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Older adults are the least likely age group to seek mental health services. However, few studies have explored a comprehensive range of sociodemographic, psychological, and social barriers and facilitators to seeking treatment in later life.A cross-sectional, national sample of Canadian older adults (55+, N = 2,745) completed an online survey including reliable and valid measures of predisposing, enabling, and need characteristics, based on Andersen's behavioral model of health, as well as self-reported use of mental health services. Univariate and hierarchical logistic regressions predicted past 5-year mental health service use.Mental health service use was most strongly and consistently associated with greater perceived need (OR = 11.48) and mental health literacy (OR = 2.16). Less self-stigma of seeking help (OR = .65) and greater neuroticism (OR = 1.57) also predicted help-seeking in our final model, although their effects were not as strong or consistent across gender, marital status, and age subgroups.The need category was crucial to seeking help, but predisposing psychological factors were also significant barriers to treatment.Interventions that target older adults high in neuroticism by improving perceptions of need for treatment, mental health literacy, and self-stigma of seeking help may be particularly effective ways of improving access to mental health services.

A small minority of older adults seek psychological help when they need it. Barriers to mental health service use among older adults include low mental health literacy and reduced opportunities for shared decision-making in health care. There is a gap in the literature examining the mental health information preferences of older adults. The objectives of this study were to describe the information preferences and predictors of preferences among older adults. In total, 229 adults aged 50 years and older in central Canada responded to a questionnaire investigating socio-demographic, psycho-social and health-related characteristics, as well as mental health information preferences. Descriptive analysis quantified participants’ ratings of information preferences and hierarchical linear regression analysis determined predictors of their preferences. Older adults rated all mental health content items as very important. Most participants preferred detailed information (two to six pages) on all treatment options (psychological, pharmacological, combined and self-help). Older adults significantly preferred discussion with a heath-care provider and written information, in comparison to other formats. Older adults also significantly preferred to consult family, friends and heath-care professionals over other sources. Socio-demographic and psycho-social characteristics accounted for some of the variance in predicting older adults’ information preferences. Findings highlight older adults’ desire to be involved in decisions concerning mental health supports. Providing balanced information concerning mental health treatment may increase empowerment in mental health help-seeking.

Muslims in Canada may have unmet psychological service needs, but little is known about their past use of, and future preferences for, mental health services. We addressed this gap with an online survey of 238 Canadian Muslims. Analyses investigated differences in intentions to seek support from various informal and formal sources. A majority (65%) of the sample reported at least moderate levels of current distress but only 48.7% sought professional treatment in their lifetimes. Participants preferred dealing with future psychological concerns themselves or with friends/family, closely followed by professional help. Imams were the least preferred source of support.

Social participation has tremendous implications for the physical and mental health of older adults. A growing body of Canadian literature has examined social participation among older adults, including frequency of participation; gender, age, and regional differences in participation; and associations with self-perceived health, loneliness, and life dissatisfaction. The current study adds to this important body of research, using a large, nationally representative sample of adults 45–85 years of age (Canadian Longitudinal Study on Aging [CLSA] baseline data [n = 51,338]), to examine nuanced characteristics associated with social participation (socio-demographics, social support, cognitive ability, mental health, physical conditions), frequency of participation, and the relationship between the aforementioned characteristics and frequency of participation. Findings indicated that compared with those who reported infrequent/no participation, more frequent participation was associated with greater social support, higher cognitive abilities, increased satisfaction with life, fewer depressive symptoms, reduced odds of self-reported mood and anxiety disorders, and fewer self-reported physical conditions. Findings highlight the importance of active social participation, and have important implications for the development and implementation of accessible community programs across Canada.

Objective: Knowledge is limited regarding the longitudinal course and predictors of mental health problems, suicide, and physical health outcomes among military and veterans. Statistics Canada, in collaboration with researchers at the University of Manitoba and an international team, conducted the Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey (CAFVMHS). Herein, we describe the rationale and methods of this important survey. Method: The CAFVMHS is a longitudinal survey design with 2 time points (2002 and 2018). Regular Force military personnel who participated in the first Canadian Community Health Survey Cycle 1.2—Mental Health and Well-Being, Canadian Forces Supplement (CCHS-CFS) in 2002 ( N = 5,155) were reinterviewed in 2018 ( n = 2,941). The World Mental Health Survey–Composite International Diagnostic Interview was used with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition ( DSM-IV) criteria. Results: The CAFVMHS includes 2,941 respondents (66% veterans; 34% active duty) and includes data on mental disorder diagnoses, physical health conditions, substance use, medication use, general health, mental health services, perceived need for care, social support, moral injury, deployment experiences, stress, physical activity, military-related sexual assault, childhood experiences, and military and sociodemographic information. Conclusions: The CAFVMHS provides a unique opportunity to further understand the health and well-being of military personnel in Canada over time to inform intervention and prevention strategies and improve outcomes. The data are available through the Statistics Canada Research Data Centres across Canada and can be used cross-sectionally or be longitudinally linked to the 2002 CCHS-CFS data.

Recent evidence suggests that eating disorders (EDs) are becoming increasingly common in older women. Previous research examining differences between younger and older women with EDs has been mixed, making it unclear whether older women with EDs represent a distinct group. We sought to determine whether there are age differences in the clinical presentation of women seeking specialty treatment for an ED. We examined the linear relationship between age and clinical constructs among adult women (N = 436) diagnosed with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, ED. Across analyses, there was no impact of age on most measures of ED symptoms, comorbid psychopathology, self-esteem, quality of life, and motivation to change. However, older age was associated with fewer interoceptive awareness difficulties, maturity fears, anxiety symptoms, and body image concerns. These findings suggest that the clinical presentation of older ED cases is largely similar, although somewhat less severe than in younger women. The implications of this research for future research and treatment are discussed.

Older adults’ mental health problems are a growing public health concern, especially because their rate of mental health service use is particularly low. Decades of mental health service utilisation models have been developed, yet key assumptions from these models focus primarily on factors that facilitate or inhibit access into the treatment system without taking into considering the dynamics of how individuals respond to their mental health problems and engage in service utilisation. More recently, dynamic models like the Network Episode Model (NEM-II) have been developed to challenge the underlying, rational choice assumption of traditional utilisation models. Given the multifaceted and complex nature of older adults’ mental health problems, the objective of this study was to examine whether the NEM-II is a helpful and appropriate model for understanding the dynamic process of how older adults navigate the mental health system, including factors that advanced and delayed help-seeking. Our qualitative analyses from 15 interviews with older adults revealed that their backgrounds, social supports and treatment systems influence, and are influenced by, their illness careers. Factors that delayed help-seeking included: a lack of support, ‘inappropriate’ referrals/advice from treatment professionals and poor mental health literacy. This research suggests the NEM-II is a helpful and appropriate theory for understanding older adults’ pathways to treatment, and has implications to enhance older adults’ access to psychological services.

Older adults who experience challenges related to mental health are unlikely to seek professional help. The voices of older adults who have navigated through mental health issues and systems of care to arrive at psychological treatment are less well understood. We conducted individual interviews with 15 adults aged 61 to 86 who sought psychological treatment. Interviews were audio-recorded, transcribed, and analyzed using narrative methods. We identified several main storylines that describe the meaning-making and treatment-seeking journeys of older adults: resistance to being labeled with mental health problems (telling stories of resistance, defining mental health issues in mysterious and uncontrollable terms, and experiencing internal role conflict); muddling through the help-seeking process (manifestations of chaos and system-level barriers); and emotional reactions to psychological treatment (hope, fear, and mistrust). Findings add to the literature base in the area of narrative gerontology, and highlight the complex experiences that older adults face when seeking psychological treatment.

Highlights • Cognitive-behavioural therapy (CBT) and motivational interviewing (MI) can be readily adapted for brief, minimally guided, online interventions. • Minimally guided online treatment is beneficial for hazardous drinking, mood difficulties, and quality of life in the short-term among young adults. • Strategies designed to increase treatment engagement will likely mitigate the risk of attrition in future programs. • Future versions of the Take Care of Me program are still needed to determine long-term effects and differential responses to treatment., Objective Many young adults struggle with comorbid alcohol misuse and emotional problems (i.e., depression and anxiety). However, there is currently a paucity of evidence-based, integrated, accessible treatment options for individuals with these comorbidities. The main goal of this study was to examine efficacy of a novel online, minimally guided, integrated program for comorbid alcohol misuse and emotional problems in young adults. Method: The study was an open-label two-arm RCT. Participants (N = 222, Mage = 24.6, 67.6% female) were randomized to one of two conditions: the Take Care of Me program (an 8-week, online integrated treatment condition consisting of 12 modules), or an online psychoeducational control condition. Intervention modules incorporated content based on principles of cognitive behavioral therapy and motivational interviewing. Participants completed assessment data at baseline, at the end of treatment (i.e., 8 weeks), and at follow-up (i.e., 24 weeks). Data were analyzed using generalized linear mixed models. Results: We observed that participants in the treatment condition showed larger reductions in depression, hazardous drinking, as well as increases in psychological quality of life and confidence at the end of treatment. We did not find group differences on total alcohol use at follow-up, but participants in the treatment group reduced their hazardous drinking and improved their quality of life at 24-week follow-up. Conclusions: Our study provides promising initial evidence for the first iteration of the comorbid alcohol misuse and emotional problems online program.

Posttraumatic stress disorder (PTSD) is associated with various physical health conditions. However, it is unclear whether the relationship between PTSD and physical health conditions differs according to age. This study aims to examine the associations between PTSD and physical health conditions across four adult age categories.We analyzed data from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions (The prevalence of nearly all physical health conditions increased according to age, whereas the prevalence of PTSD tended to decrease with age. After adjustment, PTSD was associated with a greater number of physical health conditions among all age categories (PTSD is associated with many physical health conditions across the age spectrum, particularly among younger and middle-aged adults. Results may inform targeted screening and intervention strategies to mitigate risk of physical health conditions among adults with PTSD.

Men are more likely to take their own lives, but less likely to seek professional help when they are depressed, especially as they age. Important determinants of help-seeking are perceived public and self-stigma concerning depression and suicide. Yet little research has explored sex and age differen

Substantial changes were made with the creation of the Substance Related and Addictive Disorders category in the fifth edition of the Diagnostic and Statistical Manual (DSM-5; APA in Diagnostic and statistical manual of mental disorders, 5th edn, American Psychiatric Publishing, Arlington, 2013a), including the addition of gambling disorder to the category and a reduction in the minimum threshold of diagnostic criteria required for a gambling disorder. As gambling shares many similarities with substance use disorders, it stands to reason that comorbidity rates of other psychiatric disorders would be similar among gambling and substance use disorders. The current study examines whether changes in gambling diagnostic criteria from DSM-IV to DSM-5 correspond to changes in prevalence of comorbid psychiatric disorders among disordered gamblers that result in prevalence rates more similar to those observed in alcohol and cannabis use disorders. This study utilized data from the National Epidemiological Survey for Alcohol and Related Conditions (NESARC). Results suggested that the prevalence for any comorbid disorder among disordered gamblers appeared to be similar from DSM-IV (56.7%) to DSM-5 (53.7%). Comorbidity using DSM-5 criteria were just slightly closer to, but still noticeably higher than, comorbidity prevalence observed in alcohol (25.3%) and cannabis (37.7%) disorders, with similar trends across addictions observed in most examined comorbid disorders/groupings. Our findings suggest that lowering the threshold for minimum diagnosis of gambling disorder resulted in a slight decrease in comorbidity rates though substantial differences remain between comorbid rates of disordered gambling and substance use disorders. Future DSM editions may consider a further diagnostic threshold reduction, which might result in comorbidity rates being more similar to other substance use disorders and increasing disorder similarity within the Substance Related and Addictive Disorders category.

Background Anxiety is common in patients with rheumatoid arthritis (RA) and associated with worse RA outcomes. This study assessed the feasibility and preliminary health impacts (mental and physical) of a non-therapist assisted, online mental health intervention targeting anxiety in this population. Methods Participants with confirmed RA and elevated anxiety symptoms were enrolled into the Worry and Sadness program, an Internet-based cognitive-behavioral therapy (iCBT) intervention for anxiety and depression shown to be effective in the general population. Validated self-report measures of anxiety, depression, pain interference, fatigue, physical health-related quality of life, functional status, and patient-reported disease severity were collected at baseline, post-intervention, and at three-month follow-up. Emotional distress scores were tracked between lessons. Participants provided qualitative feedback in writing post-intervention. Results We analyzed the responses of 34 participants; the majority was female (86%) and the mean age was 57 (SD = 13). Of these, 80% (n = 28) completed the study in its entirety. Among these completers, 94.1% described the program as worthwhile. We found statistically significant improvements in anxiety, depression and fatigue from baseline to three-month follow-up, with small to large effect sizes (d = 0.39–0.81). Post-hoc analyses revealed that statistically significant change occurred between baseline and post-intervention for anxiety and depression and was maintained at three-month follow-up, whereas statistically significant change occurred between baseline and three-month follow-up for fatigue. Statistically significant reductions in emotional distress occurred across the program, with a large effect size (d = 1.16) between the first and last lesson. Conclusion The Worry and Sadness program shows promise as a feasible resource for improving mental health in RA., Highlights • This study provided support for a non-therapist assisted online intervention for the improvement of anxiety in RA patients. • This online intervention demonstrated a large effect in terms of sustained anxiety reduction for program completers. • The online intervention also demonstrated beneficial effects on depression, emotional distress, and fatigue.

Research on caregiver identity in the context of memory impairment has focused primarily on more advanced stages of the cognitive impairment trajectory (e.g., dementia caregivers), failing to capture the complex dynamics of early caregiver identity development (e.g., MCI; mild cognitive impairment caregivers). The aim of this study was to develop a nuanced understanding of how caregiver identity develops in family and friends of persons living with MCI. Using constructivist grounded theory (ConGT), this study explored caregiver identity development from 18 in-depth interviews with spouses ( n = 13), children ( n = 3), and friends ( n = 2) of persons recently diagnosed with MCI. The overarching themes influencing MCI caregiver identity development included MCI changes, care-related experiences, “caregiver” interpretation, and approach/avoidance coping. These themes influenced how participants primarily identified, represented as I am a caregiver, I am not a caregiver, or liminality (i.e., between their previous identity and a caregiver identity). Irrespective of their current self-identification, all conveyed thinking about their “future self,” as providing more intensive care. MCI caregiver identity development in family and friends is a fluid and evolving process. Nearly all participants had taken on care tasks, yet the majority of these individuals did not clearly identify as caregivers. Irrespective of how participants identified, they were engaging in care, and would likely benefit from support with navigating these changes and their new, ambiguous, and evolving roles.

We investigated facets of posttraumatic growth (PTG) theory, including the nature of the index event, the relationship between suffering and PTG, and prosocial correlates of PTG.Undergraduate students (Differences emerged in PTG according to event severity, with greater PTG for those who experienced a trauma compared to a stressor. PTG was associated with nearly all trauma-related, select psychopathology/affect (e.g., anxiety, positive affect) and prosocial (e.g., empathy, volunteerism) variables. In a multivariable model, race/ethnicity, helpfulness, perceived chronicity of distress, and positive affect were associated with PTG. Curvilinear trends demonstrated that moderate chronicity of distress and current emotional distress from trauma were associated with the greatest PTG.Findings highlight factors associated with growth, including a moderately distressing trauma, positive affect, and prosocial behavior. Results clarify PTG theory and contribute to understanding conflicting evidence in prior PTG literature.

Heath, Patrick/0000-0002-7939-4916; zanon, cristian/0000-0003-3822-5275; Al-Darmaki, Prof. Fatima/0000-0001-6452-0708 WOS: 000506996000001 PubMed: 31916468 This study evaluated the dimensionality, invariance, and reliability of the Depression, Anxiety, and Stress Scale-21 (DASS-21) within and across Brazil, Canada, Hong Kong, Romania, Taiwan, Turkey, United Arab Emirates, and the United States (N = 2,580) in college student samples. We used confirmatory factor analyses to compare the fit of four different factor structures of the DASS-21: a unidimensional model, a three-correlated-factors model, a higher order model, and a bifactor model. The bifactor model, with three specific factors (depression, anxiety, and stress) and one general factor (general distress), presented the best fit within each country. We also calculated ancillary bifactor indices of model-based dimensionality of the DASS-21 and model-based reliability to further examine the validity of the composite total and subscale scores and the use of unidimensional modeling. Results suggested the DASS-21 can be used as a unidimensional scale. Finally, measurement invariance of the best fitting model was tested across countries indicating configural invariance. The traditional three-correlated-factors model presented scalar invariance across Canada, Hong Kong, Romania, Taiwan, and the United States. Overall, these analyses indicate that the DASS-21 would best be used as a general score of distress rather than three separate factors of depression, anxiety, and stress, in the countries studied.

Changes in Diagnostic and Statistical Manual (DSM) criteria for a gambling disorder from DSM-IV to DSM-5 included a drop in the minimum number of criteria required to qualify for a diagnosis. This threshold reduction resulted in a near doubling of prevalence in non-gambling focused populations. However, the impact of this change on psychiatric comorbidity with gambling is unknown. The current study aimed to: (a) examine whether the diagnostic change affected the severity of those diagnosed with a gambling disorder with respect to mental disorder comorbidity, and (b) determine whether this relationship differed across younger (18-34 years old), middle-aged (35-54 years old), and older (55 years old and over) age groups. This study utilized data from the National Epidemiological Survey for Alcohol and Related Conditions. Results indicated that the prevalence of comorbid mental health/substance use disorders did not significantly change between the DSM-IV pathological gambling group and DSM-5 gambling disorder group in the overall sample. However, among older adults, the DSM-5 gambling disorder were more likely to exhibit any anxiety disorder as well as any comorbid mental health/substance-use disorder compared to the DSM-IV pathological gamblers. No other significant differences were observed in mental health or substance-use disorders within age-specific groupings. Findings suggest that the new, less restrictive DSM-5 criteria for gambling addiction capture older gamblers with more severe clinical presentations in terms of co-occurring mental disorders, contrary to our expectation that the lowered threshold for diagnosis would result in less severe clinical cases.

Despite the myriad physical, cognitive, and social losses that are increasingly common as we age, a growing body of evidence suggests that aging is positively associated with mental health and well-being. The majority of this evidence is in the form of mental health, personality, and subjective/hedonic well-being outcomes; far less is known about lifespan differences in eudaimonic well-being. The objective of this study was to examine differences across three age groups in a relatively recent model of eudaimonia informed by self-determination theory that focuses on the process of living well, but also acknowledges outcomes of that process. In comparison to young (n = 66) and middle-aged adults (n = 66), older adults (n = 66) were especially likely to be living eudaimonically (i.e., to have intrinsic aspirations, goal autonomy, mindfulness, and basic psychological need fulfillment). The effect of age on well-being outcomes was mixed; the oldest group reported the highest levels of life satisfaction (hedonic well-being) but the lowest levels of purpose and growth (eudaimonic well-being) in comparison to their younger counterparts. As predicted by the model, basic psychological need fulfillment mediated the relationship between motivational constructs and well-being outcomes. Furthermore, the model applied equally well to younger, middle-aged, and older adults. Our results are consistent with recent theoretical models emphasizing the socioemotional benefits of aging, as well as potential challenges to well-being that exist in later life.

Brenner, Rachel/0000-0003-1069-9591; Rubin, Mark/0000-0002-6483-8561; TOPKAYA, Nursel/0000-0002-8469-9140; , Makilim Nunes Baptista/0000-0001-6519-254X; Al-Darmaki, Prof. Fatima/0000-0001-6452-0708; Mak, Winnie/0000-0002-9714-7847; Lannin, Daniel/0000-0001-8203-8253; Heath, Patrick/0000-0002-7939-4916 WOS: 000400118500001 Stigma is an important barrier to seeking psychological services worldwide. Two types of stigma exist: public stigma and self-stigma. Scholars have argued that public stigma leads to self-stigma, and then self-stigma is the primary predictor of attitudes toward seeking psychological services. However, this assertion is largely limited to U.S. samples. The goal of this research was to provide a first step in understanding the relationship between public stigma, self-stigma, and attitudes toward seeking psychological services in international contexts (N = 3,276; Australia, Brazil, Canada, Hong Kong, Portugal, Romania, Taiwan, Turkey, United Arab Emirates, and United States). Using structural equation modeling, we found that self-stigma mediated the relationship between public stigma and attitudes toward seeking services among college students in each country and region. However, differences in path strengths emphasize the need to pay attention to the role of public and self-stigma on attitudes toward seeking psychological services throughout the world.

Men’s Sheds is a growing international movement aimed at providing men with places and activities that facilitate social connectedness. Despite Men’s Sheds’ focus on males, little attention has been paid to masculinities within the specific context of these settings. The current study used a gender relations framework to explore the ways in which attendees discussed Men’s Sheds, with particular attention to discussions that were complicit and counter to traditional, hegemonic views of masculinity, and diverse positions in between these binaries. The data consisted of transcripts and field notes from four focus groups comprising mostly older, White, retired male members of a Canadian shed ( N = 22). The analysis revealed three overall themes: (1) focus on work, (2) independence, and (3) need for male-focused spaces. These themes and associated subthemes suggest that shed members ascribe to dominant masculine values and ideals, but also support more fluid and flexible views of masculinity. Implications are discussed for how working with an array of masculinities within the Men’s Sheds movement will be helpful with respect to their future growth in Canada and internationally.

Participation in social activities often has beneficial effects on mental health among older adults, although the reasons why this is true (i.e., mechanisms or mediators) have received less empirical attention. The objective of this study is to examine whether involvement in social activities is associated with less psychological distress because it fosters social engagement.We explored this hypothesis with a sample of 1089 community dwelling Canadians ranging in age from 65 to 93 who completed a cross-sectional online survey that included measures of social participation (i.e., number of activities, time spent in them, and volunteerism), social engagement (i.e., the number of friends and family they see, feel close to, and can discuss personal matters with), and psychological distress.Mediation analyses confirmed our hypothesis that participation in social activities had beneficial effects on psychological distress through social engagement. That is, individuals who participated in greater numbers of social activities were more likely to report social engagement, and greater social engagement was associated with less psychological distress. In addition, when we controlled for the effect of social engagement, involvement in greater numbers of social activities was associated with greater distress.Our findings suggest that social engagement is a reason why participation in social activities has benefits for older adults' mental health, and that increasing engagement, both within and outside of typical social activities, is a worthwhile target for efforts to improve mental health among the growing older adult population.

Help-seeking related to mental health concerns has been found to decrease as age increases (Anonymous, 2008; Crabb and Hunsley, 2006). Despite extensive literature devoted to barriers to accessing mental health services, the reasons why older adults are especially unlikely to seek treatment are not well understood. The present study had two objectives concerning the experiences of older adults accessing outpatient psychological treatment: 1) classifying pathways into treatment using the Network Episode Model (NEM; Pescosolido et al., 1998), and 2) critically examining whether these pathways effectively captured the process of seeking treatment for older adults. Utilizing secondary qualitative data from three studies (N = 35), we met our first objective of classifying pathways according to the NEM with directed content analysis. The majority (n = 21, 60%) of older adults willingly accessed treatment (choice) and 42.9% of those involved 'others' in their help-seeking by way of referrals or support. The remaining participants' (n = 14, 40%) pathways into treatment reflected a process of muddling through (being unsure of their need for mental health services and where to access support, or bouncing around the treatment system). No participants' pathways were categorized as coercive. To meet our second objective, we used conventional content analysis to explore how best to categorize pathways to treatment. Findings demonstrated that a minority of participants (n = 10, 28.6%) had a help-seeking journey that represented only one of the three pathways. Instead, most participants described a lengthy period of muddling through, eventually followed by a willingness to seek help. These findings highlight the complex process of seeking treatment, and suggest a need to implement more direct mental health literacy interventions to reduce the amount of time spent muddling through, while improving the experience of mental health help-seeking for older adults.

Background and aims The current randomized controlled trial tested whether there was benefit to providing an online gambling intervention and a separate self-help mental health intervention for anxiety and depression (i.e. MoodGYM) (G + MH), compared to only a gambling intervention (G only) among people with co-occurring gambling problems and mental health distress. The primary outcome of interest was improvement in gambling outcomes. Secondary analyses also tested for the impact of the combined intervention on depression and anxiety outcomes. Methods Participants who were concerned about their gambling were recruited to help evaluate an online intervention for gamblers. Those who met criteria for problem gambling were randomized to receive either the G only or the G + MH intervention. Participants were also assessed for current mental health distress at baseline, with three quarters (n = 214) reporting significant current distress and form the sample for this study. Participants were followed-up at 3- and 6-months to assess changes in gambling status, and improvements in depression and anxiety. Results Follow-up rates were poor (47% completed at least one follow-up). While there were significant reductions in gambling outcomes, as well as on measures of current depression and anxiety, there was no significant difference in outcomes between participants receiving the G only versus the G + MH intervention. Discussion and conclusion There does not appear to be a benefit to providing access to an additional online mental health intervention to our online gambling intervention, at least among participants who are concerned about their gambling. Trial registration: ClinicalTrials.govNCT02800096; Registration date: June 14, 2016., Highlights • Explores the benefits of providing online mental health and gambling interventions to people seeking help for their gambling • Adding a mental health intervention to an online gambling intervention does not improve gambling or mental health outcomes

Objective Stigma is commonly identified as a key reason that older adults are especially unlikely to seek mental health services, although few studies have tested this assumption. Our objectives were to: (a) examine age differences in public and self-stigma of seeking help, and attitudes toward seeking help, and (b) see whether age moderates an internalized stigma of seeking help model. Methods A total of 5,712 Canadians ranging in age from 18 to 101 completed self-report measures of public stigma of seeking help, self-stigma of seeking help, and help-seeking attitudes. Results Older participants had the lowest levels of stigma and the most positive help-seeking attitudes. Age also moderated the mediation model, such that the indirect effect of public stigma on help-seeking attitudes through self-stigma was strongest for older participants. Conclusion Our findings have implications for the influence of stigma and attitudes as barriers to treatment across the adult lifespan, and for stigma reduction interventions.

Few studies have investigated anxiety sensitivity (AS) in the context of inflammatory arthritis (IA), despite evidence of a relationship between AS and pain. This study examined cross-sectional and longitudinal relationships between AS and indicators of IA severity in 148 participants with IA. AS and its factors (social, physical, cognitive) were self-reported. Arthritis severity was physician-assessed (disease activity scales) and self-reported (physical function; pain and fatigue). Cross-sectional correlations assessed the association between AS and arthritis severity outcomes. Longitudinal multivariable mixed-effect regressions assessed the association of AS total and AS factors at each visit with disease severity outcomes. All AS factors were significantly and positively correlated (at the same visit) with function, pain, and fatigue. AS total significantly predicted pain, fatigue, and function. Cognitive AS significantly predicted fatigue, and physical AS significantly predicted pain and fatigue. Social AS significantly predicted pain, fatigue, function and weighted joint count (articular burden). AS is associated with several indicators of disease severity among those with IA; unique findings emerged across factors with the broadest disease impact by social AS. The AS factors, especially social AS, may contribute to the development and severity of IA symptoms, which may have implications for interventions.

Although participating in community social programming is associated with positive physical and mental health outcomes for older adults, older men participate less often than women. Men's Sheds is a community programme used primarily by older men that originated in Australia and is well established there. The goal of the current study was to explore men's perceptions of the need for Men's Sheds and issues concerning access to them in Canada, a country with a small but growing Men's Sheds movement. We conducted focus groups with 64 men aged 55 years and older, including Men's Sheds members and men from the community who were unfamiliar with this programme, and analysed the data using the framework analytic approach. The data revealed two primary themes concerning: (a) the need for male-focused community programmes, including the sub-themes reducing isolation, forming friendships and engaging in continued learning; and (b) access to programmes, including the sub-themes points of contact, sustaining attendance and barriers. Findings suggest that in order to reduce the likelihood of isolation and increase opportunities for social engagement, exposure to the concept of male-focused programming should begin before retirement age. In addition, such programmes should be mindful of how they are branded and marketed in order to create spaces that are welcoming to new and diverse members.

Background: Male suicide prevention strategies include diagnosis and effective management of men’s depression. Fundamental to suicide prevention efforts is public awareness, which in turn, is influenced by literacy levels about men’s depression and suicide.Aim: To examine sex differences in mental health literacy with respect to men’s depression and suicide among a cohort of Canadian respondents.Methods: 901 English-speaking Canadian men and women completed online survey questionnaires to evaluate mental health literjavascript:void(0);acy levels using 10-item D-Lit and 8-item LOSS questionnaires, which assess factual knowledge concerning men’s depression and suicide. Statistical tests (chi-square, z-test) were used to identify significant differences between sex sub-groups at 95% confidence.Results: Overall, respondents correctly identified 67% of questions measuring literacy levels about male depression. Respondents’ male suicide literacy was significantly poorer at 53.7%. Misperceptions were especially evident in terms of differentiating men’s depressive symptoms from other mental illnesses,estimating prevalence and identifying factors linked to male suicide. Significant sex differences highlighted that females had higher literacy levels than men in regard to male depression.Conclusions: Implementing gender sensitive and specific programs to target and advance literacy levels about men’s depression may be key to ultimately reducing depression and suicide among men in Canada.

OBJECTIVE: This study examined cross-sectional and longitudinal relationships between educational attainment and psychiatric disorders (i.e., mood, anxiety, substance use, and personality disorders) using a nationally representative survey of US adults. METHOD: We used data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N = 34,653). Bivariate and multiple logistic regressions examined cross-sectional and longitudinal associations between educational attainment and a variety of past-year and incident anxiety, mood, and substance use disorders, controlling for sociodemographics and psychiatric disorder comorbidity. RESULTS: Adjusted cross-sectional data indicated that educational attainment below a graduate or professional degree at Wave 2 was associated with significantly higher odds of substance use and/or dependence disorders (adjusted odds ratio range (AORR = 1.55-2.55, P CONCLUSION: Findings lend support to other published research demonstrating that educational attainment is protective against developing a spectrum of psychiatric disorders. Mechanisms underlying this relationship are speculative and in need of additional research.© 2016 Wiley Periodicals, Inc. Language: en

Objective There is a dearth of community-based epidemiologic literature that examines post-traumatic stress disorder (PTSD) across the adult lifespan. In the current study the authors address this gap by examining the ways in which PTSD differs among young (ages 20–34), middle-aged (ages 35–64), and older (age 65+) adults with respect to past-year prevalence, nature of "worst" stressful experience ever experienced before the onset of PTSD, all traumatic experiences, symptom expression, psychiatric comorbidities, and mental health–related quality of life. Methods We analyzed Wave 2 data from the National Epidemiologic Survey on Alcohol and Related Conditions, including adults with past-year diagnoses of PTSD (N = 1,715). Results The prevalence of past-year PTSD was significantly higher for young (4.3% [SE: 0.3]) and middle-aged (5.2% [SE: 0.2]) adults compared with older adults (2.6% [SE: 0.2]). Respondents in the three age groups differed with regard to their "worst" stressful experience ever experienced before the onset of PTSD and to all traumatic experiences. Older adults experienced significantly fewer traumatic experiences (mean: 5.2; SE: 0.2) compared with young (mean: 5.7; SE: 0.2) and middle-aged adults (mean: 6.4; SE: 0.1). Young and middle-aged adults had significantly greater symptom counts and greater odds of comorbid psychiatric disorders when compared with older adults. PTSD had similar effects on mental health–related quality of life across the adult lifespan. Conclusion Results highlight key differences in the characteristics of PTSD across the adult lifespan. The overall pattern of findings indicates that increasing age is associated with less severe PTSD profiles, including lower prevalence, fewer traumatic experiences, lower symptom counts, and lower odds of psychiatric comorbidity.

Background Although a large body of research has focused on social isolation and loneliness, few studies have examined social isolation and loneliness together. The objectives of this study were to examine: 1) the relationship between four groups derived from combining social isolation and loneliness (socially isolated and lonely; only socially isolated; only lonely; neither socially isolated nor lonely) and the desire for more social participation, and social support; and 2) the relationship between the four groups and psychological distress. Methods The study was based on the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Using CLSA baseline data (unweighted N = 30,079), ordinary and logistic regression analysis was used to examine the cross-sectional relationship between the four social isolation/loneliness groups and desire for more social participation and four types of social support (tangible, positive interaction, affection, and emotional support). Prospective logistic regression analysis was possible for psychological distress, which was derived from the Maintaining Contact Questionnaire administered about 18 months after the baseline questionnaire (unweighted N = 28,789). Results Findings indicate that being socially isolated and lonely was associated with the most social support gaps; this group also had an increased likelihood of psychological distress, relative to those who were neither socially isolated nor lonely. Participants who were only socially isolated, and those only lonely also perceived some social support gaps. In addition, the only lonely group was more likely to be psychologically distressed than the only socially isolated group and the neither isolated nor lonely group. Conclusion Examining the four social isolation/loneliness was useful, as it provided more nuanced risk profiles than would have been possible had we examined social isolation and loneliness separately. Findings may suggest avenues for interventions tailored to the unique needs of at-risk individuals.

Objectives: The objectives of this study were to examine: 1) whether the relationship between social network types, depressive symptoms and life satisfaction is mediated by different types ...

BACKGROUND: Alcohol misuse and emotional problems (ie, depression and anxiety) are highly comorbid among Canadian young adults. However, there is a lack of integrated, accessible, and evidence-based treatment options for these young adults.OBJECTIVE: The main goal of this study is to develop and test the efficacy of an integrated, online self-help program designed to target both alcohol misuse and emotional problems.METHODS: A two-arm randomized controlled trial design will be used to compare the efficacy of the online integrated treatment to a psychoeducational control group. A target sample of 214 participants will be recruited and randomly assigned to either condition. The integrated treatment will last 8 weeks, and participants will work through 12 modules. Modules will incorporate content based on principles of cognitive behavioral therapy and motivational interviewing. Participants in the control group will receive links to psychoeducational resources and will have access to the full treatment after follow-up. The primary outcome will be the number of Canadian standard drinks consumed in the week leading up the assessment. Secondary outcomes of interest include symptoms of depression, anxiety, alcohol-related problems, quality of life, and use of other drugs. Assessments will be completed at 3 time-points: at baseline, at the end of treatment (ie, 8 weeks), and at follow-up (ie, 24 weeks). Upon completion, data will be analyzed using generalized linear mixed models.RESULTS: Data collection began in June 2018 and will continue until January 2020. Final study results will be submitted for publication by July 2020.CONCLUSIONS: Currently, there are no integrated treatments designed to target alcohol misuse and the range of emotional problems experienced by young adults. This research stands to provide an effective, accessible (ie, Web-based), and feasible option to treat the many struggling young adults in this country.TRIAL REGISTRATION: ClinicalTrials.gov ID NCT03406039; https://clinicaltrials.gov/ct2/show/NCT03406039 (Archived by WebCite at http://www.webcitation.org/72fDefnrh).REGISTERED REPORT IDENTIFIER: PRR1-10.2196/11298.

BACKGROUND Alcohol misuse and emotional problems (ie, depression and anxiety) are highly comorbid among Canadian young adults. However, there is a lack of integrated, accessible, and evidence-based treatment options for these young adults. OBJECTIVE The main goal of this study is to develop and test the efficacy of an integrated, online self-help program designed to target both alcohol misuse and emotional problems. METHODS A two-arm randomized controlled trial design will be used to compare the efficacy of the online integrated treatment to a psychoeducational control group. A target sample of 214 participants will be recruited and randomly assigned to either condition. The integrated treatment will last 8 weeks, and participants will work through 12 modules. Modules will incorporate content based on principles of cognitive behavioral therapy and motivational interviewing. Participants in the control group will receive links to psychoeducational resources and will have access to the full treatment after follow-up. The primary outcome will be the number of Canadian standard drinks consumed in the week leading up the assessment. Secondary outcomes of interest include symptoms of depression, anxiety, alcohol-related problems, quality of life, and use of other drugs. Assessments will be completed at 3 time-points: at baseline, at the end of treatment (ie, 8 weeks), and at follow-up (ie, 24 weeks). Upon completion, data will be analyzed using generalized linear mixed models. RESULTS Data collection began in June 2018 and will continue until January 2020. Final study results will be submitted for publication by July 2020. CONCLUSIONS Currently, there are no integrated treatments designed to target alcohol misuse and the range of emotional problems experienced by young adults. This research stands to provide an effective, accessible (ie, Web-based), and feasible option to treat the many struggling young adults in this country. CLINICALTRIAL ClinicalTrials.gov ID NCT03406039; https://clinicaltrials.gov/ct2/show/NCT03406039 (Archived by WebCite at http://www.webcitation.org/72fDefnrh) REGISTERED REPORT IDENTIFIER PRR1-10.2196/11298

Objective : In order to better serve older individuals with HIV, more information is needed regarding the prevalence of medical and psychiatric comorbidities, and its influence on quality of life within a nationally representative sample. The aims of this study were to assess associations of HIV among middle-aged and older Americans with lifetime Axis I and II psychiatric disorders and suicide attempts, past-year Axis I psychiatric disorders, past-year medical conditions, obesity, and health-related quality of life. Method : Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which included 15,456 adults aged 50 and older. Results : Respondents with self-reported HIV were more likely than those without to report any lifetime Axis I disorder, any lifetime anxiety disorder, any lifetime substance and drug use disorder, any past-year Axis I and substance use disorders, hypertension, diabetes, and arthritis. HIV infection was also associated with poorer physical health-related quality of life. Discussion : Middle-aged and older adults with HIV have an increased risk of psychiatric disorders and a number of medical conditions that impair physical but not mental health-related quality of life. Comprehensive and integrated medical treatment should be designed and delivered to this underappreciated but growing group of patients.

The objective of this study was to understand the relationship between mental health service use and comorbid any anxiety and commonly occurring physical conditions (i.e., arthritis, cardiovascular disease, and gastrointestinal disease) in a national sample of older Canadians.The sample consisted of older adults aged 55 years and older from the Canadian Community Health Survey 1.2 (N = 12,792). Trained lay interviewers assessed mental disorders based on Diagnostic and Statistical Manual of Mental Disorders - 4th Edition (DSM-IV) criteria. Physical conditions were based on self-reported diagnoses by health professionals. Past-year mental health service use was categorized into whether services were utilized in the general or specialty sectors. Crosstabulations and multiple logistic regressions examined the effects of both anxiety and physical conditions on mental health service use within the general and specialty mental health sectors.Adjusted logistic regressions indicated that there was no effect of anxiety among older adults with gastrointestinal disease on mental health service use. Conversely, in adjusted regressions, having a comorbid anxiety disorder with cardiovascular disease or arthritis was associated with increased odds of service use from the general sector in comparison to cardiovascular disease and arthritis, respectively, alone. Additionally, older adults with comorbid any anxiety disorder and gastrointestinal disease in comparison to anxiety alone had lower rates of seeking mental health services; however, these effects were no longer significant in an adjusted model.Comorbidity between gastrointestinal conditions and anxiety was associated with unmet mental health service needs. This may be conceptualized in the context overlapping symptomatology in gastrointestinal conditions and anxiety.

Introduction: Little is known about the relationship between anxiety disorders and physical conditions in Canadian Veterans. The purpose of this investigation was to examine the comorbidity of anxiety and physical conditions and their relation to physical and mental health–related quality of life and activity limitations in a nationally representative sample of Canadian Veterans. Methods: Participants were selected from the cross-sectional 2010 Survey on Transition to Civilian Life ( N = 3,154, response rate = 71.0%). The sample consisted of former Canadian Armed Forces Regular Force personnel who were released from 1998 to 2007. Multivariate logistic and linear regression models evaluated associations between several commonly occurring chronic physical conditions and any anxiety disorder and correlates (i.e., quality of life and activity limitations) of comorbidity. Results: Any anxiety disorder was associated with significantly elevated rates of cardiovascular, gastrointestinal, respiratory, and musculoskeletal conditions; diabetes; and chronic pain after controlling for sociodemographics, military characteristics, any mood disorder, and heavy drinking. However, when additionally controlling for number of physical conditions, any anxiety disorder remained significantly associated with gastrointestinal conditions (adjusted odds ratio [AOR] = 1.63, 99% confidence interval [CI] = 1.07–2.50) and chronic pain (AOR = 1.79, 99% CI = 1.15–2.78). Co-occurring anxiety disorders and musculoskeletal conditions were associated with poorer physical health–related quality of life and activity limitations than musculoskeletal conditions alone. Conclusion: Anxiety disorders and physical health problems co-occur at high rates among Canadian Veterans, and this comorbidity is linked to poorer physical health–related quality of life and activity limitations. These findings have implications for supporting at-risk personnel with the transition to civilian life and for informing health promotion and prevention efforts.

Data on the prevalence of psychiatric disorders in late life are lacking. The present study addresses this gap in the literature by examining the prevalence of the broadest range of psychiatric disorders in late life to date; comparing prevalences across older adult age groups using the largest sample of adults aged 85+; and exploring gender differences in the prevalence of psychiatric disorders in late life. Using data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, we examined the prevalence of past-year mood, anxiety, and substance use disorders, and lifetime personality disorders in a nationally representative sample of 12,312 U.S. older adults. We stratified our analyses by gender and by older age groups: young-old (ages 55-64), middle-old (ages 65-74), old-old (ages 75-84), and oldest-old (ages 85+). The proportion of older adults who experienced any past-year anxiety disorder was 11.4%, while the prevalence of any past-year mood disorder was 6.8%. A total of 3.8% of older adults met criteria for any past-year substance use disorder, and 14.5% of older adults had one or more personality disorder. We observed a general pattern of decreasing rates of psychiatric disorders with increasing age. Women experienced higher rates of mood and anxiety disorders, while men had higher rates of substance use disorders and any personality disorder. Gender differences in rates of most psychiatric disorders decreased with increasing age. These data indicate that psychiatric disorders are prevalent among U.S. older adults, and support the importance of prevention, diagnosis, and treatment of psychiatric disorders in this population.

It is well-documented that social isolation is detrimental to health and well-being. What is less clear is what types of social networks allow older adults to get the social support they need to promote health and well-being. In this study, we identified social network types in a national sample of older Canadians and explored whether they are associated with perceived availability of different types of social support (affectionate, emotional, or tangible, and positive social interactions). Data were drawn from the baseline questionnaire of the Canadian Longitudinal Study on Aging for participants aged 65–85 (unweighted n = 8,782). Cluster analyses revealed six social network groups. Social support generally declined as social networks became more restricted; however, different patterns of social support availability emerged for different social network groups. These findings suggest that certain types of social networks place older adults at risk of not having met specific social support needs.

Background There has been growing interest in the relation between anxiety disorders and physical conditions in the general adult population. However, little is known about the nature of this association in older adults. Understanding the complex relationship between these disorders can help to inform prevention and treatment strategies unique to this rapidly growing segment of the population. Methods A total of 10,409 U.S. adults aged 55 + participated in Wave 1 (2001–2002) and Wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Lifetime and past-year DSM-IV anxiety, mood, and substance use disorders, and lifetime personality disorders, were assessed in both waves. Participants self-reported on whether they had been diagnosed by a healthcare professional with a broad range of physical health conditions; this study focuses on cardiovascular disease, gastrointestinal disease, and arthritis. Multivariable logistic regressions adjusted for sociodemographics, comorbid mental disorders, and number of physical health conditions assessed: (1) the relation between past-year physical conditions at Wave 1 and incident past-year anxiety disorders at Wave 2 and; (2) the relation between individual lifetime anxiety disorders at Wave 1 and incident physical conditions at Wave 2. A second set of adjusted multinomial logistic regressions examined Wave 1 sociodemographic and physical and mental health risk factors associated with incident physical condition alone, anxiety disorder alone, and comorbid anxiety and physical condition at Wave 2. Results Past-year arthritis at Wave 1 was significantly associated with increased odds of incident generalized anxiety disorder at Wave 2. Further, any lifetime anxiety disorder and posttraumatic stress disorder at Wave 1 were significantly associated with increased odds of incident gastrointestinal disease at Wave 2. Differential sociodemographic and physical and mental health predictors were significantly associated with increased odds of incident comorbid anxiety disorder and physical conditions. Conclusion Results of the current study elucidate the longitudinal bidirectional relationships between anxiety disorders and physical health conditions in a large, nationally representative sample of older adults. These results have important implications for identifying at risk older adults, which will not only impact this growing segment of the population directly, but will also potentially lessen burden on the healthcare system as a whole.

Suicidal behaviors are of significant concern for the individuals displaying such behavior and for service providers who encounter them. Using nationally representative samples of Canadian and American adults, we aimed to examine: whether age moderates the relationship between having any anxiety disorder and suicide ideation (SI), the prevalence of SI among younger and older adults, and whether age and individual anxiety disorders were differentially associated with SI. Age moderated the relationship between any anxiety disorder and SI among Americans only. Past-year SI was less prevalent among older, compared to younger, adults; though, nearly every anxiety disorder was associated with increased odds of SI among younger and older Canadian and American adults after controlling for covariates. Effect sizes were particularly large for older American adults, but were coupled with large confidence intervals. Findings contribute to a growing literature suggesting that SI in the context of anxiety is a highly prevalent and complex mental health problem across the adult lifespan.