Health Providers Research Articles

Experiences of Acculturation Stress in First-Generation Immigrant Children: Examining the Relationship Among Acculturation Stress, Depression, and Family Dynamics

AbstractThroughout the years, immigration has been a significant movement in the USA and leads to the examination of acculturative stress. By employing the acculturation stress and vulnerability models, the present study aimed to examine the association among acculturation stress, self-esteem, depression, family cohesion, and familism in first-generation immigrant children. Longitudinal data from the Children of Immigrants Longitudinal Study (CILS) were used. The analytical sample (n = 5262) was predominantly female (51.1%) and between the ages of 12 and 18 (M = 14.23) years old. SPSS 27 and AMOS 27 were utilized to conduct a path analysis to examine the relationships among acculturation stress, self-esteem, depression, family cohesion, and familism. Our results showed good fit (χ2/df ratio = 11.49; CFI = 0.91; RMSEA = 0.05, CI [.04, .05]) for the full path model. Acculturation stress had a significant, negative association with depression (β = − 0.12, p < .001); a significant, negative association with self-esteem (β = − 0.12, p < .001); and a significant, positive association with family cohesion (β = 0.60, p < .01) and the familism index (β = 0.05, p < .05). Acculturation stress was found to be predictive of self-esteem, depression, and family cohesion for first-generation immigrant children between the ages of 12 and 18 years old. This study provides general implications for how mental health providers can understand the struggles and provide culturally competent therapeutic services for children and their families.

Women's Perspectives on Post-partum Family Planning in Banyumas, Indonesia.

Background: A recent programmatic shift in the provision of family planning in the Global South led to a renewed focus on post-partum family planning (PPFP). PPFP embodies a shift in the primary narrative of global family planning programs, from fertility reduction to promoting maternal and child well-being.Purpose: We examine key factors that shape women's knowledge, attitudes and practice of PPFP in Banyumas, Indonesia.Methodology: We employed a qualitative approach utilizing focus group discussions with pregnant women and women with children aged less than 1 year old (n = 44), and in-depth interviews with health service providers (n = 10). Guided by the research questions, we conducted a thematic analysis of the transcripts.Results: Our findings demonstrate how women's agency within marriage, their social and familial networks, their interactions with healthcare providers, and policy changes related to reproductive health and health insurance schemes, all influence the extent to which women's rights to information and choice regarding post-partum family planning can be realized. Conclusions: Key implications for practice include the necessity for health providers to offer unbiased information about contraceptive options, to engage local leadership effectively, and to ensure that government targets for the PPFP program align with women's needs and the health and social conditions of the community.

Psychological and psychiatric standardized procedures for metabolic bariatric surgery: a clinical practice model for mental health providers.

Obesity is a multifactorial and chronic disease, constantly growing in prevalence. Metabolic and Bariatric Surgery (MBS) is among the most effective therapies for obesity, determining consistent long-term weight loss and maintenance. Increasing evidence suggests a relevant mental health contribution to obesity pathogenesis. European and International Guidelines for MBS emphasize the importance of a pre-surgical psychological/psychiatric assessment and a post-surgical follow-up to improve MBS outcomes. Yet, no standard psychological/psychiatric procedures currently exist. This paper overviews the psychological/psychiatric procedures which Italian mental health providers currently perform on MBS candidates to provide psychological support through every step of the MBS, from the assessment to the postsurgical follow-up, to evaluate eligibility, prevent mental health flare-ups and weight regain, as endorsed by the Board of the Italian Society of Surgery for Obesity and Metabolic Diseases (SICOB). The psychological/psychiatric procedures should encompass two phases: pre-surgical assessment and post-surgical follow-up. Pre-surgical assessment should investigate every condition that might reduce the MBS effectiveness or contraindicate the surgical process. It must include a mental state evaluation, weight history, eating behavior, body image, psychosocial conditions, and motivation. The post-surgical follow-up should offer psychological support to patients in achieving weight loss and maintenance. It should also prevent the onset or recurrence of psychiatric disorders that may affect clinical outcomes. This paper is the first to introduce a standardized protocol for psychological/psychiatric procedures for each phase of the surgical process, to allow MBS candidates to receive similar care despite geographical differences. It also serves as a potential clinical model for assessing mental eligibility or contraindications prior to MBS, and subsequently support the individual behavioral and lifestyle changes to achieve and maintain weight loss.

Potential Harm in the Psychological Treatment of Sexual and Gender Minority Youth.

Sexual and gender minority (SGM) individuals show disproportionately high rates of mental distress relative to their cisgender, heterosexual peers resulting from minority stress, or unique identity-related stressors. The majority of research on minority stress and mental health in SGM individuals has focused on adults, a notable gap given that SGM youth face unique developmental factors that intersect with identity development and availability of support resources. SGM youth therefore represent a critical population for the mental health workforce to serve competently. Mental health providers risk significant harm to their SGM youth clients if they do not understand the mechanisms underlying mental health disparities in this population. This article will review treatment practices that carry the potential for harm with SGM youth, including harms that are more overt and attempt to change SGM identities (i.e., so-called "conversion therapies"), and others that are more covert, such as neglecting to consider SGM identity in conceptualization and treatment (e.g., eating disorders), pathologizing SGM identity and behaviors (e.g., personality disorders, social anxiety), and reinforcing stigma related to SGM identities (e.g., obsessive-compulsive disorder). Accordingly, this article reviews each of these potential harms in detail and provides alternative recommendations for affirming and justice-based treatment for SGM youth.

Mental Health Care Needs and Access to Care for Adults With Intellectual Disabilities.

Adults with intellectual disabilities (IDs) are at greater risk for psychiatric disorders than the general population. Yet, they have limited access to mental health services. To examine the prevalence of psychiatric disorders in adults with ID. To describe evidence-based interventions for this population, their access to mental health care, and outline opportunities for improved access. This manuscript summarizes literature regarding psychiatric disorders in adults with ID and their access to behavioral health care. We considered articles referencing mental health care for adults with ID. PubMed and a variety of search terms were used. Studies published in English from 2010 to the date of the searches were included. Quantitative and qualitative study designs, review articles, program descriptions, and opinion papers were considered for inclusion. Additional references from the selected articles were also considered. We identified 2864 records. One hundred two records were included, consisting of work commenting on mental health and ID and access to care in the United States. The articles describe increased psychiatric comorbidities in adults with ID. They highlight the few evidence-based interventions for psychiatric comorbidities and the limited access to care. Our mental health care providers generally have minimal training and experience with people with ID, limiting access to appropriate care for these individuals. Improved access could be created by increasing education and experiences with these populations for mental health providers. Aligning policies, financing, and adequate insurance reimbursement to develop a continuum of care will be critical for these individuals.

World Stroke Organisation (WSO): Global intracerebral haemorrhage factsheet 2025.

Intracerebral haemorrhage (ICH) is stroke caused by non-traumatic bleeding into the brain. Globally, stroke was the third-leading cause of death in 2021, and ICH accounted for 28.8% of incident strokes. There were estimated to be 7,252,678 deaths due to stroke in 2021 of which ICH accounted for 3,308,367 (45.6%). When considering the burden of ICH in terms of disability adjusted life years (DALYs), ICH accounts for nearly half of the burden of stroke at 49.5%, compared to 43.8% caused by ischaemic stroke. ICH must therefore be considered on an equal footing with ischaemic stroke, so that efforts can be made to reduce its burden through public health, research and healthcare provision. Although the overall age-standardised incidence of ICH has been decreasing since 1990, the rate of reduction has been much slower in regions with lower socio-demographic index (SDI). Most of the burden of ICH lies in areas with lower SDI, with 94.2% of DALYs lost to ICH outside areas of high SDI. Geographically, the majority of DALYs due to ICH occur in Southeast Asia, East Asia, and Oceania, with 53.3% of global DALYs lost in these regions alone. The risk factors for ICH are dominated by high systolic blood pressure, which accounts for at least 50% of the burden of ICH, regardless of SDI. Areas with middle or high-middle SDI have a greater proportion of the burden of ICH accounted for by ambient particulate pollution, smoking and diets high in sodium, whereas household air pollution from solid fuels accounts for much more of the risk of ICH in low SDI regions. This World Stroke Organisation (WSO) Global ICH Fact Sheet 2025 provides the most updated information on ICH that can be used to support communication with all internal and external stakeholders, inform healthcare policy, and raise public awareness. All statistics have been reviewed and approved for use by the WSO Executive Committee.

Association of General Anesthesia for Cesarean Delivery with Postpartum Depression and Suicidality.

Compared to neuraxial anesthesia, general anesthesia (GA) for cesarean delivery is associated with an increased risk of postpartum depression (PPD) requiring hospitalization. However, obstetric complications occurring during childbirth (eg, stillbirth) are associated with both increased use of GA and increased risk of PPD, and may account for the reported association between GA and PPD. This study assessed the association of GA for cesarean delivery with PPD requiring hospitalization, outpatient visit, or emergency department (ED) visit, accounting for obstetric complications. This retrospective cohort study included women who underwent a cesarean delivery in New York State between January 2009 and December 2017. Women were followed for 1 year after discharge for readmission, outpatient visit, or ED visit. The primary outcome was PPD requiring readmission, outpatient visit, or ED visit. The 2 secondary outcomes were (1) PPD requiring readmission, and (2) suicidality. Obstetric complications included severe maternal morbidity, blood transfusion, postpartum hemorrhage, preterm birth, and stillbirth. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of PPD, PPD requiring readmission, and suicidality associated with GA were estimated using the propensity score matching and the overlap propensity score weighting methods. Of the 325,840 women included, 19,513 received GA (6.0%; 95% CI, 5.9-6.1). Complications occurred in 43,432 women (13.3%) and the GA rate for these women was 9.7% (95% CI, 9.4-10.0). The incidence rate of PPD was 12.8 per 1000 person-years, with 24.5% requiring hospital readmission, and was higher when an obstetric complication occurred (17.1 per 1000 person-years). After matching, the incidence rate of PPD was 15.5 per 1000 person-years for women who received neuraxial anesthesia and 17.5 per 1000 person-years for women who received GA, yielding an aHR of 1.12 (95% CI, 0.97-1.30). Use of GA was associated with a 38% increased risk of PPD requiring hospitalization (aHR: 1.38; 95% CI, 1.07-1.77) and with a 45% increased risk of suicidality (aHR 1.45; 95% CI, 1.02-2.05). Results were consistent when using the overlap propensity score weighting. Use of GA for cesarean delivery is independently associated with a significantly increased risk of PPD requiring hospitalization and suicidality. It underscores the need to avoid using GA whenever appropriate and to address the potential mental health issues of patients after GA use, specifically by screening for PPD and providing referrals to accessible mental health providers as needed.

Factors influencing engagement in oral cancer prevention activities among dental students and professionals in Saudi Arabia

BackgroundOral cancer is a pressing health concern in the Saudi Arabia (SA), with rising incidence and mortality rates. Despite the efforts in raising awareness, gaps persist in knowledge, attitudes, and practices (KAP) related to oral cancer prevention (OCP) among dental health professionals. This study aimed to identify the key factors influencing engagement in oral cancer prevention activities among dental students and professionals in Saudi. It examines the impact of socio-demographic characteristics and assesses their KAP related to oral cancer prevention.MethodA cross-sectional study was conducted between November 2023 and February 2024 using a pre-validated online questionnaire distributed among oral health providers across various regions and sectors in SA. The survey included questions about participants’ KAP toward OCP. Descriptive statistics and logistic regression analyses were used to analyze the data.ResultsOut of 400 oral health providers invited, 157 completed the survey. The findings showed a discrepancy between knowledge and practice. While awareness of OC was generally high, this did not consistently lead to favourable attitudes or effective practices. The engagement in OCP activities was significantly associated with good knowledge, practice and favourable attitude scores. Profession significantly influenced participation, with clinicians (P = 0.013, OR = 0.131, 95% CI: 0.026–0.653) and those in administrative roles (P = 0.030, OR = 0.101, 95% CI: 0.013–0.804) both less likely to participate compared to dental students. Knowledge was a significant predictor (P = 0.002), with providers demonstrating poor knowledge being far less likely to participate (OR = 0.053, 95% CI: 0.008–0.339).ConclusionThe study identified a critical need for enhancing OCP education and training among oral health providers in SA. The findings indicate that continuous, targeted, and culturally sensitive training could bridge the existing KAP gap, potentially leading to improved early detection and management of OC, thereby reducing its morbidity and mortality rates in the region.

Supporting psychiatric mental health nurse practitioners’ preparedness to treat mental health concerns during pregnancy: Results from a grounded theory study

Background and objective: Pregnant persons are less likely to be screened and treated for depression and anxiety during pregnancy compared to the pre- and post-natal periods, despite adverse effects associated with untreated mental health concerns during pregnancy. Patients have reported that maternal and mental health providers seem unable or unwilling to discuss treatment with psychopharmacological options during pregnancy. Literature concerning this pattern has not included the perspective of psychiatric mental health nurse practitioners (PMHNP). The objective of this study was to identify the barriers and needs of PMHNPs regarding the treatment of mental health concerns during pregnancy.Methods: In this constructivist grounded theory study, data were collected between February 2023 and February 2024 through in-depth interview. Eligible participants were PMHNPs, or PMHNP students, working with patients who might become pregnant in an outpatient setting.Results: Seventeen PMHNPs or students participated in this study. Many believed they were unprepared to treat pregnant patients and described barriers and needs that impede their comfort and willingness to treat people who are pregnant. These included inadequate training, limited research, and concerns about legal liability. PMHNPs requested more information about perinatal mental health and its treatment to be incorporated into training programs and clinical experience.Conclusions: Many PMHNPs were unaware or underinformed of available resources and best practices for treatment during pregnancy. In addition to best practices for the treatment of people who are pregnant, PMHNP programs should consider including preparation for the emotional consequences of practice as well as clear and accurate information about malpractice and liability risks.

Service Quality Standards and Organisation Performance of Private Hospitals in Eldoret City, Kenya

The private health sector has received much attention in recent times and is crucial in the expansion of access to quality healthcare. The majority of private hospitals in the country are undergoing performance challenges due to the inability to retain and satisfy their customers. Because of the improvements in health provision by county governments, private hospitals are facing increasing performance challenges due shortage of human resource personnel, shortage of medical services and inadequate medical infrastructure. Therefore, this study sought to find how the level of implementation of service quality standards affected the organisation performance of private hospitals. This study is supported by the Service Quality (SERVQUAL) model. The study is quantitative in nature guided by correlational research design. The study was conducted in Eldoret town covering major hospitals classified from Level 3B and above. The target population involved 1875 employees from 25 private hospitals in Eldoret town. A sample size of 319 respondents was chosen through the Cochran sample size formula to be representative of the whole population. The respondents (319) out of 1875 were selected using stratified and random sampling techniques. The research instrument used in data collection was a questionnaire. Data analysis was undertaken through the use of descriptive statistics; frequencies, percentages, means and standard deviation inferential statistics; correlation and linear regression with the help of Statistical Product and Service Solutions computer software. Findings showed service quality standards (β=0.240) had a significant positive effect on the performance of private hospitals in Eldoret town. It is concluded that the performance of hospitals is dependent on the extent to which service quality standards were implemented by the management of private hospitals in Eldoret. The study recommends that private hospitals regularly collect customers’ feedback to improve the standards of services/ The study findings provide solutions to private hospitals on the way to improve their performance through the adoption of quality healthcare service strategies in the delivery of services to patients

Mental Health Support for First Responders Provided Outside of California's Workers' Compensation System.

Concern about psychiatric injuries for first responders has grown. We examine alternatives to workers' compensation (WC). We conducted 15 interviews across 5 California departments contracted with non-WC mental health (MH) providers. We performed content analysis. MH support outside of WC most often was a dedicated contract with outside MH providers for assessment, diagnosis, and treatment. Departments had formal financing mechanisms with union and city support designating funding for MH care. Frustration and past WC experiences drove the desire for WC alternatives. First responders reported high levels of stigma associated with MH care. Compared to WC, these alternatives allowed more comprehensive services to injured workers along with ease of accessing care, expediting the healing process. Contracting culturally competent MH providers outside of WC for first responders has potential and needs formal evaluation.

Migration and mental health care in South Africa: the question of language in context

Access to mental healthcare for migrants is a global problem, with many challenges and barriers, including the issue of language discordance. Most research on this topic comes from well-resourced countries...

Suicide exposure in a snowball sample of mental health providers.

Suicide exposure in a snowball sample of mental health providers.

Access to Care and Health-Related Quality of Life in Multiple Sclerosis.

Despite their high health care use, it is unclear whether the health care needs of people with MS are being met and what their priorities are. We assessed priorities for access to, and affordability of care, by people living with MS in the United States. We also tested the association between perceived inadequate access to care and health-related quality of life (HRQoL). In Fall 2022, we conducted a cross-sectional survey of participants in the North American Research Committee on Multiple Sclerosis Registry about access to care and HRQoL (Health Utilities Index Mark III). We used multivariable polytomous logistic regression to test sociodemographic and clinical factors associated with access to care. We used multivariable linear regression analysis to test the association between access to care and HRQoL. We included 4,914 respondents in the analysis, of whom 3,974 (80.9%) were women, with a mean (SD) age 64.4 (9.9) years. The providers who were most reported as needed but inaccessible were complementary providers (35.5%), followed by allied health providers (24.2%), occupational therapists (22.7%), and mental health providers (20.7%). Over 80% of participants reported that it was important or very important to be able to get an appointment with their primary MS health care provider when needed, to have sufficient time in their appointments to explain their concerns, to see their neurologist if their status changed, and that their health care providers communicated to coordinate their care. Participants who reported needing to see the provider but not having access or seeing the provider but would like to see them more often had lower HRQOL (ranging from -0.059 to -0.176) than participants who saw the provider as much as needed. Gaps in access to care persist for people with MS in the United States and substantially affect HRQoL. Improving access to care for people with MS should be a health system priority.

Behavioral weight loss interventions in college health centers: A qualitative analysis of barriers and facilitators to implementation.

Emerging adults are underrepresented in standard behavioral weight loss interventions (BWLIs). Offering BWLIs in college health centers may help to address obesity in emerging adulthood by reducing student barriers associated with participation; however, implementation barriers and facilitators for health centers are unknown. Health services center administrators and providers (n=14) and students eligible to participate in a BWLI (n=9, average BMI=29.8±4.2kg/m2) participated in semi-structured interviews. Interviews focused on the need for and appropriateness of BWLIs in health centers and perceived barriers and facilitators to their implementation. Participants generally believed that BWLIs delivered through a health center were appropriate and indicated that BWLIs would be a beneficial offering on-campus. Facilitators of health center implementation included availability of trained health professionals, intradepartmental relationships, supportive infrastructure and resources, and in-house planning and execution. Barriers included limited student use and knowledge of health center offerings, narrow referral/recruitment pathways related to stigma concerns, and challenges related to infrastructure, resources, and competing demands. College health centers are a feasible and appropriate setting to offer BWLIs, though barriers to implementation exist. It will be important to construct a plan for implementation to address unique barriers in health centers prior to BWLI implementation.

The Role of Laboratory Data on Outpatient Prescriptions in Improving Collaboration with the Community and Health Outcomes

Although there have been appeals for regional cooperation for a considerable time, are hospitals and local communities really working together? Hospitals typically permit a variety of professionals to work together, share information via medical records, and directly discuss patients. A problem with treating patients at home in local communities is that doctors and pharmacists do not share the same workplace; hospitals, clinics, and pharmacies do not have a common information source equivalent to medical records. Prescriptions and medical notes are the only things that connect health provision to the community. We have added laboratory data to prescriptions for outpatients to eliminate confusion. This has improved efficacy and made it easier to avoid serious side effects. It has also prevented economic losses to some extent. An important goal of medicine is to provide individualized care. This current endeavor may be a small but steady step towards this goal.

Online Mental Health Support for New Mothers: Healthcare Professionals’ Views and Experiences

The literature has focused on women’s use of online support for perinatal mental health. However, research exploring the scope of available well-being services and the views of healthcare professionals (HCPs) who deliver this provision is extremely limited. This study focused on HCPs’ experiences providing online perinatal mental health and well-being support. Based on interviews with eight UK-based HCPs providing various forms of online perinatal mental health and well-being support, reflexive thematic analysis distilled four themes that captured experiences and perceptions of online provision: 1) New ways of working bring new opportunities; 2) Obstacles and areas for development; 3) Bridging the gap— formal and informal peer support; and 4) Too little too late: lack of mental health education in antenatal services. HCPs indicated that blended ways of working (online and face-to-face) were valuable within their services. Findings emphasize the need for online support services to be available to new and expectant mothers who may not require an HCP referral. The versatility, convenience, and accessibility of online resources bridge the gap between face-to-face services and a viable economic and effective form of mental health provision. Keywords: postpartum, mental health, health professionals, online support

The influence of trauma history on opiate use disorder in an urban treatment facility in Pennsylvania

BackgroundOpioid use disorder is one of the most severe forms of substance use disorder and is associated with high morbidity and mortality. Opiate overdose deaths in the US are increasing every year, claiming over 100,000 lives in 2022. Psychological trauma exposure and post-traumatic stress disorder are major health problems in the United States and may contribute to the development of an opiate use disorder. The purpose of this study was to examine the association of psychological trauma exposure and post-traumatic stress disorder with opiate use disorder. MethodsThis study used a retrospective design with a convenience sample size of n = 150 participants diagnosed with opiate use disorder or substance use disorder from a drug treatment center in urban Pennsylvania. Retrospective data was collected on demographic characteristics, trauma exposures, diagnoses of post-traumatic stress disorder, opiate use disorder, and substance use disorder. Demographic data was gathered using a demographic survey, psychological trauma exposure was documented using the self-reported Life Events Checklist, and a diagnosis of post-traumatic stress disorder, opiate use disorder, and substance use disorder was confirmed as documented in the medical record by mental health providers. ResultsPersons with psychological trauma exposure >5 are more likely to develop opiate use disorder, Chi-Square (χ2 = 5.17, df = 1, p = 0.023). ConclusionOur study showed that psychological trauma exposure may lead to opiate use disorder, emphasizing the importance of identification of psychological trauma exposure and post-traumatic stress disorder diagnosis as part of trauma-informed strategies during the treatment of persons with opiate use disorder to help prevent disability and death.

Study protocol for a pilot randomised controlled trial of a virtually delivered behavioural intervention (ACTION) for adults with cancer at risk for opioid use disorder

IntroductionOpioid therapy is often central to pain management during cancer care. However, opioid exposure and unaddressed psychological suffering jointly amplify opioid use disorder risk. Therefore, we iteratively developed a behavioural,...

Reproductive Health in Trans and Gender Diverse Patients.

Worldwide, approximately 4.5% of adults identify as transgender or gender diverse (TGD), with up to 8.4% of youth identifying as TGD (Scheim et al 2024), suggesting that the number of TGD patients reaching reproductive age is increasing. Unfortunately, a major limiting factor to high quality reproductive health care for TGD people is lack of provider knowledge on gender-affirming treatments and reproductive needs unique to the TGD population (Korpaisarn and Safer 2018). Moreover, TGD individuals are still subjected to discrimination and mistreatment in the healthcare setting (Clark et al 2023). This special issue, a collection of 9 reviews and one survey study (Figure) aims to highlight unique considerations for reproductive health providers caring for TGD individuals and improve knowledge in this important area.