Access To Mental Health Services Research Articles

Integrating large language models in mental health practice: a qualitative descriptive study based on expert interviews

BackgroundProgress in developing artificial intelligence (AI) products represented by large language models (LLMs) such as OpenAI’s ChatGPT has sparked enthusiasm for their potential use in mental health practice. However, the perspectives on the integration of LLMs within mental health practice remain an underreported topic. Therefore, this study aimed to explore how mental health and AI experts conceptualize LLMs and perceive the use of integrating LLMs into mental health practice.MethodIn February–April 2024, online semi-structured interviews were conducted with 21 experts (12 psychiatrists, 7 mental health nurses, 2 researchers in medical artificial intelligence) from four provinces in China, using snowballing and purposive selection sampling. Respondents’ discussions about their perspectives and expectations of integrating LLMs in mental health were analyzed with conventional content analysis.ResultsFour themes and eleven sub-themes emerged from this study. Firstly, participants discussed the (1) practice and application reform brought by LLMs into mental health (fair access to mental health services, enhancement of patient participation, improvement in work efficiency and quality), and then analyzed the (2) technological-mental health gap (misleading information, lack of professional nuance and depth, user risk). Based on these points, they provided a range of (3) prerequisites for the integration of LLMs in mental health (training and competence, guidelines for use and management, patient engagement and transparency) and expressed their (4) expectations for future developments (reasonable allocation of workload, upgrades and revamps of LLMs).ConclusionThese findings provide valuable insights into integrating LLMs within mental health practice, offering critical guidance for institutions to effectively implement, manage, and optimize these tools, thereby enhancing the quality and accessibility of mental health services.

The Impact and Future of Teletherapy in Mental Health Support

Teletherapy, a digital form of mental health support, has become an essential aspect of psychological care, driven by technological advancements and evolving societal needs. This paper examines the evolution, benefits, and challenges of teletherapy, emphasizing its accessibility, especially for underserved populations. It highlights innovations such as artificial intelligence (AI) and secure messaging and discusses ethical considerations like confidentiality and informed consent. Despite limitations, such as technical barriers and reduced non-verbal communication, teletherapy is poised to grow, offering flexible, accessible mental health services. The future of teletherapy will likely see further integration with emerging technologies, potentially reshaping the landscape of mental health care. Keywords: Teletherapy, mental health support, digital therapy, online therapy, telehealth, accessibility.

"I don't feel fully prepared": a qualitative study of recently graduated students' mental health experiences of the transition out of university.

This study aimed to better understand the mental health experiences of students as they prepared to transition out of university. Participants included 18 recently graduated students from a Canadian university. Virtual one-on-one semi-structured qualitative interviews were conducted and analyzed following the protocol for content analysis and using QSR NVivo. Four main themes were identified, including: distress and feelings of doubt, the importance of connections, the impact of the COVID-19 pandemic, and experiences with mental health service use. Participants discussed feeling pressured to succeed and a fear of failure, uncertainty and unpreparedness for next steps, the importance of connections to peers and professors, a lack of motivation and feeling 'unfinished' due to the COVID-19 pandemic response, and the need for flexible and accessible mental health services to address immediate and longer-term needs. Results have implications for better support of students as they prepare for graduation.

Factors Associated With Not Receiving Mental Health Services Among Children With A Mental Disorder in Early Childhood in the United States, 2021-2022.

Many mental disorders begin in early childhood. Without timely treatment, mental disorders experienced by young children can impair their learning ability and relationships with others, causing lifelong complications. However, not all children with a mental disorder in early childhood receive treatment. Using data collected from 46,424 children aged 2 to 8 years in the 2 most recent cycles of the National Survey of Children's Health (2021 and 2022), we estimated the prevalence of having a mental disorder and investigated factors associated with young children not receiving mental health care when needed. All analyses were adjusted for survey weights to account for the complex sampling design and nonresponse biases in generating nationally representative estimates. In 2021 and 2022, 19.0% of US children aged 2 to 8 years had 1 or more mental disorders. Of these children, 9.1% reported not receiving any needed health care in the previous 12 months, and of these, 45.8% reported not receiving mental health services when needed. The primary reasons for not receiving needed health care were problems getting an appointment (72.1%), issues related to cost (39.3%), and services needed not being available in the area (38.5%). Poor experiences with health care providers were consistently associated with not receiving needed mental health services among children with mental disorders. Our findings suggest a strong link between health care factors and not receiving needed mental health services among US children with a mental disorder in early childhood. In addition to increasing the availability of mental health services and expanding health insurance coverage, future public health efforts should prioritize enhancing patients' experiences with health care providers.

COVID-19 Lockdown and Access to Health Services Among People with Mental Health Problems in Nigeria

ABSTRACT This study assessed the roles of COVID-19 lockdown on access to mental health services in Nigeria. 172 patients who visited the hospital before and during the lockdown were recruited. The methods of data analyses were descriptive, correlations and binary logistic regression. The logistic regression confirmed that socioeconomics of participants predicted their likelihood to access mental health services in hospital during the COVID-19 lockdown. Participants accessed treatments in traditional healing homes, home treatment centers, and place of religious worship. Policymakers need to expand the existing programs for accessible and affordable mental health services and standardized alternatives during health emergencies.

State-level variation in the prevalence of child psychopathology symptoms in the US: Results from the ABCD study

ObjectiveTo estimate the prevalence of clinically meaningful youth mood, anxiety, behavioral, and attention symptoms across US states. MethodData are drawn from the Adolescent Brain Cognitive Development (ABCD) study baseline wave, which included 11,876 children ages 9-10. Statistical weighting strategies generated projected state-specific prevalence estimates for the 17 states where ABCD collected data based on state socio-demographics. Twenty dimensions of mental health were assessed with the Child Behavior Checklist using recommended cut-scores to assess clinical and sub-threshold symptoms. ResultsPsychopathology symptom prevalence varied by state and outcome. Projected prevalence of internalizing problems ranged from 11.0% [95% CI: 9.8%, 12.2%; Oklahoma] to 7.9% [95% CI: 6.9%, 9.0%; Maryland] across states. Projected prevalence of externalizing problems ranged from 6.9% [95% CI: 6.1%, 7.8%; South Carolina] to 4.5% [95% CI: 3.7%, 5.4%; California]. Regions with high symptoms included sections of the South (e.g., Oklahoma, South Carolina) and Vermont. Conduct problems had the most variability across states (i.e., greatest state-level prevalence 91% higher than the lowest). Attention problems had the least variability across states (greatest state-level prevalence 26% higher than the lowest). ConclusionsClinically meaningful psychopathology symptoms are common in children across the US, with substantial state-level variability in prevalence. Understanding variability in the prevalence of psychopathology symptoms across the US can help to inform resource allocation to increase the availability of youth mental health services.

Compound Crises: The Impact of Emergencies and Disasters on Mental Health Services in Puerto Rico

Background: Mental health in Puerto Rico is a complex and multifaceted issue that has been shaped by the island’s unique history, culture, and political status. Recent challenges, including disasters, economic hardships, and political turmoil, have significantly affected the mental well-being of the population, coupled with the limitations in the accessibility of mental health services. Thus, Puerto Rico has fewer mental health professionals per capita than any other state or territory in the United States. Objective: This comprehensive review examines the impact of disasters on mental health and mental health services in Puerto Rico. Given the exodus of Puerto Ricans from the island, this review also provides an overview of mental health resources available on the island, as well as in the continental United States. This review identifies efforts to address mental health issues, with the intent of gaining a proper understanding of the available mental health services, key trends, as well as observable challenges and achievements within the mental health landscape of the Puerto Rican population. Design: A comprehensive search using the PRIMO database of the University of Central Florida (UCF) library database was conducted, focusing on key terms related to disasters and mental healthcare and services in Puerto Rico. The inclusion criteria encompassed studies on Puerto Rican individuals, both those who remained on the island and those who migrated post-disaster, addressing the mental health outcomes and services for adults and children. We included peer-reviewed articles published from 2005 onwards in English and/or Spanish, examining the impact of disasters on mental health, accessibility of services, and/or trauma-related consequences. Results: In this scoping review, we identified 39 studies addressing the mental health profile of Puerto Ricans, identifying significant gaps in service availability and accessibility and the impact of environmental disasters on mental health. The findings indicate a severe shortage of mental health services in Puerto Rico, exacerbated by disasters such as Hurricanes Irma and Maria, the earthquakes of late 2019 and early 2020 that followed, and the COVID-19 pandemic, resulting in substantial delays in accessing care, and limited insurance coverage, particularly in rural regions. Despite these challenges, efforts to improve mental health services have included substantial federal funding and community initiative aimed at enhancing care availability and infrastructure. Limitations include the use of a single database, language restrictions, and potential variability in data extraction and synthesis. Conclusions: This scoping review highlights the significant impact of disasters on mental health in Puerto Rico and the challenges in accessing mental health services exacerbated by disasters. Despite efforts, significant gaps in mental healthcare and services persist, emphasizing the need for more rigorous research and improvements in infrastructure and workforce to enhance mental health outcomes for Puerto Ricans both on the island and in the continental United States.

Abstract B172: Evidence of behavioral research before and during cancer care in Sub-Saharan Africa: A scoping review

Abstract Introduction: Understanding the behavioral aspects of cancer care in Sub-Saharan Africa (SSA) is crucial for developing effective interventions and improving outcomes, particularly during the peri-treatment phase. Synthesizing knowledge sets the stage for prioritizing cancer-focused research in SSA. Therefore, this scoping review aims to synthesize current knowledge on cancer behavioral research during the peri-treatment phase in SSA, focusing on the behavioral and psychosocial aspects of care. Method: Comprehensive literature searches were conducted across multiple databases and grey literature sources. Studies were selected if they included participants > 18 years old undergoing peri-treatment care, randomized controlled trials, or qualitative/quantitative methodologies focused on behavioral oncology. Only full-text articles published in English were included. Data from the selected studies were systematically extracted and organized. Results: A total of 1,897 cancer patients were included across 18 out of the 24 articles analyzed, with participants aged 8-80 years old. The studies mainly included participants recently diagnosed with cancer or undergoing treatment, covering various cancer types, including prostate, cervical, gastric, liver, and colon cancer, from stage I-III. Only three of the 24 studies referenced theoretical frameworks. Each study identified behavioral factors and outcomes among their sample population. Key findings across the studies underscored significant psychological distress manifested through a spectrum of emotional and psychosocial challenges, including poor social and psychological well-being, depression, anxiety, insomnia, and agoraphobia. Cultural influences, cost considerations, and non-interference of symptoms with day-to-day activities delayed healthcare seeking, especially among women. Despite these challenges, instances of psychological resilience were noted, driven by perceived social support, religiosity, hope, and optimism. The review highlighted the complex interplay between cultural norms, stigma, and health behaviors, with stigma often rooted in cultural beliefs. Spiritual beliefs and practices were central to many participants’ cancer journey, shaping their views on illness, treatment, and recovery. Key factors affecting cancer care include healthcare accessibility, financial limitations, social support networks, healthcare provider attitudes, family involvement in treatment decisions, and emotional support. Conclusion: The findings from this scoping review reveal significant psychological distress and barriers to care among cancer patients in SSA, highlighting the urgent need for comprehensive, culturally sensitive interventions that addresses emotional, social, and cultural dimensions. This approach should integrate accessible mental health services, enhance social support networks, and promote culturally appropriate educational programs to reduce stigma and encourage timely healthcare-seeking. Citation Format: Opeyemi O. Bolajoko, Danneta S. Hooks, Motolani Adedipe, Jessica Saintibert, OluwaSeyi Toye, Clifton Sheri, Folakemi T Odedina. Evidence of behavioral research before and during cancer care in Sub-Saharan Africa: A scoping review [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B172.

The potential of a rights-based approach to refugee-focused mental health policy in Aotearoa New Zealand

ABSTRACT In accordance with international human rights commitments, individuals with a refugee background have the right to mental health services that are available, accessible, acceptable, and of good quality. However, refugee-background individuals living in Aotearoa New Zealand experience a myriad of barriers at the individual, community, and policy level that impede access to appropriate mental health services. This commentary puts forward the argument that the incorporation of a human rights-based approach to mental healthcare service at a policy level is essential for reducing barriers to care and increasing the accessibility of mental health services. The article provides key recommendations for reforming the current New Zealand Refugee Resettlement Strategy (NZRRS) to include rights-based indicators for children and youth, to monitor accessibility relative to geographic location, to disaggregate data, to extend the 12-month monitoring period and to extend monitoring beyond one mental health visit. Further research is needed to understand how best to implement these recommendations and develop insight into how Aotearoa New Zealand can more effectively uphold the rights of refugee-background individuals with the ultimate goal of developing a mental health system that is more inclusive and responsive to their needs.

Mental Health Aftercare Availability for Juvenile Justice-Involved Youth in New York City.

The goal of our study was to describe the availability of community child and adolescent mental health services, trauma-informed care, and the geographic accessibility of these services for juvenile justice-involved (JJ) youth who received mental health services while in secure detention. Data collection occurred through direct contact with the child and adolescent outpatient clinics listed on the New York State Office of Mental Health website. Zip codes were collected from the juvenile secure detention census. Of the clinics contacted, 88.5 percent accepted JJ youth; however, 43.5 percent accepted them on a conditional basis. Only 62.1 percent offered trauma-informed care, including evidence-based interventions and unspecified care. Although 84.5 percent of the clinics that would accept this population reported currently accepting new patients, reported wait times were as high as six or more months. When JJ residents' home zip codes and those of the clinics were geographically mapped, there were few clinics in the zip codes where most residents lived. The clinics that accepted youth on a conditional basis often refused high-risk patients, essentially ruling out a large majority of this population. The geographical inaccessibility of these clinics limits their ability to provide care for this vulnerable population.

Academic Essay On Equitable Access To Mental Health Services In Brazil

Equitable access to mental health services in Brazil faces complex and interconnected challenges. Among the main issues are regional inequalities, socioeconomic barriers, and the stigma associated with mental disorders. Regional inequality results in significant differences in the quality and availability of mental health services between urban and rural areas. While large cities such as São Paulo and Rio de Janeiro have advanced infrastructure and qualified professionals, rural areas and urban outskirts suffer from a lack of resources and professionals, limiting access to necessary care. Socioeconomic barriers also play a crucial role. Low-income populations face additional difficulties, such as lack of transportation and inadequate health insurance, which restrict access to mental health services. The lack of information and the stigmatization of mental disorders worsen the situation, discouraging individuals from seeking treatment due to fear of discrimination and prejudice. To address these challenges, it is essential to adopt integrated strategies. Expanding mental health infrastructure in underserved areas and creating integrated care networks are fundamental. Public policies should reduce socioeconomic inequalities by providing financial support and improving transportation. Awareness campaigns about mental health can overcome informational barriers and stigma. Continuous training of health professionals and community participation are also crucial to ensure inclusive and locally adapted care. With a coordinated effort, it is possible to promote more just and comprehensive access to mental health services in Brazil.

Effect of police enforcement and extreme social inequalities on violence and mental health among women who sell sex: findings from a cohort study in London, UK

Objectives To examine legal and social determinants of violence, anxiety/depression among sex workers. Methods A participatory prospective cohort study among women (inclusive of transgender) ≥18 years, selling sex in the last 3 months in London between 2018 and 2019. We used logistic generalised estimating equation models to measure associations between structural factors on recent (6 months) violence from clients or others (local residents, strangers), depression/anxiety (Patient Health Questionnaire-4). Results 197 sex workers were recruited (96% cisgender-women; 46% street-based; 54% off-street) and 60% completed a follow-up questionnaire. Street-based sex workers experienced greater inequalities compared with off-street in relation to recent violence from clients (73% vs 36%); police (42% vs 7%); intimate partner violence (IPV) (56% vs 18%) and others (67% vs 17%), as well as homelessness (65% vs 7%) and recent law enforcement (87% vs 9%). Prevalence of any STI was 17.5% (17/97). For street-based sex workers, recent arrest was associated with violence from others (adjusted OR (aOR) 2.77; 95% CI 1.11 to 6.94) and displacement by police was associated with client violence (aOR 4.35; 95% CI 1.36 to 13.90). Financial difficulties were also associated with client violence (aOR 4.66; 95% CI 1.64 to 13.24). Disability (aOR 3.85; 95% CI 1.49 to 9.95) and client violence (aOR 2.55; 95% CI 1.10 to 5.91) were associated with anxiety/depression. For off-street sex workers, financial difficulties (aOR 3.66; 95% CI 1.64 to 8.18), unstable residency (aOR 3.19; 95% CI 1.36 to 7.49), IPV (aOR 3.77; 95% CI 1.30 to 11.00) and alcohol/drug use were associated with client violence (aOR 3.16; 95% CI 1.26 to 7.92), while always screening and refusing clients was protective (aOR 0.36; 95% CI 0.15 to 0.87). Disability (aOR 5.83; 95% CI 2.34 to 14.51), unmet mental health needs (aOR 3.08; 95% CI 1.15 to 8.23) and past eviction (aOR 3.99; 95% CI 1.23 to 12.92) were associated with anxiety/depression. Conclusions Violence, anxiety/depression are linked to poverty, unstable housing and police enforcement. We need to modify laws to allow sex workers to work safely and increase availability of housing and mental health services.

Exploring Psychologists’ Perspectives on Preparation and Practical Experience of Tele-Counseling

<p>以視訊為本的通訊諮商於新冠肺炎疫情期間在國內快速發展。鑑此，本研究奠基在建構主義觀點進行質性研究，以深入探究心理師對於通訊諮商之準備與實施經驗。透過立意取樣與滾雪球取樣，共18位心理師參與以線上視訊形式進行之半結構式個別訪談（5男、13女；年齡為30至55歲；從事通訊諮商時數範圍為6至380小時）。資料分析上採用分析抽象階層化概念（the ladder of analytical abstraction）進行。分析結果有二。（1）通訊諮商的準備包括三層面：（a）政策規範層面。現今存有申請流程繁瑣、實施細則不明確，以及規範與實務之落差等議題，增添準備困難，如何促進法規與實務間的契合誠為重點；（b）機構與心理師層面。因經驗缺乏，心理師在準備中且戰且走，目前強調以個案福祉與諮商倫理為經緯預先建構通訊諮商流程，並妥善設置設備及熟稔操作；（c）個案層面。心理師認為要積極催化個案對通訊諮商的準備與投入，進而共構治療同盟並維持諮商架構。（2）通訊諮商的實施經驗分為助益與限制。心理師大多表示通訊諮商與實體諮商具有共通性，可發揮諮商的基礎效益，且一定程度可打破空間與距離限制，以服務特定個案；然而通訊諮商可能出現三類型限制。首先，個案評估的精準性較低、諮商歷程較難掌握；再者，通訊諮商存有形式限制，包括進行體驗型諮商或多人諮商較為困難；最後，通訊諮商的服務對象有所限制，如危機個案或未成年個案。</p> <p> </p><p>The COVID-19 pandemic has impacted the public and society as a whole and has triggered a transformation of mental health services. Tele-counseling has become a feasible alternative to face-to-face counseling for maintaining safe social distancing practices while addressing the public’s mental health issues. The term ""telecounseling"" refers to methods of counseling through video, telephone, Internet calls, and other types of telecommunication that can be conducted over long distances. Features of tele-counseling include confidentiality and flexibility, which could help the public access mental health services by overcoming obstacles such as geographical and time constraints. Notably, Taiwan legalized tele-counseling in 2019, and it developed rapidly during the pandemic, especially video call tele-counseling; however, few studies thus far have explored this. To make Taiwan a tele-counseling-friendly environment, the present study, grounded in a constructivist perspective, employed a qualitative approach to deeply explore psychologists’ views on tele-counseling, thereby elucidating their preparation for tele-counseling and relevant practical experience. Through purposive and snowball sampling, licensed psychologists participated in semi-structured individual interviews via online video conferencing (5 males, 13 females; aged between 30 and 55 years, with a range of 6 to 380 hours of experience in tele-counseling). Data were analyzed using the ladder of analytical abstraction. As a result, two factors were highlighted. First, in terms of preparation for tele-counseling, the results revealed the following. (1) When it comes to policy and regulation, some problems still exist, including a cumbersome application process, unclear enforcement rules for tele-counseling applications and implementation, and differences between regulation and practice. These issues make preparation for tele-counseling more difficult; therefore, a way to facilitate alignment between regulations and practice (as well as investment in tele-counseling) is important for optimizing the preparation and implementation of tele-counseling. (2) Due to a lack of experience, institutions’ and psychologists’ preparation for tele-counseling still depends on how it progresses. They primarily emphasized that preparation should focus more on pre-developing the tele-counseling procedure based on clients’ well-being and professional ethics, as well as setting up tele-counseling equipment and becoming familiar with its operation. Moreover, psychologists should regularly engage in professional training for tele-counseling. This is a useful means of preparing for telecounseling. (3) It is necessary to facilitate clients’ attention and investment in tele-counseling sessions, thereby developing a therapeutic alliance and maintaining the framework of counseling together. This is important for the implementation of tele-counseling. Second, in terms of the practical experience of tele-counseling, the results revealed the following: (1) Some commonalities between tele-counseling and face-to-face counseling help maintain the efficiency of tele-counseling. (2) Tele-counseling can overcome the limitation of distance and space, thereby serving needs of specific clients. (3) The features of tele-counseling result in some potential restrictions. For example, psychologists often find it difficult to assess clients’ situations and grasp the entire counseling process, which drives them to put in more effort. Some forms and methods of counseling are restricted in telecounseling, so psychologists need to put more effort into preparing for counseling, or even adjusting the ways they counsel. In addition, potential candidates suitable for tele-counseling are limited; therefore, psychologists need to provide more follow-up services based on clients’ situations and needs. To summarize, the present study not only broadens the horizon of psychologists’ experiences of tele-counseling, but also proposes some useful practical suggestions for preparing for and implementing tele-counseling. This has important implications for the development of tele-counseling in Taiwan. However, this research is still limited, and further investigation is necessary to boost this development.</p> <p> </p>

The Impact of Health Policy on Access to Healthcare: Utilizing Geographic Information Systems (GIS) for Detailed Access and Equity Mapping

Health policies are significant in relation to health equity and accessibility. Achieving equity in health care must understand the geographic distribution of health care and the impact of policy decisions on access Planners can use Geographic Information Systems (GIS) as an aid powerful to visualize and scrutinize these differences. The current study addresses some of the challenges of integrating multiple data sources, definitions of access and equity and the dynamic nature of health care processes. Furthermore, sophisticated analytical methods are needed to truly map all complex health care systems. Therefore this paper, describe a cross-sectional mental health treatment (C-SMHT) that uses a fuzzy inference system to assess justice and access to health care. Using ambiguous GIS data to address uncertainty and environmental variability, this approach provides a comprehensive picture of how policy change has shaped health disparities to improve. C-SMHT has many applications for policy makers as well as public health practitioners. This paper will provide a snapshot of mental health provider availability and utilization. Simulation studies to examine how the effectiveness of the C-SMHT approach can help to better identify underserved areas, better allocate resources, and deliver treatment were found to be good. A number of initiatives will be developed as part of this project to assess their impact on the availability of mental health services in defined areas or countries. In addition to providing recommendations to policy makers based on research findings, the simulation will also provide insights into how policies affect equity and access.

Exploring barriers to mental health service access: a preliminary study among the general Paraguayan population

This study aimed to explore the perception of barriers to accessing mental health services within the general population of Paraguay using the Barriers to Access to Care Evaluation (BACE) scale. The barriers were categorized into three types: attitudinal, instrumental, and stigma-related. The sample comprised 321 participants, the majority of whom were women (82.9%). Among the participants, 62.9% reported experiencing mental ill-health, with the most common disorders being anxiety (37.4%), depression (30.5%), and sleep disorders (20.6%). Of the participants, 157 (48.9%) reported significant attitudinal barriers, which include beliefs and perceptions about mental health treatment, among others; 87 (27.1%) reported significant stigma-related barriers, which involve prejudices and stereotypes associated with mental disorders; and 189 (58.9%) experienced significant instrumental barriers, including financial constraints and limited availability of services. Mental ill-health was significantly associated with all types of barriers. In conclusion, significant barriers to accessing mental health services persist among the Paraguayan population. These barriers must be addressed through evidence-based public policies to improve the quality-of-life of both individuals with mental ill-health and the broader general population.

Psychological Fallout of Sexual Harassment on Women across Various Social Contexts

Sexual harassment (SH) poses a significant threat to mental health, causing profound emotional distress, particularly among women. Despite legal frameworks, the psychological consequences of SH are inadequately addressed. This study examines the prevalence, manifestations and effects of SH through a structured literature review, using sources such as Google Scholar, PsycINFO and PubMed for articles published after 2018 on the psychological effects of SH. The review process included initial screening based on relevance and quality, methodological evaluation and narrative synthesis. The findings reveal SH’s severe psychological impact across various settings, including workplaces, educational institutions and intimate relationships, with consequences like fear, anxiety, shame, depression and confidence erosion. Reluctance to report SH further exacerbates the psychological toll. The study highlights the need for comprehensive strategies, recommending accessible mental health services, educational campaigns and stronger policies. Fostering a culture of respect, equality and inclusion can enhance survivors’ well-being and create a supportive environment.

Mental health service use among mothers and other birthing parents during the COVID-19 pandemic in Ontario, Canada

BackgroundParents have reported increased symptoms of depression and anxiety during the COVID-19 pandemic. This study evaluated changes in mental health and addiction (MHA)-related health service use among mothers and other birthing parents during the COVID-19 pandemic. MethodsWe conducted a repeated cross-sectional study using health administrative data in Ontario, Canada. The population included all mothers and birthing parents (≥1 child aged 1–18, no children <1 to exclude postpartum parents) between January 2016 and December 2021. We compared rates of MHA-related outpatient physician visits, hospitalizations, and emergency department (ED) visits during COVID-19 (March 2020–December 2021) to pre-COVID-19 (pre-March 2020). ResultsMHA-related outpatient visit rates increased by 17 % (rate ratio (RR) 1.17, 95 % CI 1.16–1.18) during COVID-19. Monthly utilization rates remained higher than expected across the COVID-19 period. MHA-related ED visit rates remained lower than expected during COVID-19, while MHA-related hospitalization rates returned to expected levels by August 2020. The largest relative increases in MHA-related outpatient visits during COVID-19 were in mothers and other birthing parents living in higher income (RR 1.20, 95 % CI 1.19–1.22) or urban areas (RR 1.20, 95 % CI 1.18–1.21), with children aged 1–3 years (RR 1.23, 95 % CI 1.20–1.25) and with no history of MHA-related health service use (RR 1.20, 95 % CI 1.19–1.21). LimitationsThis study only captured physician-delivered MHA-related health service use. ConclusionsThe COVID-19 pandemic was associated with an increase in MHA-related outpatient visits among mothers and other birthing parents. These findings point to the need for improvements in mental health service access.

Differential impacts of the COVID-19 pandemic on mental health service access among Medicaid-enrolled individuals.

The COVID-19 public health emergency (PHE) caused significant disruptions in the delivery of care, with in-person visits decreasing and telehealth use increasing. We investigated the impact of these changes on mental health services for Medicaid-enrolled adults and youth in Washington State. Among enrollees with existing mental health conditions, the first year of the PHE was associated with a surge in specialty outpatient mental health visits (13% higher for adults and 7% higher for youth), returning to pre-PHE levels in the second year. Conversely, youth with new mental health needs experienced a decline in specialty outpatient visit rates by ∼15% and 37% in the first and second years of the PHE, respectively. These findings indicate that while mental health service use was maintained or improved for established patients, these patterns did not extend to Medicaid-enrolled youth with new mental health needs, potentially due to barriers such as difficulty in finding providers and establishing new patient-provider relationships remotely. To bridge this gap, there is a need for a multi-faceted approach that includes improving service accessibility, enhancing provider availability, and optimizing initial care encounters, whether in-person or virtual, to better support new patients.

Spatial and Socioeconomic Patterns of Mental Health and Healthcare Utilization in Cologne, Germany.

Children and adolescents are significantly tied to their family's socioeconomic position and living environment. Neighbourhood and the living environment have been identified as potential risk factors for mental disorders in this age group. The aim of the study was to investigate the distribution of mental and behavioural disorders (prevalence) and the provision of mental health services for children and adolescents aged 0-19 years in the city of Cologne. In particular, the study aimed to examine the association of these factors with area deprivation and the availability of mental health services covered by statutory health insurance. Finally, possible spatial variations in these aspects were analysed. Claims data of children and adolescents aged 0 to 19 years included in four statutory health insurance of the year 2021 were analysed. A deprivation index using data on the level of the ZIP code area was calculated. Analyses were carried out descriptively, using ordinary least squares (OLS) and geographically weighted regression (GWR). The prevalence of mental and behavioural disorders in children and adolescents varied across ZIP code areas, with higher rates in the northern, southern, and eastern parts of the city. The results indicated that the use of services by male children and adolescents with a prevalent diagnosis of mental and behavioural disorders was higher in areas with a higher density of healthcare providers. However, prevalence was on the whole lower in areas with a higher density of healthcare providers. In addition, the density of health care providers was higher in the city centre with comparatively lower deprivation. These results indicate inadequate access to care for children and young people outside the city centre. However, due to the heterogeneity of the population in these areas, this study provides only preliminary insights. Data with a finer geographic resolution are needed for further research in order to analyse the association further.

Changes in Rates of Special Considerations in Higher Education Applications Pre- and During the COVID-19 Pandemic in Victoria, Australia.

Since the onset of the COVID-19 pandemic, a significant rise in mental ill health has been observed globally in young people, particularly those in their final years of secondary school. Students' negative experiences coincide with a critical transitional period which can disrupt milestones in social and educational development. This study aimed to use innovative population-level data to map the impact of the pandemic on students entering higher education. Pre-pandemic (2019/2020) and pandemic (2020/2021) tertiary education application data were obtained from the Victorian Tertiary Admissions Centre. Prevalence of applications for special consideration related to mental ill health were compared between cohorts across various geographical areas and applicant demographic subgroups. Relative risk regression models were used to understand the role of different risk factors. Rates of mental health-related special consideration applications increased by 38% among all applications (pre-pandemic: 7.8%, n = 56 916; pandemic: 10.8%, n = 58 260). Highest increases were observed among students in areas with both extended and close-quarter lockdown experiences, and areas impacted by 2019/2020 black summer bushfires. The increases were higher among Year 12 students and students with other special consideration needs (e.g., physical condition, learning disability). Slightly higher increases were observed in areas with higher socio-economic status, which may potentially be related to inequality in mental health service access. As consequences of mental health difficulties and academic disruption in youth can be long lasting, it is critical to establish a mental health support framework both in and outside of higher education to facilitate young people's recovery from the pandemic.