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Introduction: In this study we examined the association of homelessness and emergency department (ED) use, considering social, medical, and mental health factors associated with both homelessness and ED use. We hypothesized that social disadvantage alone could account for most of the association between ED use and homelessness.Methods: We used nationally representative data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). Emergency department use within the prior year was categorized into no use (27,674; 76.61%); moderate use (1–4 visits: 7,972; 22.1%); and high use (5 or more visits: 475; 1.32%). We used bivariate analyses followed by multivariable-adjusted logistic regression analyses to identify demographic, social, medical, and mental health characteristics associated with ED use.Results: Among 36,121 respondents, unadjusted logistic regression showed prior-year homelessness was strongly associated with moderate and high prior-year ED use (odds ratio[OR] 2.31 and 7.34, respectively, P < 0.001). After adjusting for sociodemographic factors, the associations of homelessness with moderate/high ED use diminished (adjusted OR [AOR] 1.27 and 1.62, respectively, both P < 0.05). Adjusting for medical/mental health variables, alone, similarly diminished the association between homelessness and moderate/high ED use (AOR 1.26, P < .05 and 2.07, P < 0.001, respectively). In a final stepwise model including social and healthvariables, homelessness was no longer significantly associated with moderate or high ED usein the prior year.Conclusion: After adjustment for social disadvantage and health problems, we found no statistically significant association between homelessness and ED use. The implications of our findings suggest that ED service delivery must address both health issues and social factors.

Background: The United States is experiencing an opioid epidemic. Opioid use disorder (OUD) often co-occurs with behavioral addictions like gambling disorder. However, little is known regarding the prevalence and correlates of problematic pornography use (PPU) among people seeking treatment for OUD. Method: From October 2018 to March 2020, 1,273 individuals seeking OUD treatment were screened for PPU by completing the Brief Pornography Screen (BPS), an instrument validated in clinical and community samples for assessing PPU across multiple jurisdictions. Results: Among the sample (mean age=37.9+10.5 years; range 18-73), 13.8% of individuals acknowledged some PPU symptomatology (BPS score > 1), with 4.3% screening positive for PPU (PPU+; BPS score > 4). Individuals screening positive for PPU (PPU+) versus negative (PPU-) scored higher on measures of impulsivity (total UPPS-P (20-item) score 43.0 + 8.8 SD: PPU+: 49.2 + 6.7; PPU-: 42.6 + 8.7 (p<.0001), with differences seemingly attributable to higher scores on positive urgency (PPU+: 10.3+2.9; PPU-: 7.8 + 3.1; p<.0001)), negative urgency (PPU+: 11.8 + 2.7; PPU-: 10.1 + 3.2; p=0.0001)) and sensation-seeking (PPU+: 11.2 + 2.9; PPU-: 9.5 + 3.1; p<.0001) forms of impulsivity. Additional measures assessing other clinical characteristics (e.g., related to pain, self-harm, trauma and other factors) are planned for presentation. Conclusions: Individuals seeking treatment for OUD often have symptoms of and screen positive for PPU. Among individuals with OUD, those with versus without PPU appear more impulsive, and the nature of this relationship (e.g., with respect to other clinically relevant variables including treatment outcome) warrants additional investigation. [ABSTRACT FROM AUTHOR]

This column describes the planning and development of The Equilibrium Program (TEP) for multiply traumatized and neglected children and adolescents with mental and general medical problems in São Paulo, Brazil. The program is a partnership between university faculty, various service providers, the courts, and the city government. In the first step, child psychiatry faculty from the University of São Paulo visited central-city areas and group shelters to talk to street youths to better understand their needs. A nearby community sports center building was chosen to be a center where youths could access services and engage in recreational activities and where the work of family integration could be facilitated. A multidisciplinary team conducts an in-depth assessment and creates an intervention plan, overseen by a case manager. Challenges to implementing such programs are discussed. [ABSTRACT FROM AUTHOR]

The rise in the U.S. prison population over the past 40 years has heightened scrutiny of the incarceration of children and adolescents. Correlates of later reincarceration in this group, especially correlates relating to psychiatric and substance use disorders, are understudied in the U.S. population. We aimed to establish the prevalence and correlates of the reincarceration as adults of people incarcerated before age 18. Data were derived from clinical interviews and from validated diagnostic and psychometric instruments. They were obtained as part of a cross-sectional representative survey of the civilian U.S. population, the National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). We identified 1,543 adults (4.3% of the NESARC sample) who had been incarcerated before they were 18. Of these, 55.9 percent had subsequently been incarcerated as adults. In addition to variables that have been repeatedly identified in criminological research (less education, past antisocial behavior, and parental imprisonment), substance use disorder, bipolar disorder, and longer childhood incarceration were independently associated with incarceration as an adult. The possibility that psychiatric treatment could reduce reincarceration in this group warrants longitudinal and experimental research., (© 2024 American Academy of Psychiatry and the Law.)