Mental Health History Research Articles

Police Use of Force in Mental Health Crises: An Analysis of Coronial Inquest Findings from Australia

Police are frequently the initial responders to situations involving individuals experiencing a mental health crisis. These situations sometimes escalate to the point where police resort to the use of force, resulting at times in injury and, less often, loss of life. This study draws on data from coronial inquest reports of cases involving police use of fatal force against persons with mental illness from one Australian jurisdiction. It examines the contextual factors leading up to these incidents, the personal backgrounds and mental health histories of the individuals in crisis, and the tactical approaches employed by police leading to the use of deadly force. Understanding these insights is crucial as they can potentially guide efforts to reform police practices in dealing with individuals in mental health crises and ultimately may help to prevent fatal outcomes.

A history of hydrotherapy and mental health

A history of hydrotherapy and mental health

Transitioning to fatherhood: Prospective effects of wellbeing on future depression symptoms.

Becoming a father is a critical period of life transition. Evidence suggests that lifetime history of mental health disorder/s and elevated depressive symptoms prior to conception increase risk for men's postnatal depression. Less is understood about the role of positive mental health, or wellbeing, as a protective factor for future depressive outcomes during the transition to fatherhood. The present study investigated whether men's post-natal depressive outcomes were associated with pre-conception levels of wellbeing and whether wellbeing during the post-natal period predicted depressive outcomes post-infancy. Secondary analysis of data from a national, longitudinal cohort study of men's health, namely, The Ten to Men Study (TTM), was conducted. Participants in the pre-conception sample were n = 350 men for whom data were available at both a pre-conception baseline and post-natal follow-up. The post-natal sample were n = 427 men with post-natal baseline data and post-infancy follow-up. Multivariate negative binomial regressions and logistic regression models were used to determine pre-conception and post-natal predictors of future depressive outcomes. Men's pre-conception depressive symptoms were the best predictor of post-natal depressive symptoms (IRR = 1.089, p < 0.001) and risk of moderate-severe depression (IRR = 1.193, p = 0.005) the latter of which was also predicted by a previous mental health diagnosis (IRR = 3.079, p = 0.029). Similarly, post-natal depressive symptoms were the best predictor of post-infancy depressive symptoms (IRR = 1.089, p < 0.001) and risk of moderate-severe depression (IRR = 1.193, p = 0.005) alongside lifetime prevalence of a mental health disorder (symptoms: IRR = 1.317, p = 0.011; moderate-severe depression: IRR = 2.606, p = 0.023). Preconception levels of wellbeing predicted lower post-natal depressive symptoms (IRR = 0.988, p < 0.001) and reduced risk of moderate-severe depression (IRR = 0.940, p = 0.002) after controlling for baseline symptoms and sociodemographic and behavioural confounds; however, wellbeing during the post-natal period did not predict either depressive outcome post-infancy. Fatherhood-specific risk factors for mental health outcomes (e.g., conception difficulties, maternal postnatal mental health) were not assessed in the present study, and only one aspect of wellbeing was captured. Screening for history of common mental health disorders and current symptoms is recommended to inform preventative approaches to paternal mental health care during early fatherhood. Inclusion of wellbeing in such screening procedures may be beneficial, however, further research is required to elucidate the prospective associations between wellbeing and depressive symptoms during the transition to fatherhood.

Baclofen-related deaths in Australia 2000–2022

In Australia, the therapeutic indication of baclofen (oral tablets) is for the treatment of muscle spasm. Deaths related to baclofen have been reported, as well as misuse, dependence and self-poisoning. This national retrospective study aimed to investigate the number, characteristics, circumstances, and toxicology of baclofen-related deaths in Australia, 2000–2022. We identified 102 baclofen-related deaths, with a mean age of 45.6 years and 51 % being male. Circumstances of death were: intentional toxicity (54.9 %), unintentional toxicity (30.4 %), unintentional toxicity/disease (9.8 %), and accidental injury (4.9 %). Multiple sclerosis or spinal injury was documented in 15.7 % of cases, substance use problems in 43.1 % and specifically alcohol use problems in 38.2 %. Mental health problems were documented in 73.5 %, a previous self-harm or suicide attempt in 30.4 %, and chronic pain in 37.3 %. The median baclofen blood concentration for all cases was 3.10 mg/L (25th 0.70, 75th 8.10, range 0.04–110.00), unintentional toxicity 1.95 mg/L (25th 0.70, 75th 4.35, range 0.04–24.0), intentional toxicity 6.00 mg/L (25th 1.10, 75th 13.0, range 0.05–110.0). Concomitant substance use was seen in 93.8 %, with antidepressants (69.8 %) and benzodiazepines (64.6 %) most frequently detected. In conclusion, the ‘typical’ case was middle-aged, most dying due to intentional toxicity, and likely to have a history of mental health and substance use problems. We suggest caution is needed in prescribing baclofen given its potential to be used in intentional and non-intentional overdose.

Lower extremity osteotomies for limb preservation: Indications, outcomes, and risk factors

ObjectivesTo delineate the key factors associated with treatment success or failure for patients undergoing lower extremity osteotomies to address a spectrum of lower extremity joint and limb deformities at an Integrated Limb Preservation Center (ILPC). MethodsDesign: Retrospective cohort study.Setting: Level I Academic Trauma Center.Patient selection criteria: Patients of the ILPC with at least 1-year of follow-up data regarding previous surgery to correct trauma-or developmental-related deformities between January 1, 2005, and October 1, 2022.Outcome measures and comparisons: Patients were categorized first based on etiology (developmental vs. traumatic) and then based on the nature of deformity (joint, limb, nonunion). Treatment data, demographics including age, sex, body mass index (BMI), tobacco use history, insurance status, marital status, mental health history, and history of comorbidities, concurrent procedures, and post-operative infection, revision, reoperation, and bone healing status were extracted from the medical record and compared. Treatment failure was defined as conversion of the limb preservation surgery (ies) to amputation of any type. Results139 patients were included for analysis; 47 patients in the developmental-related cohort, and 92 patients in the trauma-related cohort. The treatment success rate in terms of preserving the affected limb for patients undergoing lower extremity osteotomies was 94.7 % for the developmental-related cohort and 92.4 % for the traumatic-related cohort. 57.4 % of patients in the developmental-related cohort and 59.8 % of patients in the trauma-related underwent unplanned secondary procedures Concurrent osteomyelitis debridement (p = 0.01) and postoperative infection (p = 0.049) were the only factors measured significantly associated with conversion to amputation. ConclusionsPatients undergoing osteotomies at an ILPC to address developmental-related or trauma-related joint and/or limb deformities experienced high short-term success (>90 %) with respect to preserving the affected limb. However, 56 % of patients required subsequent unplanned surgeries and improvements in PROMs were only statistically significant in patients with trauma-related deformities. Level of evidenceIII.

Psychosocial and pandemic-related circumstances of suicide deaths in 2020: Evidence from the National Violent Death Reporting System.

To describe and explore variation in 'pandemic-related circumstances' among suicide decedents during the first year of the COVID-19 pandemic. We identified pandemic-related circumstances using decedents' text narratives in the 2020 National Violent Death Reporting System. We use time-series analysis to compare other psychosocial characteristics (e.g., mental health history, interpersonal difficulties, financial strain) of decedents pre-pandemic (2017/2018: n = 56,968 suicide and n = 7,551 undetermined deaths) to those in 2020 (n = 31,887 suicide and n = 4,100 undetermined). We characterize common themes in the narratives with pandemic-related circumstances using topic modeling, and explore variation in topics by age and other psychosocial circumstances. In 2020, n = 2,502 (6.98%) narratives described pandemic-related circumstances. Compared to other deaths in 2020 and to the pre-pandemic period, decedents with pandemic-related circumstances were older and more highly educated. Common themes of pandemic-related circumstances narratives included: concerns about shutdown restrictions, financial losses, and infection risk. Relative to decedents of the same age that did not have pandemic-related circumstances in 2020, those with pandemic-related circumstances were more likely to also have financial (e.g., for 25-44 years, 43% vs. 12%) and mental health (76% vs. 66%) psychosocial circumstances, but had similar or lower prevalence of substance abuse (47% vs. 49%) and interpersonal (40% vs. 42%) circumstances. While descriptive, these findings help contextualize suicide mortality during the acute phase of the COVID-19 pandemic and can inform mental health promotion efforts during similar public health emergencies.

Perceived Cognitive Function in Neurosurgical Patients.

This study explores perceived cognitive function in preoperative cranial neurosurgical patients and its association with neuropsychological testing (NPT). A total of 96 patients were referred for NPT by neurosurgical service. Patients completed the Neuro-QoL Item Bank v2.0-Cognitive Function-Short Form (Neuro-QoL) to measure perceived cognitive function, as well as NPT. Linear regression (LR) models were analyzed for demographic variables (ie, age, sex, handedness, educational attainment, employment/academic status, candidacy vs baseline testing, and history of neurological, mental health, and developmental conditions) and NPT outcomes (ie, intellectual estimation, attention/working memory, processing speed, executive functioning, learning/memory, language, visual-spatial, anxiety symptoms, and depression symptoms). Significant predictors from the LR models were then combined into a single model to identify the most robust predictors of perceived cognitive function. Patients were aged 17 to 79 years (M = 49.64, SD = 18.56) and comprised 45 men and 51 women. The most common referrals for NPT were related to intracranial mass (39%), Chiari malformation type 1 (33%), and deep brain stimulation (20%). Results of the final LR model indicated mental health and developmental history, as well as elevated anxiety symptoms, significantly predicted 50.7% of the variance in perceived cognitive function (F = 30.91, P < .001). Patients referred to determine surgical candidacy reported significantly fewer cognitive complaints (P < .001) vs those referred for baseline testing by approximately 0.5 SDs. Perceived cognitive function in neurosurgical patients appears to be strongly predicted by demographic factors, with mental health variables being robust predictors. Perceived cognition is not a proxy for measured cognitive function.

Disparities in pain management among transgender patients presenting to the emergency department for abdominal pain.

Transgender and gender-diverse (TGD) individuals have a gender identity or expression that differs from the sex assigned to them at birth. They are an underserved population who experience health care inequities. Our primary objective was to identify if there are treatment differences between TGD and cisgender lesbian/gay/bisexual/queer (LGBQ) or heterosexual individuals presenting with abdominal pain to the emergency department (ED). Retrospective observational cohort study of patients ≥12 years of age presenting to 21 EDs within a health care system with a chief complaint of abdominal pain between 2018 and 2022. TGD patients were matched 1:1:1:1 to cisgender LGBQ women and men and cisgender heterosexual women and men, respectively. Propensity score matching covariates included age, ED site, mental health history, and gastrointestinal history. The primary outcome was pain assessment within 60 min of arrival. The secondary outcome was analgesics administered in the ED. We identified 300 TGD patients, of whom 300 TGD patients were successfully matched for a total cohort of 1300 patients. The median (IQR) age was 25 (20-32) years and most patients were treated in a community ED (58.2%). There was no difference between groups in pain assessment within 60 min of arrival (59.0% TGD vs. 63.2% non TGD, p = 0.19). There were no differences in the number of times pain was assessed (median [IQR] 2 [1-3] vs. 2 [1-4], p = 0.31) or the severity of pain between groups (5.5 [4-7] vs. 6 [4-7], p = 0.11). TGD patients were more likely to receive nonsteroidal anti-inflammatory drugs (32.0% vs. 24.9%, p = 0.015) and less likely to receive opioids than non-TGD patients (24.7% vs. 36.9%, p = <0.001). TGD and nonbinary patients, along with LGBQ cisgender women (24.7%) and heterosexual cisgender women (34%), were less likely to receive opioids than LGBQ cisgender men (54%) and heterosexual cisgender men (42.3%, p < 0.01). There was no difference in frequency of pain assessment, regardless of gender identity or sexual orientation. More cisgender men, compared to TGD and cisgender women, received opioids for their pain.

Neuropsychiatric symptoms of patients two years after experiencing severe COVID-19: A mixed observational study

BackgroundThe impact of SARS-CoV-2 infection (COVID-19) on mental health has not been extensively studied in the medium and long term. This study assessed how clinical, biological, and social factors affect mental health in patients who recovered from severe COVID-19. The evaluation was done 90 days after hospital discharge and followed up at 12 and 24 months. MethodsA retrospective-prospective cohort mixed observational study was conducted on patients over 18 years of age who required hospitalization in Internal Medicine or ICU for severe COVID-19 pneumonia during 2020 and 2021. Demographic information, clinical variables, and data for the scales were obtained from electronic medical records and telephone interviews. For comparisons of the different variables in each clinical variable (insomnia, depression, anxiety), the Student's t-test for independent samples has been used (normal distribution); otherwise, the Mann–Whitney test will be used. All tests and intervals will be performed with a confidence level of 95. Fisher's exact or Pearson's Chi-square test has been used as appropriate for qualitative variables. Results201 patients were recruited. 37.3% presented insomnia, 22.4% anxiety, and 21.4% depressive symptoms. A direct association was established between female sex and depressive symptoms. Psychotropic history, fatigue, and C-reactive protein levels (CRP) were correlated with depression. Anosmia and ageusia, CRP, cognitive symptoms, and dyspnea predicted insomnia. Sex, orotracheal intubation (OTI), pain, fatigue, mental health history, and academic level were independent predictors of anxiety. High percentages of depressive, anxiety, and insomnia symptoms were detected in the second month after discharge and persisted at 12 and 24 months. The fatigue variable maintained a significant relationship with depressive symptoms at 2, 12 and 24 months. A possible limitation could be recall bias in retrospective data collection. ConclusionsThis is a novel study to follow up on mental health for two years in patients with severe COVID-19. Clinical, biological, and psychosocial variables could be predictors of depressive symptoms, anxiety, and insomnia. The psychiatric symptoms persisted throughout the 2-year follow-up. These findings are critical for the follow-up of these patients and open the possibility of further studies in the medium and long term.

The longitudinal trajectory of depression and anxiety across the perinatal period

The understanding of long-term depression and anxiety trajectories across the perinatal periods is lacking. This longitudinal study investigated the change trajectories of both depressive and anxiety symptoms, as well as the associations of their trajectories over five years. The study included nulliparous participants (N = 163, Mage = 33.47, SDage = 3.53) with self-reported depressive and anxiety symptoms collected via questionnaires at 30- and 35 weeks' gestation, 1.5, 3, 6, 12, 24, and 60 months postpartum. Data were analysed using structural equation latent growth modelling with and without covariates. Symptoms of depression increased significantly during pregnancy (p < .001), and both depression and anxiety symptoms increased during postpartum (p-values<.001). A previous mental health history was significantly associated with greater depressive symptomology (p = .001), and White individuals (compared to non-White) tended to have greater depression and anxiety symptoms during pregnancy (p-values<.05). At 30- and 35-weeks' gestation, 6 weeks postpartum, 3, 6, 12, 24 months, and 5 years postpartum 2.5 %, 2.0 %, 4.6 %, 4.0 %, 7.3 %, 5.6 %, 3.5 % and 8.0 % of participants had clinically significant depressive symptoms and 6.1 %, 8.5 %, 7.1 %, 12.0 %, 11.9 %, 8.1 %, 7.9 %, and 28 % had clinically significant anxiety symptoms. This study highlights the need to assess both depression and anxiety in perinatal care, and to identify individuals who may require intervention.

Gun Ownership for Safety/Protection and Unsecure Firearm Storage Practices: Suicide Risk and Prevention among U.S. Army Servicemembers

Introduction: 2021 had the highest number firearm suicide deaths in U.S. history, with veterans representing 62.4% of firearm suicide deaths. The study objective is to understand motivations for firearm ownership, storage practices, history of mental health disorders and suicide risk in servicemembers, as reported by family members. Methods. Data were obtained from a case-control psychological autopsy study of 135 suicide decedents in the U.S. Army compared to a probability sample of 255 living controls, who are also service members weighted to be representative of the Army. Next-of-kin and Army supervisor informants participated in structured interviews and assessed reasons for firearm ownership, and storage practices. The military medical record provided mental health history of suicide decedents. A subsample of 123 personal firearm owners (n = 31 cases and n = 92 living controls) addressed the study objectives. Multivariable logistic regression analyses were constructed to examine predictors of unsecured firearm storage practices. Results: Family members reported safety/protection as the main reason for suicide decedents’ firearm ownership, which was significantly associated with unsecure firearm storage practices (OR = 3.8, 95% CI, 1.65, 8.75, x2 = 9.88, p = 0.0017). Ownership for safety/protection and lifetime history of Generalized Anxiety Disorder (GAD) from the military medical record (OR = 3.65, 95% CI, 1.48 – 9.02, x2 = 7.89 p = 0.0050) predicted unsecure storage. Conclusions: Ownership for safety/protection and the presence of clinically significant anxiety predicted unsecure firearm storage practices. Future research examining motivations for gun ownership for safety/protection, anxiety, and unsecure storage practices may help target interventions to prevent suicide.

Co-Occurring Mental and Physical Health Conditions Among Older Adults With and Without Post-traumatic Stress Disorder: A Case Control Study.

Rates of post-traumatic stress disorder (PTSD) among older adults range from 0.4%-4.5%. Research examining PTSD in adults has demonstrated numerous associations between physical and mental health conditions; however, these are less well characterized in older adults. The current study aimed to identify base rates of such conditions among older adults with and without a history of PTSD. In a case control design using the National Alzheimer's Coordinating Center Uniform Data Set, adults 65 years or older from the United States who endorsed either the presence or absence of PTSD were matched by age to assess between-group differences (N = 472; 236 pairs). We examined differences across self-reported sociodemographics and physical health, mental health, and substance use histories. More participants with a history of PTSD identified as Hispanic, non-white, non-married, and functionally independent. Compared to individuals without a history of PTSD, significantly more individuals with a history of PTSD had histories of depression, anxiety, substance abuse, Parkinson's disease, seizures, insomnia, and TBI. Among participants without PTSD history, only 14.7% reported a history of TBI, compared to 41.1% of individuals with PTSD history. Findings showed expected trends toward worse physical and mental health among older adults with self-reported PTSD. There was a striking difference in the frequency of TBI history between participants with and without PTSD. These findings underscore a need to assess for PTSD among older adults, particularly those reporting a history of TBI.

A - 114 Exploring Alzheimer’s Disease: the Interplay of Depression, Substance Use, and Neurocognition

Abstract Objective Depression and substance use (SU) can significantly impact one’s neurocognition and are potential risk factors for Alzheimer’s Disease (ad). The project aimed to explore whether a history of depression and/or SU could predict baseline performance on neuropsychological assessment among individuals with and without ad. Method Data from the National Alzheimer’s Coordinating Center (NACC) was analyzed. N = 9114 participants (41.5% Male, 58.5% Female; 56.7% Normal Cognition, 43.2% ad) at their first visit were selected. A series of linear regression models, separated by presence of ad diagnosis, were run to determine if a history of depression, and/or SU, age, race, sex, education level, and APOE status would predict performance on selected neuropsychological assessments measuring facets of executive functioning (EF) (Trail Making, Digit Span, and Wechsler Adult Intelligence Scale (WAIS)). Results Depression was a significant predictor of performance on the WAIS in the normal cognition (β = −0.12,p &amp;lt; 0.001) and ad (β = −0.14,p &amp;lt; 0.001) groups, on Number of Correct Digit Span Backward Trials in the normal cognition (β = 0.09,p &amp;lt; 0.01) and ad (β = −0.10,p &amp;lt; 0.01) groups, and on Number of Correct Digit Span Forward Trials in the ad group (β = −0.11,p &amp;lt; 0.001). SU was a significant predictor of performance on Number of Correct Digit Span Backward Trials in the ad group (β = 0.20,p &amp;lt; 0.01). Demographic variables were also significant. Conclusions Depression predicted performance on multiple neuropsychological assessments across diagnostic groups compared to SU. EF facets measured across assessments may have been further impacted by ad and mental health history compared to those with normal cognition endorsing mental health history.

A - 55 Exploring the Impact of Parental Substance Use Problems and Behavior on Pre-Adolescent Cognitive Performance

Abstract Objective Adults with a parental history of substance use problems (PH+) exhibit deficits in verbal, language, visuomotor, visuospatial, and executive functioning skills. However, findings on whether PH+ affects cognition developmentally is limited. This study explored how PH+ relates to preadolescents’ cognitive performance while controlling for environmental parental factors. Methods We sampled 11,633 participants aged 8–11 (47.74% female) from the Adolescent Brain Cognitive Development Study at baseline. The Family History Assessment evaluated PH+ of alcohol and other drug use problems, with scores ranging from 0–2 parents with problematic use (PH-, PH + 1, PH + 2). PH+ of alcohol (PHA+) and other drugs (PHD+) were assessed separately. The neurocognitive battery included the NIH Toolbox, RAVLT, and Matrix Reasoning. Parental factors assessed included prenatal substance exposure, family conflict, parental warmth, parental monitoring, and parental mental health history. Hierarchical linear mixed-effects models analyzed relationships between PHA+, PHD+, other parental variables of interest, and cognitive outcomes while controlling for demographics. Results PHA+ significantly predicted inhibitory control performance, with PHA + 1 youth performing better than PHA- youth (β = 0.71, p = 0.04), above and beyond other parental behaviors. Conversely, PHD + 1 youth scored lower on immediate (β = −0.3107, p = 0.02) and delayed (β = −3.58, p = 0.01) verbal memory recall, as well as visuospatial memory (β = −1.50, p = 0.003) compared to PHD- youth. Parental factors broadly predicted performance, with parental monitoring and prenatal exposure emerging as the most consistent predictors. Conclusion These findings underscore the complex relationship between PH+, environmental parental factors, and cognition among preadolescents. Future work should explore mechanisms linking parental behaviors to adolescent cognition, given these modifiable factors offer potential for intervention.

COVID-19 Vaccine Uptake among People with Spinal Cord Injury and Dysfunction in Ontario, Canada: A Population-Based Retrospective Cohort Study.

Persons with disabilities experience numerous barriers to healthcare access including vaccine accessibility. The purpose of this study was to determine COVID-19 vaccine uptake in the spinal cord injury and disease (SCI/D) population of Ontario and identify potential factors influencing C OVID-19 vaccine uptake. This was a retrospective closed-cohort study using administrative health data on individuals with SCI/D of traumatic and non-traumatic causes to examine the monthly number of COVID-19 vaccine doses received between December 2020 and December 2023. Logistic regression analysis was used to examine the potential association between socio-demographic, clinical, and neighbourhood characteristics with initial COVID-19 vaccine receipt and booster dose uptake. By the end of the observation period in December 2023, 82.9% received the full two-dose coverage and 65.6% received at least one additional booster dose in a cohort of 3574 individuals with SCI/D. SCI/D individuals showed a comparable COVID-19 vaccine uptake percentage to the general population. Sociodemographic, clinical, and neighbourhood characteristics were associated with COVID-19 vaccine uptake in the SCI/D population, including age, type of injury, number of comorbidities, mental health history, and neighbourhood characteristics such as income. Further investigation is necessary to determine the causation effects of these relationships with vaccine uptake to address health equity concerns.

Suicidal Crisis Negotiations: An Investigation of Situational Characteristics, Hooks and Triggers

Crisis negotiation teams have previously been described as “gatekeepers” to suicidal individuals, with research showing that these are amongst the most common calls negotiators attend to. Despite this, the situational features of these calls and the communicative dynamics that may lead to the safe resolution of suicidal crises, remain poorly understood. Using a mixed method approach, situational characteristics across four suicidal incident types were examined, and “hooks” and “triggers” that were common in each incident type were identified. The results revealed some consistencies across incident types regarding incident location, and the mental health and substance use histories of subjects. Inconsistencies were observed for communication method used, weapons involved, and resolution details. Numerous hooks and triggers were identified for each incident type. The findings increase our understanding of suicidal crises and have implications for negotiator training (e.g., the features of actual suicidal incidents can inform the content of scenario-based training).

A Mixed Method Investigation of Parent-Adolescent Communication About Mental Health

PurposeParent-adolescent communication is critical for parents' recognition of a need for mental health treatment in their adolescent children. This study aimed to explore facilitators and barriers to parent-adolescent communication about mental health in order to generate ideas for interventions that improve communication and increase adolescent uptake of mental health services. MethodsTwenty adolescents aged 12 to 19 with a history of depression and/or anxiety were enrolled alongside one parent/guardian. Participants completed an online survey, followed by separate, semistructured interviews. Survey data were analyzed via paired and two-sample t tests. Separate, data-driven codebooks were developed from interview transcripts. Qualitative data were analyzed via a template analysis approach. ResultsAdolescents reported higher barriers to psychological help-seeking (24.0 + 7.3) when compared to parents (18.6 + 4.7), both on average (p = .008) and between individual dyads (p = .003). Parents reported better communication with their child (79.0 + 11.5), than adolescents did with their parents on average (68.7 + 17.3, p = .04). Fear of burdening parents, parental guilt and fear of parents' dismissal of mental health concerns were described as barriers to communication. Facilitators of communication included disclosure of familial mental health history, open-mindedness, and patience. Psychotherapy was described as positively impacting communication by assisting adolescents in understanding parents' perspectives, and teaching communication strategies. DiscussionBrief clinical interventions addressing structural and emotional barriers to psychological help-seeking, depression literacy, stigma and self-blame among parents, and disclosure of familial mental health history may encourage parent-adolescent communication and increase adolescents' access to mental health care.

Discharge Against Medical Advice: The Causes, Consequences and Possible Corrective Measures.

Patients who discharge themselves against medical advice comprise 1%-2% of hospital admissions. Discharge against medical advice (DAMA) is defined as when a hospitalised patient chooses to leave the hospital before the treating medical team recommends discharge. The act of DAMA impacts on both the patient, the staff and their ongoing care. Specifically, this means that the patient's medical problems maybe inadequately assessed or treated. Patients who decide to DAMA tend to be young males, from a lower socioeconomic background and with a history of mental health or substance misuse disorder. DAMA has an associated increased risk of morbidity and mortality. In this review of studies across Western healthcare settings, specifically adult medical inpatients, we will review the evidence and seek to address the causes, consequences and possible corrective measures in this common scenario.

Trajectory of Health-Related Quality of Life Following Pediatric Concussion

To assess changes in health-related quality of life (HRQOL) across a 12-month period following pediatric concussion and to explore whether psychological factors (ie, pre-injury mental health history, current symptoms of anxiety and depression, sleep disturbance, or grit) were associated with HRQOL. Prospective cohort study design using data collected from patients presenting to a speciality care concussion program, with each patient followed for 12 months after initial presentation. Comparison data were collected from non-concussed controls recruited from the community. A total of 49 concussed patients (median=15.4 years of age) completed the Pediatric Quality of Life Inventory (PedsQL), Patient-Reported Outcome Measure Information Systems (PROMIS) Anxiety and Depressive Symptoms short forms, Pediatric Sleep Disturbance forms, and a Short Grit Scale. Mixed effects models explored change in HRQOL across time. Total HRQOL at initial clinic presentation was significantly lower for concussed adolescents (Peds QL Total Score mean=72 [SD=16 ]) compared with non-concussed controls (mean=88 [SD=11], p <.001). HRQOL improved in the patients with concussion over a 6-month period after initial assessment with no significant changes thereafter. Pre-injury history of anxiety (coefficient= -11.388, CI=-18.49 - -4.28, p<0.001), current depressive symptoms (coefficient= -0.317, CI= -0.62 - -0.01, p<0.01), and sleep disturbance (coefficient=-0.336, CI=-0.71 - 0.04, p<0.05) all predicted lower HRQOL. HRQOL is significantly lower in the acute phase of pediatric concussion and steadily improves over the following 6 months. Psychological factors are linked to lower HRQOL and may serve as important indicators of risk for poor outcome.

Persistent post-discharge opioid use and opioid stewardship: A single-centre retrospective cohort study

Persistent post-operative opioid use is a public health concern contributing to population morbidity and mortality. Opioid stewardship is a strategy adopted to rationalise opioid prescribing and limit harmful use. We describe persistent post-discharge opioid use rates and risk factors in a single-centre cohort and describe the opioid stewardship role of our Acute Pain Service (APS). We conducted a retrospective 4-year cohort study of inpatients referred to the APS and discharged with new strong opioids prescribed. We investigated persistent post-discharge opioid use rates, risk factors and patterns of opioid use after community follow-up by APS. We found that 24% of patients discharged with new strong opioids developed persistent opioid use. Risk factors associated with persistent post-discharge opioid use in our cohort included female sex (Odds Ratios [95% confidence interval], p value, OR: 1.89 [1.11–3.22], p = 0.019), pre-admission mental health history (OR: 2.85 [1.64–4.95], p &lt; 0.001) and pre-admission opioid use (OR: 1.79 [1.03–3.11], p = 0.004). A smaller proportion of patients with APS follow-up in community developed persistent opioid use (22%) compared to those without (32%). We conclude that having opioids prescribed at time of discharge can result in persistent opioid use in up to a quarter of patients. The APS has an important protective role in rationalising opioid use in hospital but also following discharge. Development of further opioid stewardship policies is needed including improvement of patient and staff awareness and pre-operative assessment of patients with recognised risk factors.