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Coaches' knowledge, attitudes, and beliefs about mental health—or mental health literacy (MHL)—affect teams' mental health climates and the detection, referral, and treatment of athletes' mental health concerns. Thus, assessing collegiate coaches' MHL, and factors related to its presence, is critical. Using the Mental Health Literacy Scale, 1,571 NCAA (National Collegiate Athletic Association) coaches were surveyed regarding their MHL and demographic and mental health experience factors. Overall, 99.9% of the coaches surveyed believe that athletes' mental health affected their sport performances. Through hierarchical regression analyses, coaches' exposure to mental health treatment, perceived helpfulness of mental health treatment, gender (i.e., woman), years coaching (i.e., fewer years), and current NCAA division (i.e., Division III) were significantly related to their MHL, explaining 15.5% of variance. However, coaches' race/ethnicity did not reach significance. Recommendations regarding increasing coaches' MHL and hiring appropriately trained and licensed mental health and sport psychology professionals are offered. [ABSTRACT FROM AUTHOR]

Assistant coaches play an important role in National Collegiate Athletic Association (NCAA) athletic departments and spend substantial amounts of time working with student-athletes, yet no research to date has examined their knowledge of mental performance and mental health services. Therefore, the purpose of this study was to learn about NCAA Division I assistant coaches' understanding and use of mental performance and mental health services. Thirteen assistant coaches employed at universities with at least one mental performance consultant and one licensed mental health provider were interviewed. Thematic analysis procedures were used, and five themes were constructed: (a) day-to-day responsibilities of the assistant coach, (b) needing both mental performance and mental health services, (c) factors influencing understanding of mental performance and mental health services, (d) factors impacting student-athlete utilization of mental performance and mental health services, and (e) confusion between mental performance and mental health services. [ABSTRACT FROM AUTHOR]

Athletes ( I N = i 584) completed the Group Environment Questionnaire (Carron et al., 1985) to measure perceptions of cohesion and the SPLIT to assess athlete leadership behaviors. using structural equation modelling (SEM), the results showed the athlete leadership dimensions of task- and change-oriented leadership were positively related to the cohesion dimensions of ATG-T ( =.19, I p i <.05; =.62, I p i <.05, respectively) and GI-T ( =.16, I p i <.05; =.62, I p i <.05, respectively). B An examination of positive body image, sport-confidence, and sport performance evaluations in Jamaican athletes b I Chelsi Ricketts, Michigan State University; Leapetswe Malete, Michigan State University; Nicholas D. Myers, Michigan State University; André G. Bateman, The University of the West Indies, Mona, Jamaica; Caryl James Bateman, The University of the West Indies, Mona i Body image research in sport has primarily examined athletes' risk for developing body-related psychopathologies (e.g., negative body image, eating disorders), despite evidence of higher positive body image in athletes compared to non-athletes. It was hypothesized that (a) body and functionality appreciation would exert positive direct effects on sport-confidence, (b) sport-confidence would exert a positive direct effect on sport performance evaluations, and (c) body and functionality appreciation would exert positive indirect effects on sport performance evaluations through sport-confidence. The purpose of this study was to validate an athlete-reported version of the CLSS-Q. In total, 528 (high school, I n i = 346; college, I n i = 182) student-athletes completed the athlete-reported version of the 36-item CLSS-Q. To assess the factor structure of the athlete-reported CLSS-Q, we conducted a series of exploratory structural equation models (ESEM) and confirmatory factor analyses (CFA). [Extracted from the article]

Research has demonstrated children in out-of-home care have experienced trauma and a significant proportion are in need of behavioral health services (e.g. Casaneuva et al., NSCAW II baseline report: Child well-being, US Department of Health and Human Services, Washington, DC, 2011). Accessing services requires interagency coordination between child welfare and behavioral health professionals; however, challenges to coordination and collaboration may result in lack of service utilization for many youth (Hanson et al. 2016). Utilizing a mixed methodological approach, this paper describes the results of a study conducted five years after full state-wide implementation of processes designed to promote the use of evidence-based practices to inform decision-making for youth dually served by the child welfare and behavioral health systems. Outcomes from the study were used to develop strategies to address programmatic concerns and reinforce implementation supports. Study findings may aid organizations seeking to reinforce data-informed practices and employ strategies for addressing barriers at the worker and agency level. [ABSTRACT FROM AUTHOR]

Rates of hospitalizations and emergency department (ED) visits due to self-harm are important indicators for understanding the impact of the COVID-19 pandemic on mental health. The objective of this study was to assess changes in self-harm hospitalizations and ED visits in Canada during the first two years of the pandemic. Rates of self-harm hospitalizations and ED visits during the pandemic were predicted based on regression analyses that modeled trends over a 5-year pre-pandemic period from fiscal year 2015 to 2019. The ratios of observed and model predicted (expected) rates in 2020 and 2021 were estimated separately to assess changes during the pandemic. Overall, rates of self-harm hospitalizations and ED visits were lower than expected during the pandemic, especially in 2020. In 2021, rates for females returned to near-expected levels; but they remained lower than expected for males. Females aged 10–14 years had higher than expected rates. The rate ratio of observed rate over expected rate was 1.2 in 2020 but further increased to 1.8 in 2021 for both hospitalizations and ED visits. Higher than expected rates were also observed among females aged 15–19 years in 2021 only. Suicide attempts and non-suicidal self-harm cases could not be distinguished. We observed lower than or close to expected rates of self-harm hospitalizations and ED visits during the pandemic for most population groups. The increased rates for young females highlights the importance of continued surveillance post-pandemic and targeted mental health services and suicide prevention programs. • This study assessed changes in self-harm hospitalizations and ED visits in Canada during the COVID-19 pandemic. • In 2020, overall rates of self-harm hospitalizations and ED visits were lower than expected. • In 2021, rates for females returned to near-expected levels; but they remained lower than expected for males. • Females aged 10–19 years had increased rates during the pandemic, especially for females aged 10–14 years in 2021. • The findings highlight the importance of continuing surveillance post-pandemic and targeted mental health services. [ABSTRACT FROM AUTHOR]

Background: Videoconferencing is considered an alternative to face-to-face consultations and a possibility to help overcome access-to-care barriers in mental health care services. Barriers to child and adolescent mental health services are particularly apparent in the case of children and adolescents receiving child welfare services. This scoping review aims to provide an overview of research on videoconferencing in the mental health treatment of children and adolescents receiving support from child welfare services. Methods: This scoping review follows the review framework outlined by the Joanna Briggs Institute. The following databases were searched from January 2012 to April 2024: Scopus, Web of Science, PubMed, PsycINFO (Ovid), CINAHL Plus, Social Services Abstracts (ProQuest), Sociological Abstracts (ProQuest), and Google Scholar. Results: The search yielded 4322 unique records and resulted in the inclusion of 22 articles that met the inclusion criteria. The studies originated from Denmark, England, Australia, Norway, Canada, Chile, and the USA, and were grouped into four areas: (1) videoconferencing to increase access to mental health treatment for vulnerable groups (2) young people's perspectives (3) videoconferencing in interdisciplinary collaborative meetings, and (4) use, awareness, and acceptance of videoconferencing among health and social care providers. Conclusions: This scoping review shows that if videoconferencing in mental health care is to become an established and trusted method aimed at children and adolescents receiving child welfare services, several unresolved and potentially negative issues need attention and more research. This particularly applies to whether videoconferencing decreases or exacerbates inequalities in access to mental health services. A further question is whether new barriers are raised by screen-based treatment to threaten good therapeutic relationships, and by extension treatment quality and clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: The integration of mental health into primary care—i.e., the process by which a range of essential mental health care and services are made available in existing multipurpose health care settings that did not previously provide them—can be facilitated or hindered by several health system factors that are still poorly understood. This study aimed to identify health system facilitators and barriers to the integration of mental health services into primary care in the Democratic Republic of the Congo (DRC) to improve the success rate of integration programs. Methods: We conducted a multimethod, cross-sectional exploratory study. Stakeholders (managers, health service providers, service users, etc.) from sixteen of the twenty-six provinces of the DRC participated. We collected qualitative data through 31 individual, semistructured, face-to-face key informant interviews. We then collected quantitative data through a population-based survey of 413 respondents. We analyzed the interviews via thematic analysis, assigning verbatims to predefined themes and subthemes. For the survey responses, we performed descriptive analysis followed by binomial logistic regression to explore the associations between the variables of interest. Results: Strong leadership commitment, positive attitudes toward mental health care, the availability of care protocols, mental health task sharing (p < 0.001), and sufficient numbers of primary care providers (PCPs) (p < 0.001) were identified as key health system facilitators of successful integration. However, barriers to integration are mainly related to a poor understanding of what integration is and what it is not, as well as to the poor functionality and performance of health facilities. In addition, stigma, low prioritization of mental health, lack of mental health referents, low retention rate of trained health professionals, lack of reporting tools, lack of standardized national guidelines for integration (p < 0.001), lack of funding (p < 0.001), shortage of mental health specialists to coach PCPs (p < 0.001), and lack of psychotropic medications (p < 0.001) were identified as health system barriers to integration. Conclusion: Improving the functionality of primary care settings before integrating mental health care would be beneficial for greater success. In addition, addressing identified barriers, such as lack of funding and mental health-related stigma, requires multistakeholder action across all building blocks of the health system. [ABSTRACT FROM AUTHOR]

Introduction: The World Health Organization declared COVID-19 as a pandemic in March 2020. COVID-19 has since caused a significant increase in mental health problems at national and global levels. This study assessed the views of key mental health stakeholders regarding the state of mental health service provision in Malawi and the pandemic's impact on the sector. Methods: The study utilised a qualitative approach through key informant interviews (KIIs) conducted using a semi-structured interview guide. The interviews were audio recorded in English language and were manually transcribed for thematic analysis by generating codes re-classified into themes, sub-themes and quotes. Results: The results are categorised into five themes. Firstly, the availability of mental health services. All experts confirmed the lack of availability of the mental health services especially at the lower levels of care. Currently, only 0.3% of facilities offer mental health services in Malawi. Moreover, although mental health services are part of the essential health care package and, therefore, are supposed to be provided for free in public facilities at all levels, the services are centralised and only functional at a tertiary level of care in public facilities. Secondly, funding sources for mental health in public and private facilities. We learnt that public facilities depend on donor sources and there is lack of prioritisation in budget allocation for mental health services. Whereas private facilities, their major source of funding is user fees. Thirdly, government's response in the provision of mental health services during COVID-19. Almost all experts echoed that government took a proactive approach to address the mental health needs of its population during the pandemic. There was increased collaboration between the government and the private sector to provide psychosocial and counselling services to health workers working directly with COVID-19 patients in isolation centres. Furthermore, to increase awareness of the general population on where to seek counselling services. Lastly, challenges in the provision of mental health services were highlighted and how the pandemic acerbated the challenges including shortage in human resources for health and inadequate funding. Conclusion: This study underscores the urgency of addressing mental health challenges in Malawi. Policymakers must prioritize the decentralization of mental health services, explore funding opportunities, and build on the successful collaboration with the private sector. These measures will not only enhance the accessibility and quality of mental health services but also ensure that mental well-being is a central component of public health efforts in Malawi. [ABSTRACT FROM AUTHOR]

Background: Literature on psychiatric emergency services (PES) presentations during the COVID-19 pandemic showed heterogeneous results regarding patients brought in by police (BIBP). This is the first study primarily focusing on patients BIBP in a PES during the COVID-19-period. Methods: Case documentation records during the first and second wave of the COVID-19 pandemic in a PES in Berlin, Germany were analyzed using descriptive data analysis and binomial logistic regression analysis to detect factors that predict presentations BIBP. Results: 5440 PES presentations: 20.4% BIBP during the first wave vs. 16.3% during its control period; second wave: 17.6% BIBP vs. 14.9% during its control period. In both waves, absolute increases in presentations BIBP were seen compared to control (p =.029, p =.028, respectively). COVID-19-period was a predictor for presentations BIBP during the first and the second wave. The following factors also predicted presentations BIBP: younger age, male gender, aggressive behavior, suicide attempt prior to presentation and diagnosis of psychotic or substance use disorders; depressive disorders were negatively associated. Conclusions: During the two first waves of the COVID-19 pandemic, there was an increase in presentations BIBP in a PES in Berlin. Regression analysis shows that the pandemic itself was a predictor of presentations BIBP. The underlying factors of this association need to be further elucidated in future research. Additionally, general factors predicting PES presentations BIBP are reported that replenish the present literature. [ABSTRACT FROM AUTHOR]

ObjectiveMethodResultsConclusionTo test the predictive accuracy and generalisability of a personalised advantage index (PAI) model designed to support treatment selection for Post-Traumatic Stress Disorder (PTSD).A PAI model developed by Deisenhofer et al. (2018) was used to predict treatment outcomes in a statistically independent dataset including archival records for N = 152 patients with PSTD who accessed either trauma-focussed cognitive behavioural therapy or eye movement desensitisation and reprocessing in routine care. Outcomes were compared between patients who received their PAI-indicated optimal treatment versus those who received their suboptimal treatment.The model did not yield treatment specific predictions and patients who had received their PAI-indicated optimal treatment did not have better treatment outcomes in this external validation sample.This PAI model did not generalise to an external validation sample. [ABSTRACT FROM AUTHOR]

Public health interventions implemented during the COVID-19 pandemic may exacerbate anxiety symptoms for many. We conducted this study to better understand the role of leisure activity in promoting mental wellness during times of social isolation and reduced access to recreation facilities and mental health support services. We analyzed nationally representative survey data collected by Statistics Canada as part of the Canadian Perspectives Survey Series (CPSS) during May 4–10 (CPSS 2) and July 20 to 26, 2020 (CPSS 4). Data related to leisure activity and anxiety symptoms as measured by a score of more than 10 on the General Anxiety Disorder scale were examined using descriptive and log-binomial regression analyses. Survey sampling weights were applied in all analyses, and regression results were adjusted for sociodemographic characteristics. Exercise and communication with friends and loved ones were the most frequently reported leisure activity. Prevalence of moderate to severe anxiety symptoms reported by participants was lower in CPSS 4 compared to CPSS 2. Results of adjusted log-binomial regression analyses revealed lower prevalence of moderate to severe anxiety symptoms in those who engaged in exercise and communication, while those who meditated exhibited higher prevalence. In conclusion, leisure activities, such as exercise and communication with loved ones, can promote mental wellness. Future research should clarify the role of meditation for mental wellness promotion during periods of social isolation. [ABSTRACT FROM AUTHOR]

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significantly costly and increasingly prevalent disease, with treatment focused on lifestyle intervention. Integrating education and behavioral health into clinical care offers opportunities to engage and empower patients to prevent progression of liver disease. We describe the design and implementation of Behavioral Resources and Intervention through Digital Group Education (BRIDGE), a 6-session group telehealth program led by advanced practice providers (APPs) in 90-min shared medical appointments (SMAs) with small groups of MASLD patients in an academic outpatient hepatology clinic. The program contains multi-component group interventions, with didactic education and behavioral coaching, while leveraging peer-based learning and support. Methods: A mixed-methods exploratory pilot study was conducted. Feasibility and acceptability of the clinical intervention were assessed by tracking recruitment, attendance, and retention of BRIDGE participants, patient interviews, and debriefing of clinician and staff views of the clinical program. Implementation metrics included program development time, workflow and scheduling logistics, and billing compliance for sustainability. Finally, patient parameters including changes in liver enzymes, FIB-4, weight, and BMI from pre- to post-BRIDGE were retrospectively analyzed. Results: We included 57 participants (median age 57, interquartile range (IQR) 50 – 65 years), 38 (67%) female, 38 (67%) white, and 40% had public insurance. Thirty-three (58%) participants completed all six sessions, while 43 (75%) attended at least five sessions. Patients who completed all sessions were older (median age 61 vs 53.5; p = 0.01). Gender, race/ethnicity, and insurance type were not significantly associated with missed sessions, and patients had similar rates of completion regardless of weight, BMI, or stage of liver disease. Barriers to completion included personal illness, family reasons, work commitments, or insurance issues. Prior to BRIDGE, median BMI was 31.9 (SD 29 – 36), with a median weight loss of 2 pounds (IQR -2 – 6) after BRIDGE. Conclusion: The BRIDGE telehealth SMA program was feasible, well-attended, and positively reviewed. This pilot study informs future iterations of program development and evaluation of outcome measures. [ABSTRACT FROM AUTHOR]

In 2011, the New Brunswick government released the New Brunswick Mental Health Action Plan 2011–2018 (Action Plan). Following the release of the Action Plan in 2011, two progress reports were released in 2013 and 2015, highlighting the implementation status of the Action Plan. While vague in their language, these reports indicated considerable progress in implementing the Action Plan, as various initiatives were undertaken to raise awareness and provide additional resources to facilitate early prevention and intervention in children and youth. However, whether these initiatives have yielded measurable improvements in population-level mental health outcomes in children and youth remains unclear. The current study explored the impact of the Action Plan by visualizing the trend in psychosocial outcomes and service utilization of vulnerable populations in New Brunswick before and after the implementation of the Action Plan using multiple datasets from the Canadian Community Health Survey. Survey-weighted ordinary least square regression analyses were performed to investigate measurable improvements in available mental health outcomes. The result revealed a declining trend in the mental wellness of vulnerable youth despite them consistently reporting higher frequencies of mental health service use. This study highlights the need for a concerted effort in providing effective mental health services to New Brunswick youth and, more broadly, Canadian youth, as well as ensuring rigorous routine outcome monitoring and evaluation plans are consistently implemented for future mental health strategies at the time of their initiation. [ABSTRACT FROM AUTHOR]

How did mental healthcare utilization change during the COVID-19 pandemic period among individuals with pre-existing mental disorder? Understanding utilization patterns of these at-risk individuals and identifying those most likely to exhibit increased utilization could improve patient stratification and efficient delivery of mental health services. This study leveraged large-scale electronic health record (EHR) data to describe mental healthcare utilization patterns among individuals with pre-existing mental disorder before and during the COVID-19 pandemic and identify correlates of high mental healthcare utilization. Using EHR data from a large healthcare system in Massachusetts, we identified three "pre-existing mental disorder" groups (PMD) based on having a documented mental disorder diagnosis within the 6 months prior to the March 2020 lockdown, related to: (1) stress-related disorders (e.g., depression, anxiety) (N = 115,849), (2) serious mental illness (e.g., schizophrenia, bipolar disorders) (N = 11,530), or (3) compulsive behavior disorders (e.g., eating disorder, OCD) (N = 5,893). We also identified a "historical comparison" group (HC) for each PMD (N = 113,604, 11,758, and 5,387, respectively) from the previous year (2019). We assessed the monthly number of mental healthcare visits from March 13 to December 31 for PMDs in 2020 and HCs in 2019. Phenome-wide association analyses (PheWAS) were used to identify clinical correlates of high mental healthcare utilization. We found the overall number of mental healthcare visits per patient during the pandemic period in 2020 was 10–12% higher than in 2019. The majority of increased visits was driven by a subset of high mental healthcare utilizers (top decile). PheWAS results indicated that correlates of high utilization (prior mental disorders, chronic pain, insomnia, viral hepatitis C, etc.) were largely similar before and during the pandemic, though several conditions (e.g., back pain) were associated with high utilization only during the pandemic. Limitations included that we were not able to examine other risk factors previously shown to influence mental health during the pandemic (e.g., social support, discrimination) due to lack of social determinants of health information in EHR data. Mental healthcare utilization among patients with pre-existing mental disorder increased overall during the pandemic, likely due to expanded access to telemedicine. Given that clinical correlates of high mental healthcare utilization in a major hospital system were largely similar before and during the COVID-19 pandemic, resource stratification based on known risk factor profiles may aid hospitals in responding to heightened mental healthcare needs during a pandemic. [ABSTRACT FROM AUTHOR]

A Median Group session supervised by Pat de Maré is presented with discussion. Research is described in which Median Groups were convened in an open psychiatric out-patient service in the community and in a closed psychiatric ward of a general hospital. Their efficacy and the participants' satisfaction and that of the department staff are described. [ABSTRACT FROM AUTHOR]

In Brazil, the Unified Health System (SUS) is the national health system that offers free medical services to all citizens including all levels of treatment and prevention of diseases, subsidized by the government. Although SUS is universally offered, people with intellectual and developmental disabilities (I/DD) face challenges regarding healthcare. This article aims to present a description of the healthcare framework for people with I/DD in Brazil, as well as to characterize the Care Network for Person with Disabilities. This is a descriptive study that reports aspects of the structure and functioning of the health system in the country. In addition, we summarize core data from the National Health Survey that characterizes the health condition of people with I/DD in the country. Although Brazil has promoted legislation in favor of the health of people with I/DD and other disabilities, the obstacle is the implementation. Overall, there have been advances in SUS efficacy. However, challenges include long waiting times for diagnosis, habilitation/rehabilitation, inadequate transportation, and insufficient staff training on disability and I/DD, particularly. In this sense, it is necessary to monitor laws and inclusive actions so that the principles of the SUS are actually applied. [ABSTRACT FROM AUTHOR]

This article explores the challenges faced by residents and fellows in medical training programs when it comes to accessing mental health care. It emphasizes the importance of providing confidential and affordable services to address the unique stressors and stigma associated with seeking help. The article offers strategies and examples of programs that have been implemented to overcome these barriers, including convenient scheduling options and dedicated mental health services. It also highlights the need for leadership to promote a supportive culture and address misconceptions about therapy. The article aims to provide insights and recommendations for other institutions to improve mental health care for their own residents and fellows. [Extracted from the article]

Vaginal brachytherapy (VBT) is an essential component of curative intent treatment for many patients with endometrial cancer. The prevalence of trauma history in this population is unknown and important to understand considering VBT requires patients to have an instrument vaginally inserted while in the vulnerable lithotomy position. We aim to identify patients treated with intracavitary VBT and collect survey data to assess trauma endpoints. We retrospectively identified patients with endometrial cancer who underwent intracavitary VBT at our institution between 01/2017 and 08/2022. Patients were mailed and/or electronically mailed a survey that included demographics, psychosocial background, and validated trauma surveys to be filled out as they relate to their trauma experiences prior to VBT and again considering any trauma symptomatology related to VBT. Electronic medical record review was performed. Descriptive statistics as well as multivariate analysis were performed. 206 patients met inclusion criteria, 66 (32.1%) of whom returned the survey and were included for analysis. Thirty-two percent of patients self-reported a personal history of any prior mental health diagnosis. Eighty-eight percent of patients screened positive for a history of trauma exposure, 23% endorsed symptoms of PTSD related to their VBT experience, and 5% screened positive for a likely PTSD diagnosis from VBT. A majority of included patients had a history of trauma exposure prior to VBT. In a subset of patients, VBT re-induced trauma and was considered to be an independent traumatic event. This study highlights the importance of practicing trauma informed care, particularly in this patient population. • 88% of patients screened positive for trauma exposure on the BTQ, 20% indicated history of unwanted sexual contact. • 11% of patients indicated VBT triggered an increase in thoughts or flashbacks to traumatic event(s). • VBT was considered to independently induce trauma symptoms in 23% of patients. • 36% of patients would have accepted referral to psychiatric services. [ABSTRACT FROM AUTHOR]

There is growing interest in clozapine clinical use, monitoring, and research, particularly adverse drug reactions (ADRs) other than agranulocytosis. In this study we focused on clozapine pharmacovigilance. Hence, we contacted clinicians and researchers in Latin America and requested information about local psychiatric services, clozapine availability, clinical use, and ADR monitoring with the VigiBase system. Only two countries have the minimum recommended number of psychiatric beds (15 per 100,000 residents): Uruguay (N = 34.9) and Argentina (N = 17). Bolivia is the only country where clozapine is unavailable. Nine out of twenty countries (45 %) reported ADRs to VigiBase. Argentina, Brazil, Chile, Colombia, and Mexico published national guidelines for schizophrenia treatment. Chile is the sole country with clozapine clinics with drug serum monitoring. Ethnicity-related drug titration in not described in package inserts in any country. We examined in detail the 9 most frequent and important clozapine ADRs in the worldwide database (pneumonia, sudden death, cardiac arrest, agranulocytosis, myocarditis, constipation, arrhythmia, seizure, and syncope). These 9 ADRs led to 294 reports with fatal outcomes in Argentina (N = 3), Brazil (N = 3), Chile (N = 2), and Peru (N = 1). Agranulocytosis was reported from 7 countries: constipation or seizures from 8 countries. Only two countries reported pneumonia and one country reported myocarditis. The number of clozapine reports in VigiBase has no relationship to the country's population. All Latin American countries underreport clozapine associated ADRs. Latin American governments, along with clinicians, researchers, and educators, should optimize clozapine use and monitoring for the benefit of people with severe mental and some neurological disorders. [ABSTRACT FROM AUTHOR]

With annual point-in-time counts indicating a rise in unsheltered homelessness in the United States, much attention has been paid to how to best provide care to this population. Mobile medical units (MMUs) have been utilized by many programs. However, little is known regarding the evidence behind their effectiveness. A scoping review is conducted of research on MMU provision of medical services for populations experiencing homelessness in the USA to examine the extent and nature of research activity, summarize available evidence, and identify research gaps in the existing literature. Following guidelines for scoping reviews, PubMed and Google Scholar were used to identify an initial 294 papers published from January 1, 1980, to May 1, 2023, using selected keywords, which were distilled to a final set of 50 studies that met eligibility criteria. Eligible articles were defined as those that pertain to the provision of healthcare (inclusive of dental, vision, and specialty services) to populations experiencing homelessness through a MMU in the United States and have been published after peer review. Of the 50 studies in the review, the majority utilized descriptive (40%) or observational methods (36%), with 4 review and 8 controlled studies and no completed randomized controlled trials. Outcome measures utilized by studies include MMU services provided (58%), patient demographics (34%), health outcomes (16%), patient-centered measures (14%), healthcare utilization (10%) and cost analysis (6%). The studies that exist suggest MMUs can facilitate effective treatment of substance use disorders, provision of primary care, and services for severe mental illness among people experiencing homelessness. MMUs have potential to provide community-based healthcare services in settings where homeless populations reside, but the paucity of randomized controlled trials indicates further research is needed to understand if MMUs are more effective than other care delivery models tailored to populations experiencing homelessness. [ABSTRACT FROM AUTHOR]

Background: Clinician burnout has become a major issue in the USA, contributing to increased mental health challenges and problems with quality of care, productivity, and retention. Objective: The objective of this study was to understand primary care clinicians' perspectives on burnout during the COVID-19 pandemic as well as their perspectives on the causes of burnout and strategies to improve clinician well-being. Approach: This qualitative research involved in-depth interviews with 27 primary care clinicians practicing in a range of settings across the USA. Semi-structured interviews lasted between 60 and 90 min and were conducted using Zoom video conferencing software between July 2021 and February 2023. Transcripts were analyzed in NVivo software using multiple cycles of coding. Key Results: Clinicians shared their experiences with burnout and mental health challenges during the COVID-19 pandemic. Contributors to burnout included high levels of documentation, inefficiencies of electronic health record (EHR) systems, high patient volume, staffing shortages, and expectations for responding to patient emails and telephone calls. The majority of participants described the need to work after clinic hours to complete documentation. Many clinicians also discussed the need for health system leaders to make sincere efforts to enhance work-life balance and create a culture of health and well-being for health professionals. Suggested strategies to address these issues included supportive leadership, accessible mental health services, and additional administrative time to complete documentation. Conclusions: The results of this study provide an in-depth view of participating primary care clinicians' experiences and perceptions of burnout and other mental health challenges. These viewpoints can improve awareness of the issues and strategies to improve the health and well-being of our clinician workforce. Strategies include aligning payment models with the best approaches for delivering quality patient care, reducing administrative burden related to documentation, and redesigning EHR systems with a human factors approach. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to analyze the real‐time variability of suicidal ideation intensity and the relationship between real‐time and retrospective reports of suicidal ideation made on the Beck Scale for Suicidal Ideation (BSS), among young people with borderline personality disorder (BPD). Methods: Young people (15–25‐year olds) with BPD (N = 46), recruited from two government‐funded mental health services, rated the intensity of their suicidal ideation six times per day for 7 days before completing the BSS. Results: For 70% of participants, suicidal ideation changed in intensity approximately five times across the week, both within and between days. BSS ratings were most highly correlated with the highest real‐time ratings of suicidal ideation. However, this was not significantly different from the relationship between the BSS and both the average and most recent ratings. Median ratings of suicidal ideation intensity were higher on the BSS compared with an equivalent question asked in real time. Conclusion: Findings suggest that young people with BPD experience high levels of fluctuation in their intensity of suicidal ideation across a week and that retrospective reports of suicidal ideation might be more reflective of the most intense experience of suicidal ideation across the week. [ABSTRACT FROM AUTHOR]

Introduction: Suicide loss survivors can provide information not otherwise available about the circumstances preceding a suicide. In this study, we analyzed interview data from suicide loss survivors collected as part of a psychological autopsy study of U.S. Army soldiers. Methods: Next‐of‐kin (NOK) (n = 61) and Army supervisors (SUP) (n = 107) of suicide decedents (n = 135) who had died in the last 2–3 months answered open‐ended questions about suicide risk factors, ideas for improving suicide prevention, and the impact of the suicide. Responses were coded using conventional content analysis methods to identify common themes. Results: Many NOK (30%) and SUP (50%) did not observe any signs of risk preceding the soldier's suicide. The most common idea regarding suicide prevention from SUP was that the suicide was inevitable, whereas NOK were more likely to emphasize the importance of increasing mental health treatment and reducing stigma. Both NOK and SUP reported negative effects of the suicide, but SUP reported some positive effects (e.g., increased unit connectedness). Conclusions: Results underscore the challenges of using informants to identify soldiers at high risk of suicide, given many respondents did not observe any warning signs. Findings also highlight attitudinal barriers present in the military that, if targeted, may increase soldiers' help‐seeking and willingness to disclose their risk. [ABSTRACT FROM AUTHOR]

Introduction: Children living in rural, regional and remote locations experience challenges to receiving services for mental illness and challenging behaviours. Additionally, there is a lack of clarity about the workforce characteristics to address the needs of this population. Objective: To scope the literature on the rural, regional and remote child mental health and behavioural workforce and identify barriers and enabling mechanisms to mental health service provision. Design: A scoping review utilising the Joanna Briggs Institute methodology. A database search was undertaken using Medline, CINAHL, PsycINFO, ProQuest and Scopus to identify papers published 2010–2023. Research articles reporting data on mental health workforce characteristics for children aged under 12 years, in rural, regional or remote locations were reviewed for inclusion. Findings: Seven hundred and fifty‐four papers were imported into Covidence with 22 studies being retained. Retained studies confirmed that providing services to meet the needs of children's mental health is an international challenge. Discussion: The thematic analysis of the review findings highlighted four workforce strategies to potentially mitigate some of these challenges. These were: (1) The use of telehealth for clinical services and workforce upskilling; (2) Role shifting where non mental health professionals assumed mental health workforce roles; (3) Service structure strategies, and (4) Indigenous and rural cultural factors. Conclusion: A range of potential strategies exists to better meet the needs of children with mental health and behavioural issues. Adapting these to specific community contexts through co‐design and production may enhance their efficacy. [ABSTRACT FROM AUTHOR]

The given text provides a summary of the New South Wales Child Development Study (NSW-CDS), a long-term research project that aims to identify risk and protective factors for adolescent-onset mental health problems in an Australian population cohort. The study has collected multi-agency linked administrative data for over 91,000 children from birth to approximately 18 years of age, including records related to health, education, child protection, criminal justice, and welfare. The text includes information on various data collections, demographic characteristics of the cohorts, and selected characteristics of the child sub-cohort. The study aims to provide insights into child development and well-being, and the data can be useful for library patrons conducting research on specific topics in New South Wales. [Extracted from the article]

Background: Syringe services programs (SSPs) are critical healthcare access points for people with opioid use disorder (OUD) who face treatment utilization barriers. Co-locating care for common psychiatric comorbidities, like posttraumatic stress disorder (PTSD), at SSPs may reduce harms and enhance the health of individuals with OUD. To guide the development of onsite psychiatric care at SSPs, we collected quantitative survey data on the prevalence of PTSD, drug use patterns, treatment experiences associated with a probable PTSD diagnosis, and attitudes regarding onsite PTSD care in a convenience sample of registered SSP clients in New York City. Methods: Study participants were administered the PTSD Checklist for the DSM-5 (PCL-5) and asked about sociodemographic characteristics, current drug use, OUD and PTSD treatment histories, and desire for future SSP services using a structured interview. Probable PTSD diagnosis was defined as a PCL-5 score ≥ 31. Results: Of the 139 participants surveyed, 138 experienced at least one potentially traumatic event and were included in the present analysis. The sample was primarily male (n = 108, 78.3%), of Hispanic or Latinx ethnicity (n = 76, 55.1%), and middle-aged (M = 45.0 years, SD = 10.6). The mean PCL-5 score was 35.2 (SD = 21.0) and 79 participants (57.2%) had a probable PTSD diagnosis. We documented frequent SSP utilization, significant unmet PTSD treatment need, and high interest in onsite PTSD treatment. Conclusions: Study findings point to the ubiquity of PTSD in people with OUD who visit SSPs, large gaps in PTSD care, and the potential for harm reduction settings like SSPs to reach people underserved by the healthcare system who have co-occurring OUD and PTSD. [ABSTRACT FROM AUTHOR]

This article discusses the need for a new model for suicide prevention in individuals with bipolar disorder (BD). The current approaches to suicide prevention have not been effective, and suicide rates remain high in this population. The authors propose a model called "Every Patient, Every Setting, Every Provider," which emphasizes the need for universal suicide prevention interventions for all individuals with BD, regardless of their perceived risk. The model suggests that suicide prevention efforts should be implemented in all clinical care settings and involve all healthcare providers. The article provides a list of evidence-based interventions that can be used in suicide prevention for individuals with BD. [Extracted from the article]

Phenomenon:As a core competency in medical education, clinical reasoning is a pillar for reducing medical errors and promoting patient safety. Clinical reasoning is a complex phenomenon studied through the lens of multiple theories. Although cognitive psychology theories transformed our understanding of clinical reasoning, the theories fell short of explaining the variations in clinical reasoning influenced by contextual factors. Social cognitive theories propose a dynamic relationship between learners' cognitive process and their social and physical environments. This dynamic relationship highlights the essential role of formal and informal learning environments for learning clinical reasoning. Approach: My research aimed to explore the personal experience of learning clinical reasoning in a sample of postgraduate psychiatry trainee doctors using cognitive psychology and social cognitive theories. A stratified convenience sample of seven psychiatry trainee doctors working in the Mental Health Services in Qatar completed semi-structured interviews in 2020. I analyzed the data manually using theoretical thematic analysis. Findings: I identified three overarching themes with multiple subthemes. The first theme was the hierarchical cultural impact on perceived learning opportunities and learning behavior. The first theme had two subthemes that explored the relationship with team members and the expected hierarchy roles. The second theme was the impact of emotions on the learning and execution of clinical reasoning.The second theme had three subthemes that explored the personal approach to managing emotions related to perceived self-efficacy and professional image. The third theme was characteristics of learning environments and their role in learning clinical reasoning. The last theme included three subthemes that explored stressful, autonomous, and interactive environments. Insights: The results accentuate the complexity of clinical reasoning. Trainees' experience of learning clinical reasoning was influenced by factors not controlled for in the curricula. These factors constitute a hidden curriculum with a significant influence on learning. Our local postgraduate training programmes will benefit from addressing the points raised in this study for effective and culturally sensitive clinical reasoning learning. [ABSTRACT FROM AUTHOR]

Objective: This case series explored the integration of smartwatches in a community mental health service to support severe mental illness (SMI) management and intervention. We examined whether biometric data provided by smartwatches could help to predict relapse and inform treatment decisions. Method: Four Australian SMI outpatients of mixed diagnoses (age range = 19–24) were selected from a prior study. Clinicians accessed patients' biometric data (activity, sleep, heart rate, and electrodermal activity) through smartwatches. Results: Changes in circadian rhythm and electrodermal activity preceded hospitalization in two cases. Additionally, smartwatch data was effectively used to guide targeted interventions, improving patient treatment outcomes. Conclusion: Integrating smartwatches in community mental health services offers promise as adjunct tools for SMI management. However, ethical considerations on data privacy and technology reliance require further evaluation. Additionally, as this is a small case series, randomized controlled trials with larger sample sizes are required to provide evidence for generalisability of results. [ABSTRACT FROM AUTHOR]

Aim: Eating disorders (EDs) are associated with significant disease burden and unacceptably high mortality rates. Early intervention significantly improves prognosis and can prevent chronic suffering; however, large numbers of people with the illness are not being identified or managed in primary healthcare. The current study aimed to test the reliability of the face‐to‐face, clinician delivery of a previously validated, co‐designed, online screening tool for eating disorders. Methods: Individuals aged 14 and over who read, English were recruited from the community in either primary care (general practice) settings or headspace youth mental health centres. They completed the InsideOut Institute Screener (IOI‐S) face‐to‐face, delivered verbally by the study researcher clinician and then online by self‐report. The primary outcome was test‐retest reliability as measured by two‐way mixed effects model Intraclass Correlation Coefficient (ICC) with absolute agreement. Results: A total of 83 participants aged 14–81 (M 36.2) completed the study in New South Wales and the Northern Territory, Australia, between April and November 2022. The ICC between successive iterations of the test was significantly positive (0.980), demonstrating strong internal validity and test–retest reliability of the scale. Conclusions: The IOI‐S is an adaptive 6‐item screening tool designed to 'start a conversation' and determine risk using gentle language conceived by individuals with lived experience. Originally designed for online use, the current study broadens its versatility to clinical settings. The screener performs equally well when delivered face‐to‐face in clinical practice. In conjunction with increased practitioner education and improved treatment referral pathways, broad implementation of the screener in early healthcare settings can support timely identification and intervention for those with EDs. [ABSTRACT FROM AUTHOR]

Introduction: Depression management is affected by restricted budgets for mental health care in sub-Saharan Africa countries. There is need for integration of non-pharmacological interventions in primary care. This scoping review aimed to summarize research on available non-pharmacological interventions and their effectiveness against depression in Kenya. Methods: We searched PubMed, ScienceDirect, AJOL, EBSCOhost, ProQuest and Cochrane Library databases for articles reporting non-pharmacological interventions in Kenya published in English between 2000 and May 2023. Findings: Twenty-four articles that reported psychosocial (n = 20) and socioeconomic (n = 4) interventions were included in the review. Most interventions were delivered by lay professionals. Clinical outcomes included significant reduction in depression scores and symptom severity posttreatment and reduction in likelihood of having depression symptoms. Interventions were also found to be feasible and acceptable. Conclusion: Non-pharmacological interventions can be upscaled for the management of depression in Kenya. [ABSTRACT FROM AUTHOR]

Background: Health disparity and under-utilization of health services is prevalent among Asian refugees and migrants in Western countries and can profoundly impact health outcomes. Cambodians who survived extreme physical and emotional trauma during the genocides enacted by the Khmer Rouge regime in the 1970's are particularly vulnerable to poor mental health outcomes decades later. Understanding the experiences of help-seeking and service use by displaced Cambodians in Western countries may help to design more effective and culturally safe healthcare services. Aims: To identify characteristics or factors associated with help seeking behaviours and service utilization of displaced Cambodians with mental health issues living in Western countries. Methods: This review followed the Arksey & O'Malley methodological framework for scoping reviews. Articles for review were identified through searches of nine electronic databases and manual searches. Relevant articles were selected, and data was extracted and synthesized into key themes. Results: This review included 15 articles. Most of the studies were conducted in the USA (n = 13) with one each conducted in Canada and New Zealand. Seven studies used qualitative interviews, five used a cross-sectional survey approach, two used a mixed-methods approach and one was a narrative review and case series. Key findings highlighted the impact of Cambodian cultural beliefs about mental health (guilt, shame and help-seeking stigma) on service utilization and the disconnect between Western models of service provision and preferred Cambodian ways of receiving support. Conclusion: Mental health services in Western countries are likely to be under-utilized by Cambodians due to a mismatch between health beliefs and Western models of care. Further investigation of the association between health beliefs and barriers to service utilization among adult Cambodian refugees is warranted. [ABSTRACT FROM AUTHOR]

Background: Mental health challenges are widespread among adolescents undergoing significant physical, emotional, social, and academic changes. However, rates of formal help-seeking remain low, particularly among those from ethnic minorities. Aims: This study investigated the determinants of intentions to seek formal mental health help among Palestinian adolescents in Israel, focusing on mental health literacy (MHL) and trust in formal sources of information. Methods: A total of 178 adolescents (Mage = 16.24 ± 1.24 years, 61.8% female) completed measures assessing intention for formal help-seeking, psychological distress, MHL, trust in formal sources of information, sociodemographic, and clinical characteristics. Results: Findings revealed low levels of intention to seek formal help and psychological distress, alongside average or above-average levels on all MHL dimensions and trust in formal sources for information. Our analysis identified socioeconomic status (β =.17, p <.05), psychological distress (β =.18, p <.05), trust in formal sources of information (β =.28, p <.001), and two MHL dimensions: knowledge of where to seek information (β =.25, p <.01) and attitudes that promote recognition or appropriate help-seeking behavior (β =.16, p <.05) – as the main determinants of intention for formal help-seeking. Conclusions: This study underscores the critical role of trust in formal sources of information and MHL in seeking formal help among adolescents from ethnic minorities. Interventions aiming to improve access to mental health-related information, address and enhance attitudes, and foster trust in formal professionals and institutions may contribute to an increased tendency for formal mental health help-seeking among this population and others. [ABSTRACT FROM AUTHOR]

Background: Mental health literacy (MHL) has been related to health behaviors and outcomes. However, studies examining MHL as a barrier and facilitator to service use are limited, especially among minority groups. Aims: This study examined MHL as a barrier and facilitator to mental health service use among the Palestinian Bedouin minority in Israel. Methods: Twenty-five Bedouins (15 women) from southern Israel participated in semi-structured, in-depth interviews. The participants were recruited by publishing an ad on social media about the study, then through a snowball technique. The data were analyzed thematically using ATLAS.ti.9, and the intercoder reliability was 92%. Results: We identified four major themes in the interviews: (1) MHL as a barrier to service use, due to lack of knowledge about professionals in the field, mental health services, or reasons and risk factors for mental health problems; (2) traditional attitudes that acted as barriers to service use, including a preference for informal treatment, a lack of faith in mental health treatment, aversion to discussing private feelings, and the perception that mental health is a luxury; (3) MHL as a facilitator to service use by enabling accurate identification of mental distress and suggesting practical avenues for seeking help; and (4) ways to improve MHL that should be culturally sensitive and under the government agencies' responsibility. Conclusions: Interventions aimed at increasing the use of mental health services among Bedouins and reducing racial/ethnic disparities should increase knowledge in culturally adapted ways, especially regarding professionals and services, and change negative attitudes such as mental health treatment as ineffective or bonus. [ABSTRACT FROM AUTHOR]

Background: Among the multiple challenges that people experiencing mental illness in general, and schizophrenia or bipolar disorders in particular, have to face, stigma appears to be one of the most difficult to tackle. In France, the body of research about stigma regarding people experiencing schizophrenia or bipolar disorders is growing, but not as much as in other western countries. Aims: In this context, our study aims to explore and compare stigma in French people experiencing schizophrenia or bipolar disorders, along with their respective mental healthcare system experience, in order to better address them within public health policies. Methods: 20 French mental health service users experiencing schizophrenia and 20 experiencing bipolar disorders answered the Stigma Scale, which assesses three dimensions of stigma (discrimination, difficulties of divulgation and lack of positive aspects). A semi-structured interview was used to collect information about the experience of the mental healthcare system (level of information, access to diagnosis, treatment, access to psychoeducation, etc.). Results: People experiencing schizophrenia and people experiencing bipolar disorders are different populations in terms of social impairment. However, they share a comparable negative experience of the mental healthcare system and a comparable level of information about their illness, to the exception of diagnosis divulgation, as people experiencing bipolar disorders have a better access to their diagnosis. People experiencing schizophrenia perceive a higher actual discrimination than people experiencing bipolar disorders. Conclusions: Public health policies should take into account the strong perception of actual discrimination of people experiencing schizophrenia, with capitalizing on what seems beneficial for people experiencing bipolar disorders. [ABSTRACT FROM AUTHOR]

The importance and impact of youth violence is increasingly being recognised and is a cause of international concern. In the UK, youth violence, specifically knife crime, is on the increase and has resulted in the deaths of many young people. In order to explore the impact of knife crimes on mental health and wellbeing of individuals, a number of focus groups were conducted with 24 professionals from multiple agencies. Qualitative analysis showed various emerging themes, which included ineffective mental health systems, structural violence and inequalities, policing, safety and community engagement, vulnerability and resilience in minority communities. Equity in mental health services, further development and roll-out of public mental health approaches and training accompanied by sufficient resources is needed. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare the 12‐item and 36‐item versions of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 using longitudinal data from community mental health outreach service users. Methods: Using data from Tokorozawa City mental health outreach service users in Japan, total and domain WHODAS‐12 and WHODAS‐36 scores were compared. First, we examined score‐change differences by domain at the start of outreach services (T1) and 1 year later (T2) for each version. Next, we compared differences between the two versions using Pearson's correlation, Wilcoxon signed‐rank test, and Bland–Altman analysis. Results: Among 20 participants, total scores and scores of some domains (i.e., cognition, getting along, life activities, and participation) were significantly lower at T2 than at T1 on both versions (p < 0.010). WHODAS‐36 scores were significantly lower at T2 than at T1 for the self‐care domain (p = 0.018). Except for self‐care, strong correlations were found between scores from the two versions (p < 0.001). In the Wilcoxon signed‐rank test and Bland–Altman analysis, we found significant differences between the scores of the two versions in the mobility, self‐care, and participation domains. There were no significant differences in the distribution or systematic errors between the two versions in scores for the other domains or total score. Conclusion: We found strong positive correlations between WHODAS‐12 and WHODAS‐36 total scores with no statistical differences between them. For some domains, differences in distribution and systematic errors were found. [ABSTRACT FROM AUTHOR]

Complex and enduring mental health problems require greater treatment resources, usually in the form of multidisciplinary support, including providing psychological therapies. This paper reports on an NHS, tertiary-level specialist psychotherapy service offering Psychodynamic therapies with longer-term, exploratory transdiagnostic approaches to support complexity and sustained personality functioning. This paper adopts a naturalistic study design evaluating the effectiveness of Psychodynamic therapy using pre- and post-outcomes across a 10-year period. A total of n = 474 participants self-report pre- and post-outcome measures were used as the marker of effectiveness along with therapist assessments during intake and engagement. The findings showed that Psychodynamic therapy was effective in reducing psychological distress based on service-user self-report and therapist assessments. While intake scores varied by socio-demographic factors, the rate of change across most groups was similar. There were several limitations relating to data quality and completeness which reflect the naturalistic design. Despite the limits of a naturalistic design, this study provides evidence of support for the place of Psychodynamic therapies within NHS mental health care, catering to those with complex and enduring mental health problems. [ABSTRACT FROM AUTHOR]

Objectives: Therapists have long observed a phenomenon referred to as the 'revolving door' of mental health services, in which individuals often develop, seek treatment for, and recover from multiple mental illnesses across their life. However, this has not been systematically examined. If this phenomenon is widespread, one would expect that the number of lifetime disorders would exceed that of current disorders. The aim of this meta- analysis was to test this hypothesis. Methods: A search was conducted of the following databases: MEDLINE, PsycINFO and Web of Science. In total, 38 studies were included in the current review; 27 of these contained sufficient quantitative data to be included in the meta- analysis, addressing the primary research aim. The remaining 11 studies were included in the systematic review only. Results: Meta- analyses of the 27 studies indicated that the average number of lifetime disorders was 1.84 times that of current disorders. Previous treatment significantly moderated this relationship, while the clinical nature of the sample did not. Examination of the remaining studies revealed common temporal sequences, indicating disorders which typically develop first or consequently to other disorders. Conclusions: These findings provide support for the revolving door of mental illness, suggesting a need for transdiagnostic treatments and broader conceptualisation of relapse prevention. [ABSTRACT FROM AUTHOR]

First-episode psychosis (FEP) refers to the first time someone experiences an episode of psychosis, which can be frightening and confusing, leading people to make their first contact with early intervention services. Early intervention is widely accepted as beneficial for long-term recovery and symptom management. A universal feature of intervention is a relationship with mental health practitioners. Therapeutic relationships experienced as positive are also associated with better outcomes across mental health settings. However, little is known about what is helpful within therapeutic relationships for people with FEP The current review aimed to develop a rich understanding of beneficial features of therapeutic relationships for people with FEP to enhance service delivery. Databases searched were: APA PsycInfo, MEDLINE Complete, CINAHL. A systematic search yielded 178 papers, of which 16 met the inclusion criteria. Publications reviewed were from Singapore, Western Finnish Lapland, England, Canada, the United States of America, Denmark, and Australia. The papers were published across 12 journals; 81% were qualitative, 12% were quantitative, and one was a mixed methods study. It is recommended that creating a safe space to talk, taking a non-judgemental approach, and developing trust between practitioner and client should be prioritised for people with FEP. [ABSTRACT FROM AUTHOR]

This paper aims to provide an overview of the lived experience of a group of individuals who participated in an adventure therapy project, as an adjunct to their routine clinical care with an Early Intervention Service (EIS) for psychosis. We hope it will support the growing literature in this field as well as encourage other services to adopt these approaches within their settings. A group of individuals who had experienced a First Episode of Psychosis (FEP) participated in a programme of outdoor activities, culminating in a six-day residential sailing adventure (N = 5). A semi-structured interview was used to explore their experiences, and an inductive thematic analysis was undertaken to identify themes. Four key themes emerged from the analysis of the transcripts. The themes centred around what people learnt about themselves from taking part in the project: "enhanced self-perception"; "building friendships and being part of a shared experience"; "navigating and overcoming new challenges"; and "working together as a team". Adventure-based approaches offer the opportunity to enhance standard treatment outcomes in EIS, and the unique context in which they occur provides a platform to support social and occupational recovery from psychosis. [ABSTRACT FROM AUTHOR]

Exposure to toxins—such as heavy metals and air pollution—can result in poor health and wellbeing. Recent scientific and media attention has highlighted negative health outcomes associated with toxic exposures for U.S. military personnel deployed overseas. Despite established health risks, less empirical work has examined whether deployment-related toxic exposures are associated with declines in mental and physical health after leaving military service, particularly among the most recent cohort of veterans deployed after September 11, 2001. Using data from 659 U.S. veterans in the VISN 6 MIRECC Post-Deployment Mental Health Study, we tested whether self-reported toxic exposures were associated with poorer mental and physical health. At baseline, veterans who reported more toxic exposures also reported more mental health, β = 0.14, 95% CI [0.04, 0.23], p = 0.004, and physical health symptoms, β = 0.21, 95% CI [0.11, 0.30], p < 0.001. Over the next ten years, veterans reporting more toxic exposures also had greater increases in mental health symptoms, β = 0.23, 95% CI [0.15, 0.31], p < 0.001, physical health symptoms, β = 0.22, 95% CI [0.14, 0.30], p < 0.001, and chronic disease diagnoses, β = 0.15, 95% CI [0.07, 0.23], p < 0.001. These associations accounted for demographic and military covariates, including combat exposure. Our findings suggest that toxic exposures are associated with worsening mental and physical health after military service, and this recent cohort of veterans will have increased need for mental health and medical care as they age into midlife and older age. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse (TGD) youth, individuals whose gender identity is different from the sex that was assigned at birth, report higher rates of mental health and emotional challenges and are approximately twice as likely to access psychiatric inpatient services compared with cisgender peers. 1 Existing research has suggested that the minority stress that TGD youth face from having to navigate transphobic cultural contexts and systems (eg, unsupportive parents/caregivers, school staff, peers) may play a key factor in mental health disparities, such as increased risk of depression, anxiety, suicidal ideation, suicide attempts, and nonsuicidal self-harm. 1,2 These higher rates of mental health challenges among TGD youth offer an explanation as to why these youth access inpatient services significantly more frequently than cisgender peers. Research has found that TGD youth often experience discrimination during psychiatric inpatient admissions (eg, being misgendered during admission intake, facing stigmatization for an evolving gender identity, and receiving care from staff who have not been trained to provide gender-affirming care), 3 despite professional organizations, such as the American Academy of Child and Adolescent Psychiatry, underscoring the importance of TGD youth receiving psychiatric care that is inclusive and affirming. 4 Given that the inpatient setting offers a unique opportunity to facilitate positive and affirming changes for TGD youth, it is essential for providers to have a strong understanding of what affirmative care looks like within this context to best support this vulnerable patient population and reduce experiences of discrimination. [ABSTRACT FROM AUTHOR]

Background: The Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) is a well-established, clinically feasible measure of quality of life concerns when assessing relatively severe clinical populations of adult patients. To what degree might the Q-LES-Q-SF facilitate identifying quality of life concerns among parents of adolescents receiving outpatient services for psychosocial concerns for which parents are often involved in service delivery, such as social anxiety? Objective: We tested the Q-LES-Q-SF in a mixed-clinical/community sample of adolescents receiving a social anxiety evaluation and their parents. Method: We examined 134 adolescents aged 14–15 years old and their parents. Parents completed self-reports on the Q-LES-Q-SF as well as self-reports on several domains relevant to understanding their mental health. Further, parents completed reports about adolescent and family functioning known to contribute to psychosocial impairments linked to adolescent social anxiety. Results: We observed strong internal consistency estimates for the Q-LES-Q-SF. Scores taken from the Q-LES-Q-SF demonstrated significant links with survey measures designed to assess various domains of adolescent, parent, and family psychosocial functioning. Further, scores taken from the Q-LES-Q-SF uniquely related to measures of both adolescent and parent social anxiety. Conclusions: The findings support use of a short, clinically feasible measure (Q-LES-Q-SF) to assess quality of life among parents seeking mental health services for their adolescents. As such, the study informs future work that tests the ability of the Q-LES-Q-SF to screen for or identify parents whose quality of life may impact their involvement in the delivery of anxiety-related services to their adolescent. [ABSTRACT FROM AUTHOR]

Background: Integrated primary care (IPC) can address prevalent behavioral health concerns identified in pediatric office visits, but research on IPC consultation patterns is limited. Objective: This study investigated variation in consultation rates across presenting problems, patient sociodemographic factors, and IPC treatment duration. Method: Retrospective electronic health record data were extracted for 970 patients seen in 12 pediatric primary care sites and for whom behavioral health consultation was requested between June 2018 and December 2019. Logistic regressions were used to examine associations between sociodemographic variables, consultation reasons, and IPC visit type. We used multiple linear regression to assess the association between consultation reason and treatment duration. Results: Anxiety (36.2%) and disruptive behavior (29.7%) were the most common consultation reasons. Consultation requests for internalizing (anxiety, mood) problems were more prevalent in school-aged children and adolescents, whereas consultations for disruptive behavior (tantrums) and health-related issues (toileting, sleep concerns) were common in early childhood. Girls were less likely to receive consultation requests for attention deficit/hyperactivity disorder (ADHD) and autism/developmental concerns compared to boys, but more likely to receive consultation for internalizing problems. Consultation requests varied by patient race, ethnicity, visit type, and insurance type. Treatment duration after consultation was longer among patients with consultation requests for ADHD and for depression/mood concerns. Conclusions: Age-related behavioral health consultation patterns in IPC conform with expected developmental trends; however, sociodemographic findings suggest opportunities for enhancing care. Additional research is needed on IPC consultation given its promise for early identification, prevention, and treatment of pediatric mental health concerns. [ABSTRACT FROM AUTHOR]