Health Distress Research Articles

School-based mental health screenings with Ukrainian adolescent refugees in Germany: Results from a pilot study.

Since the Russian invasion of Ukraine in February 2022, high numbers of Ukrainians, mostly women and children, have left the country. As of today, Germany has accepted more than one million refugees fleeing from Ukraine including ~200,000 children and adolescents registered in German schools. Since refugee minors are typically affected by high rates of mental health issues, the identification of potential psychological problems at an early stage after arrival is essential in order to make timely referrals for vulnerable youth to diagnostic or treatment services possible. The aim of the present study was to test the feasibility of a classroom-based mental health screening procedure and to assess symptoms of PTSD, depression, and anxiety in a small sample of adolescents who had fled to Germany. Forty-two adolescents (n = 20 girls) took part in the study. Screening results showed that more than half of the sample had elevated ratings in the Refugee Health Screener (RHS) and about 45% reported clinically significant levels of PTSD. Overall, the amount of both mental health problems and current worries related to the war was significantly higher in girls compared to boys. In general, screenings were well received by the adolescents. The findings of this pilot study point to a considerable level of mental health problems and distress in adolescent refugees affected by the recent war in Ukraine. Brief psychological screenings within the school setting might represent a promising approach to identifying potential mental health disorders as early as possible in newly arriving refugee youth.

Understanding Postpartum Parents' Experiences via Two Digital Platforms

Digital platforms, including online forums and helplines, have emerged as avenues of support for caregivers suffering from postpartum mental health distress. Understanding support seekers' experiences as shared on these platforms could provide crucial insight into caregivers' needs during this vulnerable time. In the current work, we provide a descriptive analysis of the concerns, psychological states, and motivations shared by healthy and distressed postpartum support seekers on two digital platforms, a one-on-one digital helpline and a publicly available online forum. Using a combination of human annotations, dictionary models and unsupervised techniques, we find stark differences between the experiences of distressed and healthy mothers. Distressed mothers described interpersonal problems and a lack of support, with 8.60% - 14.56% reporting severe symptoms including suicidal ideation. In contrast, the majority of healthy mothers described childcare issues, such as questions about breastfeeding or sleeping, and reported no severe mental health concerns. Across the two digital platforms, we found that distressed mothers shared similar content. However, the patterns of speech and affect shared by distressed mothers differed between the helpline vs. the online forum, suggesting the design of these platforms may shape meaningful measures of their support-seeking experiences. Our results provide new insight into the experiences of caregivers suffering from postpartum mental health distress. We conclude by discussing methodological considerations for understanding content shared by support seekers and design considerations for the next generation of support tools for postpartum parents.

The Impact of Parent Torture and Family Functioning on Youth Adjustment in War-Affected Families: A Path Analysis Describing Intergenerational Trauma and the Family System.

The direct exposure to physical or psychological trauma from torture or war leads to well-documented individual health consequences. Less understood are the inclusive and intergenerational effects of war trauma on family systems and youth adjustment. The purpose was to examine mechanisms in war-affected families that explained the significant emotional and behavioral consequences of intergenerational trauma in youth through the use of multiple methods. Quantitative assessments of maternal and paternal caregivers and youth characterized associations between parent torture, parent mental health distress, parent physical health problems, family functioning, and youth adjustment. Narrative statements further contextualized processes through which the trauma of a parent impacted youth and family systems. The research was conducted in partnership with local, refugee-serving community-based organizations. The study sample included parents and youth in 96 Karen families, originating from Burma in Southeast Asia, who had been resettled to the United States through the U.S. Refugee Admissions Program. Path analysis results indicated that parent torture (β = -0.173) had statistically significant negative direct effects on youth adjustment. Parent torture had a negative indirect effect on youth adjustment through the mental health (β = -0.345) and physical health problems of parents (β = -0.305), and youth gender (β = 0.126) and trauma exposure of youth (β = -0.048). Family functioning type demonstrated a positive direct effect on youth adjustment (β = 0.449). Family type had an indirect effect on youth adjustment through youth gender (β = 0.142), youth trauma exposure (β = -0.165), parent physical health problems (β = -0.202), and parent mental health (β = 0.509). The current study developed and tested the first model of intergenerational trauma's effects on the adjustment of Karen refugee youth. Results emphasize that individual recovery from torture must be accompanied by adjunct interventions focused on family systems and youth adjustment, to holistically address intergenerational sequala of trauma.

Sociodemographic circumstances, health, and life experience shape posttraumatic distress trajectories among individuals exposed to smoke during a large-scale coal mine fire.

The 2014 Hazelwood coal mine fire in the Latrobe Valley, Australia, distributed toxic smoke into surrounding communities over 45 days. This study investigated risk and protective factors associated with four trajectories of posttraumatic distress (resilient, recovery, delayed-onset, chronic) among exposed adults. Participants (N = 709) completed surveys in 2016-2017 and 2019-2020 assessing mine fire-related particulate matter (PM2.5 ) exposure; sociodemographic, physical, and mental health variables; and exposure to other traumatic and recent stressful events. Mine fire-related posttraumatic distress was measured using the IES-R; trajectories were determined according to established clinical significance thresholds. Relative risk ratios (RRRs) were generated from multivariate multinomial regressions. The resilient trajectory was most common (77.0%). The chronic trajectory (8.5%) was associated with loneliness, RRR = 2.59, 95% CI [1.30, 5.16], and physical health diagnoses, RRR = 2.31, 95% CI [1.32, 4.02]. The delayed-onset trajectory (9.1%) was associated with multiple recent stressful events, RRR = 2.51, 95% CI [1.37, 4.59]; mental health diagnoses, RRR = 2.30, 95% CI [1.25, 4.24]; loneliness, RRR = 2.05, 95% CI [1.09, 3.88]; and male gender, RRR = 2.01, 95% CI [1.18, 3.44]. Socioeconomic advantage protected against chronic, RRR = 0.68, 95% CI [0.53, 0.86], and delayed-onset trajectory membership, RRR = 0.68, 95% CI [0.50, 0.94]; social support protected against chronic trajectory membership, RRR = 0.67, 95% CI [0.49, 0.92]. PM2.5 exposure did not determine trajectory. These findings enhance understanding of longer-term posttraumatic responses to large-scale smoke events and can inform mental health initiatives within at-risk communities.

Population-based Survey of Lifestyle Behaviours of Women with Varied Parity and Chronic Disease Statuses in Nigeria: A Discriminant, Classification Analysis

The study aimed to explore the lifestyle behaviours of women with varied parity and chronic disease statuses in Nigeria. This was a representative of women population in Ogun State in the southwest of Nigeria recruited between March and June 2022 using stratified sampling among the twenty (20) local governments in the three senatorial districts of the state. Data on parity, chronic diseases, health status, dietary patterns, and anthropometric and lifestyle factors were collected using validated questionnaires. A total of seven hundred and ninety (790) women over 18 years old (range: 18 –78) and average body mass index (BMI) of 25.9 ± 4.3 (range: 15.2 – 44.2) participated in the study. Parity rate and the prevalence of chronic diseases were 50.4% and 14.4%, respectively. Parity was associated with demographic factors as the participants, more of widows and of other ethnic descent, reported direct and inverse relationships of live births with age and level of formal education, respectively. In addition, women with chronic diseases were significantly more common in the younger age group (≤ 44 years) than in the older one (> 44 years) (32.2% vs. 4.7%; p < 0.05) and in those more likely to have separated. Moreover, whilst parity was associated with walking and consumption of foods including meat products, eggs and fruits, chronic disease was only associated with physical activity. Our findings reveal that women who are parous and / or with chronic diseases are characterized by higher BMI and more elevated health distress and health interference.

Predictors of Mental Health Service Utilization among Frontline Healthcare Workers during the COVID-19 Pandemic.

(1) Background: This study examined the prevalence and correlates of factors associated with self-reported mental health service use in a longitudinal cohort of frontline health care workers (FHCWs) providing care to patients with COVID-19 throughout 2020. (2) Methods: The study comprised a two-wave survey (n = 780) administered in April-May 2020 (T1) and November 2020-January 2021 (T2) to faculty, staff, and trainees in a large urban medical center. Factors associated with initiation, cessation, or continuation of mental health care over time were examined. (3) Results: A total of 19.1% of FHCWs endorsed currently utilizing mental health services, with 11.4% continuing, 4.2% initiating, and 3.5% ceasing services between T1 and T2. Predisposing and need-related factors, most notably a history of a mental health diagnosis and distress related to systemic racism, predicted service initiation and continuation. Among FHCWs with a prior mental health history, those with greater perceived resilience were less likely to initiate treatment at T2. Descriptive data highlighted the importance of services around basic and safety needs (e.g., reliable access to personal protective equipment) relative to mental health support in the acute phase of the pandemic. (4) Conclusions: Results may be helpful in identifying FHCWs who may benefit from mental health services.

Contagious crowds and rational faithfuls: a club theory approach

PurposeThis study investigates the observed resurgence in religious beliefs seen across many societies during the COVID-19 pandemic. Using the economic theory of religious clubs, the author models religious participation during the pandemic as a mechanism for alleviating the financial distress associated with the health distress from the pandemic.Design/methodology/approachUsing data from the COVID-19 National Longitudinal Phone Survey (NLPS) in Nigeria, the author investigates the economic motivation for religious intensity during the COVID-19 pandemic. To address endogeneity concerns, the author exploits geographic variables of temperature and longitudes as sources of COVID-19 risk.FindingsOverall, health distress stimulates religious intensity. Consistent with the economic theory of religious clubs, adverse health shocks stimulate financial distress, and the effect is stronger among religious participants. Similarly, people see God and not the government as a source of protection against COVID-19.Research limitations/implications The study’s model sees religious organizations as public goods providers, especially when governments and markets are inefficient.Practical implicationsThe study’s recommendations support an expanded role for religious networks in healthcare delivery and more public funding to attenuate the post-pandemic resurgence of social violence in economically distressed regions.Social implicationsDespite the research interest in the COVID-19 pandemic, the long-term implications, many of which relate to social behavior adjustments that cause individuals to identify more closely with their social group, need greater understanding. Suppose religious intensity is linked to economic distress. In that case, this is a major source of worry for countries whose economies are subject to higher fluctuations and where the governments and markets are inefficiently organized. These regions may be more susceptible to a resurgence in religious fundamentalism associated with the economic shocks from the pandemic. Consequently, these regions would require more public funding to attenuate the potential for costly activities like organized violence, suicide attacks and terrorist activities in the aftermath of the pandemic.Originality/valuePrompted by the observation of the increase in religious identity through religious intensity during the pandemic, the author contributes by developing theoretically-based hypotheses that are incentive-compatible to provide a rational justification for the observation. The author empirically validates the hypothesis by taking advantage of the COVID-19 National Survey in Nigeria by specifically using survey rounds 4 and 7 which have more comprehensive religious items included.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-11-2022-0719

Prevalence, risk factors, and clinical correlates of anxiety, depression, and sleep disorders in chaperones for children in the emergency department in China during COVID-19.

The outbreak of novel coronavirus pneumonia in Wuhan, Hubei Province, in 2019 and its rapid spread across the country caused severe public panic in China. The purpose of this study was to investigate the mental health problems of children's chaperones at the emergency clinic during the coronavirus disease 2019 (COVID-19) outbreak and to analyze the related influencing factors. A total of 260 chaperones for children in the emergency department participated in this cross-sectional study through the questionnaire constellation platform. The survey period was from February to June 2021. Information collected included demographic data and mental health scales. The Self-Assessment Scale for Anxiety, the Self-Rating Scale for Depression, and the Pittsburgh Sleep Quality Index assessed anxiety, depression, and sleep quality, respectively. Logistic regression was used to analyze influential factors associated with mental health problems. The prevalence of depression, anxiety, and sleep disorders among family members accompanying children attending the emergency room was 41.54%, 20.00%, and 93.08%, respectively, with 21.54% of family members suffering from moderate sleep disorders. Univariate analysis showed that being in Wuhan or not during the city closure (X2 = 8.61, P < .01) was strongly associated with the occurrence of depression; female (X2 = 4.87, P = .03), working or not (X2 = 6.39, P = .01) and fear of going to the hospital (X2 = 7.80, P = .01) were key factors for the occurrence of anxiety symptoms; Knowledge of transmission routes and prevention of COVID-19 (X2 = 12.56, P = .03) was a key factor for sleep disorders; logistic stepwise regression analysis showed that fear of going to the hospital was a risk factor for anxiety symptoms (odds ratio = 2.51, P < .01, 95% confidence interval = 1.30-4.85). Our findings suggest that mental health problems were prevalent among family members accompanying children attending the emergency department during the COVID-19 outbreak, with a high prevalence of sleep disturbances in particular. Relevant factors included presence or absence in Wuhan during the outbreak closure, gender, work or absence, and fear of hospital visits. There is a need to focus on the mental health distress of the chaperones for children in the emergency department, and to provide timely intervention and diversion.

Co-Deployment is an Answer, but What are the Questions? Insights from Officer Focus Groups in Philadelphia

ABSTRACT Cities have been experimenting with less police-centered models for responding to people experiencing mental health crises. Ten focus groups were conducted with Philadelphia police officers to understand their experiences encountering mental health distress in the community and their perspectives on a new co-deployment initiative. There was general consensus that conventional police-centered responses to mental health concerns are often problematic. However, perspectives varied on the value of co-deployment and the general feasibility of reducing police involvement. This variation is traced to different notions of what constitutes a mental health crisis, whether crises are prospectively identifiable, how dangerousness is assessed, and whether civilian co-response partners will effectively complete key response activities. Bringing greater understanding and consensus to these issues is essential to healthier and more effective responses to mental health crises.

Formal Caregivers in Intellectual Disability Facilities

IntroductionCaring for individuals with intellectual disabilities is a passionate, but challenging profession. Whether working in residential homes or in occupational facilities, its staff deals with the ordinary issues of teamwork, but also with these clients behavioral comorbidities. It often includes self-harming and aggression towards others – namely towards the staff itself. This is particularly relevant since a high turnover of staff implies the loss of people who are familiar with the needs and specificities of those clients. The quality of care provided may also be affected.ObjectivesTo investigate whether, or not, formal caregivers are at greater risk of occupational health issues, and what their main determinants are.MethodsResearch in Medline for intellectual disability caregivers. Only the relevant articles, published in English, were considered.ResultsAmong formal caregivers of people with intellectual disabilities, job dissatisfaction and job strain were found to be especially relevant and were associated to the following variables:• Younger workers or those with less professional experience• Personality and individual maladaptive coping strategies• Poor organizational support• Conflicting, ambiguous, or overloaded professional roles• Unclear work tasksThe incidence of Burnout Syndrome was also described as relevant among these workers and was associated not only to aggression towards the worker, but also to the fear of aggression.ConclusionsCaring for people with intellectual disabilities, in a residential or in an occupational context, implies heavy emotional and physical demands and a high prevalence of job dissatisfaction, Job Strain and Burnout Syndrome. In addition to the high risks to the quality of life and health of caregivers, there are consequences for the quality of the care that is provided. For this reason, guaranteeing proper work conditions should be considered part of the Social Institutions main goals. Yet, we lack specific, controlled studies that properly evaluate what measures could indeed help institutions to prevent occupational (and mental) health distress among their staff.Disclosure of InterestNone Declared

Exploring First-Year Students' Demands and Resources in the South African Context

The growing concern about the mental health and psychological distress of first-year students warrants a greater understanding of their well-being. This study explored the insights of 16 staff and service providers who engage with first-year students at a South African peri-urban campus and built on quantitative studies using the Job Demands-Resources (JD-R) model to understand student well-being. In-depth interviews offered insight into the demands and resources experienced by a largely rural student population. Five themes emerged: (a) transition to university life, (b) the nature of the academic environment, (c) the economic experiences of studying, (d) accommodations and facilities, and (e) the complex lives of first-year students. The study informs the JD-R model from a student context. Implications for practice and future research are discussed.

Mental health and post-traumatic growth in multiple sclerosis

Introductionpeople suffering from multiple sclerosis (MS) can experience post-traumatic growth (PTG), a sense of personal growth and benefit gain. Patients mental health can play an important role in PTG development.Objectivesto explore possible differences in mental health according to PTG levels.Methodsthe sample was composed of 392 outpatients with MS from Virgen de la Macarena University Hospital (268 women; 124 (31.6 %) men, ages 19-78 years old (mean 45.61 years, SD=11.16 years). Expanded Disability Status Scale (EDSS) mean score was 3.38 (SD=2.06). Relapsing remittent (n=327) and progressive (n=65) MS type were reported. Post-traumatic Growth Inventory (PGI-21) measured patients perception of personal benefit gain after MS experience. General Health Questionnaire-28 (GHQ-28) evaluated Mental Health distress symptoms. Unpaired t-test was used to identify differences in mental health distress between “low PTG ≤49 score” and “high PTG ≥50 score” groups.ResultsSignificant differences were found in social dysfunction (t=2.521, p=0.012) and severe depression (t=2.442, p=0.015), “high PTG group” (n=194) presented lower scores compare to “low PTG group” (n=198). No significant difference was detected in somatic symptoms (t=0.185, p=0.087) and anxiety and insomnia (t=0.859, p=0.391).Conclusionspatients with higher PTG reported a better mental health. This suggests the relevance of mental health status in positive outcomes development after an adverse life event. Particularly, social dysfunction and depressive symptoms should be considered in interventions aimed to promote positive outcomes as personal gain and benefit finding in MS population.Disclosure of InterestNone Declared

Asian American parents' experiences of stress, discrimination, and mental health during COVID-19.

COVID-19 has placed Asian Americans (AA) at higher risk for discrimination within the U.S. This exacerbates the mental health distress of AA parents, who are also experiencing COVID-19-related stress (e.g., health, financial, work, childcare). The risk factors associated with mental health outcomes for AA parents are not well understood. This brief report examined the relationships among COVID-19 stress, discrimination, and psychological distress of AA parents during the initial months of the pandemic. Baseline data of an ongoing longitudinal examination into the COVID-19 experiences of AA parents and their families were utilized. Participants were 166 AA parents of children ages 2-19 years. They completed an online survey about their experiences of COVID-19-related stress (i.e., childcare, school, work), discrimination, and psychological distress. The majority of AA parents were highly stressed due to school closures and childcare changes; school-age parents reported significantly more stress resulting from school closures than parents of young children or adolescents. Over 21% of AA parents experienced some discrimination resulting from COVID-19; the majority reported discrimination fears for themselves and their family/friends. Experiencing discrimination was positively associated with psychological distress, as was COVID-19 stress related to work performance and relationship quality. Conversely, the majority of parents reported increased quality time with their family (i.e., children, partners). AA parents are experiencing high levels of COVID-19-related stress, and have the added psychological burden of experiencing and fearing racial/ethnic discrimination. However, the pandemic has led to families spending more quality time together. Implications for future studies are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Shattered or Strengthened? The Impact of Extended Lockdown on Family Functioning and Quality of Relationships during the COVID-19 Pandemic

INTRODUCTION: While much research has focused on mental health and well-being during the early stage of the Covid-19 pandemic, significantly fewer studies have directly explored the connection between lockdown policies, family functioning, and effects on the mental health of parents in highly vulnerable communities in low-income countries where pre-pandemic conditions were already unstable. This study aims to address this gap and examines the quality and nature of relationships with spouses, children, and extended families in highly vulnerable communities during an extended lockdown period.&#x0D; &#x0D; METHODS: With the approval of the appropriate Institutional Review Board and after receiving verbal consent, following standard local procedures, 30 individuals participated in in-depth semi-structured telephone surveys that were conducted three months following the lifting of the lockdown restrictions to assess the impact of the extended quarantine periods on mental health, overall family functioning, and relationships with spouses/partners, children, and extended family.&#x0D; &#x0D; RESULTS: Findings indicate that mental health distress post-lockdown predicts changes in the nature and quality of relationships with spouses, children, and extended family and increased risks for family violence.&#x0D; &#x0D; CONCLUSION: Findings highlight the differential impact of global health crises on highly vulnerable communities facing complex issues with limited access to adequate care systems. By reframing large-scale pandemics as complex emergencies, our results can inform current policies and support interventions and preventive measures preparing families to better cope with similar emergencies.

Structural Pathways Between Social Support and Mental Health Among STEM Students: Implications for College Student Psychotherapy

ABSTRACT An abundance of academic resources exists for supporting college students enrolled in science, technology, engineering, and mathematics (STEM) majors. However, the dearth of research on supporting STEM students’ mental health is concerning, as STEM students face unique risks for mental health distress and utilize mental health services at lower rates than their counterparts. To begin addressing this gap in the literature, we found statistically significant structural links from STEM students’ perceived social support from friends and family to increases in their mental health. Results also revealed that male STEM students self-reported higher levels of mental health than female students. Findings are discussed in terms of implications for practice, including how college counselors and psychotherapists can use social support as one method for supporting STEM students’ mental health.

A typology of the sources of mental health precarity among migrant workers in India during the COVID-19 lockdown

When urban workplaces shut down for the COVID-19 pandemic lockdown in India, a very large number of migrant workers were forced to reverse-migrate to their largely rural points of origin. This article looks at the mental health implications of the period migrants spent without work, back at the low-resource places from which they had out-migrated, in hopes of a better life. Based on qualitative interviews conducted with reverse migrants during the COVID-19 pandemic lockdown, this article has a two-fold aim. The first aim is to reach the experiences and voiced concerns of precarious and vulnerable migrants to those who may be in a position to ameliorate their distress. Since policy-makers tend to lack time, findings from the qualitative data have been summarized in the form of a multi-dimensional typology, open to expansion by further research. The typology sees themes in money, health, information, and isolation. Second, the article follows the issues in the typology to suggest that acknowledgment of the significant role of migrant workers in India's economy, via sensitive enumeration, would be a first, and essential step to address the multiple concerns raised by migrant workers themselves. This baseline information could then be used to build subsequent dependent steps addressing the myriad causes of mental health distress among migrant workers in India.

Do Dimensional Measures of Mental Health Symptoms Predict Level of Alcohol Involvement in the General Population?

Background: There is a limited understanding of what specific mental health symptoms are associated to alcohol involvement. It is important to understand how the severity of different mental health dimensions may differ, and distinguish between, levels of alcohol involvement. Objectives: (a) explore for differences in severity of mental health symptoms between those with lower, and moderate/high alcohol involvement, (b) assess the degree to which mental health dimensions can distinguish between those with lower, and moderate/high alcohol involvement, and (c) examine what mental health dimensions are related to the highest risk of moderate/high alcohol involvement. Results: 400 participants representative of the general population in the USA were recruited online through Prolific and completed the Alcohol, Smoking and Substance Involvement Screening Test and Brief Symptom Inventory. Each of the nine mental health symptom dimensions significantly differed between lower and moderate/high alcohol involvement, with the moderate/high alcohol involvement group reporting greater severity symptoms. The nine symptom dimensions in combination also significantly distinguished lower and moderate/high alcohol involvement, however only somatization offered unique predictive utility. Lastly, global distress was also able to significantly distinguish the alcohol involvement groups, albeit to a lesser accuracy compared to the collection of individual symptom dimensions. Conclusions: These findings suggest that overall mental health distress may be important to understanding alcohol involvement, however individual symptom dimensions can add further explanatory variance. In particular, somatic symptoms may offer unique utility in understanding the relationship between mental health and alcohol involvement.

Trends in maternal mental health during the COVID-19 pandemic-evidence from Zambia.

The COVID-19 pandemic has increased social and emotional stressors globally, increasing mental health concerns and the risk of psychiatric illness worldwide. To date, relatively little is known about the impact of the pandemic on vulnerable groups such as women and children in low-resourced settings who generally have limited access to mental health care. We explore two rounds of data collected as part of an ongoing trial of early childhood development to assess mental health distress among mothers of children under 5-years-old living in two rural areas of Zambia during the COVID-19 pandemic. We examined the prevalence of mental health distress among a cohort of 1105 mothers using the World Health Organization's Self-Reporting Questionnaire (SRQ-20) before the onset of the COVID-19 pandemic in August 2019 and after the first two infection waves in October-November 2021. Our primary outcome was mental health distress, defined as SRQ-20 score above 7. We analyzed social, economic and family level characteristics as factors modifying to the COVID-19 induced changes in the mental health status. At baseline, 22.5% of women were in mental health distress. The odds of mental health distress among women increased marginally over the first two waves of the pandemic (aOR1.22, CI 0.99-1.49). Women under age 30, with lower educational background, with less than three children, and those living in Eastern Province (compared to Southern Province) of Zambia, were found to be at highest risk of mental health deterioration during the pandemic. Our findings suggest that the prevalence of mental health distress is high in this population and has further worsened during COVID-19 pandemic. Public health interventions targeting mothers' mental health in low resource settings may want to particularly focus on young mothers with limited educational attainment.

Appointment attendance behaviors in multiple sclerosis: Understanding the factors that differ between no shows, short notice cancellations, and attended appointments.

There has yet to be an examination of how appointment attendance behaviors in multiple sclerosis (MS) are related to scheduling metrics and certain demographic, clinical, and behavioral factors such as cognitive functioning and personality traits. This study aimed to examine the factors that differ between no shows (NS), short notice cancellations (SNC), and attended appointments. Participants (n=110) were persons with MS who were enrolled in a larger cross-sectional study, during which they completed a battery of neuropsychological measures. Data about their appointments in three MS-related clinics the year prior to their study evaluation were extracted from the medical record. Bivariate analyses were done, with post-hoc tests conducted with Bonferroni corrections if there was an overall group difference. A higher number of SNC were noted during the winter, with 22.4% being due to the weather. SNC were also more common on Thursdays, but less frequent during the early morning time slots (7am to 9am). In contrast, NS were associated with lower annual income, weaker healthcare provider relationships, lower self-efficacy, higher levels of neuroticism, depressive symptom severity, and health distress, and greater cognitive difficulties, particularly with prospective memory. While SNC are related to clinic structure and situational factors like the weather, NS may be more influenced by behavioral issues, such as difficulty remembering an appointment and high levels of distress. These findings highlight potential targets for reducing the number of missed appointments in the clinic, providing opportunities for improved healthcare efficiency and most importantly health.

Immigration-related Legal Collaboration in Primary Care: Evaluating Impact on Knowledge and Well-being.

To evaluate the impact of embedding an immigration attorney in a primary care clinic to address immigration-related legal needs. We conducted a mixed-methods study of 42 legal clinic participants from May 2019-February 2020. Measures included psychological distress, understanding of legal options, and self-rated general health collected prior to, following, and 60-90 days after consultation. There was significant improvement in participants' understanding of their legal immigration options pre- (4.9, SD 2.9) and post-consult (8.6, SD 2.1), and 60 days later (7.0, SD 2.8) (F=11.0, p&lt;.05), but self-rated health scores and distress did not significantly improve, although there was a high loss-to-follow up rate at 60 days (42.8%). Qualitative results underscored the interconnectedness of immigration status and health. Embedding immigration legal services in primary care improved patients' understanding of immigration-related legal options, although successfully mitigating the health impacts of vulnerable immigration status may take broader societal interventions.