Higher Rates Of Mental Illness Research Articles

A formative evaluation to inform integration of psychiatric care with other gender-affirming care

BackgroundTransgender, non-binary, and/or gender expansive (TNG) individuals experience disproportionately high rates of mental illness and unique barriers to accessing psychiatric care. Integrating TNG-specific psychiatric care with other physical health services may improve engagement, but little published literature describes patient and clinician perspectives on such models of care. Here we present a formative evaluation aiming to inform future projects integrating psychiatric care with physical health care for TNG individuals.MethodsIn this qualitative pre-implementation study, semi-structured interview guides were developed informed by the Consolidated Framework for Implementation Research to ensure uniform inclusion and sequencing of topics and allow for valid comparison across interviews. We elicited TNG patient (n = 11) and gender-affirming care clinician (n = 10) needs and preferences regarding integrating psychiatric care with other gender-affirming clinical services. We conducted a rapid analysis procedure, yielding a descriptive analysis for each participant group, identifying challenges of and opportunities in offering integrated gender-affirming psychiatric care.ResultsParticipants unanimously preferred integrating psychiatry within primary care instead of siloed service models. All participants preferred that patients have access to direct psychiatry appointments (rather than psychiatrist consultation with care team only) and all gender-affirming care clinicians wanted increased access to psychiatric consultations. The need for flexible, tailored care was emphasized. Facilitators identified included taking insurance, telehealth, clinician TNG-competence, and protecting time for clinicians to collaborate and obtain consultation.ConclusionsThis health equity pre-implementation project engaged TNG patients and gender-affirming care clinicians to inform future research exploring integration of mental health care with primary care for the TNG community and suggests utility of such a model of care.

Sensory Processing Patterns of Women in a Reintegration Facility: An Exploratory Study

Female inmates may be more likely to experience sensory processing concerns due to higher rates of mental illness and trauma compared to the general population. To investigate this, we administered the Adult/Adolescent Sensory Profile to 66 women incarcerated in a reintegration center in the US Midwest. The female inmates demonstrated no statistically significant difference from the general population in sensory-seeking behaviors (p = 0.100). However, they were statistically different in low registration (p < 0.000), sensory avoiding (p < 0.000), and sensory sensitivity (p < 0.000). These findings highlight the importance of recognizing differences in sensory processing patterns among female inmates, as sensory processing can have an impact on behavior, life skills, and reintegration efforts. In light of these results, this paper provides suggestions for sensory-specific intervention and discusses future collaborations and research.

Navigating Public Policy Responses to a Pandemic: The Balancing Act Between Physical Health, Mental Health, and Household Income

ObjectiveDuring COVID-19, governments imposed restrictions that reduced pandemic-related health risks but likely increased personal and societal mental health risk, partly through reductions in household income. This study aimed to quantify the public’s willingness to accept trade-offs between pandemic health risks, household income reduction, and increased risk of mental illness that may result from future pandemic-related policies. MethodsA total of 547 adults from an online panel participated in a discrete choice experiment where they were asked to choose between hypothetical future pandemic scenarios. Each scenario was characterized by personal and societal risks of dying from the pandemic, experiencing long-term complications, developing anxiety/depression, and reductions in household income. A latent class regression was used to estimate trade-offs. ResultsRespondents state a willingness to make trade-offs across these attributes if the benefits are large enough. They are willing to accept 0.8% lower household income (0.7-1.0), 2.7% higher personal risk of anxiety/depression (1.8-3.6), or 3.2% higher societal rate of anxiety/depression (1.7-4.7) in exchange for 300 fewer deaths from the pandemic. ConclusionResults reveal that individuals are willing to accept lower household income and higher rates of mental illness, both personal and societal, if the physical health benefits are large enough. Respondents placed greater emphasis on maintaining personal, as opposed to societal, mental health risk and were most interested in preventing pandemic-related deaths. Governments should consider less restrictive policies when pandemics have high morbidity but low mortality to avoid the prospect of improving physical health while simultaneously reducing net social welfare.

The State of Mental Health Services for Incarcerated Adults in Ontario: A Scoping Review.

Individuals with mental illness are significantly overrepresented in the Canadian justice system. Given the high rate of mental illness among individuals who are incarcerated, correctional facilities must implement accessible and effective mental health resources. This not only improves their health and well-being but also contributes to their rehabilitation efforts. However, evidence suggests that the care provided in prisons is inadequate. This scoping review asks, "What is known about the access and quality of mental health care services for adults who are incarcerated in Ontario?" Mental health care services included non-acute interventions and care that is provided in the institution. This scoping review followed the PRISMA Extension for Scoping Reviews methodology. Databases searched include MedLINE, EMBASE, CINAHL, PsycINFO, Criminal Justice Abstracts, JSTOR, Google Scholar, and the grey literature. The search yielded 354 titles and abstracts of which 16 met the inclusion criteria. Conducted from 2010-2022, the 16 studies included qualitative, quantitative, and mixed methods. Common themes that were identified related to segregation, mental health assessments, medication prescribing and access, opioid agonist therapy, psychiatric service access, systemic and institutional barriers, mental health perception, and the need for collaboration. Despite the significant demand for mental health care in Ontario correctional facilities, limitations to quality care are evident. Such limitations intersect and are then exacerbated, resulting in poor mental health care provision among the incarcerated population. More research is warranted regarding the access, quality, and efficiency of mental health care in Ontario prisons, and how factors including ethnicity, gender, and prison classification (provincial vs. federal) may influence mental health care and its outcomes.

Influencing Factors on Left-Behind Children’s Mental Health

A polarization between urban and rural areas has urged a a growing number of people leave their hometown and go to bigger cities in search for better paying jobs. This has led to a goring number of left behind children in China. Left behind children tend to endure worse mental health. This study hopes to find the influencing factors that might impact the effect of parental separation on left behind children’s mental health. By studying this, people can better protect the mental well-being of the left behind children. This study used secondary analysis, which requires synthesizing previous findings. Previous findings lack in depth investigation into each influencing factor. This study discovered that female left behind children (LBC)have higher rates of mental illness than male LBC, younger LBC have higher rates of mental illness than older LBC, and LBC who communicate with their parents less frequently have higher rates of mental illness than those who maintain close contact with them.

Opioid, methamphetamine, and polysubstance use: perinatal outcomes for the mother and infant.

The escalation in opioid pain relief (OPR) medications, heroin and fentanyl, has led to an increased use during pregnancy and a public health crisis. Methamphetamine use in women of childbearing age has now eclipsed the use of cocaine and other stimulants globally. Recent reports have shown increases in methamphetamine are selective to opioid use, particularly in rural regions in the US. This report compares the extent of our knowledge of the perinatal outcomes of OPRs, heroin, fentanyl, two long-acting substances used in the treatment of opioid use disorders (buprenorphine and methadone), and methamphetamine. The methodological limitations of the current research are examined, and two important initiatives that will address these limitations are reviewed. Current knowledge of the perinatal effects of short-acting opioids, OPRs, heroin, and fentanyl, is scarce. Most of what we know about the perinatal effects of opioids comes from research on the long-acting opioid agonist drugs used in the treatment of OUDs, methadone and buprenorphine. Both have better perinatal outcomes for the mother and newborn than heroin, but the uptake of these opioid substitution programs is poor (<50%). Current research on perinatal outcomes of methamphetamine is limited to retrospective epidemiological studies, chart reviews, one study from a treatment center in Hawaii, and the US and NZ cross-cultural infant Development, Environment And Lifestyle IDEAL studies. Characteristics of pregnant individuals in both opioid and MA studies were associated with poor maternal health, higher rates of mental illness, trauma, and poverty. Infant outcomes that differed between opioid and MA exposure included variations in neurobehavior at birth which could complicate the diagnosis and treatment of neonatal opioid withdrawal (NOWs). Given the complexity of OUDs in pregnant individuals and the increasing co-use of these opioids with MA, large studies are needed. These studies need to address the many confounders to perinatal outcomes and employ neurodevelopmental markers at birth that can help predict long-term neurodevelopmental outcomes. Two US initiatives that can provide critical research and treatment answers to this public health crisis are the US Environmental influences on Child Health Outcomes (ECHO) program and the Medication for Opioid Use Disorder During Pregnancy Network (MAT-LINK).

State-Federal Vocational Rehabilitation Services, Demographic Characteristics and Employment Outcomes for Native Americans with Mental Illnesses.

There were 9.7 million Native Americans (American Indian, Alaska Native-AI/AN- these acronyms will be used interchangeably with Native Americans throughout the paper) in 2019 comprising 2.9% of the U.S. population. Native American populations have disproportionately higher rates of mental illnesses compared to other racial groups in the U.S. Mental health is a significant public health concern for this population, impacting different areas of their lives including employment. Additionally, Native Americans continue to experience significant disparities in access to Vocational Rehabilitation (VR) services and have poor employment outcomes. However, little is known about the relationships among demographic factors, vocational rehabilitation services, and employment outcomes of Native Americans with mental illness. Consequently, the current study examined how demographic factors and VR services are related to successful employment outcomes for Native American VR clients with mental illnesses using data from the Rehabilitation Services Administration (RSA) program year (2019) Case Service Report (9-11). Both descriptive analysis and data mining approaches were used to answer the research questions. Chi-square Automatic Interaction Detector (CHAID) analysis was used to determine which of the VR services could best predict the successful employment outcome of Native Americans with mental illness. The findings of the data mining approach revealed that among all the vocational rehabilitation services, job placement assistance was the strongest predictor of successful employment among Native American clients with mental illnesses. The second most important service predicting successful employment for those who received job placement assistance was shown to be maintenance. Implications for rehabilitation counselors and future research are discussed.

Extreme weather events and mental health in Colorado (2012–2022)

PurposeClimate change is increasing the frequency and severity of extreme weather events (EWEs) such as drought and wildfires. EWEs are associated with increased rates of mental or behavioral health outcomes, including post-traumatic stress disorder (PTSD), anxiety, and depression. Understanding the relationship between EWEs and mental or behavioral health outcomes is vital, especially given the high rates of mental illness in Colorado (20% in adults). MethodsMental or behavioral health outcomes were measured through The Attitudes and Behaviors Survey (TABS), a statewide random survey of adults in Colorado that asks about respondents’ history of clinically diagnosed mental illnesses, including depression, anxiety, borderline personality disorder, schizophrenia, attention-deficit/hyperactivity disorder, and PTSD. To measure the impacts of EWEs, wildfire data were collected through FIRESTAT, and drought data were collected through the U.S. Drought Monitor. Logistic regression was used to calculate the odds of experiencing mental or behavioral health outcomes following EWEs across four TABS survey waves (2012, 2015, 2018, 2022). ResultsPreliminary results showed the odds of experiencing any kind of mental illness following a EWE were significantly higher (post-wildfire odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.34, 1.57; post-drought OR = 1.15, 95% CI = 1.04, 1.27). Final results will include illness-specific odds following EWEs and examine the relationship in the context of other social or environmental factors, including occupation, socioeconomic status, and access to health insurance. ConclusionsEWEs associated with climate change are impacting the mental or behavioral health of Coloradans. Further investigation of these relationships is critical to informing the development of effective and context-appropriate interventions in Colorado.

Substance Use Disorders, Mental Illness, and Health Care Utilization Among Adults With Recent Criminal Legal Involvement.

Individuals involved with the criminal legal system have higher rates of mental illness, addiction, and health care utilization. The authors examined whether substance use disorders and mental illness alone or in combination drive health care utilization among those with recent criminal legal involvement. This cross-sectional analysis used nationally representative data from U.S. adults with past-year criminal legal involvement (N=9,039) recorded in the National Survey on Drug Use and Health (2015-2019). Using adjusted negative binomial regression models, the authors estimated relative risks for health care utilization. Primary independent variable categories included neither substance use disorder nor mental illness, substance use disorder only, mental illness only, and both conditions. Health care utilization included emergency department (ED) visits and nights spent in inpatient care. Relative to neither mental illness nor substance use disorder, mental illness alone was associated with significantly increased acute health care services use: for ED visits, incidence risk ratio (IRR)=1.43 (95% CI=1.18-1.75) and for inpatient stays, IRR=2.14 (95% CI=1.47-3.11). Having both conditions was associated with increased ED visits (IRR=1.62, 95% CI=1.38-1.91) and inpatient stays (IRR=4.16, 95% CI=2.98-5.82). Substance use disorder alone was associated only with higher risk for ED visits compared with neither condition (IRR=1.23, 95% CI=1.01-1.50). Mental illness with or without co-occurring substance use disorder is a strong driver of acute health care utilization after interaction with the criminal legal system. Interventions tailored to the unique needs of individuals with mental illness or substance use disorder are needed for those with recent criminal legal involvement.

Participation, Barriers, and Facilitators of Cancer Screening Among LGBTQ+ Populations: A Review of the Literature

ABSTRACT Compared with cisgender and heterosexual individuals, members of the LGBTQ+ community experience worse health outcomes. This is due to a combination of structural inequities and life experiences, including higher rates of mental illness and suicidality, sexually transmitted infections, and certain cancers. Men who have sex with men are at higher risk of anal cancer, and lesbian and bisexual women are often diagnosed with breast cancer at younger ages than heterosexual women partly due to lower parity and higher bodyweight. Despite these increased risks, some evidence shows the LGBTQ+ population is less likely to participate in early detection and cancer screening programs; however, the etiology of this is unknown. This review aims to summarize the current literature on cancer screening uptake in the LGBTQ+ population, including barriers and facilitators associated with screening participation. Studies published between January 2001 and April 2022 involving individuals identified as a gender or sexual minority that assessed participation in and/or facilitators and barriers to a cancer screening procedure were included. Barriers and facilitators identified in quantitative studies were reported on the individual-, provider-, and administrative/system-level scale. A total of 50 publications were included, 38 of which were quantitative, 10 were qualitative, and 2 used mixed methods. Among 16 relevant studies, considerable variation was identified when analyzing whether sexual minority women had lower participation in cervical cancer screening programs. Among 15 studies assessing the participation of sexual minority women compared with heterosexual women in breast cancer screening, 5 studies found no difference, whereas the remainder suggested lower rates of screening among sexual minority women. Fewer studies assessed screening among sexual minority men; however, sexual minority men were more likely to report anal cancer screening than heterosexual men. Cervical cancer screening participation among transgender men and gender diverse participants was lower than cisgender participants in almost all studies. Of 9 studies reporting breast cancer screening among gender diverse or transgender individuals, 5 found lower participation among transgender or gender diverse individuals compared with cisgender women. One study identified greater odds of up-to-date mammography among transgender men compared with cisgender women. The most common individual-level barriers to screening are related to knowledge of the screening tests themselves, including screening guidelines, procedures, pain, embarrassment, and a fear of results. One of the strongest correlates in studies was perceived discrimination from health care providers, which often resulted in lack of disclosure of sexual orientation or gender identity. Provider-level factors mostly included provider communication and relationship with the patient, and patients preferred providers experienced with LGBTQ+ clients and that used sexuality-inclusive language. Having open communication about sexual orientation and gender identity was a positive facilitator for all patients. System-level barriers included inclusive documentation and physical environments in health care. This review highlights key disparities including the lower screening rates among transgender patients in all categories and lower screening rates for cervical cancer and mammography among sexual minority women. It also highlights a significant need for representative data on all LGBTQ+ populations.

The Use of Electroconvulsive Therapy on Death Row.

Despite high rates of mental illness among incarcerated people in the United States, use of electroconvulsive therapy (ECT) remains limited in jails and prisons. There are some published guidelines regarding the provision of mental health care, including ECT, in U.S. correctional facilities, but little attention has been paid to the use of ECT for individuals sentenced to death. This article examines ECT within the context of the death penalty, including court consideration of ECT in capital cases and historic uses of ECT to facilitate execution of people on death row. Given the unique clinical, legal, and ethics considerations in the use of ECT for people sentenced to death, the authors call for greater attention to these practices and propose general guidelines regarding the use of ECT in this population.

What do rural young people want from their mental health service.

Rural young people have high rates of mental illness and low rates of help-seeking making it crucial to extend research about service improvement in rural and remote Australia. To describe what rural young people want from their headspace service, and what rural headspace clinicians understand they provide. This study used a qualitative methodology with reflexive thematic analysis to analyse participant interviews and systematically derive common themes. Thirteen participants were interviewed comprising young people aged 16 to 18 years who had accessed one of three rural headspace services, together with clinicians working in those services. Key themes for both young people and clinicians comprised accessibility, flexibility, engagement, safety, youth-focus, and evidence-based treatment although there were some differences of emphasis amongst themes. There was also an additional theme for young people of awareness, and for clinicians of caring. The results supported that what young people were seeking was largely consistent with what headspace clinicians were providing. There were however some specific issues relevant to service provision in a rural context such as increased awareness of services, the need to focus on evidenced based interventions, and better promotion in schools and the local community. Service gaps such as unmet needs for young people with higher risk who might fall outside of agency requirements were also identified. Results of this study help inform better service delivery and increased awareness for mental health of young people in rural communities to improve access and outcomes.

Stratified Post-Reproduction: An Analysis of Black Women’s Barriers to Postpartum Depression Treatment

Stratified reproduction is defined as a systemic devaluation of one group’s reproductive capacity over another’s (Harris &amp; Wolfe, 2014). This article seeks to analyze the effects of stratified reproduction on the experiences of Black women with postpartum depression. Beginning with a thorough analysis of postpartum depression, its prevalence, and its methods of treatment, the paper then goes on to evaluate the existing research done on postpartum depression in Black women specifically. After analyzing evidence that indicates higher rates of mental illness among Black mothers, the paper examines stratified reproduction and a new term “stratified post-reproduction” is defined. In comparison, stratified post-reproduction, a term coined by the author, serves to elucidate the ways in which the prioritization of and concentration on white women’s post birth experiences by the medical community at large leads to a lower quality of treatment of non-white women and mothers of other marginalized groups (Primm et al., 2010). This creates a system that increases the rates of postpartum depression among Black women and keeps Black women from seeking post-birth care for this depression. The paper concludes by offering community based, feminist, and Black centered approaches to treating and caring for Black mothers in the period directly after birth. It is important to center Black voices and experiences in conversations about systemic oppression and thus the article cites research analyzing interviews done with Black mothers and focuses on research conducted by people of color and women.

Comparing Behavioral Health Outcomes and Treatment Utilization of Those With and Without Justice Involvement Within the Past Year Among American Indian and Alaska Native Adults.

Similar to other populations, worse health, increased emergency healthcare utilization, and heightened substance misuse are correlated with higher justice involvement among American Indian/Alaska Native (AI/AN) populations. The historical context and resulting contemporary injustices for AI/AN populations have directly contributed to higher rates of these health and behavioral health conditions among this population. As a result, AI/AN individuals have disproportionate rates of incarceration in the USA, with young AI/AN males having the highest odds of incarceration when compared to any other group. American Indian and Alaska Native populations are overrepresented in the criminal justice system across different touchpoints. However, there remains a scarcity of data and research on AI/AN peoples' involvement with the justice system, and what their lives look like prior to, during, and after justice involvement. The current study addresses this gap in the literature by exploring rates of substance use and mental health diagnoses and treatment utilization among justice-involved and non-justice-involved AI/AN samples. Further, we examined correlates associated with past-year service utilization. Data from the 2015-2019 National Survey on Drug Use and Health (N = 214,505 adults aged 18+) was used. For this study, we examined a subsample of 3068 AI/AN adults. Quantitative data analyses using STATA 16 were run to test for differences on service utilization, mental health status, and substance misuse between AI/AN non-justice-involved and justice-involved samples. Among adults in the sample, 446 (15%) reported justice involvement in the past year. Justice-involved AI/AN individuals were significantly more likely to use the emergency department, utilize mental health treatment, and access substance use treatment in the past year. Additionally, justice-involved AI/AN individuals reported significantly higher rates of mental illness and past-year substance use disorder. In regression models, justice involvement was significantly associated with past-year substance use treatment and past-year mental health treatment. The findings from this work highlight the differences among substance use, mental illness, and treatment utilization between justice-involved and non-justice-involved AI/AN individuals. Findings suggest that justice-involved individuals fair worse in all areas and argue for the consideration of interventions that incorporate both culturally sensitive and justice-responsive models to improve the behavioral health outcomes of these populations. Lastly, while justice-involved AI/AN populations utilize treatment services at higher and disproportionate levels, there is reason to believe that there continues to be a mismatch of need and utilization and further exploration is warranted.

Suicide among doctors in Turkey: Differences across gender, medical specialty and the method of suicide.

Doctors have higher rates of mental illness and suicide than the general population worldwide. Suicides of doctors are known to be underreported in developing countries. To the best of our knowledge, there are no studies investigating suicides among medical students and doctors in Turkey. To investigate the characteristics of suicides in medical school students and doctors in Turkey. In this retrospective study, newspaper websites and Google search engine were searched for information on medical school student and doctor suicides in Turkey between 2011 and 2021. Cases of suicide attempt, parasuicide or deliberate self-harm were not included in the study. Sixty-one suicides were reported between 2011-2021. There was a male predominance (45 (73.8%)), and more than half of the suicides (32 (52.5%)) occurred among specialist doctors. Self-poisoning, jumping from heights and firearms were the most common methods of suicide (18 (29.5%), 17 (27.9%) and 15 (24.6%), respectively). Cardiovascular surgery, family medicine, gynecology, and obstetrics specialties had the highest numbers of suicide deaths. Depression/mental illness was the most common speculated etiology. These results show that suicides among medical students and doctors in Turkey have characteristics that differ from both suicided among the general population in Turkey and doctor suicides in other countries. In this study, we identified the suicidal characteristics of medical students and doctors in Turkey for the first time. The results help us to better understand this understudied topic and provide an avenue for future studies. The data also indicate that it is important to monitor the individual and systemic difficulties experienced by doctors, starting from the medical education stage, and to provide individual and environmental support to help decrease the risk of suicide.

Sexual minority status, illicit drug use, and depressive symptoms

Youth who are lesbian, gay, bisexual, and who identify with other sexual orientations (LGB+) are at higher risk for illicit drug use and have higher rates of mental illness. The current study examined the prevalence of illicit drug use among LGB + persons and assessed the moderating effect of mental illness. Cross-sectional data from the 2015, 2017, and 2019 Youth Risk Behavioral Surveillance System were aggregated. The outcome was any reported use of cocaine, inhalants, heroin, methamphetamines, ecstasy, or hallucinogens. The primary exposure was self-reported sexual orientation category (i.e. heterosexual, gay/lesbian, bisexual, and not sure). Self-reported depressive symptoms were tested as a moderator. Logistic regression models assessed main and interactive effects. Gay or lesbian students [AOR = 1.87 95% CI: 1.45, 2.43], bisexual students [AOR = 2.07 95% CI: 1.77, 2.42], and those unsure of their sexual orientation [AOR = 1.99 95% CI: 1.65, 2.39] had increased odds of illicit drug use. Odds were higher among LGB + youth who did not have depressive symptoms (p < 0.001). Odds of illicit substance use was significantly greater in youth identifying as gay and lesbian, bisexual, and students who were not sure about their sexual orientation and among LGB + youth without depressive symptoms. Targeted, but non-stigmatizing, prevention programs are needed.

Rethinking the Ph.D. dissertation in botany: Widening the circle.

Rethinking the Ph.D. dissertation in botany: Widening the circle.

Mental Health Outcomes Among American Indian and Alaska Native U.S. Army Soldiers: A Serial Cross-Sectional Analysis.

American Indian and Alaska Native (AI/AN) individuals in the USA experience higher rates of mental illness and preventable death than the general population. Published research demonstrates that AI/AN veterans experience similar disparities to other minorities compared to non-minority veterans; few studies, however, have assessed mental health outcomes in AI/AN active duty military members. The objective of this study was to determine differences in depression, anxiety, hazardous alcohol consumption, and suicidal ideation among AI/AN soldiers compared to soldiers of other races during the Coronavirus Disease 2019 (COVID-19) pandemic. We conducted repeated cross-sectional electronic surveys to assess the mental health of active duty and activated reserve U.S. Army soldiers within three commands in the Northwestern Continental United States , Republic of Korea, and Germany during May-June 2020 (T1) and December 2020-January 2021 (T2). The primary exposure of interest in the present analysis was race and ethnicity, and the primary outcomes were probable depression with functional impairment (subsequently "depression"), probable anxiety with functional impairment (subsequently "anxiety"), hazardous alcohol use, and suicidal ideation. Multivariable logistic regression models were used to determine the association between demographics and COVID-19 concerns on mental health outcomes for each time point. A total of 21,293 participants responded to the survey at T1 (participation rate = 28.0%), and 10,861 participants responded to the survey at T2 (participation rate = 14.7%). In the multivariable model, AI/AN participants had 1.36 higher adjusted odds of suicidal ideation (95% CI: 1.02-1.82) at T1 and 1.50 greater adjusted odds of suicidal ideation at T2 (95% CI: 1.00-2.24), when compared to non-Hispanic White participants. During T1, there was no significant difference detected between AI/AN and non-Hispanic White participants for anxiety (adjusted odds ratio: 1.21; 95% CI: 0.91-1.60) (TableIV). However, AI/AN participants had 1.82 greater adjusted odds of anxiety when compared to non-Hispanic White participants at T2 (adjusted odds ratio: 1.82; 95% CI: 1.29-2.57). There were no significant differences detected between AI/AN participants and non-Hispanic White participants in multivariable models for either depression or hazardous alcohol use at both time points. Although we hypothesized that all adverse mental health outcomes would be higher for AI/AN service members at both time points, there were no significant differences at each of the time points analyzed for most of the outcomes analyzed. However, differences in suicidal ideation were found at both time points. Analyses and proposed interventions should account for diversity and heterogeneity of AI/AN populations.

Impact of post-release community mental health and disability support on reincarceration for prisoners with intellectual disability and serious mental illness in NSW, Australia.

Prisoners with an intellectual disability are overrepresented in custody and more likely to reoffend and be reincarcerated compared with the general prison population. Although prisoners with intellectual disability have many of the same risk factors for recidivism as the general prison population, the high rates of mental illness experienced by this group are key drivers of recidivism. We aimed to assess the impact of provision of post-release disability and community mental health support on rates of reincarceration in a cohort with identified intellectual disability and serious mental illness diagnosis. We conducted a historical cohort study using linked administrative data-sets, including data on hospital admissions, community mental health, disability support and corrections custody in New South Wales, Australia (n = 484). To assess the time to return to adult custody, we used survival analysis on multiple failure-time data. Over the median follow-up period of 7.4 years, 73.7% (357) received community mental health support, 19.8% (96) received disability support and 18.6% (85) received a combination of supports during a post-release period from prison. Lower hazards of reincarceration in a post-release period were associated with receipt of community mental health support (hazard ratio [HR] = 0.58, CI 0.49-0.69, P < 0.001), or a combination of community mental health and disability support (HR = 0.46, CI 0.34-0.61, P < 0.001). High rates of reincarceration for prisoners with intellectual disability and history of serious mental illness may be modifiable by provision of appropriate mental health and disability supports.

Divergence and integration of identification methods for geriatric mental health disorders in nonspecialized institutions—a qualitative study of service providers from different departments in Shanghai, China

Objectives Global epidemiological evidence indicates high rates of mental illness but low rates of diagnosis among older people. In China, service providers identify older adults with mental disorders in varied ways. Taking Shanghai as an example, this study revealed how the identification methods of geriatric mental health disorders in nonspecialized institutions diverge, providing a reference for the integration of services. Methods A purposive sampling method was adopted to conduct semi-structured interviews with 24 service providers from various nonspecialized geriatric mental health care institutions. Interview audio was recorded with consent and converted into verbatim transcripts. The interview data were analysed thematically. Results Although service providers from the health care system tended to apply a biomedical-oriented assessment, those from the social care system typically identified mental disorders among older people based on selective attention and interpersonal relationships. Although there are stark differences, the various identification mechanisms implicitly converge—the relationship with clients has become an important consideration. Conclusion Geriatric mental health issues urgently require the integration of formal and informal care resources. Referring to the idea of task transfer, social identification mechanisms are expected to be a useful supplement to traditional biomedical-oriented identification.