Impact Of Poor Mental Health Research Articles

The Impact of Poor Mental Health on Productivity and Suitable Remedies

Mental health significantly influences an individual's ability to perform tasks efficiently. Poor mental health can lead to decreased productivity, increased absenteeism, and diminished quality of work. This paper explores the relationship between mental health and productivity, highlighting key factors that contribute to poor mental health in the workplace. Additionally, it provides an overview of suitable remedies, including organizational strategies and individual interventions, to mitigate these negative effects. By understanding and addressing the impact of poor mental health, organizations can foster a healthier work environment and enhance overall productivity.

Relating preoperative MCS-12 to microdiscectomy outcomes

PurposeTo determine the impact of poor mental health on patient-reported and surgical outcomes after microdiscectomy.MethodsPatients ≥ 18 years who underwent a single-level lumbar microdiscectomy from 2014 to 2021 at a single academic institution were retrospectively identified. Patient-reported outcomes (PROMs) were collected at preoperative, three-month, and one-year postoperative time points. PROMs included the Oswestry Disability Index (ODI), Visual Analog Scale Back and Leg (VAS Back and VAS Leg, respectively), and the mental and physical component of the short form-12 survey (MCS and PCS). The minimum clinically important differences (MCID) were employed to compare scores for each PROM. Patients were categorized as having worse mental health or better mental health based on a MCS threshold of 50.ResultsOf 210 patients identified, 128 (61%) patients had a preoperative MCS score ≤ 50. There was no difference in 90-day surgical readmissions or spine reoperations within one year. At 3- and 12-month time points, both groups demonstrated improvements in all PROMs (p < 0.05). At three months postoperatively, patients with worse mental health had significantly lower PCS (42.1 vs. 46.4, p = 0.004) and higher ODI (20.5 vs. 13.3, p = 0.006) scores. Lower mental health scores were associated with lower 12-month PCS scores (43.3 vs. 48.8, p < 0.001), but greater improvements in 12-month ODI (− 28.36 vs. − 18.55, p = 0.040).ConclusionWhile worse preoperative mental health was associated with lower baseline and postoperative PROMs, patients in both groups experienced similar improvements in PROMs. Rates of surgical readmissions and reoperations were similar among patients with varying preoperative mental health status.

Internet access as a moderator of mental health and satisfaction with life during the COVID-19 pandemic: Evidence from young Filipino undergraduates from income-poor households

The COVID-19 pandemic has introduced extraordinary challenges in the personal and school lives of young people living in poverty in the Philippines. These pandemic-induced life challenges can be further complicated when the students experience mental health problems and have poor access to the Internet. Using the lens of capability approach, this cross-sectional online survey study examines how the interaction of mental health, and Internet access influence satisfaction with life during the pandemic among young, income-poor Filipino undergraduates through moderation analysis. A total of 1,393 public university students aged 18 to 24 years old from households earning an estimated monthly income of less than PhP10,000 (198USD) were included in this study. Findings reveal that more than half (53 %) of the sample report having unstable Internet access. Mental well-being was positively linked with satisfaction with life. Moreover, moderation analysis results suggest that stable Internet access can weaken the impact of poor mental health on life satisfaction among the income-poor students. The findings highlight the importance of addressing the mental and digital needs of youth living in poverty to improve their overall well-being.

Mental Health of Breastfeeding Mothers during COVID-19 Pandemic

Background: The current widespread COVID-19 outbreak has been linked to psychological distress and increased mental health symptoms including depression, anxiety, and posttraumatic stress disorder diagnoses in during the postpartum period. The psychological distress in mothers during the postpartum period can have negative consequences for both the mother and the baby. One of negative effect could be an obstacle to optimal breastfeeding. Purpose: This scoping review aims to provide the generate overview and present the results of previous studies related to the mental health of breastfeeding mothers during the COVID-19 pandemic. Methods: This study was carried out using a scoping review approach in accordance with the Arksey and O'Malley’s framework. The search strategy used the keywords that related to the PEOS framework. Databases included PubMed, Wiley Online Library, ScienceDirect, and Embase. The authors also appraised the article's quality by critical appraisal tool. Results: The most of the research was conducted in developed countries (75%). The method of that articles used quantitative method of 17 articles (85%), qualitative method 2 articles (10%) and mixed method 1 article (5%). Based on an analysis of 20 articles, three themes were obtained, namely mental health issues in breastfeeding mothers, factors affecting mental health during COVID-19, the impact of poor mental health in breastfeeding mothers. Conclusion: The Global outbreaks or pandemics have an impact including in breastfeeding mothers. Breastfeeding mothers feel that during the COVID-19 they are experiencing psychosocial problems due to internal and external factors that can influence the mother's decision to provide exclusive breastfeeding.

Confidentiality matters! Adolescent males’ views of primary care in relation to psychosocial health: a structural equation modelling approach

Objective To investigate to what degree adolescent males (1) value confidentiality, (2) experience confidentiality and are comfortable asking sensitive questions when visiting a general practitioner (GP), and (3) whether self-reported symptoms of poor mental health and health-compromising behaviours (HCB) affect these states of matters. Design Cross-sectional. Setting School-based census on life, health and primary care in Region Sörmland, Sweden. Subjects 2,358 males aged 15–17 years (response rate 84%). Main outcome measures The impact of poor mental health and HCBs on adolescent males’ valuing and experiencing private time with the GP, having professional secrecy explained, and being comfortable asking about the body, love and sex, analysed with structural equation modelling. Results Almost all respondents valued confidentiality regardless of their mental health or whether they engaged in HCBs: 86% valued spending private time with the GP, and 83% valued receiving a secrecy explanation. Among those who had visited a GP in the past year (n = 1,200), 74% had experienced private time and 42% a secrecy explanation. Three-quarters were at least partly comfortable asking sensitive questions. Adolescent males with HCBs were more likely to experience a secrecy explanation (approximative odds ratio [appOR] 1.26; p = 0.005) and to be comfortable asking about sex than their peers (appOR 1.22; p = 0.007). Respondents reporting experienced confidentiality were more comfortable asking sensitive questions (appOR 1.25–1.54; p ≤ 0.010). Conclusion Confidentiality matters regardless of poor mental health or HCBs and makes adolescent males more comfortable asking sensitive questions. We suggest that GPs consistently offer private time and explain professional secrecy. Key Points Confidentiality for adolescent males has been scantily studied in relation to mental health and health-compromising behaviours. In this study, most adolescent males valued confidentiality, regardless of their mental health and health-compromising behaviours. Health-compromising behaviours impacted only slightly, and mental health not at all, on experiences of confidentiality in primary care. When provided private time and an explanation of professional secrecy, adolescent males were more comfortable asking the GP sensitive questions.

Self-reported anxiety and depression problems and suicide ideation among black and latinx adults and the moderating role of social support.

Suicide is a critical public health problem. Over the past decade, suicide rates have increased among Black and Latinx adults in the U.S. Though depression is the most prevalent psychiatric contributor to suicide risk, Black and Latinx Americans uniquely experience distress and stress (e.g., structural adversity) that can independently operate to worsen suicide risk. This makes it important to investigate non-clinical, subjective assessment of mental health as a predictor of suicide ideation. We also investigate whether social support can buffer the deleterious impact of poor mental health on suicide ideation.We analyzed data from 1,503 Black and Latinx participants of the Washington Heights Community Survey, a 2015 survey of residents of a NYC neighborhood. Multivariable logistic regression was conducted to examine the effect of subjectively experienced problems with anxiety and depression on suicide ideation independent of depression diagnosis, and the role of social support as a moderator.Estimated prevalence of past two-week suicide ideation was 5.8%. Regression estimates showed significantly increased odds of suicide ideation among participants reporting moderate (OR = 8.54,95% CI = 2.44-29.93) and severe (OR = 16.84,95% CI = 2.88-98.46) versus no problems with anxiety and depression, after adjustment for depression diagnosis. Informational support, i.e., having someone to provide good advice in a crisis, reduced the negative impact of moderate levels of anxiety and depression problems on suicide ideation.Findings suggest that among Black and Latinx Americans, subjective feelings of anxiety and depression account for a significant portion of the suicide ideation risk related to poor mental health. Further, social support, particularly informational support, may provide protection against suicide ideation.

The Moderating Role of Social Support in the Relationship between Poor Mental Health and Excessive Alcohol Consumption: A Gender-Specific Analysis

Background: Social support can potentially attenuate the positive relationship between poor mental health and excessive drinking. The present study tried to understand: (1) whether there is a gender-specific relationship between poor mental health and excessive drinking; and (2) if and how social support moderates the relationship between poor mental health and excessive drinking. Methods: We analyzed the data from 2016 Behavioral Risk Factor Surveillance System (BRFSS; N = 33,705). Weighted data were stratified by gender and controlled for demographic variables. We assessed poor mental health and social support as correlates of heavy and binge drinking, followed by analyzing the moderation effect of social support X poor mental health interaction terms. Results: Poor mental health is linked with excessive drinking across genders. The interaction analysis shows that social support moderates the effect of ever having a poor mental health day in men’s heavy drinking, but the interaction term is not significant in all other excessive drinking models, suggesting that social support may not buffer the negative impact of poor mental health on problem drinking, particularly among women. Conclusion: Individuals with greater mental health challenges are more likely to drink hazardously, regardless of gender. Those who have low level of social support and poor mental health, particularly men, are at risk for heavy drinking. Given the majority of the interaction results is not significant, the study provides limited support for the buffering role of social support between poor mental health and problem drinking.

Association between prehypertension and psychological distress among adults in Saudi Arabia: A population-based survey.

BackgroundPrehypertension is a precursor to hypertension status. Psychological distress has been identified earlier among hypertensives; however, there is little evidence for the presumptive relationship between prehypertension and psychological distress.ObjectiveThe study aimed to assess the psychological wellbeing of the Al-Kharj, Saudi Arabia population, using the General Health Questionnaire (GHQ-12) and correlating it with prehypertensive patients in the same population.MethodsA cross-sectional analysis of the population of Al-Kharj, Saudi Arabia, was carried out between January and June of 2016. With an 85 percent response rate, a total of 1016 participants participated in the study. A multiple linear regression analysis was performed to assess the relationship between prehypertension and psychological distress.ResultsThe findings of the adjusted analysis demonstrated that, on average prehypertensive patients were more distressed psychologically than non-hypertensive patients (unstandardized Beta regression coefficient = 3.600; P-value 0.025). Similarly, on average women were found to be more psychologically distressed than men (unstandardized Beta = 1.511, P-value 0.002). Civil workers and unemployed individuals were more psychologically distressed than employed individuals (unstandardized Beta = 1.326, P-value 0.041) while adjusting for the sociodemographic and other variables such as BMI, diabetes status, cholesterol, and smoking status.ConclusionThe current study shows that as compared to normotensive patients, self-rated mental wellbeing and psychological wellbeing are all considerably poorer among prehypertensive patients. To prevent individuals from having negative psychological outcomes and their long-term complications, the Government of Saudi Arabia needs to concentrate on prehypertensive, female, and unemployed individuals. Well-designed longitudinal studies, primarily in Saudi Arabia, are needed in the future to research the cause and impact of poor mental health and prehypertension.

Impact, role, and contribution of family in the mental health of industrial workers.

The mental health of the worker population has been given special focus in the last few decades, mostly due to workplace stress and its related consequences on productivity and management. The impact of poor mental health of industrial workers on their families remains largely unexplored. Families have been found to get affected due to issues related to work-family and family-work conflict. Balancing between work and family has been found to be the major source of stress in industrial workers leading to a multitude of mental health issues and substance addiction. Families play a significant role in identifying the mental health problems in their working members and also can act as a bridge between the worker and the organization/industry in facilitating mental health care. The family members play key roles in providing significant support and care to persons suffering from serious mental illness/psychological distress. The focus of holistic management of mental health issues in industrial workers should include proper psycho-education of family members and taking into consideration their mental health needs. In this brief communication, we had tried to highlight the key issues pertaining to the impact, role, and contribution of family in the mental health of industrial workers.

Higher Education Completion Rates for Domestic Undergraduate Students Who Access Mental Health Services Using A Multi-Agency Matched Population Cohort

By linking Education, Health, and Welfare data in the Multi-Agency Data Integration Project (MADIP), our analysis looked at the impact of poor mental health on the likelihood of completing an undergraduate degree in Australia.&#x0D; IntroductionCompletion of a bachelor degree is important to both the student and the government, as it provides lifelong benefits and prevents investment loss. Previous research has reported conflicting findings regarding whether students with mental ill health are less likely to complete a degree, with an estimated 25 per cent of young adult university students experiencing mental ill-health each year.&#x0D; Objectives and ApproachOur research analysed national mental health service use and related pharmaceutical prescriptions linked with education data to determine the extent and effect of known mental health conditions on undergraduate student six-year completion rates. We followed a de-identified cohort of 120,000 students who commenced an undergraduate degree for the first time in 2011 for six years. Summary statistics and a binomial logit was used on a matched sample to confirm significance.&#x0D; ResultsWe found that students with a known mental health condition had a significantly lower six-year completion rate (58 per cent) than those students with no known mental health condition (71 per cent). By simulating a randomised control trial controlling for a wide range of demographics, we showed that these results held and that completion rates worsened with increasing severity of mental health conditions, as measured by usage of psychiatric services.&#x0D; ConclusionIntegrated data assets such as MADIP help us better understand the interaction between student success and mental health conditions which in turn will help us improve policy and better evaluate programs.

Editorial Perspective: Why I am now convinced that emotional disorders are increasingly common among young people in many countries

This editorial perspective comments on the evidence that mental health is deteriorating among children and young people at the same time as the impact of poor mental health is more impairing. It discusses the methodological difficulties in detecting a 'true' change in prevalence. There are particular gaps in the evidence from low- and middle-income countries and also in relation to autism spectrum disorders. The evidence in high-income countries points to recent increases in anxiety, depression and self-harm in teenagers, particularly young women. We need more longitudinal data to disentangle the potential explanations for these changes.

Mental health impact on the unmet need for family planning and fertility rate in rural Ethiopia: a population-based cohort study.

Although much research has focused on socio-demographic determinants of uptake of contraception, few have studied the impact of poor mental health on women's reproductive behaviours. The aim of this study was to examine the impact of poor mental health on women's unmet need for contraception and fertility rate in a low-income country setting. A population-based cohort of 1026 women recruited in their third trimester of pregnancy in the Butajira district in rural Ethiopia was assessed for symptoms of antenatal common mental disorders (CMDs; depression and anxiety) using Self-Reporting Questionnaire-20. Women were followed up regularly until 6.5 years postnatal (between 2005 and 2012). We calculated unmet need for contraception at 1 year (n = 999), 2.5 (n = 971) and 3.5 years (n = 951) post-delivery of index child and number of pregnancies during study period. We tested the association between CMD symptoms, unmet need for contraception and fertility rate. Less than one-third of women reported current use of contraception at each time point. Unmet need for birth spacing was higher at 1 year postnatal, with over half of women (53.8%) not using contraception wanting to wait 2 or more years before becoming pregnant. Higher CMD symptoms 1 year post-index pregnancy were associated with unmet need for contraception at 2.5 years postnatal in the unadjusted [odds ratio (OR) 1.09; 95% confidence interval (CI) 1.04-1.15] and fully adjusted model [OR 1.06; 95% CI 1.01-1.12]. During the 6.5 year cohort follow-up period, the mean number of pregnancies per woman was 2.4 (s.d. 0.98). There was no prospective association between maternal CMD and number of pregnancies in the follow-up period. CMD symptoms are associated with increased unmet need for family planning in this cohort of women with high fertility and low contraceptive use in rural Ethiopia. There is a lack of models of care promoting integration of mental and physical health in the family planning setting and further research is necessary to study the burden of preconception mental health conditions and how these can be best addressed.

230. Impact of poor mental health on clinical outcomes in surgically treated adolescent idiopathic scoliosis patients

BACKGROUND CONTEXT Prior literature in patients with adult spine deformity has found that poor mental health at baseline is associated with worse postoperative outcomes. PURPOSE The purpose of this study is to demonstrate that adolescent idiopathic scoliosis (AIS) patients with poor mental health at baseline can experience significant improvements with surgery. We hypothesize that in AIS, low SRS-22r mental health scores are largely due to the presence of deformity. The purpose of this study is determine if the correction of the deformity would potentially improve mental health scores. STUDY DESIGN/SETTING Retrospective review of prospective AIS registry. PATIENT SAMPLE Adolescents with idiopathic scoliosis. OUTCOME MEASURES Mental health scores and percent of patients reaching minimum clinically important difference (MCID) at 2 years postoperative. METHODS A total of 1,532 (1,261 girls, 271 boys) with available baseline and 2-years follow-up SRS-22r scores were included. Patients with baseline mental health domain scores who were 1 standard deviation below the mean ( 4.7) were classified as “high mental health” score (HMH) group. The remaining patients were classified as “intermediate mental health” score (IMH). A minimal clinically important difference (MCID) of 0.6 was used for SRS-22r for analysis RESULTS There were 247 patients in the LMH group, 1,015 in the MMH group, and 270 in the HMH group. Compared to baseline, all 3 groups demonstrated significant improvements in the overall SRS-22r scores at the 2-year follow-up: 0.8 ±0.5 in the LMH group, 0.5 ±0.4 in the IMH group, and 0.29 ±0.35 in the HMH group (P CONCLUSIONS In distinction from adult deformity patients, in the AIS population, alterations in normal body image may results in low mental health at baseline. These patients can experience significant benefit with surgery, and majority of these patients achieve MCID for the SRS-22r at the 2-year follow-up. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The impact of childhood bullying on the daily lives of Nordic children and young adolescents.

Childhood bullying may negatively affect the mental health in children and adolescents, but few studies have explored this potential link. We aimed to investigate the association between childhood bullying and the impact of poor mental health on the daily life in a population of Nordic children and adolescents aged 5-16years. This cross-sectional study was based on data from the Nordic survey on Children's Health and Wellbeing (NordChild) from 2011. The study population included 4966 children from Denmark, Finland, Iceland, Norway and Sweden. Mental health was measured by a parent-reported version of the Strength and Difficulties Questionnaire. We conducted multiple logistic regression analyses to estimate the odds ratios of poor mental health in bullied compared to non-bullied children and adolescents while adjusting for sex, age, body mass index and parental socioeconomic status. Bullied children and adolescents were four times more likely than their non-bullied peers to have mental health problems with negative impact on their daily life at home, in their relations to friends, learning in school or leisure activities (adjusted odds ratio: 4.32; 95% CI: 3.54-5.26). This study found negative impact on the mental health in bullied children and adolescents, which affected several arenas of daily life.

Using Record Linkage to Examine the Impact of Poor Mental Health on Breast Screening Uptake

BackgroundThe UK National Breast Screening Programme is estimated to reduce breast cancer mortality by 20%. To maximise the benefits of the programme, we first need to understand the underlying factors contributing to variations in screening uptake. One potentially significant factor which may contribute to these gradients in screening uptake is poor mental health.&#x0D; ObjectivesThe objectives of this study were to examine the impact of poor mental health on breast screening uptake, and whether this explained any of the previously observed socio-demographic gradients in screening uptake.&#x0D; MethodsBreast screening records were obtained from the National Breast Screening System (NBSS) and were subsequently linked to 2011 Census data within the Northern Ireland Longitudinal Study (NILS). The NILS encompasses 28\% of Census data. This was then linked to psychotropic prescribing information from the Enhanced Prescribing Database (EPD), to produce a de-identified research dataset containing 57,328 women.&#x0D; FindingsWomen with self-reported poor mental health were over 20% less likely to attend screening compared to their counterparts who didn't have poor mental health. Using psychotropic prescribing information as a proxy for the presence of mental illness yielded similar results, with those taking anxiolytics, antipsychotics or hypnotics in the three months before screening invitation significantly less likely to attend than those who were not.&#x0D; ConclusionWomen with poor mental health were significantly less likely to attend breast screening. However, poor mental health did not explain any of the previously determined socio-demographic gradients in screening uptake.

Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up.

OBJECTIVE Mental disease burden can have a significant impact on levels of disability and health-related quality of life (HRQOL) measures. Therefore, the authors investigated the significance of mental health status in adults with spinal deformity and poor physical function. METHODS A retrospective analysis of a prospective multicenter database of 365 adult spinal deformity (ASD) patients who had undergone surgical treatment was performed. Health-related QOL variables were examined preoperatively and at the 2-year postoperative follow-up. Patients were grouped by their 36-Item Short Form Health Survey mental component summary (MCS) and physical component summary (PCS) scores. Both groups had PCS scores ≤ 25th percentile for matched norms; however, the low mental health (LMH) group consisted of patients with an MCS score ≤ 25th percentile, and the high mental health (HMH) group included patients with an MCS score ≥ 75th percentile. RESULTS Of the 264 patients (72.3%) with a 2-year follow-up, 104 (28.5%) met the inclusion criteria for LMH and 40 patients (11.0%) met those for HMH. The LMH group had a significantly higher overall rate of comorbidities, specifically leg weakness, depression, hypertension, and self-reported neurological and psychiatric disease processes, and were more likely to be unemployed as compared with the HMH group (p < 0.05 for all). The 2 groups had similar 2-year postoperative improvements in HRQOL (p > 0.05) except for the greater improvements in the MCS and the Scoliosis Research Society-22r questionnaire (SRS-22r) mental domain (p < 0.05) in the LMH group and greater improvements in PCS and SRS-22r satisfaction and back pain domains (p < 0.05) in the HMH group. The LMH group had a higher rate of reaching a minimal clinically important difference (MCID) on the SRS-22r mental domain (p < 0.01), and the HMH group had a higher rate of reaching an MCID on the PCS and SRS-22r activity domain (p < 0.05). On multivariable logistic regression, having LMH was a significant independent predictor of failure to reach an MCID on the PCS (p < 0.05). At the 2-year postoperative follow-up, 14 LMH patients (15.1%) were categorized as HMH. Two LMH patients (2.2%), and 3 HMH patients (7.7%) transitioned to a PCS score ≥ 75th percentile for age- and sex-matched US norms (p < 0.01). CONCLUSIONS While patients with poor mental and physical health, according to their MCS and PCS scores, have higher medical comorbidity and unemployment rates, they still demonstrate significant improvements in HRQOL measurements postoperatively. Both LMH and HMH patient groups demonstrated similar improvements in most HRQOL domains, except that the LMH patients had difficulties in obtaining improvements in the PCS domain.

Poor Mental Health Impacts Member Experiences and Satisfaction

Estimate the impact of poor mental health and treatment on member satisfaction and experiences, among older adults with an AARP® Medicare Supplement Insurance Plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York) and Medicare Part D coverage. The association between poor mental health, treatment for a mental disorder, and health literacy was also evaluated.

Sexual Dysfunction among Older Adults: Prevalence and Risk Factors from a Nationally Representative U.S. Probability Sample of Men and Women 57–85 Years of Age

Despite increasing demand for clinical interventions into sexual problems in an aging population, epidemiological data on the subject are scarce. To examine the prevalence of sexual problems across different sociodemographic groups, and risk factors for these problems in multiple domains of life. Statistical analysis of data from the 2005-2006 National Social Life, Health, and Aging Project (NSHAP), a nationally representative U.S. probability sample of 1,550 women and 1,455 men aged 57-85 at the time of interview. Likelihood of experiencing sexual dysfunction in the preceding 12 months. Sexual problems among the elderly are not an inevitable consequence of aging, but instead are responses to the presence of stressors in multiple life domains. This impact may partly be gender differentiated, with older women's sexual health more sensitive to their physical health than is true for men. The mechanism linking life stress with sexual problems is likely to be poor mental health and relationship dissatisfaction. The NSHAP results demonstrate the consistent impact of poor mental health on women's reports of sexual problems and the less consistent association with men's problems. The results point to a need for physicians who are treating older adults experiencing sexual problems to take into account not simply their physical health, but also their psychosocial health and satisfaction with their intimate relationship.

The economics of mental health in the workplace: what do we know and where do we go?

To provide an overview of the economic impact of poor mental health in the workplace and assess the extent to which economic evaluation has been used to further the case for investment in workplace based mental health programmes. Rapid scoping review of published and grey literature. The socio-economic costs of poor mental health in the workplace are substantial but conservative, as few studies have included productivity losses from work cutback, as well as absenteeism. While few economic evaluations of workplace based mental health interventions were identified, the available evidence base suggests that they have the potential to be highly cost effective. Much of this evidence may be from the US and be less applicable elsewhere; it may also have been solely published in company documents making assessment of methodological quality difficult. The potential economic case for workplace based mental health interventions appears good. More collaboration between policy makers and the private sector would help facilitate rigorous and transparent economic evaluations. A number of evaluations are planned. The challenge is to build on these initiatives, in order to address what remains a major gap in our knowledge on the economics of mental health.

Processes linking adolescent problems to substance-use problems in late young adulthood.

The current study explores three avenues in early young adulthood through which adolescent problems may be linked to later substance use problems: problematic substance use, failure to assume adult roles and responsibilities, and exposure to pro-drug social influences. Participants (N = 1,986; 49% female) filled out surveys at ages 18, 23 and 29. Participants were 67% white, 9% black, 10% Hispanic and 8% Asian. Deviance, poor mental health, substance use, alcohol and other drug (AOD) problems, and school dropout were measured at age 18. AOD problems were also measured at age 23, as were role changes (e.g., marriage) and pro-drug social influences (e.g., friends use drugs). Indicators of substance abuse and dependence were measured at age 29. Demographics and family history of AOD were covariates. Reporting more deviant behavior and heavier drinking at age 18 was associated with a higher likelihood of abuse and dependence at age 29. Alcohol use and pro-drug social influences at age 23 appeared to mediate the effects of adolescent substance use; lack of role assumption did not. The effect of poor mental health at age 18 was not mediated by any set of variables but instead appeared to directly predict dependence at age 29. Findings highlight the importance of early young adult drinking and substance-using peers in continuing patterns of heavy substance use developed during adolescence and also underscore the long-term impact of poor mental health during adolescence on substance use problems in late young adulthood.