Mental Health Comorbidities Research Articles

Reducing medical cannabis use risk among Veterans: A descriptive study

BackgroundCanadian Veterans experiencing chronic pain report concerns about accessing accurate information on the risks associated with medical cannabis (MC) use. The Lower Risk Cannabis Use Guidelines (LRCUG) were developed to equip individuals who use cannabis recreationally with safer-use strategies. Many of the harm reduction recommendations for recreational cannabis use are relevant and important considerations for MC use. The primary objective of our study was to assess Canadian Veterans’ awareness of and interest in the LRCUG, and engagement in potential higher-risk MC use behaviours.MethodsCanadian Armed Forces Veterans living with chronic pain (N = 582) were recruited online and through the Chronic Pain Centre of Excellence for Canadian Veterans. Participants completed measures on: cannabis use (never, past, current use), sources of cannabis knowledge, mental health, and awareness of and interest in receiving the LRCUG. Chi-Square and post-hoc analyses characterized the sample and assessed for demographic differences based on cannabis use status and awareness of the LRCUG. Engagement in higher-risk MC use behaviours were aligned to LRCUG recommendations, and detailed descriptively.ResultsVeterans who currently use cannabis were more likely to be unemployed (z = 3.62, p < .01), released as a Non-Commissioned Officer (z = -3.83, p < .01), and unable to work due a disability (z = -3.43, p < .01) than Veterans who do not currently use. Less than 30% of Veterans were aware of the LRCUG, with greater awareness among individuals who currently use cannabis (n = 356). Engagement in higher-risk MC use behaviours that contradicted LRCUG recommendations ranged from ~ 9% to ~ 85%. Approximately 9% of Veterans experienced co-morbid mental health concerns, yet their MC use was not for mental health purposes (LRCUG recommendation #7). Additionally, almost 85% of Veterans engaged in daily MC use (LRCUG recommendation #5). The majority of Veterans who currently use cannabis engaged in two or more higher-risk MC use behaviours (60.2%; LRCUG recommendation #12). Almost half of all Veterans received their cannabis information from a healthcare provider or the internet.ConclusionsOur study suggests the importance of safer use guidelines tailored for MC use. Development of lower-risk MC use guidelines can support prescribing practitioners and Veterans with information needed for safer and better-informed MC use decisions, tailored to patients’ needs and circumstances.

Trauma-focused evidence-based psychotherapy for post-traumatic stress disorder delivered via video telehealth in the Veterans Health Administration.

Trauma-focused evidence-based psychotherapy (EBP) is the recommended treatment for post-traumatic stress disorder (PTSD). During and after the COVID-19 pandemic, veterans began to initiate general mental health services delivered via video telehealth at high rates. Our goal in the current project was to describe the percentage as well as the demographic, military, and clinical characteristics of veterans receiving PTSD EBPs via video telehealth versus in-person. Using data from the VA electronic health record, we identified a national cohort of all-era veterans who received individual PTSD EBP between April 2022 and April 2023 (n = 24,447). We used multivariable hierarchical Bayesian logistic regression to model the probability of receiving at least 50% of their EBP care via video telehealth. In our sample, 74.4% of veterans who received PTSD EBP used video telehealth for at least one EBP session and 66.8% of veterans received at least half of their EBP sessions by video telehealth. Female veterans, younger veterans, and veterans with fewer mental health comorbidities were more likely to have received their PTSD EBP via video telehealth. Additional strong interaction effects for Black female veterans, Hispanic female veterans, female officer veterans, and Black officer veterans. Video telehealth delivery of PTSD EBPs was more common than in-person delivery of PTSD EBPs. Consistent with underlying trends in telehealth services, female veterans, and particularly female, racial/ethnic minority veterans were more likely to receive PTSD EBP via video telehealth. Future research designed to contextualize the observed differences in video telehealth delivery of PTSD EBPs should consider the role of social determinants of health.

Consultation Liaison Psychiatry in a Tertiary Care Hospital

Background: Consultation-liaison psychiatry (CLP) is a subspecialty that bridges the gap between psychiatry and general medicine, managing the psychiatric needs of patients with physical illnesses in hospital settings. It plays a crucial role in addressing the mental health comorbidities that accompany medical conditions, improving patient care and interdisciplinary collaboration. Objective: This study aims to explore the role of CLP services in a tertiary care hospital, examining the profile of referred patients, their reasons for referral, and the psychiatric diagnoses. It seeks to assess the effectiveness of CLP in addressing psychosocial care needs and enhancing the integration of psychiatric support in medical settings. Methodology: A qualitative approach was adopted, utilizing semi-structured interviews with 220 participants, including patients, healthcare staff, and psychiatric consultants. Data was analyzed to assess patient satisfaction, efficacy of interventions, and the challenges faced by medical professionals in managing psychiatric comorbidities. Results: Among the 220 referred patients, 60% were male. Most referrals came from the general medicine department (52%), followed by pulmonary medicine (12%) and nephrology (9%). The primary reasons for referral included psychiatric evaluation of medically ill patients (38.6%), substance use assessment (18.2%), and evaluation of self-harm/suicidal ideation (13.6%). Mood disorders were the most common psychiatric diagnosis (40.9%). Conclusion: CLP services in the tertiary care hospital provided significant benefits in managing patients with complex medical and psychiatric conditions, highlighting the need for integrated care to improve overall patient outcomes.

Association Between Adolescent Violence Exposure and the Risk of Suicide: A 15-Year Study in Taiwan

Background/Objectives: According to the 2023 Ministry of Health and Welfare statistics, the suicide rate among adolescents aged 15 to 24 has steadily increased since 2018, from 3.7 to 5.5 per 100,000 populations, reaching a recent high. Although previous studies have pointed out that the future risk of suicide of those who had suffered from abuse was higher than that of the general population, researchers seldom focused on adolescent groups. Therefore, the aim of this study was to explore the risk of suicide after youth violence and the impact of subsequent comorbid mental illness and suicide risk. Methods: This retrospective matched cohort study analyzed data from the NHIRD, covering the period from 2000 to 2015. A total of 976 cases aged 10–18 who had experienced violence were included in this study. Controlled grouping was conducted by 1:10 matching based on gender, age, and the time of medical treatment, and a control group who had not experienced violence was selected for comparison. We used the Cox proportional hazards model to analyze the risk of suicide among adolescents after exposure to violence. Results: The suicide rate among adolescents who have experienced violence was significantly higher than that of the control group after 15 years of follow-up (1.0% vs. 0.5%). The prevalence of mental illness or disorders in adolescents exposed to violence was significantly higher than in the control group (45.2% vs. 40.1%). Among adolescents who had experienced violence, the methods of suicide included poisoning (solid and liquid) (53.6% vs. 43.2%), hanging (1.2% vs. 0.6%), firearms (2.4% vs. 0%), and cutting instruments (27.4% vs. 22.8%), all of which were significantly higher than in the control group. After adjusting for gender, age, residential area, and mental health comorbidities, the risk of suicide in those who had experienced violence was 1.475 times that of the control group (95% CI = 1.125–1.933; p = 0.005). Conclusions: In this study, female, younger age, and comorbid mental disorders were identified as risk factors for suicide among the adolescent victims of violence. Exposure to youth violence was associated with an increased prevalence of emotional disorders, including depression and social isolation, which subsequently elevated the suicide risk. These findings underscore the urgent need for governmental attention to the mental health of adolescent victims of violence. Implementing targeted psychological support and intervention programs could play a crucial role in mitigating the risk of suicide among this vulnerable population.

Evaluating the Knowledge, Attitudes and Practices of Early Career Pharmacists Concerning Opioid Use Disorder (OUD) and Co-morbid Mental Health Conditions: Predicting Patients Health Outcomes in Nigeria

Background: This study aims to evaluate the understanding, perceptions and practices of early career pharmacists concerning opioid use disorder and its associated mental health outcomes for patients in Nigeria. The research seeks to identify the level of knowledge that these pharmacists possess about opioid-related issues and the mental health challenges that often accompany them. By examining their attitudes and practices, the study intends to uncover potential gaps in education and training that may affect the quality of care provided to patients suffering from these interconnected health conditions. Methodology: This was a cross-sectional survey conducted across the six geopolitical zones in Nigeria. We used evidence of licensure and not more than 5 years in practice to identify eligible participants. Information sheets were sent to all potential participants through email. If interested, they signed the consent form and sent the survey online to be completed and returned within 24 hours. Results: Descriptive statistics were used to summarize the data. Out of 514 participants, the majority had accurate knowledge of basic questions as well as a negative attitude regarding how comfortable in providing patient care as well as in monitoring and assessment. 342 (66.5%) respondents and 357 (69.5%) respondents were neutral on the information regarding the percentage of patients that achieve treatment adherence and average patient satisfaction respectively, while (166, 32.3%) (128, 24.9%) reported low/negative treatment adherence and patient satisfaction respectively. Conclusion: By fostering improved knowledge and attitudes among pharmacists, it is possible to mitigate the stigma associated with mental health issues, thereby enhancing treatment adherence and ultimately leading to better health outcomes. The findings show that in as much as the knowledge of these medical conditions is substantial, the negative outcomes persist.

Global prevalence of mental health comorbidity in patients with acne: An analysis of trends from 1961 to 2023.

Acne patients increasingly face mental health challenges such as anxiety, depression, and suicidal thoughts. However, no global systematic analysis exists on this topic. To examine the prevalence of mental disorders-specifically, anxiety, depression, and suicidal thoughts-among acne patients. An exhaustive search of six databases was conducted up to May 2023. Data analysis was performed using Python and STATA MP 17, including subgroup evaluations, meta-regression, and sensitivity analyses. Forty-three studies were analyzed. Findings indicate depression, anxiety, and suicidal thoughts in acne patients are prevalent at 22%, 30%, and 12% respectively. Depression rates peaked in Asia at 42%, led by India (53%) and Saudi Arabia (51%). Anxiety was also most common in Asia, at 45%, notably in Singapore (60%) and Iran (58%). Suicidal thoughts were highest in Oceania, specifically New Zealand, at 24%. The study is limited by the inclusion of only Chinese and English-language research, potentially introducing selection bias. The results of this study highlight the incidence of mental health disorders coexisting with acne, which may help to foster greater understanding and awareness among both medical professionals and patients regarding the psychological complexities tied to acne.

Prevalence of Emotional and Binge Eating Among Patients With Obesity Attending a Specialist Weight Management Service for Bariatric Surgery in the United Kingdom.

Emotional eating (EE) is a tendency to consume food in response to positive or negative emotions, leading to obesity and an increased Body Mass Index (BMI). Evidence supports the positive association between EE and binge eating disorder (BED), but little is known about its prevalence among patients referred for bariatric surgery and the psychological characteristics of this patient population. We aim to examine (i) the prevalence of binge eating and EE, (ii) its association with the prevalence of anxiety, depression, diabetes and hypertension and (iii) the correlation between anxiety and depression with emotional and binge eating behaviours among patients attending a regional bariatric service in the UK. A cross-sectional case file design involving 285 participants (mean age = 43.88 ± 11.5, female (80.7%) and male (19.3%)) was used. Outcome measures included body weight, BMI, the Weight Loss Readiness (WLR) Questionnaire, Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9) and Alcohol Use Disorders Identification Test- Consumption (AUDIT-C). Within this patient group, the prevalence of binge eating and EE were 28.8% and 22.1% respectively. Among these, 19.3% had diabetes mellitus, 24.8% hypertension, 21% harmful alcohol use, 65% had high anxiety score and 77% high depression scores. Most correlations between body weight and variables like AUDIT-C, GAD-7, PHQ-9 scores and WLR scores for hunger, binge eating and EE were not significant. A positive association was observed between depression and anxiety with binge eating, and EE behaviours. Patients awaiting bariatric surgery have a wide range of mental and physical health comorbidities, with evidence of positive associations between higher depression and anxiety levels with abnormal eating behaviours. These findings highlight the need for screening for comorbidities in this patient population to optimise patient outcomes postbariatric surgery.

Study protocol for a randomized controlled trial to adapt a posttraumatic stress disorder intervention of patients with opioid-stimulant polysubstance use receiving methadone maintenance treatment

BackgroundThe purpose of the Treatment for Harnessing Resiliency, Improving emotional regulation, and empowering indiViduals for a brighter future (THRIVE) study is to adapt an evidence-based posttraumatic stress disorder (PTSD) treatment for use among a polysubstance population receiving methadone maintenance treatment (MMT) at an opioid treatment program. Polysubstance use of high-risk combinations, such as illicit opioids and stimulants, is a critical public health issue. Individuals who engage in these high-risk combinations are more likely to have histories of childhood trauma, multiple traumas, PTSD, and greater PTSD severity as compared to mono-substance using individuals. Trauma, co-morbid mental health disorders such as PTSD, and polysubstance use complicate treatment outcomes. This study will use eight study phases to adapt an existing evidence-based PTSD intervention, Skills Training in Affective and Interpersonal Regulation with Narrative Therapy (STAIR-NT), via a massed treatment model (i.e., condensed treatment schedule) for patients in MMT who are engaged in sustained opioid-stimulant polysubstance use.Methods and analysisThe intervention is an adapted version of the STAIR-NT protocol. The massed version created includes four 60-min sessions of skill building and two weeks of four 60-min sessions of narrative therapy. A preliminary randomized controlled trial (RCT) with 80 participants, randomized 1:1, will be conducted to assess the intervention's implementation and impact on primary short-term outcomes of polysubstance use and PTSD symptoms.Ethics and disseminationThe results of this study will inform a fully-powered effectiveness trial for individuals with PTSD and polysubstance use receiving MMT. The findings are expected to provide valuable insights into improving both PTSD and substance use outcomes, and real-world implementation insights to integrating trauma-informed care in treatment settings for vulnerable populations.RegistrationThis study is registered at ClinicalTrials.Gov as NCT06307340. Registration date 03/2024.

S10 Mental Health Comorbidities and Outcomes in Transgender and Gender Nonconforming Patients With Inflammatory Bowel Disease

S10 Mental Health Comorbidities and Outcomes in Transgender and Gender Nonconforming Patients With Inflammatory Bowel Disease

Dual burden of TB and mental ill-health: Prevalence and associated factors of anxiety and depression among TB patients in Gujarat.

The coexistence of tuberculosis (TB) and mental disorder presents a daunting public health challenge. Studies suggest that TB patients often experience co-morbid mental health problems, highlighting a dual burden of illness. However, due to limited research in Gujarat, we cannot draw definitive conclusions or develop targeted mental health interventions for this population. To investigate the prevalence of depression, anxiety, and associated factors among TB patients from Gandhinagar and Surat cities in Gujarat, India. The cross-sectional research was conducted in two cities in Gujarat, Gandhinagar and Surat, between October 2021 and July 2023. Demographic information, anxiety and depressive symptoms, and perceived TB stigma were assessed at baseline (within 1 month of treatment initiation) and at the endpoint (6 months posttreatment) using a self-constructed tool for assessing risk factors and standardized instruments, namely, the Patient Health Questionnaire-4, and the Perceived TB Stigma Scale (12 items). The study population had a mean age of 31.57 ± 12.34 years. The prevalence of anxiety and depression symptoms was found to be 10.5% (749) and 5% (359), respectively, at the baseline. TB patients with high perceived TB stigma and who had been sick for over six months were 3.1 times more likely to experience anxiety symptoms (Adjusted Odds Ratio (AOR) = 3.10, 95% CI: 2.22, 4.23) and 1.6 times more likely to experience symptoms of depression (Adjusted Odds Ratio (AOR) = 1.60, 95% CI: 1.12, 2.53). Gender, occupation, and socioeconomic level were significantly associated with both anxiety and depression (P < 0.05). Being single (AOR: 3.29; 95% CI: 2.45-7.53), low socioeconomic status (AOR: 5.41; 95% CI: 2.44-7.97), and being on TB treatment (AOR: 4.35; 95% CI: 1.83-15.65) were strongly associated anxiety and depressive symptoms. The findings of the current study indicate that TB patients experience a considerable burden of symptoms of both anxiety and depression. It highlights the need for incorporating mental healthcare support within TB care programmes.

Characteristics and quality of life of people living with comorbid disorders in substance use recovery residences.

Opioid use disorder (OUD) is associated with significant morbidity and mortality; however, research on physical and mental health comorbidities and health-related quality of life (HRQoL) among people taking medication for OUD (MOUD) and living in recovery residences is sparse. We investigated the prevalence of comorbidities and examined which EQ-5D-5L HRQoL dimensions are most affected by these comorbidities. Data were collected from 358 residents living in 14 Texas-based recovery residences from April 2021 to June 2023. The EQ-5D-5L descriptive system comprises five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression). Each dimension has five levels of perceived problems, dichotomized into "No problems" (level 1) and "Any problems" (levels 2-5) for analyses. Cross-sectional analyses of residents' characteristics, comorbidities (categorized as mental health disorders or association with major body systems), and EQ-5D-5L dimensions were conducted using Chi-squared or Student t-tests. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). The mean [SD] age of residents was 36.0 [8.9]. Most residents were non-Hispanic White (68.7%), male (59.7%), unemployed (66.3%), and engaged in polysubstance use (75.4%). The most frequently reported comorbidities were mental health (26.5%), respiratory (26.3%), neurological (19.3%), cardiovascular (18.2%), and musculoskeletal (17.0%) disorders. The most reported HRQoL problems were anxiety/depression (75.8%) and pain/discomfort (53.2%). In the unadjusted regression models, all comorbidities, except mental health (negative association) and digestive (no association) disorders, were positively associated with HRQoL problems. The usual activities dimension was the most affected by comorbidities, followed by mobility and pain/discomfort. Increasing age was positively associated with cardiovascular disorders (aOR = 1.06; 95% CI = 1.03-1.10), musculoskeletal disorders (aOR = 1.03; 95% CI = 1.00-1.06), mobility problems (aOR = 1.05; 95% CI = 1.01-1.09), and pain/discomfort problems (aOR = 1.02; 95% CI = 1.00-1.05). Illicit drug use was positively associated with mobility problems (aOR = 3.36; 95% CI = 1.20-9.45). Neurological (aOR = 2.71; 95% CI = 1.38-5.33) and musculoskeletal (aOR = 2.57; 95% CI = 1.25-5.29) disorders were positively associated with pain/discomfort problems. MOUD duration was negatively associated with mental health disorders (aOR = 0.14; 95% CI = 0.08-0.22) but not HRQoL. Comorbidities significantly predict HRQoL among individuals with OUD. Our findings highlight the need for an integrated care model to treat OUD and comorbidities to sustain recovery and improve health and HRQoL.

Substance Use Service Utilization and Barriers to Access Among Homeless Veterans: A Scoping Review

The high prevalence of military veteran substance use (SU) when compared to their nonveteran counterparts has been described as an urgent public health issue. The commonality of severe mental and physical health comorbidities in this population affects their ability to recover and relates to the onset and maintenance of homelessness. While veteran-targeted housing and SU interventions exist, they are being underutilized. This scoping review synthesizes published peer-reviewed articles from 1990 to 2021 at the intersections of housing, substance abuse, and service utilization by homeless veterans. Qualitative thematic analysis of 119 retained peer-reviewed articles revealed five key themes: (1) the association between SU and housing stability, (2) gendered comparisons with service needs and provision, (3) consideration for comorbidities, (4) social support and relationship-centered interventions, and (5) barriers to health care services. This review offers a series of concerns, outcomes, and recommendations that might be valuable for practitioners, health care providers, and community stakeholders when implementing or re-evaluating new or existing homeless veteran treatment programs.

The Rising Burden of Cardiovascular Disease and Thrombosis in India: An Epidemiological Review.

Cardiovascular disease (CVD) associated with intravascular thrombosis is emerging as a significant public health concern in India, driven by a complex interplay of lifestyle, genetic predisposition, andsocio-economic factors. This review examines recent trends in the prevalence, risk factors, and epidemiology of these conditions within the Indian population. A systematic search and selection process was employed to identify relevant studies, focusing on articles published between 2007 and 2024. Key findings indicate that rapid urbanization, dietary shifts, and increased stress levels contribute significantly to the rising rates of CVD and thrombosis. This review also highlights the critical comorbidity of mental health and CVD where mental health disorders exacerbate cardiovascular risks and complicate treatment outcomes. Adopting healthy lifestyles, the early detection and diagnosis of intravascular thrombosis and its predisposing factors, timely prevention, increased public awareness about available treatments, accessibility to healthcare resources, and mental health integration are the keys to preventing mortality associated with cardiovascular diseases.

Healthcare costs and resource utilization of patients with chronic post-traumatic stress disorder: a retrospective US claims analysis of commercially insured patients.

Aim: Exploring the healthcare costs and resource use among privately insured US patients with post-traumatic stress disorder (PTSD). Methods: This study used Merative MarketScan data. The index date was defined as the first PTSD claim. Study period included a 1-year pre-index and 2-year post-index follow-up. Cases with only acute PTSD, cancer, or insurance gap during the study period were excluded. The PTSD with (PwC) and PTSD without comorbidities (PwoC) cohorts were defined by the presence/absence of comorbid mental health conditions (schizophrenia, bipolar and major depressive disorder). Baseline PTSD (BP) cohort included PwoC cases with only index PTSD event and without FDA-approved PTSD medications or psychotherapy. Sub-analysis is conducted among patients with PTSD and substance/alcohol use disorder. Study cohorts were matched in a 1:1:1 ratio. Results: The matched sample included 5076 patients (1681 PwC, 1681 PwoC, 1714 BP). PwC patients had higher 2-year PTSD-related costs than PwoC and BP patients ($3762 vs $1750 and $841; all p<0.001). The same trend was noted among all-cause and anxiety-related costs. PwC patients had higher 2-year PTSD-related inpatient and emergency department (ED) rates than PwoC (10.2% vs 1.7% and 6.8% vs 2.6%, all p<0.001) and inpatient and outpatient rates than BP (10.2% vs 2.1% and 98.0% vs 93.1%; all p≤0.004). The sub-analysis had 3776 patients (3154 PwC, 537 PwoC, 85 BP). PwC had higher 2-year PTSD-related costs than PwoC and BP ($7668 vs $2919 and $1,483; all p<0.001). The same trend was noted in all-cause and anxiety-related costs. PwC also had higher 2-year PTSD-related inpatient and ED rates than PwoC (25.6% vs 10.4% and 12.7% vs 5.2%; all p<0.001) and inpatient and outpatient rates than BP (25.6% vs 8.2% and 95.5% vs 84.7%; all p<0.001). Conclusion: PTSD is associated with high healthcare costs and resource use. The highest economic burden was observed in patients with PTSD and mental health comorbidities.

Emergency Department Visits Involving Hallucinogen Use and Risk of Schizophrenia Spectrum Disorder

Interest in and use of hallucinogens has been increasing rapidly. While a frequently raised concern is that hallucinogens may be associated with an increased risk of psychosis, there are limited data on this association. To examine whether individuals with an emergency department (ED) visit involving hallucinogen use have an increased risk of developing a schizophrenia spectrum disorder (SSD). This population-based, retrospective cohort study (January 2008 to December 2021) included all individuals aged 14 to 65 years in Ontario, Canada, with no history of psychosis (SSD or substance induced). Data were analyzed from May to August 2024. An incident ED visit involving hallucinogen use. Diagnosis of SSD using a medical record-validated algorithm. Associations between ED visits involving hallucinogens and SSD were estimated using cause-specific adjusted hazard models. Individuals with an incident ED visit involving hallucinogens were compared with members of the general population (primary analysis) or individuals with ED visits involving alcohol or cannabis (secondary analysis). The study included 9 244 292 individuals (mean [SD] age, 40.4 [14.7] years; 50.2% female) without a history of psychosis, with a median follow-up of 5.1 years (IQR, 2.3-8.6 years); 5217 (0.1%) had an incident ED visit involving hallucinogen use. Annual rates of incident ED visits involving hallucinogens were stable between 2008 and 2012 and then increased by 86.4% between 2013 and 2021 (3.4 vs 6.4 per 100 000 individuals). Individuals with ED visits involving hallucinogens had a greater risk of being diagnosed with an SSD within 3 years compared with the general population (age- and sex-adjusted hazard ratio [HR], 21.32 [95% CI, 18.58-24.47]; absolute proportion with SSD at 3 years, 208 of 5217 with hallucinogen use [3.99%] vs 13 639 of 9 239 075 in the general population [0.15%]). After adjustment for comorbid substance use and mental health conditions, individuals with hallucinogen ED visits had a greater risk of SSD compared with the general population (HR, 3.53; 95% CI, 3.05-4.09). Emergency department visits involving hallucinogens were associated with an increased risk of SSD within 3 years compared with ED visits involving alcohol (HR, 4.66; 95% CI, 3.82-5.68) and cannabis (HR, 1.47; 95% CI, 1.21-1.80) in the fully adjusted model. In this cohort study, individuals with an ED visit involving hallucinogen use had a greater risk of developing an SSD compared with both the general population and with individuals with ED visits for other types of substances. These findings have important clinical and policy implications given the increasing use of hallucinogens and associated ED visits.

Diabetes distress and depression in type 2 diabetes. A cross-sectional study in 18,000 individuals in the Central Denmark region.

Type 2 diabetes is linked to psychological distress and a doubled risk of depression. This study aims to characterize individuals with type 2 diabetes experiencing diabetes distress and/or depression in relation to lifestyle and metabolic outcomes. A population-based survey in 2020 targeted individuals with type 2 diabetes (aged 18-75 years) in the Central Denmark Region. This cross-sectional study assessed diabetes distress (using Problem-Area-in-Diabetes-scale) and depression (via hospital diagnosis and prescribed medication) as exposures. Logistic regression, adjusting for potential confounders, compared exposed and non-exposed groups on lifestyle habits, metabolic factors and medication usage related to cardio-metabolic risks. Of 18,222 respondents with type 2 diabetes (46% response rate), 11% had depression, 14% had diabetes distress and 4% had both. Compared to those with neither condition, those with depression were more often smokers (OR: 2.0, 95% CI: 1.8; 2.3) and sedentary in leisure time (OR: 2.0, 95% CI: 1.8; 2.2). Diabetes distress was associated with elevated HbA1c (OR: 1.8, 95% CI: 1.5; 2.0) and treatment with insulin (OR: 1.8, 95% CI: 1.6; 2.0). Half with diabetes distress displayed stable blood glucose levels. Those with both conditions had a higher risk of sedentary behaviour (OR: 2.7, 95% CI: 2.3; 3.2), clinical insomnia (OR: 6.5, 95% CI: 5.5; 7.7) and low self-rated health (OR: 7.5, 95% CI: 6.3; 9.0) than those with either psychological condition in isolation. This study emphasizes the importance of recognizing distinct features and risk factors associated with diabetes distress and depression in individuals with type 2 diabetes. Tailored care strategies for comorbid mental health issues are crucial for comprehensive management.

Room for Change: Rural Low-Barrier Housing Policy and Program Models for People with Substance Use and Mental Health Comorbidities

Rural North American communities experience disproportionate burdens of housing instability and toxic drug poisonings. These regions face complex intersections of homelessness, substance use, and mental health issues, and innovative strategies are required to effectively address these crises. In British Columbia, Canada, new funding opportunities to address rural homelessness for complex populations have come after a lag in available resources. Complex Care Housing is a model aimed at filling gaps in the current housing and care continuum for people with mental health and substance use challenges. Due to rural-specific social characteristics, new housing models require ongoing evaluation to ensure programs meet the quality and fidelity of gold standard Housing First programs that upload the tenets of harm reduction and person-centeredness.

Food Insecurity Among LGBQ+ Veterans

Food insecurity is associated with numerous adverse health outcomes. Little is known about the prevalence of and risks for food insecurity among veterans identifying as lesbian, gay, bisexual, queer, and similar (LGBQ+), a population facing unique social barriers and medical comorbidities. To examine food insecurity and potential risk factors among LGBQ+ veterans. This retrospective, cross-sectional study used administrative data from all US Veterans Health Administration (VHA) facilities nationally. Participants included veterans screened for food insecurity between March 1, 2021, and August 31, 2023. Positive response to food insecurity screening administered in VHA facilities as part of routine clinical care. Prevalence of and sociodemographic, clinical, and psychosocial factors associated with food insecurity among veterans identifying as LGBQ+ or heterosexual and those with "don't know" responses regarding their sexual orientation. Of 3 580 148 veterans screened, the mean (SD) age was 61.6 (0.4) years; 3 192 507 (89.2%) were assigned male sex at birth. A total of 83 292 veterans (2.3%) identified as LGBQ+, and 10 183 (0.3%) had "don't know" responses. LGBQ+ veterans (5352 [6.4%]) and veterans with "don't know" responses (635 [6.2%]) were more than twice as likely as heterosexual veterans (90 426 [2.6%]) to have positive screen results for food insecurity. While risk factors for food insecurity were similar for veterans across sexual orientation groups, LGBQ+ veterans had higher rates of several risk factors compared with heterosexual veterans, including age younger than 45 years (45.3% vs 19.5%), female sex assigned at birth (44.1% vs 10.0%), being in a minoritized racial or ethnic group (34.7% vs 29.8%), unmarried or unpartnered status (69.1% vs 39.7%), low income (16.4% vs 14.9%), homelessness or housing instability (10.3% vs 5.4%), anxiety (7.7% vs 4.3%), depression (31.1% vs 19.3%), suicidality (3.6% vs 1.4%), posttraumatic stress disorder (42.2% vs 30.2%), substance use disorder (13.1% vs 9.0%), military sexual trauma (24.0% vs 5.4%), and recent intimate partner violence (2.6% vs 1.4%). In this cohort study of veterans screened for food insecurity, LGBQ+ veterans and those with "don't know" responses for sexual orientation experienced food insecurity at nearly 2.5 times the rate of heterosexual veterans. While risk factors for food insecurity were similar across groups, LGBQ+ veterans faced a higher prevalence of particular risks, including homelessness and several mental health and trauma-related comorbidities. Future work should examine targeted screening and interventions tailored to identifying and addressing food insecurity in this population, given their increased vulnerability and burden of food insecurity.

Understanding and Addressing LGBTQ+ Cancer Health Disparities.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) cancer survivors disproportionately experience physical and mental health comorbidities compared with their heterosexual and cisgender counterparts. A recent study by Waters and colleagues evaluates associations between LGBTQ+ identity and physical and mental health comorbidities and activity limitations using Behavioral Risk Factor Surveillance System data. Consistent with previous work, their findings suggest that LGBTQ+ survivors have higher odds of several chronic conditions, including asthma, depressive disorders, heart attacks, kidney disease, stroke, and diabetes, as well as reporting disabilities related to vision and cognition and difficulty with activities of daily living, including walking, dressing, and running errands. Waters and colleagues expand on previous work by providing estimates separately for sexual orientation and gender identity. Their results for lesbian, gay, and bisexual survivors were similar to those for LGBTQ+ survivors overall. In novel findings, they report much stronger associations between identifying as transgender or gender nonconforming and nearly all comorbidities compared with cisgender survivors, including those who identify as lesbian, gay, or bisexual. This commentary advocates for the importance of future work considering the drivers of disparities in cancer outcomes based on sexual orientation and gender identity. See related article by Waters et al., p. 1405.

Do mindfulness interventions cause harm? Findings from the Learning to Apply Mindfulness to Pain (LAMP) Pragmatic Clinical Trial.

Although mindfulness-based interventions (MBIs) are widely used in clinical and nonclinical settings, there has been little systematic study of their potential risks. To address this gap, we examined differences in psychological and physical worsening among participants in the usual care and intervention conditions of a 3-group, randomized pragmatic trial (Learning to Apply Mindfulness to Pain [LAMP]) that tested the effectiveness of 2 approaches to delivering MBIs to patients with chronic pain. The sample consisted of 374 male and 334 female patients with chronic pain enrolled in the LAMP trial who completed a 10-week follow-up survey, 61% of whom had a mental health diagnosis. Psychological and physical worsening was assessed by a checklist asking whether participants experienced specific symptoms since beginning the study. We used multivariable logistic regression models with imputed data to determine whether predicted probabilities of increased symptoms differed between usual care and the 2 MBIs. Participants in usual care were more likely to report experiencing increased psychological and physical worsening than were those in the MBIs, including an increase in disturbing memories; sadness, anxiousness, and fatigue; isolation and loneliness; and feeling more upset than usual when something reminded them of the past. MBIs do not appear to cause harm, in terms of increased symptoms, for this population of patients with chronic pain and high levels of mental health comorbidities. Preregistration with an analysis plan at www.ClinicalTrials.gov: NCT04526158. Patient enrollment began December 4, 2020.