Applying the EDAS Method in Psychopathology and Health Care A Systematic Review of Decision-Making Models

To explore the extent to which associations between sleep problems and functional impairment are attributable to comorbid mental and physical health problems. Sleep problems are being increasingly recognized as a source of morbidity and role impairment. Little is known, however, about the extent to which associations between sleep problems and functional impairment are attributable to comorbid mental and physical health problems. We utilized data from the German Health Survey (n = 4181; response rate: 87.6%; ages 18-65 years) to examine the relationships between sleep problems (assessed by the Pittsburgh Sleep Quality Inventory (PSQI)), mental and physical health comorbidity, and disability and health-related quality of life (assessed by the Medical Outcomes Scale Short Form-36 (SF-36)). A total of 1595 (35.2%) respondents reported current sleep problems (PSQI score of >5). After adjusting for sociodemographic factors, we found the presence of sleep problems was associated with having one or more physical health problems (adjusted odds ratio (AOR) = 1.21, 95% Confidence Interval (CI) = 1.01-1.45) and one or more mental disorders (AOR = 3.58, 95% CI = 2.95-4.35). Among persons with one or more physical health problems, the co-occurrence of a sleep problem was associated with poorer physical component scores on the SF-36 (45.7 versus 48.6, p <.001) and increased odds of >or=1 disability days in the past 30 days due to physical problems (AOR = 1.55, 95% CI = 1.20-1.98), even after adjusting for sociodemographic factors and comorbidity with other mental and physical health conditions. More than one third of adults in the community report sleep problems. These often co-occur with other physical and mental health problems, and when they do they are generally associated with an increased burden of role disability and functional impairment.

ABSTRACTIntroductionOver the last decade, the number of older people in custody with common mental and physical health problems has increased. Little is known about the effectiveness of interventions targeting this age group.ObjectiveTo codevelop a practical guidance toolkit(s) to support the delivery of interventions to benefit the common mental and physical health of older people in custody.MethodsTwelve 3‐h workshops between March and April 2023 were conducted with 26 participants at two prison sites in the North of England. The six workshops in each site consisted of research‐based activities and interlinked taster sessions. The research data were collected by the research team to identify the causal links between common mental and physical health problems; activity preferences; the feasibility, acceptability and sustainability of delivering the activities and engagement barriers, which formed a bespoke questionnaire. The taster sessions (drugs and alcohol for males, chair yoga for females, books and crafting, and a historical session for both males and females) were delivered by the research team and prison staff. Feedback from the workshop participants was documented using an adapted questionnaire to record the experiences of those taking part. A micro‐costing framework was used to estimate the cost.ResultsSimilar common mental and physical health factors were listed by males and females. Symptoms of common mental health problems were improved by engaging with others of the same age, conducting activities outside and a consistent prison regime. Activity preferences (e.g., creative activities) were underpinned by a sense of purpose, learning new things, gaining and sharing skills. Engagement was supported by building good relationships and offering guidance through peer support, with activities led by staff of a similar age. Activities were more likely to be deemed feasible, acceptable and sustainable when aligned with the prison strategy and in conjunction with the regime. The average cost per participant for the intervention delivery was higher for males than females (£157 vs. £89).ConclusionOlder people in custody report high levels of mental and physical health problems. Engagement with people in custody helps to support the development of interventions maximising possible health benefits. Further research is required to develop an evidence‐base for this group of people in custody.Patient or Public ContributionPeople in custody were involved in the design and implementation of the workshops. The Project Advisory Group advised us on our research methodology and evaluated the feasibility, acceptability and sustainability of the activities using a questionnaire; they also provided practical advice about the project delivery.

Risks, roles and responsibilities: Evaluating falls in inpatient mental healthcare settings for older people

While it is known that some UK Armed Forces (UK AF) personnel and veterans experience physical and mental health problems, the possible future healthcare needs of military veterans are unknown. To estimate the number of military personnel who may experience physical and/or psychological health problems associated with their military service. Data were obtained via Freedom of Information requests to several sources, including Defence Statistics. Raw data from research studies were also used where available. Data were analysed using meta-analytic methods to determine the rate of physical, mental or comorbid health problems in AF personnel. Musculoskeletal problems were the predominant reason for medical discharge from service. In terms of mental health, meta-analyses estimated that veteran reservists (part-time military members) previously deployed to operational areas had the highest proportion of general health problems (35%), previously deployed veteran regulars (those in full time military employment) and veteran reservists had the highest proportion of post-traumatic stress disorder (9%), and regular personnel with a deployment history had the highest proportion of alcohol problems (14%). Overall, our findings suggest that at least 67515 veterans are likely to suffer from mental and/or physical health problems at some point as a result of their service between 2001 and 2014. The results of this study highlight that the difficulties personnel may face are largely musculoskeletal or mental health-related. These findings may help with planning the provision of future physical and mental health care and support for those who serve in the UK AF.

AimsThis study examines the prevalence and associations between recent violence experience, mental health and physical health impairment among Female Sex Workers (FSWs) in north Karnataka, India.BackgroundMulti-morbidity, in particular the overlap between physical and mental health problems, is an important global health challenge to address. FSWs experience high levels of gender-based violence, which increases the risk of poor mental health, however there is limited information on the prevalence of physical health impairments and how this interacts with mental health and violence.MethodWe conducted secondary analysis of cross-sectional quantitative survey data collected in 2016 as part of a cluster-RCT with FSWs called Samvedana Plus. Bivariate and multivariate analyses were used to examine associations between physical impairment, recent (past 6 months) physical or sexual violence from any perpetrator, and mental health problems measured by PHQ-2 (depression), GAD-2 (anxiety), any common mental health problem (depression or anxiety), self-harm ever and suicidal ideation ever.Result511 FSWs participated. One fifth had symptoms of depression (21.5%) or anxiety (22.1%), one third (34.1%) reported symptoms of either, 4.5% had ever self-harmed and 5.5% reported suicidal ideation ever. Over half (58.1%) reported recent violence. A quarter (27.6%) reported one or more chronic physical impairments. Mental health problems such as depression were higher among those who reported recent violence (29%) compared to those who reported no recent violence (11%). There was a step-wise increase in the proportion of women with mental health problems as the number of physical impairments increased (e.g. depression 18.1% no impairment; 30.2% one impairment; 31.4% ≥ two impairments). In adjusted analyses, mental health problems were significantly more likely among women who reported recent violence (e.g. depression and violence AOR 2.42 (1.24–4.72) with rates highest among women reporting recent violence and one or more physical impairments (AOR 5.23 (2.49–10.97).ConclusionOur study suggests multi-morbidity of mental and physical health problems is a concern amongst FSWs and is associated with recent violence experience. Programmes working with FSWs need to be mindful of these intersecting vulnerabilities, inclusive of women with physical health impairments and include treatment for mental health problems as part of core-programming.Samvedana Plus was funded by UKaid through Department for International Development as part of STRIVE (structural drivers of HIV) led by London School of Hygiene and Tropical Medicine and the What Works to Prevent Violence Against Women and Girls Global Programme led by South African Medical Research Council

Increasing life expectancy in the USA makes a better understanding of the heterogeneous healthcare needs of the aging population imperative. Many aging studies have discovered multimorbid health problems focusing mainly on various physical health conditions, but not on combined mental or behavioral health problems. There is also a paucity of studies with older adults who use professional healthcare services caring for their mental and substance-related conditions. This study aims to enhance the knowledge of older peoples’ complex healthcare needs involving physical, mental, and behavioral conditions; examine the relationship between multi-morbid health profiles and specialty healthcare service utilization; and investigate its association to poverty. The study data were derived from the National Survey on Drug Use and Health (NSDUH) in 2013 (n = 6296 respondents aged 50 years and older). To identify overall health conditions, nine indicators, including physical, mental, and substance/alcohol, were included. Healthcare service utilization was measured with four mutually exclusive categories: No treatment, mental health treatment only, substance use treatment only, and both. We identified four health profiles: Healthy (82%), having physical health problems (6%), physical and mental health problems (4%), and behavioral problems (8%). Older people’s health profiles were differentially associated with healthcare use. Those living in poverty with both physical and mental health problems or substance/alcohol health problems were less likely to receive mental health and substance use treatments than those with more financial resources. Implications for geriatric healthcare practices and policy are discussed.

BackgroundAnabolic-androgenic steroids (AAS) are used to increase muscle strength and improve appearance, but users also carry the risk of developing physical and mental health problems. In Norway, the substance use disorder treatment system provides health care to this patient group, but few AAS users have sought such treatment. Therefore, a service was created to inform AAS users and next of kin of potential negative consequences and their treatment options. This study describes health problems, motivations for AAS cessation, and treatment desires among AAS users.MethodsOver four years, 232 AAS users and 60 next of kin contacted the information service and received an hour-long information session with healthcare personnel. Information about AAS use, physical and mental health problems, substance use, motivation for cessation, and whether the information seeker desired treatment were registered. Qualitative interviews were conducted among seven individuals and analyzed thematically to explore information service experiences.ResultsOf the 232 AAS users, 179 (77.2%) desired treatment after completing the information session and 53 (22.9%) were unsure or did not want treatment. Those who desired treatment were significantly older, had used AAS longer, reported more physical and mental health side effects, and a higher proportion reported having children than those who did not desire treatment. Although 181 (78.0%) reported co-occuring physical and mental health problems, mental health problems were the most common motivation for AAS cessation (n = 108, 47.8%), followed by a combination of mental and physical health problems (52, 23.0%). Findings from qualitative interviews suggest that barriers to treatment may be overcome with an easily accessible service that informs about addiction treatment and facilitates the treatment entry process.ConclusionsHealthcare professionals who encounter users of AAS should have knowledge about AAS use and adverse effects. The desire for health care reveals extensive health problems and the user group is so non-homogeneous that examination and treatment must be adapted individually with focus on physical, mental and social factors as well as possible dependence of AAS and/or psychoactive substances.

The central place of psychiatry in health care worldwide.

Although research has documented factors influencing whether military personnel seek treatment for mental health problems, less research has focused on determinants of treatment-seeking for physical health problems. To explicitly compare the barriers and facilitators of treatment-seeking for mental and physical health problems. US soldiers (n = 2048) completed a survey with measures of barriers and facilitators of treatment-seeking for mental and physical health problems as well as measures of somatic symptoms and mental health. The top barrier for both mental and physical health treatment-seeking was a preference for handling problems oneself. The top facilitators for both symptom types were related to treatment improving quality of life. Differential endorsement of barriers occurred for treatment of mental versus physical health symptoms. In contrast, facilitators were endorsed more for physical than for mental health treatment. While there were few gender differences, officers reported more barriers and facilitators than did enlisted personnel. Screening positive for mental or physical health problems was associated with greater endorsement of both barriers and facilitators for physical and mental health treatment, respectively. The leading barriers and facilitators for seeking treatment for mental health and physical problems are relatively similar, suggesting that health education should consider decision-making in seeking both mental and physical healthcare. Interventions should be tailored to reduce barriers for officers and improve facilitators for junior enlisted personnel, and address barriers and facilitators for service members screening positive for a mental or physical health problem.

The Link Between Homeless Women's Mental Health and Service System Use

Abstract. Background: Welfare benefit policies have important implications for public health. They aim to reduce the risk of poverty, promote employment for people who can work, and help maintain the livelihood of people who are not able to work due to unemployment, disability or old age. They may help reduce the economic and health consequences of recessions, however the 2008 recession and subsequent rise in government debt has also led to welfare reforms that reduce access to and adequacy of welfare benefits. This thesis uses the recent recession and subsequent welfare reforms in the UK as natural experiments to investigate the relationship between recession, welfare benefit policies and mental health. Study design: I use routine administrative and survey data for England and systematic review methods to investigate the impact of the recession on mental health and the impact of welfare benefit reforms on mental health and employment. Study 1 reflects on the methodological challenges of investigating natural policy experiments such as those outlined in this thesis. Study 2 investigates the impact of initial rises in unemployment during the recession on suicides, Study 3 investigates trends in self-reported mental health problems during and after the recession when welfare reforms were introduced. Study 4 investigates the mental health effects of a specific policy introduced from 2010 to use a new tougher assessment to reassess the eligibility of disability benefit claimants. Study 5 presents a systematic review of international evidence investigating the employment effects of changes to the eligibility and adequacy of out-of-work disability benefits. Study 6 investigates the employment effects of the disability benefit reassessment policy in England. Results: The onset of the 2008 recession in England and subsequent rise in unemployment was associated with a rise in suicides. The association between increases in unemployment and rises in suicides was stronger in the 2008 recession than it had been in the previous 1990s recession, suggesting that welfare policies may have been less effective at reducing the mental health impact of unemployment. The trend in suicides however continued to increase between 2010 and 2013 even after unemployment peaked and began to decline. The prevalence of reported mental health problems also increased from 2009. Whilst unemployment trends explained some of the initial increase in reported mental health problems, it did not explain the continued increase and widening of inequalities from 2010 to 2013. The policy introduced in 2010 to reassess the eligibility of disability benefit claimants was associated with adverse trends in mental health, including a further rise in suicides, self reported mental health problems and antidepressant prescribing. A systematic review of international evidence indicated that similar policies did not generally increase employment, but rather moved people from disability benefits onto other benefits. The disability benefit reassessment policy introduced in 2010 appears to have moved people with mental health problems from inactivity into unemployment, but there was no evidence that it had improved the employment chances of people out-of-work with mental or physical health problems. Conclusion: It is likely the 2008 recession had an adverse impact on mental health. This may have been greater than it would otherwise have been because of changes to the welfare system over recent decades. Welfare benefit reforms since the recession have then potentially exacerbated this situation, and may have led to further adverse trends in mental health that particularly affected the most disadvantaged groups. These welfare policies have not led to improved employment chances for people out-of-work with health problems, suggesting that the harms may outweigh any benefits. These policies have been associated with an increase in the numbers of people out-of-work with mental health problems potentially leading to greater reliance on welfare in the future.

Mental and physical health problems are more prevalent among individuals with an intellectual disability (ID) than in the general population. Studies suggest that there may be significant associations between these co-occurring disorders and aggressive behaviour, but few studies have taken into account multiple mental and physical problems, as well as their level of severity. The main goal of this study was to identify the associations between different types of aggressive behaviour and various types of physical and mental health problems. These associations were explored through a cross-sectional study of 296 adult men and women with mild or moderate ID living in the community and receiving ID services. Information was gathered through interviews with ID participants, case managers and file review. The results show that individuals with ID who have more mental and physical health problems have higher odds of displaying aggressive behaviour than those with fewer and less severe physical health problems. These results can help guide future prevention and intervention strategies for persons with ID who display aggressive behaviour or who are at risk of become aggressive.

Adverse childhood experiences (ACEs) have been linked to mental and physical health problems, leading to ACEs being viewed as a public health concern. Yet, less research has focused on the prevalence and impact of ACEs among diverse racial and ethnic groups. Given the increasing diversity in the USA, coupled with research that has found certain racial and ethnic groups to experience larger-scale adversity such as poverty or discrimination more frequently than White individuals, it is important to understand how ACEs are experienced by people of color. The current study examined the prevalence of ACEs among diverse racial and ethnic groups, and associations between ACE score and mental and physical health. Even after adjusting for sociodemographic factors, ACE scores of 3 or higher were linked to more physical and mental health problems. Furthermore, there was a significant interaction effect between ACE score and race on mental health, while none of the interaction terms were significant between ACE score and race on physical health. This suggests that higher ACE scores have a more detrimental impact on mental health for people of color. Implications for social work include implementing community-level ACE-informed responses, especially in communities that serve traditionally marginalized populations.

BackgroundCannabis use is increasing among young Norwegians and several studies show a high incidence of common physical health problems. An association has previously been found between cannabis use and mental health problems. Since physical and mental health problems often co-occur, the aim of this study is to explore the relationship between cannabis use and physical health problems.MethodsIn 2017–2019, the Norwegian youth survey Ungdata collected data from 249,100 Norwegian adolescents, which equalled around 80% of all lower secondary school pupils (13–15 years) and about 50% of upper secondary pupils (16–19 years) in Norway. Descriptive analysis was used to calculate the prevalence of cannabis use and bi- and multivariate logistic regression analysis to examine the association between cannabis use and physical health problems, controlled for sociodemographics and mental health problems.ResultsAlmost 10% of Norwegian adolescents had used cannabis once or more in the previous 12 months. The use of cannabis increased with age and it was more prevalent among boys. There is a clear connection between physical health problems and cannabis use (OR = 1.582 (CI: 1.527–1.638)) even after adjusting for sociodemographic variables and mental health problems (OR = 1.366 (CI: 1.312–1.423)).ConclusionMore studies are needed to explore if there might a bidirectional relationship between cannabis use and physical health problems where physical problems increase cannabis use and cannabis use increases the risk of physical health problems. More knowledge on the effect of and motivation for cannabis use are important for policy makers and health care professionals involved in young people.

To compare children with mental and physical health problems regarding (1) perceived disease severity; (2) the impact of their condition on their families; (3) their utilization of health care services (including satisfaction with care); and (4) parents' health literacy about their child's condition and its treatment. Furthermore, we examined whether parents' health literacy differs between types of mental health condition. Parental reports about their 9- to 14-year-old children with mental (n=785) or physical health problems (n=475) were analyzed from the population-based National Survey of Children with Special Health Care Needs in Switzerland. Mental health problems were perceived as being more severe (p<0.001) and exerting a larger impact upon the family (e.g., financial impact) than physical health problems. Furthermore, fewer parents of children with a mental health problem mentioned having a particular person or place to contact if they needed information or advice regarding the child's condition (p=0.004) and were satisfied with the health care services their child received (p<0.001). The odds of low health literacy was higher among parents with children suffering from mental health problems vs. parents of children with physical health problems (OR in the adjusted model=1.92; 95% CI 1.47-2.50; p<0.001); this finding held generally for mental health problem (although only a trend was observable for internalizing problems). The large impact of children's mental health conditions on themselves and their families might be reduced by adapting the provision of health care and by increasing parents' health literacy.