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Background. Mental health mobile applications (apps) have the potential to expand the provision of mental health and wellness services to traditionally underserved populations. There is a lack of guidance on how to choose wisely from the thousands of mental health apps without clear evidence of safety, efficacy, and consumer protections. Purpose. This Technical Brief proposes a framework to assess mental health mobile applications with the aim to facilitate selection of apps. The results of applying the framework will yield summary statements on the strengths and limitations of the apps and are intended for use by providers and patients/caregivers. Methods. We reviewed systematic reviews of mental health apps and reviewed published and gray literature on mental health app frameworks, and we conducted four Key Informant group discussions to identify gaps in existing mental health frameworks and key framework criteria. These reviews and discussions informed the development of a draft framework to assess mental health apps. Iterative testing and refinement of the framework was done in seven successive rounds through double application of the framework to a total of 45 apps. Items in the framework with an interrater reliability under 90 percent were discussed among the evaluation team for revisions of the framework or guidance. Findings. Our review of the existing frameworks identified gaps in the assessment of risks that users may face from apps, such as privacy and security disclosures and regulatory safeguards to protect the users. Key Informant discussions identified priority criteria to include in the framework, including safety and efficacy of mental health apps. We developed the Framework to Assist Stakeholders in Technology Evaluation for Recovery (FASTER) to Mental Health and Wellness and it comprises three sections: Section 1. Risks and Mitigation Strategies, assesses the integrity and risk profile of the app; Section 2. Function, focuses on descriptive aspects related to accessibility, costs, organizational credibility, evidence and clinical foundation, privacy/security, usability, functions for remote monitoring of the user, access to crisis services, and artificial intelligence (AI); and Section 3. Mental Health App Features, focuses on specific mental health app features, such as journaling and mood tracking. Conclusion. FASTER may be used to help appraise and select mental health mobile apps. Future application, testing, and refinements may be required to determine the framework’s suitability and reliability across multiple mental health conditions, as well as to account for the rapidly expanding applications of AI, gamification, and other new technology approaches.

Neonatal abstinence syndrome (NAS), largely a consequence of prenatal opioid exposure, results in substantial morbidity. Population-based studies of NAS going beyond Medicaid populations and hospital discharge data (HDD) alone are limited. Using statewide Tennessee (TN) HDD and birth certificate (BC) data, we examined trends and evaluated maternal and infant factors associated with NAS. We conducted a population-based descriptive study during 2013–2017 in TN. NAS infants were identified with International Classification of Diseases (ICD)-9-Clinical Modification (CM) and ICD-10-CM codes in HDD and linked to BC data using iterative deterministic matching algorithms. Descriptive analyses were conducted for infant and maternal factors (exposures) by NAS (outcome). Multivariable logistic regression models were used to estimate adjusted ORs and 95% CIs. NAS incidence increased from 13.4 to 15.4 per 1,000 live births between 2013 and 2017 (15% increase; ptrend

Suicide rates in the United States (US) reached a peak in 2018 and declined in 2019 and 2020, with substantial and often growing disparities by age, sex, race/ethnicity, geography, veteran status, sexual minority status, socioeconomic status, and method employed (means disparity). In this narrative review and commentary, we highlight these many disparities in US suicide deaths, then examine the possible causes and potential solutions, with the overarching goal of reducing suicide death disparities to achieve health equity.The data implicate untreated, undertreated, or unidentified depression or other mental illness, and access to firearms, as two modifiable risk factors for suicide across all groups. The data also reveal firearm suicides increasing sharply and linearly with increasing county rurality, while suicide rates by falls (e.g., from tall structures) decrease linearly by increasing rurality, and suicide rates by other means remain fairly constant regardless of relative county urbanization. In addition, for all geographies, gun suicides are significantly higher in males than females, and highest in ages 51–85 + years old for both sexes. Of all US suicides from 1999–2019, 55% of male suicides and 29% of female suicides were by gun in metropolitan (metro) areas, versus 65% (Male) and 42% (Female) suicides by gun in non-metro areas. Guns accounted for 89% of suicides in non-metro males aged 71–85 + years old. Guns (i.e., employment of more lethal means) are also thought to be a major reason why males have, on average, 2–4 times higher suicide rates than women, despite having only 1/4—1/2 as many suicide attempts as women. Overall the literature and data strongly implicate firearm access as a risk factor for suicide across all populations, and even more so for male, rural, and older populations.To achieve the most significant results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs to reduce suicidal behaviors, and 2) enhanced population-based strategies for ameliorating the two most prominent modifiable targets for suicide prevention: depression and firearms.

Although sexual minorities represent a small proportion of the general population, this group has been observed to be at an increased risk of developing various pathologies, including substance use and eating disorders. Research suggests that foods high in added fat and refined carbohydrates may trigger an addictive response, especially in at-risk individuals. Consequently, food addiction is associated with elevated risk for obesity, diet-related disease, and psychological distress. However, there is limited research on whether food addiction, like substance use, may be elevated among sexual minorities, and whether self-compassion may be a protective factor. Thus, the current study aims to test whether food addiction is elevated in sexual minorities (relative to heterosexuals) and if discrimination and self-compassion may be related to food addiction among sexual minorities. In a community sample of 356 participants (43.3% sexual minority), sexual minorities had almost twice the prevalence of food addiction (16.9%) as heterosexuals (8.9%). Also, sexual minorities on average experienced more food addiction symptoms (M = 2.73, SD = 1.76) than heterosexuals (M = 1.95, SD = 1.59). For sexual minorities, heterosexist harassment was associated with increased food addiction, while self-compassion appeared to be a protective factor. Further research needs to examine between-group differences among sexual minorities for better treatment and interventions for food addiction.