High Rates Of Mental Disorders Research Articles

The prevalence of mental illness and unmet needs of police custody detainees.

Internationally, there is evidence of high rates of mental disorders amongst police custody detainees but this literature is limited, and there has been little research into the unmet needs of police detainees in the UK, orelsewhere. Such research could support better focussedinterventions for improving health and recidivism outcomes. To examine psychiatric and developmental morbidity amongst police detainees, and ascertain differences in need between morbidity categories. We used a cross-sectional study design and interviewed a 40% sample of people entering police custody in one South London police station over a 2-week period. A series of standardised measures was administered to screen for the presence of mental illness, general health and social care needs. A cohort of 134 people was generated, of whom nearly one-third (39, 29%) had current mental illness (major depression and/or psychosis); more had a lifetime diagnosis (54, 40%). Just under a fifth met the threshold for post-traumatic stress disorder (11, 8%). Clinically relevant alcohol or daily cannabis use affected about one quarter of the sample. Twenty-one percent (or 28) screened positive for personality disorder, 11% (or 15) for attention deficit hyperactivity disorder and 4% (6) for intellectual disability. Nearly one-fifth (24, 18%) were at risk for suicide. Those with psychosis, and those deemed at risk for suicide, had the highest levels of unmet need and, indeed, overall need. The most frequent unmet need was for accommodation. Our findings not only confirm high rates of mental health problems amongst police detainees but also demonstrate their high risk of suicide and high levels of unmet need, especially as regards accommodation. This underscores the need to provide mental health services in police stations, to help identify and resolve these issues at this early stage in the criminal justice system. Extending accommodation capacity to help some arrestees may help to save lives and interrupt cycling through the criminal justice system.

Mental health, suicidal behavior and sexual orientation in Portugal

IntroductionSexual minority individuals consistently report higher rates of mental disorders and suicidal behavior than heterosexuals. However, much of this research is limited to Anglo-Saxon studies and no information on Portuguese reality is available.ObjectivesThe purpose of this study is to compare levels of mental functioning and suicidal behavior among heterosexual, bisexual, and homosexual individuals in Portugal.MethodsUsing online surveys, 1140 individuals (62.40% women, Mage = 36.83, SDage = 13.39, 76.4% heterosexual, 9.4% bisexual, and 14.2% gay or lesbian) completed the BSI subscales for depression and anxiety symptoms, as well as the Suicide Behaviors Questionnaire-Revised.ResultsSelf-identified bisexual participants presented higher levels of depressive and anxiety symptoms and higher levels of suicidal ideation and likelihood of suicidal behavior than homosexual and heterosexual participants (who scored the lowest); yet, homosexual participants showed higher levels of suicide attempts. Also, depression and anxiety symptoms were strongly and positively correlated with all dimensions of suicidal behavior. Finally, hierarchical multiple regression analysis showed that higher levels of depression and non-heterosexual sexual orientations were significant predictors of suicidal ideation and the likelihood of suicidal behavior.ConclusionsThe present study adds to the evidence that sexual minority individuals are at risk of increased mental health problems and suicidal behavior, compared to heterosexuals, and reiterates the need for local political and legislative efforts to normalize LGB identities, fighting continued institutional heterosexism, interpersonal intolerance. Mental health providers and mental health policymakers need to consider these results if they want to address inequalities in mental health and in suicidality among these minority groups.

Dynamics of Mental Health and Healthcare Use among Children and Young Adults

AbstractDespite the high rates of mental disorder in adolescents and young adults, treatment utilisation is low. Using Australian longitudinal administrative and survey data, we show an increasing proportion of young people are accessing nervous system scripts as they age. Younger cohorts have increasingly accessed these scripts earlier; usage is generally higher among disadvantaged groups and in regions with better mental health service access. Less than half of all young adults facing very high psychological distress in 2018 had recently accessed mental health care. Instead of professional help, young people turn to friends and family for help with personal and emotional problems.

Mental Health Services in a U.S. Prison During the COVID-19 Pandemic.

Pandemics pose unique risks to people in correctional facilities. Among other vulnerabilities, incarcerated populations often have high rates of mental disorders and substance use disorders, which may increase risks for morbidity and mortality during a pandemic. California's San Quentin State Prison (SQSP) experienced multiple outbreaks during the 1918 influenza pandemic, and, a century later, the prison faces a new pandemic. This Open Forum describes the modification of mental health services in SQSP during the early stages of the COVID-19 pandemic. The authors explore the challenges of reducing risks of viral contagion while maintaining high-quality mental health care in a correctional setting.

The lesbian, gay, bisexual and transgender communities' mental health care needs and experiences of mental health services: An integrative review of qualitative studies.

INTRODUCTION: The lesbian, gay, bisexual and transgender (LGBT) communities are a minority population that experience a range of health disparities, including mental health. Because these groups have higher rates of mental disorder than the general population it is, therefore, pertinent to identify their specific mental health needs and their experiences when accessing mental health care. To identify the mental health needs of the LGBT communities and their experiences of accessing mental health care. An integrative review of qualitative studies was conducted. A total of fourteen studies were selected for this review. The studies identified that participants' experiences of accessing mental health care were related to (a) experiencing stigma and (b) staff's lack of knowledge and understanding of LGBT people's needs. They identified a need for mental health care that promotes the principles of equity, inclusion and respect for diversity. The LGBT communities while not a homogenous group, face unique challenges when dealing with their mental health needs. Services that promote health equity and self-acceptance are important for this group. It is vital that mental health nursing education incorporate models that promote equity, inclusion and respect for diversity regarding this group of people.

Prevalence of Mental Ill-Health in a Cohort of First Responders Attending the Fort McMurray Fire.

The study was designed to estimate the prevalence of mental disorders in a cohort of firefighters who had been deployed to a devastating fire in Fort McMurray, Alberta, in 2016. A cohort of firefighters was established and followed up by online questionnaires. The contact in October 2018 to March 2019 included the PCL-5 questionnaire screening for post-traumatic stress disorder (PTSD) and the Hospital Anxiety and Depression Scale (HADS) screening for anxiety and depression. A sample was selected comprising all scoring ≥31 on the PCL-5 or ≥12 on either scale of the HADS, 30% of those scoring 8 to 11 on the HADS, and 10% of those with lower scores on all scales. This sample was assessed through a structured clinical interview to categorize disorders as defined in Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5). Interviews were carried out face-to-face or by telephone between August 2019 and February 2020. Diagnoses in the interview sample were reweighted to obtain prevalence estimates for the whole cohort. In an analysis of receiver operating characteristics (ROC), possible cut points for scores from each screening questionnaire were examined. In 2018 to 2019, 1,000 of the cohort of 1,234 firefighters completed the HADS and 998 completed the PCL-5. Of these, 282 were identified for structured clinical interviews for DSM-5 (SCID) assessment. Interviews were carried out with 192. Among those assessed, 40.6% met the criteria for PTSD, 30.7% for an anxiety disorder, and 28.5% for a depressive disorder. When reweighted to allow for sampling and losses to assessment, cohort prevalence estimates were as follows: PTSD 21.4% (15.7% to 29.1%), anxiety disorders 15.8% (11.0% to 22.5%), and depressive disorders 14.3% (9.9% to 20.8%). Lower prevalence estimates were obtained when using the cut point with least misclassification in the ROC analysis. Using the gold-standard SCID assessment, high rates of mental disorders were found in this cohort of firefighters who had experienced a devastating fire. Fewer cases would have been identified by screening questionnaire alone.

Mood disorders comorbidity in obese bariatric patients: the role of the emotional dysregulation

BackgroundObese patients seeking bariatric surgery are known to show high rates of mental disorders, mainly mood and eating disorders. The aim of the present study is to evaluate psychiatric comorbidities, affective temperamental dimensions, emotional dysregulation and impulsivity in a sample of obese bariatric patients, exploring the differences between obese patients with and without mood disorders (MD). MethodsA total of 69 obese patients were consecutively enrolled between March and November 2019 during the presurgical evaluation routinely performed before the bariatric intervention. Sociodemographic and clinical features were collected by psychiatrists during a single consultation. Affective temperaments, emotional dysregulation and impulsivity were also investigated through self-report questionnaires. Epidemiological and clinical variables were compared between patients with and without MD. ResultsIn our sample, almost 3 out of 4 patients presented a lifetime psychiatric disorder, mainly MD (n=33, 48%), binge eating disorder (BED) (n=34, 49%) and anxiety disorders (n=30, 43%). Compared to N-MD patients, those with MD showed higher rates of psychiatric comorbidity with BED, bulimia and panic disorder. In addition, obese patients with MD showed more frequently cyclothymic, depressive and anxious temperaments, and higher mean scores on the psychometric questionnaires assessing emotional dysregulation and impulsivity compared to obese subjects without MD. Limitationsthe small sample size, the retrospectively assessment of psychiatric disorders and the self-report questionnaires. ConclusionsA subgroup of obese patients, especially among those with MD, show high emotional dysregulation, affective lability and impulsiveness that could represent suitable substrates for the development of compulsive and addictive eating habits.

Mental illnesses and related vulnerabilities in the Hijra community: A cross-sectional study from India

The Hijra community is a cultural and gender grouping in South Asia broadly similar to western transgender communities, but with literature suggesting some differences in gender experience and patterns of psychosocial adversity. The present study aims to describe patterns of mental illness and psychoactive substance use in Hijra subjects and study their association with gender experience and psychosocial adversity. Fifty self-identified Hijras availing HIV-prevention services in New Delhi, India, were interviewed. Data on mental disorders, psychoactive substance use, quality of life, discrimination, empowerment, violence and gender identity were assessed using structured instruments. Subjects were mostly in their mid-twenties, and had joined the Hijra community in their mid-teens. More subjects (46%) were involved in begging than in traditional Hijra roles (38%). Sex work was reported by 28% subjects. The rates of lifetime mental illness was 38%, most commonly alcohol abuse (26%); others had anxiety or depressive disorders (8% each), somatoform disorders (6%) and bulimia nervosa (n = 1). Disempowerment was mostly experienced in domains of autonomy and community participation; 52% had experienced sexual or psychological violence. Discrimination was attributed to gender (100%), appearance (28%) or sexual orientation (28%). There were negative correlations between the physical domain of WHO-QOL and physical violence and depression scores; and between discrimination and WHO-QOL environmental, physical and psychological domains. This Hijra group showed high rates of mental disorder and substance involvement, related to QOL domains and experiences of discrimination and disempowerment.

Spouses bereaved by suicide: A population-based longitudinal cohort comparison of physician-diagnosed mental disorders and hospitalized suicide attempts

BackgroundThis study compares a longitudinal population-based sample of spouses bereaved by suicide and those bereaved by other sudden deaths to determine if suicide-bereaved spouses (SBS) experience greater rates of physician-diagnosed mental disorders. Methods: First, married individuals whose spouse died by suicide, sudden natural death (SND) and unintentional injury (UI) were compared to non-bereaved matched cohorts to determine if there were differences in mental disorder rates between bereavement groups and non-bereaved matches. Second, SBS (n = 365), spouses bereaved by SND (n = 1000), and spouses bereaved by UI (n = 270), were compared using inverse probability treatment weighting and generalized estimating equations to calculate relative rates of mental disorders 5 years before/after death. Outcomes: All bereaved cohorts had higher rates of mental disorders compared to non-bereaved cohorts. SBS had the greatest rate of depression post-bereavement (50·96%), followed by UI (38·52%) and SND (33·70%) spouses. When comparing bereavement cohorts, a significant group-by-time interaction (P = 0·047) revealed the rate change for depression was significantly different between suicide and UI-bereaved spouses, with SBS having higher rates of depression before bereavement. SBS had increased rates of any mental disorder both pre (ARR = 1·35, 95% CI = 1·03-1·18, P<·05) and post spousal death (ARR = 1·24, 95% CI = 1·03-1·45, P<·05) when compared to UI spouses signifying pre-existing mental disorders. Post-bereavement, SBS had greater rates of depression only when compared to SND-bereaved spouses (ARR = 1·31, 95% CI = 1·10-1·55, P<·01). Interpretation: SBS have the greatest rates of depression and any mental disorder before the death of their spouse, suggesting suicide bereavement may be unique. Sudden spousal bereavement is a vulnerable time for mental disorders.

Risk for Depressive Symptoms among Hospitalized Women in High-Risk Pregnancy Units during the COVID-19 Pandemic.

Objective: Higher rates of mental disorders, specifically depression, were found among affected people in previous epidemiological studies taken after disasters. The aim of the current study was to assess risk for depression among pregnant women hospitalized during the “coronavirus disease 2019” (COVID-19) pandemic, as compared to women hospitalized before the COVID-19 pandemic. Study design: A cross-sectional study was performed among women hospitalized in the high-risk pregnancy units of the Soroka University Medical Center (SUMC). All participating women completed the Edinburgh Postnatal Depression Scale (EPDS), and the results were compared between women hospitalized during the COVID-19 strict isolation period (19 March 2020 and 26 May 2020) and women hospitalized before the COVID-19 pandemic. Multivariable logistic regression models were constructed to control for potential confounders. Results: Women hospitalized during the COVID-19 strict isolation period (n = 84) had a comparable risk of having a high (>10) EPDS score as compared to women hospitalized before the COVID-19 pandemic (n = 279; 25.0% vs. 29.0%, p = 0.498). These results remained similar in the multivariable logistic regression model, while controlling for maternal age, ethnicity and known mood disorder (adjusted odds ratio (OR) 1.0, 95% CI 0.52–1.93, p = 0.985). Conclusion: Women hospitalized at the high-risk pregnancy unit during the COVID-19 strict isolation period were not at increased risk for depression, as compared to women hospitalized before the COVID-19 pandemic.

Improving the Wellbeing of Female Prisoners via Psychological Skills Training: A Feasibility Study.

Prisoners display significantly higher rates of mental disorders and lower mental wellbeing than the general population. The integration of positive psychological interventions in offender supervision has received recent advocacy. The aim of the current pre-post pilot study was to determine the short-term effects of group-based resilience training on mental health outcomes for female offenders and explore intervention acceptability. Offenders (n = 24) self-selected to partake in a multi-component psychological skill program based on positive psychology, cognitive-behavioural therapy, and mindfulness-based activities. The training was taught in nine sessions of 1.5 hr each. Baseline and follow-up measurements of mental wellbeing and psychological distress were collected and focus groups conducted to investigate participants' experiences, acceptability, and appropriateness of the training. Moderate to large effect sizes indicating significant improvements were observed for wellbeing, g = 0.75 and distress, g = 0.56. Training was well received by participants and staff and was delivered feasibly within the prison context. The results are encouraging, and a future well-powered study using a rigorous controlled design is warranted.

577 The Intersection Between Burns and Psychiatric Disorders

Abstract Introduction Burns constitute a major health problem accounting together with fires for more than 300.000 deaths per year worldwide and for a great rate of disability-adjusted life years (DALYs). Identifying the relationship between mental disorders and burns is crucial since the former seems to constitute an important risk factor for the latter. At the same time, clinical experience and scientific evidence suggest that survivors of burns often develop psychiatric sequelae, causing poorer outcomes and lower quality of life. Methods We conducted a systematic review in order to study the relationship between burns and psychopathology as well as the quality of life. We used the search engine “PubMed” with the term “((psychiatric[Title/Abstract]) OR psychological[Title/Abstract]) AND burns[Title/Abstract]” without limits regarding the time of publication, resulting in 761 studies. Using the Covidence online platform that enables screening of the articles by two reviewers, we screened the articles, first by title and abstract and then by full text. Non-English papers or papers with no full texts will be excluded from the study. We aim to register the review in the official international prospective register of the National Institute for Health Research (PROSPERO). Results Preliminary results suggest that a history of mental disorder is common among burn patients, whether self-inflicted or not. Research tends to focus on self-inflicted burns which are expected to show such an association. Indeed, psychotic disorders, drug dependence and depression constitute significant risk factors for self-immolation. At the same time, the presence of a mental disorder may be associated with a worse prognosis (burn complications, patient morbidity, and mortality, multiple hospitalizations, increased cost for treatment). Burn survivors are also at risk for developing psychiatric complications, such as Post Traumatic Stress Disorder (PTSD), depression and anxiety disorders, as well as experiencing a lower quality of life. It appears that the disfigurement, loss of function and change in body image perception caused by the burns lead to the emergence or recurrence of a psychiatric condition. Last but not least, the relationship between delirium in the Burns Intensive Care Unit patients is well established. Conclusions There seems to exist a significant ambidirectional connection between burns and mental disorders. Higher rates of mental disorders among burn patients in the pre- and post-burn period complicate the situation and lead to poorer results if left untreated. Applicability of Research to Practice Identifying risk factors for burns associated with the medical history, early recognition and appropriate treatment of mental disorders after the burn incident, improving rehabilitation and psychosocial re-integration of this patient population.

Neurocognitive Function and Fetal Alcohol Spectrum Disorder in Offenders with Mental Disorders.

Individuals with a history of offending behavior show high rates of mental disorder as well as fetal alcohol spectrum disorder (FASD). Neurocognitive impairments are common in both mental disorders and FASD and may interface with offending behavior. Understanding these impairments could effectively inform clinical considerations among this population. The purpose of this study was to characterize the life experiences and examine the neurocognitive profile of a group of adult forensic psychiatric outpatients. We also investigated potential differences between offenders with FASD and the rest of the sample. Data were collected on 45 subjects on numerous variables, including demographics, background information, offending histories, and comorbidities. Subjects also completed extensive neurocognitive testing. The sample was primarily male (82.2%) with a mean age of 42 years. There was a high prevalence of lifetime adversity and varied offense histories. Subjects showed the most significant neurocognitive impairment in executive function, visual memory (immediate and delayed recall), and full-scale IQ. The FASD group (n = 12) did not differ significantly from the No-FASD group (n = 33) on any background variables. The FASD group showed significantly lower neurocognitive scores in the areas of verbal IQ, full-scale IQ, working memory, processing speed, and expressive vocabulary.

Misconceptions About Working in Correctional Psychiatry.

Incarcerated individuals have high rates of mental disorders and substance use disorders compared with the general population, yet correctional facilities in the United States have difficulty recruiting mental health professionals. This has led to shortages in the availability of clinicians who can provide psychiatric care in these settings. During training and in practice, mental health professionals may develop misconceptions about correctional psychiatry that deter them from the field. This article examines common misconceptions about working in correctional psychiatry, including that correctional psychiatry provides unnecessary care to criminals, supports mass incarceration, is dangerous work, represents a less respectable subspecialty, and excludes clinicians from teaching and research opportunities. This article seeks to provide a resource for mental health professionals considering working with incarcerated patients.

Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study.

Despite a reported high rate of mental disorders in refugees, scientific knowledge on their risk of suicide attempt and suicide is scarce. We aimed to investigate (1) the risk of suicide attempt and suicide in refugees in Sweden, according to their country of birth, compared with Swedish-born individuals and (2) to what extent time period effects, socio-demographics, labour market marginalisation (LMM) and morbidity explain these associations. Three cohorts comprising the entire population of Sweden, 16-64 years at 31 December 1999, 2004 and 2009 (around 5 million each, of which 3.3-5.0% refugees), were followed for 4 years each through register linkage. Additionally, the 2004 cohort was followed for 9 years, to allow analyses by refugees' country of birth. Crude and multivariate hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. The multivariate models were adjusted for socio-demographic, LMM and morbidity factors. In multivariate analyses, HRs regarding suicide attempt and suicide in refugees, compared with Swedish-born, ranged from 0.38-1.25 and 0.16-1.20 according to country of birth, respectively. Results were either non-significant or showed lower risks for refugees. Exceptions were refugees from Iran (HR 1.25; 95% CI 1.14-1.41) for suicide attempt. The risk for suicide attempt in refugees compared with the Swedish-born diminished slightly across time periods. Refugees seem to be protected from suicide attempt and suicide relative to Swedish-born, which calls for more studies to disentangle underlying risk and protective factors.

Audit of fidelity of implementation of the Older prisoner Health and Social Care Assessment and Plan (OHSCAP)

ABSTRACTNumbers of older prisoners have been increasing in recent years and there is no national strategy addressing their care. Older prisoners have more physical health needs, complex social care needs and high rates of mental disorder compared with younger prisoners. These needs are often not identified or addressed. We developed the Older prisoner Health and Social Care Assessment and Plan (OHSCAP), a structured approach for identifying and managing the health and social care needs of older prisoners. It consists of an assessment, care plan and review of needs. The current study aims to establish the fidelity of implementation of the OHSCAP as part of a larger RCT. Compliance with training and the manual, identification of needs and quality of care planning were all audited. Results showed that the OHSCAP was not implemented as intended. Identified needs were not consistently translated into care plan actions. There was little evidence to suggest prisoner involvement in the care planning process. Clear difficulties in collaborative working were also idenfified. Implications with respect to effectively embedding complex interventions within prisons, along with wider policy related issues affecting the entire prison estate are discussed.

5.74 COMPARATIVE RISKS OF CHILDHOOD ADVERSITY AND HOMELESSNESS ON YOUNG ADULT MENTAL ILLNESS

In the United States, approximately 1.5 million children experience homelessness each year. Although homelessness is well-recognized as a strong risk factor for PTSD, less is known about its other long-term mental health outcomes. More so, there remains the question of the interaction of trauma childhood experiences and childhood housing insecurity. To this end, we sought to examine whether adverse childhood experiences (ACEs), a means of quantifying exposure to traumatic experiences, which also has been shown to predict higher rates of mental disorders, might further clarify this association.

22.2 BRIDGING ACCESS TO CARE THROUGH SCHOOL CLINICS

In 2019, the outlook for child and adolescent mental health services is disconcerting because of mental health facility closures and fewer hospital beds. Nationally, minority populations are overrepresented, with higher rates of mental disorders and more barriers to accessing care. Immigrant students experience anxiety with government decrees that threaten the stability of their home and family, compounding concerns for increasing suicide and self-harm. Strengthening of schools’ mental health resource capacity improves identification, assessments, treatments, and outcomes for youth and their families.

Mental Disorder, Service Utilization, and GPA: Studying Mental Health of Former Child Welfare and Youth Experiencing Homelessness in a Campus Support Program

Research has identified higher rates of mental disorders among former child welfare youth and youth experiencing homelessness when compared with their peers in the general population. Given the growing number of campus support programs serving these youth, research should focus on students in these programs to understand whether mental health problems interfere with these students’ receipt of program services, which can lead to unsatisfactory academic performance. This study collected both quantitative and qualitative data from students in a campus support program to examine the prevalence of mental disorders, mental health service use, receipt of program services, students’ grade point average, and their perceptions of obstacles and motivations to academic success. Implications for social work research and practice are discussed.

"Use the Back Door": Treating Incarcerated Patients in Community Mental Health Facilities.

Incarcerated individuals are a vulnerable population who face not only high rates of mental disorders, substance use disorders, and other chronic medical conditions but also widespread social stigmatization. These patients occasionally present for treatment in community health care settings, including mental health facilities, where staff that do not often provide care for incarcerated patients may be unprepared for their visits. This column examines whether treatment of incarcerated patients should be managed differently than treatment of other patients at community mental health facilities and provides suggestions for clinical management.