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Background: Globally, adolescent depression is prevalent. There is, however, a dearth of studies investigating behavioral intention to professional help-seeking regarding mental health problems among adolescents having probable depression. Based on the Stress Coping Theory, the hypothesis that personal resources and active coping would mediate between interpersonal resources and behavioral intention to professional help-seeking was investigated., Methods: Students from five junior middle schools, three senior high schools, and one vocational school were selected to participate in the survey from February to March 2022 via convenient sampling. The questionnaire collected participants' characteristics, depression, peer acceptance/support, resilience, self-compassion, active coping, and behavioral intention to professional help-seeking. The final sample included 1,425 Chinese adolescents having probable depression (Patient Health Questionnaire score ≥ 10). SPSS 23.0 and Mplus 8.3 were employed to analyze the data., Results: The prevalence of behavioral intention to professional help-seeking was 15.4%. Adjusted for background factors, peer acceptance, resilience, self-compassion, and active coping were significantly associated with behavioral intention to professional help-seeking (ORa ranged from 1.05 to 1.31). The indirect effects via active coping (β = 0.020) and a serial indirect effect via personal resources and active coping (β = 0.029) were statistically significant. The direct effect from interpersonal resources to behavioral intention to professional help-seeking was non-significant., Conclusion: The prevalence of behavioral intention to professional help-seeking among adolescents with probable depression was low and might render early detection/intervention ineffective. It is important to increase the intention to seek help from professionals. One possibility is to enhance interpersonal/personal resources and active coping., Competing Interests: Declarations. Ethics approval and consent to participant: This study was approved by the Medical Research Ethics Committee of the Affiliated Wenzhou Kangning Hospital of Wenzhou Medical University (No. KNLL-20211011002). Informed consent was obtained from all participants and their parents. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background and Objectives: The widespread adoption of virtual care during the pandemic may not have been uniform across populations, including among paediatric immigrants and refugees. We sought to examine the association between virtual mental healthcare utilisation and immigration factors., Methods: This population-based cohort study of immigrants and refugees (3-17 years) used linked health administrative databases in Ontario, Canada (March 2020 to December 2021). Exposures included self-reported Canadian language ability (CLA) at arrival and immigration category (economic class, family class and refugee). The primary outcome was the visit modality (inperson/virtual) measured as a rate of physician-based mental healthcare visits. Modified Poisson regression model estimated adjusted rate ratios (aRRs) with 95% CIs., Results: Among 22 420 immigrants, 12 135 (54%) did not have CLA (economic class: 6310, family class: 2207, refugees: 3618) and 10 285 did (economic class; 6293, family class: 1469, refugees: 2529). The cohort's mean age (SD) was 12.0 (4.0) years and half (50.3%) were female. Of 71 375 mental health visits, 47 989 (67.2%) were delivered virtually. Compared with economic class immigrants with CLA (referent), refugees with and without CLA had a lower risk of virtual care utilisation (CLA: aRR 0.89, 95% CI 0.86 to 0.93; non-CLA: aRR 0.80, 95% CI 0.77 to 0.83), as did family class immigrants with CLA (aRR 0.96, 95% CI 0.92 to 0.99). No differences in virtual care utilisation were observed among economic class immigrants with CLA and other immigrant groups., Conclusions: Language ability at arrival and immigration category are associated with virtual mental healthcare utilisation. Whether findings reflect user preference or inequities in accessibility, particularly for refugees and those without CLA at arrival, warrants further study., Competing Interests: Competing interests: NRS reported receiving personal fees from the BMJ Group Archives of Disease in Childhood, grants from the Canadian Institutes for Health Research and the Ontario Ministry of Health, grants from the Centre for Addiction and Mental Health, and grants from The Hospital for Sick Children outside the submitted work., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: A retrospective naturalistic evaluation was undertaken to identify if pre- and post-disaster factors may predict the likelihood of those considered "at risk" of post-traumatic stress disorder (PTSD) entering a post-disaster clinical treatment program., Methods: The intake data of 881 people referred to the program following the Queensland (Australia) natural disasters of 2010-11 was evaluated. Those referred scored >2 on the Primary Care PTSD scale. Assessment included the disaster exposure experience, demographic and clinical information, and measures of coping and resilience. Descriptive analyses and a Classification Tree Analysis (CTA) were undertaken to ascertain which factors may predict treatment participation., Results: The treatment group (TG) in comparison to the non-treatment group (NTG) were more likely to perceive their life was threatened (85.1% vs 8.1%), less able to cope (67% vs 25.8%) and less resilient (4.2% vs 87.5%). The CTA using all the assessment variables found the Connor-Davidson (2-item scale) ( P < 0.001), degree of property damage ( P < 0.001), financial losses ( P < 0.001), perception their life was threatened ( P < 0.001) and insurance claims ( P < 0.003) distinguished the TG from the NTG., Conclusions: The study identified factors that distinguished the TG from the NTG and predicted the likelihood of participation in a post-disaster mental health treatment.

Background: There is limited evaluation of approaches to identify patients with new onset bipolar affective disorder (BPAD) when using administrative datasets., Methods: Using the Massachusetts All-Payer Claims Database (APCD), we identified individuals with a 2016 diagnosis of bipolar disorder with mania and examined patterns of psychiatric and medical care over the preceding 48 months., Results: Among 4806 individuals aged 15-35 years with a 2016 BPAD with mania diagnosis, 3066 had 48 months of historical APCD data, and of those, 75 % involved information from ≥2 payors. After excluding individuals with historical BPAD or mania diagnoses, there were 583 individuals whose 2016 BPAD with mania diagnosis appeared to be new (i.e., 34 new diagnoses per 100,000 individuals aged 15-35 years). Most individuals received medical care, e.g., 98 % had outpatient visits, 76 % had Emergency Department (ED) visits, and 50 % had mental health-related ED visits during the 48 months prior to their first mania diagnosis. One-third (37.2 %) had a depressive episode before their initial BPAD with mania diagnosis., Limitations: Study was conducted in one state among insured individuals. We used administrative data, which permits evaluation of large populations but lacks rigorous, well-validated claims-based definitions for BPAD. There could be diagnostic uncertainty during illness course, and clinicians may differ in their diagnostic thresholds., Conclusions: Careful examination of multiple years of patient history spanning all payors is essential for identifying new onset BPAD diagnoses presenting with mania, which in turn is critical to estimating population rates of new disease and understanding the early course of disease., Competing Interests: Declaration of competing interest Dr. Benson reports volunteering for the Epic Behavioral Health Specialty Steering Board. Dr. Smoller is a member of the Scientific Advisory Board of Sensorium Therapeutics (with options), and has received grant support from Biogen, Inc. He is PI of a collaborative study of the genetics of depression and bipolar disorder sponsored by 23andMe for which 23andMe provides analysis time as in-kind support but no payments. Dr. Hsu consults for Cambridge Health Alliance, Brandeis University, University of Southern California, and Columbia University, and has received compensation for keynote speeches from the University of South Carolina and Invitrx., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The Latinx community faces an increasing amount of mental health challenges and disparities in care. While the contributing factors are complex, there are likely potential barriers related to connecting with mental health support and accessing care that can be addressed., Methods: To investigate barriers in connecting to mental health care, we conducted a cross-sectional survey of mental health service use and barriers in an urban community with a primarily Hispanic/Latinx ethnicity using a modified random walk approach for door-to-door data collection with a two-cluster sampling frame. Survey included questions on socio-demographic, mental health status, desire and attempt to seek care, and the Barriers to Access to Care Evaluation. Shapley additive explanation (SHAP) identified impactful barriers and demographic characteristics. Our primary outcome was the number of respondents who saw a professional in the past 12 months and the key determinants that enabled their successful connection. Secondary outcomes were people with poor mental health who had wanted or tried to seek any source of mental health support., Results: Of the 1004 respondents enrolled, 70.5% were foreign born; 63.4% were women. In the past 12 months, 23.8% of respondents wanted to connect with mental health care; 15.5% tried to connect, and only 11.7% successfully connected to mental health services. The two most cited barriers had the highest SHAP values: concerns about treatments available (65%) and financial costs (62.7%). Additional barriers with high SHAP values: being seen as weak and having no one to help them find care. Of demographic characteristics, age had the highest SHAP values., Conclusion: In a community with a high density of Latinx immigrants, just under half of respondents wanting mental health care successfully connected. Perceived informational, financial, and stigma-related barriers impacted the likelihood to connect with mental health care. These factors should be considered when designing programs and interventions to improve mental health care access and services in the Latinx community., (© 2024. The Author(s).)

Background: Technology-enhanced mental health platforms may serve as a pathway to accessible and scalable mental health care; specifically, those that leverage stepped care models have the potential to address many barriers to patient care, including low mental health literacy, mental health provider shortages, perceived acceptability of care, and equitable access to evidence-based treatment. Driving meaningful engagement in care through these platforms remains a challenge., Objective: This study aimed to examine predictors of engagement in self-directed digital mental health services offered as part of an employer-based mental health benefit that uses a technology-enabled care platform., Methods: Using a prospective, longitudinal design, we examined usage data from employees who had access to an employer-sponsored mental health care benefit. Participants had access to a digital library of mental health resources, which they could use at any time, including daily exercises, interactive programs, podcasts, and mindfulness exercises. Coaching and teletherapy were also available to. The outcome was engagement with the self-directed digital mental health resources, measured by the number of interactions. Poisson regression models included sociodemographic characteristics, patient activation, mental health literacy, well-being, PHQ-9 and GAD-7 scores at baseline, primary concern for engaging in treatment, and the use of coaching or teletherapy sessions., Results: In total 950 individuals enrolled in the study, with 38% using any self-directed digital mental health resources. Approximately 44% of the sample did not use the app during the study period. Those using both self-directed digital and 1:1 modalities made up about one-quarter of the sample (235/950, 24.7%). Those using only coaching or therapy (170/950, 17.9%) and those using only self-directed digital mental health resources (126/950, 13.3%) make up the rest. At baseline, these groups statistically significantly differed on age, PHQ-9, GAD-7, MHLS, and primary concern. Receipt of coaching and teletherapy was associated with the number of self-directed digital mental health resources interactions in adjusted Poisson regression modeling. Use of any coach visit was associated with 82% (rate ratio [RR] 1.82, 95% CI 1.63-2.03) more self-directed digital mental health resource interactions while use of any teletherapy session was associated with 80% (RR 1.80, 95% CI 1.55-2.07) more digital mental health resources interactions (both P<.001). Each additional year of age was associated with increased digital mental health resources interactions (RR 1.04, 95% CI (1.03-1.05), and women had 23% more self-directed digital resources interactions than men (RR 1.23, 95% CI 1.09-1.39)., Conclusions: Our key finding was that the use of coaching or teletherapy was associated with increased self-directed digital mental health resource use. Higher self-directed digital resource engagement among those receiving coaching or therapy may be a result of provider encouragement. On the other hand, when a participant engages with 1 modality in the platform, they may be more likely to begin engaging with others, becoming "super users" of all resources., (©Molly Aideen Nowels, Meghan McDarby, Lilla Brody, Evan Kleiman, Sara Sagui Henson, Cynthia Castro Sweet, Elissa Kozlov. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 07.11.2024.)

Objective: The study aims to evaluate anxiety and depression levels and access to mental health services among internally displaced persons (IDPs) in Mogadishu, Somalia., Design: A community-based, cross-sectional survey was carried out in IDP camps. Face-to-face interviews were conducted using a modified Hospital Anxiety and Depression Scale. Data were analysed using SPSS V.25.0, incorporating univariate and logistic regression analyses., Setting: The study was conducted in 10 IDP camps located in the districts of Daynile and Kahda in the Banadir region of Somalia between November and December 2023., Participants: The study included 522 randomly sampled individuals aged 18-70 years living in the selected IDP camps., Results: The study revealed high prevalence rates of anxiety (43.7%) and depression (35.8%) among IDPs in the selected districts. Of those with anxiety, 54% were categorised as borderline cases and 46% as severe cases. Similarly for depression, 72.7% were classified as borderline cases and 27.3% as severe cases. Significant associations were found between anxiety symptoms and variables such as camp residence (OR: 3.872, 95% CI 2.333 to 6.424), female gender (OR: 2.387, 95% CI 1.604 to 3.552), young age (OR: 6.319, 95% CI 4.309 to 9.267), marriage contract (OR: 4.569, 95% CI 2.850 to 7.325), lack of education (OR: 1.92, 95% CI 1.349 to 2.737) and past experiences of trauma (OR: 5.207, 95% CI 3.274 to 8.281). Depressive symptoms were significantly associated with younger age (OR: 1.536, 95% CI 1.069 to 2.208), lack of formal education (OR: 1.661, 95% CI 1.153 to 2.395) and history of trauma (OR: 3.695, 95% CI 2.529 to 5.400). Additionally, the study highlighted a grave shortage of mental health and psychosocial support (MHPSS) services. User evaluations of MHPSS services varied, indicating room for improvement., Conclusion: The study revealed elevated levels of anxiety and depression among IDPs in the districts of Kahda and Daynile in the Banadir region of Somalia, underscored by a critical shortage of MHPSS services, emphasising the need for tailored mental health interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Suicidal persons' contacts with services present a key opportunity for suicide prevention. However, interventions by services are not always effective. A deeper understanding of suicidal service users' agency and its implications may facilitate the provision of meaningful responses to help-seeking during suicidal crises. This abductive study explores the recovery-related agency of suicide attempt survivors and the perceived role of interactions with services in facilitating or hindering it., Methods: Fourteen Finnish suicide attempt survivors were interviewed in-depth on their experiences of interacting with services during a recent suicidal episode. An operationalization of recovery-related agency as the expressed ability to take (mental or physical) action in a direction perceived as aiding recovery from suicidality (i.e., the coupling of recovery-related intentionality and power) was used to explore transcribed interviews through directed content analysis. Data were further categorized based on whether the service context was perceived as helpful or unhelpful to recovery efforts., Results: All participants expressed both agency and non-agency in relation to their recovery process. The relational context provided by services was presented as highly relevant for the achievement and sustainability of recovery-related agency as well as for participants' experience of safety in instances when agency was lacking. The results are presented as a typology of recovery-related agency in its perceived relational context, with the categories of sustained agency, strained agency, contained non-agency and uncontained non-agency., Conclusions: The concept of agency helped capture important aspects of suicidal individuals' recovery-related efforts and the role of services in facilitating or hindering them. The findings illuminate the value of viewing suicidal service users as agents of their own recovery process as well as the potential costs of ignoring this perspective in service delivery and design., (© 2024. The Author(s).)

Importance: The rising suicide rates in the US emphasize the need for effective prevention. While telehealth has transformed access to mental health care, the impact of telehealth on suicide outcomes is unknown., Objective: To evaluate the association of virtual mental health services with individual-level suicide-related events (SREs)., Design, Setting, and Participants: This retrospective cohort study using broadband access as an instrumental variable assessed a national sample of Veterans Health Administration patients who received mental health care between March 1, 2020, and December 31, 2021. Participants were recently separated (ie, discharged or released from active duty) veterans who completed their active duty service between March 1, 2019, and December 31, 2020, and who received at least 2 outpatient or inpatient diagnoses related to major depressive disorder, substance use disorder, or posttraumatic stress disorder within the year before their most recent separation date. Data were analyzed May 1 to October 31, 2023., Exposure: Percentage of a patient's total mental health visits that were conducted virtually by psychiatrists, psychologists, or social workers within a calendar month., Main Outcomes and Measures: Binary measure indicating whether the patient had experienced an SRE (defined as a nonfatal suicide attempt, intentional self-harm, or suicide death) in a specific month and year as evaluated an instrumental variable probit model., Results: The sample included 66 387 data points from 16 236 unique recently separated veterans. Among these entries, 44 766 were for male veterans (67.4%), the mean (SD) age across the sample was 32.9 (8.9) years, and the sample was representative of the US veteran population. There were 929 SREs (1.4%). Virtual mental health visits comprised a mean (SD) of 44.6% (46.1%) of all mental health visits. In instrumental variable probit analyses accounting for factors simultaneously associated with use of virtual mental health care and SRE risk, a 1% increase in the probability of virtual mental health visits was associated with a 2.5% decrease in SREs., Conclusions and Relevance: Findings from this cohort study using a retrospective quasi-experimental design found that an increase in virtual mental health visits relative to total visits was associated with a statistically significant decrease in SREs, suggesting that providing virtual mental health services may reduce suicide-related outcomes.

Background: Transition readiness, or skills and preparation for navigating adult health care, is an important factor in the successful transition from child and adolescent mental health services (CAMHS) to adult care; however, predictors of transition readiness are not fully understood. One factor which may impact transition readiness among youth accessing CAMHS is the presence of a co-occurring physical health condition; however, this has not been previously examined. Within a cohort of youth receiving CAMHS, the objective of this study was to understand if there is an association between co-occurring physical health conditions and transition readiness and if this relationship is impacted by severity of mental health symptoms., Methods: This study was a secondary analysis of baseline data from the Longitudinal Youth in Transition Study, including 237 16- to 18-year-old youth accessing outpatient CAMHS from four different clinical sites. Participants completed self-report measures on mental health symptoms, functioning, service use, transition readiness, and physical health conditions. Multiple linear regression models were used to measure the association between the presence of health conditions and transition readiness scores as well as determine if there was an interaction between mental health symptoms and physical health conditions to predict transition readiness., Results: Co-occurring physical conditions were reported by 41% of youth and were associated with greater overall transition readiness. There was no interaction between mental health symptom severity and co-occurring physical conditions, though attention problems were independently associated with lower transition readiness scores., Conclusions: Youth accessing CAMHS who have a co-occurring physical condition have overall greater transition readiness than youth without a co-occurring condition. Further research should explore the role of frequency and types of healthcare encounters in transition readiness for transition age youth needing ongoing mental health care to better understand how to support self-management and care navigation skill development., (© 2024 The Author(s). Child: Care, Health and Development published by John Wiley & Sons Ltd.)

Background: There are an estimated 25 million transgender and gender diverse (TGD) individuals worldwide, with 1.2%-2.7% of this population being under the age of 18. Community studies describe increased rates of mental health difficulties such as depression, self-harm, suicidal ideation and difficulties with peer relationships for TGD youth over cisgender peers. However, comparatively little is known about the mental health symptomatology of TGD youth attending specialist mental health services (CAMHS) in the UK., Method: This cross-sectional study explored data from 170 young people participating in the Beating Adolescent Self-Harm (BASH) trial. Baseline data about self-harm, depression, and impact on daily life was compared for those who identified as TGD (n = 18) with those who identified as cisgender (n = 152)., Results: In the transgender group, 18 (100%) scored ≥27 on the MFQ suggesting severe depression and had total scores on the SDQ impact scale of ≥3, in the very high range. In comparison in the cisgender group, 140 (92.1%) scored ≥27 on the MFQ and 103 (67.8%) had total scores on the SDQ impact scale of ≥3. The TGD group reported higher rates of self-harm, poorer peer relationships, less prosocial behaviour and greater interference with friendships and leisure activities and impact in the classroom. Both groups reported similar symptoms of depression., Conclusions: Whilst this exploratory study has limitations, these results suggest that TGD youth attending CAMHS may experience greater mental health problems than their cisgender peers., (© 2024 The Author(s). Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Background: Due to rapidly increasing youth suicides in the U.S state of Utah, the legislature funded creation of a 24/7 texting-based smartphone app in Spanish and English targeting Utah's school aged population. Recent research elsewhere (in the Netherlands) suggests cost inhibits help seeking among the economically disadvantaged. We evaluate the relationship between poverty and app usage during the onset of the COVID-19., Method: Local demographics, social determinants of health and COVID-19 infection rates were modeled using a Bayesian spatio-temporal approach examining usage rates., Results: When controlling for generally researched suicide crisis covariates, app usage is shown to vary depending on economic status of the population, with the largest relative increases in use among disadvantaged youth., Discussion: This bilingual Spanish/English, texting (SMS) based, smart phone app crisis hotline proved effective at providing adolescents from certain populations access to mental health care. The groups discussed are in Census Block Groups (CBGs - neighborhoods) with higher poverty, and/or lower population density (rural areas). The usage of the crisis hotline by these populations increased relative to the overall population as the COVID-19 pandemic unfolded. However, adolescents from areas of higher mobility (our proxy for housing insecure) and those in areas with larger non-White populations had a relative decrease in usage., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

There is concern that basing healthcare budgets on risk adjustment estimates derived from historical utilisation data may reinforce patterns of unmet need. We propose a method to avoid this, based on a measure of how closely local health organisations align resources to the needs of their populations. We refer to this measure as the 'responsiveness of expenditure to need' and estimate it using national person-level data on use of acute hospital and secondary mental health services in England. We find large variation in responsiveness in both services and show that higher expenditure responsiveness in mental health is associated with fewer suicides. We then re-estimate the national risk-adjustment model removing the data from the organisations with the lowest expenditure responsiveness to need. As expected, higher need individuals are estimated to have higher expenditure needs when less responsive organisations are removed from the estimation of the risk-adjustment. Removal of organisations with below-average responsiveness results in the neediest deciles of individuals having an extra £163 (7%) annual need for acute hospital care and an additional £79 (27%) annual need for mental health services. The application of this approach to risk adjustment would result in more resources being directed towards organisations serving higher-need populations., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Objectives: Young Australians living in rural and remote locations have poorer mental health outcomes and higher rates of self-harm and suicide than their major city counterparts. Significant service gaps and barriers exist in accessing general and youth-specific mental health services. With a lack of access, comes delays in treatment and associated poorer outcomes. This paper describes the characteristics of young people requiring an aeromedical retrieval (AR) for acute inpatient psychiatric care., Study Design and Methods: A retrospective secondary analysis was conducted of Royal Flying Doctor Service ARs for a six-year period from 2016 to 2021. Data were summarised by demographic, geographic, and diagnostic factors., Results: The total sample size was 1534 (60% male, 40% female; and 31% aged 12-17 years, 69% aged 18-24 years), with 668 (43.5%) affected by schizophrenia and related disorders. Port Augusta, 300 km north of Adelaide, had the highest proportion of aeromedical retrievals (4.4%). The Women's and Children's Hospital in Adelaide received the highest proportion of retrievals (25.6%). Statistically significant gender and age differences were identified as were specific high-usage geographical locations across several Australian states., Conclusions: AR is essential for young people in accessing specialist acute health services. Developmentally appropriate, responsive, youth mental health services are mostly located in large, already well-resourced major cities. Our study provides valuable information to assist governments, communities, and services to enhance the resources available for young people who live rurally., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

This study undertakes a scoping review of reviews on barriers to accessing mental health care for refugees and asylum seekers in high-income countries. By assessing mental health care access using the Levesque's conceptual framework, we identify barriers along the patient care pathway and highlight research gaps. Following PRISMA-ScR guidelines, 10 relevant systematic and scoping reviews were identified and analyzed. Seven common barriers were identified, that could be located across different stages of the conceptual framework. Demand-side barriers included: (1) refugees' understanding of mental illness, (2) fear of stigma, (3) lack of awareness of services, (4) attitudes towards formal treatment; while supply-side barriers comprised: (5) language barriers, (6) practical and structural issues, and (7) providers' attitudes and competence. There was a focus on demand-side barriers as key determinants for low service use. We observed a paucity of quantitative studies linking barriers and indicators of access to care. In the context of well-established mental health care systems, previous research has largely explained low access through peculiarities of refugees and asylum seekers, thereby neglecting the role of supply-side factors (including system structures and attitudes of service providers). We discuss how future research can critically question prevailing assumptions and contribute to rigorous evidence., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To study the proportion and predictors of outpatient physician follow-up within 60 days of substance-related emergency department (ED) visits for Ontario youth., Methods: We examined administrative data on substance-related ED visits before and during the COVID-19 pandemic among youths aged 10-24 years in Ontario, Canada. Substance-related visits were identified using International Classification of Diseases-10-CA codes. We described demographic characteristics, receipt of mental health services in the year before the ED visit, disposition from the ED, and follow-up services within 60 days of the ED visit., Results: Between April 1, 2017, and May 31, 2021, 64,236 youth had at least one ED visit for substance use. Visits for alcohol were the most common (49%), followed by cannabis (32.3%). ED visits for all substances were more prevalent during the pandemic than prepandemic, except visits for alcohol. The receipt of follow-up physician care for substance use was low (33.2% prepandemic) but increased during the pandemic (41.7%; adjusted odds ratio 1.34, 95% CI 1.28, 1.39) and varied between substances. Mental health service history in the year before the substance-related ED visit had the strongest association with receipt of follow-up physician care within 60 days (adjusted odds ratio 6.86, 95% CI 6.57, 7.17)., Discussion: Youth frequently do not receive physician follow-ups within two months of the substance-related ED visit, although higher follow-up proportions were seen during the pandemic after the implementation of virtual care. Further research is required to understand why follow-up is low and to examine interventions that can increase connection to care., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Aims: The aim of this study was to examine the association between women's migrant status (majority, immigrant, descendant) and use of postpartum mental healthcare and investigate whether migration characteristics are associated with mental healthcare use., Methods: Retrospective cohort study. We included all mothers of children born between 2002 and 2018 in 34 municipalities of Denmark who had an identified mental health need as clinically assessed by a child health visitor (CHV) or by a score of 11 or more on the Edinburgh Postpartum Depression Scale (EPDS). Women were followed until the first mental healthcare received 2 years' postpartum, death or emigration. Using Cox regression models, we estimated the time to mental healthcare by migrant status and explored the role of migration characteristics., Results: A total of 29% of women ( n = 45,573) had a mental health need identified by the CHV, and 7% ( n = 4968) had an EPDS ⩾ 11. Immigrants accounted for 19.5%, and descendants for 4.7% of the sample. Immigrants were at lower risk of using mental healthcare than the majority group (CHV: hazard ratio adjusted (HRa) 0.75 (0.70-0.79), EPDS: HRa 0.67 (0.58-0.78)), as were descendants (CHV: HRa 0.77 (0.70-0.86), EPDS: HRa 0.69 (0.55-0.88)). Among migrants, those not refugees, newly arrived, whose partners were immigrants or descendants, and those originally from Africa showed a lower risk of using postpartum mental healthcare., Conclusions: Our findings emphasize the need to strengthen access to mental healthcare for immigrants and descendants experiencing postpartum mental health concerns and consider migration characteristics as indicators of potential inequalities in access to maternal mental healthcare ., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Proximity to mental health services is a predictor of timely access to services. The present study sought to investigate whether travel time was associated with engagement in coordinated specialty care (CSC) for early psychosis, with specific attention to whether the interaction of travel time by race and ethnicity had differential impact., Data Source/study Setting: Data collected between 2019 and 2022 as part of the New Journeys evaluation, the CSC model in Washington State., Study Design: This cross-sectional study included a sample of 225 service users with first episode psychosis (FEP) who had received services from New Journeys., Data Collection: Service users' addresses, and the physical location of CSC were geocoded. Spatial proximity was calculated as travel time in minutes. Scheduled appointments, attendance and program status were captured monthly by clinicians as part of the New Journeys measurement battery., Principal Findings: Proximity was significantly associated with the number of appointments scheduled and attended, and program status (graduation/completion and disengagement). Among Hispanic service users with spatial proximity further away from CSC (longer commutes) was associated with a lower likelihood of graduating/completing CSC compared to non-Hispanic service users (p = .04). Non-white services users had a higher risk of disengagement from CSC compared to white service users (p = .03); additionally, the effects of spatial proximity on disengagement were amplified for non-White service users (p = .03)., Conclusions: Findings suggest that proximity is associated with program engagement and partially explains potential differences in program status among ethnoracial group., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The current study explored differences in mental health problems, services utilization, and support of graduate students by gender, race/ethnicity, and year in school., Participants: Participants consisted of 734 graduate students from a large, Midwestern university., Methods: Graduate students answered a series of questionnaires in fall 2021 assessing their mental health, services utilization, and perception of services., Results: Women (vs men) and participants in their second year and beyond (vs first year) reported greater mental health problems, negative impact of the pandemic, and more services utilization. White (vs non-White) participants reported greater negative impact of the pandemic, greater services utilization, and less financial strain. Finances, lack of knowledge about resources, and inadequate communication from the university about services were reported as treatment barriers., Conclusion: Graduate students struggle with mental health, and universities may need to improve communication with and tailor their services to graduate students specifically to better support them.

Objective: Individuals with unhealthy alcohol use and comorbid depression or anxiety may be vulnerable to alcohol use escalation in times of stress such as the COVID-19 pandemic. Among a cohort of individuals with pre-pandemic unhealthy drinking, we compared changes in alcohol use by whether people had a depression or anxiety diagnosis and examined whether mental health treatment was related to these changes., Method: Using electronic health record data from Kaiser Permanente Northern California, we analyzed drinking changes during the pandemic (3/1/2020-6/30/2022) among adults identified in primary care with unhealthy alcohol use (exceeding daily/weekly recommended limits) pre-pandemic (1/1/2019-2/29/2020). Outcomes were mean changes in number of heavy drinking days (prior 3 months), drinks/week, drinks/day, and drinking days/week. Multivariable linear regression models were fit to (a) compare outcomes of patients with depression or anxiety diagnoses to those without, and (b) among patients with depression or anxiety, estimate associations between mental health treatment and outcomes., Results: The sample included 62,924 adults with unhealthy alcohol use, of whom 12,281 (19.5%) had depression or anxiety. On average, alcohol use significantly decreased across all measures during the pandemic; however, patients with depression or anxiety had greater decreases in drinks/week (adjusted mean difference [aMD] [CI] = -0.34 [-0.55, -0.12]) and drinking days/week (-0.15 [-0.20, -0.10]). No associations were found between mental health treatment and changes in drinking., Conclusions: Contrary to expectations, patients with unhealthy alcohol use and depression or anxiety decreased alcohol use more than those without depression or anxiety during COVID-19, regardless of whether they accessed mental health services.

Objectives: Early interventions improve outcomes for people at high risk of psychosis and are likely to be cost saving. This group tends to seek help for emotional problems - depression and anxiety - via primary care services, where early detection methods are poor. We sought to determine prevalence rates of high risk for psychosis in UK primary care mental health services and clinical outcomes following routinely delivered psychological therapies., Methods: We used a brief screen designed for settings with low base rates and significant time constraints to determine prevalence of high risk for psychosis in UK 'Talking Therapies' services. We examined socio-demographic characteristics, presenting problems and recovery trajectories for this group, compared with people not at risk of psychosis., Results: A 2-item screen selected for specificity yielded a prevalence rate of 3% in primary care mental health services. People at elevated risk of psychosis were younger and more likely to report at least one long-term physical condition. This group presented with higher levels of depression, anxiety and trauma symptoms at assessment and were less likely to have recovered at the end of treatment, compared to people not at risk., Conclusions: Very brief screening tools can be implemented in busy health care settings. The 3% of referrals to UK primary care psychological therapies services at elevated risk of psychosis typically present with more severe symptoms and greater levels of comorbidity and may require augmented interventions to recover fully., (© 2024 The Author(s). British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Objective: Black women in the United States experience increased risk for mental disorders and are less likely to have access to appropriate mental health treatment compared with White women. To develop culturally responsive strategies to improve Black women's access to mental health treatment, the authors evaluated social determinants associated with mental health treatment utilization and unmet mental health needs among Black reproductive-age women with serious psychological distress., Methods: The authors performed a secondary analysis of data from the National Survey on Drug Use and Health. Data from 2009 to 2019 were pooled and restricted to Black women ages 18-44 years with serious psychological distress (N=4,171). Logistic regressions were conducted to identify personal and social determinants (e.g., education, employment status, poverty, and insurance status) of mental health treatment utilization, alternative mental health treatment utilization (e.g., spiritual support and self-help), and perceived unmet mental health needs., Results: Education and employment status were significantly associated with all three outcomes. Among the women who reported unmet mental health needs, opposition to treatment and cost were the highest endorsed barriers. Differences were found by pregnancy status, with pregnant women being significantly less likely to endorse cost (p<0.001) and more likely to endorse time and transportation as barriers (p<0.01) to receiving mental health treatment., Conclusions: Strategies to improve mental health outcomes for Black women should focus on reducing cost and transportation barriers and on the development of culturally responsive intervention approaches that address Black women's concerns about mental health treatment., Competing Interests: The authors report no financial relationships with commercial interests.

To examine the association between scope-of-practice (SoP) regulations and racial disparities in pediatric mental health services. We used the National Survey of Children's Health (2016-2020; n = 33,790) to examine racial disparities in unmet mental health care needs and receipt of mental health medication between states with and without SoP expansions for psychologists and nurse practitioners (NP). Our primary outcomes were (1) unmet mental health care needs and (2) receipt of mental health medication. We examined heterogeneous treatment effects of SoP expansion on the outcomes using logistic regression with interaction terms between SoP expansion and race/ethnicity. We estimated population-level racial disparities for both outcomes stratified by SoP expansion to identify differences in racial disparities. The psychologist SoP expansion-associated reduction in unmet need was 15.8 percentage-points (CI= -25.3, -6.2) larger for Other-race children than for White children. The psychologist SoP expansion-associated increase in medication was 5.1%-points (CI=. 0.8, 9.4) larger for Black children and 5.6%-points (CI = 0.5, 10.8) for Other-race children. No differences were found for NP SoP expansion. Racial disparities in both outcomes were lower in psychologist SoP expansion states but varied in NP SoP states. Expanded SoP was generally associated with lower racial disparities in pediatric mental health care access., Competing Interests: Declarations. Conflicts of Interest: Phillip Hughes was awarded the 2023 Patrick H. DeLeon Prize for Outstanding Student Contribution to the Advancement of Pharmacotherapy from APA Division 55 (Society for Prescribing Psychology). The other authors have no relevant conflicts to disclose., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: In recent times, the world has witnessed unprecedented challenges, with the COVID-19 pandemic being a major disruptor to various aspects of daily life. This article delves into the profound impact of pandemics on primary care, specifically focussing on changes in antidepressant prescriptions and mental health referrals before, during, and after lockdowns in England, UK., Methods: In this retrospective study, we used anonymised individual-level electronic health record data from general practitioner (GP) practices in the North of England, UK. We applied a negative binomial-logit hurdle model and a multinominal logit regression model to assess the impact on antidepressant prescriptions and GP referral types, respectively., Results: The initiation of antidepressant prescriptions showed a notable decrease during and post lockdowns, with a minor uptick in ongoing antidepressant prescriptions during the lockdown periods. Over the course of lockdowns and beyond, there was a growing trend of patients being referred to social prescribing interventions. Notably, individuals from ethnic minorities were more inclined to receive fewer medical treatments and more social prescribing interventions., Conclusion: The increase in antidepressant prescriptions during the pandemic-related lockdowns was expected due to these challenging circumstances. Reduced referrals to secondary mental health services occurred as online counselling services were deemed inappropriate by some doctors, and patients were hesitant to seek face-to-face help. Notably, there was a rise in social prescribing referrals, emerging as a valuable resource for psychological support amid heightened mental health strain. Additionally, ethnic minority patients were less likely to receive medical treatments but more likely to be referred to social prescribing services. Despite the inevitable negative impacts of the COVID-19 pandemic, these findings highlight the active role of non-clinical support in a social model of health, addressing unmet needs and reducing barriers to mental health care for certain groups., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Homeless seniors confront distinct challenges regarding their mental health needs and service access. This study aims to illuminate the mental health landscape of homeless seniors by examining the prevalence of mental illness, utilization of mental health services, and perceived need for mental health care. The study comprises 177 homeless seniors in New York, NY. Findings indicate 10.2% experiencing depression, 10.2% schizophrenia, and 5.7% bipolar disorder. Despite high prevalence, there is a significant gap between diagnosed mental health conditions and service utilization, with only 50% of those with depression seeking care. Perceived need for mental health services emerges as a critical aspect of the study, with over half of those suffering from depression (61.1%; n = 11), PTSD (75%; n = 3), schizophrenia (77.8%; n = 14), and other mental illnesses (100%; n = 1) expressing a need for mental health care. Also, mental health conditions, loneliness, and levels of social support play significant roles in a need for mental health services., Competing Interests: Declarations. Research Involving Human Participants: - In February 2019, this study was approved by the IRB. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent: Informed consent was collected from all individual participants. Conflict of interest: The authors of this study declare that we have no conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: While understanding racial/ethnic disparities in mental health services use is a growing priority in colleges and universities, little is known the attitudes that may contribute to these disparities. Methods: This study investigates the relationship between clinic diversity, ethnic-racial identity, discrimination, and treatment attitudes. College students n  = 250 (Asian 21%, Black 11%, Latinx 23%, and White 45%) participated in an online experimental task rating hypothetical clinic websites that varied by clinician diversity and completed a series of self-report questionnaires. Results: Clinician diversity did not influence treatment attitudes, but discrimination and ethnic-racial identity were significantly related to treatment attitudes. Additionally, the relationship between public regard and treatment attitudes was moderated by race/ethnicity. Conclusions: By focusing on treatment attitudes rather than behaviors, this study addresses potential areas of intervention to address racial/ethnic disparities in college mental health.

The Veterans Health Administration (VA) increasingly purchases community-based care (CC) to improve healthcare access, including behavioral health. In 2018, VA introduced standardized episodes of care (SEOCs) to guide authorization and purchase of CC services for specific indications in a defined timeframe without bundling payment. In this retrospective cross-sectional study, we describe trends in VA and CC behavioral healthcare utilization using the VA Outpatient Psychiatry SEOC definition. Counts of Outpatient Psychiatry SEOC-allowable service and procedure codes during fiscal years 2016-2019 were organized according to four SEOC-defined service types (evaluation and management, laboratory services, psychiatry services, transitional care) and measured as percentages of all included codes. Trends comparing behavioral healthcare utilization between Veterans using any CC versus VA only were analyzed using a linear mixed effects model. We identified nearly 3 million Veterans who registered 60 million qualifying service and procedure codes, with overall utilization increasing 77.8% in CC versus 5.2% in VA. Veterans receiving any CC comprised 3.9% of the cohort and 4.7% of all utilization. When examining service type as a percent of all Outpatient Psychiatry SEOC-allowable care among Veterans using CC, psychiatry services increased 12.2%, while transitional care decreased 8.8%. In regression analysis, shifts in service type utilization reflected descriptive results but with attenuated effect sizes. In sum, Outpatient Psychiatry SEOC-allowable service utilization grew, and service type composition changed, significantly more in CC than in VA. The role of SEOCs and their incentives may be important when evaluating future behavioral healthcare quality and value in bundled services., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Objective: This study was designed to assess the relationship between mental health service utilization and heavy episodic drinking (HED) after controlling for demographic and student-level variables. Participants: A national sample of college undergraduate respondents to the 2017-2018 Healthy Minds Study survey ( n  = 67,427). Methods: Hierarchical logistic regression entering all variables on a single step. Subsequent logistic regression was used to assess interactions between mental health service variables and select demographic and student level variables. Results: Twenty-two demographic and student-level variables were associated with current HED (9 protective and 11 risk factors). Current mental health therapy was associated with a lower risk of current HED while mental health medication use in the past 12 months (but not currently) was associated with a higher risk of HED. Conclusions: Findings provide guidance to college/university community professionals given the responsibility of designing and implementing programs for mitigation of alcohol misuse on their campus.

Background: Access to university mental health services is poorly characterized. Our objectives were to (1) assess patterns of access and (2) explore predictability of contact with student mental health services. Participants: Data derived from the U-Flourish study, which includes a survey of successive cohorts of incoming undergraduate students attending Queen's University, located in Ontario, Canada (Cohort 1: 2018, Cohort 2: 2019). Methods: Survey data sets were deterministically linked to administrative data provided by Student Wellness Services. Analyses included cross-tabulation, logistic and negative binomial regression. Predictive modeling used LASSO regression. Results: Baseline symptoms were robust determinants of access. For example, a PHQ-9 rating in the severe range (≥ 20) was associated with an OR of 9.71 (95% CI: 4.46-21.1). A predictive algorithm did not outperform cut point-based interpretation of PHQ-9 or GAD-7 ratings. Conclusions: Self-reported symptoms are consistently associated with service use, supporting the widespread use of symptom screens.

Importance: More than 150 million people in India need mental health care but few have access to affordable care, especially in rural areas., Objective: To determine whether a multifaceted intervention involving a digital health care model along with a community-based antistigma campaign leads to reduced depression risk and lower mental health-related stigma among adults residing in rural India., Design, Setting, and Participants: This parallel, cluster randomized, usual care-controlled trial was conducted from September 2020 to December 2021 with blinded follow-up assessments at 3, 6, and 12 months at 44 rural primary health centers across 3 districts in Haryana and Andhra Pradesh states in India. Adults aged 18 years and older at high risk of depression or self-harm defined by either a Patient Health Questionnaire-9 item (PHQ-9) score of 10 or greater, a Generalized Anxiety Disorder-7 item (GAD-7) score of 10 or greater, or a score of 2 or greater on the self-harm/suicide risk question on the PHQ-9. A second cohort of adults not at high risk were selected randomly from the remaining screened population. Data were cleaned and analyzed from April 2022 to February 2023., Interventions: The 12-month intervention included a community-based antistigma campaign involving all participants and a digital mental health intervention involving only participants at high risk. Primary health care workers were trained to identify and manage participants at high risk using the Mental Health Gap Action Programme guidelines from the World Health Organization., Main Outcomes and Measures: The 2 coprimary outcomes assessed at 12 months were mean PHQ-9 scores in the high-risk cohort and mean behavior scores in the combined high-risk and non-high-risk cohorts using the Mental Health Knowledge, Attitude, and Behavior scale., Results: Altogether, 9928 participants were recruited (3365 at high risk and 6563 not at high risk; 5638 [57%] female and 4290 [43%] male; mean [SD] age, 43 [16] years) with 9057 (91.2%) followed up at 12 months. Mean PHQ-9 scores at 12 months for the high-risk cohort were lower in the intervention vs control groups (2.77 vs 4.48; mean difference, -1.71; 95% CI, -2.53 to -0.89; P < .001). The remission rate in the high-risk cohort (PHQ-9 and GAD-7 scores <5 and no risk of self-harm) was higher in the intervention vs control group (74.7% vs 50.6%; odds ratio [OR], 2.88; 95% CI, 1.53 to 5.42; P = .001). Across both cohorts, there was no difference in 12-month behavior scores in the intervention vs control group (17.39 vs 17.74; mean difference, -0.35; 95% CI, -1.11 to 0.41; P = .36)., Conclusions and Relevance: A multifaceted intervention was effective in reducing depression risk but did not improve intended help-seeking behaviors for mental illness., Trial Registration: Clinical Trial Registry India: CTRI/2018/08/015355.

A cross-sectoral partnership was formed in 2021 in support of the recommendations in an audit on access to state-funded mental health services. In this first paper, we aimed to describe the demographic and service utilisation of adults with a mental health diagnosis in the Western Australian state-funded health system from 2005 to 2021. Inpatient, emergency department, specialised (ambulatory) community mental health service, and death records were linked in individuals aged ≥ 18 years with a mental health diagnosis in Western Australia. Altogether, 392,238 individuals with at least one mental health service contact between 1st January 2005 and 31st December 2021 were included for analysis. Females, Aboriginal and/or Torres Strait Islander people, and those who lived outside major cities or in the most disadvantaged areas were more likely to access state-funded mental health services. While the number of individuals who accessed community mental health services increased over time (from 28,769 in 2005 to 50,690 in 2021), the percentage increase relative to 2005 was notably greater for emergency department attendances (127% for emergency department; 76% for community; and 63% for inpatient). Conditions that contributed to the increase for emergency department were mainly alcohol disorder, reaction to severe stress and adjustment disorders, and anxiety disorders. Sex differences were observed between conditions. The pattern of access increased for emergency department and the community plus emergency department combination. This study confirmed that the patterns of access of state-funded mental health services have changed markedly over time and the potential drivers underlying these changes warrant further investigation., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Department of Health Western Australia Human Research Ethics Committee (approval number: RGS0000004782) and the Curtin University Human Research Ethics Committee (approval number: HRE2022-0001). A waiver of consent was sought for the project. Consent for Publication: This manuscript followed the Reporting of studies Conducted using Observational Routinely-collected Data (RECORDS) statement ( https://www.record-statement.org/checklist.php ). Competing Interests: The authors have no competing interests to declare that are relevant to this article., (© 2024. The Author(s).)

Introduction: Youth experience significant mental health (MH) needs, and gender- and racially/ethnically-diverse youth are less likely than peers to receive care. School-based health centers (SBHCs) are a healthcare delivery model that may decrease disparities. This study examined the role of SBHCs in reducing disparities in MH care receipt among SBHC clients., Methods: Data from electronic health records of 5,396 youth ages 12 to 21 years who visited 14 SBHCs in one California county from 2021 to 2023 were analyzed in 2023-2024 using multiple logistic regression to assess disparities in MH care receipt and depression screenings., Results: Receipt of MH care from SBHCs varied significantly by gender but not age, sexual orientation, or race/ethnicity. Compared to female clients, males had reduced odds (AOR: 0.50) and gender-diverse clients had higher odds (AOR: 2.70) of receiving MH care. For receipt of depression screenings, male clients had reduced odds (AOR: 0.86); Latino clients had higher odds than white clients (AOR: 1.80); and older adolescents and young adults had higher odds than younger adolescents (AORs: 1.44 and 1.45, respectively). Receipt of follow-up MH care after a positive depression result varied only by gender, with male clients having reduced odds (AOR: 0.63)., Discussion: SBHCs may reach youth who are traditionally less likely to seek care in other settings, including racially/ethnically- and gender-diverse youth. As in other settings, engaging males in healthcare is an area for improvement. These findings help to demonstrate the potential of SBHCs for decreasing disparities in mental health care., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: Household economic adversity during adolescence is hypothesized to be a risk factor for poor mental health later in life. To test this hypothesis, we conducted a quasi-experimental analysis of an economic shock, the Great Recession of 2007-2009. We tested if going through adolescence during the Great Recession was associated with increased risk of major depressive episodes (MDE) and mental health treatment in young adulthood with potential moderation by household poverty to explore differences by economic adversity., Methods: We analyzed data on young adults age 18-29 years from the 2005-2019 National Survey on Drug Use and Health (N = 145,394). We compared participants who were adolescents during the recession to those followed-up prior to the recession. Regression analysis tested effect modification by household poverty status., Results: Adolescent exposure to the Great Recession was associated with higher likelihood of MDE during young adulthood (aOR = 1.30, 95% CI = 1.23, 1.37); there was no relationship with mental health treatment. Effects on MDE were stronger among those in households with higher incomes compared to those living in poverty., Conclusion: Findings support the hypothesis that exposure to the Great Recession during adolescence may have increased risk for MDE, but raise questions about whether the mechanism of this association is economic distress., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Child and adolescent mental health are major public health concerns in the US. Overall, 20% of US children have a reported mental health condition, while an estimated 40% will be diagnosed with one by age 18. Despite these concerns, little is known about factors associated with access to mental health services among children and adolescents. We analyzed data from a sample of 6655 children (aged 6 to 17 years) with either anxiety and/or depression drawn from the 2020-2021 National Survey of Children's Health (NSCH). A multivariable logistic regression model was fit to investigate predisposing, enabling, and need factors associated with caregiver's (i.e., parent or other guardian) perceived access to mental health services for their children. Approximately 50.8% of caregivers perceived obtaining mental health services for their children to be somewhat difficult, very difficult, or impossible. Children meeting criteria for having a medical home had lower odds of experiencing such difficulties (adjusted [a]OR = 0.38; 95% CI: 0.30-0.49). Further, compared to children who sometimes or never had health insurance coverage for mental or behavioral health needs, children who were always insured (aOR: 0.19; 95% CI 0.14, 0.25) and those who usually had coverage (aOR: 0.38; 95% CI 0.28, 0.51) had lower odds of experiencing perceived difficulties in obtaining care. The results indicate several enabling and need predictors of perceived access to mental health services--highlighting potential structural barriers to care access. Efforts to address access challenges should adopt a multifaceted approach and be tailored to families living in poverty, those with limited health coverage, and minoritized children with less than optimal general health., Competing Interests: Declarations. Competing Interests: The authors have no potential financial or non-financial conflicts of interest to declare with respect to the research, authorship, and/or publication of this article. Ethical Approval: The current study was exempt from IRB approval since we utilized de-identified, publicly-available secondary data, and the study was not considered human subjects research., (© 2024. The Author(s).)

Objectives: Common mental disorders affect high proportions of university students. This systematic review aims to summarize the barriers and facilitators to help-seeking for depression and anxiety among university students and provide evidence to improve mental health services. Methods: EMBASE, MEDLINE, and PsycINFO were searched for eligible papers. Inclusion criteria: (1) published between 1990 and 2021, (2) written in English, (3) had qualitative or quantitative methodology, (4) involved university students, (5) students had depression or anxiety, (6) students were explicitly asked about barriers and facilitators, (7) >60% of study population had mental illness. Results: Ten studies were included into this review. The most common barriers were self-reliance, stigma, and poor mental health literacy. Good mental health literacy and social encouragement were significant facilitators. Conclusions: Universities could encourage help-seeking by targeting stigma and increasing mental health literacy. Future research could explore the role of self-reliance in help-seeking and identify more facilitators.

Objective: Discriminatory practices in mental health care undermine the right to health of marginalized service users. Intersectional approaches enable consideration of multiple forms of discrimination that occur simultaneously and remain invisible in single-axis analyses. The authors reviewed intersectionality-informed qualitative literature on discriminatory practices in mental health care to better understand the experiences of marginalized service users and their evaluation and navigation of mental health care., Methods: The authors searched EBSCO, PubMed, MEDLINE, and JSTOR for studies published January 1, 1989-December 14, 2022. Qualitative and mixed-methods studies were eligible if they used an intersectional approach to examine discrimination (experiences, mechanisms, and coping strategies) in mental health care settings from the perspective of service users and providers. A qualitative evidence synthesis with thematic analysis was performed., Results: Fifteen studies were included in the qualitative evidence synthesis. These studies represented the experiences of 383 service users and 114 providers. Most studies considered the intersections of mental illness with race, sexual and gender diversity, or both and were performed in the United States or Canada. Four themes were identified: the relevance of social identity in mental health care settings, knowledge-related concerns in mental health care, microaggressions in clinical practice, and service users' responses to discriminatory practices., Conclusions: Discriminatory practices in mental health care lead to specific barriers to care for multiply marginalized service users. Universities and hospitals may improve care by building competencies in recognizing and preventing discrimination through institutionalized training., Competing Interests: The authors report no financial relationships with commercial interests.

Introduction: The COVID-19 pandemic led to major disruptions in the lives of university students, which is a population that is already at a greater risk of mental health concerns. Little is known about how the pandemic impacted distress and mental health services utilization among university students across the United States., Methods: Using survey data from the National College Health Assessment, both before the COVID-19 pandemic (pre-March 2020, n  = 88,986) and during the pandemic (Spring 2021, n  = 96,489), the present study examined mental health symptoms and utilization of mental health services among undergraduate students attending four-year universities in the United States., Results: There were notable increases in measures of psychological distress and reductions in well-being from before the pandemic to during the pandemic. However, overall utilization rates of mental health services slightly decreased from pre-pandemic to during the pandemic. Predictors of severe psychological distress included those who experienced loneliness, COVID-19 related stressors, and loss of a loved one from COVID-19. COVID-related stressors and loneliness were associated with higher utilization rates of mental health services, while well-being and resilience were associated with lower utilization rates., Discussion: Analyses revealed that several demographic groups were at an elevated risk for severe psychological distress, including non-binary, female, and sexual minority students, and especially those who identify as both non-binary and non-heterosexual. Results indicated that students of color, especially female students of color, were less likely to receive mental health services. Future research is needed to increase our understanding of the barriers to mental health service use among high-risk university students., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Russell, Abidogun, Lindley and Griffin.)

Objectives: To examine the relationship between acculturation, cultural perceptions surrounding mental health (MH) burden and utilization of MH services among South Asian (SA) adults in the United States., Design: Cross-sectional study., Setting: Online survey., Participants: Four hundred five SA adults (≥18 years old) residing in the United States., Methods: Cross-sectional study of acculturation, attitudes toward MH burden, and MH service utilization was conducted via online survey. Multivariate logistic regression models were employed to understand how these factors were associated with MH service utilization., Main Outcome Measure: Utilization of MH services., Results: Among the 405 participants, 49.0% identified as immigrants (75.1% Indian, 8% Bangladeshi, 5.5% Pakistani, and 3.8% from other SA countries). Current utilization of MH services was associated with comfort conversing in English (odds ration [OR]=5.99; 95% confidence interval [CI]=1.63, 27.02), having English-speaking peers (OR=3.80; 95% CI=1.12, 12.93), and having family (OR=2.37; 95% CI=1.21, 4.64) and peers (OR=5.64; 95% CI=1.71, 18.66) who used MH services. Participants with mostly SA peers (OR=0.48; 95% CI=0.23, 0.97) reported lower lifetime MH service utilization, and those with positive perceptions about MH burden reported higher lifetime utilization (OR=1.04; 95% CI=1.01, 1.09)., Conclusions: Comfort expressing emotions in English, knowledge of family/peer MH service use, and type of social connections were associated with MH service utilization among SA immigrants. Interventions should aim to increase SA languages in which MH services are offered and to engage with SA communities to increase acceptance of MH service utilization., Competing Interests: Conflict of Interest: No conflict of interest reported by the authors.

Objectives: This study aims to examine the proportions of patients referred to mental health, social and voluntary, community and social enterprise (VCSE) services and general practice and to assess care gaps among people presenting to the hospital following self-harm., Design: Population-based observational study. Data were extracted from hospital records., Setting: Three emergency departments (EDs) in Manchester, UK., Participants: 26 090 patients aged 15+ years who presented to participating EDs following self-harm and who received a psychosocial assessment by a mental health specialist., Primary and Secondary Outcome Measures: Primary outcome measures are as follows: care gaps, estimated from the proportion of patients with evidence of social and mental health needs with no new or active referral to mental health, social and VCSE services. Secondary outcome measures are as follows: proportions of referrals by groups of patients, estimated mental health and social needs of patients. Indicators of mental health and social need were developed with academic clinicians (psychiatrist, general practitioner and social worker) and expert lived experience contributors., Results: 96.2% (25 893/26 909) of individuals were estimated as having mental health needs. Among this group, 29.9% (6503/21 719) had no new or active referral to mental health services (indicating a care gap). Mental healthcare gaps were greater in men and those who were aged under 35 years, from a black, South Asian or Chinese ethnic group, living in the most deprived areas and had no mental health diagnosis, or alcohol, substance misuse, anxiety or trauma-related disorder. 52.8% (14 219/26 909) had social needs, with care gaps greater for men, individuals aged 45-64 and those who were unemployed or had a diagnosed mental disorder., Conclusions: Care gaps were higher among hospital-presenting groups known to have increased risks of suicide: men, those in middle age, unemployed individuals and those misusing substances. Improved access to mental health, social and VCSE services and general practice care is vital to reduce inequities in access to self-harm aftercare., Competing Interests: Competing interests: NK reports research grants and fees to related his research and implementation work in self-harm and suicide prevention from the Department of Health and Social Care, the National Institute for Health and Care Research, the Healthcare Quality Improvement Partnership and the National Institute for Health and Care Excellence (NICE). NK does not receive industry funding for research. NK is a member of England's National Suicide Prevention Strategy Advisory Group and is supported by Mersey Care NHS Foundation Trust. NK chaired the NICE guideline development group for the NICE depression in adults' guideline and was a topic expert member for the NICE suicide prevention guideline. NK chaired the guideline development group for the NICE guidelines on the longer-term management of self-harm and was a topic advisor on the 2022 NICE guideline on self-harm. FM was a member of the 2022 NICE guideline development committee. The other authors declare no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Harnessing mobile health (mHealth) solutions could improve the delivery of mental health services and mitigate their impact in Uganda and similar low-resource settings. However, successful adoption requires that mHealth solutions have good usability. We have previously implemented a telephone service to provide mental health information and advice in English and Luganda, utilizing an automated interactive voice response (IVR) system linked to live agents, including mental health care workers and peer support workers., Objective: This study aims to assess the usage and usability of this mental health telephone service., Methods: We obtained usage data from the system's call logs over 18 months to study call volumes and trends. We then surveyed callers to gather their characteristics and assess usability using the Telehealth Usability Questionnaire. Additionally, call recordings were evaluated for conversation quality by 3 independent health care professionals, using the Telephone Nursing Dialogue Process, and correlations between quality and usability aspects were investigated., Results: Over 18 months, the system received 2863 meaningful calls (ie, calls that went past the welcome message) from 1125 unique telephone numbers. Of these, 1153 calls (40.27%) stopped at the prerecorded IVR information, while 1710 calls (59.73%) opted to speak to an agent. Among those who chose to speak with an agent, 1292 calls (75.56%) were answered, 393 calls (22.98%) went to voicemail and were returned in the following working days, and 25 calls (1.46%) were not answered. Usage was generally sustained over time, with spikes in call volume corresponding to marketing events. The survey (n=240) revealed that most callers were caregivers of patients with mental health issues (n=144, 60.0%) or members of the general public (n=46, 19.2%), while a few were patients with mental health issues (n=44, 18.3%). Additionally, the majority were male (n=143, 59.6%), spoke English (n=180, 75.0%), had postsecondary education (n=164, 68.3%), lived within 1 hour or less from Butabika Hospital (n=187, 77.9%), and were aged 25-44 years (n=160, 66.7%). The overall usability score for the system was 4.12 on a 5-point scale, significantly higher than the recommended target usability score of 4 (P=.006). The mean scores for usability components ranged from 3.66 for reliability to 4.41 for ease of use, with all components, except reliability, scoring higher than 4 or falling within its CI. Usability scores were higher for Luganda speakers compared with English speakers, but there was no association with other participant characteristics such as sex, distance from the hospital, age, marital status, duration of symptoms, or treatment status. The quality of call conversations (n=50) was rated at 4.35 out of 5 and showed a significant correlation with usability (Pearson r=0.34, P=.02)., Conclusions: We found sustained usage of the mental health telephone service, along with a positive user experience and high satisfaction across various user characteristics. mHealth solutions like this should be embraced and replicated to enhance the delivery of health services in Uganda and similar low-resource settings., (©Johnblack K Kabukye, Juliet Nakku, Jackline Niwemuhwezi, James Nsereko, Rosemary Namagembe, Iris Dorothee Emilie Groen, Ritah Neumbe, Denis Mubiru, Caroline Kisakye, Roseline Nanyonga, Marie Sjölinder, Susanne Nilsson, Caroline Wamala-Larsson. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 21.10.2024.)

Aims: There is increasing concern over the mental distress of youth in recent years, which may impact mental healthcare utilisation. Here we aim to examine temporal patterns of mental healthcare expenditures in the Netherlands by age and sex in the period between 2015 and 2021., Methods: Comprehensive data from health insurers in the Netherlands at the 3-number postal code level were used for cluster weighted linear regressions to examine temporal patterns of mental healthcare expenditure by age group (18-34 vs 35-65). The same was done for medical specialist and general practitioner costs. Additionally, we examined interactions with gender, by adding the interaction between age, year and sex to the model., Results: Mental healthcare costs for younger adults (18-34) were higher than those for older adults (35-65) at all time points (β = 0.22, 95%-CI = 0.19; 0.25). Furthermore there was an increase in the strength of the association between younger age and mental healthcare costs from β = 0.22 (95%-CI = 0.19; 0.25) in 2015 to β = 0.37 (95%-CI = 0.35; 0.40) in 2021 ( p < 0.0001) and this was most evident in women ( p < 0.0001). Younger age was associated with lower general practitioner costs at all time points, but this association weakened over time. Younger age was also associated with lower medical specialist costs, which did not weaken over time., Conclusions: Young adults, particularly young women, account for an increasing share of mental healthcare expenditure in the Netherlands. This suggests that mental distress in young people is increasingly met by a response from the medical system. To mitigate this trend a public mental health approach is needed.

Introduction: Many mental disorders begin in early childhood. Without timely treatment, mental disorders experienced by young children can impair their learning ability and relationships with others, causing lifelong complications. However, not all children with a mental disorder in early childhood receive treatment., Methods: Using data collected from 46,424 children aged 2 to 8 years in the 2 most recent cycles of the National Survey of Children's Health (2021 and 2022), we estimated the prevalence of having a mental disorder and investigated factors associated with young children not receiving mental health care when needed. All analyses were adjusted for survey weights to account for the complex sampling design and nonresponse biases in generating nationally representative estimates., Results: In 2021 and 2022, 19.0% of US children aged 2 to 8 years had 1 or more mental disorders. Of these children, 9.1% reported not receiving any needed health care in the previous 12 months, and of these, 45.8% reported not receiving mental health services when needed. The primary reasons for not receiving needed health care were problems getting an appointment (72.1%), issues related to cost (39.3%), and services needed not being available in the area (38.5%). Poor experiences with health care providers were consistently associated with not receiving needed mental health services among children with mental disorders., Conclusion: Our findings suggest a strong link between health care factors and not receiving needed mental health services among US children with a mental disorder in early childhood. In addition to increasing the availability of mental health services and expanding health insurance coverage, future public health efforts should prioritize enhancing patients' experiences with health care providers.

US Asian adults and people with limited English proficiency (LEP) confront mental health treatment receipt disparities. At the intersection of racial and language injustice, Asian adults with LEP may face even greater disparity, but studies have not assessed this through explicitly intersectional approaches. Using 2019 and 2020 National Survey of Drug Use and Health data, we computed disparities in mental health treatment among those with mental illness comparing: non-Hispanic (NH) Asian adults with LEP to NH White adults without LEP (joint disparity), NH Asian adults without LEP to NH White adults without LEP (referent race disparity), NH Asian adults with LEP to those without LEP (referent LEP disparity), and the joint disparity versus the sum of referent disparities (excess intersectional disparity). In age- and gender-adjusted analyses, excess intersectional disparity was 26.8% (95% CI, -29.8 to 83.4) of the joint disparity in 2019 and 63.0% (95% CI, 29.1-96.8) in 2020. The 2019 joint disparity was 1.37 (95% CI, 0.31-2.42) times that if the race-related disparity did not vary by LEP, and if LEP-related disparity did not vary by race; this figure was 2.70 (95% CI, 0.23-5.17) in 2020. These findings highlight the necessity of considering the intersection of race and LEP in addressing mental health treatment disparities. This article is part of a Special Collection on Mental Health., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: The objectives of this study are as follows: (1) to estimate the prevalence of suicide risk among individuals seeking mental health and addiction (MHA) services in Nova Scotia; (2) to examine the relationship between substance use and suicide risk among this population., Setting: MHA intake programme, a province-wide centralised intake process established in 2019 by the Department of Health and Wellness of Nova Scotia., Participants: We included 22 500 MHA intake clients aged 19-64 years old who contacted MHA intake from 2020 to 2021., Primary Outcome Measures: During the intake assessment, clients were assessed for suicide risk (past suicide attempt, suicidal ideation during the interview or 2 weeks before the interview)., Results: The lifetime prevalence of suicide attempt was 25.25% in the MHA clients. The prevalence of mild and moderate/high suicide risk was 34.14% and 4.08%, respectively. Clients who used hallucinogens had the highest prevalence of mild and moderate/high suicide risk (61.3% and 12.9%, respectively), followed by amphetamine/methamphetamine (47.6% and 13.3%, respectively) and sedative/hypnotics (47.2% and 8.9%, respectively) users. Stimulant (aOR=1.84, 95% CI 1.23 to 2.75) and hallucinogen (aOR=3.54, 95% CI 1.96 to 6.43) use were associated with increased odds of moderate/high suicide risk compared with denying current use. Additionally, alcohol (aOR=1.17, 95% CI 1.06 to 1.30) and tobacco (aOR=1.20, 95% CI 1.10 to 1.30) use were associated with increased odds of mild suicide risk., Conclusion: Suicide behaviours were prevalent among clients seeking MHA services. Substance use is an important factor associated with suicide risk in this population. This result underscored the importance of considering substance use patterns when assessing suicide risk and highlighted the need for targeted interventions and preventive measures for individuals engaging in substance use. Future interventional studies are needed to identify and evaluate effective strategies for reducing substance use and suicide risk among clients of MHA central intake., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Importance: Flexible parental leave schemes can help families balance work, childcare, and postpartum treatment, including treatment for mental health. In Sweden, both parents are eligible to use parental leave simultaneously in the first year after birth; however, the consequences for postpartum mental health care uptake remain underinvestigated., Objective: To examine the association between parents' use of simultaneous parental leave and their use of postpartum mental health care in Sweden., Design, Setting, and Participants: This cohort study obtained baseline data from national registries in Sweden, including live births of singleton offspring between January 1, 2014, to December 31, 2015, and simultaneous parental leave use (any vs none) in the 12 months after birth. The population-based sample was composed of parental dyads (mothers and fathers) who were eligible for simultaneous parental leave and were followed up from January 1, 2015, to December 31, 2016. Statistical analyses were conducted between December 15, 2023, and August 14, 2024., Exposure: Simultaneous parental leave use up to 12 months post partum., Main Outcomes and Measures: Total population register data were used to identify maternal and paternal outpatient care visits for mental health (substance use disorder [SUD], mood or affective disorders, and stress-related disorders) and psychotropic prescription dispensations (antidepressants and anxiolytics) during the first postpartum year. Logistic regression was applied to estimate the odds of these outcomes by simultaneous parental leave use, controlling for parents' age, sociodemographic characteristics, and prebirth mental health care use. Robustness analyses using propensity score matching were performed., Results: The sample comprised 207 283 parental dyads, of whom 153 342 (74.0%) did not use simultaneous parental leave in the first postpartum year and 53 941 (26.0%) did. Among those who used simultaneous parental leave, the mean (SE) age at childbirth was 29.63 (0.02) years for mothers and 32.80 (0.03) years for fathers. Compared with mothers who did not use parental leave simultaneously with their partners, mothers who did were more likely to receive antidepressant prescriptions in the first postpartum year (odds ratio [OR], 1.07; 95% CI, 1.02-1.11). Fathers who used simultaneous parental leave vs those who did not had increased odds of SUD-related outpatient care visits (OR, 1.10; 95% CI, 1.02-1.20). Longer simultaneous parental leave was associated with greater odds of mental health care use for both parents, and earlier leave was associated with greater odds of health care use by mothers. Findings for mothers, but not fathers, remained significant in robustness analyses using propensity score matching., Conclusions and Relevance: This cohort study found that simultaneous parental leave use was associated with greater health care uptake for postpartum mental health conditions in both mothers and fathers. This finding supports the need to consider the benefits of generous family policies as well as the risks of structural obstacles to postpartum mental health care access across the world.

Introduction: There are disparities in child mental health treatment access and treatment retention in terms of race and ethnicity, socioeconomic status (SES), and insurance coverage. Institutions have invested in the integrated primary care (IPC) treatment model with the goal of improving treatment access and promoting child mental health equity., Objective: This study compared treatment attendance in an outpatient psychiatry clinic (OPC) versus an IPC clinic to assess whether the IPC was associated with reduced disparities in access to care and treatment retention., Methods: This study assessed whether there were differences in who is connected to care from the intake appointment to first follow-up appointment., Results: Results showed that the IPC clinic served a more diverse patient population than the OPC clinic in terms of SES, race, and ethnicity. Differences in treatment attendance in the IPC and OPC were also found. After controlling for race, ethnicity, insurance, and distance from patient's home zip code to clinic, the IPC treatment setting was associated with poorer intake and follow-up appointment attendance., Conclusions: The IPC model may be more accessible to historically underserved youth, but the treatment setting does not inherently eliminate disparities in child mental health treatment retention. Replication of this study has the potential to contribute to the external validity of study findings, improve quality assurance policies, and develop equitable workflow policies. Future research is needed to identify factors that can improve treatment attendance for populations who face greater retention barriers and to shine light on ways that healthcare systems may inadvertently maintain disparity in treatment retention., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The objective of this study was to determine regional variation in need for mental health care for Aboriginal and Torres Strait Islander adults (18+ years)., Methods: Three Australian Indigenous health surveys were analysed, and prevalence rates of high/very high psychological distress (as per the Kessler-5 tool) by the Index of Relative Socio-economic Disadvantage were computed and combined via meta-analysis. These estimates were applied to census population data to estimate regional needs and summed to geographic planning regions. Final estimates were assessed for face validity by comparing with other existing estimates of mental health need., Results: The Index of Relative Socioeconomic Disadvantage had a dose-response relationship with high/very high psychological distress, whereby the more disadvantaged an area, the greater the levels of reported distress. This methodology resulted in varying levels of need within South East Queensland., Conclusions: The approach was found to have good face validity and provides a data-driven method to determine relative levels of need., Implications for Public Health: To ensure equity of mental health service provision, planners should account for variation in levels of need within a catchment. This method may be used throughout Australia to determine regional variation in need for care where other data are lacking to ensure evidence-based investment planning decisions at the local level., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: In Australia, the first nationwide COVID-19 lockdown occurred in March 2020 bringing challenges for early intervention psychosis (EIP) services. Limited evidence exists on the impacts of the pandemic on treatment outcomes among EIP clients., Methods: This prospective cohort study analysed routine data from 15 headspace Early Psychosis centres in Australia. Participants were 12 to 25 years, meeting criteria for First Episode Psychosis (FEP) or Ultra High Risk of psychosis (UHR) comparing those who commenced treatment 'pre-COVID-19' (between 16th August 2018 and 15th August 2019), and 'during-COVID-19' (between 1st March 2020 and 15th September 2020). Clinical symptoms at treatment commencement were assessed using the Brief Psychiatric Rating Scale (BPRS) and the Kessler Psychological Distress Scale (K10). with outcomes after 6 months compared between cohorts using linear mixed-effects regression, controlling for confounders., Results: Of 1246 young people analysed (653 FEP, 596 UHR), significant improvements were observed with treatment in both groups (5 to 13-point reduction in BPRS score per 6-months treatment). Treatment effectiveness reduced during-COVID-19 for psychosis symptoms, with the FEP BPRS treatment effect lower by 4.3 points (95%CI: 0.5, 8.1). UHR clients had lower BPRS negative symptoms during-COVID-19 (p = 0.020). Service contacts increased during-COVID-19, with increased telehealth services (p < 0.001)., Conclusions: Early intervention remained effective for FEP and UHR, despite the pandemic and transition of EIP services to virtual service delivery. Reduced treatment efficacy in FEP psychosis symptoms may indicate potential limitations of telehealth. Further research to examine longer term clinical and functional outcomes due to the pandemic is required., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Reducing the use of coercive measures in inpatient child and adolescent mental health services (CAMHS) requires an understanding of current rates and associated factors. We conducted a systematic review of research published between Jan 1, 2010, and Jan 10, 2024, addressing rates and risk factors for mechanical, physical, or pharmacological restraint, seclusion, or forced tube feeding in inpatient CAMHS. We identified 30 studies (including 39 027 patients or admissions) with low risk of bias. Median prevalence was 17·5% for any coercive measure, 27·7% for any restraint, and 6·0% for seclusion. Younger age, male sex, ethnicity or race other than White, longer stay, and repeated admissions were frequently linked to coercive measure use. Variable rates and conflicting risk factors suggest that patient traits alone are unlikely to determine coercive measure use. More research, especially in the form of nationwide studies, is needed to elucidate the impact of care and staff factors. Finally, we propose reporting guidelines to improve comparisons over time and settings., Competing Interests: Declaration of interests NL was granted funding from the Swedish Research Council for a research project on inpatient CAMHS and coercive measure use. NL and AM received a research grant from ALF Medicine (Region Stockholm). NL has worked as a medical officer at the Swedish National Board of Health and Welfare describing and supporting inpatient CAMHS care nationally. AM has received payments from the Swedish Agency for Health Technology Assessment and Assessment of Social Services for providing medical expertise in a working group conducting a systematic review of alternatives to coercive measures in institutional care of children and youth. AM works as an inpatient child and adolescent psychiatrist and orders the use of coercive measures in clinical practice. MSL and AR declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)