History Of Mental Health Treatment Research Articles

Predictive modeling of initiation and delayed mental health contact for depression

BackgroundDepression is prevalent among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans, yet rates of Veteran mental health care utilization remain modest. The current study examined: factors in electronic health records (EHR) associated with lack of treatment initiation and treatment delay; the accuracy of regression and machine learning models to predict initiation of treatment.MethodsWe obtained data from the VA Corporate Data Warehouse (CDW). EHR data were extracted for 127,423 Veterans who deployed to Iraq/Afghanistan after 9/11 with a positive depression screen and a first depression diagnosis between 2001 and 2021. We also obtained 12-month pre-diagnosis and post-diagnosis patient data. Retrospective cohort analysis was employed to test if predictors can reliably differentiate patients who initiated, delayed, or received no mental health treatment associated with their depression diagnosis.Results108,457 Veterans with depression, initiated depression-related care (55,492 Veterans delayed treatment beyond one month). Those who were male, without VA disability benefits, with a mild depression diagnosis, and had a history of psychotherapy were less likely to initiate treatment. Among those who initiated care, those with single and mild depression episodes at baseline, with either PTSD or who lacked comorbidities were more likely to delay treatment for depression. A history of mental health treatment, of an anxiety disorder, and a positive depression screen were each related to faster treatment initiation. Classification of patients was modest (ROC AUC = 0.59 95%CI = 0.586–0.602; machine learning F-measure = 0.46).ConclusionsHaving VA disability benefits was the strongest predictor of treatment initiation after a depression diagnosis and a history of mental health treatment was the strongest predictor of delayed initiation of treatment. The complexity of the relationship between VA benefits and history of mental health care with treatment initiation after a depression diagnosis is further discussed. Modest classification accuracy with currently known predictors suggests the need to identify additional predictors of successful depression management.

Exploring the impact of social protest on mental health: A study of the 2019 “Social Uprising” in Chile

Socio-political conflicts, especially if accompanied by violent events, can affect the mental health of the population. This study aimed to estimate the causal effect of social protest-related violence on depressive symptoms during the 2019 social uprising in Chile. We collected population-representative data from a nationwide longitudinal survey (n = 2918), the fourth wave of which took place during the months of the social uprising in Chile (November 2019 and March 2020). Depressive symptoms were measured using the Patient Health Questionnaire-9, while violence related to social protest was measured as the perception of destruction at the neighbourhood level. To assess the casual relationship between destruction perception and depressive symptoms, we utilized an instrumental variable regression model. Our analysis controlled for relevant sociodemographic factors, participation in social protest, and history of mental health treatment. Results showed that perceived neighbourhood destruction during the 2019 social uprising significantly increased PHQ-9 score by 3.702 points, prevalence of moderate to severe depressive symptoms by 18.7%, and likelihood of having a Subthreshold or Major Depressive Episode by 15.2% (p < 0.01). The impact of perceived destruction on depressive symptoms varies by gender, with a significant effect found in men (an increase in depression indicators of 5.769 points, 26.8% and 23.0%, respectively, p < 0.05) but not in women. Stratified regression models by age demonstrate a positive association between the perception of neighbourhood destruction and depressive symptoms across all age groups, with a stronger effect observed among young adults. We found a casual effect of violence related to social protest on depressive symptoms. These findings have implications for the planning of social policies aimed at protecting the mental well-being of the population in times of increasing socio-political turmoil.

Effects of family-based treatment on adolescent outpatients treated for anorexia nervosa in the Eating Disorder Unit of Helsinki University Hospital

BackgroundFamily therapy for adolescent anorexia nervosa (AN) has stronger evidence of efficacy in comparison with individual therapy, and family-based treatment (FBT) is the most evaluated in numerous randomized clinical trials. However, few studies have focused on how FBT performs outside of research settings. The current study is the first to assess clinical outcomes of FBT for adolescent AN in Finland, in a specialized outpatient clinic.AimThe naturalistic outcome of outpatient FBT for adolescent AN was investigated.MethodsFifty-two female patients and their families who received FBT at a tertiary eating disorders unit participated in the study. Data on their pre-treatment parameters, treatment details, and condition at the end of treatment (EOT) was collected from their medical records.ResultsAt EOT, a majority (61.5%) had achieved a full weight restoration [percentage of expected body weight (%EBW) ≥ 95%]. Participants with an %EBW ≥ 95 at EOT had a significantly higher pre-treatment %EBW than those with an EBW < 95% at EOT. Participants with an EBW ≥ 95% at EOT showed significantly higher total weight gain during the treatment period, a higher rate of regular menstrual periods at EOT, significantly lower rates of dietary restrictions, and less cognitive or behavioral symptoms of the eating disorder overall, compared to participants who did not achieve a normal body weight. In 22 cases (42.3%), there was no need for further treatment at the end of FBT. Participants who needed further treatment after FBT, compared to those who did not, showed significantly higher rates of psychiatric comorbidity, history of mental health treatment, and need for psychopharmacological treatment.ConclusionsIn this naturalistic study, and in line with previous studies, FBT for AN appeared to be an effective and sometimes sufficient intervention, especially for patients with milder weight deficit and less severe psychiatric comorbidities. The results show that FBT can be successfully implemented in Finland and suggest that training more ED clinicians in FBT would be beneficial.Trial registration: The study was retrospectively registered on February 8th, 2023, in ClinicalTrials.gov Protocol Registration and Results System, identifier: NCT05734573.

Utility of the Counseling Center Assessment of Psychological Symptoms Screen in a Collegiate Athlete Population.

Mental health screening as a part of collegiate athletic preparticipation evaluations is becoming increasingly common, but effective and efficient screening depends on a screening tool that can accurately identify mental health symptoms and the need for mental health intervention. Case-control study. Archival clinical records review. Two cohorts of incoming National Collegiate Athletics Association Division I collegiate athletes (N = 353). Athletes completed the Counseling Center Assessment of Psychological Symptoms (CCAPS) Screen as a part of their preparticipation evaluation. These data were then matched with basic demographic data and mental health treatment history from clinical records, and the utility of the CCAPS Screen in determining a future or ongoing need for mental health services was analyzed. Score differences for each of the 8 CCAPS Screen scales (Depression, Generalized Anxiety, Social Anxiety, Academic Distress, Eating Concerns, Frustration, Family Distress, and Alcohol Use) were found based on several demographic variables. Logistic regression analysis demonstrated that female sex, team sport participation, and the Generalized Anxiety scale score predicted future participation in mental health treatment. Decision tree testing of the CCAPS scales showed low utility in classifying those who received mental health treatment versus those who did not. The CCAPS Screen did not appear to differentiate well between those who eventually received mental health services and those who did not. This should not be taken to mean that mental health screening is not useful but rather that a 1-time, state-based screening is not sufficient for athletes who experience intermittent but recurring stressors in a dynamic environment. A proposed model for improving the current standard of practice for mental health screening is provided as a focus of future research.

PSYCHOLOGICAL TREATMENT VARIANT WITH EYE MOVEMENT DESENSITIZATION AND REPROCESSING: A CASE REPORT

Background: EMDR (eye movement desensitization and reprocessing) is a structured psychotherapy method that facilitates the treatment of various psychopathologies and problems related to both traumatic events and more common but emotionally stressful experiences.1 Due to the confinement due to the COVID-19 (Coronavirus Disease 2019) pandemic, people have developed a mixture of anticipatory anxiety, stress, tiredness, misunderstanding and fear, a psychological and emotional mixture that does not fit into any of the existing boxes in the classification of mental disorders.2 Eye Movement Desensitization and Reprocessing (EMDR) has abundant evidence of efficacy in trauma spectrum disorders. Its efficacy in anxious and depressive disorders in children and adolescents has been scarcely studied.3 Objective: To evaluate the efficacy of an alternative EMDR protocol. Methods: It is about a 13-year-old female adolescent who seeks care after having made her second suicide attempt after 9 months of failed psychological and psychiatric therapy, the standard EMDR protocol is executed in a first unsuccessful session and a variant of the EMDR protocol that occurred incidentally achieving the therapeutic goal. Results: This is an adolescent with a history of failed mental health treatment, the standard intervention protocol with EMDR was executed without success, however; In a second attempt, the patient spontaneously proceeds with desensitization from positive experiences without ever directly addressing the traumatic event. In this case, the reprocessing of the events occurred through positive experiences for the patient instead of what is indicated in the standard protocol where the trauma is reprocessed through the negative event. Conclusion: Psychological treatment using EMDR was effective despite its atypical execution, therefore variations to the original protocol can be applied.

The relationship between mental illness stigma and self-labeling.

One way that stigma may interfere with treatment-seeking is its impact on whether an individual self-labels as someone with mental illness (MI). While identifying and labeling oneself as experiencing MI is an important early step in seeking treatment, self-labeling may also make individuals more susceptible to the negative effects of internalized, anticipated, and experienced stigma. In the present study, we examined the relationship between MI stigma and self-labeling. We hypothesized that endorsement of stereotypes, prejudice, and discrimination would be higher among those individuals who do not self-label and that those who did self-label would endorse higher levels of anticipated, internalized, and experienced stigma. We conducted a survey of stigma and mental health via MTurk. The sample included 257 individuals who met criteria for a current probable diagnosis of depression, generalized anxiety, or posttraumatic stress disorder (PTSD). We compared those individuals who responded "yes" to ever experiencing MI (n = 202) to those who responded "no" (n = 52) on demographic variables, mental health symptoms and treatment history, and stigma. Individuals who did not self-label as having MI were more likely to be younger, male, and single. They also endorsed higher levels of stereotypes, prejudice, discrimination, and experienced stigma. Self-labelers endorsed more internalized stigma than those who did not self-label. Findings suggest that associations between stigma and self-labeling are complex. Consistent with modified labeling theory, stigma may both act as a barrier to adopting a label of MI and increase vulnerability to stigma if the label is adopted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Trends in Language Use During the COVID-19 Pandemic and Relationship Between Language Use and Mental Health: Text Analysis Based on Free Responses From a Longitudinal Study.

The COVID-19 pandemic and its associated restrictions have been a major stressor that has exacerbated mental health worldwide. Qualitative data play a unique role in documenting mental states through both language features and content. Text analysis methods can provide insights into the associations between language use and mental health and reveal relevant themes that emerge organically in open-ended responses. The aim of this web-based longitudinal study on mental health during the early COVID-19 pandemic was to use text analysis methods to analyze free responses to the question, "Is there anything else you would like to tell us that might be important that we did not ask about?" Our goals were to determine whether individuals who responded to the item differed from nonresponders, to determine whether there were associations between language use and psychological status, and to characterize the content of responses and how responses changed over time. A total of 3655 individuals enrolled in the study were asked to complete self-reported measures of mental health and COVID-19 pandemic-related questions every 2 weeks for 6 months. Of these 3655 participants, 2497 (68.32%) provided at least 1 free response (9741 total responses). We used various text analysis methods to measure the links between language use and mental health and to characterize response themes over the first year of the pandemic. Response likelihood was influenced by demographic factors and health status: those who were male, Asian, Black, or Hispanic were less likely to respond, and the odds of responding increased with age and education as well as with a history of physical health conditions. Although mental health treatment history did not influence the overall likelihood of responding, it was associated with more negative sentiment, negative word use, and higher use of first-person singular pronouns. Responses were dynamically influenced by psychological status such that distress and loneliness were positively associated with an individual's likelihood to respond at a given time point and were associated with more negativity. Finally, the responses were negative in valence overall and exhibited fluctuations linked with external events. The responses covered a variety of topics, with the most common being mental health and emotion, social or physical distancing, and policy and government. Our results identify trends in language use during the first year of the pandemic and suggest that both the content of responses and overall sentiments are linked to mental health.

Psycho-Emotional Factors Associated with Depressive Symptoms during Lockdown Due to the COVID-19 Pandemic in the Mexican Population

The COVID-19 pandemic has had a significant impact on mental health, leading to the increase of depressive symptoms. Identifying these symptoms and the factors associated with them in women and men will allow us to understand possible mechanisms of action and develop more specific interventions. An online survey was conducted from 1 May to 30 June 2020 using snowball sampling; the final sample comprised 4122 adult inhabitants of Mexico; 35% of the total sample displayed moderate-to-severe depressive symptoms, with a greater proportion of depression being among female respondents. A logistic regression analysis revealed that individuals under 30 years of age, those with high levels of stress due to social distancing, those with negative emotions, and those who reported a significant impact of the pandemic on their lives have a higher risk of depression. Women with a history of mental health treatment and men with a history of chronic disease were also more likely to experience depressive symptoms. Social environment and sex are factors that intervene in the development of depressive symptoms, meaning that appropriate early identification and intervention models should be designed for the care of men and women in highly disruptive situations such as the recent pandemic.

Predictors of caregiver burden before starting family-based treatment for adolescent anorexia nervosa and associations with weight gain during treatment

PurposeCaregivers play a pivotal role in the success of family-based treatment (FBT) for anorexia nervosa (AN). Caregiver burden is frequently demonstrated in eating disorders (EDs) and may impact FBT outcomes. This study examined factors associated with caregiver burden before starting FBT and whether pre-treatment caregiver burden was associated with weight gain during FBT.MethodsParticipants included 114 adolescents with AN or atypical AN (mean age = 15.6 years, SD = 1.4) and a primary caregiver (87.6% mothers) who received FBT in the United States. Before starting treatment, participants completed self-report measures of caregiver burden (via the Eating Disorder Symptom Impact Scale), caregiver anxiety, caregiver depression, and ED symptoms. Clinical characteristics and percentage of target goal weight (%TGW) at FBT session 1 and 3 and 6 months after starting treatment were obtained via retrospective chart review. Hierarchical regressions examined predictors of caregiver burden before FBT initiation. Associations between pre-treatment caregiver burden and %TGW gain at 3 and 6 months after starting FBT were assessed with hierarchical regressions.ResultsCaregiver anxiety (p < 0.001), family history of EDs (p = 0.028), adolescent mental health treatment history (p = 0.024), and ED symptoms (p = 0.042) predicted caregiver burden before starting FBT. Pre-treatment caregiver burden was not associated with %TGW gain at 3 or 6 months. Males demonstrated less %TGW gain than females at 3 months (p = 0.010) and 6 months (p = 0.012).ConclusionProactively evaluating caregiver burden before starting FBT is suggested. Providing recommendations and/or referrals for identified caregiver vulnerabilities could indirectly impact FBT progress. Males in FBT could require longer courses of treatment and extra vigilance to this demographic is suggested.Level of evidence: Level III, case–control analytic study.

When Patients Become Colleagues

When Patients Become Colleagues

Suicides Among American Indian or Alaska Native Persons - National Violent Death Reporting System, United States, 2015-2020.

Compared with the general U.S. population, American Indian or Alaska Native (AI/AN) persons, particularly those who are not Hispanic or Latino (Hispanic) AI/AN, are disproportionately affected by suicide; rates among this group consistently surpass those among all other racial and ethnic groups (1). Suicide rates among non-Hispanic AI/AN persons increased nearly 20% from 2015 (20.0 per 100,000) to 2020 (23.9), compared with a <1% increase among the overall U.S. population (13.3 and 13.5, respectively) (1). Understanding characteristics of suicide among AI/AN persons is critical to developing and implementing effective prevention strategies. A 2018 report described suicides in 18 states among non-Hispanic AI/AN persons only (2). The current study used 2015-2020 National Violent Death Reporting System (NVDRS) data among 49 states, Puerto Rico, and the District of Columbia to examine differences in suicide characteristics and contributing circumstances among Hispanic and non-Hispanic AI/AN populations, including multiracial AI/AN. Results indicated higher odds across a range of circumstances, including 10 of 14 relationship problems (adjusted odds ratio [aOR] range=1.2-3.8; 95% CI range=1.0-5.3) and six of seven substance use problems (aOR range=1.2-2.3; 95% CI range=1.1-2.5), compared with non-AI/AN persons. Conversely, AI/AN decedents had reduced odds of having any current known mental health condition, any history of mental health or substance use treatment, and other common risk factors (aOR range=0.6-0.8; 95% CI=0.2-0.9). Suicide is preventable. Communities can implement a comprehensive public health approach to suicide prevention that addresses long-standing inequities affecting AI/AN populations (3).

Primary Care Veteran Preferences for Receiving Information about Mental Health Services: Cross-Sectional Survey

The purpose of this study was to understand contextual characteristics of how veterans in primary care prefer to receive mental healthcare information (i.e., information about mental health symptoms/services) in terms of provider, location, and format. One hundred sixteen primary care veterans with behavioral health concerns (58% depression, 37% PTSD, 50% hazardous alcohol use) participated in a cross-sectional phone and mail survey. Forty-seven percent had recently received mental health services; Fifty-three percent had not. Overall, veterans preferred receiving mental health information from behavioral health providers (<em>n</em> = 55, 47%) and via individual face-to-face communication (<em>n</em> = 65, 56%). However, veterans without recent mental health treatment were more likely to endorse home as their most preferred location (<em>n</em> = 18, 29%) and mailed self-help materials as their most preferred format (<em>n</em> = 11, 18%) compared to veterans with recent mental health treatment. Veterans with recent mental health treatment were more likely to endorse Veterans Affairs behavioral health clinics as their most preferred location (<em>n</em> = 23, 43%) and face-to-face communication as their most preferred format (<em>n</em> = 37, 69%) compared to veterans without recent mental health treatment. When tailoring mental health communication to veterans with behavioral health concerns, findings suggest that recent mental health treatment history is an important distinction. These results can inform development of public health messaging, decision aids, and psychoeducational material for veterans. Future research should evaluate the impact of age, gender, and service era on preferences to better understand how to tailor messaging and materials to more specific groups of veterans.

Examining the effectiveness of a family‐focused training to prevent youth suicide

AbstractObjectiveThe present study investigates the effectiveness of a novel, consumer‐informed, family training for youth suicide prevention.BackgroundResearch suggests family members play a key role in reducing suicide risk for their children. However, family members often do not possess the necessary knowledge, confidence, and skills needed to intervene with a suicidal youth.MethodFamily members (N = 582) participated in the It's Time to Talk About It: Family Training for Youth Suicide Prevention (ITT‐FT) and completed pretest and posttest measures. Additionally, 158 family members completed a 6‐month follow‐up evaluation.ResultsResults indicated significant improvements in knowledge, effective attitudes, perceived behavioral control, social norms, and intentions immediately after the training. Knowledge and perceived behavioral control were sustained at follow‐up. Participants identifying as Hispanic/Latinx exhibited greater decreases in stigma related to help‐seeking. Those who had a family history of mental health treatment experienced a greater increase in social norms related to other families seeking help.ConclusionFindings underline the importance of implementing a family‐focused program aimed at improving training outcomes such as knowledge, confidence, and intentions—key constructs associated with behavior change.ImplicationsImprovement in several domains following the training highlight the critical role family members can play in reducing youth suicide risk.

Women admitted to forensic psychiatry in Flanders (Belgium): who are they?

PurposeDespite the rising number of females in forensic psychiatry, research about their characteristics remains limited and is currently lacking in Belgium. Optimizing knowledge about the characteristics of these women will lead to a better understanding of this specific group. Therefore, the aim of the study was to gain insight into the characteristics of female forensic psychiatric patients in Flanders, Belgium.Design/methodology/approachA case file study was carried out in the forensic psychiatric hospital Sint-Jan-Baptist in Zelzate, Belgium. The files of female patients admitted in the period 2006–2017 were analysed (N = 82) based on a checklist including sociodemographic, mental health care and offence-related characteristics as well as historical risk factors.FindingsThe study revealed that female patients have been confronted with a large number of adverse experiences during both childhood and adulthood, were frequently diagnosed with borderline personality disorder and usually had an extensive mental health treatment history with many drop-outs. The majority of the female patients had committed violent offences towards relatives.Practical implicationsThese findings are similar to those of other jurisdictions and highlight the importance of a gender-responsive treatment. This kind of treatment should include trauma-informed care, gender-sensitive risk-assessment and adapted versions of dialectical behavioural therapy and schema-focussed therapy. Additionally, treatment should focus on breaking the intergenerational transmission of violence and mental health problems by targeting parenting skills.Originality/valueTo the best of the authors’ knowledge, this is the first study that scientifically scrutinized the detailed characteristics of female forensic psychiatric patients in Flanders, Belgium. Recommendations for gender-responsive treatment and directions for future research are discussed.

Mental Health Treatment Seeking and History of Suicidal Thoughts Among Suicide Decedents by Mechanism, 2003-2018

Understanding mental health and substance use treatment seeking and suicidality among suicide decedents is important to determine prevention efforts. To evaluate differences in treatment seeking and suicidality between suicide decedents who died by firearms and those who died by other methods. Cross-sectional data were collected on 234 652 suicide decedents from 2003 to 2018. Participant information was reported by their state of residence to the National Violent Death Reporting System. Statistical analysis was performed from July 1, 2021, to January 21, 2022. Main outcomes were treatment for mental health and substance use at time of death, previous treatment for mental health and substance use, history of suicidal ideation or plans, history of suicide attempts, and disclosure of suicidal ideation or plans. A total of 234 652 participants (182 520 male [77.8%]; 205 966 White [87.8%]; mean [SD] age, 46.3 [18.2] years [range, 3-112 years]) were included in this study. Compared with suicide decedents who died by another method (n = 117 526 [50.1%]), those who died by firearm (n = 117 126 [49.9%]) were more likely to have disclosed thoughts or plans of suicide within the month prior to death (odds ratio [OR], 1.16 [95% CI, 1.13-1.18]) and were less likely to have previously attempted suicide (OR, 0.44 [95% CI, 0.43-0.46]). Compared with those who died by poisoning, those who used a firearm were more likely to have had a history of suicidal thoughts or plans (OR, 1.19 [95% CI, 1.15-1.23]) and to have disclosed their thoughts or plans of suicide within the month prior to death (OR, 1.06 [95% CI, 1.03-1.10]). Compared with those who died by hanging, those who used a firearm were more likely to have disclosed their thoughts or plans of suicide to another person within the month prior to their death (OR, 1.14 [95% CI, 1.11-1.17]). These findings provide information that suggests who is at risk to die by firearm suicide. Community-based interventions in suicide prevention could help reduce access to firearms during a time of crisis. The finding that firearm suicide decedents were more likely to disclose their suicidal thoughts or plans provides an important avenue for prevention.

Stigma towards People with Mental Illness among Portuguese Nursing Students.

Stigma is a substantial obstacle when caring for people with mental illness. Nursing students’ negative attitudes towards people with mental illness may impact the quality of care delivered and consequentially patient outcomes. In this study, we assessed the stigmatising attitudes and beliefs of nursing students towards people with mental illness and examined its relationship with several psycho-socio-demographic variables. This was a quantitative, cross-sectional descriptive correlational study, which was developed with a non-probabilistic convenience sample of 110 nursing students. Stigmatising attitudes and beliefs were assessed using the Portuguese version of the Attribution Questionnaire AQ-27. Results show that the dimensions of stigma with higher scores were help, pity, coercion and avoidance. However, significant differences were only observed depending on the year of study (fourth-year students, who already had clinical placements in this area, are less likely to show stigma), the relationship (family is less prone to show coercion), the history of mental health treatment (students with a history of mental health treatment have more tendency to help) and whether they considered working in the mental health field (students who have considered working in this field are less prone to show anger, avoidance and think of patients as dangerous). Therefore, we conclude that education in a classroom setting alone is not enough to reduce stigma in nursing students, clinical placement in the area is required to achieve such results. It is thus essential to improve nursing curricula worldwide so that students are exposed to both psychiatric nursing theory and clinical practice in the first years of the nursing degree.

Obsessions and Compulsions

Aaron T. Beck, M.D., is among the most impactful figures in the entire history of mental health treatment and his ideas have made important contributions to the understanding and treatment of OCD. I am honored to have the opportunity to write this essay in his memory. His legacy of alleviating suffering and improving the lives of people with emotional problems, and taking the time to carefully train others who continue this important work, will live on.

Factors associated with mental health service access among Australian community-dwelling survivors of stroke

Purpose To describe types of mental health treatment accessed by community-based stroke survivors and factors associated with access. Methods A sub-group of registrants from the Australian Stroke Clinical Registry completed a supplementary survey 2.5 years post-stroke. Self-reported information about depression/anxiety and treatment access were collected. Demographic and clinical data were obtained through linkages with registry and government data. Staged multivariable logistic regression was conducted to examine factors associated with treatment access. Results Among 623 registrants surveyed (37% female, median age 69 years), 26% self-reported a medical diagnosis of depression/anxiety at 2.5 years post-stroke. Of these, only 30% reported having accessed mental health services, mostly through government-funded Medicare schemes. Younger age (odds ratio (OR) 0.95, 95% CI 0.93, 0.98), history of mental health treatment (OR 3.38, 95% CI 1.35, 8.48), feeling socially isolated (OR 2.32, 95% CI 1.16, 4.66), self-reported medical diagnosis of depression/anxiety (OR 4.85, 95% CI 2.32, 10.14), and government-subsidised team care plan arrangement (OR 4.05, 95% CI 1.96, 8.37) were associated with receiving treatment. Conclusions Many stroke survivors have untreated depression/anxiety. Primary care practitioners should be supported in undertaking effective detection and management. Older and newly diagnosed individuals should be educated about depression/anxiety and available supports. Implications for rehabilitation Primary care providers play a pivotal role in the pathway to mental health care, and therefore should always screen for depression/anxiety and provide comprehensive assessment and referral to specialist services where necessary. Targeted psychoeducation should be provided to survivors of stroke who are older and newly diagnosed with depression/anxiety, to increase awareness about mood problems following stroke. Primary care providers should collaborate with other health professionals (e.g., through coordinating a team care arrangement plan), to address patients’ multiple and complex rehabilitation needs. Rehabilitation professionals should remain informed about current evidence-based treatments for post-stroke depression/anxiety and pathways that enable their patients to access these services.

Psychological Distress, Post-Traumatic Stress, and Suicidal Ideation Among Resettled Nepali-Speaking Bhutanese Refugees in the United States: Rates and Predictors.

Bhutanese refugees may exhibit psychological distress (PD), post-traumatic stress (PTS), and suicidal ideation (SI), but little is known about predictors of these mental health problems. To examine rates and predictors of PD, PTS, and SI among Bhutanese refugees. Cross-sectional correlational study of 209 Bhutanese refugees in Midwestern United States. Data were collected using the Hopkins Symptom Checklist/Nepali version and Refugee Health Screener-15/PTS subscale and then analyzed using simultaneous multiple regression. Rates of PD, PTS, and SI were 18.7%, 8.1%, and 7.7%, respectively. Significant predictors of PD were a history of mental health treatment (p<.001) and fewer years of schooling (p = .032). Predictors of PTS were history of mental health treatment (p<.001), female gender (p = .016), fewer years of schooling (p = .012), and being single/previously married (p = .004). PTS predicted SI (ρ<.001). Health providers should routinely assess Bhutanese refugees' mental health status for timely further assessment and treatment.

Exploring Adolescent Experiences with Disclosing Self-Injurious Thoughts and Behaviors Across Settings.

Disclosure of self-injurious thoughts and behaviors (SITBs) is critical to current treatment and prevention programs. Limited research has examined patterns of and barriers to SITB disclosure in adolescents. This work is critical given the limits of confidentiality in this population. Over 1,000 adolescents aged 13-17 with a history of mental health treatment and SITBs were recruited online. Participants reported their history with disclosing SITBs across a range of relationships, honesty in and barriers to disclosure to healthcare providers, and their experiences with breaches of confidentiality to parents/guardians. We examined relationships among these experiences and a range of outcomes, including perceived likelihood of future disclosure. Participants reported most frequent disclosure of all SITBs to friends, and more frequent disclosure of nonsuicidal self-injury compared to suicide ideation or attempts. Adolescents were most likely to disclose SITBs when directly asked by healthcare providers, though many participants reported continued SITB concealment. The most commonly endorsed barrier to disclosure was fear that the provider would tell a parent/guardian. Experiences with confidentiality breaches involving a non-collaborative breach were negatively associated with future disclosure, mental health symptoms, and adolescent-parent relationships. SITB disclosure is a cornerstone to their treatment and prevention. Better understanding of to whom and when, barriers, and the impact of disclosure experiences is critical. Our research suggests that most adolescents do not want their parents to know about their SITBs, and that fear of parent involvement prevents disclosure. Results have several implications for SITB assessment across physical and mental healthcare settings.