Use Of Mental Health Care Services Research Articles

Socioeconomic Inequality in Perceived Need for Mental Healthcare in Patients with Type 2 Diabetes Mellitus in Hamadan, Western Iran

Background and aims: The use of mental healthcare services in type 2 diabetes mellitus (T2DM) patients can depend on socioeconomic status (SES). The current study aimed to evaluate socioeconomic inequality in the perceived need for mental healthcare in patients with T2DM in Hamadan, Western Iran. Methods: This cross-sectional study was conducted between March and July 2023 in Hamadan, Western Iran. The study included T2DM patients who were referred to the Diabetes Center of Hamadan. The variables included in the study were demographics, SES, health insurance status, social support, and self-rated mental health. The outcome of interest was the perceived need for mental healthcare. The socioeconomic inequality was evaluated using concentration index and decomposition analysis. Results: A total of 393 patients (mean age: 56.48±10.65, 62% female and 88% urban inhabitants) were enrolled. The prevalence of perceived need for mental healthcare was 43%, and 50.30% of the patients (85) had delay/avoidance of mental healthcare services. The concentration index (95% confidence interval) of perceived mental healthcare needs was -0.24 (-0.18, -0.30), indicating that perceived needs are more concentrated in the socio-economically disadvantaged patients. Decomposition analysis revealed that low economic status and illiteracy were the main contributors to the inequality (approximately 50%). Cost, minimization, and stigma were the most frequently reported reasons for avoidance/delay of mental healthcare services, respectively. Conclusion: There was a pro-poor socioeconomic inequality in perceived need for mental healthcare among T2DM patients. Healthcare policies and facilities to reduce socioeconomic inequality should mainly focus on disadvantaged T2DM patients.

A community case detection tool to promote help-seeking for mental health care among children and adolescents in Ugandan refugee settlements: a stepped wedge cluster randomised trial

Strategies to promote mental health care help-seeking among children are needed, especially in low-income and middle-income countries and in complex settings. The aim of this trial was to compare a vignette-based, community-level, proactive case detection tool (CCDT) against standard awareness raising for promoting mental health help-seeking among children and adolescents. This stepped wedge cluster randomised trial was conducted in the Bidi Bidi, Kyaka II, Kyangwali, Omugo, and Rhino refugee settlements in Uganda. Community gatekeepers received a 2-day training session on using the CCDT to proactively detect children with mental health concerns and encourage children (or their caregivers) to use the mental health-care service run by Transcultural Psychosocial Organization Uganda. At baseline, organisations implemented routine detection or mental health awareness-raising activities. At cross-over to CCDT implementation, gatekeepers used the tool in their daily activities. The primary outcome was mental health-care service use by children and adolescents. Child population size estimates at the zone level were not available. Therefore, service use was calculated using total population size. We report the effect of CCDT implementation as an incidence rate ratio (IRR), which we produced from a model that accounts for calendar time, exposure time, and person-time. IRRs were estimated for the analysis of effect over time in the per-protocol and intention-to-treat populations. The trial is registered with the ISRCTN registry, number ISRCTN19056780. 28 administrative zones were selected for trial participation by October, 2021. Between Jan 1, and Nov 8, 2022, seven clusters of four zones sequentially crossed over from routine care to CCDT implementation in 1-month intervals. The CCDT was implemented by 177 trained community gatekeepers. In 9 months, 2385 children visited a mental health-care service; of these, 1118 (47%) were girls and 1267 (53%) were boys (mean age 12·18 years [SD 4.03]). 1998 children made a first or re-entry visit to a service; of these, 937 (47%) were girls and 1061 (53%) were boys (mean age 12·08 years [SD 4·06]). Compared to standard awareness-raising activities, CCDT implementation was associated with an increase in mental health-care service use in the first month after implementation (20·91-fold change [95% CI 12·87-33·99]). Despite a slight decline in service use over time in both the CCDT and pre-CCDT zones, CCDT zones maintained a time-average 16·89-fold increase (95% CI 8·15-34·99) in mental health service use. The CCDT enabled community gatekeepers to increase mental health-care service use by children and adolescents. Vignette-based strategies rooted in the community could become a valuable contribution towards reducing the mental health-care gap among children, especially when accompanied by accessible mental health-care services. Sint Antonius Stichting Projects. For the Arabic, French and Spanish translations of the abstract see Supplementary Materials section.

Mental health and aging in New Zealand: mixed-methods analysis of experiences of healthcare from a survey of older adults with mental health conditions

ABSTRACT Little is known about the experiences of older people who seek mental healthcare in New Zealand. From a survey of 227 older people, we explored the use of mental healthcare services with quantitative and qualitative questions. Mental health needs were not being met in nearly one in five; a similar proportion was not satisfied with services providing mental healthcare. Reasons included long waiting times, lack of continuity of care and cost. Better co-ordination of primary and secondary services and improved accessibility of mental health services for older adults is needed.

The impact of employment on mental healthcare use among people with disability: distinguishing between part- and full-time employment.

Employment can improve mental health among people with disability (PWD), however, little is known about how different levels of workforce participation influence mental healthcare use. The aim of this study was to estimate the extent to which different levels of working hours are associated with changes in mental healthcare use among PWD. Data on working hours and healthcare use among working age PWD who were receiving government benefits (N=260 825) was obtained from Australian Census-linked administrative records between 2011 and 2019. Individual fixed effects panel models were used to estimate the impact of increased working hours on mental healthcare (services and prescriptions). Heterogeneity analyses by job security and key sociodemographic characteristics were conducted. Compared to not working, we found that working 1-14, 15-29, and ≥30 hours per week was respectively associated with a 3.3%, 18.0%, and 9.9% reduction in the use of mental healthcare prescriptions as well as a 6.8%, 18.4%, and 22.3% reduction in the use of mental healthcare services by PWD. The effects were larger for PWD in more secure work and those living in rural and disadvantaged areas. Working more hours was associated with reduced mental healthcare use among PWD. Policy interventions should consider the broader benefits of enabling part-time and secure work placements for PWD, particularly for those living in rural and disadvantaged regions.

Depression stigma, depression literacy, and psychological help seeking attitudes among school and university students

Very little research has specifically investigated depression stigma and its correlation with depression literacy and help-seeking attitudes among students. This study aimed to assess the levels and correlations of stigma, literacy, and psychological help-seeking attitudes related to depression among a sample of high school and university students in Jordan. A descriptive, correlational, cross-sectional design was employed using an anonymous, online, self-report survey. This study included a total of 650 students aged 16 to 24 years. The participants were found to have high levels of depression stigma, low levels of depression literacy, and negative attitudes towards seeking psychological help. The most frequently reported sources of psychological help were family members, relatives, and friends. A significant negative correlation was found between depression stigma and depression literacy. The predictive factors of depression stigma were depression literacy, age, gender, education, father's educational level, family size, and having history of mental health problems among family members, relatives, or friends. This study provides valuable information on the common mental health needs and concerns among students in Jordan. The findings also highlight the importance of developing and implementing depression awareness and prevention education campaigns for students in schools and universities. Such campaigns may increase students' knowledge about depression, enhance their use of mental healthcare services, and prevent or decrease their risk of developing depression.

Psychosocial Determinants of Mental Healthcare Use Among Mexican-origin Women from Farmworker Families in Southern California.

Little is known about the contribution of psychosocial factors related to mental healthcare use among Mexican-origin women from farmworker families. Therefore, this study assessed relationships between acculturative stress, depressive symptoms, mental healthcare service use, and preferences for seeking care. Linear and logistic regression models and chi-square tests were performed to analyze survey data from 78 Mexican-origin women from farmworker families. Women were recruited in collaboration with promotoras and completed measures of acculturative stress, depressive symptoms, and mental healthcare use and preferences. Overall, 29.5% of the sample reported clinically significant depressive symptomatology. Acculturative stress was positively associated with depressive symptoms (b = 0.43, 95%CI = 0.27,0.59) after controlling for years in the U.S., primary language, and demographic characteristics. In addition, acculturative stress was associated with lower odds of mental healthcare use (OR = 0.96) after controlling for years in the U.S. and depressive symptoms. However, this association was no longer statistically significant when controlling for health insurance status and access to transportation. Mexican-origin women with high levels of acculturative stress were significantly more likely to seek care from a psychiatrist/psychologist than their peers (54.3% vs. 45.7%); however, this preference was not indicative of their use of mental healthcare services. Results suggest that acculturative stress is a risk factor for depressive symptoms and might contribute to a delay in seeking mental healthcare services in Mexican-origin women from farmworker families. Thus, interventions for this group should address aspects of acculturative stress as a strategy to increase mental health services use.

Structural and Intermediary Social Determinants of Health and the Emotional and Behavioral Health of US Children.

Children grow up in homes where varying environmental and socioeconomic contexts have a bearing on their emotional and behavioral health (EBH). This study used data from a representative sample of the child supplement of the US National Health Information Survey (NHIS) and applied the social determinants of health (SDoH) framework to explore factors associated with child EBH. We conducted a path analysis of the child's EBH measured by the strengths and difficulties questionnaire (SDQ) from their macro and socioeconomic contexts, e.g., policy, household, and other health system risk factors. For children in the sample, aged 4 to 17 years old (n = 9205), most path relationships to child SDQ scores were statistically significant. The total effects from a child's visit to a mental health specialist (0.28) and child's age (0.22) had the highest coefficients to child SDQ scores. A modified model showed a better fit with X2 (4) = 22.124, RMSEA = 0.021, and 90% CI [0.013-0.03], CFI = 0.98. Findings indicate that child factors such as being older, the use of mental healthcare services, and family socioeconomic status were significantly associated with EBH, calling attention to the need for more responsive policy and behavioral health interventions that address household/familial and child-level factors, critical determinants of child wellbeing.

Examining Patterns of Psychotherapy Service Utilization Among Medicaid-Enrolled Adolescents.

Adolescents with behavioral health disorders (i.e., mental health disorders and substance use) often experience frequent recurrence of symptoms, suggesting a need for an ongoing behavioral health intervention, rather than a single course of treatment. However, little is known about mental health care service use among adolescents over longer periods. The authors examined longitudinal patterns of outpatient behavioral health service utilization in a large sample of adolescents. Medicaid claims for 8,197 adolescents (ages 10.0-13.9 years, mean±SD=11.5±1.2; 61% male) from one Indiana county between 2006 and 2017 were examined, with a focus on outpatient psychotherapy visits. Latent class analysis (LCA) was used to detect clusters of longitudinal patterns of outpatient psychotherapy visits across 5 years, beginning with an adolescent's first behavioral health visit. A five-class LCA model emerged with unique classes of service use based on duration and level of engagement (frequency) of monthly outpatient psychotherapy visits. Most adolescents fell in the nonuse class (38.7% of the sample). Additional classes were defined as late-onset low engagement (17.1%), early-onset high engagement (15.5%), early-onset moderate engagement (16.7%), and continuously high engagement (11.9%). Statistically significant differences were found across the classes in average duration and frequency of involvement (p<0.001), as well as in demographic characteristics (race, age, gender, and ethnicity) and behavioral health diagnoses (p<0.001). These findings confirm that adolescents with behavioral health diagnoses do not follow a uniform pattern of psychotherapy utilization. The distinct patterns of service use point toward the need to identify appropriate long-term service recommendations for adolescents.

Healthcare Utilization 12 Months Prior to Fatal and Non-fatal Suicidal Behaviour in Cape Town, South Africa

The purpose of this study was to characterize healthcare use for general care and mental health one year before suicidal behavior among individuals with fatal and non-fatal suicidal behavior (NFSB) in Cape Town, South Africa. We linked electronic health records of 484 participants from a case series of 93 completed suicides on whom forensic autopsies were performed at a mortuary in Cape Town, between August 2014 and January 2016; and 391 patients admitted to hospital following NFSB between June 2014 and March 2015, and between August 2015 and August 2017. Time from last healthcare visit to date of suicidal behavior (fatal or non-fatal) was calculated, and Kaplan Meier curves were used to compare the differences by psychiatric diagnoses and study group. Overall, 64.5% of completed suicides and 65.9% of NFSB patients sought general healthcare in the year before suicidal behavior. Most of these visits occurred at hospital outpatient clinics (40.8%) and primary healthcare facilities (31.3%). The prevalence of preexisting psychiatric diagnoses and the use of mental healthcare services was lower for individuals who completed suicide compared to NFSB patients. Common reasons for a healthcare visit among individuals who completed suicide were chronic disease and assault; and psychiatric illness (depression, bipolar, and/or substance use disorders), chronic disease and HIV among NFSB patients. A large proportion of individuals with fatal and NFSB interacted with the healthcare system before suicidal behavior. These findings suggest opportunities for suicide prevention at primary healthcare facilities, antiretroviral treatment centers and emergency departments. HIGHLIGHTS Healthcare access is common among individuals with fatal and NFSB in the year before suicidal behavior. The prevalence of mental disorder diagnoses is higher among NFSB patients than among individuals who completed suicide. A greater proportion of NFSB patients accessed mental healthcare services compared to individuals who completed suicide.

Health and health-related behaviours in refugees and migrants who self-identify as sexual or gender minority - A National population-based study in Sweden.

SummaryBackgroundTo examine health and health-related behaviors in migrant and refugee individuals who identify as sexual or gender minority, and in comparison to their heterosexual peers.MethodsThe study included 168,952 individuals (aged 16–84 years, males: 45·9%, sexual or gender minorities: 3·1%) who answered the Swedish National Public Health Survey in 2018 and 2020. Participants were grouped into Swedish-and Western-born (White) heterosexual, White sexual- or gender minority, migrant heterosexual, migrant sexual- or gender minority, refugee heterosexual, and refugee sexual- or gender minority. Outcomes included mental health (for example suicidal ideation, wellbeing), general health, risky behaviors (risk alcohol use, risk gambling, and substance use), and experiences of violence. Associations between 1) sexual- or gender -ethnic identities and 2) gender-ethnic identities and all outcomes were analyzed using logistic and linear regression adjusting for sex, age, and educational level.FindingsBeing a sexual- or gender minority, regardless of ethnic minority status, was associated with worse general health and mental ill-health compared to heterosexual peers including suicidal ideation in refugee sexual- or gender minority individuals (OR 2·42, 95 % CI 1·44–4·08). Ethnic minorities (heterosexual and sexual- or gender minority migrants and refugees) had lower odds of drug and risk alcohol use compared to White heterosexual peers but higher odds of risk gambling (1·88, 1·49–2·37 for refugee heterosexuals). Transgender refugees had high odds for risk gambling (8·62, 1·94–38·40) and exposure to physical violence (7·46, 2·97–18·70).InterpretationIn this national population-based study, sexual and gender minority individuals have worse mental and general health regardless of ethnic minority status. We did not find evidence for worse health in sexual- or gender minority refugees in comparison to migrant, and White sexual- or gender minorities and their heterosexual peers. Transgender individuals (White and ethnic minority) experienced significantly higher levels of physical violence. Public health policy should emphasize preventive measures to reduce exposure to violence and discrimination in sexual- and gender minority individuals, increase access and use of mental healthcare services and sensitise healthcare professionals about higher rates of health and related issues faced by sexual- and gender minority individuals including those with multiple minority identities.FundingWe received no external funding for this study and hence the funder had no role in the study design, data collection, data analysis, data interpretation, writing of the manuscript and the decision to submit.

The risk of outpatient mental health care service use following departure from work: a cohort register study of migrant and non-migrant women

BackgroundNon-workforce participation is associated with increased risk of mental disorder in the general population. Migrant women face disadvantage in the labour market but use mental health services to a lesser extent. This study investigates the risk of using mental health services following departure from the workforce among women in Norway, and if the strength of the relationship varies for migrant and non-migrant women.MethodsUsing linked registry data, we followed a cohort of 746,635 women who had a stable workforce attachment over a three-year period. We used Cox proportional hazard models to determine the risk of using outpatient mental health services (OPMH) following departure from the workforce. We included an interaction analysis to determine if the relationship differed by migrant group and length of stay and conducted subsequent stratified analyses.ResultsDeparture from the workforce was associated with a 40% increased risk of using OPMH services among all women. Interaction analyses and subsequent stratified analyses indicated that departure from the workforce was associated with an increased risk of using OPMH services among non-migrant women and among women from countries outside of the European Economic Area, regardless of length of stay. For women from the European Economic Area with 2–6 years or 7–15 years in Norway, however, there was no increased risk.ConclusionsDeparture from the workforce is associated with increased risk of mental health service use, also among migrant women. Migrant women as a group, are more often temporarily employed and therefore at greater risk of falling out of the workforce and developing a mental disorder. However, women with shorter length of stays may experience greater barriers to care and service use may be a poorer indicator of actual mental disorder.

Estimating a Model for Mental Healthcare Utilization Using Subjective Unmet Need and Psychological Distress Measures.

The objective of this study is to assess the predictive value of self-reported need and psychological distress in mental healthcare service use across racial and ethnic groups in California. Using 2014-2018 data for adults aged 18-64 in the California Health Interview Survey, both logistic and Poisson regression models are used to estimate mental healthcare utilization. Patient-reported outcome measures, such as psychological distress, are commonly used to evaluate healthcare utilization patterns. The Kessler-6 screener for psychological distress is frequently used as a tool for determining whether someone's level of distress necessitates evaluation by a mental healthcare professional. Serious psychological distress has been widely studied as a predictor of higher healthcare expenditures and use; however, moderate distress and self-reported need has been less examined in the literature. Seventy-two percent of individuals with moderate psychological distress felt like they needed to see a professional for their mental or emotional needs compared to 4% of individuals with serious psychological distress. Individuals with moderate psychological distress had 34% of all healthcare visits for mental or emotional needs during the study period, compared to 17% for those with serious psychological distress. Subjective unmet need for mental healthcare was reported by 77% of those who utilized mental healthcare during the study period. Studying subjective unmet need, in addition to moderate and serious distress, provides additional understanding of the need for mental healthcare and mental healthcare utilization.

Trends in Primary Mental Health Care Service Use and Subsequent Self-Harm in Western Sydney Australia: Policy and Workforce Implications.

Background: This study investigated the trends in primary mental health care (PMHC) service use and hospital-treated self-harm in Western Sydney (Australia). Methods: A data linkage study and descriptive ecological study of PMHC referrals investigated the trends in referrals, treatment attendance, hospital-treated self-harm, and health care practitioners (HCPs) for the period of 2013−2018 (n = 19,437). Results: There was a substantial increase in referrals from 2016. The majority of referrals were females (60.9%), those aged <45 years (71.3%), and those presenting with anxiety or affective disorders (78.9%). Referrals of those at risk of suicide increased from 9.7% in 2013 to 17.8% in 2018. There were 264 (2.2%) cases of subsequent hospital-treated self-harm, with higher rates among those at risk of suicide and those who attended <6 sessions. The number of HCPs per referral also increased from 2013, as did waiting times for treatment initiation. Conclusion: Individuals presenting to PMHC services at risk of suicide, and who subsequently presented to a hospital setting following self-harm, were more likely to either not attend services following a referral or to attend fewer services. This trend occurred in the context of an increase in the number of clients per HCP, suggesting workforce capacity has not kept pace with demand.

The role of migration in mental healthcare: treatment satisfaction and utilization

Migration rates increase globally and require an adaption of national mental health services to the needs of persons with migration background. Therefore, we aimed to identify differences between persons with and without migratory background regarding (1) treatment satisfaction, (2) needed and received mental healthcare and (3) utilization of mental healthcare.In the context of a cross-sectional multicenter study, inpatients and day hospital patients of psychiatric settings in Southern Germany with severe affective and non-affective psychoses were included. Patients’ satisfaction with and their use of mental healthcare services were assessed by VSSS-54 and CSSRI-EU; patients’ needs were measured via CAN-EU.In total, 387 participants (migratory background: n = 72; 19%) provided sufficient responses for analyses. Migrant patients were more satisfied with the overall treatment in the past year compared to non-migrant patients. No differences between both groups were identified in met and unmet treatment needs and use of supply services (psychiatric, psychotherapeutic, and psychosocial treatment).Despite a comparable degree of met and unmet treatment needs and mental health service use among migrants and non-migrants, patients with migration background showed higher overall treatment satisfaction compared to non-migrants. The role of sociocultural and migrant-related factors may explain our findings.

The Impact of the COVID-19 School Closure on Adolescents’ Use of Mental Healthcare Services in Sweden

The Impact of the COVID-19 School Closure on Adolescents’ Use of Mental Healthcare Services in Sweden

Depression and mental health service use among 12–17 year old U.S. adolescents: Associations with current parental and sibling military service

ObjectiveTo examine whether having a parent and/or a sibling currently serving in the military is associated with major depression and use of mental health services among 12–17 year old adolescents in the United States. MethodDescriptive and multivariate logistic regression analyses are conducted using pooled data from the 2016–2019 National Survey of Drug Use and Health (NSDUH). Analyses are weighted and standard errors are adjusted for the complex sampling design. ResultsAdolescents are more likely to have a sibling than a parent currently serving in the military. Having a sibling currently in the military increases the likelihood of having a lifetime and a past-year major depressive episode (MDE), but not a past-year MDE with severe role impairment or use of mental health services. Having a parent in the military is not associated with any measure of MDE, but increases use of specialty outpatient, specialty inpatient/residential, and non-specialty mental health services net of MDE and sociodemographic controls. ConclusionConsiderable attention has focused on risk and resilience among the dependent children of current service members. A better understanding of how the current military service experiences of siblings, as well as parents, influences related adolescents’ mental health, mental health care service use, substance use, and health behaviors has the potential to contribute to programs and interventions that can enhance the well-being of youth with intra-generational, as well as inter-generational, connections to the military. Adolescents who have a sibling currently serving in the military are an at-risk population for MDE and potentially other mental and behavioral health problems.

Mental Health Resource Use Among Patients Undergoing Curative Intent Treatment for Bladder Cancer.

Patients with bladder cancer may experience mental health distress. Mental health-care service (MHS) use can quantify the magnitude of the problem. The Ontario Cancer Registry was used to identify all patients with bladder cancer treated with curative-intent cystectomy or radiotherapy in Ontario, Canada (2004-2013). Population-level databases were used to identify MHS use (visits to general practitioner, psychiatrist, emergency department, or hospitalization). Generalized estimating equations were used to compare rates of MHS use. Baseline, peritreatment, and posttreatment MHS use were defined as visits from 2 years to 3 months before, 3 months before to 3 months after, and from 3 months after to 2 years after start of treatment, respectively. From 2004 to 2013, 4296 patients underwent cystectomy (n = 3332) or curative-intent radiotherapy (n = 964). Compared with baseline, the rate of MHS use was higher in the peritreatment (adjusted rate ratio [aRR] = 1.64, 95% confidence interval [CI] = 1.48 to 1.82) and posttreatment periods (aRR = 1.45, 95% CI =1.30 to 1.63). By 2 years posttreatment, 24.6% (95% CI = 23.4% to 25.9%) of all patients had MHS use. Patients with baseline MHS use had substantially higher MHS use in the peritreatment (aRR = 5.77, 95% CI = 4.86 to 6.86) and posttreatment periods (aRR = 4.58, 95% CI = 3.78 to 5.55). Female patients had higher use MHS use overall, but males had a higher incremental increase in the posttreatment period compared with baseline (2-sided Pinteraction = .02). Male patients had a statistically significant increase in MHS use following surgery or radiotherapy, whereas female patients only had an increase following surgery. MHS use is common among patients undergoing treatment for bladder cancer, particularly in the peritreatment period. Screening for mental health concerns in this population is warranted.

Naturalistic follow-up study of rehospitalization rates and assigned disability status of patients with first-episode schizophrenia spectrum psychosis in South East Latvia: preliminary results

Background Patients with first-episode schizophrenia spectrum psychosis (FEP) are at risk of not visiting an out-patient psychiatrist and are assigned disability status within a short period after diagnosis. Objective The aim of this study was to conduct a naturalistic follow-up of FEP patients to explore their use of mental healthcare services and the rate of assigned disability status after FEP. Methods This was the first study in Latvia to include all consecutive patients with FEP admitted to the largest regional hospital in South East Latvia, Daugavpils Psychoneurological Hospital (DPNH). Patients received standard treatment in a real-world environment. The mean follow-up time was 33 months (Min = 20 months, Max = 40 months). Results From the 94 consecutive FEP patients admitted to DPNH (1 January 2016 to 31 December 2017), 68 participated and provided informed consent to be followed up. During the first 12 months after discharge from the acute psychiatric ward, 23% (n = 14) never visited a psychiatrist, and 6.5% (n = 4) had a single visit to get prescription for medication. Furthermore, 36.1% (n = 22) had a rehospitalization during the first 12 months. At the end of follow-up period, 34.4% (n = 21) of patients were assigned disability status within a median time of 8 months (IQR 4.5‒20.0). Conclusion Approximately, one-third of patients did not continue treatment as out-patients after FEP. One-third of FEP patients were assigned disability status. We suggest that Latvia needs improved treatment options for FEP patients, such as early intervention.

Integrating Healthcare Services for Indigenous Australian Students at Boarding Schools: A Mixed-Methods Sequential Explanatory Study.

Introduction:Many Aboriginal and Torres Strait Islander Australian adolescents from remote communities attend boarding schools, requiring integrated healthcare between home and schools. This study explored students’ health status, healthcare service use and satisfaction.Methodology:A two-phased mixed-methods explanatory design was implemented. 32 Indigenous primary and 188 secondary boarding school students were asked their health status, psychological distress, use of healthcare services in community and boarding school, and service satisfaction. Results were fed back to students, parents and community members, and education and healthcare staff to elicit further explanation and interpretation.Results:In the previous year, 75% of primary and 81% of secondary boarding school students had visited a doctor. More than 90% were satisfied with healthcare services used. Despite 27.1% reporting high psychological distress, students did not perceive distress as reducing their overall health, nor was distress associated with mental healthcare service use.Discussion:Despite high levels of service use and satisfaction, this study highlighted the need for improved healthcare integration for Indigenous adolescents between school-based and remote community services. Further research is needed to identify students’ expectations and models for healthcare integration.Conclusion:With resourcing, schools could play a greater role in facilitating access to healthcare.

Outpatient mental healthcare service use among women with migrant background in Norway: a national register study

BackgroundStudies show that migrant women are at greater risk of common mental disorders than the majority population, yet underrepresented in healthcare services. This study investigates the use of outpatient mental healthcare services over a five-year period among migrant and descendant women compared to majority women in Norway.MethodsUsing linked national registry data, we selected all women resident in Norway between 2009 and 2013 (N = 1,834,822). We conducted generalised estimated equations with logistic regression to assess if the odds of using outpatient mental healthcare services differed for migrant and descendant women compared to majority women. We also conducted generalised estimated equations with negative binomial regression to calculate consultation incidence rate ratios for migrant and descendant women relative to majority women among those with a common mental disorder.ResultsBoth migrant and descendant women had lower odds (OR = 0.47 and OR = 0.60 respectively) of using outpatient mental healthcare services than majority women. Odds of using services increased with length of residency. We also found significant variation by country of origin. Among women with common mental disorders who had used services, migrants, but not descendants, had a lower consultation rate ratio than majority women. Analyses by region of origin revealed that this did not apply to women from EU European countries, North America and Australia and New Zealand.ConclusionWomen with migrant background are, overall, underrepresented in OPMH services. Findings indicate that migrant women may not only experience barriers to seeking and accessing care but also in maintaining access to care. This may especially be the case for newly arrived migrant women and women from non-Western countries. Treatment may not be culturally adapted for these groups. Closer investigation of the barriers migrant women experience after using OPMH services is required.