Prior Mental Health Service Research Articles

University Student Stress and Behavioral Health During the COVID-19 Pandemic

Higher education students have experienced increased stressors and behavioral health problems during the COVID-19 pandemic. The current study further investigated such phenomena in a sample of university students collected between June 2020 to December 2021. Students (N = 1,441) from a Mid-Atlantic public university were recruited via email lists and a psychology department research participant pool. The participants completed an online survey with items pertaining to demographic factors, biopsychosocial stressors, and measures of behavioral health functioning. All variables were examined descriptively, and regression analyses were used to examine hypothesized cross-sectional relationships between demographic factors and biopsychosocial stressors, on the one hand, and behavioral health functioning, on the other. Experiencing notable levels of biopsychosocial stressors was common, though a linear trend across semesters was not observed with respect to behavioral health functioning. Gender was the most consistent demographic predictor of behavioral health functioning, whereas the most common biopsychosocial stressor predictors for behavioral health functioning were stress/worry, social isolation, discrimination, and prior mental health services. Results corroborate and extend prior research evidencing notable levels of biopsychosocial stressors and behavioral health problems reported by higher education students during the COVID-19 pandemic. Implications for campus administrators and behavioral health providers concern vulnerabilities for a range of pandemic-time challenges being experienced by their constituents to which to attend.

Characteristics of Fatalities Among Sexual- and Gender-Diverse Youth in the United States: 2015-2020.

Sexual- and gender-diverse youth face unique stressors that negatively impact their health. The objective of this study was to use National Fatality Review-Case Reporting System data to epidemiologically describe fatalities among identified sexual- and gender-diverse youth to inform future prevention efforts. We used 2015 to 2020 data from the National Fatality Review-Case Reporting System to identify deaths among sexual- and gender-diverse youth and compare their characteristics to a matched sample of youth from these same data who were not known to be sexual- and gender-diverse. Demographic, injury, death, history, and life stressor characteristics were analyzed using descriptive statistics. During the study period, 176 fatalities were identified among sexual- and gender-diverse youth. Decedents' mean age was 15.3 years. A greater proportion of deaths was attributed to suicide among sexual- and gender-diverse youth (81%) compared with nonsexual- and gender-diverse youth (54%). Receiving prior (69%) and/or current (49%) mental health services was more common among sexual- and gender-diverse youth, compared with nonsexual- and gender-diverse youth (50% and 31%, respectively). Sexual- and gender-diverse youth were significantly more likely to experience problems in school or be victims of bullying, compared with nonsexual- and gender-diverse youth (63% versus 47% and 28% versus 15%, respectively). Suicide was the most common manner of death for sexual- and gender-diverse youth, despite many decedents receiving current or prior mental health services. These findings indicate the need to improve and diversify interventions to prevent these deaths.

A qualitative study exploring the acceptability of a telehealth intervention for family members of people experiencing a first episode psychosis: PERCEPTION.

Family members of people experiencing a first-episode psychosis (FEP) can experience high levels of carer burden, stigma, emotional challenges, and uncertainty. This indicates the need for support and psychoeducation. To address these needs during the COVID-19 pandemic, we developed a multidisciplinary, blended, telehealth intervention, incorporating psychoeducation and peer support, for family members of FEP service users: PERCEPTION (PsychoEducation for Relatives of people Currently Experiencing Psychosis using Telehealth, an In-person meeting, and ONline peer support). The aim of the study was to explore the acceptability of PERCEPTION for family members of people who have experienced an FEP. Ten semi-structured interviews were conducted online via Zoom and audio recorded. Maximum variation sampling was used to recruit a sample balanced across age, gender, relatives' prior mental health service use experience, and participants' relationship with the family member experiencing psychosis. Data were analysed by hand using reflexive thematic analysis. Four themes were produced: 'Developing confidence in understanding and responding to psychosis'; 'Navigating the small challenges of a broadly acceptable and desirable intervention'; 'Timely support enriches the intervention's meaning'; and 'Dealing with the realities of carer burden'. Broadly speaking, PERCEPTION was experienced as acceptable, with the convenient, safe, and supportive environment, and challenges in engagement being highlighted by participants. Data point to a gap in service provision for long-term self-care support for relatives to reduce carer burden. Providing both in-person and online interventions, depending on individuals' preference and needs, may help remove barriers for family members accessing help.

Lifelong mental health service use among 15–22 years old offenders: a document-based, mixed-methods descriptive study

ObjectivesAmong young offenders, psychiatric morbidity and comorbidity are common, but our knowledge about their use of mental health services during childhood and adolescence is scarce. We aimed to describe the...

The Association Between Prior Mental Health Service Utilization and Risk of Recidivism among Incarcerated Ontario Residents.

There is mixed evidence on the link between mental health and addiction (MHA) history and recidivism. Few studies have examined post-release MHA care. Our objective was to examine the association between prior (pre-incarceration) MHA service use and post-release recidivism and service use. We conducted a population-based cohort study linking individuals held in provincial correctional institutions in 2010 to health administrative databases. Prior MHA service use was assigned hierarchically in order of hospitalization, emergency department visit and outpatient visit. We followed up individuals post-release for up to 5 years for the first occurrence of recidivism and MHA hospitalization, emergency department visit and outpatient visit. We use Cox-proportional hazards models to examine the association between prior MHA service use and each outcome adjusting for prior correctional involvement and demographic characteristics. Among a sample consisting of 45,890 individuals, we found that prior MHA service use was moderately associated with recidivism (hazard ratio (HR): 1.20-1.50, all P < 0.001), with secondary analyses finding larger associations for addiction service use (HR range: 1.34-1.54, all P < 0.001) than for mental health service use (HR range: 1.09-1.18, all P < 0.001). We found high levels of post-release MHA hospitalization and low levels of outpatient MHA care relative to need even among individuals with prior MHA hospitalization. Despite a high risk of recidivism and acute MHA utilization post-release, we found low access to MHA outpatient care, highlighting the necessity for greater efforts to facilitate access to care and care integration for individuals with mental health needs in correctional facilities.

Law Enforcement Pathways to Mental Health: Secondary Traumatic Stress, Social Support, and Social Pressure.

The mental health of law enforcement officers (LEO) is critical to the safety and well-being of the officers and the public they serve. However, LEO face significant on-the-job stressors that undermine mental health, and there is a lot to be learned about when and how LEO seek and enter mental health services. The present study sought to explore variables related to mental health seeking behavior, the role of social engagement and social pressure in the decision to seek mental health services, and the most common pathways into mental health utilized by LEO. A small sample of 86 LEO were recruited from the social media page of a law enforcement nonprofit support organization to take several self-report measures on past mental health service usage and intentions to seek future services, the Inventory of Attitudes Toward Seeking Mental Health Services, the Professional Quality of Life Survey, and a measure of social engagement on mental health topics. Results indicate that while a number of factors are associated with intentions to seek future services, the primary factor in past mental health seeking behavior was secondary traumatic stress. Those who sought mental health services reported higher social engagement and social pressure to seek help. LEO entered mental health services for a variety of reasons and through a variety of provider options, such that no one provider source was preferred. Though the present study was limited by a small sample size, reliance on self-report measures, and occurred during a time of civil unrest that sparked the “defund the police” movement, the results serve as a starting point for understanding the pathways into mental health services for LEO and the roles of secondary trauma and prior mental health service experience.

The association of gender and persistent opioid use following an acute pain event: A retrospective population based study of renal colic

This study aims to explore gender-related differences in persistent opioid use following an acute pain episode and evaluate potential explanatory variables. This retrospective population-based study using administrative databases included all opioid-naïve patients in Ontario with renal colic between 2013 and 2017. The primary outcome was to assess any association between persistent opioid use at 3-6 months by gender. Key confounding covariates and explanatory variables examined included both care- and patient-related factors, specifically past evidence of mental health diagnoses. The dataset of 64,240 males and 37,656 females demonstrated that 8.7% of males and 9.6% of females had evidence of persistent opioid use 3-6 months after presentation (OR 1.11, 95% CI 1.05, 1.17). Females had a higher incidence of mental health services utilization [44.5% vs 29.6% (p<0.001)] and were more likely to be on a provincial disability program [5.1% vs 3.8% (p<0.001)]. Age, income quintile, mental health diagnoses and dose of opioid prescribed were associated with the primary outcome in both genders. On adjusted analysis for multiple confounding and explanatory variables, females were still more likely than males to demonstrate persistent opioid use (OR 1.07, 95% CI 1.01, 1.13) with even more pronounced associations at 1-2 years. After controlling for key covariates, females are at slightly higher risk of demonstrating long term opioid use following an episode of renal colic. Evidence of prior mental health service utilization and acute colic care did not appear to significantly explain these observations.

Evaluating the Effectiveness of a Statewide School-Based Behavioral Health Program for Rural and Urban Elementary-Aged Students

Community and School-Based Behavioral Health Service (CSBBH) was developed through a collaborative process that included schools, behavioral health providers, counties, and a payor. The clinical model within CSBBH relies on a common factors approach. To evaluate the effectiveness of CSBBH to meet the needs of students across a diverse state, clinical model performance and outcomes were examined for 2,584 Medicaid-eligible children aged 4.5 to 11 years in urban and rural communities. First, propensity score matching was used to compare CSBBH to Treatment as Usual (TAU). CSBBH was associated with greater improvement in child functioning and slightly lower therapeutic alliance compared to TAU. Next, the utility of the model for urban vs. rural students was compared. As expected, there were many differences at baseline between children in urban and rural settings. Compared to children from rural settings, children from urban settings were more culturally diverse and had higher rates of utilization of prior mental health services but had lower rates of complex diagnoses. Despite these differences, the service was consistently applied across schools and caregiver-reported outcomes were comparable and positive across groups. Teachers in urban and rural schools reported improvements in hyperactivity, but other outcomes (e.g., prosocial behavior, emotional symptoms) varied. This study highlights the importance of a scalable and sustainable payor–provider collaborative approach to address the needs of children across a diverse state.

Factors affecting mental health service use among university students following an episode of mass violence.

Episodes of mass violence can increase mental health (MH) symptoms among survivors, possibly leading to increased MH service use. Within the context of an episode of mass violence that impacted a university community, we prospectively explore the predisposing (demographics, clinical levels of MH symptoms, victimization history, objective exposure, and social support), enabling (MH stigma, prior MH service use,), and need (MH symptoms, current social support) variables that influence posttragedy MH service use. In the original study, 593 students completed surveys at 2 time points during their first year of college. After the tragedy, students were invited to participate in a post event survey for a final sample of n = 142. A total of 14.3% of our sample accessed MH services post event. Results indicate that demographic factors were not related to MH service use. When examined jointly in a logistic regression, the final model suggests that prior MH service use and greater objective exposure were related to posttragedy MH service use. Other predisposing, enabling, and need factors were not associated with MH service use. Prior experience with MH services may help survivors engage in services following a disaster. As disaster MH service models tend to target outreach to those with the greatest exposure, this may be why those survivors had greater MH service use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Assessing Acceptability of the Term: "Psychopathology" Among Youth Aged 18-25.

A prevailing model for mental health care for youth and families is to provide services within a "psychopathology" focused framework. This approach can compound problems for youth by imparting negative labels on them, and may be associated with iatrogenic impacts of interventions (e.g., stigmatization, lowered self-efficacy, dependency). This study assessed perceptions of the term "psychopathology" among 486 youth aged 18-25, with 39% of these youth receiving prior mental health services. Results indicated statistically significant differences in perception of the term, with youth who had received mental health services perceiving it more negatively than youth who had not. Findings suggest receipt of mental health services among young people may sensitize them to negative aspects of the term psychopathology, indicating the need for caution in using this term and other terms that may have negative impacts on mental health service use among youth.

Racial/ethnic disparities in prior mental health service use among incarcerated adolescents

Research on racial and ethnic disparities in mental health and substance abuse service use among incarcerated youth in the U.S. is inconclusive. This cross-sectional study adds to our understanding of racial and ethnic disparities by examining the prior use of mental health and substance abuse services among incarcerated juveniles. Guided by Andersen's behavioral model of health service utilization, a series of logistic regression analyses were conducted on a non-probability sample of 13–19year-old youth in two residential facilities for juvenile offenders in Western Pennsylvania (N=181). Black and Hispanic youth were less likely than White youth to have used mental health and substance abuse services, even when controlling for predisposing, enabling, and need factors. Additional analyses revealed that these differences did not hold across all service types, specifically with regards to outpatient service use. Significant differences did exist, however, in the prior use of inpatient mental health and substance abuse services. This suggests that White youth are often funneled into the mental health system, while youth of color enter the justice system. Implications for racial/ethnic disproportionality in service use and justice system involvement are discussed.

Mental Health Service Use Among Firefighters With Suicidal Thoughts and Behaviors.

This study aimed to characterize rates and correlates of mental health service use, as well as barriers to care, among a sample of firefighters reporting a history of suicide ideation, plans, or attempts during their firefighting careers. Participants (N=483) completed a Web-based survey assessing history of suicidal thoughts and behaviors, prior mental health service utilization, and barriers to treatment. Overall, 77% of participants reported receipt of mental health services during their firefighting careers (attempt history, 93%; plan but no attempt, 77%; and ideation only 68%). Firefighters with fewer years of service were less likely than those with more years to have accessed treatment. Service nonusers were more likely than service users to report concerns regarding reputation and embarrassment as barriers to care. Findings from this preliminary investigation suggest that the majority of firefighters with a history of elevated suicide risk have received mental health services.

Mental Health Services for Parents Who Lost a Child to Cancer: If We Build Them, Will They Come?

To examine bereavement mental health service use, barriers to use, and factors associated with use in parents bereaved by cancer. A multicenter, cross-sectional study of 120 parents bereaved by cancer between 6 months and 6 years after their loss was performed. Parents completed self-report assessments of mental health service use and barriers, prolonged grief, depression, anxiety, attachment styles, and sense of meaning by phone, in person, or on their own. Forty-one percent of bereaved parents were currently using mental health services (talk therapy, psychotropic medication, and/or a support group), most commonly within the first 2 years after their loss. Talk therapy was the most frequently used service, although 36% of parents who discontinued therapy did so because it was not helpful. Forty percent of parents who wanted bereavement support reported they were not receiving services. The most common barriers to service use were that it was too painful to speak about the loss (64%) and too difficult to find help (60%). Factors associated with current mental health service use included more recent loss, prior mental health service use, subclinical/increased depression, insecure attachment styles, and a decreased sense of meaning. Minority parents were more likely to have unmet needs than nonminority parents. Parents appear to need, want, and often access bereavement mental health services, which could be offered in oncology settings. However, barriers to service use must be addressed, particularly for those with more debilitating grief symptoms and for minorities. High treatment dropout rates suggest the importance of improving retention, training providers, and developing effective grief interventions.

Outpatient Psychotropic Medication Use in the US: A Comparison Based on Foster Care Status

Using data from the Client/Patient Sample Survey, a nationally representative study of outpatient mental health service utilization, the prevalence and correlates of psychotropic medication receipt for youth who live with families and in foster care are compared. The medication rate is similar for both groups, with slightly more than one-third of youth treated with medication. Additionally, when medication is prescribed, it is the sole intervention provided for close to one half of each group, and the distribution of other services received (such as clinical case management and collateral services) is similar, regardless of living situation. However, the predictors of medication use differ for the two groups. Among foster care youth, only presenting problems of depressed mood, being withdrawn, and suicidality significantly increase the odds of medication; among youth with families, sociodemographic characteristics (male gender), and a range of clinical factors (disruptive behavior disorder, presenting problems of hyperactivity and sleep disturbance, prior mental health service receipt, and inpatient or residential care referral sources) increase the likelihood of medication. The conclusion that distinct sets of factors predict medication for the two groups was reinforced by results of multivariate analyses; foster care status moderates the association between medication receipt and only one of the correlates examined (gender). Implications, limitations, and areas for future research are presented.

Trauma-Focused Treatment in a State System of Care: Is It Worth the Cost?

The efficacy of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in treating child traumatic stress inspires nationwide dissemination, yet widespread adoption by state systems of care is lagging. A significant barrier is the cost of implementation and maintenance of evidence-based services. Thus, the current study examined the annual costs of mental health services accrued for 90 publiclyinsured, trauma-exposed children from the time they began participation in a TF-CBT implementation project to 1 year after their admission. These costs were compared to those accrued over that same time period by 90 trauma-exposed control children that were matched by demographics and prior mental health services utilization using a propensity score matching algorithm and provided outpatient treatment as usual. Results indicated that (a) 27.5 % of the total cost was attributed to high-end services utilized by only 1.67 % of children; (b) two times more money was spent on low-end mental health services received by the TF-CBT group than the control group, and (c) five times more money was spent on high-end mental health services received by the control group than the TF-CBT group in that year. These data suggest that providing evidence-based trauma-focused outpatient treatment to children with trauma-related problems may offset the eventual need for services that are more restrictive and costly.

VA primary care-mental health integration: patient characteristics and receipt of mental health services, 2008-2010.

In 2007, the U.S. Department of Veterans Affairs (VA) health system began nationwide implementation of primary care-mental health integration (PC-MHI) programs to enhance mental health access and promote treatment of common mental health conditions for patients in primary care settings. This report describes patients initiating PC-MHI services in fiscal years (FYs) 2008-2010, including those who received prior mental health services. Using VA administrative records, the investigators examined characteristics and services utilization of individuals who initiated PC-MHI services in FY 2008 (N=76,985), FY 2009 (N=107,417), or FY 2010 (N=149,938). PC-MHI service initiation increased by 95%, from 76,985 to 149,938 veterans. Over time, new user cohorts were increasingly younger, newer to VA services, and less likely to have received VA mental health treatment in the prior year. This study documents substantial expansion in VA PC-MHI program activity. PC-MHI program expansion may increase access to mental health services in primary care settings.

Exploring Racial Disparities in The Brief Jail Mental Health Screen.

The authors analyzed validation data from the Brief Jail Mental Health Screen (BJMHS) to determine whether race predicted screening results and if such a prediction was driven by particular screen items. A total of 22,000 individuals entering five jails over two 8-month periods were screened. The authors constructed binary logistic regression models to assess the impact of race on screening positive and endorsing particular items. Blacks and Latinos had lower odds than Whites of screening positive. Blacks and Latinos had somewhat lower odds than Whites of endorsing two or more symptom items but had appreciably lower odds of endorsing items regarding prior mental health service utilization. Racial differences in BJMHS screening results likely reflect the reproduction of racial disparities rather than valid differences because results were driven by items reflecting known barriers in access to mental health services. Nonetheless, the instrument is likely to remain an improvement over typical jail screening procedures.

Pediatric Emergency Consultations: Prior Mental Health Service Use in Suicide Attempters

This study investigated the relationship between presenting complaints and prior mental health encounters in youth seen for emergency psychiatric consultation. Records of youths aged 9-17 years old receiving a psychiatric consultation in a pediatric emergency department from 2002 to 2007 were examined (N=1,900). Youth were classified by presenting complaint: suicide attempt, suicidal ideation, and behavioral problems. Nearly half of the youth presented with behavior problems, and 39% presented with suicidal ideation and/or attempt. Those presenting with both suicide attempt and behavior problems were most likely to have made a prior suicide attempt. Those presenting with suicide attempt alone were least likely to report current mental health treatment, while youth presenting with behavior problems alone were the most likely to report current mental health treatment. Further research is needed to better understand the role that emergency departments play in the course of care and to maximize the opportunity to make lasting and effective community-based care connections.

The Impact of Mobile Crisis Services on the Use of Community-Based Mental Health Services

Objective: To examine the impact of community-based mobile crisis services on postcrisis community-based mental health service use and user characteristics related to likelihood of postcrisis service use. Method: Differences in use of postcrisis mental health services and timing between a community-based intervention cohort and a matched hospital-based cohort were assessed using a Cox proportional hazards model. Results: A mobile crisis intervention consumer was 17% more likely to receive community-based mental health services within 90 days after the crisis event. Controlling for prior service use, mobile crisis intervention consumers with no prior mental health service use were 48% more likely to receive community-based mental health services within 90 days after the crisis event than a consumer from the hospital-based intervention cohort. Consumers more likely to use postcrisis services were African American, homeless, experiencing acute problems, previous mental health service users, and severely mentally disabled. Conclusions: Implications for social work practice are discussed.

From Mental Health to Juvenile Justice: What Factors Predict This Transition?

We identify youth who are at risk for a critical transition from mental health to juvenile justice. A statewide longitudinal sample of Medicaid-eligible youth (aged 10–17) in the public mental health system (n = 5,455), during approximately one fiscal year (July 1, 1994–August 30, 1995), was used to determine the risk factors for, and timing of, a subsequent juvenile justice detention or commitment during the three subsequent fiscal years (1994–1997). Logistic regression and Cox Proportional Hazards modeling were used. Risk factors for juvenile justice detention or commitment included being: male, black or Hispanic, in junior high school, involuntarily admitted to mental health, having a DSM-IV diagnosis of conduct disorder, alcohol problems, a constellation of risk behavior, and receiving prior mental health services. Factors that accelerate the timing of detention or commitment in the juvenile justice system after a mental health visit included most of the general risk factors except risk behavior and involuntary admission were no longer significant and having a DSM-IV nonalcohol drug use diagnosis, antisocial behavior, and school problems became significant. Our study helps to identify youth who are at risk for multiple system use so that they may be provided appropriate services to prevent multiple system use.