Chronic Mental Illness Research Articles

How can healthcare providers involve with families in the care of patients with chronic mental illness? A mixed methods protocol study to adapt the clinical practice guideline.

Chronic mental illnesses have long periods, are recurring, and require continuous care as well as an integrated and collaborative approach to organize the care. The purpose of this article is to summarize the most important steps necessary for adapting a clinical practice guideline for family-centered collaborative care of patients with chronic mental illnesses referring to the medical centers. As the study will be an exploratory mixed methods study, the design will be carried out as a sequential qualitative-quantitative study (QUAL quan), consisting of 3 phases, 9 modules, and 24 sequential steps, which is based on the Guidelines International Network to adapt the guideline manual. In the first phase, the prerequisites for adaptation of the clinical guideline were established. In the second phase, to collect evidence, a qualitative study (semi-structured interview) will be conducted to explore the dimensions and components of the care needs of patients with chronic mental disorders and their families from the perspectives of patients, caregivers, and healthcare providers. Additionally, a literature review to extract relevant clinical guidelines and articles will be done. A panel of experts will screen and evaluate potential clinical guidelines, and a draft guideline will be developed. It is expected that these findings will meet the needs of patients with mental illness and their caregivers by providing integrated care and improving collaborative care within the sociocultural context of Iran.

Return to Community Mental Health Centers after the Pandemic: A Qualitative Study on Turkish Patients' Subjective Experiences.

Community mental health centers (CMHCs) are important institutions for individuals with chronic mental illness. During the COVID-19 period, patients with mental health could not optimally access care in CMHCs. To explore the experiences of patients using a CMHC after its closure due to the COVID-19 pandemic. This was a descriptive qualitative study that included 16 patients with mental disorders who regularly used CMHCs during the pre-pandemic period. Their data were collected between March 2022 and August 2022 using face-to-face, in-depth semi-structured interviews. All interviews were recorded and the content analysis method was used to analyze the data. The age range of the 16 study participants was 29-53 years with a mean age of 40.8 ± 6.5 years. Nine (56.3%) participants were men, and 7 (43.7%) were women. Ten (62.5%) participants had schizophrenia, whereas 6 (37.5%) had bipolar disorder. According to content analysis, the five main themes that emerged based on the statements of participants were the effects of change, difficulties experienced, support needs, coping experiences, and suggestions. The results showed that although patients using CMHCs are struggling with the adverse consequences of the pandemic process, they also have difficulty managing their diseases and daily life due to their inability to access psychosocial services in the CMHCs. The patients reported their negative experiences and need for support during the pandemic. The study highlights the need to adequately accommodate mental health services delivery during future pandemics that may impose movement restrictions.

Frailty index in the Colonias of the Rio Grande Valley: health related quality of life and resilience

BackgroundFrailty is characterized by an accumulation of deficits that lead to vulnerability to adverse health outcomes. The Frailty Index (FI) quantifies frailty by measuring deficits that increase susceptibility to stressors. This study focused on a population of Mexican Americans living in vulnerable communities in the Rio Grande Valley of south Texas. We used a Frailty Index developed based on common health-related data--the Patient Health Questionnaire (PHQ-9) and a Health-related Quality of Life survey (Duke Health Profile). Quality of life, resilience, and frailty are interrelated and influenced by chronic illness, mental illness, poverty, cognitive impairment, and community support.MethodsWe used Logistic regression analysis, factor component analysis, receiver operating characteristic curves, and odds ratios to identify potential associations between clinical variables and candidate predictor variables and seven physiological health variables, and two survey instruments. We analyzed data obtained from participants (894) that live in two Colonias located on the Texas-Mexico border. We calculated the FI with seven physiological variables, PHQ-9 score, and the 11 domain-specific Duke Profile scores, for a total of 19 health deficits. We then dichotomized FI (>0.25) and determined ROC curves through model selection to determine best predictors of frailty.ResultsFemales (n = 622) had a higher starting frailty, and males (n = 272) had a significantly greater change rate with age. Women score higher in anxiety, depression, anxiety/depression, and pain. The frailty index and quality of life markers are strongly inversely related; poorer quality of life leads to greater frailty independent physiological health variables, the PHQ 9, sex, and age.ConclusionThe study highlights the importance of addressing modifiable mental health and social stressors to reduce frailty. Furthermore, it suggests that factors supporting resilience and well-being, such as physical and mental health, social support, and perceived health, play a crucial role in frailty development. The findings have implications for interventions targeting vulnerable populations and emphasize the need for further research on the relationship between health-related quality of life and frailty.

Food insecurity increases risk of depression and anxiety among women in Senegal living with diabetes and/or hypertension.

Food insecurity affects close to half the population of Senegal, West Africa, a country simultaneously affected by the ongoing global diabetes pandemic. Diabetes and food insecurity are associated with adverse mental health, yet research exploring the relationship between chronic physical illness, food insecurity, and mental illness in Senegal is currently lacking. The objective of this study was to investigate the association between food insecurity and depression and anxiety, separately, in Senegalese women living with diabetes and hypertension. Food insecurity was measured using the Household Food Insecurity Access Scale. Occurrence of depression and anxiety symptoms was assessed using the Modified Hopkins Symptoms Checklist Survey (HSCL-25). A sensitivity analysis examining the relationship between food insecurity and depression and anxiety was performed by comparing two previously validated cutoff values (1.75 and 2.25) on the HSCL-25. Most participants (83%) had some level of food insecurity. More than 80% of the sample were depressed or anxious using 1.75 as the cutoff, while 42 and 60% were depressed or anxious, respectively, using 2.25 as the cutoff. Food insecurity increased relative risk for depression (RRR: 1.40, 95% CI: 1.05-1.31, 1.75 as cutoff; RRR: 1.06, 95% CI: 0.99-1.14, 2.25 as cutoff) and anxiety (RRR: 1.17, 95% CI: 1.05-1.31, 1.75 as cutoff; RRR: 1.11, 95% CI: 1.04-1.19, 2.25 as cutoff). These findings demonstrate that among populations suffering from diabetes and hypertension, food insecurity is a modifiable risk factor for depression and anxiety and a potential intervention target in this setting.

Analysis of the effectiveness of cognitive rehabilitation for patients with chronic mental illness: A meta-analysis

BACKGROUND People suffering from chronic mental illness are sensitive to stressful stimuli, lack coping skills, and have low self-esteem due to problems such as social situations. They also experience depression, isolation, fear, and frustration. Due to cognitive dysfunction, people suffering from chronic mental illness have inadequate cognitive processes that lead to distorted thinking. AIM To confirm the effectiveness of cognitive rehabilitation therapy in improving cognitive function and alleviating behavioral and psychological symptoms in patients with chronic mental illness, and to identify the cognitive function that had the main effect. METHODS The quality of the studies was evaluated using the Assessment of Multiple Systematic Reviews criteria, and data published from 2011 to December 2022 were searched using PubMed, Cochrane, RISS, KISS, and DBpia. The keywords used in the search were “mental illness,” “cognitive rehabilitation,” “cognition,” and “mental.” A meta-analysis was conducted on the 12 selected papers. RESULTS The level of evidence for the 12 documents was that of a randomized experimental study. Intervention types in cognitive rehabilitation can be divided into cognitive behavior, cognitive training, cognitive rehabilitation, and computerized cognitive programs. Most of the studies were on schizophrenia, and the measurement areas were cognitive functions (e.g ., concentration, memory, and executive function) as well as depression, sociability, and quality of life. As a result of the meta-analysis of each variable, the effect size for cognitive rehabilitation treatment was in the following order: Sociability, memory, concentration, executive function, quality of life, and depression. Particularly, sociability and memory exhibited significant effects. CONCLUSION Cognitive rehabilitation aids cognitive function and sociability in patients with chronic mental illness and can be used as evidence for cognitive rehabilitation in mental health and occupational therapy.

Work performance and its clinical correlates in patients with chronic mental illness: The Chinese version of Vocational Cognitive Rating Scale and the work behavior inventory.

Occupational function assessment is essential for rehabilitation of severe mental illness but lacks comprehensive tools. This study examines the psychometric properties of the Chinese versions of the Vocational Cognitive Rating Scale (VCRS) and the Work Behavior Inventory (WBI) in 60 chronic patients from a psychiatric daycare center and identifies clinical correlates of occupational function measured on the Positive and Negative Syndrome Scale (PANSS). The Chinese VCRS and WBI showed adequate internal consistency, interrater and test-retest reliability, and good convergent validity with the Comprehensive Occupational Therapy Evaluation Scale. Factor analysis favored a one-factor solution of the VCRS; and a four-factor structure in the WBI including Efficiency, Social Interaction, Appropriateness, and Regularity. The VCRS and Efficiency were predicted by fewer disorganization but greater affective symptoms. Social Interaction was negatively predicted by resistance symptoms. Appropriateness was associated with all but negative symptoms. Regularity was predicted by fewer negative symptoms. Considering work behavior altogether, WBI total scores were predicted by fewer negative, fewer disorganization, and greater affective symptoms. Findings suggest that the Chinese VCRS and WBI have sound psychometric properties and are suitable for both clinical trials and for planning personalized rehabilitation programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Work Performance and Its Clinical Correlates in Patients With Chronic Mental Illness: The Chinese Version of Vocational Cognitive Rating Scale and the Work Behavior Inventory

Supplemental Material for Work Performance and Its Clinical Correlates in Patients With Chronic Mental Illness: The Chinese Version of Vocational Cognitive Rating Scale and the Work Behavior Inventory

Effects of Emotional Schema Therapy and Dialectical Behavior Therapy on Psychological Distress and Cognitive-Behavioral Avoidance in Patients with Bipolar II Disorder

Background: Bipolar II disorder (BD-II) is a chronic mental illness with recurrent episodes of depression that causes emotional disorders in patients. Objectives: The present study aimed to investigate the effects of Emotional Schema Therapy (EST) and Dialectical Behavior Therapy (DBT) on psychological distress and cognitive-behavioral avoidance in patients with BD-II. Methods: This study was carried out using a quasi-experimental pretest-posttest design with a control group. The study population consisted of all patients with BD-II visiting the counseling centers in Dezful, Iran, in 2021, and the research sample included 45 eligible individuals selected using purposive sampling. The patients were randomly assigned to two intervention groups and one control group (n = 15 per group). The participants in the first and second intervention groups attended eleven 90-minute sessions of EST and DBT, respectively. However, those in the control group were placed on the waiting list. The research instruments included the Kessler Psychological Distress Scale (K10) and the Cognitive-Behavioral Avoidance Scale. The data were analyzed using analysis of covariance (ANCOVA) and Bonferroni post hoc test in SPSS software (version 26). Results: According to the results, there was a significant reduction in levels of psychological distress and cognitive-behavioral avoidance among the participants of the EST and DBT groups, compared to those in the control group (P < 0.001). Conclusions: Emotional Schema Therapy and Dialectical Behavior Therapy reduced psychological distress and cognitive-behavioral avoidance in patients with BD-II. Therefore, therapists and health professionals can use EST and DBT interventions, along with other effective therapeutic approaches, to reduce psychological distress and cognitive-behavioral avoidance in patients with BD-II.

Wisdom capacities in people with and without chronic mental health problems: A representative survey on a general German adult population

Wisdom capacities are important for coping with difficult and ambiguous life situations. People with chronic mental health problems often have problems in coping with life problems. Until now, there are no comparative and representative data on the distribution of wisdom capacities people with and without chronic mental health problems. Identifying strengths and limitations in wisdom capacities in both groups will give a basis for specific focus in wisdom training in clinical settings and public health. This cross-sectional observation study examined a German population with a representative sample of 2505 persons aged 16 – 95 years in 2019. Sociodemographic data as well as chronic mental illnesses data were collected, and wisdom capacities were assessed by the 12-WD Wisdom Scale. The surveys were carried out using interviews and self-report questionnaires at the respondents’ homes by an experienced social research company. The wisdom capacities value and problem relativization, as well as emotion acceptance were scored the highest by people with and without chronic mental health problems. Uncertainty tolerance, sustainability and perspective change received the lowest scores. People with chronic mental health problems had slightly lower overall wisdom affinity (M = 7.00, SD = 1.41 on a scale of 0 – 10) as compared to mentally healthy people (M = 7.7, SD = 1.38). Specifically, persons with chronic mental health problems reported the lowest ratings on wisdom capacities requiring active cognitive reflections (sustainability, perspective change, and uncertainty tolerance). In conclusion, since there are rather small quantitative differences between persons with and without chronic mental health problems, the wisdom concept seems appropriate to be applied to all individuals, regardless of the severity and nature of mental health problems. Wisdom enhancement, for instance, by means of wisdom training, may be focused on wisdom capacities which were rated comparably low, including perspective change, uncertainty tolerance and sustainability.

Relationship between Hormonal Contraception and Mental Health: A Cross-sectional Study in Ecuador

Millions of women worldwide use hormonal contraceptives as an effective form of contraception. However, the focus on their side effects to date has mainly been on the physical aspects, although the most common reason for discontinuation is depression. The main objective of our research is to assess the impact hormonal contraceptives have on mood in women of childbearing age. Surprisingly, there are few studies investigating depression related to hormonal contraceptive use. More research is needed to better inform women and physicians about contraceptive-related depression, as well as clinical guidelines on the different types of oral contraceptives and their possible depressogenic properties. A nationally representative sample of women aged 12 years and older from the 2018 National Health and Nutrition Survey (ENSANUT) was used. We used multicollinearity tests to rule out possible statistical modeling problems and a binary logistic linear regression model where Odds Ratio (OR) with their 95% confidence intervals (95% CI) were estimated for each of the independent variables. In addition, we used specificity tests to test the fit between our dependent and independent variables. That is, our results reveal that the use of hormonal contraceptives increased 3.12-fold (OR=3.12; CI=3.046-3.321) the likelihood of chronic mental illnesses such as depression. This result is statistically significant (p<0.05). It was also demonstrated that women in rural areas with lower income and low schooling are more susceptible to mental disorders compared to the rest of the population. We also showed that variables such as age, a greater number of children, obesity, low schooling, unemployment, being a migrant and greater urban density have a positive influence on the probability of suffering from chronic mental disorders. The results of this study showed that, although poor mental health is correlated with the type of family planning, fear of depression should not be an obstacle to choosing between these methods. It became evident that depression is a multifactorial issue. This study showed that the type of family planning method itself cannot be the cause of depression and should be considered by family planners and counselors.

Prevalence of Depression and Patterns among Adult Hypertensive Patients Attending a Primary Care Clinic in South-South, Nigeria

Depression is a chronic mental illness, an important health problem and a leading cause of ill health and disability worldwide. Depressed patients present with a depressed mood, loss of interest in pleasurable activities, decreased energy, feelings of low self-worth or guilt, appetite or sleep disturbances, and poor concentration. Depressive symptoms are common in chronic medical illnesses like hypertension but are not recognized and treated. This study evaluated the prevalence and pattern of depression among hypertensive patients in a primary care clinic in South-South, Nigeria. This is a descriptive cross-sectional study involving 312 adult hypertensive patients attending the Family Medicine clinic of the Rivers State University Teaching Hospital, Port Harcourt selected by a systematic random sampling method. A specially designed questionnaire was used to record participants' characteristics and Patient Health Questionnaire 9 was used to evaluate for depressive symptoms. The data collected were analysed using the statistical package for social sciences (SPSS) version 20. The study lasted for 3 months and ethical approval was obtained from the ethical committee of the Rivers State University Teaching Hospital. The study showed that the prevalence of depression was 26.6%. The respondents with ages ranging between 50 – 59 years had the highest frequency of depression, 30.1% (25). More female respondents 71.1% (59) were depressed. The highest proportion of the respondents that were depressed 42.2% (35) had secondary education. More than half of the depressed respondents were married 57.8% (48). More than half of the respondents, 62.7% (52) had a monthly income below ₦50,000.

Exploring the impact of chronic medical conditions on maternal mental health: A National Inpatient Sample analysis

BackgroundPregnancy and postpartum period are associated with stress and pain. Chronic medical conditions can aggravate depressive and psychotic mental illnesses in the peripartum period. AimThe study aimed to investigate the association between different chronic medical conditions and mental illnesses during pregnancy and the postpartum period using the National Inpatient Sample (NIS). MethodsPregnant women or women in the postpartum period were retrieved from the NIS 2016–2019 database using the International Classification of Diseases (ICD)-10 and set as our targeted population. Postpartum depression, puerperal psychosis, and mental illnesses related to pregnancy were also retrieved as our outcomes of interest. STATA 15 was used to analyze the data and investigate the relationship between chronic medical conditions and pregnancy-related mental illnesses. Results2,854,149 admissions were retrieved from the database with a mean age of 29 ± 6 years old. Univariate and multivariate analyses showed a significant association between chronic medical conditions and postpartum depression, puerperal psychosis, and other mental illnesses. On univariate analysis, heart failure (odds ratio [OR] = 13.9; 95% confidence interval [CI] = 3.5–55.88; P < 0.001), alcohol misuse (OR = 5.3; 95% CI = 1.7–16.4; P = 0.004), and migraine (OR = 3.9; 95% CI = 2.8–5.3; P < 0.001) showed high association with postpartum depression. Epilepsy (OR = 54.37; 95% CI = 7.4–399.34; P < 0.001), systemic lupus erythematosus (OR = 24.66; 95% CI = 3.36–181.1; P = 0.002), and heart diseases (OR = 15.26; 95% CI = 3.6–64.5; P < 0.001) showed the highest association with puerperium psychosis. Alcohol misuse (OR = 8.21; 95% CI = 7.4–9.12; P < 0.001), osteoarthritis (OR = 6.02; 95% CI = 5.41–6.70; P < 0.001), and migraine (OR = 5.71; 95% CI = 5.56–5.86; P < 0.001) showed the highest association with other mental illnesses during pregnancy and the postpartum period. ConclusionHeart diseases, alcohol misuse, migraine, systemic lupus erythematosus, and epilepsy were the most important chronic medical conditions associated with mental diseases during pregnancy and the postpartum period. This investigation recommends integrating management of chronic diseases and mental health care together. Specifically, screening for mental illnesses should be a routine part of care for patients with chronic medical conditions, especially during pregnancy and early postpartum. By identifying and addressing mental health issues early on, healthcare providers can improve the overall health and well-being of these patients, ultimately leading to better maternal and fetal outcomes.

Diosgenin normalization of disrupted behavioral and central neurochemical activity after single prolonged stress.

Introduction: Post-traumatic stress disorder (PTSD) is a chronic mental illness triggered by traumatic experiences such as wars, natural disasters, or catastrophes, and it is characterized by anxiety, depression and cognitive impairment. Diosgenin is a steroidal sapogenin with known neuroprotective and antioxidant properties. This study aimed to assess the pharmacological potential of diosgenin in a single prolonged stress (SPS) model of PTSD, plus other behavioral models along with any consequent alterations in brain neurochemistry in male mice. Methodology: SPS was induced by restraining animals for 2h, followed by 20min of forced swim, recuperation for 15min, and finally, exposure to ether to induce anesthesia. The SPS-exposed animals were treated with diosgenin (20, 40, and 60mg/kg) and compared with the positive controls, fluoxetine or donepezil, then they were observed for any changes in anxiety/depression-like behaviors, and cognitive impairment. After behavioral screening, postmortem serotonin, noradrenaline, dopamine, vitamin C, adenosine and its metabolites inosine and hypoxanthine were quantified in the frontal cortex, hippocampus, and striatum by high-performance liquid chromatography. Additionally, animal serum was screened for changes in corticosterone levels. Results: The results showed that diosgenin reversed anxiety- and depression-like behaviors, and ameliorated cognitive impairment in a dose-dependent manner. Additionally, diosgenin restored monoamine and vitamin C levels dose-dependently and modulated adenosine and its metabolites in the brain regions. Diosgenin also reinstated otherwise increased serum corticosterone levels in SPS mice. Conclusion: The findings suggest that diosgenin may be a potential candidate for improving symptoms of PTSD.

Associations Between Mental and Physical Illness Comorbidity and Hospital Utilization.

Characterize the prevalence of chronic physical illness types and mental illness and their comorbidity among adolescents and young adults (AYA) and assess the association of comorbidity on hospital utilization. This study features a population-level sample of 61 339 insurance-eligible AYA with an analytic sample of 49 089 AYA (aged 12-21) in Vermont's 2018 all-payer database. We used multiple logistic regressions to examine the associations between physical illness types and comorbid mental illness and emergency department (ED) use and inpatient hospitalization. The analytic sample was 50% female, 63% Medicaid, and 43% had ≥1 chronic illness. Mental illness was common (31%) and highly comorbid with multiple physical illnesses. Among AYA with pulmonary illness, those with comorbid mental illness had 1.74-times greater odds (95% confidence interval [CI]: 1.49-2.05, P ≤.0005) of ED use and 2.9-times greater odds (95% CI: 2.05-4.00, P ≤.0005) of hospitalization than those without mental illness. Similarly, comorbid endocrine and mental illness had 1.84-times greater odds of ED use (95% CI: 1.39-2.44, P ≤.0005) and 2.1-times greater odds of hospitalization (95% CI: 1.28-3.46, P = .003), comorbid neurologic and mental illness had 1.36-times greater odds of ED use (95% CI: 1.18-1.56, P ≤.0005) and 2.4-times greater odds of hospitalization (95% CI: 1.73-3.29, P ≤.0005), and comorbid musculoskeletal and mental illness had 1.38-times greater odds of ED use (95% CI: 1.02-1.86, P = .04) and 2.1-times greater odds of hospitalization (95% CI: 1.20-3.52, P = .01). Comorbid physical and mental illness was common. Having a comorbid mental illness was associated with greater ED and inpatient hospital utilization across multiple physical illness types.

Comparison of Emergency Department Use Between Pregnant People With and Without Disabilities in Ontario, Canada

Emergency department (ED) use in pregnancy is common and occurs for a variety of reasons, including obstetrical complications, exacerbated underlying conditions, and inadequate outpatient health care access. People with disabilities have elevated rates of certain medical, psychiatric, and obstetrical conditions as well as inadequate access to prenatal care; their risk of ED use in pregnancy is not known, however. To compare the risk of ED use in pregnancy among people with physical, sensory, and intellectual or developmental disabilities with those without disabilities. Population-based cohort study leveraging linked administrative health data sets in Ontario, Canada, April 2003 to March 2019. Analysis included all recognized pregnancies to people with a preexisting physical, sensory, intellectual or developmental, or 2 or more (multiple) disabilities, and those without a disability. Data were analyzed from May 2022 to January 2023. Disability was ascertained using algorithms applied to 2 or more outpatient physician visits or 1 or more ED visits or hospitalizations before conception. Modified Poisson regression-generated adjusted relative risks (aRR) and 95% CIs for any ED visit in pregnancy, from the estimated conception date up to the end of the pregnancy, adjusted for age, parity, income quintile, rurality, immigrant status, and preexisting chronic conditions, mental illness, and substance use disorders. The cohort included 2 659 895 pregnant people with physical (221 739 participants; mean [SD] age, 29.8 [6.1] years), sensory (71 891 participants; mean [SD] age, 29.1 [6.4] years), intellectual or developmental (3877 participants; mean [SD] age, 26.1 [6.7] years), and multiple disabilities (14 359 participants; mean [SD] age, 29.5 [6.5] years), and pregnant people without a disability (2 348 023 participants; mean [SD] age, 29.4 [5.9] years). The rate of ED visits in pregnancy was 25.4% in people without a disability (596 771 visits). Relative to these individuals, the aRR for ED use was elevated in people with physical (aRR, 1.26; 95% CI, 1.25-1.27), sensory (aRR, 1.15; 95% CI, 1.14-1.17), intellectual or developmental (aRR, 1.33; 95% CI, 1.28-1.38), and multiple disabilities (aRR, 1.43; 95% CI, 1.40-1.46). In this population-based study, people with disabilities were at elevated risk of ED use in pregnancy. This finding underscores the need for research on the benefits of proactive strategies to manage preexisting conditions in these individuals, improve their access to outpatient obstetrical and medical care, and prepare them for when ED visits occur.

Sexual Well-Being in Individuals with Schizophrenia: A Pilot Study on the Role of Self-Esteem and Acceptance of Illness.

Schizophrenia is one of the most severe chronic mental illnesses. It drastically changes an individual's life and well-being. Sexual well-being in schizophrenia is often sidelined, even though it is one of the main areas for maintaining quality of life. Based on the conservation of resources theory (COR) and empirical data, we assume that self-esteem and acceptance of illness help in coping with schizophrenia and maintaining sexual well-being. This pilot study aimed to determine the relationship between self-esteem, acceptance of illness, and sexual well-being in Polish individuals with schizophrenia. The results of 60 individuals were included in this study. In the present study, the Self-Esteem Scale (SES), Acceptance of Illness Scale (AIS), and Short Sexual Well-Being Scale (SSWBS) were used. The study showed a significant association between self-esteem, acceptance of illness, and sexual well-being. Self-esteem (β = 0.62) and acceptance of illness (β = 0.55) acted as positive and significant predictors of sexual well-being in individuals with schizophrenia. Acceptance of illness was also found to play a mediating role between self-esteem and sexual well-being in people with schizophrenia (indirect effect: β = 0.34; LLCI = 0.063; ULCI = 0.839). The current pilot study demonstrates the relationship between self-esteem, acceptance of illness, and sexual well-being. Our findings highlight the significant role of acceptance of illness in maintaining sexual well-being among individuals with schizophrenia.

Main results and public health implications of the National School Health Survey (ENSE), Colombia 2017.

The school population represents a fundamental group for health promotion actions, given that the foundations of healthy behaviors in adult life are established in children and adolescents, who can be greatly influenced by the school. To describe the health-related behavioral factors of schoolchildren between 13 and 17 years of age in secondary and middle school in Colombia. A national cross-sectional study was conducted (i.e., School Health Survey -ENSE-) that recorded information on dietary practices, physical activity, alcohol and drug consumption, injuries and bullying, and oral, visual and hearing health. Sampling was probabilistic, cluster and multistage. Schoolchildren have low consumption of fruits, vegetables (13.1%) and dairy (76.5 %), high consumption of ultra-processed foods (82.4 %), sugary drinks (74.0 %) and fast foods (14.8 %), frequent addition of salt at the table (43.3 %), low compliance with physical activity recommendations (15.0 %) and high sedentary lifestyle (46.3 %), frequent consumption of alcohol (44.7 %) and psychoactive substances (14.7 %), in addition to prevalent situations of bullying (15.4 %), rejection (8.2 %) and verbal aggression (42.7 %). The ENSE shows critical inequalities by gender, ethnicity and social class, throughout the country. The indicators observed in schoolchildren are precursors of various chronic and degenerative diseases and mental illness, which requires the urgent attention of the different social actors in the country.

Clinical features and outcomes in acute psychosis: A retrospective hospital-based study in rural patients of central India.

Acute and transient psychotic disorder (ATPD) is a distinct diagnostic category (F23) in ICD-10 which includes non-schizophrenic and non-affective psychoses following a transient course. The clinical features, diagnostic stability, and epidemiology of ATPD have not been adequately explored in the developing countries. The aim was to explore the socio-demographic and clinical characteristics of ATPD as well as examine the diagnostic stability and longitudinal revisions in the diagnosis of ATPD. An observational retrospective study based on 10-year OPD records of ATPD patients was conducted in a tertiary health care center after ethics committee approval. A total of 120 patient records were analyzed for socio-demographic data, clinical symptoms, mental status examination findings, diagnosis on the first visit, and subsequent revisions in the diagnosis. The mean age of ATPD patients was 31.8 (±11.73) years. Delusion was the most common psychiatric symptom in ATPD patients followed by abnormal speech, hallucinations, and disorganized behavior. Antecedent psychosocial stressors were found in 44.2% cases. More than half of ATPD patients (51%) followed up after initial symptom remission and were diagnosed with chronic mental illnesses (schizophrenia or bipolar affective disorder). The ATPD patients experiencing a stressor at the onset of illness were less likely to develop chronic mental illness compared to the ones who did not have antecedent stressors. Irrespective of the genetic and phenomenological distinctiveness of ATPD, which has led to its inclusion as a separate diagnostic category in ICD-10, ATPD is an unstable diagnosis.

Token Economy for People With Severe Mental Illness: A Narrative Review of the Literature

Background: People with chronic mental illness have long been rejected from society and lost their self-identity and self-efficacy due to individual obstacles, such as continuous negative symptoms, lack of motivation, or social obstacles, like stigma, which reduce their self-confidence and prevent them from engaging in healthy activity patterns. One of the behavioral therapy methods used to increase the motivation of people with severe mental illness is token economy. Objectives: The purpose of this narrative review was to review and investigate the impact of the token economy on people with severe mental illness. Methods: A search for studies published from 2002 to 2022 in PubMed and Google Scholar databases was conducted using the keywords “token economy”, “token reinforcement”, “contingency management”, “severe mental disorder”, “serious mental illness”, “chronic psychiatric disorder”, and “participation”. Results: In the initial search, 92 articles were obtained, and after reviewing and rejecting duplicates, 44 articles related to severe mental illness and token economy remained. Finally, 15 articles met the inclusion criteria and were selected for review. token economy can be an effective method in improving the performance of daily life activities, reducing the symptoms of mental illnesses and avoiding drugs, reducing alcohol consumption, and quitting smoking Conclusion: token economy can be an effective method in improving the performance of daily life activities, reducing the symptoms of mental illnesses, drug abstinence, reducing alcohol use, and quitting smoking, but in reducing violence, the results of the studies were contradictory. It is recommended to carry out wider studies on the impact of the token economy method on the occupational performance and participation of chronic mental patients.

713-P: The Concomitant Health Needs and Health Care Utilization Patterns of U.S. Women with Lifetime Criminal Legal Involvement and Diabetes, 2015–2019

Background: Over 100 million Americans have a history of criminal legal involvement (CLI), which is increasingly recognized as a risk for poor disease outcomes. Women with diabetes and CLI may have unique needs and utilization patterns, but this population has not been studied. Methods: Using nationally representative data, we examined a sample of respondents with lifetime CLI and self-reported diabetes. We compared rates by gender of physical conditions, mental health conditions, and substance use disorders using multivariate logistic regression considering relevant sociodemographic confounders. We then estimated the adjusted odds of outpatient, emergency department and inpatient hospitalization using similar models. Stata 16.1 was used. Results: In our sample of US adults with diabetes and CLI (N=2,742), 28% were women. Women were generally of lower socioeconomic status but more likely to have insurance. Compared to men, women reported higher rates of comorbid physical conditions, including having ≥2 conditions (aOR 1.5, 95% CI 1.2-1.9); higher rates of serious mental illness (aOR 2.5, 95% CI 1.8-3.6), any mental illness (aOR 2.1, 95% CI 1.6-2.6), and past year major depression (aOR 2.1, 95% CI 1.6-2.8). They were less likely to have a substance use disorder (aOR 0.7, 95% CI 0.5-0.9). Compared to men, women were more likely to use the emergency department (aOR 1.2, 95% CI 1.1-1.3) with a trend towards increased hospitalizations (aOR 1.2, 95% CI 0.9-1.5). They were also more likely to use outpatient care (aOR 2.1, 95% CI 1.3-3.5). Conclusions: Women with diabetes and CLI have higher rates of chronic disease and mental illness, but lower rates of substance use disorders, a pattern which is distinct. Additional research should consider if addressing the unique needs of this marginalized population could improve diabetes outcomes and decrease unnecessary acute care utilization. Disclosure L.Hawks: None. R.J.Walker: None. L.E.Egede: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK132505-01A1)