Need For Mental Health Care Research Articles

Child Anxiety and Depression During the COVID-19 Pandemic and Unmet Mental Health Care Needs.

Child anxiety and depression increased in recent years, while access to health care improved in some ways and worsened in others. The purpose of this study was to understand the prevalence of child anxiety and depression during the COVID-19 pandemic, unmet mental health care need among children with these conditions, and whether disparities exist by race/ethnicity and sex. A cross-sectional secondary data analysis was conducted using the 2021 National Survey of Children's Health (ages 3-17 years, unweighted n = 42,175). Parent/caregiver-reported child anxiety and depression prevalence was greater among non-Hispanic White children than those of other racial/ethnic groups and females compared to males, after adjusting for covariates. Unmet mental health care need among children with anxiety and depression was greater among Hispanic children than those of other racial/ethnic groups, after adjusting for covariates. In conclusion, this study identified a disparity in unmet need between Hispanic children and those of other races and ethnicities. Implications for policy and practice are discussed.

Determinants of unmet needs for mental health services amongst adolescents in Shiraz, Iran: a cross-sectional study.

Mental disorders are increasingly prevalent among adolescents without appropriate response. There are a variety of reasons for unmet mental health needs, including attitudinal and structural barriers. Accordingly, we investigated perceived mental health needs, using mental health services, and their barriers in adolescents. This cross-sectional study was conducted in 2022 in Shiraz, Iran. Demographic characteristics, the Adolescent Unmet Needs Checklist, and the Young Schema Questionnaire were administered to 348 adolescents aged 13-19 years. Adolescents were classified as having no needs, fully met needs, partially met needs, or wholly unmet needs. Logistic regression analysis was used to determine factors associated with perceived unmet need and refer participants to healthcare centers. 193 (55.5%) adolescents reported perceived need for mental healthcare out of whom, 21.6% reported fully and 21.6% partially unmet needs. Noticeably, only 12.4% of needy participants reported met need. "Reluctance to seek mental healthcare" and "asked but not receiving help" were common barriers to using the services. The present study reveals unmet mental healthcare needs as a significant public health concern among the adolescents. To address this significant concern, reorientation of primary care, removing economic barriers from mental healthcare services, and improving health literacy in the community are recommended.

Integrated Digital Mental Health Care: A Vision for Addressing Population Mental Health Needs.

The unmet need for mental health care continues to rise across the world. This article synthesizes the evidence supporting the components of a hypothetical model of integrated digital mental health care to meet population-wide mental health needs. This proposed model integrates two approaches to broadening timely access to effective care: integrated, primary care-based mental health services and digital mental health tools. The model solves for several of the key challenges historically faced by digital health, through promoting digital literacy and access, the curation of evidence-based digital tools, integration into clinical practice, and electronic medical record integration. This model builds upon momentum toward the integration of mental health services within primary care and aligns with the principles of the Collaborative Care Model. Finally, the authors present the major next steps toward implementation of integrated digital mental health care at scale.

Abstract TMP19: Need for Enhancing Mental Health Care in Stroke Patients: Insights Into Post-Stroke Anxiety and Depression From the National Health Interview Survey (NHIS) Data

Background: Stroke is a leading cause of chronic disability, with neuropsychiatric presentations being increasingly recognized as complications that hinder rehabilitation and patient outcomes. This study investigates factors influencing anxiety and depression prevalence in stroke patients. Methods: Utilizing 2019 National Health Interview Survey (NHIS) data, we conducted chi-square tests and multivariate logistic regression models, adjusting for various factors. We also assessed the proportion of anxiety and depression patients undergoing therapy and/or medication. Results: There were 1204 (N=7,745,925) participants with stroke and 30,743 (N=242,831,595) without stroke. After applying appropriate sample weights, we identified that patients aged 65-75 and >=75 had similar odds but demonstrated decreased likelihood of depression compared to younger patients with stroke (OR=0.4, 95%CI (0.2,0.9). Moreover, stroke patients with high school education or higher were less likely to have anxiety (OR=0.6, 95%CI (0.4,0.9) while patients with medicare/medicaid were more likely to have anxiety (OR=2.9, 95% CI (1.1,7.7) after adjusting for demographic factors. Therapy use was suboptimal with only 24.2% and 43.4% of stroke patients with mild-moderate and severe anxiety, respectively, currently receiving therapy. For depression, therapy was sought by only 20.0% and 35.9% with mild/moderate and severe depression, respectively. Furthermore, medication use was noted in 42.6% and 48.4% of patients with stroke with mild-moderate and severe anxiety, respectively while 35.3% and 59.3% of stroke patients with mild-moderate and severe depression were taking medication. Conclusion: Demographic factors were found to significantly affect the prevalence of anxiety and depression among stroke patients with sub-optimal utilization of therapy and treatment. Appropriate guidelines are necessary for routine screening and treatment of anxiety and depression among stroke patients.

128. Hazardous Alcohol Drinking and Attitude Among Youth With Mental Health Care Needs

128. Hazardous Alcohol Drinking and Attitude Among Youth With Mental Health Care Needs

How gender and low mental health literacy are related to unmet need for mental healthcare: a cross-sectional population-based study in Sweden

BackgroundMen are more likely to have unmet need for mental healthcare than women. However, an under-investigated aspect of the gender difference is the role of mental health literacy. This study investigated how combinations of gender and mental health literacy were related to two indicators of unmet need: not perceiving a need for mental healthcare despite poor mental health, and refraining from seeking mental healthcare.MethodsThis cross-sectional study was based on a questionnaire sent to a general population sample, aged 16–84 years, in Stockholm County, Sweden, in 2019. Of the 1863 respondents (38%), 1563 were included (≥18 years). The sample was stratified into four groups, men and women with low or high mental health literacy, using the third quartile of the Mental Health Knowledge Schedule. The likelihood of not perceiving a need for mental healthcare and refraining from seeking mental healthcare, at any time in life, were investigated by calculating odds ratios with 95% confidence intervals.ResultsMen with low mental health literacy were most likely to not perceive a need for mental healthcare, also when adjusting for age, education, and poor mental health (OR 5.3, 95% CI 3.6–7.7), and to refrain from seeking mental healthcare, also when adjusting for age and education (OR 3.3, 95% CI 1.7–6.4), followed by men with high mental health literacy (OR 1.9, 95% CI 1.5–2.4, and OR 1.5, 95% CI 1.0-2.2) and women with low mental health literacy (OR 1.9, 95% CI 1.2–2.9, and OR 2.1, 95% CI 1.1–3.9). Women with high mental health literacy were least likely (reference group).ConclusionThe results show differences in the likelihood of unmet need for mental healthcare based on combinations of gender and mental health literacy level, with men having low mental health literacy being most at risk, and women with high mental health literacy being least at risk. This challenges generalisations of a gender difference in unmet need by showing heterogeneity among men and women based on mental health literacy. Men with low mental health literacy may be particularly in need of targeted interventions to reduce potential individual and societal consequences of their unmet need.

Mental Health Care Utilization and its Barriers among Iranian Breast Cancer Survivors: A Cross-sectional Study.

Depression and anxiety are common comorbidities complicating the care of breast cancer patients, but many patients do not receive the needed care. We aimed to assess utilization of mental health care and its barriers in breast cancer survivors. This cross-sectional study was conducted on 311 patients with breast cancer, in Iran, November 2021 to March 2022. Perceived need and utilization of mental health care and barriers to service utilization were measured based on self-report. Depression, Anxiety, and Stress Scale-21 and Multidimensional Scale of Perceived Social Support were used to assess depression, anxiety, and stress as well as social support, respectively. A linear and logistic regression model was used to analyze the data using SPSS version 22. A P-value less than 0.05 was considered statistically significant. 70.1% of the participants perceived need for mental health care, 28.0% of them had used mental health services, and 72% were classified as having unmet needs. The most common perceived barrier to service use was patients' self-adequacy. The prevalence of extremely severe levels of depression, anxiety, and stress was 14.8%, 23.5%, and 10.6%. Also, 48.6%, 78.5%, and 75.6% of patients received a high level of social support from friends, family, and significant others. Findings highlight a substantial unmet need for mental health care and low utilization of mental health services among breast cancer survivors. Given the significant prevalence of depression, anxiety, and stress in this population, it is imperative to address the underutilization of mental health services and to further examine the barriers preventing patients from seeking the care they require.

Male Survivors’ Disclosure of Conflict‐Related Sexual Violence in Mental Health Care Settings: Results from a Phenomenological Study with Clinical Experts in Germany

Conflict‐related sexual violence (CRSV) can severely impair survivors’ mental health and prompt their need for mental health care. Male survivors face gender‐related barriers to disclosing experiences of sexual violence, yet the understanding of factors impeding or promoting disclosure is limited. This knowledge gap is even more pronounced regarding male disclosure in refugee settings. The high prevalence of CRSV experiences in male refugees in European host countries points to the urgency of understanding male disclosure processes along with its barriers and facilitators, in order to provide for adequate mental health care. 10 clinical experts working with male survivors of CRSV in Germany were interviewed adopting an explorative phenomenological approach and using the Problem‐Centered Interview. Qualitative content analysis yielded five themes describing male disclosure of CRSV: 1. Experiences of CRSV commonly remain nonverbalized, 2. Disclosure of CRSV is a dialogical and iterative process, 3. The process of (non‐)disclosure is a negotiation of agency, 4. Disclosure of CRSV affects the survivor’s psychoemotional state, and 5. Disclosure and recovery are interdependent processes. Additionally, seven categories describing barriers to and facilitators of male disclosure were extracted: 1. trauma characteristics, 2. survivor variables, 3. clinician variables, 4. interpreter variables, 5. interpersonal variables, 6. contextual variables, and 7. sociocultural variables. Clinical experts emphasize the effectivity of a gender‐specific communicative taboo for male refugee survivors that intersect with socio‐cultural norms. Variables characterizing survivors who are at risk of not disclosing CRSV are identified. A discussion of clinical approaches to address the taboo surrounding CRSV and to support male refugee survivors in agentic disclosure and recovery is provided.

1171 The need for mental health screening and care at a high-risk fourth trimester clinic

1171 The need for mental health screening and care at a high-risk fourth trimester clinic

Primary care-based screening and recruitment for an adolescent depression prevention trial: Contextual considerations during a youth mental health crisis.

Rising rates of adolescent depression in the wake of COVID-19 and a youth mental health crisis highlight the urgent need for accessible mental healthcare and prevention within primary care. Digital mental health interventions (DMHIs) may increase access for underserved populations. However, these interventions are not well studied in adolescents, nor healthcare settings. The purpose of this study was to identify barriers and facilitators to screening and recruitment activities for PATH 2 Purpose (P2P): Primary Care and Community-Based Prevention of Mental Disorders in Adolescents, a multi-site adolescent depression prevention trial comparing two digital prevention programs within four diverse health systems in two U.S. states. This qualitative study is a component of a larger Hybrid Type I trial. We conducted semi-structured key informant interviews with clinical and non-clinical implementers involved with screening and recruitment for the P2P trial. Informed by the Consolidated Framework for Implementation Research (CFIR), interviews were conducted at the midpoint of the trial to identify barriers, facilitators, and needed adaptations, and to gather information on determinants that may affect future implementation. Respondents perceived the P2P trial as valuable, well aligned with the mission of their health systems. However, several barriers were identified, many of which stemmed from influences outside of the healthcare settings. Universal and site-specific outer setting influences (COVID-19 pandemic, youth mental health crisis, local community conditions) interacted with Inner Setting and Innovation domains to create numerous challenges to the implementation of screening and recruitment. Our findings emphasize the need for ongoing, comprehensive assessment of dynamic inner and outer setting contexts prior to and during implementation of clinical trials, as well as flexibility for adaptation to unique clinical contexts. The CFIR is useful for assessing determinants during times of rapid inner and outer setting change, such as those brought on by the COVID-19 pandemic, youth mental health crisis, and the corresponding exacerbation of resource strain within healthcare settings. PATH 2 Purpose: Primary Care and Community-Based Prevention of Mental Disorders in Adolescents https://www.clinicaltrials.gov/study/NCT04290754.

Assessed and self-perceived unmet needs for mental health care in the general population in Antwerp

Introduction: A public mental health care approach requires knowledge about which proportion of the population needs mental health care, and which people need it but don’t seek or receive it and why.
 Who is it for? We investigated (unmet) needs for mental health care in the general population to optimize the distribution of mental health care services, which benefits all Antwerp citizens who need mental health care.
 Involvement and engagement: Important stakeholders who were involved are the (Antwerp) psychiatric hospitals, who funded the research and were involved in the design of the study and interpretation of results. The involvement and engagement of (ex) patients in mental health care was limited, but a pilot test of the survey was conducted with this group.
 Method: A representative sample was invited in 2021 to participate in a population survey about mental wellbeing and mental health care use in Antwerp. A total of 1208 individuals aged 15 – 80 years old participated. We investigated unmet needs for mental health care using a normative approach (assessed mental health problems) and subjective approach (self-perceived mental health problems)
 Results: A total of 10.4% of the sample was defined as having a need for mental health care but only half of them used health care for their mental health, resulting in a population prevalence of 5.5% clinically assessed unmet mental health needs. Among all people who did not use mental health care, 12.1% perceived a mental health need (fully unmet), and 23.3% of mental health care users perceived the care as insufficient (partially unmet), leading to a total population prevalence of 14.0% perceived unmet needs. However, more women and younger people perceived unmet needs, while clinically assessed unmet needs were higher among men and older people.
 Learning: Estimates of met and unmet mental health needs are complex given the diversity of operationalizations of different levels of need, and can only be established by a dialectic of individual and populational perspectives. Assessed and perceived (unmet) mental health needs are both relevant and complementary but are related to different factors. Nonetheless, a general conclusion is that the prevalence of unmet mental health needs is high. Some vulnerable groups should be targeted for detection of mental health problems and interventions, for example through outreaching care.
 Next steps: Further research should explore how assessed and perceived needs interact, and how this is predictive of help seeking and mental health outcomes.

Prevalence of Subjective Unmet Mental Healthcare Needs, Barriers, and Socioeconomic Inequality among Adult Individuals with Physical, Visual, Hearing, and Speech Disabilities in West of Iran

People with disabilities are susceptible to mental disorders, so it is very important to check and monitor their access to mental health services. There has been no study in this regard in Iran. This study aimed to measure the prevalence and socioeconomic inequality of subjective unmet needs for mental healthcare services (SUNMH) among individuals with disabilities and the various reasons behind them in the west of Iran. This descriptive-analytical and cross-sectional study was conducted on 613 people with disabilities over 18 years of age in Sanandaj city in 2023. Simple random sampling was used, and a questionnaire was applied to collect the data. The multivariate logistic regression was used to determine significant predictors of SUNMH. The concentration index (C) and concentration curve (CC) were calculated to measure inequality in the prevalence of SUNMH. Data were analyzed using STATA software version 16.0 (Stata Corp, College Station, TX, USA. About 47% of people had experienced SUNMH. Lack of financial ability with 45%, insufficient payment of basic health insurance for mental health services with 27%, and noncoverage of mental health services by basic health insurance with 25% were the three main reasons for SUNMH. According to the logistic regression model, unemployment (OR: 2.70, 95% CI: 1.31–5.53), not having supplementary insurance (OR: 2.03, 95% CI: 1.11–4.74), having another member with a disability in the household (OR: 3.33, 95% CI: 1.34–8.29), and poor economic status increased the odds of experiencing unmet need for mental health services by about 3, 2, 3, and 21 times, respectively (OR: 21.11, 95% CI: 13.72–48.11). The concentration index was −0.496, indicating a greater concentration of SUNMH in people with low socioeconomic status. Access to health services is not suitable among people with disabilities and a significant percentage of them suffer from SUNMH. Policy recommendations are proposed to address the primary obstacle of financial barriers to SUNMH and increase access to the necessary services, which include increasing the allocation of financial resources to specialized mental health services for individuals with disabilities and expanding disability-specific health insurance coverage with government financial support.

Religiosity, Anxiety, Depression, and Suicidal Ideation in Brazilian Patients with Sickle Cell Disease

Introduction: Sickle cell disease (SCD) is an inherited hemoglobinopathy that can evolve with time, in some individuals, as a debilitating chronic pain syndrome with emotional dysfunctions. Objective: To evaluate different types of religiosities: organizational (ORA), non-organizational (NORA), and intrinsic religiosity (IR), and their correlation with mental health in individuals with SCD. The variables analyzed were depression, anxiety, and catastrophic and suicidal thoughts. Method: This is a descriptive cross-sectional study, which is part of a crossover randomized clinical trial. We recruited adults among individuals with SCD from Bahia-Brazil. We used: Duke's religiosity index, Hospital Anxiety and Depression Scale (HADS), and Brazilian Portuguese Pain Catastrophizing Scale (BP-PCS) data. The Spearman correlation and Fisher exact test were used for statistics considering alpha 95%. Results: Of the 131 individuals approached for participation, 75 completed all questionnaires with genotype HbSS and HbSC. Of them, 49 (65,3%) were women, with an average age of 34.13 +10.02, 66 (88.0%) self-declared black, 63 (84.0%) declared to belong to a religious group, 67 (89.3%) with a high form of religious involvement. The mean of intense pain was 3.86 + 2.74; 40 (53.33%) had anxiety, 25 (33.33%) had depression, and 15 (20.0%) declared having suicidal thoughts. There was a negative correlation between depression and IR (r = -0.240, p = 0.038) and a correlation between average pain and NORA (r = 0.301, p = 0.009). An association between NORA and chronic pain was verified (p = 0.023), OR (p < 0.001), NORA (p = 0.042), and IR (p = 0.004) with evangelical SCD subjects. Conclusion: This study highlights the need for mental health care in patients with SCD due to the high rates of anxiety and depression, with the need to include religiosity since it is a frequent and important element in the lives of people with SCD.

Brazilian Scale for Evaluation of Mental Health Care Needs: Additional Evidence.

To investigate validity evidence of the Brazilian Scale for Evaluation of Mental Health Care Needs (CuidaSM). This is a psychometric study, which seeks additional evidence of internal structure. Data collection was carried out in 11 Primary Health Care (PHC) services , which implement the Health Care Planning (HCP) methodology, distributed across the five Brazilian regions. The preliminary version of CuidaSM, containing a block self-referred by the user and another block evaluated by PHC professionals, was applied to users aged 18 or over who attended the PHC services for consultation with a higher education professional. The techniques of confirmatory factor analysis and network analysis were used to investigate validity evidence. For the primary data of the confirmatory factor analysis, the factorial loads and the item's predictive power (R2) were used. Six model adjustment indices were adopted and reliability was measured by three indicators using Bayesian estimation. A total of 879 users participated in the study. By confirmatory factor analysis, factorial loads ranged from 0.43 to 0.99 and R2 from 0.19 to 0.98. Both the primary indicators and the model adequacy indices were established at satisfactory and consistent levels. The network analysis showed that the items were appropriately associated with their peers, respecting the established dimensions, which again indicates the sustainability and stability of the proposed model. The study findings confirm a consistent and reliable model of the instrument, through a combination of techniques. Considering the importance of using solid instruments in clinical practice, CuidaSM is a promising tool for population-based management and network care organization, aligned with HCP proposals.

Age Disparities in Prevalence of Anxiety and Depression Among US Adults During the COVID-19 Pandemic

High levels of anxiety and depression were documented shortly after the arrival of the COVID-19 pandemic and were more prevalent in younger adults than in older adults. Knowing whether these age disparities persisted throughout multiple years of the COVID-19 pandemic and identifying associated factors will help guide health policy. To investigate age disparities in anxiety and depression during the COVID-19 pandemic. This cross-sectional study consisted of a nationally representative online survey administered between April 2020 and August 2022 and included US adults who were not incarcerated. Data were analyzed between March and September 2022. The first 27 months of the COVID-19 pandemic included wide variation in infection rates, turbulence in US political and social life, and geopolitical instability. Primary exposures include individuals' age and economic precarity and pandemic-related events (eg, weekly state-level case counts and individual vaccination status). Symptoms of anxiety and depression were assessed via responses to 2-item screeners (Generalized Anxiety Disorder 2-item for anxiety and Patient Health Questionnaire-2 for depression). An individual's symptoms were identified as clinically elevated if scores exceeded validated thresholds. This study included 3 028 923 respondents (mean [SD] age, 48.9 [17.0] years; 1 567 603 [51.8%] female). In multiple regression analyses that include state fixed effects and survey-week fixed effects, likely anxiety and depressive disorders among 291 382 (40%) and 238 505 (33%) of adults aged 18 to 39 years, respectively, compared with 357 820 (31%) and 274 534 (24%) of adults aged 40 to 59 years and 225 295 (20%) and 183 695 (16%) adults aged 60 years and older. Levels declined throughout the pandemic period for those aged 40 years and older but remained elevated for younger adults. Analyses identified several associated factors of these age disparities. Younger adults' anxiety and depression increased more than older adults' after surges in COVID-19 case counts but decreased less following vaccination against the virus. Additionally, approximately one third of the age gap among individuals with depression and anxiety was attributed to economic precarity, to which younger adults are disproportionately exposed. In this cross-sectional study of anxiety and depression during the COVID-19 pandemic, economic precarity was associated with high anxiety and depression among younger adults in the US compared with older adults in the US. These findings suggest a need for greater mental health care and economic policies targeted toward younger adults.

PSYCHOTHERAPEUTIC TOOLS IN DEALING WITH NEGATIVE PSYCHOEMOTIONAL STATES BY EXAMPLE OF ONLINE GAMES "TETRIS" AND "FARM"

Introduction: The war has exacerbated the negative psycho-emotional states of people living in Ukraine and abroad. Right now, there is an urgent need for quality mental health care. The search for new effective and at the same time simple methods of providing relevant psychological and psychotherapeutic assistance determines the relevance of this research.
 The aim: To investigate and prove the effectiveness of the dosed daily use of an online game as a psychotherapeutic tool in dealing with the negative psychoemotional states of people living abroad during the war in Ukraine.
 Materials and Methods: 500 people took part in the experimental research - Ukrainian immigrants in China, the USA, Portugal and Germany – 267 women and 233 men aged 18-35, who were randomly divided into control and experimental groups of 250 each. The research continued for 13 months. Methods: psychological counselling, psychoeducation, dosed daily using online games «Tetris» and «Farm» in the control and experimental groups, respectively. Diagnostic methods: Questionnaire for the detection of psychosomatic disorders, Depression Self-Assessment Scale and Anxiety Self-Assessment Scale.
 Results: In the primary diagnosis, the following results were obtained: high rates of psychosomatic disorders in 70,8% of the control and 66,7% of the experimental groups; depression in 63,3% of the control and 66,7% of the experimental groups; high rates of anxiety in 66,7% of the control and 70% of the experimental groups. After using the online games «Tetris» and «Farm» in the control and experimental groups, respectively, the following results were obtained: high rates of psychosomatic disorders decreased to 37,5% of people in the control group and 33,3% in the experimental group; 33,3% of people in the control group and 30% in the experimental group have depression; high rates of anxiety were found in 33,3% of people in the control group and 26,7% in the experimental group, which is half as much as the previous indicators.
 Conclusions: the results of the experimental research suggest that the dosed daily use of the online game «Farm» is an effective psychotherapeutic tool in dealing with negative psycho-emotional states, proven by the authors.

Factors Associated With People's Accessibility to Mental Healthcare Services in Ukraine: Focusing on Household Head Vulnerability.

Objectives: This study examines the factors associated with access to mental healthcare services among people living in the government-controlled areas (GCAs) of Donetsk and Luhansk oblasts in Ukraine. Methods: The 2020 Ukraine Multi-Sector Needs Assessment conducted by REACH was subjected to frequency analysis, percentage analysis, and binary logistic regression to confirm the factors associated with accessibility to mental healthcare services among Ukrainian household heads. Results: Older household heads, heads with high accessibility to healthcare facilities, and those with low health expenditures were highly likely to have low access to mental healthcare services. Household heads' awareness of household members' medical assistance eligibility was significantly and positively associated with the former's mental healthcare accessibility. Conclusion: This study revealed the mental health vulnerability of people living in GCAs in Ukraine, in which the situation progresses from conflict to war. The need for mental healthcare, which is adversely affected by armed conflict, is expected to increase. Accordingly, further studies should clarify the demand for and methods to enhance mental healthcare services to ensure the timely provision of these services in the future.

Mental healthcare utilization among head and neck cancer patients: A longitudinal cohort study.

To investigate utilization of mental healthcare among head and neck cancer (HNC) patients from diagnosis to 2years after treatment, in relation to psychological symptoms, mental disorders, need for mental healthcare, and sociodemographic, clinical and personal factors. Netherlands Quality of life and Biomedical Cohort study data as measured before treatment, at 3 and 6months, and at 1 and 2years after treatment was used (n=610). Data on mental healthcare utilization (iMCQ), psychological symptoms (Hospital Anxiety and Depression Scale, Cancer Worry Scale), mental disorders (CIDI interview), need for mental healthcare (Supportive Care Needs Survey Short-Form 34, either as continuous outcome indicating the level of need or dichotomized into unmet need (yes/no)) and several sociodemographic, clinical and personal factors were collected. Factors associated with mental healthcare utilization were investigated using generalized estimating equations (p<0.05). Of all HNC patients, 5%-9% used mental healthcare per timepoint. This was 4%-14% in patients with mild-severe psychological symptoms, 4%-17% in patients with severe psychological symptoms, 15%-35% in patients with a mental disorder and 5%-16% in patients with an unmet need for mental healthcare. Among all patients, higher symptoms of anxiety, a higher need for mental healthcare, lower age, higher disease stage, lower self-efficacy and higher social support seeking were significantly associated with mental healthcare utilization. Mental health care utilization among HNC patients is limited, and is related to psychological symptoms, need for mental healthcare, and sociodemographic, clinical and personal factors.

Heyy, how are you doing? – Redefine employees’ outlook towards mental health

Learning outcomes The learning outcomes of this case study are to understand the business-to-business (B2B) consumer outlook on mental health care in emerging markets; analyse the challenges faced in creating a need for mental health care in Indian workplaces; explore the business attractiveness of the B2B model and understand the business potential of the B2B segment at heyy,; and contemplate different innovative strategies that could change consumer mindset on mental health care in emerging markets. Case overview/synopsis Ankit, the founder and CEO of heyy, was facing a conundrum. “heyy,” was built on normalizing mental well-being at workplaces. His mental health-care app heyy, had crossed 50,000 subscribers within a few months of launch. The mobile app was designed to spread mental health awareness and provide various levels of mental well-being interventions. Business-to-consumer and B2B customer segmentation had been targeted by this start-up. The B2B space consisted of employees working with partner organizations. The adoption rates of employees using the features of heyy, declined after the initial app download. The employees had yet to fully become acclimatized to the features of heyy,. Exploring the business potential and investigating the business attractiveness of the B2B segment were the focus of the present study. Ankit contemplated various strategies he could adopt to increase user adoption of “heyy,” services by employees in his partner organizations. The case study strives to address the question – “What are the risks faced by organizations when entering the mental health-care industry in emerging markets like India, where mental health care is still not openly discussed?” Complexity academic level This case study is designed to be taught as part of the “entrepreneurship development” and “strategic management” courses for undergraduates, postgraduates and students of executive programmes in management. Students need to be aware of basic strategic management concepts such as BCG matrix, SWOT analysis and business canvas before working on this case study, so they could dissect the case from multiple perspectives to get a comprehensive outlook on the case. Supplementary materials Teaching notes are available for educators only. Subject code CSS 11: Strategy.

Perceived Need, Unmet Need for Mental Health Care and Related Factors Among Mothers of Children with Autism Spectrum Disorder in Hamadan, Western Iran

Background: There is no reliable data on the perceived need of mothers of children with autism spectrum disorder (ASD) for mental services, and it is unclear how much of mothers' needs are met in Western Iran. Objective: This study aimed to quantify the perceived need and avoidance/delay for mental health care among mothers of children with ASD and also to elucidate the factors associated with perceived need and avoidance/delay. Method: This is a cross-sectional study involving all mothers of children with ASD in Hamadan City, Western Iran. Socio-demographic characteristics, depression, anxiety, stress as well as perceived need and avoidance/delay, and associated factors were obtained using researcher-made and standard validated questionnaires. Penalized logistic regression analysis via data augmentation was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Result: In total of 103 mothers, approximately 75% and 61% of mothers reported a perceived need and avoiding/delaying needed services during the past 12 months, respectively. Psychological stress and lower family income were significant determinants of the perceived need for mental health care. Minimization (OR: 6.06; 95% CI: 1.33-27.68), low perceived treatment effectiveness (4.40; 1.05-18.35), and financial barrier (4.26; 1.01-17.86) were the most important reasons for avoiding/delaying needed services, respectively. Conclusion: The prevalence of perceived needs and unmet needs is high. Effective psychosocial interventions should be provided to reduce the mental health care gap among mothers of children with ASD.