Search Results (124)

Background: International migration is a growing global phenomenon involving diverse groups, such as labor migrants, international marriage migrants, refugees, and international students. International migrants face unique mental health challenges influenced by adversities such as social isolation and limited access to mental health services. This study employs bibliometric methods to systematically analyze the global body of literature on international migrants’ mental health. Methods: The literature on the mental health of international migrants published until October 2024 was searched using the Web of Science database. The search terms included (‘International migrants’ OR ‘migrant workers’ OR ‘international students’ OR ‘refugees’ OR ‘asylum seekers’ OR ‘smuggled migrants’) AND ‘mental health’. VOSviewer was used to conduct bibliometric analysis, focusing on co-authorship patterns, keyword co-occurrence, and citation networks. Results: Over the past four decades, research on the mental health of international migrants has grown substantially, with major migration destinations such as the United States, Europe, and Australia playing prominent roles in this field. ‘Post-traumatic stress disorder (PTSD)’ was the most frequent keyword in publications, with strong links to ‘trauma’ and ‘depression’. In recent years, with the impact of global socioenvironmental changes and emergencies such as the COVID-19 pandemic, the research focus has gradually shifted towards social support, service accessibility, and cultural adaptation. Conclusions: International migration is a far-reaching global phenomenon, and addressing the mental health of migrant populations is essential for advancing public health, social cohesion, and sustainable development. This study provides the first bibliometric overview of research in this domain, mapping its thematic evolution and collaborative structure. The findings offer valuable insights into the field’s development and may support future interdisciplinary collaboration and the formulation of culturally informed, evidence-based approaches in migrant mental health. Full article

Trauma-informed care (TIC) is an increasingly implemented approach in human services, but little research documents implementation within veterinary services. This study explored emotional experiences of veterinary clients and the perceived emotions/behaviors of their pets, studied experiences of TIC, and ascertained the extent to which experiences of TIC predicted client outcomes. Clients (N = 274) were surveyed about their experiences of veterinary care. Clients documented positive and negative emotional experiences, with negative emotions associated with more serious presenting issues. TIC was experienced during veterinary visits. Principal component analyses found that TIC fell into the following five factors: (1) transparent and client-centered communication; (2) client supports and strengths; (3) emotional safety and empowerment; (4) physical safety and comfort; (5) informed consent. Hierarchical regressions revealed that, after controlling for reason for the visit, client-reported emotions and pet emotions/behaviors, 53.9% and 56.3% of the variance in client satisfaction and client disappointment was accounted for by TIC practices, respectively. The results show that although the outcomes for pets receiving veterinary care might not always be positive, which can lead to negative emotional experiences for clients, these can be ameliorated and lead to positive client outcomes through utilizing TIC. Full article

This study uses a public health approach to identify the comorbid risk factors and protective factors that influence the likelihood of an officer-involved shooting (OIS). Methods: We analyzed 7.5 years of hospital inpatient data obtained from the state of Texas. The OIS subjects (n = 177) were civilians who were shot during a legal intervention involving law enforcement. The control group (n = 33,539) included persons who were hospitalized due to injuries from a car accident. Logistic regression models were used to identify the predictors of an OIS incident. The data included information on chronic diseases, vulnerable population status, health insurance, mental health diagnoses, substance use disorders, and recent trauma. Results: About one-fourth (24.3%) of OIS subjects had a diagnosed mental illness, compared to 8.4% of control subjects (p < 0.001). Factors that greatly increased the risk for an OIS included the following: schizophrenia (AOR = 2.7; CI: 1.6, 4.6), methamphetamine use disorder (AOR = 3.5; CI: 2.2, 5.5), and recent family bereavement (AOR = 8.5; CI: 1.8, 39.6). Six subjects (3.4%) were persons experiencing homelessness (PEH). Protective factors that lowered the risk for an OIS included commercial health insurance (AOR = 0.27; CI: 0.17, 0.45) and Medicaid insurance (AOR = 0.61; CI: 0.11, 0.93). Conclusions: These findings underscore the preventable nature of many OIS incidents, especially those that involve untreated mental illness, homelessness, substance use disorders, and recent trauma. Addressing the root causes of these incidents will likely require interdisciplinary collaboration among law enforcement, public health agencies, and social services. Full article

Internet scams have become more sophisticated and prevalent in countries such as Canada, the US, the UK, and Australia. Australia has made some progress in effective scam intervention strategies and seen possible growth in public awareness. However, there is a lack of insight into factors associated with profound shame and embarrassment, emotional distress such as anxiety and depression, and trauma and suicide in scam victims. To fill this gap, this perspective paper aimed to provide insight into the factors associated with the negative mental health impacts of internet scams by integrating a narrative literature review with a victim case study detailing a group’s experience of an investment scam in Australia. It found that internet scams cause emotional and social issues like depression, anxiety, trauma, and isolation, mostly prolonged upon substantial loss. The author’s insight into the intensely negative mental health impacts of an investment scam allows for the presentation of a group who struggled to access adequate support and mental health care in their response to insidious organized crime. Better education, resilience-building, and support systems are needed. These shortcomings call for strategies for tailored digital mental health services such as emotionally attuned, trauma-informed digital companionship through human-like artificial intelligence (AI) applications. Full article

Diversion programs are increasingly used as alternatives to criminal penalties for women involved in commercial sex, yet limited research has examined how such programs support behavior change across diverse subgroups, particularly between sex-trafficked and non-trafficked participants. This study evaluates changes in readiness for change among 131 women who participated in a court-ordered diversion program led by survivors of sex trafficking. Participants were classified as sex-trafficked or non-trafficked based on self-reported age of entry and experiences of third-party control. The program offered a range of trauma-informed services aimed at fostering holistic well-being and facilitating a pathway out of sex trafficking and prostitution. Participants engaged in group classes focused on job interview skills, emotion regulation, substance use awareness, and psychoeducation related to trauma. Life skills workshops addressed financial literacy, relationship dynamics, and conflict resolution. In addition, participants received referrals to GED programs, career training, mental health services, and emergency housing as needed. Program duration typically ranged from 12 to 16 weeks, adjusted for individual needs. Results from a repeated-measures Analysis of Variance (ANOVA) revealed a significant increase in readiness for change (p < 0.05) from program entry to completion. However, women with trafficking histories demonstrated smaller gains than their non-trafficked peers, suggesting that trauma-related and systemic barriers may limit the impact of short-term interventions. These findings underscore the importance of tailoring diversion programs to address the complex needs of sex-trafficked individuals and support the development of differentiated trauma-responsive strategies within diversion frameworks. Full article

Family violence is a social issue that impacts families and communities every day in Canada and around the world. As family violence rates continue to increase there is an urgent need for cross-sectoral collaboration to codesign social work and social service systems, in partnership with those experiencing family violence. This article will share learnings from a two-year community-based participatory research study that worked alongside survivors and witnesses of family violence, community partners from diverse social service agencies, and researchers, to understand experiences of family violence in racialized communities in Peel region, Ontario, Canada. An intersectional-trauma-informed approach guided the work that included establishing a community advisory board, hiring peer research assistants, Photovoice, and holding a knowledge exchange event (KEE) with survivors and witnesses of family violence, researchers, and community partners to rapidly generate ideas for intervention areas through a 25/10 crowdsourcing activity and codesign preliminary solutions through a mini hackathon. Key findings from the photovoice highlighted systemic failures and gaps experienced by those facing family violence. As we shifted into ideation, this preliminary focus on systems solidified and top ideas identified included barrier-free, culturally aware provision of services ranging from mental health supports, safe housing, financial independence, and accessing wrap-around services. Our work concluded with the collaborative development of preliminary solutions to these ideas and emphasized the need for cross-sectoral partnerships and lived experience engagement to change systems. Centering the voices of those who have experienced FV in system-level change and advocacy is necessary to ensure services and supports meet the needs of service users. Full article

Background: The suicide rate among Iraqis is rising, with many analysts attributing it to political instability, exposure to trauma, economic hopelessness, social stigma surrounding mental health as well as cultural and societal pressures. However, the prevalence of suicidal ideation and associated risk factors in Iraqi youth is unknown, requiring urgent attention and effective public health initiatives. Thus, the aim of this study was to explore rates of suicidal ideation and associated risk factors among female secondary school students in Baghdad, Iraq. Method: A cross-sectional study was conducted, utilising quantitative survey data collected in four girls’ secondary schools across Baghdad, Iraq, between August and December 2023. The survey consisted of questions relating to their demographic characteristics (age, gender, school) and a series of measures pertaining to participants’ levels of suicidal ideation, as well as factors commonly identified in the literature as predictors of suicide. Results: Four-hundred and two female participants took part. Participants were aged between 13 and 17 years (M = 15.50; SD = 1.22). In total 11.3% of the students scored in the at-risk range for suicidal behaviour and only 20.1% (n = 91) said they had not had some thoughts of suicide in the previous two weeks. Previous diagnoses of anxiety, high levels of depression and hopelessness, and poor quality of life were significant risk factors for suicidal ideation. On average, students reported moderate levels of depression and high levels of hopelessness. Conclusions: Female Iraqi secondary school students experience high levels of suicidality, alongside several other known risk factors for suicide ideation. However, a limitation of this study is that cross-sectional designs limit causal interpretation. Findings emphasise the importance of developing targeted school-based interventions to support students’ mental health. Increasing research and attention in this area is vital to not only improving the mental health of students in Iraq but also reducing the stigma around mental health and suicide. Future policies should include specific mental health support for those young people affected by conflict, displacement and family loss, integrating trauma-informed care into both mental health and educational services. Full article

In the current clinical psychiatric practice in most of the world, treatment decisions are based on a person’s capacity to make these decisions. When a person lacks the capacity to understand and appreciate treatment decisions, in many jurisdictions a third-party substitute decision maker (SDM) is appointed on his or her behalf in order to promote safety and optimal clinical outcome. In Ontario, Canada, for example, family members (typically) or public guardians are appointed as SDMs, and they form an integral part of the medical–legal system in psychiatric care. Clinicians working with both patients and their SDMs in these circumstances encounter unique challenges and deliver care in specialized ways, though little research has focused on their experiences and reflections. Based on focus group data, this qualitative study uses a descriptive and interpretative phenomenological approach through thematic analysis to examine these aspects from clinicians working in both inpatient and outpatient settings of an urban teaching hospital’s psychiatric services in Toronto, Canada. Seven key themes emerged: Clinicians (1) appreciate hardships and challenges in lives of SDMs and patients—including the challenging emotions and experiences on both sides, and the risks and relational changes from being an SDM; (2) have an understanding of the patient’s situation and respect for patient autonomy and wishes—they are promoter of autonomy and mindful of patients’ prior wishes amidst patients’ fluctuating capacity, facilitating communication, keeping patients informed and promoting transitioning from SDM to self-determination; (3) have a special working relationship with family SDMs—including supporting SDMs, avoiding harm from delayed or denied treatment, and educating and collaborating with SDMs while maintaining professional boundaries; (4) at times find it difficult working with SDMs—stemming from working with over-involved or uninterested family SDMs, coping with perceived poor SDM decisions, and they sometimes ponder if SDMs are necessary; (5) delineate differences between family and Public Guardian and Trustee (PGT) SDMs—they see PGT as closely aligned with medical decision makers, while family SDMs are more intimately involved and more likely to disagree with a physician’s recommendation; (6) recognize the importance of the SDM role in various contexts—through seeing social values in having SDMs, and acknowledging that having SDMS help them to feel better about their actions as they work to protect the patients; and (7) express ideas on how to improve the current system—at public, societal, and family SDM levels. We conclude that clinicians have unique mediating roles, with privilege and responsibility in understanding the different roles and challenges patients and SDMs face, and have opportunities to improve patient and SDM experiences, clinical outcomes, carry out education, and advocate for ethically just decisions. These clinical roles also come with frustration, discomfort, moral distress and at times vicarious trauma. Clinicians’ unique understanding of this complex and nuanced intersection of patient care provides insight into the core issues of autonomy, duty to care and protect, advocacy, and emotional dynamics involved in this sector as a larger philosophical and social movement to abolish SDMs, as advocated by the Convention on the Rights of Persons with Disability (CRPD), is taking place. We briefly discuss the role of supported decision making as an alternative as. Full article

(1) Background: Traumatic brain injury (TBI) is caused from rapid head acceleration/deceleration, focal blows, blasts, penetrating forces, and/or shearing forces, whereas hypoxic–anoxic injury (HAI) is caused through oxygen deprivation events, including strangulation. Most service-seeking domestic violence (DV) survivors have prior mechanistic exposures that can lead to both injuries. At the time of our study, some evidence existed about the exposure to both injuries over the course of a survivor’s lifetime from abuse sources, yet little was known about their co-occurrence to the same survivor within the same episode of physical intimate partner violence (IPV). To better understand the lived experience of service-seeking DV survivors and the context in which partner-inflicted brain injury (PIBI) is sustained, we sought to understand intentional brain injury (BI) exposures that may need to be addressed and accommodated in services. Our aims were to 1. characterize the lifetime co-occurrence of strangulation and intentional head trauma exposures from all abuse sources to the same survivor and within select physical episodes of IPV and 2. establish the lifetime prevalence of PIBI. (2) Methods: Survivors seeking DV services in the state of Ohio in the United States of America (U.S.) completed interview-administered surveys in 2019 (n = 47). Community-based participatory action approaches guided all aspects of the study development, implementation, and interpretation. (3) Results: The sample was primarily women. Over 40% reported having Medicaid, the government-provided health insurance for the poor. Half had less than a postsecondary education. Over 80% of participants presented to DV services with both intentional head trauma and strangulation exposures across their lifetime from intimate partners and other abuse sources (i.e., child abuse, family violence, peer violence, sexual assault, etc.), though not always experienced at the same time. Nearly 50% reported an experience of concurrent head trauma and strangulation in either the first or last physical IPV episode. Following a partner’s attack, just over 60% reported ever having blacked out or lost consciousness—44% experienced a loss of consciousness (LOC) more than once—indicating a conservative estimate of a probable brain injury by an intimate partner. Over 80% of service-seeking DV survivors reported either a LOC or two or more alterations in consciousness (AICs) following an IPV attack and were classified as ever having a partner-inflicted brain injury. (4) Conclusions: Most service-seeking IPV survivors experience repetitive and concurrent exposures to abusive strangulation and head trauma through the life course and by intimate partners within the same violent event resulting in brain injury. We propose the use of the term partner-inflicted brain injury (PIBI) to describe the physiological disruption of normal brain functions caused by intentional, often concurrent and repeated, traumatic and hypoxic neurologic insults by an intimate partner within the context of ongoing psychological trauma, coercive control, and often past abuse exposures that could also result in chronic brain injury. We discuss CARE (Connect, Acknowledge, Respond, Evaluate), a brain-injury-aware enhancement to service delivery. CARE improved trauma-informed practices at organizations serving DV survivors because staff felt knowledgeable to address and accommodate brain injuries. Survivor behavior was then interpreted by staff as a “can’t” not a “won’t”, and social and functional supports were offered. Full article

Key affected populations (KAPs), including women who use drugs, engage in sex work, or live with HIV, are disproportionately affected by HIV, gender-based violence, substance use, and mental health. In Kazakhstan, they face significantly higher rates of intimate partner violence (IPV), with prevalence ranging from 45% to 75% compared to the national average of 27%, alongside barriers to accessing IPV services. This community-level implementation trial with a waitlist control group evaluated the effectiveness, safety, and acceptability of a self-paced mobile health intervention (UMAI-WINGS) for women from KAPs in Kazakhstan. The study enrolled 508 women, with 306 in Almaty City (intervention) and 200 in Almaty Oblast (waitlist control). IPV rates (physical, sexual, and psychological) were assessed at baseline and 6-months post-intervention. Participants in the intervention community were significantly less likely to report psychological (−23.0%), sexual (−27.0%), and physical IPV (−29.0%) at the 6-month follow-up compared to the control group. These results demonstrate the potential of digital, community-driven interventions to reduce IPV among marginalized women and offer a scalable, evidence-based model for implementation. The success of the UMAI-WINGS underscores the value of community-based, mobile health approaches for advancing trauma-informed, survivor-centered care and closing critical service gaps for underserved populations. Full article

Homelessness for families in Alberta, Canada, is a growing concern despite an abundance of research and continued support for Housing First programs, and the consequences can be severe. This study used a descriptive qualitative design to examine the experiences of families currently living in or that have a history of homelessness with the goal of developing recommendations to improve system coordination. Participants included parents who had at least one dependent child while homeless (n = 15) and staff who were currently working at a homeless support service (n = 18). Interviews were analyzed using a thematic inductive approach and integrated using functional narrative analysis. Four themes emerged: (1) Housing as a Foundation for Success in Other Domains; (2) Challenges with System Navigation: A Door Within a Door Within a Door; (3) Services’ Contributions to Trauma; and (4) Exposure to Social Bias and Stigma Within Services. We posit several recommendations for policy and service delivery which focus on finding “homes” and building community connections, enhancing Housing First program models, expanding on existing trauma-informed approaches, and prioritizing system-level change. Full article

Background/Objectives: Childhood trauma has a documented impact on development, and may also affect functioning and well-being in transition-age youth (TAY). There is a need to explore approaches, such as trauma-informed care (TIC), to enhance the services provided during the transition to adulthood. The objective of this scoping review was to explore the extent of the literature on the potential of TIC for supporting TAY. Methods: We focused on initiatives grounded in TIC to support TAY between the ages of 14 and 25 who have histories of trauma. The search strategy involved nine databases and the gray literature. The titles, abstracts, and full text were screened in duplicate by reviewers, and then data were extracted. Results: A total of 19 references were included and classified into three categories: (1) importance of TIC to support TAY (k = 5); (2) description of TIC initiatives (k = 6); and (3) evaluation of TIC initiatives supporting TAY (k = 2). Seven references were classified into more than one category. The references documented 10 TIC models or initiatives, half of which were evaluated and showed promising results. Important components of TIC initiatives supporting TAY included staff training and support; collaborative and multidisciplinary work; systemic changes; addressing trauma and its impacts; and a strength-based and youth-focused approach. Conclusions: The review emphasizes the importance of acknowledging and responding to trauma and its impact in TAY and advances the core components of TIC in the context of the TA, including its systemic nature. Although we cannot conclude that TIC is effective in supporting the TA at the moment—given that the literature is still in its early stages—the review shows that it is at least promising. Limitations, as well as future lines of work are discussed. Full article

Background/Objective: To address the growing demand for mental health services, Nova Scotia Health introduced the Rapid Access Stabilization Program (RASP) through its Mental Health and Addictions Program (MHAP) in April 2023. RASP is designed to help reduce long wait times, frequent emergency department visits, and admissions to provide early intervention for individuals experiencing mental health problems. The RASP focuses on rapid access and early mental health intervention, aiming to prevent the worsening of patients’ symptoms, improve access to psychiatric care, and reduce service pressures on programs like the Community Mental Health Program (CMHP), which provide more extended, ongoing mental health support. This study compared participants’ sociodemographic and clinical profiles in the RASP and the CMHP. Methods: Data were collected from 1392 participants accessing mental health support either through the RASP or CMHP. A comparative analysis of sociodemographic factors (e.g., age, education, and income) and clinical characteristics (e.g., depression, anxiety, resilience, and substance use) was conducted. Chi-square tests and independent sample t-tests were used to evaluate the mean differences between the groups. Results: Significant sociodemographic and clinical differences emerged between the RASP and CMHP participants. The RASP group was older (M = 40.10 vs. 34.52 years) and more socioeconomically stable, with higher rates of employment (55.3% vs. 47.9%) and homeownership (36.5% vs. 17.7%). In contrast, the CMHP group had higher unemployment (25.7% vs. 16.5%) and lower income levels, with 47.5% earning <CAD 29,590 compared to 30.3% in the RASP group. Clinical profiles differed markedly: depression was more prevalent in the RASP (48.2% vs. 19.3%), whereas the CMHP had higher rates of psychosis (10.6% vs. 2.5%) and substance use disorder (7.8% vs. 1.9%). The RASP participants exhibited higher anxiety (GAD-7: M = 14.17 vs. 11.81) and depression symptoms (PHQ-9: M = 16.62 vs. 14.20) but lower resilience (BRS: M = 2.47 vs. 2.77). The CMHP participants had more adverse childhood experiences (ACE: M = 3.92 vs. 3.16) and lower suicidal intent (81.4% vs. 99.4% had no intention to act). Conclusions: The findings highlighted the unique profiles between the RASP and CMHP participants, suggesting the need for program-specific interventions. While the CMHP participants may benefit from integrated social support and trauma-informed care, the RASP participants may require cognitive behavioral therapy and resilience-building interventions. Tailoring mental health services to meet these unique needs could enhance program effectiveness and patient outcomes across both groups. Full article

Introduction: Traumatic brain injuries (TBIs) are conditions affecting brain function caused by blunt or penetrating forces to the head. Symptoms may include confusion, impaired consciousness, coma, seizures, and focal or sensory neurological motor injuries. Objective: This study evaluated sex hormone profiles and their predictive role in returning consciousness after severe traumatic brain injury. Materials and Methods: We included 120 patients with TBIs and collected comprehensive information about each patient, including the cause of the trauma, age, gender, Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), and neuroradiological imaging data. The ISS was used to assess the severity of the trauma. At the same time, the lowest GCS score was recorded either before sedation and intubation in the emergency room or by emergency medical services personnel. For female participants, samples were collected during the luteal phase of the menstrual cycle (days 18 to 23). Results: The mean age of male patients was 33.40 years, ranging from 23 to 45 years, while female patients had an average age of 34.25 years, ranging from 25 to 48 years. The primary cause of injury for both genders was motor vehicle accidents. In male patients, testosterone levels were significantly higher in those classified as responsive (RC) compared to those non-responsive (NRC), with levels of 2.56 ± 0.47 ng/mL versus 0.81 ± 0.41 ng/mL (p = 0.003). A cut-off point of 1.885 ng/mL for testosterone levels in males was established, achieving a sensitivity and specificity of 86.7% and 86.7%, respectively. In female patients, progesterone levels were elevated in those who regained consciousness, measuring 1.80 ± 0.31 ng/mL compared to 0.62 ± 0.31 ng/mL (p = 0.012). A cut-off point of 1.335 ng/mL for progesterone levels in females was determined, with a sensitivity and specificity of 93.3% and 86.7%, respectively. Conclusions: We can conclude that sex hormone levels in the acute phase of TBIs can vary between males and females. Notably, serum testosterone levels in males and progesterone levels in females with TBIs are significant prognostic factors for assessing the likelihood of regaining consciousness after such injuries. These findings underscore the importance of considering sex hormone profiles in TBI recovery prognosis. Full article

Background: During the COVID-19 pandemic, perioperative nurses faced extraordinary demands in frontline roles, leading many to leave their positions. This study investigates the factors influencing their decisions to resign or change roles during or after the pandemic, providing insights into systemic, ethical, and emotional contributors to professional attrition. Methods: A qualitative study was conducted at a university hospital in Spain between December 2021 and March 2022. A hermeneutic phenomenological approach was used to analyze the lived experiences of perioperative nurses who worked during the pandemic and subsequently resigned or changed role. Data were collected through in-depth individual interviews and analyzed using Atlas.ti (version 22). Ethical issues such as informed consent and participants confidentiality were upheld. Results: Eighteen perioperative nurses participated. Four themes emerged: (1) balancing professional duty and personal limits, (2) the role of workplace culture (emphasizing peer support and managerial neglect), (3) resilience and moral conflict, and (4) the emotional cost of caring. Conclusions: Attrition among perioperative nurses during the COVID-19 pandemic was driven by physical and emotional exhaustion, lack of managerial support, ethical dilemmas, and emotional trauma. Healthcare organizations should implement strategies such as strengthening leadership, providing mental health resources, and creating a supportive work culture to improve staff retention and ensure workforce sustainability in future crises. The clinical implications highlight the need for specific interventions to support the emotional and professional well-being of perioperative nurses, ensuring high quality care and continuity of health services. Full article