Anxiety Stress Research Articles

COVID-19 led work environment disruption in India and its impact on the workers’ mental wellbeing

This study is designed to assess the impact of the Covid-19 pandemic on the mental wellbeing of remote e-workers. The study opts for a survey-based research and measures anxiety related to Covid-19 and job stress through Covid-19-related Anxiety Stress (CAS-7) and new Job Stress Scale (JSS-22) standardized instruments. For a sample of 79 respondents, a moderate Covid-19 related anxiety and Job Stress was observed. The mean score for the CAS was 18.31 ± 3.46 indicating a moderate Covid-19 related anxiety. Further, a noticeable trend was observed in the subscales of the Job Stress Scale where mean Job Stress was 12.32 ± 3.87; and Role Expectation Conflict was 13.86 ± 4.87. Coworker Support was 15.92 ± 4.54 and for Anxiety the score was 12.39 ± 5.15. The overall results of job stress scale indicate a moderate occupational anxiety and stress. Age, gender and the work experience are seen to have varied impacts on the anxiety and stress in e-workers. The study adds support to extending the literature that emphasizes implementation of policies for an improved mental and psychological well-being in the situation like COVID-19 pandemic and in such future disruptive events.

Exploring College-Aged Student Anxiety: Aggravating Factors and Coping Strategies

<i>Undergraduate college-aged students are increasingly experiencing anxiety. Yet, many struggle to cope effectively, resulting in poor school performance and compromised health and well-being. Our goal was to identify common anxiety-inducing and aggravating stressors, as well as preferred adaptive coping strategies, in this exploratory study to inform anxiety intervention development. A total of 19 undergraduate students (17 female and 2 male) were recruited. Students previously diagnosed or treated for anxiety by a clinician participated in a two-week, daily diary entry study. A total of 219 diary entries were transcribed and thematically analyzed for student reports of awareness variables and associated coping responses. Data were compared and triangulated. Framed by cognitive-behavioral approaches to anxiety and the transactional theory of stress and coping, we identified five primary categories of anxiety-inducing or aggravating stressors: academic time management and performance, communication anxiety, competing life stressors, others’ presence and problems, and </i><i>generalized uncertainty. In addition, we found that students primarily utilized adaptive coping strategies, employing a mix of intrapersonal (e.g., alone time, breaks, hobbies/music, and staying productive) and interpersonal techniques (e.g., hanging out with and talking with friends and family). Findings highlight common anxiety stressors and demonstrate preferred and efficacious coping strategies employed by students, providing valuable insight into best practices for student well-being interventions beyond a clinical setting to manage anxiety and improve student well-being.</i>

Assessing the determinants of crash propensity using structural equation modeling: Role of distractions caused by fellow drivers

Introduction: Aggressive behavior of drivers is a source of crashes and high injury severity. Aggressive drivers are part of the driving environment, however, excessive aggressive driving by fellow drivers may take the attention of the recipient drivers away from the road resulting in distracted driving. Such external distractions caused by the aggressive and discourteous behavior of other road users have received limited attention. These distractions caused by fellow drivers (DFDs) may agitate recipient drivers and ultimately increase crash propensity. Aggressive driving behaviors are quite common in South Asia and, thus, it is necessary to determine their contribution to distractions and crash propensity. Method: Our study aimed to evaluate the effects of DFDs using primary data collected through a survey conducted in Lahore, Pakistan. A total of 801 complete responses were obtained. Various hypotheses were defined to explore the associations between the latent factors such as DFDs, anxiety/stress (AS), anxiety-based performance deficits (APD), hostile behavior (HB), acceptability of vehicle-related distractions (AVRD), and crash propensity (CP). Structural Equation Modeling (SEM) was employed as a multivariate statistical technique to test these hypotheses. Results: The results supported the hypothesis that DFDs lead to AS among recipient drivers. DFDs and AS were further found to have positive associations with APDs. Whereas, there was a significant negative association between DFD, AS, and AVRD. As hypothesized, DFD and AS had positive associations with CP, indicating that distractions caused by aggressive behaviors leads to stress and consequently enhances crash propensity. Practical applications: The results of this study provide a statistically sound foundation for further exploration of the distractions caused by the aggressive behaviors of fellow drivers. Further, the results of this study can be utilized by the relevant authorities to alter aggressive driving behaviors and reduce DFDs.

Psychosocial status and risk perception among Iranian healthcare workers during the fifth wave of the COVID-19 pandemic

BackgroundHealthcare workers (HCWs) are essential resources, and their health and wellbeing are key not only for offering constant and useful care facilities to clients, but also for maintaining the safety of the workforce and patients. The risk of severe mental health problems among HCWs may have increased during large outbreaks of COVID-19. To evaluate the psychosocial status and risk perception of HCWs who participated in treating COVID-19 patients in Northern Iran, we performed a web-based cross-sectional study.MethodsThe web-based cross-sectional design was applied between June 27 and September 2, 2021. Using convenience sampling, 637 HCWs were recruited from hospitals in Northern Iran (Mazandaran). The HCWs completed self-report questionnaires that included a sociodemographic information form, the 12-item General Health Questionnaire, Impact of the Event Scale-Revised, Risk Perception Questionnaire, and Anxiety Stress Scale‐21. The data were analyzed via descriptive and inferential statistics and univariate/multivariate logistic regression to assess the risk factors linked to each psychosocial consequence.ResultsThe results reveal that the COVID-19 pandemic had an adverse psychosocial influence on HCWs, which was already apparent 1.5 years after the crisis began. Based on the results, 71.6%, 55.6%, and 32.3% of HCWs reported having anxiety, depression, and stress symptoms, respectively, since the outbreak of this disease. The logistic regression models displayed that marital status, having children, and working hours with patients were all risk factors of psychosocial impairment.ConclusionsThe outbreak of COVID-19 can be considered an important experience of a bio-disaster resulting in a significant rate of psychiatric problems in HCWs. There is a need for designing and promoting supportive programs to help HCWs cope and to improve their psychosocial state, and the present study has detected for whom psychosocial support may be effective and practical 1.5 years after the primary outbreak. Moreover, detecting and managing concerns and reducing infection-related embarrassment/stigma are essential for improving HCWs’ mental health.

Work-Life Balance of Oil and Gas Public Sector Employees in India: A survey

Abstract: This paper provides an insight into the Work life balance of Oil & Gas Public Sector Employees. Work-life balance has been one of the main topics of research in the academic and business field over the last few years. One of the ways to increase turnover and improve efficiency would be to enhance the work-life balance of an organisation's employees. The general hypothesis stated in the research pertains to the relationship between Work life balance, Job stress, Role expectation, Co-worker support and Work-family relation. The control variables assessed in the design was the participants’ gender. A quantitative research method is selected and questionnaire is used as the research instrument to collect data. The questionnaire contained 24 close-ended items- focusing on four domains, mainly, Job stress (anxiety and time stress); Co-worker support; Role expectation conflict and Work-family conflict. There are 129 samples randomly selected from 5 Oils & Gas Public Sector Units (males= 99, females=30). The data collected is analysed by using Statistical Packages for Social Science Version 21.0 (SPSS Version 21.0) software. Hypothesis was tested by adopting statistical techniques such as mean, standard deviation, regression analysis and ANOVA. The results showed that Anxiety Stress and Time stress, being sub-domains of Job stress had an impact on the respondents, especially those with a work experience of more than 15 years in their current organization.

Work-Life Balance of Oil & Gas Public Sector Employees in India: A Survey

This paper provides an insight into the Work life balance of Oil & Gas Public Sector Employees. Work-life balance has been one of the main topics of research in the academic and business field over the last few years. One of the ways to increase turnover and improve efficiency would be to enhance the work-life balance of an organisation's employees. The general hypothesis stated in the research pertains to the relationship between Work life balance, Job stress, Role expectation, Co-worker support and Work-family relation. The control variables assessed in the design was the participants’ gender. A quantitative research method is selected and questionnaire is used as the research instrument to collect data. The questionnaire contained 24 close-ended items- focusing on four domains, mainly, Job stress (anxiety and time stress); Co-worker support; Role expectation conflict and Work-family conflict. There are 129 samples randomly selected from 5 Oils & Gas Public Sector Units (males= 99, females=30). The data collected is analysed by using Statistical Packages for Social Science Version 21.0 (SPSS Version 21.0) software. Hypothesis was tested by adopting statistical techniques such as mean, standard deviation, regression analysis and ANOVA. The results showed that Anxiety Stress and Time stress, being sub-domains of Job stress had an impact on the respondents, especially those with a work experience of more than 15 years in their current organization. Keywords: Public Sector Unit, Employees, Work Life Balance, Conflict

Levels of anxiety and postcoital depression in early childhood care in a Colombian municipality. A case study

The crisis caused by COVID - 19, brought with it serious mental health problems, which represented in many countries a public health problem, it is emphasized that mental health is of great importance in different contexts, both family and work, taking into account that it is essential to generate social and productive links. The objective of this article is to describe the levels of anxiety and depression of an early childhood worker in a municipality of Colombia, due to the return to the workplace and contact with children, through a descriptive quantitative approach methodology where the DASS- 21 Scale (Depression, Anxiety, Stress -21) was applied, Anxiety Stress -21) established with seven items in each level, extremely high scores of anxiety and depression were evidenced, for which reason, proposals for action were designed individually and organizationally in order to help reduce those levels currently presented in the worker.

The role of parenting stress in anxiety and sleep outcomes in toddlers with congenital heart disease.

This retrospective cohort study investigates how parenting stress, measured at 4 months of age by use of a classic three-dimensional parent-reported scale (Parenting Stress Index, 4th Ed. or PSI-4), can predict anxiety symptoms and quality of sleep at 24 months in toddlers with congenital heart disease (CHD). Sixty-six toddlers with CHD followed at our cardiac neurodevelopmental follow-up clinic were included in this study. As part of their systematic developmental assessment program, parents completed questionnaires on their stress level (PSI-4) when their child was 4 months old, and on their child's anxiety symptoms and quality of sleep at 24 months. Eight multiple linear regression models were built on the two measures collected at 24 months using the PSI-4 scores collected at 4 months. For each measure, four models were built from the PSI-4 total score and its three subscales (Parental Distress, Parent-Child Dysfunctional Interaction, Difficult Child), controlling for sex and socioeconomic status. The PSI-4 Difficult Child subscale, which focuses on parenting anxiety related to the child's behavioral problems and poor psychosocial adjustment, accounted for 17% of the child's anxiety symptoms at 24 months. The two other PSI-4 subscales (Parental Distress and Parent-Child Dysfunctional Interaction) and the PSI-4 total score did not contribute significantly to the models. None of the four regression models on perceived quality of sleep were significant. It is important to note that 33% of parents responded defensively to the PSI-4. Parenting stress related to the child's behavioral problems and poor psychosocial adjustment, measured when the child is 4 months old, is associated with the child's ulterior anxiety symptoms. As very few standardized tools are available to assess the behavioral and psychoaffective development of infants, this study highlights the importance of early psychosocial screening in parents of infants with CHD. The high rate of significant Defensive Responding Indices reminds us to not take parent reports at face value, as their actual stress levels might be higher.

2.12 Contextualization of COVID-19 Anxiety Stressors of Child and Adolescents Patients During Acute Psychiatric Treatment

The primary aim of this study was to understand and contextualize COVID-19 stressors in child and adolescent patients during acute psychiatric treatment, through comparing the diagnosis of those with anxiety to those without a diagnosis of anxiety.

The Spread of COVID19 in the Pakistan: Anxiety, Depression and Post-Traumatic Stress Disorder

Abstract: The first to be detected in Wuhan, China, was COVID-19 recognized as a coronavirus disease at the end of 2019. The disorder is very infectious and has a steadily growing worldwide prevalence. Because of its global circulation, the World Health Organization (WHO) recognized the pandemic as is the normal practice in such pandemics, a lockout is normally forced into all public areas to restrict the transmission of the disease and to minimize the risk for new cases. However, health care providers are sadly left to contend with the many problems that occur as a consequence of this situation. The people in general take those action. The mean anxiety rate in general was 19.01 ± 9.2, 18.12 ± 10 and 20,12 ± 12.0. The number of participants with mild to extremely serious depression was 81 (72.3%); moderate to extremely severe anxiety is 96 (85.7%); and 101 (90.1%). moderate to intense stress levels were recorded. It is obvious that many neurological disorders such as anxiety, stress and depression impact a large number of health professionals. It is vital for government action to ensure the mental health of health care provider is controlled consistently and to try to reduce their burdens. A large number of Pakistani participants in this study experienced fear, fatigue, and depression. Approximately 89% of health care providers feared their families, while 80% feared that COVID19 might come on their own. This is a comparative figure for Wuhan, where only 50,4% of health care provider patients treated for COVID-19 were depressed, 44.6% had anxiety, 34% had insomnia, and a significant proportion had depression, anxiety, (560 [44.6 percent]), insomnia, and distress (899[71.5 percent]). (527 [34.0 percent])

Associations between fear of COVID-19, dental anxiety, and psychological distress among Iranian adolescents

ObjectivesThe present study evaluated the association of fear of COVID-19 with dental anxiety, oral health-related quality of life (OHRQoL), and psychological distress (depression, anxiety and stress), as well as exploring the mediating role of dental anxiety in the association of fear of COVID-19 with OHRQoL and psychological distress.MethodsA cross-sectional study was conducted among adolescents in high schools of Qazvin city (Iran) from March-June 2021, recruited through a two-stage cluster sampling method. All the adolescents completed a self-administered survey assessing (i) fear of COVID-19, (ii) depression, anxiety and stress, (iii) OHRQoL, and (iv) dental anxiety. Structural equation modelling was used to evaluate all the hypothesised associations, and the model fit was estimated.ResultsA total of 2429 adolescents participated in the study. The conceptual model fitted the data well. Fear of COVID-19 had a direct effect on dental anxiety (B = 0.316; bias-corrected bootstrapping 95% CI = 0.282, 0.349), depression (B = 0.302; bias-corrected bootstrapping 95% CI = 0.259, 0.347), anxiety (B = 0.289; bias-corrected bootstrapping 95% CI = 0.246, 0.334), stress (B = 0.282; bias-corrected bootstrapping 95% CI = 0.237, 0.328), and OHRQoL (B = −0.354; bias-corrected bootstrapping 95% CI = −0.530, −0.183). Also, dental anxiety mediated the association of fear of COVID-19 with depression, anxiety stress, and OHRQoL.ConclusionsHigh levels of fear of COVID-19 were associated with high levels of dental anxiety and poorer OHRQoL. Moreover, fear of COVID-19 was positively associated with anxiety, depression and stress. Increased levels of dental anxiety were also associated with increased anxiety, stress, depression, and poorer OHRQoL.

Primigravida TM III Anxiety Levels in Facing the Labor Process Judging from Mother's Knowledge

Introduction: Pregnancy can be a source of anxiety stressors, especially in primigravida mothers' third trimester of pregnancy. One of the efforts made by health workers to reduce the level of anxiety in pregnant women facing the delivery process is by providing health services and counseling, and health education during pregnancy check-ups (ANC). Every woman believes that pregnancy is a natural thing that must be lived. On the other hand, some argue that it is an event that determines the next life. Anxiety and anxiety in pregnant women, if not treated seriously, will impact and affect the physical and psychological of both the mother and the fetus. Objective: This study aims to analyze the relationship between knowledge and the level of anxiety of primigravida TM III in dealing with childbirth at the Wae Rii Health Center and Langke Rembong Regency. Methods: The research design used in this research is descriptive correlative with a cross-sectional approach. A sample of 70 respondents was selected using the purposive sampling technique using inclusion and exclusion criteria. Data on pregnant women were taken from the register book and distributed in knowledge and anxiety questionnaires. Statistical test using chi-square test. Results: Most of the 35 people with good knowledge had a mild level of anxiety. The results of the statistical test showed a p-value of 0.000 which means a p-value <0.05, so there is a statistically significant relationship between knowledge and the anxiety level of TM III primigravida mothers in dealing with labor at the Work Center of Manggarai Regency, especially Wae Rii and Langke Rembong District.

How Can We Help Healthcare Workers during a Catastrophic Event Such as the COVID-19 Pandemic?

Healthcare workers (HCWs) have significantly suffered during the COVID-19 pandemic, reporting a high prevalence of anxiety, depression and post-traumatic stress disorder (PTSD). We investigated with this survey whether HCWs benefitted from supportive measures put in place by hospitals and how these measures were perceived. This cross-sectional survey, which was conducted during the first wave of COVID-19 at the Geneva University Hospitals, Switzerland, between May and July 2021, collected information on the use and perception of practical and mental health support measures provided by the hospital. In total, 3461 HCWs participated in the study. Regarding the practical support measures, 2896 (84%) participants found them useful, and 2650 (76%) used them. Regarding the mental health support measures, 3149 (90%) participants found useful to have the possibility of attending hypnosis sessions, 3163 (91%) to have a psychologist within hospital units, 3202 (93%) to have a medical nursing psychiatric permanence available seven days a week, and 3171 (92%) to have a hotline available seven days a week. In total, 436 (13%) HCWs used at least one of the available mental health support measures. During the COVID-19 pandemic, the support measures were valued by HCWs. Given the high prevalence of psychiatric issues among HCWs, these measures seem necessary and are likely to have alleviated the suffering of HCWs.

Corporeal rehabilitation to manage acute stress in critically ill patients

BackgroundIntensive care unit (ICU) patients often endure discomfort and distress brought about by their medical environment and the subjective experience of their stay. Distress, pain, and loss of control are important predictors of future neuropsychiatric disorders. Depression, anxiety, and post-traumatic stress are common after discharge. We aimed at mitigating acute stress and discomfort via a novel intervention based on body image rehabilitation and rehabilitation of senses performed following a holistic approach guided by positive communication (corporeal rehabilitation care, CRC).ResultsWe conducted a prospective observational study on 297 consecutively enrolled patients participating in at least one CRC session. Benefits of CRC were assessed on both subjective analogical scales of stress, pain, and well-being criteria, and objective clinical measures of dyspnea, respiratory rate, and systolic arterial pressure, just after CRC and long after (a median of 72 min later) to estimate its remote effect. Results showed that CRC had a positive effect on all overt measures of distress (acute stress, pain, discomfort) just after CRC and remotely. This beneficial effect was also observed on dyspnea and respiratory rate. Results also showed that best CRC responders had higher baseline values of stress and heart rate and lower baseline values of well-being score, indicating that the care targeted the population most at risk of developing psychological sequelae. Interestingly, a positive CRC response was associated with a better survival even after adjustment for physiologic severity, indicating a potential to identify patients prompt to better respond to other therapeutics and/or rehabilitation.ConclusionThis study demonstrated the feasibility of an innovative holistic patient-centered care approach and its short-term positive effects on critical parameters that are considered risk factors for post-intensive care syndrome. Further studies are warranted to study long-term benefits for patients, and overall benefits for relatives as well as ICU staff.

Life satisfaction in the caregivers of schizophrenia and factors associated with it: a cross sectional study from South India

Schizophrenia is a mental disorder characterized by distortions of thinking and perception, in the process of care giving the caregivers are faced with many challenges. These challenges have a significant impact on the life satisfaction of caregivers. The study investigates various factors associate with life satisfaction in caregivers of schizophrenia
 The aim: 1. To evaluate the socio-demographic correlates associated with life satisfaction in the care givers of schizophrenia.
 
 To evaluate the association between life satisfaction with resilience, anxiety, stress, depression perceived social support, self-esteem, self-efficacy, and perceived stigma in the care takers of schizophrenia patients.
 
 Material and methods. In cross sectional study, 513 care takers of schizophrenia were evaluated using semi-structured socio demographic perfoma, DASS-21, Connor-Davidson Resilience 25 item scale, Self Esteem Scale (Rosenberg), The Satisfaction with Life Questionnaire and family stigma stress scale.
 Result. The study showed that background of the caregiver, socioeconomic status, family type, education and marital status are significantly positive correlated with life satisfaction. The study also showed significant positive correlation between resilience, perceived social support, self-esteem and self-efficacy with life satisfaction. There is also significant negative correlation between perceived stigma, anxiety stress and depression with life satisfaction.
 Conclusion. The study showed that life satisfaction in the care givers of schizophrenia depends on different biopsychosocial variables. There is strong positive correlation between self-esteem, other person support and resilience with life satisfaction, whereas there is moderate positive correlation between self-efficacy, family support and friend support with life satisfaction. There is significant negative correlation between stress, anxiety, depression, and stigma with life satisfaction. We recommended psycho educational interventional programmes in the community level which help to increase resilience self-esteem and self-efficacy. Such programmes also decrease the stigma which in turn increases the social support to the caregivers

Complicated Grief in a Spanish Sample of Victims of Terrorism: Evidence of Validity of the Inventory of Complicated Grief.

The Inventory of Complicated Grief (ICG) is the most widely used instrument to measure complicated grief (CG), but its psychometric properties have hardly been examined in relatives of those who died by violent means. The objective of this study was to obtain evidence of validity of the ICG in a relatives of those who died due to terrorist attacks in Spain. The factorial structure, internal consistency, and relationship with depression, anxiety, and post-traumatic stress were analyzed in a Spanish sample of 211 relatives of people who died in terrorist attacks. The ICG presented a one-factor structure that supports the validity of its total score. This score showed excellent internal consistency indices (alpha = .927; omega = .932) and adequate correlation indices with depression, anxiety, and post-traumatic stress (r = .71, .63 and .76, respectively). The ICG provides reliable and valid measures of CG in adults who have lost a family member due to violent death.

Affective responses to both climbing and nordic walking exercise are associated with intermediate-term increases in physical activity in patients with anxiety and posttraumatic stress disorder – a randomized longitudinal controlled clinical pilot trial

Affective responses to both climbing and nordic walking exercise are associated with intermediate-term increases in physical activity in patients with anxiety and posttraumatic stress disorder – a randomized longitudinal controlled clinical pilot trial

Factors of body dissatisfaction among lebanese adolescents: the indirect effect of self-esteem between mental health and body dissatisfaction

BackgroundBody dissatisfaction (BD) rates are alarmingly high, especially among adolescents, thus. Having a better understanding of correlates associated with BD seems to be an important issue in this developmental context. Furthermore, as adolescence is an essential time in the development of self-perception and self-esteem the current study assesses factors associated with BD among Lebanese adolescents and evaluates the indirect effect of self-esteem between depression/anxiety/stress and BD.MethodsThis is a cross-sectional study among 555 Lebanese adolescents, ages 15–18, who completed an online survey incorporating BD, socioeconomic status, weight and height, physical activity index, Rosenberg Self Esteem Scale, Beirut Distress Scale, Hamilton Anxiety Rating Scale, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index and Global Physical Activity Questionnaire.ResultsThe results of a stepwise linear regression, taking the body dissatisfaction score as the dependent variable, showed that higher BMI (B = 0.47), feeling pressured by media/TV to lose weight (Beta = 2.80), higher depression (Beta = 0.39), exercising to lose weight (Beta = 1.84) and following a diet to lose weight (Beta = 1.58) were significantly associated with more body dissatisfaction, whereas higher self-esteem (Beta=-0.11) and more psychological distress (Beta=-0.21) were significantly associated with less body dissatisfaction. Self-esteem played an indirect role in the associations between anxiety and body dissatisfaction and stress and body dissatisfaction.ConclusionsBD is common among young Lebanese adolescents. Treating adolescents with low self-esteem and psychological issues is crucial in preventing anticipated BD and future eating disorders.

Discrimination, Substance Use, and Mental Health among Sexual and Gender Minority Adults Accessing Day Shelter Services

Background Sexual and gender minority (SGM) adults are overrepresented in the population of individuals experiencing homelessness, and high rates of substance use are common in this group. Plausibly, poor mental health and discrimination may contribute to substance use among SGM adults experiencing homelessness. This study described participant characteristics, and the interrelations among sociodemographic variables, substance use, mental health, and discrimination experiences among 87 SGM adults seeking services at a day shelter in Oklahoma City, OK. Discrimination experiences were characterized by race (White vs. non-White), sex (female vs. male), sexual identity (heterosexual vs. sexual minority), and gender identity (gender conforming vs. gender minority). Methods Participants reported their past 30-day tobacco (cigarette/cigarillos, alternative tobacco products [ATP]), alcohol, and marijuana use, as well as everyday and lifetime major discrimination experiences, substance use problems, depression, anxiety, and post-traumatic stress disorder (PTSD). Independent samples t-tests examined differences in discrimination based on substance use and mental health. Results Participants had high rates of tobacco and marijuana use, substance use problems, depression, anxiety, and PTSD. Over 80% reported experiencing everyday or lifetime major discrimination. Depression and PTSD were associated with ATP use, and anxiety was associated with alcohol use. All mental health variables were associated with substance use problems and everyday discrimination. Depression was associated with lifetime major discrimination. Conclusions SGM adults accessing shelter services frequently experienced discrimination and poor mental health, and substance use was common. Future research should examine the causal impact of discrimination on mental health and substance use among SGM adults experiencing homelessness.

The relationship between outpatient service use and emergency department visits among people treated for mental and substance use disorders: analysis of population-based administrative data in British Columbia, Canada

BackgroundResearch findings on the association between outpatient service use and emergency department (ED) visits for mental and substance use disorders (MSUDs) are mixed and may differ by disorder type.MethodsWe used population-based linked administrative data in British Columbia, Canada to examine associations between outpatient primary care and psychiatry service use and ED visits among people ages 15 and older, comparing across people treated for three disorder categories: common mental disorders (MDs) (depressive, anxiety, and/or post-traumatic stress disorders), serious MDs (schizophrenia spectrum and/or bipolar disorders), and substance use disorders (SUDs) in 2016/7. We used hurdle models to examine the association between outpatient service use and odds of any ED visit for MSUDs as well count of ED visits for MSUDs, stratified by cohort in 2017/8.ResultsHaving had one or more MSUD-related primary care visit was associated with lower odds of any ED visit among people treated for common MDs and SUDs but not people treated for serious MDs. Continuity of primary care was associated with slightly lower ED use in all cohorts. One or more outpatient psychiatrist visits was associated with lower odds of ED visits among people treated for serious MDs and SUDs, but not among people with common MDs.ConclusionFindings highlight the importance of expanded access to outpatient specialist mental health services, particularly for people with serious MDs and SUDs, and collaborative models that can support primary care providers treating people with MSUDs.