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BackgroundDuring the COVID-19 pandemic, health care systems were faced with the urgent need to implement strategies to address the behavioral health needs of health care workers. A primary concern of any large health care system is developing an easy-to-access, streamlined system of triage and support despite limited behavioral health resources.ObjectiveThis study provides a detailed description of the design and implementation of a chatbot program designed to triage and facilitate access to behavioral health assessment and treatment for the workforce of a large academic medical center. The University of California, San Francisco (UCSF) Faculty, Staff, and Trainee Coping and Resiliency Program (UCSF Cope) aimed to provide timely access to a live telehealth navigator for triage and live telehealth assessment and treatment, curated web-based self-management tools, and nontreatment support groups for those experiencing stress related to their unique roles.MethodsIn a public-private partnership, the UCSF Cope team built a chatbot to triage employees based on behavioral health needs. The chatbot is an algorithm-based, automated, and interactive artificial intelligence conversational tool that uses natural language understanding to engage users by presenting a series of questions with simple multiple-choice answers. The goal of each chatbot session was to guide users to services that were appropriate for their needs. Designers developed a chatbot data dashboard to identify and follow trends directly through the chatbot. Regarding other program elements, website user data were collected monthly and participant satisfaction was gathered for each nontreatment support group.ResultsThe UCSF Cope chatbot was rapidly developed and launched on April 20, 2020. As of May 31, 2022, a total of 10.88% (3785/34,790) of employees accessed the technology. Among those reporting any form of psychological distress, 39.7% (708/1783) of employees requested in-person services, including those who had an existing provider. UCSF employees responded positively to all program elements. As of May 31, 2022, the UCSF Cope website had 615,334 unique users, with 66,585 unique views of webinars and 601,471 unique views of video shorts. All units across UCSF were reached by UCSF Cope staff for special interventions, with >40 units requesting these services. Town halls were particularly well received, with >80% of attendees reporting the experience as helpful.ConclusionsUCSF Cope used chatbot technology to incorporate individualized behavioral health triage, assessment, treatment, and general emotional support for an entire employee base (N=34,790). This level of triage for a population of this size would not have been possible without the use of chatbot technology. The UCSF Cope model has the potential to be scaled, adapted, and implemented across both academically and nonacademically affiliated medical settings.

Background: Medically ill youth are at increased suicide risk, necessitating early detection. This study aimed to assess the feasibility of administering the Death Implicit Association Test (Death IAT) to pediatric medical inpatients. Methods: Participants completed measures including the Ask Suicide-Screening Questions (ASQ) and the Death IAT. Results: Over 90% of participants found the Death IAT to be acceptable and more than 75% of participants were comfortable completing the task. There was a small, but statistically significant, improvement from pre-survey to post-survey reports of mood (t(174) = 3.02, p = 0.003, d = 0.15). Participants who endorsed a past suicide attempt on the ASQ had significantly higher “suicide” trial D-scores than those without a past suicide attempt (Wilcoxon W = 1312; p = 0.048; d = 0.61). Conclusions: Implementing an IAT measure among pediatric medical inpatients was feasible and acceptable. In exploratory analyses, “suicide” trial IAT D-scores were associated with past suicide attempts, suggesting future studies should examine whether implicit measures may be useful in hospital settings to augment detection of youth suicide risk.

FREE copy of the measure and scoring and interpretation guide for the Subjective Wellbeing Questionnaire (SSWQ).

The current study seeks to better understand the process by which medical professionals assess mental illness and their subsequent steps when mental illness is suspected or diagnosed (e.g., psychiatric or psychological referral, prescribing medication, etc.). Participants included 36 licensed medical professionals (80% physicians, 20% non-physicians) who are currently practicing in the United States. All participants completed an online survey that included questions about 1) participant demographics, 2) participant’s medical practice and training, 3) prevalence of mental illness in their patient population, 4) how they assess mental illness symptoms, and 5) steps they generally take if they recognize these symptoms in their patients. Additional questions asked about the specific referral processes for patients for whom the physician suspected low, moderate, and severe psychopathology. More than half (56.7%) of participants indicated they have not received training about mental health. Although nearly two-thirds (65.7%) of participants reported using routine screening measures, more than one third (35.3%) reported that non-medical professionals conduct these screenings. Results suggest that regardless of the severity of the patients’ mental illness the majority of participants referred the patient to a mental health professional; around three-quarters referred to specific providers. The second most common referral step was prescribing medications. This study highlights the importance of leveraging medical professionals’ interactions with their patients to improve mental health referrals for patients who may benefit from further mental health evaluation or treatment.

This study investigates how effective middle and high-school teachers in Indonesia are as informants in identifying mental health problems in adolescents (13-18 years old) identified by parents and students as at risk of experiencing mental health issues. We will compare the correlation between Indonesian teachers’ reports with parental and self-report to corresponding correlations in a large-scale existing UK data set publicly available from the UK data archive.

Measures of positive well-being are needed to support the shift away from a deficit-based approach to mental health. This study examined one measure, the Mental Health Continuum-Short Form (MHC-SF), as a measure of positive well-being used in school-based mental health monitoring efforts. This study used latent profile analysis (LPA) to explore the mental health classifications of 10,880 California high school students' responses to MHC-SF emotional, psychological, and social well-being items. Five latent mental wellness profiles emerged, including two ordered profiles (i.e., High Well-Being and Low Well-Being) and three profiles spanning the two ordered profiles. The High Well-Being profile had the most favorable psychological adjustment, and the three moderate well-being range profiles had differentiated functioning. Informing the utility of the MHC-SF, this study also compared the MHC-SF categorical diagnostic criteria with the LPA's empirical classification approach and found the two classification approaches to be congruent. The findings provide an impetus for educators to attend to students in moderate well-being ranges and emphasize promoting positive mental well-being as an essential component of school-based mental health services.

Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved without addressing the significant mental health and substance use problems among people living with HIV (PLWH) and people vulnerable to acquiring HIV. These problems exacerbate the many social and economic barriers to accessing adequate and sustained healthcare, and are among the most challenging barriers to achieving the end of the HIV epidemic. Rates of mental health problems are higher among both people vulnerable to acquiring HIV and PLWH, compared with the general population. Mental health impairments increase risk for HIV acquisition and for negative health outcomes among PLWH at each step in the HIV care continuum. We have the necessary screening tools and efficacious treatments to treat mental health problems among people living with and at risk for HIV. However, we need to prioritize mental health treatment with appropriate resources to address the current mental health screening and treatment gaps. Integration of mental health screening and care into all HIV testing and treatment settings would not only strengthen HIV prevention and care outcomes, but it would additionally improve global access to mental healthcare.

Background The mental health of first responders is an area of growing concern, with recent studies indicating significantly higher rates of PTSD, anxiety and depression than found in the general population (Berger et al., 2012; Syed et al., 2020). Many organisations use mental health screening to identify individuals at risk of developing posttraumatic stress disorder (PTSD) or other mental health conditions, though its effectiveness conducted pre- or post-employment is unclear. Aims This research aims to investigate the role that mental health screening may have in predicting PTSD and other types of psychological injury in first responders. Methods A systematic review of the research literature related to pre-employment screening of personality and other factors which may be predictive of later depression or PTSD symptoms in first responders was conducted. Nested case-control studies of 300 serving police officers with pre-employment personality screening (MMPI-2) data linked to information on long-term sick leave for psychological injury was analysed. A separate set of linked mental health surveys was conducted to examine variance in the number and severity of symptoms reported. Results Measures of dynamic factors including physiological responses to simulated trauma and maladaptive coping styles had stronger evidence as predictors of psychological vulnerability than assessments of static factors such as trauma history or pre-existing psychopathology. With the nested case control studies, conditional logistic regression analyses found no associations between any of the MMPI-2 scale scores, either in isolation or combination, and later psychological injury (OR = 0.89; 95% CI 0.78-1.02). Possible reasons for these findings are discussed, one being the under-reporting of symptoms. This hypothesis was tested by comparing responses on identical validated questionnaires (DASS-21 and PCL-5) administered by different organisations. As expected, police officers reported significantly lower levels of anxiety (p < 0.05) and PTSD (p < 0.001) symptoms on the employer-administered survey compared to the anonymous independent survey. Conclusions The available research evidence does not support the type of pre-employment mental health screening conducted by many first responder organisations. The under-reporting of symptoms in employer-administered surveys is a major barrier to the effectiveness of any screening.

Throughout the last decade, the Department of Defense (DOD) has experienced dozens of malicious insider attacks, causing significant damage to U.S. national security and the needless loss of life from mass shootings. Senior officials with the White House, the DOD, and other federal agencies have directed the development of new human-capital acquisitions processes to mitigate selecting federal civilians and military personnel who are susceptible to committing misconduct or insider attacks. The statistical relevance surrounding the DOD personnel problems associated with misconduct and significant insider attacks reinforces the need for reformed methodologies specifically directed toward the human-capital acquisitions process. This capstone report first demonstrates the scientific evidence and behavioral similarities associated with individuals who engage in misconduct and historical malicious insider attacks within the DOD. The intent is to then justify the implementation of innovative screening methodologies within the acquisition process to disqualify applicants with severe indicators of vulnerable predisposition precursors exhibited by individuals who commit misconduct and insider attacks. The report's recommended Enhanced Assessment Program focuses efforts on preliminarily screening tentative candidates for mental health disorders and personality traits as an initial point to identify the threat-vulnerable predisposition precursors for further evaluation. http://archive.org/details/mitigatingdepart1094566616 Major, United States Army Approved for public release. distribution is unlimited

Background Previous studies have reported a wide range of prevalence of post-donation anxiety, depression, and regret in living kidney donors (LKDs). It is also unclear what risk factors are associated with these outcomes. Methods We screened 825 LKDs for anxiety and depression using 2-item GAD-2 and PHQ-2 scales and asked about regret. Results Overall, 5.5% screened positive for anxiety, 4.2% for depression, and 2.1% reported regretting their donation. While there was moderate correlation between positive anxiety and depression screens (r = 0.52), there was no correlation between regret and positive screens (r

Background Mental health (MH) problems have considerable personal and societal implications. Systematic MH screening may raise general practitioners’ (GP) awareness of the current need of treatment in their listed patients. The focus of MH screening has so far been on increasing diagnostic rates and treatment of mental disorders, whereas cessation of MH treatment after normal test results has rarely been studied. This study aims to examine the mental healthcare trajectories after MH screening combined with feedback on both positive and negative screening results to the GP. Methods This prospective cohort study is based on data from 11,714 randomly selected individuals aged 30–49 years, who were invited to a preventive health check in Denmark during 2012–2015. A total of 5970 (51%) were included. MH status was assessed using the SF-12 Health Survey Mental Component Summary score, and scores were categorised into poor, moderate, and good MH. ‘Mental healthcare’ within 1 year of follow-up covered the following MH support: psychometric testing by GP, talk therapy by GP, contact to psychologist, contact to psychiatrist, and psychotropic medication. Results MH was found to be poor in 9%, moderate in 25%, and good in 66% of participants. After 1 year, mental healthcare was initiated in 29% of the participants with poor MH who did not receive mental healthcare at baseline, and mental healthcare was ceased in 44% of the participants with good MH who received mental healthcare at baseline. Odds ratio (OR) for initiation of mental healthcare was associated with worse MH screening status: poor MH: OR 7.1 (5.4–9.4), moderate MH: OR 2.4 (1.9–3.1), compared to those with good MH. OR for cessation of mental healthcare was associated with better MH screening status: good MH: OR 1.6 (1.1–2.6), moderate MH: OR 1.6 (1.0–2.4), compared to those with poor MH. Initiation and cessation of mental healthcare appeared to be time-related to the MH screening. Conclusions MH screening combined with feedback on both positive and negative screening results to the GP may contribute to relevant initiation and cessation of mental healthcare. Trial registration Registration of the Check Your Health-trial: ClinicalTrials.gov (NCT02028195), 7 March 2014. Electronic supplementary material The online version of this article (10.1186/s12875-018-0864-9) contains supplementary material, which is available to authorized users.

© 2015 American Psychological Association. The high burden of exposure to chronic life adversities and trauma is quite prevalent, but assessment of this risk burden is uncommon in primary care settings. This calls for a brief, multiple dimensional mental health risk screening tool in primary care settings. We aimed to develop such a screening tool named the University of California, Los Angeles (UCLA) Life Adversities Screener (LADS). Using pooled data across 4 studies from the UCLA Center for Culture, Trauma, and Mental Health Disparities, 5 domains of mental health risk including perceived discrimination, sexual abuse histories, family adversity, intimate partner violence, and trauma histories, were identified. Regression models for depression (Centers for Epidemiology Studies Depression Scale) and posttraumatic stress disorder (Posttraumatic Diagnostic Scale), controlling for demographic factors, were fitted to develop a weighted continuous scale score for the UCLA LADS. Confirmatory factor analysis supported the 5-domain structure, while item response theory endorsed the inclusion of each item. Receiver operating characteristic analysis indicated that the score was predictive for classifying subjects as reaching clinical threshold criteria for either depression (Beck Depression Inventory-II ≥ 14 or Patient Health Questionnaire-9 ≥ 10) or anxiety (Patient Health Questionnaire-13 ≥10). An optimal cut of 0.33 is suggested based on maximizing sensitivity and specificity of the LADS score, identifying patients at high risk for mental health problems. Given its predictive utility and ease of administration, the UCLA LADS could be useful as a screener to identify racial minority individuals in primary care settings who have a high trauma burden, needing more extensive evaluation.

Background There is a growing consensus about the importance of mental health screening of youths in welfare and juvenile justice institutions. The Massachusetts Youth Screening Instrument-second version (MAYSI-2) was specifically designed, normed and validated to assist juvenile justice facilities in the United States of America (USA), in identifying youths with potential emotional or behavioral problems. However, it is not known if the USA norm-based cut-off scores can be used in Switzerland. Therefore, the primary purpose of the current study was to estimate the diagnostic performance and optimal cut-off scores of the MAYSI-2 in a sample of Swiss youths in welfare and juvenile justice institutions. As the sample was drawn from the French-, German- and Italian-speaking parts of Switzerland, the three languages were represented in the total sample of the current study and consequently we could estimate the diagnostic performance and the optimal cut-off scores of the MAYSI-2 for the language regions separately. The other main purpose of the current study was to identify potential gender differences in the diagnostic performance and optimal cut-off scores. Methods Participants were 297 boys and 149 girls (mean age = 16.2, SD = 2.5) recruited from 64 youth welfare and juvenile justice institutions (drawn from the French-, German- and Italian-speaking parts of Switzerland). The MAYSI-2 was used to screen for mental health or behavioral problems that could require further evaluation. Psychiatric classification was based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime version (K-SADS-PL). The MAYSI-2 scores were submitted into Receiver-Operating Characteristic (ROC) analyses to estimate the diagnostic performance and optimal ‘caution’ cut-off scores of the MAYSI-2. Results The ROC analyses revealed that nearly all homotypic mappings of MAYSI-2 scales onto (cluster of) psychiatric disorders revealed above chance level accuracy. The optimal ‘caution’ cut-off scores derived from the ROC curve for predicting (cluster of) psychiatric disorders were, for several MAYSI-2 scales, comparable to the USA norm-based ‘caution’ cut-off scores. For some MAYSI-2 scales, however, higher optimal ‘caution’ cut-off scores were found. Conclusions With adjusted optimal ‘caution’ cut-off scores, the MAYSI-2 screens potential emotional or behavioral problems well in a sample of Swiss youths in welfare and juvenile justice institutions. However, as for choosing the optimal ‘caution’ cut off score for the MAYSI-2, both language as well as gender seems to be of importance. The results of this study point to a compelling need to test the diagnostic performance and optimal ‘caution’ cut-off scores of the MAYSI-2 more elaborately in larger differentiated language samples in Europe.

Purpose Although the prevalence of mental health disorders in Nigeria is comparable to most developed countries, access to mental health care in Nigeria is limited. Improving access to care requires innovative approaches that deliver mental health interventions at the community level. The aim of this study was to determine the feasibility and acceptability of integrating mental health screening into an existing community-based program for prevention of mother-to-child transmission of HIV targeted at pregnant women and their male partners. Methods Pregnant women and their male partners from 117 churches enrolled in the healthy beginning initiative (HBI) in southeast Nigeria participated in the mental health screening project. Two members from each church were trained as church-based health advisors to administer the 12-item general health questionnaire. Results Ninety-three percent of the pregnant women and their male partners agreed to participate and fully completed the questionnaire. Overall, 21.7 % of the respondents scored above the threshold of 11 indicating significant psychological distress, with women having significantly higher scores than men. Conclusion Mental health screening is feasible and well accepted among a cohort of pregnant women and their male partners. Church members can be trained as health advisors to administer mental health screening. Mental health interventions can be developed on the framework of the HBI.

Community-based perinatal depression recognition and management: a qualitative study on the perspectives of pharmacists and an educational resource. Introduction Perinatal depression (PND) is a significant public health problem affecting up to 13% of mothers and often remains undiagnosed. Pharmacists are highly accessible to perinatal mothers and are in an ideal position to screen women for PND.. Objectives To explore the perspectives of Australian pharmacists about their current experiences with perinatal women and the prospect of pharmacist-led PND screening. Methods In Phase 1, semistructured phone interviews were conducted with twenty Australian pharmacists. The subsequent development, implementation and evaluation of the "Perinatal Mental Health in the Pharmacy" (PMHP) educational program with fifteen Australian pharmacists constituted Phase 2 of this study. Results Phase 1 results indicated that pharmacists believed they were ideally placed to screen for PND but that they required further training to do so. Participants in Phase 2 of the study reported that their tertiary training did not adequately prepare them for conducting PND screening and that the PMHP educational intervention improved their confidence in assessing and referring suspected cases of PND. Conclusion Pharmacy represents just one of multiple avenues within the community where PND may be detected. The reported improvement in pharmacist confidence with PND detection and referral upon completion of the educational intervention suggests that though pharmacists are willing to conduct PND-screening, they require further training before pharmacy-based screening programs can be implemented. Further research into the outcomes of pharmacist-led PND screening is recommended.