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Mass violence incidents (MVIs) result in significant psychological distress for survivors and the broader community. Support services (mental health services, support groups, religious support) can buffer negative effects of MVIs and facilitate recovery. However, the extent to which community members are aware of and use support services post-MVIs is unknown. A probability sample of 5991 adults (M ean age = 45.6, SD = 17.6), mostly female (53%) and White (71%), were recruited from six communities that had experienced an MVI. Participants answered questions on their awareness and use of support services after the MVI and completed measures assessing predisposing, enabling, and need factors that may influence service use. Approximately 20% of participants reported they were aware of mental health services, 20% reported awareness of support groups, and 16% reported awareness of religious support. Younger participants with higher income (predisposing factors), high social support (enabling factor), and direct MVI exposure and psychological distress (need factors) were more likely to report awareness of support services. Of those aware of services, approximately 21% reported using support services. Those with direct MVI exposure and psychological distress were more likely to use each type of service. Otherwise, use of mental health services, support groups, and religious support varied across predisposing factors (race, age, income). Overall, findings suggest there is limited awareness of support services post-MVI, despite the well-documented mental health burden after these incidents. This suggests the need for improved communication about available services after MVIs. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? How do people with dementia living alone differ from those living with others, both cross-sectionally and longitudinally over a two-year period? • What is the main finding of this study? People living alone had better cognitive and functional ability than those living with others but experienced poorer physical, social, and psychological health and reduced quality of life, satisfaction with life, and well-being. These differences persisted over time, and they were more likely to move into long-term care. • What is the meaning of the finding? To facilitate continuing in place for people with dementia living alone requires a dual focus on supporting functional ability and addressing psychosocial needs, in the context of an enabling policy framework. To compare the experiences of people with dementia living alone or with others and how these may change over two years. We analysed longitudinal data from three assessment waves, one year apart, in the British IDEAL cohort. Participants with mild-to-moderate dementia were recruited through National Health Service providers, where possible with a family caregiver, and interviewed at home. The current analyses include 281 people with dementia living alone and 1,244 living with others at baseline; follow-up data were available for 200 and 965 respectively at time 2 and 144 and 696 respectively at time 3. For those living alone, 140 nonresident caregivers contributed at baseline, 102 at time 2 and 81 at time 3. For those living with others, 1,127 family caregivers contributed at baseline, 876 at time 2 and 670 at time 3. Assessments covered: cognitive and functional ability; self-reported perceptions of health, mood, social engagement, quality of life, satisfaction with life and well-being; use of in-home and community care; and transitions into residential care. People living alone tended to have better cognitive and functional ability and were more frequent users of in-home care. However, they experienced poorer physical, social, and psychological health and reduced quality of life, satisfaction with life, and well-being. These differences persisted over time and rates of transition into residential care were higher. To facilitate continuing in place for people with dementia living alone, a dual focus on supporting functional ability and add ressing psychosocial needs is essential in the context of an enabling policy framework. [ABSTRACT FROM AUTHOR]

Various intervention usage is associated with positive outcomes for children with autism. However, the intensity of these interventions tends to be below recommendations, especially for minoritized children. This study aimed to examine how average weekly intervention hours among children vary by sociodemographic factors. Regression analyses were conducted using data from 2,857 participants with autism included in the Simons Simplex Collection. Findings indicated the amount and type of intervention received varied by race, ethnicity, family income, and maternal education. This study marks an important step in documenting the extent of sociodemographic intervention disparities; and, helps to elucidate which therapy types are most readily underused and by which groups to help inform approaches to increase more equitable access. [ABSTRACT FROM AUTHOR]

Background: Evidence generated on utilization of maternal health services during times of conflict can inform the development of targeted interventions. The deadly war in Tigray caused the health system to collapse. However, utilization of maternal health services is not well documented that might help in design effective interventions applicable during armed conflict. Thus, this study aimed to assess maternal health service utilization and bridge the gap in healthcare provision and support during conflict.. Methods: A community-based cross-sectional survey was conducted among mothers of children under the age of 1 year in six accessible zones of Tigray from August 4–20, 2021. The study participants were selected through a random sampling method. The study was conducted during the armed conflict where the access to health services was limited due to the damaged and looted health facilities. A descriptive study was used to characterize the study population and data were presented using proportions and percentages. A Chi-square test was used for categorical variables and a P-value of 0.05 was considered significant.. Results: A total of 4,381 participants were included in the study. Modern contraceptives were used by 1002 (22.9%) of women, and injectable contraceptives were the most common method used by 472 (47.1%) women. Likewise, only 830 (36.5%),1956 (47.1%), and 623 (15.0%) respondents reported the use of optimal antenatal care (ANC), skilled delivery, and postnatal care (PNC) in the first 24 h by mothers, respectively. About 34% of women received comprehensive abortion care services. Most delivery services took place in hospitals. Residence has shown a significant difference in using maternal health services at p-value < 0.001. Conclusion: The conflict in Tigray has had a profound impact on maternal health services, resulting in a significant disruption that is disproportionately high in rural areas. Immediate action is required to provide access to lifesaving interventions for basic maternal health services. The timely initiation of these services is crucial in addressing the pressing needs of pregnant women and their infants. By implementing comprehensive and targeted interventions, we can mitigate the potential long-term consequences and ensure that maternal health services are effectively reinstated. [ABSTRACT FROM AUTHOR]

This study focused on differences for service utilization and satisfaction, along with perceived future service use and need for rural versus frontier residing older adults. A sample of older adults (age 65+), stratified using United States government and State of Wyoming definitions for rural (n = 70) and frontier (n = 72) counties, were interviewed. Frontier respondents indicated less education, monthly income, fewer financial resources, less experience with technology, decreased potential for telehealth, fewer computers, and less Internet access. Differences were evident for the use and need of services between the comparison groups with policy concerns identified. [ABSTRACT FROM AUTHOR]

Abstract Background Evidence generated on utilization of maternal health services during times of conflict can inform the development of targeted interventions. The deadly war in Tigray caused the health system to collapse. However, utilization of maternal health services is not well documented that might help in design effective interventions applicable during armed conflict. Thus, this study aimed to assess maternal health service utilization and bridge the gap in healthcare provision and support during conflict. . Methods A community-based cross-sectional survey was conducted among mothers of children under the age of 1 year in six accessible zones of Tigray from August 4–20, 2021. The study participants were selected through a random sampling method. The study was conducted during the armed conflict where the access to health services was limited due to the damaged and looted health facilities. A descriptive study was used to characterize the study population and data were presented using proportions and percentages. A Chi-square test was used for categorical variables and a P-value of 0.05 was considered significant. . Results A total of 4,381 participants were included in the study. Modern contraceptives were used by 1002 (22.9%) of women, and injectable contraceptives were the most common method used by 472 (47.1%) women. Likewise, only 830 (36.5%),1956 (47.1%), and 623 (15.0%) respondents reported the use of optimal antenatal care (ANC), skilled delivery, and postnatal care (PNC) in the first 24 h by mothers, respectively. About 34% of women received comprehensive abortion care services. Most delivery services took place in hospitals. Residence has shown a significant difference in using maternal health services at p-value

Abstract Background Mental disorders are a significant contributor to disease burden. However, there is a large treatment gap for common mental disorders worldwide. This systematic review summarizes the factors associated with mental health service use. Methods PubMed, Scopus, and the Web of Science were searched for articles describing the predictors of and barriers to mental health service use among people with mental disorders from January 2012 to August 2023. The initial search yielded 3230 articles, 2366 remained after removing duplicates, and 237 studies remained after the title and abstract screening. In total, 40 studies met the inclusion and exclusion criteria. Results Middle-aged participants, females, Caucasian ethnicity, and higher household income were more likely to access mental health services. The use of services was also associated with the severity of mental symptoms. The association between employment, marital status, and mental health services was inconclusive due to limited studies. High financial costs, lack of transportation, and scarcity of mental health services were structural factors found to be associated with lower rates of mental health service use. Attitudinal barriers, mental health stigma, and cultural beliefs also contributed to the lower rates of mental health service use. Conclusion This systematic review found that several socio-demographic characteristics were strongly associated with using mental health services. Policymakers and those providing mental health services can use this information to better understand and respond to inequalities in mental health service use and improve access to mental health treatment.

Abstract Background The prevalence of mental health conditions among women with HIV in Canada ranges between 29.5% and 57.4%, highlighting the need for accessible mental health care. We aimed to (1) describe the availability and use of mental health services among women with HIV and (2) identify characteristics associated with reporting that shortages of these services presented a problem in their care. Methods Baseline data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study were analysed. Self-reported availability and use of mental health services were examined using descriptive statistics. Participants indicated whether a lack of mental health support was a problem in their care. Logistic regression models were constructed to determine associations between sociodemographic, clinical, and psychosocial characteristics and reported problematic shortages. Results Of 1422 women, 26.7% (n = 380) used mental health services in the last year, which most accessed through their HIV clinic. Thirty-eight percent (n = 541) reported that a shortage of mental health support was a problem in their care. Among this subset, 22.1% (n = 119) used services at their HIV clinic, 26.5% (n = 143) reported available services but did not use them, and 51.4% (n = 277) either indicated that these services were unavailable, did not know if such services were available, or were unengaged in HIV care. Factors associated with reporting problematic shortages included rural residence [adjusted odds ratio (aOR): 1.69, 95% confidence interval (CI): 1.03–2.77], higher education level (aOR: 1.43, 95% CI: 1.02–2.02), and higher HIV stigma score (aOR: 1.03, 95% CI: 1.02–1.03). Conversely, African/Caribbean/Black identity (aOR: 0.37, 95% CI: 0.26–0.54), history of recreational drug use (aOR: 0.56, 95% CI: 0.39–0.81), and Quebec residence (aOR: 0.69, 95% CI: 0.50–0.96) were associated with lower odds of reporting service shortages. Conclusion Our findings highlight the HIV clinic as the primary location of mental health service use. However, existing services may not be sufficient to reach all patients or meet specific needs. Furthermore, the low uptake among those reporting a shortage suggests a lack of connection to services or patient knowledge about their availability. Characteristics associated with reporting shortages reflect geographic and socioeconomic disparities that must be accounted for in future service design.

Introduction: Alcohol's harm to others (AHTO) refers to harms caused to those other than the drinker. The current paper estimates the prevalence of formal and informal supports sought due to AHTO and examines whether the type of support accessed varies by sociodemographic, economic and harm‐related characteristics. Methods: An Australian sample of 2574 people completed the 2021 AHTO survey, out of which 888 perceived they experienced harm from another's drinking. Prevalence of accessing services and supports was measured. Additionally, several sociodemographic factors, economic factors and harm‐related factors were included in multivariable logistic regression models predicting service/support use. Specifically, four models were constructed probing use of any service/support, use of police, use of counselling services and use of family/friend support. Results: Of the survey sample, 12.4% accessed any support/service. Seeking support from family and/or friends was most common, followed by police, counselling, healthcare services and being admitted to hospital. Women had higher odds of accessing counselling and family/friend support. Respondents with a higher education level and two or more financial stressors had higher odds of accessing police and counselling. Respondents harmed by a stranger had higher odds of accessing police, whereas respondents harmed by someone they know had higher odds of seeking support from family/friends. Experiencing more severe harm was associated with greater odds of accessing any support. Discussion and Conclusions: Several sociodemographic and economic factors were associated with accessing different supports. These findings may inform service development, interventions and policy changes for people affected by others' drinking. [ABSTRACT FROM AUTHOR]

IntroductionMethodsResultsConclusionsGreater psychopathology among individuals with intellectual disabilities, as well as distress among their parents, are negatively associated with personal growth among the latter. This study examines the role of parents’ social support and their attitudes toward service use as mediators of the relationship between psychopathology among adolescents/young adults with intellectual disabilities and growth among their parents.Structured questionnaires which included measures of psychopathology of individuals with intellectual disabilities, parental distress, social support, attitudes toward service use and personal growth were completed by 195 parents of adolescents and young adults with intellectual disabilities or a dual diagnosis of intellectual disability and psychopathology.Parent’s perception of the adolescent/young adult’s emotional state and social support were found to be associated with personal growth. Social support was found to mediate the relationships between the adolescent/young adult’s psychopathology and parental distress and personal growth. Parents’ attitudes toward use of services were not found to be related to growth.Social support plays a pivotal role in the lives of parents of individuals with intellectual disabilities. Professionals working with individuals with intellectual disabilities should seek to enhance social support for their parents. [ABSTRACT FROM AUTHOR]

Background: Mental disorders are a significant contributor to disease burden. However, there is a large treatment gap for common mental disorders worldwide. This systematic review summarizes the factors associated with mental health service use. Methods: PubMed, Scopus, and the Web of Science were searched for articles describing the predictors of and barriers to mental health service use among people with mental disorders from January 2012 to August 2023. The initial search yielded 3230 articles, 2366 remained after removing duplicates, and 237 studies remained after the title and abstract screening. In total, 40 studies met the inclusion and exclusion criteria. Results: Middle-aged participants, females, Caucasian ethnicity, and higher household income were more likely to access mental health services. The use of services was also associated with the severity of mental symptoms. The association between employment, marital status, and mental health services was inconclusive due to limited studies. High financial costs, lack of transportation, and scarcity of mental health services were structural factors found to be associated with lower rates of mental health service use. Attitudinal barriers, mental health stigma, and cultural beliefs also contributed to the lower rates of mental health service use. Conclusion: This systematic review found that several socio-demographic characteristics were strongly associated with using mental health services. Policymakers and those providing mental health services can use this information to better understand and respond to inequalities in mental health service use and improve access to mental health treatment. [ABSTRACT FROM AUTHOR]

Background: The prevalence of mental health conditions among women with HIV in Canada ranges between 29.5% and 57.4%, highlighting the need for accessible mental health care. We aimed to (1) describe the availability and use of mental health services among women with HIV and (2) identify characteristics associated with reporting that shortages of these services presented a problem in their care. Methods: Baseline data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study were analysed. Self-reported availability and use of mental health services were examined using descriptive statistics. Participants indicated whether a lack of mental health support was a problem in their care. Logistic regression models were constructed to determine associations between sociodemographic, clinical, and psychosocial characteristics and reported problematic shortages. Results: Of 1422 women, 26.7% (n = 380) used mental health services in the last year, which most accessed through their HIV clinic. Thirty-eight percent (n = 541) reported that a shortage of mental health support was a problem in their care. Among this subset, 22.1% (n = 119) used services at their HIV clinic, 26.5% (n = 143) reported available services but did not use them, and 51.4% (n = 277) either indicated that these services were unavailable, did not know if such services were available, or were unengaged in HIV care. Factors associated with reporting problematic shortages included rural residence [adjusted odds ratio (aOR): 1.69, 95% confidence interval (CI): 1.03–2.77], higher education level (aOR: 1.43, 95% CI: 1.02–2.02), and higher HIV stigma score (aOR: 1.03, 95% CI: 1.02–1.03). Conversely, African/Caribbean/Black identity (aOR: 0.37, 95% CI: 0.26–0.54), history of recreational drug use (aOR: 0.56, 95% CI: 0.39–0.81), and Quebec residence (aOR: 0.69, 95% CI: 0.50–0.96) were associated with lower odds of reporting service shortages. Conclusion: Our findings highlight the HIV clinic as the primary location of mental health service use. However, existing services may not be sufficient to reach all patients or meet specific needs. Furthermore, the low uptake among those reporting a shortage suggests a lack of connection to services or patient knowledge about their availability. Characteristics associated with reporting shortages reflect geographic and socioeconomic disparities that must be accounted for in future service design. [ABSTRACT FROM AUTHOR]

Refugees experience elevated rates of mental health problems, but little is known about mental health service utilization and quality among asylum seekers and refugees in Europe. In a 12‐month follow‐up study of newly arrived refugees (N = 166, Mage = 32.38 years, 30.7% female) and a nationwide cross‐sectional study (N = 579, Mage = 33.89 years, 36.2% female) of refugees who had been living in Germany for an average of 6 years, we examined objective need for mental health treatment, perceived need, access to treatment services, and adequacy of treatment. We defined minimally adequate mental health treatment according to the WHO World Mental Health Survey as ≥8 sessions of psychotherapy (minimally adequate psychotherapy) or pharmacotherapy plus ≥4 medical visits (minimally adequate pharmacotherapy). In both studies, two in three individuals screened for mental health symptoms and additionally perceived a need for professional treatment. Of those, less than half had contact to any service provider, with only 1 in 14 receiving minimally adequate psychotherapy. Overall, no more than one in seven of refugees in need received minimally adequate treatment. Despite a comprehensive mental health‐care system, refugees' access to mental health care and the treatment provided are inadequate. Health policies are urgently needed to provide equitable mental health care for all. [ABSTRACT FROM AUTHOR]

This qualitative study explored reasons for high emergency department (ED) use (3 + visits/year) among 299 patients with mental disorders (MD) recruited in four ED in Quebec, Canada. A conceptual framework including healthcare system and ED organizational features, patient profiles, and professional practice guided the content analysis. Results highlighted insufficient access to and inadequacy of outpatient care. While some patients were quite satisfied with ED care, most criticized the lack of referrals or follow-up care. Patient profiles justifying high ED use were strongly associated with health and social issues perceived as needing immediate care. The main barriers in professional practice involved lack of MD expertise among primary care clinicians, and insufficient follow-up by psychiatrists in response to patient needs. Collaboration with outpatient care may be prioritized to reduce high ED use and improve ED interventions by strengthening the discharge process, and increasing access to outpatient care. [ABSTRACT FROM AUTHOR]

Background: Youth involved in child welfare have high rates of mental health problems and are known to receive mental health services from multiple settings. Still, gaps remain in our understanding of service use patterns across settings over the course of youth's involvement with child welfare. Objective: To examine the settings, reasons for contact, persons involved in initiating care, and timing of each mental health service contact for individuals over their involvement with the child welfare system, and to identify factors that predict multi-setting use. Methods: Data on mental health service contacts were collected retrospectively from charts for youth aged 11-18 (n=226) during their involvement with child welfare services in Montreal, Quebec. Logistic regression analysis was conducted to determine predictors of multi-setting mental health services use (defined as =3 settings). Results: 83% of youth had at least one mental health service contact over the course of their child welfare services follow-up, with 45% having multi-setting use. Emergency Departments were the top setting for mental health services. Youth with a higher number of placements and from neighborhoods with greater social and material deprivation were significantly likelier to use =3 mental health service settings over the course of their followup. Conclusion: These findings suggest a need for enhanced collaboration between youth-serving sectors to ensure that continuous and appropriate mental health care is being offered to youth followed by child welfare systems. The relationship between placement instability and multi-setting mental health service use calls for specific policies to ensure that young people do not experience multiple discontinuities of care. [ABSTRACT FROM AUTHOR]

Background Mental health problems, particularly anxiety and depression, are common in patients with chronic kidney disease (CKD) and negatively impact quality of life, treatment adherence and mortality. However, the degree to which mental health and addiction services are utilized by those with CKD is unknown. We examined the history of mental health and addiction service use of individuals across levels of kidney function. Methods We performed a population-based cross-sectional study using linked healthcare databases from Ontario, Canada from 2009 to 2017. We abstracted the prevalence of individuals with mental health and addiction service use within the previous 3 years across levels of kidney function [estimated glomerular filtration rate (eGFR) ≥60, 45 to <60, 30 to <45, 15 to <30, <15 ml/min/1.73 m2 and maintenance dialysis]. We calculated prevalence ratios (PRs) to compare prevalence across kidney function strata, while adjusting for age, sex, year of cohort entry, urban versus rural location, area-level marginalization and Charlson comorbidity index. Results Of 5 956 589 adults, 9% (n  = 534 605) had an eGFR <60 ml/min/1.73 m2 or were receiving maintenance dialysis. Fewer individuals with an eGFR <60 ml/min/1.73 m2 had a history of any mental health and addiction service utilization (crude prevalence range 28–31%) compared with individuals with an eGFR ≥60 ml/min/1.73 m2 (35%). Compared with an eGFR ≥60 ml/min/1.73 m2, the lowest prevalence of individuals with any mental health and addiction service utilization was among those with an eGFR of 15 to <30 ml/min/1.73 m2 {adjusted PR 0.86 [95% confidence interval (CI) 0.85 to 0.88]}, an eGFR <15 ml/min/1.73 m2 [adjusted PR 0.81 (95% CI 0.76–0.86)] and those receiving maintenance dialysis [adjusted PR 0.83 (95% CI 0.81–0.84)]. Less use of outpatient services accounted for differences in service utilization. Conclusions Mental health and addiction service utilization is common but less so in individuals with advanced CKD in Ontario, Canada. [ABSTRACT FROM AUTHOR]

Background: The population of people with dementia increases yearly, imposing a growing burden on family caregivers. Psychological distress impacts the mental health of family caregivers of people with dementia. Caregiver psychological distress can result in increased social resource utilisation and unmet multicare needs. Purpose: The study explored the psychological distress of family caregivers of people with dementia and examined the impact on social resource utilisation and multicare needs. Methods: A descriptive‐correlational study collected data in Taiwan from a cross‐sectional sample of family caregivers of people with dementia using a self‐report questionnaire. Data were analysed using linear and logistic regression. Results: A total of 301 caregivers provided data for analysis. Nearly two‐thirds of caregivers were female with a mean age of 57 years old (SD = 12). Over half of the family caregivers of people with dementia experienced mild‐to‐moderate psychological distress. The greater the psychological distress, the greater the probability of using social resources (1.09 times per 1‐point increase, p = 0.002). Psychological distress was positively associated with the number of caregivers' care needs (β = 0.371, p < 0.001). Conclusions: Findings of this study can assist healthcare professionals in better understanding the psychological distress and care needs of caregivers. Services designed to meet the needs of family caregivers will improve psychological distress. [ABSTRACT FROM AUTHOR]

Background As populations age, frailty and the associated demand for health care increase. Evidence needed to inform planning and commissioning of services for older people living with frailty is scarce. Accurate information on incidence and prevalence of different levels of frailty and the consequences for health outcomes, service use and costs at population level is needed. Objectives To explore the incidence, prevalence, progression and impact of frailty within an ageing general practice population and model the dynamics of frailty-related healthcare demand, outcomes and costs, to inform the development of guidelines and tools to facilitate commissioning and service development. Study design and methods A retrospective observational study with statistical modelling to inform simulation (system dynamics) modelling using routine data from primary and secondary health care in England and Wales. Modelling was informed by stakeholder engagement events conducted in Hampshire, England. Data sources included the Royal College of General Practitioners Research and Surveillance Centre databank, and the Secure Anonymised Information Linkage Databank. Population prevalence, incidence and progression of frailty within an ageing cohort were estimated using the electronic Frailty Index tool, and associated service use and costs were calculated. Association of frailty with outcomes, service use and costs was explored with multistate and generalised linear models. Results informed development of a prototype system dynamics simulation model, exploring population impact of frailty and future scenarios over a 10-year time frame. Simulation model population projections were externally validated against retrospective data from Secure Anonymised Information Linkage. Study population The Royal College of General Practitioners Research and Surveillance Centre sample comprised an open cohort of the primary care population aged 50 + between 2006 and 2017 (approx. 2.1 million people). Data were linked to Hospital Episode Statistics data and Office for National Statistics death data. A comparable validation data set from Secure Anonymised Information Linkage was generated. Baseline measures Electronic Frailty Index score calculated annually and stratified into Fit, Mild, Moderate and Severe frailty categories. Other variables included age, sex, Index of Multiple Deprivation score, ethnicity and Urban/rural. Outcomes Frailty transitions, mortality, hospitalisations, emergency department attendances, general practitioner visits and costs. Findings Frailty is already present in people aged 50–64. Frailty incidence was 47 cases per 1000 person-years. Frailty prevalence increased from 26.5% (2006) to 38.9% (2017). Older age, higher deprivation, female sex, Asian ethnicity and urban location independently predict frailty onset and progression; 4.8% of ‘fit’ people aged 50–64 years experienced a transition to a higher frailty state in a year, compared to 21.4% aged 75–84. Individual healthcare use rises with frailty severity, but Mild and Moderate frailty groups have higher overall costs due to larger population numbers. Simulation projections indicate frailty will increase by 7.1%, from 41.5% to 48.7% between 2017 and 2027, and associated costs will rise by £5.8 billion (in England) over an 11-year period. Conclusions Simulation modelling indicates that frailty prevalence and associated service use and costs will continue to rise in the future. Scenario analysis indicates reduction of incidence and slowing of progression, particularly before the age of 65, has potential to substantially reduce future service use and costs, but reducing unplanned admissions in frail older people has a more modest impact. Study outputs will be collated into a commissioning toolkit, comprising guidance on drivers of frailty-related demand and simulation model outputs. Study registration This study is registered as NCT04139278 www.clinicaltrials.gov. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/116/43) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 44. See the NIHR Funding and Awards website for further award information. Plain language summary Why was this research needed? More people are living longer with long-term medical conditions or disabilities. They are more likely to be admitted to hospital and need health care. People with these vulnerabilities are living with ‘frailty’, which can be mild, moderate or severe. Our research is aimed to produce information on how common frailty is, how it changes over time, what can influence it getting worse, and how it will impact our future population. What did we do? We analysed two large data sets from England and Wales (2006–17) to find out the numbers of people aged 50 + living with frailty, their characteristics (e.g. age, sex, living in deprived areas) and how these influenced frailty occurring and worsening. We explored how often they used general practitioner/hospital services and how much that cost. This information was used in a computer model to predict what would happen in the future. What did we find? The proportion of people with frailty increased from 26.5% in 2006 to 38.9% in 2017, including large increases in people with mild and moderate frailty. Older age, female sex, Asian ethnicity, and living in more deprived or urban areas, all increased the risk of someone becoming frail, and of their frailty worsening. The large numbers of people with mild and moderate frailty led to the highest costs overall. The computer model predicted that the proportion of people with frailty will increase by another 7.1% between 2017 (41.5%) and 2027 (48.7%), and associated costs will rise by £5.8 billion over an 11-year period. What does this mean? We have estimated how the number of people with frailty and their use of services will continue to rise in the future. Taking action to reduce people’s risk of becoming frail, particularly before age 65, and slowing frailty progression can reduce the need for services. We will report this information to people who plan health care so they can provide more effective care for people with frailty. Scientific summary Background As the population ages, prevalence of frailty and associated demand for health care in both primary and secondary care settings will rise. Identification and clinical management of frailty are a priority, but capacity and resources for delivery remain limited. There is an evidence gap in relation to the planning, commissioning and delivery of services for older people living with frailty and questions remain about the incidence and prevalence of different levels of frailty and the consequences for health outcomes, service use and costs. Objectives The overarching aim of this study was to explore the incidence, prevalence, progression and impact of frailty within the ageing population. The specific study objectives were to: identify incidence and prevalence of frailty states in an ageing population; identify frailty trajectories and transitions in severity in the older population over time; explore drivers of progression of frailty, including clinical, socio-economic and demographic factors; examine the impact of frailty on service use, costs and pathways of care; explore the relationship between frailty status, socioeconomic factors, practice factors and service use and outcomes (mortality, unplanned admissions, residential care use); and predict trends in frailty, modelling of health and care demand and costs over time and in different service contexts. The final aim of these analyses was to inform the development of guidelines and tools to facilitate commissioning and service development, thus providing an evidence-based approach to planning primary and secondary care services for patients aged 50 and over with different levels of frailty. Study design and methods This study used a retrospective observational study design with statistical modelling to inform simulation (system dynamics) modelling using routine healthcare data from primary and secondary care. Retrospective data were used to determine population prevalence, incidence and progression of frailty within an ageing cohort using the electronic Frailty Index (eFI) tool and data from the English Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) databank, with additional data from the Welsh Secure Anonymised Information Linkage (SAIL) Databank. Associated service use and costs were determined from linked routine data. Statistical analysis of the RCGP RSC data involved both descriptive summaries as well as multistate modelling to identify key socioeconomic variables (e.g. age, gender, deprivation, ethnicity) that are independently associated with frailty. A cost analysis of both primary and secondary care data was also conducted using generalised linear models to identify factors associated with costs and provide estimates of adjusted mean costs, by frailty and age categories. Five stakeholder engagement group (SEG) sessions were held at appropriate times throughout the study period to seek input from a broad range of health and care professionals and commissioners, members of the general public, patients and carers. These sessions focused on different aspects of the research as the project evolved, starting with the type of services available for people living with frailty and who would use them, to gaining feedback on ongoing analyses and ways of presenting the results, to informing and appraising the developing simulation model and suggesting scenarios that could be applied. Information from the statistical modelling as well as that gathered during patient and professional stakeholder events was used to inform the development of a system dynamics simulation model which could be used to examine the incidence, and progression of frailty in the 50 and over population. An initial model was developed and validated with the RCGP RSC data before further external validation against a comparable large data set from SAIL. The simulation was further adapted to use Office for National Statistics (ONS) population estimates for England, thus allowing exploration of future population trends in frailty prevalence and health service impact over a 10-year period following 2017. As one of the benefits of simulation modelling is to consider ‘what-if’ scenarios, the baseline simulation model was used to explore future trends in frailty prevalence and the associated primary and secondary care demand if present trends continue. Further ‘what-if’ scenarios exploring the impact of reduced frailty incidence, slowed frailty progression and reduced unplanned hospitalisation were carried out. Study population The primary data source for the study was the RCGP RSC, providing primary care data from England. The sample comprised an open cohort of the primary care population aged 50 and over (approx. 1.1 million people) during the year 2006, rising to 1,491,954 in 2017, with a total of 2.1 million people included overall and 15.5 million person-years of data. The data were linked to Hospital Episode Statistics (HES) secondary care data and ONS death registry data. A comparable data set from Wales, provided by SAIL, was used for external validation of the simulation model and included approximately 1.3 million people and 11 million person-years of data. Baseline measures The eFI score was calculated for all adults aged 50 +, with scores recalculated at 12-month intervals for the study period. The population was stratified into Fit, Mild, Moderate and Severe frailty groups according to their eFI score [Fit: (0–0.12); Mild: (0.13–0.24); Moderate: (0.25–0.36); Severe: (> 0.36)]. Other variables included age, sex, Index of Multiple Deprivation (IMD) score, ethnicity, long-term condition diagnoses, urban/rural indicators, practice size. Outcomes Frailty transitions, mortality, primary care [general practice surgery and home visits, telephone and electronic consultations, and individual medicines], secondary care [ambulance calls, emergency department (ED) attendances, critical care admissions, hospitalisations (unplanned and elective) and outpatient appointments] and care home residence. Costs were estimated for primary and secondary care and total care service use for the different frailty categories over 12 years. The influence of frailty on outcomes, service use and costs was explored using the RCGP RSC databank and via multistate and generalised linear models. These analyses along with information gathered during stakeholder events were used to inform the development of a prototype system dynamics simulation model (implemented in AnyLogic software) to explore the development and impact of frailty in the population and likely future scenarios over a 10-year time frame. The simulation model population projections were externally validated against retrospective data from the SAIL data set. The prototype simulation model was further adapted to use ONS population estimates for England, thus enabling population level projections of frailty in those aged 50 and over for a 10-year period following 2017. Baseline (‘no service changes’) projections of both the prevalence of frailty in the population and the associated primary, secondary and residential care use were examined over the period 2017–27. ‘What-if’ scenarios exploring the impact of reduced frailty incidence, slowed frailty progression and reduced unplanned hospitalisations were carried out. Findings Frailty is already present in those aged 50–64, with approximately 10% of this age group having mild, moderate or severe frailty at baseline. The overall incidence of frailty in people aged 50 + was 47 cases per 1000 person-years at risk (PYAR). Mortality increased with age and frailty severity. The overall prevalence of frailty increased from 26.5% to 38.9% over the 12-year study period, with the greatest change in prevalence in the mild and moderate frailty categories. At least one transition between frailty categories was observed in 32.7% (n = 709,377) of the cohort over a median follow-up of 7 years. The average age of transition from fit to mild was 69 years, fit/mild to moderate was 77 years and any category to severe was 81 years. In order of impact, older age, higher deprivation, female sex, Asian ethnicity and urban location are independent predictors of frailty onset and progression. For example, 4.8% of people aged 50–64 in the Fit category will experience a transition to a higher frailty state in a 12-month period, as compared to 21.4% in people aged 75–84. Trends in primary and secondary care service use were observed within frailty categories and age groups. Mean face-to-face appointments were generally similar within frailty categories across age groups, but with a notable decrease in appointments with older age in the severe category. Prescriptions increased with increasing age in both Fit and Mild frailty categories but decreased in moderate and severe categories. When stratified by age, mean annual outpatient appointments, ED attendances and hospital admissions (both elective and unplanned) were similar across age groups within the Fit and Mild categories, and decreased with increasing age in the moderate and severe categories. Individual annual total use of primary and secondary care services rise with frailty severity, but overall costs for people living with frailty are highest in the mild and moderate frailty groups due to their larger population numbers. An approximate doubling in costs was observed between fit and mild frailty categories, a trebling for moderate frailty, and quadrupling for severe frailty. Stakeholder engagement established that in addition to core primary and secondary care services, future work will need to consider additional community health care and social care services to provide a more complete overview of total care use and costs, while acknowledging that data on these services is more difficult to obtain. A focus on having the right services at the right time, for example preventative and well-being services for middle-aged adults to reduce onset of frailty, and supportive services for older adults to slow frailty progression and enable continued independence and hospital avoidance were discussed. The role of health inequalities and deprivation as demonstrated by the analyses was considered key to diversify service planning according to local needs. Simulation modelling has provided a useful means of capturing both the statistical modelling and cost analysis elements of the study along with the suggestions from both the patient and professional members involved in the stakeholder events. The development of the model with 16 connected subgroups and connected flows in and out of the groups has been an iterative approach and has benefited from the information contained in the two large data sets (RCGO RSC and SAIL) as well as ONS population estimates and projections. The system dynamics (SD) model has been extensively validated against summary descriptive data from the RCGP RSC cohort (with a 6.9% error) and externally against a similar data set from SAIL (9.3% error) before being scaled up (using ONS estimates for the number of people entering the 50 + population and those turning 65, 75 or 85 in a given year) to consider how frailty incidence and prevalence at a national population level could be represented over the period of the cohort study (2006–17) and 10 years into the future. The prototype simulation model is therefore able to consider the estimated frailty dynamics for England as well as the associated service use and costs in both baseline and ‘what-if’ scenarios. A baseline (no service changes) scenario experiment suggests what might happen if there is no change to current service provision and interventions caring for the population aged 50 and over (which is projected to increase from 20,045,766 to 21,755,097 between 2017 and 2027). Preliminary results suggest a projected increase in primary care service use and medication use with the cost for providing GP services and individual medicines in England rising by £3.1 billion for people with frailty. For secondary care, the rise in costs is estimated to be £2.7 billion for patients with frailty. The simulation predicted that the proportion of people with frailty will increase by another 7.1% between 2017 (41.5%) and 2027 (48.7%), and associated costs will rise by £5.8 billion over an 11-year period. A scenario experiment exploring reducing frailty incidence by 5% indicates that almost 180,000 people remain fit each year rather than becoming frail (121,000 fewer mildly frail people, 27,500 fewer moderately frail and 12,800 fewer severely frail), which in turn could result in almost 300,000 fewer GP consultations (in the first year of the intervention) among the mildly frail and 14,000 fewer would be needed by those with moderate and severe frailty. In relation to secondary care services, there would be 114,000 fewer events among those that are mildly frail and an extra 57,000 among those that are fit. This would result in 5.3 million fewer secondary care service events in those with some degree of frailty over the projected 10-year period. Reducing frailty incidence could result in 26,418 fewer unplanned admissions and 47,506 fewer elective admissions. The cost savings from all these service use changes could amount to £266 million per annum by 2027. A scenario experiment exploring a reduction in frailty progression indicates that almost 222,000 people remain mildly frail each year rather than becoming moderately or severely frail (68,200 fewer moderately frail and 110,000 fewer severely frail). The corresponding impact on primary care service use is projected to be 623,700 fewer GP consultations (face-to-face, telephone, home visits and e-consultations) per annum in 2027. In relation to secondary care services there could be 64,111 fewer Accident and Emergency (A&E) attendances, 1540 fewer admissions to critical care and 350,762 fewer outpatient appointments as well as 53,162 fewer unplanned admissions and 54,283 fewer elective admissions. The cost savings from all these service use changes could amount to £298.9 million per annum by 2027. A scenario experiment considering reducing the number of unplanned hospital admissions among patients with frailty by 5% indicates 89,000 fewer hospital admissions. The cost saving from this service use change could amount to £153.8 million per annum by 2027. Findings will be used to inform guidelines and recommendations for service providers and commissioners. Conclusions This study provides new and robust evidence on incidence, prevalence and progression of frailty in an ageing population, in particular highlighting that frailty is already present in those aged 50–64 and that healthcare use and costs related to older people with frailty are substantial. The statistical modelling suggests that age, sex, deprivation, ethnicity and urban/rural location are all independently associated with frailty onset and progression and costs. The large increases in individual costs with more severe frailty need to be considered together with overall population prevalence of frailty categories, and the larger overall total costs of care for people with mild or moderate frailty need to be taken into account when deciding which services would be most cost-effective. The simulation model provides projections of frailty prevalence and associated service use and costs over 10 years. Frailty prevalence, service use and costs will continue to rise in the future due in part to the ageing population. Scenario analyses indicate that reduction of incidence and slowing of progression, particularly before the age of 65, has potential to reduce future service demand in both primary and secondary care settings. For example, in relation to primary care, reducing frailty incidence in all age groups could result in reduced GP consultations and home visits as well as fewer medicines used. In secondary care settings, there could also be reductions in ED attendances, hospital admissions and outpatient appointments. Reducing unplanned hospitalisations in older people with frailty would have a more modest impact on costs. The outputs and findings from each element of the study will be collated into a commissioning toolkit, comprising guidance on drivers of frailty-related demand and simulation model outputs that can be used for prediction of future demand and exploration of different service scenarios. Study registration This study is registered as NCT04139278 www.clinicaltrials.gov. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/116/43) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 44. See the NIHR Funding and Awards website for further award information.

ObjectivesSmall area analysis is a health services research technique that facilitates geographical comparison of services supply and utilization rates between health service areas (HSAs). HSAs are functionally relevant regions around medical facilities within which most residents undergo treatment. We aimed to identify HSAs for psychiatric outpatient care (HSA-PSY) in Switzerland.MethodsWe used HSAr, a new and automated methodological approach, and comprehensive psychiatric service use data from insurances to identify HSA-PSY based on travel patterns between patients' residences and service sites. Resulting HSA-PSY were compared geographically, demographically and regarding the use of inpatient and outpatient psychiatric services.ResultsWe identified 68 HSA-PSY, which were reviewed and validated by local mental health services experts. The population-based rate of inpatient and outpatient service utilization varied considerably between HSA-PSY. Utilization of inpatient and outpatient services tended to be positively associated across HSA-PSY.ConclusionsWide variation of service use between HSA-PSY can hardly be fully explained by underlying differences in the prevalence or incidence of disorders. Whether other factors such as the amount of services supply did add to the high variation should be addressed in further studies, for which our functional mapping on a small-scale regional level provides a good analytical framework.

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]

As permanent supportive housing (PSH) is the main strategy promoted to reduce homelessness, understanding how PSH resident profiles may be differentiated is crucial to the optimization of PSH implementation – and a subject that hasn't been studied yet. This study identified PSH resident profiles based on their housing conditions and service use, associated with their sociodemographic and clinical characteristics. In 2020–2021, 308 PSH residents from Quebec (Canada) were interviewed, with K-means cluster analysis produced to identify profiles and subsequent analyses to compare profiles and PSH resident characteristics. Of the three profiles identified, Profiles 1 and 2 (70% of sample) showed moderate or poor housing, neighborhood, and health conditions, and moderate or high unmet care needs and service use. Besides their "moderate" conditions, Profile 1 residents (52%) reported being in PSH for more than two years and being less educated. With the "worst" conditions and high service use, Profile 2 (18%) included younger individuals, while Profile 3 (30%) showed the "best" conditions and integrated individuals with more protective determinants (e.g., few in foster care, homelessness at older age, more self-esteem), with a majority living in single-site PSH and reporting higher satisfaction with support and community-based services. Profiles 1 and 2 may be provided with more psychosocial, crisis, harm reduction, and empowerment interventions, and peer helper support. Profile 2 may benefit from more intensive and integrated care, and better housing conditions. Continuous PSH may be sustained for Profile 3, with regular monitoring of service satisfaction and met needs. [ABSTRACT FROM AUTHOR]

A few epidemiological studies have examined personality disorders (PDs) among children and adolescents in secondary mental health services. This study aims to describe the prevalence and incidence of PDs among children and adolescents who have attended Danish child and adolescent psychiatric services (CAPS). Using register-based data, we studied all patients under the age of 18 years who were admitted to in- and outpatient CAPS (N = 115,121) in Denmark from 2007 to 2017. A total of 4952 patients were diagnosed with a PD during the study period. The mean prevalence was 859 patients per year, and the mean incidence was 274 patients per year, including an increased incidence and prevalence of borderline, anxious, and unspecified PDs over the decade. The number of patients diagnosed with PDs increased from 700 to 851 per year, but the proportion of patients with PDs compared to all psychiatric diagnoses decreased from 4.2% to 2.8% over the study period. The PD population had an older age (14.8 years vs. 11.3 years; p < 0.001), a higher likelihood of being female (74% vs. 44%; p < 0.001), and four times more contacts with the psychiatric emergency departments than other patients with a psychiatric diagnosis. Future studies should focus on (a) implementing further epidemiological studies in different countries; (b) tracking diagnostic practices to facilitate comparisons and provide feedback for training clinicians and raising awareness; and (c) estimating trajectories of PDs, including costs within the CAPS, to facilitate informed decision-making regarding the future organization and provision of services to these children, adolescents, and their families. [ABSTRACT FROM AUTHOR]

The growing number of autistic adults challenges the limited adult service system. While data on service use and barriers are available, there is limited information from the individual's perspective on which services are most helpful in adulthood and how service use is connected to community participation outcomes. Forty autistic adults participated in a study combining global positioning system community participation measures with survey and interview data on service use, including which services are most helpful in adulthood, barriers to services, and service needs. Participation outcomes were analyzed relative to demographics, number and types of services received in the past 2 years, and current mental health service use. Participants received an average of two services in the past 2 years, most frequently mental health and employment services. Individuals currently seeing a mental health counselor were more likely to be working full-time and visit more community locations compared to those who were not seeing a counselor. Participants reported mental health services as the most helpful service received in adulthood followed by employment services. While an emphasis is often placed on employment services in the transition to adulthood, findings suggest a need for integrated mental health and employment services for autistic adults. The number of autistic adults is growing, but there are fewer services to support them in adulthood. Many autistic adults need some support services to lead successful adult lives. We know a lot about the services autistic adults use and some of the problems with using these services, but we do not know which services are most helpful to them and how the services they use relate to how they interact with their communities. Forty autistic adults took part in a study about service use and community participation. They completed surveys, interviews, and carried a global positioning system tracker. They answered questions about which services are most helpful in adulthood, things that make it hard to use services, and what services they needed. Most participants used two services in the past 2 years, most frequently mental health and employment services. Adults who were currently seeing a mental health counselor were more likely to be working full-time and visit more locations in the community compared to those who were not seeing a counselor. Mental health services were reported as the most helpful service they received as adults, followed by employment services. We often focus on the importance of employment services after high school, but our findings show a need for both mental health and employment services for autistic adults. [ABSTRACT FROM AUTHOR]

AbstractThis study aimed to describe university students’ use of mental health services and the barriers to help-seeking by sexual orientation and gender identity and to examine the factors related to these variables. A total of 7,136 first-year students from five Chilean universities participated. They answered an online survey on mental health service use, barriers to help-seeking, 12-month mental disorders, and sociodemographic variables. Data were analyzed using logistic and negative binomial regression models. Lesbian, gay, bisexual, trans, questioning, and other sexual and gender minority (LGBTQ+) students, especially trans and gender non-conforming participants, reported higher mental health service use than non-LGBTQ+ students. Sexual minority students were less likely to report the help-seeking barriers "prefer to handle on one’s own" and "talk with friends/family", but were more likely to report the barriers "cost", "unsure where to go", and "time, transportation, or scheduling problems". Some variables were associated with service use and barriers in both groups (e.g. lower parental education was associated with lower service use), while others were only associated with one group (e.g. non-LGBTQ+ women reported higher service use). These results suggest that initiatives aimed at promoting access to mental health services should be tailored to different subpopulations of university students. [ABSTRACT FROM AUTHOR]

Aims and method: We aimed to estimate the costs of care for people with a personality disorder diagnosis and compare service use and costs for those receiving specialist input and those receiving generic care. Service use data were obtained from records and costs calculated. Comparisons were made between those who received care from specialist personality disorder teams and those who did not. Demographic and clinical predictors of costs were identified with regression modelling. Results: Mean total costs before diagnosis were £10 156 for the specialist group and £11 531 for the non-specialist group. Post-diagnosis costs were £24 017 and £22 266 respectively. Costs were associated with specialist care, comorbid conditions and living outside of London. Clinical implications: Receiving increased support from a specialist service may reduce the need for in-patient care. This may be clinically appropriate and results in a distribution of costs. [ABSTRACT FROM AUTHOR]

This scoping review examined the methodologies used to measure access to care in serious injury-related disability populations, for whom access to care post-discharge has significant implications for patient outcomes and rehabilitation trajectories. Four electronic databases were searched for literature published between 1 January 2000 and 15 February 2022. Relevant articles needed to relate to access to care in adult community-dwelling trauma and rehabilitation populations. The initial search identified 679 articles. Following de-duplication, the title/abstract screening was completed on 533 articles, and 56 full-text articles were reviewed. Thirty-eight articles met the eligibility criteria and were included in this review. Of the 38 studies included, there was large heterogeneity in the methodologies used to measure access to care. Two articles used multidimensional measures of access to care. There is an urgent need to establish the use of multidimensional measures as standard practice in access-to-care research. Failure to account for the multidimensional nature of access to care limits the full realisation of access for people with serious injury-related disability and prevents the implementation of processes that could improve access to health, rehabilitation, and support services and enhance the quality of care for individuals with a serious injury-related disability. A consistently comprehensive approach to rehabilitation research will provide clearer insight into users' experiences and how to optimise their engagement with services. Multidimensional measures of access to care need to be developed, validated, and used to capture the complexity of access to rehabilitation care and what is important to users. More comprehensive evidence can strengthen consensus on the gold standard of what must be included in the measurement of access to rehabilitation care, to improve service reach and relevance. [ABSTRACT FROM AUTHOR]

Severe, prolonged early deprivation is associated with later neurodevelopmental difficulties. Despite elevated levels of contact with service providers, these problems often persist into adult life and are associated with impairment in adulthood (e.g., unemployment, higher rates of depression and anxiety symptoms and poorer subjective wellbeing). Here, we aimed to explore the ongoing service needs and experiences of adoptees and their parents from the English and Romanian Adoptees (ERA) study, in those with a history of early deprivation and neurodevelopmental problems. Our descriptive thematic analysis highlighted difficulties with independent living, particularly financial management and problems with decision-making. Where specific forms of support had been accessed (e.g., medication for attention-deficit/hyperactivity disorder) they were often helpful, although there was some ambivalence towards taking medication due to side effects. However, the neurodevelopmental problems were not well understood and were often overlooked by service providers. There is a need for greater awareness among frontline service providers of the neurodevelopmental impact of early adversity. Participants also identified that their support needs were largely unmet and that their parents were having to fill this gap. Similarities and differences between the experiences highlighted here and those identified with idiopathic neurodevelopmental disorders are discussed, as are several recommendations for educational improvements for service providers. Plain Language Summary: People who have experienced severe, prolonged institutional deprivation are at increased risk of neurodevelopmental disorders. Despite spending many years in warm, loving families, the English and Romanian Adoptees (ERA) study has shown that these problems often persist into adulthood and are associated with a range of negative outcomes. Importantly, these poorer outcomes seem to occur despite contact with support/service providers. In this study, we interviewed the adoptees and their parents about their support needs, and experiences with trying to obtain support and communicate with service providers. Support needs included help with independent living and support with managing finances. Our participants described a range of difficulties with obtaining support, including a lack of understanding of the link between early adversity and later mental health, and that neurodevelopmental problems were often overlooked. Consequently, the adoptive parents had largely been left to fill this gap in unmet needs. However, where support had been accessed, it was often described as helpful. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. This study aims to systematically synthesize the literature on service utilization and costs for children with ADHD. The search included 9 databases for peer-reviewed primary studies in English from 2007 to 2023. Two independent reviewers conducted title/abstract and full-text screenings and quality assessment. Meta-analysis was conducted on direct medical costs. Thirty-two studies were included. Children with ADHD have used more pharmaceuticals, mental health, and special education services than children without ADHD (counterparts). Nevertheless, one study found that children with ADHD were twice as likely to have unmet health needs than their counterparts. Annual health system costs per patient were highly varied and higher in children with ADHD ($722-$11 555) than their counterparts ($179-$3646). From a societal perspective, children with ADHD were associated with higher costs ($162-$18 340) than their counterparts ($0-2540). The overall weighted mean direct medical cost was $5319 for children with ADHD compared with $1152 for their counterparts when all studies with different sample sizes were considered together, with the difference being $4167. Limited literature on productivity losses associated with ADHD reported them as a substantial cost. ADHD in children had a "large" effect on the increment of direct medical costs. ADHD was associated with increased service utilization and costs. However, unmet health needs or underuse among children with ADHD was also evident. Governments should endeavor to improve access to effective services for children with ADHD to mitigate the impact of ADHD. • Attention-deficit/hyperactivity disorder (ADHD) was associated with substantial healthcare and societal costs. • There is evidence of unmet needs and underuse of services among children with ADHD. • Strategies to improve service access and utilization are needed to reduce inequity across different sociodemographic groups and to mitigate the long-term adverse outcomes of ADHD. [ABSTRACT FROM AUTHOR]

Objective: To update a systematic review of the literature on the barriers and enablers of service access and utilization for children and adolescents with a diagnosis, or symptoms of attention deficit/hyperactivity disorder (ADHD), from the perspective of caregivers, clinicians, and teachers. Methods: Five databases were searched for peer-reviewed literature published from May 2012 to March 2023. Two independent reviewers completed a two-stage screening process and quality assessment. Results: Of 4,523 search results, 30 studies were included. Five main themes were generated: 1) Awareness of ADHD, 2) Stigma, 3) Parental choice and partnerships, 4) Education services as an integral component, 5) Referrals, waiting times, and logistics. More than half of the studies reported poor acknowledgement, expertise of ADHD, and stigma. Conclusion: Findings highlight the need for ongoing ADHD education for all involved and policy changes to service delivery systems to increase the availability of health providers with specialist ADHD expertise. [ABSTRACT FROM AUTHOR]

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Background Self-harm is a significant problem in university students because of its association with emotional distress, physical harm, broader mental health issues and potential suicidality. Research suggests that fewer than half of students who have self-harmed seek professional help when at university. Aims This study aimed to explore the help-seeking journeys of university students who had engaged in self-harm, to identify perceived facilitators and barriers to securing both formal and informal support. Method Participants comprised 12 students who had self-harmed during their university tenure. Engaging in two semi-structured interviews over the academic year, they shared insights into their help-seeking behaviours and proposed enhancements to local services. Data underwent reflexive thematic analysis within a critical realist framework. Results The analysis identified four themes: ‘The initial university phase poses the greatest challenge’, ‘Perceived criteria for “valid” mental health problems’, ‘Evading external judgements, concerns and consequences’ and ‘The pivotal role of treatment options and flexibility in recovery’. Conclusions Students felt isolated and misunderstood, which amplified self-harming tendencies and diminished inclinations for help-seeking. A prevalent belief was that for self-harm to be deemed ‘valid’, it must manifest with a certain severity; however, concurrent fears existed around the ramifications of perceived excessive severity. Participants expressed a desire for streamlined pathways to mental health resources, encompassing both university and external mental health services. Insights from this study could guide future research and inform current service paradigms within academic and healthcare systems.

BackgroundDespite an increased risk of certain eye conditions which can lead to visual impairment (V.I.), there is evidence of a greater delay to treatment-seeking among adults from minority ethnic communities (MEC). MEC adults may also be underrepresented on V.I. registers, within early intervention services, and among the beneficiaries of national V.I. charities. However, much of this evidence is outdated or anecdotal.MethodsThis secondary analysis of V.I. Lives survey data explored use of eye health and support services and mobility aids among a matched control sample of 77 MEC and 77 adults aged 18 and over from white communities (WC). Participants were matched on age, gender, UK region and urban/rural setting. Additional subgroup analysis was conducted for Asian (n = 46) and black participants (n = 22).ResultsThere were no significant group differences in areas such as eye health service use, registration status, contact with charities, and level of practical support received. But MEC participants were significantly more likely than WC participants to have received direct payments from social services to cover their care needs, Χ2 (1, 154) = 8.27, p = 0.004, and to use apps on their mobile for mobility, Χ2 (1, 154) = 5.75, p = 0.017. In contrast, WC participants were significantly more likely to agree that they were getting the level of emotional support to get on with their life, U = 3,638, p = 0.010, to feel confident to ask their friends for support, U = 2,416, p = 0.040, and to have a guide dog for mobility, Χ2 (1, 154) = 3.62, p = 0.057, although the latter did not reach statistical significance. Within the MEC group, Asian participants were significantly more likely than black participants to use a long cane, Χ2 (1, 68) = 7.24, p = 0.007, but they were significantly less likely to agree that they had received the right level of support when they started to experience V.I., U = 236.5, p = 0.040.ConclusionThe preliminary findings suggests that there is scope to increase support provided by V.I. charities and the V.I. register, although, contrary to existing evidence, there were no statistically significant differences in eye health service use, registration status and use of wider support services. Further research is required to confirm these findings and explore reasons for differences.

Objective: Given the high prevalence of Black youth experiencing homelessness, this study sought to understand if race impacts service use and whether other marginalized identities (e.g., gender, sexual orientation) are associated with unique service patterns among youth experiencing homelessness. Method: We used data collected from 1,046 homeless youth (ages 13–24) in Los Angeles County, CA, between October 2011 and June 2013. We used classification tree analyses to rank predictors of service use in order of importance and to test linear and nonlinear relationships among selected variables. Results: Across service type (i.e., shelter, therapy, employment, or health services), the classification tree analyses highlighted race as a primary predictor of service use. Conclusions: Critical race theory may be a useful framework for future explorations of service use among Black youth experiencing homelessness. Furthermore, as race consistently emerges as a feature of importance, providers should consider how race impacts service use. [ABSTRACT FROM AUTHOR]

The aim of this study was to build evidence about how to tailor services to meet the individual needs of young people by identifying predictors of amounts of child and adolescent mental health service use. We conducted a secondary analysis of a large administrative dataset from services in England was conducted using the Mental Health Services Data Set (years 2016–17 and 2017–18). The final sample included N = 27,362 episodes of care (periods of service use consisting of at least two attended care contacts and less than 180 days between care contacts) from 39 services. There were 50–10,855 episodes per service. The descriptive statistics for episodes of care were: Mage = 13 years, SDage = 4.71, range = 0–25 years; 13,785 or 50% male. Overall, there were high levels of heterogeneity in number of care contacts within episodes of care: M = 11.12, SD = 28.28, range = 2–1529. Certain characteristics predicted differential patterns of service use. For example, young people with substance use (beta = 6.29, 95% CI = 5.06–7.53) or eating disorders (beta = 4.30, 95% CI = 3.29–5.30) were particularly more likely to have higher levels of service use. To build on this, evidence is needed about predictors of child and adolescent mental health treatment outcome and whether the same characteristics predict levels of improvement as well as levels of service use. [ABSTRACT FROM AUTHOR]

The current manuscript examines concurrent and longitudinal associations between the utilization of outpatient and intensive psychiatric services among Medicaid-enrolled youth. Using an administrative dataset of Medicaid claims from 2007 to 2017, youth were included if they were between the ages of 10–18 (M = 13.4, SD = 2.6) and had a psychiatric Medicaid claim (N = 33,590). Psychiatric services were coded as outpatient, emergency department (ED), inpatient, or residential based on Medicaid codes. Logistic regression analyses indicated that the receipt of even one outpatient visit significantly reduced the odds of having an ED, inpatient, and residential visit within 60-, 90-, and 120-day windows. Survival analyses indicated most youth did not have any ED, inpatient, or residential visit following their first outpatient visit. For remaining youth, having an outpatient visit significantly increased the risk of having an ED, inpatient, and residential visit following their initial appointment, which may suggest these youth are being triaged to a more appropriate level of care. Classification accuracy analyses indicated a cutoff of 2 outpatient visits yielded maximum accuracy in determining youth with ED, inpatient, and residential visits. Findings highlight use of outpatient-level services in reducing risk of more intensive service utilization. [ABSTRACT FROM AUTHOR]

Objectives: We identified types of interventions used by bereaved family members and examined associations with demographic and medical factors. Furthermore, we examined associations between distress and intervention use among bereaved families. Methods: Bereaved families (n = 85) were recruited from three children's hospitals 3–12 months after their child died of cancer. One eligible sibling (ages 8–17) per family was randomly selected for participation. During home visits 1-year post-death, parents reported on their own and the sibling's intervention use, helpfulness, and dose (self-help books, support groups, therapy, medication), and distress, defined as internalizing, externalizing, and total problems (Adult Self Report, Child Behavior Checklist). Results: Fifty percent of mothers used medications (n = 43); utilization was low among fathers (17%, n = 9) and siblings (5%, n = 4). Individuals with more total problems were more likely to use medications (mothers: rpb = 0.27; p = 0.02; fathers: rpb = 0.32; p = 0.02; siblings: rpb = 0.26; p = 0.02). Mothers and siblings with more total problems used more services (r = 0.24; p = 0.03 and r = 0.29; p = 0.01, respectively). Among mothers, the overall regression was significant, R 2 = 0.11, F (2, 80) = 4.954, p = 0.01; the deceased child's age at death was significantly associated with total services used (b = 0.052, p = 0.022). Among fathers, the overall regression was significant, R 2 = 0.216, F (3, 49) = 4.492, p = 0.007; race and years of education were significantly associated with total services used (b = 0.750, p = 0.030 and b = 0.154, p = 0.010). Among siblings, the overall regression was significant R 2 = 0.088, F (2, 80) = 3.867, p = 0.025; greater total problems were significantly associated with total services used (b = 0.012, p = 0.007). Significance of results: Although few background factors were related to intervention use, bereaved mothers and siblings may seek services if they have more distress. Healthcare providers should be aware of the types of services that are most often utilized and helpful to bereaved families to connect them with appropriate resources. Future research should investigate other predictors of intervention use and outcomes after the death of a child. [ABSTRACT FROM AUTHOR]

Objective: To assess whether prevalence of treatment for ADHD varies by location of mental healthcare among US college students aged 18 to 25 with professionally diagnosed ADHD. Method: Our analysis uses cross-sectional data from the National College Health Assessment (NCHA) and evaluated the relationship between types of care received and location of mental health services received in the past year (dichotomized into "use of any on-campus services" and "use of off-campus services only"). We generated unadjusted and adjusted logistic regression models of each type of treatment. Results: Students who reported receiving mental healthcare on campus were less likely to receive any medication (aOR 0.66, 95% CI [0.60, 0.72]), any therapy (aOR 0.82, 95% CI [0.75, 0.89]), and any medication or therapy for ADHD (aOR 0.63, 95% CI [0.57, 0.70]). Conclusion: Future research should evaluate the causes of lower prevalence of ADHD treatment among students receiving mental healthcare from campus-based clinics. [ABSTRACT FROM AUTHOR]

This study aims to analyze the role of social media in using public policy on health services in the literature Scopus indexed. Deep social media government has become more critical in e-government. Considering social media for taking the policy, the government is the internal medium to push public policy on services and health to increase the government's performance. This research analyzed 454 Scopus database documents from 2018-2023 using "health service," "policy," and "service use" as keywords. The data was filtered using bibliometrics based on the relevance of keywords, author's country, and year of publication, limited to the last five years. Information is saved in RIS format and processed through device soft Citespace. CiteSpace software is used for publication data visualization and government plan formulation. Effective social media policy requires good management for public decision-making. The study analyzed only one topic on Scopus without using international index databasesI'll summarize three research by presenting papers based on criteria like publications, origin countries, fields of study, authors, institutions, issues, and citations. Medicine studies with percentages are dominant, King's College London leads, Draheim contributes the most, and the US is the biggest contributor. [ABSTRACT FROM AUTHOR]

Abstract Background Adolescents have special sexual and reproductive health (ASRH) needs and are susceptible to poor health outcomes. The global burden of ill sexual health includes a significant proportion of Adolescents. The existing ASRH services in Ethiopia and particularly in the Afar region are currently not well suited to meet the needs of pastoralist adolescents. This study assesses the level of ASRH service utilization among pastoralists in Afar regional state, Ethiopia. Method A community based cross-sectional study was conducted from January to March 2021 in four randomly chosen pastoralist villages or kebeles of Afar, Ethiopia. A multistage cluster sampling procedure was used to select 766 volunteer adolescents aged 10–19. SRH services uptake was measured asking whether they had used any SRH service components during the last year. Data was collected through face-to-face interviews with a structured questionnaire; data entry was done with Epi info 3.5.1. Logistic regression analyses was used to assess associations with SRH service uptake. SPSS version 23 statistical software package was used for advanced logistic regression analyses to assess the associations between dependent and predictor variables. Results The study revealed that two-thirds or 513 (67%) of the respondents are aware of ASRH services. However, only one-fourth (24.5%) of the enrolled adolescents used at least one ASRH service in the past twelve months. ASRH services utilization was significantly associated with gender (being female [AOR = 1.87 (CI 1.29–2.70)], being in school [AOR = 2.38(CI: 1.05–5.41), better family income [AOR = 10.92 (CI; 7.10–16.80)], prior discussions of ASRH issues [AOR = 4.53(CI: 2.52, 8.16)], prior sexual exposure [AOR = 4.75(CI: 1.35–16.70)], and being aware of ASRH services [AOR = 1.96 (CI: 1.02–3.822)]. Being pastoralist, religious and cultural restrictions, fear of it becoming known by parents, services not being available, income, and lack of knowledge were found to deter ASRH service uptake. Conclusion Addressing ASRH needs of pastoralist adolescents is more urgent than ever, sexual health problems are increasing where these groups face broad hurdles to SRH service uptake. Although Ethiopian national policy has created an enabling environment for ASRH, multiple implementation issues require special attention to such neglected groups. “Gender-culture-context-appropriate” interventions are favorable to identify and meet the diverse needs of Afar pastoralist adolescents. Afar regional education bureau and concerned stakeholders need to improve adolescent education to overcome social barriers (e.g. humiliation, disgrace, and deterring gender norms) against ASRH services through community outreach programs. In addition, economic empowerment, peer education, adolescent counseling, and parent-youth communication will help address sensitive ASRH issues.

ObjectiveEpisodes of mass violence can increase mental health (MH) symptoms among survivors, possibly leading to increased MH service use. Within the context of an episode of mass violence that impacted a university community, we prospectively explore the predisposing (demographics, clinical levels of MH symptoms, victimization history, objective exposure, and social support), enabling (MH stigma, prior MH service use,), and need (MH symptoms, current social support) variables that influence posttragedy MH service use.MethodIn the original study, 593 students completed surveys at 2 time points during their first year of college. After the tragedy, students were invited to participate in a post event survey for a final sample of n = 142.ResultsA total of 14.3% of our sample accessed MH services post event. Results indicate that demographic factors were not related to MH service use. When examined jointly in a logistic regression, the final model suggests that prior MH service use and greater objective exposure were related to posttragedy MH service use. Other predisposing, enabling, and need factors were not associated with MH service use.ConclusionPrior experience with MH services may help survivors engage in services following a disaster. As disaster MH service models tend to target outreach to those with the greatest exposure, this may be why those survivors had greater MH service use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

AbstractSexual and reproductive health (SRH) care and support are provided to adolescents living with HIV, with the aim to build safer sex negotiation skills, sexual readiness and reproductive preparedness while reducing unintended pregnancies and sexually transmitted infections. We consider how different settings might either constrain or facilitate access to resources and support. Ethnographic research was conducted in Malawi in teen club clinic sessions at an enhanced antiretroviral clinic from November 2018 to June 2019. Twenty-one individual and five group interviews were conducted with young people, caregivers, and healthcare workers, and were digitally recorded, transcribed, and translated into English for thematic analysis. Drawing on socio-ecological and resilience theories, we considered the different ways in which homes, schools, teen club clinics, and community settings all functioned as interactional, relational, and transformational spaces to allow young people to talk about and receive information on sexuality and health. Young people perceived that comprehensive SRH support enhanced their knowledge, sexual readiness, and reproductive preparedness. However, their desire to reproduce at an early age complicated their adoption of safer sex negotiation skills and SRH care. Engaging and talking about SRH and related issues varied according to physical and social space, suggesting the value of multiple locations for support and resources for young people with HIV.

Objective: Recovery Colleges support recovery for adults with mental health problems, through coproduction and education principles. This study aimed to determine whether students at three Recovery Colleges in England were representative of mental health service users. Methods: Gender, age, ethnicity, diagnosis, involuntary detention, and inpatient admission were extracted from clinical records. Data for all service user students enrolled, and those who had attended 70% of a Recovery College course were compared to mental health services caseloads, using chi-square goodness-of-fit tests. Results: Clinical records were identified for 1,788 students. Significant differences were identified for gender, age, and diagnosis (p <.001). In some Colleges, more students had recent inpatient admissions or involuntary detentions. Conclusions and Implications for Practice: Service user students were largely representative of mental health service users, although some groups were underrepresented. Further research is needed to understand why, so that Recovery Colleges can continue to address inequalities. Impact and Implications: This is the first multisite investigation into the characteristics of Recovery College students. It found that students are largely representative of people using mental health services, at different stages of their recovery. However, Colleges and mental health services could work on improving access for male, younger and older service users, and individuals with certain mental health diagnoses. [ABSTRACT FROM AUTHOR]

Early detection and intervention can counteract mental disorders and risk behaviours among adolescents. However, help-seeking rates are low. School-based screenings are a promising tool to detect adolescents at risk for mental problems and to improve help-seeking behaviour. We assessed associations between the intervention "Screening by Professionals" (ProfScreen) and the use of mental health services and at-risk state at 12 month follow-up compared to a control group. School students (aged 15 ± 0.9 years) from 11 European countries participating in the "Saving and Empowering Young Lives in Europe" (SEYLE) study completed a self-report questionnaire on mental health problems and risk behaviours. ProfScreen students considered "at-risk" for mental illness or risk behaviour based on the screening were invited for a clinical interview with a mental health professional and, if necessary, referred for subsequent treatment. At follow-up, students completed another self-report, additionally reporting on service use. Of the total sample (N = 4,172), 61.9% were considered at-risk. 40.7% of the ProfScreen at-risk participants invited for the clinical interview attended the interview, and 10.1% of subsequently referred ProfScreen participants engaged in professional treatment. There were no differences between the ProfScreen and control group regarding follow-up service use and at-risk state. Attending the ProfScreen interview was positively associated with follow-up service use (OR = 1.783, 95% CI = 1.038–3.064), but had no effect on follow-up at-risk state. Service use rates of professional care as well as of the ProfScreen intervention itself were low. Future school-based interventions targeting help-seeking need to address barriers to intervention adherence. Clinical Trials Registration: The trial is registered at the US National Institute of Health (NIH) clinical trial registry (NCT00906620, registered on 21 May, 2009), and the German Clinical Trials Register (DRKS00000214, registered on 27 October, 2009). [ABSTRACT FROM AUTHOR]

This study used administrative data to compare the socio-demographics, health conditions, and health service use of autistic adults with adults with and without other developmental disabilities, after matching for age and sex. Autistic women and men were more likely to have a wide range of physical and mental health conditions compared to adults without developmental disabilities. Rates of co-occurring health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except for a higher prevalence of psychiatric conditions among autistic adults. Notably increased psychiatric service use was evident among autistic women and men compared to the other groups. Among age-matched autistic women and men, significant differences were found for physical (i.e. Crohn's disease/colitis, rheumatoid arthritis) and psychiatric conditions (i.e. psychotic disorders, non-psychotic disorders), as well as service use (i.e. emergency department visits, hospitalizations, family doctor and neurologist visits). These findings suggest autistic adults have high health care needs, as do adults with other developmental disabilities. Mental health support is especially critical for autistic adults and research examining sex and gender effects will assist in tailoring health promotion and intervention efforts. This study used administrative data from Ontario, Canada to compare the health conditions and service use of autistic women and men with adults with other developmental disabilities and with adults without developmental disabilities. Autistic women and men were more likely to have physical and mental health conditions compared to adults without developmental disabilities. Rates of health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except more autistic adults had psychiatric conditions. Autistic women and men used higher rates of psychiatric services compared to all other groups. When comparing autistic women with same aged autistic men, sex differences were found for specific physical (Crohn's disease/colitis, rheumatoid arthritis) and psychiatric conditions (psychotic disorders, non-psychotic disorders), as well differences in service use (emergency department visits, hospitalizations, family doctor and neurologist visits). These results further highlight the high health needs and service use of autistic women and men, as well as adults with other developmental disabilities. It is critical for future research to focus on mental health support for autistic adults and to better understand how to tailor supports to best serve autistic women. [ABSTRACT FROM AUTHOR]