Mental Health Morbidity Research Articles

Prevalence of self-inflicted injuries among transgender and gender diverse adolescents and young adults compared to their peers: an examination of interaction with mental health morbidity

PurposeCompare occurrence of self-inflicted injuries among transgender and gender diverse (TGD) youth to that of their cisgender peers while accounting for mental health diagnoses. MethodsReview of electronic health records from three integrated health care systems identified 1087 transfeminine and 1431 transmasculine adolescents and young adults. Poisson regression was used to calculate prevalence ratios comparing the proportion of TGD participants with at least one self-inflicted injury (a surrogate for suicide attempt) before index date (first evidence of TGD status) to the corresponding proportions in presumed cisgender male and female referents matched on age, race/ethnicity, and health plan. Interactions between gender identities and mental health diagnoses were assessed on multiplicative and additive scales. ResultsTGD adolescents and young adults were more likely to have a self-inflicted injury, various mental health diagnoses, and multiple mental health diagnoses than their cisgender peers. The prevalence of self-inflicted injuries among TGD adolescents and young adults was high even in the absence of mental health diagnoses. Results were consistent with positive additive interaction and negative multiplicative interaction. ConclusionsUniversal suicide prevention efforts for all youth, including those with no mental health diagnoses, and more intensive suicide prevention efforts for TGD adolescents and young adults and those with at least one mental health diagnosis are warranted.

First-year Medical Students’ Varying Vulnerability to Developing Depressive Symptoms and Its Predictors: a Latent Profile Analysis

ObjectivePrevious meta-analytic data have demonstrated the propensity for mental morbidity among medical students (Rotenstein et al. JAMA. 2016;316(21):2214–36). However, there is a lack of research on medical students’ varying depression vulnerabilities and predictive factors. The present study aims to gain a better understanding of the development of mental health morbidity and its predictive factors among first-semester medical students.MethodsIn November 2020 and January 2021, 184 first-semester students from two medical schools were surveyed regarding depression (PHQ-9), self-efficacy, resilience, and cognitive self-regulation. Using latent profile analysis, we identified distinct depression development profiles. We applied a multinomial logistic regression analysis to determine how self-efficacy, resilience, and cognitive self-regulation and their changes predicted profile membership.ResultsFive profiles of depression development were identified: profile 1, no depression (53.8%); profile 2, mild depression (26.1%); profile 3, depression increase I (9.2%); profile 4, depression increase II (9.8%); and profile 5, persistent depression (1.1%). Students with initially high self-efficacy, resilience, and cognitive self-regulation levels were more likely to belong to the no depression profile. A decrease in self-efficacy and cognitive self-regulation was associated with both depression increase profiles (profiles 3 and 4), and a decrease in resilience was found to be a predictor of profile 4.ConclusionStudents who enter medical school have varying states of mental health, and they differ in their vulnerability to developing depressive symptoms. The promotion of resilience, self-efficacy, and cognitive self-regulation strategies may be key in preventing students’ depression in the first semester of medical school.

Pediatricians’ perspectives on childhood behavioral and mental health problems in Jordan

BackgroundMental health disorders among children are highly prevalent worldwide. In most countries, the primary care physician is point of first contact with the medical system for children with these problems. There are few data from developing countries about the ways in which these children present barriers that may hinder appropriate recognition, treatment, or referral. This study sought to explore the range and expression of childhood behavioral disorders encountered by primary care pediatricians in Jordan, as well as barriers to the identification and management of these conditions.ResultsWe used qualitative methodology to conduct 8 focus-group interviews with physicians in Jordan. A total of 36 physicians participated. Themes that emerged from the interviews were organized into four categories. The first category described specific behavioral disorders encountered by physicians, autism being the most common and problematic. Second were themes related to system issues impacting the approach to behavioral problems. These included deficiencies in physician training and a lack of mental health services. Third were family-related issues such as parenting practices and family structure that were perceived to contribute to behavioral morbidity. Finally, sociocultural attitudes that included resistance to medicalization, reluctance to discuss behavioral issues, and interpretation of certain childhood behaviors affected help-seeking behavior and acceptance of diagnosis and treatment.ConclusionsSociocultural and structural issues strongly influence the presentation and management of behavioral and mental health conditions among pediatric patients in Jordan. These findings have significant implications for the development of approaches to the detection and management of these problems in developing countries. The creation of robust pathways for early detection and intervention among children at risk for mental health can help reduce the burden of mental health morbidity in the region.

292 - Disseminated coccidioidomycosis and the associated mental health morbidity, a case report

292 - Disseminated coccidioidomycosis and the associated mental health morbidity, a case report

Avoidant attachment transmission to offspring in families with a depressed parent

BackgroundInsecure attachment is associated with mental health morbidity. We explored associations between parent and offspring attachment style in a longitudinal study of families with a depressed parent. MethodsParents (N = 169) with a DSM-IV mood disorder and their adult offspring (N = 267), completed the Adult Attachment Questionnaire at one or more time points during up to 9.7 years of follow-up. Linear mixed effects models explored associations between parent and offspring anxious and avoidant attachment scores. Residualized models accounted for parent and offspring depression severity. ResultsAvoidant attachment scores were associated between parents and offspring with (p = .034) and without (p = .012) adjustment for baseline age and sex of parent and offspring. Depressed father-offspring relationships showed more avoidant attachment in offspring compared to depressed mother-offspring pairs (p = .010). After accounting for depression severity, parent average residualized avoidant attachment scores did not significantly correlate with those of offspring (unadjusted p = .052; adjusted p = .085), though the effect sizes did not change substantially, and 75 % of the correlation was retained. Parent-son relationships exhibited stronger avoidant attachment correlations compared to parent-daughter pairs (p = .048). LimitationsSmall sub-sample of fathers, parent and offspring assessments not always completed at the same time, and use of a self-report attachment style instrument. ConclusionsFamilial transmission of insecure avoidant attachment, a risk factor for negative mental health outcomes, merits research as a potential treatment target. In this preliminary study, its transmission to offspring seemed mostly independent of depression. Depressed fathers and their sons may deserve focus to reduce insecure avoidant attachment and improve clinical course.

Emotional, behavioral, and physical health consequences of loneliness in young adult survivors of childhood cancer: Results from the Childhood Cancer Survivor Study.

Young adults in the general population are at risk of experiencing loneliness, which has been associated with physical and mental health morbidities. The prevalence and consequences of loneliness in young adult survivors of childhood cancer remain unknown. A total of 9664 young adult survivors of childhood cancer (median age at diagnosis 10.5years [interquartile range (IQR), 5-15], 27.1years at baseline [IQR, 23-32]) and 2221 siblings enrolled in the Childhood Cancer Survivor Study completed a self-reported survey question assessing loneliness on the Brief Symptom Inventory-18 at baseline and follow-up (median follow-up, 6.6years). Multivariable models evaluated the prevalence of loneliness at baseline only, follow-up only, and baseline+follow-up, and its associations with emotional distress, health behaviors, and chronic conditions at follow-up. Survivors were more likely than siblings to report loneliness at baseline+follow-up (prevalence ratio [PR] 2.2; 95% confidence interval [CI], 1.7-3.0) and at follow-up only (PR, 1.4; 95% CI, 1.1-1.7). Loneliness at baseline+follow-up was associated with elevated risk of anxiety (relative risk [RR], 9.8; 95% CI, 7.5-12.7), depression (RR, 17.9; 95% CI, 14.1-22.7), and current smoking (odds ratio [OR], 1.7; 95% CI, 1.3-2.3) at follow-up. Loneliness at follow-up only was associated with suicidal ideation (RR, 1.5; 95% CI, 1.1-2.1), heavy/risky alcohol consumption (RR, 1.3; 95% CI, 1.1-1.5), and new-onset grade 2-4 chronic conditions (RR, 1.3; 95% CI, 1.0-1.7). Young adult survivors of childhood cancer have elevated risk of experiencing loneliness, which is associated with future emotional distress, risky health behaviors, and new-onset chronic conditions.

The Influence of Parent's Cardiovascular Morbidity on Child Mental Health: Results from the National Health Interview Survey.

This study assessed the association between cardiovascular disease (CVD), the leading cause of death in the United States, among parents and child mental health. Our sample included 9076 children aged 6 to 17 years. Data were pooled from the 2016-2018 waves of the National Health Interview Survey. We fitted a logistic regression to obtain the odds ratios in favor of child mental health problems for parental CVD. We also fitted a multinomial logistic regression to obtain the odds in favor of the severity of mental health problems (i.e., minor, definite, and severe). The adjusted odds of facing difficulties for a child of a parent with CVD were 1.64 (95% CI: 1.28-2.11) times that of their peers whose parents did not have CVD. The adjusted relative risk of facing minor and definite difficulties for a child of a parent with CVD were 1.48 (95% CI: 1.13-1.94) and 2.25 (95% CI: 1.47-3.46) times that of their peers of parents without CVD. The results suggest a strong association between child mental health and parental cardiovascular morbidity, demonstrating the need for the development or adaptation of existing public health interventions to facilitate mental health support for children of parents with CVD.

Association Between Periviable Delivery and New Onset of or Exacerbation of Existing Mental Health Disorders.

To evaluate whether there is an association between periviable delivery and new onset of or exacerbation of existing mental health disorders within 12 months postpartum. We conducted a retrospective cohort study of individuals with liveborn singleton neonates delivered at 22 or more weeks of gestation from 2008 to 2017 in the MarketScan Commercial Research Database. The exposure was periviable delivery , defined as delivery from 22 0/7 through 25 6/7 weeks of gestation. The primary outcome was a mental health morbidity composite of one or more of the following: emergency department encounter associated with depression, anxiety, psychosis, posttraumatic stress disorder, adjustment disorder, self-harm, or suicide; new psychotropic medication prescription; new behavioral therapy visit; and inpatient psychiatry admission in the 12 months postdelivery. Secondary outcomes included components of the primary composite. Those with and without periviable delivery were compared using multivariable logistic regression adjusted for clinically relevant covariates, with results reported as adjusted incident rate ratios (aIRRs). Effect modification by history of mental health diagnoses was assessed. Incidence of the primary outcome by 90-day intervals postdelivery was assessed. Of 2,300,244 included deliveries, 16,275 (0.7%) were periviable. Individuals with periviable delivery were more likely to have a chronic health condition, to have undergone cesarean delivery, and to have experienced severe maternal morbidity. Periviable delivery was associated with a modestly increased risk of the primary composite outcome, occurring in 13.8% of individuals with periviable delivery and 11.0% of individuals without periviable delivery (aIRR 1.18, 95% CI 1.12-1.24). The highest-risk period for the composite primary outcome was the first 90 days in those with periviable delivery compared with those without periviable delivery (51.6% vs 42.4%; incident rate ratio 1.56, 95% CI 1.47-1.66). Periviable delivery was associated with a modestly increased risk of mental health morbidity in the 12 months postpartum.

The Mental Health Impact of the COVID-19 Pandemic on Healthcare Workers in the Eastern Mediterranean Region: A Scoping Review.

Objectives: This scoping review is to investigate the existing literature on the mental health of Healthcare workers, including stress or distress, anxiety, depression, burnout, insomnia, and fear or phobia within the different countries in the Eastern Mediterranean region (EMR) during the COVID-19 pandemic. Methods: We systematically searched to consolidate studies across EMR countries regarding the mental health morbidity studied, the scales, and the methodology used. The review focused on peer-reviewed academic literature published from March 2020 to November 2021. Results: One hundred sixty-seven articles were included in the review. Most publications came from lower-middle-income countries such as Iran, Pakistan, and Egypt. Most of the literature was specific to Stress/Distress (n = 94), followed by anxiety (n = 93), depression (n = 66), burnout (n = 27), insomnia (n = 20), and fear/phobia (n = 12). Conclusion: Fear, phobia, and insomnia have all been examined extensively worldwide, yet they were among the Eastern Mediterranean region's least explored outcomes. In addition, most underdeveloped countries have a low rate of publication.

Mental Health Morbidities and their Correlates among the Adolescents in Kamrup (Metro), Assam: A School-Based Study.

India has the largest adolescent population worldwide, and among this group, mental health issues account for 16% of the total global burden of disease and injury. Disturbingly, approximately half of these health conditions manifest before the age of 14 years. To assess the prevalence of depression, anxiety, and stress along with its correlates among the adolescents in the schools of Kamrup (Metro) district, Assam. This cross-sectional study was conducted in 10 randomly selected high schools in the study area among the adolescents selected from 8th to 10th standards in the age group of 14 to 17 years. A pre-designed, pre-tested interview schedule, the modified Kuppuswamy scale, and 'Depression Anxiety Stress Scale-21 Items' (DASS 21) questionnaire were used for data collection. The mean ± 2SD age of the adolescents was 14.74 ± 1.58 years. Among the adolescents, the overall prevalence of depression, anxiety, and stress was found to be 22.2%, 24.4%, and 6.9%, respectively. The occurrence of mental health morbidities among adolescents is notably widespread, yet researchers have largely overlooked this aspect. This underscores the need for comprehensive investigations into the factors that contribute to these mental health issues.

Prevalence and correlates of depression, anxiety, and stress among high school students in a block of Hooghly district, West Bengal: Across-sectional study.

Adolescent mental health is a concern. A high magnitude of deranged mental health conditions among adolescents is prevailing, which often gets extended into adulthood too. Hence, assessment of mental health morbidities like depression, anxiety, and stress is crucial to address them. This study aimed to estimate the prevalence of depression, anxiety, and stress among school-going adolescents studying in classes IX-XII and find out its correlates among the subjects. This cross-sectional study was conducted among 812 adolescents studying in classes IX-XII in four randomly selected schools of Haripal block of Hooghly district, West Bengal, in 2022. A complete enumeration of students in each class of the selected schools was done. Data were collected by using a pretested schedule that included standardized depression, anxiety, and stress scale (DASS-21). Descriptive statistics and a Chi-square test were applied. Regression analysis was doneto determine associations and compute the adjusted odds ratio. Data were analyzed using SPSS version 23. Overall prevalence of depression, anxiety, and stress were found to be 52.3%, 47.4%, and 33.7% respectively. Subscale scores shows 16.1% and 10.8% suffered from extremely severe depression and anxiety, respectively. It was noted that these were more common among female students, the late adolescent age group (16-19 years), students having social problems in the family, and those reporting using substances. The prevalence of depression, anxiety, and stress being high among school students indicates a significant burden of mental health disease. Effective strategies to alleviate the adverse mental health, along with early identification of disease, can help in along way.

Mental health outcome in hospitalized COVID-19 patients: An observational analysis from North Indian tertiary care hospital

AimThe study investigate the severity of perceived stress and wide domains of psychiatric symptoms reported on initial screening in hospitalized patients of COVID-19 with a second aim to determine the role of sociodemographic factors and coping styles in the hospitalized patients of COVID-19. MethodTotal 224 patients of COVID-19 infection, hospitalized in various isolation facilities were assessed via web-based self-reported questionnaires on perceived stress scale, brief cope inventory, and DSM-5 crosscutting level-1 questionnaire. ResultsMajority of the patients reported moderate level of stress followed by mild and severe. Depression and Anxiety symptoms were most common psychopathologies though the patients have reported greater severity in various domains of psychiatric symptoms. Coping styles explains most of variance (64.8%) of the perceived stress. Similarly total PSS scores, coping styles, COVID-19 status and sociodemographic factors contributed significantly to the variance of all psychiatric symptoms. ConclusionFactors like female gender, being married, belonging to nuclear families, service class and urban domicile are the significant factors determining higher risk of stress and developing more psychopathologies. Furthermore, coping styles used by the patients have a greater moderating effect on mental health symptoms and their perceived stress which can be a major area for interventions to reduce the mental health morbidities.

Provider-supported self-management cognitive behavioral therapy for insomnia (Tele-Self CBTi): Protocol for a randomized controlled trial

BackgroundCognitive Behavioral Therapy for Insomnia (CBTi) is recommended as first-line treatment for insomnia, yet patient access to CBTi is limited. Self-help CBTi could increase patient access. Self-help CBTI with provider sup]port is more effective and is preferred by patients. Self-help CBTi has not been evaluated in veterans; a population with greater medical and mental health morbidity and more severe sleep difficulties than non-veterans. Moreover, those with mental health conditions have been largely excluded from prior CBTi self-help trials. Stablishing the efficacy of provider-supported Self-help CBTi is an important first step for expanding veteran access to CBTi. MethodsIn a 2-armed randomized controlled trial, a provider-supported self-help CBTi (Tele-Self CBTi) is compared to Health Education for improving insomnia severity (primary outcome) among treatment-seeking veterans with insomnia disorder. Tele-Self CBTi is comprised of two treatment components: self-help CBTi via a professionally designed manual developed using an iterative process of expert review and patient input; and 6 telephone-based support sessions lasting >20 min. Outcomes are assessed at baseline, 8 weeks, and 6 months after baseline. The primary outcome, insomnia severity, is measured using the Insomnia Severity Index. Secondary outcomes include self-reported and actigraphy-assessed sleep, fatigue, depression symptoms, and sleep-related quality of life. ConclusionInnovative approaches are essential to improving overall health among veterans; a population with highly prevalent insomnia disorder. If effective, Tele-Self CBTi may bridge the gap between unavailable resources and high demand for CBTi and serve as the entry level intervention in a stepped model of care. Clinical trials.gov identifierNCT03727438

582: A MULTICENTER STUDY OF MENTAL HEALTH RESOURCES AVAILABLE FOR CAREGIVERS OF CHILDREN IN THE PICU

Introduction: PICU parents or guardians are at increased risk of mental health morbidities including acute stress disorder, anxiety, and depression. This preliminary analysis of a multicenter survey seeks to quantify the availability of evidence-based caregiver resources. Methods: We developed a 120-item IRB-reviewed exempt electronic survey based on the Society for Critical Care Medicine’s Family Centered Care Guidelines and local nursing leadership perspectives. Primary domains include the PICU environment and policies, education, and resources and staffing. We emailed the Pediatric Acute Lung Injury and Sepsis Investigators members a request for PICU nursing leader contact information, the intended respondents, at their institutions. We administered the survey to nurse leaders (n=95) using Qualtrics. We analyzed results using descriptive statistics, using first response from each center. Results: Thus far, we have received 39% (n=37) total and 19% (n=18) unique center responses. Of unique centers, 28% were free standing children’s hospitals 72% were PICUs within adult-pediatric institutions. 89% allowed caregivers at the PICU bedside overnight in all rooms and 67% had noise reduction strategies implemented. All nurse leaders agreed or strongly agreed that caregivers were invited to be present and contribute to PICU rounds when caregiver was present. When the caregiver was away from bedside 67% perceived caregivers were invited to round remotely. Caregiver presence was permitted during CPR (89%) and intubations and central catheter placement (22%). 33% had sedation and analgesia protocols to support end of life comfort. 67% had a standard PICU orientation process and 28% had standardized education to increase caregiver bedside engagement. 39% of respondents had PICU journals and 22% had peer support groups available. Social work attempts to evaluate every family at all centers and all had spiritual care resources available. Conclusions: PICUs provide many of the evidence-based resources recommended through the guidelines of family centered care with significant variability among centers. More study is needed to understand which resources are most impactful for caregivers and families.

Mental Health Morbidities and Time to Cancer Diagnosis Among Adults With Colon Cancer in England

Mental health morbidity (MHM) in patients presenting with possible cancer symptoms may be associated with prediagnostic care and time to cancer diagnosis. To compare the length of intervals to cancer diagnosis by preexisting MHM status in patients who presented with symptoms of as-yet-undiagnosed colon cancer and evaluate their risk of emergency cancer diagnosis. This cohort study was conducted using linked primary care data obtained from the population-based Clinical Practice Research Datalink, which includes primary care practices in England, linked to cancer registry and hospital data. Included participants were 3766 patients diagnosed with colon cancer between 2011 and 2015 presenting with cancer-relevant symptoms up to 24 months before their diagnosis. Data analysis was performed in January 2021 to April 2022. Mental health conditions recorded in primary care before cancer diagnosis, including anxiety, depression, schizophrenia, bipolar disorder, alcohol addiction, anorexia, and bulimia. Fast-track (also termed 2-week wait) specialist referral for investigations, time to colonoscopy and cancer diagnosis, and risk of emergency cancer diagnosis. Among 3766 patients with colon cancer (median [IQR] age, 75 [65-82] years; 1911 [50.7%] women ), 623 patients [16.5%] had preexisting MHM recorded in primary care the year before cancer diagnosis, including 562 patients (14.9%) with preexisting anxiety or depression (accounting for 90.2% of patients with preexisting MHM) and 61 patients (1.6%) with other MHM; 3143 patients (83.5%) did not have MHM. Patients with MHM had records of red-flag symptoms or signs (ie, rectal bleeding, change in bowel habit, or anemia) in the 24 months before cancer diagnosis in a smaller proportion compared with patients without MHM (308 patients [49.4%] vs 1807 patients [57.5%]; P < .001). Even when red-flag symptoms were recorded, patients with MHM had lower odds of fast-track specialist referral (adjusted odds ratio [OR] = 0.72; 95% CI, 0.55-0.94; P = .01). Among 2115 patients with red-flag symptoms or signs, 308 patients with MHM experienced a more than 2-fold longer median (IQR) time to cancer diagnosis (326 [75-552] days vs 133 [47-422] days) and higher odds of emergency diagnosis (90 patients [29.2%] vs 327 patients [18.1%]; adjusted OR = 1.63; 95% CI, 1.23-2.24; P < .001) compared with 1807 patients without MHM. This study found that patients with MHM experienced large and prognostically consequential disparities in diagnostic care before a colon cancer diagnosis. These findings suggest that appropriate pathways and follow-up strategies after symptomatic presentation are needed for earlier cancer diagnoses and improved health outcomes in this large patient group.

The Interface Between Colon Cancer and Mental Health Morbidities

The Interface Between Colon Cancer and Mental Health Morbidities

Prevalence of Mental Health and Social Connection among Patients Seeking Tobacco Dependence Management: A Pilot Study.

Introduction: with regards to tobacco dependence management, there are certain barriers to successful smoking cessation for patients, such as untreated anxiety and depression. Complicating the impact of mental health morbidities on tobacco dependence may be the significant portion of patients whose mental health issues and limited social connections are undiagnosed and unaddressed. We hypothesize that patients with no prior mental health diagnoses who are treated for tobacco dependence have high rates of undiagnosed mental health morbidities. Methods: patients were recruited from a tobacco treatment clinic in 2021. Every patient who came for an inaugural visit without a prior diagnosis of mental health disease was screened for depression, anxiety, social isolation and loneliness. Sociodemographic variables were collected. Results: over a 12-month period, 114 patients were seen at the tobacco treatment clinic. Of these 114 patients, 77 (67.5%) did not have a prior diagnosis of a mental health disease. The mean age was 54.3 ± 11.2 years, 52 (67.5%) were females, and 64 (83.1%) were Black/African American. The mean age of starting smoking was 19.3 ± 5.2 years, and 43 (55.8%) had never attempted to quit smoking in the past. With regards to mental health screening, 32 (41.6%) patients had a score of 9 or greater on the Patient Health Questionnaire (PHQ) 9, 59 (76.6%) had a score of 7 or greater on the Generalized Anxiety Disorder (GAD) 7, 67 (87.0%) were identified with social isolation and 70 (90.1%) for loneliness on screening. Conclusion: there was a high prevalence of undiagnosed mental health morbidities and social disconnection in patients who were actively smoking and were struggling to achieve smoking cessation. While a larger scale study is necessary to reaffirm these results, screening for mental health morbidities and social disconnection may be warranted in order to provide effective tobacco dependence management.

O43 - Together we can co-design perinatal interprofessional psychosocial education for maternity clinicians

This project addresses a significant problem. Each year in Australia, 300,000 women give birth and 20% will experience mental health morbidity with suicide reported as a leading cause of maternal death. Maternity care health professionals have a pivotal role in identifying and responding to women experiencing mental health concerns. Many clinicians however, lack skills to assess and respond appropriately and there are limited opportunities for training and skills practice in an interprofessional simulated environment recommended in national guidelines The aim of this research is to co-design, implement and evaluate a comprehensive ongoing education program for maternity health professionals related to psychosocial issues in the perinatal period. This presentation will discuss the co-design development phases of the project. Phases 1 & 2 used mixed methods gathering both qualitative and quantitative data. Including two workshops key stakeholders, maternity clinician needs assessment and focus groups. A scoping review identified gaps in lack of current perinatal psychosocial education and experiential learning opportunities in this space. A co-design team was formed with lived experience consumers, experts and clinicians with experience in psychosocial concerns to develop the program The two initial workshops key stakeholders (n=40), maternity clinician a survey (n=133) and focus groups (n=52) were conducted to identify the key learning priorities across a local health district in NSW. This data was used by a co-design team to develop the overall program content, modes and learning objectives for face-to face and online workshops. The principles of co-design Equal Partnership; Openness; Respect; Empathy; Design Together were displayed in this process working to create a safe interprofessional learning program. Together co-design with lived experience consumers and interprofessional experts by experience in the development phase can positively impact the co-design team and create better program outcomes for all.

Cohort profile: pathways to care among people with disorders of sex development (DSD)

PurposeThe ‘DSD Pathways’ study was initiated to assess health status and patterns of care among people enrolled in large integrated healthcare systems and diagnosed with conditions comprising the broad category...

Birth Outcomes, Health, and Health Care Needs of Childbearing Women following Wildfire Disasters: An Integrative, State-of-the-Science Review.

Background:The frequency and severity of extreme weather events such as wildfires are expected to increase due to climate change. Childbearing women, that is, women who are pregnant, soon to be pregnant, or have recently given birth, may be particularly vulnerable to the effect of wildfire exposure.Objectives:This review sought to systematically assess what is known about birth outcomes, health, and health care needs of childbearing women during and after exposure to wildfires.Methods:An integrative review methodology was utilized to enable article selection, data extraction, and synthesis across qualitative and quantitative studies. Comprehensive searches of SCOPUS (including MEDLINE and Embase), CINAHL, PubMed, and Google Scholar identified studies for inclusion with no date restriction. Included studies were independently appraised by two reviewers using the Crowe Critical Appraisal Tool. The findings are summarized and illustrated in tables.Results:Database searches identified 480 records. Following title, abstract, and full text screening, sixteen studies published between 2012 and 2022 were identified for this review. Eleven studies considered an association between in utero exposure to wildfire and impacts on birth weight and length of gestation. One study reported increased rates of maternal gestational diabetes mellitus and gestational hypertension following exposure; whereas one study reported differences in the secondary sex ratio. Two studies reported higher incidence of birth defects following in utero exposure to wildfire smoke. Three studies reported increased mental health morbidity, and one study associated a reduction in breastfeeding among women who evacuated from a wildfire disaster.Discussion:Evidence indicates that wildfire exposure may be associated with changes to birth outcomes and increased morbidity for childbearing women and their babies. These effects may be profound and have long-term and wide-ranging public health implications. This research can inform the development of effective clinical and public health strategies to address the needs of childbearing women exposed to wildfire disaster. https://doi.org/10.1289/EHP10544