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Wittevrongel E, Kessels R, Everaert G, Vrijens M, Danckaerts M, van Winkel R. A user perspective on youth mental health services: Increasing help-seeking behaviour requires addressing service preferences and attitudinal barriers. Early Interv Psychiatry 2024. [PMID: 38853403 DOI: 10.1111/eip.13584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
AIM Although the incidence of mental health problems is highest in young people, the majority do not seek help. Reducing the discrepancy between need for care and access to services requires an understanding of the user perspective, which is largely lacking. This study aimed to examine preferences for mental health service attributes and their relative importance among young people, as well as the potential impact on actual help-seeking intentions. METHODS Youth aged 16-24 years (N = 258) participated in a discrete choice experiment. In addition to choosing which service would suit their needs most out of two service options in nine choice sets, participants were asked whether they would consult the chosen service in the case of mental health problems. Demographic information was also collected, as well as their current mental health status, experience with and perceived barriers to care. Panel mixed logit models were estimated. RESULTS Young people's preferences were mostly driven by the attribute 'format', with a preference for individual rather than group therapy. Other attributes, in order of importance, were 'wait times' (short), 'cost' (low), 'healthcare professionals' expertise' (particular experience with working with youth aged 12 to 25 years), and 'location' (house in a city). However, a majority of young people would not consult the service they had indicated, mainly due to attitudinal barriers such as wanting to deal with problems on their own (self-reliance). CONCLUSIONS Addressing psychological barriers to access care should be a priority in mental health policies. Furthermore, entry point services, in particular, should be able to provide the option of individual treatment.
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Affiliation(s)
- Eline Wittevrongel
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Centre for Clinical Psychiatry, Leuven, Belgium
- KU Leuven, University Psychiatric Centre (UPC), Leuven, Belgium
| | - Roselinde Kessels
- Department of Data Analytics and Digitalization, Maastricht University, Maastricht, The Netherlands
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Geert Everaert
- Neuro-Psychiatric Clinic Saint Joseph V.Z.W, Pittem, Belgium
| | - May Vrijens
- Asster Psychiatric Hospital, Sint-Truiden, Belgium
| | - Marina Danckaerts
- KU Leuven, University Psychiatric Centre (UPC), Leuven, Belgium
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Centre for Developmental Psychiatry, Leuven, Belgium
| | - Ruud van Winkel
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Centre for Clinical Psychiatry, Leuven, Belgium
- KU Leuven, University Psychiatric Centre (UPC), Leuven, Belgium
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Senger B, MacDonald Q, Pencer A, Crocker CE, Hughes J, Tibbo PG. Referral pathways to early intervention services for psychosis and their influence on perceptions of care: An interpretive phenomenological analysis. Early Interv Psychiatry 2024. [PMID: 38797712 DOI: 10.1111/eip.13553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/26/2023] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
AIM Most young adults experiencing psychosis enter early intervention services (EIS) via inpatient and emergency departments. These experiences are suggested to negatively impact their views of treatment and engagement in EIS. However, limited research has examined the impact of young adults' prior help-seeking experiences on these outcomes. The present study aimed to explore how young adults engaged in EIS have experienced initial help-seeking and make sense of these experiences in the context of their current treatment. METHODS Using an interpretative phenomenological analysis approach, semi-structured interviews were conducted with 12 young adults (mean age = 24.83) within their first 3-12 months of treatment in EIS. Interviews aimed to examine their experiences of help-seeking and referral to EIS as well as the impact of these experiences on their subsequent perception of, and engagement with EIS. RESULTS 3 superordinate themes emerged: (1) Navigating the Maze of Healthcare (2) Dignity and (3) Impact of Help-Seeking and Referral Experiences. Participants with referral pathways involving urgent care services described more adversity during their referral pathway and tended to describe help-seeking experiences as contributing to negative views towards EIS and diminished engagement in treatment. CONCLUSIONS The impact of early negative experiences with healthcare on views towards EIS and engagement is evident in participants' accounts. Sense making was further contextualized by participants' illness insight, degree of recovery, and social support throughout experiences. Emergent themes highlight the need for psychiatric services to emphasize service users' dignity and for EIS to provide opportunities for patients to process past negative mental healthcare experiences to strengthen engagement.
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Affiliation(s)
- Brannon Senger
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Quinn MacDonald
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alissa Pencer
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Candice E Crocker
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jean Hughes
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Philip G Tibbo
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Roach A, Bennett S, Heyman I, Coughtrey A, Stokes I, Ndoci X, Balakrishnan S, Astle N, Drinkwater J, Evans R, Frederick U, Groszmann M, Jones S, McDonnell K, Mobley A, Murray A, O’Sullivan H, Ormrod S, Prendegast T, Rajalingam U, Webster E, Webster R, Vinton G, Shafran R. Clinical effectiveness of drop-in mental health services at paediatric hospitals: A non-randomised multi-site study for children and young people and their families - study protocol. PLoS One 2024; 19:e0302878. [PMID: 38722844 PMCID: PMC11081357 DOI: 10.1371/journal.pone.0302878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/14/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Despite the high prevalence of mental health difficulties in children and young people with long-term health conditions (LTCs), these difficulties and experiences are often overlooked and untreated. Previous research demonstrated the effectiveness of psychological support provided via a drop-in mental health centre located in a paediatric hospital. The aim of this prospective non-randomised single-arm multi-centre interventional study is to determine the clinical effectiveness of drop-in mental health services when implemented at paediatric hospitals in England. METHODS It is hypothesised that families who receive psychological interventions through the drop-in services will show improved emotional and behavioural symptoms. Outcomes will be measured at baseline and at 6-month follow-up. The primary outcome is the difference in the total difficulties score on the Strengths and Difficulties Questionnaire (SDQ) reported by parent or child at 6 months. Secondary outcomes include self and parent reported Paediatric Quality of Life Inventory (PedsQL), self-reported depression (PHQ-9) and anxiety measures (GAD-7) and family satisfaction (CSQ-8). DISCUSSION This trial aims to determine the clinical effectiveness of providing psychological support in the context of LTCs through drop-in mental health services at paediatric hospitals in England. These findings will contribute to policies and practice addressing mental health needs in children and young people with other long-term health conditions. TRIAL REGISTRATION ISRCTN15063954, Registered on 9 December 2022.
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Affiliation(s)
- Anna Roach
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Great Ormond Street Children’s Hospital, London, United Kingdom
- Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Great Ormond Street Children’s Hospital, London, United Kingdom
- Cambridge Children’s Hospital Project Team and Paediatric Psychological Medicine Service, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Anna Coughtrey
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Great Ormond Street Children’s Hospital, London, United Kingdom
| | - Isabella Stokes
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- University College Hospitals, London, United Kingdom
| | - Xhorxhina Ndoci
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sonia Balakrishnan
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Nicki Astle
- Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, Cambridgeshire, United Kingdom
| | | | - Rebecca Evans
- Sheffield Children’s Hospital, Sheffield, United Kingdom
| | - Una Frederick
- Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough, United Kingdom
| | | | - Steve Jones
- Sheffield Children’s Hospital, Sheffield, United Kingdom
| | | | - Amanda Mobley
- Leeds Teaching Hospital Trust, Paediatric Psychology, E Floor Martin Wing, Leeds General Infirmary, Leeds, United Kingdom
| | - Abbie Murray
- Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough, United Kingdom
| | | | - Sarah Ormrod
- University College Hospitals, London, United Kingdom
| | | | - Usha Rajalingam
- Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, Cambridgeshire, United Kingdom
| | - Emily Webster
- Sheffield Children’s Hospital, Sheffield, United Kingdom
| | - Rebecca Webster
- Cambridge and Peterborough Foundation Trust, Child Development Centre, City Care Centre, Peterborough, United Kingdom
| | - Gareth Vinton
- University College Hospitals, London, United Kingdom
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Great Ormond Street Children’s Hospital, London, United Kingdom
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Xavier SM, Malla A, Mohan G, Mustafa S, Padmavati R, Rangaswamy T, Joober R, Schmitz N, Margolese HC, Iyer SN. Trust of patients and families in mental healthcare providers and institutions: a cross-cultural study in Chennai, India, and Montreal, Canada. Soc Psychiatry Psychiatr Epidemiol 2024; 59:813-825. [PMID: 37848572 DOI: 10.1007/s00127-023-02576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada, and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up. METHODS Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Nonparametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers. RESULTS The study included 333 patients (Montreal = 165, Chennai = 168) and 324 family members (Montreal = 128, Chennai = 168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up. CONCLUSION This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes.
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Affiliation(s)
- Salomé M Xavier
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
- University of Warwick, Coventry, CV4 7AL, UK
| | - Sally Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Ramachandran Padmavati
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
| | - Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, 600 101, Tamil Nadu, India
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
- University of Tübingen, Geschwister-Scholl-Platz 72074, Tübingen, Germany
| | - Howard C Margolese
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
- Prevention and Early Intervention Program for Psychosis, McGill University Health Centre (PEPP-MUHC), 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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Ridout B, Forsyth R, Amon KL, Navarro P, Campbell AJ. The Urgent Need for an Evidence-Based Digital Mental Health Practice Model of Care for Youth. JMIR Ment Health 2024; 11:e48441. [PMID: 38534006 PMCID: PMC11004617 DOI: 10.2196/48441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 01/07/2024] [Accepted: 01/25/2024] [Indexed: 03/28/2024] Open
Abstract
Australian providers of mental health services and support for young people include private and public allied health providers, government initiatives (eg, headspace), nongovernment organizations (eg, Kids Helpline), general practitioners (GPs), and the hospital system. Over 20 years of research has established that many young people prefer to seek mental health support online; however, clear client pathways within and between online and offline mental health services are currently lacking. The authors propose a Digital Mental Health Practice model of care for youth to assist with digital mental health service mapping. The proposed model offers accessible pathways for a client to engage with digital mental health services, provides clear navigation to access support for individual needs, and facilitates a seamless connection with offline mental health services using a transferable electronic health records system. This future-looking model also includes emerging technologies, such as artificial intelligence and the metaverse, which must be accounted for as potential tools to be leveraged for digital therapies and support systems. The urgent need for a user-centered Digital Mental Health Practice model of care for youth in Australia is discussed, highlighting the shortcomings of traditional and existing online triage models evident during the COVID-19 pandemic, and the complex challenges that must be overcome, such as the integration of diverse mental health care providers and establishment of a robust electronic health records system. Potential benefits of such a model include reduced pressure on emergency rooms, improved identification of immediate needs, enhanced referral practices, and the establishment of a cost-efficient national digital mental health care model with global applicability. The authors conclude by stressing the consequences of inaction, warning that delays may lead to more complex challenges as new technologies emerge and exacerbate the long-term negative consequences of poor mental health management on the economic and biopsychosocial well-being of young Australians.
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Affiliation(s)
- Brad Ridout
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rowena Forsyth
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Krestina L Amon
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Andrew J Campbell
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Rutherford K, Hiseler L, O'Hagan F. Help! I Need Somebody: Help-Seeking Among Workers with Self-Reported Work-Related Mental Disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2024; 34:197-215. [PMID: 37639211 DOI: 10.1007/s10926-023-10123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Worker mental health has emerged as one of the most significant challenges in contemporary workplaces. Knowing what intervention is effective is important to help workers adapt to mental health disorders but connecting workers to helpful resources is just as important and perhaps more of a challenge. With the multiple stakeholders involved, mental health disorders arising in the workplace pose specific challenges to help-seeking. The present study sought to explore the lived experience of workers and the personal and contextual influences on help-seeking among workers with work-related mental health disorders. METHODS A qualitative methodology was employed utilizing purposive sampling to conduct semi-structured interviews with individuals (n = 12) from various occupational backgrounds who had experienced a work-related (self-declared) mental health disorder. A Critical Theory approach was used to inform study design and analysis. Interpretative phenomenological analysis and thematic content analysis were combined to analyze the data. RESULTS Three main themes emerged including: (1) self-preservation through injury concealment and distancing themselves from workplace stressors to minimize/avoid internal and external stigma; (2) fatigue relating to complex help-seeking pathways, accumulation of stressors, eroding the worker's ability to make independent decisions regarding supports; and (3) (mis)trust contributed to resources accessed by participants. CONCLUSIONS Along with internalized stigma, findings point to the important role of social identity and trust and how these are influenced by relationships and organizational contexts. Findings indicate the need to educate workplace parties such as supervisors on mental health and pathways to help, simplifying pathways to service and removing barriers to help seeking including stigmatizing behaviours. Future quantitative research and intervention development directed at workplace mental health should integrate models and frameworks emphasizing relational and organizational dimensions in help-seeking.
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Affiliation(s)
- Kara Rutherford
- Department of Psychology, Trent University, Peterborough, ON, Canada
| | - Lara Hiseler
- Department of Psychology, Trent University, Peterborough, ON, Canada
| | - Fergal O'Hagan
- Department of Psychology, Trent University, Peterborough, ON, Canada.
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Wittevrongel E, van Winkel R, Jackers M, Colman L, Versyck M, Camp E, Everaert G, Vrijens M, Baeyens D, Danckaerts M. How to make mental health services more youth-friendly? A Delphi study involving young adults, parents and professionals. Health Expect 2023; 26:2532-2548. [PMID: 37608557 PMCID: PMC10632649 DOI: 10.1111/hex.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/15/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Although youth-friendly service characteristics have been previously identified, consensus among a representative group of stakeholders about which of these characteristics are truly relevant to the youth-friendliness of services is currently lacking. In our study, young adults, parents and professionals were consulted on this topic to reveal existing (dis)agreement. In addition, (dis)agreement on feasibility for implementation in clinical practice was also assessed. METHODS A mixed-method Delphi approach was used with three online questionnaire rounds and a physical meeting. Young adults (18-26 years) and parents were part of a public panel and professionals were allocated to the professional panel. In the rounds, participants were asked to rate the importance and feasibility of each item. Subsequently, the percentage agreement (% of participants giving a score of 7 or above on a 9-point Likert scale) within and across panels was calculated. Consensus was assumed to have been reached when at least 70% agreement was achieved. A thematic analysis of the qualitative data, obtained in the rounds and the physical meeting, was performed to identify overarching themes and characteristics of relevance to the youth-friendliness of services. RESULTS For 65% of the items included in the Delphi questionnaire, consensus on importance was reached within both panels. Participants showed more insecurity about the feasibility of these items, however. Our thematic analysis revealed reasons for disagreement between and within the panels. CONCLUSIONS Our study revealed substantial between- and within-panel agreement on youth-friendly service characteristics. We recommend that the items for which consensus was reached should be used as a checklist in terms of youth mental health service development, design and delivery. The characteristics for which there was disagreement between and within the panels should inspire an ongoing trialogue between young adults, parents and professionals both on the individual level and the service level. PATIENT OR PUBLIC CONTRIBUTION In this study, (parents of) young adults with lived experience were included as experts, including one of the coauthors. This coauthor contributed to the manuscript by having a final say about the included quotes.
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Affiliation(s)
- Eline Wittevrongel
- Department of Neurosciences, Research Group Psychiatry, Center for Clinical PsychiatryKU LeuvenLeuvenBelgium
- University Psychiatric Center (UPC) KU LeuvenLeuvenBelgium
| | - Ruud van Winkel
- Department of Neurosciences, Research Group Psychiatry, Center for Clinical PsychiatryKU LeuvenLeuvenBelgium
- University Psychiatric Center (UPC) KU LeuvenLeuvenBelgium
| | - Maarten Jackers
- Department of Neurosciences, Research Group Psychiatry, Center for Clinical PsychiatryKU LeuvenLeuvenBelgium
| | | | - Melina Versyck
- Faculty of MedicineKU LeuvenLeuvenBelgium
- mArquee Multiversum Psychiatric HospitalAntwerpenBelgium
| | - Eline Camp
- Faculty of MedicineKU LeuvenLeuvenBelgium
| | - Geert Everaert
- Neuro‐Psychiatric Clinic Saint Joseph V.Z.W.PittemBelgium
| | - May Vrijens
- Asster Psychiatric HospitalSint‐TruidenBelgium
| | - Dieter Baeyens
- Faculty of Psychology and Educational Sciences, Parenting and Special EducationKU LeuvenLeuvenBelgium
| | - Marina Danckaerts
- University Psychiatric Center (UPC) KU LeuvenLeuvenBelgium
- Department of Neurosciences, Research Group Psychiatry, Center for Developmental PsychiatryKU LeuvenLeuvenBelgium
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Sampogna G, Brohan E, Luciano M, Chowdhary N, Fiorillo A. Psychosocial interventions for carers of people with severe mental and substance use disorders: a systematic review and meta-analysis. Eur Psychiatry 2023; 66:e98. [PMID: 37997647 PMCID: PMC10755580 DOI: 10.1192/j.eurpsy.2023.2472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Severe mental disorders - such as schizophrenia, bipolar disorder, and substance use disorders - exert a negative impact not only on affected people but also on their carers. To support carers of people with severe mental disorders, several psychosocial interventions have been developed. METHODS This systematic review and meta-analysis aimed to assess whether psychosocial interventions for carers of persons with schizophrenia, bipolar disorder, or substance use disorders produce benefit/harm with respect to a series of outcomes - including subjective and objective burden, depressive symptoms, well-being/quality of life, sleep, skills/knowledge, self-efficacy, physical health - as compared to standard support/support as usual or other control conditions. RESULTS In carers of persons with schizophrenia, psychoeducational interventions were associated with significant improvement in personal burden, well-being, and knowledge about the illness; and a supportive-educational intervention with an improvement in personal burden. In carers of persons with bipolar disorder, psychoeducational interventions were associated with significant improvement in personal burden and depressive symptoms; family-led supportive interventions with an improvement in family burden; family-focused intervention and online "mi.spot" intervention with a significant reduction in depressive symptoms. Psychosocial interventions used for carers of persons with substance use disorders were found to be overall effective on the level of well-being, but the low number of trials did not allow detection of differences between the various psychosocial interventions. CONCLUSIONS The quality of the evidence ranged from very low to moderate, suggesting the need for further better-quality research.
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Affiliation(s)
- Gaia Sampogna
- Department of Mental Health, University of Campania “L. Vanvitelli”, Naples, Italy
- WHO Collaborating Centre for Research and Training, Naples, Italy
| | - Elaine Brohan
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mario Luciano
- Department of Mental Health, University of Campania “L. Vanvitelli”, Naples, Italy
- WHO Collaborating Centre for Research and Training, Naples, Italy
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Andrea Fiorillo
- Department of Mental Health, University of Campania “L. Vanvitelli”, Naples, Italy
- WHO Collaborating Centre for Research and Training, Naples, Italy
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Richardson CL, Black D, Lindsey L, Nazar H. Community pharmacies as a place for informal carer support in mental health and wellbeing. Int J Clin Pharm 2023; 45:1302-1306. [PMID: 37269442 PMCID: PMC10239217 DOI: 10.1007/s11096-023-01606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/12/2023] [Indexed: 06/05/2023]
Abstract
There are 5.3 million informal carers in the United Kingdom who take on caring responsibilities for family and friends. Informal carers can be forgotten patients within health and care services, yet because of carer burden, they are at risk of deterioration in health and wellbeing. There are higher levels of anxiety, depression, burnout and low self-esteem amongst carers but, to our knowledge work to date has mainly focused on supporting carers to provide better care for their family member, and less on carers' health and wellbeing. There is increasing interest in social prescribing as a method of linking patients with community-based services to improve health and wellbeing. Initiatives have included social prescribing via community pharmacies which are already recognized to be accessible for support and signposting. The coming together of community pharmacy services and social prescribing could represent a framework to better support carers in their mental health and wellbeing.
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Affiliation(s)
- Charlotte Lucy Richardson
- Faculty of Medical Sciences, School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, NE2 7RU, UK.
| | - David Black
- Faculty of Medical Sciences, School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, NE2 7RU, UK
| | - Laura Lindsey
- Faculty of Medical Sciences, School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, NE2 7RU, UK
| | - Hamde Nazar
- Faculty of Medical Sciences, School of Pharmacy, Newcastle University, King George VI Building, Newcastle Upon Tyne, NE2 7RU, UK
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Pederson CA, Dir AL, Schwartz K, Ouyang F, Monahan PO, Tu W, Wiehe SE, Aalsma MC. Associations between outpatient treatment and the use of intensive psychiatric healthcare services. Clin Child Psychol Psychiatry 2023; 28:1380-1392. [PMID: 36737059 DOI: 10.1177/13591045231154106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The current manuscript examines concurrent and longitudinal associations between the utilization of outpatient and intensive psychiatric services among Medicaid-enrolled youth. Using an administrative dataset of Medicaid claims from 2007 to 2017, youth were included if they were between the ages of 10-18 (M = 13.4, SD = 2.6) and had a psychiatric Medicaid claim (N = 33,590). Psychiatric services were coded as outpatient, emergency department (ED), inpatient, or residential based on Medicaid codes. Logistic regression analyses indicated that the receipt of even one outpatient visit significantly reduced the odds of having an ED, inpatient, and residential visit within 60-, 90-, and 120-day windows. Survival analyses indicated most youth did not have any ED, inpatient, or residential visit following their first outpatient visit. For remaining youth, having an outpatient visit significantly increased the risk of having an ED, inpatient, and residential visit following their initial appointment, which may suggest these youth are being triaged to a more appropriate level of care. Classification accuracy analyses indicated a cutoff of 2 outpatient visits yielded maximum accuracy in determining youth with ED, inpatient, and residential visits. Findings highlight use of outpatient-level services in reducing risk of more intensive service utilization.
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Affiliation(s)
- Casey A Pederson
- Indiana University School of Medicine, Department of Psychiatry, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
| | - Allyson L Dir
- Indiana University School of Medicine, Department of Psychiatry, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
| | - Katherine Schwartz
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Indiana University School of Medicine, Department of Biostatistics & Health Data Sciences, Indianapolis, IN, USA
| | - Patrick O Monahan
- Indiana University School of Medicine, Department of Biostatistics & Health Data Sciences, Indianapolis, IN, USA
| | - Wanzhu Tu
- Indiana University School of Medicine, Department of Biostatistics & Health Data Sciences, Indianapolis, IN, USA
| | - Sarah E Wiehe
- Indiana University School of Medicine, Department of Pediatrics, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA
| | - Matthew C Aalsma
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
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11
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Wong R, Podolsky A, Levitt A, Da Silva A, Kodeeswaran S, Markoulakis R. A Qualitative Exploration of Ontario Caregivers' Perspectives of Their Role in Navigating Mental Health and/or Addiction Services for Their Youth. J Behav Health Serv Res 2023; 50:486-499. [PMID: 37311969 DOI: 10.1007/s11414-023-09843-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/15/2023]
Abstract
Many youth experiencing mental health and/or addiction (MHA) concerns rely on their caregivers to find and access services. Considering that caregivers often play a significant role in their youth's treatment trajectory, a descriptive qualitative study was used to explore how caregivers (n = 26) in the Greater Toronto Area perceive their role in navigating MHA care for their youth (ages 13 to 26). The Person-Environment-Occupation model was used to guide the thematic analysis. The findings reveal three main themes (1) the internal experience of caregiving, which describes caregivers' emotions and thought processes; (2) the external factors impacting the caregiver's ability to find and access youth MHA services, which explores systemic and social factors that impact navigation; and (3) the demands of the caregiving role. The discussion highlights the importance of supporting the wellbeing of caregivers as they navigate youth MHA services and can provide useful information for healthcare professionals and policy-makers to increase equitable access to youth MHA services.
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Affiliation(s)
- Rachel Wong
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Anna Podolsky
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Anthony Levitt
- Sunnybrook Research Institute, Toronto, ON, Canada
- Family Navigation Project, Sunnybrook Health Sciences Centre, 1929 Bayview Avenue, RM 205, Toronto, ON, M4G 3E8, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Sugy Kodeeswaran
- Family Navigation Project, Sunnybrook Health Sciences Centre, 1929 Bayview Avenue, RM 205, Toronto, ON, M4G 3E8, Canada
| | - Roula Markoulakis
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
- Sunnybrook Research Institute, Toronto, ON, Canada.
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12
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Boonstra A, van Mastrigt GAPG, Evers SMAA, van Amelsvoort TAMJ, Leijdesdorff SMJ. @ease peer-to-peer youth walk-in centres in The Netherlands: A protocol for evaluating longitudinal outcomes, follow-up results and cost-of-illness. Early Interv Psychiatry 2023; 17:929-938. [PMID: 37283500 DOI: 10.1111/eip.13443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/06/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023]
Abstract
AIM Innovative youth mental health services around the globe vigorously work on increasing highly needed mental health care accessibility but their service users and care effectiveness have rarely been studied. The Dutch youth walk-in centres of @ease opened in 2018, with currently 11 locations at which free anonymous peer-to-peer counselling is offered to young people aged 12-25. The aim of this protocol is to outline the to-be-conducted research at @ease. METHODS Three studies are outlined: (1) an outcome evaluation of @ease visits using hierarchical mixed model analyses and change calculations, (2) a cost-of-illness study using calculations for costs of truancy and care usage among these help-seeking young people, with regression analyses for risk group identification, and (3) a follow-up evaluation at three, six and 12 months to assess long-term effects after ending @ease visits. Data provided by young people include demographics, parental mental illness, truancy, past treatment, psychological distress (CORE-10) and health-related quality of life (EQ-5D-5L). Social and occupational functioning (SOFAS), suicidal ideation and need for referral are rated by the counsellors. Questionnaires are filled out at the end of every visit and at follow-up via e-mail or text, provided permission is given. DISCUSSION Research regarding the visitors and effectiveness of the @ease services is fully original. It offers unique insights into the mental wellbeing and cost-of-illness of young people who may otherwise remain unseen while suffering from a high disease burden. The upcoming studies shed light on this unseen group, inform policy and practice and direct future research.
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Affiliation(s)
- Anouk Boonstra
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ghislaine A P G van Mastrigt
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Silvia M A A Evers
- CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | | | - Sophie M J Leijdesdorff
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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13
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Davis A, Gourdine R. Intersectionality and Social Security Age-18 Redetermination: Reducing the Stress and Trauma of Transition for Black Transition-Age Youth with Disabilities. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2023; 40:513-523. [PMID: 38031577 PMCID: PMC10686266 DOI: 10.1007/s10560-022-00892-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/01/2023]
Abstract
Greater attention is being paid to the transition to adulthood for youth with disabilities. We are also at a period of reckoning with the vestiges of slavery, Jim Crow, and a lack of constitutional protections for Black-identifying persons. The contemporary impact of inequitable access to opportunities, services, and supports that would improve the quality of life of racialized Black individuals has added consequences for Black youth with disabilities. A sub-population of youth with disabilities receives monthly support in the form of Supplemental Security Income (SSI), with a disproportionate number of Black-identifying youth qualifying for SSI. Such youth are impacted by the intersectionality of racism, disability, and poverty. The outcome of an SSI age-18 redetermination can be precarious and occurs in the backdrop of these intersectional forces, impacting the life course of racialized Black youth and their families on a scale that is concerning. The authors describe the time frames of pre age-18 redetermination, age-18 redetermination and post age-18 redetermination in the contexts of intersectionality and transition, and articulate what type of services and supports can reduce the experience of chronic stress in the lives of racialized Black youth facing an SSI age-18 redetermination, and thereby improve the outcomes of these youth as they transition to adulthood.
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Affiliation(s)
- Amber Davis
- Johns Hopkins University, 716 North Broadway, Baltimore, MD 21205, USA
| | - Ruby Gourdine
- Professor Emeritus, Howard University, 601 Howard Place NW, Washington, DC 20059, USA
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14
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Savaglio M, Yap MBH, Smith T, Vincent A, Skouteris H. "I literally had no support": barriers and facilitators to supporting the psychosocial wellbeing of young people with mental illness in Tasmania, Australia. Child Adolesc Psychiatry Ment Health 2023; 17:67. [PMID: 37296407 DOI: 10.1186/s13034-023-00621-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND There has been limited focus on understanding the barriers and facilitators to meeting the broader psychosocial needs of young people with mental illness from the perspectives of young people. This is required to advance the local evidence base and inform service design and development. The aim of this qualitative study was to explore young people's (10-25 years) and carers' experiences of mental health services, focusing on barriers and facilitators to services supporting young people's psychosocial functioning. METHODS This study was conducted throughout 2022 in Tasmania, Australia. Young people with lived experience of mental illness were involved in all stages of this research. Semi-structured interviews were conducted with 32 young people aged 10-25 years with experience of mental illness, and 29 carers (n = 12 parent-child dyads). Qualitative analysis was guided by the Social-Ecological Framework to identify barriers and facilitators at the individual (young person/carer level), interpersonal, and service/systemic level. RESULTS Young people and carers identified eight barriers and six facilitators across the various levels of the Social-Ecological Framework. Barriers included, at the individual level: (1) the complexity of young people's psychosocial needs and (2) lack of awareness/knowledge of services available; at the interpersonal level: (3) negative experiences with adults and (4) fragmented communication between services and family; and at the systemic level: (5) lack of services; (6) long waiting periods; (7) limited service accessibility; and (8) the missing middle. Facilitators included, at the individual level: (1) education for carers; at the interpersonal level: (2) positive therapeutic relationships and (3) carer advocacy/support; and at the systemic level: (4) flexible or responsive services, (5) services that address the psychosocial factors; and (6) safe service environments. CONCLUSIONS This study identified key barriers and facilitators to accessing and utilising mental health services that may inform service design, development, policy and practice. To enhance their psychosocial functioning, young people and carers want lived-experience workers to provide practical wrap-around support, and mental health services that integrate health and social care, and are flexible, responsive and safe. These findings will inform the co-design of a community-based psychosocial service to support young people experiencing severe mental illness.
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Affiliation(s)
- Melissa Savaglio
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Marie B H Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toni Smith
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | | | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Warwick Business School, University of Warwick, Coventry, UK.
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15
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Hugunin J, Khan S, McPhillips E, Davis M, Larkin C, Skehan B, Lapane KL. Pediatrician and Child Adolescent Psychiatrist Perspectives of Coordinated Care for Emerging Adults. J Adolesc Health 2023; 72:770-778. [PMID: 36604207 PMCID: PMC10121759 DOI: 10.1016/j.jadohealth.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/03/2022] [Accepted: 12/01/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To explore pediatrician and child/adolescent psychiatrists' perspectives of the role of coordinated care for emerging adults with serious mental health conditions, particularly as they transition to adult care. METHODS Semi-structured individual interviews of a purposive sample of 10 pediatricians and 11 child/adolescent psychiatrists in Massachusetts were used to explore coordinated care for emerging adults. Following verbatim transcription and double coding, we conducted a thematic analysis to identify key themes. Care coordination concepts explored included a case discussion, teamwork, communication methods, medication management, transition to adult care, the healthcare home, and youth and family role. Organizational and societal barriers were also discussed. RESULTS Providers described key barriers to continuous, coordinated care for youth with serious mental health conditions, including poor communication systems between providers, no organized process for the transition from pediatric to adult care, state licensing laws (particularly impacting college-age youth), inadequate connection to community supports, and poor reimbursement rates for psychiatric care. Termination of primary care in young adults and inadequate medication side effect monitoring were described as key gaps in care. DISCUSSION The current system of coordinated care for emerging adults with serious mental health conditions is a perfect storm of challenges that creates a vicious cycle of interconnected barriers which lead to fragmented, discontinuous, and sub-par care for this population.
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Affiliation(s)
- Julie Hugunin
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
| | - Sara Khan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Emily McPhillips
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Celine Larkin
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts; Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Brian Skehan
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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16
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Giabbanelli PJ, Rice KL, Nataraj N, Brown MM, Harper CR. A systems science approach to identifying data gaps in national data sources on adolescent suicidal ideation and suicide attempt in the United States. BMC Public Health 2023; 23:627. [PMID: 37005568 PMCID: PMC10067278 DOI: 10.1186/s12889-023-15320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 02/24/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Suicide is currently the second leading cause of death among adolescents ages 10-14, and third leading cause of death among adolescents ages 15-19 in the United States (U.S). Although we have numerous U.S. based surveillance systems and survey data sources, the coverage offered by these data with regard to the complexity of youth suicide had yet to be examined. The recent release of a comprehensive systems map for adolescent suicide provides an opportunity to contrast the content of surveillance systems and surveys with the mechanisms listed in the map. OBJECTIVE To inform existing data collection efforts and advance future research on the risk and protective factors relevant to adolescent suicide. METHODS We examined data from U.S. based surveillance systems and nationally-representative surveys that included (1) observations for an adolescent population and (2) questions or indicators in the data that identified suicidal ideation or suicide attempt. Using thematic analysis, we evaluated the codebooks and data dictionaries for each source to match questions or indicators to suicide-related risk and protective factors identified through a recently published suicide systems map. We used descriptive analysis to summarize where data were available or missing and categorized data gaps by social-ecological level. RESULTS Approximately 1-of-5 of the suicide-related risk and protective factors identified in the systems map had no supporting data, in any of the considered data sources. All sources cover less than half the factors, except the Adolescent Brain Cognitive Development Study (ABCD), which covers nearly 70% of factors. CONCLUSIONS Examining gaps in suicide research can help focus future data collection efforts in suicide prevention. Our analysis precisely identified where data is missing and also revealed that missing data affects some aspects of suicide research (e.g., distal factors at the community and societal level) more than others (e.g., proximal factors about individual characteristics). In sum, our analysis highlights limitations in current suicide-related data availability and provides new opportunities to identify and expand current data collection efforts.
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Affiliation(s)
- Philippe J Giabbanelli
- Department of Computer Science and Software Engineering, Miami University, 205W Benton Hall, High St, Oxford, OH, 45056, USA.
| | - Ketra L Rice
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Nisha Nataraj
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Margaret M Brown
- Defense Suicide Prevention Office (DSPO), Department of Defense, Washington, DC, USA
| | - Christopher R Harper
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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17
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Sheikhan NY, Henderson JL, Halsall T, Daley M, Brownell S, Shah J, Iyer SN, Hawke LD. Stigma as a barrier to early intervention among youth seeking mental health services in Ontario, Canada: a qualitative study. BMC Health Serv Res 2023; 23:86. [PMID: 36703119 PMCID: PMC9877499 DOI: 10.1186/s12913-023-09075-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Stigma associated with mental health challenges is a major barrier to service seeking among youth. Understanding how stigma impacts service-seeking decisions from the perspectives of youth remains underexplored. Such research is necessary to inform effective stigma reduction. OBJECTIVE This study aims to understand how stigma influences service seeking among youth with mental health challenges. METHODS Qualitative inquiry was taken using youth engagement, underpinned by pragmatism. Data were collected via 4 virtual focus groups with 22 purposively selected youth participants with lived experience of mental health challenges in Ontario, Canada. Focus group guides were developed collaboratively among research team members, including youth co-researchers. Data were analyzed inductively using reflexive thematic analysis. RESULTS Three main themes were constructed from the data: point of entry into the system, being biomedicalized or trivialized, and paving the way for non-stigmatizing services. Initial contact with the mental healthcare system was seen to be affected by stigma, causing participants to delay contact or be refused services if they do not fit with an expected profile. Participants described a constant negotiation between feeling 'sick enough' and 'not sick enough' to receive services. Once participants accessed services, they perceived the biomedicalization or trivialization of their challenges to be driven by stigma. Lastly, participants reflected on changes needed to reduce stigma's effects on seeking and obtaining services. CONCLUSION A constant negotiation between being 'sick enough' or 'not sick enough' is a key component of stigma from the perspectives of youth. This tension influences youth decisions about whether to seek services, but also service provider decisions about whether to offer services. Building awareness around the invisibility of mental health challenges and the continuum of wellness to illness may help to break down stigma's impact as a barrier to service seeking. Early intervention models of care that propose services across the spectrum of challenges may prevent the sense of stigma that deters youth from accessing and continuing to access services.
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Affiliation(s)
- Natasha Y. Sheikhan
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
| | - Jo L. Henderson
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
| | - Tanya Halsall
- grid.28046.380000 0001 2182 2255University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, ON K1Z 7K4 Canada
| | - Mardi Daley
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
| | - Samantha Brownell
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
| | - Jai Shah
- grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1 Canada
| | - Srividya N. Iyer
- grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1 Canada
| | - Lisa D. Hawke
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
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18
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Self-Identification of Mental Health Problems Among Young Adults Experiencing Homelessness. Community Ment Health J 2023; 59:844-854. [PMID: 36681751 PMCID: PMC9867546 DOI: 10.1007/s10597-022-01068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/05/2022] [Indexed: 01/22/2023]
Abstract
Young adults experiencing homelessness (YAEH) have high rates of mental health problems but low rates of mental health service use. This study examined identification of mental health problems among YAEH in seven U.S. cities and its relationship to service use. YAEH that screened positive for depression, psychological distress, or Post Traumatic Stress (n = 892) were asked whether they felt they had a mental health problem. One-third identified as having a mental health problem (35%), with 22% endorsing not sure. Multinomial logistic regression models found that older age, cisgender female or gender-expansive (compared to cisgender male), and LGBQ sexual orientation, were positively associated with self-identification and Hispanic race/ethnicity (compared to White) was negatively associated. Self-identification of a mental health problem was positively associated with use of therapy, medications, and reporting unmet needs. Interventions should target understanding mental health, through psychoeducation that reduces stigma, or should reframe conversations around wellness, reducing the need to self-identify.
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19
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Leclair MC, Charette Y, Seto M, Nicholls TL, Roy L, Dufour M, Crocker AG. Barriers and facilitators of access and utilization of mental health services among forensic service users along the care pathway. BMC Health Serv Res 2022; 22:1495. [PMID: 36476220 PMCID: PMC9730649 DOI: 10.1186/s12913-022-08848-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The verdict of Not Criminally Responsible on account of a Mental Disorder (NCRMD) is increasingly used to access specialized mental health services in Canada and elsewhere. This situation highlights the importance of ensuring timely access to services in the community to prevent violence and justice involvement. The objective of the present study is to identify individual and contextual barriers and facilitators of access to mental health services during the period preceding an offense leading to a verdict of NCRMD. METHODS The sample includes 753 people found NCRMD in Québec, Canada. All episodes of mental health hospitalizations and service use before the index offense were identified using provincial administrative health data, for an average period of 4.5 years. Access was conceptualized as a function of the possibility of seeking, reaching and receiving appropriate health care services, based on Lévesque and colleagues patient-centred model of access to care. Generalized linear models were computed to identify the individual and contextual predictors of: (1) seeking mental healthcare (at least one contact with any type of services for mental health reasons); (2) reaching psychiatric care (at least one contact with a psychiatrist); (3) receiving psychiatric care, operationalized as (3a) continuity and (3b) intensity. Factors associated with volume of emergency mental health services were examined as exploratory analysis. RESULTS Geographical considerations were highly important in determining who reached, and who received specialized mental health care - above and beyond individual factors related to need. Those who lived outside of major urban centres were 2.6 times as likely to reach psychiatric services as those who lived in major urban centres, and made greater use of emergency mental health services by 2.1 times. Living with family decreased the odds of seeking mental healthcare by half and the intensity of psychiatric care received, even when adjusting for level of need. CONCLUSIONS Findings support efforts to engage with the family of service users and highlights the importance of providing resources to make family-centred services sustainable for health practitioners. Health policies should also focus on the implementation of outreach programs, such as Forensic Assertive Community Treatment teams as part of prevention initiatives.
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Affiliation(s)
- Marichelle C. Leclair
- grid.14848.310000 0001 2292 3357Department of Psychology & School of Public Health, Université de Montréal, Montréal, Canada ,Institut national de psychiatrie légale Philippe-Pinel, Montréal, Canada
| | - Yanick Charette
- Institut national de psychiatrie légale Philippe-Pinel, Montréal, Canada ,grid.23856.3a0000 0004 1936 8390School of Social Work and Criminology, Université Laval, Québec City, Canada
| | - Michael Seto
- Forensic Research Unit, Royal Ottawa Health Care Group, Ottawa, Canada
| | - Tonia L. Nicholls
- grid.498716.50000 0000 8794 2105Department of Psychiatry, University of British Columbia & British Columbia (BC) Mental Health & Substance Use Services, Vancouver, Canada
| | - Laurence Roy
- Institut national de psychiatrie légale Philippe-Pinel, Montréal, Canada ,grid.14709.3b0000 0004 1936 8649School of Occupational Therapy, McGill University, Montréal, Canada
| | - Mathieu Dufour
- Institut national de psychiatrie légale Philippe-Pinel, Montréal, Canada
| | - Anne G. Crocker
- Institut national de psychiatrie légale Philippe-Pinel, Montréal, Canada ,grid.14848.310000 0001 2292 3357Department of Psychiatry and Addictology & School of Criminology, Université de Montréal, Montréal, Canada
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20
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Leclair MC, Charette Y, Caulet M, Crocker AG. Care Pathways, Health Service Use Patterns and Opportunities for Justice Involvement Prevention Among Forensic Mental Health Clients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:907-917. [PMID: 35130089 PMCID: PMC9659796 DOI: 10.1177/07067437221076723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The objective of the present study is to describe the patterns of health service use and of prescription claims in the year preceding an offense leading to a verdict of not criminally responsible on account of a mental disorder (NCRMD). METHODS Provincial health administrative databases were used to identify medical services, hospitalizations, and ambulatory prescription claims among 1,014 individuals found NCRMD in Québec. Contacts in the year preceding the offense were analyzed using descriptive analyses and latent class analysis. RESULTS Overall, 71.4% of subjects were in contact with services for mental health reasons within a year of their NCRMD offense. Among those that received services and not hospitalized for psychiatric reasons at the time of the offense, 20.7% committed the NCRMD offense within a week of the most recent mental health contact. Among those that had at least one prescription claim for an antipsychotic, 45.8% were not taking any antipsychotic at the time of the offense. Latent class analysis provided a multidimensional representation of mental health service use and showed that 58.4% of subjects had no or very rare contact with services. CONCLUSIONS Many forensic patients are likely to have experienced service disruption or discontinuity while in the community, for reasons that may relate to perceived need for care, to service organization, or to the acceptability, availability, and accessibility of services. Given the serious impact of the "forensic" label on the lives of service users, not to mention the increased pressure on resources, the considerable economic costs, and the impact on victims, there is reason to advocate for a greater involvement of mental and physical health service providers in early prevention of violence, which requires reorganizing resources to share the forensic knowledge upstream, before an offense is committed.
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Affiliation(s)
- Marichelle C Leclair
- Department of Psychology, Université de Montréal, Institut national de psychiatrie légale Philippe-Pinel, Montréal, QC, Canada
| | - Yanick Charette
- School of Social Work and Criminology, Université Laval, Institut national de psychiatrie légale Philippe-Pinel, Québec City, QC, Canada4440
| | - Malijaï Caulet
- 5599Institut national de psychiatrie légale Philippe-Pinel, Montréal, QC, Canada
| | - Anne G Crocker
- Department of Psychiatry & Addictions and School of Criminology, Université de Montréal, 5599Institut national de psychiatrie légale Philippe-Pinel, Montréal, QC, Canada
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21
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Henderson J, Hawke LD, Iyer SN, Hayes E, Darnay K, Mathias S, Thabane L. Youth Perspectives on Integrated Youth Services: A Discrete Choice Conjoint Experiment. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:524-533. [PMID: 34874207 PMCID: PMC9234900 DOI: 10.1177/07067437211044717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Integrated youth services (IYS) are an emerging model of care offering a broad range of mental health and social services for youth in one location. This study aimed to determine the IYS service characteristics most important to youth, as well as to determine whether different classes of youth have different service preferences, and if so, what defines these classes. METHODS Ontario youth aged 14-29 years with mental health challenges were recruited to participate in a discrete choice experiment (DCE) survey. The DCE contained 12 attributes, each represented by 4 levels representing core characteristics of IYS models. To supplement the DCE questions, demographic information was collected and a mental health screener was administered. Preferences were examined, latent class analyses were conducted, and latent classes were compared. RESULTS As a whole, participants endorsed the IYS model of service delivery. Among 274 youth, there were three latent classes: 1) the Focused Service (37.6%) latent class prioritized efficient delivery of mental health services. 2) The Holistic Services (30.3%) latent class prioritized a diverse array of mental health and social services delivered in a timely fashion. 3) The Responsive Services (32.1%) latent class prioritized services that matched the individual needs of the youth being served. Differences between classes were observed based on sociodemographic and clinical variables. CONCLUSIONS IYS is an acceptable model of care, in that it prioritizes components that reflect youth preferences. The differences in preference profiles of different groups of youth point to the need for flexible models of service delivery. Service design initiatives should take these preferences into account, designing services that meet the needs and preferences of a broad range of youth. Working locally to co-design services with the youth in the target population who wish to be engaged will help meet the needs of youth.
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Affiliation(s)
- Joanna Henderson
- 26632Centre for Addiction and Mental Health.,7978University of Toronto Department of Psychiatry
| | - Lisa D Hawke
- 26632Centre for Addiction and Mental Health.,7978University of Toronto Department of Psychiatry
| | | | - Em Hayes
- 26632Centre for Addiction and Mental Health
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22
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Birnbaum ML, Garrett C, Baumel A, Germano NT, Lee C, Sosa D, Ngo H, Fox KH, Dixon L, Kane JM. Digital Strategies to Accelerate Help-Seeking in Youth With Psychiatric Concerns in New York State. Front Psychiatry 2022; 13:889602. [PMID: 35664474 PMCID: PMC9157179 DOI: 10.3389/fpsyt.2022.889602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mental illness in transition age youth is common and treatment initiation is often delayed. Youth overwhelmingly report utilizing the Internet to gather information while psychiatric symptoms emerge, however, most are not yet ready to receive a referral to care, forestalling the established benefit of early intervention. Methods A digital outreach campaign and interactive online care navigation platform was developed and deployed in New York State on October 22, 2020. The campaign offers live connection to a peer or counselor, a self-assessment mental health quiz, and educational material all designed to promote help-seeking in youth and their allies. Results Between October 22, 2020 and July 31, 2021, the campaign resulted in 581,981 ad impressions, 16,665 (2.9%) clicks, and 13,717 (2.4%) unique website visitors. A third (4,562, 33.2%) completed the quiz and 793 (0.1%) left contact information. Of those, 173 (21.8%) completed a virtual assessment and 155 (19.5%) resulted in a referral to care. The median age of those referred was 21 years (IQR = 11) and 40% were considered to be from low-income areas. Among quiz completers, youth endorsing symptoms of depression or anxiety were more likely to leave contact information (OR = 2.18, 95% CI [1.39, 3.41] and OR = 1.69, 95% CI [1.31, 2.19], respectively) compared to those not reporting symptoms of depression or anxiety. Youth endorsing symptoms of psychosis were less likely to report a desire to receive a referral to care (OR = 0.58, 95% CI [0.43, 0.80]) compared to those who did not endorse symptoms of psychosis. Conclusion Self-reported symptomatology impact trajectories to care, even at the earliest stages of help-seeking, while youth and their allies are searching for information online. An online care navigation team could serve as an important resource for individuals with emerging behavioral health concerns and help to guide the transition between online information seeking at baseline to care.
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Affiliation(s)
- Michael L. Birnbaum
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Chantel Garrett
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Amit Baumel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Nicole T. Germano
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Cynthia Lee
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Danny Sosa
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Hong Ngo
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Kira H. Fox
- Department of Psychology, Barnard College, Columbia University, New York, NY, United States
| | - Lisa Dixon
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - John M. Kane
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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23
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Dickson KS, Sklar M, Chen SZ, Kim B. Characterization of multilevel influences of mental health care transitions: a comparative case study analysis. BMC Health Serv Res 2022; 22:437. [PMID: 35366865 PMCID: PMC8976965 DOI: 10.1186/s12913-022-07748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
Mental health care transitions are increasingly prioritized given their potential to optimize care delivery and patient outcomes, especially those focused on the transition from inpatient to outpatient mental health care. However, limited efforts to date characterize such mental health transition practices, especially those spanning multiple service setting contexts. Examination of key influences of inpatient to outpatient mental health care transitions across care contexts is needed to inform ongoing and future efforts to improve mental health care transitions. The current work aims to characterize multilevel influences of mental health care transitions across three United States-based mental health system contexts.
Methods
A comparative multiple case study design was used to characterize transition practices within the literature examining children’s, non-VA adult, and VA adult service contexts. Andersen’s (1995) Behavioral Health Service Use Model was applied to identify and characterize relevant distinct and common domains of focus in care transitions across systems.
Results
Several key influences to mental health care transitions were identified spanning the environmental, individual, and health behavior domains, including: community capacity or availability, cross-system or agency collaboration, provider training and experience related to mental health care transitions, client care experience and expectations, and client clinical characteristics or complexity.
Conclusions
Synthesis illustrated several common factors across system contexts as well as unique factors for further consideration. Our findings inform key considerations and recommendations for ongoing and future efforts aiming to plan, expand, and better support mental health care transitions. These include timely information sharing, enhanced care coordination and cross setting and provider communication, continued provider/client education, and appropriate tailoring of services to improve mental health care transitions.
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Trusty WT, Swift JK, Rasmussen EB. A Behavioral Economic Model of Help-Seeking for Depression. Perspect Behav Sci 2021; 44:541-560. [DOI: 10.1007/s40614-021-00308-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/28/2022] Open
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Abstract
This study investigated the relationship between reappraisal and suppression with depression and mental well-being among university athletes. It was hypothesized reappraisal would associate with lower depression and greater mental well-being, whereas suppression would associate with greater depression and reduced mental well-being. Employing a cross-sectional design, 427 participants (Mage = 20.18, SD = 1.52; 188 males and 239 females) completed questionnaires assessing mental health and strategy use. Hierarchical multiple regressions revealed reappraisal was positively associated, and suppression negatively associated with mental well-being, ΔR2 = 4.8%, ΔF(2, 422) = 17.01, p < .001; suppression, β = −0.08, p = .028; reappraisal, β = 0.21, p < .001, but neither were associated with depression, ΔR2 = 0.4%, ΔF(2, 422) = 1.33, p = .267; suppression, β = 0.06, p = .114; reappraisal, β = 0.03, p = .525. Results highlight reappraisal as correlated with mental well-being in student-athletes, and therefore, reappraisal could be beneficial for managing stress in sport. Reappraisal may implicate how well-being is promoted through sport, but future experimental research is needed to confirm causal relationships.
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Morin MH, Bergeron AS, Levasseur MA, Iyer SN, Roy MA. Les approches familiales en intervention précoce : repères pour guider les interventions et soutenir les familles dans les programmes d’intervention pour premiers épisodes psychotiques (PPEP). SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088181ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Xavier SM, Jarvis GE, Ouellet-Plamondon C, Gagné G, Abdel-Baki A, Iyer SN. Comment les services d’intervention précoce pour la psychose peuvent-ils mieux servir les migrants, les minorités ethniques et les populations autochtones ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088188ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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