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• Gender-affirming mental health care supports gender diversity and builds resilience. • Effective interventions address individual, interpersonal, and system-level needs. • Barriers and societal stigma affect well-being and access to care for TGD youth. Gender-affirming care is a framework that has developed over the past two decades and has experienced a rapid proliferation of empirical evidence. Given increased attention to transgender and gender diverse (TGD) youth in sociocultural spheres, there is a need to examine the current evidence base for effective gender-affirming mental health treatment. In this State of the Science review, we highlight general treatment frameworks that best support TGD youth and families in a variety of contexts, using gender-affirming psychosocial approaches. We use groupings of presenting concerns for TGD youth and families outlined by Coyne et al. (2020) to highlight differing mental health support needs, emphasizing the need for individual, contextually-based care models that consider aspects of gender-related marginalization and resilience. We further discuss needs for care access and equity and need for further attention in future research and intervention approaches. [ABSTRACT FROM AUTHOR]

The Veterans Health Administration (VA) increasingly purchases community-based care (CC) to improve healthcare access, including behavioral health. In 2018, VA introduced standardized episodes of care (SEOCs) to guide authorization and purchase of CC services for specific indications in a defined timeframe without bundling payment. In this retrospective cross-sectional study, we describe trends in VA and CC behavioral healthcare utilization using the VA Outpatient Psychiatry SEOC definition. Counts of Outpatient Psychiatry SEOC-allowable service and procedure codes during fiscal years 2016–2019 were organized according to four SEOC-defined service types (evaluation and management, laboratory services, psychiatry services, transitional care) and measured as percentages of all included codes. Trends comparing behavioral healthcare utilization between Veterans using any CC versus VA only were analyzed using a linear mixed effects model. We identified nearly 3 million Veterans who registered 60 million qualifying service and procedure codes, with overall utilization increasing 77.8% in CC versus 5.2% in VA. Veterans receiving any CC comprised 3.9% of the cohort and 4.7% of all utilization. When examining service type as a percent of all Outpatient Psychiatry SEOC-allowable care among Veterans using CC, psychiatry services increased 12.2%, while transitional care decreased 8.8%. In regression analysis, shifts in service type utilization reflected descriptive results but with attenuated effect sizes. In sum, Outpatient Psychiatry SEOC-allowable service utilization grew, and service type composition changed, significantly more in CC than in VA. The role of SEOCs and their incentives may be important when evaluating future behavioral healthcare quality and value in bundled services. [ABSTRACT FROM AUTHOR]

The Brief Jail Mental Health Screen (BJMHS) is one of the most well-known and frequently used tools to conduct routine mental health screening at jail intake. In prior research, the BJMHS results typically have been evaluated overall (i.e., yes/no positive screen). However, there is heterogeneity in symptom presentation and treatment histories among people with serious mental illness, and there are potential consequences of this heterogeneity for mental health administration and policy in jails. We conducted a latent class analysis of BJMHS item-level results using administrative data for 37,998 people booked into a southeastern, metropolitan, U.S. county jail over a 3.5-year period. A 4-class solution provided the best fitting and most interpretable model. The largest class (89.5%) comprised people unlikely to report symptoms or treatment histories (limited symptoms). The next class comprised people who were unlikely to report ongoing symptoms but reported medication and hospitalization (managed symptoms). The third class (2.5%) included people likely to report feeling useless/sinful, prior hospitalization, and current psychiatric medication (depressive symptoms). The fourth class (1.0%) comprised people likely to report thought control, paranoia, feeling useless/sinful, medication, and hospitalization (psychotic symptoms). Controlling for sociodemographic and booking characteristics, people in the managed, depressive, and psychotic symptoms classes had significantly longer jail stays compared to those in the limited symptoms class. People in the managed and depressive symptoms classes were at heightened risk of re-arrest compared to the limited symptoms class. Findings can inform case prioritization and the allocation of resources to support efficient and effective jail-based mental health services. [ABSTRACT FROM AUTHOR]

Objective: Proximity to mental health services is a predictor of timely access to services. The present study sought to investigate whether travel time was associated with engagement in coordinated specialty care (CSC) for early psychosis, with specific attention to whether the interaction of travel time by race and ethnicity had differential impact. Data Source/Study Setting: Data collected between 2019 and 2022 as part of the New Journeys evaluation, the CSC model in Washington State. Study Design: This cross-sectional study included a sample of 225 service users with first episode psychosis (FEP) who had received services from New Journeys. Data Collection: Service users' addresses, and the physical location of CSC were geocoded. Spatial proximity was calculated as travel time in minutes. Scheduled appointments, attendance and program status were captured monthly by clinicians as part of the New Journeys measurement battery. Principal Findings: Proximity was significantly associated with the number of appointments scheduled and attended, and program status (graduation/completion and disengagement). Among Hispanic service users with spatial proximity further away from CSC (longer commutes) was associated with a lower likelihood of graduating/completing CSC compared to non-Hispanic service users (p =.04). Non-white services users had a higher risk of disengagement from CSC compared to white service users (p =.03); additionally, the effects of spatial proximity on disengagement were amplified for non-White service users (p =.03). Conclusions: Findings suggest that proximity is associated with program engagement and partially explains potential differences in program status among ethnoracial group. [ABSTRACT FROM AUTHOR]

Pragmatic measures of evidence-based practice (EBP) implementation can support and evaluate implementation efforts. We examined the predictive validity of therapist reports of EBP strategy delivery for children's mental health outcomes. Data were obtained from 1,380 sessions with 248 children delivered by 76 therapists in two county systems. Children (Mage=11.8 years, SD = 3.7) presented with internalizing (52%), externalizing (27%), trauma (16%), and other (5%) concerns. Therapists reported their delivery of EBP strategies on a revised version of the EBP Concordant Care Assessment (ECCA; Brookman-Frazee, et al., Administration and Policy in Mental Health and Mental Health Services Research, 48, 155–170, 2021) that included 25 content (e.g., parenting, cognitive behavioral) and 12 technique strategies (e.g., modeling, practice/role-play). On average, 5.6 ECCA session reports (SD = 2.3) were obtained for each client, and caregivers reported symptoms on the Brief Problem Checklist (Chorpita, et al., Journal of Consulting and Clinical Psychology, 78(4), 526–536, 2010) at baseline, weekly over two months, and again at four months. Multilevel models examined whether the mean extensiveness of each EBP strategy predicted trajectories of child outcomes. More individual technique (6 of 12) than content strategies (1 of 25) were associated with outcome trajectories. For techniques, more extensive use of Performance Feedback and Live Coaching and less extensive use of Addressing Barriers were associated with greater declines in total symptoms, and more extensive use of Establishing/Reviewing Goals, Tracking/Reviewing Progress, and Assigning/Reviewing Homework was associated with declines in externalizing symptoms. For content, more extensive use of Cognitive Restructuring was associated with declines in total symptoms. In addition, higher average extensiveness ratings of the top content strategy across sessions was associated with greater declines in total and externalizing symptoms. Therapist-reported delivery of some EBP strategies showed evidence of predictive validity and may hold utility in indexing quality of care. [ABSTRACT FROM AUTHOR]

In 2023, the White House included the implementation and improvement of assisted outpatient treatment in a list of under-researched strategies to support recovery and long-term treatment engagement for people with serious mental illness. Assisted outpatient treatment is a community-based, court-ordered, mental health treatment program for a subset of individuals with serious mental illness who have a history of difficulty adhering to treatment and staying well while living in the community. There is research supporting the use of assisted outpatient treatment for this specific population, however, the majority focuses on limited geographic regions, specific program organizations, and is outdated. Meanwhile, assisted outpatient treatment programs have increasingly been adopted by counties and states across the country. More research is needed to ensure that assisted outpatient treatment programs are being implemented in the most effective and equitable way possible. In this paper, the authors identify several key gaps in the current literature base relating to the effectiveness and implementation of assisted outpatient treatment. [ABSTRACT FROM AUTHOR]

This article uses data from a doctoral thesis concerning service users' views on what works for them in relation to their mental health wellness following a suicidal ideation/attempt in Aotearoa New Zealand. In particular, it focuses on the experiences of service users regarding mental health crisis team responses and what they wanted from their crisis teams specifically. Participants indicated that what they wanted was to feel heard, respected and not judged, consistent with the core conditions of therapeutic alliance within such professions as social work, counselling and psychology. Social work has a valuable role to play in emphasising and advocating for social, contextual and non-medical responses within crisis teams and service delivery. [ABSTRACT FROM AUTHOR]

The article focuses on the final issue of 2024, which compiles nine insightful articles that delve into critical themes in social work practice and policy. Topics include the identity construction of social workers, client perceptions of care, reflexive analyses of participatory research methodologies, and the lived experiences of diverse individuals, emphasizing the significance of context and critical reflection in ethical social work.

Many women experiencing homelessness and intimate partner violence (IPV) often do not use formal support services due to barriers such as finances, inaccessibility, controlling partners, and stigma. The current literature lacks studies that examine the formal service experiences of women who have undergone both homelessness and IPV. Therefore, the current study used a qualitative-dominant design and explored the formal service needs of these women, barriers and facilitating factors associated with accessing services, and how the women's identities affected their experiences with formal services. Interviews with 10 women were conducted, and a reflexive thematic analysis was conducted using a critical feminist and intersectionality lens. The most common factors that led to homelessness were conflict and precarious circumstances leading to housing instability. Common barriers were systemic, psychological, dismissal, minimization, and financial barriers. The most common needs were health, finances, and basic necessities. The most common facilitating factors were support networks and resilience, growth, and proactivity. The social positionings most commonly affecting their experiences were class and race/ethnicity. These findings highlighted the voices of marginalized women and can be used to implement positive change in formal services that cater to this subgroup of women. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the impact of baseline learner characteristics on motivational interviewing (MI) skill acquisition with and without virtual standardized patient (VSP) supplementation. Data from a two-group, randomized trial of 120 volunteer health care professionals recruited from a Department of Veterans Affairs and Department of Defense medical facility were used for this exploratory analysis. Training conditions included a branching storyline VSP, which provided MI skill rehearsal/feedback, and an academic study control. Nine multivariate analysis of variance models were used to examine the effects of baseline characteristics, assigned training condition, and their respective interactions in predicting MI skill improvements from baseline to posttraining. Follow-up between-subjects effects for significant omnibus tests were examined to evaluate the main effects for the baseline characteristics and the interaction effects. A statistically significant interaction was found between training condition and previous MI training, F(3, 99) = 2.77, p =.046; Pillai's trace =.077; ηp2 =.077, on motivational interviewing treatment integrity skill change. This study serves as an initial step in the direction of elucidating, which learners benefit most from simulation-based mental health care training using VSPs. We found that learners with minimal previous MI training benefited more from supplemented training with a VSP rather than traditional academic study alone. Public Significance Statement: This study reports on an exploratory analysis examining the impact of baseline learner characteristics on motivational interviewing (MI) skill acquisition with and without virtual standardized patient (VSP) supplementation. Learners with minimal previous MI training experienced greater increases in relational skills when training with a VSP. The VSP used in this study represents a scalable tool that may be particularly helpful for training novice clinicians in MI relational skills. [ABSTRACT FROM AUTHOR]

This article describes a 20+-year learning collaboration between a clinical psychology program and a state mental health department focused in part on the joint mission of educating and training doctoral students in the development and implementation of data-based decision making in public mental health systems of care. Funded by the state government, the collaboration was designed to assure meaningful contributions to service improvement and to prepare doctoral psychology students for leadership roles in public service. This partnership provided paid graduate assistantships and opportunities for students and others to contribute to accumulated clinical science via practice-based research. We provide a brief contextual overview of events that set the stage for the university/state department team-up; the vision, goals, and structural processes of the collaborative training opportunity; and students' roles and educational objectives. We then describe outcomes to date including contributions to the system of care and clinical science, placement of students and early-career staff in public service leadership positions, and students' retrospective perceptions of their learning and development affected by their training experiences in the collaboration. Finally, the authors discuss implications and recommendations for universities that might consider implementing such a partnership. Public Significance Statement: This article describes a long-standing learning collaboration between a state government agency and a university. The partnership provides clinical psychology doctoral students with advanced training in mental health leadership with a focus on data-based decision making in public mental health care while contributing to local service improvement and to clinical science via practice-based research. [ABSTRACT FROM AUTHOR]

Multicultural peer-consultation teams represent one promising approach to supporting mental health providers by providing consultation that is multiculturally conscious and integrates front-and-center concepts related to diversity in identities and lived experiences (i.e., multiculturalism), intersectionality, inclusivity, health equity, antiracism, and anti-oppression. Herein, we take an implementation science-informed approach to describing the development, implementation, and sustainment of multicultural peer-consultation teams in two professional settings—a Veterans Affairs hospital and a psychology department training clinic. We operationalize the core and adaptable components of this model. Last, we reflect on our collective lessons learned and offer recommendations based on our efforts to create teams across mental health care settings. Thus, the present article may function as an implementation blueprint of sorts that others can follow as they consider ways that they can create similar teams at their institutions. Public Significance Statement: With increased recognition of widening health inequities disproportionately impacting communities that have been systematically excluded and/or harmed by the mental health field, there is a crucial need for educational approaches that empower and equip clinicians with the knowledge and skills to provide care that is multiculturally conscious, inclusive, equitable, antiracist, and anti-oppressive. Multicultural peer-consultation teams represent one approach aligned with these goals. This article describes the multicultural peer-consultation model and reports on its implementation across distinct mental health care settings, with the aim of continued wide-scale dissemination to ultimately make a sustained public health impact. [ABSTRACT FROM AUTHOR]

As Training and Education in Professional Psychology (TEPP's) outgoing editorial team ends their term, the authors reflect on the journal's contributions to health service psychology (HSP) and suggest potential priorities and opportunities as both the journal and the science of education and training continue to mature. TEPP's aim is to serve as a forum for thoughtful and rigorous conceptual and empirical investigation of current issues in HSP education and training, and for candid self-reflection about strengths, shortcomings, and growth opportunities in HSP education. The authors review the journal's contributions to this aim through three primary goals established at the beginning of their editorial term: (a) engage the broad training community in sharing its best conceptual and empirical work relevant to education and training across training levels, settings, and focus areas; (b) advance the science of education and training through strong empirical research; and (c) expand emphasis on the sociocultural context in which education and training occurs (Bell et al., 2019). The authors conclude with recommendations to the incoming TEPP editorial team and prospective authors for next steps in advancing HSP education and training. Public Significance Statement: Training and Education in Professional Psychology outgoing editorial team reflects on progress toward their goals for the journal's contributions to education and training in health service psychology. These goals include advancing education that is evidence-based, responsive to the sociocultural context, and that prepares the next generations of health service psychologists to address societal mental health needs. The authors conclude with recommendations for next steps in supporting innovative and effective education and training. [ABSTRACT FROM AUTHOR]

Objectives: Early interventions improve outcomes for people at high risk of psychosis and are likely to be cost saving. This group tends to seek help for emotional problems – depression and anxiety – via primary care services, where early detection methods are poor. We sought to determine prevalence rates of high risk for psychosis in UK primary care mental health services and clinical outcomes following routinely delivered psychological therapies. Methods: We used a brief screen designed for settings with low base rates and significant time constraints to determine prevalence of high risk for psychosis in UK 'Talking Therapies' services. We examined socio‐demographic characteristics, presenting problems and recovery trajectories for this group, compared with people not at risk of psychosis. Results: A 2‐item screen selected for specificity yielded a prevalence rate of 3% in primary care mental health services. People at elevated risk of psychosis were younger and more likely to report at least one long‐term physical condition. This group presented with higher levels of depression, anxiety and trauma symptoms at assessment and were less likely to have recovered at the end of treatment, compared to people not at risk. Conclusions: Very brief screening tools can be implemented in busy health care settings. The 3% of referrals to UK primary care psychological therapies services at elevated risk of psychosis typically present with more severe symptoms and greater levels of comorbidity and may require augmented interventions to recover fully. [ABSTRACT FROM AUTHOR]

This article discusses the controversy surrounding pre-operative opioid tapering and its potential to advance personalized, patient-centered pain medicine. The use of opioids for chronic non-cancer pain management is common, but it is associated with negative outcomes in the peri-operative period, such as respiratory failure and surgical site infections. The article presents the findings of a pilot study that assessed the feasibility of a pharmacist-led opioid tapering program before elective hip or knee arthroplasty. The study found high adherence to the program and positive outcomes in terms of physical functioning and quality of life. However, the study has limitations, and further research is needed to determine the effectiveness of pre-operative opioid tapering in a broader patient population. [Extracted from the article]

Aims: The aim of this study was to examine the association between women's migrant status (majority, immigrant, descendant) and use of postpartum mental healthcare and investigate whether migration characteristics are associated with mental healthcare use. Methods: Retrospective cohort study. We included all mothers of children born between 2002 and 2018 in 34 municipalities of Denmark who had an identified mental health need as clinically assessed by a child health visitor (CHV) or by a score of 11 or more on the Edinburgh Postpartum Depression Scale (EPDS). Women were followed until the first mental healthcare received 2 years' postpartum, death or emigration. Using Cox regression models, we estimated the time to mental healthcare by migrant status and explored the role of migration characteristics. Results: A total of 29% of women (n = 45,573) had a mental health need identified by the CHV, and 7% (n = 4968) had an EPDS ⩾ 11. Immigrants accounted for 19.5%, and descendants for 4.7% of the sample. Immigrants were at lower risk of using mental healthcare than the majority group (CHV: hazard ratio adjusted (HRa) 0.75 (0.70–0.79), EPDS: HRa 0.67 (0.58–0.78)), as were descendants (CHV: HRa 0.77 (0.70–0.86), EPDS: HRa 0.69 (0.55–0.88)). Among migrants, those not refugees, newly arrived, whose partners were immigrants or descendants, and those originally from Africa showed a lower risk of using postpartum mental healthcare. Conclusions: Our findings emphasize the need to strengthen access to mental healthcare for immigrants and descendants experiencing postpartum mental health concerns and consider migration characteristics as indicators of potential inequalities in access to maternal mental healthcare. [ABSTRACT FROM AUTHOR]

Aim: To explore general nurses' experiences of modifying and implementing contextually suitable Safewards interventions into medical and surgical hospital wards. Design: Qualitative action research was used working with nurses as co‐researchers. Methods: Pre‐implementation focus groups were conducted in April 2022 to understand and explore the current strategies nurses utilized to avert, respond to or decrease violence. Following this, two Safewards interventions were modified by the nurses on the wards. Post‐implementation focus groups were conducted in October 2022, to explore the nurses' experience of implementing Safewards interventions and the effect on their nursing practice. Data were analysed using Braun and Clarke's framework for thematic analysis. Results: Three themes emerged from the analysis of the pre‐implementation focus groups that reflected the type of violence experienced by these nurses and the context within which they occurred: 'the space is hectic'; 'it can feel like a battlefield'; and 'the aftermath'. These themes encompass the nurses' experience of violence from patients and their visitors. Following the implementation of two modified Safewards interventions, the analysis of the focus groups reflected a change in nursing skills to avert or respond to violence: 'Safewards in action'; 'empathy and self‐reflection'; and 'moving forward'. Conclusion: Safewards interventions can be successfully modified and used in general hospital wards and influence nursing practice to manage patient and visitor violence. Implications for the Profession: In the interests of safety, successful interventions to reduce violence towards general hospital nurses should be a priority for managers and healthcare organizations. Averting, mitigating and managing violence can decrease the negative professional and personal effect on nurses and ultimately improve well‐being, job satisfaction and retention rates. Furthermore, decreasing violence or aggressive incidents leads to a safer patient experience and decreased number of nursing errors ultimately improving patient experiences and outcomes. Understanding nurses' experiences of violence and working with them to explore and develop contextually relevant solutions increases their capacity to respond to and avert violent incidents. Contextually modified Safewards interventions offer one such solution and potentially has wider implications for healthcare settings beyond the specific wards studied. Impact: This study addressed the implementation of modified Safewards strategies in medical and surgical wards to prevent violence.Three themes emerged from the analysis of the pre‐implementation focus groups that reflected the type of violence experienced by these nurses and the context within which they occurred.Following the implementation of two modified Safewards interventions, the post‐implementation focus groups reported positive changes to their practices using the modified resources to prevent violence from patients and their visitors.Mental health interventions, such as those used in the Safewards model can be modified and provide a tool kit of interventions that can be used by medical and surgical nurses. Reporting Method: This paper has adhered to the COREQ guidelines. Patient or Public Contribution: No patient or public contribution. What Does this Paper Contribute to the wider Global Clinical Community?: This paper outlines and discusses the action research approach undertaken to work with general hospital nurses to modify mental health nurses' Safewards interventions into their clinical practice.This paper provides evidence of the 'real world' application of Safewards interventions by medical and surgical nurses in general hospital wards.This paper presents qualitative findings based on focus group methods to highlight the narratives of general nurses and their experiences of violence. [ABSTRACT FROM AUTHOR]

This article discusses the importance of collaboration in achieving health equity, particularly in the context of Federally Qualified Health Centers (FQHCs). It focuses on the efforts of Harmony Healthcare Long Island (HHLI), a not-for-profit FQHC in Nassau County, New York, to improve health outcomes for vulnerable populations. HHLI collaborates with various stakeholders, including community-based organizations, businesses, faith-based organizations, and school districts, to better understand and address the needs of their patients and the community. The article also highlights specific initiatives, such as the Perinatal Infant Community Health Collaborative (PICHC), that aim to improve perinatal and infant health outcomes and reduce disparities. HHLI's partnerships with organizations like the Women's Diversity Network and Hofstra University further contribute to their efforts. The article concludes by discussing the financing collaborations for a sustainable future, including the New York State 1115 Demonstration Waiver, which integrates primary care providers with community-based organizations to address health-related social needs. Overall, HHLI strives to address health equity and improve outcomes through collaboration and community partnerships. [Extracted from the article]

The article discusses the establishment and work of the Health Equity Taskforce (HET) by Northwell Health and community organizations in the New York City metropolitan area. The HET was formed to distribute COVID-19 vaccines equitably and has expanded its focus to address various health disparities. The taskforce has faced challenges such as healthcare inaccessibility, vaccine scarcity, mistrust, misinformation, and cultural factors. However, they have overcome these obstacles by engaging with communities, incorporating community input, providing tailored outreach and education, and using data to assess needs. The HET has successfully distributed vaccines and identified new priorities for collaboration and programs to address health needs. They take a holistic approach to health equity, utilizing models such as cultural competence, community-based research, and integrating health into various sectors. They also prioritize mental health and community engagement for effective initiatives. [Extracted from the article]

Teachers play a critical role in school mental health. They aid in the identification and referral of students in need of mental health services and are key players in implementing interventions. Nevertheless, teachers often lack the education and training needed to support youths' mental health. Increasing teachers' mental health literacy (MHL) is recognized as a needed area of focus in improving systems' responses to youths' mental health needs, yet no current tools assess teachers' complete MHL. A measure of MHL for in‐service teachers based on current conceptualizations of MHL in the context of schools was developed and tested. The 24‐item scale was tested in a sample of 407 full‐time teachers in the United States and initial psychometric testing supports its use. The analytic strategy included an exploratory factor analysis (EFA), reliability analysis via Cronbach's α, and convergent validity analysis via zero‐order correlations between the Teachers' MHL Scale and theoretically linked constructs. The final scale includes four subscales that measure teachers' understanding of how to promote well‐being, recognize potential problems, link students in need to appropriate resources, and the link between well‐being and school success. The underlying theory supporting the tool's development and suggestions for its use are discussed. Practitioner Points: Increasing teachers' mental health literacy (MHL) is recognized as a needed area of focus to improve systems' responses to youths' mental health needs, yet no current tools assess teachers' complete MHL.Teachers' MHL is a multidimensional construct that includes promoting well‐being, recognizing potential problems, linking students to resources, and believing students with mental health needs can learn.The Teachers' MHL Scale is a 24‐item scale that can be used to measure in‐service teachers' MHL, gauge teachers' needs, support their professional development, and guide ongoing efforts to engage educators in school mental health. [ABSTRACT FROM AUTHOR]

Background: Over 50% of hospitalized patients have comorbid psychiatric diagnoses, resulting in increased risk of morbidity such as longer lengths of stay, worse health-related quality of life, and increased mortality. However, data regarding colorectal surgery postoperative outcomes in patients with psychiatric diagnoses (PD) are limited. Methods: We queried a single institution's National Surgical Quality Improvement Program from 2013-2019 for major colorectal procedures. Postsurgical outcomes for patients with and without PD were compared. Primary outcomes were prolonged length of stay (pLOS) and 30-day readmission. Results: From a total of 1447 patients, 402 (27.8%) had PD. PD had more smokers (20.9% vs 15%) and higher mean body mass index (29.1 kg/m2 vs 28.2 kg/m2). Bivariate outcomes showed more surgical site infections (SSI) (10.2% vs 6.12%), reoperation (9.45% vs 6.35%), and pLOS (34.8% vs 29.0%) (all P values <.05) in the PD group. On multivariate analysis, PD had higher likelihood of reoperation (OR 1.53, 95% CI: [1.02-2.80]) and SSI (OR 1.82, 95% CI: [1.25-2.66]). Discussion: Psychiatric diagnoses are a risk factor for adverse outcomes after colorectal procedures. Further studies are needed to evaluate the benefit of perioperative mental health support services for these patients. [ABSTRACT FROM AUTHOR]

About 40 years after the reforms leading to the closure of psychiatric hospitals (Ospedale Psichiatrico [OP]) in Italy in favor of a widespread model with a strong rehabilitation emphasis, Italy has chosen to close High Security Hospitals as well (Ospedale Psichiatrico Giudiziario [OPG]). The new forensic treatment model is expected to be more respectful of the person, including the perpetrators of violent crimes, and aims to be less stigmatizing and more rehabilitative. Despite the favorable premises of the reform (Law n. 81/2014), Italian psychiatrists are now obliged to answer calls to give evidence on strictly legal issues such as the social dangerousness of the mentally ill offender drawing on evidence or paradigms that many believe do not belong to medical knowledge. Psychiatrists must now learn to communicate about the relationship between psychiatry and society as required by law. This public expression engages with the cultural climate of society. Otherwise, the risk is of increasing the level of complexity leading to real misunderstandings that paradoxically may feed the stigma. The Italian reform provides an opportunity for reflection on some issues concerning psychiatric action, on how the public perceives the mentally ill and their psychiatrists, on the relationship between psychiatry and the world of law, on clinical methodologies for structured professional judgment, on public communication regarding severe mental illness, and the risk that psychiatrists may inadvertently be blamed for conveying an unwelcome message about mental illness and social dangerousness—we have called this social sensitivity against psychiatrists "hermanoia," blaming the messenger. The authors do not provide certain solutions but propose good practices. [ABSTRACT FROM AUTHOR]

Introduction: Early parenting services in Australia offer brief structured residential programs to address moderate to severe non‐psychotic mental health problems among women and unsettled infant/toddler behaviours. The aims were to (1) estimate the immediate and medium‐term impact of a five‐night psychoeducational residential early parenting program on postpartum depressive symptoms and (2) identify the factors associated with improvement or worsening of postpartum depressive symptoms after completing the program and six weeks post‐discharge. Methods: Audit of routinely collected medical record data from pre‐admission, pre‐discharge and post‐discharge assessments of a consecutive cohort of women admitted, with their infants/toddlers in a 15‐month period to Masada Private Hospital Early Parenting Centre. Data included structured questions assessing: demographic characteristics, access to family and social support, past and current mental health problems, reproductive and obstetric health, chronic health conditions, breastfeeding problems, coincidental major life events, health risk behaviours and infant/toddler feeding, sleeping and crying behaviours. Standardised instruments included the Partner Interaction after Birth Scale (PIBS), the MacLean Screening Instrument for Borderline Personality Disorder (MSI‐BPD), Modified Fatigue Assessment Scale (FAS) and selected items from the Karitane Parenting Confidence Scale. The primary outcomes were Edinburgh Postnatal Depression Scale scores at pre‐discharge and follow up assessments. Data were analysed using multinomial logistic regression models in which individual and psychosocial characteristics at pre‐admission were included as predictors of the likelihood of the changes of the outcomes from pre‐admission to pre‐discharge and follow up. Results: Complete data from 1220 of 1290 (95%) eligible women were available to assess pre‐admission to pre‐discharge and from 559 (45.8%) to assess pre‐discharge to six‐week follow‐up changes. The mean pre‐admission EPDS score was 11.7 (95% CI: 11.5; 12.0), pre‐discharge it was 7.1 (95% CI: 6.9; 7.4) and at six‐week follow up it was 5.7 (95% CI: 5.3; 6.1). We found that almost all women experienced a clinically meaningful and rapid improvement in depressive symptoms of at least this magnitude (reduction in mean EPDS scores of 4.6 points from pre‐admission to pre‐discharge (five nights) and a further reduction of 1.2 points pre‐discharge to follow up) (six weeks) and we identified an interpretable set of risk factors for symptoms that did not improve or worsened. The adverse outcomes were associated with having symptoms of borderline personality disorder, a partner experienced as lacking kindness and care, coincidental adverse events and having a child younger than six months. Conclusion: Residential early parenting programs, which take a psycho‐educational approach to strengthening caregiving skills, maximising agency, and reducing helplessness, have a rapid beneficial effect on women's postpartum depressive symptoms. These programs provide a valuable and effective component of comprehensive mental health services. Long‐term dialectical behaviour therapy is indicated for women with borderline personality disorder traits for whom early parenting programs alone are insufficient to improve depressive symptoms. [ABSTRACT FROM AUTHOR]

Objective/Background: Unmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID‐19 pandemic but data on the extent of this problem are needed. Aim: The aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare. Method: Women in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup‐PPD‐COVID‐19 cross‐sectional study, reported on sociodemographic, social support health‐related factors, and COVID‐19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD‐7]) using self‐report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD‐7 ≥ 10 for anxiety. Mental healthcare was defined as self‐reported current mental health treatment. Results: Of the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD‐7 ⟨ 10), anxiety (n = 848; 7.2%; GAD‐7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD‐7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59‐0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41‐7.01), were more likely to receive mental healthcare. Conclusion: There are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID‐19 pandemic. Studies beyond the COVID‐19 pandemic and covering the whole range of mental health problems in the perinatal period are warranted to understand the gaps in perinatal mental healthcare. [ABSTRACT FROM AUTHOR]

This article examines the trends in psychotherapy utilization for perinatal mental health disorders among privately insured adults in the United States from 2008 to 2020. The study found that psychotherapy rates increased by 250% during this period, with the highest rates among white individuals, followed by black, Hispanic, and Asian individuals. However, after adjusting for age and comorbidity, the rate of increase in psychotherapy among Asian individuals decreased, while the rate among white individuals slightly increased. The findings highlight the need for further research to understand the factors driving these trends and to ensure appropriate mental health care for all individuals during the perinatal period. [Extracted from the article]

Background: Serotonin reuptake inhibitors are commonly used for treatment of mental health problems in pregnancy but may cause neonatal adaptation syndrome. It is unknown whether reduction or discontinuation of medication prior to delivery may mitigate this effect. Methods: We present a case series of 38 women who either tapered their medication prior to delivery or maintained or increased their dose. Results: Greater reductions in maternal antidepressant dose just prior to delivery were associated with fewer admissions to the neonatal intensive care unit (NICU) for infants. There was a slightly greater increase in depressive symptoms across delivery for women who tapered, which was not statistically significant. Conclusions: NICU admissions may be less frequent among neonates whose mothers tapered their medication prior to delivery. Large prospective randomized trials are needed to further study this practice. [ABSTRACT FROM AUTHOR]

Background: The linkage between substance use and youth suicidality is less developed due to the predominant focus on certain types of substances (e.g., alcohol consumption, prescription opioid misuse). This study examines polysubstance use and its mutual impact on suicidal thoughts and behaviors among US adolescents. Methods: Data from 2019 Youth Risk Behavior Survey were utilized. Associations between the concurrent use of five substances (cigarette, e-cigarette, alcohol, marijuana, and prescription opioid) and suicidality (suicidal thoughts, suicide plans, and suicide attempts) were measured by logistic regression models. The combined effect of polysubstance use on suicidality was further assessed by structural equation modeling. Results: About two in five (42.1%) adolescents used at least one type of substances in the past month and one in seven (13.5%) used three or more types concurrently (polysubstance use). Adolescents with polysubstance use behaviors were three to five times more likely to experience suicidal thoughts (OR=3.8, p < 0.05), make a suicide plan (OR=3.5, p < 0.05), or attempt suicide (OR=4.6, p < 0.05) than non-users. In the final structural model, polysubstance use and suicidality were significantly correlated with each other (β=0.37, p < 0.05). Collectively, polysubstance use explained about 14% of variance in youth suicidality. Conclusions: Polysubstance use shows a significant impact on youth suicidality. School-based health centers and educational programs are recommended to reduce substance use and suicidal behaviors among adolescents. Accessible mental health services and targeted treatments are needed for polysubstance users to mitigate their risk of suicide. [ABSTRACT FROM AUTHOR]

Youth experience significant mental health (MH) needs, and gender- and racially/ethnically-diverse youth are less likely than peers to receive care. School-based health centers (SBHCs) are a healthcare delivery model that may decrease disparities. This study examined the role of SBHCs in reducing disparities in MH care receipt among SBHC clients. Data from electronic health records of 5,396 youth ages 12 to 21 years who visited 14 SBHCs in one California county from 2021 to 2023 were analyzed in 2023–2024 using multiple logistic regression to assess disparities in MH care receipt and depression screenings. Receipt of MH care from SBHCs varied significantly by gender but not age, sexual orientation, or race/ethnicity. Compared to female clients, males had reduced odds (AOR: 0.50) and gender-diverse clients had higher odds (AOR: 2.70) of receiving MH care. For receipt of depression screenings, male clients had reduced odds (AOR: 0.86); Latino clients had higher odds than white clients (AOR: 1.80); and older adolescents and young adults had higher odds than younger adolescents (AORs: 1.44 and 1.45, respectively). Receipt of follow-up MH care after a positive depression result varied only by gender, with male clients having reduced odds (AOR: 0.63). SBHCs may reach youth who are traditionally less likely to seek care in other settings, including racially/ethnically- and gender-diverse youth. As in other settings, engaging males in healthcare is an area for improvement. These findings help to demonstrate the potential of SBHCs for decreasing disparities in mental health care. [ABSTRACT FROM AUTHOR]

Key Points: Question: Can an antistigma campaign and a mobile technology–based electronic decision support system result in reduced stigma and improved mental health for adults at high risk of common mental disorders at the primary health care level? Findings: This cluster randomized clinical trial included 44 primary health center clusters with 9928 eligible participants (3365 in the high-risk cohort). There was a significant difference in mean depression scores between intervention vs control groups at 12 months, with lower scores in high-risk cohort. Meaning: A multifaceted primary health center intervention with high implementation fidelity may be effective in reducing depression risk. This cluster randomized clinical trial evaluates the use of a digital mental health intervention and community-based antistigma campaign in reducing risk of depression and mental health–related stigma. Importance: More than 150 million people in India need mental health care but few have access to affordable care, especially in rural areas. Objective: To determine whether a multifaceted intervention involving a digital health care model along with a community-based antistigma campaign leads to reduced depression risk and lower mental health–related stigma among adults residing in rural India. Design, Setting, and Participants: This parallel, cluster randomized, usual care–controlled trial was conducted from September 2020 to December 2021 with blinded follow-up assessments at 3, 6, and 12 months at 44 rural primary health centers across 3 districts in Haryana and Andhra Pradesh states in India. Adults aged 18 years and older at high risk of depression or self-harm defined by either a Patient Health Questionnaire–9 item (PHQ-9) score of 10 or greater, a Generalized Anxiety Disorder–7 item (GAD-7) score of 10 or greater, or a score of 2 or greater on the self-harm/suicide risk question on the PHQ-9. A second cohort of adults not at high risk were selected randomly from the remaining screened population. Data were cleaned and analyzed from April 2022 to February 2023. Interventions: The 12-month intervention included a community-based antistigma campaign involving all participants and a digital mental health intervention involving only participants at high risk. Primary health care workers were trained to identify and manage participants at high risk using the Mental Health Gap Action Programme guidelines from the World Health Organization. Main Outcomes and Measures: The 2 coprimary outcomes assessed at 12 months were mean PHQ-9 scores in the high-risk cohort and mean behavior scores in the combined high-risk and non–high-risk cohorts using the Mental Health Knowledge, Attitude, and Behavior scale. Results: Altogether, 9928 participants were recruited (3365 at high risk and 6563 not at high risk; 5638 [57%] female and 4290 [43%] male; mean [SD] age, 43 [16] years) with 9057 (91.2%) followed up at 12 months. Mean PHQ-9 scores at 12 months for the high-risk cohort were lower in the intervention vs control groups (2.77 vs 4.48; mean difference, −1.71; 95% CI, −2.53 to −0.89; P <.001). The remission rate in the high-risk cohort (PHQ-9 and GAD-7 scores <5 and no risk of self-harm) was higher in the intervention vs control group (74.7% vs 50.6%; odds ratio [OR], 2.88; 95% CI, 1.53 to 5.42; P =.001). Across both cohorts, there was no difference in 12-month behavior scores in the intervention vs control group (17.39 vs 17.74; mean difference, −0.35; 95% CI, −1.11 to 0.41; P =.36). Conclusions and Relevance: A multifaceted intervention was effective in reducing depression risk but did not improve intended help-seeking behaviors for mental illness. Trial Registration: Clinical Trial Registry India: CTRI/2018/08/015355. [ABSTRACT FROM AUTHOR]

Children and young people with a social worker (CYPwSW) have particular mental health profiles and needs. Research indicates that despite having higher levels of mental health distress this group tend to experience inequitable access to specialist mental health services. Therefore, much of their mental health support currently falls to generalists including paediatricians. We are currently undertaking a four-year study the CAMHS Referrals and Outcomes for Adolescents and Children with Social Workers (COACHES). Here we present initial insights from an analysis of 20,166 unique case notes which identified 1) High thresholds for entry to CAMHS 2) A requirement that young people must be perceived as stable prior to accessing services 3) that young people often did not feel that their voices were taken seriously 4) the importance of time for trust. Based off these findings and expert-by-experience's insights, we conclude by suggesting ways that paediatricians and health care professionals can best support CYPwSW. These include being the 'connective tissue' around young people's support network, gently and proactively building relationships, redressing power imbalances and supporting transitions to adulthood. [ABSTRACT FROM AUTHOR]

School nurses are members of the school-based mental and behavioral health support team. This consensus document was developed by school nurses and school nurse leaders in collaboration with leaders from national associations and organizations with a vested interest in K-12 mental and behavioral health. The document is also publicly available on the National Association of School Nurses website. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the ethical challenges of managing the weight of psychiatric patients in the least restrictive manner in secure mental health settings and whether these could be considered as a source of moral distress for health practitioners, which may be linked to staff burnout and ultimately lead to suboptimal patient care. Design/methodology/approach: A qualitative semi-structured interview study design was used to explore the understanding, views and experiences of six staff members working on two medium-secure wards in a UK mental health hospital using an opportunity sampling technique and Interpretative Phenomenological Analysis. Findings: Analysis of semi-structured interviews revealed a multitude of moral events that evoked feelings of frustration, powerlessness and anxiety related to the management of obesity in the least restrictive way, which is indicative of moral distress. Research limitations/implications: Due to the small sample size and the qualitative nature of the research, the findings of this study are of explorative in nature. Further quantitative research would be required to establish a causative link between the ethical challenges associated with obesity management and staff's moral distress. Practical implications: Addressing the health-care professionals' knowledge deficit on how to achieve the right balance in their duty of care through inclusion of bioethics into professional discussions and training could improve staff's well-being and the organisation's ethical climate. Originality/value: To the best of the authors' knowledge, this is the first qualitative work exploring the role of least restrictive practice in the challenges associated with health promotion within secure psychiatric settings, and the effect these challenges have on mental health staff. [ABSTRACT FROM AUTHOR]

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Purpose: Psychosocial care is an integral component of caring for individuals living with cancer. The identification of psychosocial distress has been acknowledged as a hallmark of quality cancer care, and screening for distress standards has been established in several countries. The purpose of this brief review is to highlight recent developments in screening for distress in oncology populations; to provide insight into significant trends in research and implementation; and to explore implications for oncology nursing practice. Methods: This paper reports a brief review of the literature from March 2021 to July 2024 on the topic of screening for distress in oncology. The literature was accessed through PubMed and reviewed by two authors. Trends in the topics presented were identified independently and then discussed to achieve consensus. Results: The search within the designated period produced 47 publications by authors in North America, Australasia, and Europe. Topic trends included the design and adaptation of tools for special populations, the use of technology, descriptions of programs, identification of benefits, challenges, and overcoming barriers to screening for distress. Conclusions: Screening for distress is endorsed as part of the provision of quality oncology care. Nurses have an important role in screening individuals at risk for developing psychosocial problems and acting to reduce the associated morbidity. By continuing to be informed and educated about the emerging developments in screening for distress, nurses can understand and overcome barriers to implementation. [ABSTRACT FROM AUTHOR]

The publication of this supplement is funded by Pfizer and brought to you by the AAFP. Journal editors were not involved in the development of this content. [ABSTRACT FROM AUTHOR]

Background With the advent of artificial intelligence (AI) in healthcare, digital platforms like ChatGPT offer innovative alternatives to traditional medical consultations. This study seeks to understand the comparative outcomes of AI-assisted ChatGPT consultations and conventional face-to-face interactions among infertility patients. Methods A cross-sectional study was conducted involving 120 infertility patients, split evenly between those consulting via ChatGPT and traditional face-to-face methods. The primary outcomes assessed were patient satisfaction, understanding, and consultation duration. Secondary outcomes included demographic information, clinical history, and subsequent actions post-consultation. Results While both consultation methods had a median age of 34 years, patients using ChatGPT reported significantly higher satisfaction levels (median 4 out of 5) compared to face-to-face consultations (median 3 out of 5; p < 0.001). The ChatGPT group also experienced shorter consultation durations, with a median difference of 12.5 minutes (p < 0.001). However, understanding, demographic distributions, and subsequent actions post-consultation were comparable between the two groups. Conclusions AI-assisted ChatGPT consultations offer a promising alternative to traditional face-to-face consultations in assisted reproductive medicine. While patient satisfaction was higher and consultation durations were shorter with ChatGPT, further studies are required to understand the long-term implications and clinical outcomes associated with AI-driven medical consultations. Key Messages What is already known on this topic: Artificial intelligence (AI) applications, such as ChatGPT, have shown potential in various healthcare settings, including primary care and mental health support. Infertility is a significant global health issue that requires extensive consultations, often facing challenges such as long waiting times and varied patient satisfaction. Previous studies suggest that AI can offer personalized care and immediate feedback, but its efficacy compared with traditional consultations in reproductive medicine was not well-studied. What this study adds: This study demonstrates that AI-assisted ChatGPT consultations result in significantly higher patient satisfaction and shorter consultation durations compared with traditional face-to-face consultations among infertility patients. Both consultation methods were comparable in terms of patient understanding, demographic distributions, and subsequent actions postconsultation. How this study might affect research, practice, or policy: The findings suggest that AI-driven consultations could serve as an effective and efficient alternative to traditional methods, potentially reducing consultation times and improving patient satisfaction in reproductive medicine. Further research could explore the long-term impacts and broader applications of AI in clinical settings, influencing future healthcare practices and policies toward integrating AI technologies. [ABSTRACT FROM AUTHOR]

Background and Hypothesis The World Health Organization's (WHOs) Mental Health Gap Action Programme (mhGAP) aims to improve healthcare for mental, neurological, and substance use disorders in nonspecialized settings, with a focus on low- and middle-income countries (LMICs). mhGAP includes guidelines for the treatment of psychoses (including schizophrenia), which were recently updated in 2023. The complexity of the WHO guideline update process and the updated recommendations on psychoses are presented. Study Design The WHO guideline development process is outlined as well as the evidence appraisal and the translation of the evidence into recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The guideline update process includes a review of the literature, a compilation of systematic reviews, and extracting data related to critical and important outcomes. The updated recommendations and the justifying evidence are discussed. Study Results The WHO mhGAP guidelines for psychoses are adapted to LMICs, and consist of 13 recommendations in 2023, whereof 5 were updated, and 1 recommendation was newly developed. Background information on how these recommendations were obtained, and significant changes since the previous guideline update in 2015 are provided. Conclusions Unlike other guidelines, the WHO must consider various countries, contextual factors, and the WHO Model Lists of Essential Medicines when developing its guidelines. A transformation of the WHO guideline for psychoses into a living guideline would ensure always up-to-date recommendations and facilitate shared decision-making. [ABSTRACT FROM AUTHOR]

Background To provide precision cognitive remediation therapy (CR) for schizophrenia, we need to understand whether the mechanism for improved functioning is via cognition improvements. This mechanism has not been rigorously tested for potential moderator effects. Study Design We used data (n  = 377) from a randomized controlled trial using CIRCuiTS, a therapist-supported CR, with participants from first-episode psychosis services. We applied structured equation modeling to test whether: (1) CR hours explain the goal attainment functional outcome (GAS) at posttreatment, (2) global cognitive improvement mediates GAS, and if (3) total symptoms moderate the CR hours to cognitive improvement pathway, and/or negative symptoms moderate the cognition to functioning pathway, testing moderator effects via the mediator or directly on CR hours to functioning path. Study Results CR produced significant functioning benefit for each therapy hour (Coeff = 0.203, 95% CI 0.101–0.304, P  < .001). The mediated path from CR hours to cognition and cognition to functioning was small and nonsignificant (Coeff = 0.014, 95% CI = −0.010, 0.037, P  = .256). Total symptoms did not moderate the path to cognition (P  = .211) or the direct path to outcome (P  = .896). However, negative symptoms significantly moderated the effect of cognitive improvements on functioning (P  = .015) with high negative symptoms reducing the functional gains of improved cognition. Conclusions Although cognitive improvements were correlated with functioning benefit, they did not fully explain the positive effect of increased therapy hours on functioning, suggesting additional CR factors also contribute to therapy benefit. Negative symptoms interfere with the translation of cognitive improvements into functional gains so need consideration. [ABSTRACT FROM AUTHOR]

Background: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, for which there are effective pharmacological treatments that improve symptoms and reduce complications. Guidelines published by the National Institute for Health and Care Excellence recommend that primary care practitioners prescribe medication for adult ADHD under shared-care agreements with Adult Mental Health Services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support. Aim: This study aimed to describe elements of support, and their availability/use, in primary care prescribing for adult ADHD medication in England to improve access for this underserved population and inform service improvement. Design and setting: Cross-sectional surveys were used to elicit data from commissioners, health professionals (HPs), and people with lived experience of ADHD (LE) across England about elements supporting pharmacological treatment of ADHD in primary care. Method: Three interlinked cross-sectional surveys were used to ask every integrated care board in England (commissioners), along with convenience samples of HPs and LEs, about prescribing rates, AMHS availability, wait times, and shared-care agreement protocols/policies for the pharmacological treatment of ADHD in primary care. Descriptive analyses, percentages, and confidence intervals were used to summarise responses by stakeholder group. Variations in reported provision and practice were explored and displayed visually using mapping software. Results: Data from 782 responders (42 commissioners, 331 HPs, 409 LEs) revealed differences in reported provision by stakeholder group, including for prescribing (95% of HPs versus 64% of LEs). In all, >40% of responders reported extended AMHS wait times of ≥2 years. There was some variability by NHS region – for example, London had the lowest reported extended wait time (25%), while East of England had the highest (55%). Conclusion: Elements supporting appropriate shared-care prescribing of ADHD medication via primary care are not universally available in England. Coordinated approaches are needed to address these gaps. [ABSTRACT FROM AUTHOR]

Self-Determination Theory (SDT) maintains that the satisfaction of the basic psychological needs for autonomy, competence, and relatedness is associated with optimal individual functioning, including in the workplace. A self-report instrument, the Work-related Basic Need Satisfaction scale (W-BNS), has previously been developed and validated in Dutch and Italian. We aimed to validate an English version of the W-BNS. We also evaluated a bifactor model to assess the extent to which the item responses could be explained by a single, underlying general latent trait. A Rasch calibration was also carried out to assess the extent to which the scores conformed to the assumptions of 'fundamental measurement' and could be converted to a common metric. We used data from 141 staff employed by a large UK-based mental health service provider. The postulated three-factor structure provided a good fit to the data. However, a bifactor model, introducing an underlying general factor, provided a superior fit. The items generally conformed to the Rasch measurement model. Evidence of convergent/divergent validity was observed via the correlations between the W-BNS scores and those for the Basic Psychological Needs Satisfaction and Frustration Scale (BPNFS). Regarding construct validity, both the separate needs and total W-BNS scores statistically significantly predicted an individual's reported intention to leave the current employer. Our findings foster research with the WBNS and have implications for how the W-BNS is optimally implemented in practice as a useful brief tool for assessing staff work-related need satisfaction. [ABSTRACT FROM AUTHOR]

Objective: Both structural (e.g., ageism) and personal (e.g., stigma) barriers hinder older adults' access to and engagement with mental health care. These barriers are particularly problematic for those vulnerable to interpersonal violence and abuse (e.g., due to social isolation). This study presents a quality improvement program aimed at older adults who have experienced significant stressful events, particularly elder mistreatment, within a larger trauma specialty clinic. Leveraging home-based telemedicine, the clinic provides evidence-based psychotherapy tailored to the needs of older adults. Methods: From 2021 through 2023, the authors retrospectively examined treatment initiation, engagement, completion, and clinical outcomes among 231 older adults age 60+ who reported trauma that met DSM-5 criterion A criteria for post-traumatic stress disorder, depression, or other mental health comorbid conditions related to their traumatic event. The clinic uses an automated measurement-based care approach that facilitates Quality Improvement projects, allowing the tracking of treatment initiation, engagement, completion, and clinical outcomes for all patients. Results: The results indicated high treatment completion, high engagement with telemedicine-delivered interventions, and, most importantly, significant changes in clinical outcomes. Conclusion: These findings highlight the importance of expanding telemedicine-based mental health services for older adults, challenging ageist norms, and prioritizing older adults' mental health needs by providing tailored services to this patient population. [ABSTRACT FROM AUTHOR]

While mental health frameworks are increasingly accepted in Countering Violent Extremism (CVE) policies, little is known about practitioners' experiences when individuals are mentally ill. This paper discusses how mental health clinicians review interactions between psychopathology and violent extremism, and which challenges Dutch practitioners face in decision-making processes around including severely mentally ill people in CVE individual case management approaches. Inclusion means that people are identified as (potential) violent extremists, which justifies CVE interventions on top of regular mental health care. Semi-structured interviews were conducted with 12 international mental health clinicians and 13 Dutch CVE practitioners. Data was analysed with qualitative thematic analysis. Results show that professionals usually view the risk of extremist violence, and not psychopathology, as the decisive factor for inclusion, unless (forensic) mental health clinicians advise otherwise. Nevertheless, some practitioners can experience challenges around making dichotomous choices about including mentally ill persons. Some expressed concerns about illegitimately labelling certain people as 'radicalised' when they suffer from severe mental illnesses (e.g. psychosis). CVE cases with mental illnesses are, however, characterised by heterogeneity, non-dichotomy and missing information. False negatives and false positives concerning uptake in pre-emptive CVE policies can have detrimental individual and societal effects. Future research suggestions are provided. [ABSTRACT FROM AUTHOR]

The willingness of friends or family to share concerns about an 'intimate' preparing to perpetrate public, mass violence, such as violent extremism or targeted violence, is considered a possible part of preventative strategies. To understand what is needed to help intimate bystanders share information on potential acts of violent extremism or targeted violence, we conducted 25 semi-structured qualitative interviews with experts in intimate bystander reporting, including law enforcement, social service and mental health providers, faith-based leaders, staff in school threat assessment programs, and community practitioners in California and Illinois. Results showed reporting was impeded by multiple factors, including lack of knowledge about violent extremism and reporting processes, fear of being incorrect, difficulty distinguishing between violent extremism and mental illness, low trust in law enforcement, and lack of standardized reporting processes. Practitioners said reporting could be improved by several interventions, including increasing awareness about reporting processes, improving reporting methods and policies, training community members who can take reports, and increasing trust between community members and law enforcement. Improving bystander reporting for targeted violence and violent extremism in the U.S. requires collaboratively strengthening law enforcement and community capacities based on sound theory, best practices, and monitoring and evaluation. [ABSTRACT FROM AUTHOR]

This study introduces the novel Fuzzy-Enhanced Predictive Neural System for Student Mental Health (FEPS-MH) approach to mental health assessment and intervention for college students. FEPS-MH synergistically combines a Backpropagation (BP) Neural Network with a Deep Fuzzy-Based Neural Network (DFBNN), leveraging the strengths of both systems to handle the complexities of mental health data in the context of big data analytics. The BP Neural Network, known for its effective learning and generalization capabilities, is integrated with the DFBNN to process imprecise, uncertain, or subjective data, typical in mental health assessments. The core objective of FEPS-MH is to provide a more accurate, robust, and sensitive analysis of mental health states, incorporating the nuanced variations and uncertainties inherent in psychological data. This system is designed to analyze a vast array of data sources, including but not limited to, behavioral patterns, self-reported questionnaires, and social media interactions, to identify potential mental health issues among college students. FEPS-MH's capabilities extend beyond mere assessment; it is also equipped to recommend personalized intervention strategies. Utilizing big data analysis, the system not only predicts potential mental health crises but also suggests tailored intervention approaches based on the unique psychological profile of each student. This study demonstrates the feasibility and effectiveness of FEPS-MH through a series of tests and validations using real-world data. The results indicate a significant improvement in both the accuracy of mental health assessments and the efficacy of suggested interventions. FEPS-MH stands as a promising tool for educational institutions, offering a data-driven, sensitive, and comprehensive approach to student mental health care. Its implementation could revolutionize the field of mental health support in college environments, making it a vital asset for proactive psychological wellness in educational settings. [ABSTRACT FROM AUTHOR]

Transgender and gender-diverse (TGD) individuals experience significantly greater all-cause mortality and mental health disparities compared to their cisgender peers. Gender-affirming hormone therapy (GAHT) is a safe and effective treatment option for gender dysphoria that dramatically improves psychosocial health outcomes but may adversely impact fertility. Medical society guidelines recommend medical fertility preservation (FP) counseling and pre-fertility treatment psychoeducational implications consultation from qualified, reproductive mental health professionals (MHPs) for TGD individuals pursuing FP or third-party reproductive treatment. However, sparse literature exists specific to the structure of mental health psychoeducational consultation for TGD individuals pursuing FP. This narrative review highlights important areas for discussion in pre-fertility treatment mental health consultations. Results indicate that implications counseling should be conducted by an MHP with specialized training in reproductive mental health with TGD populations to reduce the risk of harm and promote successful emotional navigation of fertility treatment. Such counseling should be psychoeducational and not gatekeeping in nature and may include consideration of the psychosocial (e.g. emotional, relational, ethical, spiritual, social) risks and benefits of various family-building options. During these consultations, TGD individuals can explore their hopes and fears related to fertility and future family-building plans and discuss realistic treatment expectations, individual strengths, coping and communication strategies, and identify key support network members who may aid in navigating the fertility treatment process. MHPs can provide referrals to appropriate resources if necessary to help TGD individuals navigate treatment while coping with psychological symptoms and promoting behavior change. [ABSTRACT FROM AUTHOR]

Objective: Discriminatory practices in mental health care undermine the right to health of marginalized service users. Intersectional approaches enable consideration of multiple forms of discrimination that occur simultaneously and remain invisible in single-axis analyses. The authors reviewed intersectionality-informed qualitative literature on discriminatory practices in mental health care to better understand the experiences of marginalized service users and their evaluation and navigation of mental health care. Methods: The authors searched EBSCO, PubMed, MEDLINE, and JSTOR for studies published January 1, 1989–December 14, 2022. Qualitative and mixed-methods studies were eligible if they used an intersectional approach to examine discrimination (experiences, mechanisms, and coping strategies) in mental health care settings from the perspective of service users and providers. A qualitative evidence synthesis with thematic analysis was performed. Results: Fifteen studies were included in the qualitative evidence synthesis. These studies represented the experiences of 383 service users and 114 providers. Most studies considered the intersections of mental illness with race, sexual and gender diversity, or both and were performed in the United States or Canada. Four themes were identified: the relevance of social identity in mental health care settings, knowledge-related concerns in mental health care, microaggressions in clinical practice, and service users' responses to discriminatory practices. Conclusions: Discriminatory practices in mental health care lead to specific barriers to care for multiply marginalized service users. Universities and hospitals may improve care by building competencies in recognizing and preventing discrimination through institutionalized training. [ABSTRACT FROM AUTHOR]

Objective: The authors sought to investigate whether utilization of inpatient occupational therapy (OT) was associated with reduced risk for 30-day psychiatric readmission in the Veterans Health Administration (VHA). Methods: The authors conducted a secondary analysis of VHA medical record data for veterans who received inpatient psychiatric care from 2015 to 2020 (N=176,889). Mixed-effects logistic regression was used to model psychiatric readmission within 30 days of discharge (yes or no) as a function of inpatient psychiatric OT utilization (none, one, two, three, or four or more encounters) and other care utilization (e.g., previous psychiatric hospitalization), as well as clinical (e.g., primary diagnosis), sociodemographic (e.g., race-ethnicity), and facility (e.g., complexity) characteristics. Sensitivity analyses were conducted to evaluate the robustness of findings (e.g., stratification by discharge disposition). Results: Relatively few veterans received inpatient psychiatric OT (26.2%), and 8.4% were readmitted within 30 days. Compared with veterans who did not receive inpatient psychiatric OT, those with one (OR=0.76), two (OR=0.64), three (OR=0.67), or four or more encounters (OR=0.64) were significantly (p<0.001) less likely to be readmitted within 30 days. These findings were consistent across all sensitivity analyses. Conclusions: Veterans who received inpatient OT services were less likely to experience psychiatric readmission. A clear dose-response relationship between inpatient psychiatric OT and readmission risk was not identified. These findings suggest that OT services may facilitate high-value inpatient psychiatric care in the VHA by preventing readmissions that stymie recovery and incur high costs. Future research may establish the causality of this relationship, informing policy regarding increased access to inpatient psychiatric OT. [ABSTRACT FROM AUTHOR]

Objective: Black women in the United States experience increased risk for mental disorders and are less likely to have access to appropriate mental health treatment compared with White women. To develop culturally responsive strategies to improve Black women's access to mental health treatment, the authors evaluated social determinants associated with mental health treatment utilization and unmet mental health needs among Black reproductive-age women with serious psychological distress. Methods: The authors performed a secondary analysis of data from the National Survey on Drug Use and Health. Data from 2009 to 2019 were pooled and restricted to Black women ages 18–44 years with serious psychological distress (N=4,171). Logistic regressions were conducted to identify personal and social determinants (e.g., education, employment status, poverty, and insurance status) of mental health treatment utilization, alternative mental health treatment utilization (e.g., spiritual support and self-help), and perceived unmet mental health needs. Results: Education and employment status were significantly associated with all three outcomes. Among the women who reported unmet mental health needs, opposition to treatment and cost were the highest endorsed barriers. Differences were found by pregnancy status, with pregnant women being significantly less likely to endorse cost (p<0.001) and more likely to endorse time and transportation as barriers (p<0.01) to receiving mental health treatment. Conclusions: Strategies to improve mental health outcomes for Black women should focus on reducing cost and transportation barriers and on the development of culturally responsive intervention approaches that address Black women's concerns about mental health treatment. [ABSTRACT FROM AUTHOR]

Objective: Transgender youths are more likely than cisgender youths to need mental health care because of their high exposure to discrimination and victimization, including within health care systems. Accordingly, transgender youths have low care satisfaction and high rates of treatment dropout, further exacerbating existing mental health inequities. To reduce these inequities, mental health providers need knowledge and skills to enhance transgender youths' treatment engagement and benefits. However, a comprehensive set of practices addressing the needs of transgender youth patients and their providers does not exist. The authors developed gender-affirming psychotherapy (GAP), an evidence-informed set of skills and principles to augment mental health treatments for transgender youths. Methods: GAP was developed by using a human-centered design, a methodological approach for creating interventions that prioritize the needs of key stakeholders, which in this study included mental health providers and transgender youths and their parents (N=36). A scoping review of the literature and stakeholder focus groups were conducted to create GAP, which encompasses core principles and skills to enhance mental health services for transgender youths. Results: GAP encompasses 27 principles and 38 skills, organized within 10 domains. All principles and skills were designed to be relevant for various provider types (e.g., psychiatrists and social workers) and to be flexibly adapted to meet diverse patient needs. Conclusions: GAP offers a scalable and flexible approach to addressing the growing mental health care needs of transgender youths. The findings of this study suggest that a human-centered design is a feasible and efficient method for developing interventions to address health inequities. [ABSTRACT FROM AUTHOR]

Human emotions are broadly categorized into seven types namely, sorrow, happiness, fear, anger, disgust, surprise, and neutral. Emotion detection is essential in various applications in the domains of education, gaming, advertising, application development, mental health diagnosis and treatment, surveillance, human- computer interaction, criminals' statement verification, etc., In literature, there is significant work on facial expressions to detect emotions in educational settings. Detection of emotions are carried out through soft biometrics and Convolution Neural Networks. This is a widely researched topic in the recent past. In this work, a thorough analysis of emotion recognition on basis of facial expressions is carried out. The work involves analysing effective emotion detection from various parts of face of participants involved in online classes. A new hybrid neural network model is derived by improvising InceptionV3 architecture in this work. On Online Learning Spontaneous Facial Expression Database (OLSFED), the proposed architecture produces very promising results exceeding the performance of InceptionV3. While comparing the proposed hybrid Inception V3 model with the other neural network models in existing literature, it was found that the proposed model also outperforms ResNet50, MobileNetV1 and EfficientNetB0 (with Swish activation function). On comparing the proposed model with state-of-the-art methodologies, it was observed that the proposed hybrid InceptionV3 architecture outperforms MobileNetV2 and CNN10 architectures. Also, from the various experiments done on OLSFED dataset, it was inferred that emotion recognition on periocular and mouth region together provides a very close performance to emotion recognition on the whole face. [ABSTRACT FROM AUTHOR]