Co-occurring Mental Health Problems Research Articles

Probing heterogeneity to identify individualized treatment approaches in autism: Specific clusters of executive function challenges link to distinct co-occurring mental health problems.

Many autistic people struggle with mental health problems like anxiety, depression, inattention, and aggression, which can be challenging to treat. Executive function challenges, which impact many autistic individuals, may serve as a risk factor for mental health problems or make treating mental health conditions more difficult. While some people respond well to medication or therapy, others do not. This study tried to understand if there are different subgroups of autistic young people who may have similar patterns of executive function strengths and challenges-like flexibility, planning, self-monitoring, and emotion regulation. Then, we investigated whether executive function subgroups were related to mental health problems in autistic youth. We found three different types of executive function subgroups in autistic youth, each with different patterns of mental health problems. This helps us identify specific profiles of executive function strengths and challenges that may be helpful with identifying personalized supports, services, and treatment strategies for mental health conditions.

Relationship Between Oral Health and Mental Health in Individuals with Substance Use Disorder: A Short Commentary

Substance use disorders are highly widespread in the United States, exerting significant adverse effects on individuals’ wellbeing, overall contentment, and societal functionality. Our review of the literature shows a close connection between Substance Use Disorder (SUD) and oral health problems, revealing a mutual association between drug addiction and oral health. Moreover, our review further indicates that individuals seeking treatment for addiction display a notably elevated occurrence of coexisting mental health disorders. Recent studies suggest a potential bidirectional relationship between mental health and dental well-being, emphasizing the broader implications for mental health and oral health outcomes even in individuals not involved in substance use. Based on the above review, we perceive a considerable gap to examine any relationship between oral health and mental health in individuals with SUD. Having co-occurring oral health and mental health problems can significantly reduce quality of life in individuals with SUD. There appears to be a critical need to investigate any relationship between oral health and mental well-being in individuals grappling with SUD. It is crucial to inform both mental health and dental health professionals, as well as substance addiction counselors about any potential existence of such a relationship. Recognizing this link could contribute to the development of more effective strategies to encourage individuals with SUD to seek treatment and address both their oral and mental health needs.

HEAVY DRINKING, MENTAL HEALTH PROBLEMS AND RECOVERY IN OLDER ADULTS: EXPLORING SUPPORT NEEDS

Abstract Many older adults who consume alcohol at harmful levels experience mental health problems. Common life events such as retirement, bereavement, and declining health, can contribute to anxiety and depression, with alcohol consumption being used as a coping mechanism. Tailored support is crucial to address the unique needs of older adults facing both alcohol misuse and mental health problems. These patients often fall into gaps between services (family practice/alcohol/mental health), which are unable to meet their complex support needs. This qualitative study aimed to understand the lived experiences of older adults with co-occurring heavy drinking and mental health problems, support received and unmet needs. We conducted semi-structured interviews with 14 older adults living in the North of England (completed Summer 2023). Thematic analysis and constant comparison were employed in data analysis. Findings highlighted the importance of age-tailored initiatives such as access to mental health support while actively drinking, supervised detoxification, increased peer support and services that are age inclusive and friendly. Risk factors such as grief, loneliness, financial problems and undiagnosed trauma in older adults contributed to development of these conditions. Older adults need services to work together, integrated around patient needs and addressing heavy drinking and mental health concerns at the same time. Future research should focus on improving mental health literacy and, developing holistic and preventive interventions to address risk factors for co-occurring alcohol and mental health problems in older adults.

Mental Health Providers' Perspectives on What Helps and Hinders in Psychotherapy for Autistic Adults with Co-occurring Mental Health Problems.

Autistic adults experience disproportionate rates of co-occurring mental health problems. Psychotherapy has been recognized as an appropriate treatment approach, but evidence is limited. Researchers used a qualitative research paradigm to explore the experiences of mental health providers who provide psychotherapy to autistic adults. The Enhanced Critical Incident Technique was used to interview 13 mental health providers regarding perceptions of facilitating therapy with autistic adults. This research highlights challenges to providing psychotherapy to autistic adults while also illuminating ways that mental health providers have worked to ameliorate such challenges and create positive experiences in therapy. This research also contrasts therapy for autistic adults relative to the general population. Practice recommendations and suggestions for future research are offered.

Effectiveness of Family-Involved Interventions in Reducing Co-Occurring Alcohol Use and Mental Health Problems in Young People Aged 12-17: A Systematic Review and Meta-Analysis.

There is a high prevalence rate of co-occurring alcohol use and mental health problems in young people. This is associated with adverse outcomes and poses a substantial public health concern. We identified and synthesized evidence on the effectiveness of family-involved interventions in reducing alcohol use and mental health problems in young people aged 12-17. Seven databases were searched from inception to January 2023. Data from 19 articles reporting on 14 trials were pooled through random-effects meta-analysis for each outcome using Review Manager 5.3. Pooled estimates resulted in non-significant findings for alcohol use (SMD -0.60; 95% CI -1.63 to 0.42; p = 0.25; 6 trials; 537 participants), internalizing symptoms (SMD -0.13; 95% CI -0.37 to 0.10; p = 0.27), externalizing symptoms (SMD -0.26; 95% CI -0.66 to 0.15; p = 0.22) and substance use (SMD -0.33; 95% CI -0.72 to 0.06; p = 0.10). In contrast, significant intervention effects were identified for the mechanism of change, family conflict (SMD -0.30; 95% CI -0.51 to -0.09; p = 0.005). Consequently, addressing family functioning may not be sufficient in reducing co-occurring alcohol use and mental health problems. Non-significant intervention effects could be due to a lack of content addressing the relationship between alcohol use and mental health problems. Future intervention development could explore whether to incorporate such content and how best to involve the family.

Prevalence of Co-Occurring Physical and Mental Health Problems in People with Drug Addiction in Pakistan

Drug addiction is a relapsing, chronic disorder in which drug abusing and compulsive drug-seeking behaviors are prevalent. The objective of the research was to explore the prevalence of different types of drug addictions along with co-occurring physical and mental health problems. Since 2021, a team of Happy Life Psychological Services (HLPS), Pakistan has dealt with 6000 triages and 156 admissions. The sample of the study was 156 participants with drug addiction collected from February 2021 to January 2023. The outcome of the study reflected that male have higher number of drug addiction (78.8%) compared to females and the most common age of drug addiction is middle adults (67.9%). In people with drug addiction, the highly used drug was tobacco (23.41%), the most common mental health problem was anxiety disorders (28.62%), the most common medical comorbidity was Hepatitis B & C (50%), and they had higher level of suicidal thoughts (49.32%). The study recommends nationwide concerted actions to decline the illicit demands of drugs. Mass media, law enforcement, medical practitioners, local communities, NGOs, international agencies, and affected families are the possible stakeholders that should be included to make up strategies to manage the issue of drug addiction in Pakistan.

Co-occurring alcohol and mental health problems in the military: Prevalence, disparities, and service utilization.

To examine the prevalence of co-occurring alcohol and mental health (MH) problems (COPs), perceived MH service need, and MH service utilization among active duty service members, and to identify differences in gender, race/ethnicity, age, and sexual orientation and gender identity. 16,699 active duty service members participated in the Department of Defense's 2015 Health Related Behaviors Survey. Measures included demographics, combat deployment, smoking status, problematic alcohol use (Alcohol Use Disorders Identification Test-C, AUDIT-C), posttraumatic stress disorder (PTSD Checklist, Civilian Version, PCL-C), depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder-7, GAD-7), and perceived need for and use of MH services. We examined groups of service members with probable: COP, alcohol problem only, MH problem only, and neither. Eight percent of service members reported COPs, 26.89% reported alcohol use problem only, and 9.41% reported a MH condition only. COPs were more common among those who were lesbian, gay, bisexual, and transgender (LGBT), those who had three or more combat deployments, and smokers, and less common among those aged 35 years and older, Asian or Black, and in the Air Force and Coast Guard (relative to Navy). Those reporting a probable MH problem only were significantly less likely to report use of past year MH counseling than those with probable COPs; otherwise, patterns of service utilization and perceived need were similar. COPs are common enough that screening for and attention to their co-occurrence are needed in the military, and some subgroups of service members are at particularly high risk for COPs. Future research and policy should delve deeper into how the needs of service members with COPs can be addressed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cultural Adaptation and Validation of the Urdu Version of the Cognitive Emotion Regulation Questionnaire (CERQ) in Male Patients With Substance Use Disorders (SUDs) in Pakistan.

BackgroundAdults with substance use disorders (SUDs) often have co-occurring mental health problems. Emotion regulation may play a vital role in mental health problems. The Cognitive Emotion Regulation Questionnaire (CERQ) is a widely used measure for assessing cognitive emotion regulation. However, it has not been used in Pakistan on patients with co-occurring SUDs and mental health issues. The present study aims to translate and adapt the CERQ into the Urdu language and to determine its reliability and convergent validity in a sample of male patients with SUDs in Pakistan.MethodParticipants completed a demographic information form, the CERQ, the Depression, Anxiety, and Stress Scale Short Form [DASS-21)], and the Rosenberg Self-Esteem Scale [RSES)] in Urdu.ResultsMale participants (N = 237) 18–50 years of age (M = 29.8, SD = 8.1) were recruited from four substance use disorder treatment centers and hospitals in Karachi. The reliability of the Urdu version of the CERQ was based on an examination of its internal consistency reliability (Cronbach's α) and test–retest reliability for both the total scale and its subscales. Internal consistency for the CERQ total (α = 0.80) was adequate, as it was for subscales of self-blame, (0.76) acceptance (0.78), rumination (0.72), positive refocusing (0.79), focus on planning (0.89), positive reappraisal (0.81), putting into perspective (0.83), catastrophizing (0.73), and other blame (0.70). The 10–14 day test–retest reliability of the CERQ total score was 0.86. Higher CERQ scores were significantly (ps < 0.001) negatively associated with DASS-21depression (r = –0.24), anxiety (r = –0.23), and stress (r = –0.27) subscales, as well as the DASS-21 total score (r = –0.26) and positively associated with the RSES self-esteem score (r = 0.30).ConclusionThe Urdu version of the CERQ is a reliable measure for investigating cognitive emotion regulation strategies related to mental health and SUDs in Pakistan.

Family dynamics, trauma, and child-related characteristics: examining factors associated with co-occurring mental health problems in clinically-referred children with and without an intellectual (and developmental) disability.

Psychiatric disorders are common in youth with intellectual and developmental disabilities. This is a vulnerable group of children whose behavioural problems often have more complicated care needs than other children, which can place a great deal of stress on their families. However, the association of family mental health issues, level of intellectual ability, and diagnostic co-morbidity in children is relatively under-studied. In the present study, we investigated the relationship among child diagnoses, family mental health problems, risk for self-injury, and disruption in care among children with (N = 517) and without (N = 517) intellectual and developmental disabilities. A negative binomial regression showed that mental health problems in multiple family members, self-injurious behaviour, and self-reported abuse/trauma was related to greater likelihood of provisional diagnoses of co-occurring psychiatric disorders in both a clinically referred sample and a sample with IDD. Implications for care-planning are discussed.

Analyzing dynamic change in children’s socioemotional development using the strengths and difficulties questionnaire in a large United Kingdom longitudinal study.

Many children who suffer from one mental health issue also suffer from at least one co-occurring disorder and a range of developmental psychopathology theories, including developmental cascade and network models, have been proposed to explain this widespread co-occurrence. Autoregressive latent trajectory models with structured residuals (ALT-SR) and multilevel graphical vector autoregression (GVAR) are recently proposed complementary approaches that can help operationalize and test these theories and provide new insights into the reciprocal relations between multiple mental health domains to advance the understanding of the development of co-occurring mental health problems. This study uses ALT-SR and multilevel GVAR models to analyze the temporal, contemporaneous, and between-person relations between key dimensions of child mental health: emotional problems, peer problems, conduct problems, hyperactivity/inattention, and prosociality as measured by the parent-reported Strengths and Difficulties Questionnaire (SDQ) in 17,478 children from the U.K. Millennium Cohort study at ages 3, 5, 7, 11, 14, and 17 years. Children's strengths and difficulties in different domains of psychosocial functioning were dynamically associated with each other over- and within-time. The ALT-SR highlighted that hyperactivity/inattention plays a central role in affecting other domains over developmental time, while the GVAR model highlighted comparably strong bidirectional relations between conduct problems and prosociality as well as between emotional problems and peer problems. This study confirms that mental health difficulties influence one another dynamically over time. The complementary techniques of ALT-SR and GVAR models offer different insights into co-occurring mental health problems and hold promise for supporting the building of more comprehensive developmental psychopathological theories that acknowledge the interconnectedness of different domains of mental health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Engagement during a Mixed In-Person and Remotely Delivered Psychological Intervention for Youth with Functional Abdominal Pain Disorders and Anxiety.

Functional abdominal pain disorders (FAPD) are common disabling pain conditions frequently associated with co-occurring mental health problems such as anxiety. Psychological therapies such as cognitive behavioral therapy (CBT) have been shown to be effective. Therefore, it is important to understand participant engagement (i.e., use of intervention tools) to such approaches, and if engagement impacts treatment response. The Aim to Decrease Anxiety and Pain Treatment (ADAPT) is an effective psychological treatment approach using a blend of in-person sessions and interventionist phone support with self-paced web modules to manage pain and anxiety. The current study used a mixed-methods approach to investigate micro-level and macro-level participant engagement during the ADAPT program. In-person/phone session attendance was high (>95%) although scheduling adjustments were common (25.5%). Varied levels of engagement with web tools were observed. Thematic analysis also revealed variability in patterns of use. Additionally, while participants indicated they generally understood how to use certain skills (e.g., problem solving, detective thinking), and these skills were effective in managing symptoms during treatment, these activities were generally underutilized. Further, participant engagement did not predict response to the ADAPT intervention. These findings are important as the demand for accessible psychotherapeutic tools to manage pain and anxiety is likely to remain high.

Resist or Adapt? A Narrative Analysis of Endeavors for Belonging Among Young Adults with Co-Occurring Substance Use and Mental Health Problems

The article explores how young adults with co-occurring substance use and mental health problems experience and describe their own and others’ contributions to their sense of community belonging. This article is part of a larger qualitative interview study of young adults. The data for this report were the individual interviews with two study participants. These participants were chosen because they offered in-depth understandings relating to various aspects of community belonging. A thematic narrative analysis of the interview data was carried out. Central to this model of analysis is to transform unstructured qualitative interview data into a unified narrative for each participant, structured around a thematic plot. The analysis revealed two plots: ‘Having to go against yourself to be an insider', and ‘You have to realize that you have problems and try to do something about them'. We interpreted the first narrative as an expression of marginalized people feeling they deserve recognition from society, while the second narrative reflected the idea that each person has a personal responsibility for being valued. We conclude that the narratives expressed the importance of helping young adults to place their lived experiences in a larger social context.

Psychological correlates of smoker’s identity in adults reporting mental health diagnoses

ABSTRACT Objective: Smoking and tobacco use co-occur with mental health problems. We examined the relationships between smoker’s identity and positive factors in smokers with mental health problems. We also examined the associations between smoker’s identity and psychopathology. Methods: We distributed an anonymous electronic survey to individuals participating in the National Alliance on Mental Illness e-mail list. Participants self-reported mental health diagnoses. Constructs assessed were meaning in life, purpose in life, self-efficacy, social support, smoker’s identity, depression, anxiety, stress, confidence in being able to quit tobacco, and concern that quitting tobacco would worsen mental health. Results: Participants endorsing a perception that smoking was part of their identity reported decreased purpose in life and self-efficacy. Smoker’s identity was negatively and positively associated with confidence in quitting tobacco and concern that quitting could worsen mental health, respectively. Individuals who endorsed a smoker’s identity reported increased anxiety symptoms. Conclusions: Our study shows a link between smoker’s identity and various positive and psychopathological factors in smokers reporting mental health diagnoses. Future research and treatment should consider transdiagnostic factors within the context of individuals with co-occurring smoking and mental health problems.

The Role of State Medicaid Expansions in Integrating Comprehensive Mental Health Services into Opioid Treatment Programs: Differences Across the Rural/Urban Continuum.

Co-occurring mental health (MH) problems are common among those with opioid use disorders (OUDs). However, most opioid treatment programs (OTPs) do not provide MH services. We measured the association between state level characteristics (Medicaid expansion status and rurality) and MH/OUD services integration. We used a generalized linear model to estimate how the association between integration and Medicaid expansions varied across levels of rurality (National Survey on Substance Abuse Treatment Services; 2018; n = 1507 OTPs). The predicted probability of OTPs offering MH services decreased as rurality increased, and the strength of the negative association was greater in non-expansion states ([Formula: see text]=-0.038, SE = 0.005, p < 0.0001) than in expansion states ([Formula: see text]=-0.020, SE = 0.003, p < 0.0001). Access to integrated MH services was lowest in rural non-Medicaid expansion states, despite the high risk of opioid misuse and a high need for MAT and MH services in this population.

Interventions for Alcohol and Drug Use Disorders in Young People: 10 Key Evidence-Based Approaches to Inform Service Delivery

Effective treatment of alcohol and drug disorders in young people is critical to reducing substance-related harm; however, research examining treatment for young people often trails the adult literature. This review identifies 10 evidence-based treatment and service delivery principles that can be applied to treatment settings for young people. Screening and brief intervention is effective across a range of settings. Incorporating peer networks in service delivery can improve treatment engagement and outcomes, and a harm reduction approach may be beneficial. Treatment outcomes are improved by family involvement, while motivational interviewing and cognitive behavioural therapies benefit older adolescents, and contingency management and pharmacotherapy can augment family or individual interventions. Addressing co-occurring mental health problems is essential. eHealth interventions hold promise as a means of complementing existing therapies. There is now an established evidence base to inform treatment in young people, however, gaps in the literature remain. Ongoing challenges include integrating evidence into practice, and providing services that are both effective and welcoming to young people.

Autism spectrum disorder/Takiwātanga: An Integrated Data Infrastructure-based approach to autism spectrum disorder research in New Zealand.

New Zealand has few estimates of the prevalence of autism spectrum disorder and no national registry. The use of administrative data sources is expanding and could be useful in autism spectrum disorder research. However, the extent to which autism spectrum disorder can be captured in these data sources is unknown. In this study, we utilised three linked administrative health data sources from the Integrated Data Infrastructure to identify cases of autism spectrum disorder among New Zealand children and young people. We then investigated the extent to which a range of mental health, neurodevelopmental and related problems co-occur with autism spectrum disorder. In total, 9555 unique individuals aged 0–24 with autism spectrum disorder were identified. The identification rate for 8-year-olds was 1 in 102. Co-occurring mental health or related problems were noted in 68% of the autism spectrum disorder group. The most common co-occurring conditions were intellectual disability, disruptive behaviours and emotional problems. Although data from the Integrated Data Infrastructure may currently undercount cases of autism spectrum disorder, they could be useful for monitoring service and treatment-related trends, types of co-occurring conditions and for examining social outcomes. With further refinement, the Integrated Data Infrastructure could prove valuable for informing the national incidence and prevalence of autism spectrum disorder and the long-term effectiveness of clinical guidelines and interventions for this group.Lay abstractNew Zealand has few estimates of the prevalence autism spectrum disorder and no national registry or data set to identify and track cases. This hinders the ability to make informed, evidence-based decisions relating to autism spectrum disorder. In this study, we utilised linked health and non-health data to develop a method for identifying cases of autism spectrum disorder among children and young people in New Zealand. In addition, we examined rates of co-occurring mental health, neurodevelopmental and related conditions among this cohort and compared these to the general population. The method identified almost 10,000 children and young people with autism spectrum disorder in New Zealand. Co-occurring mental health or related problems were found in over 68% of this group (nearly seven times higher than the general population), and around half were identified with multiple co-occurring conditions. The most frequently identified conditions were intellectual disability, disruptive behaviours and emotional problems. We have developed a useful method for monitoring service and treatment-related trends, number and types of co-occurring conditions and examining social outcomes among individuals with autism spectrum disorder. While the method may underestimate the prevalence of autism spectrum disorder in New Zealand, it provides a significant step towards establishing a more comprehensive evidence base to inform autism spectrum disorder–related policy.

Interventions for drug-using offenders with co-occurring mental health problems.

Interventions for drug-using offenders with co-occurring mental health problems.

Substance Use in Adolescents: Diagnostic Dilemma with Case Examples

Substance use in adolescents is a public health problem that poses many challenges for health care providers. Adolescents frequently abuse multiple substances simultaneously, further confounding the symptoms and signs of their presentation. Adolescents with substance use disorders often have co-occurring mental health problems predating or resulting from substance use, complicating their diagnoses and treatment. Additionally, many adolescents who use substances do not perceive their own need for treatment or acknowledge their level of functional impairment, which influences their symptom report. In this article, we use case examples to review common drug and alcohol problems present in adolescents and the challenges to diagnosis and treatment. [ Psychiatr Ann. 2019;49(6):263–268.]

A latent class analysis of the co-occurrence of sexual violence, substance use, and mental health in youth

Purpose: The purpose of this study was to understand co-occurrence of sexual violence, substance use, and mental health in youth and see if there are differences in experiences among sexual identities, races, and genders. Methods: The 2017 Youth Risk Behavior Survey sampled 14,638 high school students. Latent class analysis was used to understand the relationship between incidence of sexual violence, substance use, and depression and suicidality in a nationally representative sample. The model controlled for demographic and bullying covariates. Results: A four-class solution provided optimal fit. Classes were low risk (51.8%); low violence, frequent substance use, and high depression and suicidal ideation (29.7%); experienced violence and moderate mental health issues(5.1%); and some violence, high substance use, and high depression and suicidal ideation (13.4%). Youth who identified as sexual minority youth were almost 2.5–5 times more likely to be in the three higher risk classes than their heterosexual peers. Those who identified as “I don’t know” were almost 3 times more likely to be in the three higher risk classes than heterosexual youth. Multiracial youth had higher likelihood of being in the three riskier classes compared to Caucasian youth. Females were 2.5 and 3 times more likely to be in the low violence and some violence classes compared to males. Conclusion: The study’s finding distinct classes of co-occurring behavioral and mental health outcomes fill gaps in the current literature and informs practitioners that LGB youth and bi/multiracial youth were at an elevated risk of co-occurring victimization, substance use, and mental health problems.

Effectiveness of Training Therapists to Deliver An Individualized Mental Health Intervention for Children With ASD in Publicly Funded Mental Health Services

Publicly funded mental health services play an important role in addressing co-occurring mental health problems in children with autism spectrum disorder (ASD); however, therapists report lacking training to effectively serve this complex population. To test the effectiveness of training community therapists in An Individualized Mental Health Intervention for ASD (AIM HI) on challenging behaviors across 18 months among children with ASD and identify moderators and mediators of any intervention effects. Cluster randomized trial conducted in 29 publicly funded outpatient and school-based mental health programs in southern California from 2012 to 2017. Programs were randomized to receive immediate AIM HI training or provide usual care followed by receipt of AIM HI training. Therapist participants were recruited from enrolled programs, and child participants were recruited from participant therapists' caseloads. Data were analyzed from 202 children with ASD who were aged 5 to 13 years. The AIM HI protocol is a package of parent-mediated and child-focused strategies aimed to reduce challenging behaviors in children with ASD who are 5 to 13 years old. It was designed for delivery in publicly funded mental health services based on a systematic assessment of therapist training needs and child clinical needs. The therapist training and consultation process takes approximately 6 months and includes an introductory workshop, 11 structured consultation meetings as the therapist delivers AIM HI with a current client, and case-specific performance feedback from trainers. Child participants were assessed for challenging behaviors using the Eyberg Child Behavior Inventory (ECBI) and Social Skills Improvement System (SSIS) Competing Problem Behaviors scales based on parent report at baseline and at 6-month intervals for 18 months. Outcomes were analyzed using intent-to-treat models. In total, 202 children with ASD (mean [SD] age, 9.1 [2.4] years; 170 [84.2%] male; 121 [59.9%] Latinx) were eligible, enrolled, and included in the analyses. Statistically significant group by time interactions for the ECBI Intensity (B = -0.38; P = .02) and ECBI Problem (B = -1.00; P = .005) scales were observed, with significantly larger decreases in ECBI Intensity scores in the AIM HI group (B = -1.36; P < .001) relative to the usual care group (B = -0.98; P < .001) and a significantly larger decrease in ECBI Problem scores in the AIM HI group (B = -1.22; P < .001) relative to the usual care group (B = -0.20; P = .29). Therapist fidelity moderated these intervention effects. The present findings support the effectiveness of training therapists to deliver the AIM HI model to children with ASD receiving publicly funded mental health services. ClinicalTrials.gov identifier: NCT02416323.