Rates Of Mental Health Disorders Research Articles

Knowledge of psychology in Cambodia: Exploring the relationships to demographics, psychopathology, and idioms of distress.

Rates of mental health disorders in Cambodia are markedly higher than in other low- or middle-income countries. Despite these high rates, mental healthcare resources remain scarce and mental health stigma is pervasive, particularly for vulnerable populations of young women and individuals of low socioeconomic status. To address this gap, teaching Western mental health treatments and using a mental healthcare framework are recommended within the Cambodian context. However, Western frameworks do not address cultural syndromes or idioms of distress and operate from an individualistic perspective that does not address cultural values and beliefs. The present study employs a mental health literacy framework in an exploratory analysis of rates of psychological knowledge in a nationally representative sample of Cambodian adults (N = 2,690). To address recommendations for increasing mental healthcare, we designed a survey to investigate Cambodians' knowledge about mental health constructs. Results indicated that only 18.9% of Cambodians knew about psychology, and chi-square analyses revealed that women, individuals in rural areas, and individuals with significant distress due to cultural symptoms and syndromes reported knowing about psychology significantly less than their male and non-distressed counterparts. Additionally, those who reported higher income and higher levels of education indicated significantly higher rates of psychological knowledge, as did those with clinically significant rates of PTSD, at a rate of knowledge approaching significance. Implications for this study include the need to tailor interventions and resources to vulnerable populations, to assess the fit of current recommendations for the Cambodian context, and to further emphasize the need for culturally responsive interventions that address all presentations of Cambodian distress and align with understandings of mental health within the nation.

Mental and Physical Stress Responses to Personal Ultrafine Particle Exposure in Adolescents.

Incidence rates of mental health disorders among adolescents is increasing, indicating a strong need for effective prevention efforts at a population level. The etiology of mental health disorders includes genetic, social, and environmental factors. Ultrafine particles (UFPs; particles less than 0.1 μm in diameter) have been shown to exert neurotoxic effects on the brain; however, epidemiologic evidence on the relationship between UFPs and childhood mental health outcomes is unclear. The objective of this study was to determine if exposure to UFPs was associated with symptoms of mental health in adolescents. Adolescents completed personal UFP monitoring for one week as well as a series of validated Patient-Reported Outcomes Measurement Information System (PROMIS) assessments to measure five domains of mental and physical stress symptoms. Multivariable linear regression models were used to estimate the association between PROMIS domain T-scores and median weekly personal UFP exposure with the inclusion of interactions to explore sex differences. We observed that median weekly UFP exposure was significantly associated with physical stress symptoms (β: 5.92 per 10-fold increase in UFPs, 95% CI [0.72, 11.13]) but no other measured domains. Further, we did not find effect modification by sex on any of the PROMIS outcomes. The results of this study indicate UFPs are associated with physical symptoms of stress response among adolescents, potentially contributing to mental health disorders in this population.

Associations between problematic internet use and substance misuse among US college students

Problematic internet use (PIU) is more common in young adult populations than any other adult age group. Previous research has suggested that PIU is associated with higher rates of mental health disorders, psychological distress, and some substance misuse behaviors in college students. This study utilizes data from 417,780 US college students to explore associations between PIU and a variety of substance use outcomes. Unadjusted and adjusted odds ratios were used to investigate associations between PIU and substance use disorder (SUD) diagnosis, misuse of cigarettes, e-cigarettes, alcohol, marijuana, cocaine/methamphetamine, sedatives, hallucinogens, opiates, inhalants, MDMA, other club drugs, prescription pain killers, prescription sedatives, and prescription stimulants. Among the 417,780 US college students included in our analytic cohort, 123,330 (29.52%) reported PIU. Students who demonstrated PIU had a significantly higher risk of substance misuse behaviors, including misuse of opiate, sedative, hallucinogen, club drugs, and inhalant, illicit use of prescription pain killers, and SUD diagnosis, than their peers who did not demonstrate patterns of PIU. These findings highlight the need to promote the physical, social, and emotional wellbeing of students more effectively by considering PIU in prevention and intervention efforts aimed to decrease the prevalence of addictive behaviors in US college settings.

Epidemic Rates of Child and Adolescent Mental Health Disorders Require an Urgent Response

A new Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC) documents the high prevalence of mental health disorders among America's children even before the pandemic.1 Pandemic era reports recently led the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children's Hospital Association (CHA) to issue a joint declaration of a national emergency in child and adolescent mental health.2 This new MMWR represents remarkable work compiling diverse information from nine nationally-representative data sets. Findings indicate high rates of mental health disorders among US children and youth, including evidence that even very young children experience mental health conditions. Twenty percent of all children have an identified mental health condition annually while forty percent of all children will meet criteria by age 18. MMWR findings show that children living in poverty and minoritized children fare worse than their peers in access to care, identifiable risk factors, and prevalence of certain mental health conditions. Despite high rates of mental health conditions, the MMWR documents low rates of treatment (about 11.4% annually for White, 9.8% for Black, and 8.7% for LatinX children).

Piloting an Evidence-Based Assessment Protocol for Incarcerated Adolescents

ABSTRACT Although evidence-based assessment is considered an essential component of evidence-based practice, few adolescents have access to evidence-based assessment. Despite experiencing high rates of mental health disorders, incarcerated justice-involved adolescents are rarely able to access evidence-based psychiatric care. In this article, we discuss the components of an evidence-based assessment protocol designed and piloted with incarcerated adolescents involved in Rhode Island’s juvenile justice system. In particular, we describe the components of our evidence-based protocol, ways in which evidence-based assessment may need to be modified when working with this population, and discuss policy and clinical implications relevant to increasing access to evidence-based assessment among incarcerated adolescents.

LEGAL ACCEPTANCE OF LGBT IN INDIA: REVIEW ON ITS IMPLICATIONS ON HAVING EQUAL OPPORTUNITIES,FAMILY ACCEPTANCE AND BETTER MENTAL HEALTH

LGBT individuals experience higher rates of mental health disorders than their heterosexual peers. Family affirmative environment will lead to better mental health.The decriminalizing of colonial-era section 377 has given huge hope to this minority community.Future challenges still remain a question mark.But leap towards change has been initiated.Family acceptance will start from sensitizing the general population after legal reinforcement in various areas.The aim of this study is to explore strategies and programs to promote equal opportunity for LGBT youth. To review the role of family environment and functioning (family cohesion, family expressiveness, family conflict) of LGBT youth and their mental health.

Trauma Exposure and Mental Health Prevalence Among First Aiders.

IntroductionFirst aiders are commonly exposed to different forms of traumatic event (TE) during their duties, such as Chronic Indirect Vicarious Exposure which refers to an indirect exposure to aversive details of the trauma (APA, 2013). If the psychopathological impact of TE is well documented, the mental health of first aiders remains neglected. Therefore, our main objectives are (i) to study the link between exposure to traumatic events and psychopathological outcomes and (ii) to quantify the rates of mental health disorders among first aiders.MethodOur sample comprised of 53 volunteer first aiders (21 females and 32 males) with an average age of 32.4 years (SD = 13.6 years). Traumatic event exposure and mental health were assessed through a set of validated questionnaires completed online.ResultsRates of mental health outcomes were higher than within the general population. Females showed higher scores of post-traumatic stress disorder (PTSD) than males. PTSD scores were significantly correlated with all mental issues scores, apart from tobacco use and eating disorders scores. There was a significant correlation between the number of traumatic events and the years of experience. Exposure to traumatic events only correlated with nicotine dependency. No other correlation reaches statistical significance.DiscussionThe scores of all mental health outcomes were high; a surprising result, as volunteer first aiders are thought to be recruited for their strong dispositional cognitive and emotional abilities. The high levels of post-traumatic stress disorder and burnout, along with the prevalent anxiety and depression, highlight the need for greater psychosocial support. Resilience training and peer support would be useful interventions in this group.

Prenatal alcohol exposure and mental health at midlife: A preliminary report on two longitudinal cohorts.

Although the effects of prenatal alcohol exposure (PAE) have been studied extensively, there is relatively little information available on adult mental health functioning among exposed individuals. The current study compares the self-reported midlife mental health status of individuals who were prenatally exposed to alcohol and diagnosed in childhood with the effects of this exposure with that of unexposed individuals. Participants (N=292) were recruited from two longitudinal cohorts in Atlanta and Seattle and asked to complete an Adult Health Questionnaire that surveyed their current health and mental health status. The questionnaire was completed either in-person or remotely and included questions about current symptoms of depression and anxiety and mental health disorder diagnoses. The analysis compared a Nonexposed Contrast group to those in two exposure groups: (1) Alcohol Exposed with Fetal Alcohol Effect but not meeting criteria for Fetal Alcohol Syndrome (FAS) and (2) Alcohol Affected and meeting criteria for FAS. Both alcohol-exposed groups reported higher levels of current depressive symptoms and a higher prevalence of diagnoses of depression, anxiety, bipolar disorder, and/or attention deficit/hyperactivity disorder. No differences were noted for psychotic disorders. PAE was also associated with greater environmental stressors, including higher levels of adverse childhood events and lower current socioeconomic status. Path analyses suggested that PAE was indirectly related to mood disorders with its effects being mediated by other environmental factors. PAE is associated with greater rates of mental health disorders in middle adulthood. These outcomes appear to result from multiple stressors that affect individuals made vulnerable by their early alcohol exposure. Clinical outcomes could be improved by prevention efforts directed at preventing prenatal alcohol use and reducing environmental stressors later in life, and by the early identification of PAE and its effects.

Understanding the pandemic experience for people with a preexisting mental health disorder.

The COVID-19 pandemic has led to increased rates of mental health disorders. Individuals with and without preexisting psychiatric disorders were surveyed about their experiences during the pandemic. Sexual minority status was also examined with respect to psychological and physical distress. Therapists with private practices recruited their clients to participate in the study;additional participants were recruited from a participant pool at a northeastern university. Participants (n = 183) completed questionnaires on SurveyMonkey that included demographic questions, stress-related questions as measured by the Impact of Events Scale-Revised, physical symptoms as measured by the Cohen and Haberman Inventory of Physical Symptoms, anxiety and depression as measured by the Patient Health Questionnaire-4, and coping as measured by the Brief COPE Inventory. A 2 (Sexual Minority Status) x 2 (Preexisting Diagnosis) multivariate analysis of variance revealed that those participants with a self-disclosed preexisting psychiatric disorder and those who identified as lesbian, gay, bisexual, transgender, and queer/questioning showed more stress-related symptoms, anxiety and depression, physical complaints, and maladaptive coping behaviors. Those participants with a preexisting psychiatric condition were higher in anxiety, depression, physical symptoms, and maladaptive coping behavior. Those who identified as a sexual minority were higher in anxiety, depression, posttraumatic stress, physical symptoms, and maladaptive coping. There was also an interaction effect on depression, anxiety, and physical symptoms. Those who were both a sexual minority and had a preexisting psychiatric condition were highest in these variables. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Abstract 13624: Rates of Depression, Anxiety and Stress in Parents of Children With Congenital Heart Disease Using the DASS

Introduction: There have been many studies investigating the rate of mental health disorders for caregivers of children with congenital heart disease (CHD) but the types and timing of evaluation vary. The Cardiac Neurodevelopmental Outcome Collaborative recommends using the Depression Anxiety Stress Scale (DASS) to evaluate parents between 6-36 months of age. The DASS is a self-completed questionnaire that evaluates for depression, anxiety and stress. There has not been a study investigating the use of DASS in parents of children with CHD. Hypothesis: Our hypothesis was that DASS scores would peak initially and improve with time. Methods: This study was a single centered, retrospective review from January 1, 2018 to June 1, 2020. Eligible subjects were parents of CHD patients seen in our Neurodevelopmental clinic who completed the DASS. Demographic data, clinical history of the child and DASS scores were recorded. Cox-regression analysis was conducted using a composite end point of having an abnormal score in any of the three DASS domains, depression, anxiety or stress. Data for mothers and fathers were analyzed separately. Results: 273 mothers and 139 fathers were enrolled. For mothers, elevated scores in each domain were increased at the 12 and 24 months appointments. For fathers, scores for each domain were elevated initially, followed by a decrease before peaking later on. Paternal scores for depression were increased at 36 months and paternal scores for anxiety and stress were increased at 30 months. Increased length of stay for the index surgery was associated with an abnormal DASS score for mothers (B 0.02, p< 0.01) and fathers (B 0.01, p=0.04). Being in a relationship with the father (B -0.8, p<0.01) was associated with freedom of an abnormal DASS score for mothers. Conclusions: Abnormal DASS scores peak at different time points for mothers and fathers. These time points may be critical time points to offer social support for parents. In addition, increased length of stay for the child’s index surgery and the parents being in a relationship are important factors in the development of mental distress in parents.

Socio-economic and psychological impact of COVID-19 pandemic in a Spanish cohort BIOVAL-D-COVID-19 study protocol

ObjectiveSARS-CoV-2 outbreak has a negative psychological impact among general population. Data comparing mental health status before and during the outbreak is needed. The BIOVAL-D-COVID-19 study assess the socio-economic and psychological impact of the COVID-19 pandemic and lockdown in a representative sample of non-institutionalized Spanish adult population, and estimate the incidence of mental health disorders, including suicidal behaviours, and possible related factors. MethodObservational longitudinal study including two online surveys: baseline survey (T0) performed during 2019 and follow-up survey (T1) conducted 12-month later. The latter included nine sections: socio-demographic, health status, mental health, employment conditions and status, material deprivation, use of healthcare services, intimate partner violence and resilience. Four of the nine sections are administered in T0 and T1 assessments. Longitudinal data analyses will estimate adjusted incidence rates of mental health disorders using Poisson regression models. Risk and protective factors will be analysed through multiple logistic regression models.

Maternal Mental Health Disorders Following Very Preterm Birth at 5 Years Post-Birth.

Mothers of children born very preterm (VP) are at increased risk of developing postnatal depression, anxiety, and post-traumatic stress symptoms. However, mental health disorder rates are rarely assessed in this population compared with full-term peers, and it is unclear if postnatal distress symptoms precede higher rates of maternal mental health disorders at 5 years post-birth in both birth groups. Mothers of children born VP (n = 65; mean [SD] age at birth, 33.9 [5.0]; 72.1% tertiary educated) and full-term (n = 90; mean [SD] age at birth, 33.4 [4.0]; 88.2% tertiary educated) completed questionnaires assessing symptoms of depression, anxiety, and trauma within 4 weeks of birth. At 5 years post-birth, they participated in a structured diagnostic interview assessing mood, anxiety, and trauma-related mental health disorders, both current and over the lifetime. There was little evidence for differences between mothers in the VP and full-term groups in rates of any mental health disorder at 5 years (VP = 14%, full-term = 14%) or lifetime (VP = 41%, full-term = 37%). In mothers of children born VP, elevated postnatal post-traumatic stress symptoms were associated with higher rates of mental health disorders at 5 years (odds ratio = 21.5, 95% confidence interval = 1.35-342). Findings suggest that preterm birth may not lead to increased odds of later developing maternal mental health disorders, despite known risks of elevated postnatal distress following a VP birth. However, those with post-traumatic stress symptoms following a VP birth could be more vulnerable, and assessment and monitoring is recommended.

Racism, Chronic Disease, and Mental Health: Time to Change Our Racialized System of Second-Class Care.

In this article, we describe how the “weathering hypothesis” and Adverse Childhood Experiences set the stage for higher rates of chronic disease, mental health disorders and maternal mortality seen in African American adults. We illustrate the toll that untreated and overtreated mental health disorders have on Black individuals, who have similar rates of mental health disorders as their white counterparts but have fewer outpatient mental health services and higher rates of hospitalizations. We discuss the history of Medicaid, which, while passed alongside Medicare during the Civil Rights era, was Congress’s concession to Southern states unwilling to concede federal oversight and funds to the provision of equal healthcare for poor and Black people. Medicaid, which covers 33% of all Blacks in the US and suffers from chronic underfunding and state efforts to weaken it through demonstration waivers, is a second-class system of healthcare with eligibility criteria that vary by state and year. We propose the adoption of a national, single payer Medicare for All system to cover everyone equally, from conception to death. While this will not erase all structural racism, it will go a long way towards leveling the playing field and achieving greater equity in the US.

Feasibility of a mental health informed physical activity intervention for the carers of children with developmental and epileptic encephalopathy

AimParents and carers of children with developmental and epileptic encephalopathies (DEEs) experience high rates of mental health disorders including depression and posttraumatic stress disorder. Physical activity is an evidence-based strategy which may help to improve the wellbeing of this population. MethodWe delivered a 4-week physical activity group program via a private Facebook group for carers of children with DEEs and their nominated support person. The facilitators provided education and motivation on different weekly topics (e.g. goal setting, overcoming barriers to exercise) and encouraged social support between participants. All participants were provided with a physical activity tracker (Fitbit). The primary outcome was feasibility and secondary outcomes included psychological distress, quality of life, physical activity levels, and PTSD symptoms. ResultsN=20 (parents and support partners) were recruited. All participants remained in the program for the full duration and 85% completed the post assessment questionnaires. High acceptability was observed in the qualitative interviews and exploratory analysis of pre-post outcomes found significant improvements in psychological distress and quality of life (ps < 0.01), while changes in physical activity levels and PTSD symptoms were non-significant. ConclusionA mental health informed physical activity program delivered via Facebook is feasible for carers of children with DEEs and may help improve wellbeing.

Initial Outcomes of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy Tailored to Public Safety Personnel: Longitudinal Observational Study.

BackgroundCanadian public safety personnel (PSP) experience high rates of mental health disorders and face many barriers to treatment. Internet-delivered cognitive behavioral therapy (ICBT) overcomes many such barriers, and is effective for treating depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms.ObjectiveThis study was designed to fill a gap in the literature regarding the use of ICBT tailored specifically for PSP. We examined the effectiveness of a tailored ICBT program for treating depression, anxiety, and PTSD symptoms among PSP in the province of Saskatchewan.MethodsWe employed a longitudinal single-group open-trial design (N=83) with outcome measures administered at screening and at 8 weeks posttreatment. Data were collected between December 5, 2019 and September 11, 2020. Primary outcomes included changes in depression, anxiety, and PTSD symptoms. Secondary outcomes included changes in functional impairment; symptoms of panic, social anxiety, and anger; as well as treatment satisfaction, working alliance, and program usage patterns.ResultsClients reported large symptom reductions on measures of depression and anxiety, as well as moderate reductions on measures of PTSD and secondary symptoms, except for social anxiety. Most clients who reported symptoms above clinical cut-offs on measures of depression, anxiety, and PTSD during screening experienced clinically significant symptom reductions. Results suggested good engagement, treatment satisfaction, and working alliance.ConclusionsTailored, transdiagnostic ICBT demonstrated promising outcomes as a treatment for depression, anxiety, and PTSD among Saskatchewan PSP and warrants further investigation.Trial RegistrationClinicaltrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032

Assessment of Cardiovascular Risk in Transgender Patients Presenting for Gender-Affirming Care

BackgroundThe transgender population is rapidly growing in the United States and abroad. Transgender men and women are marginalized as a result of their transgender status, with resultant health repercussions. This and other factors such as increased substance use, mental health disorders, violence, and chronic stress may place transgender individuals at higher risk for cardiovascular disease. Additionally, many transgender patients pursue gender-affirming hormone therapy, which has been linked to increased rates of some cardiovascular events such as metabolic syndrome, venous thromboembolism, and stroke. Despite the likelihood of elevated cardiovascular risk in this population, there is a paucity of published data about the cardiovascular risk of this population. MethodsWe present baseline cardiovascular data from a transgender population at a large tertiary care center prior to the initiation of hormone therapy. ResultsThe described transgender population had much higher rates of mental health disorders and substance use than the general population. Furthermore, there were high rates of undiagnosed and untreated comorbidities, such as hypertension and dyslipidemia, that increase risk for cardiovascular disease. Baseline risk assessment using the ASCVD (Atherosclerotic Cardiovascular Disease) and QRISK3 calculators showed higher-than-expected cardiovascular risk, particularly given the young age of our patient population. ConclusionsTransgender individuals are at high baseline cardiovascular risk. These data help fill some important knowledge gaps in this patient subgroup, and provide us with much-needed data to help guide our management and counseling of individuals seeking this type of care.

Coping With the COVID-19 Pandemic: Examining Gender Differences in Stress and Mental Health Among University Students

The COVID-19 pandemic has imposed a wide variety of unprecedented challenges, many of which appear to be disproportionately affecting the mental health and well-being of young adults. While there is evidence to suggest university students experience high rates of mental health disorders, less is known about the specific impacts of the COVID-19 pandemic on student mental health and how they are coping with this stress. To address this gap, we conducted an online study among undergraduate students (n = 366) to examine the impact of the COVID-19 pandemic on academics, social isolation, and mental health, as well as the extent to which they have been implementing a variety of coping strategies. The pandemic had a more pronounced negative effect on female students' academics, social isolation, stress and mental health compared to male counterparts. Moreover, for females, frequent use of social media as a coping mechanism was associated with greater perceived negative impacts on their academic performance and stress levels, compared to males. However, frequent social media use related to similar negative mental health effects for both males and females. While male and female students both reported using substances to cope, for males the use of cannabis was associated with greater negative impacts on academic outcomes, stress and mental health compared to females. These findings highlight the need for adequate student support services across the post-secondary sector, and point to the importance of gender informed interventions to address the impacts of the COVID-19 pandemic.

Development, item analysis, and initial reliability and validity of three forms of a multiple-choice mental health literacy assessment for college students (MHLA-c)

Despite increasing rates of mental health disorders among college students, there are a limited number of validated mental health literacy measures that can be quickly administered and scored in this population. We developed a 54-item multiple-choice measure, consisting of three forms with 18 items on each form. Our items focus on knowledge of more than 20 mental health disorders including their etiology, risk factors, diagnoses, symptoms, treatment, course, and outcome, as well as the application of this knowledge to real world situations. Data were collected on three independent samples of undergraduate students enrolled at an urban public university system in the northeast United States: pilot (n=292), test refinement (n=1,272), and validation (n=683). Basic demographics for the combined test refinement and validation samples were: age=22 ± 4.9 years; 62.2% female; 71.7% non-White. We report on the development of the Mental Health Literacy Assessment-college (MHLA-c) and provide support for its reliability and validity. We also provide descriptive statistics, stratified by gender, college major, and personal experience with a mental health issue to enable its use in diverse settings. The MHLA-c may be useful in measuring knowledge of mental health disorders and related topics among college students. Moreover, the availability of parallel forms will facilitate its use within educational or interventional studies that employ pre-post testing designs.

Sex and Mental Health Disorder Differences Among Military Service Members With Patellofemoral Syndrome.

Mental health disorders are associated with persistent knee pain, but the association between these conditions has had little investigation in the military. The purpose of this study was to identify rates of mental health disorders in patients with patellofemoral pain (PFP) and determine differences by sex and whether mental health copresence influences outcomes. Eligible patients with a new PFP diagnosis were categorized according to sex and presence of mental health disorders. Outcomes included odds of mental health disorder before/after initial PFP diagnosis based on sex, and knee-related health care use between patients with/without mental health disorders. In 81,832 individuals with PFP (71.1% men; mean age 33; 91.5% active duty), copresence of any mental health disorders was common (18% men; 28% women). Women had more depression and anxiety; men had more post-traumatic stress disorder and substance abuse disorders. Concurrent mental health disorders after initial PFP diagnosis resulted in higher medical costs and odds of a recurrence (OR 1.24; 95% CI 1.20, 1.28; P < .001). Mental health disorders are common in military service members seeking care for patellofemoral pain. Differences in prevalence vary by sex, and presence of mental health disorders adversely affected long-term health care outcomes.

Cost-Effectiveness Analysis Combining Medical and Mental Health Services for Older Adults with HIV in New York City.

Older adults with the human immunodeficiency virus or HIV (OAWH), people 50 years and older, are aging with the disease and experience low quality of life. Mental health disorders trigger and worsen health inequalities with larger impacts on the quality of life of OAWH. This paper evaluated two rival health interventions using a standard decision-analytic model and quantified the cost per quality-adjusted life-years (QALY) to understand the differential in cost and effectiveness of an additional unit of perfect health. HIV medical care was compared with a combined strategy that includes both HIV medical and behavioral care. Primary data from a convenience sample (n=139) collected in New York City and outcomes for healthy older adults from the literature were used in this study. The incremental cost-effectiveness ratio (ICER) evaluating the economic cost and health benefits of the new intervention was $36,166 per QALY, which is less than the willingness to pay ($75,000). The ICER for Hispanics was $35,325 and for White/Caucasians was $40,499. Integrated medical plus behavioral care is cost-effective and improves quality of life among OAWH. Given the high rates of mental health disorders along with an underutilization of behavioral care among OAWH, timely and effective mental health programs are paramount to increase quality of life.