Availability Of Mental Health Resources Research Articles

The Impact of School Environment on Student Health Behaviors: Insights from Qualitative Interviews

The relationship between the school environment and student health behaviors is increasingly pertinent amidst rising health concerns among youths. This qualitative study, conducted across diverse socioeconomic backgrounds in Vietnam, explores the multifaceted influences of school settings on the health behaviors of students. Data were collected through semi-structured interviews and focus group discussions involving students, teachers, parents, and administrators from three schools, each representing urban, suburban, and rural settings. The study identified key factors within schools' physical and social environments that significantly impact health behaviors. These include the availability and condition of physical facilities, the nutritional quality of food offered, peer influences, teacher engagement in health education, and the availability of mental health resources. Socioeconomic factors and cultural attitudes towards health and education also emerged as significant determinants. The findings suggest that improvements in physical resources, enhanced teacher training in health education, standardized healthy food offerings, and greater availability of mental health services are critical for fostering healthier behaviors among students. This study underscores the need for holistic policy interventions tailored to diverse educational settings to promote overall student health.

Breaking Barriers: Unraveling the Connection between Mental Health Literacy, Attitudes towards Mental Illness, and Self-Stigma of Psychological Help-Seeking in University Students

Despite the high prevalence of mental health difficulties during the period of emerging adulthood and the availability of mental health resources, young adults are reluctant to seek professional psychological help. A significant contributor to this treatment gap is the inadequate levels of mental health literacy (MHL). The present study aimed to investigate the association between MHL with attitudes toward mental illness and the self-stigma of seeking psychological treatment among university students. The sample consisted of 485 university students (24.5% males, 75.5% females) with a mean age of 19.54 years (SD = 1.45) drawn from a regional university in Greece. MHL, attitudes towards severe mental illness, and self-stigma of help-seeking were assessed using the Mental Health Literacy Scale (MHLS), the Attitudes towards Severe Mental Illness (ASMI), and the Self-Stigma of Seeking Help Scale (SSOSH), respectively. MHLS was positively correlated with three out of four subscales of ASMI, namely stereotyping, optimism, and coping, and negatively related to SSOSH. Multivariate linear regression analysis adjusting for various confounders showed that students with higher MHL were more likely to report non-stigmatizing attitudes towards mental illness and lower self-stigma of help-seeking from mental health professionals. According to our findings, higher MHL was related to more positive views regarding mental illness and lower self-stigma of help-seeking. To lessen the self-stigma of seeking professional help, MHL must be addressed as an important component of psychoeducational interventions at universities aiming to support students’ help-seeking intentions and practices.

The COVID-19 pandemic and OBGYN residency training: We have a problem and it’s not just masks

BackgroundThe COVID-19 pandemic has left no one untouched. Resident trainees have been driven to reconsider virtually every component of their daily lives. The purpose of this pilot study is to evaluate the impact of the COVID-19 pandemic on Obstetrics and Gynecology (OBGYN) residency training and education.MethodsA cross-sectional pilot study was conducted between 2/2022 and 5/2022. A survey was created and distributed to OBGYN residents. The survey queried the effects of the pandemic on OBGYN residents’ procedure skills training and mental health.ResultsA total of 95 OBGYN residents across programs affiliated with each American College of Obstetricians and Gynecologists (ACOG) district participated in the survey. Among them, just over half (n = 52, 55%) self-identified as under-represented minorities. A significant majority, 80% (n = 81), felt their gynecological training was inadequate, with 70% of fourth-year residents expressing a lack of confidence in their ability to independently practice gynecology after graduation. This lack of confidence among fourth-year residents suggests a notable disparity in readiness for independent gynecological practice, linked to meeting ACGME requirements before completing their residency (p = 0.013). Among the residents who reported a negative impact of the pandemic on their mental health (n = 76, 80%), about 40% (n = 31) had contemplated self-harm or knew a colleague who considered or attempted suicide (p < 0.001). This issue was especially pronounced in residents experiencing burnout (n = 44, 46%), as nearly half (n = 19, 43%) reported suicidal thoughts or knew someone in their program who had such thoughts or engaged in self-harm (p = 0.048).ConclusionsResidents expressed concerns about reduced hands-on gynecological training and doubts about their readiness for independent practice post-residency, highlighting the need for enhanced support through mentorship and revised training curriculums. Additionally, despite the availability of mental health resources to address pandemic-induced burnout, their underuse suggests a need for more accessible time for residents to use at their discretion and flexible training schedules that encourage mental health support resource utilization.

Waitlist management in child and adolescent mental health care: A scoping review

Background: Although many mental health disorders first emerge during early childhood or adolescence, there is a significant gap between demand and availability of mental health resources, leading to long waitlists for services. Objective: The objective of this scoping review was to identify and characterize the research literature related to the range of waitlist management strategies that have been implemented in outpatient child and adolescent mental health care. Methods: Electronic databases reviewed included: Medline (Ovid), Embase (Ovid), PubMed, PsychINFO, SCOPUS, CINAHL, and ISI Web of Science. Grey literature databases included: OpenGrey, Conference Papers Index, and Proquest Digital Dissertations. Articles were screened by two reviewers in two steps: first by title and abstract, then full text level.Data were extracted using an a-priori developed data extraction framework, which was piloted and modified iteratively. Results: A total of 119 papers related to waitlist interventions in child and adolescent mental health were reviewed. Of these 119 papers, 11% were reviews, summary, or theoretical papers; 8% used a randomized control trial design and 2.5% were trial protocols. Most studies used less rigorous designs, such as uncontrolled before-and- after designs. The large majority focused on just one waitlist strategy each. The most commonly used approaches included: prioritization/triage and initial assessment; brief consultation and advice or brief therapy approaches; group-based models; interim services; increasing capacity; and strategies to decrease non-attendance. Most studies were conducted in the United Kingdom or Canada. Discussion: While mental health systems are complex, most studies examining waitlist initiatives explored the implementation of single initiatives. It is unlikely that a single waitlist strategy can be effective in managing wait times for children’s mental health. Rather, consistent and systemic approaches to address wait times that consider the impact of the reduction approach on the patient, the program, and the community are needed.

Primary-Care Prescribers' Perspectives on Deprescribing Opioids and Benzodiazepines in Older Adults.

PurposeOpioids and benzodiazepines (BZDs) are frequently implicated as contributing to falls in older adults. Deprescribing of these medications continues to be challenging. This study evaluated primary-care prescribers’ confidence in and perceptions of deprescribing opioids and BZDs for older adults.MethodsFor this study, we conducted a quantitative analysis of survey data combined with an analysis of qualitative data from a focus group. A survey evaluating prescriber confidence in deprescribing opioids and BZDs was distributed to providers at 15 primary-care clinics in North Carolina between March-December 2020. Average confidence (scale 0–100) for deprescribing opioids, deprescribing BZDs, and deprescribing under impeding circumstances were reported. A virtual focus group was conducted in March 2020 to identify specific barriers and facilitators to deprescribing opioids and BZDs. Audio recordings and transcripts were analyzed using inductive coding.ResultsWe evaluated 61 survey responses (69.3% response rate). Respondents were predominantly physicians (54.8%), but also included nurse practitioners (24.6%) and physician assistants (19.4%). Average overall confidence in deprescribing was comparable for opioids (64.5) and BZDs (65.9), but was lower for deprescribing under impeding circumstances (53.7). In the focus group, prescribers noted they met more resistance when deprescribing BZDs and that issues such as lack of time, availability of mental health resources, and patients seeing multiple prescribers were barriers to deprescribing.ConclusionFindings from quantitative and qualitative analyses identified that prescribers were moderately confident in their ability to deprescribe both opioids and BZDs in older adults, but less confident under potentially impeding circumstances. Future studies are needed to evaluate policies and interventions to overcome barriers to deprescribing opioids and BZDs in primary care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40266-022-00967-6.

Experiences and views of clinical psychologists working in non-urban areas of KwaZulu-Natal, South Africa

The process of integrating mental health care into primary health care remains slow in many non-urban areas of low to middle-income countries. The present study explored clinical psychologists’ experiences of working in non-urban areas of KwaZulu-Natal to assess the progress of integrating mental health into primary health care. Twenty-nine clinical psychologists participated in this study and provided input on the following areas: clinical psychologists’ preparedness, through training, to work in resource-constrained non-urban areas; availability of mental health resources; and understanding of the clinical psychologists’ role in their work context. Over half (51.7%) of the participants reported that their training did not prepare them to work in resource-constrained non-urban areas and more than two-thirds (72.4%) reported a lack of basic resources needed for optimal mental health care in non-urban areas of KwaZulu-Natal. The findings reflect the need for comprehensive training of clinical psychologists to enhance their competency and confidence to work in resource-constrained settings. Furthermore, investment in the promotion of clinical psychology services and more conducive mental health service environments is necessary.

Bill would fund hiring of school counselors, social workers, psychologists

Less than a week after the U.S. surgeon general's issuance of a public health advisory to provide recommendations on addressing mental health challenges confronting children, adolescents and young adults (see MHW, Dec. 13), Senate lawmakers have introduced what observers say may provide some solution: legislation to boost the availability of mental health resources and investments in more mental health providers in public schools.

EAP 2.0: reimagining the role of the employee assistance program in the new workplace

Mental illness is a highly prevalent problem that affects millions of individuals. Like many other previous natural disasters and terrorist attacks, the recent Covid-19 pandemic has placed an enormous stress on the world and its workforce. In many ways the pandemic revealed gaps in the quality and availability of mental health resources, and, by magnifying the intense demand, it also spurred innovation. Telemedicine and virtual trauma-related services became examples of ways in which evaluation, treatment and counselling services could be delivered directly and efficiently to people who were confined to their dwellings and hospital beds. For many, the workplace has been a source of stress but also a vital component of one’s self-worth, day-to-day purpose, and a resource for wellness programs and brief counselling services, not to mention, at least in many countries like the United States, a source for health insurance. The employee assistance program (EAP) is an example of a workplace-counselling and triage service that has enormous potential to meet the growing needs of individuals both in ‘normal’ times and during disasters. By better understanding the EAP’s current structure alongside the advent of new technologies, it may be possible to develop a new and improved EAP model to meet a changing global landscape. For EAP to succeed and ultimately be scalable in an increasingly competitive and value-conscious marketplace, its processes of care will first require a bottom-up review with meaningful outcomes data. This will be necessary to drive continuous quality improvement and to demonstrate EAP 2.0’s value to both employer and employee alike.

Adoption of care management activities by primary care nurses for people with common mental disorders and physical conditions: A multiple case study.

WHAT IS KNOWN ON THE SUBJECT?: The collaborative care model is a well-known model to improve care quality for people with common mental disorders and physical conditions in primary care. The role of care manager is central to the collaborative care model, and primary care nurses are well-positioned to play that role. Adopting the role of care manager by primary care nurses is challenging due to several contextual factors; however, few implementation studies examined the context and current practices before implementing the role of care manager and the collaborative care model. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper contributes to the advancement of knowledge about the pre-assessment of current practices before implementing the collaborative care model and the role of care manager. The paper offers a better understanding of the relationships between the context and the performance of care management activities by primary care nurses. The paper describes an innovative analysis technique to assess the gap between care management activities recommended in the collaborative care model and actual nursing activities. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Primary care nurses would benefit from having timely access to clinical support from mental health nurse practitioners in order to build their competency. Determinants of practice and the analysis technique to assess current practices will help other researchers or quality improvement teams to develop their plan when implementing the role of care manager. ABSTRACT: Introduction Few studies assessed current nursing practices before implementing the collaborative care model and the role of care manager for people with common mental disorders (CMDs) and physical conditions in primary care settings. Aim Evaluate the main determinants of practice that influence the adoption of care management activities by primary care nurses for people with CMDs and physical conditions. Methods A qualitative multiple case study was conducted in three primary care clinics. A total of 33 participants were recruited. Various data sources were combined: interviews (n=32), nurse-patient encounters' observations (n=7), documents and summaries of meetings with stakeholders (n=8). Results Seven determinants were identified (1) access to external mental health resources; (2) clarification of local CMD care trajectory; (3) compatibility between the coordination of nursing work and the role of care manager; (4) availability of mental health resources within the primary care clinic; (5) competency in care management and competency building; (6) responsibility sharing between the general practitioner and the primary care nurse; and (7) common understanding of the patient treatment plan. Implications for practice To build their competency in care management for people with CMDs, primary care nurses would benefit from having clinical support from mental health nurse practitioners.

A Global Pandemic and Substance Use Disorder: Healthcare Professionals’ Viewpoints on the Merging of Two Crises

Introduction COVID-19 has resulted in extraordinary adversities. Mandates such as distancing and variations to treatment services were implemented to slow transmission of the virus, but created new challenges for persons with Substance Use Disorder (SUD). To better understand this phenomenon, we surveyed healthcare professionals on how they believe COVID-19 has impacted persons with SUD and what needs to occur to effectively treat this vulnerable population. Methods: Attending physicians, residents, nurses, medical and nursing students, and other healthcare professionals were asked to respond to three open-ended questions related to the impact of COVID-19 on persons with SUD. Two independent coders reviewed the comments utilizing constant comparative analysis to develop themes. Results: Common themes of concern were found from the respective participants (n = 205) including: lack of access to treatment, feelings of isolation, negative impacts on mental health, and the possibility of relapse. Healthcare strategies to effectively treat and help persons with SUD included increasing access to treatment including telehealth, development of peer support groups, availability of mental health resources, development of enhanced communication channels between providers and patients, and systematic changes. Conclusion: During the COVID-19 pandemic, overdose deaths have dramatically increased. As the short-term and long-term effects of the pandemic become more apparent, swift and comprehensive responses and policies must be enacted. This study provides insight from healthcare providers on the effects of the pandemic for persons with SUD. Many preexisting issues remain unresolved (e.g. stigma and healthcare disparities), and now the pandemic has presented new obstacles as noted by the providers. The findings from this study provide implications for important discussion regarding the development of strategies for substance use treatment and harm reduction.

Promoting the Mental Health of University Students in China: Protocol for Contextual Assessment to Inform Intervention Design and Adaptation.

BackgroundChinese students are extremely vulnerable to developing mental illness. The stigma associated with mental illness presents a barrier to seeking help for their mental health.ObjectiveThe Linking Hearts—Linking Youth and ‘Xin’ (hearts) project is an implementation science project that seeks to reduce mental illness stigma and promote the mental health of university students in Jinan, China. The Linking Hearts project consists of 3 components. In this paper, we outline the protocol for the first component, that is, the contextual assessment and analysis of the mental health needs of university students as the first step to inform the adaptation of an evidence-based intervention to be implemented in Jinan, China.MethodsSix local universities will participate in the Linking Hearts project. A total of 100 students from each university (n=600) will engage in the contextual assessment through self-report surveys on depression, anxiety, stress, mental health knowledge, and mental health stigma. Quantitative data will be analyzed using several descriptive and inferential analyses via SPSS. A small number of participants (144 students and 144 service providers) will also be engaged in focus groups to assess the socio-environmental contexts of university students’ health and availability of mental health resources. Qualitative data will be transcribed verbatim and NVivo will be used for data management. Social network analysis will also be performed using EgoNet.ResultsLinking Hearts was funded in January 2018 for 5 years. The protocol of Linking Hearts and its 3 components was approved by the research ethics boards of all participating institutions in China in November 2018. Canadian institutions that gave approval were Ryerson University (REB2018-455) in January 2019, University of Alberta (Pro00089364), York University (e2019-162) in May 2019, and University of Toronto (RIS37724) in August 2019. Data collection took place upon ethics approval and was completed in January 2020. A total of 600 students were surveyed. An additional 147 students and 138 service providers took part in focus groups. Data analysis is ongoing. Results will be published in 2021.ConclusionsFindings from this contextual assessment and analysis will generate new knowledge on university students’ mental health status, mental health knowledge, and resources available for them. These findings will be used to adapt and refine the Acceptance and Commitment to Empowerment-Linking Youth N’ Xin intervention model. The results of this contextual assessment will be used to inform the adaptation and refinement of the mental health intervention to promote the mental health of Chinese university students in Jinan.International Registered Report Identifier (IRRID)RR1-10.2196/25009

Treatment pathways of Alzheimer in Nigeria

Alzheimer poses lots of challenges in Low and Middle Income Countries, especially in Nigeria. Globally, the causes of Alzheimer are poorly understood. Cultural factors affect the preference of mental health treatment for treating people living with Alzheimer's disease (PLWA However, Alzheimer's and its gender differentials have been given little consideration in particular. Twenty-four in-depth study was conducted with caregivers and family members/relatives of people living with Alzheimer's (PLWA) residing in the study area. 52.2 percent of respondents were female out of the total while 45.8 percent were male. For male respondents, 40.4%; 49.4 %; 49.2%; 35 % and 28.3% indicated spiritual preference of mental health counseling; traditional; medical practitioner; both traditional and spiritual and psychiatrist respectively. On the other hand, 59.6%; 50.6%; 50.8%; 65% and 70.7% of female respondents indicated spiritual; traditional; medical practitioner; both traditional and spiritual and psychiatrist respectively. This research found that gender disparities primarily affected the mental health intervention care pathways. The availability of mental health resources to support adult mental health were key factors which could influence mental health status.

Civilian Forensic Technician and Sworn Police Officer Job-Related Stress.

Forensic Technicians provide crime scene investigation services and are exposed to stressful violent crimes, motor vehicle accidents, biological or chemical hazards, and other appalling imagery. Forensic Technicians would likely experience physical and psychological stress after exposure to trauma, and security vulnerabilities similar to Sworn Police Officers. The perceived availability of mental health resources,job-related physical, psychological stress, and traumatic experiences of both Forensic Technicians and Sworn Police Officers from California law enforcement agencies were investigated using a self-reported survey. Responses were evaluated for any significant differences in the perceived stress, job-related physical stress, and resulting psychological impact affecting the participants. The survey contained a mix of True/False, Circle/Check the Appropriate Box, or Likert Scale (1-5) responses. The results were evaluated statistically and discussed. Results indicated Sworn Police Officers and Forensic Technicians have different on-duty stress levels, but similar off-duty stress levels. Nearly two-thirds of 54 job-related stressors were not significantly different between the two occupations. However, Forensic Technicians reported more adverse effects in 17 physical and psychological job-related activities compared with Sworn Police Officers. Forensic Technicians reported lower awareness levels and availability of agency mental health support services than were reported by Sworn Police Officers. This study reports for the first time an unexpected outcome that perceived and job-related psychological stress is greater for Forensic Technicians than Sworn Police Officers. Possible reasons for this disparity will be discussed as well as stress management tools that should be implemented to reduce health risk factors for both career professionals as well as increase public safety.

The Impact of Mental Health Resources on Police Officer Action

Concern over interactions between the police and public is more prevalent today than ever before. Specifically, the number of interactions between the police and individuals with mental health disorders (MHD) has increased as the resources from the mental health systems continue to decrease. To better understand these interactions, this paper focuses on police response to mental health calls for service (MHCFS), with specific attention to resources available for officers. Using factorial surveys, police responses from departments across the USA were analyzed using hierarchical linear mixed modeling. The results suggest the availability of mental health resources are significant predictors in the actions taken by police. Implications are clear, police require more mental health-related resources available to them at the scene.

Mental Health Issues in Coronavirus Disease 2019 Pandemic: Evolving a Strategy

AbstractCoronavirus disease 2019 (COVID-19) pandemic has become a global health emergency in a short span of time. Novel kind of the disease, highly infectious nature, rapid progress with serious medical complications and risk of death, and absence of effective treatment and vaccine have all added to a community fear. Need for social distancing, social isolation, and quarantine in contacts further contributes to the fear and also creates a stigma. Declaration of lockdown in many parts of the world to prevent spread of illness has been associated with socioeconomic consequences with great loss to the world economy as well unemployment in a large section of the population. All these factors impose a high risk of mental health problems like anxiety, fear, worries, sleep disturbances, depression, etc. in the general population, and also worsening of the existing symptoms in persons with existing mental illness. The impact of the pandemic on mental health is likely to be long lasting, and a great challenge to the mental health professionals and the policy makers. This paper discusses various strategies to effectively manage the mental health issues in the light of limited availability of mental health resources and restricted access to health services due to lockdown in low-resource settings.

Reducing distress and promoting resilience: a preliminary trial of a CBT skills intervention among recently HIV-diagnosed MSM in China

ABSTRACTPeople living with HIV/AIDS (PLWHA) in China experience significant psychological distress, due to high rates of stigma and low availability of mental health resources. Recently diagnosed Chinese PLWHA who are men who have sex with men (MSM) are particularly vulnerable to distress, facing both HIV and sexual orientation stigma. Reducing distress and enhancing psychological resilience is critical in promoting wellbeing. However, no research to date has examined evidence-based interventions to reduce psychological symptoms and improve resilience in this population. Based on qualitative research on their mental health needs, we developed a culturally tailored, brief 3-session CBT skills-based intervention for integration into primary care [Yang, J. P., Simoni, J., Cheryan, S., Shiu, C., Chen, W., Zhao, H., & Lu, H. (2018). The development of a brief distress reduction intervention for individuals recently diagnosed with HIV in China. Cognitive Behavioral Practice, 25(2), 319–334. doi:10.1016/j.cbpra.2017.08.002]. The intervention includes cognitive restructuring to address depressive thought patterns, behavioral activation to decrease isolation, and paced breathing to reduce anxiety. We conducted a pilot Type 1 hybrid effectiveness-implementation trial assessing pre–post mental health outcomes as well as feasibility, acceptability, and appropriateness information. Ten recently diagnosed MSM completed the research protocol of three individual weekly sessions. Paired-samples t tests demonstrated significant reduction in HIV-related distress, depression, problems with adjustment, as well as improvements in resilience, and perceived social support. Participants and community advisory board members found the intervention highly acceptable, appropriate, and feasible. Preliminary data from the first known study examining a psychological intervention with evidence-based components for recently diagnosed Chinese MSM suggests that this brief intervention may be useful for reducing distress and promoting resilience.

An Eye Movement Desensitization and Reprocessing (EMDR) Group Intervention for Syrian Refugees With Post-traumatic Stress Symptoms: Results of a Randomized Controlled Trial.

The number of refugees has increased significantly over the past few years. PTSD and depression are among the most common mental health problems among refugees. Eye Movement Desensitization and Reprocessing (EMDR), an effective treatment for PTSD, is usually administered individually. The availability of mental health resources would be greatly enhanced when EMDR can be delivered to groups. The EMDR G-TEP is a group protocol based on Early EMDR intervention protocols. There is clinical evidence and one field study published on the effect of EMDR G-TEP and there is only one RCT published on the treatment of PTSD and depression in a refugee camp. The aim of our study was to investigate the efficacy of EMDR G-TEP in treating post-trauma symptoms and depression and preventing the development of chronic PTSD among refugees living in a refugee camp. 47 adult participants with PTSD symptoms were randomly allocated to experimental (n = 18) and control (n = 29) groups. We measured Impact of Event Scale (IES-R), Beck Depression Inventory-II (BDI-II) and International Neuropsychiatric Interview (MINI) at pre-, post- and 4-week follow-up. Analysis of the results showed that the EMDR G-TEP group had significantly lower PTSD and depression symptoms after intervention. The percentage of PTSD diagnosis decreased from 100 to 38.9% in the EMDR G-TEP group and was unchanged in the control group. Following the EMDR G-TEP intervention 61.1% of the experimental group no longer had a PTSD diagnosis; this decrease was maintained at 4 weeks follow-up. In the control group the percentage of people who no longer met the diagnostic criteria for PTSD was 10.3% post-test and 6.9% at 4 weeks follow-up. A significant decrease in depression symptoms from pre-test levels was found in EMDR group but not in the control group follow up-test. This study indicated that EMDR G-TEP effectively reduced PTSD symptoms among refugees living in a camp, after two treatment sessions conducted over a period of 3 days. Further studies need to be performed using a larger number of participants, followed for a longer period of time and given more treatment sessions to strengthen our findings.

The Global Implications of Bullying and Other Forms of Maltreatment, in the Context of Migratory Trends and Psychiatric Resources.

This article identifies countries with the highest prevalence of bullying and other forms of maltreatment and examines the significance of these epidemiologic findings in the context of migration and availability of mental health resources. The relevance of higher prevalence of bullying and other forms of maltreatment in certain parts of the world has significant public health bearing not only on the nations affected by them but worldwide, because migrants carry with them the effects of victimization. The significant risk of abuse and violence affecting immigrants may be compounded by the effects of polyvictimization.

Inequalities in the Use of Services Provided by Psychiatrists in Spain: A Multilevel Study

The objective was to identify individual or contextual inequalities in visits to psychiatrists in Spain, a country with a regionalized health care system and variable integration of mental health and primary care. This cross-sectional study used data for the noninstitutionalized population from the 2006 Spanish Health Interview Survey (N=29,478). A score of ≥ 3 on the General Health Questionnaire represented a need for mental health care. The probability of having visited a psychiatrist in the previous four weeks was analyzed in relation to individual-level variables (age, social class, health insurance, and country of origin) and contextual socioeconomic variables (Gross Domestic Product; a measure of income equality; and characteristics of regional mental health systems, such as human resources, services, and organization). Multilevel logistic regression models were used. A total of 161 individuals (.55% of the sample) reported a visit to a psychiatrist during the previous four weeks. Individuals age 65 and older and immigrants from low-income countries were less likely to report a visit. Visits to psychiatrists were more common in regions with higher rates of psychiatrists per hospital (odds ratio [OR]=1.47, 95% confidence interval [CI]=1.18-1.83), more human resources for mental health (OR=1.03, CI=1.01-1.06), and better integration of primary care and specialized mental health care (OR=1.90, CI=1.32-2.76). Individual and contextual inequalities in use of psychiatrists' services exist in Spain. Better coordination between primary and mental health care and greater availability of mental health resources were associated with greater use. Policies seeking better integration of care should be promoted.

Depression Least Likely if You Live in South Dakota

Depression Least Likely if You Live in South Dakota