Urgent Mental Health Research Articles

The association of quality of life and fear of progression in patients with pulmonary hypertension: a cross-sectional network analysis

BackgroundThe quality of life (QoL) of patients with pulmonary hypertension (PH) is severely compromised. Fear of progression (FoP) may be an important predictor of compromising the QoL in PH patients. Therefore, our study aimed to investigate the association between QoL and FoP among PH patients.MethodsA cross-sectional study comprising 255 patients was conducted using convenience sampling, using the Self-administered socio-demographic information questionnaire, the World Health Organization quality of life questionnaire abbreviated version, and the Chinese version of the Fear of Progression Questionnaire-Short Form. Network analysis was completed using R software.ResultsIn the current network model, the QoL in the psychological domain had the highest node centrality (strength = 1.155). The highest bridge centrality node was physiological health-related fear (bridge strength = 0.303). The edge between physiological health-related fear and social family-related fear has the highest strength (edge weights = 0.596).ConclusionsThis study revealed that the psychological domain of QoL is likely to be the most dominant in the overall QoL of PH patients. It can serve as a primary focus for QoL management strategies to improve the overall QoL of PH patients. Furthermore, physical health-related fear is an urgent mental health concern to be alleviated in PH patients' FoP. As a bridge variable, physical health-related fear can be used as a potential clinical intervention target for developing and utilizing intervention programs to alleviate the FoP in PH patients, which may help maintain or even enhance the psychological and overall QoL of PH patients.

Emergency hospital admissions for stress-related presentations among secondary school-aged minoritised young people in England.

Minoritised young people face a double burden of discrimination through increased risk of stress and differential treatment access. However, acute care pathways for minoritised young people with urgent mental health needs are poorly understood. To explore variation in stress-related presentations (SRPs) to acute hospitals across racial-ethnic groups in England. We examined rates, distribution, duration and types of SRPs across racial-ethnic groups in a retrospective cohort of 11- to 15-year-olds with one or more emergency hospital admissions between April 2014 and March 2020. SRPs were defined as emergency admissions for potentially psychosomatic symptoms, self-harm and internalising, externalising and thought disorders. White British (8-38 per 1000 births) and Mixed White-Black (9-42 per 1000 births) young people had highest rates of SRPs, whereas Black African (5-14 per 1000 births), Indian (6-19 per 1000 births) and White other (4-19 per 1000 births) young people had the lowest rates of SRPs. The proportion of readmissions were highest for Pakistani (47.7%), White British (41.4%) and Mixed White-Black (41.3%) groups. Black Other (36.4%) and White Other (35.8%) groups had the lowest proportions of readmissions. The proportion of admission durations ≥3 days was higher for Black Other (16.6%), Bangladeshi (16.3%), Asian Other (15.9%) and Black Caribbean (15.8%) groups than their White British (11.9%) and Indian (11.8%) peers. The type of SRPs varied across racial-ethnic groups. Patterns of SRP admissions systematically differed across racial-ethnic groups, indicative of inequitable triage, assessment and treatment processes. These findings highlight the need for implementation of race equality frameworks to address structural racism in healthcare pathways.

Determining unmet need: clinical relevance of suspected neurodivergence in first-episode psychosis.

We explored the prevalence of autism and attention-deficit hyperactivity disorder in first-episode psychosis. Through service evaluation involving 509 individuals, detailed analyses were conducted on neurodevelopmental traits and patterns of service utilisation. Prevalence of neurodivergence in first-episode psychosis was 37.7%. Neurodivergent individuals used urgent mental health services more frequently (Mann-Whitney U = 25925, Z = -2.832, P = 0.005) and had longer hospital stays (Mann-Whitney U = 22816, Z = -4.886, P ≤ 0.001) than non-neurodivergent people. Neurodivergent people spend more than twice as long in mental health hospitals at a time than the non-neurodivergent people (Mann-Whitney U = 22 909.5, Z = -4.826, P ≤ 0.001). Mediation analysis underscored indirect impact of neurodivergence on hospital stay durations through age at onset of psychosis and use of emergency services. Prevalence of neurodevelopmental conditions in first-episode psychosis is underestimated. Neurodivergent individuals show increased utilisation of mental health services and experience psychosis earlier. Early assessment is crucial for optimising psychosis management and improving mental health outcomes.

Reducing mental health emergency visits: population-level strategies from participatory modelling

BackgroundEmergency departments (EDs) are often the front door for urgent mental health care, especially when demand exceeds capacity. Long waits in EDs exert strain on hospital resources and worsen distress for individuals experiencing a mental health crisis. We used as a test case the Australian Capital Territory (ACT), with a population surge of over 27% across 2011–2021 and a lagging increase in mental health care capacity, to evaluate population-based approaches to reduce mental health-related ED presentations.MethodsWe developed a system dynamics model for the ACT region using a participatory approach involving local stakeholders, including health planners, health providers and young people with lived experience of mental health disorders. Outcomes were projected over 2023–2032 for youth (aged 15–24) and for the general population.ResultsImproving the overall mental health care system through strategies such as doubling the annual capacity growth rate of mental health services or leveraging digital technologies for triage and care coordination is projected to decrease youth mental health-related ED visits by 4.3% and 4.8% respectively. Implementation of mobile crisis response teams (consisting of a mental health nurse accompanying police or ambulance officers) is projected to reduce youth mental health-related ED visits by 10.2% by de-escalating some emergency situations and directly transferring selected individuals to community mental health centres. Other effective interventions include limiting re-presentations to ED by screening for suicide risk and following up with calls post-discharge (6.4% reduction), and limiting presentations of frequent users of ED by providing psychosocial education to families of people with schizophrenia (5.1% reduction). Finally, combining these five approaches is projected to reduce youth mental health-related ED presentations by 26.6% by the end of 2032.ConclusionsPolicies to decrease youth mental health-related ED presentations should not be limited to increasing mental health care capacity, but also include structural reforms.

COVID-19’s impact on drug overdose fatalities and urgent mental health care demand in the US

COVID-19’s impact on drug overdose fatalities and urgent mental health care demand in the US

Alone on the frontline: The first report of PTSD prevalence and risk in de-occupied Ukrainian villages.

The ongoing Russian invasion of Ukraine marks a critical juncture in a series of events posing severe threat to the health of Ukrainian citizens. While recent reports reveal higher rates of PTSD in Ukrainian refugees following Russia's invasion - data for Ukrainians remaining at the warfront is inherently difficult to access. A primarily elderly demographic, Ukrainians in previously Russian-occupied areas near the front (UPROANF) are at particular risk. Data was sourced from screening questionnaires administered between March 2022 and July 2023 by mobile health clinics providing services to UPROANF. Previously occupied villages in Eastern and Southern Ukraine. UPROANF attending clinics completed voluntary self-report surveys reporting demographics, prior health diagnoses, and PTSD symptom severity (n = 450; Meanage = 53.66; 72.0% female). Participants were exposed to Russian occupation of Ukrainian villages. The PTSD Checklist for the DSM-V (PCL-5) with recommended diagnostic threshold (i.e. 31) was utilized to assess PTSD prevalence and symptom severity. ANCOVA was used to examine hypothesized positive associations between (1) HTN and (2) loneliness and PTSD symptoms (cumulative and by symptom cluster). Between 47.8% and 51.33% screened positive for PTSD. Though cumulative PTSD symptoms did not differ based on HTN diagnostic status, those with HTN reported significantly higher PTSD re-experiencing symptoms (b = 1.25, SE = 0.60, p = .046). Loneliness was significantly associated with more severe cumulative PTSD symptoms (b = 1.29, SE = 0.31, p < .001), re-experiencing (b = 0.47, SE = 0.12, p < .001), avoidance (b = .18, SE = 0.08, p = .038), and hypervigilance (b = 0.29, SE = 0.13, p = .036). PTSD prevalence was higher than other war-exposed populations. Findings highlight the urgent mental health burden among UPROANF, emphasizing the need for integrated care models addressing both trauma and physical health. Given the significance of loneliness as a risk factor, findings suggest the potential for group-based, mind-body interventions to holistically address the physical, mental, and social needs of this highly traumatized, underserved population.

Teleassistance Telerehabilitation Services for urgent mental health needs of people with Intellectual and Developmental disabilities

Abstract Persons with intellectual disability (PwID) and/or and autism spectrum disorder with high support needs (ASD-HSN) have resulted to be among the most vulnerable populations to COVID-19 and distress factors associated to the measures for containing its spread. Many health, rehabilitation, and assistance needs were managed through the use of telemedicine, specifically teleassistance (TA) and telerehabilitation (TR), with regard to the prevention and treatment of the epidemic illness as well as the continuity of care required for the condition of developmental disability and co-occurring physical or mental disorders. TA and TR can function either directly or indirectly with the PwID/ASD; in the latter case, a family member, a regular caregiver, or a technician provides local mediation. This paper examines the most common TA and TR activities, along with their requirements, applications, and goals. All of these activities should be in line with the overarching goal of each customized therapy and rehabilitation plan, which is to enhance and support the quality of life for people with intellectual and developmental disabilities. Studies on TA and TR efficacy for PwID/ASD are limited, especially concerning adulthood. The scant research that is currently available demonstrates efficacy in maintaining or marginally enhancing cognitive, adaptive, and vocational skills. In addition to managing both routine and unusual activities as well as critical episodes, family members and other caregivers reported feeling more empowered about their educational and interpersonal abilities with the PwID/ASD. The primary benefits over traditional in-person services have been found to be greater accessibility and availability as well as a reduction in both physical and psychological distance. The primary limits include the absence of all elements of the therapeutic alliance pertaining to face-to-face communication, possible poor ability to use technology, accessibility of the technology itself, concerns regarding privacy, and variables that divert attention connected to the household setting. Even while telemedicine has proven to be feasible and beneficial thus far, it is doubtful that traditional techniques will be able to be replaced, at least not anytime soon. Telemedicine could, nonetheless, serve as a useful addition, integration, or short-term substitute. Future studies should provide light on the indications, contextual deployment, efficacy evaluation, and operational stability over time of certain TA and TR activities in addition to the use of artificial intelligence, machine learning, and interactive avatars.Disclosure of InterestNone Declared

Prediction of emergency department revisits among child and youth mental health outpatients using deep learning techniques

BackgroundThe proportion of Canadian youth seeking mental health support from an emergency department (ED) has risen in recent years. As EDs typically address urgent mental health crises, revisiting an ED may represent unmet mental health needs. Accurate ED revisit prediction could aid early intervention and ensure efficient healthcare resource allocation. We examine the potential increased accuracy and performance of graph neural network (GNN) machine learning models compared to recurrent neural network (RNN), and baseline conventional machine learning and regression models for predicting ED revisit in electronic health record (EHR) data.MethodsThis study used EHR data for children and youth aged 4–17 seeking services at McMaster Children’s Hospital’s Child and Youth Mental Health Program outpatient service to develop and evaluate GNN and RNN models to predict whether a child/youth with an ED visit had an ED revisit within 30 days. GNN and RNN models were developed and compared against conventional baseline models. Model performance for GNN, RNN, XGBoost, decision tree and logistic regression models was evaluated using F1 scores.ResultsThe GNN model outperformed the RNN model by an F1-score increase of 0.0511 and the best performing conventional machine learning model by an F1-score increase of 0.0470. Precision, recall, receiver operating characteristic (ROC) curves, and positive and negative predictive values showed that the GNN model performed the best, and the RNN model performed similarly to the XGBoost model. Performance increases were most noticeable for recall and negative predictive value than for precision and positive predictive value.ConclusionsThis study demonstrates the improved accuracy and potential utility of GNN models in predicting ED revisits among children and youth, although model performance may not be sufficient for clinical implementation. Given the improvements in recall and negative predictive value, GNN models should be further explored to develop algorithms that can inform clinical decision-making in ways that facilitate targeted interventions, optimize resource allocation, and improve outcomes for children and youth.

Investigating the effect of an online enhanced care program on the emotional and physical wellbeing of patients discharged from hospital with acute decompensated heart failure: Study protocol for a randomised controlled trial: Enhanced care program for heart failure.

Depression is highly prevalent and associated with increased hospitalisations and mortality among patients with heart failure (HF). This study will evaluate the effectiveness and cost-effectiveness of an online wellbeing program for patients discharged from hospital with acute decompensated heart failure (ADHF) in (i) improving emotional and physical wellbeing, and (ii) decreasing healthcare utilisation. Two-arm randomised controlled trial. Eligible patients with ADHF will be recruited pre-discharge from two hospitals. Five hundred and seventy participants will be randomised to receive the intervention (online enhanced care program for HF: 'Enhanced HF Care') or usual care. Enhanced HF Care includes health education (11 micro-learning modules) and monitoring of depression and clinical outcomes via fortnightly/monthly surveys for 6 months, with participants offered tailored advice via video email and SMS. Cardiac nurses track real-time patient data from a dashboard and receive automated email alerts when patients report medium- or high-risk levels of depression or clinical symptoms, to action where needed. General practitioners also receive automated alerts if patients report medium- or high-risk survey responses and are encouraged to schedule a patient consultation. Sixty-five participants enrolled to-date. Co-primary outcomes ('Minnesota Living with Heart Failure Questionnaire' Emotional and Physical subscales) and healthcare utilisation (secondary outcome) at 1- and 6-month post-recruitment will be compared between treatment arms using linear mixed effects regression models. This study has the potential to reduce the burden of depression for patients with HF by prioritising urgent mental health needs and clinical symptoms while simultaneously empowering patients with self-care knowledge. The trial was prospectively registered via the Australian New Zealand Clinical Trials Registry: ACTRN12622001289707. Issue date: 4 October 2022.

Exploring the mechanism of Si-Ni-San against depression by UPLC-Q-TOF-MS/MS integrated with network pharmacology: experimental research.

Depression is becoming an urgent mental health problem. Si-Ni-San has been widely used to treat depression, yet its underlying pharmacological mechanism is poorly understood. Thus, we aim to explore the antidepressant mechanism of Si-Ni-San by chemical analysis and in-silico methods. Compounds in Si-Ni-San were determined by ultra-high performance liquid chromatography coupled with quadrupole time-of-flight tandem mass spectrometry (UPLC-Q-TOF-MS/MS). Then, bioactive compounds were obtained from Traditional Chinese Medicines for Systems Pharmacology Database and Analysis Platform and SwissADME, and the potential targets of which were acquired from SwissTargetPrediction. Depression-related targets were collected from GeneCards. The intersection between compound-related targets and depression-related targets were screened out, and the overlapped targets were further performed protein-protein interaction, biological functional and pathway enrichment analysis. Finally, networks of Si-Ni-San against depression were constructed and visualized by Cytoscape. One hundred nineteen compounds in Si-Ni-San were determined, of which 24 bioactive compounds were obtained. Then, 137 overlapped targets of Si-Ni-San against depression were collected. AKT1, PIK3R1, PIK3CA, mTOR, MAPK1 and MAPK8 were the key targets. Furthermore, PI3K-Akt signalling pathway, serotonergic synapse, MAPK signalling pathway and neurotrophin signalling pathway were involved in the antidepressant mechanism of Si-Ni-San. It showed that components like sinensetin, hesperetin, liquiritigenin, naringenin, quercetin, albiflorin and paeoniflorin were the mainly key active compounds for the antidepressant effect of Si-Ni-San. This study demonstrated the key components, key targets and potential pharmacological mechanisms of Si-Ni-San against depression. These results indicate that Si-Ni-San is a promising therapeutic approach for treatment of depression, and may provide evidence for the research and development of drugs for treating depression.

Mental health in Kindergarten to Grade 12 schools during the COVID-19 crisis: Literature review and survey suggesting multi-tiered support systems

Background: As a result of the COVID-19 pandemic, educational systems worldwide were disrupted. Students, educators, and parents faced challenges from the rapid switch to distance learning with attendant social isolation and limited teacher or peer interaction, along with excessive demand and worries from the lasting pandemic. It exacerbated preexisting mental health crises within school communities. Amidst such challenges, psychiatrists prescribed tailored medication regimens to manage individual mental health in the time of crisis, ensuring continuity of care and support for those affected. Methods: A scoping review was conducted to identify studies of Kindergarten to 12th grade school members' mental health and mental health support programs offered by schools and institutions during the COVID-19 pandemic. We also conducted a survey to examine mental health concerns faced by grade 6 to 12 teachers, school staff, children, and parents in Connecticut, United States. Results: While publication bias may be extant, we found well-documented studies of exacerbation and the emergence of mental health problems among parents, teaching staff, and students during the COVID-19 pandemic. Based on our comprehensive review of relevant literature and analysis of survey results, we have identified four key themes pertaining to the mental health challenges encountered by parents, teaching and non-teaching staff, and students in Kindergarten through 12th grade (K-12). Moreover, upon examining pertinent mental health interventions and models, we have identified the multi-tiered systems of support as an effective approach to address these difficulties, with explanations on how to utilize the framework during a crisis. This system is designed with tiers that provide various levels of interventions aimed at helping schools effectively manage the psychological well-being of their members during a crisis. Conclusions: Drawing on findings from literature reviews and surveys, this study sheds light on the difficulties surrounding mental health in schools during times of crisis such as the COVID-19 pandemic. Moreover, it puts forward a recommendation for employing multi-tiered support strategies to address these challenges and promote psychological well-being within educational settings amidst crisis. By adopting a multi-tiered systems of support framework that integrates various interventions tailored to individual needs, schools can effectively manage mental health concerns among their members. The study underscores the critical role of psychiatry in providing specialized care and medication management to support mental health in educational environments, particularly during times of crisis, with important implications to address the urgent mental health demands in Kindergarten to 12th grade schools.

Generalized Anxiety Disorder Among University Students Due To COVID-19

Generalized Anxiety Disorder (GAD) is a common but urgent mental health problem during disease outbreaks. With the outbreak of COVID-19’s second wave, educational institutions were closed, and the students had to remain confined to online teaching[1]learning, which might create many psychological problems. This study assesses the prevalence of generalized anxiety disorder among university youth students due to COVID-19. A cross-sectional online survey was conducted among 176 (response rate: 76.5%) university students studying at the Central Department of Education. The Generalized Anxiety Disorder scale (GAD-7) questionnaire was used to assess anxiety disorder. Students were selected using a simple random sampling technique and sent the questionnaire link created in the Kobo toolbox to them requesting voluntary participation. The collected responses were analyzed using descriptive statistics and multivariate logistic regression to find the GAD prevalence and associated factors. A study found that 47.7% of university students had generalized anxiety disorder due to COVID-19. Older participants had a lower likelihood of anxiety disorder compared to those under 30 (OR 0.267). Buddhists had higher odds than Hindus (OR 5.237), and students in Bagmati and Lumbini Provinces had higher odds than those in Koshi Province (OR 8.116 and OR 6.086, respectively). Students not infected with COVID-19 had higher odds of anxiety disorder than infected students (OR 7.564), and those not vaccinated had higher odds than those vaccinated (OR 2.883). Taken together, age, religion, province of residence, COVID-19 vaccination status, and perceived risk due to COVID-19 played a role in determining the prevalence of generalized anxiety disorder among students.

Addressing the Mental Health of Nursing Students During the Pandemic: The Evaluation of a Needs Assessment by a College of Nursing Mental Health Task Force.

A Mental Health Task Force (MHTF) was developed in a large public college of nursing in the Southeastern United States to address the urgent mental health needs expressed by growing numbers of nursing students related to the coronavirus disease 2019 (COVID-19). The purpose of this study was to report on a needs assessment conducted by the MHTF. The needs assessment study design was a 16-item cross-sectional online survey and four "Town Hall" focus groups with nursing students, faculty, and staff (n = 1-8 participants per group). Survey data were analyzed using descriptive statistics and free-text questions from the survey and focus groups were analyzed using a qualitative descriptive approach. Undergraduate and graduate students (n = 115) ranging in age from 17 to 50 years completed the survey; 95% female, 94% full-time, 56% employed, 77% White, and 81% in the Bachelor of Science in Nursing program. Eleven students participated in the focus groups. The analysis of the free-text survey questions identified the students' perceived needs. Mental health care was the most frequently requested, followed by faculty check-ins, stress management, and peer support. The administration of the survey provided an opportunity for students to communicate concerns and make requests. To address the ongoing effects of the COVID-19 pandemic on nursing students, multi-modal needs assessments should be conducted periodically to identify priority mental health needs.

Examining how observed need-supportive and need-thwarting teaching behaviours relate to pupils’ affective outcomes in physical education

This study aims to investigate the complexity of the practices of pedagogies of affect in physical education in response to urgent mental health issues among children and young people. As a proxy for measuring the effects of pedagogies of affect on pupils’ outcomes, self-determination theory (SDT) has informed teaching approaches for student motivation and psychological wellness and, thus, it could be an indicator perspective for mental health. Previous SDT studies in physical education have shown the relationship between pupils’ perceptions of need-supportive and need-thwarting teaching behaviours and affective outcomes. Nevertheless, no attempts have been made to test this teacher–pupil relationship involving observations of naturalistic teaching behaviour. Accordingly, this study examined how these observed teaching behaviours relate to pupils’ affective outcomes represented by basic psychological need satisfaction and frustration, (de)motivation, positive and negative affect, and sense of coherence. Employing a cross-sectional design, this study conducted observations of one indoor lesson per class and administered a set of questionnaires to pupils. In total, 20 teachers and 381 pupils aged 11 to 15 from seven different Scottish secondary schools participated in this study. The results showed that the factor of the observed structure before the activity was significantly related to affective outcomes, while the observed controlling teaching behaviour was related to negative outcomes. Although non-significant relationships between some factors of observed teaching behaviour and pupils’ variables were also found, this observational study is significant as it provides direct evidence of teacher–pupil interactions in the real-life context for developing pedagogies of affect.

Impact of COVID-19 on mental health in Bhutan: a way forward for action.

The coronavirus disease 2019 (COVID-19) pandemic continues to impact mental health and wellbeing globally. There is a lack of scientific documentation highlighting the mental health impact of COVID-19 in Bhutan. We present the mental health burdens and control measures taken, and suggest ways to further strengthen mental health services in Bhutan. During the pandemic, a rise in depression and anxiety had been reported in Bhutan. Depression rose from an average prevalence of 9 per 10,000 between 2011 and 2019 to 16 per 10,000 in 2020 and 32 per 10,000 in 2021. Similarly, anxiety rose from an average prevalence of 18 per 10,000, to 29 per 10,000 in 2020, and 55 per 10,000 in 2021. Psychological impacts related to isolation due to lockdowns, economic losses, and poor coping abilities were associated with negative outcomes. Stigma and discrimination towards mental health disorders discouraged mentally distressed people from seeking care. In response to increased demand, Bhutan's government initiated a range of interventions including home delivery of medicines and tele-counselling to people in need of urgent mental health care. Mental health care in Bhutan can be further improved through investment in services and human resources, and decentralization of services to the community.

Pediatric emergency department physicians' perceptions of virtual mental health assessments for urgent needs.

Pressures related to the COVID-19 pandemic have created the need to develop innovative ways to deliver mental health care, especially for urgent needs. After the launch of a pediatric Emergency Department (ED) Virtual Care service, we aimed to evaluate pediatric ED physicians' experiences with the use of ED virtual care for mental health assessments. This mixed-methods study was conducted at a pediatric academic health center in Ontario, Canada. Pediatric ED physicians who conducted ED virtual mental health assessments from May to December 2020 were eligible. Participants completed a 22-question novel survey and were invited to participate in a focus group. Descriptive and thematic analyses were used to analyze the data. Twenty-nine physicians provided mental health services through the ED virtual care platform. Twenty-five physicians (86% response rate) completed the survey and 3 (10%) participated in a focus group. While many agreed that virtual care benefits patients (67%), key barriers identified included time constraints, lack of mental health clinician support, and uncertainty around the pediatric ED physicians' role in these types of assessments. Despite these barriers, physicians recognized the potential benefit of the ED virtual care service for mental health assessments and were largely amenable to improving this process should mental health support be available. While many physicians agreed that there is a potential benefit of the ED virtual care platform for urgent mental health assessments, time constraints and lack of confidence in providing satisfactory virtual mental health care with minimal mental health support limited its acceptability. These findings can inform the future implementation of mental health services using an innovative virtual ED platform.

ADDRESSING THE MENTAL HEALTH NEEDS OF HOMEBOUND OLDER ADULTS IN AGING SERVICE SETTINGS

Abstract Despite significant and urgent mental health needs among low-income homebound older adults, the existing mental health service systems’ reach for these older adults is almost nonexistent. Given the current and projected geriatric mental health workforce shortages, innovative approaches are needed to better serve these underserved older adults. This presentation will focus on a series of randomized clinical trials that tested acceptable and feasible mental health service delivery models for homebound older adults who are served by aging service network agencies that provide hot meals and case management. Findings from the real-world effectiveness trials of tele-delivered behavioral activation treatment for depression and loneliness by bachelor’s-level lay counselors who are embedded in aging service agencies will be shared. Ways to promote a wider adoption of scalable and sustainable mental health service delivery models for homebound older adults will be discussed.

Fear, Anxiety and Depression among Bosnia and Herzegovina Citizens during the Third Wave of COVID-19.

Objective: During the COVID-19 pandemic, fear, anxiety, and depression have become global concerns among the wider public. This study aimed to examine the occurrence of fear, anxiety and depressive symptoms associated with COVID-19, to assess influencing factors that lead to the development of these mental health conditions and to examine any changes in the mental health patterns of the society since the initial study a year ago in Sarajevo, Bosnia and Herzegovina. Method : An anonymous online survey based on Fear of COVID-19 Scale (FCV-19S), General Anxiety Disorder-7 (GAD-7) and Patients Health Questionnaires (PHQs) was conducted in the general population of Sarajevo in Bosnia and Herzegovina. Results: From 1096 subjects, 81.3% were females, 33.8% had a high school degree, 56.4% were married, 53.4% were engaged in intellectual labor, 42.3% experienced fear, 72.9% had anxiety symptoms and 70.3% had depressive symptoms during the COVID-19 pandemic and their mean age was 35.84 ± 10.86. Half (50.1%) of the subjects were COVID-19 positive and 63.8% had COVID-19 symptoms when responding to the questionnaire. Experiencing COVID-19 related fear (OR = 1.972) and having moderate to severe depressive symptoms (OR = 9.514) were associated with the development of mild to severe anxiety symptoms during the COVID-19 pandemic, which were in turn associated with the development of moderate to severe depressive symptoms (OR = 10.203) and COVID-19 related fear (OR = 2.140), respectively, thus creating a potential circulus vicious. COVID-19 positive subjects (OR = 1.454) were also more likely to develop mild to severe anxiety symptoms during the COVID-19 pandemic. Conclusion: In conclusion, the prevalence of fear, anxiety symptoms and depressive symptoms rose dramatically since the beginning of the COVID-19 pandemic in Bosnia and Herzegovina. They were interconnected and were significantly associated with age, gender, marital status and COVID-19 status. Therefore, an urgent mental health intervention is needed for the prevention of mental health problems.

Perspectives of education and mental health professionals on adolescent school-based mental health promotion: a qualitative exploration

BackgroundInterdisciplinary interventions for school-based mental health promotion (SBMHP) for adolescents (10–19 years old) provide a unique opportunity to address the urgent mental health needs across this population. EspaiJove.net, a SBMHP programme, has delivered mental health workshops to over 24118 adolescents in Barcelona, Spain, since 2012. This study aimed to explore the perspectives from professionals involved in EspaiJove.net regarding the needs, challenges, and opportunities for adolescent SBMHP, to guide future interventions. MethodsFollowing an interpretivist approach rooted in social constructionism, semi-structured online interviews were conducted with six mental health professionals and five education professionals recruited through purposeful sampling from four schools participating in EspaiJove.net in Barcelona, Spain. Data collection was done between November and December, 2021. An interview guide and ongoing researcher reflexivity contributed to attaining data saturation. Bracketing, member checking, and debriefing were used to ensure rigour. Data were analysed through thematic content analysis. The University of Liverpool's Ethics Committee approved this study. FindingsData showed that: (1) there is a shared understanding among education and mental health professionals towards mental health and its promotion; (2) there is an urgent need for adolescent mental health promotion; and (3) participants' perceived roles and responsibilities in SBMHP varied, but favourable views towards the implementation of SBMHP were unanimous. There was perceived urgency towards adolescent mental health promotion, partly attributed to the effects of the COVID-19 pandemic. The link established between schools and mental health centres through EspaiJove.net fostered an interdisciplinary collaboration that spanned well beyond the intervention. The major challenge affecting the feasibility of SBMHP unanimously described was the scarcity of resources and political will to invest in mental health promotion. InterpretationPerspectives arising from EspaiJove.net reveal favourable views towards SBMHP among participants. Although limited by size, the consistency of the findings add strength to the study. Given the similarities between the UK and Spain's Education and Health Systems, these findings could contribute to the advancement of SBMHP in the UK. Despite current challenges, such as the scarcity of resources and political will identified in this study, capitalising on schools as health-promoting assets and fostering interdisciplinary collaboration through SBMHP could be a cost-effective way to address the current global mental health crisis. FundingNone.

54.4 Reaching At-Risk Youth by Telehealth in Texas: Experience From the Texas Child Health Access Through Telemedicine Program

The Texas Senate passed a bill during the 86th legislative session known as Senate Bill 11 to address accessibility to mental health services for the youth of Texas. The bill leverages the expertise and capacity of the 12 health-related institutions of higher education in Texas to address the urgent mental health challenges in Texas. One of the 5 initiatives ordered in the legislation was the establishment of a statewide telehealth system providing direct mental health services to schools now known as the Texas Child Health Access Through Telemedicine (TCHATT) Program.