Undiagnosed Mental Health Problems Research Articles

Investigating the impact of undiagnosed anxiety and depression on health and social care costs and quality of life: cross-sectional study using household health survey data.

There is uncertainty around the costs and health impacts of undiagnosed mental health problems. Using survey data, we aim to understand the costs and health-related quality-of-life decrements from undiagnosed anxiety/depression. We analysed survey data from two waves of the North West Coast Household Health Survey, which included questions on disease, medications, and Patient Health Questionnaire 9 (PHQ-9) and Generalised Anxiety Disorder 7 (GAD-7) scores (depression and anxiety scales). People were judged as having undiagnosed anxiety/depression problems if they scored ≥5 on the PHQ-9 or GAD-7, and did not declare a mental health issue or antidepressant prescription. Linear regression for EuroQol 5-Dimension 3-Level (EQ-5D-3L) index scores, and Tweedie regression for health and social care costs, were used to estimate the impact of undiagnosed mental health problems, controlling for age, gender, deprivation and other health conditions. Around 26.5% of participants had undiagnosed anxiety/depression. The presence of undiagnosed anxiety/depression was associated with reduced EQ-5D-3L index scores (0.040 lower on average) and increased costs (£250 ($310) per year on average). Using a higher cut-off score of 10 on the PHQ-9 and GAD-7 for undiagnosed anxiety/depression had similar increased costs but a greater reduction in EQ-5D-3L index scores (0.076 on average), indicating a larger impact on health-related quality of life. Having undiagnosed anxiety or depression increases costs and reduces health-related quality of life. Reducing stigma and increasing access to cost-effective treatments will have population health benefits.

Factors Contributing to the Social Exclusion of Secondary School Aged Youth

The study describes secondary school nurses’, subject teachers’, special needs teachers’, study counsellors’ and school social workers’ (n=60) experiences of factors that contribute to the development of social exclusion in adolescents. The data were collected in Finland using an online survey tool in 2022 and analysed using inductive content analysis. Some factors associated with social exclusion of the adolescents concerned the youth themselves: problems with self-esteem, learning, emotional intelligence, mental health and intoxicants; while other factors concerned families: problems with family dynamics, interaction, mental health and socioeconomic issues. Inadequate support and mental health services were also mentioned by the participants. Mental health problems, especially depression, are relatively common in families and a major risk factor for the development of social exclusion. In addition, some of the other factors, for example problems in family dynamics, could be secondary, reflecting diagnosed or undiagnosed mental health problems. The risk of social exclusion is likely to increase if several of these factors are accumulated in a young person’s life, possibly passed on from the earlier generation and reinforced in the family home.

A qualitative study of the capabilities of family members of veterans living with operational stress injuries

AbstractObjectiveThis qualitative study explores the experiences of 26 family members supporting Canadian Armed Forces veterans living with mental health problems including operational stress injuries (OSIs).BackgroundThe research focusing on military‐connected families emphasizes the impacts of service on the families. Little is known about how families impact military veterans, particularly those diagnosed with OSIs. This research addresses that gap by revealing the capabilities and demands characterizing their everyday lives.MethodSemistructured interviews with 26 individuals identifying as family members of Canadian Armed Forces (CAF) veterans and three focus groups (three participants in each group for a total of nine) with family members of CAF veterans released within the preceding 10 years were conducted. The veterans were living with broadly defined diagnosed and undiagnosed mental health problems including OSIs. Using the family adjustment and adaptation (FAAR) model as an organizational framework, demands and capabilities embodied within the everyday lives of the family members were revealed.ResultsMonitoring the well‐being of the veteran, managing daily life, accessing and mobilizing resources, and caregiving were discussed as capabilities by participants in this study. These capabilities buffer the demands associated with the veteran's mental health problems.ConclusionsResults of this study endorse recommendations for family‐centered program and service development, modeled on approaches that recognize the systemic and relational contexts instrumental in supporting positive outcomes for veterans with OSIs.ImplicationsFurther research exploring the complex, interdependent, and interactional role of families supporting veterans with OSIs is warranted.

Impact of Covid-19 on people and Work from Home

already experiencing significant revenue and job losses. The ability to ‘Work from Home’ (WFH) can helpdamp down the impact of the situation, undoubtedly. Overall, the effects of WFH arrangements rely a loton the job status of parents and presence of dependents (children & elderly), and this current situation islikely to intensify these differences. It does not necessarily mean, however, that the effect of the crisisshould inevitably be gender neutral. Working women have been particularly affected. It seems to be veryfascinating to work from home, while sitting on a comfortable couch, casually dressed, even sometimesin sleep suits, without stepping out in scorching heat and wasting time in traveling, but this may not be apreferred situation for everybody, especially women. The most significant impact on working womenduring the crisis will be trying to balance household demands, childcare needs and work demands.The group most likely to be hardest hit then would be lower income families with young children, and singlemothers in particular. Generally women are in charge of planning, organizing and recalling of everythingthat needs to be remembered. The mental stress and load that comes with such work has risenexponentially in present circumstances. Even though many countries are relied on lockdown to controlwidespread of COVID-19 pandemic, the mental problems such as depression, anxiety, insomnia, suicidalthoughts and other psychological trauma are most common in case of normal individual and extensive incase of people who are psychologically ill. Females are more prone to psychological distress. The mainconcern is to manage and provide opportunities for regulation of stress caused due to anxiety and lack ofpeer contact. Another main threat is an increased risk of parents to develop mental illness, women mayalso suffer from domestic violence and consequently it results child maltreatment. The current scenariomay be particularly challenging especially for children and adolescents with special needs ordisadvantages, such as disabilities, also if someone has prior trauma experiences, undiagnosed mentalhealth problems, background of migration and low socioeconomic status.Dr. Sana HassanUniversity College of Medicine and Dentistry,The University of Lahore, Teaching Hospital,Lahore, Pakistan

Disclosure, Social Support, and Mental Health are Modifiable Factors Affecting Engagement in Care of Perinatally-HIV Infected Adolescents: A Qualitative Dyadic Analysis.

Adolescents living with perinatally acquired HIV in South Africa face significant barriers to successful transition from pediatric to adult care. We performed in-depth qualitative interviews with 41 adolescents living with HIV and 18 of their caregivers to investigate modifiable factors to improve engagement in care prior to transition to adult care. Based on dyadic, inductive content analysis, findings suggest that HIV status disclosure, social support, and mental health are targets for improvement in engagement in care. Early disclosure and a sense of belonging facilitated engagement in care, while barriers included delayed or inadequate disclosure, denial, and lack of disclosure to others. Adherence support improved by having a biological mother as a direct supervisor. Barriers to care included changing caregivers, abandonment, undiagnosed mental health problems and learning difficulties. Despite these factors, the majority of adolescents showed resilience and remained engaged in care despite difficult circumstances.

College students’ disclosure of mental health problems on campus

Objective To explore, in two studies, student experiences with disclosing diagnosed and undiagnosed mental health problems to faculty, staff, and peers. Participants: Participants for both studies were college students at two 4-year public universities. Study 1 was conducted in June 2016 and Study 2 in August 2017. Methods: In Study 1, participants had a formal diagnosis of a mental health condition, were registered for accommodations, and completed semi-structured interviews (n = 6). In Study 2, participants (n = 66) were mostly non-diagnosed and completed an online survey. Results: Study 1 interviews were coded for interactions with faculty (52% positive, 40% negative), staff (100% positive), and peers (31% positive, 54% negative). In Study 2, participants reported better experiences disclosing to peers than faculty. Disclosure experience varied by type of mental health problem. Conclusions: Collaboration across campus and community agencies will better support students with diagnosed and undiagnosed mental health problems.

Capital depreciation: The lack of recovery capital and post-release support for prisoners leaving the Drug Recovery Wings in England and Wales

BackgroundThis article draws on the evaluation of the pilot Drug Recovery Wings (DRWs), which were introduced ten prisons in England and Wales, with the intention of delivering abstinence-focused drug recovery services. The DRW pilots can be seen as representing the extension of the recovery paradigm – so prevalent elsewhere in UK drug policy – to the prison system. This study aimed to provide a detailed account of DRW prisoners’ expectations and experiences in the transition from prison to the community and explore the potential for ‘doing recovery’ in prison and on release. MethodsIn-depth, qualitative interviews were conducted in prison with 61 prisoners across six of the DRWs. Follow-up interviews six months after release were conducted with 21 prisoners and 26 ‘recovery supports’ (people identified as being close to the prisoners). Data from one, other or both sources was available for 36 prisoners. All interviews were fully transcribed and coded. ResultsThe majority of the 61 had long histories of alcohol and/or opiate dependence, childhood adversity, undiagnosed mental health problems and few educational qualifications. Nonetheless, many had long histories of employment – mostly in manual trades. The majority described themselves as being ‘in recovery’ at the time of the first interview in prison. While one of the main aims of the DRWs was to support prisoners’ recovery journeys into the community, this aspect of their work did not materialize. Professional support at release was largely absent or, where present, ineffectual. Many were released street-homeless or to disordered and threatening hostels and night-shelters. Only three of the 36 were fully abstinent from drink and drugs at time of re-interview, although some had moderated their use. A substantial number had returned to pre-imprisonment levels of use, often with deeply damaging impacts on those around them. Discussion and conclusionsThis research suggests a fundamental contradiction between recovery and imprisonment. In large part, imprisonment serves to erode recovery capital while, at the same time, making psychoactive substances readily available. Looking to the future, every effort should be made to divert substance users from imprisonment in the first place. Where that fails, the primary aim should be to reduce the erosion of recovery capital during imprisonment: through family support work, providing proper housing, training and education opportunities and ensuring a graduated reintroduction of prisoners into the community.

Subjects affected by a substance use disorder with or without a comorbid mental disorder: Looking for differential factors

This article draws on the evaluation of the pilot Drug Recovery Wings (DRWs), which were introduced ten prisons in England and Wales, with the intention of delivering abstinence-focused drug recovery services. The DRW pilots can be seen as representing the extension of the recovery paradigm – so prevalent elsewhere in UK drug policy – to the prison system. This study aimed to provide a detailed account of DRW prisoners’ expectations and experiences in the transition from prison to the community and explore the potential for ‘doing recovery’ in prison and on release.In-depth, qualitative interviews were conducted in prison with 61 prisoners across six of the DRWs. Follow-up interviews six months after release were conducted with 21 prisoners and 26 ‘recovery supports’ (people identified as being close to the prisoners). Data from one, other or both sources was available for 36 prisoners. All interviews were fully transcribed and coded.The majority of the 61 had long histories of alcohol and/or opiate dependence, childhood adversity, undiagnosed mental health problems and few educational qualifications. Nonetheless, many had long histories of employment – mostly in manual trades. The majority described themselves as being ‘in recovery’ at the time of the first interview in prison. While one of the main aims of the DRWs was to support prisoners’ recovery journeys into the community, this aspect of their work did not materialize. Professional support at release was largely absent or, where present, ineffectual. Many were released street-homeless or to disordered and threatening hostels and night-shelters. Only three of the 36 were fully abstinent from drink and drugs at time of re-interview, although some had moderated their use. A substantial number had returned to pre-imprisonment levels of use, often with deeply damaging impacts on those around them.This research suggests a fundamental contradiction between recovery and imprisonment. In large part, imprisonment serves to erode recovery capital while, at the same time, making psychoactive substances readily available. Looking to the future, every effort should be made to divert substance users from imprisonment in the first place. Where that fails, the primary aim should be to reduce the erosion of recovery capital during imprisonment: through family support work, providing proper housing, training and education opportunities and ensuring a graduated reintroduction of prisoners into the community.

Beyond-Control Behavior: From Court to Mental Health Institution, and the Challenge of Managing Behavioral Crisis among Children and Adolescents in Trinidad and Tobago

There is a noticeable trend in the admission of children and adolescents into the local adult psychiatric hospital in Trinidad (St. Ann’s Hospital). This facility was built in 1900 as an asylum with 400 patients but currently houses 800 patients, among whom are children and adolescents. A brief review showed that many were referred for what parents deem beyond-control behavior. The characteristics of the children and adolescents admitted for inpatient treatment have never been reviewed. The specific aims were to analyze the (1) demographic characteristics; (2) reasons for referral; (3) source of referral, and (4) diagnoses. Methods: This is a retrospective study. The records of children and adolescents admitted between 2009 and 2013 were reviewed. The participants would have been evaluated and diagnosed on the ward by the consultant psychiatrist. A data capture sheet was developed, based on the information contained in the patient intake form. Two nursing staff members were trained on data extraction. The data sheet was pretested with 20 files before a final adjustment was developed. Result: In summary, the findings showed that the major source of referral was from the judiciary (34%), followed by relatives (22%) and private care providers (20%, e.g., general medical practitioners). The least frequent source of referral was the child and adolescent mental health service (child guidance clinic). Based on the data, the results show that there are statistically significant associations between beyond-control behavior and major depression, ADHD and conduct disorder diagnoses. In assessing the strength of the associations based on the phi coefficient, beyond-control behavior has a weak negative association with major depression, but weak positive associations with both ADHD and conduct disorder. Looking at absolute values, the relationship between beyondcontrol behavior and ADHD is the strongest. Conclusions: In this analysis there were significant association between beyond-control behavior and varieties of mental disorders. The behavior displayed by the children and adolescent may be an indication of undiagnosed mental health problems.

Mental Health Conditions and Symptoms in Pediatric Hospitalizations: A Single-Center Point Prevalence Study

BackgroundChildren and adolescents necessitating hospitalization for physical health conditions are at high risk for mental health conditions; however, the prevalence of mental health conditions and symptoms among hospitalized children and adolescents is uncertain. The objective of this study was to determine the proportion of hospitalized children and adolescents who have diagnosed mental health disorders or undiagnosed mental health problems. MethodsIn this single-center point prevalence study of hospitalized children between the ages of 4 and 21 years, patients or their parents reported known mental health diagnoses and use of services using the Services Assessment for Children and Adolescent, and they reported patient mental health symptoms using the Pediatric Symptom Checklist, 17-item form (PSC-17). ResultsOf 229 eligible patients, 119 agreed to participate. Demographic characteristics of patients who enrolled were not statistically significantly different from those of patients who declined to participate. Among participants, 26% (95% confidence interval [CI], 18%–35%) reported a known mental health diagnosis. On the PSC-17, 29% (95% CI, 21%–38%) of participants had a positive screen for mental health symptoms. Of those with a positive screen, 38% (95% CI, 21%–55%) had no known mental health diagnosis, and 26% (95% CI, 12%–43%) had not received ambulatory mental health services in the 12 months before hospitalization. ConclusionsMental health conditions and symptoms are common among patients hospitalized in a tertiary children's hospital, and many affected patients are not receiving ambulatory mental health services.

Current and Future Perspectives of Liaison Psychiatry Services: Relevance for Older People's Care.

A large number of people admitted to medical wards have co-morbid mental health problems, and these predominantly include depression, dementia and delirium. An additional one third of medically ill patients remain in hospitals with undetected and, therefore, undiagnosed mental health problems. The comorbidity of mental and physical illnesses leads to poor health outcomes, prolonged inpatient stays and use of inpatient resources, involvement of various affiliated health services, introduction of medications and discharge to long-term facilities, including residential and nursing 24-h care, increased both readmission rates and mortality. The establishment of Liaison psychiatry services to meet the needs for people with mental health problems admitted to medical wards is a priority for many acute health Trusts. This has an economical background in terms of cost-savings, especially in relation to the older adults, with decreasing readmission rates and quicker hospital discharges. In the current review, we address the latest policies regarding Liaison psychiatry services; especially those for older people with dementia and delirium, and discuss their future shaping.

P-1010 - JERI - a finnish integrated intervention model for adolescents at risk for psychosis

Introduction Jorvi Early psychosis Recognition and Intervention (JERI) - team at Helsinki University Central Hospital (HUCH) is an early detection and intervention team for adolescents at risk for psychosis. Objectives The JERI team meets with adolescents at ages between 12–22 at school or at home together with their parents and with community co-worker, for example with social worker, teacher, nurse or GP, who has contacted the team for reason of unclear or undiagnosed mental health problems. Aims The main purpose of JERI team is to identify the possible risk of psychosis by interview instruments and meet the client and family together with community co worker(s) to find a way to reduce stress. Methods The model is based on idea of community and family oriented care and stress-vulnerability model of psychosis. The JERI hypothesis is that stress-reducing care where family and community co workers are involved could decrease pre-psychotic symptoms and increase functioning ability in adolescents at risk for psychosis. Results As an example: A school nurse contacts JERI-team because of a schoolboy who has started to stay at home recently. His parents argue a lot, he is bullied at school and he has problems in school performance. The parents would be involved in discussions about the family situation, the school social worker about how to stop bullying and the teacher how to support the school performance despite of possible cognitive problems. Conclusions Presented model seems to work according to clinical experience and an earlier follow-up study.

The creation of a Dementia Nurse Specialist role in an acute general hospital

Older people form the largest group occupying acute hospital beds and many of them will have undiagnosed mental health problems. The creation of a Dementia Nurse Specialist role in a district general hospital provided the opportunity to assess the extent of the previously unmet need among patients, carers and nursing staff. Over 30 patients were seen each month, while around 6 to 12 were diagnosed as having dementia. Other activities undertaken as part of the role included providing information and support for carers, and advice on management of behaviours and support for ward staff. The role also involved policy writing, pathway and local strategy planning, care plan development, and formal and informal teaching on dementia. It is argued that this fixed-term post demonstrated that a Dementia Nurse Specialist could provide significant input in an acute hospital setting, by improving the experience of hospitalization for vulnerable older people and their carers.

Fetal alcohol spectrum disorders - an Irish perspective.

The impact of prenatal alcohol exposure is far reaching and transgenerational but is largely under diagnosed. This has been a major public health concern but remains an area that has lacked attention with regards service development and research in Ireland. There is a need for mental health professionals to have a good working knowledge of the range of deficits associated with prenatal alcohol exposure. Knowledge of these deficits will facilitate identification of affected children for early diagnosis and intervention. This paper reviews available literature on this topic using broad search criteria. The aim of this article is to create greater awareness among professionals working with children in Ireland considering the high rates of alcohol consumption and the fact that most cases of FASD present with chronic undiagnosed mental health problems.

Low Workplace Social Capital as a Predictor of Depression: The Finnish Public Sector Study

In a prospective cohort study of Finnish public sector employees, the authors examined the association between workplace social capital and depression. Data were obtained from 33,577 employees, who had no recent history of antidepressant treatment and who reported no history of physician-diagnosed depression at baseline in 2000-2002. Their risk of depression was measured with two indicators: recorded purchases of antidepressants until December 31, 2005, and self-reports of new-onset depression diagnosed by a physician in the follow-up survey in 2004-2005. Multilevel logistic regression analysis was used to explore whether self-reported and aggregate-level workplace social capital predicted indicators of depression at follow-up. The odds for antidepressant treatment and physician-diagnosed depression were 20-50% higher for employees with low self-reported social capital than for those reporting high social capital. These associations were not accounted for by sex, age, marital status, socioeconomic position, place of work, smoking, alcohol use, physical activity, and body mass index. The association between social capital and self-reported depression attenuated but remained significant after further adjustment for baseline psychological distress (a proxy for undiagnosed mental health problems). Aggregate-level social capital was not associated with subsequent depression.

A preliminary communication on whether general dental practitioners have a role in identifying dental patients with mental health problems.

To examine whether general dental practitioners regard themselves as having a role in identifying dental patients with mental health problems. Telephone interviews were conducted with, and postal questionnaires were sent to, a random sample (n = 94) of general dental practitioners on Health Authority lists within the Mersey Region. A total of 84 general dental practitioners responded, resulting in an 89% response rate. The majority of general dental practitioners had encountered patients with mental health problems (78% of interviewees, 56% of questionnaire responders). However, nearly half of the interviewees (46%) do not refer patients with mental health problems. When referrals to dental specialists were made, they tended to be regarding a physical manifestation rather than a psychological one. The majority of interviewees and questionnaire responders (55% and 82% respectively) expressed a 'positive' response to the development of a referral role. Nevertheless, there were some reservations concerning the practicalities of its development and implementation. The majority of general dental practitioners consider a role in identifying patients with possible mental health problems. This role might include, being able to identify patients with undiagnosed mental health problems, and being aware of dental conditions which may be caused by mental health problems. To achieve this, inter-professional co-operation between general dental practitioners and other health professionals requires development.

Have dentists a role in identifying mentally ill patients?

Objective To examine whether general dental practitioners regard themselves as having a role in identifying dental patients with mental health problems. Method Telephone interviews were conducted with, and postal questionnaires were sent to, a random sample (n = 94) of general dental practitioners on Health Authority lists within the Mersey Region. A total of 84 general dental practitioners responded, resulting in an 89% response rate. Results The majority of general dental practitioners had encountered patients with mental health problems (78% of interviewees, 56% of questionnaire responders). However, nearly half of the interviewees (46%) do not refer patients with mental health problems. When referrals to dental specialists were made, they tended to be regarding a physical manifestation rather than a psychological one. The majority of interviewees and questionnaire responders (55% and 82% respectively) expressed a 'positive' response to the development of a referral role. Nevertheless, there were some reservations concerning the practicalities of its development and implementation. Conclusion The majority of general dental practitioners consider a role in identifying patients with possible mental health problems. This role might include, being able to identify patients with undiagnosed mental health problems, and being aware of dental conditions which may be caused by mental health problems. To achieve this, inter-professional co-operation between general dental practitioners and other health professionals requires development.