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Background Many epidemiological studies have reported the association between various social factors and health status in mothers during and after pregnancy. However, little is known about their joint and longitudinal impact. We therefore examined the association of lack of social support and trust during pregnancy and at 2.5 years postpartum with health status in mothers. Methods To adequately address time-varying exposure, marginal structural models were fitted to a pseudopopulation constructed by inverse probability weighting. The model included records of 90,071 mothers participating in the Japan Environment and Children's Study. Social support and trust were measured using a 9-item questionnaire (Q1-9). Mental and physical health were measured using Mental and Physical Component Summary scores from the 8-item Short-Form Health Survey. Results For the Mental Component Summary, the magnitude of the effect estimate was largest when participants lacked close friends/neighbors (Q4) at only 2.5 years postpartum (= -6.23), followed by a lack in emotional support (Q2) at the same time point (= -4.94). For the Physical Component Summary, effect estimates were negligible. The magnitude of the effect estimates of lack of social support and trust tended to be larger when there was a lack at only 2.5 years postpartum than at both time points. Conclusions These findings suggest that, after childbirth, a loss in social support, particularly in a concrete or instrumental aspect, carries high risk, especially for mental health. Our results highlight the importance of supporting mothers for more than a few years after pregnancy.

Introduction Every 40seconds, one person in the world commits suicide. As such, suicide is considered a public health problem, and prior suicide attempt is one of the risk factors associated with completed suicide. Despite the strategies implemented and the studies carried out, in Colombia suicide figures are on the rise, more markedly in the economically active population. Objective To identify the sociodemographic, family, personal, economic and religious factors associated with suicide attempt in patients of productive age (18-62 years old) in a mental health institution in Bogota, Colombia. Methods An analytical prevalence study was conducted at the Nuestra Senora de la Paz mental health clinic in Bogota. To explore the relationship between the factors described and suicide attempt, a review of 350 medical records of the selected population was carried out. Results In total, 37.7% of the sample presented a suicide attempt. Associations were found between the suicide attempt and higher education than primary school (PR=0.47 [0.23-0.97]), no economic income (PR=1.72 [1.13-2.61]), no partner (PR=2.10 [1.33-3.32]), alcohol consumption (p=0.045), hallucinogen use (PR=2.39 [0.97-3.43]) and the presence of personality disorder (PR=1.93 [1.11-3.34]). Conclusions The results of the study are similar to those previously described in other studies around the world. There is a need to recognise and address various factors associated with suicide attempt in depressed patients in order to implement promotion and prevention actions, early identification and specific interventions that have an impact on the numbers of completed suicide in the country.

OBJECTIVES: We examined the prevalence of substance use as a coping mechanism and identified relationships between maternal mental health over time and use of substances to cope during the Coronavirus Disease 2019 (COVID-19) pandemic among pregnant women in the U.S.A. METHODS: Self-reported repeated measures from 83 pregnant women were collected online in April 2020 and May 2020. Women retrospectively reported their mental/emotional health before the pandemic, as well as depression, stress, and substance use as a result of the pandemic at both time points. Linear regression measured cross-sectional and longitudinal associations between mental health and substance use. RESULTS: Pre-COVID-19 reports of poorer mental/emotional health (b = 0.46) were significantly (p < .05) associated with number of substances used to cope with the pandemic. Elevated stress (b = 0.35) and depressive symptoms (b = 0.27) and poorer mental/ emotional health (b = 0.14) in April were also significantly related to higher numbers of substances used in May (p < .05). CONCLUSION: Pregnant women’s psychological well-being may be a readily measured indicator of substance use risk during crises such as the COVID-19 pandemic. Interventions addressing increased stress and depression may also mitigate the emergence of greater substance use among pregnant women.

Rapid identification and management of students with COVID-19 symptoms, exposure, or disease are critical to halting disease spread and protecting public health. We describe the interdisciplinary isolation and quarantine program of a large, public university, the University of Virginia, Charlottesville. The program provided students with wraparound services, including medical, mental health, academic, and other support services during their isolation or quarantine stay. The program successfully accommodated 844 cases during the fall 2020 semester, thereby decreasing exposure to the rest of the university and the local community. (Am J Public Health. 2021;111(10):1772–1775. https://doi.org/10.2105/AJPH.2021.306424 )

What national, regional, or state-level initiatives could the reintroduction ofthe CHSIs be aligned with? IMPROVING COMMUNITY HEALTH In 2013, a pivotal report ofthe National Research Council and the Institute of Medicine (now the National Academy of Medicine), US Health in International Perspective: Shorter Lives, Poorer Health, comprehensively and clearly outlined the health differences and reasons for these differences between the United States and its peer high-income countries, including 16 democracies.6 Sadly, US health ranking was near the bottom as measured by life expectancy, which had improved but not as fast as in peer countries. The smaller gains in US life expectancy were actually reversed before the COVID-19 pandemic, from a peak of 78.84 years in 2014 to 78.54 years through 2018.7 And during the pandemic, the US media has shone a bright light on the US health disadvantage by highlighting greater COVID19-associated mortality in the United States than reported in peer countries.8 In the wake ofthe National Research Council and Institute of Medicine report, the American Public Health Association began an initiative to become the healthiest nation in a generation (by 2030), which included a strategy to promote the building of safe and healthy communities because the average life span across the nation is rooted in the health of communities.9 If data on community health outcomes and determinants are not widely accessible to communities, gaps in knowledge will remain about current community health and any health progress. Furthermore, the National Prevention Strategy also steers communities to implement evidence-based recommendations strategically to create healthy and safe community environments, integrate clinical and community preventive services locally, empower people, and eliminate health disparities in priority activities of tobacco-free living, preventing drug abuse and excessive alcohol use, healthy eating, active living, injury and violence-free living, and promotion of reproductive and sexual health and mental health and emotional wellbeing.14 Similarly, Healthy People 2020, and now Healthy People 2030, also calls for communities to use their goals and objectives to set local priorities.11 Setting effective community target objectives will depend on current knowledge of health outcomes and health determinants at the level of community action as well as accessible data for surveillance and monitoring ofthe targets. CONCLUSIONS Although national initiatives, such as the Federal Data Strategy and the National Committee on Vital Health Statistics, identify key health indicators to move the entire health status ofthe nation forward, local communities often need additional data, including smaller geographic areas of data for community health planning, interventions, programs, evaluation, and monitoring ultimately for advocacy and public health action.

Background This paper examined whether distinct life-course trajectories of psychological distress from adolescence to midlife were associated with poorer mental health outcomes during the pandemic. Methods We present a secondary analysis of two nationally representative British birth cohorts, the 1958 National Child Development Study (NCDS) and 1970 British Cohort Study (BCS70). We used latent variable mixture models to identify pre-pandemic longitudinal trajectories of psychological distress and a modified Poisson model with robust standard errors to estimate associations with psychological distress, life satisfaction and loneliness at different points during the pandemic. Results Our analysis identified five distinct pre-pandemic trajectories of psychological distress in both cohorts. All trajectories with prior symptoms of psychological distress irrespective of age of onset, severity and chronicity were associated with a greater relative risk of poorer mental health outcomes during the pandemic and the probability of poorer mental health associated with psychological distress trajectories remained fairly constant. The relationship was not fully attenuated when most recent pre-pandemic psychological distress and other midlife factors were controlled for. Conclusions Whilst life-course trajectories with any prior symptoms of psychological distress put individuals at greater risk of poor mental health outcomes during the pandemic, those with chronic and more recent occurrences were at highest risk. In addition, prior poor mental health during the adult life-course may mean individuals are less resilient to shocks, such as pandemics. Our findings show the importance of considering heterogeneous mental health trajectories across the life-course in the general population in addition to population average trends.

Research Objective There has been a documented rise of racism and hostility towards Asian Pacific Islanders (API) groups across the nation. With the anticipated population‐level increase in mental health issues as a result of COVID‐19, API college students are an especially high risk group to consider as API young and emerging adults tend to report similar levels of depression and anxiety symptoms compared with their peers, but underutilize service relative to their level of need. The objective of this presentation is to understand the impact of the pandemic on API mental health using large‐scale data, by evaluating pre‐pandemic (Fall 2019), initial months of the pandemic (March‐May 2020) and recent pandemic (Fall 2020) trends in API mental health and treatment utilization, as well as discussing the public health implications in higher education settings for API student populations. Study Design Data comes from 3 administrations of the Healthy Minds Study: Sept‐Dec 2019 (n=33,372 students across 32 campuses), March‐May 2020 (n=12,039 students across 7 campuses) and Sept‐Dec 2020 (n=15,949 students across 28 campuses). This data represents the largest and most comprehensive nationally recognized assessment of API student mental health symptoms, help‐seeking behavior and experiences of discrimination directly related to COVID‐19. We used bi‐variate analyses to compare mental health symptoms and treatment utilization across API students who identified as international students and those who reported US citizenship or permanent residency in the US. We used cross‐sectional logistic regression models to assess the association between discrimination and mental health symptoms and help‐seeking behavior. Population Studied Young and emerging adults who identify as Asian or Pacific Islander and are enrolled at a college or university in the United States. Principal Findings Comparing Fall 2019 to Fall 2020, we found that API non‐international students reported a 23% increase in severe anxiety, a 10% increase in moderate or severe anxiety, and a 9% increase in severe depression; API international students reported a 16% increase in severe depression and a 12% increase in severe anxiety. In Spring 2020, 22% of API students experienced COVID‐related discrimination or hostility (25% in Fall 2020). COVID‐related discrimination or hostility was associated with greater odds of meeting the criteria for one or more clinically significant mental health conditions [aOR: 1.83; 95% CI: 1.35‐2.49; p=0.000]. Treatment utilization among Asian students with at least one clinically significant mental health condition decreased by 26% between Fall 2019 and Spring 2020. Conclusions Throughout the COVID‐19 pandemic, both API international and non‐international students reported increases in mental health symptoms and decreases in treatment utilization. Our analyses also suggest that COVID‐related discrimination is correlated with greater odds of clinically significant mental health symptoms as well decreased help‐seeking. Implications for Policy or Practice The racialization of COVID‐19 has the potential to produce long‐lasting effects on attitudes towards API populations. Culturally tailored psychoeducation, collaborative care models and active recruitment of diverse and culturally‐competent mental health providers are potential avenues to facilitate help‐seeking. Given the mental health challenges that API populations are facing, it will be crucial to make an active effort towards resolving mental health treatment disparities already looming in API communities.

Sexual minority young persons may be at risk for compounding mental health effects of the COVID-19 pandemic due to their existing vulnerabilities for psychological inequities. Indeed, recent research has documented that sexual minority young persons are experiencing compounding psychiatric effects associated with the COVID-19 pandemic. Furthermore, researchers and practitioners have hypothesized that sexual minority youth and young adults may experience unique hardships related to their sexual and gender identities and familial conflict as a result of the COVID-19 pandemic and living arrangement changes with their parents and families. This study aims to investigate whether there are changes in sexual minority (and nonsexual minority) young adults' (SMYAs') mental health and well-being among those living with and living without their parents before and after the start of COVID-19. Among a cross-sectional sample of SMYAs (n = 294;Mage = 22 years;age range = 18-26) and non-SMYAs (n = 874;Mage = 22 years;age range = 18-26) defined by whether they were living with or living without their parents before and after the start of COVID-19, we retrospectively analyzed changes in psychological distress and well-being. SMYAs who returned to their parents' homes during post-onset of COVID-19 reported greater mental distress and lower well-being, followed by those who were living with their parents both before and after the start of COVID-19. Patterns were not consistent among non-SMYAs, and lower magnitudes of change were seen. There is a significant public health need for mental health services and family education resources for supporting SMYAs in the context of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement Researchers and practitioners hypothesized that sexual minority youth and young adults may experience unique hardships related to family as a result of the COVID-19 pandemic stay-at-home orders. Our results show that both sexual minority and heterosexual young adults who consistently lived with their parents before and during the pandemic and who moved back home with their parents experienced increases in psychological distress and decreases in well-being, with greater burden seen among sexual minority young adults and those who moved back home with their parents. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Background The impact of online care on patients’ functional and psychological outcomes is critical to determine yet still unknown. Objective To evaluate how a novel online health model that facilitates physician-patient collaboration compares with in-person care for improving psoriasis patients’ functional status and mental health. Methods This 12-month randomized controlled equivalency trial randomized psoriasis patients 1:1 to online or in-person care. Functional impairment and depression were assessed at baseline and at 3-month intervals using the 5-level EuroQol-5 Dimensions (EQ-5D-5L) and Patient Health Questionnare-9 (PHQ-9). Results 296 patients were randomized to online or in-person groups. The between-group difference in overall improvement in EQ VAS (EuroQol Visual Analogue Scale) was -0.002 (95% CI -2.749, 2.745), falling within equivalence margin ±8. The between-group difference in overall improvement in EQ-5D-5L index was 0 (95% CI -0.003, 0.003), falling within equivalence margin ±0.1. The between-group difference in overall improvement in PHQ-9 was -0.33 (95% CI -1.20, 0.55), falling within equivalence margin ±3. Limitations Slightly different attrition rates between online and in-person arms (11% versus 9%), but no impact on outcomes. Conclusion The online health model was equivalent to in-person care for reducing functional impairment and depressive symptoms in psoriasis patients.

Veterans Health Administration (VHA) continues to expand the mental health (MH) workforce to meet increasing demand for services. In the present study, longitudinal unbiased recursive partitioning models (conditional inference trees) were created to identify optimal cutoffs for outpatient staffing ratios associated with success on VHA's measures of quality, access, and satisfaction. Quarterly Staff-to-Patient Ratios (SPRs), defined as the number of full-time equivalent providers per 1,000 veterans receiving outpatient mental health care, were calculated for 12 quarters from fiscal years 2016-2018. Associations between VHA metrics associated with quality, access, and satisfaction were evaluated in relation to the overall outpatient SPR. The root node identified an overall outpatient SPR of 7.39 as the split for optimal MH performance. Root nodes associated with metrics addressing population coverage, continuity of care, and experience of care identified SPRs of 7.87, 6.81, and 7.42, respectively. In all analyses, the lowest SPRs were associated with the lowest performance on VHA MH metrics, while the highest SPRs were associated with the highest performance. Analyses support VHA's current recommended minimum outpatient SPR of 7.72 as a reasonable target to provide high-quality care, access, and satisfaction. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Promoting the cessation of smoking in mental healthcare is a priority of international health organizations as it is the most cost-effective intervention in psychiatry.To explore the representations of psychiatrists on their role in active smoking cessation prevention in severe psychiatric disorders.Psychiatrists and residents in psychiatry were recruited at a national level by professional mailings.One thousand four hundred and sixty participants were included in the study, and only 46% reported actively promoting smoking cessation. In multivariate analyses, participants aged35years were more likely to promote cessation of tobacco smoking, as well as the two thirds who believe that psychiatry is a systemic discipline with complex interactions between brain, body and mind. Almost two thirds of those promoting tobacco cessation reported lacking time to combine psychiatric and physical examination during one session. The psychiatrists who reported not promoting tobacco smoking cessation also reported never dealing with physical health in case of the absence of a general practitioner and thinking that physical examination may have a negative impact on the therapeutic relationship. Almost all (96%) reported promoting the need for a general practitioner for their patients. We found no significant difference between the public and private sectors (P0.05).Young psychiatrists are more prone than their elders to promote smoking cessation but report lacking time to include it in their daily practice. Promotion of tobacco smoking cessation should be included in the components for quality evaluation for mental health services and specific sessions dedicated to this intervention.

The construction industry is the most significant occupational contributor to suicide rates worldwide. This is credited to strenuous working conditions, lack of awareness in mental health culture, but more so, that help-seeking is seen as a weakness. This study aims to investigate the role of the construction project manager in creating a culture of suicide prevention on-site. This is achieved through delving into the principles of culture creation within differing industries, with adaptations for construction managers, through a comparative analysis of culture creation literature. Twenty-two interviews with employees are undertaken. Representative data gathered are analysed and presented, to highlight the levels of knowledge, barriers and proposed solutions, for construction project managers. Results are broken down into ‘awareness of and openness to discussing suicide prevention’, ‘barriers to the adoption of suicide-prevention measures’ and ‘proposed solutions to the adoption of suicide-prevention measures’. The interviews give an insight into the acceptance of the need for stronger mental health support structures, without necessarily any regard for the method of their implementation. The originality and subsequent value in the research are the proposed use of construction project managers as the conduit in beginning to address and, as a result, develop a culture of suicide prevention on-site.

No abstract available.

ImportanceAlthough several predictors of COVID-19 vaccine hesitancy have been identified, the role of physical health has not been well-examined, and the association with mental health is unknown.ObjectiveTo examine the association of pre-pandemic mental health, physical health, and shielding with vaccine hesitancy after the announcement of the successful testing of the Oxford University/AstraZeneca vaccine.Design, Setting, and ParticipantsWe used individual-level data from a pandemic-focused investigation (COVID Survey), a prospective cohort study nested within the UK Understanding Society (Main Survey) project. In the week immediately following the announcement of successful testing of the first efficacious inoculation (November/December 2020), data on vaccine intentionality were collected in 12,035 individuals aged 16-95 years. Pre-pandemic, study members had responded to enquiries about diagnoses of mental and physical health, completed the 12-item General Health Questionnaire for symptoms of psychological distress (anxiety and depression), and indicated whether they or someone in their household was shielding.Main outcome measuresSelf-reported intention to take up a vaccination for COVID-19. To summarise our results, we computed odds ratios with accompanying 95% confidence intervals for indices of health and shielding adjusted for selected covariates.ResultsIn an analytical sample of 11,955 people (6741 women), 15.4% indicated that they were vaccine hesitant. Relative to their disease-free counterparts, shielding was associated with a 24% lower risk of being hesitant (odds ratio; 95% confidence interval: 0.76; 0.59, 0.96), after adjustment for a range of covariates which included age, education, and ethnicity. Corresponding results for cardiometabolic disease were 22% (0.78; 0.64, 0.95), and for respiratory disease were 26% (0.74; 0.59, 0.93). Having a pre-pandemic diagnosis of anxiety or depression, or a high score on the distress symptom scale, were all unrelated to the willingness to take up a vaccine.Conclusions and relevancePeople who have been prioritised for COVID-19 vaccination owing to a physical condition are more likely to take it up. These effects were not apparent for indices of mental health.

This study characterized the prevalence of transphobic adverse childhood experiences (ACEs) among young trans women (YTW) and assessed its relationship with poor mental health and sexual risk. A survey was administered between 2012 and 2014 to 300 YTW aged 16-24 living in the San Francisco Bay Area. Transphobic childhood verbal abuse, physical abuse, and high transphobic childhood adversity were endemic, and we found strong associations with depression, posttraumatic stress disorder, and any and receptive anal intercourse. ACEs may be critical social determinants of mental and sexual health for YTW and validated measures to screen for ACEs are needed, along with interventions that provide gender-affirmative support for parents.

Smartphone apps for mental health (MH apps) and wellness reach millions of people and have the potential to reduce the public health burden of common mental health problems. Thousands of MH apps are currently available, but real-world consumers generally gravitate toward a very small number of them. Given their widespread use and the lack of empirical data on their effects, understanding the content within MH apps is an important public health priority. An overview of the content within these apps could be an important resource for users, clinicians, researchers, and experts in digital health. Here, we offer summaries of the content within highly popular MH apps. Our aim is not to provide comprehensive coverage of the MH app space. Rather, we sought to describe a small number of highly popular MH apps in three common categories: meditation and mindfulness, journaling and self-monitoring, and AI chatbots. We downloaded the two most popular apps in each of these categories (respectively: Calm, Headspace; Reflectly, Daylio; Replika, Wysa). These six apps accounted for 83% of monthly active users of MH apps. For each app, we summarize information in four domains: intervention content, features that may contribute to engagement, the app’s target audience, and differences between the app’s free version and its premium version. In the years ahead, rigorous evaluations of highly popular MH apps will be needed. Until then, we hope that this overview helps readers stay up-to-date on the content within some of the most widely used digital mental health interventions.

Objective: This study investigated outcomes in community mental health research that were important to caregivers of people with schizophrenia. Using an online survey conducted from August 1–31, 2020, data were collected from caregivers belonging to the LINE Schizophrenia Family Association. Caregivers identified outcomes important in community mental health research. Two researchers categorized caregivers’ statements into research outcomes.Results: A total of 132 caregivers completed the online self-reported questionnaire, and 296 caregiver statements were identified. Qualitative analysis identified 17 outcome categories. The caregivers tended to value having more free time, maintaining an appropriate relationship with people with schizophrenia, and being able to cope with their symptoms. This exploratory study newly demonstrates the outcomes that caregivers of people with schizophrenia consider important in community mental health research. The findings may be useful in selecting outcomes for future studies of caregivers.

OBJECTIVE Police and emergency services personnel are at an increased risk of developing mental health issues. We sought to compare patterns of exposure to work-related and nonwork stressors and associations with posttraumatic stress symptoms and psychological distress among police and emergency services employees. METHOD A total of 14,868 employees from 33 ambulance, fire and rescue, police, and state emergency service agencies around Australia participated in a survey to assess the prevalence of exposure to work-related and nonwork stressors, and the prevalence of mental health conditions. Associations between work and nonwork stressors and mental health problems were estimated using logistic regression models and population attributable risk (PAR) percentages. RESULTS Traumatic events experienced while working in the police and emergency services sector were the most frequently reported stressor (51%). Stressful events experienced at work in the sector were associated with significantly higher levels of suspected posttraumatic stress symptoms (odds ratio = 4.5, PAR = 65%) and high psychological distress (odds ratio = 2.5, PAR = 40%) compared to stressors experienced away from the sector. CONCLUSIONS Stressors experienced at work are a risk factor for developing posttraumatic stress symptoms and distress in the sector. Organizations should have comprehensive policies and programs to help prevent the development of mental health problems and to support personnel who develop mental health problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background Healthcare workers (HCWs) involved in administration and patient management during COVID-19 pandemic are at high risk of developing psychological problems related to fear and stress of contacting COVID infection. This is augmented by the stigma faced at home and society, owing to the nature of their job. Aim To assess the mental health issues and stigma amongst health care workers involved in COVID care. Methodology We conducted a hospital based cross sectional study where 150 health care workers involved in the care of COVID-19 patients, directly and indirectly, were selected using systematic random sampling. They were assessed using Depression, Anxiety and Stress Scale (DASS-21) Hindi Version, The Impact of Event Scale - Revised scale and a Modified Stigma scale. Results Significant psychological stress, anxiety, depression and high risk for developing post-traumatic stress disorder was found in more than half of the healthcare workers, albeit more in those having direct contact with COVID patients (p

Introduction: Among adolescents and young adults, cannabis use is prevalent. Prior studies characterizing withdrawal effects in this age range have primarily included treatment seeking or comorbid ...

Parents of infants who require neonatal intensive care unit (NICU) hospitalization encounter stressors that place them at a higher risk of developing a mental health issue during and after NICU discharge. This population is often underdiagnosed, leading to potential detrimental effects on parenting behaviours, parent/infant bonding, and child neurodevelopment. This review explores what mental health issues parents experience during and after NICU discharge, what mental health resources are currently available, what mental health screening tools are used, and what factors place NICU parents at an increased risk of developing a mental health issue. The review revealed that mental health issues are not isolated; if a parent experiences psychological distress, it can progress to depression or post-traumatic stress disorder (PTSD) if left untreated. Psychotherapy most frequently contributed to a reduction in mental health symptoms, but was rarely offered beyond NICU discharge.

A university student with a background of atopy presented to her general practitioner (GP) 2 weeks following an episode of throat tightening and dizziness occurring after touching cashew nut to her lip. She took antihistamine medication immediately and went to sleep, fearing for her life. On waking, she felt astounded to be alive. Her symptoms resolved gradually over the following week. She waited 2 weeks for an appointment with her GP, who referred her to allergy clinic. Eight months later, she was still waiting for her clinic appointment, and was left fearing a future fatal reaction, having been provided with no interim treatment. Not all patients who have severe allergic reactions present to the emergency department. Living with the constant fear of anaphylaxis can be overwhelming for patients and their families, and it can negatively impact mental health. Therefore, we advise early allergy counselling and early EpiPen prescription.

There is an urgent need to equip community-based careworkers with the skills to address the mental health needs of orphans and vulnerable children (OVC) as an essential response to shortages in human resources for mental health in Sub-Saharan Africa. We conducted a quasi-experimental feasibility trial in South Africa to adapt and evaluate an established year-long semi-structured, manualized video-feedback caregiver intervention (the Mediational Intervention for Sensitizing Caregivers; MISC) for community-based organizations (CBOs).Following a year-long iterative cross-cultural adaptation of MISC, we recruited 88 OVC (ages 7-11; 45.5% girls) and their CBO careworkers (MISC-CBO was acceptable and feasible in terms of attendance and post-intervention interviews. MISC improved child mental health, as well as the quality of careworker caregiving in terms of interactive effects for affective and cognitive (Expanding) components of MISC, and main effects for the cognitive components of Rewarding and Provision of meaning. MISC components did not mediate the effects of the intervention.The current study shows that laypersons with no tertiary education and virtually no prior training who undergo MISC training can improve caregiving quality and the mental health of OVCs.

Study objectives Digital cognitive behavioral therapy for insomnia (dCBT-I) can reduce acute insomnia and depressive symptoms and prevent symptom recurrence. The current study evaluated self-efficacy in managing insomnia symptoms as a potential mediator of the relationship between prior dCBT-I and subsequent insomnia and depressive symptoms assessed during the coronavirus 2019 (COVID-19) pandemic. Method Participants were 208 adults who completed a randomized controlled trial of dCBT-I versus sleep education in 2016-2017 and also completed self-report assessments of insomnia, depression, and self-efficacy in managing insomnia symptoms. Data were collected in May 2020, five weeks into state-wide COVID-19 stay-at-home orders. Regression and mediation analyses were used to evaluate the extent to which self-efficacy accounted for the relationship between treatment condition and improvement in insomnia and depressive symptoms from pre-treatment to COVID-19 follow-up. Results Prior dCBT-I predicted greater self-efficacy in managing insomnia symptoms. Self-efficacy accounted for 49% and 67% of the protective effect of dCBT-I against COVID-era insomnia and depressive symptoms, respectively. Conclusions This study affirms the importance of self-efficacy as a key intervention outcome and potential mechanism by which dCBT-I predicts future sleep and mental health. Future studies that evaluate the role of self-efficacy in treatment effectiveness and resilience can provide additional clues about how to optimize dCBT-I for maximum benefit to public health.

Youth living with perinatally acquired HIV (YLPHIV) have been found to have a range of mental disorders. Some adult HIV studies have linked mental health to adverse metabolic outcomes due to dysregulation of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, but this association has not previously been explored in YLPHIV.We investigated the association of mental health measures with metabolic outcomes in YLPHIV and HIV-uninfected youth (HIV-U) and linear regression was used to assess the adjusted associations.Overall, 203 YLPHIV (median age = 10.7years; 52% female; mean duration on ART 8 years, 12% CD4 count 50 copies/mL) and 44 HIV-U (median age = 10.3 years; 55% female) were enrolled. YLPHIV had higher median total cholesterol (4.2 vs 3.9 mmol/L, p = 0.049) and triglyceride (0.9 vs 0.7 mmol/L, p < 0.001) compared to HIV-U. We found higher percentage of poor functional competence (40% vs 25%, p = 0.02) and self-concept (23% vs 9%, p = 0.03) and higher depression (6% vs 2%, p < 0.01), anger (6% vs 2%, p = 0.04) and disruptive behaviour (4% vs 0%, p < 0.01) in YLPHIV as compared to HIV-U. Among YLPHIV, higher scores of anger were associated with higher total cholesterol and higher low-density lipoprotein (s = 0.010, p = 0.041 and s = 0.012, p = 0.048 respectively) and disruptive behaviour with higher low-density lipoprotein (s = 0.010, p = 0.043) after adjusting for age, sex and BMIZ.This is the one of first study to investigate the association of mental health with metabolic outcomes among YLPHIV. The association of increased anger and disruptive behaviour with increased lipid concentration is a novel finding. Further longitudinal studies are needed to evaluate the causal relationships between mental health and metabolic outcomes.

ADHD is the most common neurodevelopmental disorder presenting to child and adolescent mental health, paediatric, and primary care services. Timely and effective interventions to address core ADHD symptoms and co-occurring problems are a high priority for healthcare and society more widely. While much research has reported on the benefits and adverse effects of different interventions for ADHD, these individual research reports and the reviews, meta-analyses and guidelines summarizing their findings are sometimes inconsistent and difficult to interpret. We have summarized the current evidence and identified several methodological issues and gaps in the current evidence that we believe are important for clinicians to consider when evaluating the evidence and making treatment decisions. These include understanding potential impact of bias such as inadequate blinding and selection bias on study outcomes; the relative lack of high-quality data comparing different treatments and assessing long-term effectiveness, adverse effects and safety for both pharmacological and non-pharmacological treatments; and the problems associated with observational studies, including those based on large national registries and comparing treatments with each other. We highlight key similarities across current international clinical guidelines and discuss the reasons for divergence where these occur. We discuss the integration of these different perspective into a framework for person/family-centered evidence-based practice approach to care that aims to achieve optimal outcomes that prioritize individual strengths and impairments, as well as the personal treatment targets of children and their families. Finally, we consider how access to care for this common and impairing disorder can be improved in different healthcare systems., European Child & Adolescent Psychiatry, 32 (8), ISSN:1435-165X, ISSN:1018-8827

Chronic low back pain is the second leading cause of disability in the United States, and it is often associated with severe fatigue. However, little is known about individual differences that may be related to poorer mental health and pain among individuals with severe fatigue and chronic low back pain. The aim of the current investigation was to explore the role of fatigue severity and fatigue sensitivity in terms of anxiety and depressive symptoms, pain catastrophizing, pain interference, and pain severity among 783 adults with severe fatigue and chronic low back pain (76.1% female, M(age) - 43.29 years, SD = 11.64). Results suggest that fatigue severity and fatigue sensitivity were statistically significant predictors for anxiety (β=0.17, 95% CI [0.10, 0.25], p

While tobacco products (such as combustible cigarettes and nicotine vaping products) and cannabis use rates remain high in the general United States (U.S.) population, veterans from the conflicts in Iraq and Afghanistan (i.e., OEF/OIF veterans) are at high risk of high rates of cannabis and tobacco use. Co-use of tobacco and cannabis (i.e., using both substances within a specified period of time or combining the drugs within the same device for use) is of growing prevalence in the U.S. However, little is understood about the prevalence rates of tobacco and cannabis co-use among U.S. veterans and its associations with mental health symptomology. The current study conducted a preliminary analysis of co-use patterns of tobacco and cannabis and associated mental health outcomes among a sample of Iraq/Afghanistan (i.e. OEF/OIF) veterans (N= 1,230). Results indicated high rates of lifetime and past 30-day use of both substances. Past 30-day co-users endorsed significantly higher levels of stress, PTSD, depression, and anxiety compared to singular product users. Results suggest that the addition of cannabis use in conjunction with tobacco use may be associated with greater mental health symptoms among veterans. Findings indicate veteran tobacco and cannabis co-users may benefit from mental health care to help mitigate poor mental health symptoms.

The COVID-19 pandemic has significantly impacted the lives of children, youth, and their families and their access to mental health services through new virus containment measures, such as social distancing guidelines, school and service closures, and the emergence of online mental health services. In this study, we utilized a total of 47,417 interRAI assessments to evaluate the impact of the current pandemic on the mental health service needs and referral trends of children and youth across 55 mental health service agencies in Ontario, Canada. Child and youth assessments that were conducted in the period of March 1 to October 31 in 2018 and 2019 were compared with the same period in 2020 to assess pandemic-related differences. Findings demonstrated that mental health assessments among children and youth decreased significantly during the pandemic period, with the greatest decline observed among children from low-income neighborhoods. Results also demonstrated a change in the proportion of mental health concerns previously seen in children and youth. Specifically, referrals for anxiety, depression, self-harm, problem videogaming, and Internet use increased, whereas referrals related hyperactivity/distractibility, risk of harm to others, aggressive, and disruptive behavior decreased. A decrease in bullying and increase in domestic violence exposure was also noted during the pandemic, with no reported differences in children and youth's experiences of physical abuse, sexual abuse, emotional abuse, and neglect. The clinical implications for children, youth, and their families, especially those within more vulnerable communities, are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

The considerable demand versus supply gap of evidence-based treatments for borderline personality disorder (BPD) indicates the need for modular steps of care to tailor fit between individual patients' needs along the trajectory of their clinical course and effective interventions. These trajectories may or may not include lengthy specialized psychotherapies. Good psychiatric management (GPM) for BPD is being practiced by an increasing number of mental health professionals as a basic starting block of mental health services in the community. It remains an open question what duration of GPM is optimal, what the content of a shortened version of GPM may be, and how such brief treatment may be integrated into larger long-term treatment plans for patients with BPD. The present practice review elaborated on a brief version of GPM, addressed its conceptual background and the notion of stepped care in the treatment of BPD, and discussed the clinical tasks and contents of brief psychiatric management in 10 sessions (or lasting 4 months). It also summarized the moderate evidence base of brief forms of GPM: 2 randomized controlled trials of 10-session GPM, and 1 randomized controlled trial of a 6-session GPM psychoeducational group, have found medium-to-large effects in reducing BPD symptoms. Finally, this review offered 2 clinical vignettes of patients either stepping up or down the intensity of their treatment to illustrate how to implement brief GPM and suggested open avenues for future development and clinical practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cardiovascular complications from drugs of abuse are becoming more apparent because of increased usage worldwide. Substance abuse can cause acute and chronic cardiovascular complications and is increasing in prevalence especially in young adults. These substances contribute to the development of acute coronary syndrome, type 2 myocardial injury, arrhythmias, and cardiomyopathies, and have numerous other cardiovascular complications. Although no screening guidelines exist, clinical awareness of these potential complications and their prevention, clinical presentation, diagnosis, and treatment are critically important. Management of cardiovascular disease should be coupled with appropriate social and mental health interventions to provide sustained clinical benefit. The higher the number of substances used recreationally, the greater the risk of premature heart disease. Epidemiological studies showed that 1 in 5 young adults misuse several substances and often start using at younger ages with a greater risk for adverse health outcomes over the long term. The aim of this review is to highlight the basic epidemiology, cardiac complications, and disease-specific treatment options of commonly abused substances including methamphetamine, cocaine, alcohol, anabolic-androgenic steroids, cannabis, and tobacco.

Objectives: This study aimed to determine the effects of happiness training on the psychological well-being of thalassaemia major (TM) patients. TM is a chronic haematological disease that can have profound effects on patients’ mental health and psychological well-being. Methods: This quasi-experimental study with a pre/post-test design was performed on 52 patients with TM attending the thalassaemia care centre of Imam Khomeini Hospital in Zabol city, Iran, from August to December 2020. The patients were randomly categorised into experimental and control groups. In the experimental group, happiness training was performed in eight sessions, each for 60 minutes. The control group received routine care. The data collection tool employed was the Ryff’s Scale of Psychological Well-Being. Data were analysed by SPSS 16 using descriptive (mean ± standard deviation) and inferential (paired and independent t-test) statistics. Results: Regarding the psychological well-being score at the pre-test stage, there was no statistically significant difference between the intervention (74.92 ± 6.36) and control (74.57 ± 5.83) groups (P = 0.83). After the intervention, however, a statistically significant difference was observed between the two groups in terms of psychological well-being (P

Objectives: To characterize attitudes and perceptions regarding risks and benefits of cannabis before Canadian legalization for recreational use, both in general and between cannabis users and nonusers. Methods: A cross-sectional sample of community adults assessed in the month before legalization (September 17 to October 17, 2018). Overall, 1,480 individuals (60% female) of an average age of 34.5 years (±13.92) were included in the analysis; 48% reported cannabis use in the past 6 months. Attitudes and perceptions were assessed using a subset of items from the Canadian Cannabis Survey, the National Survey on Drug Use and Health, and the Risks and Benefits of Cannabis Use. Results: Most commonly identified risks of cannabis were impaired memory (67%) and legal problems (54%). Most also identified addiction as a risk (52%), although 25% reported that cannabis was not addictive. The most commonly identified benefits were for pain relief (94%) and management of stress, anxiety, or depression (80%). Active cannabis users systematically reported lower endorsement of risks and higher endorsement of benefits. Only 6% of respondents anticipated increasing cannabis use postlegalization. Among other legal substances, medical cannabis was considered the most socially acceptable, followed by alcohol, recreational cannabis, electronic cigarettes, and then combustible cigarettes. Conclusion: Before legalization, attitudes toward cannabis in this sample of Canadian adults were generally favorable, particularly for medical cannabis. Perceptions of risk were often compatible with existing evidence, but notable proportions underendorsed risk of cannabis use disorder and overendorsed benefits for mental health. These results suggest priorities for public health messaging and provide benchmarks for understanding attitudinal changes postlegalization.

Mental health treatment noncompliance (preintake attrition, premature termination) has serious consequences both for mental health providers, as well as for individuals suffering from mental illness. However, prior work has examined preintake attrition and premature treatment termination separately, which limits our ability to determine when attrition is highest (before or after intake), and whether different factors predict attrition throughout the treatment process. Moreover, preintake attrition has been conceptualized as failing to attend a scheduled intake, thereby overlooking potential attrition that may occur earlier. The current investigation sought to fill these gaps using data from a university training mental health clinic. Of the 264 individuals who initiated contact with the clinic between 2012 and 2017, only about a quarter of individuals successfully completed therapy. Nearly 60% of prospective clients who contacted the clinic did not schedule intake. Although 10% of attrition occurred before the clinic could even recontact prospective clients, being placed on a waitlist accounted for the most attrition. Indeed, nearly two thirds of individuals placed on the waitlist did not schedule an intake, accounting for 30% of the overall sample. Client factors (age, previous psychotherapy engagement) did not predict preintake attrition, but wait times did. Having just one "no show" for an appointment predicted premature termination, decreasing the likelihood of completion to one in four. Together, these findings suggest that attrition was the highest prior to scheduling intake, and different factors predicted preintake attrition and premature termination. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Neighborhood characteristics are associated with residents' healthcare use. However, we understand less about these relationships among formerly homeless persons, who often have complex healthcare needs, including mental health and substance use disorders. Among formerly homeless Veterans, we examined: (a) how neighborhood characteristics are associated with Veteran Health Administration (VHA) healthcare use and, (b) if these relationships varied by Veterans' level of healthcare need. We obtained data on our cohort of 711 Veterans housed through VHA's permanent supportive housing program (HUD-VASH) in 2016-2017 from VHA's Homeless Registry, VHA's electronic health records, and the U.S. Census. We studied the relationships between neighborhood characteristics (% Veteran, % in poverty, % unemployed, % using public transportation, and % vacant properties) and VA healthcare use (primary care visits, outpatient mental health visits, and "high use" of emergency departments [> 4 visits]) using mixed-effects logistic and negative binomial regression models, controlling for patient demographics. We further examined moderation by patient healthcare need (calculated from cost and clinical data). We found that veterans in neighborhoods with higher percentages of residents who (a) were Veterans or (b) used public transportation were more likely to have high emergency department use. Those in neighborhoods with higher public transportation use had more primary care visits while those in neighborhoods with more property vacancies had more outpatient mental health visits. Among those with high healthcare needs, residents of areas with more Veterans had higher emergency department use. Promoting public transportation use and social engagement with other Veterans in residential neighborhoods may influence HUD-VASH Veterans' VA healthcare use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Anxiety and depression are highly prevalent and disabling mental health disorders, with comorbidity often posing as a barrier to successful treatment outcomes, thus creating a need for more intensive treatment options. Outpatient clinicians are more likely to refer patients with severe symptoms of anxiety and depression to inpatient hospitalizations rather than partial hospital programs (PHPs) or intensive outpatient programs (IOPs), despite evidence that inpatient hospitalization is associated with high costs and other risks following discharge. The present study reviews two case studies of patients who received cognitive-behavioral therapy/dialectical behavior therapy (CBT/DBT)-based IOP treatment in a private New York clinic. We evaluated treatment outcomes for 73 adult patients (50.7% female) with a mean age of 29.10 years (SD = 10.30). At intake, patients averaged 2.15 diagnoses (SD = 0.94, range = 4) and the majority (80.8%) were prescribed psychotropic medication. Treatment was structured and individually tailored, with patients receiving an average of 21.77 hours (SD = 15.06) of psychotherapy over 12.63 treatment sessions (SD = 9.76), across 12.21 days (SD = 9.61). We observed a clinically and statistically significant change in symptoms of anxiety (t = 6.24, p

This study examined whether romantic relationship functioning was associated with mental health treatment utilization in male and female veterans. Veterans (N = 760) enrolled in a longitudinal registry completed self-report measures and a diagnostic interview for posttraumatic stress disorder (PTSD). Mental health treatment utilization data procured from Veterans Affairs administrative records were analyzed over 12 months. For men with PTSD, greater romantic relationship dysfunction was associated with more total mental health visits, medication management visits, and group psychotherapy visits. For women with PTSD, romantic relationship dysfunction was negatively associated with total mental health, individual psychotherapy, and group therapy visits. For women without PTSD, greater relationship dysfunction was associated with fewer total mental health visits and group therapy visits. For men, relationship difficulties appear to be positively related to mental health service use; however, for women, relationship difficulties appear to have no relation or a negative relation to mental health service use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background COVID-19 is a global pandemic that has raised worldwide public health concerns. The wide spread of the virus has led to unprecedented disturbance to regular life for people around the globe and impacted their mental health. Aims The aims of the current study were to investigate the prevalence of psychiatric symptoms related to insomnia, depression, and anxiety, and identify risk factors contributing to psychological stress in Lebanese young population during COVID-19 pandemic. Method A cross-sectional study was done on the Lebanese young population. Participants were 4397 males and females aged 18 to 35 years who filled a self-administered online questionnaire. Three validated scales were used to measure the mental health status of the participants during the COVID-19 pandemic: 7-item Insomnia Severity Index for insomnia, the Patient Health Questionnaire 9-item depression module for depression, and the 7-item Generalized Anxiety Disorder scale for anxiety. Results The median interquartile range scores for anxiety, insomnia, and depression, were 8 (4–13), 10 (5–14), and 9 (5–12) respectively. Higher anxiety scores were reported with female gender (P

Prior research suggests that a significant number of veterans with posttraumatic stress disorder (PTSD) do not have this diagnosis recognized in the electronic health record (EHR). Unfortunately, such diagnostic errors can lead to improper allocation of already scarce health care services and resources. In this study, we examined concordance between PTSD diagnoses in the Veterans Affairs (VA) EHR and PTSD diagnoses based on a semistructured diagnostic interview and mental health service use in a sample of veterans (N = 1,299) enrolled in VA healthcare. Results from negative binomial regressions showed that veterans with PTSD based on the diagnostic interview and the EHR (true positives) used the most mental health care services. There were no significant differences between those without PTSD based on the interview and the EHR (true negatives) and those with PTSD based on interview that was not recognized in the EHR (false negatives) on total nonemergent outpatient mental health visits. However, veterans in the false negative group had more mental health-related emergent care visits (i.e., emergency room, urgent care, hospitalization) than veterans in the true negative group. Our findings suggest that veterans with PTSD who are not coded as such in the EHR may not be utilizing needed outpatient care but are seeking and receiving costly emergent care. Thus, accurate recognition of PTSD in the EHR is essential for connecting patients to outpatient mental health services. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: Disability in patients with scleroderma (SSc) has been associated with poor health-related quality of life (HRQoL) in all dimensions, including physical, psychological, and social dimensions. Objective: This study was conducted to examine different factors that may be associated with functional disability and poor HRQoL, with the aim of targeting these factors in the future to improve physical activity, functional outcomes, and HRQoL. Methods: A single-center cross-sectional study was conducted on 38 patients with SSc to compare characteristics between patients with and without disability using the Health Assessment Questionnaire Disability Index (HAQ-DI). Quality of life was assessed using the Short Form-36 (SF-36). Linear regressions were performed to examine variables contributing to functional disability. Results: Almost 65.78% (n = 25) of patients in the study group reported functional disability. The presence of functional disability was associated with reduced HRQoL, as reflected by physical function (P = 0.0001), physical role (P = 0.016), bodily pain (P = 0.001), general health (P = 0.002), social functional (P = 0.002), emotional role (P = 0.042), and mental health (P = 0.025) domains of the SF-36 score. Multiple linear regression indicated that the main predictive factors associated with HAQ-DI were the modified Hand Mobility in Scleroderma, modified Rodnan skin score, DIstance walked in 6 minutes, BOrg dyspnea index, and SAturation of oxygen at 6 minutes (DIBOSA), and Fatigue Severity Scale among patients with SSc. Conclusion: In patients with SSc, recognizing the relationships between clinical findings and functional disability will allow the development of further management strategies to minimize disease severity and enhance HRQoL.

Background: to describe the prevalence of mental health comorbidity in children with type 2 diabetes compared to a matched population without diabetes and children with type 1 diabetes. Methods: Population-based cohorts of 528 youth (7–18 years of age) with prevalent type 2 diabetes, 1519 matched children without diabetes and 778 youth with type 1 diabetes were identified from a clinical registry and linked to health care records to assess the prevalence of mental health comorbidity using ICD-9CM, ICD-10CA and ATC codes. Findings: Compared to their matched peers, children with type 2 diabetes where more likely to have a mood or anxiety disorder before and after diagnosis [RR 2‧38 (1‧63, 3‧48) p

Purpose Literature is scarce regarding cancer care utilization during the massive outbreak of coronavirus disease 2019 (COVID-19) in the Republic of Korea. We investigated functional impairments in mental health and their relationships with depression, anxiety regarding the viral epidemic, and disruptions in healthcare service utilization among cancer patients in the COVID-19 pandemic era.Materials and Methods We used an online survey with questions related to the disturbances faced by patients with cancer in utilizing healthcare services in the pandemic era. Current mental health status was assessed using the Work and Social Adjustment Scale (WSAS), Stress and Anxiety to Viral Epidemics-6 (SAVE-6) scale, Patient Health Questionnaire-9 (PHQ-9), Insomnia Severity Index (ISI), Brief Resilience Scale (BRS), Cancer-Related Dysfunctional Beliefs about Sleep Scale (C-DBS), and Fear of COVID-19 over Cancer (FCC).Results Among the 221 responders, 95 (43.0%) reported disruptions in healthcare service utilization during the COVID-19 pandemic. Logistic regression analysis revealed that functional impairment in the mental health of these patients was expected due to disruptions in healthcare service utilization, high levels of depression, anxiety regarding the viral epidemic, fear of COVID over cancer, and low resilience. Mediation analysis showed that patient resilience and cancer-related dysfunctional beliefs about sleep partially mediated the effects of viral anxiety on functional impairment.Conclusion In this pandemic era, patients with cancer experience depression, anxiety regarding the viral epidemic, and disruptions in healthcare service utilization, which may influence their functional impairments in mental health.

Graphical abstract, Background The COVID-19 pandemic raises health issues worldwide. Infected pregnant women may have negative mental health outcomes, but little is known about their emotional experiences. Aim We aimed to understand the experience of women infected with COVID-19 during pregnancy, regarding their feelings, their relationships, and the influence of social media. Methods We conducted a qualitative study among 22 women infected with COVID-19 during pregnancy, from a tertiary hospital during the first wave of the pandemic in Brazil (May–August 2020). We applied semi-directed interviews, sociodemographic and health data sheets, and field diaries. We built the sample purposefully. Interviews were audio-recorded and transcribed verbatim. We used thematic analysis and discussed data considering the health psychology framework. Results We created five categories following a timeline perspective, from before infection to the experience after recovering. Pregnant women were resistant to believing the diagnosis. They described a fear of serious symptoms or death, concerns about the fetus, sorrow from being isolated, and worries about stigma. Family relationships were ambiguous, generating either support or tension. The attachment to the health team through telemedicine or support during hospitalization produced a feeling of security. Conclusions Participants psychologically denied the COVID-19 diagnosis and did not accomplish isolation properly, even upon medical recommendations. The illness may produce a traumatic experience, regardless of mild or severe symptoms, but family/friend support and contact with the health team helped them to cope. We offer important insights for the clinical approach and future research, emphasizing that infected pregnant women require emotional support.