The Impact of Governmental and Workplace Measures on the Employment Sustainability of Chronically Ill Individuals

BACKGROUND: Multiple sclerosis (MS) is a chronic inflammation of the central nervous system that can result in cognitive and physical deficits. It can lead to early retirement in 50% of the cases in the first 15 years of the disease without governmental support and to date, there are only a few studies which focus on measures to support people with MS at the workplace. OBJECTIVE: The aim of this study is to analyse the governmental support measures to maintain the working capacity of people with MS and to provide improvements and further approaches for their support. METHODS: A two-stage study was conducted by means of qualitative interviews. The first study was conducted using the problem-centred form with 10 experts from the health and social care sector who work with people affected by MS. The second study was conducted using qualitative interviews in biographical form with 20 people suffering from MS. RESULTS: The study participants mentioned various suggestions for improving the existing governmental support measures, such as a central support office for illness-related questions, relaxing the strict requirements for support measures, giving the regulation of support measures to federal government, changing the pension system and providing financial support for individual therapies and outpatient therapies. Currently, MS patients lack knowledge about contact persons for MS-specific questions, as well as intensive cooperation between labour market service, health service providers and companies to help find a job. CONCLUSION: A combination of the governmental support measures available so far with the proposed optimisations or additions by MS patients and experts can lead to a significant reduction in disease-specific absences and limitations, which in turn results in the preservation of the ability to work. All suggestions from the interviews need to be explored further to investigate a possible implementation.

Limited research concerning existing inequities in mental health care and support services in the United Kingdom captures perceptions and lived experiences of the significantly underrepresented Muslim population. Underpinned by social constructivist theory, we used consultation to facilitate public and patient involvement and engagement (PPIE) to identify inequities in mental health care and support experienced by Muslims from minoritised ethnic communities living in deprived areas in Liverpool, UK. The rationale was to (a) better inform standards and policies in healthcare and (b) provide a psychologically safe space to members of the Muslim community to share perceptions and experiences of mental health care and support services. To ensure trustworthiness of the data, member checking was adopted. This paper describes the procedure to achieving this consultation, including our recruitment strategy, data collection and analysis as well as key findings. Twenty-seven consultees attended the women's consultation and eight consultees attended the men's consultation. Consultees were from Yemeni, Somali, Sudanese, Egyptian, Algerian, Pakistani and Moroccan communities and share the Islamic faith. Four key interlinked themes were identified from consultees' narratives: (1) broken cycle of trust; (2) an overmedicalised model of care; (3) community mental health prevention initiatives; and (4) culturally conscious training and education. The Muslim population has identified numerous barriers to accessing mental health support and there is a need to resource activities that would aid deeper understanding of mental health support needs through continuous and meaningful community initiatives. This would afford mental health practitioners and organisations opportunities for developing realistic anti-racism strategies, effectively adopting social prescription, strengthening partnerships and collaborations aimed at supporting delivery of evidence-based mental health care provisions to tackle mental health inequities. This paper reports on the involvement and engagement of Muslims from minoritised ethnic communities living in the Liverpool city region.

Background:Depression and anxiety are commonly reported (40% and 11%-52%) among adults receiving dialysis, compared with ~10% among all Canadians. Mental health in dialysis care is underrecognized and undertreated.Objective:(1) To describe preferences for mental health support reported by Albertans receiving dialysis; (2) to compare depression, anxiety, and quality-of-life (QOL) domains for people who would or would not engage in support for mental health; and (3) to explore sociodemographic, mental health, and QOL domains that explain whether people would or would not engage in support for mental health.Design:A cross-sectional survey.Setting:Alberta, Canada.Patients:Adults receiving all modalities of dialysis (N = 2972).Measurements:An online survey with questions about preferences for mental health support and patient-reported outcome measures (Patient Health Questionnaire–9 [PHQ-9], Generalized Anxiety Disorder–7 [GAD-7], and Kidney Disease QOL Instrument–36 [KDQOL-36]).Methods:To address objectives 1 and 2, we conducted chi-square tests (for discrete variables) and t tests (for continuous variables) to compare the distributions of the above measures for two groups: Albertans receiving dialysis who would engage or would not engage in support for mental health. We subsequently conducted a series of binary logistic regressions guided by the purposeful variable selection approach to identify a subset of the most relevant explanatory variables for determining whether or not people are more likely to engage in support for mental health (objective 3). To further explain differences between the two groups, we analyzed open-text comments following a summative content analysis approach.Results:Among 384 respondents, 72 did not provide a dialysis modality or answer the PHQ-9. The final data set included responses from 312 participants. Of these, 59.6% would consider engaging in support, including discussing medication with a family doctor (72.1%) or nephrologist (62.9%), peer support groups (64.9%), and talk therapy (60%). Phone was slightly favored (73%) over in person at dialysis (67.6%), outpatient (67.2%), or video (59.4%). Moderate to severe depressive symptoms (PHQ-9 score ≥10) was reported by 33.4%, and most respondents (63.9%) reported minimal anxiety symptoms; 36.1% reported mild to severe anxiety symptoms (GAD-7 score ≥5). The mean (SD) PHQ-9 score was 8.9 (6.4) for those who would engage in support, and lower at 5.8 (4.8) for those who would not. The mean (SD) GAD-7 score was 5.2 (5.6) for those who would engage in support and 2.8 (4.1) for those who would not. In the final logistic regression model, people who were unable to work had 2 times the odds of engaging in support than people who are able to work. People were also more likely to engage in support if they had been on dialysis for fewer years and had lower (worse) mental health scores (odds ratios = 1.06 and 1.38, respectively). The final model explained 15.5% (Nagelkerke R2) of the variance and with 66.6% correct classification. We analyzed 146 comments in response to the question, “Is there anything else you like to tell us.” The top 2 categories for both groups were QOL and impact of dialysis environment. The third category differed: those who would engage wrote about support, whereas those who would not engage wrote about “dialysis is the least of my worries.”Limitations:A low response rate of 12.9% limits representativeness; people who chose not to participate may have different experiences of mental health.Conclusions:Incorporating patients’ preferences and willingness to engage in support for mental health will inform future visioning for person-centered mental health care in dialysis.

BACKGROUND Barriers to accessing mental health support are common experiences reported by university students. Digital tools can improve equitable access to the indicated level of support and provide actionable insight and recommendations. OBJECTIVE This study aimed to evaluate the acceptability and effectiveness of a web-based self-guided mental health and well-being support platform (U-Flourish Platform) that was tailored specifically for university students. METHODS The i-spero® platform was adapted in partnership with students to provide evidence-based well-being plans, mental health symptom tracking, and automated alerts and recommendations based on self-report data from students. After providing informed consent, students registered to access the platform and completed baseline demographic information and weekly validated screening measures of anxiety (GAD), depression (PHQ), and well-being (SWEMWEBS) over 8 weeks. At 6 weeks, students completed a user-experience survey. Paired t-tests were used to compared symptom scores and chi-squared tests assessed changes in symptom screening status over the 8-week period. Unadjusted logistic regression was used to assess whether baseline demographic factors and symptom screening status were associated with user-experience outcomes. RESULTS The analyses included data from 404 consenting students. At 6-weeks, most students (75%) expressed satisfaction with the platform, felt it was easy to use and understand (85%), and found the platform helpful for supporting their mental health (58%). Adherence was relatively high (76%) and attrition was relatively low (26%) after 6 weeks but reduced substantively thereafter; associated with timing of the end of incentivized use and end of term examinations and assignments. Mean anxiety (1.55 vs. 2.19, p<.0001; Cohen’s d=0.36), depression (0.94 vs. 1.36, P=.0001; Cohen’s d=0.33), and well-being (24.87 vs. 22.28, P<.0001, Cohen’s d=0.34) scores were improved at 8-Weeks vs baseline, with the greatest positive effects for students who screened positive for anxiety (Cohen’s d=1.16) and depression (Cohen’s d=2.22) at baseline. There was no evidence of differences in user-experience across demographic factors (i.e. gender, international student status, and lifetime history of a mental disorder) or baseline screening status, except for males who had lower odds (OR=0.40, 95% CI: 0.18-0.90) of finding the platform easy to use compared to female students. Of the 404 student-users, 142 created at least one well-being plan, with 75% and 57% of them being endorsed as helpful and being satisfactory in the support they provided, respectively. Most students reported satisfaction with the Platform (75%), it being easy to use (85%), and it having a positive impact on their mental health (58%). CONCLUSIONS Evidence supports that a self-guided digital well-being and mental health support platform is an acceptable and useful resource for university students. Therefore, student-tailored digital tools should be considered as part of an integrated and comprehensive whole-university approach for student well-being and mental health support.

Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students. We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children's Anxiety and Depression Scale (RCADS). Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support. Of those not reporting prior access, 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, cumulative ACE scores were significantly positively associated with both prior access to mental health support (odds ratio (OR)=1.36; 95% confidence interval (CI): 1.29-1.43) and perceived unmet need for mental health services (OR=1.47; 95% CI: 1.37-1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR)=1.25; 95% CI: 1.17-1.34 with a significant interaction between RCADS and ACE scores, aOR=0.88; 95% CI: 0.84-0.93) as well as perceived unmet need (aOR=1.32; 95% CI: 1.21-1.43 with a significant interaction between RCADS and ACE scores, aOR=0.85; 95% CI: 0.78-0.91). Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.

This study explored the emerging role of ChatGPT in mental health and psychological support. Employing a narrative case study approach, I examined vignettes from users who interacted with ChatGPT for various mental health and psychological needs. These cases were purposively sampled. The analysis revealed a diverse range of applications for ChatGPT, including coping with grief and loss, simulating conversations with deceased loved ones, seeking emotional support, developing social skills, managing ADHD symptoms, and serving as an on-demand mental health resource. Users consistently reported finding comfort, practical assistance, and immediate accessibility in these interactions. However, highlighted also are the potential risks associated with AI-assisted mental health support. These included the possibility of reliance on AI, complications in natural grieving processes, and the blurring of boundaries between AI and human connections. This paper emphasizes that ChatGPT may provide valuable support, but it should not be seen as a replacement for human therapists or comprehensive mental health treatment plans. The study also suggests that AI chatbots like ChatGPT are emerging as complementary tools in mental health support. However, their integration into mental health care requires careful consideration of ethical implications, privacy concerns, and the preservation of essential human elements in therapeutic relationships. Further research is recommended to guide the development of effective and ethical AI-assisted mental health and psychological support.

BackgroundAustralian rural and regional communities are marked by geographic isolation and increasingly frequent and severe natural disasters such as drought, bushfires and floods. These circumstances strain the mental health of their inhabitants and jeopardise the healthy mental and emotional development of their adolescent populations. Professional mental health care in these communities is often inconsistent and un-coordinated. While substantial research has examined the barriers of young people’s mental health and help-seeking behaviours in these communities, there is a lack of research exploring what adolescents in rural and regional areas view as facilitators to their mental health and to seeking help when it is needed. This study aims to establish an in-depth understanding of those young people’s experiences and needs regarding mental health, what facilitates their help-seeking, and what kind of mental health education and support they want and find useful.MethodWe conducted a qualitative study in 11 drought-affected rural and regional communities of New South Wales, Australia. Seventeen semi-structured (14 group; 3 individual) interviews were held with 42 year 9 and 10 high school students, 14 high school staff, and 2 parents, exploring participants’ experiences of how geographical isolation and natural disasters impacted their mental health. We further examined participants’ understandings and needs regarding locally available mental health support resources and their views and experiences regarding mental illness, stigma and help-seeking.ResultsThematic analysis highlighted that, through the lens of participants, young people’s mental health and help-seeking needs would best be enabled by a well-coordinated multi-pronged community approach consisting of mental health education and support services that are locally available, free of charge, engaging, and empowering. Participants also highlighted the need to integrate young people’s existing mental health supporters such as teachers, parents and school counselling services into such a community approach, recognising their strengths, limitations and own education and support needs.ConclusionsWe propose a three-dimensional Engagement, Empowerment, Integration model to strengthen young people’s mental health development which comprises: 1) maximising young people’s emotional investment (engagement); 2) developing young people’s mental health self-management skills (empowerment); and, 3) integrating mental health education and support programs into existing community and school structures and resources (integration).

In the light of the new diagnostic criteria for multiple sclerosis (MS) and currently available early treatment, this study aimed to explore whether, and to what extent, disclosure of the diagnosis of MS or clinically isolated syndrome (CIS) affects patients' anxiety, mood and quality of life (QoL). Eligible participants were all patients referred for the first time to the Neurological Unit who had manifested symptoms suggestive of MS for no more than 6 months. All patients were evaluated for (i) QoL (SEIQoL and MS-QoL54), (ii) Anxiety (STAI) and Depression (CMDI) on study inclusion (T0), 30 days after diagnosis disclosure (T30), and after 1 (T1y) and 2 (T2y) years' follow-up. Two hundred and twenty-nine patients were enrolled; 93 of these were unaware of their diagnosis. Patients who already knew their diagnosis (100 with CIS and 22 with MS) were excluded from the main analyses and used to perform control analyses. At the end of the screening, an MS diagnosis was disclosed to 18 of the 93 patients, whereas a CIS diagnosis was disclosed to 62 patients (12 patients received a diagnosis other than MS or CIS). Thirty days after diagnosis disclosure, irrespective of the diagnosis disclosed, both QoL and Anxiety and Depression were significantly rated as better compared to the start of screening, (p(s) < 0.03), and this improvement remained stable over the two annual follow-ups. However, as suggested by a significant 'Time' × 'Diagnosis' interaction with regard to both QoL and Anxiety and Depression (p(s) < 0.02), the effect of the disclosure in the short term differed depending on CIS or MS diagnosis. Specifically, on MSQoL, which is a health-related QoL scale, we found a statically significant improvement, immediately after the diagnosis disclosure, in both the MS and CIS groups (p(s) < 0.01). Differently, on SEIQoL, which is a non health-related QoL measure, and on the anxiety scale, we observed a statistically significant improvement only in the group which received a MS diagnosis (p(s) < 0.03). This first prospective study provides objective data showing that early disclosure of MS diagnosis improves both the patient's QoL and psychological well-being. In addition, the results seem to suggest that CIS disclosure does not lead to the same favourable effects.

“Watching my family being killed by terrorists made me really depressed”: Mental health experiences, challenges and needed support of young internally displaced persons in northern Nigeria

Background. During the recent decade, the working capacity of patients with multiple sclerosis (MS) in many countries is determined by International Classification of Functioning, Disability and Health (ICF) based on biopsychosocial view. It not only identifies the condition of health of patients, but also suggests measures to improve their inclusion into society. However, in Lithuania, the ICF principles for determining the level of working capacity are applied in a fragmentary way, and more often the biological-physical parameters of a person’s health status are used. Thus, the establishment of relationship between ICF and working capacity level would create assumptions to legitimize the use of this classification that subsequently would contribute to the well-being of people with MS. The aim of this research is to carry out a comprehensive biopsychosocial assessment of Lithuanian MS patients and to determine how their level of working capacity is related to the results of various categories of ICF.Subjects and methods. The cross-sectional study involved 184 people with MS including 157 people who had applied to the Disability and Working Capacity Assessment Office under the Ministry of Social Security and Labour of the Republic of Lithuania (DWCAO) to determine their working capacity level and 27 people with MS who hadn’t yet applied to DWCAO. The subjects were interviewed using a brief ICF core set for MS; sociodemographic and disease data were also collected.Results. 66% of patients with MS reported that they had a complete difficulty of moving around by means other than walking (ICF category d455), 32% – remunerative employment (d850). 81% of patients with MS had no difficulties in higher-level cognitive functions (b164), 63% in carrying out daily routine (d230), 57% – in solving problems (d175). 7–10% of patients faced negative attitudes of their family members or health care specialists and they considered it as a difficulty. Those with working capacity level of 0–25% faced higher difficulties in almost all ICF categories, compared to people with higher working capacity. MS patients with working capacity level of 30–40% had more difficulties of seeing, urination, muscle power functions, walking and moving around by means other than walking than MS patients with working capacity level of 45–55%; they also faced more difficulties in moving around functions and had a different brain structure than those with working capacity level of 60–100%.Conclusions. The value of ICF categories for assessment of the working capacity level of people with MS is different. The higher the level of person’s working capacity, the less restrictions patients with MS indicate in assessing ICF categories.

While positive changes in mental health have been found following gender-affirming hormone treatment (GAHT), it is unclear how pre-GAHT mental health and social support can influence treatment outcomes. To address this, a retrospective longitudinal design was used in which 137 participants completed measures of social support, anxiety, and depression prior to GAHT (T0) and a measure of life satisfaction 18 months after GAHT (T1). The data showed no significant differences in life satisfaction at T1 based on T0 caseness of anxiety or depression. It was also found that T1 life satisfaction was not predicted by levels of anxiety, depression, or social support at T0. The lack of significant differences in life satisfaction at 18 months post-GAHT based on pre-GAHT mental health, coupled with no evidence for the predictive role social support suggest that these factors are not central to long-term life satisfaction. For many, lower mental wellbeing may be part of the experience of awaiting GAHT and should not be regarded as indicative of longer-term issues. Instead, facilitation of social support connections and mental health support should be offered both concurrently with, and for those awaiting, GAHT.

The rapid evolution of large language models (LLMs), such as Bidirectional Encoder Representations from Transformers (BERT; Google) and GPT (OpenAI), has introduced significant advancements in natural language processing. These models are increasingly integrated into various applications, including mental health support. However, the credibility of LLMs in providing reliable and explainable mental health information and support remains underexplored. This scoping review systematically maps the factors influencing the credibility of LLMs in mental health support, including reliability, explainability, and ethical considerations. The review is expected to offer critical insights for practitioners, researchers, and policy makers, guiding future research and policy development. These findings will contribute to the responsible integration of LLMs into mental health care, with a focus on maintaining ethical standards and user trust. This review follows PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and the Joanna Briggs Institute (JBI) methodology. Eligibility criteria include studies that apply transformer-based generative language models in mental health support, such as BERT and GPT. Sources include PsycINFO, MEDLINE via PubMed, Web of Science, IEEE Xplore, and ACM Digital Library. A systematic search of studies from 2019 onward will be conducted and updated until October 2024. Data will be synthesized qualitatively. The Population, Concept, and Context framework will guide the inclusion criteria. Two independent reviewers will screen and extract data, resolving discrepancies through discussion. Data will be synthesized and presented descriptively. As of September 2024, this study is currently in progress, with the systematic search completed and the screening phase ongoing. We expect to complete data extraction by early November 2024 and synthesis by late November 2024. This scoping review will map the current evidence on the credibility of LLMs in mental health support. It will identify factors influencing the reliability, explainability, and ethical considerations of these models, providing insights for practitioners, researchers, policy makers, and users. These findings will fill a critical gap in the literature and inform future research, practice, and policy development, ensuring the responsible integration of LLMs in mental health services. DERR1-10.2196/62865.

Lesbian, gay, bisexual, trans, queer/questioning, plus young people have a higher risk of poor mental health in comparison to cisgendered heterosexual young people, and they underutilise mental health services and support. In addition, there is a paucity of research conducted in United Kingdom examining mental health early intervention provision for lesbian, gay, bisexual, trans, queer/questioning, plus young people. To produce a model of what works for early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people and increase understanding of lesbian, gay, bisexual, trans, queer/questioning, plus young people's access to, navigation of, and engagement with mental health support. This was a multi-methods theory-led case study evaluation with three distinct stages: (1) a meta-narrative review of existing literature to develop a theoretical framework to explain effective mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people; (2) an online and offline service mapping exercise to locate current mental health early intervention support for lesbian, gay, bisexual, trans, queer/questioning, plus young people in the United Kingdom in order to produce a service typology; and (3) a theory-led case study evaluation of 12 case study sites selected from the service typology produced in stage 2, to establish the components of appropriate quality, early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Stage 1 produced an interdisciplinary theoretical framework indicating that early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus youth must prioritise addressing normative environments that marginalise youth, lesbian, gay, bisexual, trans, queer/questioning, plus identities and mental health problems. Stage 2 mapping found 111 services, the majority in urban settings in England. There was an absence of mainstream National Health Service support that specifically addressed the needs of lesbian, gay, bisexual, trans, queer/questioning, plus young people. The majority of lesbian, gay, bisexual, trans, queer/questioning, plus youth mental health support was provided by voluntary/community organisations. Stage 3 case study evaluation found that an intersectional, youth-rights approach is the most appropriate way to deliver early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Youth rights should underpin mental health support to address the multiple marginalisation, isolation and stigmatisation that lesbian, gay, bisexual, trans, queer/questioning, plus young people may experience and to enable them to make informed independent decisions about their own bodies and lives, and for the right to freedom of safe self-expression to be upheld. The model that we have produced contains 13 principles that are necessary to the provision of mental health support, and to improve access to, engagement with, and navigation of mental health services. In the United Kingdom, a rights-based approach to mental health service provision is not prominent. In addition, at the time of writing, lesbian, gay, bisexual, trans, queer/questioning, plus young people are facing active legislative and policy attacks on their human rights. This study provides the first large-scale theory-led evaluation of early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with common mental health problems. The resulting intersectional, youth-rights approach provides evidence on ways of improving lesbian, gay, bisexual, trans, queer/questioning, plus young people's mental health. Further research on the implementation of an intersectional, youth-rights approach to early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with mental health problems is required. This study is registered as PROSPERO CRD42019135722. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 47. See the NIHR Funding and Awards website for further award information.

ObjectiveLittle work has evaluated integrated models of care in multiple sclerosis (MS) and the composition of MS care teams across Canada is largely unknown. We aimed to gather information regarding existing models of MS care across Canada, and to assess the perceptions of health care providers (HCPs) regarding the models of care required to fully meet the needs of the person with MS.MethodsWe conducted an anonymous online survey targeting Canadian HCPs working in MS Clinics, and neurologists delivering MS care whether or not they were based in an MS Clinic. We queried the types of HCPs delivering care within formal MS Clinics, wait times for HCPs, the perceived importance of different types of HCPs for good quality care, assessments conducted, and whether clinic databases were used. We summarized survey responses using descriptive statistics.ResultsOf the 716 HCPs to whom the survey was distributed, 100 (13.9%) people responded. Of the 100 respondents, 85 (85%) indicated that their clinical practice included people with MS and responded to specific questions about clinical care. The most common types of providers within MS Clinics with integrated models of care were neurologists and MS nurses. Of 23 responding MS Clinics, 10 (43.5%) indicated that there were not enough neurologists, and 16 (69.6%) indicated that there were not enough non-neurologist HCPs to provide adequate care. More than 50% of clinics reported wait times exceeding 3 months for physiatrists, physiotherapists, psychiatrists, psychologists, neuropsychologists and urologists; in some clinics wait times for these providers exceeded 1 year. Multiple disciplines were identified as important or very important for delivering good quality MS care. Over 90% of respondents thought it was important for neurologists, nurse practitioners, MS nurses and psychiatrists to be co-located within MS Clinics.ConclusionCanadian HCPs viewed the ideal MS service as being multidisciplinary in nature and ideally integrated. Efforts are needed to improve timely access to specialized MS care in Canada, and to evaluate how outcomes are influenced by access to care.

BackgroundThe COVID-19 pandemic created many challenges for our society. In this study, we explore how measures of mental health, coping strategies, and social support during the pandemic varied by glaucoma status.MethodsA cohort of patients aged 40 and over enrolled in the NIH All of Us Research Program, a nationwide longitudinal cohort, who answered the COVID-19 Participant Experience (COPE) survey was obtained. We analyzed several measures of mental health, coping strategies, and social support used during the early stages of the COVID-19 pandemic. Surveys were recurring and answered from May 2020 to February 2021. Demographics and the most recently answered survey responses were obtained and stratified by glaucoma status. Pearson’s Chi-squared tests and multivariable logistic regressions adjusting for age, gender, race, ethnicity, and income were used to generate p-values, odds ratios (ORs) and 95% confidence intervals (CIs) between outcome measures and glaucoma status.ResultsOf 42,484 patients who responded to All of Us COPE survey items, 2912 (6.9%) had a diagnosis of glaucoma. On Pearson’s Chi-squared tests glaucoma patients were less likely to report drinking alcohol (P = 0.003), eating more food than usual (P = 0.004), and using marijuana (P = 0.006) to cope with social distancing than those without a diagnosis of glaucoma. Further, glaucoma patients had lower rates of probable mild, moderate, or severe depression as calculated by Patient Health Questionnaire-9 (PHQ-9) scores (P < 0.001) and had lower rates of reporting some or a lot of stress from social distancing (P < 0.001). However, glaucoma patients were less likely to report having someone to help prepare meals (P = 0.005) or help with daily chores (P = 0.003) if they became sick with COVID-19. In multivariable logistic regression analyses adjusting for confounding factors, no differences were found for measures of mental health or social support.ConclusionsGlaucoma patients did not fare worse on many measures of mental health and coping strategies during the early stages of the COVID-19 pandemic compared those without glaucoma. However, a substantial proportion of glaucoma patients still endorsed stress, social isolation, and probable depression, representing challenges for disease management.