Behavioral Health Services

This study explores how stigma influences community experiences among individuals with serious mental illness (SMI), using the structural-function-experiential (SFE) model as a guiding framework. Qualitative semi-structured and social network interviews were conducted with 30 participants receiving assertive community treatment (ACT) services in New York state. Modified grounded theory approach guided the analysis. Four themes emerged: (1) "Maybe I'm as crazy as they say I am," (2) avoiding disclosure and relationships, (3) providers or no one, and (4) longing for connection. These themes illustrate how stigma operates in an ecological framework such as the SFE model consisting of structural, functional, and experiential dimensions of community. Stigma disrupts social relationships, inhibits disclosure, and reinforces social isolation. Applying the SFE model highlights community-level mechanisms through which stigma can be mitigated. Findings inform transformative change efforts to enhance social inclusion and recovery for people with SMI.

BackgroundValid, reliable measures of psychosocial constructs are needed in oral health research. This study quantitatively evaluated the psychometric properties of nine new Oral Health Behavior Social Support (OHBSS) scales, which measured support for three oral health behaviors (brushing, flossing, dental care), queried for each of three sources (family, health providers, others/friends).MethodsYoung Mexican-origin adults in the southwestern United States-Mexico border region completed an online survey, in English or Spanish (N = 502). Survey items included: OHBSS scales, general social support scales, oral health behaviors, self-rated oral health status, dental anxiety, acculturation and socio-demographics. Subsample 1 participants also completed a dental exam (N = 41). Subsample 2 participants also completed a repeat OHBSS survey two-to-six weeks later (N = 56).Psychometric properties were tabulated, overall and by language preference (English or Spanish). Convergent and divergent validity were evaluated via correlations between the dental-specific OHBSS social support scales, scores from three validated general social support scales, and scales expected to be largely unrelated (acculturation, dental anxiety). Correlations examined predictive validity between the OHBSS scales and oral health behaviors, and self-reported and clinical outcomes. Test–retest reliability was assessed via intraclass correlation coefficients in Subsample 2.ResultsOf 502 participants, 60% preferred speaking English, 37% were single, and 21% were male. OHBSS scores indicated that health providers then family provided the most support for all three oral health behaviors, while others/friends did not provide much support. Spanish speakers tended to have higher OHBSS scores than English speakers.Correlations followed expected patterns and supported convergent and divergent validity, in the full sample and across languages. OHBSS scales exhibited many significant weak-moderate positive correlations (r = 0.10–0.38) with general social support scales. Few (11/108) significant correlations (< -0.16) were observed between OHBSS scales, acculturation, and dental anxiety. OHBSS scales exhibited some significant weak-moderate positive correlations with oral health-promoting behaviors. OHBSS scales were not associated with clinical outcomes. OHBSS scales exhibited good test–retest reliability overall and in Spanish.ConclusionPsychometric properties for the OHBSS scales were acceptable in both English and Spanish versions. The scales are valid and reliable tools for assessing social support for oral health-promoting behaviors from family, health providers, and others/friends.Trial registrationNot applicable.

Opioid use disorder (OUD) is associated with significantly increased mortality rates compared to the general population, driven by overdose risk, high-risk behaviors, and comorbid conditions. While opioid agonist treatment reduces mortality, identifying risk factors for death among individuals with OUD remains critical for improving outcomes. A retrospective analysis of the 2020 National Readmission Database identified OUD admissions using International Classification of Diseases, 10th Revision, Clinical Modification codes. Patients over 18 years of age were included, and statistical analyses, including logistic regression, assessed 30-day readmission and mortality predictors. Data were analyzed using IBM Statistical Package for the Social Sciences Statistics for Windows, version 1.0.0.1327 (IBM Corp., Armonk, NY). Nonsurvivors were generally older (median age: 58 vs. 47 years) and had a higher prevalence of severe comorbidities, including cardiac arrest (24.1% vs. 0.4%, p < 0.001), respiratory failure (83.0% vs. 16.2%, p < 0.001), and acute kidney injury (61.9% vs. 16.8%, p < 0.001). Mortality was more common among patients with Medicare (44.4% vs. 31.7%) and in larger hospitals. Psychiatric conditions, such as depression and suicidal ideation, were more frequent in survivors, suggesting potential protective effects or earlier intervention. Multivariable analysis identified cardiac arrest (odds ratio, OR: 20.210, p < 0.001), respiratory failure (OR: 9.993, p < 0.001), and liver failure (OR: 4.298, p < 0.001) as the strongest mortality predictors, while female sex and psychiatric disorders were associated with lower mortality risk. Mortality among patients with OUD is influenced by age, comorbidities, hospital characteristics, and healthcare disparities. Integrated care approaches that address both medical and psychiatric conditions are essential for improving survival outcomes. Future research should focus on targeted interventions to mitigate high-risk factors and enhance harm reduction strategies for this vulnerable population.

IntroductionThe core resting-state networks (RSNs) have been shown to be dysfunctional in individuals with internalizing disorders (IDs; e.g., anxiety, depression). Source-localised, closed-loop brain training of infraslow (≤ 0.1 Hz) EEG signals may have the potential to reduce symptoms associated with IDs and restore normal core RSN function.MethodsWe conducted a pilot randomized, double-blind, sham-controlled, parallel-group (3-arm) trial of infraslow neurofeedback (ISF-NFB) in adult females (n = 60) with IDs. Primary endpoints, which included the Hospital Anxiety and Depression Scale (HADS) and resting-state EEG activity and connectivity, were measured at baseline and post 6 sessions.ResultsThis study found credible evidence of strong nonspecific effects as evidenced by clinically important HADS score improvements (i.e., reductions) across groups. An absence of HADS score change differences between the sham and active groups indicated a lack of specific effects. Although there were credible slow (0.2–1.5 Hz) and delta (2–3.5 Hz) band activity reductions in the 1-region ISF-NFB group relative to sham within the targeted region of interest (i.e., posterior cingulate), differences in activity and connectivity modulation in the targeted frequency band of interest (i.e., ISFs = 0.01–0.1 Hz) were lacking between sham and active groups. Credible positive associations between changes in HADS depression scores and anterior cingulate cortex slow and delta activity also were found.ConclusionsShort-term sham and genuine ISF-NFB resulted in rapid, clinically important improvements that were nonspecific in nature and possibly driven by placebo-related mechanisms. Future ISF-NFB trials should consider implementing design modifications that may better induce differential modulation of ISFs between sham and treatment groups, thereby enhancing the potential for specific clinical effects in ID populations.Trial RegistrationThe trial was prospectively registered with the Australia New Zealand Clinical Trials Registry (ANZCTR; Trial ID: ACTRN12619001428156).Supplementary InformationThe online version contains supplementary material available at 10.3758/s13415-025-01279-z.

This study describes the role of psychiatric pharmacists (PPs) in medication management at a county-hospital-based primary care clinic serving adults with intellectual and developmental disabilities (IDD). During a 20-week period, PPs provided 308 interventions for 97 patients with IDD, 55% of whom had a concomitant psychiatric/behavioral disorder and 70% of whom were taking at least one psychotropic medication. PP services included medication reviews (48%), medication histories (13%), collaborative care (12%), pharmacotherapy interventions (11%), advisory services (9%), and patient/caregiver education (7%). Psychotropics were involved in 66% of interventions. Our results demonstrate that PPs may address psychotropic-related challenges in this practice setting by performing a variety of services. Additional studies are needed to fully evaluate the impact of this integrative model.

Objective To introduce New2Neuropsychology (N2N), an organization that seeks to increase recruitment of historically underrepresented minoritized (URM) students, and to examine preliminary data on N2N’s impact and effectiveness in increasing knowledge about neuropsychology for URM students. Method This paper reviews relevant literature on factors informing the development of N2N. We also present descriptive data on N2N’s impact to date, and results of pre- and post- surveys for presentations about neuropsychology delivered to 90 college students (mean age = 24.23, 64.4% juniors or seniors) between November 2021 – March 2023. Results N2N has reached >500 students in events across 27 schools and, with the American Academy of Clinical Neuropsychology, disseminated $84,000 in scholarships to URM students. N2N presentation attendees reported increased understanding of neuropsychology and the training pathway (ps < .001, Cohen’s ds = 0.94 − 1.73) and increased confidence in their ability to become neuropsychologists (p < .001, d = 0.41). There were no overall pre-post differences for interest in pursuing a career in neuropsychology (p > .05); however, a subset of students who reported low interest at baseline (n = 57) reported a statistically significant increase in their interest post-presentation (p < .01, d = 0.36). Conclusions To date, N2N has progressed toward its goal, showing preliminary success increasing knowledge about neuropsychology for URM students. With continued development and support, N2N seeks to transform the pathway to neuropsychology for URM students, expanding accessibility of N2N resources across diverse groups and connecting URM students to neuropsychology research and clinical experiences.

A deficits model is the cornerstone for health professions education, practice and scholarship. Focusing on diseases, addictions, social risk factors, and other deficits leads us to see medicalized beings with problems, also known as “patients”. This approach does particular harm to those who come from marginalized communities, groups who have always been viewed through the deficits lens by their colonizers/oppressors. When we focus on understanding strengths—including culture, language, resilience, skills, and resources we can begin to see "people" as full human beings possessing the tools necessary for their own healing. This approach, also known as “asset mapping”, will allow us to provide more effective, decolonized care, and will open the door to deeper healing for all involved.

The global health community has recognized that social determinants of health account for most of the inequities of health outcomes, including mental health outcomes, across and within countries. Strategies to overcome such inequities must focus on modifiable social factors. In this viewpoint, we argue for the preeminence of employment among social determinants of mental health for several reasons. People with mental health disabilities want to work, and a well-validated model of supported employment that is effective and cost-effective now exists. Employment leads to improvements in income, daily structure, self-esteem, social support, community integration and illness management, and people who are employed experience fewer emergencies and hospitalizations. Employment is empowering because people can use added income to activate their own choices regarding other social determinants. Supported employment actualizes the recovery paradigm: People who are employed in competitive jobs of their choice develop a meaningful functional life, increased self-esteem and new social supports. We provide examples of supported employment developments in diverse settings and discuss the implications of scaling up these services worldwide.