Mental Health Reasons Research Articles

Access courses and their contribution to the widening participation agenda in the UK

Reasons for mental health nursing shortages in the UK are many and complex. The COVID-19 pandemic has highlighted the need to fill vacant posts, while at the same time negatively impacting on the UK's international recruitment strategy. Whereas international recruitment is essential to reduce workforce shortages, it offers only a short-term solution and potentially leaves lower-income countries with increased nursing shortages themselves. This article considers that a long-term domestic approach to recruitment is needed to reduce future workforce deficits. It is argued that benefits of access courses are increased if delivered by the university directly, as a familiarity with systems, the campus and supportive networks are promoted, and the potential for targeted support is increased. Further research is needed to establish the benefits, but access courses delivered this way may provide a more sustainable solution to nursing workforce shortages in the UK and beyond.

Technology use and interest in digital apps for mental health promotion and lifestyle intervention among young adults with serious mental illness

Digital technology holds promise for reaching young adults with serious mental illness. This study seeks to characterize technology use and explore interests in digital health interventions among young adults with serious mental illness. A survey was collected from participants age 18–35 enrolled in a lifestyle intervention trial about their technology ownership and use; technology use for mental health or other health reasons; and interest in health apps. Responses from 150 participants were summarized. Differences in technology use were compared between individuals with psychotic (n = 65) and non-psychotic disorders (n = 85). Most participants owned mobile phones (92%) and used social media (95%). Smartphone ownership was higher among participants with non-psychotic (98%) compared to psychotic (84%) disorders. Many participants searched online for information about their mental health (73%) or general health (79%). More participants with non-psychotic compared to psychotic disorders expressed interest in apps for depression (71% vs. 54%) or anxiety (78% vs. 54%). Interest in apps for lifestyle, behavioral health, and other health needs was similar between diagnostic groups. These findings may not generalize to all young adults with serious mental illness. There is high access, use, and interest in technology among young adults with serious mental illness. This highlights potential for integrated digital interventions for mental and physical health in this high-risk group.

Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons.

Background: Patients with mental disorders (MD) are at high risk for a wide range of chronic physical illnesses (CPI), often resulting in greater use of acute care services. This study estimated risk of emergency department (ED) use and hospitalization for mental health (MH) reasons among 678 patients with MD and CPI compared to 1,999 patients with MD only.Methods: Patients visiting one of six Quebec (Canada) ED for MH reasons and at onset of a MD in 2014–15 (index year) were included. Negative binomial models comparing the two groups estimated risk of ED use and hospitalization at 12-month follow-up to index ED visit, controlling for clinical, sociodemographic, and service use variables.Results: Patients with MD, more severe overall clinical conditions and those who received more intensive specialized MH care had higher risks of frequent ED use and hospitalization. Continuity of medical care protected against both ED use and hospitalization, while general practitioner (GP) consultations protected against hospitalization only. Patients aged 65+ had lower risk of ED use, whereas risk of hospitalization was higher for the 45–64- vs. 12–24-year age groups, and for men vs. women.Conclusion: Strategies including assertive community treatment, intensive case management, integrated co-occurring treatment, home treatment, and shared care may improve adequacy of care for patients with MD-CPI, as well as those with MD only whose clinical profiles were severe. Prevention and outreach strategies may also be promoted, especially among men and older age groups.

Supporting youth mental health during the COVID-19 pandemic.

Supporting youth mental health during the COVID-19 pandemic.

21.1 Building Remote Bridges: Mental Health Care Coordination in the COVID-19 Pandemic

We will describe the impact of a pilot clinical program providing time-limited therapeutic and case management support for patients discharging from the hospital. The Community Advocacy, Resource, and Engagement (CARE) Team is a 30-day bridge service (with the option to extend if indicated) offering care coordination, short-term therapy and medication management, phone coaching, and community advocacy for patients identified as being high risk for readmission. A sample of 98 patients were referred to the CARE Team. Data were obtained via a semi-structured phone survey and chart review. A primary outcome measure was the number of emergency department (ED) visits and mental health hospitalizations in the 60 days post–CARE Team involvement; due to the absence of a control group, we compared these events with the 60-day period before CARE Team involvement for the same population. Other outcome measures were family satisfaction and linkage to longer term treatment. The IRB at Seattle Children’s Hospital approved this study. The average age was 13 years (range = 6-17 years) and the majority of patients lived with a caregiver, although a few were in state custody. This sample presented with a broad range of diagnoses. All CARE Team patients were linked with ongoing mental health treatment; the average patient and family satisfaction rating was 4.1 on a scale of 1 to 5. There was a 31% decrease in the number of mental health hospitalizations in the 60 days post–CARE Team compared to 60 days pre-index hospitalization (from 29 to 20). We also noticed a 52% decrease in ED visits for mental health reasons not resulting in hospitalization (from 33 to 16). The average duration of services was 6.4 weeks; the COVID-19 pandemic impacted availability of services, thus extending many patients’ involvement with the team. We saw a decrease in the number of hospitalizations and ED visits after patients discharged from the CARE Team compared to before their linkage with the team. Families were satisfied with the service. Given recent trends of increasing suicidality and hospitalizations in youth, there is an enormous need for novel clinical services like the CARE Team to provide case management and therapeutic support as patients transition out of the hospital.

Association between suicide, external-cause and all-cause mortality and irregular mental health discharge among the US veteran population

Background Irregular hospital discharge is highly prevalent among people admitted to hospital for mental health reasons. No study has examined the relationship between irregular discharge, post-discharge mortality and treatment setting (i.e. mortality after patients are discharged from acute in-patient or residential mental health settings). Aims To understand the relationship between irregular discharge and mortality among patients discharged from acute in-patient and residential settings. Method A retrospective study was conducted in members of the US veteran population discharged from acute in-patient or residential settings of the US Department of Veterans Affairs between 2003 and 2018. Multivariate Cox proportional hazards were used to evaluate associations between irregular discharge and suicide, external-cause (as defined by ICD-10 Codes: V01-Y98) and all-cause mortality in the first 30-, 90- and 180-days post-discharge. Results There were over 1.5 million mental health discharges between 2003 and 2018. Patients with an irregular discharge were at increased risk for suicide, external-cause and all-cause mortality in the first 180 days after discharge. In the first 30 days after discharge, patients with irregular discharge had more than three times greater suicide risk than patients with regular discharge (adjusted hazard ratio (HR) = 3.41, 95% CI 2.21–5.25). Suicide risk was higher among patients with irregular discharge in the first 30 days after acute in-patient discharge (adjusted HR = 1.55, 95% CI 1.11–2.16). In both settings, the mortality risk associated with irregular discharge attenuated but remained elevated within 90 and 180 days. Conclusions Irregular discharge after an acute in-patient or residential stay poses a large risk for mortality soon after discharge. Clinicians must identify effective interventions to mitigate harms associated with irregular discharge in these settings.

Clinical yoga program utilization in a large health care system.

The U.S. Department of Veterans Affairs (VA) offers yoga for multiple conditions. Little information is available regarding how frequently yoga is utilized, by whom, or for which medical conditions. Here we describe referral patterns and patient adoption rates in a clinical yoga program, including telehealth yoga, at VA Palo Alto Health Care System (VAPAHCS). Referral and demographic data were extracted from the electronic medical records of 953 veterans (692 male, 261 female) referred to the outpatient clinical yoga program between 2010 and 2016. Attendance data were extracted from the same time plus 1 year. Referee demographics were compared to the overall VAPAHCS population. Twenty-two of the 187 referring providers accounted for half (50.4%) of referrals, predominantly from primary care and mental health clinics. Compared to the overall VAPAHCS patient population, referees were similar age and more likely to be female. Attendance was associated with age (older veterans were more likely to attend) but not gender. Those referred for mental health reasons were more likely to attend yoga compared to those referred for physical symptoms or for wellness (e.g., strength, health, mindfulness). Telehealth yoga follow through was lower but attendance rate similar to in-person yoga. These data provide an overview of referral and uptake in a large VA setting. Overall, referral was performed by a few providers in mental health and primary care clinics. The typical demographic of attendee was a White male from the Vietnam War era, reflective of the VA population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Relative Deprivation, Conspicuous Consumption, and Medical Financial Hardship: Potential Reasons for Debt and Mental Health

ABSTRACT This paper examines the associations of potential reasons for debt–including relative deprivation, conspicuous consumption, and medical financial hardship, and how these reasons for debt are associated with mental health. It examines how much debt explains the relationship with poor mental health. We used the 2010 Alabama Omnibus Survey with data on 507 respondents. We found that all three potential reasons for debt were at first associated with more days of poor mental health. Moreover, lower debt and debt stress explained some of the relationship with poor mental health. We also find the conspicuous consumption and mental health association is explained by the debt variables. We conclude with how comparison to others is negatively associated with mental health for individuals and families, especially in the context of a post Great Recession sample.

A Retrospective Cohort Study Comparing the Use of Provincially Funded Mental Health Services between Female Military Spouses Living in Ontario and the General Population

The spouses of military members experience frequent geographic mobility, absences, risk, and other lifestyle dimensions that may cause a greater need for mental health services and barriers to their use, relative to civilians. This was a retrospective, matched cohort study of female spouses of Canadian Armed Forces (CAF) members posted between 04/01/2008 and 03/31/2013 with follow-up to 03/31/2017. 3,358 military-connected spouses were identified and 13,342 civilians matched 4:1 on age, sex, and region of residence. Psychiatric hospitalizations and emergency department (ED) visits, psychiatrist visits, and mental health-related primary care visits were studied. Almost one third of spouses of CAF members visited a family physician for mental health reasons, while a minority visited an ED, a psychiatrist or were hospitalized. Spouses of CAF members were as likely to see a primary care physician, less likely to visit a psychiatrist, visited all measured outpatient sources of mental health services less frequently than the general population and had a longer interval to their first psychiatrist visit than the general population. Information on how mental health services are accessed in the public health system are critical to understanding pathways of care, and the planning and delivery of mental health services to military-connected families.

Facilitators and barriers to cycling in older residents of New South Wales, Australia

ObjectiveTo investigate facilitators and barriers to all types of cycling in adults aged ≥50 years. MethodsAn online survey of 1335 cyclists aged ≥50 years residents of New South Wales (NSW), Australia. ResultsAlmost all participants (98.5%) reported physical health and fitness as a reason for riding a bicycle, followed by mental health (68.1%), social (58.3%) and environmental reasons (44%). Top reported barriers to cycling included motorist behaviour or aggression (34.4%), speed and volume of traffic (27.1%), proximity to motor vehicle traffic (26%) and not enough separated bike lanes (22.7%). Females and occasional riders were significantly more likely to report these barriers than men and regular riders respectively. Key facilitators included improved attitudes towards cyclists compared to current attitudes (69.5%), separate bike lanes (63.4%), education and training of motorists (57.5%). DiscussionStrategies designed to improve cycling participation in older adults need to address barriers to cycling and to tailor interventions for under-represented groups such females.

Réflexion sur l’évolution à 10 ans des urgences pédopsychiatriques, CHRU-Nancy

IntroductionMental illness is one of the most common causes of disability, morbidity and mortality in childhood. According to the scientific literature, the prevalence of mental health disorders is an estimated 10% to 20% in the USA and similar results are found in France. Although primordial, outpatient care often appears insufficient with inequalities in its geographical distribution and its accessibility. These past decades have been marked by an increase in consultations for mental disorders in pediatric emergency departments. Is this trend indicative of a “defect” in the healthcare organization? Identifying the root causes of this inflation in psychiatric consultations seems of paramount importance in the improvement of healthcare policies. In France and worldwide, only a few studies deal with this subject. That is why we proposed to observe the evolution of the number of consultations for mental health reasons in the pediatric emergency department of Nancy University Hospital and to detail their characteristics. Materials and methodsAncillary comparative and retrospective study (2003–2013) on minors having received a child psychiatry consultation within the pediatric emergency department of Nancy University Hospital. ResultsThe number of consultations for mental health reasons increased by 119% (97 in 2003; 212 in 2013), while consultations for pediatrics reasons remained stable over the period studied. Consultations mainly dealt with females representing 55.6% of consultations in 2003 and 63.7% in 2013. Mean age of consultants was stable: 13.9 years (standard deviation=3.3 years) in 2003; 14.1 (2.5) years in 2013. Family structure witnessed a three-fold increase in the single-parent model. Regarding consultation motives, behavioral disorders were significantly more represented in 2013: 27.7% (RR=1.7; 95% CI 1.0–2.8; P<0.05) versus 16.5%. As far as diagnosis is concerned (ICD-10), emotional and behavioral disorders increased to 35.9% from 12.6% (RR=2.8; IC95% 1.6–5.1; P=0.0001). ConclusionsIn France, as well as in other western countries, the number of visits in pediatric emergency departments for mental health reasons more than doubled over a 10-year span. This growth mostly concerned externalizing disorders as a motive for consultation. Causes for this increase are multifactorial and closely related to the prevalence of psychiatric disorders in children. Some studies showed that economic factors played a major role on mental illness during such a downturn as the financial crisis of 2007–2008. Unemployment caused by economic crises can weaken pediatric caregivers and therefore their patients. Evolution of family structure and value also explains this trend. These past decades, the two-parent model, relevant till the 1960s, has evolved to a point where single parents are more quickly overwhelmed. Family values are now focused on consensus rather than duty and hedonism has become a central value. Women are more involved in the working world which became for all a performance field. Several studies have shown that social settings where competitiveness is the norm breed externalized disorders in children by advocating short-term efficiency. Moreover, the widespread use of screens in households as well as early exposure impact the psychomotor development, decrease the amount of sleep and may be responsible for the occurrence of many psychiatric disorders. There are some epidemiological reasons too. In 1971, Omran introduced a concept called “epidemiological transition” explaining how mental health issues appeared in the limelight through to the decline of infectious and cardiovascular diseases. This phenomenon has already occurred in western countries which could explain the increase in the prevalence of psychiatric disorders. In Africa, there is evidence it may have already started. Beyond all these considerations, the increase in consultations for mental disorders in pediatric emergency departments can be explained by a change in care consumption habits. Going straight to the local emergency department, accessible on a 24/7 basis, is easier than waiting for an outpatient appointment and is also free for the have-nots lacking proper insurance coverage. Scarce resources in ambulatory care may also explain the increased recourse to emergency services. Several reports have shown a lack of child psychiatrists and their uneven geographical distribution. For example, in the US only a third of children with mental disorders receive proper care, a lack which doubled between 1997 and 2010. Despite the reason for this trend, it is important to propose a better fitting of the healthcare system to the population needs, and to improve prevention and early identification. All these changes require further collective reflection.

Mental Health Services Provision in Primary Care and Emergency Department Settings: Analysis of Blended Fee-for-Service and Blended Capitation Models in Ontario, Canada.

Treating mental illnesses in primary care is increasingly emphasized to improve access to mental health services. Although family physicians (FPs) or general practitioners are in an ideal position to provide the bulk of mental health care, it is unclear how best to remunerate FPs for the adequate provision of mental health services. We examined the quantity of mental health services provided in Ontario's blended fee-for-service and blended capitation models. We evaluated the impact of FPs switching from blended fee-for-service to blended capitation on the provision of mental health services in primary care and emergency department using longitudinal health administrative data from 2007 to 2016. We accounted for the differences between those who switched to blended capitation and non-switchers in the baseline using propensity score weighted fixed-effects regressions to compare remuneration models. We found that switching from blended fee-for-service to blended capitation was associated with a 14% decrease (95% CI 12-14%) in the number of mental health services and an 18% decrease (95% CI 15-20%) in the corresponding value of services. This result was driven by the decrease in services during regular-hours. During after-hours, the number of services increased by 20% (95% CI 10-32%) and the corresponding value increased by 35% (95% CI 17-54%). Switching was associated with a 4% (95% CI 1-8%) decrease in emergency department visits for mental health reasons. Blended capitation reduced provision of mental health services without increasing emergency department visits, suggesting potential efficiency gain in the blended capitation model in Ontario.

Mental Health Services in the United States Public High Schools.

Mental health services in the United States public schools are an important component of the academic success of a student. Not all schools, however, have the necessary personnel and funding to offer such services. In this paper, we provide an analysis of data collected from schools in 3 geographic locations. Comparisons were made of the availability of personnel to assess and treat mental health disorders in students enrolled in city, urban, and suburban schools, with over 10,000 schools represented. The data were part of the 2015 to 2016 School Survey on Crime and Safety. Accessibility of mental health practitioners and reasons that limited efforts of a school to provide the services were assessed. Statistically significant differences were identified by school location, demonstrating that those in rural communities were most challenged providing diagnostic assessment and treatment for students by school mental health professionals, for several reasons. Increased state and county funding to support mental health practitioners in public high schools is one suggestion to address mental health disorders in students. Other strategies are offered for timely and appropriate diagnoses and treatment for mental health disorders that may impact the quality of life of a student for a lifetime.

Mental health in hospital emergency departments: cross-sectional analysis of attendances in England 2013/2014

ObjectiveTo describe the population of patients who attend emergency departments (ED) in England for mental health reasons.MethodsCross-sectional observational study of 6 262 602 ED attendances at NHS (National Health Service)...

The Impact of the North Carolina Statewide Telepsychiatry Program (NC-STeP) on Patients' Dispositions From Emergency Departments.

The number of patients seeking treatment in emergency departments (EDs) for mental health reasons is rising, and these patients are often kept in the ED until they can be treated or discharged, leading to overcrowding. Telepsychiatry may alleviate overcrowding by increasing the rate of discharges home. ED discharge records for 86,931 patients with psychiatric symptoms were examined to compare patient disposition and length of stay (LOS) between times when the North Carolina Statewide Telepsychiatry Program (NC-STeP) program was available or unavailable. For patients with a LOS of >2 days (N=3,144) and when NC-STeP was available, 62% (N=1,941) were discharged home, and 29% (N=922) were transferred to a psychiatric facility. When NC-STeP was unavailable (N=2,662), 43% (N=1,139) of these patients were discharged home, and 46% (N=1,230) were transferred to a psychiatric facility. For patients with a LOS of 1-2 days and when NC-STeP was available (N=41,713), 77.0% (N=32,131) were discharged home, and 15.4% (N=6,441) were transferred to a psychiatric facility, compared with 74.2% (N=29,237) discharged home and 13.9% (N=5,495) transferred to a psychiatric facility when NC-STeP was unavailable (N=39,412). The increases in discharges home and decreases in referrals to psychiatric facilities when NC-STeP was available were statistically significant for patients in both groups (p<0.001). Results suggest that telepsychiatry programs such as NC-STeP increase the number of discharges home and decrease transfers to psychiatric facilities, likely promoting patient satisfaction and improving ED efficiency.

The Occupational Depression Inventory: A new tool for clinicians and epidemiologists

BackgroundDepressive symptoms induced by insurmountable job stress and sick leave for mental health reasons have become a focal concern among occupational health specialists. The present study introduces the Occupational Depression Inventory (ODI), a measure designed to quantify the severity of work-attributed depressive symptoms and establish provisional diagnoses of job-ascribed depression. The ODI comprises nine symptom items and a subsidiary question assessing turnover intention. MethodsA total of 2254 employed individuals were recruited in the U.S., New Zealand, and France. We examined the psychometric and structural properties of the ODI as well as the nomological network of work-attributed depressive symptoms. We adopted an approach centered on exploratory structural equation modeling (ESEM) bifactor analysis. We developed a diagnostic algorithm for identifying likely cases of job-ascribed depression (SPSS syntax provided). ResultsThe ODI showed strong reliability and high factorial validity. ESEM bifactor analysis indicated that, as intended, the ODI can be used as a unidimensional measure (Explained Common Variance = 0.891). Work-attributed depressive symptoms correlated in the expected direction with our other variables of interest―e.g., job satisfaction, general health status―and were markedly associated with turnover intention. Of our 2254 participants, 7.6% (n = 172) met the criteria for a provisional diagnosis of job-ascribed depression. ConclusionsThis study suggests that the ODI constitutes a sound measure of work-attributed depressive symptoms. The ODI may help occupational health researchers and practitioners identify, track, and treat job-ascribed depression more effectively. ODI-based research may contribute to informing occupational health policies and regulations in the future.

Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: a mixed-method study

BackgroundEmergency department (ED) use is often viewed as an indicator of health system quality. ED use for mental health (MH) reasons is increasing and costly for health systems, patients, and their families. Patients with mental disorders (MD) including substance use disorders (SUD) and suicidal behaviors are high ED users. Improving ED services for these patients and their families, and developing alternatives to ED use are thus key issues. This study aimed to: (1) describe the implementation of three innovative interventions provided by a brief intervention team, crisis center team, and family-peer support team in a Quebec psychiatric ED, including the identification of implementation barriers, and (2) evaluate the impacts of these ED innovations on MH service use and response to needs.MethodUsing mixed methods with data triangulation, the implementation and impact of the three above-named ED interventions were studied. Quantitative data were collected from 101 participants (81 patients, 20 family members) using a user questionnaire and patient medical records. Qualitative data were gathered from focus groups (n = 3) with key intervention staff members (n = 14). The user questionnaire also included open-ended questions. Descriptive, comparative and content analyses were produced.ResultsKey implementation issues were identified in relation to system, organizational and patient profiles, similar to results identified in most studies in the ED implementation literature aimed at improving responsiveness to patients with MD. Results were encouraging, as the innovations had a significant impact for improved patient MH service use and adequacy of care. Services also seemed adapted to patient profiles. Family members were grateful for the help received in the ED.ConclusionsBefore implementing innovations, managers need to recognize the basic issues common to all new healthcare interventions: the need for staff training and strong involvement, particularly among physicians, development of collaborative tools especially in cases of potential cultural clash between staff and organizations, and continuous quality assessment. Future research needs to confirm the pertinence of these interventions, especially use of family-peer support teams in ED, as a highly innovative intervention. Broader ED strategies could also be deployed to improve MH services and decrease ED use for MH reasons.

Caregiver Report of the Utilization of School-Based Services and Supports Among Clinically Anxious Youth

Despite the high prevalence of and documented impairment associated with pediatric anxiety disorders, less than half of youth access mental health services. This study examined (a) the utilization of eight school services and supports (e.g., seen a school counselor for a mental health reason, placement in a special class for a behavior or emotional difficulty) and (b) demographic (gender, age) child clinical (anxiety severity and impairment) and family (parent psychopathology, caregiver strain) predictors of service utilization. Participants included 208 anxious youth between ages 6 to 18 years ( M = 10.92, SD = 3.29, 51% male, 64% White) who were enrolled in a school-based randomized controlled trial for anxiety treatment; only baseline data were used for this study. Parents, children, teachers and independent evaluators completed measures of the above predictors. Results indicated that less than half (48%) of youth received school services for anxiety. Several predictors of higher total service utilization were identified. Youth with comorbid externalizing behaviors were more likely to be referred for and receive school-based services. Consistent with published data in community samples, less than half of anxious youth received needed services. Results suggest a need for improvements in school assessments and service referral mechanisms for students with anxiety.

Experiences of Police and Emergency Services Employees with Workers' Compensation Claims for Mental Health Issues.

Purpose To assess employees' experiences of the workers' compensation claim process for psychological trauma, stress or a mental health condition sustained during the course of work in the police and emergency services sector. Methods 14,868 employees (69.4% male, response rate = 22%) from around Australia participated in Answering the Call: the Beyond Blue National Mental Health and Wellbeing Study of Police and Emergency Services, and were asked questions regarding their workers' compensation experiences for mental health reasons. Results 14% of all employees in police and emergency services organisations had made a workers' compensation claim for mental health reasons. Only 8.2% of employees making a claim had a positive experience (95% CI 6.6-9.8) while 70.3% had a poor experience (95% CI 67.6-73.0). Two-thirds of employees who had made a claim reported that the process was unsupportive and stressful, and over half reported that it had an overall negative impact on their recovery. Employees with poor overall support from their managers and those who perceived negative stigma about mental health in their workplace were more likely to report poor experiences. Conclusions The workers' compensation process is perceived negatively by most police and emergency services employees who have experience with it, and a majority found that it negatively impacted on their recovery. Ways to reform the system to better support employees experiencing significant functional impairments related to mental health issues should be urgently considered.

Bisexual mental health and gender diversity: Findings from the 'Who I Am' study.

People who identify as bisexual, transgender or gender diverse report poorer mental health than their homosexual and cisgender counterparts. The aim of this article is to shed light on the mental health experiences of gender diverse bisexual people and the reasons for poor mental health in this group. This article reports on a subset of a largecross-sectional survey of bisexual Australians (n = 2651), examining predictors of poor mental health among the 19% (n = 474) of respondents who identified as transgender or gender diverse. Very high rates of psychological distress, mental illness and suicidality were reported by participants who identified as transgender and gender diverse. Higher levels of internalised biphobia and less participation in lesbian, gay, bisexual, transgender and intersex community events predicted higher psychological distress (P <0.05). The high rates of mental health problems among transgender and gender diverse bisexual Australians mean it is essential that general practitioners and those on the frontline of mental healthcare provision recognise the need to engage with these groups. This research provides new insights to supportand inform this engagement.