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Kerman N, Marshall CA, Polillo A, Voronov J, de Pass T, Easton C, Ward B, Noble A, Hwang SW, Kozloff N, Stergiopoulos V, Kidd SA. Service restrictions from emergency shelters among people experiencing homelessness: Uncovering pathways into unsheltered homelessness and institutional circuitry. Soc Sci Med 2024; 348:116831. [PMID: 38574591 DOI: 10.1016/j.socscimed.2024.116831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
Service restrictions refer to temporary or permanent bans of individuals from a program or an organization's services, and are widely used in emergency shelter systems. Limited research exists on how service restrictions unfold and their impacts on people experiencing homelessness. This qualitative study used in-depth interviews with timeline mapping to examine the antecedents and consequences of service restrictions from emergency shelters among people experiencing homelessness in two cities in Ontario, Canada. A total of 49 people experiencing homelessness who had been restricted from an emergency shelter program in the past year were recruited and included in the study analysis. A pragmatic and integrative approach was used for data analysis that involved the development of meta-matrices to identify prominent and divergent perspectives and experiences with regard to service restriction antecedents and consequences. Study findings underscored that service restrictions were often the result of violence and aggression, primarily between service users. There were regional differences in other service restriction reasons, including substance use and possession. Service restrictions affected the shelter status of almost all participants, with many subsequently experiencing unsheltered homelessness, and cycling through institutional health, social, and criminal justice services (i.e., institutional circuitry). Other health and social consequences included substance use relapses and hospitalizations; cold-related injuries due to post-restriction unsheltered homelessness; suicidality; food insecurity; diminished contact with support network and connections; and intense feelings of anger, fear, and hopelessness. Overall, the study findings advance our understanding of the role of homeless services in pathways into unsheltered homelessness and institutional circuitry, which raise critical questions about how to mitigate the harms associated with service restrictions, while concurrently facilitating safety and upholding the rights of people experiencing homelessness and emergency shelter staff.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada.
| | - Carrie Anne Marshall
- Western University, School of Occupational Therapy, 1201 Western Road, London, Ontario, Canada
| | - Alexia Polillo
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada
| | - Joseph Voronov
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada
| | - Timothy de Pass
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada
| | - Corinna Easton
- Western University, Faculty of Health Sciences, 1201 Western Road, London, Ontario, Canada
| | - Brooklyn Ward
- Western University, Faculty of Health Sciences, 1201 Western Road, London, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, 1919 Riverside Drive, Ottawa, Ontario, Canada
| | - Amanda Noble
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, Canada; University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor Street West, Toronto, Ontario, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, Canada; University of Toronto, Division of General Internal Medicine, 1 King's College Circle, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1025 Queen Street West, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1051 Queen Street West, Toronto, Ontario, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1051 Queen Street West, Toronto, Ontario, Canada
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Fleury MJ, Armoon B. Profiles of Permanent Supportive Housing Residents Related to Their Housing Conditions, Service Use, and Associated Sociodemographic and Clinical Characteristics. Psychiatr Q 2024:10.1007/s11126-024-10071-0. [PMID: 38584240 DOI: 10.1007/s11126-024-10071-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
As permanent supportive housing (PSH) is the main strategy promoted to reduce homelessness, understanding how PSH resident profiles may be differentiated is crucial to the optimization of PSH implementation - and a subject that hasn't been studied yet. This study identified PSH resident profiles based on their housing conditions and service use, associated with their sociodemographic and clinical characteristics. In 2020-2021, 308 PSH residents from Quebec (Canada) were interviewed, with K-means cluster analysis produced to identify profiles and subsequent analyses to compare profiles and PSH resident characteristics. Of the three profiles identified, Profiles 1 and 2 (70% of sample) showed moderate or poor housing, neighborhood, and health conditions, and moderate or high unmet care needs and service use. Besides their "moderate" conditions, Profile 1 residents (52%) reported being in PSH for more than two years and being less educated. With the "worst" conditions and high service use, Profile 2 (18%) included younger individuals, while Profile 3 (30%) showed the "best" conditions and integrated individuals with more protective determinants (e.g., few in foster care, homelessness at older age, more self-esteem), with a majority living in single-site PSH and reporting higher satisfaction with support and community-based services. Profiles 1 and 2 may be provided with more psychosocial, crisis, harm reduction, and empowerment interventions, and peer helper support. Profile 2 may benefit from more intensive and integrated care, and better housing conditions. Continuous PSH may be sustained for Profile 3, with regular monitoring of service satisfaction and met needs.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montréal, Québec, Canada.
- Douglas Hospital Research Centre, Montréal, Québec, Canada.
| | - Bahram Armoon
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Douglas Hospital Research Centre, Montréal, Québec, Canada
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Burridge L, Jones R, Borg SJ, O'Loghlen JJ, Geraghty TJ. Methodologies to measure access to care post-discharge in adults with serious injury-related disability: a scoping review. Disabil Rehabil 2024; 46:1266-1273. [PMID: 37021354 DOI: 10.1080/09638288.2023.2192974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE This scoping review examined the methodologies used to measure access to care in serious injury-related disability populations, for whom access to care post-discharge has significant implications for patient outcomes and rehabilitation trajectories. METHODS Four electronic databases were searched for literature published between 1 January 2000 and 15 February 2022. Relevant articles needed to relate to access to care in adult community-dwelling trauma and rehabilitation populations. RESULTS The initial search identified 679 articles. Following de-duplication, the title/abstract screening was completed on 533 articles, and 56 full-text articles were reviewed. Thirty-eight articles met the eligibility criteria and were included in this review. Of the 38 studies included, there was large heterogeneity in the methodologies used to measure access to care. Two articles used multidimensional measures of access to care. CONCLUSIONS There is an urgent need to establish the use of multidimensional measures as standard practice in access-to-care research. Failure to account for the multidimensional nature of access to care limits the full realisation of access for people with serious injury-related disability and prevents the implementation of processes that could improve access to health, rehabilitation, and support services and enhance the quality of care for individuals with a serious injury-related disability.
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Affiliation(s)
- L Burridge
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Australia
| | - R Jones
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - S J Borg
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Australia
| | - J J O'Loghlen
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Australia
| | - T J Geraghty
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
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Fleury MJ, Imboua A, Grenier G. Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation. Community Ment Health J 2024:10.1007/s10597-024-01239-w. [PMID: 38383882 DOI: 10.1007/s10597-024-01239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
This qualitative study explored reasons for high emergency department (ED) use (3 + visits/year) among 299 patients with mental disorders (MD) recruited in four ED in Quebec, Canada. A conceptual framework including healthcare system and ED organizational features, patient profiles, and professional practice guided the content analysis. Results highlighted insufficient access to and inadequacy of outpatient care. While some patients were quite satisfied with ED care, most criticized the lack of referrals or follow-up care. Patient profiles justifying high ED use were strongly associated with health and social issues perceived as needing immediate care. The main barriers in professional practice involved lack of MD expertise among primary care clinicians, and insufficient follow-up by psychiatrists in response to patient needs. Collaboration with outpatient care may be prioritized to reduce high ED use and improve ED interventions by strengthening the discharge process, and increasing access to outpatient care.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Armelle Imboua
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
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DiGuiseppi G, Pedersen ER, Rodriguez A, D’Amico EJ, Tucker JS. Associations between service use and behavioral health trajectories among young adults experiencing homelessness. Child Youth Serv Rev 2024; 156:107354. [PMID: 38644956 PMCID: PMC11031190 DOI: 10.1016/j.childyouth.2023.107354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Purpose To examine associations of service use (housing, mental health, substance use, education, and employment) with depression and substance use disorder (SUD) trajectories among young adults experiencing homelessness. Method Secondary data come from 276 young adults who participated in an intervention to reduce substance use and sexual risk behaviors. Participants were recruited from three drop-in centers in Los Angeles County from 2018 to 2020, and completed surveys at baseline, 3-, 6-, 12-, and 24-months post-baseline. Latent growth curve models examined trajectories of depression and SUD; service use in the past three months was used to predict growth trajectories. Results More frequent use of mental health services (but not other services) at baseline was associated with greater depression symptoms at baseline, linear declines in depression, and a quadratic increase in depression. Service use at baseline was not associated with likelihood of SUD at baseline or changes in SUD over time. Conclusions Young adults in most need of behavioral services are likely to receive services for mental health, but not SUD. Use of mental health services may reduce depression symptoms over time, but continuing care may be needed to prevent symptom returns. More work is needed to connect young adults with SUD treatment and improve effectiveness of these services.
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Affiliation(s)
- Graham DiGuiseppi
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34th Street, Los Angeles, CA 90089, United States
- RAND Corporation, 4570 5th Avenue, Suite 600, Pittsburgh, PA 15213, United States
| | - Eric R. Pedersen
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, 250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, United States
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Anthony Rodriguez
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116, United States
| | | | - Joan S. Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
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Edbrooke-Childs J, Rashid A, Ritchie B, Deighton J. Predictors of amounts of child and adolescent mental health service use. Eur Child Adolesc Psychiatry 2023; 32:2335-2342. [PMID: 36114311 PMCID: PMC10576665 DOI: 10.1007/s00787-022-02063-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/05/2022] [Indexed: 11/03/2022]
Abstract
The aim of this study was to build evidence about how to tailor services to meet the individual needs of young people by identifying predictors of amounts of child and adolescent mental health service use. We conducted a secondary analysis of a large administrative dataset from services in England was conducted using the Mental Health Services Data Set (years 2016-17 and 2017-18). The final sample included N = 27,362 episodes of care (periods of service use consisting of at least two attended care contacts and less than 180 days between care contacts) from 39 services. There were 50-10,855 episodes per service. The descriptive statistics for episodes of care were: Mage = 13 years, SDage = 4.71, range = 0-25 years; 13,785 or 50% male. Overall, there were high levels of heterogeneity in number of care contacts within episodes of care: M = 11.12, SD = 28.28, range = 2-1529. Certain characteristics predicted differential patterns of service use. For example, young people with substance use (beta = 6.29, 95% CI = 5.06-7.53) or eating disorders (beta = 4.30, 95% CI = 3.29-5.30) were particularly more likely to have higher levels of service use. To build on this, evidence is needed about predictors of child and adolescent mental health treatment outcome and whether the same characteristics predict levels of improvement as well as levels of service use.
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Affiliation(s)
- Julian Edbrooke-Childs
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 4-8 Rodney Street, London, N1 9JH, UK.
| | - Anisatu Rashid
- Child Outcomes Research Consortium, UCL and Anna Freud Centre, London, UK
| | - Benjamin Ritchie
- Child Outcomes Research Consortium, UCL and Anna Freud Centre, London, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 4-8 Rodney Street, London, N1 9JH, UK
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Moore KL, Munson MR, Jaccard J. Ethnic Identity and Mechanisms of Mental Health Service Engagement Among Young Adults with Serious Mental Illnesses. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01842-9. [PMID: 37870731 PMCID: PMC11035489 DOI: 10.1007/s40615-023-01842-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE Young adults from minoritized racial and ethnic groups have lower rates of engagement in treatment for serious mental illnesses (SMI). Previous research suggests a relationship between ethnic identity development and engagement in mental health services, but it remains unclear how a sense of belonging and attachment to one's racial and ethnic group influences participation in treatment among young adults with SMI. METHODS Bivariate analyses and structural equation modeling (SEM) were used to examine whether ethnic identity was associated with treatment engagement (attendance and investment in treatment) and how ethnic identity might influence engagement through theoretical proximal mediators. Eighty-three young adults with SMI (95% from minoritized racial and ethnic groups) were recruited from four outpatient psychiatric rehabilitation programs and assessed at least 3 months after initiating services. RESULTS Stronger ethnic identity was associated with greater investment in treatment but not with treatment attendance. The SEM analysis indicated that stronger ethnic identity may improve investment in treatment by enhancing hope (0.53, p < .05) and beliefs that mental health providers are credible (0.32, p < .05), and by increasing self-efficacy (-0.09, p < .05). Proximal mediators of engagement were associated with investment in treatment (hope and credibility, p < .05, and self-efficacy p = 0.055). CONCLUSIONS Findings provide preliminary evidence of an empirical and theoretical relationship between ethnic identity development and engagement in treatment among young adults with SMI. Assessment and strengthening of a young person's ethnic identity may be a promising approach for improving their engagement in services and reducing inequities in their care.
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Affiliation(s)
- Kiara L Moore
- New York University, Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA.
| | - Michelle R Munson
- New York University, Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - James Jaccard
- New York University, Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
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Hill KN, Olsavsky A, Barrera M, Gilmer MJ, Fairclough DL, Akard TF, Compas BE, Vannatta K, Gerhardt CA. Factors associated with mental health service use among families bereaved by pediatric cancer. Palliat Support Care 2023; 21:829-835. [PMID: 35938399 PMCID: PMC9905324 DOI: 10.1017/s1478951522001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We identified types of interventions used by bereaved family members and examined associations with demographic and medical factors. Furthermore, we examined associations between distress and intervention use among bereaved families. METHODS Bereaved families (n = 85) were recruited from three children's hospitals 3-12 months after their child died of cancer. One eligible sibling (ages 8-17) per family was randomly selected for participation. During home visits 1-year post-death, parents reported on their own and the sibling's intervention use, helpfulness, and dose (self-help books, support groups, therapy, medication), and distress, defined as internalizing, externalizing, and total problems (Adult Self Report, Child Behavior Checklist). RESULTS Fifty percent of mothers used medications (n = 43); utilization was low among fathers (17%, n = 9) and siblings (5%, n = 4). Individuals with more total problems were more likely to use medications (mothers: rpb = 0.27; p = 0.02; fathers: rpb = 0.32; p = 0.02; siblings: rpb = 0.26; p = 0.02). Mothers and siblings with more total problems used more services (r = 0.24; p = 0.03 and r = 0.29; p = 0.01, respectively). Among mothers, the overall regression was significant, R2 = 0.11, F(2, 80) = 4.954, p = 0.01; the deceased child's age at death was significantly associated with total services used (b = 0.052, p = 0.022). Among fathers, the overall regression was significant, R2 = 0.216, F(3, 49) = 4.492, p = 0.007; race and years of education were significantly associated with total services used (b = 0.750, p = 0.030 and b = 0.154, p = 0.010). Among siblings, the overall regression was significant R2 = 0.088, F(2, 80) = 3.867, p = 0.025; greater total problems were significantly associated with total services used (b = 0.012, p = 0.007). SIGNIFICANCE OF RESULTS Although few background factors were related to intervention use, bereaved mothers and siblings may seek services if they have more distress. Healthcare providers should be aware of the types of services that are most often utilized and helpful to bereaved families to connect them with appropriate resources. Future research should investigate other predictors of intervention use and outcomes after the death of a child.
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Affiliation(s)
- Kylie N. Hill
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Anna Olsavsky
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- The Ohio State University College of Medicine, Columbus, OH
| | - Maru Barrera
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | - Kathryn Vannatta
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Cynthia A. Gerhardt
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- The Ohio State University College of Medicine, Columbus, OH
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Chen C, Bailey C, Baikie G, Dalziel K, Hua X. Parents of children with disability: Mental health outcomes and utilization of mental health services. Disabil Health J 2023; 16:101506. [PMID: 37517905 DOI: 10.1016/j.dhjo.2023.101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Caring for a child with disability may result in stress and difficulties for parents, leading to mental health problems. OBJECTIVE This study aims to investigate the prevalence of mental health problems, mental health service utilization, and costs in parents of children with disabilities compared to parents of children without disabilities. METHODS We used data from the Longitudinal Study of Australian Children, a nationally representative sample of children recruited in 2004 with biennial follow-up and linkage to out-of-hospital health service use and billing data for the parents. Descriptive analyses were used to present parental mental health measured using the Kessler 6. Generalized linear models were conducted to examine whether being the parent of a child with disability was associated with higher mental health service utilization and costs compared to those without disability. RESULTS A total of 4935 children and their parents were included in this study. There was a higher prevalence of mental health problems for parents of children with disabilities compared to those without in all child ages. Regression analyses indicated that parents of children aged 12-17 years with disabilities had significantly higher mental health service utilization and costs compared to parents of children without disabilities (biennial cost difference = $86.37, 95%CI ($15.67-$157.07)). However, these differences were not observed among parents of children aged 4-11 years. CONCLUSION There are high levels of mental health concerns among parents of children with disabilities in Australia. Mental health interventions are needed to support parents of children aged 4-11 years where there appear to be unmet health needs.
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Affiliation(s)
- Chu Chen
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton, VIC 3053, Australia
| | - Cate Bailey
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton, VIC 3053, Australia
| | - Gordon Baikie
- Department of Neurodevelopment and Disability, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton, VIC 3053, Australia
| | - Xinyang Hua
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton, VIC 3053, Australia.
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Lustig S, Kaess M, Schnyder N, Michel C, Brunner R, Tubiana A, Kahn JP, Sarchiapone M, Hoven CW, Barzilay S, Apter A, Balazs J, Bobes J, Saiz PA, Cozman D, Cotter P, Kereszteny A, Podlogar T, Postuvan V, Värnik A, Resch F, Carli V, Wasserman D. The impact of school-based screening on service use in adolescents at risk for mental health problems and risk-behaviour. Eur Child Adolesc Psychiatry 2023; 32:1745-1754. [PMID: 35488938 PMCID: PMC10460322 DOI: 10.1007/s00787-022-01990-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
Early detection and intervention can counteract mental disorders and risk behaviours among adolescents. However, help-seeking rates are low. School-based screenings are a promising tool to detect adolescents at risk for mental problems and to improve help-seeking behaviour. We assessed associations between the intervention "Screening by Professionals" (ProfScreen) and the use of mental health services and at-risk state at 12 month follow-up compared to a control group. School students (aged 15 ± 0.9 years) from 11 European countries participating in the "Saving and Empowering Young Lives in Europe" (SEYLE) study completed a self-report questionnaire on mental health problems and risk behaviours. ProfScreen students considered "at-risk" for mental illness or risk behaviour based on the screening were invited for a clinical interview with a mental health professional and, if necessary, referred for subsequent treatment. At follow-up, students completed another self-report, additionally reporting on service use. Of the total sample (N = 4,172), 61.9% were considered at-risk. 40.7% of the ProfScreen at-risk participants invited for the clinical interview attended the interview, and 10.1% of subsequently referred ProfScreen participants engaged in professional treatment. There were no differences between the ProfScreen and control group regarding follow-up service use and at-risk state. Attending the ProfScreen interview was positively associated with follow-up service use (OR = 1.783, 95% CI = 1.038-3.064), but had no effect on follow-up at-risk state. Service use rates of professional care as well as of the ProfScreen intervention itself were low. Future school-based interventions targeting help-seeking need to address barriers to intervention adherence.Clinical Trials Registration: The trial is registered at the US National Institute of Health (NIH) clinical trial registry (NCT00906620, registered on 21 May, 2009), and the German Clinical Trials Register (DRKS00000214, registered on 27 October, 2009).
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Affiliation(s)
- Sophia Lustig
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Nina Schnyder
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- School of Public Health, The University of Queensland, Brisbane, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
- Clinic of Child and Adolescents Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Alexandra Tubiana
- Department of Psychiatry and Clinical Psychology, Centre Psychothérapique de Nancy, Nancy, France
| | - Jean-Pierre Kahn
- Department of Psychiatry and Clinical Psychology, Centre Psychothérapique de Nancy, Nancy, France
- Université de Lorraine, Nancy, France
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Christina W Hoven
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Shira Barzilay
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
- Department of Community Health, University of Haifa, Haifa, Israel
| | - Alan Apter
- Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Judit Balazs
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Bjørknes University College, Oslo, Norway
| | - Julio Bobes
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - Pilar Alejandra Saiz
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, University of Oviedo, Oviedo, Spain
| | - Doina Cozman
- Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Padraig Cotter
- Child and Adolescent Mental Health Services North Cork Area, HSE South, Mallow, Ireland
| | - Agnes Kereszteny
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Tina Podlogar
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Vita Postuvan
- Slovene Center for Suicide Research, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
| | - Airi Värnik
- Estonian-Swedish Mental Health and Suicidology Institute, Tallinn, Estonia
- Tallinn University School of Natural Science and Health, Tallinn, Estonia
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Vladimir Carli
- Department of Public Health Sciences, Methods Development and Training in Suicide Prevention, National Swedish Prevention of Mental Ill-Health and Suicide (NASP)WHO Collaborating Centre for ResearchKarolinska Institute, Stockholm, Sweden
| | - Danuta Wasserman
- National Institute for Health, Migration and Poverty, Rome, Italy
- Department of Public Health Sciences, Methods Development and Training in Suicide Prevention, National Swedish Prevention of Mental Ill-Health and Suicide (NASP)WHO Collaborating Centre for ResearchKarolinska Institute, Stockholm, Sweden
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11
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Klinkby IMI, Hastrup LH, Bo S, Storebø OJ, Simonsen E, Kongerslev MT. Prevalence and incidence of personality disorders among children and adolescents in Danish mental health services: a nationwide register study. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02274-w. [PMID: 37566164 DOI: 10.1007/s00787-023-02274-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
A few epidemiological studies have examined personality disorders (PDs) among children and adolescents in secondary mental health services. This study aims to describe the prevalence and incidence of PDs among children and adolescents who have attended Danish child and adolescent psychiatric services (CAPS). Using register-based data, we studied all patients under the age of 18 years who were admitted to in- and outpatient CAPS (N = 115,121) in Denmark from 2007 to 2017. A total of 4952 patients were diagnosed with a PD during the study period. The mean prevalence was 859 patients per year, and the mean incidence was 274 patients per year, including an increased incidence and prevalence of borderline, anxious, and unspecified PDs over the decade. The number of patients diagnosed with PDs increased from 700 to 851 per year, but the proportion of patients with PDs compared to all psychiatric diagnoses decreased from 4.2% to 2.8% over the study period. The PD population had an older age (14.8 years vs. 11.3 years; p < 0.001), a higher likelihood of being female (74% vs. 44%; p < 0.001), and four times more contacts with the psychiatric emergency departments than other patients with a psychiatric diagnosis. Future studies should focus on (a) implementing further epidemiological studies in different countries; (b) tracking diagnostic practices to facilitate comparisons and provide feedback for training clinicians and raising awareness; and (c) estimating trajectories of PDs, including costs within the CAPS, to facilitate informed decision-making regarding the future organization and provision of services to these children, adolescents, and their families.
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Affiliation(s)
| | - Lene Halling Hastrup
- Psychiatric Research Unit, Mental Health Services Region Zealand, Slagelse, Denmark
- Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - Sune Bo
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Mental Health Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Erik Simonsen
- Research Unit, Region Zealand Mental Health Services East, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mickey T Kongerslev
- Department of Psychology, University of Southern Denmark, Odense, Denmark.
- Research Unit, Region Zealand Mental Health Services East, Roskilde, Denmark.
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12
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Ribeiro WS, Romeo R, King D, Owens S, Gronholm PC, Fisher HL, Laurens KR, Evans-Lacko S. Influence of stigma, sociodemographic and clinical characteristics on mental health-related service use and associated costs among young people in the United Kingdom. Eur Child Adolesc Psychiatry 2023; 32:1363-1373. [PMID: 35088184 PMCID: PMC10326138 DOI: 10.1007/s00787-022-01947-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/11/2022] [Indexed: 11/03/2022]
Abstract
This study examined the influence of stigma, psychopathology, and sociodemographic characteristics on mental health-related service use and costs related to service use in a cohort of young people in the UK. Using data from a community sample of young people aged 9-17 years and their caregivers, we assessed 407 young people's use of services due to mental health problems, young people's psychopathology, demographic characteristics, maternal education and caregivers' stigma-related beliefs. Unit costs related to services were gathered from national annual compendia and other widely used sources. We assessed predictors of service use through logistic regression analysis and developed generalised linear models to identify factors associated with costs of mental health-related service utilisation. Persistent psychopathology, socioeconomic disadvantage, and low caregiver intended stigma-related behaviour were associated with increased likelihood of service use among young people. Older age and socioeconomic disadvantage were associated with increased costs. Different factors influenced contact with services and the cost associated with their use - persistent psychopathology and socioeconomic disadvantage increased, and caregivers' intended stigma-related behaviour decreased the likelihood of using services, whereas socioeconomic disadvantage and older age were associated with increased costs. Social determinants of mental health problems play an important role in the use and costs of different types of mental health-related services for young people. Discordance between drivers of service use and costs implies that young people who are more likely to access services due to mental health problems do not necessarily receive care at the intensity they need.
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Affiliation(s)
- Wagner Silva Ribeiro
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Renee Romeo
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Derek King
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | | | - Petra C Gronholm
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Kristin R Laurens
- School of Psychology and Counselling, Queensland University of Technology (QUT), Brisbane, Australia
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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13
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Zepro NB, Ali NT, Tarr N, Medhanyie AA, Paris DH, Probst-Hensch N, Merten S. Sexual and reproductive health services use among adolescents in pastoralist settings, northeastern Ethiopia. BMC Health Serv Res 2023; 23:677. [PMID: 37349790 DOI: 10.1186/s12913-023-09616-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 05/30/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Adolescents have special sexual and reproductive health (ASRH) needs and are susceptible to poor health outcomes. The global burden of ill sexual health includes a significant proportion of Adolescents. The existing ASRH services in Ethiopia and particularly in the Afar region are currently not well suited to meet the needs of pastoralist adolescents. This study assesses the level of ASRH service utilization among pastoralists in Afar regional state, Ethiopia. METHOD A community based cross-sectional study was conducted from January to March 2021 in four randomly chosen pastoralist villages or kebeles of Afar, Ethiopia. A multistage cluster sampling procedure was used to select 766 volunteer adolescents aged 10-19. SRH services uptake was measured asking whether they had used any SRH service components during the last year. Data was collected through face-to-face interviews with a structured questionnaire; data entry was done with Epi info 3.5.1. Logistic regression analyses was used to assess associations with SRH service uptake. SPSS version 23 statistical software package was used for advanced logistic regression analyses to assess the associations between dependent and predictor variables. RESULTS The study revealed that two-thirds or 513 (67%) of the respondents are aware of ASRH services. However, only one-fourth (24.5%) of the enrolled adolescents used at least one ASRH service in the past twelve months. ASRH services utilization was significantly associated with gender (being female [AOR = 1.87 (CI 1.29-2.70)], being in school [AOR = 2.38(CI: 1.05-5.41), better family income [AOR = 10.92 (CI; 7.10-16.80)], prior discussions of ASRH issues [AOR = 4.53(CI: 2.52, 8.16)], prior sexual exposure [AOR = 4.75(CI: 1.35-16.70)], and being aware of ASRH services [AOR = 1.96 (CI: 1.02-3.822)]. Being pastoralist, religious and cultural restrictions, fear of it becoming known by parents, services not being available, income, and lack of knowledge were found to deter ASRH service uptake. CONCLUSION Addressing ASRH needs of pastoralist adolescents is more urgent than ever, sexual health problems are increasing where these groups face broad hurdles to SRH service uptake. Although Ethiopian national policy has created an enabling environment for ASRH, multiple implementation issues require special attention to such neglected groups. "Gender-culture-context-appropriate" interventions are favorable to identify and meet the diverse needs of Afar pastoralist adolescents. Afar regional education bureau and concerned stakeholders need to improve adolescent education to overcome social barriers (e.g. humiliation, disgrace, and deterring gender norms) against ASRH services through community outreach programs. In addition, economic empowerment, peer education, adolescent counseling, and parent-youth communication will help address sensitive ASRH issues.
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Affiliation(s)
- Nejimu Biza Zepro
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland.
- University of Basel, Basel, Switzerland.
- College of Health Sciences, Samara University, Afar, Ethiopia.
| | | | - Natalie Tarr
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland
- Center for African Studies, University of Basel, Basel, Switzerland
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Daniel Henry Paris
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland
- University of Basel, Basel, Switzerland
- Center for African Studies, University of Basel, Basel, Switzerland
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14
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Rice ER, DiGuiseppi G, Onasch-Vera L, Casey E, Cooper T, DiBattiste M. A Longitudinal Exploration of How Connections to Staff Facilitate Efficacy and Service Use in Drop-in Centers Serving Youth Experiencing Homelessness. J Prev (2022) 2023; 44:359-371. [PMID: 36929457 DOI: 10.1007/s10935-023-00728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Youth experiencing homelessness (YEH) benefit from a variety of services to meet their immediate and long-term needs. Drop-in centers are a popular service venue used by YEH. However, the mechanisms responsible for engaging youth in drop-in services are not clear. The current study uses longitudinal data to explore the role of positive staff relationships in increasing youths' knowledge and efficacy to access and subsequently use drop-in center services. METHODS 731 youth (Mage = 21.8, SD = 2.2, 25.1% female) accessing services at three drop-in centers in Los Angeles, California participated in the study. Surveys were completed at baseline, 1-month, and 3-months later. Path models examined the direct effect of positive relationships with adult staff on service use at the 3-month follow-up, and the indirect effect of service knowledge (assessed at the 1-month follow-up). RESULTS The direct effect model showed that positive staff relationships at baseline were significantly associated with number of services used at the 3-month follow-up (aIRR = 1.24, 95% CI: 1.00, 1.54). Positive staff relationships were also associated with greater service knowledge at 1-month (b = 0.93, p < 0.001), which in turn was associated with greater service use at 3-months (IRR = 1.15, 95% CI: 1.04, 1.28). The indirect effect of service knowledge was significant (b = 0.13, p = 0.02), suggesting that the association between positive staff relationships and service use was completely mediated by service knowledge. CONCLUSIONS The current study adds to the literature by demonstrating that positive relationships with staff lead to increased service use by increasing youths' knowledge and efficacy to access services. Efforts should be made to develop positive relationships with YEH in order to engage them in essential services needed to exit homelessness.
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Affiliation(s)
- Eric R Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, 90015, USA.
| | - Graham DiGuiseppi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, 90015, USA
| | - Laura Onasch-Vera
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, 90015, USA
| | - Erin Casey
- My Friend's Place, 5850 Hollywood Blvd, Los Angeles, CA, 90028, USA
| | - Toni Cooper
- My Friend's Place, 5850 Hollywood Blvd, Los Angeles, CA, 90028, USA
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15
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Wang X, Beltran S, Burns R, Hamel M, Gray S, Gryglewicz K. Suicide Risk Help-Seeking Among Middle- to Old-Age Adults: A Systematic Review. Innov Aging 2023; 7:igac079. [PMID: 36815014 PMCID: PMC9940623 DOI: 10.1093/geroni/igac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Indexed: 01/28/2023] Open
Abstract
Background and Objectives Suicide has become a major public health concern worldwide and in the United States. Rates of suicide increase during the life course and are highest among middle- to old-age adults. Help-seeking represents a crucial coping mechanism that can mitigate suicide risk. Yet, less is known about suicide risk help-seeking, especially among these age groups. To address this knowledge gap, a systematic review of existing literature was performed to obtain a refined understanding of help-seeking for suicide risk among middle- to old-age adults. Research Design and Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, electronic databases and key journals with suicide and/or gerontology focuses were searched to identify peer-reviewed publications in English between 2010 and 2020. A total of 4 732 unduplicated publications were screened for relevance based on titles and abstracts, of which 52 were reviewed in full text. Results Twenty-four articles met inclusion criteria and were included in the qualitative synthesis. These articles discussed a range of topics, including the prevalence of service utilization, service use prior to a suicide death, and correlates of help-seeking. In general, the prevalence of service utilization was low and varied by suicidal history (eg, higher prevalence among individuals with a history of suicide attempts than those with suicide ideation only). Key facilitators (eg, current or history of suicidal thoughts, plans, or attempts) and barriers (eg, stigma) for service use and help-seeking were also identified. Discussion and Implications Findings highlight the need for future studies and tailored services to improve age-appropriate and culturally responsive suicide prevention and intervention strategies for middle- to old-age adults.
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Affiliation(s)
- Xiaochuan Wang
- Address correspondence to: Xiaochuan Wang, PhD, School of Social Work, University of Central Florida, Orlando, FL 32816, USA. E-mail:
| | - Susanny Beltran
- School of Social Work, University of Central Florida, Orlando, Florida, USA
| | - Rachael Burns
- School of Social Work, University of Central Florida, Orlando, Florida, USA
| | - Marie Hamel
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA
| | - Sydney Gray
- School of Social Work, University of Central Florida, Orlando, Florida, USA
| | - Kim Gryglewicz
- School of Social Work, University of Central Florida, Orlando, Florida, USA
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16
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Tsiplova K, Ungar WJ, Szatmari P, Cost K, Pullenayegum E, Duku E, Volden J, Smith IM, Waddell C, Zwaigenbaum L, Bennett TA, Elsabbagh M, Georgiades S, Zaidman-Zait A. Measuring the association between behavioural services and outcomes in young children with autism spectrum disorder. Res Dev Disabil 2023; 132:104392. [PMID: 36493738 DOI: 10.1016/j.ridd.2022.104392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) receive a wide range of services. AIMS To examine the association between behavioural services received by children with ASD between ages 2 and 5 years and outcomes during primary school years. METHODS A total of 414 preschool-aged children diagnosed with ASD were enrolled at five Canadian sites and were assessed within four months of diagnosis (T1), six months later (T2), 12 months later (T3), at school entry (T4), and then annually (T5-T8) to 11 years of age. The association between the receipt of behavioural services during T1 to T3 and T8 outcomes related to adaptive behaviour and behavioural problems was modelled using linear regressions adjusted for immigrant status, family income, child's age at diagnosis, site, sex assigned at birth, and baseline (T1) outcome. RESULTS Children who received behavioural services during at least one time period from T1 to T3 did not have significantly different outcomes at T8 than children who did not receive any behavioural services. IMPLICATIONS Pre-school use of behavioural services was not found to affect outcomes during later childhood. Numerous challenges accompany studies of the association between pre-school service use and later outcomes in a heterogeneous ASD sample. Recommendations for study design are provided.
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Affiliation(s)
- Kate Tsiplova
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada.
| | - Peter Szatmari
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1×8, Canada
| | - Katherine Cost
- Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1×8, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Eric Duku
- Offord Centre for Child Studies, McMaster University, 1280 Main St. W. - MIP 201A, Hamilton, Ontario L8S 4K1, Canada; Department of Psychiatry and Behavioural Neuroscience, McMaster University, St. Joseph's Healthcare Hamilton, West 5th Campus, Administration B3, 100 West 5th Street, Hamilton, Ontario L8N 3K7, Canada
| | - Joanne Volden
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 3-48 Corbett Hall, Edmonton, Alberta T6G 2G4, Canada
| | - Isabel M Smith
- Department of Pediatrics, Dalhousie University, IWK Health Centre, 5850 University Avenue, P. O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada; Autism Research Centre, IWK Health Centre, 4th Floor Link Building, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
| | - Charlotte Waddell
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, Room 2435, 515 West Hastings Street Vancouver, British Columbia V6B 5K, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue Edmonton, Alberta T6G 1C9, Canada
| | - Teresa A Bennett
- Offord Centre for Child Studies, McMaster University, 1280 Main St. W. - MIP 201A, Hamilton, Ontario L8S 4K1, Canada; Department of Psychiatry and Behavioural Neuroscience, McMaster University, St. Joseph's Healthcare Hamilton, West 5th Campus, Administration B3, 100 West 5th Street, Hamilton, Ontario L8N 3K7, Canada
| | - Mayada Elsabbagh
- Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec H3A 2B4, Canada
| | - Stelios Georgiades
- Offord Centre for Child Studies, McMaster University, 1280 Main St. W. - MIP 201A, Hamilton, Ontario L8S 4K1, Canada; Department of Psychiatry and Behavioural Neuroscience, McMaster University, St. Joseph's Healthcare Hamilton, West 5th Campus, Administration B3, 100 West 5th Street, Hamilton, Ontario L8N 3K7, Canada
| | - Anat Zaidman-Zait
- Department of School Counseling and Special Education, Constantiner School of Education, Tel Aviv University, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; The School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
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17
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Erskine HE, Blondell SJ, Enright ME, Shadid J, Wado YD, Wekesah FM, Wahdi AE, Wilopo SA, Vu LM, Dao HTK, Nguyen VD, Emerson MR, Fine SL, Li M, Blum RW, Whiteford HA, Scott JG. Measuring the Prevalence of Mental Disorders in Adolescents in Kenya, Indonesia, and Vietnam: Study Protocol for the National Adolescent Mental Health Surveys. J Adolesc Health 2023; 72:S71-S78. [PMID: 36229399 DOI: 10.1016/j.jadohealth.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In low- and middle-income countries, there are limited data on mental disorders among adolescents. To address this gap, the National Adolescent Mental Health Surveys (NAMHS) will provide nationally representative prevalence data of mental disorders among adolescents in Kenya, Indonesia, and Vietnam. This paper details the NAMHS study protocol. METHODS In each country, a multistage stratified cluster sampling design will be used. Participants will be eligible pairs of adolescents aged 10-17 years and their primary caregiver. Adolescents will be assessed for social phobia, generalized anxiety disorder, major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and post-traumatic stress disorder using the Diagnostic Interview Schedule for Children, version 5. Demographics, risk and protective factors, and service use information will also be collected. In the parallel clinical calibration study, diagnoses of major depressive disorder, social phobia, and generalized anxiety disorder made using the Diagnostic Interview Schedule for Children, version 5 will be calibrated against a diagnostic assessment by in-country clinicians in a separate sample. RESULTS Data collection for the national survey and clinical calibration study will commence in 2021, with dissemination of findings and methodology due to occur in 2022. CONCLUSIONS Accurately quantifying the prevalence of mental disorders in adolescents is essential for service planning. NAMHS will address this lack of prevalence data, both within the NAMHS countries and within their respective regions, while establishing a gold-standard methodology for data collection on adolescent mental health in low- and middle-income countries. More broadly, NAMHS will encourage capacity building within each country by establishing linkages between researcher, clinician, government, and other networks.
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Affiliation(s)
- Holly E Erskine
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; Institute for Health Metrics and Evaluation, Seattle, Washington.
| | - Sarah J Blondell
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Meaghan E Enright
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Jamileh Shadid
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | | | - Frederick Murunga Wekesah
- African Population and Health Research Center, Nairobi, Kenya; Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston
| | - Amirah Ellyza Wahdi
- Center for Reproductive Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Siswanto Agus Wilopo
- Center for Reproductive Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Loi Manh Vu
- Institute of Sociology, Vietnam Academy of Social Sciences, Hanoi, Vietnam
| | | | - Vinh Duc Nguyen
- Institute of Sociology, Vietnam Academy of Social Sciences, Hanoi, Vietnam
| | - Mark R Emerson
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Shoshanna L Fine
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mengmeng Li
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Robert W Blum
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Harvey A Whiteford
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; Institute for Health Metrics and Evaluation, Seattle, Washington
| | - James G Scott
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia; Metro North Mental Health Service, Herston, Queensland, Australia
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18
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Hinze V, Ford T, Gjelsvik B, Byford S, Cipriani A, Montero-Marin J, Ganguli P. Service use and costs in adolescents with pain and suicidality: a cross-sectional study. EClinicalMedicine 2023; 55:101778. [PMID: 36712889 PMCID: PMC9874333 DOI: 10.1016/j.eclinm.2022.101778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Persistent/recurrent pain for more than three months and suicidality (suicide and self-harm related thoughts and behaviours) are serious and co-occurring health problems in adolescence, underscoring the need for targeted support. However, little is known about service use and costs in adolescents with pain-suicidality comorbidity, compared to those with either problem alone. This study aimed to shed light on service use and costs in adolescents with pain and/or suicidality, and the role of individual and school characteristics. Methods We analysed cross-sectional, pre-intervention data from a large cluster randomised controlled trial, collected between 2017 and 2019 on a representative sample of 8072 adolescents (55% female; aged 11-15 years; 76% white) in 84 schools in the UK. We explored service use settings, covering health, social, educational settings, and medication for mental health problems over three months. Data were analysed using descriptive statistics and two-part hurdle models to obtain odds ratios (ORs) and incident rate ratios (IRRs). Findings 9% of adolescents reported comorbidity between pain and suicidality, 11% only suicidality, 13% only pain, and 66% neither pain nor suicidality. Approximately 55% of adolescents used services, especially general practitioner visits, outpatient appointments for injuries and contacts with a school nurse or pharmacist. Compared to adolescents with neither pain nor suicidality: (i) adolescents with pain (OR 3.79, 95% CI 2.63-5.48), suicidality (1.68, 1.12-2.51), and pain-suicidality comorbidity (2.35, 1.26-4.41) were more likely to use services and (ii) if services were used, they were more likely to have higher total costs (Pain: IRR 1.25, 95% CI 1.11-1.42; Suicidality: 1.27, 1.11-1.46; Comorbidity: 1.57, 1.34-1.85). Interpretation In our study, adolescents with pain and suicidality reported increased contact with health, social, and educational services, which could provide an opportunity for suicide prevention. Given the diversity of identified settings, multi-sector suicide prevention strategies are paramount. Funding Wellcome Trust [WT104908/Z/14/Z; WT107496/Z/15/Z]; Stiftung Oskar-Helene-Heim.
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Affiliation(s)
- Verena Hinze
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Hershel Smith Building, Robinson Way, Cambridge Biomedical Campus, Cambridge CB2 0SZ, UK
| | - Bergljot Gjelsvik
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Sarah Byford
- King’s College London, King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Oxford, UK
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Poushali Ganguli
- King’s College London, King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, UK
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19
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Impara E, Bakolis I, Bécares L, Dasch H, Dregan A, Dyer J, Hotopf M, Stewart RJ, Stuart R, Ocloo J, Das-Munshi J. COVID-19 ethnic inequalities in mental health and multimorbidities: protocol for the COVEIMM study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2511-2521. [PMID: 35737082 PMCID: PMC9219393 DOI: 10.1007/s00127-022-02305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The COVID-19 pandemic may have exacerbated ethnic health inequalities, particularly in people with multiple long-term health conditions, the interplay with mental health is unclear. This study investigates the impact of the pandemic on the association of ethnicity and multimorbidity with mortality/service use among adults, in people living with severe mental illnesses (SMI). METHODS This study will utilise secondary mental healthcare records via the Clinical Record Interactive Search (CRIS) and nationally representative primary care records through the Clinical Practice Interactive Research Database (CPRD). Quasi-experimental designs will be employed to quantify the impact of COVID-19 on mental health service use and excess mortality by ethnicity, in people living with severe mental health conditions. Up to 50 qualitative interviews will also be conducted, co-produced with peer researchers; findings will be synthesised with quantitative insights to provide in-depth understanding of observed associations. RESULTS 81,483 people in CRIS with schizophrenia spectrum, bipolar or affective disorder diagnoses, were alive from 1st January 2019. Psychiatric multimorbidities in the CRIS sample were comorbid somatoform disorders (30%), substance use disorders (14%) and personality disorders (12%). In CPRD, of 678,842 individuals with a prior probable diagnosis of COVID-19, 1.1% (N = 7493) had an SMI diagnosis. People in the SMI group were more likely to die (9% versus 2% in the non-SMI sample) and were more likely to have mental and physical multimorbidities. CONCLUSION The effect of COVID-19 on people from minority ethnic backgrounds with SMI and multimorbidities remains under-studied. The present mixed methods study aims to address this gap.
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Affiliation(s)
- E Impara
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - I Bakolis
- Centre for Implementation Science, Health Services, Population and Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - H Dasch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - A Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - J Dyer
- Black Thrive Global, NHS-E/I, London, UK
| | - M Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R J Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - R Stuart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - J Ocloo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- Centre for Implementation Science, Health Services, Population and Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) At King's College Hospital NHS Foundation Trust, London, UK
| | - J Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
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20
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Jegede O, Na PJ, Rhee TG, Stefanovics EA, Rosenheck RA. Psychiatric and Substance Use Disorders and Related Service Use in the Diverse Black Sub-Populations in the United States. J Racial Ethn Health Disparities 2022; 9:2237-2247. [PMID: 34590245 DOI: 10.1007/s40615-021-01163-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE Existing literature on the epidemiology of psychiatric and substance use disorders and service use among African Americans in the USA has not fully addressed the heterogeneity of Black populations. This study compares the proportions and diverse characteristics of these sub-populations, their mental and substance use diagnoses, and related service use. METHODS The data for this study was obtained from the restricted version of the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III). Participants who identified as Black/African Americans were categorized into four groups: African-born, Caribbean-born, US-born with at least one immigrant parent, and US-born with both parents born in the USA. Effect sizes were used to evaluate bivariate between-group differences and multinomial logistic regression analysis was used to identify factors that independently differentiated each of the first three groups from the reference group termed US-born. RESULTS This exploratory analysis strengthened the notion of the immigrant paradox as African- and Caribbean-born Black individuals scored significantly higher on all measures of quality of life and had fewer mental health and substance use diagnoses, but this advantage was not observed in the children of immigrants born in the USA. There were few significant differences in service use across the groups after adjusting for clinical characteristics. CONCLUSION The differences observed in the diverse Black populations of the USA, across measures of mental and physical health, and substance use, deserve attention in future research, policy, and program development.
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Affiliation(s)
- Oluwole Jegede
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Peter J Na
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
- U.S. Department of Veterans Affairs, Education, and Clinical Center, New England Mental Illness Research, 950 Campbell Avenue, West Haven, CT, USA
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
- U.S. Department of Veterans Affairs, Education, and Clinical Center, New England Mental Illness Research, 950 Campbell Avenue, West Haven, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
- U.S. Department of Veterans Affairs, Education, and Clinical Center, New England Mental Illness Research, 950 Campbell Avenue, West Haven, CT, USA
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21
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Wamser-Nanney R, Campbell CL. Factors associated with caregiver help seeking behavior among at-risk children. Child Abuse Negl 2022; 134:105937. [PMID: 36327764 DOI: 10.1016/j.chiabu.2022.105937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/15/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Few at-risk school-age children receive needed psychological help, and our understanding of predictors of service use in this population is limited. Many broader contextual factors have received little attention including caregiver's trauma history and social support, father involvement, family functioning, and neighborhood satisfaction. The links between types of and cumulative maltreatment have also been inconsistent, and prior work has not always accounted for children's symptoms. OBJECTIVE The current study examined child, caregiver, family, neighborhood, and maltreatment factors in relation to past-year mental health service use among at-risk eight-year-old children. Cumulative and types of maltreatment were both investigated to help elucidate the role of these experiences. PARTICIPANTS/SETTING/METHOD Eight hundred and forty-five eight-year-old at-risk children (48.3 % male; 59.5 % Black) from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) were included. RESULTS A small portion of children (12.4 %) received psychological help in the previous year. Children's externalizing symptoms, residing with a non-biological caregiver, cumulative maltreatment and sexual and emotional abuse were associated with seeking psychological services, whereas physical abuse, neglect, and domestic violence exposure were not. Other caregiver factors, and family and neighborhood factors were also unrelated. CONCLUSIONS Non-biological caregivers as well as caregivers of children with higher levels of externalizing symptoms may be more inclined to seek out mental health services, along with greater, and specific, maltreatment experiences. These findings indicate that child factors may be key in understanding help seeking, however, it is important to further consider other broader contextual factors in future work.
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Affiliation(s)
- Rachel Wamser-Nanney
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.
| | - Claudia L Campbell
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
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22
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Smith KJ, Victor C. The Association of Loneliness With Health and Social Care Utilization in Older Adults in the General Population: A Systematic Review. Gerontologist 2022; 62:e578-e596. [PMID: 34875042 DOI: 10.1093/geront/gnab177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Loneliness is proposed to be linked with increased service use. This review examined the association of loneliness and health and social care utilization (HSCU) in older adults from the general population. RESEARCH DESIGN AND METHODS Four databases were screened for studies that examined the association of loneliness (predictor) with HSCU (outcome) in older adults (defined as the majority of sample 60 or older). Study quality was assessed with the National Institutes for Health scale for observational cohorts and cross-sectional studies. RESULTS We identified 32 studies, of which 9 prospective studies were evaluated as being good or good-fair quality. Two good-fair quality studies found that loneliness at baseline was associated with subsequent admission to a residential care home. There was emerging evidence that loneliness was associated with emergency department use (n = 1) and cardiovascular disease-specific hospitalization (n = 1). Once adjusted for confounders, the highest quality studies found no association of baseline loneliness with physician utilization, outpatient service utilization, skilled nursing facility use, and planned or unplanned hospital admissions. The remaining studies were cross-sectional, or of fair to poor quality, and inadequate to reliably determine whether loneliness was associated with a subsequent change in HSCU. DISCUSSION AND IMPLICATIONS There was heterogeneity in study design, measurement, and study quality. This generated an inconsistent evidence base where we cannot determine clear inferences about the relationship between loneliness and HSCU. Only one consistent finding was observed between 2 good-fair quality studies regarding care home admission. To determine clinical implications and make reliable inferences, additional good quality longitudinal research is needed.
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Affiliation(s)
- Kimberley J Smith
- School of Psychology, Faculty of Health and Medicine, University of Surrey, Guildford, UK
| | - Christina Victor
- Department of Health Sciences, Brunel University London, Uxbridge, UK
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23
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Jegede O, Rhee TG, Stefanovics EA, Zhou B, Rosenheck RA. Rates and correlates of dual diagnosis among adults with psychiatric and substance use disorders in a nationally representative U.S sample. Psychiatry Res 2022; 315:114720. [PMID: 35834863 DOI: 10.1016/j.psychres.2022.114720] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Treatment needs of adults diagnosed with both psychiatric and substance use disorders (i.e., dual diagnosis) have not received detailed characterization in a nationally representative US sample. Data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III were used to compare socio-behavioral, diagnostic, and service use characteristics of dually diagnosed adults to those with psychiatric disorders or SUDs alone. Adults with dual diagnosis were estimated to constitute 25.8% of those with any psychiatric disorder; 36.5% of those with any SUD and 17.8% of the 75.8 million adults with either disorder. Among those with psychiatric disorders, the independent correlates of dual diagnosis reflected substantial social or psychopathological disadvantages (e.g., violent behavior, poor mental health-related quality of life [HRQOL], police trouble, homelessness, and incarceration). Similarly, among those with SUD all independent correlates of dual diagnosis also reflected social or psychopathological disadvantages including poor mental HRQOL, witnessing trauma in childhood, childhood sex abuse, drug use diagnoses, suicide attempt, medical problems, having more than one SUD diagnosis, child neglect, repeated adult traumas, and less social support. Provision of medical, psychiatric, addiction and especially diverse social services in an integrated and accessible setting appear necessary and deserve further study.
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Affiliation(s)
- Oluwole Jegede
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States; Connecticut Mental Health Center, 34 Park Street, New Haven CT 06519, United States.
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, United States; Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, United States
| | - Elina A Stefanovics
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, United States
| | - Bin Zhou
- Yale School of Public Health, New Haven, CT, United States
| | - Robert A Rosenheck
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, United States
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24
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Wamser-Nanney R, Campbell CL. Correlates of caregiver's help seeking behavior among young maltreated children. Child Abuse Negl 2022; 126:105520. [PMID: 35091133 DOI: 10.1016/j.chiabu.2022.105520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Relatively few maltreated children receive mental health services, despite the importance of treatment in combating the deleterious impact of maltreatment. Characteristics of the child, caregiver, and family have been investigated in relation to caregiver's help seeking behavior for children's psychological difficulties; yet, these associations have been inconsistent, and are very understudied among younger maltreated children. Other aspects of the child's environment, such as father involvement, negative life events, and neighborhood risk and satisfaction have not been examined. It is also uncertain how cumulative maltreatment and the specific forms of maltreatment - sexual, physical, and emotional abuse, neglect, and domestic violence, are associated with mental health consultation. OBJECTIVE The aim of the current study was to utilize an ecological model that included child, caregiver, family, neighborhood, and maltreatment factors to better understand caregiver's help seeking behavior. PARTICIPANTS/SETTING/METHOD The study relied upon 448 six-year-old maltreated children (47.5% male; 48.7% Black) from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) study. RESULTS Several factors, including child's gender and externalizing symptoms, and caregiver educational attainment and depression and were associated with mental health consultation. Cumulative maltreatment, however, was unrelated. When the specific forms of maltreatment were included, none of the individual maltreatment types were tied to help seeking behavior. CONCLUSIONS Child and caregiver factors, such as child's level of behavioral challenges as caregiver's level of education and depression, may contribute to decisions regarding seeking services for young, maltreated children. However, neither cumulative nor the forms of maltreatment may correspond with help seeking among young, maltreated children.
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Affiliation(s)
- Rachel Wamser-Nanney
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA.
| | - Claudia L Campbell
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
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25
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Song W, Salzer MS, Nonnemacher SL, Shea L. Lifespan service receipt and unmet needs among individuals on the autism spectrum. Adm Policy Ment Health 2022; 49:694-705. [PMID: 35320442 DOI: 10.1007/s10488-022-01192-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/18/2023]
Abstract
Timely data on service use and needs across the lifespan are essential to developing an effective and efficient service delivery system that is responsive to developmental issues. This study uses data from one of the largest statewide surveys conducted between 2017 and 2018 to compare service use and unmet needs among individuals on the autism spectrum across the lifespan. A statewide sample of 5792 caregivers of autistic children and adults were included in the study. Logistic regressions were conducted to compare service use and need among six age groups ranging from early childhood (0-5 years) to later adulthood (31+) while adjusting for sociodemographic characteristics. We found that the transition-age adult group (18-21 years) was less likely to receive services, including speech/language therapy, occupational therapy, one-on-one support, and social skill training, than adolescents. However, case management and mental health services increased with age. Young adults (22-30 years) were more likely to report unmet needs than both adolescents and transition-age adult groups. The use of services overall decrease and service needs increased compared to results from an earlier statewide survey that was conducting in 2009-2010. These results can be used to inform developmentally appropriate autism-related healthcare policies and service development and delivery. This study offers a more detailed look at differences between adult age subgroups that are novel. Further research is needed about the prevalence of ASD in adulthood, clinical trajectories, and outcomes in order to support autistic adults in getting the appropriate services and supports.
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Affiliation(s)
- Wei Song
- College of Public Health, Temple University, 1700 N. Broad St., Suite 313, 19122, Philadelphia, PA, USA.
| | - Mark S Salzer
- Temple University Collaborative on Community Inclusion of Individuals with, Psychiatric Disabilities, 1700 N. Broad St., Suite 304, 19122, Philadelphia, PA, USA
| | - Stacy L Nonnemacher
- Bureau of Supports for Autism and Special Populations, Department of Human Services, 801 Market St, 19107, Philadelphia, Pennsylvania, PA, USA
| | - Lindsay Shea
- Policy and Analytics Center, A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, 19104, Philadelphia, PA, USA
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26
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Wan Mohd Yunus WMA, Kauhanen L, Sourander A, Brown JSL, Peltonen K, Mishina K, Lempinen L, Bastola K, Gilbert S, Gyllenberg D. Registered psychiatric service use, self-harm and suicides of children and young people aged 0-24 before and during the COVID-19 pandemic: a systematic review. Child Adolesc Psychiatry Ment Health 2022; 16:15. [PMID: 35216630 PMCID: PMC8874300 DOI: 10.1186/s13034-022-00452-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has impacted on psychiatric symptoms of children and young people, but many psychiatric services have been disrupted. It is unclear how service use, self-harm and suicide has changed since the pandemic started. To gain timely information, this systematic review focused on studies based on administrative data that compared psychiatric service use, self-harm and suicide before and during the pandemic among children and young people. METHODS AND FINDING A systematic review of studies published in English from 1 January 2020 to 22 March 2021 was conducted, using the Web of Science, PubMed, Embase and PsycINFO databases. Increases or reductions in service use were calculated and compared using percentages. Of the 2,676 papers retrieved, 18 were eligible for the review and they provided data from 19 countries and regions. Most studies assessed changes during the early phase of the COVID-19 pandemic, from March to July 2020, and three assessed the changes until October 2020. Fifteen studies reported a total of 21 service use outcomes that were quantitively examined. More than three-quarters of the 21 outcomes (81%) fell by 5-80% (mean reduction = 27.9%, SD = 35%). Ten of the 20 outcomes for psychiatric emergency department (ED) services reduced by 5% to 80% (mean = 40.1%, SD = 34.9%) during the pandemic. Reductions in service use were also recorded for ED visits due to suicide ideation and self-harm, referrals to secondary mental health services, psychiatric inpatient unit admissions and patients receiving treatment for eating disorders. However, there were also some increases. Suicide rate and the number of ED visits due to suicide attempts have increased, and there was an increase in the number of treatment sessions in a service that provided telemedicine. CONCLUSION Most of the studies showed reductions in the use of psychiatric services by children and young people during the early phase of the pandemic and this highlighted potential delays or unmet needs. Suicide rate has increased during the second wave of the pandemic. Further studies are needed to assess the pattern of service use in the later phases of the COVID-19 pandemic.
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Affiliation(s)
- Wan Mohd Azam Wan Mohd Yunus
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship, University of Turku, Turku, Finland ,grid.410877.d0000 0001 2296 1505Department of Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor Bahru, Johor Malaysia
| | - Laura Kauhanen
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland
| | - Andre Sourander
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship, University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XDepartment of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - June S. L. Brown
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, England, UK
| | - Kirsi Peltonen
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship, University of Turku, Turku, Finland
| | - Kaisa Mishina
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship, University of Turku, Turku, Finland
| | - Lotta Lempinen
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship, University of Turku, Turku, Finland
| | - Kalpana Bastola
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.502801.e0000 0001 2314 6254Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sonja Gilbert
- grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014 Turku, Finland ,grid.1374.10000 0001 2097 1371INVEST Research Flagship, University of Turku, Turku, Finland
| | - David Gyllenberg
- Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Lemminkäinenkatu 3, 3rd. floor, 20014, Turku, Finland. .,INVEST Research Flagship, University of Turku, Turku, Finland. .,National Institute for Health and Welfare, Helsinki, Finland. .,Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.
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Gaigl G, Täumer E, Allgöwer A, Becker T, Breilmann J, Falkai P, Gühne U, Kilian R, Riedel-Heller SG, Ajayi K, Baumgärtner J, Brieger P, Frasch K, Heres S, Jäger M, Küthmann A, Putzhammer A, Schneeweiß B, Schwarz M, Kösters M, Hasan A. The role of migration in mental healthcare: treatment satisfaction and utilization. BMC Psychiatry 2022; 22:116. [PMID: 35168572 PMCID: PMC8845273 DOI: 10.1186/s12888-022-03722-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Migration rates increase globally and require an adaption of national mental health services to the needs of persons with migration background. Therefore, we aimed to identify differences between persons with and without migratory background regarding (1) treatment satisfaction, (2) needed and received mental healthcare and (3) utilization of mental healthcare.In the context of a cross-sectional multicenter study, inpatients and day hospital patients of psychiatric settings in Southern Germany with severe affective and non-affective psychoses were included. Patients' satisfaction with and their use of mental healthcare services were assessed by VSSS-54 and CSSRI-EU; patients' needs were measured via CAN-EU.In total, 387 participants (migratory background: n = 72; 19%) provided sufficient responses for analyses. Migrant patients were more satisfied with the overall treatment in the past year compared to non-migrant patients. No differences between both groups were identified in met and unmet treatment needs and use of supply services (psychiatric, psychotherapeutic, and psychosocial treatment).Despite a comparable degree of met and unmet treatment needs and mental health service use among migrants and non-migrants, patients with migration background showed higher overall treatment satisfaction compared to non-migrants. The role of sociocultural and migrant-related factors may explain our findings.
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Affiliation(s)
- Gabriele Gaigl
- Department of Psychiatry and Psychotherapy, University Hospital, Klinikum der Universität München, Ludwig-Maximilians University Munich, Nußbaumstraße 7, D-80336, Munich, Germany.
| | - Esther Täumer
- Department of Psychiatry and Psychotherapy, University Hospital, Klinikum der Universität München, Ludwig-Maximilians University Munich, Nußbaumstraße 7, D-80336, Munich, Germany
| | - Andreas Allgöwer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, BKH, Günzburg, Germany
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Klinikum der Universität München, Ludwig-Maximilians University Munich, Nußbaumstraße 7, D-80336, Munich, Germany
| | - Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, Ulm University, BKH, Günzburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | | | - Jessica Baumgärtner
- Department of Psychiatry, Psychotherapy and Psychosomatic, University of Augsburg, Medical Faculty, BKH Augsburg, Augsburg, Germany
| | | | - Karel Frasch
- Department of Psychiatry II, Ulm University, BKH, Günzburg, Germany
- District hospital Donauwörth, Donauwörth, Germany
| | | | - Markus Jäger
- Department of Psychiatry II, Ulm University, BKH, Günzburg, Germany
- District hospital Kempten, Kempten, Germany
| | | | | | | | | | - Markus Kösters
- Department of Psychiatry II, Ulm University, BKH, Günzburg, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatic, University of Augsburg, Medical Faculty, BKH Augsburg, Augsburg, Germany
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28
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Ulrich SM, Walper S, Renner I, Liel C. Characteristics and patterns of health and social service use by families with babies and toddlers in Germany. Public Health 2022; 203:83-90. [PMID: 35033738 DOI: 10.1016/j.puhe.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In the field of family health, cross-sectoral collaboration is promoted to reach vulnerable groups and overcome the prevention dilemma. To understand the extent to which these measures counteract the effects of social inequality with respect to health and social service uptake, we aim to identify socio-economic, health-related and psychosocial characteristics and patterns that are associated with the (non-)use of services. STUDY DESIGN This was a German representative cross-sectional study of 6860 mothers with a child younger than 48 months who answered the written questionnaire during child developmental examinations at paediatric practices in 2015. METHODS Associations were measured using logistic regression, and characteristics of user patterns were analysed using latent class analysis. RESULTS Mothers using universal services were less likely to report psychosocial stress and had more likely more socio-economic resources than mothers who did not use these services. The selective services pregnancy counselling (18.2%) were predominantly used by mothers who considered abortion during pregnancy (Odds Ratio [OR] = 3.9), mothers who received social welfare benefits (OR = 2.4), single parents (OR = 1.6) and mothers without social support (OR = 1.5). Four patterns of service use were identified: multi-service users (5.6%), low-service users (22.5%), medical service users (30.5%) and medical and social service users (41.6%). Families with less socio-economic resources were found in both the low-service group and the multi-service group; multi-users were more likely to have children with adverse perinatal characteristics and parenting stress. CONCLUSION We discuss whether low-service users are hard to reach, whereas multi-users are difficult to supply. Overall, there is a need to strengthen early psychosocial support.
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Affiliation(s)
- Susanne M Ulrich
- National Centre for Early Prevention, German Youth Institute, Department of Families and Family Policies, Munich, Germany.
| | - Sabine Walper
- National Centre for Early Prevention, German Youth Institute, Department of Families and Family Policies, Munich, Germany.
| | - Ilona Renner
- National Centre for Early Prevention, Federal Centre for Health Education, Cologne, Germany.
| | - Christoph Liel
- National Centre for Early Prevention, German Youth Institute, Department of Families and Family Policies, Munich, Germany.
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29
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Fogg C, Fraser SDS, Roderick P, de Lusignan S, Clegg A, Brailsford S, Barkham A, Patel HP, Windle V, Harris S, Zhu S, England T, Evenden D, Lambert F, Walsh B. The dynamics of frailty development and progression in older adults in primary care in England (2006-2017): a retrospective cohort profile. BMC Geriatr 2022; 22:30. [PMID: 34991479 PMCID: PMC8740419 DOI: 10.1186/s12877-021-02684-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frailty is a common condition in older adults and has a major impact on patient outcomes and service use. Information on the prevalence in middle-aged adults and the patterns of progression of frailty at an individual and population level is scarce. To address this, a cohort was defined from a large primary care database in England to describe the epidemiology of frailty and understand the dynamics of frailty within individuals and across the population. This article describes the structure of the dataset, cohort characteristics and planned analyses. METHODS Retrospective cohort study using electronic health records. Participants were aged ≥50 years registered in practices contributing to the Oxford Royal College of General Practitioners Research and Surveillance Centre between 2006 to 2017. Data include GP practice details, patient sociodemographic and clinical characteristics, twice-yearly electronic Frailty Index (eFI), deaths, medication use and primary and secondary care health service use. Participants in each cohort year by age group, GP and patient characteristics at cohort entry are described. RESULTS The cohort includes 2,177,656 patients, contributing 15,552,946 person-years, registered at 419 primary care practices in England. The mean age was 61 years, 52.1% of the cohort was female, and 77.6% lived in urban environments. Frailty increased with age, affecting 10% of adults aged 50-64 and 43.7% of adults aged ≥65. The prevalence of long-term conditions and specific frailty deficits increased with age, as did the eFI and the severity of frailty categories. CONCLUSION A comprehensive understanding of frailty dynamics will inform predictions of current and future care needs to facilitate timely planning of appropriate interventions, service configurations and workforce requirements. Analysis of this large, nationally representative cohort including participants aged ≥50 will capture earlier transitions to frailty and enable a detailed understanding of progression and impact. These results will inform novel simulation models which predict future health and service needs of older people living with frailty. STUDY REGISTRATION Registered on www.clinicaltrials.gov October 25th 2019, NCT04139278 .
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Affiliation(s)
- Carole Fogg
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Simon D S Fraser
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Paul Roderick
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Road, Oxford, OX2 6ED, UK
- Royal College of General Practitioners, Research and Surveillance Centre, 30, Euston Square, London, NW1 2FB, UK
| | - Andrew Clegg
- Academic Unit for Ageing & Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Sally Brailsford
- Southampton Business School, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Abigail Barkham
- Southern Health NHS Foundation Trust, Unit 1 Wessex Way, Colden Common, Winchester, SO21 1WP, UK
| | - Harnish P Patel
- Medicine for Older People, University Hospitals Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, Southampton Centre for Biomedical Research, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Vivienne Windle
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Scott Harris
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Shihua Zhu
- School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Tracey England
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Dave Evenden
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Francesca Lambert
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Bronagh Walsh
- School of Heath Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
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30
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Fikretoglu D, Sharp ML, Adler AB, Bélanger S, Benassi H, Bennett C, Bryant R, Busuttil W, Cramm H, Fear N, Greenberg N, Heber A, Hosseiny F, Hoge CW, Jetly R, McFarlane A, Morganstein J, Murphy D, O'Donnell M, Phelps A, Richardson DJ, Sadler N, Schnurr PP, Smith P, Ursano R, Hooff MV, Wessely S, Forbes D, Pedlar D. Pathways to mental health care in active military populations across the Five-Eyes nations: An integrated perspective. Clin Psychol Rev 2021; 91:102100. [PMID: 34871868 DOI: 10.1016/j.cpr.2021.102100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/29/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022]
Abstract
Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the past six years to update and broaden the discussion on pathways to mental healthcare in military populations. We find that at a broad population level, there is improvement in several indicators of mental health care access, with greater gains in initial engagement, time to first treatment contact, and subjective satisfaction with care, and smaller gains in objective indicators of adequacy of care. Among individual-level barriers to care-seeking, there is progress in improving recognition of need for care and reducing stigma concerns. Among organizational-level barriers, there are advances in availability of services and cultural acceptance of care-seeking. Other barriers, such as concerns around confidentiality, career impact, and deployability persist, however, and may account for some remaining unmet need. To address these barriers, new initiatives that are more evidence-based, theoretically-driven, and culturally-sensitive, are therefore needed, and must be rigorously evaluated to ensure they bring about additional improvements in pathways to care.
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Affiliation(s)
- Deniz Fikretoglu
- Defence Research and Development Canada, 1133 Sheppard Ave. West, Toronto, ON, Canada.
| | | | - Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | | | | | | | | | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | | | | | | | - Fardous Hosseiny
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rakesh Jetly
- Department of National Defence, Ottawa, ON, Canada
| | | | | | - Dominic Murphy
- Combat Stress, Leatherhead, Surrey, UK; King's College London, London, UK
| | - Meaghan O'Donnell
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Andrea Phelps
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Don J Richardson
- Parkwood Institute- St. Joseph's Health Care London, London, ON, Canada
| | - Nicole Sadler
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | | | - Patrick Smith
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | | | - Miranda Van Hooff
- Military and Emergency Services Health Australia (MESHA), Woodville, SA, Australia
| | | | - David Forbes
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - David Pedlar
- Canadian Institute for Military and Veteran Health Research, Queen's University, Kingston, ON, Canada
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31
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Heinig I, Wittchen HU, Knappe S. Help-Seeking Behavior and Treatment Barriers in Anxiety Disorders: Results from a Representative German Community Survey. Community Ment Health J 2021; 57:1505-1517. [PMID: 33471256 PMCID: PMC8531057 DOI: 10.1007/s10597-020-00767-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/23/2020] [Indexed: 11/24/2022]
Abstract
Although effective therapies exist, treatment rates of anxiety disorders (AD) are low, raising the question why affected individuals do not receive treatment. We provide data from the nationally representative German Health Interview and Examination Survey-2011 (DEGS1) on the help-seeking behavior and perceived treatment barriers of 650 subjects with Diagnostic and Statistical Manual of Mental Disorders' (DSM-IV AD). Only 26% of all cases with AD in the community reported having had contact with mental health services because of their anxiety problems in their lifetime. 16% were currently receiving professional help, most frequently by psychotherapists (8%), psychiatrists (5%) and general practitioners (5%). 40% of all cases never even considered seeking help and 31% reported barriers to treatment, such as self-reliance (18%) or beliefs that treatments were ineffective (9%), unavailable (8%) or too stigmatizing (7%). Measures to increase treatment rates should thus target individual as well as public attitudes and health literacy to increase awareness of and access to evidence-based interventions.
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Affiliation(s)
- Ingmar Heinig
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Nußbaumstr. 7, 80336, Munich, Germany
| | - Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
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32
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Hansen AS, Christoffersen CH, Telléus GK, Lauritsen MB. Referral patterns to outpatient child and adolescent mental health services and factors associated with referrals being rejected. A cross-sectional observational study. BMC Health Serv Res 2021; 21:1063. [PMID: 34625073 PMCID: PMC8501731 DOI: 10.1186/s12913-021-07114-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outpatient child and adolescent mental health services (CAMHS) are faced with the challenge of balancing increasing demands with limited resources. An additional challenge is high rejection rates of referrals which causes frustration for referring agents and families. In order to effectively plan and allocate available resources within CAMHS there is a need for up-to-date knowledge on referral patterns and factors associated with rejection of referrals. METHODS In this cross-sectional observational study we did a retrospective review of all referrals (n = 1825) for children (0-18) referred for assessment at the outpatient CAMHS of the North Denmark Region in 2018. RESULTS The most common referral reasons to CAMHS were attention deficit disorder (ADHD/ADD) (27.9%), autism spectrum disorder (22.4%), affective disorders (14.0%) and anxiety disorders (11.6%). The majority of referrals came from general practitioners, but for neurodevelopmental disorders educational psychologists were the primary referral source. Re-referrals constituted more than a third of all referrals (35.9%). Children in care were overrepresented in this clinical sample and had an increased risk (Adj. OR 2.54) of having their referrals rejected by CAMHS. Referrals from general practitioners were also associated with an increased risk of rejection (Adj. OR 3.29). CONCLUSIONS A high proportion of children with mental disorders have a repeated need for assessment by CAMHS. There is a need for future research on predictors of re-referral to outpatient services to identify potential targets for reducing re-referral rates as well as research on how to optimize service provision for children with a repeated need for assessment. General practitioners are the main gatekeepers to CAMHS and research on interventions to improve the referral process should be aimed towards general practitioners.
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Affiliation(s)
- Anna Sofie Hansen
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
| | | | - Gry Kjaersdam Telléus
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000, Aalborg, Denmark.,Psychology, Department of Communication and Psychology, Aalborg University, Rendsburggade 14, 9000, Aalborg, Denmark
| | - Marlene Briciet Lauritsen
- Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
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33
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Brattfjell ML, Jozefiak T, Wichstrøm L. Predictors of community versus specialty mental health service use: a prospective cohort study. Eur Child Adolesc Psychiatry 2021; 30:953-960. [PMID: 32557208 PMCID: PMC8140979 DOI: 10.1007/s00787-020-01575-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/10/2020] [Indexed: 12/22/2022]
Abstract
Child and adolescent mental health specialized services (CAMHS) are supposed to serve those who are most seriously disturbed and impaired. However, little is known about how children receiving treatment at different levels of care differ. The present study seeks to determine whether having a psychiatric disorder and resulting impairment measured in early childhood increases the odds of receiving help in CAMHS versus from community services during middle childhood or whether other factors (e.g., parenting stress, family functioning) also influence service utilization. A screen-stratified sample (n = 995 of the 2003-2004 birth cohorts) in Trondheim, Norway was assessed biennially from age 4-12 with semi-structured diagnostic interviews and recording of service use, family functioning, parental perceived need, and parenting stress. Behavioral disorders more strongly predicted CAMHS than community service use, whereas impairment predicted community service use. However, impairment increased the odds of receiving services in CAMHS if the parents perceived a need for help. Parental perceived need for help also increased the odds of CAMHS use independent of diagnosis and impairment. Having an emotional disorder, attention deficit/hyperactivity disorder (ADHD), parenting stress, previous service use, or family functioning did not predict service use at either level. Whereas children with behavioral disorders received help from CAMHS, children with emotional disorders did not receive services at either level. ADHD did not predict service use, indicating that young children with ADHD without comorbid disorders are not sufficiently detected. Efforts to detect, refer and treat emotional disorders and ADHD at the appropriate level should be increased.
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Affiliation(s)
- Maria Larsen Brattfjell
- Department of Psychology, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
| | - Thomas Jozefiak
- Faculty of Medicine and Health Sciences, Institute of Mental Health RKBU, Norwegian University of Science and Technology, P. O. Box 8905, 7491, Trondheim, Norway
| | - Lars Wichstrøm
- Department of Psychology, Norwegian University of Science and Technology, 7491, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olavs Hospital, Torgarden, P. O. Box 3250, 7006, Trondheim, Norway
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34
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Abstract
While extensive evidence links service use for mental health problems to demographic variables and positive attitudes, studies have not explored the role of transdiagnostic risk factors, like distress intolerance (DI) and repetitive negative thinking (RNT). This study examined the relationship between parental DI and RNT on mental health treatment seeking for parents themselves and their children. Results suggest higher DI and RNT predict service use among parents (p < 0.05) but were not significantly associated with help seeking for their children, indicating that factors more proximal to the child may have greater influence when parents make treatment decisions for their children. Results also indicte that DI moderates the relationship between parent psychopathology and parent service use, such that parent psychopathology is significantly associated with service use for those with lower DI, but not at moderate or high levels of DI. Implications for marketing mental health information to parents and engaging them in treatment are discussed.
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Affiliation(s)
- Zabin S Patel
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA.
| | - Elizabeth Casline
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
| | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
| | - Kiara R Timpano
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
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35
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Ishler KJ, Biegel DE, Wang F, Olgac T, Lytle S, Miner S, Edguer M, Kaplan R. Service Use Among Transition-Age Youth with Autism Spectrum Disorder. J Autism Dev Disord 2021. [PMID: 33864557 DOI: 10.1007/s10803-021-04999-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
This study explored predictors of service use among 174 transition-age youth (age 16-30) with an Autism Spectrum Disorder using Andersen's (J Health Soc Behav 36(1):1-10, 1995) healthcare utilization model. Family caregivers were interviewed about past 6-month use of 15 services. On average, youth used 6.1 and needed 3.2 additional services. Greater service use was associated with two predisposing (caregiver college educated, caregiver not married/partnered), two enabling (youth has Medicaid waiver, youth in high school), and one need factor (lower adaptive functioning). Use of specific services was most strongly related to enabling (Medicaid waiver, in high school) and need factors (lower adaptive functioning, comorbid mental health diagnosis). Findings provide a snapshot of the "service cliff" faced by families and highlight the need for additional research.
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36
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Hyland P, Vallières F, Cloitre M, Ben-Ezra M, Karatzias T, Olff M, Murphy J, Shevlin M. Trauma, PTSD, and complex PTSD in the Republic of Ireland: prevalence, service use, comorbidity, and risk factors. Soc Psychiatry Psychiatr Epidemiol 2021; 56:649-658. [PMID: 32632598 DOI: 10.1007/s00127-020-01912-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 06/30/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE This study represents the first assessment of the prevalence of trauma exposure, and Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD), ever conducted in the general population of the Republic of Ireland. Additionally, prevalence of past-year mental health service use, comorbidity with major depression and generalized anxiety, and risk factors associated with PTSD and CPTSD were assessed. METHODS A nationally representative sample of non-institutionalized Irish adults (N = 1020) completed self-report measures of trauma history, trauma-related psychopathology, mental health service use, and concurrent mental health problems. RESULTS Lifetime exposure to one or more traumatic events was 82.3%, and 67.8% reported experiencing two or more traumatic events. Males and females significantly differed in their frequency of exposure to eight of 16 traumatic events. The past-month prevalence for PTSD was 5.0% (95% CI 3.7%, 6.3%) and 7.7% (95% CI 6.1%, 9.4%) for CPTSD. Of those who screened positive for PTSD or CPTSD, 48.6% accessed mental health care in the past year. Comorbidity with major depression and generalized anxiety was high, especially among those with CPTSD. Several unique and shared risk factors for PTSD and CPTSD were identified. CONCLUSION Approximately one-in-eight Irish adults met diagnostic requirements for PTSD or CPTSD, and comorbidity with other disorders was high. History of interpersonal trauma and exposure to multiple types of trauma in different developmental periods were associated with CPTSD. Many individuals did not access mental health care revealing a substantial mental health treatment gap.
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Affiliation(s)
- Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland. .,Trinity College, Trinity Centre for Global Health, University of Dublin, Dublin, Ireland.
| | - Frédérique Vallières
- Trinity College, Trinity Centre for Global Health, University of Dublin, Dublin, Ireland
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | | | - Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.,NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Jamie Murphy
- School of Psychology, Ulster University, Derry, Northern Ireland, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland, UK
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Adams RE, Hu Y, Figley CR, Urosevich TG, Hoffman SN, Kirchner HL, Dugan RJ, Boscarino JJ, Withey CA, Boscarino JA. Risk and protective factors associated with mental health among female military veterans: results from the veterans' health study. BMC Womens Health 2021; 21:55. [PMID: 33557798 PMCID: PMC7869200 DOI: 10.1186/s12905-021-01181-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/13/2021] [Indexed: 11/10/2022]
Abstract
Background This study focuses on factors that may disproportionately affect female veterans’ mental health, compared to men, and is part of a larger study assessing the prevalence of mental health disorders and treatment seeking among formerly deployed US military service members. Methods We surveyed a random sample of 1,730 veterans who were patients in a large non-VA hospital system in the US. Based on previous research, women were hypothesized to be at higher risk for psychological problems. We adjusted our results for confounding factors, including history of trauma, childhood abuse, combat exposure, deployments, stressful life events, alcohol misuse, psychological resources, and social support. Results Among the veterans studied, 5% were female (n = 85), 96% were White (n = 1,161), 22.9% were Iraq/Afghanistan veterans (n = 398), and the mean age was 59 years old (SD = 12). Compared to males, female veterans were younger, unmarried, college graduates, had less combat exposure, but were more likely to have lifetime PTSD (29% vs. 12%.), depression (46% vs. 21%), suicidal ideation (27% vs. 11%), and lifetime mental health service use (67% vs. 47%). Females were also more likely to have low psychological resilience and to have used psychotropic medications in the past year. Using multivariate logistic regression analyses that controlled for risk and protective factors, female veterans had greater risk for lifetime PTSD, depression, suicidal thoughts, and for lifetime use of psychological services, compared to males. Since 95% of the population in this study were male and these results may have been statistically biased, we reran our analyses using propensity score matching. Results were consistent across these analyses. Conclusion Using a sample of post-deployment veterans receiving healthcare services from a large non-VA health system, we find that female veterans are at greater risk for lifetime psychological problems, compared to male veterans. We discuss these findings and their implications for service providers.
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Affiliation(s)
- Richard E Adams
- Department of Sociology, Kent State University, 215 Merrill Hall, 700 Hilltop Drive, Kent, OH, 44242-0001, USA
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA
| | - Charles R Figley
- Tulane Traumatology Institute, Tulane University, 127 Elk Place, New Orleans, LA, 70112, USA
| | - Thomas G Urosevich
- Ophthalmology Service, Geisinger Clinic, 126 Market Way, Mount Pocono, PA, 18344, USA
| | - Stuart N Hoffman
- Department of Sleep Medicine, Geisinger Clinic, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA
| | - Ryan J Dugan
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA
| | - Joseph J Boscarino
- Clinical Psychology Department, William James College, 1 Wells Ave, Newton, MA, 02459, USA
| | - Carrie A Withey
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA.
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Potrebny T, Wiium N, Haugstvedt A, Sollesnes R, Wold B, Thuen F. Trends in the utilization of youth primary healthcare services and psychological distress. BMC Health Serv Res 2021; 21:115. [PMID: 33536017 PMCID: PMC7860003 DOI: 10.1186/s12913-021-06124-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/27/2021] [Indexed: 12/28/2022] Open
Abstract
Background Psychological distress among young people is increasing in Northern Europe. According to established healthcare utilization theory, this will create a greater need for youth primary healthcare and subsequently lead to more help-seeking behavior by distressed young people. The aim of this study was to investigate the association between the use of youth primary healthcare services and psychological distress in times of increasing mental health problems and increased service need. Methods This study consisted of five waves of repeated annual cross-sectional data collected from young people (aged 13–19) living in Norway between 2014 and 2018 (n = 368,579). Population-weighted and design-adjusted generalized linear regression with a log-link was used to examine the use of youth primary healthcare services over time. Results We found that a large proportion of young people use primary healthcare services and that young people with high levels of psychological distress use primary healthcare services twice as much as their peers with low levels of psychological distress. In addition, between 2014 and 2018 both psychological distress and primary healthcare service utilization increased: psychological distress increased by 5% and total primary healthcare service use increased by 500 consultations per 1000 young people. Overall, psychological distress had a conditional association with youth primary healthcare service use and could account for between 16 and 66% of the change in the use of services between 2014 and 2018, depending on the service type. However, the absolute increase seen in the use of primary healthcare services was mainly driven by young people with low levels of psychological distress as opposed to young people with high psychological distress. This suggest a converging trend. Conclusions Our findings suggest that there might be serious barriers between need and help-seeking behavior for young people with high levels of psychological distress and that the pattern of utilization among young people with lower distress may indicate overuse, possibly as an inadvertent consequence of a newly introduced school absence policy. While further research is needed to confirm these findings, our work may inform healthcare providers and policy makers about primary healthcare utilization trends among young people. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06124-w.
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Affiliation(s)
- Thomas Potrebny
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway. .,Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway.
| | - Nora Wiium
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ragnhild Sollesnes
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Bente Wold
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Frode Thuen
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Hansen AS, Telléus GK, Mohr-Jensen C, Lauritsen MB. Parent-perceived barriers to accessing services for their child's mental health problems. Child Adolesc Psychiatry Ment Health 2021; 15:4. [PMID: 33514400 DOI: 10.1186/s13034-021-00357-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/11/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Many children and adolescents with impairing mental health disorders are not in contact with specialized child and adolescent mental health services (CAMHS). In order to close the service gap, it is important to increase our knowledge of barriers to access. The aim of this study was to investigate parent perceived barriers to accessing services for their child's mental health problems to identify potential areas for improvement of access to CAMHS. METHOD In this cross-sectional observational study 244 parents of children and adolescents referred to outpatient psychiatric assessment were interviewed using the Children's services interview regarding barriers to accessing child mental health services across healthcare, educational services and social services. Parent reported barriers were analyzed in relation to the child's age, referral reason, symptom duration and impairment of the child. RESULTS The most commonly reported barriers were lack of information about were to seek help (60.3%), the perception that professionals did not listen (59.8%) and professionals refusing to initiate interventions or provide referral to services (53.7%). Lack of knowledge, stigmatization and unavailability of services were common themes across barriers to help-seeking. Long symptom duration and parent rated impairment was associated with increased risk of reporting several barriers to help-seeking. CONCLUSION Parents seeking help for their child's mental health encounter numerous barriers that could explain part of the treatment gap and long duration of mental health problems in children prior to referral to CAMHS.
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Collopy CM, Cosh SM, Tully PJ. Screening and referral is not enough: a qualitative exploration of barriers to access and uptake of mental health services in patients with cardiovascular diseases. BMC Health Serv Res 2021; 21:49. [PMID: 33419443 PMCID: PMC7796597 DOI: 10.1186/s12913-020-06030-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/18/2020] [Indexed: 01/06/2023] Open
Abstract
Background Cardiovascular diseases (CVD) are commonly comorbid with mental health disorders, portending poorer cardiac prognosis. Despite the high prevalence of depression and anxiety, and guidelines recommending routine depression screening and referral, uptake of mental healthcare in CVD populations remains low. Reasons for the underutilisation of mental health and psychological services for this population remain largely unknown. Methods Thirteen CVD patients with clinically significant psychological symptoms (depression, anxiety and/or stress) participated in one-on-one in-depth semi-structured interviews. Data were analysed using inductive thematic analysis. Results Barriers to uptake included the timing of referral and screening, with patients reporting a need for longer term follow-up. A lack of information provision and understanding around mental health and services, especially following cardiac-events were further barriers. A reluctance to report mental health or engage in services was also identified, with patients indicating a preference for informal peer support networks. A range of practical barriers such as mobility, transport and cost were also reported. Conclusions Longer term follow-up and routine mental health assessment may be beneficial to facilitate use of mental health services. Upskilling of practitioners around mental health may be a further avenue to promote information provision and enhance service use. Further focus on enhancing informal peer support may be a valuable initial approach for the CVD population. The implications for improving services and enhancing service use are discussed.
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Affiliation(s)
- C M Collopy
- School of Psychology, University of New England, Armidale, NSW, 2351, Australia
| | - S M Cosh
- School of Psychology, University of New England, Armidale, NSW, 2351, Australia.
| | - P J Tully
- Freemasons Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, SA, Australia
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Wang Y, Wilson A, Hu Z, Lu L, Li W, Peng K, Wu L, Xin Y, Drescher J, Ou J, Chen R. Counselling and psychotherapy service use in Chinese sexual minority populations: a nationwide survey. BMC Psychiatry 2021; 21:11. [PMID: 33413187 DOI: 10.1186/s12888-020-03010-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study investigated the prevalence and factors associated with counselling and psychotherapy service use among Chinese sexual minority populations. METHODS A nationwide cross-sectional study was performed using snowball sampling method, which led to the inclusion of 18,193 participants. Participants' sociodemographic background, clinical, and psychological data were gathered. Multivariate logistic regression analysis was performed to explore any associated factors. RESULTS There were 2007 participants who had used counselling and psychotherapy service out of the total population. Among those who had used psychotherapy services, 80.2% participants perceived discrimination, 1.1% reported that they had been refused treatment by a counsellor and/or psychotherapist, 1.6% had experienced verbal harassment, and 8.4% reported that their counsellor and/or psychotherapist lacked knowledge and experience in treating sexual minorities. In addition, regression analyses indicated that those who were divorced/widowed, had religious beliefs, and those who had experienced discrimination, verbal harassment, and rejection for treatment by health professionals all had an increased likelihood of utilising counselling and psychotherapy service. CONCLUSIONS Service providers and policy makers in China should improve the quality and availability of counselling and psychotherapy services to address the mental health needs of sexual minority populations.
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Green JG, Oblath R, DeYoung G, Álvarez K, Wang Y, Bird H, Canino G, Duarte CS, Alegría M. Does childhood mental health service use predict subsequent mental health service use during Latino youth transition to young adulthood? Evidence from the Boricua Youth Study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1439-1448. [PMID: 32215687 PMCID: PMC7529673 DOI: 10.1007/s00127-020-01859-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 03/11/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Studies document the substantial underutilization of mental health services by US Latinos in young adulthood. Rates of service use are higher in childhood, raising questions about whether mental health service use during childhood may facilitate access to services later in life. This article examines the extent to which utilization of mental health services in childhood is predictive of utilization in young adulthood among US Latinos. METHODS Data come from the Boricua Youth Study, a longitudinal study of Puerto Rican youth at two sites (South Bronx, New York, and the standard metropolitan area of San Juan, Puerto Rico). Data were collected in three waves during childhood (ages 5-13; surveyed 1 year apart), with an approximately 11-year follow-up in young adulthood (ages 16-29). In childhood, parents reported on youth mental health service use (Waves 1-3). In Wave 4, as youth transitioned to young adults (N = 2004), they reported on their past year mental health service use. RESULTS Whereas 30.2% of parents reported their child received mental health services, only 3.5% of young adults reported mental health service use in the past year. After controlling for young adult disorders and their severity, childhood disorders were associated with increased likelihood of mental health service use in young adulthood. Childhood mental health service use was also associated with young adult service use; however, this association attenuated when controlling for childhood disorders. CONCLUSION Findings suggest the importance of specifically considering childhood disorders in understanding mechanisms for improving access to mental health services among Latino young adults.
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Affiliation(s)
- Jennifer Greif Green
- Wheelock College of Education and Human Development, Boston University, 2 Silber Way, Boston, MA, 02215, USA.
| | - Rachel Oblath
- Wheelock College of Education and Human Development, Boston University, 2 Silber Way, Boston, MA, 02215, USA
| | - Gerrit DeYoung
- Wheelock College of Education and Human Development, Boston University, 2 Silber Way, Boston, MA, 02215, USA
| | - Kiara Álvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Hector Bird
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Ponce Medical School, Ponce, PR, USA
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico Medical School, San Juan, PR, USA
| | - Cristiane S Duarte
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine and Psychiatry, Harvard Medical School, Boston, MA, USA
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Boscarino JJ, Figley CR, Adams RE, Urosevich TG, Kirchner HL, Boscarino JA. Mental health status in veterans residing in rural versus non-rural areas: results from the veterans' health study. Mil Med Res 2020; 7:44. [PMID: 32951600 PMCID: PMC7504679 DOI: 10.1186/s40779-020-00272-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 09/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The majority of Veterans Affair (VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status. METHODS Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including PTSD, major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors. RESULTS A total of 1730 subjects (55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information (n = 38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores; they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors (e.g., age, gender, marital status and education). CONCLUSIONS Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.
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Affiliation(s)
- Joseph J Boscarino
- Clinical Psychology Department, William James College, Newton, MA, 02459, USA
| | - Charles R Figley
- School of Social Work, Tulane University, New Orleans, LA, 70112, USA
| | - Richard E Adams
- Department of Sociology, Kent State University, Kent, OH, 44242, USA
| | | | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, 44-00, Danville, PA, 17822, USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, 44-00, Danville, PA, 17822, USA.
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Penzenstadler L, Gentil L, Grenier G, Khazaal Y, Fleury MJ. Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions. BMC Psychiatry 2020; 20:431. [PMID: 32883239 PMCID: PMC7469095 DOI: 10.1186/s12888-020-02835-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This longitudinal study identified risk factors for frequency of hospitalization among patients with any medical condition who had previously visited one of six Quebec (Canada) emergency departments (ED) at least once for mental health (MH) conditions as the primary diagnosis. METHODS Records of n = 11,367 patients were investigated using administrative databanks (2012-13/2014-15). Hospitalization rates in the 12 months after a first ED visit in 2014-15 were categorized as no hospitalizations (0 times), moderate hospitalizations (1-2 times), and frequent hospitalizations (3+ times). Based on the Andersen Behavioral Model, data on risk factors were gathered for the 2 years prior to the first visit in 2014-15, and were identified as predisposing, enabling or needs factors. They were tested using a hierarchical multinomial logistic regression according to the three groups of hospitalization rate. RESULTS Enabling factors accounted for the largest percentage of total variance explained in the study model, followed by needs and predisposing factors. Co-occurring mental disorders (MD)/substance-related disorders (SRD), alcohol-related disorders, depressive disorders, frequency of consultations with outpatient psychiatrists, prior ED visits for any medical condition and number of physicians consulted in specialized care, were risk factors for both moderate and frequent hospitalizations. Schizophrenia spectrum and other psychotic disorders, bipolar disorders, and age (except 12-17 years) were risk factors for moderate hospitalizations, while higher numbers (4+) of overall interventions in local community health service centers were a risk factor for frequent hospitalizations only. Patients with personality disorders, drug-related disorders, suicidal behaviors, and those who visited a psychiatric ED integrated with a general ED in a separate site, or who visited a general ED without psychiatric services were also less likely to be hospitalized. Less urgent and non-urgent illness acuity prevented moderate hospitalizations only. CONCLUSIONS Patients with severe and complex health conditions, and higher numbers of both prior outpatient psychiatrist consultations and ED visits for medical conditions had more moderate and frequent hospitalizations as compared with non-hospitalized patients. Patients at risk for frequent hospitalizations were more vulnerable overall and had important biopsychosocial problems. Improved primary care and integrated outpatient services may prevent post-ED hospitalization.
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Affiliation(s)
- Louise Penzenstadler
- grid.14709.3b0000 0004 1936 8649Douglas Hospital Research Center, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3 Canada ,grid.150338.c0000 0001 0721 9812Hôpitaux Universitaires Genève, Département de psychiatrie, Service d’addictologie, Rue du Grand-Pré 70c, 1202 Geneva, Switzerland
| | - Lia Gentil
- grid.14709.3b0000 0004 1936 8649Douglas Hospital Research Center, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3 Canada ,Institut universitaire sur les dépendances du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l’Île-de-Montréal, 950 Louvain East, Montréal, Québec, H2M 2E8 Canada
| | - Guy Grenier
- grid.14709.3b0000 0004 1936 8649Douglas Hospital Research Center, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3 Canada
| | - Yasser Khazaal
- grid.8515.90000 0001 0423 4662Centre hospitalier universitaire vaudois, Département de psychiatrie, Service de médecine des addictions, Policlinique d’addictologie, Rue du Bugnon 23, 1011 Lausanne, Switzerland ,grid.14848.310000 0001 2292 3357Département de psychiatrie et d’addictologie, Université de Montréal, 2900 bld Eduard-Montpetit, Montréal, Québec, H3T1J4 Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Center, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec, H4H 1R3, Canada. .,Institut universitaire sur les dépendances du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec, H2M 2E8, Canada.
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Leanza L, Studerus E, Mackintosh AJ, Beck K, Seiler L, Andreou C, Riecher-Rössler A. Predictors of study drop-out and service disengagement in patients at clinical high risk for psychosis. Soc Psychiatry Psychiatr Epidemiol 2020; 55:539-548. [PMID: 31646355 DOI: 10.1007/s00127-019-01796-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE Study drop-out during follow-up and service disengagement frequently occur in patients at clinical high risk for psychosis (CHR-P). However, little is known about their predictors. Therefore, we aimed to analyze the rate and reasons for drop-out and service disengagement in CHR-P patients and investigate their sociodemographic and clinical predictors. METHODS Data from 200 patients of the prospective Früherkennung von Psychosen (FePsy) study were analyzed with competing risks survival models, considering drop-out and transition to psychosis as competing events. To investigate whether symptoms changed immediately before drop-out, t tests were applied. RESULTS Thirty-six percent of patients dropped out within 5 years. Almost all drop-outs also disengaged from our service. Hence, study drop-out was used as a proxy for service disengagement. Patients with more severe baseline disorganized symptoms and a late inclusion into the study were significantly more likely to disengage. Immediately before disengagement, there was significant improvement in negative symptoms only. CONCLUSION A considerable proportion of CHR-P patients disengaged from our clinical study and service. Patients who were included during a later study period with more assessments disengaged more often, which might have been due to more frequent invitations to follow-up assessments and thereby increasing participation burden. Hence, our study provides a cautionary note on high-frequency follow-up assessments. Larger-scale studies evaluating predictors on multiple domains would help to further elucidate drop-out and disengagement.
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Affiliation(s)
- Letizia Leanza
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Erich Studerus
- Division of Personality and Developmental Psychology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Amatya J Mackintosh
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Katharina Beck
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Leonie Seiler
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Christina Andreou
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
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van der Ven E, Susser E, Dixon LB, Olfson M, Gilmer TP. Racial-Ethnic Differences in Service Use Patterns Among Young, Commercially Insured Individuals With Recent-Onset Psychosis. Psychiatr Serv 2020; 71:433-439. [PMID: 31931683 DOI: 10.1176/appi.ps.201900301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate racial-ethnic differences in use of mental health services and antipsychotic medication in the year following the recent onset of a psychotic disorder and to examine the role of household income as a proxy for socioeconomic status. METHODS Deidentified administrative claims data from the OptumLabs Data Warehouse were used to identify 8,021 commercially insured individuals ages 14 through 30 with a recent-onset psychotic disorder (January 1, 2011, through December 31, 2015). The authors compared mental health service use among African-American (11.5%), Hispanic (11.0%), and non-Hispanic white (77.4%) individuals during the year following an index diagnosis and adjusted these analyses for household income. RESULTS The probability of any use of outpatient mental health services was lower among African-American (67.4%±1.4%) and Hispanic individuals (66.5%±1.5%) compared with non-Hispanic white patients (72.3%±0.6%; p<0.05 for each comparison). Among those who used services, African-American and Hispanic individuals had fewer mean outpatient mental health visits per year compared with non-Hispanic whites (9.7±0.7 and 10.2±0.7 versus 14.3±0.5, respectively, p<0.001 for each comparison). These racial-ethnic differences in service use remained after adjustment for household income. CONCLUSIONS Among young, commercially insured individuals using outpatient services following an index diagnosis of psychotic disorder, African Americans and Hispanics received less intensive outpatient mental health care than their non-Hispanic white counterparts. Amid the upsurge of early intervention programs, special attention should be paid to increasing access to mental health services for racial-ethnic minority groups.
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Affiliation(s)
- Els van der Ven
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
| | - Lisa B Dixon
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
| | - Mark Olfson
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
| | - Todd P Gilmer
- Mailman School of Public Health, Columbia University, New York (van der Ven, Susser); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); New York State Psychiatric Institute, New York (Susser, Dixon, Olfson); Vagelos College of Physicians and Surgeons, Columbia University, New York (Dixon, Olfson); Department of Family Medicine and Public Health, University of California, San Diego, and OptumLabs, Cambridge, Massachusetts (Gilmer)
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47
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Loranger C, Fleury MJ. Factors Associated with Perceived Continuity of Care Among Patients Suffering from Mental Disorders. Community Ment Health J 2020; 56:670-679. [PMID: 31863224 DOI: 10.1007/s10597-019-00528-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 12/11/2019] [Indexed: 11/29/2022]
Abstract
This cross-sectional study identified variables associated with continuity of care among 327 patients with mental disorders receiving services from a variety of professionals in different Quebec settings. Based on the Andersen's Behavioral Model, a linear regression analysis was performed. Attention deficit and mood disorders were negatively associated with continuity of care, while substance use disorders and quality of life revealed positive associations. Consulting a psychologist was linked to weaker continuity of care whereas visiting a drug rehabilitation center, social support, and satisfaction with services were positively related. Fostering social support, comprehensive and integrated care, and facilitating access to psychologists could lead to improved continuity of care.
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Affiliation(s)
- Claudie Loranger
- Research Centre, Centre intégré de santé Et Services Sociaux de L'Outaouais, 20 rue Pharand, Gatineau, QC, J9A 1K7, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montréal, QC, Canada
- Department of Psychiatry, McGill University, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montréal, QC, Canada.
- Department of Psychiatry, McGill University, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
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48
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Jagger G, de la Fuente-Tomas L, Stochl J, Allan SM, Clay F, Kenedler L, Treise C, Perez J. Early Intervention in Psychosis Treatment Components Utilization in Patients Aged Over 35. Community Ment Health J 2020; 56:206-10. [PMID: 31564011 DOI: 10.1007/s10597-019-00479-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
Early Intervention in Psychosis (EIP) services have been youth-focused since their inception. In England, recent National Institute for Health and Care Excellence (NICE) guidelines and new National Health Service (NHS) Standards for EIP recommend the expansion of the age acceptability criterion from 14-35 to 14-65. In the Cambridgeshire and Peterborough EIP service (CAMEO), we ran a service evaluation to assess the initial impact of this policy change. It aimed to elicit EIP treatment components utilization by patients with first-episode psychosis (FEP) aged over 35, in comparison with those under 35. We found that the over-35s required more contacts from EIP healthcare professionals, especially from care coordinators (coefficient = .239; Robust SE = .102; Z = 6.42; p = 0.019) and social workers (coefficient = 18.462; Robust SE = .692; Z = .016; p < 0.001). These findings indicate that FEP patients aged over 35 may present with more complex and sustained clinical/social needs. This may have implications for EIP service development and commissioning.
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49
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Elkington KS, Lee J, Brooks C, Watkins J, Wasserman GA. 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. J Subst Abuse Treat 2020; 112:49-59. [PMID: 32199546 DOI: 10.1016/j.jsat.2020.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/16/2020] [Accepted: 01/19/2020] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Katherine S Elkington
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, United States of America.
| | - Jacqueline Lee
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, United States of America
| | - Catherine Brooks
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, United States of America
| | - Jillian Watkins
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, United States of America
| | - Gail A Wasserman
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, United States of America
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50
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Oexle N, Ribeiro W, Fisher HL, Gronholm PC, Laurens KR, Pan P, Owens S, Romeo R, Rüsch N, Evans-Lacko S. Childhood bullying victimization, self-labelling, and help-seeking for mental health problems. Soc Psychiatry Psychiatr Epidemiol 2020; 55:81-88. [PMID: 31324960 DOI: 10.1007/s00127-019-01743-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Previous research found sustained high levels of mental health service use among adults who experienced bullying victimization during childhood. This could be due to increased psychopathology among this group, but other factors, such as self-perception as having a mental health problem, might contribute to increased service use. Additionally, the relationship between informal help-seeking for mental health problems and bullying victimization is incompletely understood. METHODS The present study examined associations between the frequency of bullying victimization and both formal service use and informal help-seeking for mental health problems independent from psychopathology. Data on bullying victimization, service use, informal help-seeking for mental health problems, psychopathology, and self-labelling as a person with mental illness were collected among 422 young people aged 13-22 years. RESULTS In logistic regression models, controlling for past and current psychopathology and using no bullying victimization as the reference category, we identified a greater likelihood of mental health service use among persons who experienced frequent bullying victimization, as well as a greater likelihood of seeking informal help among persons who experienced occasional victimization. Increased self-identification as a person with mental illness completely mediated the positive association between frequent bullying victimization and mental health service use. CONCLUSIONS Our findings suggest that services to support persons who experienced frequent bullying victimization should focus on improving empowerment and self-perception. Additionally, there might be unserved need for formal support among those who experienced occasional bullying victimization.
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Affiliation(s)
- Nathalie Oexle
- Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany
| | - Wagner Ribeiro
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A2AE, UK
| | - Helen L Fisher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Petra C Gronholm
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A2AE, UK.,Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Kristin R Laurens
- School of Psychology, Australian Catholic University, Brisbane, Australia.,School of Psychiatry, University of New South Wales, Sydney, Australia.,Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Pedro Pan
- Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Department of Psychiatry, Universidade Federal de Sâo Paulo, São Paulo, Brazil
| | - Shanise Owens
- Office of Minority Health, Office of the Secretary, US Department of Health and Human Services, Rockville, MD, USA
| | - Renee Romeo
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Nicolas Rüsch
- Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany
| | - Sara Evans-Lacko
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, WC2A2AE, UK. .,Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
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