Chronic Mental Health Conditions Research Articles

A Scoping Review of Trauma, Mental Health and First Responders in Australia.

Exposure to traumatic and/or violent events is an inherent part of the first responder role, which increases the risk of developing acute and chronic mental health symptoms and conditions. Suicidality for Australian first responders have recently increased with prevalence considered much higher compared with the general population. To inform specific recommendations for Australian first responders, there is a need to establish what evidence is available regarding these issues within the Australian context. The aim of this scoping review was to explore the impacts of trauma on the mental health of Australian first responders, the strategies recommended to address these issues and any unique needs in rural contexts. A scoping review was undertaken following PRISMA guidelines for scoping reviews. Peer-reviewed articles on Australian first responder mental health from seven databases were screened for inclusion. This review highlights that despite available evidence on the types of traumas and adverse mental health outcomes experienced, less evidence exists pertaining to intervention effectiveness. There are major gaps in evidence within rural and remote contexts which hinders effective planning and delivery of support for rural and regional first responders. Clinicians such as mental health nurses, particularly in rural areas, need to be aware of these gaps which impact planning and delivery of support and are in prime position to ensure screening, interventions and strategies are used and evaluated to determine their suitability for rural first responders.

Ketamine in the effective management of chronic pain, depression, and posttraumatic stress disorder for Veterans: A meta-analysis and systematic review.

Ketamine has emerged as a promising treatment alternative for the management of chronic pain. Despite encouraging findings in civilian populations, and favourable results from trials examining its efficacy in military populations, there is still a dearth of information pointing to optimal specifications related to ketamine administration for pain, depression, and posttraumatic stress disorder (PTSD) in military populations. This meta-analysis and systematic review synthesised available evidence on the effectiveness, tolerability, and feasibility of ketamine in the management of chronic pain and mental health conditions in military populations. This review followed the Cochrane's Guide for systematic reviews of interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) as frameworks for data collection and synthesis. A total of 11 studies and 22 independent samples were retained for data analyses. Across samples, improvements in pain, depression, and PTSD outcomes were evident, with the use of ketamine leading to significant reductions, g = 1.76, SE = 0.19, 95% CI (1.39, 2.13), Z = 9.26, p <.001. These effect sizes were robust with moderate-to-large effects. In addition, the reductions in symptoms were observed in both active-duty and Veteran groups, and for different routes of ketamine administration, frequencies of ketamine administration, duration of ketamine treatments, dosage, study design, and allowance for concurrent treatments. This review provides a preliminary synthesis of available evidence which suggests that ketamine may be a potential option for the treatment of depression, PTSD, and chronic pain in military populations. The viability of ketamine as an alternative treatment may be particularly impactful for those who are treatment resistant, experience chronic symptoms, and/or have exhausted conventional treatments. More research is warranted in order verify the findings presented in this review.

The rehabilitation treatment beliefs questionnaire-revised: assessing adolescents' treatment beliefs.

While there are several studies on children's and adolescents' beliefs about illness and medication treatment, there is limited research on their treatment beliefs in the context of rehabilitation. The Rehabilitation Treatment Beliefs Questionnaire (RTBQ) was the first instrument available to assess pediatric patients' rehabilitation-related treatment beliefs. However, the RTBQ had some limitations that we aimed to address in this study: We revised the content of the RTBQ to include previously unaddressed dimensions of rehabilitation-related treatment beliefs, and we thoroughly tested its psychometric properties based on a sizeable, multicenter sample of adolescents with different chronic diseases. Across 11 pediatric rehabilitation clinics throughout Germany, eligible patients aged 12-18 years with any chronic physical or mental health condition were invited to participate in an online survey. Psychometric evaluation included item analysis, exploratory factor analysis, internal consistency and construct validity. The sample comprised N = 294 adolescents (M = 14.2 years) with various chronic conditions. Psychometric testing demonstrated a coherent factor structure with 6 interpretable scales covering process and outcome expectations, expectations of one's own role in the treatment process, structural expectations, concerns, and emotions, the latter three representing previously unaddressed dimensions of rehabilitation-related treatment beliefs. Internal consistency was acceptable to good. Construct validity analyses showed mostly hypotheses-consistent correlations with related constructs. The revised RTBQ provides a psychometrically well-tested, adolescent-specific, and disease-generic instrument that captures multiple dimensions of rehabilitation-related treatment beliefs. Practical implications include identifying adolescents' beliefs about rehabilitation treatment in order to actively involve them in their illness management.

Chronic Physical and Mental Health Conditions Associated With Employment Status in Veterans

Veterans commonly experience both poor health and employment difficulty. However, the research examining potential relationships between chronic physical and mental health conditions and employment in veterans has important limitations. This study examines those potential relationships using large-scale, nationally representative data. The authors' hypothesis was that veterans experiencing these conditions would be less likely to be employed than veterans without the conditions and, further, that there may be differences in these relationships when comparing male veterans with female veterans. The study team conducted a pooled cross-sectional analysis of nationally representative data from the 2004-2019 administrations of the Medical Expenditures Panel Survey, which had items addressing health conditions, employment, and military experience. The authors assessed the relationship between health conditions and employment using multivariate logistic regression. Control variables included demographics, SES, family size, and survey year. Veterans experiencing diabetes, high blood pressure, stroke, emphysema, arthritis, serious hearing loss, poor self-reported mental health, poor self-reported health, depression, or psychological distress were less likely to be employed than veterans without those conditions, even after adjusting for potential confounding factors. Veterans with diabetes had 25% lesser odds of being employed than veterans without the condition (95% CI=0.65, 0.85). Veterans with increased likelihood of depression had 35% lesser odds of being employed than veterans without depression (95% CI=0.52, 0.81). This study adds evidence to the understanding of the role of chronic health conditions in employment status of veterans. The results support arguments for programs that aid veterans with both their health and their employment.

Screening for Unhealthy Alcohol Use Among Patients With Multiple Chronic Conditions in Primary Care

IntroductionUnhealthy alcohol use (UAU) increases risk for and exacerbation of chronic health conditions. As such, screening, prevention, and management of UAU is especially critical to improving health outcomes for patients with multiple physical or mental chronic health conditions (MCC). It is unclear to what extent multiple chronic condition (MCC) status is a barrier to screening for UAU in the primary care setting. We hypothesized that patients with MCC would be at lower odds of being screened for UAU compared with patients with no MCC. MethodsWe performed a secondary analysis of electronic health record data for patients from 67 primary care practices in Virginia (2020-2023). Using the Center for Medicare and Medicaid Services’ chronic disease framework, we classified patients by MCC status: no MCC, physical MCC (P-MCC), mental health MCC (MH-MCC), and physical & mental health MCC (P&MH-MCC). We used multiple logistic regressions with an added practice-level random effect to analyze the relationship between MCC status and odds of receiving an alcohol-related assessment, of being screened for UAU with a U.S. Preventive Services Task Force (USPSTF)-recommended instrument, and of screening positive for UAU within the past 2 years. ResultsWithin a final cohort of n= 11,789, a total of 6796 patients (58%) had MCC (29% P-MCC, 4% MH-MCC, and 25% P&MH-MCC). In all, 69% of patients were screened for UAU, while 16% were screened with a USPSTF-recommended instrument and 7% screened positive for UAU. Relative to those with no MCC, patients with P&MH-MCC had 0.9 times lower odds of receiving any screening for UAU [95% CI: (0.8, 1.0), p = 0.0240], while patients with only P-MCC or only MH-MCC had similar odds. There was no difference in odds of being screened with a USPSTF-recommended instrument based on MCC status. Patients with MH-MCC and P&MH-MCC had 1.8 and 1.5 times greater odds, respectively, of screening positive for UAU [95% CI: (1.3, 2.7), p= 0.0014) and 95% CI: (1.2, 1.8), p=0.0003)]. ConclusionAlthough patients with chronic mental health conditions were more likely to screen positive for UAU than patients without MCC, Virginia primary care patients with P&MH MCC were less likely to receive an alcohol-related assessment during the past 2 years. Given the overall modest rate of screening with a USPSTF-recommended instrument, further efforts are needed to create the conditions for high quality alcohol-related preventive service delivery in primary care, particularly for patients with high complexity and/or mental health conditions.

Variations in Pattern of Social Media Engagement between Individuals with Chronic Conditions and Mental Health Conditions

The use of the internet and supported apps is at historically unprecedented levels for the exchange of health information. The increasing use of the internet and social media platforms can affect patients’ health behavior. This study aims to assess the variations in patterns of social media engagement between individuals diagnosed with either chronic diseases or mental health conditions. Data from four iterations of the Health Information National Trends Survey Cycle 4 from 2017 to 2020 were used for this study with a sample size (N) = 16,092. To analyze the association between the independent variables, reflecting the presence of chronic conditions or mental health conditions, and various levels of social media engagement, descriptive statistics and logistic regression were conducted. Respondents who had at least one chronic condition were more likely to join an internet-based support group (Adjusted Odds Ratio or AOR = 1.5; Confidence Interval, CI = 1.11–1.93) and watch a health-related video on YouTube (AOR = 1.2; CI = 1.01–1.36); respondents with a mental condition were less likely to visit and share health information on social media, join an internet-based support group, and watch a health-related video on YouTube. Race, age, and educational level also influence the choice to watch a health-related video on YouTube. Understanding the pattern of engagement with health-related content on social media and how their online behavior differs based on the patient’s medical conditions can lead to the development of more effective and tailored public health interventions that leverage social media platforms.

Global perspectives on bipolar disorder treatment: in-depth comparative analysis of international guidelines for medication selection.

Bipolar disorder, a chronic mental health condition characterised by fluctuations in mood, energy and functionality, affects millions of individuals worldwide. Its management requires a comprehensive approach, and, as such, treatment guidelines have a pivotal role in guiding clinicians to alleviate symptoms, prevent relapse and enhance overall patient well-being. However, the treatment landscape is far from homogenous, with significant variations existing across different countries. This study aimed to explore and compare treatment guidelines for bipolar disorder in various regions, shedding light on the factors that influence therapeutic approaches and thus offering insights that could contribute to the ongoing refinement of evidence-based practices in management. The study explores various international treatment guidelines for bipolar disorder that have been updated after 2014. Guidelines from the UK, Canada, Australia/New Zealand, South Korea and the International College of Neuropsychopharmacology are scrutinised to identify factors contributing to the observed differences among them. The variations in recommended drugs across guidelines arise from the approaches employed in guideline development - whether relying on expert consensus or meta-analysis results. Timing disparities in conducting these analyses and the selection of studies also exert influence. Moreover, differences in metabolic enzymes among diverse races and the health policies implemented by individual nations play a significant part in shaping these differences. The primary hindrance to consistent treatment conclusions lies in the scarcity of high-quality research results, leading to variations in guidelines. Enhancing evidence-based recommendations necessitates the undertaking of large-scale studies dedicated to assessing treatments for bipolar disorder.

Development and Validation of a Measure to Assess Patient Experiences With Video Care Encounters

As video-based care expands in many clinical settings, assessing patient experiences with this care modality will help optimize health care quality, safety, and communication. To develop and assess the psychometric properties of the video visit user experience (VVUE) measure, a patient-reported measure of experiences with video-based technology. In this survey study, veterans completed a web-based, mail, or telephone survey about their use of Veterans Healthcare Administration (VHA) virtual care between September 2021 and January 2022. The survey was completed by patients who reported having a VHA video visit on their own device or a VHA-issued device and linked to VHA utilization data for the 6 months following the survey. Data analysis was performed from March 2022 to February 2023. The survey included 19 items about experiences with video visits that were rated using a 4-point Likert-type scale (strongly disagree to strongly agree). First, an exploratory factor analysis was conducted to determine the factor structure and parsimonious set of items, using the McDonald Omega test to assess internal consistency reliability. Then, a confirmatory factor analysis was conducted to test structural validity, and bivariate correlations between VVUE and VHA health care engagement were calculated to test concurrent validity. Finally, predictive validity was assessed using logistic regression to determine whether VVUE was associated with future VHA video visit use. Among 1887 respondents included in the analyses, 83.2% (95% CI, 81.5%-84.8%) were male, 41.0% (95% CI, 38.8%-43.1%) were aged 65 years or older, and the majority had multiple chronic medical and mental health conditions. The exploratory factor analysis identified a 10-item single-factor VVUE measure (including questions about satisfaction, user-centeredness, technical quality, usefulness, and appropriateness), explaining 96% of the total variance, with acceptable internal consistency reliability (ω = 0.95). The confirmatory factor analysis results confirmed a single-factor solution (standardized root mean squared residual = 0.04). VVUE was positively associated with VHA health care engagement (ρ = 0.47; P < .001). Predictive validity models demonstrated that higher VVUE measure scores were associated with future use of video visits, where each 1-point increase on VVUE was associated with greater likelihood of having a video visit in subsequent 6 months (adjusted odds ratio, 1.04; 95% CI, 1.02-1.06). The findings of this study of veterans using video visits suggest that a brief measure is valid to capture veterans' experiences receiving VHA virtual care.

Family and community resilience: a Photovoice study

BackgroundAdverse childhood experiences (ACEs), in combination with adverse community environments, can result in traumatic stress reactions, increasing a person’s risk for chronic physical and mental health conditions. Family resilience refers to the ability of families to withstand and rebound from adversity; it involves coping with disruptions as well as positive growth in the face of sudden or challenging life events, trauma, or adversities. This study aimed to identify factors contributing to family and community resilience from the perspective of families who self-identified as having a history of adversity and being resilient during the COVID-19 pandemic.MethodsThis study used Photovoice, a visual participatory research method which asks participants to take photographs to illustrate their responses to a research question. Participants consisted of a maximum variation sample of families who demonstrated family level resilience in the context of the pair of ACEs during the COVID-19 pandemic. Family members were asked to collect approximately five images or videos that illustrated the facilitators and barriers to well-being for their family in their community. Semi-structured in-depth interviews were conducted using the SHOWeD framework to allow participants to share and elucidate the meaning of their photos. Using thematic analysis, two researchers then independently completed line-by-line coding of interview transcripts before collaborating to develop consensus regarding key themes and interpretations.ResultsNine families were enrolled in the study. We identified five main themes that enhanced family resilience: (1) social support networks; (2) factors fostering children's development; (3) access and connection to nature; (4) having a space of one’s own; and (5) access to social services and community resources.ConclusionsIn the context of additional stresses related to the COVID-19 pandemic, resilient behaviours and strategies for families were identified. The creation or development of networks of intra- and inter-community bonds; the promotion of accessible parenting, housing, and other social services; and the conservation and expansion of natural environments may support resilience and health.

Treatment histories, barriers, and preferences for individuals with symptoms of generalized anxiety disorder.

Generalized anxiety disorder (GAD) is a prevalent and chronic mental health condition, associated with considerable individual and economic burden. Despite the availability of effective treatments, many individuals do not access support. The current study explores treatment histories, barriers to help-seeking, and cognitive behavioral therapy (CBT) treatment preferences for individuals with clinically significant GAD symptoms. The utility of Health Belief Model (HBM) in predicting help-seeking is also examined. A cross-sectional design with 127 participants (Mage = 29.17; SD = 11.86; 80.3% female) was used. Sixty-two percent of participants reported previously seeking psychological treatment, and approximately 28% received CBT in the first instance. The most influential treatment barriers were a desire to solve the problem on one's own (M = 1.96, SD = 0.96), followed by affordability (M = 1.75, SD = 1.15) and feeling embarrassed or ashamed (M = 1.75, SD = 1.06). The most preferred treatment modes were in-person individual treatment (M = 7.59, SD = 2.86) followed by remote treatment via videoconferencing (M = 4.31, SD = 3.55). Approximately 38% of the variance in intention to seek treatment was associated with the HBM variables, with perceived benefit of treatment being the strongest predictor. Results have the potential to inform mental health service delivery by reducing treatment barriers and aligning public health campaigns with benefits of psychological treatments.

Using an intersectionality-based approach to evaluate mental health services use among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver.

To cope with homonegativity-generated stress, gay, bisexual and other men who have sex with men (GBM) use more mental health services (MHS) compared with heterosexual men. Most previous research on MHS among GBM uses data from largely white HIV-negative samples. Using an intersectionality-based approach, we evaluated the concomitant impact of racialization and HIV stigma on MHS use among GBM, through the mediating role of perceived discrimination (PD). We used baseline data from 2371 GBM enrolled in the Engage cohort study, collected between 2017 and 2019, in Montreal, Toronto and Vancouver, using respondent-driven sampling. The exposure was GBM groups: Group 1 (n = 1376): white HIV-negative; Group 2 (n = 327): white living with HIV; Group 3 (n = 577): racialized as non-white HIV-negative; Group 4 (n = 91): racialized as non-white living with HIV. The mediator was interpersonal PD scores measured using the Everyday Discrimination Scale (5-item version). The outcome was MHS use (yes/no) in the prior 6 months. We fit a three-way decomposition of causal mediation effects utilizing the imputation method for natural effect models. We obtained odds ratios (ORs) for pure direct effect (PDE, unmediated effect), pure indirect effect (PIE, mediated effect), mediated interaction effect (MIE, effect due to interaction between the exposure and mediator) and total effect (TE, overall effect). Analyses controlled for age, chronic mental health condition, Canadian citizenship, being cisgender and city of enrolment. Mean PD scores were highest for racialized HIV-negative GBM (10.3, SD: 5.0) and lowest for white HIV-negative GBM (8.4, SD: 3.9). MHS use was highest in white GBM living with HIV (GBMHIV) (40.4%) and lowest in racialized HIV-negative GBM (26.9%). Compared with white HIV-negative GBM, white GBMHIV had higher TE (OR: 1.71; 95% CI: 1.27, 2.29) and PDE (OR: 1.68; 95% CI: 1.27, 2.24), and racialized HIV-negative GBM had higher PIE (OR: 1.09; 95% CI: 1.02, 1.17). Effects for racialized GBMHIV did not significantly differ from those of white HIV-negative GBM. MIEs across all groups were comparable. Higher MHS use was observed among white GBMHIV compared with white HIV-negative GBM. PD positively mediated MHS use only among racialized HIV-negative GBM. MHS may need to take into account the intersecting impact of homonegativity, racism and HIV stigma on the mental health of GBM.

Mental health, chronic and infectious conditions among pregnant persons in US state prisons and local jails 2016-2017.

Pregnant individuals in incarcerated settings have unique healthcare needs. Rates of mental health, infectious diseases, and chronic disease are higher among nonpregnant incarcerated women compared with those who are not, but the prevalence of these conditions among pregnant people in custody has not been documented. The objective of this study is to describe the prevalence of metabolic, infectious, and mental health conditions in pregnant people to identify the medical needs of high-risk pregnancies in US state prisons and local jails. This was a prospective epidemiologic surveillance of a convenience sample of state prisons (n = 20) and local jails (n = 3). We used purposive and snowball sampling to recruit a national sample of prisons and jails of a range of sizes and geographies. Reporters submitted to our study database monthly data on selected pregnancy comorbidities for 6 months between 2016 and 2017. Screening, diagnosis, and tracking of these conditions are derived from each facility's medical record and health care delivery systems. Of the 445 newly admitted pregnant people in prisons and 243 in jails, the most prevalent conditions were mental health conditions and hepatitis C. Specifically, 34.1% (n = 152) in prison and 23.5% (n = 57) in jail had a substance use disorder, and 27.4% (n = 122) of those in prison and 17.7% (n = 43) in jail had a psychiatric diagnosis. Finally, 20.2% (n = 91) in prison and 6.6% (n = 16) in jail had hepatitis C. This study demonstrates that chronic medical and mental health conditions are prevalent among pregnant people in US prisons and jails. However, significant variability in the reported number of cases of these conditions from state to state and between facility types implies a lack of or inadequate screening practices. These data indicate the need for comprehensive screening and appropriate care for the complex needs of pregnant incarcerated people.

Mental Health Status among Individuals with Spouses Residing in Long-term Care Facilities: Using Propensity Score Matching

Purpose: The number of older adults with dementia who reside in long-term care institutions has significantly grown. When older adults with dementia are institutionalized, their spouses, who were providing care at home, may experience chronic mental health conditions. This study examined and compared the mental health status of older adults who institutionalized their spouses with dementia in long-term care institutions versus that of older adults who reside with their spouses in their homes.Methods: The analysis included 95 spouses of institutionalized individuals and 285 control group participants, drawn from 63,617 participants of the 2018 Korean Community Health Survey.Results: The results showed that the spouses of institutionalized individuals with dementia had more depressive symptoms, poorer sleep quality, and experienced greater stress than those in the control group.Conclusion: It is necessary to provide supportive care, for alleviating depressive symptoms, poor sleep quality, and stress, to individuals whose spouses are residing in long-term care facilities. For a spouse caregiver, navigation help and education on the changing roles after an older adult’s admission to a long-term care facility would be necessary.

The Use of Authorized Concealment to Minimize Nocebo Side Effects: A Survey of US Public Attitudes

Introduction: To minimize nocebo effects, it may be possible to employ authorized concealment, in which clinicians tell patients about the nocebo phenomenon and ask if they would prefer not to be informed about mild treatment side effects. Objective: The objective of the study was to understand public evaluations of authorized concealment for reducing nocebo effects. Methods: An online cross-sectional survey was completed by a demographically diverse US national community sample between June 2 and 6, 2023. Participants were 1,012 adults residing in 48 states, ages ranging from 18 to 94 (mean = 43.2), 65.4% regularly taking medication, and 66.6% reporting a chronic physical or mental health condition. After learning about nocebo effects, participants rated and estimated their likelihood of consenting to four potential methods for authorized concealment of mild side effects. The four methods were ranked for preference and ranked again with the options of (1) receiving all side-effect information and (2) having the opportunity to select among disclosure methods. Results: A majority of participants (86.2%) positively endorsed at least one authorized concealment method and 88.2% estimated they would consent to at least one method. Authorized concealment in which individuals learned only the most common side effects or had side-effect information available online received more positive ratings and rankings. A final ranking yielded preferences for receiving all side-effect information (30.4%) and having the opportunity to select side-effect disclosure method (31.8%). Conclusions: Our study suggests that many in the public could be open to authorized concealment for mild side effects when it is explained in reference to nocebo effects.

An Integrative Review of Adverse Childhood Experiences and Reproductive Traumas of Infertility and Pregnancy Loss.

Adverse childhood experiences (ACEs) can lead to chronic diseases and mental health conditions; however, less is known about the associations of ACEs to the reproductive traumas of infertility and pregnancy loss. The purpose of this integrative review was to explore relationships between ACEs and the reproductive traumas of infertility and pregnancy loss. We searched PubMed, SocINDEX, PsycINFO, and CINAHL databases in December 2021 and 2022. Inclusion criteria were qualitative or quantitative research, systematic or integrative reviews, or meta-analysis articles in English that were peer-reviewed and full-text, addressing any ACE from the ACE Checklist and infertility or pregnancy loss. A total of 20 articles were included in the review. We used Whittemore and Knafl's integrative review framework, Preferred Reporting Items for Systematic Reviews and Meta-analyses for reporting, and Covidence software for data management. A quality appraisal using Joanna Briggs Institute critical appraisal tools was performed. Relevant data were extracted into a matrix for iterative comparison. Twenty studies were included in the review. Results support there may be an association between pregnancy loss and infertility in women with a history of ACE, although results are mixed between infertility and ACEs. We also identified other concepts related to ACEs and the reproductive traumas of infertility and pregnancy loss and include racial and ethnically diverse populations, social determinants of health, modifiable risk factors, and stress appraisals. Midwives and other women's health care providers should be aware that ACEs may be associated with pregnancy loss and infertility, although additional research is needed to further explore the relationships with infertility, mental health, and hypothalamic-pituitary-adrenal axis dysregulation from allostatic load. Trauma-informed care and the development of effective interventions are warranted for women who experience ACEs. Providers should consider earlier interventions, including emotional services, for women with a history of ACE or reproductive trauma.

Sociodemographic characteristics and longitudinal progression of multimorbidity: A multistate modelling analysis of a large primary care records dataset in England.

Multimorbidity, characterised by the coexistence of multiple chronic conditions in an individual, is a rising public health concern. While much of the existing research has focused on cross-sectional patterns of multimorbidity, there remains a need to better understand the longitudinal accumulation of diseases. This includes examining the associations between important sociodemographic characteristics and the rate of progression of chronic conditions. We utilised electronic primary care records from 13.48 million participants in England, drawn from the Clinical Practice Research Datalink (CPRD Aurum), spanning from 2005 to 2020 with a median follow-up of 4.71 years (IQR: 1.78, 11.28). The study focused on 5 important chronic conditions: cardiovascular disease (CVD), type 2 diabetes (T2D), chronic kidney disease (CKD), heart failure (HF), and mental health (MH) conditions. Key sociodemographic characteristics considered include ethnicity, social and material deprivation, gender, and age. We employed a flexible spline-based parametric multistate model to investigate the associations between these sociodemographic characteristics and the rate of different disease transitions throughout multimorbidity development. Our findings reveal distinct association patterns across different disease transition types. Deprivation, gender, and age generally demonstrated stronger associations with disease diagnosis compared to ethnic group differences. Notably, the impact of these factors tended to attenuate with an increase in the number of preexisting conditions, especially for deprivation, gender, and age. For example, the hazard ratio (HR) (95% CI; p-value) for the association of deprivation with T2D diagnosis (comparing the most deprived quintile to the least deprived) is 1.76 ([1.74, 1.78]; p < 0.001) for those with no preexisting conditions and decreases to 0.95 ([0.75, 1.21]; p = 0.69) with 4 preexisting conditions. Furthermore, the impact of deprivation, gender, and age was typically more pronounced when transitioning from an MH condition. For instance, the HR (95% CI; p-value) for the association of deprivation with T2D diagnosis when transitioning from MH is 2.03 ([1.95, 2.12], p < 0.001), compared to transitions from CVD 1.50 ([1.43, 1.58], p < 0.001), CKD 1.37 ([1.30, 1.44], p < 0.001), and HF 1.55 ([1.34, 1.79], p < 0.001). A primary limitation of our study is that potential diagnostic inaccuracies in primary care records, such as underdiagnosis, overdiagnosis, or ascertainment bias of chronic conditions, could influence our results. Our results indicate that early phases of multimorbidity development could warrant increased attention. The potential importance of earlier detection and intervention of chronic conditions is underscored, particularly for MH conditions and higher-risk populations. These insights may have important implications for the management of multimorbidity.

Complementary andIntegrative Medicine Prevalence andUtilization inInternational Military andVeteran Settings andCommunities: A Systematic Review.

Active duty military personnel and veterans have unique and complex health needs, with the high demands of military life often leading to chronic physical and mental health conditions. Complementary and integrative medicine (CIM) could be a possible solution to this problem. Some military health systems have started integrating CIM into health care delivery. However, there has been no systematic evaluation of the prevalence and utilization of CIM in military and veteran populations globally. A Preferred Reporting Items For Systematic Reviews and Meta-Analysis Protocols protocol was used to systematically search for original research assessing the prevalence and utilization of CIM among active serving military or veterans. CINAHL, MEDLINE, Scopus, and AMED databases were searched up to February 3, 2023. A total of 27 studies met the inclusion criteria and were included in this review. The overall quality of evidence was high with a low risk of bias. Utilization of CIM varied. The lowest utilization demonstrated that only 1.9% of services delivered by military health system were CIM. The majority of studies found utilization rates between 30% and 80%, with some studies reporting use as high as 90%. The most commonly used CIM therapies included chiropractic care, massage, mindfulness/meditation, and acupuncture. Utilization of CIM products was high and ranged from 32% to 87%. The most frequently used products were dietary supplements, particularly multivitamins and minerals and protein supplements/amino acids. The use of herbal products was high among veterans ranging from 10% to 79%. The high demand for CIM by military personnel and veterans has important implications for policy, funding allocation, and integration of these services into clinical practice, particularly by countries not currently doing so. Further research is needed to assess the implementation of CIM into real-world settings to explore barriers and facilitators for their use in clinical practice and, by extension, their integration into the wider health care system.

SAT351 Utilization of Emergency Services by Transgender People in the United States, 2006-2018

Abstract Disclosure: D. Stroumsa: None. E.E. Marsh: None. P.N. Pfeiffer: None. C. Jiang: None. A. Vrolijk: None. M.B. Moravek: None. Bridging the Gap: Utilization of Emergency Services by Transgender People in the United States, 2006-2018Introduction: Transgender or nonbinary (Trans) people face significant health disparities, including in access to primary and preventive care. These disparities are driven by structural, interpersonal, and individual stigma, which lead to barriers accessing care and avoidance of primary care, and to increased reliance on emergency care. We aimed to characterize ED use by Trans patients, and changes in such use over time. Methods: Data was obtained from the Nationwide Emergency Department Sample (NEDS) , which is a weighted stratified sample of hospital-based ED visits. Using gender-dysphoria related ICD-9 and ICD-10 diagnostic codes, we compared visits among trans people to those without such a diagnosis, adjusting for age, region, urbanicity, primary payer, and income quartile. We evaluated rates of chronic condition and mental health conditions as primary diagnosis at presentation and at admission. Presence of chronic conditions was assessed using the ICD-9 Chronic Condition Indicator for 2006-2014. Results: There was a rapid temporal increase in the proportion of visits with a trans-related diagnosis, from 0.001% of visits in 2006 to 0.016% in 2018. There were significant demographic differences between trans people and others. Trans people were significantly more likely to be admitted, adjusting for payment, age group, region, income and mental health condition (overall 52.4% vs. 17.3%, adjusted OR= 7.368 95% CI (6.771, 8.017)). A large proportion of ED visits by trans individuals was associated with a mental health diagnosis (28.7%, compared with 3.9% for others, p&amp;lt;0.001; adjusted OR =2.01, 95% CI 1.91-2.11) and/or with a chronic condition (58.2% vs. 19.2%, p&amp;lt;0.001; adjusted OR =3.65, 95% CI 3.61-3.69). Similarly, hospital admission among trans people was much more likely to be linked to a mental health condition (37.2% vs. 5.3% , p&amp;lt;0.001; adjusted OR = 2.78, 95% CI 2.44-3.16) or chronic condition (67.3% vs 41.3%, p&amp;lt;0.001; adjusted OR = 2.21, 95% CI 1.78-2.75) Discussion: The high admission rates, and high proportion of trans people with a chronic condition or with mental illness, may represent worse overall health due lack of primary care, or a delay in seeking emergency care among Trans people. Lastly, these findings could be a manifestation of a higher likelihood of a trans-related diagnostic code being charted among trans people at admission, or bias towards higher likelihood of trans people receiving a mental-health related diagnosis. There is a need for increasing access to affirming primary and mental health care among trans people, and increased training of emergency clinicians. Presentation Date: Saturday, June 17, 2023

Integrating Social Care into Healthcare: A Review on Applying the Social Determinants of Health in Clinical Settings.

Despite the substantial health and economic burdens posed by the social determinants of health (SDH), these have yet to be efficiently, sufficiently, and sustainably addressed in clinical settings-medical offices, hospitals, and healthcare systems. Our study contextualized SDH application strategies in U.S. clinical settings by exploring the reasons for integration and identifying target patients/conditions, barriers, and recommendations for clinical translation. The foremost reason for integrating SDH in clinical settings was to identify unmet social needs and link patients to community resources, particularly for vulnerable and complex care populations. This was mainly carried out through SDH screening during patient intake to collect individual-level SDH data within the context of chronic medical, mental health, or behavioral conditions. Challenges and opportunities for integration occurred at the educational, practice, and administrative/institutional levels. Gaps remain in incorporating SDH in patient workflows and EHRs for making clinical decisions and predicting health outcomes. Current strategies are largely directed at moderating individual-level social needs versus addressing community-level root causes of health inequities. Obtaining policy, funding, administrative and staff support for integration, applying a systems approach through interprofessional/intersectoral partnerships, and delivering SDH-centered medical school curricula and training are vital in helping individuals and communities achieve their best possible health.

Internal migration following adverse life events: Assessing the likelihood of return migration and migration toward family.

There are well-documented associations between life course changes and migration; yet, the occurrence, order, and timing of reasons for migrating are growing increasingly diverse. Migration following adverse life events, such as a divorce or an involuntary job loss, may be qualitatively distinct from migration undertaken for other reasons. Moves, especially long-distance moves, following adverse life events, may be defined more by seeking family and familiar locations. Moreover, a heightened probability of migration may occur not only immediately after an adverse life event but also in the years after. We explore these questions in the US context with longitudinal data from the 1983 to 2019 waves of the Panel Study of Income Dynamics, which provides information on residential locations, locations of family members, and adverse life events for individuals over time. We focus on five specific events: divorce, the death of a spouse, involuntary job loss, the onset of a chronic physical health condition, and the onset of a chronic mental health condition. Using multivariate regression, we find that divorce and job loss induce long-distance moves, especially return moves and moves towards family. Chronic physical conditions deter moving in general but increase the chances of return moves (after a period of time) and moves towards family. These results have implications for understanding migration as a response to adverse life events, both immediately and over time.