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Pengpid S, Muanido A, Peltzer K. Prevalence and associated factors of undiagnosed depression and generalized anxiety disorder among a national sample of women and men in Mozambique in 2022-23. J Affect Disord 2025; 381:525-531. [PMID: 40194633 DOI: 10.1016/j.jad.2025.03.202] [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: 10/22/2024] [Revised: 03/30/2025] [Accepted: 03/31/2025] [Indexed: 04/09/2025]
Abstract
BACKGROUND The study's objective was to assess adult Mozambicans' prevalence and associated factors of undiagnosed depressive and anxiety disorders. METHOD This cross-sectional study analyzed data from the 2022-23 Mozambique Demographic and Health Survey (MDHS), including 13,183 women (aged 15-49 years) and 5380 men (aged 15-54 years) that completed the mental health module. RESULTS The analytic women sample (15-49 years) included 1619 females with depressive and/or anxiety disorders. The proportion of undiagnosed depressive and/or anxiety disorders were 81.0 % and 19.0 % had diagnosed depressive and/or anxiety disorders. The analytic men sample (15-54 years) included 288 males with depressive and/or anxiety disorders. The proportion of undiagnosed depressive and/or anxiety disorders was 67.4 % and 32.6 % had diagnosed depressive and/or anxiety disorders. In adjusted logistic regression analysis, Islamic, no, or other religion (Adjusted Odds Ratio-AOR: 1.16, 95 % Confidence Interval (CI): 1.04-1.29), currently pregnant (AOR: 1.13, 95 % CI: 1.05-1.21) were positively associated with undiagnosed depressive and/or anxiety disorders, and almost daily internet use (AOR: 0.75, 95 % CI: 0.64-0.87) was negatively associated with undiagnosed depressive and/or anxiety disorders. In addition, in univariable analysis, poorer wealth status, barriers to health care access (distance and financial) were positively associated with undiagnosed depressive and/or anxiety disorders, and currently working, urban residence, having health insurance coverage and cancer screening were negatively associated with undiagnosed depressive and/or anxiety disorders. LIMITATIONS Our findings only referred to participants having positive screening results of depressive and anxiety disorders, and no clinical diagnoses by medical providers were made. CONCLUSIONS The study makes a significant contribution to understanding mental health in Mozambique and highlights the critical need for improving mental health services, particularly for undiagnosed cases. These findings can inform policies and programmes aimed at better mental health outcomes across different population groups in Mozambique.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand; Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | | | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand; Department of Psychology, University of the Free State, Bloemfontein, South Africa; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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2
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Kaur MN, Zeng C, Malapati SH, McCleary NJ, Meyers P, Bryant AS, Pusic AL, Edelen MO. Health-related social needs mitigate ethnoracial inequities in patient-reported mental health. Qual Life Res 2025; 34:1761-1772. [PMID: 40042742 DOI: 10.1007/s11136-025-03935-w] [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] [Accepted: 02/19/2025] [Indexed: 05/29/2025]
Abstract
PURPOSE To characterize the relationship between ethnoracial identity, health-related social needs (HRSNs), and mental health (MH), and to examine the mediating role of HRSNs on the relationship between MH and ethnoracial identity. METHODS Data from 30,437 adults who were seeking care within Mass General Brigham integrated health system in United States and had completed PROMIS Global Health within three years of their most recent HRSNs screening between March 1, 2018 and January 31, 2023 were included. The presence and magnitude of PROMIS Global MH score differences for six ethnoracial groups (White non-Hispanic, White Hispanic, Black (Hispanic and non-Hispanic), Asian non-Hispanic, Other non-Hispanic and Other Hispanic (includes Asian Hispanic) was assessed. Regression-based mediation analyses were used to examine mediating role of four HRSNs (food insecurity, housing instability, transportation barriers and inability to pay for housing utilities) on relationship between ethnoracial identity and MH. RESULTS Compared to White Non-Hispanic patients, ethnoracial minorities had worse MH, after adjusting for age, sex, education, employment, marital status, comorbidities, and insurance type. This relationship remained statistically significant (p < 0.001) for White Hispanic, Asian non-Hispanic and Other non-Hispanic patients, where HRSNs mediated 57%, 88% and 70% of the relationship between ethnoracial identity and MH respectively. For Blacks and Other Hispanic patients, HRSNs fully mediated this relationship. CONCLUSION Disparities in MH may be driven by structural racism and experiences of racism that result in differentials in HRSNs, rather than ethnoracial identity. Efforts directed at measuring and addressing the HRSNs, in addition to structural factors are critical to achieving MH equity.
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Affiliation(s)
- Manraj N Kaur
- Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Patient-Reported Outcomes, Value and Experience (PROVE) Center, Boston, MA, 02115, USA.
| | - Chengbo Zeng
- Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Patient-Reported Outcomes, Value and Experience (PROVE) Center, Boston, MA, 02115, USA
| | - Sri Harshini Malapati
- Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Patient-Reported Outcomes, Value and Experience (PROVE) Center, Boston, MA, 02115, USA
| | - Nadine J McCleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | | | | | - Andrea L Pusic
- Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Patient-Reported Outcomes, Value and Experience (PROVE) Center, Boston, MA, 02115, USA
| | - Maria O Edelen
- Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Patient-Reported Outcomes, Value and Experience (PROVE) Center, Boston, MA, 02115, USA
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Kazdin AE. Perceived need for treatment for mental disorders: A review and critical evaluation. Clin Psychol Rev 2025; 119:102591. [PMID: 40381402 DOI: 10.1016/j.cpr.2025.102591] [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: 02/18/2025] [Revised: 05/02/2025] [Accepted: 05/06/2025] [Indexed: 05/20/2025]
Abstract
Mental disorders are highly prevalent worldwide. Unfortunately, most people with these disorders do not receive any treatment. This is due in part to a large set of barriers that impede treatment delivery. An initial barrier is the perception that one does not need treatment. Perceived need for treatment (PNFT) refers to whether an individual sees a need to obtain an intervention for their mental health problem. Among individuals with a mental disorder, lack of perceived need is the most common reason people give for not initiating treatment. This article describes PNFT, its characteristics, correlates, and predictors. A critical evaluation of the concept challenges key notions such as whether meeting criteria for a disorder means that someone needs treatment, whether PNFT actually is the initial obstacle limiting treatment seeking, how people may seek an intervention but do not elect mental health treatment, and that PNFT is neither a necessary nor a sufficient condition for entering treatment. Several research priorities are discussed including the importance of perceived need among parents and other caregivers, evaluating whether increasing the rates of PNFT would actually increase service use, the need to study the treatment needs of many neglected groups, and considering whether PNFT influences other facets of the treatment process (e.g., adherence to treatment, dropping out early) where perceiving there no longer is a mental health problem may occur.
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Affiliation(s)
- Alan E Kazdin
- Department of Psychology, Yale University, Henry Koerner Center, 149 Elm Street, New Haven 06511, CT, USA.
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Guo Y, Wu Y, Liu Z, Fan S, Wang H. Ethnic Disparities in Mental Health Among Adults in China. JAMA Netw Open 2025; 8:e259591. [PMID: 40372758 PMCID: PMC12082376 DOI: 10.1001/jamanetworkopen.2025.9591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 03/10/2025] [Indexed: 05/16/2025] Open
Abstract
Importance There are significant gaps in the research on ethnic disparities in mental health status among adults nationwide in China. Evidence is needed to fill these gaps. Objective To examine the mental health status by ethnic group in China and to explore the sociodemographic and health-related factors associated with these mental health disparities. Design, Setting, and Participants This cross-sectional study used data from a multicenter, population-based survey conducted from June to August 2023. Participants were required to be aged 18 years or older and Chinese nationals and permanent residents. After quota sampling based on Chinese population statistics, 30 054 questionnaires were included in final analyses. Data were analyzed from March to April 2024. Exposures Ethnicity, categorized as Han or minority group (ie, Achang, Bai, Blang, Bonan, Buyei, Dai, Daur, Deang, Derung, Dong, Dongxiang, Ewenki, Gaoshan, Gelao, Gin, Hani, Hezhen, Hui, Jingpo, Jino, Kazak, Kirgiz, Korean, Lahu, Lhoba, Li, Lisu, Man, Maonan, Miao, Monba, Mongol, Mulao, Naxi, Nu, Oroqen, Pumi, Qiang, Russ, Salar, She, Sui, Tajik, Tatar, Tibetan, Tu, Tujia, Uyghur, Uzbek, Va, Xibe, Yao, Yi, Yugur, and Zhuang), as well as unrecognized ethnic groups in China, ie, populations in the People's Republic of China that have been assimilated into the Han or other recognized ethnic groups but have not yet been officially identified). Main Outcomes and Measures Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7-item scale. Any positive (≥1) response to the ninth item of Patient Health Questionnaire-9 was considered as having suicidal ideation. Results Among the 30 054 eligible participants (median [IQR] age, 43 [29-54] years; 15 043 [50.1%] female), 27 299 (90.8%) were from the Han ethnic group and 2755 (9.2%) were from ethnic minority groups. Compared with Han participants, participants from ethnic minority groups had significantly higher prevalence of moderate to major depression symptoms (25.5% vs 19.0%; P < .001), moderate to severe anxiety symptoms (17.4% vs 12.3%; P < .001), and suicidal ideation (29.4% vs 20.9%; P < .001). Participants from ethnic minority groups had higher odds of these outcomes even after adjusting for sociodemographic and behavioral factors (moderate to major depression symptoms: adjusted odds ratio [aOR], 1.18; 95% CI, 1.07-1.29; moderate to severe anxiety symptoms: aOR, 1.23; 95% CI, 1.10-1.37; suicidal ideation: aOR, 1.34; 95% CI, 1.22-1.46]). For members of ethnic minority groups, having 2 or more chronic conditions was associated with a higher likelihood of moderate to severe anxiety symptoms (aOR, 1.57; 95% CI, 1.13-2.18) and suicidal ideation (aOR, 1.73; 95% CI, 1.30-2.29). Conclusions and Relevance In this cross-sectional study in China, significant disparities of mental health were observed between Han and ethnic minority populations. Members of ethnic minority groups were at a significantly higher risk for experiencing moderate to major depression symptoms, moderate to severe anxiety, and suicidal ideation, particularly when exposed to specific risk factors, such as chronic health conditions and social stressors. Targeted public health interventions are needed to address the mental health needs of ethnic minority populations.
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Affiliation(s)
- Yi Guo
- Peking University First Hospital, Peking University, Beijing, China
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
| | - Zhongjian Liu
- Peking University First Hospital, Peking University, Beijing, China
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Siyuan Fan
- School of Public Health, Imperial College London, London, United Kingdom
| | - Haibo Wang
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
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Bélanger SM, Christiansen SG, Kalseth J, Kaspersen SL, Erlangsen A, Reneflot A, Hauge LJ, Stene-Larsen K. Utilization of mental health care among people bereaved by suicide in Norway: A trajectory analysis. J Psychiatr Res 2025; 185:130-137. [PMID: 40179690 DOI: 10.1016/j.jpsychires.2025.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 02/13/2025] [Accepted: 03/22/2025] [Indexed: 04/05/2025]
Abstract
BACKGROUND Losing a loved one to suicide is an extremely stressful event that is associated with mental health issues. However, little is known about the health care utilization of those bereaved by suicide. Identifying distinct trajectories of mental health care utilization can help reveal gaps in service provision, barriers to access, and opportunities for targeted interventions. AIMS To uncover distinct patterns of mental health care utilization in association with suicide bereavement and explore sociodemographic factors and subsequent suicide risk associated with these patterns. METHOD We analyzed Norwegian population-wide registry data on mental health care utilization at three different levels among 14 781 adults bereaved by suicide from 2010 to 2019 using group-based multi-trajectory modeling to identify groups with distinct mental health care utilization trajectories. Socio-demographic differences between trajectory groups were analyzed in multinomial logistic regression models and the associated risk of suicide was obtained with cox proportional hazards regression models. RESULTS We identified four distinct trajectories of mental health care utilization. Two distinct groups of individuals bereaved by suicide either rarely contacted mental health care providers ("Low") or only consulted with general practitioners only ("GP only"). In the latter group, the utilization rate increased post-bereavement. One group of bereaved ("Acute increase") increased their mental health care utilization significantly after the loss, while another group ("High") consistently had a high utilization rate. These groups differed with respect to kinship to the deceased and sociodemographic factors. Individuals in the "GP only" and "High" group had significantly higher risk of suicide when compared to those in the "Low" group. CONCLUSIONS Individuals bereaved by suicide exhibited diverse patterns of mental health care utilization, reflecting a broad spectrum of needs and responses to loss.
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Affiliation(s)
- Sissel Marguerite Bélanger
- Norwegian Institute of Public Health, Department of Mental Health, PO Box 222 Skøyen, N-0213, Oslo, Norway; University of Oslo, Faculty of Medicine, Institute of Health and Society, Oslo, Norway.
| | | | - Jorid Kalseth
- Department of Health Research, SINTEF Digital, Trondheim, Norway
| | | | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Anne Reneflot
- Department of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lars Johan Hauge
- Department of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kim Stene-Larsen
- Department of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
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Zhang X, Geng T, Yu L, Li J, Han D, Xu J, Wang T, Yun R, Yao G, Cheng J. Real-world pilot of case management in schizophrenia: exploring factors influencing patient participation, potential for relapse prevention and effects on diverse clinical outcomes. Gen Psychiatr 2025; 38:e101864. [PMID: 40303881 PMCID: PMC12039027 DOI: 10.1136/gpsych-2024-101864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 03/21/2025] [Indexed: 05/02/2025] Open
Affiliation(s)
- Xiao Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tong Geng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ling Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jingjing Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Dongying Han
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jianfang Xu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tianzi Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ruisheng Yun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Guizhong Yao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jia Cheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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Jung MH, Shin SH. Determinants of Community Mental Health Service Utilization Among Psychiatric Outpatients at a Tertiary Medical Institution: Applying Andersen's Behavioral Model. Healthcare (Basel) 2025; 13:996. [PMID: 40361774 PMCID: PMC12072166 DOI: 10.3390/healthcare13090996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2025] [Revised: 04/17/2025] [Accepted: 04/23/2025] [Indexed: 05/15/2025] Open
Abstract
Objectives: This study examined factors influencing community mental health service utilization and identified strategies to improve accessibility for psychiatric outpatients receiving care at the Department of Psychiatry. Methods: This cross-sectional descriptive survey utilized a structured questionnaire to collect data from 136 patients receiving outpatient psychiatric care at a tertiary medical institution in Seoul, Korea. Logistic regression analysis was performed using SPSS version 26.0 for Windows. Results: Logistic regression analysis identified significant factors influencing the utilization of community mental health services: being a man (OR = 3.33), duration of illness (OR = 2.31), recognition of service institutions (OR = 39.09), internalized stigma (OR = 4.90), and stress (OR = 3.14). Conclusions: To encourage the utilization of community mental health services by patients with mental illness, psychiatric nurses should increase the level of understanding and information about community-based mental health support. Additionally, details on community mental health services should be provided from the earliest stages of illness in a variety of gender-specific ways during discharge education, and patients with high levels of internalized stigma and stress should be encouraged to have an insight of their illness and to take an active role in their recovery.
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Affiliation(s)
- Min Hee Jung
- Major in Psychiatric Mental Health Nurse Practitioner Program, Graduate School of Nursing, Kyung Hee University, Seoul 02447, Republic of Korea;
| | - Sung Hee Shin
- College of Nursing Science, Kyung Hee University, Seoul 02447, Republic of Korea
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Lee J, Gang M. Factors Influencing Intention to Use Mental Health Services among Persons in Custody in South Korea. JOURNAL OF FORENSIC NURSING 2025:01263942-990000000-00133. [PMID: 40200405 DOI: 10.1097/jfn.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2025]
Abstract
PURPOSE To identify factors influencing the intention to use mental health services by persons in custody. METHODS Two hundred and three adult male and female persons in custody in South Korea completed a written questionnaire. Data were collected between May 1 and October 31, 2023. Descriptive statistics, t-tests, ANOVA, and multiple regression were completed. RESULTS Regression analyses indicated that mental health literacy (ß = 0.20, p = 0.003), social support (ß = -0.15, p = 0.018), and the need for mental health services (ß = 0.16, p = 0.021) were significant factors contributing to intention to use mental health services (F = 11.12, p < 0.001). CONCLUSION To increase use of mental health services, it is essential to assess what persons in custody need, identify health literacy levels and tailor information as needed, and establish mental health systems that connect to social resources.
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Affiliation(s)
- Joonyeong Lee
- Author Affiliations: College of Nursing, Chungnam National University, Daejeon, South Korea
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Muwonge JJ, Jablonska B, Dalman C, Burström B, Galanti MR, Hollander AC. More or less equal? Trends in horizontal equity in mental health care utilization in Stockholm county, Sweden (2006-2022). Repeated survey-registry linked studies. Int J Equity Health 2025; 24:98. [PMID: 40200310 PMCID: PMC11980088 DOI: 10.1186/s12939-025-02453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 03/18/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Horizontal equity is defined as equal care for equal needs, regardless of socioeconomic factors. This study investigated trends in horizontal equity in mental health care (MHC) utilization in Sweden from 2006 to 2022. Monitoring equity provides valuable information for healthcare system governance (e.g., planning and resource allocation) necessary for ensuring equitable provision of services. METHODS A total of 81,650 Stockholm residents aged 18-64, who participated in the Hälsa Stockholm surveys of 2006, 2010, 2014 or 2021, were analysed. Their subsequent use of MHC (primary, in- and outpatient specialized care, and psychotropic medication) within six months after survey response was collected from registries between 2006 and 2022. Concentration index (CI) and need-standardized CI (Horizontal inequity index, HI), summative measures of inequalities, were used in this study. HI was estimated using self-reported psychological distress (measured with the General health questionnaire 12 in 2006-2014 and Kessler 6 in 2021) as the primary need indicator, with general health status and long-term limiting illness as additional need indicators. Equivalized disposable household income was used as the ranking variable, while education status, migration status, age, and sex were included as non-need variables that we controlled for in the analyses. RESULTS Lower-income individuals used MHC services more than their higher-income counterparts with comparable levels of psychological distress. These "pro-poor" inequities in the probability of MHC use increased from HI = -0.057 [95% Confidence Limits, CL: -0.079, -0.034] in 2006/2007 to HI = -0.130 [95% CL: -0.159, -0.102] in 2014/2015. By 2021/2022, the "pro-poor" inequities had decreased (HI = -0.034 [95% CL: -0.06, -0.009]), partly due to an increase in MHC use among higher-income groups but a decrease in the lowest income group. Standardizing for additional need indicators reduced the "pro-poor" inequities but maintained the observed trends. Among non-Nordic migrants, "pro-rich" inequities fell between 2006/2007 and 2014/2015 but rose in 2021/2022, with significant "pro-rich" inequities among non-European migrants in 2021/2022 (HI = 0.100 [95% CL: 0.024, 0.176]). Among patients in outpatient services, "pro-poor" inequities in visit frequency decreased over time (2006-2022). CONCLUSION We observed increasingly higher probability of MHC use among lower-income individuals than their higher-income peers with similar (measured) needs from 2006 to 2015. However, during the pandemic (2021/2022), potential access problems led to diminishing of "pro-poor" inequities in the total sample, and to "pro-rich" inequities among non-Nordic migrants. The Covid-19 disruption to the healthcare system-such as restrictions on in-person visits and the rapid transition to digital healthcare services-along with its impact on care-seeking, may explain the trend shifts.
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Affiliation(s)
- Joseph Junior Muwonge
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Beata Jablonska
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Brown DMY, Lerner I, Cairney J, Kwan MY. Independent and Joint Associations of Physical Activity and Sleep on Mental Health Among a Global Sample of 200,743 Adults. Int J Behav Med 2025; 32:180-194. [PMID: 38532194 DOI: 10.1007/s12529-024-10280-8] [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] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Previous research has demonstrated that both sleep and physical activity (PA) are independently associated with various indicators of mental health among adults. However, their joint contribution to mental health has received limited attention. The present study used cross-sectional data from the Mental Health Million Project to examine the independent and joint effects of sleep and PA on mental health among a global sample of adults, and whether these effects differ among individuals receiving mental health treatment. METHOD The sample included 200,743 participants (33.1% young adults, 45.6% middle-aged adults, 21.3% older adults; 57.6% females, 0.9% other) from 213 countries, territories, and archipelagos worldwide that completed a comprehensive 47-item assessment of mental health including both problems (i.e., ill-being) and assets (i.e., well-being): the Mental Health Quotient. Participants also reported their weekly frequency of PA and adequate sleep, and mental health treatment status. A series of generalized linear mixed models were computed. RESULTS Independent dose-response associations were observed, whereby greater amounts of PA and adequate sleep were each associated with better mental health. In addition, a synergistic interaction was observed in which the positive correlation of PA with mental health was strengthened with greater frequency of adequate sleep. These benefits were less pronounced among adults receiving mental health treatment. CONCLUSION While findings suggest sleep can help to offset the negative influence of a physically inactive lifestyle (and vice versa), our results point to a "more is better" approach for both behaviors when it comes to promoting mental health.
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Affiliation(s)
- Denver M Y Brown
- Department of Psychology, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX, USA.
| | - Itamar Lerner
- Department of Psychology, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX, USA
| | - John Cairney
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Matthew Y Kwan
- Department of Child and Youth Studies, Brock University, St. Catherines, Canada
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11
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Reaume S, Dubin J, Perlman C, Ferro M. Mental health service contact in children with and without physical-mental multimorbidity. Soc Psychiatry Psychiatr Epidemiol 2025:10.1007/s00127-025-02877-5. [PMID: 40131381 DOI: 10.1007/s00127-025-02877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Accepted: 03/06/2025] [Indexed: 03/27/2025]
Abstract
PURPOSE To estimate six-month prevalence of child mental health service contacts and quantify associations between child health status and mental health service contacts, including number of types of contacts. METHODS Data come from 6,242 children aged 4-17 years in the Ontario Child Health Study. A list of chronic conditions developed by Statistics Canada measured physical illness. The Emotional Behavioural Scales assessed mental illness. Child health status was categorized as healthy, physical illness only, mental illness only, and multimorbid (≥ 1 physical and ≥ 1 mental illness). Mental health service contact was aggregated to general medicine, urgent medicine, specialized mental health, school-based, alternative, and any contact (≥ 1 of the aforementioned contacts). Regression models quantified associations between health status and type of mental health contact, including number of types of contacts. RESULTS Weighted prevalence estimates showed 261,739 (21.4%) children had mental health-related service contact, with school-based services being the most common contact amongst all children, regardless of health status. Children with multimorbidity had higher odds for every mental health contact than healthy controls (OR range: 4.00-6.70). A dose-response was observed, such that the number of contacts increased from physical illness only (OR = 1.49, CI: 1.10-1.99) to mental illness only (OR = 3.39, CI: 2.59-4.44) to multimorbidity (OR = 4.13, CI: 2.78-6.15). CONCLUSION Over one-fifth of children had mental health-related service contact and contacts were highest among children with multimorbidity. Types of mental health contacts for children with multimorbidity are diverse, with further research needed to elucidate the barriers and facilitators of mental health use.
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Affiliation(s)
| | - Joel Dubin
- University of Waterloo, Waterloo, Canada
| | | | - Mark Ferro
- University of Waterloo, Waterloo, Canada
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12
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Stene LE, Glad KA, Stensland SØ, Nilsen LG, Dyb G. Proactive psychosocial follow-up of youth exposed to a terrorist attack: longitudinal study linking interviews and register-based data. BJPsych Open 2025; 11:e48. [PMID: 40071476 PMCID: PMC12001956 DOI: 10.1192/bjo.2024.838] [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: 08/18/2023] [Revised: 11/12/2024] [Accepted: 11/15/2024] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Knowledge on efficient approaches to the provision of post-disaster psychosocial care is urgently needed. To prevent unmet healthcare needs, proactive follow-up by municipal contact persons was recommended for survivors of the Utøya youth camp attack in Norway. AIMS To examine characteristics of the survivors by whether or not they had a contact person in the early (0-5 months), intermediary (5-15 months) and long-term (20-32 months) aftermath of the attack, and to describe the survivors' experiences with the contact person. METHOD We analysed data from three waves of interviews with survivors conducted 4-5, 14-15 and 30-32 months after the attack, as well as register-based data on the use of mental health services from 3 years before until 3 years after the attack. RESULTS Survivors with a contact person early post-attack were less likely to receive care from mental health services concurrently or to have anxiety/depression symptoms subsequently compared with survivors without a contact person in the same period. Survivors with a contact person in the intermediary aftermath were more satisfied with the overall help they received, but also more likely to have long-term anxiety/depression symptoms. Survivors with a contact person in the long term were more likely to be financially disadvantaged. Approximately half of the survivors with a contact person found this highly or very highly useful, whereas one-third found it of little use or not at all useful. CONCLUSIONS The proactive outreach reached survivors across sociodemographic characteristics during the recommended first year of follow-up, which could be conducive to prevention of unmet healthcare needs. Still, there was considerable variation in the perceived usefulness and duration of the follow-up.
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Affiliation(s)
- Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway
| | - Kristin Alve Glad
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway
| | | | - Lisa Govasli Nilsen
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway
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13
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Fleury MJ, Cao Z, Grenier G, Huỳnh C, Meng X. Classes of outpatient quality of care among individuals with substance-related disorders, based on a survey and health insurance registry. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2025; 170:209619. [PMID: 39755156 DOI: 10.1016/j.josat.2024.209619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 12/12/2024] [Accepted: 12/26/2024] [Indexed: 01/06/2025]
Abstract
OBJECTIVES Improving quality of care for individuals with substance-related disorders (SRD) should be a priority considering SRD are associated with high morbidity. This study aimed to identify classes of individuals with SRD based on their clinical characteristics and the quality of outpatient care they received, and to verify whether better quality of care was associated with other respondent characteristics and more favorable subsequent outcomes. METHODS Data came from the 2013-14 and 2015-16 Canadian Community Health Survey (N = 42,099), merged with administrative data from Quebec's health insurance registry. Investigating a cohort of 1473 individuals with SRD, we conducted Latent class analysis based on the respondents' diagnoses and outpatient quality of care indicators such as access, diversity, continuity and regularity of care received in the 12 months preceding interview. Chi-Square, Fisher's exact tests or t-tests, and logistic regression associate classes with sociodemographic and health behavior (e.g., suicidal behaviors) correlates, and outcomes (repeated emergency department use, hospitalization, quality of life) over the three months following interview, respectively. RESULTS The study identified four classes: (1) Individuals with polysubstance-related disorders and other health disorders, receiving high diversity and moderate regularity of care (6 % of sample); (2) Individuals with alcohol-related disorders, receiving low quality of care (41 %); (3) Individuals with drug-related disorders, receiving high overall quality of care (9 %); and (4) Individuals with alcohol-related disorders, receiving high continuity of family doctor care (44 %). Classes 2 and 4 showed better social conditions (e.g., higher education), health behaviors, and subsequent outcomes than Classes 1 and 3, despite receiving lower quality of care - especially mental healthcare. CONCLUSION Study outcomes related more to health and social conditions than to the quality of outpatient care received, especially as outpatient care alone might not meet needs of Classes 1 and 3 individuals having important health and social issues, unmet care needs and worse outcomes. Results suggest that interventions like assertive community treatment or intensive case management with integrated SRD-mental health disorders treatment could better respond to the needs of Classes 1 and 3. Overall, enhanced care, including peer support, might benefit all individuals with SRD.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Douglas Hospital Research Center, Montreal, Quebec, Canada.
| | - Zhirong Cao
- Douglas Hospital Research Center, Montreal, Quebec, Canada.
| | - Guy Grenier
- Douglas Hospital Research Center, Montreal, Quebec, Canada.
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, Canada.
| | - Xianghei Meng
- Department of Psychiatry, McGill University, Douglas Hospital Research Center, Montreal, Quebec, Canada.
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Kazdin AE. Indirect Interventions: Lifestyle Options to Treat Mental Disorders. Healthcare (Basel) 2025; 13:505. [PMID: 40077067 PMCID: PMC11899711 DOI: 10.3390/healthcare13050505] [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: 01/30/2025] [Revised: 02/19/2025] [Accepted: 02/24/2025] [Indexed: 03/14/2025] Open
Abstract
Mental disorders are highly prevalent worldwide. Unfortunately, most people with these disorders do not receive any treatment. This is due in part to a large set of barriers (e.g., no access to therapists or clinics, lack of insurance, stigma) that impede seeking and obtaining mental health services. Many lifestyle interventions that are not part of traditional mental health services have indirect effects on reducing symptoms of mental disorders. These are interventions that target a direct focus (e.g., physical health, socialization, general well-being) but also have indirect and significant impact on reducing mental disorders. This article discusses indirect interventions as an additional way of reaching people in need of help with mental health problems. Interventions such as physical activity and exercise, diet, addressing sleep problems, yoga, tai chi, qigong, and volunteering have indirect beneficial effects. This article highlights the scope of mental illness as a background, introduces indirect interventions, and details three illustrations with evidence that targeting one focus with indirect effects on improving mental disorders. The interventions point to a category of interventions are not systematically used in the care of mental health problems. Among their many advantages is the prospect of their use at the levels of individuals and populations. Indirect interventions do not replace any of the current advances in treatment but add to ways of reaching people in need.
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Affiliation(s)
- Alan E Kazdin
- Department of Psychology, Yale University, Henry Koerner Center, 149 Elm Street, New Haven, CT 06511, USA
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15
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Otamendi T, Sanghera SK, Mortenson WB, Li LC, Silverberg ND. Patient perceptions of persistent symptoms after mild traumatic brain injury and their influence on mental health treatment-seeking: a grounded theory study. Disabil Rehabil 2025:1-9. [PMID: 39878340 DOI: 10.1080/09638288.2025.2454973] [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: 05/09/2024] [Revised: 12/05/2024] [Accepted: 01/04/2025] [Indexed: 01/31/2025]
Abstract
PURPOSE Mental health conditions after mild traumatic brain injury (mTBI) are common and can complicate injury outcomes, but are under-treated. According to the Common Sense Model of Self-Regulation, the way patients perceive their health conditions can influence the way they manage them, including if, when, and how they seek treatment. This study explored how individuals perceive persistent symptoms after mTBI, in order to develop a grounded theory about what motivates and demotivates them to seek mental health treatment after their injury. METHODS Seventeen adults experiencing persistent symptoms after mTBI participated in semi-structured interviews, which were analyzed using constructivist grounded theory. RESULTS An explanatory model of patient perceptions was developed with three interrelated categories: (1) Symptom persistence and uncertainty result in life challenges; (2) Self-advocating for answers through extensive treatment-seeking; preference for biomedical treatment; (3) Mental health problems are caused by symptom persistence, therefore mental health treatment is supplementary. CONCLUSION Findings suggest a potential barrier to seeking mental health treatment during complicated mTBI recovery: if patients do not consider mental health as an important cause of their ongoing symptoms, they may feel less motivated to prioritize mental health treatment.
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Affiliation(s)
- Thalia Otamendi
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
| | - Simrit K Sanghera
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
| | - W Ben Mortenson
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver
| | - Linda C Li
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Noah D Silverberg
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
- Department of Psychology, University of British Columbia, Vancouver, Canada
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Muwonge JJ, Dalman C, Burström B, Jablonska B, Hollander AC. Exploring socio-economic inequalities in mental healthcare utilization in adults with self-reported psychological distress: a survey-registry linked cohort design. Epidemiol Psychiatr Sci 2025; 34:e6. [PMID: 39846121 PMCID: PMC11822448 DOI: 10.1017/s2045796024000842] [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: 06/12/2024] [Revised: 11/29/2024] [Accepted: 12/04/2024] [Indexed: 01/24/2025] Open
Abstract
AIMS Although individuals with lower socio-economic position (SEP) have a higher prevalence of mental health problems than others, there is no conclusive evidence on whether mental healthcare (MHC) is provided equitably. We investigated inequalities in MHC use among adults in Stockholm County (Sweden), and whether inequalities were moderated by self-reported psychological distress. METHODS MHC use was examined in 31,433 individuals aged 18-64 years over a 6-month follow-up period, after responding to the General Health Questionnaire-12 (GHQ-12) in 2014 or the Kessler Six (K6) in 2021. Information on their MHC use and SEP indicators, education, and household income, were sourced from administrative registries. Logistic and negative binomial regression analyses were used to estimate inequalities in gained MHC access and frequency of outpatient visits, with psychological distress as a moderating variable. RESULTS Individuals with lower education or income levels were more likely to gain access to MHC than those with high SEP, irrespective of distress levels. Education-related differences in gained MHC access diminished with increasing distress, from a 74% higher likelihood when reporting no distress (odds ratio, OR = 1.74 [95% confidence interval, 95% CI: 1.43-2.12]) to 30% when reporting severe distress (OR = 1.30 [0.98-1.72]). Comparable results were found for secondary care but not primary care i.e., lower education predicted reduced access to primary care in moderate-to-severe distress groups (e.g., OR = 0.63 [0.45-0.90]), and for physical but not digital services. Income-related differences in gained MHC access remained stable or increased with distress, especially for secondary care and physical services. CONCLUSIONS Overall, individuals with lower education and income used MHC services more than their counterparts with higher socio-economic status; however, low-educated individuals faced inequities in primary care and underutilized non-physician services such as visits to psychologists.
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Affiliation(s)
- J. J. Muwonge
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - C. Dalman
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - B. Burström
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - B. Jablonska
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - A-C. Hollander
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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17
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Fleury MJ, Rochette L, Cao Z, Grenier G, Massamba V, Lesage A. Profiles of physician follow-up care, correlates and outcomes among patients affected by an incident mental disorder. BMC PRIMARY CARE 2025; 26:7. [PMID: 39799284 PMCID: PMC11724569 DOI: 10.1186/s12875-024-02674-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 11/29/2024] [Indexed: 01/15/2025]
Abstract
OBJECTIVES This study identified profiles of outpatient physician follow-up care and other practice features, mostly after detection of incident mental disorders (MD), and associated these profiles with patient characteristics and subsequent adverse outcomes. METHODS A cohort of 170,957 patients age 12 + with a new or recurrent MD detected in 2019-20 was investigated based on data from the Quebec Integrated Chronic Disease Surveillance System. Latent class analysis was performed to identify follow-up care profiles, mostly within one year of MD detection. Bivariate analyses tested associations between profiles and patient characteristics; logistic regressions examined relationships between profiles and adverse outcomes after one year. RESULTS Five profiles were identified: Profiles 2 and 5 (64%) offered low mental health (MH) outpatient follow-up care, while the others dispensed higher MH follow-up care. Profiles differed in patient characteristics and related outcomes. Labelled "Follow-up care by usual psychiatrist", Profile 1 (1% of sample) included younger patients with the most health and social issues. Profile 2 (50%), "Low MH follow-up care but high prior consultations for physical reasons", mostly integrated older patients with chronic physical illnesses. Profile 3 (11%), "Follow-up care by general practitioners (GP) and psychiatrists", referred to physicians other than the usual ones (e.g., walk-in practice) and encompassed patients with severe MD conditions. Profile 4 (23%), "High follow-up care by usual GP and prior consultations for physical reasons", showed the typical characteristics of patients treated in primary care (more common MD, women, less materially and socially deprived). Profile 5 (15%), "Low MH follow-up care and prior consultations for physical reasons", integrated more younger men, materially deprived patients, and with substance-related disorders (SRD) or co-occurring MD-SRD. More Profile 1 and 3 patients lived in university regions - those of Profile 4 were the least numerous in such regions. More Profile 5 patients lived in metropolitan and rural areas. Risk of death was higher in Profiles 5, 2, 3, and risk of frequent ED use and hospitalization higher in Profiles 1, 3, and 5 - patients with severe health and social issues. CONCLUSION The study confirmed the need to improve prompt, adequate and continuous follow-up care for patients with incident MD.
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Affiliation(s)
- Marie-Josée Fleury
- Douglas Hospital Research Centre, Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Louis Rochette
- Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montreal, QC, Canada
| | - Victoria Massamba
- Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Alain Lesage
- Département de psychiatrie, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Université de Montréal, Montreal, QC, Canada
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18
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Suffel AM, Carreira H, Walker J, Grint D, Osborn D, McDonald HI, Warren-Gash C. The association of maternal mental health with vaccination coverage and timeliness in early childhood - A historical cohort study in England using electronic health records. Vaccine 2025; 43:126529. [PMID: 39566366 DOI: 10.1016/j.vaccine.2024.126529] [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: 06/17/2024] [Revised: 11/08/2024] [Accepted: 11/08/2024] [Indexed: 11/22/2024]
Abstract
BACKGROUND Maternal mental illness (MMI) affects almost a quarter of mothers and may impact a child's development and physical health. It remains unclear whether MMI is associated with altered utilization of vaccination services. Understanding this association could help to identify families in need of additional support. METHODS Using primary care data from England, we conducted a historical cohort study of 397,519 children born in England between 2006 and 2014 with linked maternal records. Associations between different types of MMI (common mental disorders, severe mental illness and alcohol and substance use disorder) with childhood immunisation were explored using logistic regression for differences in coverage and accelerated failure time models for differences in timeliness before the child's fifth birthday. RESULTS While there were no differences in vaccination coverage at the age of one, children of mothers with common mental disorders had lower odds of being vaccinated at the ages of two (OR 0.95, 95 %CI: 0.93-0.98) and five (OR 0.86, 95 % CI 0.84-0.89) in comparison to children of mothers with no record of MMI. Vaccination coverage was even lower for children of mothers with comorbid substance disorder and common mental disorder (OR 0.70, 95 % CI: 0.62-0.78 at the age of five). There were no significant differences in timeliness of vaccine receipt by MMI. CONCLUSIONS Inequalities in vaccination coverage associated with MMI grow with increasing age of the child. Extending support services for women with MMI beyond the child's first year of life could offer potential to improve vaccination uptake and reduce childhood infections.
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Affiliation(s)
- Anne M Suffel
- NIHR Health Protection Research Unit in Immunisation at the London School of Hygiene and Tropical Medicine, London, United Kingdom; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Helena Carreira
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jemma Walker
- NIHR Health Protection Research Unit in Immunisation at the London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Grint
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Osborn
- Department of Psychiatry, University College London, United Kingdom; Camden and Islington NHS Foundation Trust, United Kingdom
| | - Helen I McDonald
- NIHR Health Protection Research Unit in Immunisation at the London School of Hygiene and Tropical Medicine, London, United Kingdom; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Life Science, University of Bath, United Kingdom
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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19
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Li Y, Chang JJ, Xian H, Arnold LD. Factors Associated with Mental Health Service Use Among Children with ADHD from Adolescence to Early Adulthood. J Behav Health Serv Res 2025; 52:86-108. [PMID: 39407044 DOI: 10.1007/s11414-024-09917-z] [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] [Accepted: 09/20/2024] [Indexed: 01/01/2025]
Abstract
Childhood attention-deficit/hyperactivity disorder (ADHD) is common and is associated with lifelong adverse outcomes. Little is known about factors associated with mental health service use (MHSU) among children with ADHD from adolescence to early adulthood. This retrospective cohort study aims to investigate factors associated with MHSU among children with ADHD from adolescence to early adulthood using secondary data from Waves I to III of the National Longitudinal Study of Adolescent Health (n = 554). Multivariable Poisson regression and Generalized Estimating Equation were used to estimate adjusted relative risks and 95% confidence intervals. Results indicate that factors significantly associated with MHSU from adolescence to early adulthood included race/ethnicity, a routine physical exam last year, and a history of suicidal ideation or attempt. Findings of the study extend the current understanding by identifying predictors and barriers for MHSU and inform the development of targeted intervention programs for increasing MHSU among children with ADHD.
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Affiliation(s)
- Yueqi Li
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Jen Jen Chang
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Hong Xian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Lauren D Arnold
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
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20
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Vickery A. Exploring the Characteristics of Men Aged 55+ Who Use Mental Health Community Care and Support Services: A Secondary Analysis of the Adult Psychiatric Morbidity Study in England. J Aging Health 2025; 37:64-74. [PMID: 38235737 PMCID: PMC11566065 DOI: 10.1177/08982643241227251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
ObjectivesThe aim of this study is to understand the demographic and situational characteristics of men over 55 who have used a community support service. Method: Hierarchical multivariable logistic regression was conducted using anonymised data from the Adult Psychiatric Morbidity Study 2014. Results: Need factors such as having a common mental disorder (CMD), poor general health and having counselling/therapy were the most relevant to use of a community support service. It was more common for older men (85+), single men, and those who reported experiencing several traumatic life events to have used a community support service. Discussion: The results are critically discussed by considering the roles of gender, ageing, and social support, which might influence the use of community support services. There is a need for more awareness of categories such as age and previous service use, and how they might influence community support help seeking.
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Affiliation(s)
- Alex Vickery
- Cardiff School of Education and Social Policy, Cardiff Metropolitan University, Bristol, UK
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21
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Yuan Y, Manuel J. Factors Associated with Housing Stability Among Individuals with Co-Occurring Serious Mental Illness and Substance Use Disorders Receiving Assertive Community Treatment Services. Community Ment Health J 2024:10.1007/s10597-024-01443-8. [PMID: 39739210 DOI: 10.1007/s10597-024-01443-8] [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: 04/16/2024] [Accepted: 12/21/2024] [Indexed: 01/02/2025]
Abstract
Assertive Community Treatment (ACT) is a community-based, multidisciplinary mental health treatment model with improved housing stability as a treatment goal. We know little about factors contributing to housing stability among ACT participants with co-occurring serious mental illness and substance use disorders, who account for 30% of the ACT participant population. Informed by the behavioral model of health service use, the present study aimed to examine the relationship between housing stability and theoretically relevant factors. We retrospectively abstracted the data from two ACT teams' treatment service planning and tracking system. Stable housing was defined by living in a private residence or permanent supportive housing throughout the assessment periods; unstable housing was defined by having at least one unstable housing situation (e.g., jail or prison) throughout the assessment periods. The sample included 57 individuals with 272 assessment charts. Multivariate logistic regression results show that service engagement was associated with housing stability and that receiving housing supportive services was inversely associated with housing stability. The findings support prior literature in that service engagement remained a "critical ingredient" of the ACT model and highlights the importance of the supportive aspect of housing services in improving housing stability among individuals with co-occurring disorders.
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Affiliation(s)
- Yeqing Yuan
- Department of Social Work, Samuel Merritt University, Oakland, CA, USA.
| | - Jennifer Manuel
- University of Connecticut School of Social Work, CT, Hartford, USA
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22
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Stacherl B, Entringer TM. From feeling depressed to getting diagnosed: Determinants of a diagnosis of depression after experiencing symptoms. Int J Soc Psychiatry 2024:207640241303038. [PMID: 39723626 DOI: 10.1177/00207640241303038] [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] [Indexed: 12/28/2024]
Abstract
BACKGROUND Receiving a formal diagnosis for a depressive disorder is a prerequisite for getting treatment, yet the illness inherently complicates care-seeking. Thus, understanding the process from depression symptoms to diagnosis is crucial. AIMS This study aims to disentangle (1) risk factors for depression symptoms from (2) facilitators and barriers to receiving a diagnosis after experiencing depression symptoms. METHOD We used data from the German Socio-Economic Panel. Within a sample of 40,238 individuals, we investigated factors predicting depression symptoms, assessed with the SF-12 Mental Component Summary score. Additionally, within a subsample of 3,444 individuals with depression symptoms, we analyzed factors associated with receiving a first-ever diagnosis in the subsequent year. These factors included health status, demographics, socioeconomic characteristics, personality traits, and health infrastructure. RESULTS Depression symptoms were associated with chronic physical conditions, female gender, middle age, living alone, fewer close friends, being unemployed or not working, lower income, lower agreeableness, conscientiousness, or extraversion, and higher neuroticism. Additionally, poorer overall mental and physical health, female gender, older age, unemployment, and neuroticism were positively associated with receiving a formal diagnosis. Access to general practitioners and psychotherapists was not associated with receiving a formal diagnosis. CONCLUSIONS Our results replicated previous research on risk factors for depression symptoms. Moreover, some risk factors for experiencing symptoms (female gender, middle age, unemployment, and higher neuroticism) subsequently also facilitated receiving a formal depression diagnosis. Thus, this study underscores the importance of considering the chronological sequence in the process from depression symptoms to diagnosis.
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Affiliation(s)
| | - Theresa M Entringer
- German Institute for Economic Research (DIW Berlin), Germany
- Department of Psychology, University of Greifswald, Germany
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Cai X, Zhang Y, Shi C, Wong GHY, Luo H, Wang H. Prescription of Nonpharmacologic Interventions in Memory Clinics: Data from the Clinical Pathway for Alzheimer's Disease in China (CPAD) Study. J Am Med Dir Assoc 2024; 25:105273. [PMID: 39307174 DOI: 10.1016/j.jamda.2024.105273] [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: 03/26/2024] [Revised: 08/06/2024] [Accepted: 08/18/2024] [Indexed: 10/27/2024]
Abstract
OBJECTIVES Nonpharmacologic interventions are recommended to improve outcomes in dementia. Little is known about their prescription in practice, especially in non-Western populations. We investigated individual- and institution-level characteristics associated with nonpharmacologic interventions prescription in China. DESIGN A multicenter observational study. SETTING AND PARTICIPANTS This study used cross-sectional data from 889 community-dwelling outpatients living with dementia aged ≥45 years from a multicenter registry of 28 memory clinics in China. METHODS Prescription records of nonpharmacologic interventions, carer and clinic characteristics, and reasons for declining interventions were collected. Multilevel logistic regression was used to identify factors associated with the prescription. RESULTS Nonpharmacologic interventions were prescribed in 323 people (36.3%) with mild cognitive impairment or dementia. Cognitive activities and carer training/support were the most prescribed interventions. Multilevel logistic regression showed that 73% of the variance in prescription was attributed to institutional characteristics of the memory clinic. Greater caregiving gain [odds ratio (OR), 1.05; 95% CI, 1.02-1.09], lower burden (OR, 0.97; 95% CI, 0.95-1.00), worse carer-perceived dyad relationship (OR, 0.83; 95% CI, 0.70-0.99), and family history of dementia (OR, 2.08; 95% CI, 1.19-3.65) were individual-level factors associated with prescription. Among 440 people considered having a need but received no prescription, declined by user/carer was the main reason for not prescribing (70.7%). Skepticism about effectiveness by physicians/carers and carers being unable or lacking resources to use the interventions were the common reasons given. CONCLUSIONS AND IMPLICATIONS A relatively low prescription rate of nonpharmacologic interventions is related to both individual- and institution-level factors. Carer support and education, instrumental support, and prescription guidelines across specialties and sites are possible strategies to improve access to nonpharmacologic interventions in dementia care.
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Affiliation(s)
- Xinxin Cai
- Department of Applied Social Sciences & Research Centre for Gerontology and Family Studies, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yingyang Zhang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Cheng Shi
- School of Graduate Studies & Institute of Policy Studies, Lingnan University, Hong Kong, China
| | - Gloria H Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Huali Wang
- Dementia Care & Research Center, Beijing Dementia Key Lab, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.
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Domínguez T, Puebla DP, Fresán A, Sheinbaum T, Nieto L, Robles R, López SR, de la Fuente-Sandoval C, Lara Muñoz MDC, Barrantes-Vidal N, Celada-Borja CA, Rosel-Vales M, Saracco R. Why do some Mexicans with psychosis risk symptoms seek mental health care and others do not? Psychiatry Res 2024; 342:116199. [PMID: 39341179 DOI: 10.1016/j.psychres.2024.116199] [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: 07/19/2024] [Revised: 09/09/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024]
Abstract
Help-seeking barriers differ according to the sociocultural context and country-specific mental healthcare system. More research is needed in low-middle-income countries, where early psychosis programs are still scarce, and the mental health care gap is wide. This study aims to explore predisposing, enabling, and need factors associated with mental health service utilization in 481 Mexicans self-reporting psychosis risk symptoms, as well as differences between those who were currently mental health service users (MHSU) and those who were not (non-MHSU). Participants responded to self-reported measures through an online survey. The factors associated with an increased probability of using mental health services were having an occupation, having a medium/high socioeconomic status, an intention to seek help from a mental health professional, fewer help-seeking barriers, moderate/severe anxious symptoms, higher distress associated with psychosis risk symptoms and social functioning impairment. Findings provide relevant information for designing more effective strategies to improve help-seeking, early identification, and timely treatment delivery in Mexico. The need to generate strategies focused on reducing stigma, enhancing psychosis literacy in the community, and increasing the identification of emerging signs of psychosis in primary healthcare professionals is highlighted, mainly when co-occurring with other psychiatric symptoms.
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Affiliation(s)
- Tecelli Domínguez
- Centro de Investigación en Salud Mental Global, Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz"-UNAM, Mexico City, Mexico.
| | | | - Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Tamara Sheinbaum
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Lourdes Nieto
- Centro de Investigación en Salud Mental Global, Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz"-UNAM, Mexico City, Mexico
| | - Rebeca Robles
- Centro de Investigación en Salud Mental Global, Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz"-UNAM, Mexico City, Mexico
| | - Steven R López
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | | | | | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain; Fundació Sanitària Sant Pere Claver, Spanish Mental Health Research Network (CIBERSAM), Spain
| | - César Augusto Celada-Borja
- Clínica de Esquizofrenia, Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Mauricio Rosel-Vales
- Clínica de Esquizofrenia, Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Ricardo Saracco
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
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25
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Huff NR, Dunderdale L, Kellogg AJ, Isbell LM. Factors related to help-seeking and service utilization for professional mental healthcare among young people: An umbrella review. Clin Psychol Rev 2024; 114:102504. [PMID: 39395209 DOI: 10.1016/j.cpr.2024.102504] [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: 02/20/2024] [Revised: 09/12/2024] [Accepted: 09/18/2024] [Indexed: 10/14/2024]
Abstract
The aim of this umbrella review is to summarize evidence on factors that influence help-seeking and service utilization for professional mental healthcare among young people ages 0-30. The CINAHL, Cochrane, Epistemonikos, MEDLINE, PsycINFO, PubMed, and Web of Science databases were searched in December 2023 for systematic reviews in English. The search yielded 26 eligible reviews, all of which are medium or high quality. Primary study overlap was rare. Using an established framework, we organize intrapersonal (n = 37), interpersonal (n = 14), institutional (n = 9), community (n = 7), and public policy (n = 6) factors. The most frequently reviewed factor at each level is trust of professionals (intrapersonal), close others' support for treatment (interpersonal), cost (institutional), availability (community), and insurance (public policy). Stigma is widely referenced (18 reviews) and classified as multi-dimensional. Narrative synthesis reveals population-specific variability (e.g., rural, racial/ethnic minority, refugees, immigrants) in the importance of many factors. To develop interventions and healthcare systems sensitive to young people's needs, we recommend promoting stigma-reduction campaigns, and targeting trustworthiness, affordability, anonymity, accessibility, and mental health literacy. Identifying commonalities and differences across populations and contexts assists in the design of nuanced and efficient treatment delivery systems for young people, who are at a critical time for their mental health.
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Affiliation(s)
- Nathan R Huff
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America.
| | - Laura Dunderdale
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Alexander J Kellogg
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Linda M Isbell
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
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26
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Pedro LMR, de Oliveira MF, Pereira MD, da Fonseca AD, Canavarro MC. Factors Associated with Prospective Acceptability and Preferences for Unified Transdiagnostic Cognitive-Behavioral Treatments and Group Therapy in the Portuguese General Population. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:857-876. [PMID: 38839662 PMCID: PMC11489295 DOI: 10.1007/s10488-024-01391-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
Group transdiagnostic cognitive-behavioral therapy (CBT) offers a promising solution for limited mental health access in Portugal. Understanding barriers to patient adherence is crucial for successful implementation. This study aimed to characterize the prospective acceptability and preferences for unified transdiagnostic CBT and group therapy in the Portuguese general population and explore their correlates. A sample of 243 participants (18-88 years old), recruited online, completed an online survey collecting information on sociodemographic and clinical characteristics, acceptability of transdiagnostic CBT treatments, specifically of Unified Protocol (UP), acceptability of group therapy, therapeutic format preferences, beliefs about group therapy and help-seeking attitudes. Most participants were receptive to and perceived as useful both unified transdiagnostic CBT and group therapy. Overall, participants presented significantly more favorable attitudes than unfavorable attitudes toward unified transdiagnostic CBT and group therapy (p < .001). Multivariate analyses revealed that (1) favorable attitudes toward transdiagnostic treatments were negatively associated with being employed and positively associated with living in an urban area, and higher efficacy scores; (2) unfavorable attitudes toward transdiagnostic treatments were positively associated with being married/cohabitating and negatively associated with vulnerability scores; (3) being female, living in an urban area, and higher efficacy and myth scores emerged as positive predictors of favorable attitudes toward group therapy; and (4) efficacy and vulnerability scores and help-seeking propensity emerged as negative predictors of unfavorable attitudes toward group therapy. These findings highlight the importance of delineating strategies to increase knowledge and acceptance of unified transdiagnostic CBT and group therapy in the Portuguese population, addressing specific individual characteristics.
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Affiliation(s)
- Liliana Maria Rodrigues Pedro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal.
| | | | - Marco Daniel Pereira
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
| | - Ana Dias da Fonseca
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
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Armoon B, Grenier G, Fleury MJ. Perceived Higher Unmet Care Needs among Adults in Permanent Supportive Housing. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:843-856. [PMID: 38819494 DOI: 10.1007/s10488-024-01390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
This study is original in that it assesses various types of care needs, barriers to care, and factors associated with higher unmet needs among 308 permanent supportive housing (PSH) residents in Quebec (Canada). Data from structured interviews that featured the Perceived Need for Care Questionnaire were collected from 2020 to 2022, controlling for the COVID-19 pandemic period. Eight types of care (e.g., information, counseling) were accounted for. Based on the Behavioral Model for Vulnerable Populations, predisposing, need, and enabling factors associated with higher unmet care needs were assessed using a negative binomial regression model. The study found that 56% of adult PSH residents, even those who had lived in PSH for 5 + years, had unmet care needs. Twice as many unmet needs were due to structural (e.g., care access) rather than motivational barriers. Living in single-site PSH, in healthier neighborhoods, having better quality of life and self-esteem, and being more satisfied with housing and outpatient care were associated with fewer unmet care needs. PSH residents with co-occurring mental disorders (MD) and substance use disorders (SUD), and with moderate or severe psychological distress were likely to have more unmet needs. Better access to care, counseling and integrated treatment for co-occurring MD-SUD might be improved, as well as access to information on user rights, health and available support. Welfare benefits could be increased, with more peer support and meaningful activities, especially in single-site PSH. The quality of the neighborhoods where PSH are located might also be better monitored.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montréal, Québec, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Montréal, Québec, Canada.
- Department of Psychiatry, McGill University, Montréal, Québec, Canada.
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montréal, QC, H4H 1R3, Canada.
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Formánek T, Krupchanka D, Perry BI, Mladá K, Osimo EF, Masopust J, Jones PB, Plana-Ripoll O. Contribution of severe mental disorders to fatally harmful effects of physical disorders: national cohort study. Br J Psychiatry 2024; 225:436-445. [PMID: 39115008 PMCID: PMC11557285 DOI: 10.1192/bjp.2024.110] [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: 03/08/2024] [Revised: 05/01/2024] [Accepted: 05/15/2024] [Indexed: 11/13/2024]
Abstract
BACKGROUND It remains unknown whether severe mental disorders contribute to fatally harmful effects of physical illness. AIMS To investigate the risk of all-cause death and loss of life-years following the onset of a wide range of physical health conditions in people with severe mental disorders compared with matched counterparts who had only these physical health conditions, and to assess whether these associations can be fully explained by this patient group having more clinically recorded physical illness. METHOD Using Czech national in-patient register data, we identified individuals with 28 physical health conditions recorded between 1999 and 2017, separately for each condition. In these people, we identified individuals who had severe mental disorders recorded before the physical health condition and exactly matched them with up to five counterparts who had no recorded prior severe mental disorders. We estimated the risk of all-cause death and lost life-years following each of the physical health conditions in people with pre-existing severe mental disorders compared with matched counterparts without severe mental disorders. RESULTS People with severe mental disorders had an elevated risk of all-cause death following the onset of 7 out of 9 broadly defined and 14 out of 19 specific physical health conditions. People with severe mental disorders lost additional life-years following the onset of 8 out 9 broadly defined and 13 out of 19 specific physical health conditions. The vast majority of results remained robust after considering the potentially confounding role of somatic multimorbidity and other clinical and sociodemographic factors. CONCLUSIONS A wide range of physical illnesses are more likely to result in all-cause death in people with pre-existing severe mental disorders. This premature mortality cannot be fully explained by having more clinically recorded physical illness, suggesting that physical disorders are more likely to be fatally harmful in this patient group.
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Affiliation(s)
- Tomáš Formánek
- Department of Psychiatry, University of Cambridge, Cambridge, UK; and Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
| | - Dzmitry Krupchanka
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Benjamin I. Perry
- Department of Psychiatry, University of Cambridge, Cambridge, UK; and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Karolína Mladá
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic; and Department of Psychiatry, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Emanuele F. Osimo
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; Institute of Clinical Sciences, Imperial College, London, UK; MRC London Institute of Medical Sciences, London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Jiří Masopust
- Department of Psychiatry, University Hospital Hradec Králové, Hradec Králové, Czech Republic; and Faculty of Medicine, Charles University, Hradec Králové, Czech Republic
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK; and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; Aarhus University Hospital, Aarhus, Denmark; and National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
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Gao Y, Burns R, Leach L, Chilver MR, Butterworth P. Examining the mental health services among people with mental disorders: a literature review. BMC Psychiatry 2024; 24:568. [PMID: 39164690 PMCID: PMC11334396 DOI: 10.1186/s12888-024-05965-z] [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: 02/18/2024] [Accepted: 07/15/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Mental disorders are a significant contributor to disease burden. However, there is a large treatment gap for common mental disorders worldwide. This systematic review summarizes the factors associated with mental health service use. METHODS PubMed, Scopus, and the Web of Science were searched for articles describing the predictors of and barriers to mental health service use among people with mental disorders from January 2012 to August 2023. The initial search yielded 3230 articles, 2366 remained after removing duplicates, and 237 studies remained after the title and abstract screening. In total, 40 studies met the inclusion and exclusion criteria. RESULTS Middle-aged participants, females, Caucasian ethnicity, and higher household income were more likely to access mental health services. The use of services was also associated with the severity of mental symptoms. The association between employment, marital status, and mental health services was inconclusive due to limited studies. High financial costs, lack of transportation, and scarcity of mental health services were structural factors found to be associated with lower rates of mental health service use. Attitudinal barriers, mental health stigma, and cultural beliefs also contributed to the lower rates of mental health service use. CONCLUSION This systematic review found that several socio-demographic characteristics were strongly associated with using mental health services. Policymakers and those providing mental health services can use this information to better understand and respond to inequalities in mental health service use and improve access to mental health treatment.
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Affiliation(s)
- Yunqi Gao
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
| | - Richard Burns
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Liana Leach
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Miranda R Chilver
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Peter Butterworth
- School of Psychology, Deakin University, Melbourne, Australia
- Department of Health, Economics, Wellbeing and Society, Australian National University, Canberra, Australia
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Zhou M, Lageborn CT, Sjölander A, Larsson H, D'Onofrio B, Landén M, Lichtenstein P, Pettersson E. Psychiatric Diagnoses in Parents and Psychiatric, Behavioral, and Psychosocial Outcomes in Their Offspring: A Swedish Population-Based Register Study. Am J Psychiatry 2024; 181:761-773. [PMID: 39086283 DOI: 10.1176/appi.ajp.20230353] [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: 08/02/2024]
Abstract
OBJECTIVE Associations were examined between six psychiatric diagnoses in parents and a broad range of psychiatric and nonpsychiatric outcomes in their offspring. METHODS All individuals born in Sweden between 1970 and 2000 were linked to their biological parents (N=3,286,293) through Swedish national registers. A matched cohort design, with stratified Cox regression and conditional logistic regression analyses, was used examine associations between six psychiatric diagnoses in the parents and 32 outcomes in their offspring. All children, including those exposed and those not exposed to parents with psychiatric diagnoses, were followed from their date of birth to the date of emigration from Sweden, death, or December 31, 2013, when the offspring were 14-44 years old. RESULTS In terms of absolute risk, most children who had parents with psychiatric diagnoses were not diagnosed in specialist care themselves, and the proportion of offspring having any of the 16 types of psychiatric conditions ranged from 22.17% (of offspring exposed to parental depression) to 25.05% (of offspring exposed to parental drug-related disorder) at the end of follow-up. Nevertheless, in terms of relative risk, exposure to any of the six parental psychiatric diagnoses increased probabilities of the 32 outcomes among the offspring, with hazard ratios that ranged from 1.03 to 8.46 for time-to-event outcomes and odds ratios that ranged from 1.29 to 3.36 for binary outcomes. Some specificities were observed for parental diagnoses of psychosis and substance-related disorders, which more strongly predicted psychotic-like and externalizing-related outcomes, respectively, in the offspring. CONCLUSIONS The intergenerational transmission of parental psychiatric conditions appeared largely transdiagnostic and extended to nonpsychiatric outcomes in offspring. Given the broad spectrum of associations with the outcomes, service providers (e.g., psychiatrists, teachers, and social workers) should consider clients' broader psychiatric family history when predicting prognosis and planning interventions or treatment.
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Affiliation(s)
- Mengping Zhou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Christine Takami Lageborn
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Brian D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
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Saunders E, Pevie NW, Bedford S, Gosselin J, Harris N, Rash JA. Moms in motion: Predicting healthcare utilization patterns among mothers in Newfoundland and Labrador. PLoS One 2024; 19:e0304815. [PMID: 38980863 PMCID: PMC11233017 DOI: 10.1371/journal.pone.0304815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/18/2024] [Indexed: 07/11/2024] Open
Abstract
Mothers have a significant influence on family dynamics, child development, and access to family services. There is a lack of literature on the typical Canadian maternal experience and its influence on access to services for mothers despite recognizing the importance of mothers. A cross-sectional study was conducted to address this research gap that employed Andersen's Behavioral Model of Health Service Use in conjunction with a feminist lens. A total of 1,082 mothers who resided in Newfoundland and Labrador (NL) participated in a province-wide survey in 2017 and reported on their wellbeing, family life, and healthcare utilization. Stepwise binomial logistic regressions and linear regressions were used to predict initiation and continued service utilization within the preceding 12 months, respectively. Mothers who participated in this survey were older, and were more likely to be in a relationship than those in the Canadian census, while no difference was observed in annual income. Approximately half of mothers accessed services for themselves over the previous 12-months, with the overwhelming majority accessing services for their children. Medical services were the most likely to be utilized, and mental health and behavioural services were the most likely services to be needed, but not available. Sociodemographic (e.g., age, education attainment), familial relationships and role satisfaction, health need, and health practices predicted maternal initiation and continued use of services, with a larger number of variables influencing maternal service initiation as compared to continuous use of services. Sociodemographic (e.g., maternal age, community population), maternal social support, health need, and maternal health practices predicted maternal access of at least one child service while family relationships, health need, and maternal health practices predicted maternal use of a range of child services conditional on initial access. These results can support the provincial health system to better support access to care by acknowledging the interdependent nature of maternal and child health care utilization. They also highlight the importance of equitable healthcare access in rural locations. Results are discussed in terms of their clinical relevance to health policy.
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Affiliation(s)
- Emily Saunders
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Noah W. Pevie
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Shannon Bedford
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Julie Gosselin
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Nick Harris
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Joshua A. Rash
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
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Arahanthabailu P, Praharaj SK, Purohith AN, Yesodharan R, Rege S, Appaji R. Exploring barriers to seek mental health services among patients with severe mental illness and their caregivers in a modified assertive community treatment program: A qualitative thematic analysis. Indian J Psychiatry 2024; 66:621-629. [PMID: 39257514 PMCID: PMC11382755 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_314_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 09/12/2024] Open
Abstract
Background Affordability, lack of public mental healthcare facilities, inadequate insurance coverage, and stigma and discrimination are barriers to mental healthcare utilization in India. There is limited research on these barriers and the factors influencing the use of mental health services. Aim To explore the barriers to seeking mental healthcare for individuals with severe mental illness and their caregivers in a modified assertive community treatment program. Methods In a qualitative study using a descriptive thematic analysis, we conducted in-depth interviews with 19 adults, including seven individuals with severe mental illness and twelve caregivers. All the participants had been in the modified assertive community treatment program for at least two years. Using thematic analysis, we identified and grouped codes into subthemes and then clustered into themes. Results Three major themes on barriers to seeking mental health services emerged: service-related factors, societal-related factors, and illness-related factors. Service-related factors included affordability, accessibility and geographical disparity, and noncoverage under insurance schemes. Societal-related factors included social stigma and discrimination, lack of mental health service knowledge and seeking other forms of treatment, and poor social support. Illness-related factors included poor insight into the illness and no relief from the symptoms despite medication. Conclusions Barriers to seeking mental healthcare can be categorized as service-related, societal-related, and illness-related. Identifying these factors will improve mental health service delivery.
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Affiliation(s)
- Praveen Arahanthabailu
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Samir K Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abhiram N Purohith
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Renjulal Yesodharan
- Department of Psychiatric (Mental Health) Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sumita Rege
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rashmi Appaji
- Department of Psychiatry, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India
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Penner KE, Roy R, Hanlon-Dearman AC, Cheung K, Katz C, Schleider JL, Roos LE, Cameron EE. "Bottom of My Own List:" Barriers and Facilitators to Mental Health Support Use in Caregivers of Children with Neurodevelopmental Support Needs. J Autism Dev Disord 2024:10.1007/s10803-024-06409-z. [PMID: 38907781 DOI: 10.1007/s10803-024-06409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/24/2024]
Abstract
This study investigated barriers and facilitators to mental health service use (e.g., interventions, educational programs) in caregivers of children with neurodevelopmental disorders and/or neurodevelopmental problems, as they experience high levels of distress and low help-seeking behaviour. Caregivers of children aged 0 to 12 with neurodevelopmental disorders and/or neurodevelopmental problems (N = 78) completed a mixed-method online survey about their mental health and service use. Caregiver-reported psychological distress and mental health service use were positively correlated. Most participants (66.2%) were above the clinical cut-off score for anxiety, depression, or caregiving stress; of these participants, 45.7% had not accessed mental health services for themselves within the past year. Lack of time and difficulties arranging childcare were noted barriers; patient-oriented suggestions for service improvement were provided. The findings add novel information on factors to increase mental health service use in this population. Recommendations for clinical practice for those practitioners who provide services for children with neurodevelopmental disorders and/or neurodevelopmental problems are included.
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Affiliation(s)
- Kailey E Penner
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
| | - Rachel Roy
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
| | - Ana C Hanlon-Dearman
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Rehabilitation Centre for Children (RCC), Specialized Services for Children and Youth (SSCY) Centre, Winnipeg, MB, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Kristene Cheung
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
- Manitoba FASD Centre, SSCY Centre, Winnipeg, MB, Canada
| | - Cara Katz
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | | | - Leslie E Roos
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Emily E Cameron
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada.
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
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Zerr A, McCabe K, Zhang D, Yeh M. Parent Explanatory Model Personalization as a Method of Reducing Risk for Poor Engagement and Outcomes in PCIT among Culturally Diverse Families. J Clin Med 2024; 13:3541. [PMID: 38930070 PMCID: PMC11204725 DOI: 10.3390/jcm13123541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Evidence supports the efficacy of Behavioral Parent Training (BPT) interventions such as Parent-Child Interaction Therapy (PCIT) for treating child behavior problems; however, treatment engagement and outcomes vary across ethnic groups. Risk for poor treatment engagement and outcomes may be attributed in part to misalignment between parent explanatory model components (PEMs) and the traditional BPT model, including treatment expectations, etiological explanations, parenting styles, and family support for treatment. The present study aims to examine whether personalized treatment adaptations addressing these PEM-BPT misalignments reduce risk for poor treatment engagement and outcomes. Methods: The authors previously utilized the PersIn framework to develop a personalized version of PCIT (MY PCIT) that assesses these PEMs in order to identify families at risk for poor treatment engagement and outcomes. Families were identified as high risk (due to PEM-BPT misalignment) and low risk (meaning those without identified PEM-BPT misalignment) for specific PEMs. Families at elevated risk then received tailored treatment materials designed to improve alignment between the parental explanatory model and the PCIT treatment explanatory model. A recent pilot trial of MY PCIT demonstrated positive treatment outcomes; however, the extent to which adaptations were successful in reducing the underlying risk factors has not yet been examined. Results: Findings demonstrate that the personalization approach was effective in reducing indicators of risk, and that families who were initially at high and low risk during pre-treatment reported similar levels of treatment engagement and outcomes by post-treatment. Conclusions: The findings suggest that this personalized approach has the potential to reduce risk associated with poor treatment engagement and outcomes for culturally diverse families.
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Affiliation(s)
- Argero Zerr
- Department of Psychology, California State University Channel Islands, 1 University Dr., Camarillo, CA 93012, USA
| | - Kristen McCabe
- Department of Psychological Sciences, University of San Diego, 5998 Alcala Park, San Diego, CA 92110, USA
- Child and Adolescent Services Research Center, San Diego, CA 92123, USA
| | - Dongbowei Zhang
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
| | - May Yeh
- Child and Adolescent Services Research Center, San Diego, CA 92123, USA
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
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Mortier P, Conde S, Alayo I, Amigo F, Ballester L, Cirici Amell R, Guinart D, Contaldo SF, Ferrer M, Leis A, Mayer MA, Portillo-Van Diest A, Puértolas-Gracia B, Ramírez-Anguita JM, Peña-Salazar C, Sanz F, Kessler RC, Palao D, Pérez Sola V, Mehlum L, Qin P, Vilagut G, Alonso J. Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge. JAMA Netw Open 2024; 7:e2417131. [PMID: 38922620 PMCID: PMC11208976 DOI: 10.1001/jamanetworkopen.2024.17131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/13/2024] [Indexed: 06/27/2024] Open
Abstract
Importance There is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. Objective To compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization. Design, Setting, and Participants This retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024. Exposures Socioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations. Main Outcomes and Measures Postdischarge premature death (ie, all-cause death before age 70 years) and suicide (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted. Results A total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with postdischarge intentional self-harm (AHR, 2.83 [95% CI, 1.97-4.05] for females; 3.29 [95% CI, 2.47-4.40] for males), with depressive disorders (AHR, 2.13 [95% CI, 1.52-2.97]) and adjustment disorders (AHR, 1.94 [95% CI, 1.32-2.83]) among males, and with bipolar disorder among females (AHR, 1.94 [95% CI, 1.21-3.09]). Postdischarge intentional self-harm was associated with index admissions for intentional self-harm (AHR, 1.95 [95% CI, 1.73-2.21] for females; 2.62 [95% CI, 2.20-3.13] for males) as well as for adjustment disorders (AHR, 1.48 [95% CI, 1.33-1.65] for females; 1.99 [95% CI, 1.74-2.27] for males), anxiety disorders (AHR, 1.24 [95% CI, 1.10-1.39] for females; 1.36 [95% CI, 1.18-1.58] for males), depressive disorders (AHR, 1.54 [95% CI, 1.40-1.69] for females; 1.80 [95% CI, 1.58-2.04] for males), and personality disorders (AHR, 1.59 [95% CI, 1.46-1.73] for females; 1.43 [95% CI, 1.28-1.60] for males). Conclusions and Relevance In this cohort study of patients discharged from psychiatric hospitalization, risk for premature death and suicide was significantly higher compared with the general population, suggesting individuals discharged from psychiatric inpatient care are a vulnerable population for premature death and suicidal behavior.
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Affiliation(s)
- Philippe Mortier
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Susana Conde
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Itxaso Alayo
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
- Biosistemak Institute for Health Systems Research, Barakaldo, Bizkaia, Spain
| | - Franco Amigo
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Laura Ballester
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Roser Cirici Amell
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Daniel Guinart
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM, ISCIII), Madrid, Spain
- Mental Health Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Psychiatry, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | | | - Montserrat Ferrer
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Angela Leis
- Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Miguel Angel Mayer
- Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ana Portillo-Van Diest
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Beatriz Puértolas-Gracia
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Juan Manuel Ramírez-Anguita
- Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Carlos Peña-Salazar
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
- Mental Health and Intellectual Disability Services, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Neurology Department, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Ferran Sanz
- Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Instituto Nacional de Bioinformatica–ELIXIR-ES (IMPaCT-Data-ISCIII), Barcelona, Spain
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Diego Palao
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM, ISCIII), Madrid, Spain
- Department of Mental Health, Hospital Universitari Parc Taulí; Institut d’Investigació i Innovació Parc Taulí (I3PT), Unitat de Neurociències Traslacional I3PT-INc Universitat Autònoma de Barcelona, Sabadell, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Víctor Pérez Sola
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM, ISCIII), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gemma Vilagut
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Jordi Alonso
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
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Huang H, Huynh B, Nidey N, Huang H. Meaningful Engagement in Depression and Anxiety Collaborative Care: Associations With Systematic Case Review. J Acad Consult Liaison Psychiatry 2024; 65:254-260. [PMID: 38309684 DOI: 10.1016/j.jaclp.2024.01.006] [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: 10/16/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Collaborative care (CC) is an evidence-based model of care for treating behavioral health conditions in primary care settings. The CC team consists of a primary care provider, behavioral health care manager (CM), and a consultant psychiatrist who collaborate to create treatment plans. To date, there is limited data on factors associated with meaningful engagement in CC programs. OBJECTIVE To identify the proportion of patients who were meaningfully engaged and to investigate the factors associated with meaningful engagement in a CC program. METHODS Data was collected from a CC program implemented across 27 adult primary care clinics in a Midwestern, U.S. academic medical system. Logistic regression (n = 5218) was used to estimate the odds of receiving meaningful engagement. RESULTS Data was collected from 6437 individuals with 68% being female and a mean age of 45 years old (standard deviation 17.6). Overall, 57% of patients were meaningfully engaged; however, this proportion differed based on demographic and clinical factors. Among modifiable clinical factors, systematic case reviews between the CM and psychiatrist (odds ratio: 10.2, 95% confidence interval: 8.6-12.1) and warm handoffs (odds ratio: 1.3, 95% confidence interval: 1.1-1.5) were associated with a higher likelihood of receiving meaningful engagement. CONCLUSIONS The presence of systematic case reviews between the behavioral health CM and the consultant psychiatrist was highly associated with meaningful engagement. When implementing such programs, high fidelity to the core principles including regularly scheduled systematic case reviews should be pursued.
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Affiliation(s)
- Heather Huang
- Department of Psychiatry, University of Wisconsin Hospitals and Clinics, Madison, WI.
| | - Brandon Huynh
- Department of Psychiatry, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - Nichole Nidey
- College of Public Health, University of Iowa, Iowa City, IA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA
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Subramaniam DS, Zhang Z, Timmer Z, DeMarco EC, Poirier MP, Hinyard LJ. Palliative Care and Mental Health among Pancreatic Cancer Patients in the United States: An Examination of Service Utilization and Health Outcomes. Healthcare (Basel) 2024; 12:842. [PMID: 38667604 PMCID: PMC11050506 DOI: 10.3390/healthcare12080842] [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: 02/28/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Palliative care (PC) utilization remains low among pancreatic cancer patients. This study explores the association of PC with mental health service and pharmacotherapy utilization among pancreatic cancer patients. METHODS Retrospective analysis was conducted on a sample of patients in the United States with newly diagnosed pancreatic cancer using Electronic Health Record data from Optum's Integrated Claims-Clinical data set. Subsequent diagnoses of anxiety and depression and PC consultation encounters were determined using ICD-9/10 codes. Adjusted associations of mental health treatments with PC and patient characteristics were quantified using multiple logistic regression. RESULTS Among newly diagnosed pancreatic cancer patients (n = 4029), those with PC consultations exhibited a higher prevalence of anxiety (33.9% vs. 22.8%) and depression (36.2% vs. 23.2%). Mental health service use and pharmacotherapy varied, with the highest utilization among patients having both anxiety and depression. Treatment pattern was also influenced by age (aOR 1.832 for age <55 vs. 65-70 years). Notably, PC consultations showed no significant effect on the likelihood of documented treatment. DISCUSSION Our study emphasizes underutilization of PC and MH treatment for pancreatic cancer patients. These findings imply a crucial need for further investigation into palliative care's role in addressing mental health concerns among pancreatic cancer patients.
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Affiliation(s)
- Divya S. Subramaniam
- Department of Health and Clinical Outcomes Research, Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine, St. Louis, MO 63108, USA (Z.T.); (M.P.P.)
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Flores MW, Mullin B, Sharp A, Kumar A, Moyer M, Cook BL. Examining Racial/Ethnic Disparities in Tobacco Dependence Treatment Among Medicaid Beneficiaries Using Fifty State Medicaid Claims, 2009-2014. J Racial Ethn Health Disparities 2024; 11:755-763. [PMID: 37326794 PMCID: PMC11287441 DOI: 10.1007/s40615-023-01558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/17/2023]
Abstract
In the USA, low-income racial/ethnic minority groups experience higher smoking rates and greater smoking-related disease burden than their White counterparts. Despite the adverse effects, racial/ethnic minorities are less likely to access tobacco dependence treatment (TDT). Medicaid is one of the largest payers of TDT in the USA and covers predominantly low-income populations. The extent of TDT use among beneficiaries from distinct racial/ethnic groups is unknown. The objective is to estimate racial/ethnic differences in TDT use among Medicaid fee-for-service beneficiaries. Using a retrospective study design and 50 state (including the District of Columbia) Medicaid claims (2009-2014), we employed multivariable logistic regression models and predictive margin methods to estimate TDT use rates among adults (18-64) enrolled (≥ 11 months) in Medicaid fee-for-service programs (January 2009-December 2014) by race/ethnicity. The population included White (n = 6,536,004), Black (n = 3,352,983), Latinx (n = 2,264,647), Asian (n = 451,448), and Native American/Alaskan Native (n = 206,472) beneficiaries. Dichotomous outcomes reflected service use in the past year. Any TDT use was operationalized as any smoking cessation medication fill, any smoking cessation counseling visit, or any smoking cessation outpatient visit. In secondary analyses, we disaggregated TDT use into three separate outcomes. Results suggested that Black (10.6%; 95% CI = 9.9-11.4%), Latinx (9.5%; 95% CI = 8.9-10.2%), Asian (3.7%; 95% CI = 3.4-4.1%), and Native American/Alaskan Native (13.7%; 95% CI = 12.7-14.7%) beneficiaries had lower TDT use rates compared to White beneficiaries (20.6%). Similar racial/ethnic treatment disparities were identified across all outcomes. By identifying significant racial/ethnic disparities in TDT use between 2009 and 2014, this study provides a benchmark against which to measure recent interventions in state Medicaid programs improving equity in smoking cessation interventions.
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Affiliation(s)
- Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Brian Mullin
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
| | - Amanda Sharp
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Center for Mindfulness & Compassion, Cambridge Health Alliance, Cambridge, MA, USA
| | - Anika Kumar
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Heller School of Social Policy, Brandies University, Waltham, MA, USA
| | - Margo Moyer
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Mortier P, Vilagut G, García-Mieres H, Alayo I, Ferrer M, Amigo F, Aragonès E, Aragón-Peña A, Asúnsolo Del Barco Á, Campos M, Espuga M, González-Pinto A, Haro JM, López Fresneña N, Martínez de Salázar AD, Molina JD, Ortí-Lucas RM, Parellada M, Pelayo-Terán JM, Pérez-Gómez B, Pérez-Zapata A, Pijoan JI, Plana N, Polentinos-Castro E, Portillo-Van Diest A, Puig T, Rius C, Sanz F, Serra C, Urreta-Barallobre I, Kessler RC, Bruffaerts R, Vieta E, Pérez-Solá V, Alonso J. Health service and psychotropic medication use for mental health conditions among healthcare workers active during the Spain Covid-19 Pandemic - A prospective cohort study using web-based surveys. Psychiatry Res 2024; 334:115800. [PMID: 38387166 DOI: 10.1016/j.psychres.2024.115800] [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: 09/19/2023] [Revised: 01/30/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024]
Abstract
Little is known about healthcare workers' (HCW) use of healthcare services for mental disorders. This study presents data from a 16-month prospective cohort study of Spanish HCW (n = 4,809), recruited shortly after the COVID-19 pandemic onset, and assessed at four timepoints using web-based surveys. Use of health services among HCW with mental health conditions (i.e., those having a positive screen for mental disorders and/or suicidal thoughts and behaviours [STB]) was initially low (i.e., 18.2 %) but increased to 29.6 % at 16-month follow-up. Service use was positively associated with pre-pandemic mental health treatment (OR=1.99), a positive screen for major depressive disorder (OR=1.50), panic attacks (OR=1.74), suicidal thoughts and behaviours (OR=1.22), and experiencing severe role impairment (OR=1.33), and negatively associated with being female (OR = 0.69) and a higher daily number of work hours (OR=0.95). Around 30 % of HCW with mental health conditions used anxiolytics (benzodiazepines), especially medical doctors. Four out of ten HCW (39.0 %) with mental health conditions indicated a need for (additional) help, with most important barriers for service use being too ashamed, long waiting lists, and professional treatment not being available. Our findings delineate a clear mental health treatment gap among Spanish HCW.
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Affiliation(s)
- Philippe Mortier
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Gemma Vilagut
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Helena García-Mieres
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Itxaso Alayo
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Biosistemak Institute for Health Systems Research, Barakaldo, Bizkaia, Spain
| | - Montse Ferrer
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Franco Amigo
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Enric Aragonès
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Spain
| | - Andrés Aragón-Peña
- Epidemiology Unit, Regional Ministry of Health, Community of Madrid, Madrid, Spain; Fundación Investigación e Innovación Biosanitaria de AP, Comunidad de Madrid, Madrid, Spain
| | - Ángel Asúnsolo Del Barco
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, United States
| | - Mireia Campos
- Service of Prevention of Labor Risks, Medical Emergencies System, Generalitat de Catalunya, Spain
| | - Meritxell Espuga
- Occupational Health Service. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana González-Pinto
- BIOARABA, Hospital Universitario Araba-Santiago, UPV/EHU, Vitoria-Gasteiz, Spain; CIBER Salud Mental (CIBERSAM), Madrid, Spain
| | - Josep M Haro
- CIBER Salud Mental (CIBERSAM), Madrid, Spain; Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | | | - Juan D Molina
- CIBER Salud Mental (CIBERSAM), Madrid, Spain; Villaverde Mental Health Center, Clinical Management Area of Psychiatry and Mental Health, Psychiatric Service, Hospital Universitario 12 de Octubre, Madrid, Spain; Research Institute Hospital 12 de Octubre (i+12), Madrid, Spain; Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Rafael M Ortí-Lucas
- Service of Preventive Medicine and Quality of Attention, University Clinical Hospital of Valencia, Valencia, Spain
| | - Mara Parellada
- CIBER Salud Mental (CIBERSAM), Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Maria Pelayo-Terán
- CIBER Salud Mental (CIBERSAM), Madrid, Spain; Servicio de Psiquiatría y Salud Mental. Hospital el Bierzo, Gerencia de Asistencia Sanitaria del Bierzo (GASBI). Gerencia Regional de Salud de Castilla y Leon (SACYL). Ponferrada, León, Spain; Area de Medicina Preventiva y Salud Pública. Universidad de León, León, Spain
| | - Beatriz Pérez-Gómez
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; National Center of Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - José Ignasio Pijoan
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Clinical Epidemiology Unit-Hospital Universitario Cruces/ OSI EEC, Bilbao, Spain/ Biocruces-Bizkaia Health Research Institute, Spain
| | - Nieves Plana
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - Elena Polentinos-Castro
- Research Unit Primary Care Management, Madrid Health Service, Madrid, Spain; Department of Medical Specialities and Public Health. King Juan Carlos University, Madrid, Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud RICAPPS-(RICORS). Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ana Portillo-Van Diest
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Teresa Puig
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Department of Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Cristina Rius
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Ferran Sanz
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain; Research Progamme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, MELIS, Universitat Pompeu Fabra, Barcelona, Spain; Instituto Nacional de Bioinformatica - ELIXIR-ES, Barcelona, Spain
| | - Consol Serra
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain; CiSAL-Centro de Investigación en Salud Laboral, Hospital del Mar Research Institute/UPF, Barcelona, Spain
| | - Iratxe Urreta-Barallobre
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Donostia University Hospital, Clinical Epidemiology Unit, San Sebastián, Spain; Biodonostia Health Research Institute, Clinical Epidemiology, San Sebastián, Spain
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronny Bruffaerts
- Center for Public Health Psychiatry, Universitair Psychiatrisch Centrum, KU Leuven, Leuven, Belgium
| | - Eduard Vieta
- CIBER Salud Mental (CIBERSAM), Madrid, Spain; Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Víctor Pérez-Solá
- CIBER Salud Mental (CIBERSAM), Madrid, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Jordi Alonso
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
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Sultana T. Intersectional Effect of Gender, Race, and Socioeconomic Status in Mental Health Service Utilization: Evidence from the Canadian Community Health Survey 2015-2016. Community Ment Health J 2024; 60:589-599. [PMID: 38041771 DOI: 10.1007/s10597-023-01213-y] [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: 09/07/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
This study examined the intersectional effects of gender, race, and socioeconomic status (SES) on mental health service utilization (MHSU) employing the intersectionality framework. Data was extracted from Canadian Community Health Survey 2015-2016 with a total of 85,619 sample. Covariate adjusted prevalence ratio (aPR) and the predicted probability of MHSU from intersectional analyses were estimated using Poisson regression with robust variance. The prevalence of MHSU was 15.04% overall, 19.61% among women, 10.27% among men, 21.56% among white women and 11.12% among white men. The study observed overall significant intersectional effect of SES by gender and race on MHSU. For instance, white men with the lowest income were more likely to have MHSU compared to their counterparts. Similarly, the predicted probability of MHSU decreased with the increase of SES that varied by gender and race. Two-way and three-way interactions also confirmed statistical significance (p-interaction < 0.05) of intersectional effect of gender, race, and SES. The observed socioeconomic differences in MHSU across gender and racial groups can be explained by intersectionality.
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Affiliation(s)
- Toufica Sultana
- General Education Cell, Eastern University, Dhaka, Bangladesh.
- South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh.
- Department of Sociology, University of Saskatchewan, Saskatoon, Canada.
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Lawrence-Sidebottom D, Huffman LG, Beam AB, Guerra R, Parikh A, Roots M, Huberty J. Rates of Trauma Exposure and Posttraumatic Stress in a Pediatric Digital Mental Health Intervention: Retrospective Analysis of Associations With Anxiety and Depressive Symptom Improvement Over Time. JMIR Pediatr Parent 2024; 7:e55560. [PMID: 38412001 PMCID: PMC10933721 DOI: 10.2196/55560] [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: 12/15/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND More than 2 out of 3 children and adolescents in the United States experience trauma by the age of 16 years. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been an increasing uptake of digital mental health interventions (DMHIs) among youths, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youths participating in DMHIs and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youths. OBJECTIVE This study aims to use retrospective data from youths participating in a DMHI to (1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms; (2) determine whether trauma exposure and elevated PTS symptoms impact the improvement of comorbid anxiety and depressive symptoms throughout participation in care; and (3) determine whether participation in a non-posttraumatic DMHI is linked to reductions in PTS symptoms. METHODS This study was conducted using retrospective data from members (children ages 6 to 12 years) involved in a pediatric collaborative care DMHI. Participating caregivers reported their children's trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments. RESULTS Among eligible participants (n=966), 30.2% (n=292) reported at least 1 traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n=119), 73% (n=87) exhibited elevated anxiety symptoms and 50% (n=59) exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety but not depressive symptoms (anxiety: F2,287=26.11; P<.001). PTS symptoms also decreased significantly throughout care, with 96% (n=79) of participants showing symptom reductions. CONCLUSIONS This study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and nontrauma-exposed youths, among participants in a pediatric collaborative care DMHI. Youths with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma while also highlighting the critical need to assess symptoms of PTS in children seeking treatment.
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Affiliation(s)
| | | | | | | | | | | | - Jennifer Huberty
- Bend Health Inc, Madison, WI, United States
- FitMinded Inc LLC, Phoenix, AZ, United States
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Nagel LC, Tesky VA, Schall A, Müller T, König J, Pantel J, Stangier U. Compliance with CBT referral in nursing home residents diagnosed with depression: Results from a feasibility study. Heliyon 2024; 10:e23379. [PMID: 38148800 PMCID: PMC10750160 DOI: 10.1016/j.heliyon.2023.e23379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Objectives Patient-level factors that influence compliance with a recommendation for CBT in nursing home residents diagnosed with depression were identified. Methods Within a cluster-randomized trial on stepped care for depression in nursing homes (DAVOS-study, Trial registration: DRKS00015686), participants received an intake interview administered by a licensed psychotherapist. If psychotherapy was required, patients were offered a referral for CBT. Sociodemographic characteristics, severity of depression, loneliness, physical health, antidepressant medication, prior experience with psychotherapy, and attitudes towards own aging were assessed. A binary regression determined predictors of compliance with referral. Results Of 123 residents receiving an intake interview, 80 were recommended a CBT. Forty-seven patients (58.8 %) followed the recommendation. The binary logistic regression model on compliance with recommended CBT was significant, χ2(9) = 21.64, p = .010. Significant predictors were age (Odds Ratio (OR) = 0.9; 95 % Confidence Interval (CI) = 0.82, 0.99; p = .024) and depression (OR = 1.33; 95 % CI = 1.08, 1.65; p = .008). Conclusion Within the implemented setting compliance rate was comparable to other age groups. Future interventions should include detailed psychoeducation on the benefits of psychotherapy on mild depressive symptoms in older age and evidence-based interventions to address the stigma of depression. Interventions such as reminiscence-based methods or problem-solving could be useful to increase compliance with referral, especially in very old patients (80+). Language barriers and a culturally sensitive approach should be considered when screening residents.
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Affiliation(s)
| | | | - Arthur Schall
- Department of General Medicine, Goethe University, Frankfurt, Germany
| | - Tanja Müller
- Frankfurt Forum for Interdisciplinary Ageing Research, Goethe University, Frankfurt, Germany
| | - Jochem König
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Johannes Pantel
- Department of General Medicine, Goethe University, Frankfurt, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology, Goethe University, Frankfurt, Germany
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Theis S, Bitterlich N, von Wolff M, Stute P. Measuring Quality of Life: Incorporating Objectively Measurable Parameters within the Cross-Sectional Bern Cohort Study 2014 (BeCS-14). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:94. [PMID: 38248557 PMCID: PMC10815394 DOI: 10.3390/ijerph21010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
Up until now, the measurement of Quality of Life (QoL) was based on validated subjective rating tools rather than objective measurement. To become more independent of the self-assessment of probands, a way to objectively measure QoL should be found. A monocenter, cross-sectional, observational, non-interventional trial was performed from 2012 to 2014 at Inselspital Bern to evaluate the bio-functional status (BFS), a complex, generic, non-invasive, sex- and age-validated assessment tool, in a wide range of areas. A standardized battery of assessments was performed on 464 females and 166 males, ages 18 to 65 (n = 630). In addition to the survey of the BFS, participants replied-among others-to the validated questionnaire SF-36 for health-related QoL (n = 447, subgroup 1). Since the accepted cut-off value for BFA calculation is age ≥ 35 years, subgroup 2 included 227 subjects (all participants aged ≥ 35 years out of subgroup 1). In order to be able to compare the eight SF-36 subscales to BFS parameters, a comparable score set of single BFS items had to be constructed. Subsequently, we aimed to statistically identify BFS item combinations that best represented each SF-36 subscale. All eight SF-36 subscales were significantly represented by various different combinations of BFS items. A total of 24 single BFS items significantly correlated with SF-36 subscales, of which 15 were objective and nine were subjective. All eight SF-36 subscales were significantly represented by various different combinations of BFS items leading to stronger correlations (range five to nine BFS items), and overall, sex and age did not affect these associations, but in the SF-36 subscales 'bodily pain' (sex) and 'role limitations due to physical health problems' (age in men). To our knowledge, we are the first to correlate a validated set of 34 objective and 9 subjective parameters with subjectively evaluated SF-36 subscales. This first study on the objectifiability of the SF-36 questionnaire demonstrated that questions on quality of life can be answered independently of a subjective assessment by subjects in future scientific studies.
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Affiliation(s)
- Susanne Theis
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Division of Gynecological Endocrinology and Reproductive Medicine, Langenbeckstr. 1, 55131 Mainz, Germany;
| | - Norman Bitterlich
- Independent Researcher, Draisdorfer Str. 21, 09114 Chemnitz, Germany;
| | - Michael von Wolff
- University Clinic Bern, Division of Gynecological Endocrinology and Reproductive Medicine, University Women’s Hospital, Inselspital Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland;
| | - Petra Stute
- University Clinic Bern, Division of Gynecological Endocrinology and Reproductive Medicine, University Women’s Hospital, Inselspital Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland;
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da Conceição V, Mesquita E, Gusmão R. Effects of a stigma reduction intervention on help-seeking behaviors in university students: A 2019-2021 randomized controlled trial. Psychiatry Res 2024; 331:115673. [PMID: 38113809 DOI: 10.1016/j.psychres.2023.115673] [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: 09/25/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Stigma is one of the most frequently identified help-seeking barriers, but there is a lack of research on the effects of stigma reduction interventions on actual mental health help-seeking behaviors during crucial academic years. This research explores the effects of stigma on university students' mental health care help-seeking behaviors before and during the pandemic. METHODS A randomized control trial spanned from 2019 to 2021 at the University of Porto, along five evaluation moments, with students into one control group and two intervention groups-the interventions aimed to reduce depression stigma. RESULTS Among the 702 participants (mean age 18.87, 59.4 % female), the intervention groups significantly increased help-seeking behaviors. In 2020, the intervention groups, having reduced stigma, continued to demonstrate to be more prompt to seek mental health help. In 2021, 22 months, the effects of the intervention on help-seeking were no longer significant; however, participants in the intervention groups showed less severe symptomatology. CONCLUSION Stigma reduction interventions have a pronounced effect on enhancing help-seeking behaviors among university students, even during times of crisis. This study advocates for prioritizing stigma reduction in academic settings, highlighting its value in promoting mental health access during crucial academic and life challenges.
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Affiliation(s)
- Virgínia da Conceição
- EPIUnit - Institute of Public Health, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
| | - Edgar Mesquita
- EPIUnit - Institute of Public Health, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Ricardo Gusmão
- EPIUnit - Institute of Public Health, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Portugal
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Soleimanvandiazar N, Mohaqeqi Kamal SH, Basakha M, Karim S, Ahmadi S, Ghaedamini Harouni G, Sajjadi H, Setareh Forouzan A. Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241229622. [PMID: 38339828 PMCID: PMC10859068 DOI: 10.1177/00469580241229622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
Unequal utilization in healthcare can potentially affect the right to health. Access to healthcare services and achieving positive health outcomes and health equity are essential principles in promoting human rights. This study aims to assess and analyze socioeconomic-related inequalities in outpatient health services utilization (OHSU) among various socio-demographic subgroups to inform policies that foster health equity. Data were collected through a cross-sectional survey of 1200 households in Tehran, Iran. Inequality in OHSU among the socio-demographic subgroups was calculated by concentration, Wagstaff, and Erigers indices. Decomposition was used to identify the factors contributing to inequality in OHSU. Marginal effect and elasticity were used to calculate the relative absolute shares of socio-demographic variables in the inequality. The rate of OHSU was 63.61% (CI: 60-66.80) which concentrated among households with better socioeconomic status. Based on the results, living in an affluent neighborhood (Relative share (RS): 85.48) and having a disabled member in the household (RS: 6.58) were the most important factors in the concentration of OHSU in favor of the privileged groups. In contrast, very low levels of health knowledge (RS: -83.79) and having basic insurance coverage (RS: -3.92) concentrated OHSU in favor of the lower socioeconomic households. The study was conducted based on survey data, and this may lead to some limitations. Given that this study was a cross-sectional study, we were unable to establish causal relationships between explanatory variables and outpatient health service utilization and its relevant predictors. Households with disabled member(s), as well as a member(s) with chronic diseases, may experience severe inequalities in access to healthcare services. Policies that facilitate access to health services for these households can play a significant role in improving health equity.
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Affiliation(s)
| | | | - Mehdi Basakha
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Sina Ahmadi
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Homeira Sajjadi
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Sanabria-Mazo JP, Colomer-Carbonell A, Fernández-Vázquez Ó, Noboa-Rocamora G, Cardona-Ros G, McCracken LM, Montes-Pérez A, Castaño-Asins JR, Edo S, Borràs X, Sanz A, Feliu-Soler A, Luciano JV. A systematic review of cognitive behavioral therapy-based interventions for comorbid chronic pain and clinically relevant psychological distress. Front Psychol 2023; 14:1200685. [PMID: 38187407 PMCID: PMC10766814 DOI: 10.3389/fpsyg.2023.1200685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Chronic pain frequently co-occurs with clinically relevant psychological distress. A systematic review was conducted to identify the efficacy of cognitive behavioral therapy-based interventions for patients with these comorbid conditions. Methods The systematic search was carried out in Medline, PsycINFO, Web of Science, and Scopus up to March 18th, 2023. Four reviewers independently conducted screenings, extraction, and quality assessment. Results Twelve randomized controlled trials and one non-randomized controlled trial involving 1,661 participants that examined the efficacy of Cognitive Behavioral Therapy (nine studies), Mindfulness-based Interventions (three studies), Acceptance and Commitment Therapy (one study), and Behavioral Activation Therapy for Depression (one study) were included. Compared to treatment as usual, six out of eight studies of traditional Cognitive Behavioral Therapy reported significant differences in the reduction of depressive symptoms at post-treatment (d from 1.31 to 0.18) and four out of six at follow-up (d from 0.75 to 0.26); similarly, five out of six reported significant differences in the reduction of anxiety symptoms at post-treatment (d from 1.08 to 0.19) and three out of four at follow-up (d from 1.07 to 0.27). Overall, no significant differences between traditional Cognitive Behavioral Therapy and treatment as usual were reported at post-treatment and follow-up in the studies exploring pain intensity and pain catastrophizing. Conclusion The available evidence suggests that traditional Cognitive Behavioral Therapy may produce significant benefits for the improvement of depression, anxiety, and quality of life, but not for pain intensity and pain catastrophizing. More evidence is needed to determine the effects of MBI, ACT, and BATD. Systematic review registration PROSPERO, CRD42021219921.
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Affiliation(s)
- Juan P. Sanabria-Mazo
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ariadna Colomer-Carbonell
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Óscar Fernández-Vázquez
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Georgina Noboa-Rocamora
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Gemma Cardona-Ros
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | | | | | - Sílvia Edo
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Xavier Borràs
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Antoni Sanz
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Albert Feliu-Soler
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan V. Luciano
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
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Yimer TM, Chan GCK, Belete H, Hides L, Leung J. Treatment-seeking behavior and barriers to mental health service utilization for depressive symptoms and hazardous drinking: The role of religious and traditional healers in mental healthcare of Northwest Ethiopia. Glob Ment Health (Camb) 2023; 10:e92. [PMID: 38179466 PMCID: PMC10765018 DOI: 10.1017/gmh.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/24/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024] Open
Abstract
Understanding mental healthcare seeking and associated factors is essential for planning mental health services. This study aimed to assess treatment seeking and barriers to care for depressive symptoms and hazardous drinking in a community sample of Northwest Ethiopia. A cross-sectional study was conducted to screen 1,728 participants for depressive symptoms (n = 414) and hazardous drinking (n = 155). Participants were asked whether they had sought mental healthcare. We also assessed the barriers to seeking mental healthcare. Logistic regression was used to identify associated factors. Among people with depressive symptoms, 14.3%, 15.5%, and 19.6% sought treatment from healthcare settings, non-healthcare settings, or any sources, respectively. Religious places (39.5%) were the most helpful treatment sources. People with low levels of internalized stigma (adj OR = 3.00 [1.41, 6.42]) and positive attitudes towards mental illness (adj OR = 2.84 [1.33, 6.07]) were nearly threefold more likely to seek depression treatment. No participants with hazardous drinking sought treatment from healthcare settings, and only 1.3% had sought help from families/friends. Over 97% of participants with depressive symptoms and hazardous drinking reported at least one barrier to treatment-seeking from a healthcare setting. Religious and traditional healers were as important as healthcare settings for treatment-seeking.
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Affiliation(s)
- Tesfa Mekonen Yimer
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gary CK Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Habte Belete
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
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Chakrapani V, Bharat S. Mental health in India: Sociocultural dimensions, policies and programs - An introduction to the India Series. SSM - MENTAL HEALTH 2023; 4:100277. [PMID: 38807921 PMCID: PMC7616029 DOI: 10.1016/j.ssmmh.2023.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
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Bagade T, Mersha AG, Majeed T. The social determinants of mental health disorders among women with infertility: a systematic review. BMC Womens Health 2023; 23:668. [PMID: 38093258 PMCID: PMC10720205 DOI: 10.1186/s12905-023-02828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Infertility is associated with mental health disorders in women, even if a successful pregnancy resolves infertility. However, the link between social determinants of health (SDoH) and mental health in women with infertility is not well understood. We aimed to investigate the determinants thoroughly so that mental health screening and services can be tailored to suit women with infertility who are vulnerable to mental health disorders. METHODOLOGY All observational studies that included women participants of reproductive age with infertility and assessed social determinants associated with mental health disorders were searched using a combination of keywords from MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science databases and published in English. Two reviewers conducted screening, data extraction, quality assessment and risk of bias. The protocol was registered on PROSPERO (number CRD42022343962). RESULTS The systematic review included 32 studies out of 3405 screened articles from January 1st 2010 to 16th October 2023. Compared to women without infertility, the prevalence of mental health disorders, including anxiety, depression, psychological distress, and stress, is high among women with infertility, with the severity being influenced by social determinants-those with higher education, employment, higher personal or family income, private health insurance, higher social support, stronger religious beliefs, and higher spiritual well-being reported better mental health outcomes. CONCLUSION The study highlights the need for early detection, tailored interventions, and integrated and comprehensive support systems to address the mental health needs of women with infertility and improve their well-being.
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Affiliation(s)
- Tanmay Bagade
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, 2285, Australia.
| | - Amanual Getnet Mersha
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, 2285, Australia
| | - Tazeen Majeed
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, 2285, Australia
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Garg R, Chavan BS, Das S, Puri S, Banavaram AA, Benegal V, Rao GN, Varghese M, Gururaj G. Treatment gap for mental and behavioral disorders in Punjab. Indian J Psychiatry 2023; 65:1269-1274. [PMID: 38298876 PMCID: PMC10826874 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_839_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/03/2022] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Background and Aims There is no data on the treatment gap and health care utilization for mental disorders from Punjab. The present study reports on the same by using the data collected during the National Mental Health Survey. Settings and Design Multisite, multistage, stratified, random cluster sampling study conducted in four districts, namely Faridkot, Moga, Patiala, and Ludhiana (for urban metro areas). Data were collected from October 2015 to March 2016. Materials and Methods Mini International Neuropsychiatric Interview 6.0.0 and Adapted Fagerstrom Nicotine Dependence Scale were used to diagnose mental and behavioral disorders and tobacco use disorder, respectively. Pathways Interview Schedule of the World Health Organization was applied to persons having any disorder to assess treatment gap and health care utilization. Exploratory focused group discussions (FGDs) were conducted to understand the community perceptions regarding mental and behavioral disorders. Results The treatment gap for mental and behavioral disorders was 79.59%, and it was higher for common mental disorders than severe mental disorders and higher for alcohol and tobacco use disorders as compared to opioid use disorders. The median treatment lag was 6 months. Only seven patients out of 79 were taking treatment from a psychiatrist, and the average distance traveled by the patient for treatment was 37.61 ± 45.5 km. Many attitudinal, structural, and other barriers leading to high treatment gaps were identified during FGDs in the community, such as stigma, poor knowledge about mental health, deficiency of psychiatrists, and distance from the hospital. Conclusions Vertical as well as horizontal multisectoral integration is required to reduce the treatment gap and improve healthcare utilization. Increasing mental health literacy, providing high-quality mental health services at the primary-healthcare level and human resources development are the need of the hour.
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Affiliation(s)
- Rohit Garg
- Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Bir Singh Chavan
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Subhash Das
- Department of Psychiatry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Sonia Puri
- Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Arvind A. Banavaram
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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