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The supply / demand issue in behavioral health care is a well-established fact, and the mental health toll of the COVID-19 pandemic continues to add challenges to an already taxed system. Existing healthcare models are not set up to adequately address the increasing mental health related needs. As such, innovative models are needed to provide patients with access to appropriate, evidence-based behavioral health care within routine clinical care. This paper introduces Precision Behavioral Health (PBH) as an example of such a model. PBH is an innovative, digital first care delivery model that provides an ecosystem of evidence-based digital mental health interventions to patients as a frontline behavioral health treatment within routine care in a large multispecialty group medical center in the United States. This paper describes the implementation of PBH within a practice research network set-up as part of an integrated behavioral health department. We will present how our team leveraged the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance; "What is RE-AIM?," n.d.) implementation science framework, which emphasizes the design, dissemination, and implementation processes at the individual, staff, and organizational levels, to prioritize key implementation constructs to enhance the successful integration of PBH within routine care. We describe how each of these constructs were operationalized to aid data gathering for rapid evaluation and lessons learned. We discuss the benefits of these types of initiatives across multiple stakeholders including patients, providers, organizations, payers, and digital intervention vendors. [ABSTRACT FROM AUTHOR]

This paper presents an application that can be taken when conducting mental health intervention within the Latino immigrant population. Using a social ecological lens, it provides an overview of experiences and factors to detail the characteristics, trauma, and resilience factors present within this population. Utilizing Ungar's framework on resilience, that decenters the individual from experiences of trauma to position them alongside their social network and resources, it proposes an application for future intervention and research efforts. Addressing intervention at a foundational level allows for the supplementing and shaping of current methods to address the mental health needs of this community. [ABSTRACT FROM AUTHOR]

Mental health challenges have been recognized as one of the most prevalent issues impacting children and families within the United States. Children and families of color are disproportionately affected by this due to lack of access to preventative and ongoing supports, and programs that can help address their overall well-being. These issues are even more severe for those that are at risk or interact with the child welfare system. Social workers use various clinical modalities to assess and support them. In the recent years, child welfare agencies have turned to Evidence based programs (EBPs) as a best practice to meet the needs of children and families. The Title IV-E Prevention Services Clearinghouse, established by the Administration of Children and Families is a landmark effort to review and promote such EBP's that prevents foster care placements, including mental health programs. While the Clearinghouse has reviewed 141 programs and services, out of which 71 have been rated as promising, supported, or well-supported, there is a dearth of culturally responsive programs that have met the Clearinghouse criteria. Given the overrepresentation of African American and Native American Families in the child welfare system, and the critical role of the Clearinghouse in reviewing and promoting EBPs, this paper highlights the philosophical, administrative, cultural and logistical barriers for culturally relevant programs to be accepted into the Clearinghouse. It also provides specific recommendations on how the Clearinghouse and researchers can build EBPs that account for the intersection between mental health, social location and cultural identities of the children and families that social workers serve. [ABSTRACT FROM AUTHOR]

There were 9.7 million Native Americans (American Indian, Alaska Native-AI/AN- these acronyms will be used interchangeably with Native Americans throughout the paper) in 2019 comprising 2.9% of the U.S. population. Native American populations have disproportionately higher rates of mental illnesses compared to other racial groups in the U.S. Mental health is a significant public health concern for this population, impacting different areas of their lives including employment. Additionally, Native Americans continue to experience significant disparities in access to Vocational Rehabilitation (VR) services and have poor employment outcomes. However, little is known about the relationships among demographic factors, vocational rehabilitation services, and employment outcomes of Native Americans with mental illness. Consequently, the current study examined how demographic factors and VR services are related to successful employment outcomes for Native American VR clients with mental illnesses using data from the Rehabilitation Services Administration (RSA) program year (2019) Case Service Report (9–11). Both descriptive analysis and data mining approaches were used to answer the research questions. Chi-square Automatic Interaction Detector (CHAID) analysis was used to determine which of the VR services could best predict the successful employment outcome of Native Americans with mental illness. The findings of the data mining approach revealed that among all the vocational rehabilitation services, job placement assistance was the strongest predictor of successful employment among Native American clients with mental illnesses. The second most important service predicting successful employment for those who received job placement assistance was shown to be maintenance. Implications for rehabilitation counselors and future research are discussed. [ABSTRACT FROM AUTHOR]

Suicide is a critical public health issue in the United States, recognized as the tenth leading cause of death across all age groups (Centers for Disease Control and Prevention, 2020). Despite the Islamic prohibition on suicide, suicidal ideation and suicide mortality persist among Muslim populations. Recent data suggest that U.S. Muslim adults are particularly vulnerable, with a higher attempt history compared to respondents from other faith traditions. While the underlying reasons for this vulnerability are unclear, it is evident that culturally and religiously congruent mental health services can be utilized to steer suicide prevention, intervention, and postvention in Muslim communities across the United States. However, the development of Suicide Response toolkits specific to Muslim populations is currently limited. As a result, Muslim communities lack a detailed framework to appropriately respond in the event of a suicide tragedy. This paper aims to fill this gap in the literature by providing structured guidelines for the formation of a Crisis Response Team (CRT) through an Islamic lens. The CRT comprises of a group of individuals who are strategically positioned to respond to a suicide tragedy. Ideally, the team will include religious leaders, mental health professionals, healthcare providers, social workers, and community leaders. The proposed guidelines are designed to be culturally and religiously congruent and take into account the unique cultural and religious factors that influence Muslim communities' responses to suicide. By equipping key personnel in Muslim communities with the resources to intervene in an emergent situation, provide support to those affected, and mobilize community members to assist in prevention efforts, this model can help save lives and prevent future suicide tragedies in Muslim communities across the United States. [ABSTRACT FROM AUTHOR]

Suicide among American Muslims is understudied, despite recent research highlighting increased suicide attempts among this population. While suicide is forbidden in Islam, formal guidelines for addressing and responding to suicide within Muslim communities did not exist until recently. The Stanford Muslim Mental Health and Islamic Psychology Lab has responded to a number of suicides in Muslim communities across North America and implemented an original model for suicide response and community healing. This approach incorporates Islamic principles and values to create a culturally and religiously congruent response to suicide that can support loss survivors and steer impacted communities toward healing. The Muslim Postvention Community Healing session described in this paper aims to provide a safe space for individuals impacted by suicide to come together and process their emotions, while also using Islamic teachings to guide the healing process. This unique model has the potential to serve as a valuable resource for Muslim communities across North America, and beyond, in addressing and responding to suicide. [ABSTRACT FROM AUTHOR]

Histories of psychiatry in the United States can shed light on current areas of need in mental health research and treatment. Often, however, these histories fail to represent accurately the distinct trajectories of psychiatric care among black and white populations, not only homogenizing the historical narrative but failing to account for current disparities in mental health care among these populations. The current paper explores two parallel histories of psychiatry in the United States and the way that these have come to influence current mental health practices. Juxtaposing the development of psychiatric care and understanding as it was provided for, and applied to, black and white populations, a picture of the theoretic foundations of mental health emerges, revealing the separate history that led to the current uneven state of psychiatric care. [ABSTRACT FROM AUTHOR]

Faith-based organizations (FBOs) can play an important role in improving health outcomes. Lay community health advisors (CHAs) are integral to these efforts. This paper assesses the sustainability of a CHA training program for congregants in African-American and Latino FBOs and subsequent implementation of educational workshops. The program is unique in that a health care chaplain in an academic medical center was central to the program's development and implementation. Forty-eight CHAs in 11 FBOs were trained to teach workshops on cardiovascular health, mental health, diabetes, and smoking cessation. Two thousand four hundred and forty-four participants attended 70 workshops. This program has the potential to be a model to educate individuals and to address health inequities in underserved communities. Health care chaplains in other medical centers may use this as a model for enhancing community engagement and education. [ABSTRACT FROM AUTHOR]

There is a dearth of research on the intersection of incarceration and psychological distress among men who have sex with men including African American (AAMSM) and Latino MSM (LMSM), populations which bear a large burden of HIV in the U.S. Recent incarceration is an important context to examine psychological distress given the critical implications it has on health outcomes. Using baseline data from the Latino and African American Men's Project (LAAMP), a multi-site randomized HIV behavioral intervention trial, this paper examined the association between previous incarceration within the past three months (i.e., recent incarceration) and psychological distress in the past four weeks, assessed by the Kessler Psychological Distress Scale (K10). Among 1482 AAMSM and LMSM (AAMSM: 911, LMSM: 571), we found 768 (52%) were previously incarcerated, but not in past three months and 138 (9.3%) had been recently incarcerated. After adjusting for race, education, access to resources, current living arrangement, HIV status, and substance use, participants who had been recently incarcerated were more likely to have mild psychological distress i.e., K10 score 20–24 (aRRR:1.43, 95% CI 1.20, 1.71) or severe psychological distress, i.e., K10 score > 30 (aRRR: 1.89, 95% CI 1.22, 2.93) in the past four weeks than those never incarcerated and those previously incarcerated, but not in past three months. Our findings have implications for mental health and HIV prevention services for AAMSM and LMSM with previous incarceration within the past three months. [ABSTRACT FROM AUTHOR]

Rates of mental illness have increased dramatically over the past 15 years in the United States [Products—Data Briefs—Number 283—August 2017. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db283.htm. Published August 15, 2017]. Additionally, life expectancy has fallen over the past several years due to increases in death from suicide, opioid overdose, and alcoholic liver cirrhosis as reported by Case and Deaton [Deaths of despair and the future of capitalism. Princeton University Press, 2020]. Over the last decade some have questioned whether these changes are due to neoliberal capitalist policies and ideologies. Neoliberal capitalism incorporates theories of eliminating all restrictions on the market and decreasing government assistance programs as reported by Harvey [A brief history of neoliberalism, Oxford University Press, 2005]. Since then these policies have led to income inequality, disempowerment of workers, outsourcing of manufacturing jobs, inadequate social services, mass incarceration and an expensive and ineffective healthcare system as reported by Case and Deaton [Deaths of despair and the future of capitalism. Princeton University Press, 2020] and Nkansah-Amankra et al. [International Journal of Health Services 43(2):217-240, 2013]. Studies have shown that the consequences of these policies and ideologies likely have a role in increasing rates of mental illness. This paper will discuss how these factors increase mental distress and postulate ways that mental health professionals can advocate for change. [ABSTRACT FROM AUTHOR]

This study examined hospitalizations in a large, all-payer, nationally representative sample of inpatient hospitalizations in the US and identified differences in rates of hospitalization for conditions by race and ethnicity in autistic adults. Conditions examined included mood disorders, epilepsy, schizophrenia, and ambulatory care sensitive conditions (ACSCs). Compared to white, non-Hispanic autistic adults, Black, Hispanic, Asian or Pacific Islander (API), and autistic adults of another race had lower prevalence of admission for a principal diagnosis of a mood disorder. Conversely, Black, Hispanic, API, and autistic adults of another race had higher odds of admission for epilepsy than white autistic adults. Black and Hispanic autistic adults were more likely to have schizophrenia as a principal diagnosis compared to white autistic adults, but only Black autistic adults had increased odds for admission for an ACSCs compared to white autistic adults. Differences in diagnosis prevalence among hospitalized autistic adults may suggest differential access to comprehensive outpatient care that could prevent such hospitalizations, while also pointing to concerns of differential validity of diagnostic tools and treatment approaches. Insurance policy and programs should prioritize optimizing outpatient care to ensure access to care and emphasize the need for equitable treatment. [ABSTRACT FROM AUTHOR]

The following research used a paper and pencil survey to assess programming for mental health and wellness in 7742 law enforcement agencies throughout the United States. A total of 465 respondents provided data to two open-ended questions to share several types of programs and services that would be beneficial for agencies to support officers who experience job challenges or stress. The qualitative data was analyzed via constant-comparison method by two independent coders who engaged in several techniques to aid in trustworthiness. The resulting themes included officer wellness initiatives, counseling, and the role of the overall agency culture in order to provide access to support and for reducing the stigma for police seeking services for mental health. Implications include the need for program and policy changes within law enforcement agencies. [ABSTRACT FROM AUTHOR]

Indian Americans now constitute the nation's second largest foreign-born population group in the United States (U.S.). Concerning Indian American youth, there is a paucity of information about their experiences in the U.S., particularly with respect to cultural stress and model minority stress, and whether these stressors have an impact on their mental health. This article describes the dual experiences of Indian American youth in the Indian and American cultures and discusses two theoretical frameworks (cultural stress and model minority stress) that illuminate dynamics influencing the lives of these youth. We illustrate three core pathways (independent, synergistic and indirect) by which cultural stress and model minority stress can influence the mental health of Indian American youth. Social workers and other behavioral health providers can assist Indian American youth by examining their own biases related to the model minority stereotype, helping school personnel assess the impact of this stereotype, and remembering that Indian American youth are not a monolith. Researchers need to disaggregate data on Asian Americans to gather accurate statistics on the Indian American population and refine model-minority-stereotype assessment instruments. [ABSTRACT FROM AUTHOR]

During the start of the COVID-19 pandemic in 2020, lockdowns and movement restrictions were thought to negatively impact population mental health, since depression and anxiety symptoms were frequently reported. This study investigates the effect of COVID-19 mitigation measures on mental health across the United States, at county and state levels using difference-in-differences analysis. It examines the effect on mental health facility usage and the prevalence of mental illnesses, drawing on large-scale medical claims data for mental health patients joined with publicly available state- and county-specific COVID-19 cases and lockdown information. For consistency, the main focus is on two types of social distancing policies, stay-at-home and school closure orders. Results show that lockdown has significantly and causally increased the usage of mental health facilities in regions with lockdowns in comparison to regions without such lockdowns. Particularly, resource usage increased by 18% in regions with a lockdown compared to 1% decline in regions without a lockdown. Also, female populations have been exposed to a larger lockdown effect on their mental health. Diagnosis of panic disorders and reaction to severe stress significantly increased by the lockdown. Mental health was more sensitive to lockdowns than to the presence of the pandemic itself. The effects of the lockdown increased over an extended time to the end of December 2020. [ABSTRACT FROM AUTHOR]

Disasters share a common potential for significant ecological and psychosocial disruption at the individual, community, and societal levels, and are especially harmful to members of social groups in vulnerable situations, including youth in foster care and those recently emancipated from care. These young people are susceptible to mental health challenges and understanding their resiliency is key to mitigating pandemic-related harms. This qualitative study aims to (1) understand how the COVID-19 pandemic affected the mental health of older youth between the ages of 18 and 23 (M = 20.5 years, S.D. = 1.7 years), currently in or aged out of foster care (M = 5.9 years in care, S.D. = 4.4 years), and experiencing mental health challenges, and (2) gain insight into the resiliency that supports young people in dealing with these challenges. Twenty-six young people (77% female-identifying, 38% White, 27% Hispanic) in the USA participated in in-depth interviews. Salient themes include: 1) supportive relationships, 2) adaptive coping skills and mindsets, and 3) environmental, institutional, and social supports. Results amplify the voices of these young people concerning the impact of COVID-19 on their mental health and foreground the dynamic strategies they are using to alleviate their distress. [ABSTRACT FROM AUTHOR]

Over the past two decades, numerous studies have linked the subjective experience of neighborhood disorder (perceptions of crime, dilapidation and ambient strains) with poorer health. We test whether religious struggles (religious doubts and feeling abandoned or punished by God) mediate this association. Our counterfactual mediation analyses of data from the 2021 Crime, Health, and Politics Survey (CHAPS) (n = 1741) revealed consistent indirect effects of neighborhood disorder through religious struggles for anger, psychological distress, sleep disturbance, poorer self-rated health, and shorter subjective life expectancy. This study contributes to previous work by integrating the study of neighborhood context and religion. [ABSTRACT FROM AUTHOR]

Mental health conditions, including substance use disorders, are one of the most commonly occurring yet least commonly treated health ailments in the United States. Religious congregations serve as important providers of mental health services, as they can fill this gap with accessible care. This study provides an up-to-date accounting of mental health service provision by religious congregations, using a nationally representative survey of U.S. congregations collected in 2012 and 2018–19. Half of all congregations in the U.S. provided a program or service targeting mental illness or substance use disorder in 2018-19, and rates of provision increased among Christian congregations between 2012 and 2018–19. [ABSTRACT FROM AUTHOR]

This study examined risk and protective factors associated with depression among adolescents in the United States. A sample of 11,738 participants with current or past depression who were between 12 and 17 years was selected from the 2019 National Survey of Children's Health. Two multivariable logistic regression models examined the relationship between six predictors (being bullied, bullied others, difficulties making or keeping friends, family communication, school engagement, and involvement in extracurricular activities) and outcome variables (past or current depression). Results showed that being bullied or bullying others increased the likelihood of past and current depression. Having little or no difficulties making or keeping friends and engagement in school and extracurricular activities reduced the odds of having past or current depression. Frequent family communication reduced the likelihood of current, but not past depression. Results were significant beyond the associations between covariates (sex, age levels, race, and federal poverty levels) and dependent variables. Caregivers and health professionals should encourage positive social connections with family and peers as well as participation in school and extracurricular activities to protect adolescents from depression. [ABSTRACT FROM AUTHOR]

We examine the heterogeneous effects of childhood bullying victimization and chronic bullying victimization on a wide range of outcomes using data from the National Longitudinal Survey of Youth in the United States. Bullying victimization is categorized as childhood or chronic depending on the duration of victimization. We find that bullying victimization negatively affects the physical and mental health of youths, and increases the likelihood of engaging in risky behaviors, such as, smoking and marijuana use. The adverse effects tend to increase in magnitude with chronic bullying victimization. In addition, chronic bullying victimization increases the likelihood of utilizing mental health services and experiencing life-disrupting emotional problems in adulthood. [ABSTRACT FROM AUTHOR]

Epidemiological evidence suggests that regular physical activity (PA) positively impacts individuals' mental health (MH). The PA-MH relationship may be critical among immigrants owing to psycho-social-cultural influences. This scoping review of 61 studies employed a holistic bio-psycho-socio-cultural framework to thoroughly investigate the complex relationship between PA (across life domains) and immigrants' MH in Western countries. A systematic search of five electronic databases (Medline, PubMed, Embase, PsycINFO and Anthropology Plus) was conducted to locate relevant articles. No limitations were applied to study design, age, gender, home country, MH condition or PA type. A bio-psycho-socio-cultural-informed conceptual model guided the analysis of the multi-domain PA-MH relationship. Immigrant PA-MH studies were conducted and reported most commonly in the USA (38%), Australia (18%), and Canada (11%). Overall, PA was positively related to MH. Each domain-specific PA appeared to be associated with unique MH-promoting pathways/mechanisms. Leisure-related PA may support MH by enhancing self-agency and minimizing risky behaviors, whilst travel- and domestic-related PA may promote self-accomplishment and physical engagement. Ethnic sports appeared to enhance resilience. Occupational-related PA was associated with either positive or negative MH, depending on the type of occupation. A bio-psycho-socio-cultural-informed model is required to gain an encompassing and integrated understanding of immigrants' health. The first iteration of such a model is presented here, along with an illustration of how the model may be used to deepen analysis and understanding of the multi-domain PA-MH relationship among immigrants and inform public health planners and practitioners. [ABSTRACT FROM AUTHOR]

Little is known about the mental health status of Brazilians living in the U.S. We assessed the prevalence and correlates of depression to guide the development of culturally relevant community-based mental health interventions. An online survey was conducted between July and August 2020 among a sample of Brazilian women living in the U.S. (age 18 and over, born in Brazil, English or Portuguese speaking) recruited through Brazilian social media pages and community organizations. The survey assessed depression using the Center for Epidemiological Study Depression Scale (CES-D-10), the Everyday Discrimination Scale (EDS), the Oslo Social Support Scale (OSSS), and community strengths (CS). We first assessed the correlation between CES-D-10 scores and EDS, OSSS, and CS. We found that half of the participants (52.2%) had CES-D-10 scores of 10 or greater, indicating the presence of depressive symptomatology. In a multivariable model controlling for significant covariates (age, time lived in U.S.), EDS was positively associated with CES-D-10 scores (β = 0.64, 95% CI = 0.45, 0.83), while OSSS was negatively associated with CES-D-10 scores (β = -0.53, 95% C I= -0.80, -0.27). No statistically significant relationship was observed between CES-D-10 and CS scores. In this sample of Brazilian immigrant women, depressive symptomatology was highly prevalent, and experiences of discrimination were associated with increased symptoms of depression. There is a need to understand and address mental health in Brazilian immigrant women. [ABSTRACT FROM AUTHOR]

South Asians face stressors as a growing immigrant group in America. Work is needed to understand how these stressors impact mental health to identify those at risk of depression and design interventions. This study examined associations of three stressors (discrimination, low social support, limited English proficiency) with depressive symptoms in South Asians. Using cross-sectional data from the Mediators of Atherosclerosis in South Asians Living in America study (N = 887), we fit logistic regression models to evaluate independent/joint effects of three stressors on depression. Overall prevalence of depression was 14.8%; 69.2% of those with all three stressors had depression. The combined effect of high discrimination/low social support was significantly greater than the sum of the individual factors. Experiences of discrimination, low social support, or limited English proficiency, as well as a combination of these factors, should be considered when diagnosing/treating South Asian immigrants in a culturally appropriate manner. [ABSTRACT FROM AUTHOR]

Residents of the United States and China have responded very differently to the implementation of COVID-19 preventive measures. This study introduces the uncertainty reduction theory and the need for cognitive closure (NFC) framework into the context of a public health crisis and compares models across the United States and China. Specifically, we collected survey data to examine how NFC, trust in government, and attitudes toward preventive measures predicted pandemic compliance behaviors, depressive symptoms, and life satisfaction among 745 college students (399 from China and 346 from the United States). Chinese participants trusted their government more, believed COVID preventive measures to be more beneficial, and reported more pandemic compliance and fewer depressive symptoms than U.S. participants. Trust in government and attitudes towards preventive measures mediated the relationships between NFC and pandemic compliance behaviors among Chinese participants but not U.S. participants. NFC predicted better mental health outcomes among participants in China compared to U.S. participants. Trust in government mediated NFC and mental health outcomes among Chinese participants. Trust in government predicted better mental health (fewer depressive symptoms and more life satisfaction) in both the United States and China. Theoretical and practical implications of these findings for promoting mental health and pandemic compliance behavior during the COVID-19 pandemic are discussed. [ABSTRACT FROM AUTHOR]

Racial trauma has long been an issue in American society. Recent incidents of racial violence, including the attack and murder of George Floyd and the rise of anti-Asian hate have garnered significant media attention. People often use social media to express their emotions and perspectives on national events, and it has become a popular forum for posting and commenting on content related to timely social issues. In effort to understand individual perspectives, and experiences of racial trauma discussed on social media, we analyzed content labeled with the hashtag "racial trauma" on TikTok during significant racial incidents from March 2020 to May 2022. Results of content analysis showed six themes, (1) encountering racism, (2) traumatic experiences, (3) consequences of experiencing racial trauma, (4) expressing difficult feelings, (5) questioning and challenging oppression, denial, and privilege, and (6) a call to action: raising awareness. Findings inform clinicians' understanding of how their clients experience racial trauma. Clinical implications for incorporating a nuanced understanding of racial trauma in mental health treatment are discussed. [ABSTRACT FROM AUTHOR]

Latinx students experience stress at higher rates than European-American college-students in the U.S. and report the highest levels of anxiety among all other college-students, which can be a potential barrier to success. However, family members are identified as important sources of support by Latinx young-adults, and feeling support from family indicates a higher likelihood to remain enrolled in college. Few studies have explored the role of siblings in this relationship. This study examined whether positive and negative relationship qualities (RQ) between Latinx siblings may interact with level of anxiety, predicting academic stress (AS) and future aspirations (FA). Findings indicated that younger siblings with high anxiety and high negative RQ experienced higher levels of AS, while older siblings with low or mean-level anxiety and high negative RQ experienced high AS. Younger siblings with low anxiety, and high negative RQ with older siblings experienced low FA. The findings provide evidence that sibling relationship quality in Latinx students moderates the associations with anxiety, academic stress, and future aspirations, and that the presence of negative relationship qualities carried particular implications for future aspirations and academic stress. Understanding the influence of Latinx sibling RQ on mental health and AS can offer insight into the role of sibling relationships in the context of health, academic retention, and success in Latinx young people. Highlights: Examined if relationship qualities between Latinx siblings interact with anxiety, academic stress, and future aspirations. The presence of negative relationship qualities carries particular implications for future aspirations and academic stress Younger siblings with high anxiety and high negative relationship qualities experienced higher levels of academic stress. The higher the positive sibling relationship quality, the higher the future aspirations. Understanding influences of Latinx sibling relationships on mental health and academics can guide university efforts. [ABSTRACT FROM AUTHOR]

Geography may influence mental health by inducing changes to social and physical environmental and health-related factors. This understanding is largely based on older studies from Western Europe. We sought to quantify contemporary relationships between urbanicity and self-reported poor mental health days in US counties. We performed regression on US counties (n = 3142) using data from the County Health Rankings and Roadmaps. Controlling for state, age, income, education, and race/ethnicity, large central metro counties reported 0.24 fewer average poor mental health days than small metro counties (t = − 5.78, df = 423, p <.001). Noncore counties had 0.07 more average poor mental health days than small metro counties (t = 3.06, df = 1690, p = 0.002). Better mental health in large central metro counties was partly mediated by differences in the built environment, such as better food environments. Poorer mental health in noncore counties was not mediated by considered mediators. [ABSTRACT FROM AUTHOR]

Limited research has examined the mental health of individuals experiencing homelessness in Hawai'i, which bears the nation's second highest homelessness rate. Mental health, substance use, treatment need, and health data were collected from 162 unhoused individuals in Hawai'i County by visiting community locations where they congregate (e.g., beaches, vacant buildings). 77% of participants were Native Hawaiian/Pacific Islander (NH/PI) with participants demonstrating severe rates of mental and substance use disorders including 57% experiencing major depressive disorder (MDD), 56% experiencing generalized anxiety disorder (GAD), and 64%, 74%, and 12% experiencing alcohol, methamphetamine, and opioid use disorders, respectively—heightening overdose risk. Treatment need was high (62%) but health was poor (85% reporting fair/poor health), with MDD and GAD predicting reduced general health (p < 0.05). Study findings indicate Hawai'i unhoused individuals are disproportionately Indigenous NH/PI, enduring striking mental and physical health disparities that may be reduced by increasing access/utilization of community mental health programs/services. [ABSTRACT FROM AUTHOR]

Young adults experiencing homelessness (YAEH) have high rates of mental health problems but low rates of mental health service use. This study examined identification of mental health problems among YAEH in seven U.S. cities and its relationship to service use. YAEH that screened positive for depression, psychological distress, or Post Traumatic Stress (n = 892) were asked whether they felt they had a mental health problem. One-third identified as having a mental health problem (35%), with 22% endorsing not sure. Multinomial logistic regression models found that older age, cisgender female or gender-expansive (compared to cisgender male), and LGBQ sexual orientation, were positively associated with self-identification and Hispanic race/ethnicity (compared to White) was negatively associated. Self-identification of a mental health problem was positively associated with use of therapy, medications, and reporting unmet needs. Interventions should target understanding mental health, through psychoeducation that reduces stigma, or should reframe conversations around wellness, reducing the need to self-identify. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic disrupted the lives of adolescents worldwide, and research on the mental health effects are ongoing. Adolescents living in rural areas of the United States were already known to be at a disadvantage in terms of access to mental health services, as well as elevated rates of mental health concerns and self-harm risk. Research on how these factors may have changed since the pandemic began is needed to better understand which areas saw the biggest impact and where we can best direct resources to assist youth. Data from the current study were taken from a project examining adolescent mental health and self-harm risk. The pandemic disrupted the timeline for the study resulting in data being collected in two separate waves: before (n = 695) and after (n = 206) the pandemic began. Comparisons were made between these two samples on multiple factors including depression, anxiety, emotion dysregulation, alcohol and substance use, experiencing of bullying, overall impairment, mental health services access, and self-harm. Results indicated that adolescents in the pandemic sample were more likely to have seen a counselor and been hospitalized for a mental health reason, and were more likely to have experienced past-year suicide thoughts and plans than adolescents in the pre-pandemic sample. The pandemic sample also showed more depression and anxiety symptoms, greater emotion dysregulation, and greater intensity of recent suicide ideation. Implications for assisting youth through post-pandemic times are discussed. [ABSTRACT FROM AUTHOR]

Background: Depression is one of the top mental health concerns among biology graduate students and has contributed to the "graduate student mental health crisis" declared in 2018. Several prominent science outlets have called for interventions to improve graduate student mental health, yet it is unclear to what extent graduate students with depression discuss their mental health with others in their Ph.D. programs. While sharing one's depression may be an integral step to seeking mental health support during graduate school, depression is considered to be a concealable stigmatized identity (CSI) and revealing one's depression could result in loss of status or discrimination. As such, face negotiation theory, which describes a set of communicative behaviors that individuals use to regulate their social dignity, may help identify what factors influence graduate students' decisions about whether to reveal their depression in graduate school. In this study, we interviewed 50 Ph.D. students with depression enrolled across 28 life sciences graduate programs across the United States. We examined (1) to what extent graduate students revealed their depression to faculty advisors, graduate students, and undergraduates in their research lab, (2) the reasons why they revealed or concealed their depression, and (3) the consequences and benefits they perceive are associated with revealing depression. We used a hybrid approach of deductive and inductive coding to analyze our data. Results: More than half (58%) of Ph.D. students revealed their depression to at least one faculty advisor, while 74% revealed to at least one graduate student. However, only 37% of graduate students revealed their depression to at least one undergraduate researcher. Graduate students' decisions to reveal their depression to their peers were driven by positive mutual relationships, while their decisions to reveal to faculty were often based on maintaining dignity by performing preventative or corrective facework. Conversely, graduates performed supportive facework when interacting with undergraduate researchers by revealing their depression as a way to destigmatize struggling with mental health. Conclusions: Life sciences graduate students most commonly revealed their depression to other graduate students, and over half reported discussing depression with their faculty advisor. However, graduate students were reluctant to share their depression with undergraduate researchers. Power dynamics between graduate students and their advisors, their peers, and their undergraduate mentees influenced the reasons they chose to reveal or conceal their depression in each situation. This study provides insights into how to create more inclusive life science graduate programs where students can feel more comfortable discussing their mental health. [ABSTRACT FROM AUTHOR]

Macrostructural characteristics, such as cost of living and state-level anti-poverty programs relate to the magnitude of socioeconomic disparities in brain development and mental health. In this study we leveraged data from the Adolescent Brain and Cognitive Development (ABCD) study from 10,633 9-11 year old youth (5115 female) across 17 states. Lower income was associated with smaller hippocampal volume and higher internalizing psychopathology. These associations were stronger in states with higher cost of living. However, in high cost of living states that provide more generous cash benefits for low-income families, socioeconomic disparities in hippocampal volume were reduced by 34%, such that the association of family income with hippocampal volume resembled that in the lowest cost of living states. We observed similar patterns for internalizing psychopathology. State-level anti-poverty programs and cost of living may be confounded with other factors related to neurodevelopment and mental health. However, the patterns were robust to controls for numerous state-level social, economic, and political characteristics. These findings suggest that state-level macrostructural characteristics, including the generosity of anti-poverty policies, are potentially relevant for addressing the relationship of low income with brain development and mental health. Lower income is associated with smaller hippocampal volume and mental health problems. Here, the authors show that this association is weaker in areas of the United States that are less expensive or that have a stronger social safety net. [ABSTRACT FROM AUTHOR]

COVID-19 has disrupted the lives of families across the United States and all over the world. Stress is known to have a negative impact on parent–child feeding interactions; hence, the purpose of this study is to examine how COVID-related parenting stress, which was measured using a newly developed scale, is related to parent mental health, nonresponsive feeding, and children's self-regulation of eating. 119 parents of children ages 2–7 years old filled out questions about COVID-related parenting stress, mental health, nonresponsive feeding behaviors, and children's self-regulation of eating. A series of multiple regressions were run to predict parent anxiety and psychological distress from COVID-related parenting stress. COVID-related parenting stress was found to be a significant predictor of both parent anxiety and psychological distress. When COVID-related parenting stress was further broken down into COVID-Related Job/Financial Security Stress and COVID-Related Family Safety/Stability Stress, COVID-Related Job/Financial Security Stress predicted psychological distress while COVID-Related Family Safety/Stability Stress predicted parent anxiety. Moderation analyses were also run to test the difference across the parents of children under 5 years of age and those of children who were 5 years of age and older regarding the association of COVID-related parenting stress and either parent anxiety or psychological distress. There was no significant difference across age. Lastly, COVID-related parenting stress and nonresponsive feeding practices were simultaneously entered into a multiple regression to predict children's self-regulation of eating, and COVID-related parenting stress and parent distrust in appetite were both found to decrease children's ability to self-regulate energy intake. Based on findings from this study, researchers interested in improving children's self-regulation of eating and long-term health outcomes should continue to target the reduction of nonresponsive parent feeding behaviors, but they should also aim to look beyond specific parent feeding behaviors by attempting to help parents manage stressors in their lives. [ABSTRACT FROM AUTHOR]

Physical function decline due to aging or disease can be assessed with quantitative motion analysis, but this currently requires expensive laboratory equipment. We introduce a self-guided quantitative motion analysis of the widely used five-repetition sit-to-stand test using a smartphone. Across 35 US states, 405 participants recorded a video performing the test in their homes. We found that the quantitative movement parameters extracted from the smartphone videos were related to a diagnosis of osteoarthritis, physical and mental health, body mass index, age, and ethnicity and race. Our findings demonstrate that at-home movement analysis goes beyond established clinical metrics to provide objective and inexpensive digital outcome metrics for nationwide studies. [ABSTRACT FROM AUTHOR]

Objectives: To propose a measure for adverse maternal experiences (AMEs) and examine if AMEs are independently associated with delivery of a neonatal abstinence syndrome (NAS) diagnosed infant. Methods: Using the Pregnancy Risk Assessment Monitoring System (PRAMS) stressful life events questions, we constructed a composite measure of AMEs. We conducted a retrospective analysis of linked Birth Certificate Data, Hospital Discharge Data and PRAMS data for 2012–2018 using the composite measure. Our analytic sample included 6358 singleton deliveries. We calculated prevalence of NAS and AMEs and prevalence odds ratio (POR) for delivery of an NAS-diagnosed infant adjusting for maternal sociodemographic characteristics, pre-pregnancy depression, prescription medicine 12 months prior to pregnancy, and smoking during pregnancy. Results: The overall prevalence of NAS in Delaware during 2012–2018 was 2.2% (95% CI 1.8–2.6); 9.5% (95% CI 8.7–10.2) of women reported AMEs. After adjustment, women with AMEs had 1.1 times greater odds (aPOR 2.1; 95% CI 1.3–3.3) to deliver a NAS-diagnosed infant as compared with women without AMEs. Conclusions: Although the cross-sectional nature of the study limits drawing any causal inferences, there are co-occurring factors that support plausibility of an association between AMEs and delivering NAS-diagnosed infants. Addressing AMEs, mental health and substance use screening and treatment as part of preconception and prenatal care may mitigate risks. [ABSTRACT FROM AUTHOR]

Integrated behavioral health care (IBHC) models are a growing trend for health care delivery, particularly in the primary setting. Clinicians working within IBHC contexts provide a spectrum of behavioral health services, including screening, prevention and health promotion, assessment, and treatment services. Integration of behavioral health providers into primary and specialty medical settings addresses the significant need for behavioral health services, improves care quality, improves patient experience, and reduces costs of care, access issues, and delays in service provision. While benefits are clear, what type of model to implement and which behavioral health care providers to include in that model remain elusive. This is partly due to the failure of IBHC models to include all behavioral health providers in their design, a lack of clarity of the expertise of each provider, and how providers work together. IBHC models are also complicated by contextual issues such as the relative availability of each profession, population health needs in different clinic populations, and financial factors. The purpose of this manuscript is to the clarify roles and responsibilities of different behavioral health professions including similarities and differences in their training, areas of unique expertise (role distinctions), shared responsibilities (role overlap), and relative cost and availability in the United States. [ABSTRACT FROM AUTHOR]

Black women living with HIV (BWLWH) face intersectional adversities impacting their wellbeing. This study utilized network analysis to assess the associations among adversities linked to racism, sexism, HIV stigma, and socioeconomic status (income, housing, education) and determine which adversities predict mental health outcomes, HIV viral load, and medication adherence more consistently among BWLWH. 119 BWLWH aged 18 years or older completed self-report measures on sociodemographics, adversity factors, and mental health outcomes. Viral load count was obtained through blood draws, and medication adherence was measured via Wisepill adherence monitoring device. Multiple regression analysis was used to assess if the more central factors in the network also predicted health outcomes more consistently than the less central factors. The four most central factors in the network were income, housing, gendered racial microaggression (GRM) frequency, and GRM appraisal. Multiple regression analysis revealed that GRM frequency, GRM appraisal, and the number of traumas contributed uniquely and were positively associated with both depressive symptoms and posttraumatic stress disorder symptoms. HIV-related discrimination contributed uniquely and was positively associated with HIV viral load. [ABSTRACT FROM AUTHOR]

To understand ED providers' perspective on how to best care for individuals who present to US emergency departments (EDs) following self-injurious behavior, purposive recruitment identified nursing directors, medical directors, and social workers (n = 34) for telephone interviews from 17 EDs. Responses and probes to "What is the single most important thing ED providers and staff can do for patients who present to the ED after self-harm?" were analyzed using directed content analysis approach. Qualitative analyses identified four themes: treat patients with respect and compassion; listen carefully and be willing to ask sensitive personal questions; provide appropriate care during mental health crises; connect patients with mental health care. Participants emphasized treating patients who present to the ED after self-injurious behavior with respect and empathy. Hospitals could incentivize provider mental health training, initiatives promoting patient-provider collaboration, and reimbursement strategies ensuring adequate staffing of providers with time to listen carefully. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to better understand what the scientific community is saying about refugees and mental health, how it is discussed, and to understand the impact of their outputs over time through a bibliometric analysis. Subjects and methods: This research uses bibliometric analysis on 465 documents, including peer-reviewed journal articles and books, sourced from an online database of peer-reviewed literature. Results: Contrary to the exponential rate in which research productivity has grown in the past 20 years, the literature on the mental health of refugees in the United States has not shown significant changes. The researched themes, methods, and their findings appear to have echoed much of it from the past. Conclusions: Some implications of such echoing include that the means by which the scientific communities approach the topic of mental health of refugees has largely been unchanged. Also, various refugee communities in the US appear to share similar mental health conditions and experiences, irrespective of when and where they resettle. [ABSTRACT FROM AUTHOR]

Mental health parity legislation can improve mental health outcomes. U.S. state legislators determine whether state parity laws are adopted, making it critical to assess factors affecting policy support. This study examines the prevalence and demographic correlates of legislators' support for state parity laws for four mental illnesses— major depression disorder, post-traumatic stress disorder (PTSD), schizophrenia, and anorexia/bulimia. Using a 2017 cross-sectional survey of 475 U.S. legislators, we conducted bivariate analyses and multivariate logistic regression. Support for parity was highest for schizophrenia (57%), PTSD (55%), and major depression (53%) and lowest for anorexia/bulimia (40%). Support for parity was generally higher among females, more liberal legislators, legislators in the Northeast region of the country, and those who had previously sought treatment for mental illness. These findings highlight the importance of better disseminating evidence about anorexia/bulimia and can inform dissemination efforts about mental health parity laws to state legislators. [ABSTRACT FROM AUTHOR]

Gender differences may play a role in functional outcomes for individuals with schizophrenia. To better understand differences, an exploratory secondary analysis was conducted using data from a large, multi-site study of individuals with schizophrenia in treatment at Veterans Affairs medical centers. Participants completed surveys at baseline (n = 801; 734 men, 67 women) to assess demographics, symptoms, social supports, and recovery; and one year (n = 662; 604 men, 58 women) to assess quality of life and functioning. Hierarchical linear regressions examined interactions of baseline factors with functioning and quality of life. Women and men did not differ significantly in baseline social support, psychiatric symptoms, or recovery. Female gender predicted higher occupational functioning, while social functioning in men was inversely related to baseline symptom severity. Being married predicted higher quality of life for women, but not men. These findings may inform gender tailoring of services for schizophrenia. [ABSTRACT FROM AUTHOR]

Background: Healthcare fragmentation may lead to adverse consequences and may be amplified among older, sicker patients with mental health (MH) conditions.Objective: To determine whether older Veterans with MH conditions have more fragmented outpatient non-MH care, compared with older Veterans with no MH conditions.Design: Retrospective cohort study using FY2014 Veterans Health Administration (VHA) administrative data linked to Medicare data.Participants: 125,481 VHA patients ≥ 65 years old who were continuously enrolled in Medicare Fee-for-Service Parts A and B and were at high risk for hospitalization.Main Outcome and Measures: The main outcome was non-MH care fragmentation as measured by (1) non-MH provider count and (2) Usual Provider of Care (UPC), the proportion of care with the most frequently seen non-MH provider. We tested the association between no vs. any MH conditions and outcomes using Poisson regression and fractional regression with logit link, respectively. We also compared Veterans with no MH condition with each MH condition and combinations of MH conditions, adjusting for sociodemographics, comorbidities, and drive-time to VHA specialty care.Key Results: In total, 47.3% had at least one MH condition. Compared to those without MH conditions, Veterans with MH conditions had less fragmented care, with fewer non-MH providers (IRR = 0.96; 95% CI: 0.96-0.96) and more concentrated care with their usual provider (OR = 1.08 for a higher UPC; 95% CI: 1.07, 1.09) in adjusted models. Secondary analyses showed that those with individual MH conditions (e.g., depression) had fewer non-MH providers (IRR range: 0.86-0.98) and more concentrated care (OR range: 1.04-1.20). A similar pattern was observed when examining combinations of MH conditions (IRR range: 0.80-0.90; OR range: 1.16-1.30).Conclusions: Contrary to expectations, having a MH condition was associated with less fragmented non-MH care among older, high-risk Veterans. Further research will determine if this is due to different needs, underuse, or appropriate use of healthcare. [ABSTRACT FROM AUTHOR]

Objective: Access to trauma-informed sexual and reproductive health services (SRHS) among persons with mental illness (MI) is inadequate and may contribute to health disparities among this population. This qualitative study investigated health professionals' perspectives of SRHS delivery to patients receiving care at a behavioral health hospital. Methods: Semi-structured interviews were conducted in a convenience sample of 26 mental health professionals recruited from one behavioral health hospital. Interviews assessed participants' perceptions of current SRHS offerings, barriers, and opportunities to implement patient-centered SRHS at the hospital. A constant comparison thematic analysis was employed. Results: Participants noted patients' overlapping sexual and reproductive health (SRH) and mental health needs. Most participants indicated clinical responsibility to address these needs. However, participants stated they infrequently provided SRHS because of structural barriers within the healthcare system. Barriers included a lack of hospital policy and health professional education on SRH. Some participants who navigated around these barriers reported using an existing SRH screening tool. Conclusions: Patients receiving care at this behavioral health hospital have unmet SRHS needs. This lack of care may undermine the health of patients with MI. Addressing system level gaps requires clinical re-prioritization. Promising approaches to address this gap include reverse-integrated care models and improved SRHS training of health professionals. [ABSTRACT FROM AUTHOR]

Extending research on determinants of preparations for old age across adulthood, we examined the relationship between well-being, perceived control, and preparations for old age over time, along with variation in the strength of these relationships depending on domains of functioning, cultures, and age. We analyzed longitudinal data from the Ageing as Future study assessing changes in well-being, perceived control, and preparations in four different life domains (social relations, finances, work, and health) across a five-year period collected from adults aged from 30 to 85 years in Germany (N = 623), Hong Kong (N = 317), and the USA (N = 315). Positive feelings about one's current situation predicted greater perceived control five years later, and vice versa. Also, perceived control and preparations were positively associated over time, with only a few exceptions within each domain. For example, high control beliefs were related to subsequent greater preparations and well-being within the domain of social relations and finances, with weak effects of culture. These results suggest that current well-being may promote adaptive behaviors in later life, with the accumulated effects over time. Thus, focusing on how to improve our well-being may promote engagement in preparations for old age. Our results also indicate that these relations in our model vary by contexts, highlighting the importance of variability in age-related processes. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the relationships between demographic covariates, vocational rehabilitation (VR) services, and employment outcomes of individuals with anxiety disorders. The specific research question for the current study investigate demographic variables and vocational rehabilitation services as predictors of competitive employment outcomes. Methods: Data for the present study were extracted from the most recent United States Rehabilitation Service Administration 2018 Case Service Report (RSA-911) data. A purposeful selection, multivariate logistic regression analysis was conducted to examine the case service report data of 9266 individuals with anxiety disorders who received vocational rehabilitation services based on their demographic variables and receipt of VR services. Results: The results indicated that African Americans and Latinx, people who have completed high school or more, people who do not receive disability-related benefits, and those who received more vocational rehabilitation services were more likely to be gainfully employed. In addition, receipt of financial support for life crises and occupational credentials (i.e., other services and maintenance services) and vocational rehabilitation counseling and guidance services were significant predictors of employment outcomes. Conversely, receipt of supported employment and transition services were negatively associated with employment outcome. Conclusions: In the present study, we identified VR services that can improve and risk factors that can impede employment outcomes of people with anxiety disorders. We also identified medical, psychosocial, and vocational interventions that can lessen the effect of anxiety disorders on physical and mental health functioning. [ABSTRACT FROM AUTHOR]

The "spiritual but not religious" (SBNR) are a growing group in the religious landscape of the United States. Thousands of studies to date have been devoted to the study of religion and health, but far less attention has been given to the study of the "spiritual but not religious." In this study, we address this gap by using two waves of longitudinal data from the National Study of Youth and Religion (2005–2008). We assess whether within-person changes in SBNR identity are associated with health and mental health in emerging adulthood and consider several pathways that may account for observed differences. Results suggest that consistently identifying as SBNR was associated with worse physical and mental health relative to youth that were consistently religious. Using parametric mediation analyses, we found evidence that three of our four proposed mediators (religious attendance, sense of closeness to God, and religious doubt, but not life meaning) partially explained these mental health differences. This study therefore makes an important advance in assessing the health implications of (non)-religion/spirituality early in the life course. [ABSTRACT FROM AUTHOR]

Children in foster care in the United States face unique challenges related to access to health and education services. With the COVID-19 pandemic, many of those services were temporarily disrupted, adding burden to an already strained system. This observational study describes the experiences of licensed and kinship caregivers (N = 186) during the peak of COVID-19 stay-at-home orders and as restrictions to services were lifted, to understand the overall impact of COVID-19 on this already vulnerable population. Purposive sampling methods were used, where caregivers known to have received placement of children prior to, during, and following COVID-19 stay-at-home orders were identified and recruited to complete a 45-minute phone-administered survey assessing stress, risks for contracting COVID-19, strain resulting from COVID-19, and access to services for children in foster care in their care across five domains: healthcare, mental health, education, child welfare, and family visitation. Differences by caregiver type (licensed, kinship) and timing in the pandemic were examined. Licensed and kinship caregivers reported similar social and economic impacts of COVID-19, including similar rates of distress for themselves and the youth placed with them. Almost half of caregivers experienced challenges accessing mental health services, with access to services more disrupted during COVID-19 stay-at-home orders. Caregiver reports regarding the social and economic impacts of COVID-19 were similar across the study, suggesting that lessened restrictions have not alleviated strain for this population. [ABSTRACT FROM AUTHOR]

Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted. [ABSTRACT FROM AUTHOR]

There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors' interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda. [ABSTRACT FROM AUTHOR]

Searching online for health information plays a vital role in the decision-making process to seek mental healthcare for relationship and sexual issues, especially among people with marginalized identities. The landscape of intimate arrangements in the U.S. is rapidly changing, yet it is unclear whether diverse intimate relationships are discussed in popular relationship-focused mental health resources. In the present research, we sought to understand how six diverse intimate relationships were represented in a set of online mental health resources focused on relationship and sexuality issues. We conducted a content analysis of 23 mental health articles; articles were coded for surface-level (1) and complex (2 through 5) representation: (1) the frequency at which six diverse relationship types were mentioned, (2) awareness of stigma (prejudicial experiences based on relationship type), (3) unique situations (experiences that are specific to a relationship type), (4) clinical recommendations (suggestions made for a specific relationship type) and (5) inclusive language. Overall, the frequency at which relationships were mentioned (surface-level representation) greatly varied: monogamous relationships (82.61%), singles (39.13%), blended families/stepfamilies (26.09%), same-sex/queer relationships (21.74%), multi-racial/cultural relationships (21.74%), and consensually non-monogamous relationships (0%). Complex representations, including stigma, unique situations, and recommendations for each diverse relationship type were infrequently mentioned (< 14% and, in many cases, never mentioned). These results illustrate that relationships other than monogamy were infrequently mentioned and, if mentioned, content related to diverse relationships lacked relevant and inclusive details, including clinical recommendations. [ABSTRACT FROM AUTHOR]

Violent crime remains a prevalent threat to population health within the United States. States offer varying policy approaches to prevent violent crime and support behavioral health, such as community-based programs that include substance use disorder prevention and treatment. Using state mental health agency data, we construct a panel of U.S. states over nine years and apply an instrumental variables empirical model with state and time fixed effects to adjust for policy endogeneity, omitted variable bias, and time trends. We find that a 10% increase in community-directed state mental health agency expenditures yielded nearly a 4% reduction in violent crime rates. Larger magnitude reductions in violent crime rates were associated with the presence of gun control regulations and increases in the proportion of the population completing secondary education. Policymakers should consider the added benefit of violent crime reduction when considering budgetary allocations of community-directed state mental health agency expenditures. [ABSTRACT FROM AUTHOR]