt

Higher Education Institutes (HEIs) have been met with an unprecedented demand on their student counselling and wellbeing services in recent years with the impacts of COVID-19 and high rates of mental health concerns amongst student populations. Online mental health programs offer one solution by providing students with quick and easy access to effective therapeutic content. The Focused Minds Program is an evidence-based eight-module online self-guided cognitive behavioural intervention that targets the transdiagnostic risk factor of perfectionism and has been shown to decrease depression, anxiety, and disordered eating. The program was implemented at a UK university between 2021 and 2023. Recruitment occurred via departmental emails, academic staff, and the university's counselling staff and website. Participants were provided with access to the intervention for 6-weeks and completed weekly surveys of psychosocial measures. The trial's implementation was assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework: reach (uptake via the recruitment channels), effectiveness (outcomes on psychometric measures of mental wellbeing), adoption (staff and organisational support), implementation (intervention engagement and attrition), and maintenance (continued implementation across the trial period). Key barriers to successful implementation, as well as proposed solutions, are discussed to guide future online mental health interventions provided in HEIs.

Why do young men not seek help for affective mental health issues? A systematic review of perceived barriers and facilitators among adolescent boys and young men

Men are less likely to seek help for their mental health than women, but less is known about the specific patterns of help-seeking in adolescent boys and young men. This is concerning as adolescent boys and young men have high suicide rates but a low take-up of services. It is therefore of particular importance that the access needs of this group are understood. This review sought to identify the barriers and facilitators faced by adolescent boys and young men in help-seeking for affective mental health disorders. A search of the PubMed, APA PsycInfo, and Cochrane databases identified 3961 articles, of which 12 met the inclusion criteria. Six of the studies were qualitative, five were quantitative and one used mixed methods. Two authors independently extracted data and assessed the quality of the articles. Five key themes were identified, including the impact of social norms, with the subthemes of conformity to masculine norms and self-stigma, limited availability of information about mental health, and 'male-friendly' mental health literacy campaigns. Other themes referred to the help-seeking preferences of adolescent boys and young men, in terms of informal or formal and online or offline help-seeking. Some of the factors were well-researched (e.g., conformity to masculine norms as a barrier) whereas other factors (e.g., self-compassion as a facilitator) were less researched. These barriers and facilitators need to be considered in the development of future strategies to improve the help-seeking behaviour of adolescent boys and young men.

Rates and correlates of study enrolment and use of a chatbot aimed to promote mental health services use for eating disorders following online screening

OBJECTIVE

We developed a chatbot aimed to facilitate mental health services use for eating disorders (EDs) and offered the opportunity to enrol in a research study and use the chatbot to all adult respondents to a publicly available online ED screen who screened positive for clinical/subclinical EDs and reported not currently being in treatment. We examined the rates and correlates of enrolment in the study and uptake of the chatbot.

METHOD

Following screening, eligible respondents (≥18 years, screened positive for a clinical/subclinical ED, not in treatment for an ED) were shown the study opportunity. Chi-square tests and logistic regressions explored differences in demographics, ED symptoms, suicidality, weight, and probable ED diagnoses between those who enroled and engaged with the chatbot versus those who did not.

RESULTS

6747 respondents were shown the opportunity (80.0% of all adult screens). 3.0% enroled, of whom 90.2% subsequently used the chatbot. Enrolment and chatbot uptake were more common among respondents aged ≥25 years old versus those aged 18-24 and less common among respondents who reported engaging in regular dietary restriction.

CONCLUSIONS

Overall enrolment was low, yet uptake was high among those that enroled and did not differ across most demographics and symptom presentations. Future directions include evaluating respondents' attitudes towards treatment-promoting tools and removing barriers to uptake.

Community resource facilitation use by ethnic minority groups with traumatic brain injury in the Midwestern United States

OBJECTIVE

This study surveyed the use of community-based resource facilitation (RF) services by ethnic minority survivors of traumatic brain injury (TBI) living in the Midwestern United States.

METHOD

Past records of RF use by survivors of TBI were reviewed. Demographics and patterns of RF use across 3 ethnic groups were documented. Reported barriers to community integration related to ethnic identity were identified using Chi-square test of independence.

RESULTS

Ethnic minority survivors were less likely to use RF services than white survivors. Caucasian women and men utilized RF services at similar rates, whereas more African American men and Latina women used RF services. Caucasians received information about RF from a greater variety of sources than ethnic minority survivors. Ethnic identity was significantly associated with greater reported needs for TBI awareness.

CONCLUSIONS

A pattern of differential RF use by survivors from ethnic minority groups was noted, suggesting potential socio-cultural influences on help-seeking behavior after TBI. These factors should be considered to develop more accessible and equitable strategies of RF service referral and support. Future investigations of cultural perspectives of TBI and injury-related services may improve understanding of the likelihood and necessity of community-based RF service use by diverse populations.

Factors Associated with Prospective Acceptability and Preferences for Unified Transdiagnostic Cognitive-Behavioral Treatments and Group Therapy in the Portuguese General Population

Group transdiagnostic cognitive-behavioral therapy (CBT) offers a promising solution for limited mental health access in Portugal. Understanding barriers to patient adherence is crucial for successful implementation. This study aimed to characterize the prospective acceptability and preferences for unified transdiagnostic CBT and group therapy in the Portuguese general population and explore their correlates. A sample of 243 participants (18-88 years old), recruited online, completed an online survey collecting information on sociodemographic and clinical characteristics, acceptability of transdiagnostic CBT treatments, specifically of Unified Protocol (UP), acceptability of group therapy, therapeutic format preferences, beliefs about group therapy and help-seeking attitudes. Most participants were receptive to and perceived as useful both unified transdiagnostic CBT and group therapy. Overall, participants presented significantly more favorable attitudes than unfavorable attitudes toward unified transdiagnostic CBT and group therapy (p < .001). Multivariate analyses revealed that (1) favorable attitudes toward transdiagnostic treatments were negatively associated with being employed and positively associated with living in an urban area, and higher efficacy scores; (2) unfavorable attitudes toward transdiagnostic treatments were positively associated with being married/cohabitating and negatively associated with vulnerability scores; (3) being female, living in an urban area, and higher efficacy and myth scores emerged as positive predictors of favorable attitudes toward group therapy; and (4) efficacy and vulnerability scores and help-seeking propensity emerged as negative predictors of unfavorable attitudes toward group therapy. These findings highlight the importance of delineating strategies to increase knowledge and acceptance of unified transdiagnostic CBT and group therapy in the Portuguese population, addressing specific individual characteristics.

Trends in Psychiatric Day Care Practices in Japan: An Analysis Using the National Database of Health Insurance Claims Open Data

BACKGROUND

Psychiatric day care is a key framework for outpatient rehabilitation in Japanese psychiatric treatment. It targets a wide range of diseases and performs various roles. The current status and utilization of psychiatric day care in Japan have changed owing to an increase in the availability of other social resources and the coronavirus disease 2019 (COVID-19) pandemic. However, no reports have quantitatively analyzed the trends or current situation of psychiatric day care in Japan. Therefore, this study aimed to analyze the status of the operation of psychiatric day care in Japan and its trends by sex, region, and age group.

METHODS

Based on the publicly available data from the Japanese National Database of Health Insurance Claims and Specific Health Checkups (NDB Open Data), we investigated changes in the numbers related to psychiatric day care nationwide from fiscal year (FY) 2017-2021. Furthermore, we calculated the numbers of psychiatric day care facilities use per 1,000 people by prefecture, sex, and age group in 2021. A Mann-Whitney U test was conducted to compare the total number of psychiatric day care facilities used in months during periods of emergency declarations and priority preventative measures with those used in months when there were no such periods. Pearson's correlation coefficient test was conducted to examine the correlation between the numbers of psychiatric beds per 100,000 people and the annual numbers of psychiatric day care facilities use per 1,000 people in each prefecture. A Mann-Whitney U test was conducted to compare the number per 1,000 people per year of prefectures with or without capital- and government-designated cities and compare the annual total number (FY 2017-2021) by sex.

RESULTS

Overall, the number of psychiatric day care facilities use tended to decrease. The monthly data showed a significant decrease in the total number of psychiatric day care facilities' usage during periods of emergency declarations and priority preventative measures (p=0.02). The numbers of "psychiatric short care" use increased in 2021 and those of psychiatric day-night care (>3 years / >3 days per week) use showed an increasing trend from 2020. The overall number of psychiatric day care facilities' usage per 1,000 people by prefecture was significantly lower in prefectures having cities with populations of 700,000 or more (p<0.01). A significant positive correlation was found between the number of psychiatric day care facilities use per 1,000 people by prefecture and the number of psychiatric beds per 100,000 people by prefecture (r=0.61, p<0.01). The usage of psychiatric day care facilities was significantly lower for women (p<0.01). In terms of age group, the use of psychiatric day care facilities was significantly lower for younger age groups (under 65 years of age) (p<0.01).

CONCLUSIONS

Trends in the numbers reflected differences in user attributes and regional differences. It is necessary to establish a management system tailored to individual attributes and in regions where support is difficult to reach.

Predictors of psychiatric treatment-seeking attitudes in older adults

OBJECTIVES

Understanding the factors that contribute to treatment-seeking attitudes among older adults-a growing population with frequent mental health concerns-is vital. Although past research has identified some demographic and belief-based predictors of mental health treatment attitudes among this population, previous studies are limited by only evaluating these variables in isolation and not distinguishing between different types of treatment (e.g. medication and psychotherapy).

METHODS

In a pre-registered online survey of 606 older adults (age 60 years and older), we evaluated stigmatizing attitudes, etiological beliefs about depression, psychological symptoms, and health literacy as well as attitudes about psychotherapy and medication separately.

RESULTS

Pre-registered linear regression analyses showed that greater stigmatizing attitudes uniquely predicted more negative attitudes for both therapy and medication treatment seeking over and above gender, education, income, extrinsic barriers, health literacy, depression, and anxiety. Additionally, loneliness was a significant predictor of less favorable medication attitudes. Exploratory analysis revealed that attributing depression to a chemical imbalance predicted positive attitudes about medication, but not psychotherapy.

CONCLUSION

These findings indicate that older adults' treatment-seeking behaviors are separately influenced by stigma, etiological beliefs, and loneliness.

Adult psychiatric inpatient admissions and length of stay before and during the COVID-19 pandemic in a large urban hospital setting in Vancouver, British Columbia

Introduction

During the COVID-19 pandemic individuals with mental illnesses faced challenges accessing psychiatric care. Our study aimed to describe patient characteristics and compare admissions and length of stay (LOS) for psychiatric-related hospitalizations before and during the COVID-19 pandemic.

Methods

We conducted a retrospective analysis using health administrative data comparing individuals with an acute psychiatric admission between two time periods: 1st March 2019 to 31st December 2019 (pre-COVID) and 1st March 2020 to 31st December 2020 (during-COVID). Multivariable negative binomial regression was used to model the association between most responsible diagnosis type and the two-time periods to hospital LOS, reporting the Rate Ratio (RR) as the measure of effect.

Results

The cohort comprised 939 individuals who were predominately male (60.3%) with a severe mental illness (schizophrenia or mood-affective disorder) (72.7%) and a median age of 38 (IQR: 28.0, 52.0) years. In the multivariable analysis, anxiety disorders (RR: 0.63, CI: 0.4, 0.99) and personality disorders (RR: 0.52, CI: 0.32, 0.85) were significantly associated with a shorter LOS when compared to individuals without those disorders. Additionally, when compared to hospital admissions for non-substance related disorders the LOS for patients with substance-related disorders were significantly shorter during the COVID period (RR: 0.45, CI: 0.30, 0.67) and pre-COVID period (RR: 0.31, CI: 0.21, 0.46).

Conclusions

We observed a significant difference in the type and length of admissions for various psychiatric disorders during the COVID-19 period. These findings can support systems of care in adapting to utilization changes during pandemics or other global health events.

Prevalence and associated risk factors for suicidal ideation, non-suicidal self-injury and suicide attempt among male construction workers in Ireland

BACKGROUND

Suicide among male construction workers are reported to be disproportionally high compared to the working age population. However, there is minimal understanding of the prevalence and associated factors for suicidal ideation, non-suicidal self-injury, and suicide attempt among this occupational group globally.

METHODS

A cross-sectional study was conducted on a large sample of male construction workers in Ireland (n = 1,585). We investigated the prevalence of suicidal ideation, non-suicidal self-injury and suicide attempts and sociodemographic, occupational, and mental health factors associated with these three outcomes. Multivariable Poisson regression was performed to estimate the prevalence rate ratio of suicidal ideation (model 1 primary outcome), while multivariable logistic regression was used to estimate the odds ratio of non-suicidal self-injury (model 2 primary outcome), and suicide attempt (model 3 primary outcome).

RESULTS

The lifetime prevalence rate for suicidal ideation was 22%, 6% for non-suicidal self-injury, and 6% for suicide attempt. In univariate modelling, socio-demographic and occupation-specific factors associated with the three outcomes included younger age (suicidal ideation and non-suicidal self-injury), not being in a relationship (suicide attempt) and working 35-44 h per week (suicidal ideation and suicide attempt). The mental health factors generalized anxiety disorder, depression, and suicide bereavement were significantly associated with increased risk of the three outcomes. In fully adjusted multivariable models, increasing severity of generalized anxiety disorder and depression were associated with an increased prevalence rate ratio of suicidal ideation, and a higher odds ratio of non-suicidal self-injury and suicide attempt.

CONCLUSION

Suicidal ideation, non-suicidal self-injury and suicide attempt are significant issues for male construction workers that require specific attention. Findings highlight a need to support younger male construction workers and those bereaved by suicide. They also highlight the need for the early detection and treatment of generalized anxiety disorder and depression in order to intervene in, and potentially prevent, suicidality among male construction workers.

Suicidality associated with decreased help-seeking attitudes in college students: Implications for identifying and treating at-risk students

Suicide is a leading cause of death in college-aged youth, yet only half of all college students report engaging in professional mental health help-seeking. We examined how the various aspects of young adults' suicidality were associated with their openness to pursue professional mental health care in the future (i.e., "future help-seeking intentions"). Multilevel binary logistic regressions were tested in a sample of 24,446 U.S. college undergraduates with suicidality. The moderating effect of past service utilization on future help-seeking intentions was also tested. Strikingly, young people reporting past-year suicidal ideation, past-year suicidal attempts, and self-reported likelihood of a future suicide attempt demonstrated decreased likelihood of future help-seeking intentions, while those reporting prior diagnosis of a mental health condition and/or past service utilization demonstrated an increased likelihood. Past service utilization also significantly moderated the effect of suicide disclosure, such that youth reporting prior disclosure and prior professional treatment-seeking demonstrated greater odds of future help-seeking intentions relative to those who had disclosed suicidality but never utilized professional services. In order to mitigate the mental health crisis facing youth, further exploration is necessary to understand why students with suicidality do not report openness to seek help. It is also imperative to develop and implement novel strategies to identify at-risk students, understand and alleviate relevant barriers to treatment, and promote positive help-seeking attitudes and behaviors.

Predictive modeling of initiation and delayed mental health contact for depression

BACKGROUND

Depression is prevalent among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans, yet rates of Veteran mental health care utilization remain modest. The current study examined: factors in electronic health records (EHR) associated with lack of treatment initiation and treatment delay; the accuracy of regression and machine learning models to predict initiation of treatment.

METHODS

We obtained data from the VA Corporate Data Warehouse (CDW). EHR data were extracted for 127,423 Veterans who deployed to Iraq/Afghanistan after 9/11 with a positive depression screen and a first depression diagnosis between 2001 and 2021. We also obtained 12-month pre-diagnosis and post-diagnosis patient data. Retrospective cohort analysis was employed to test if predictors can reliably differentiate patients who initiated, delayed, or received no mental health treatment associated with their depression diagnosis.

RESULTS

108,457 Veterans with depression, initiated depression-related care (55,492 Veterans delayed treatment beyond one month). Those who were male, without VA disability benefits, with a mild depression diagnosis, and had a history of psychotherapy were less likely to initiate treatment. Among those who initiated care, those with single and mild depression episodes at baseline, with either PTSD or who lacked comorbidities were more likely to delay treatment for depression. A history of mental health treatment, of an anxiety disorder, and a positive depression screen were each related to faster treatment initiation. Classification of patients was modest (ROC AUC = 0.59 95%CI = 0.586-0.602; machine learning F-measure = 0.46).

CONCLUSIONS

Having VA disability benefits was the strongest predictor of treatment initiation after a depression diagnosis and a history of mental health treatment was the strongest predictor of delayed initiation of treatment. The complexity of the relationship between VA benefits and history of mental health care with treatment initiation after a depression diagnosis is further discussed. Modest classification accuracy with currently known predictors suggests the need to identify additional predictors of successful depression management.

Patterns and predictors of mental health service use among older veterans with alcohol use disorder who received a video-enabled tablet

Objectives: Video-based telehealth may expand access to mental health services among older veterans with alcohol use disorder (AUD). We examined the modalities through which mental health services were rendered, and predictors of video visits before and after video-enabled tablet receipt from the Veterans Health Administration. Method: 11,210 veterans aged 60 or older with a diagnosis of AUD who received a tablet between 1 April 2020 and 25 October 2021 were identified. The electronic health record was used to characterized encounters by modality of mental health care delivery in the six months pre/post tablet receipt. Logistic regression examined predictors of a video visit for mental health. Results: Phone was the most common modality; however, the proportion of video encounters increased from 8.7% to 26.2% after tablet receipt. Individuals who were older, male, and had more physical health conditions, were less likely to have a video visit. Individuals who were married, resided in urban areas, had a history of housing instability, and had more mental health conditions, were more likely to have a video visit. Conclusion: Video-enabled tablets may help older adults with AUD overcome access barriers to mental health services, although targeted support for certain groups may be necessary.

Gender differences in psychological help-seeking attitudes: a case in Türkiye

Background/aim

Mental disorders pose a substantial public health challenge within the overall disease burden. This study aims to determine the factors associated with seeking psychological help among individuals experiencing depression according to gender differences in Türkiye.

Methods

The study utilized microdata from Türkiye Health Survey conducted by the Turkish Statistical Institute in 2016, 2019, and 2022. Binary logistic regression analysis was employed to determine the factors associated with seeking psychological help.

Results

The study's findings reveal that variables such as survey year, age, education level, employment status, general health status, disease status, depression status, day service status in the hospital, daily activity status, tobacco use status, and alcohol use status are associated with the status of receiving psychological help.

Conclusion

Gender-specific analysis indicated variations in the significance and impact of these variables among individuals seeking psychological help. In the development of preventive strategies for mental health protection, special attention should be given to factors associated with the psychological help-seeking behavior of both women and men. Prioritizing and addressing these factors will contribute to more effective mental health interventions.

Telemental Health Use Is Associated With Lower Health Care Spending Among Medicare Beneficiaries With Major Depression

BACKGROUND

Some policymakers are concerned that expanding telehealth coverage may increase Medicare expenditures. However, there is limited evidence on the association of telehealth use with utilization and spending among Medicare beneficiaries with major depression.

OBJECTIVE

To examine the differences in spending and utilization among telemental health users and non-telemental health users with major depression.

METHODS

We examined 2014-2019 traditional Medicare claims data for beneficiaries aged ≥50 years with major depression in Texas. Multivariable generalized linear models were used to assess the relationships between telemental health use and Medicare spending and utilization while adjusting for patient demographics and programmatic and clinical factors.

RESULTS

In each of the years between 2014 and 2019, an average of 4.6% Medicare beneficiaries with major depression had at least 1 telemental health visit. Compared with beneficiaries without a telemental health visit, those who had a telemental health visit were significantly more likely to be enrolled in Medicaid, be Medicare eligible due to a disability, live in a lower income area or in a rural area, and have a higher comorbidity index. Beneficiaries utilizing telemental health services incurred higher unadjusted Medicare spending than those not receiving telemental health services. However, this difference appeared due to beneficiary and programmatic characteristics rather than telemental health use. Adjusting for model covariates, the telemental health group had lower overall per member per year predicted spending, inpatient admissions, and emergency department visits than non-telemental health users.

CONCLUSION

Our findings suggest that telemental health care use may improve access to mental health care without increasing Medicare spending among telemental health users in Texas.

Determinants and outcome correlates of engagement with a mobile mental health intervention for depression and anxiety in middle-aged and older adults

OBJECTIVES

To examine baseline factors (i.e., age, gender, mobile device proficiency, sensory impairment) associated with app engagement in a 12-week mental health app intervention and to explore whether app engagement predicts changes in depression and anxiety symptoms among middle-aged and older adults.

METHOD

Mobile device proficiency, sensory impairment, depression, and anxiety symptoms were measured using questionnaires. App engagement was defined by metrics characterizing the core intervention features (i.e., messages sent to therapist, mindfulness meditation minutes, action tasks completed). Multiple regressions and multilevel models were conducted.

RESULTS

Forty-nine participants (M age = 57.40, SD = 11.09 years) enrolled. Women (β = .35, p < .05) and participants with less sensory impairment completed more action tasks (β = -.40, p < .05). Depressive and anxiety symptoms measured within the app declined significantly across treatment. Clinical significant improvements were observed for depression in 48.9% and for anxiety in 40% of participants. App engagement metrics were not predictive of depression or anxiety symptoms, either incrementally in time-lagged models or cumulatively in hierarchical linear regression analyses.

CONCLUSION

App engagement is multifaceted; participants engaged differently by gender and ability. Participation in this digital mental health intervention reduced depression and anxiety symptoms, but these findings should be interpreted with caution as the study did not include a control condition. Our findings underscore the importance of considering individual factors that may influence use of a digital mental health intervention.

Treatment of last resort? Psychological therapy seeking in chronic pain patients

OBJECTIVE

Our goal was to assess how many chronic pain patients seek psychological treatment for their condition and what psychological and demographic characteristics are associated with that decision.

METHODS

The association between pain intensity, quality of life and psychological treatment seeking was tested in two hypothetical models which differed according to beliefs about either external or internal control over pain.

RESULTS

A minority of patients had experience with psychological treatment of chronic pain. Patients who had that experience were younger, suffered from more intense pain, and applied many more coping strategies than patients who never tried this kind of treatment. Intense pain and low quality of life motivated chronic pain patients to seek psychological treatment only if they believed that doctors could control their pain.

DISCUSSION

The study results stress the importance of diversifying the methods used to treat chronic pain and educating patients about the benefits of psychological treatment. Low numbers of chronic pain patients who take advantage of psychological treatment indicate that encouragement from medical professionals might be necessary.

When stroke survivors' self-ratings are inconsistent with the ratings of others: a cohort study examining biopsychosocial factors associated with impaired self-awareness of functional abilities

Background Stroke survivors' self-ratings of functional abilities are often inconsistent with ratings assigned by others (e.g. clinicians), a phenomenon referred to as 'impaired self-awareness' (ISA). There is limited knowledge of the biopsychosocial contributors and consequences of post-stroke ISA measured across the rehabilitation journey. This multi-site cohort study explored biopsychosocial correlates of ISA during subacute rehabilitation (inpatient) and at 4 months post-discharge (community-dwelling). Methods Forty-five subacute stroke survivors participated (Age M (s.d.) =  71.5 (15.6), 56% female), and 38 were successfully followed-up. Self-assessments were compared to those of an independent rater (occupational therapist, close other) to calculate ISA at both time points. Survivors and raters completed additional cognitive, psychological and functional measures. Results Multivariate regression (multiple outcomes) identified associations between ISA during inpatient admission and poorer outcomes at follow-up, including poorer functional cognition, participation restriction, caregiver burden, and close other depression and anxiety. Regression models applied cross-sectionally, including one intended for correlated predictors, indicated associations between ISA during inpatient admission and younger age, male sex, poorer functional cognition, poorer rehabilitation engagement and less frequent use of non-productive coping (adjusted R 2  = 0.60). ISA at community follow-up was associated with poorer functional cognition and close other anxiety (adjusted R 2  = 0.66). Conclusions Associations between ISA and poorer outcomes across the rehabilitation journey highlight the clinical importance of ISA and the value of assessment and management approaches that consider the potential influence of numerous biological and psychosocial factors on ISA. Future studies should use larger sample sizes to confirm these results and determine the causal mechanisms of these relationships.

Patterns in suicide by marital status in Hong Kong, 2002-2020: Is marriage still a protective factor against suicide?

BACKGROUND

Marriage has long been considered protective against suicide, but shifting social norms since 2000 in Hong Kong raise doubts regarding whether this is still the case. The aim of the study was to investigate the changing association between suicide and marital status.

METHODS

Official suicide data for 2002-2020 in Hong Kong were obtained. Suicide rates and suicide risk ratios were calculated by gender, age group, and marital status (married, never-married, widowed, divorced/separated).

RESULTS

Suicide risk decreased significantly over time for men and women of all ages. People who were never-married, divorced/separated, had significantly higher suicide risks than their married counterparts. Increasing suicide risks over time were observed for never-married men aged 20-49 years, never-married women aged 35-49 years, and divorced/separated men aged 20-34 years. Widowed men and women of any age had higher suicide risks compared with previous studies in Hong Kong.

LIMITATIONS

Marital status is a time-varying covariate, and the time spent in a given marital status could affect suicide risk. Some age and gender subgroups had much smaller sample sizes than others, thus it is possible that our suicide risk estimates were overestimated.

CONCLUSIONS

Despite rapidly social changing in Hong Kong during the study period, marriage remains a strong protective factor against suicide for men and women. The protective effect is particularly evident for younger people. Increasing suicide rates for divorced/separated, never-married, or widowed people suggest that they require more psychosocial support.

Exploring the Characteristics of Men Aged 55+ Who Use Mental Health Community Care and Support Services: A Secondary Analysis of the Adult Psychiatric Morbidity Study in England

ObjectivesThe aim of this study is to understand the demographic and situational characteristics of men over 55 who have used a community support service. Method: Hierarchical multivariable logistic regression was conducted using anonymised data from the Adult Psychiatric Morbidity Study 2014. Results: Need factors such as having a common mental disorder (CMD), poor general health and having counselling/therapy were the most relevant to use of a community support service. It was more common for older men (85+), single men, and those who reported experiencing several traumatic life events to have used a community support service. Discussion: The results are critically discussed by considering the roles of gender, ageing, and social support, which might influence the use of community support services. There is a need for more awareness of categories such as age and previous service use, and how they might influence community support help seeking.

Mental health self-care during the COVID-19 pandemic: a prospective cohort study in Australia

INTRODUCTION

Pandemic public health measures have affected mental health for many people. We sought to determine how people were managing their mental health concerns during the pandemic, and to identify worker characteristics where actions were more common.

METHODS

A prospective cohort of 1646 Australians, who were in paid employment prior to the pandemic, completed a survey during 27 April- 26 July 2020 on changes in work, health, and actions taken to manage their mental health concerns. Descriptive statistics were calculated to determine actions taken to manage mental health concerns during the prior month, such as lifestyle changes, exercise, use of online resources, and talking to others. Regression models identify worker characteristics where actions were more common.

RESULTS

Lifestyle changes were the most frequently reported action to manage mental health concerns (78%), and were more common for women (OR = 2.33, 95%CI=[1.82, 3.03]), and people experiencing recent work loss (OR = 1.54, 95%CI=[1.04, 2.28]). Overall, mental health self-care was more common for people experiencing psychological distress, or with pre-existing mental conditions. Talking to friends about mental health, and making changes to diet and exercise, was more common for women and those aged 18-24 years. Psychological distress was a significant indicator for consulting with health professionals.

CONCLUSION

Actions to manage mental health concerns during the pandemic were common, as were conversations with friends or family members. During economic crises, support and services should focus on reducing barriers to formal mental health care, particularly for people who less commonly seek help, and those experiencing moderate to high levels of psychological distress.

Predictive variables of depressive symptoms and anxiety in older adults from primary care: a cross-sectional observational study

BACKGROUND

By 2050, the number of people aged 60 years and older will have doubled worldwide and the most common mental disorders in this age group are currently depressive symptoms and anxiety. This study aimed to analyze the Basic and Instrumental Activities of Daily Living (BADLs and IADLs, respectively) in older adults; socio-demographic, clinical, lifestyle, and environmental variables; and cognitive impairment related to the appearance of depressive symptoms and anxiety.

MATERIAL AND METHODS

A cross-sectional observational study was conducted with 327 participants aged ≥65 years in primary care. The variables were Yesavage's Geriatric Depression Scale, the Goldberg Anxiety Subscale, socio-demographic, clinical, lifestyle, environmental variables, BADLs, IADLs, and the Spanish version of the Mini-Mental State Examination.

RESULTS

An analysis of variance was carried out for the predictive multiple linear regression models. '≥ 1 chronic pathology' and 'low dependency' in BADL are negatively associated with anxiety, while 'physical activity' and 'low dependency' in BADL are associated with positive factors for depressive symptoms.

CONCLUSIONS

Predictor variables could improve the early detection of anxiety and depressive symptoms by general practitioners and serve as a basis for future studies and personalised-adapted cognitive stimulation programs.

Sociodemographic Factors as Predictors of the Duration of Long-term Psychotherapy: Evidence from a Finnish Nationwide Register Study

OBJECTIVE

The role of sociodemographic factors in determining psychotherapy duration has been largely unexplored despite their known association with treatment use. We examined the association between sociodemographic factors and rehabilitative psychotherapy treatment duration, as well as any changes in duration over time.

METHOD

We used three register-based nationally representative cohorts. Participants included employed Finnish individuals (n = 5572, 77% women, mean age = 37) who started psychotherapy treatment in 2011, 2013 or 2016 and were followed until 2019. We used negative binomial regression to examine the association between sociodemographic factors (age, gender, education, occupational status, income, geographical area of residence, and onset year of treatment) with treatment duration.

RESULTS

The mean treatment duration was 27 months (with a standard deviation of 12 months). Several sociodemographic factors were associated with treatment duration. Gender and education were found to have the largest impact on treatment duration, with females having a longer duration (IRR 1.08, 95% CI 1.04-1.11) and those with low education having a shorter duration (IRR 0.91, 95% CI 0.85-0.97), resulting in a difference of 2-3 months. Treatment duration also increased in later years, which suggests potentially increasing differences in treatment implementation. At largest, the combined effect of all factors corresponded to a 10-month difference in treatment duration.

CONCLUSIONS

The duration of long-term psychotherapy varied across the sociodemographic groups and increased in all studied groups in the 2010s.

Using Real-World Data to Explore the Impact of One-Time Financial Grants Among Young Adult Cancer Survivors

Young adult (YA) cancer survivors experience worse financial outcomes than older survivors. This analysis used data from Expect Miracles Foundation to explore the impact of one-time financial grants on financial well-being and access to health care. Among 300 respondents, the average grant was $1526 (standard deviation = $587; range $300-$3000). Respondents reported improved ability to pay expenses (t = 4.45, p < 0.001), increased financial decision-making power (t = 2.79, p = 0.06), decreased medical debt impact (t = 2.1, p = 0.04), improved transportation access (t = 2.38, p = 0.02), and fewer challenges in accessing care (t = 3.0, p = 0.005) 6 months after receiving a financial grant. Financial assistance offers YAs an opportunity to meet medical and nonmedical expenses.

A Gender Hypothesis of sex disparities in adverse drug events

Pharmacovigilance databases contain larger numbers of adverse drug events (ADEs) that occurred in women compared to men. The cause of this disparity is frequently attributed to sex-linked biological factors. We offer an alternative Gender Hypothesis, positing that gendered social factors are central to the production of aggregate sex disparities in ADE reports. We describe four pathways through which gender may influence observed sex disparities in pharmacovigilance databases: healthcare utilization; bias and discrimination in the clinic; experience of a drug event as adverse; and pre-existing social and structural determinants of health. We then use data from the U.S. FDA Adverse Event Reporting System (FAERS) to explore how the Gender Hypothesis might generate novel predictions and explanations of sex disparities in ADEs in existing widely referenced datasets. Analyzing more than 3 million records of ADEs between 2014 and 2022, we find that patient-reported ADEs show a larger female skew than healthcare provider-reported ADEs and that the sex disparity is markedly smaller for outcomes involving death or hospitalization. We also find that the sex disparity varies greatly across types of ADEs, for example, cosmetically salient ADEs are skewed heavily female and sexual dysfunction ADEs are skewed male. Together, we interpret these findings as providing evidence of the promise of the Gender Hypothesis for identifying intervenable mechanisms and pathways contributing to sex disparities in ADEs. Rigorous application of the Gender Hypothesis to additional datasets and in future research studies could yield new insights into the causes of sex disparities in ADEs.

Association between psychological distress and mental help-seeking intentions in international students of national university of Singapore: a mediation analysis of mental health literacy

BACKGROUND

International students encounter a wide range of challenges that can have a significant impact on their mental health. Seeking help is one of the primary means of managing mental health, and more attention is required. This study aimed to investigate the psychological distress(PD), mental health literacy(MHL), and mental help-seeking intentions(MHSI) in international students of National University of Singapore(NUS), to explore the correlation between the three and to verify the mediating role of MHL in PD and MHSI.

METHODS

This cross-sectional study was conducted between May and July 2023 using the Mental Help Seeking Intention Scale(MHSIS), Patient Health Questionnaire-9(PHQ-9), Generalized Anxiety Disorder-7(GAD-7), and Mental Health Literacy Scale(MHLS). 281 international students(177 males, 104 females;) in NUS completed self-report questionnaires. SPSS 25.0 was applied to the data for descriptive analysis, Pearson correlation analysis and stepwise regression analysis. Mediation analysis fully for all potential confounding factors were conducted.

RESULTS

Significant correlations were found between PD, MHL and MHSI. MHLS- knowledge of how to seek professional information(MHLS- H) completely mediated the association of anxiety with MHSI[B=-0.271; 95% confidence interval(CI): (-0.067, 0.0037)]; MHLS- attitude that promote recognition or appropriate help-seeking behavior(stigma)(MHLS- H) partially mediated the association of PD with MHSI[B = 0.104, 95% CI: (0.008, 0.179)]; with mediating effects accounting for 100% and 24.847% of the total effect. In addition, demographic variables such as gender, years in Singapore and residence type mediated both the direct and indirect effect of the mediation model.

CONCLUSIONS

MHL mediated both the direct and indirect effects on the association between PD and MHSI, especially, the mediator of the MHLS- H and MHL-A. It means that MHSI in this population can be improved by increasing MHL and thus the PD. The findings suggest that, such as providing information about how to access to professional services and promoting disorder recognition to the international students, may help them develop their psychological well-being and good mental health care decisions.

Help-seeking following a flooding event: a cross-sectional analysis of adults affected by flooding in England in winter 2013/14

BACKGROUND

Flooding can cause long-term, significant impacts on mental health in affected populations. We explored help-seeking behaviour of households affected by flooding.

METHODS

A cross-sectional analysis was conducted on National Study of Flooding and Health data on households flooded in England in winter 2013/14. Participants (Year 1: n = 2006; Year 2: n = 988; Year 3: n = 819) were asked if they sought help from health services and other sources. Logistic regression was conducted to calculate odds ratios (ORs) of help-seeking in flooded and disrupted participants compared to unaffected, adjusted for a priori confounders.

RESULTS

The odds of seeking help from any source 1 year after flooding were greater for flooded participants [adjusted OR (aOR): 1.71, 95% confidence interval (CI): 1.19-1.45] and those disrupted by flooding (aOR: 1.92, 95% CI: 1.37-2.68) compared to unaffected participants. This continued in the second year (flooded: aOR 6.24, 95% CI: 3.18-13.34; disrupted: aOR: 2.22, 95% CI: 1.14-4.68), and help-seeking remained greater in flooded than unaffected participants in the third year. Flooded and disrupted participants were particularly likely to seek help from informal sources. Help-seeking was more prevalent amongst participants with mental health outcomes, but a notable proportion of individuals with any mental health outcome did not seek help (Year 1: 15.0%; Year 2: 33.3%; Year 3: 40.3%).

CONCLUSIONS

Flooding is associated with increased demand for formal and informal support, persisting for at least 3 years, and an unmet need for help amongst affected individuals. Our findings should be considered in flood response planning to reduce the long-term adverse health impacts of flooding.

[Assistive technologies for elderly patients with dementia: perspectives from the bioethics of health care.]

Dementia is currently one of the most common diseases affecting elderly people, ranking seventh among leading causes of death. As it causes memory loss, difficulties in reasoning, and resulting difficulties in making and executing decisions, assistive technologies and cognitive stimulation are valuable resources in the care process. Based on a theoretical inquiry into the bioethics of health care, and drawing on the work of Aline Albuquerque and Victor Montori, this article focuses on three main issues: first, the concept of bioethics in health care, patient-centered care, and the idea of clinical empathy. Second, it looks at the use of assistive technologies in caring for elderly patients with dementia. Lastly, we offer a discussion of whether the care process could be considered a health technology.

Factors associated with patient activation among individuals with depression within racial/ethnic groups in the United States

Increasing patient activation may be vital for improving quality of care for individuals with depression. Among adults with depression who reside in the United States, we sought to examine the association of depression severity, race/ethnicity, and household income with patient activation and within identify factors associated with patient activation within race/ethnicity groups. Data from the 2020 US National Health and Wellness Survey, a cross-sectional, general population survey, were used to identify White, Black/African American, Asian, and Hispanic respondents with self-reported physician-diagnosed depression. Generalized linear models were used to identify factors associated with patient activation. Analyses included 8,216 respondents (mean age = 44 years, 68.0% female). Depression severity was negatively associated with patient activation (β = -0.29, p < 0.001). Patient activation was significantly higher in Black vs. White respondents (β = 1.50, p = 0.001) and in respondents with a household income of $25,000-$49,999 (β = 0.96, p = 0.015), $50,000-$99,000 (β = 0.88, p = 0.031), and ≥$100,000 (β = 1.78, p < 0.001) vs. <$25,000. Adjusted mean patient activation scores were highest among Black respondents (61.1), followed by Hispanic (60.2), White (59.6), and Asian (59.0) respondents. Neither race/ethnicity nor household income moderated the relationship between depression severity and patient activation; however, the factors most strongly associated with patient activation differed by race/ethnicity. These results indicate that the pathway to improving patient activation in individuals with depression may vary by race/ethnicity. Understanding factors associated with patient activation can help inform the design of interventions to increase patient activation in individuals with depression.

Impact of community mental health services on the adult psychiatric admission through the emergency unit: a 20-year population-based study

Background

There is a lack of real-life population-based study examining the effect of community mental health services on psychiatric emergency admission. In Hong Kong, Integrated Community Center for Mental Wellness (ICCMW) and telecare service were introduced in 2009 and 2012, respectively. We examined the real-life impact of these services on psychiatric emergency admissions over 20 years.

Methods

Number of psychiatric emergency admissions between 2001 and 2020 was retrieved from the Hong Kong Clinical Data Analysis & Reporting System. We used an interrupted time series analysis to examine monthly psychiatric admission trend before and after service implementation, considering socioeconomic and environmental covariates.

Findings

A total of 108,492 psychiatric emergency admissions (47.8% males; 64.9% aged 18-44 years) were identified from the study period, of which 56,858, 12,506, 12,295, 11,791, and 15,051 were that for schizophrenia-spectrum disorders, bipolar affective disorders, unipolar mood disorders, neuroses, and substance use disorders. ICCMW introduction has an immediate effect on psychiatric emergency admission (adjusted estimate per 100,000: -10.576; 95% CI, -16.635 to -4.518, p < 0.001), particularly among adults aged 18-44 years (-8.543; 95% CI, -13.209 to -3.877, p < 0.001), females (-5.843; 95% CI, -9.647 to -2.039, p = 0.003), and with neuroses (-3.373; 95% CI, -5.187 to -1.560, p < 0.001), without a significant long-term effect. Unemployment, seasonality, and infectious disease outbreak were significant covariates.

Interpretation

ICCMW reduced psychiatric emergency admission, but no further reduction following full implementation. Community mental health services should be dynamically tailored for different populations and socioeconomic variations over time.

Funding

None.

Ethnic identity and barriers for using mental health services among Arab-Bedouin women coping with emotional distresses

The study aimed to explore barriers to mental health service attainment among Bedouin women living in different residential environments in southern Israel. We hypothesized that emotional distress and the utilization of mental health services would be influenced by the living environment and ethnic identity factors. The sample included 376 Arab-Bedouin women, 126 Arab-Bedouin women from the recognized and unrecognized villages, and 250 Arab-Bedouin women from the central localities. Quantitative methods were used, including emotional distress (GHQ12), ethnic identity scale (EIS), mental health literacy (MHLS), and barriers to mental health services attainment (BACE). Results indicated that participants from the central localities demonstrated a greater inclination to seek and utilize mental health services. Furthermore, higher rates of affirmation of ethnic identity were also found to be a predictive factor for the willingness to attain mental health services. These findings further support the role of residential environment and ethnic identity in shaping mental health service utilization patterns. Current research explored barriers to mental health services seek and attainment for Arab-Bedouin women in different residential environments in southern Israel. Ethnic identity factors and barriers such as stigma and access to resources predicted the tendency to seek help. Findings emphasize the need to address barriers to seeking help and the role of ethnic identity in mental health service attainment for Arab-Bedouin women.

The Reciprocal Relationship of Physical Capacity and Mental Health: A Random Intercept Cross-Lagged Panel Model Analysis

This study investigates the mutual influence of mental health and physical capacity in older adults, considering potential gender differences. Data from 7,504 Medicare beneficiaries aged 65+ from the NHATS 2011-2015 surveys were analyzed using a random intercept cross-lagged panel model in Mplus. Results revealed moderate within-person effects of physical capacity on mental health (βt12 = -.19, βt23 = -.32, βt34 = -.42, βt45 = -.40), while the reverse relationship showed smaller effects (βt12 = -.02, βt23 = -.03, βt34 = -.03, βt45 = -.02). Gender differences emerged, with the influence of mental health on physical capacity being significant in men but not women. Additionally, correlations between changes in physical capacity and mental health were stronger for men. Lastly, lagged effects of physical capacity on mental health were notably stronger than the reverse. The findings suggest that enhancing physical capacity may alleviate depression and anxiety symptoms in older adults, particularly men.

An exploration of suicidal ideation and attempts, and care use and unmet need among suicide-ideators in a Belgian population study

BACKGROUND

Suicidal ideation, or thinking about death and suicide, is common across all layers of society. The aim of this paper is to add to the understanding of suicidal ideation in the general population, as well as help-seeking behaviors and perceived unmet mental health needs among those who report suicidal thoughts.

METHODS

The research is part of a representative population-based survey study of mental wellbeing in Antwerp (Flanders, Belgium) carried out in 2021. A total of 1202 participants between 15 and 80 years old answered the Ask Suicide-Screening Questions (ASQ), and an additional question about suicide plans. Participation was by invitation only and possible online or via a postal paper questionnaire. Univariate and multivariate logistic regression analyses were used to explore the association between both current suicidal ideation and self-reported lifetime suicide attempt with the sociodemographic factors age, gender, educational level, origin and financial distress. Moreover, formal care use for mental health was examined among those experiencing suicidal ideation, and logistic regression analyses were used to assess associated sociodemographic factors. Finally, perceived unmet mental health needs were assessed among suicide ideators.

RESULTS

The point-prevalence of suicidal ideation was 8.6% and was higher among younger age groups and individuals reporting financial distress. The lifetime-prevalence of suicide attempts is 6.5% and was higher in younger people and individuals with a primary educational level and with financial distress. About half (45.6%) of those with suicidal ideation consulted a professional for mental health problems in the past twelve months. Men and those with a primary educational level were less likely to seek help. Half of suicide ideators without care use perceived some need for mental health care, and a third of suicide ideators who used care perceived the obtained help as insufficient, resulting in a population prevalence of 3.6% suicide ideators with a fully or partially perceived unmet need.

CONCLUSIONS

The prevalence of suicide attempts, suicidal ideation and unmet needs among suicide-ideators is high in this Belgian sample. Mental health care need perception in suicide ideators needs further investigation.

Health status and health-care utilization among men recently released from a superjail: a matched prospective cohort study

PURPOSE

Continuity of care and access to primary care have been identified as important contributors to improved health outcomes and reduced reincarceration among people who are justice-involved. While the disproportionate burden of health concerns among incarcerated populations is well documented, less is known about their health service utilization, limiting the potential for effective improvements to current policy and practice. This study aims to examine health status and health care utilization among men recently released from a superjail in a large metropolitan area to better understand patterns of use, risk factors and facilitators.

DESIGN/METHODOLOGY/APPROACH

Participants included adult men (n = 106) matched to a general population group (n = 530) in Ontario, Canada, linked to medical records (88.5% linkage) to examine baseline health status and health utilization three-months post-release. The authors compared differences between the groups in baseline health conditions and estimated the risk of emergency department, primary care, inpatient hospitalization and specialist ambulatory care visits.

FINDINGS

Superjail participants had a significantly higher prevalence of respiratory conditions, mental illness, substance use and injuries. Substance use was a significant risk factor for all types of visits and emergency department visits were over three times higher among superjail participants.

ORIGINALITY/VALUE

This empirical case is illustrative of an emerging phenomenon in some regions of the world where emergency departments serve as de facto "walk-in clinics" for those with criminal justice involvement. Strategic approaches to health services are required to meet the complex social and health needs and disparities in access to care experienced by men released from custody.

@ease peer-to-peer youth walk-in centres in The Netherlands: A protocol for evaluating longitudinal outcomes, follow-up results and cost-of-illness

AIM

Innovative youth mental health services around the globe vigorously work on increasing highly needed mental health care accessibility but their service users and care effectiveness have rarely been studied. The Dutch youth walk-in centres of @ease opened in 2018, with currently 11 locations at which free anonymous peer-to-peer counselling is offered to young people aged 12-25. The aim of this protocol is to outline the to-be-conducted research at @ease.

METHODS

Three studies are outlined: (1) an outcome evaluation of @ease visits using hierarchical mixed model analyses and change calculations, (2) a cost-of-illness study using calculations for costs of truancy and care usage among these help-seeking young people, with regression analyses for risk group identification, and (3) a follow-up evaluation at three, six and 12 months to assess long-term effects after ending @ease visits. Data provided by young people include demographics, parental mental illness, truancy, past treatment, psychological distress (CORE-10) and health-related quality of life (EQ-5D-5L). Social and occupational functioning (SOFAS), suicidal ideation and need for referral are rated by the counsellors. Questionnaires are filled out at the end of every visit and at follow-up via e-mail or text, provided permission is given.

DISCUSSION

Research regarding the visitors and effectiveness of the @ease services is fully original. It offers unique insights into the mental wellbeing and cost-of-illness of young people who may otherwise remain unseen while suffering from a high disease burden. The upcoming studies shed light on this unseen group, inform policy and practice and direct future research.

Barriers and facilitators of older adults for professional mental health help-seeking: a systematic review

BACKGROUND

Older adults are at an increased risk for mental health issues, yet they are less likely to seek professional help. This systematic review aims to identify and summarize literature on the barriers and facilitators that older adults face when seeking professional mental health help.

METHODS

A comprehensive literature search was conducted using multiple databases including PubMed-Medline, EMBASE, ProQuest central, CINAHL and Scopus to identify relevant studies published between 2010 and 2021 that focused on barriers and/or facilitators to seeking help for depression, anxiety, and psychological distress among older adults aged 65 years or older. Studies' risk of bias was assessed using the Newcastle-Ottawa Scale and results of studies were synthesized guided by the methodological framework of Rodgers and colleagues.

RESULTS

A total of eight cross-sectional studies, from Australia, United States, Mexico, Netherlands, and Malaysia met the inclusion criteria for this review. Included studies reported that the majority of their participants had anxiety or depression, yet they exhibited a preference for informal mental health help over professional help. Stigma, negative beliefs about mental health professional services, and cost were the most reported barriers. Main reported facilitators were prior positive experience with mental health services and high socioeconomic status.

CONCLUSION

Older adults are in need of interventions normalizing mental health help seeking and ensuring these services are accessible in terms of costs. This should be the focus of policy makers, healthcare providers, and public health practitioners working with older adults.

PROTOCOL REGISTRATION

PROSPERO 2021 CRD42021238853.

Family function and adolescent altruistic behavior: the multiple mediating effects of self-affirmation and psychological resilience

Introduction

The current study aimed to explore the relationship between family function and adolescent altruistic behavior, as well as the mediating effects of self-affirmation and psychological resilience in this relationship.

Methods

A survey was conducted on 972 high school students in Guangdong Province using the Family APGAR, GHQSense of Adequacy, Chinese version of Connor-Davidson Resilience Scale, and Altruistic Behavior Scale.

Results

Results found that the score of psychological resilience of males was significantly higher than that of females, but the score of altruistic behavior was significantly lower than that of females. Family function had a positive predictive effect on altruistic behavior. Psychological resilience played a mediating role between family function and altruistic behavior. Self-affirmation and psychological resilience played chain mediating roles between family function and altruistic behavior.

Discussion

This study indicated that family care is crucial for the development of adolescent altruistic behavior, and that it can promote the development of altruistic behavior through the enhancement of self-affirmation and psychological resilience.

Young adults' adoption and use of mental health apps: efficient, effective, but no replacement for in-person care

Objective: Millions of people use mobile phone or computer-based applications-apps-to maintain their mental health and connect with treatment providers through text- and video-based chat functions. The present study sought to understand young adults' motivations for adopting this technology using the unified theory of acceptance and use of technology (UTAUT), how they use mental health apps, and the gratifications they receive from using mental health apps. Participants: One hundred-eighteen mental health app users responded to an online survey. Methods: A survey was conducted with students at a Midwestern university. The survey included questions regarding current mental health services, mental health apps used, UTAUT and gratifications survey items. Results: A regression analysis suggested users' performance expectancies, effort expectancies, and facilitating conditions predicted the adoption of mental health apps. Young adults most often use mental health apps for stress relief. While they preferred in-person treatment, users described mental health apps as efficient and helpful. Conclusion: Overall, the results reinforce the sense of optimism for the future of mental health apps, suggesting the potential for apps to supplement-but not necessarily replace-in-person care.

Factors Associated With Loss to Follow-up After Laparoscopic Sleeve Gastrectomy: A Single-Center Retrospective Study

Purpose

After bariatric surgery, postoperative follow-up is important for evaluating long-term outcomes, such as successful weight loss and improvement of metabolic parameters. However, many patients are lost to follow-up within 1 year. This study aimed to identify the follow-up rate of bariatric surgery and predictive factors of loss to follow-up (LTF).

Materials and Methods

We retrospectively reviewed the data of 61 patients receiving bariatric surgery for obesity (laparoscopic sleeve gastrectomy; LSG group) and 872 for early gastric cancer (EGC group) from November 2018 to July 2020 in a single center. After 1:1 matching, we compared the LTF rate. In the LSG group, we analyzed the factors associated with LTF. Additionally, we collected weight data in the LTF group by a telephone survey.

Results

By 1:1 matching, 47 patients for each group were identified. The LTF rates of the LSG and EGC groups were 34.0% (16 patients) and 2.1% (one patient), respectively (P=0.0003). In the LSG group, the LTF rate increased over the postoperative month. Of the patients, 29.5% who missed a scheduled appointment within one year comprised the LTF group. In the analysis, no significant factors associated with LTF were identified. The only factor with borderline significance was dyslipidemia with medication (P=0.094).

Conclusion

The LSG group demonstrated a high LTF rate, although adherence to follow-up was closely related to postoperative outcomes. Therefore, educating patients on the significance of follow-up is important. Particularly, continuous efforts to identify the associated factors and develop a multidisciplinary management protocol after bariatric surgery are necessary.

A HOPE Online Community Peer Support Intervention for Help Seeking: A Randomized Controlled Trial

OBJECTIVE

A 6-week study was conducted to test the effectiveness of the Harnessing Online Peer Education (HOPE) intervention on anxiety, help seeking (requests for electronic resources [e-resources] on anxiety reduction), and online engagement.

METHODS

Three hundred participants with moderate to severe anxiety (i.e., seven-item Generalized Anxiety Disorder scale [GAD-7] scores ≥10) were randomly assigned to social media (i.e., Facebook) groups with or without peer leaders. The study was conducted from April 5 to May 17, 2020. GAD-7 scores, e-resource requests, and online engagement were measured at baseline and at weeks 2, 4, and 6.

RESULTS

GAD-7 scores improved in both intervention and control groups, with no difference between conditions. Participants in the intervention group were more likely than those in the control group to request e-resources (OR=10.27, 95% CI=4.52-23.35) and engage online (OR=2.84, 95% CI=1.70-4.76).

CONCLUSIONS

The HOPE intervention effectively promoted mental health help-seeking behavior and online engagement.

Assisted Suicide and Euthanasia in Mental Disorders: Ethical Positions in the Debate between Proportionality, Dignity, and the Right to Die

The admission of people suffering from psychiatric and neurocognitive disorders to euthanasia and physician-assisted suicide (E/PAS) in some European and non-European countries represents a controversial issue. In some countries, the initial limitation of E/PAS to cases of severe physical illness with poor prognosis in the short term has been overcome, as it was considered discriminatory; thus, E/PAS has also been made available to subjects suffering from mental disorders. This decision has raised significant ethical questions regarding the capacity and freedom of self-determination; the family, social, and economic contexts; the social consideration of the sense of dignity and the pressure on the judgment of one's personal value; the contextual therapeutic possibilities; the identification of figures involved in the validation and application; as well as the epistemological definitions of the clinical conditions in question. To these issues must be added the situation of legislative vacuum peculiar to different countries and the widespread lack of effective evaluation and control systems. Nonetheless, pessimistic indicators on global health status, availability of care and assistance, aging demographics, and socioeconomic levels suggest that there may be further pressure toward the expansion of such requests. The present paper aims to trace an international overview with the aim of providing ethical support to the debate on the matter. Precisely, the goal is the delimitation of foundations for clinical practice in the complex field of psychiatry between the recognition of the irreversibility of the disease, assessment of the state of physical and mental suffering, as well as the possibility of adopting free and informed choices.

Understanding experiences of mental health help-seeking in Arab populations around the world: a systematic review and narrative synthesis

BACKGROUND

Racial and ethnic disparities in mental health service utilisation and access is well established. Mental illness is common among Arab populations globally, but most individuals display negative attitudes towards mental health and do not seek professional help. The aim of this systematic review was to determine 1) help-seeking behaviours 2) help-seeking attitudes and 3) help-seeking barriers and facilitators, related to mental health services among Arab adults.

METHOD

A pre-defined search strategy and eligibility criteria allowed for database searching using terms related to: mental health, Arabs, help-seeking, as well as experiences and behaviours. Seventy-four articles were included and analysed through narrative synthesis. Results were reported using the PRISMA guidelines. The review protocol was registered prospectively on PROSPERO (CRD42022319889).

RESULTS

Arabs across the world have negative attitudes towards formal help-seeking and are reluctant to seek help, despite the presence of psychological distress. There is little information on factors that influence help-seeking behaviours and rates of service use. Preference for informal help sources such as family and friends were expressed and considered more acceptable. Low mental health literacy, stigma, gender, age, education, religion, acculturation, and immigrant status were the most common factors influencing help-seeking attitudes. Barriers to help-seeking included stigma, privacy and confidentiality, trust, mental health literacy, language, logistics, and culture related barriers. Increasing societal and family awareness, external support and encouragement, shared culture between the client and therapist, quality of doctor patient relationship, and feelings of connectedness with the host country among refugees were mentioned facilitators. Mixed findings for the role of religion, and family and community, in relation to facilitating or hindering help-seeking were reported.

CONCLUSIONS

There is an increased likelihood and preference to seek informal sources of psychological support among Arabs. Contextual and cultural factors impeding help-seeking for Arabs are common across the world. Future research should address actual utilisation rates of services to better understand factors that influence help-seeking behaviours and facilitators to help-seeking. Increasing mental health literacy and developing anti stigma campaigns is necessary. Developing culturally informed interventions should inform future efforts to promote help-seeking among this population.

Ecological Factors of Telemental Healthcare Utilization Among Adolescents with Increased Substance Use During the COVID-19 Pandemic: The Moderating Effect of Gender

Background

Adolescent substance use is often associated with concurrent mental health problems (e.g., depression, suicide attempts, parental emotional and physical abuse, not feeling close to people at school, and lower virtual connectedness) at multiple ecological levels.

Objective

This study examined whether such risk factors among adolescents were associated with the use of telemental healthcare (TMHC) and whether gender moderated these associations.

Methods

Data were drawn from the Adolescent Behaviors and Experiences Survey, collected by the U.S. Centers for Disease Control and Prevention from January to June 2021. A hierarchical multiple logistic regression analysis was conducted using a national sample of 1,460 students in Grades 9-12 in the United States who reported having used more alcohol and/or drugs during the pandemic than before it started.

Results

The results showed that only 15.3% of students sought TMHC. Students reporting increased substance use during the pandemic were more likely to use TMHC if they experienced more severe mental health problems (e.g., suicide attempts) compared to other ecological factors, such as issues with their family, school, or community. Analysis of the moderating effect showed that the closer male students felt to people at school, the more likely they were to seek TMHC, whereas the opposite was true for female students.

Conclusions

The findings highlighted that feeling close to people at school is an important aspect of understanding the help-seeking behavior of female and male adolescent substance users.

Heatwave and mental health

Physical health has been associated with ambient temperature and heatwave. With the frequent occurrence of heatwave, the adaptive effects and mechanisms on mental health remain uncertain. On the basis of the China Health and Nutrition Survey, we estimated the relationship between heatwaves and self-assessed mental health scores in the Chinese population aged 50 and above. This study has identified that with each additional heatwave event, mental health scores decreased by an average of 0.027 points, which is equivalent to 0.3% of the average level. Heat is more likely to affect groups with low education, no medical insurance, and living in rural areas. In mechanistic exploration, we found that stress emotion is a fully mediating effect. Heat led to reduced health activities and more frequent drinking, which may lead to lower psychological well-being. Moreover, good dietary preference is a regulator that can help mitigate the adverse effects of heat on mental health. This study corroborates the impact of heat on spiritual welfare, and demonstrates the mechanisms and channels of impact, which can help reduce global economic losses due to mental health problems.

The relationships between perceived mental illness prevalence, mental illness stigma, and attitudes toward help-seeking

Previous research suggests that, despite the commonality of mental illness in the United States, the majority of U.S. individuals with mental illness do not seek treatment. One important factor that contributes to this lack of treatment utilization is mental illness stigma. Such stigma may result, in part, from many individuals in the U.S. underestimating the prevalence of mental illness. To test whether this is the case, 638 adults from across the U.S. completed measures related to perceived prevalence of mental illness, private stigma, perceived public stigma, and help-seeking. Findings indicated participants significantly underestimated the given-year prevalence rate of mental illness. The perceived given-year prevalence rate was significantly correlated with lower private stigma and more positive attitudes towards help-seeking. Personal stigma significantly predicted attitudes towards help-seeking. Findings also suggested that individuals who have received mental health services have a higher perceived prevalence rate of mental illness, as well as lower levels of personal stigma and more positive attitudes towards help-seeking. These findings support the notion that helping the general public recognize the true prevalence rate of mental illness could reduce personal mental illness stigma and facilitate help-seeking behaviors. However, future experimental studies are needed to test this hypothesis.

Palliative care use and utilization determinants among patients treated for advanced stage lung cancer care in the community and academic medical setting

PURPOSE

Despite clinical guidelines, palliative care is underutilized during advanced stage lung cancer treatment. To inform interventions to increase its use, patient-level barriers and facilitators (i.e., determinants) need to be characterized, especially among patients living in rural areas or those receiving treatment outside academic medical centers.

METHODS

Between 2020 and 2021, advanced stage lung cancer patients (n = 77; 62% rural; 58% receiving care in the community) completed a one-time survey assessing palliative care use and its determinants. Univariate and bivariate analyses described palliative care use and determinants and compared scores by patient demographic (e.g., rural vs. urban) and treatment setting (e.g., community vs. academic medical center) factors.

RESULTS

Roughly half said they had never met with a palliative care doctor (49.4%) or nurse (58.4%) as part of cancer care. Only 18% said they knew what palliative care was and could explain it; 17% thought it was the same as hospice. After palliative care was distinguished from hospice, the most frequently cited reasons patients stated they would not seek palliative care were uncertainty about what it would offer (65%), concerns about insurance coverage (63%), difficulty attending multiple appointments (60%), and lack of discussion with an oncologist (59%). The most common reasons patients stated they would seek palliative care were a desire to control pain (62%), oncologist recommendation (58%), and coping support for family and friends (55%).

CONCLUSION

Interventions should address knowledge and misconceptions, assess care needs, and facilitate communication between patients and oncologists about palliative care.

Association of Depression and Poor Mental Health With Cardiovascular Disease and Suboptimal Cardiovascular Health Among Young Adults in the United States

Background Depression is a nontraditional risk factor for cardiovascular disease (CVD). Data on the association of depression and poor mental health with CVD and suboptimal cardiovascular health (CVH) among young adults are limited. Methods and Results We used data from 593 616 young adults (aged 18-49 years) from the 2017 to 2020 Behavioral Risk Factor Surveillance System, a nationally representative survey of noninstitutionalized US adults. Exposures were self-reported depression and poor mental health days (PMHDs; categorized as 0, 1-13, and 14-30 days of poor mental health in the past 30 days). Outcomes were self-reported CVD (composite of myocardial infarction, angina, or stroke) and suboptimal CVH (≥2 cardiovascular risk factors: hypertension, hypercholesterolemia, overweight/obesity, smoking, diabetes, physical inactivity, and inadequate fruit and vegetable intake). Using logistic regression, we investigated the association of depression and PMHDs with CVD and suboptimal CVH, adjusting for sociodemographic factors (and cardiovascular risk factors for the CVD outcome). Of the 593 616 participants (mean age, 34.7±9.0 years), the weighted prevalence of depression was 19.6% (95% CI, 19.4-19.8), and the weighted prevalence of CVD was 2.5% (95% CI, 2.4-2.6). People with depression had higher odds of CVD than those without depression (odds ratio [OR], 2.32 [95% CI, 2.13-2.51]). There was a graded association of PMHDs with CVD. Compared with individuals with 0 PMHDs, the odds of CVD in those with 1 to 13 PMHDs and 14 to 30 PHMDs were 1.48 (95% CI, 1.34-1.62) and 2.29 (95% CI, 2.08-2.51), respectively, after adjusting for sociodemographic and cardiovascular risk factors. The associations did not differ significantly by sex or urban/rural status. Individuals with depression had higher odds of suboptimal CVH (OR, 1.79 [95% CI, 1.65-1.95]) compared with those without depression, with a similar graded relationship between PMHDs and suboptimal CVH. Conclusions Depression and poor mental health are associated with premature CVD and suboptimal CVH among young adults. Although this association is likely bidirectional, prioritizing mental health may help reduce CVD risk and improve CVH in young adults.

Investigating the effects of suicide exposure among a clinical sample of active duty service members

Suicide exposure warrants further investigation as a risk factor for suicide among military service members. This study aimed to examine associations among suicide exposure, suicidal ideation (SI), and psychological symptoms in a clinical sample of service members (N = 1,565, 64.4% suicide-exposed) and identify how one's relationship with the deceased impacts suicidality and psychological health in exposed individuals. A secondary analysis of cross-sectional survey data was conducted. Generalized linear regression analyses were used to identify associations between suicide exposure and both current SI and psychological symptoms among all participants; the associations between suicide exposure characteristics and psychological symptoms were only examined among exposed individuals. Exposure was not significantly associated with higher SI, β = .007, SE = .16, p = .965, but was associated with PTSD, β = 1.60, SE = 0.49, p = .001; anxiety, β = .68, SE = .31, p = .031; and insomnia symptoms, β = .98, SE = .25, p < .001. Among participants who had been exposed, high/long impact of exposure was positively associated with SI, β = 0.94, SE = .26, p < .001, and psychological symptoms, PTSD: β = 2.32, SE = .77, p = .002; anxiety: β = 1.39, SE = .50, p = .005; insomnia: β = .96, SE = .39, p = .015. Results illustrate the significant issue of suicide exposure within the military and show consideration of suicide exposure as a potential risk factor for adverse psychological outcomes is warranted.