Mental Health

Introduction Although mental health problems are common in the workplace, discrimination against mental health is still prominent. Characteristics of one’s own occupation can influence aspects of stigma and attitudes to mental health problems in the workplace context, but there are limited studies examining differences in them between occupational groups. Objectives We investigated occupational differences in mental health stigma, and attitudes to both mental and physical health in the workplace. Methods Data from the British Social Attitudes 2015 survey were used. Logistic regression models were conducted to investigate associations between occupational categories and stigma as measured by desire for social distance, as well as attitudes towards mental and physical health in the workplace. Occupational categories were based on the National Statistics Socio-economic Classification. Measures for attitudes to mental and physical health in the workplace include whether paid work is good for mental and physical health, how soon one should return to work following depression, whether work can help speed recovery from depression, whether one’s medical history should affect their promotion, including depression, schizophrenia and diabetes. Desire for social distance from people with depression and schizophrenia was measures using unlabelled vignettes. Results We found occupational differences in attitudes towards mental and physical health in the workplace, but not in levels of stigma. People in lower supervisory and technical (group 4), semi-routine and routine (group 5) occupations were more likely to have negative attitudes towards mental and physical health in the workplace compared to managerial and professional occupations (group 1). Both occupation groups were less likely than group 1 to believe that paid work is good for mental health (group 4: odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.24-0.61; group 5: OR = 0.34, 95% CI = 0.24-0.49). They were also less likely to believe that people with depression should return to work when they can do some or most of the job (group 4: OR = 0.67, 95% CI = 0.48-0.94; group 5: OR = 0.52, 95% CI = 0.41-0.66). People in group 5 were less likely to believe that paid work is good for physical health (OR = 0.69, 95% CI = 0.53 to 0.89) and that having schizophrenia should not affect promotion at work (OR = 0.78, 95% CI = 0.62-0.97) than group 1. Conclusions Our study reinforced the importance of job characteristics on attitudes to mental health in the workplace. First, employers need to invest more in improving their employees’ well-being. Second, governments should provide more support and resources for small companies to help them develop mental health policies and practices. Third, modifications need to be made to improve job control for employees and to ensure enough reasonable adjustments can be made. Disclosure of Interest G. Cheung: None Declared, A. Ronaldson: None Declared, C. Henderson Consultant of: C.H. has received consulting fees from Lundbeck and educational speaker fees from Janssen.

ABSTRACTThis presentation will focus on the importance of addressing mental health in the overall response to the Deepwater Horizon Oil Spill. Emphasis will be placed on evidence based, integrated mental and behavioral health services in primary care clinics as an essential component of physical and mental health care. Community surveillance data collected by LSUHSC Department of Psychiatry in the fall of 2010 and one year post spill revealed increased symptoms of depression, anxiety, and posttraumatic stress compared to national norms. Symptoms were higher for individuals directly impacted by the spill. The Mental and Behavioral Health Capacity Project (MBHCP), part of the Gulf Region Health Outreach Program (GRHOP), was developed across the four impacted states of Louisiana, Mississippi, Alabama, and Florida.In collaboration with the Primary Care Capacity Project (PCCP) and other GRHOP projects, it is designed to decrease disparities in care and develop an evidence-based system of integrated mental and behavioral health services within primary care clinics. In Louisiana, seven impacted parishes, culturally diverse and predominantly rural, were designated for services. Louisiana MBHCP (MBHCP-LA) is applying established principles of collaborative care combining on-site and telemedicine consultation, training, therapeutic services, and care management. It is working with PCCP to develop and utilize a technologically advanced telemedicine system to integrate mental and behavioral health into electronic health records to meet physical and mental health needs. Preliminary analysis of screening and follow-up data beginning in May 2013 from 303 clients who completed measures at intake into services indicates that integrating mental health services in primary care clinics resulted in significant decreases at follow-up in reported depression, generalized anxiety, and posttraumatic stress disorder symptoms. The data showed that the greater the decrease in reported depression, anxiety, and posttraumatic stress symptoms at follow-up, the greater the decrease in physical health symptoms. While the MBHCP-LA integration of mental and behavioral health in primary care clinics in parishes heavily impacted by the Deepwater Horizon Oil Spill has been in place for less than a year, the outcomes are promising in reducing both behavioral and physical health symptoms. The clinics are reporting greater comfort in addressing mental and behavioral health problems as well as more resilience by having mental and behavioral health partners. MBHCP-LA will continue to evaluate improvement in physical and mental health symptoms as well as resilience and quality of life by more fully addressing mental and behavioral health concerns.

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

10.1176/appi.ps.59.1.105

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused the cancellation or postponement of virtually every sporting event, resulting in training disruptions, income loss, and career uncertainties for athletes around the world. At present, the effect of the COVID-19 pandemic on the mental and emotional health of athletes is not well understood. Purpose: To investigate the effect of the COVID-19 pandemic on the mental and emotional health of athletes and to identify risk factors associated with poor mental health outcomes. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed, Embase, and Cochrane Library databases were searched to identify all articles reporting on athletes’ mental and emotional health during the COVID-19 pandemic. Articles were selected based on relevant inclusion and exclusion criteria. Study characteristics, athlete demographics, and COVID-19 mental health data (sex-, type of sport—, and level of play—specific differences) were collected from each included article and analyzed. Results: A total of 35 studies were included in the final analysis, comprising athletes around the world and across numerous sports and levels of play. Most studies utilized at least 1 validated mental health questionnaire and assessed for outcomes such as depression, anxiety, stress, motivation, and athletic identity. Overall, athletes reported worse mental and emotional health during the COVID-19 pandemic, although these effects were attenuated by home training programs and quarantine training camps. Female sex and more elite levels of play were associated with an increased risk for poor mental health outcomes. Type of sport was associated with mixed results, with individual and team sports carrying different increased risks for poor mental and emotional health. Nearly all studies recommended the need for increased psychological support of athletes during the COVID-19 pandemic. Conclusion: The effect of the COVID-19 pandemic on the mental and emotional health of athletes is complex and multifaceted. Increased social interactions with coaches and teammates, continued access to training facilities and mental health professionals, and active utilization of healthy coping mechanisms can improve mental health outcomes for athletes in the era of COVID-19.

LettersJuly 2023Mental Health and Health-Related Quality of Life After Firearm Injury: A Preliminary Descriptive StudyFREESydney C. Timmer-Murillo, PhD, Sarah J.H. Melin, MPH, Carissa W. Tomas, PhD, Timothy J. Geier, PhD, Amber Brandolino, MS, Andrew T. Schramm, PhD, Christine L. Larson, PhD, Terri A. deRoon-Cassini, PhDSydney C. Timmer-Murillo, PhDDivision of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, Sarah J.H. Melin, MPHMedical College of Wisconsin, Milwaukee, Wisconsin, Carissa W. Tomas, PhDDivision of Epidemiology & Social Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, Timothy J. Geier, PhDDivision of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, Amber Brandolino, MSDivision of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, and Division of Data Surveillance & Informatics, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, Andrew T. Schramm, PhDDivision of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, Christine L. Larson, PhDDepartment of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, Terri A. deRoon-Cassini, PhDDivision of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, and Division of Data Surveillance & Informatics, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WisconsinAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-0309 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Firearm injury is a public health crisis in the United States (1). Organizations have called for the consideration of long-term consequences of firearm violence, particularly for those directly impacted. Interpersonal firearm violence survivors report significantly worse physical health and functioning compared with the general population and other mechanisms of traumatic injury (1). Furthermore, firearm violence impacts the mental health of survivors and communities. Yet, there is limited work examining self-reported mental and physical health consequences of firearm violence for survivors acutely after injury, thwarting health care systems' ability to comprehensively intervene.Objective: To describe the mental health symptoms and health-related quality of life of firearm injury survivors 6 months after injury.Methods: A convenience sample of 87 adults was recruited from the trauma service of a level 1 trauma center in a midwestern, mid-sized city. Data were pooled from 2 studies occurring at the same center between the years of 2014 to 2016 and 2017 to 2021; both studies examined psychological and biological outcomes of traumatic injury (2). Participants were recruited in the emergency department or during hospitalization. Inclusion criteria were: 1) being 18 years of age or older, 2) having a Glasgow Coma Scale score of at least 13 on arrival, 3) having an unintentional suicidal self-injury, and 4) communicating in English. Exclusion criteria were: 1) experiencing loss of consciousness greater than 30 minutes, 2) experiencing posttraumatic amnesia for more than 24 hours, or 3) being in police custody. Although both studies recruited participants with all mechanisms of injury, the current investigation presents data on patients with interpersonal firearm-related injuries. Baseline sessions occurred up to 1 month postinjury and follow-up approximately 6 months after injury. After consent, participants completed measures on posttraumatic stress disorder (PTSD; PTSD Symptom Checklist for DSM-5); depression, anxiety, and stress (Depression, Anxiety, and Stress Scale [DASS-21]); and physical health-related quality of life (Short Form 12). Studies were approved by the Medical College of Wisconsin institutional review board and were funded by the National Institute of Mental Health. The funding organization was not involved in study design, data collection, or analyses.Findings: The Table provides demographic characteristics and outcome variables at baseline and 6 months. At baseline, patients exhibited symptoms of PTSD with a mean score of 27.15 (SD, 19.19), but symptoms were more severe at 6 months at a mean score of 38.66 (SD, 19.91). The PTSD mean score was above the recommended diagnostic cutoff of 34 for PTSD after interpersonal trauma and was higher than previous injury samples (3). Using interpretation guidelines from DASS-21, anxiety was "mild" at baseline with a mean score of 9.28 (SD, 9.23) and "moderate" at 6 months with a mean score of 11.20 (SD, 11.17). Depressive symptoms were in the "normal" range at baseline with a mean score of 7.25 (SD, 8.91), and higher at 6 months, nearing the cutoff to mild range at a mean score of 9.56 (SD, 10.87). Patients reported normal stress levels at a mean score of 9.52 (SD, 9.31) at baseline. Although reported stress was higher at 6 months with a mean score of 12.93 (SD, 11.29), it was still within the normal range. Patients' health-related quality of life was poor at baseline at a mean score of 30.48 (SD, 13.94), remained poor at 6 months with a mean score of 30.45 (SD, 19.22), and was well below scores reported in previous studies of both injury populations and the general population (4). The Figure shows changes in outcome measures from baseline to 6 months.Table. Sample Demographics, and Mental Health and Health-Related Quality-of-Life Descriptive StatisticsCharacteristicDescriptive StatisticRangeSex, n (%) Female77 (88.5)– Male10 (11.5)–Race, n (%) Asian1 (1.1)– Black/African American69 (79.3)– Hispanic/Latinx11 (12.6)– White/European American6 (6.9)–Psychiatric history,* n (%) Yes36 (41.4)– No50 (57.5)–Mean age (SD), y32.96 (10.06)18–57Mean Injury Severity Score (SD)13.12 (8.49)1–43Mean PCL-5–PTSD score† (SD) Baseline (n = 87)27.15 (19.19)1–72 6 mo (n = 41)38.66 (19.91)2–73Mean DASS-21–Anxiety score† (SD) Baseline (n = 87)9.29 (9.23)0–42 6 mo (n = 41)11.20 (11.17)0–42Mean DASS-21–Depression score† (SD) Baseline (n = 87)7.25 (8.91)0–42 6 mo (n = 41)9.56 (10.87)0–42Mean DASS-21–Stress score† (SD) Baseline (n = 87)9.52 (9.31)0–38 6 mo (n = 41)12.93 (11.29)0–42Mean SF-12 Physical Health score‡ (SD) Baseline (n = 87)30.48 (13.94)5.17–55.48 6 mo (n = 41)30.45 (19.22)0–60.73DASS-21 = Depression, Anxiety, Stress Scale; PCL-5 = PTSD Checklist for DSM-5, measure of PTSD symptom severity; PTSD = posttraumatic stress disorder; SF-12 = Short Form 12, for physical health.* One participant declined to answer.† Higher scores are indicative of worse symptoms for PTSD, Depression, Anxiety, and Stress.‡ Lower scores are indicative of poorer health for Physical Health. Download table Table. Sample Demographics, and Mental Health and Health-Related Quality-of-Life Descriptive StatisticsFigure. Mental and physical health outcome variables across time.Error bars depict SE. DASS-21 = Depression, Anxiety, and Stress Scale; PCL-5 = PTSD Checklist for DSM-5, measure of PTSD symptom severity; PTSD = posttraumatic stress disorder; SF-12 = Short Form 12, for physical health.* Lower SF-12 scores correspond to poorer health. General population average from Haider et al (4). Download figure Download PowerPoint Discussion: The need to understand the physical and mental health consequences of firearm injury in the United States is vital. In this preliminary descriptive study, firearm injury survivors reported poor PTSD acutely after the injury that persisted at 6 months. Furthermore, these patients endorse poor physical health–related quality of life across time, with values worse than previously studied injury samples (4). Medical advancements have increased the survivability of firearm injury, though survivors still carry the burden of injury as the mental and physical health outcomes seem poorer relative to the general population and those who have sustained other traumatic injuries (1, 4). These findings must be considered within the context of limitations including the small convenience sample, relatively short follow-up, and lack of data on preinjury mental health comorbidity. However, this preliminary study highlights the needs to better understand and manage the mental health consequences of firearm injury. Early screening and comprehensive care may improve outcomes in this at-risk population.

The Link Between Homeless Women's Mental Health and Service System Use

Background Study conditions are relevant for university students’ mental health and well-being. Previous research identified single factors associated with mental health, but it remains unclear, which study conditions at higher education institutions should be priority targets for institutional action. The aim of this study is to provide a comprehensive overview of students’ satisfaction with their study conditions and to analyse their associations with students’ mental health. Methods The cross-sectional StudiBiFra study encompasses data from 24,533 students across 13 higher education institutions in Germany. Data was collected between June 2021 and March 2023 using the Bielefeld Questionnaire on Study Conditions and (Mental) Health. Students rated study conditions in 22 domains and four scales of mental health outcomes. Mean scores for all scales were calculated and linear regressions were used to analyse bivariate associations. Results All domains of study conditions were associated with all domains of students’ men-tal health with regression coefficients ranging from r = 0.21 to r = 0.78. The more satisfied students were with their study conditions, the higher the reported well-being, and the lower the depressive symptoms, cognitive stress symptoms, and exhaustion. The highest associations were found for the domains of study conditions “examinations and academic achievements”, “time requirements”, and “fit of course content/competency development” with highest re-gression coefficients for the outcome of exhaustion. Conclusions The findings reveal significant moderate to high associations for all assessed study conditions with students’ mental health. Institutional action should focus on these study conditions by emphasising topics such as applying competencies during studies and good co-ordination of content and examinations. Thus, decreasing student burden and time pressure has the potential to promote mental well-being. Key messages • Study conditions are significantly associated with students’ mental health. • Higher education institutions should focus on study conditions to promote students’ mental well-being.

Children and youth face major gaps in access to mental and behavioral health services. Rates of identification of mental health conditions in the pediatric population continue to lag well behind what we know about the prevalence of these conditions. In addition, most children and youth with identified disorders do not get adequate treatment. Conservative figures place prevalence of diagnosable mental health conditions as at least 20% of the pediatric population, rising with older age. Increasing stress on families also leads to more needs for prevention and mental health promotion. And the separation between mental and physical health ignores much evidence of the substantially higher rates of mental and behavioral health conditions among children and youth with physical health conditions (2–3 times the rates found among pediatric patients without physical health conditions).1,2 Some access problems reflect major limitations in the mental health workforce (far too few child psychiatrists, psychologists, developmental-behavioral pediatricians, and other mental health professionals). Workforce limitations in turn reflect the weak financial base for children’s mental health services, providing relatively few incentives for young people to enter the children’s mental … Address correspondence to James M. Perrin, MD, MassGeneral Hospital for Children, 125 Nashua St, #860, Boston, MA 02114. E-mail: jperrin{at}mgh.harvard.edu

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

This study aimed to merge existing methodologies of identifying high-risk soldiers to create a comprehensive testable model to assist leaders in the identification, mitigation, and prevention of negative behavioral health (BH) issues. In 2011, a total of 2,664 active duty U.S. Army soldiers completed a survey of demographic and military characteristics, combat exposures, and BH diagnoses and symptoms. Multivariable linear and logistic regression models were fit to examine the relationship between demographic and military characteristics, subthreshold behavioral and social health issues, and positive screening for BH symptoms. The "recent loss of someone close" and self-reporting a history of BH issues were the strongest and most consistent predictors of subthreshold behavioral and social health issues. This study found that individual and occupational factors were associated with subthreshold behavioral and social health issues, which were in turn, associated with screening positive for BH symptoms. The recent loss of someone close (an indicator of grief and loss) was not the study's primary research question, but warrants further investigation to determine its impact on the mental well-being of soldiers.

WPA Project on Partnerships for Best Practices in Working with Service Users and Carers.

Experts Shine Spotlight on Racial Differences in Illness

The global burden of neuropsychiatry diseases and related mental health conditions is enormous, underappreciated and under resourced, particularly in the developing nations. The absence of adequate and quality mental health infrastructure and workforce is increasingly recognized. The ethical implications of inequalities in mental health for people and nations are profound and must be addressed in efforts to fulfil key bioethics principles of medicine and public health: respect for individuals, justice, beneficence, and non-malfeasance. Stigma and discrimination against people living with mental disorders affects their education, employment, access to care and hampers their capacity to contribute to society. Mental health well-being is closely associated to several Millennium Development Goals and economic development sectors including education, labour force participation, and productivity. Limited access to mental health care increases patient and family suffering. Unmet mental health needs have a negative effect on poverty reduction initiatives and economic development. Untreated mental conditions contribute to economic loss because they increase school and work absenteeism and dropout rates, healthcare expenditure, and unemployment. Addressing unmet mental health needs will require development of better mental health infrastructure and workforce and overall integration of mental and physical health services with primary care, especially in the developing nations.

Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.