Hero’s Journey: A New Narrative for People with Long-Term Mental Health Challenges

BackgroundYoung adulthood is an important transitional life phase that can determine a person’s educational and employment trajectories. The aim of this study was to examine the impact of somatic long-term health challenges in adolescence on upper secondary school completion, not in education, employment or training (NEET status) and receiving disability pension in early adulthood. Additional disparities in educational and employment achievements were also investigated in relation to socioeconomic background.MethodsThe sample consisted of all young adults born in the period 1990 to 1996, (N = 421,110). Data were obtained from the Norwegian Patient Registry which is linked to the Central Population Register, education and income registries and the Historical Event Database in Statistics Norway. These data sources provide longitudinal population data. Statistical analyses were performed using multiple logistic regression and computed average marginal effects after the multiple logistic regression.ResultsThe results showed that, compared to young adults without long-term health challenges, young adults with the diagnoses inflammatory bowel disease, epilepsy, diabetes, sensory impairment, spinal muscular atrophy (SMA), spina bifida (SB) and cerebral palsy (CP) had lower odds of completing upper secondary education. Moreover, young adults with long-term health challenges had higher odds of NEET status by age 21 compared to those without a long-term health challenge. As for the odds of NEET status by age 21, the results showed that young adults with epilepsy, SMA, SB and CP in particular had the highest odds of receiving disability pension compared to young adults without long-term health challenges.ConclusionsThis longitudinal study revealed that on average young adults with long-term health challenges, compared to those without, struggle to participate in education and employment. The findings highlight the need for preventive measures especially in relation to young adults with neurological conditions such as epilepsy, SMA, SB, and CP.

IntroductionThe COVID-19 pandemic has left lasting effects that extend beyond the acute phase of infection, with increasing evidence of long-term health consequences. This study aimed to assess the prevalence of post-COVID symptoms and conditions and to identify associated risk factors, including pre-existing chronic diseases, COVID-19 vaccination status, and severity of acute infection.MethodsThis retrospective cross-sectional study was conducted in 10 family medicine practices in Croatia. The data collected from medical records included demographics, COVID-19 vaccination status, SARS-CoV-2 infection history and severity, and documented health conditions before and after infection. Descriptive statistics were used to summarize the data. Group differences were analyzed using the independent samples t-test or χ2 test. Variables significant in univariate analyses (p < 0.05) were included into multivariate regression models. Multiple linear regression was used to identify predictors of COVID-19 severity, and binary logistic regression was applied to determine factors associated with post-COVID conditions. Results are presented as regression coefficients (β) or odds ratios (OR) with 95% confidence intervals (CI). A p-value < 0.05 was considered statistically significant.ResultsThe study included 1,423 participants (58.0% female; mean age 52.6 ± 17.2 years), of whom 82.4% had confirmed SARS-CoV-2 infection and 32.3% were unvaccinated. At least one chronic disease was present in 28.1% of participants. The most frequently reported post-COVID conditions were brain fog (4.9%), neurological disorders (4.7%), cardiovascular diseases (2.9%), shortness of breath (2.8%), obesity (2.7%) and mental health disorders (2.6%). Greater COVID-19 severity was independently associated with pulmonary disease (β = 0.22; p = 0.031) and older age, particularly 51–65 years (β = 0.31; p < 0.001) and ≥66 years (β = 0.50; p < 0.001). COVID-19 vaccination was associated with milder disease (β = −0.21; p < 0.001). Previous cardiovascular and musculoskeletal diseases significantly increased the risk of thromboembolism. Diabetes, obesity, and number of vaccine doses were predictors of brain fog, while neurological comorbidities predicted post-COVID mental health disorders.ConclusionPost-COVID symptoms and conditions represent an important long-term public health challenge. Family medicine physicians play a key role in early recognition, monitoring, and management of post-COVID sequelae, contributing to improved long-term patient outcomes.

Background Many children grow up with adult alcohol misuse in the home. A clearer understanding of this exposure’s long-term mental health consequences and the role of associated child maltreatment experiences and potential protective factors could guide relevant intervention strategies. Objective To prospectively evaluate the association between living with adult alcohol misuse during childhood and major depressive disorder (MDD) during adulthood; whether child maltreatment explains the association; and whether sex, school bonding, or neighborhood bonding moderate the association. Participants and setting: This study used longitudinal data from 783 individuals followed from childhood to age 39. Methods At grade 9, participants were asked whether they lived with adults who misused alcohol. Diagnostic assessments of MDD were conducted across three time-points during participants’ thirties and participants were categorized as having met diagnostic criteria 0, 1, or 2 or more times. Results Ordinal logistic regressions found that children living with adult alcohol misuse showed greater chronicity of adult MDD (OR = 1.63; 95% CI: 1.05, 2.52). There was a 49% reduction in the odds ratio and the association was no longer statistically significant when child maltreatment was included in the model (OR = 1.32; 95% CI: 0.84, 2.07). No statistically significant moderation of associations was observed. Conclusions Children exposed to adult alcohol misuse, and maltreatment often associated with this misuse, may be at risk for mental health challenges well into adulthood. Interventions that address childhood exposure to adult alcohol misuse and associated maltreatment may be important to mitigate long-term mental health challenges to exposed children.

BackgroundDespite clinical advances, individuals with childhood-onset type 1 diabetes (T1DM) may face long-term socioeconomic and health challenges, but population-based evidence remains scarce.MethodsWe analyzed data from the Italian PASSI surveillance system (2011-2018, 2023). Adults aged 18-50 self-reporting diabetes diagnosed before age 18 and currently using insulin were classified as T1DM cases and matched 1:2 by age and sex to healthy controls. Outcomes included marital status, employment, financial hardship, self-rated health, and days with physical, mental, or activity impairment. Association between T1DM and the outcomes of interest was evaluated using multivariable logistic regression, adjusting for age and sex. Results were presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). This study was conducted within the framework of the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI).ResultsAmong 319,801 individuals, 331 had T1DM and were matched with 662 controls. T1DM was associated with higher odds of unemployment (aOR 1.57, 95%CI 1.20-2.07), severe financial hardship (aOR 1.81, 95%CI 1.05-3.13), and poor self-rated health (aOR 6.64, 95%CI 2.53-17.43). T1DM individuals more often reported ≥14 days/month of physical (aOR 2.95, 95%CI 1.54-5.65) or mental (aOR 2.16, 95%CI 1.46-3.19) impairment, and activity limitation (aOR 1.73, 95%CI 1.06-2.82). No differences emerged in terms of educational attainment or depression screening.ConclusionsAdults with early-onset T1DM experience persistent socioeconomic and health disparities despite similar educational attainment. Integrated, long-term support-including mental health and financial assistance-is needed to mitigate impacts beyond glycemic control.Key messages• Early-onset T1DM is linked to long-term socioeconomic vulnerability and health impairment in adulthood.• Beyond glycemic control, mental health and financial support are crucial for individuals with T1DM.

Unlike developments in short-term clinical and community care, the recovery movement has not yet gained foothold in long-term mental health services. In the Netherlands, approximately 21,000 people are dependent on long-term mental health care and support. To date, these people have benefited little from recovery-oriented care, rather traditional problem-oriented care has remained the dominant approach. Based on the view that recovery is within reach, also for people with complex needs, a new care model for long-term mental health care was developed, the active recovery triad (ART) model. In a period of 2.5 years, several meetings with a large group of stakeholders in the field of Dutch long-term mental health care took place in order to develop the ART model. Stakeholders involved in the development process were mental health workers, policy advisors, managers, directors, researchers, peer workers, and family representatives. The ART model combines an active role for professionals, service users, and significant others, with focus on recovery and cooperation between service users, family, and professionals in the triad. The principles of ART are translated into seven crucial steps in care and a model fidelity scale in order to provide practical guidelines for teams implementing the ART model in practice. The ART model provides guidance for tailored recovery-oriented care and support to this “low-volume high-need” group of service users in long-term mental health care, aiming to alter their perspective and take steps in the recovery process. Further research should investigate the effects of the ART model on quality of care, recovery, and autonomy of service users and cooperation in the triad.

Millions of individuals are affected by human trafficking globally, and many of them experience long-term psychological and physiological health issues that remain largely unaddressed. This case study provides a brief overview of the most common long-term health challenges survivors of human trafficking face and the barriers they experience as they try to access services through the unique lens of a survivor. The importance of a healing-centered approach is introduced as a much-needed extension to the more widely used yet still underutilized trauma-informed processes in survivor care. Finally, the case study provides suggestions for future directions to understand and respond to the long-term health care and mental health needs of survivors after their trafficking experience.

Although research findings point to the importance of leisure activities for people with severe mental illness, there is no research into the specific effects of holiday trips. This Open Forum describes the experience of going on holiday trips for people with chronic mental health problems in the Netherlands. A qualitative research design was used. Material for the research was collected by participant observation on two trips and in-depth interviews of 11 travelers and four psychiatric nurses who accompanied the travelers. The trips contributed to rehabilitation by promoting and supporting, among other things, community participation, social relations, skill development, and new perceptions of identity. The trips also helped travelers to maintain balance in everyday life. For the nurses the trips provided a learning environment outside of medical institutions.

Although research findings point to the importance of leisure activities for people with severe mental illness, there is no research into the specific effects of holiday trips. This Open Forum describes the experience of going on holiday trips for people with chronic mental health problems in the Netherlands. A qualitative research design was used. Material for the research was collected by participant observation on two trips and in-depth interviews of 11 travelers and four psychiatric nurses who accompanied the travelers. The trips contributed to rehabilitation by promoting and supporting, among other things, community participation, social relations, skill development, and new perceptions of identity. The trips also helped travelers to maintain balance in everyday life. For the nurses the trips provided a learning environment outside of medical institutions

Experiencing childhood abuse elevates risks for long-term mental health challenges (MHC); this complex relationship is underexplored among women with HIV. Informed by the 'chains of risk' life-course approach, we examined pathways from childhood abuse to mental health among women with HIV. Using longitudinal data from the Canadian HIV Women's Sexual & Reproductive Health Cohort Study [CHIWOS], we examined associations between childhood abuse history (sexual, physical, verbal) and current poverty (income, food insecurity, housing insecurity) at time 1 (T1, August 2013-May 2015), substance use and past 3-month violence at time 2 (T2, June 2015-January 2017), and MHC (depression, PTSD, mental functioning) at time 3 (T3, February 2017-December 2018). We conducted path analysis to examine direct and indirect effects from childhood abuse to adult MHC via poverty, substance abuse, and violence. Most (68%) participants with reported data (n=1,315) experienced childhood abuse. Childhood abuse was associated with adulthood poverty, violence, substance use, and MHC. T1 poverty was associated with T2 substance use and violence, and T3 MHC. Violence was associated with T3 MHC. The total standardized effect of childhood abuse on T3 MHC was 0.27 ( p <0.001). Half of this effect was indirect (β=0.13, p <0.001), with poverty accounting for 43% of the total indirect effect (β=0.06, p =0.003). Among women with HIV in Canada, childhood abuse was associated with poorer adulthood mental health; this association was mediated by poverty, violence, and substance use in adulthood. Findings emphasize the need for life-course approaches in women-centred violence and trauma-aware HIV care.

Mental health problems are common among people with rheumatological conditions and other long-term health problems. For example, depression and anxiety are significantly more prevalent among people with arthritis than in...

Our objective was to measure the association between structural racism, a previously unmeasured but theoretically causal factor, and assisted living communities (ALCs) location as fewer ALCs are located in counties with a greater percentage of the population reported as Black (PPB). We used a recently developed measure of structural racism—the racial opportunity gap (ROG), which compares the economic mobility of Black and White people who grew up in the same area with parents who had similar incomes. We estimated a multilevel mixed-effects bivariate regression model to examine the factors contributing to the presence of ALC. We relied on state and county random effects. The likelihood of an assisted living being located in a census tract in 2019 was significantly positively associated with the percent of the population over the age of 65 (OR=150.1573, p=<0.001), the PPB (OR=2.9916, p=0.004), and higher median incomes (OR=1.0, p=<0.001). In contrast, rurality (OR=0.5656, p=<0.001), unemployment rates (OR=0.0288, p=<0.001), and census tracts that have a high PPB in addition to a high county ROG (OR=.0058, p=0.0137) are all associated with a lesser likelihood of an ALC. The interaction coefficient between the ROG and PPB reverses the previously documented negative association between the PPB and ALC presence. This result empirically supports the premise that structural racism, not population race alone, is a negative determinant of where an ALC is located within a county.

Clinical pathways (CPWs) are structured care plans that set out essential steps in the care of patients with a specific clinical problem. Amidst calls for the prioritisation of integrated mental and physical health care for young people, multidisciplinary CPWs have been proposed as a step towards closer integration. There is very limited evidence around CPWs for young people with mental and physical health needs, necessitating a review of the literature. The aim of this review is to understand how clinical pathways have been used to deliver mental health support to children and young people with long-term physical health conditions and their effectiveness across a range of outcomes. The databases MEDLINE, CENTRAL, PsycINFOand CINAHL were searched from inception to 6September 2023. Keywords linked to children and young people, mental health, long-term physical health conditionsand CPWs were used. Studies using either quantitative or qualitative research designs were included. All studies must have evaluated a CPW to provide mental health support to children and young people (up to 25 years old) with long-term health physical conditions. Both mental and physical health outcomes were considered. Pathways were grouped by integration 'model' as described in the wider literature. The initial search returned 4082 studies after deduplication. A total of eight studies detailing six distinct care pathways (232 participants [170 children and young people; 50 caregivers; 12 healthcare professionals]) met eligibility criteria and were included in the analysis. Four pathways were conducted within an 'integrated model'; two were a combination of 'integrated' and 'colocated'; and none within a 'co-ordinated model'. Only pathways within an integrated model reported quantitative health outcomes, with improvements across a range of mental health measures. One negative physical health outcome was reported from an integrated diabetes pathway, but this should be interpreted with caution. This review identified a range of CPW designs but most fell under an integrated model. The results suggest that calls for integrated mental health pathways in this population may be appropriate;however, conclusions are limited by a paucity of evidence.

While survival rates for pediatric cancer have improved significantly, the disease and its treatments often lead to severe side effects and long-term physical and mental health challenges. Evidence suggests that physical activity can positively influence multiple health domains, even during the acute treatment phase. This session will provide research on a) the benefits of physical activity for physical and mental health in children with cancer, b) the practical implementation of the KikliFit project within the acute treatment phase, and c) the accompanying implementation research that evaluates and informs the integration of physical activity into practices.

Racial Inequalities in Mortality from Coronavirus: The Tip of the Iceberg

Introduction The considerable number of road crashes resulting in death, injury and disability makes road safety a crucial issue worldwide [1], [2]. Preventing road deaths, addressing severe injuries in road traffic and their long-term effects, both mental and physical, remains a critical aspect of achieving a resilient and future-proof transportation system. Aims To summarize findings from longitudinal studies on mental health, psychological outcomes, and mental health-related quality of life (HRQoL) following road traffic crashes (RTCs) in order to suggest implications to improve recovery and rehabilitation. Methods Long-term consequences (LTCs), physical and mental health, quality of life, and road traffic crash were the keywords used to search the PubMed, Scopus, and Web of Science electronic databases. The initial search yielded 420 records, reduced to 390 after the removal of duplicates. Following the PRISMA 2020 guidelines, 50 observational studies published between 2010 and 2024 were identified as relevant, and one was found through citation searching. At the full-text reading 17 papers were excluded. As a result, 34 articles were included in the review. These studies investigated the long-term physical and psychological consequences of road crashes across all categories of adult road users. Seven papers showed a specific focus on mental health outcomes, including post-traumatic stress syndrome, pain-related psychological distress, depressive symptoms, mental HRQoL, and cognitive impairment. Results The reviewed studies consistently show that RTCs can lead to substantial long-term mental health consequences. A considerable number of individuals experience post-traumatic stress symptoms, with higher rates observed among those with more severe injuries. Persistent pain and residual physical or psychological symptoms are common even several months after the crash, often impairing daily functions and delaying return to work. Depression and anxiety symptoms are associated with slower recovery, and negative expectations about recovery strongly predict persistent pain and emotional distress over time. Mental HRQoL, measured by means of standardized instruments, generally improves within the first year after the crash, but often remains below pre-injury levels, especially among those with longer hospital stays or more severe injuries. Sociodemographic and clinical factors such as female sex, middle age, higher injury severity, and low physical or mental HRQoL scores are significantly associated with poorer mental health outcomes. In contrast, higher education levels, better physical functioning, and protective behaviors (such as the use of safety equipment) are associated with improved mental recovery and reintegration into daily life and work. Overall, these findings highlight the need for targeted mental health screening and supportive interventions in the post-injury care of RTC survivors. Characteristics of the included studies are summarized in Table 1. Conclusions This review emphasizes the importance of early psychological screening, targeted intervention, and policy efforts to mitigate the mental health burden among RTC survivors.