Search Results (208)

Objective: This study aimed to investigate the impact of depression and anxiety disorders on mortality in women diagnosed with gynecologic cancers, utilizing nationwide retrospective cohort data. Methods: Data from the Korean National Health Insurance Service (NHIS) database, covering women diagnosed with cervical, endometrial, or ovarian cancers between 2007 and 2014, were analyzed. Women diagnosed with depression or anxiety disorders within one year after cancer diagnosis were identified and compared with a control group comprising patients with gynecologic cancers who did not develop either disorder during the same post-diagnosis period. Mortality was evaluated as the primary outcome. Results: Of 85,327 women analyzed, 784 (0.9%) were diagnosed with depression or anxiety disorders. Patients with depression or anxiety exhibited significantly higher mortality (38.4% vs. 29.9%; p < 0.001). Multivariate analysis indicated that depression significantly increased mortality risk (OR 1.46, 95% CI 1.27–1.66), whereas anxiety alone showed no significant effect (OR 0.97, 95% CI 0.74–1.27). Combined depression and anxiety showed the highest mortality risk (OR 1.47, 95% CI 1.31–1.65). Conclusions: Depression and anxiety disorders are significant predictors of increased mortality in women with gynecologic cancers, emphasizing the necessity for integrated mental health assessment and interventions in oncologic care to improve both survival and quality of life. Full article

With the arrival of an aging society and the continuous extension of the human lifespan, the quality of life has not improved in a corresponding manner. People’s demand for happiness and health is increasing. As a result, a model emerged that integrates tourism and medical services, which is health tourism. This growing demand has prompted many service providers to see it as a business opportunity and enter the market. Tourism can help travelers release work stress and restore physical and mental balance; meanwhile, health check-ups and disease treatment can help them regain health. Consumers have long favored health and medical tourism because it helps relieve stress and promotes overall well-being. As people age, some consumers experience a gradual decline in physical functions, making it difficult for them to participate in regular travel services provided by traditional travel agencies. Therefore, this study aims to explore the service needs of health and medical tourism customers (tourists/patients) and the interrelationships among these service needs, so that health and medical tourism service providers can develop more customized and diversified services. This study identifies four key drivers of medical tourism services: medical services, medical facilities, tour planning, and hospitality facilities. This study uses the APA (attention and performance analysis) method to assess each dimension and criterion and utilizes the DEMATEL method with the NRM (network relationship map) to identify network relationships. By combining APA and NRM techniques, this study develops the APA-NRM technique to evaluate adoption strategies and identify suitable paths for health tourism services, providing tailored development strategies and recommendations for service providers to enhance the service experience. Full article

This study examines how medically disqualified NCAA Division I student-athletes experience the abrupt end of their athletic careers and how those experiences reflect broader cultural and psychological dynamics within college sport. Utilizing an interpretive phenomenology analysis, we explore if the experiences of National Collegiate Athletic Association (NCAA) Division I student-athletes, who become medically disqualified, can be conceptualized by researchers through the stages of the Kübler-Ross model addressing grief responses. Unlike the prior research criticizing the application of the model to injured athletes, we found ample support for the possible applicability of each emotional stage; however, our study findings also reveal that the staged transitions do not necessarily follow in sequential order, as suggested by Kübler-Ross. Thus, the model applies as a general framework of grief from loss, but not as a fixed set of grieving processes for elite student-athletes who become medically disqualified. We conclude with implications for NCAA policy, athlete mental health services, and the cultivation of exit cultures that prioritize human well-being over athletic productivity. Full article

Background/Objectives: Violence is a significant occupational health issue for paramedics, yet underreporting limits efforts to identify and mitigate risk. Leveraging a novel, point-of-event violence reporting system, we aimed to identify characteristics of 9-1-1 calls associated with an increased risk of violence in a single paramedic service in Ontario, Canada. Methods: We retrospectively analyzed all electronic violence and patient care reports filed by paramedics in Peel Region and used logistic regression to identify call-level predictors of any violence and, more specifically, physical or sexual assault. Results: In total, 374 paramedics filed 974 violence reports, 40% of which documented an assault, corresponding to a rate of 4.18 violent encounters per 1000 9-1-1 calls. In adjusted models, the risk of violence was elevated for calls originating from non-residential locations (e.g., streets, hotels, bars), occurring during afternoon or overnight shifts, and involving young or working-age males. Presenting problems related to intoxication, mental health, or altered mental status were strongly associated with increased risk, with particularly high adjusted odds ratios for assault. Conclusions: These findings support the utility of near-miss and violence surveillance systems and highlight the need for multidisciplinary crisis response to high-risk calls, especially those involving mental health or substance use. Full article

Background/Objectives: The Rapid Access and Stabilization Program (RASP), launched in Nova Scotia in April 2023, aims to improve timely psychiatric care, reduce reliance on emergency services, and provide early intervention. This study describes the sociodemographic and clinical characteristics of the RASP participants and examines their association with acute service use. Methods: This cross-sectional descriptive study used self-reported surveys and administrative data from 738 RASP participants. Descriptive statistics summarized key sociodemographic and clinical variables. Associations between these characteristics and acute service use (emergency department visits, inpatient admissions, and mobile crisis calls) were examined using chi-square and Fisher’s Exact tests. Bonferroni correction was applied for multiple comparisons. Results: The sample was predominantly female (65.2%) and aged 20–40 years (38.4%). Despite high rates of severe anxiety (53.9%) and depression (36.0%), acute service use was low: emergency department visits (7.2%), mobile crisis calls (1.0%), and inpatient admissions (0.8%). Preliminary analyses showed that education level and housing status were associated with ED visits and inpatient admissions. However, these associations did not remain statistically significant after Bonferroni correction. Conclusions: Although mental health symptom severity was high, acute mental health service use remained low after RASP enrollment, indicating the program’s potential in reducing reliance on crisis services. No participant characteristics were significantly associated with acute service use after adjustment, underscoring the complexity of predicting utilization and the need for robust multivariable models. Continued investment in rapid access programs may be essential to improving timely mental health care and supporting early intervention strategies. Full article

Background/Objectives: Healthcare workers (HCW) have increased the risk of occupational stress injuries and adverse mental health outcomes, which were exacerbated during the COVID-19 pandemic. Understanding HCW psychological distress patterns and help-seeking behaviors can inform responsive resource development that may mitigate negative outcomes in future crises. This paper provides insights on monthly trends in HCW distress and support utilization at a large Canadian hospital over a 14-month period. Methods: As part of a hospital-wide wellness initiative during COVID-19, the STEADY program emailed monthly confidential wellness assessments to hospital staff from April 2020 to May 2021. The assessments included screens for burnout, anxiety, depression and posttraumatic stress, types of support accessed, and demographic information. Repeated cross-sectional data were summarized as monthly proportions and examined alongside longitudinal COVID-19 data. Results: A total of 2498 wellness assessments were submitted (M = ~168 monthly, range: 17–945). Overall, 67% of assessments had at least one positive screen for distress. Average positive screens were 44% for anxiety, 29% for depression, 31% for posttraumatic stress, and 53% for burnout. Despite high distress, most respondents used informal supports (e.g., family/friends), highlighting limited formal support use. Conclusions: HCWs experienced sustained high levels of psychological distress during the COVID-19 pandemic, with burnout remaining a predominant and persistent concern. The limited use of formal support services may indicate barriers to accessing these types of supports. Our findings underscore the need for accessible and acceptable mental health supports for HCW during prolonged crises. Full article

Background: Pain is a common, often debilitating ailment that may necessitate considerable health service utilization. However, there is a need to assess the associations of pain intensity and other variables with health service utilization among United States adults who have pain. Methods: This cross-sectional database analysis made use of the Medical Expenditure Panel Survey full-year consolidated data file and included United States adults (≥18 years) who have pain. The dependent variables consisted of four health service utilization variables, which included the number of emergency room visits, inpatient discharges, office visits, and outpatient visits in 2021. The number of visits or discharges were categorized as either ≥1 or 0. The independent variable was pain intensity (extreme, quite a bit, moderate, or little pain). Other variables analyzed included age, race, ethnicity, sex, marriage, education, employment, income, insurance, chronic conditions, limitations, exercise, smoking, physical health, and mental health. Chi-squared tests compared differences between pain intensity groups, and multivariable logistic regression models assessed the associations of pain intensity and other variables with each of the four health service utilization variables. The analysis was weighted for national estimates. The significance (alpha) level was 0.05. Results: This analysis included 6280 adults, representing 89,314,769 United States adults with pain. In the multivariable analyses, there were statistically significant associations for extreme pain (odds ratio = 1.72, 95% confidence interval = 1.27–2.33), quite a bit of pain (odds ratio = 1.75, 95% confidence interval=1.37–2.24), and moderate pain (odds ratio = 1.28, 95% confidence interval = 1.02–1.60) versus little pain with emergency room visits, extreme pain (odds ratio = 2.10, 95% confidence interval = 1.44–3.08) and quite a bit of pain (odds ratio = 1.66, 95% confidence interval = 1.21–2.28) versus little pain with inpatient discharges, and quite a bit of pain (odds ratio = 1.47, 95% confidence interval = 1.03–2.11) versus little pain with office visits. There was no correlation between pain intensity levels and outpatient visits. In addition, several other variables were associated with various health service utilization variables. Conclusions: This database analysis discovered greater pain intensity levels were often correlated with increased health service utilization, including more emergency room, inpatient, and office visits. These findings may inform the development of targeted interventions for people with specific characteristics. Further work is needed to implement initiatives that optimize health service utilization and ultimately improve health outcomes for United States adults who have pain. Full article

Despite initial concerns about the severe negative impact of COVID-19 on individuals with a history of mental health problems and suicide attempts, its effects remain unclear. This study examined the pandemic’s impact on individuals with and without lived experience of suicide attempts. An online nationwide sample of 1351 adults from the United States completed questionnaires from 26 May to 25 June 2021. A history of suicide attempt(s) (n = 159; 12%) was associated with significantly higher odds of utilizing mental health services, hospitalization for psychiatric reasons, and contacting hotlines. This history predicted worse outcomes in functioning, optimism, despair, and impairment. Notably, 57.6% of these individuals believed surviving a suicide attempt made them more resilient, while 21.9% expressed uncertainty about its impact on their resilience. In sum, participants with a history of suicide attempt(s) reported more depressive symptoms, worse daily functioning, more despair, less optimism, and greater service utilization during the pandemic, yet many also cited increased resilience due to their suicide history. Full article

The aim of this work is to explore and understand the lived experience of nurses who chose to schedule visits with an Emotional Support Animal (ESA), i.e., a dog, during their working shift. Background/Objectives: Nursing practice is rigorous, weighted with intense responsibility that creates an environment conducive to stress and anxiety for the nurses, who have reported a higher level of work stress than other healthcare professionals. Knowing and addressing the factors impacting mental health/nurses’ well-being is crucial to providing care to patients. Stressful work environments result in burnout, compassion fatigue, depression, anxiety, suicide, and resignation. Understanding nurses’ perspectives on work related stress encourages hospitals to structure practices supporting nurses’ mental health and ability to provide quality care. Methods: A qualitative hermeneutic phenomenological approach was employed. Participants scheduled six weekly 10-min visits with Rex, a certified Service Dog for anxiety depression and PTSD, and registered ESA. A sample of 11 RNs participated in Rex visits at the workplace; field notes were taken during observations of visits. Semi-structured 30-min interviews conducted via Zoom, audio-recorded, and transcribed with NVivo were conducted. Results: Data were examined with Interpretative Phenomenological Analysis. Four main themes emerged: Preparing for the unknown, Doing the work, Refueling and resetting-Visits with Rex, What about nurses? Conclusions: This study highlights the need for nurses and hospital systems to incorporate self-care/self-reflection, including time/opportunities for nurses’ stress management during their practice. Knowledge of nurses receiving ESA interventions sheds light on how to protect/preserve the well-being of nurses practicing in this demanding profession. ESAs for nurses in the workplace offers an option to utilize dog therapy to re-energize and continue their shift renewed and refreshed. Full article

The Morehouse School of Medicine Prevention Research Center (MSM-PRC) conducted a Community Health Needs and Assets Assessment (CHNAA) survey using a Community-Based Participatory Research (CBPR) approach. In this article, we will demonstrate the application of CBPR in informing research agenda and implementation strategies. We will discuss the practical considerations and potential benefits of engaging the community in data collection, interpretation, and utilization to address community health challenges. Emphasizing collaboration, co-learning, and respect, and guided by the CBPR principles, CHNAA ensured that community voices led to the identification and integration of the research priorities. Overseen by the Community Coalition Board (CCB) and its Data Monitoring and Evaluation (DME) Committee, the survey featured closed- and open-ended questions addressing social determinants of health. Out of 1000 targeted participants, 754 provided valid responses, with a 75% response rate. Most respondents were female and represented a racially diverse group. Descriptive statistics and thematic analysis revealed that key health concerns were diabetes, COVID-19, mental health, and high blood pressure. Barriers to care included lack of food access, affordable housing, and limited mental health services. The findings led to five public health initiatives launched between 2023 and 2024 demonstrating the CBPR model’s effectiveness in aligning community needs with actionable solutions. Full article

The genocide commemoration week in Rwanda often triggers heightened mental health (MH) needs, necessitating targeted support. Understanding factors influencing repeat MH service utilization is essential for effective interventions. This cross-sectional study analyzed data from individuals seeking MH services during the 2024 Rwandan genocide commemoration week, distinguishing between first-time and repeat users. Descriptive and logistic regression analyses examined factors associated with repeat utilization. Of the 825 individuals who accessed MH services during Rwanda’s 2024 genocide memorial week, 76% were repeat users. Bivariate analysis showed that age and insurance coverage were significantly associated with repeat service utilization, while gender and province were not. Logistic regression revealed that individuals aged 31–50 (AOR = 2.29, 95% CI: 1.13–4.64, p = 0.022) and those without insurance coverage (AOR = 3.31, 95% CI: 1.78–6.18, p < 0.001) were more likely to be repeat users compared to the reference groups (18–30 years old and those with insurance, respectively). Gender and province remained nonsignificant in the adjusted model. Improving MH access, particularly for middle-aged individuals and the uninsured, is crucial. Addressing barriers to care could enhance service delivery during the commemoration period. Full article

Specialized mental health services (SMHS) should be accessible to all populations. This study investigated the accessibility of public SMHS for children and adolescent patients, as well as their caregivers, in Mexico. A cross-sectional survey was conducted with 400 patient–caregiver dyads receiving care at two primary SMHS facilities. The survey included indicators within four dimensions of accessibility: (1) organizational entry into SMHS; (2) organizational processes within SMHS; (3) ecological factors; (4) financial aspects. Additionally, six outcome variables were explored, including perceived health conditions and quality of care indicators. A principal component analysis (PCA) was utilized to construct four accessibility indices. Subsequently, multiple linear regression models were applied to examine the relationship between these accessibility indices and the outcome variables. Several indicators yielded notable results. The average emergency ward waiting time was 74.3 min (SD = 95.99), the post-hospitalization wait time was 1.28 weeks (SD = 1.85), and the average medical costs amounted to 962.6 Mexican pesos (SD = 2555.1). Several of the tested relationships between accessibility indices and outcome variables were statistically significant; organizational processes within SMHS and financial indices had a higher number of these significant relationships. These findings highlight the significant challenges in improving accessibility to public SMHS for children and adolescents in Mexico. Full article

Introduction: Cannabis use disorder (CUD) is being increasingly diagnosed in the United States, but access to treatment remains unequal, particularly in New York. Identifying the factors that contribute to disparities in receiving treatment for CUD among different population groups is essential for ensuring effective and targeted interventions. This study explores the sociodemographic factors influencing treatment utilization for CUD in New York. Methods: Data for this study were retrieved from the 2018 Treatment Episode Data Set—Discharges (TEDS-D) of the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Sample size for the study is 422,319 people with CUD. Logistic regression analysis was performed to examine the odds of receiving treatment for CUD based on demographic and socioeconomic factors, as well as the type of treatment setting. Results: The results revealed significant disparities in treatment utilization. Asians/Pacific Islanders and Hawaiian Natives had lower odds of receiving treatment compared to African Americans (OR = 0.367, 95% CI 0.341–0.394). Similarly, Caucasians had the lowest odds of receiving treatment (OR = 0.270, 95% CI 0.266–0.275). Females were less likely to receive treatment compared to males (OR = 0.756, 95% CI 0.744–0.768). Those with higher educational attainment (over four years of college) had the lowest odds of receiving treatment, while individuals with 9–11th grade education had the highest odds. Employment status also influenced treatment access, with the unemployed having the highest odds, and full-time employees having the lowest. Additionally, individuals with no source of income had significantly lower odds of receiving treatment. Conclusions: This study highlights significant disparities in the provision of treatment for CUD in New York, influenced by sociodemographic factors such as race, gender, age, education, and employment status. These findings emphasize the need for targeted interventions to reduce these disparities and improve treatment access for underserved populations. Full article

Background: Ongoing access and equity concerns for culturally diverse populations in mental health warrant a shift from cultural competence to cultural humility training. This review aimed to systematically assess the breadth of conceptual and training literature in peer-reviewed publications drawn from PsycINFO, CINAHL plus, Google Scholar and Scopus, from 2007–2018, utilizing cultural humility as the key search term and its relevance to service provision. Methods: This method utilized a five-stage scoping review framework. Results: Results were that a total of 246 publications were extracted. Following employing an abstract review method and removing duplicates, this resulted in a full-text review of 56 publications. The emerging themes included the following: culturally informed conceptual frameworks; culturally diverse training approaches; racial inequalities in mental health services; culturally informed national and international perspectives; race and international transcultural mental health. Conclusions: Conclusions were that including cultural humility principles in service provision and training enables greater self-awareness towards racial bias and negative cultural stereotypes at both practice and organizational levels, ultimately aimed at enhancing mental health service provision by mitigating the structural barriers encountered by service users. Full article

Parent Peer Support (PPS) provided by other caregivers who have lived experience raising a child with mental health conditions (e.g., such as anxiety, depression, attention, and/or behavior disorders) holds promise as a service that can improve outcomes by helping young people and their families overcome system- and individual-level barriers to receiving care. Here, we describe the development of a collaboration of researchers and Family-Run Organizations (FROs) to provide research support for PPS through three phases (1) developing a research agenda and study aims through a Patient-Centered Outcomes Research Institute (PCORI) “Pipeline to Proposal” grant; (2) designing a pilot study, including refining the measurement framework for a successful grant application to the National Institute of Mental Health (NIMH); and (3) implementing the study through the incorporation of research methodology into FRO operations without disrupting the organizations’ missions. This paper summarizes the participatory action research (PAR) strategies employed by this interdisciplinary research team throughout the three phases, covering the benefits and challenges of these unique partnership activities. We focus on how this project was able to increase the relevance of the research to the FROs and the communities they serve and improve dissemination and utilization of the results to support other PPS projects. Full article