Mental health service use by young people: the role of caregiver characteristics.
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ABSTRACT:
SUBMITTER: Gronholm PC
PROVIDER: S-EPMC4374853 | biostudies-other | 2015
REPOSITORIES: biostudies-other
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Project description:Neuropsychiatric disorders (including substance misuse) are associated with the greatest burden of functional disability in young people, and contributory factors remain poorly understood. Early-onset substance use is one candidate risk factor which may inform functional prognosis and facilitate direction of interventions aiming to curtail impairment. Accordingly, we modelled associations between early-onset use of alcohol, tobacco, cannabis and amphetamine-type stimulants (ATSs) and longitudinal socio-occupational functioning (indexed by the Social and Occupational Functioning Assessment Scale) in an observational cohort presenting to early intervention mental health services. A clinical proforma collated demographic, clinical, and socio-occupational information for up to 60-months from presentation to services in young people aged 17-30. Of the wider cohort (n = 2398), 446 participants were selected with complete alcohol and substance use data. Latent class analysis was used to derive an 'early-onset' (n = 243) and 'later-onset' class (n = 203) based on age of first use of alcohol, tobacco, cannabis and ATSs. Maximum-likelihood multilevel analyses modelled functioning over time in care and tested associations with substance use latent class, age, gender and diagnosis. Membership in the 'early-onset' class (B = -1.64, p = 0.05), male gender (B = -3.27, p<0.001) and psychotic disorder diagnosis (B = -7.62, p<0.001) were associated with poorer functioning at presentation and at least one other time-point. To our knowledge, this is the first study to explore associations of early-onset substance use and longitudinal functioning in a cohort of young people with mental disorders. The identified factors may be useful for directing specific social (e.g. Social Recovery Therapy) or occupational (e.g. Individual Placement and Support) interventions to at-risk individuals, early in illness course.
| S-EPMC6336340 | biostudies-literature
Project description:Most young adults with mental health symptoms do not receive treatment or access services. It remains important to identify barriers to service utilization to improve access to care. The current study was a prospective analysis examining predictors of (a) mental health service utilization and (b) perceived unmet need for mental health services. Barriers to service utilization were examined by prior depression severity status and college student status. Participants included a subsample of young adults ages 18-23 at time of recruitment who were participating in a longitudinal monthly study who completed both baseline and a 15-month follow-up assessment (N?=?622, 80% of larger study). At month 15, 23% of young adults reported receiving mental health services in the past 12 months; 26% of young adults reported a perceived unmet need for mental health services at some point in the past 12 months. There were differences in demographic and mental health predictors of service utilization and perceived unmet need for services. Women, sexual minorities, those with moderate depression, those with more impairment from depression, and perceived past year poor mental health were associated with greater likelihood of receiving services. Similar demographic characteristics were associated with greater likelihood of perceiving unmet need for services. Barriers to service utilization differed by severity of depression symptoms and student status. Young adults have distinct reasons for not accessing mental health services; addressing these to improve accessibility to care remains critical.
| S-EPMC6081266 | biostudies-literature
Project description:BackgroundYoung people can receive mental health care from many sources, from formal and informal sectors. Caregiver characteristics/experiences/beliefs may influence whether young people get help and the type of care or support used by their child. We investigate facilitators/barriers to receiving formal and/or informal care, particularly those related to the caregiver's profile.MethodsWe interviewed 1,400 Brazilian primary caregivers of young people (aged 10-19), participants of a high-risk cohort. Caregivers reported on young people's formal/informal mental health care utilization, and associated barriers and facilitators to care. Data were also collected on youth mental health and its impact on everyday life; and caregiver characteristics-education, socioeconomics, ethnicity, mental health, and stigma. Logistic regression models were used to examine the relationship between caregiver and young people characteristics with formal/informal care utilization.ResultsPersistence and greater impact of youth mental health conditions were associated with a higher likelihood of care, more clearly for formal care. Caregiver characteristics, however, also played a key role in whether young people received any care: lower parental stigma was associated with greater formal service use, and lower socioeconomic class showed higher odds of informal care (mainly from religious leaders).ConclusionsThis study highlights the key role of the caregivers as gatekeepers to child treatment access, particularly parental stigma influencing whether young people received any mental health care, even in a low resource setting. These results help to map barriers for treatment access and delivery for young people, aiming to improve intervention efforts and mental health support.
| S-EPMC9251818 | biostudies-literature
Project description:BackgroundMental ill-health is the leading cause of disability worldwide. Moreover, 75% of mental health conditions emerge between the ages of 12 and 25 years. Unfortunately, due to lack of resources and limited engagement with services, a majority of young people affected by mental ill-health do not access evidence-based support. To address this gap, our team has developed a multimodal, scalable digital mental health service (Enhanced Moderated Online Social Therapy [MOST+]) merging real-time, clinician-delivered web chat counseling; interactive user-directed online therapy; expert and peer moderation; and peer-to-peer social networking.ObjectiveThe primary aim of this study is to ascertain the feasibility, acceptability, and safety of MOST+. The secondary aims are to assess pre-post changes in clinical, psychosocial, and well-being outcomes and to explore the correlations between system use, perceived helpfulness, and secondary outcome variables.MethodsOverall, 157 young people seeking help from a national youth e-mental health service were recruited over 5 weeks. MOST+ was active for 9 weeks. All participants had access to interactive online therapy and integrated web chat counseling. Additional access to peer-to-peer social networking was granted to 73 participants (46.5%) for whom it was deemed safe. The intervention was evaluated via an uncontrolled single-group study.ResultsOverall, 93 participants completed the follow-up assessment. Most participants had moderate (52/157, 33%) to severe (96/157, 61%) mental health conditions. All a priori feasibility, acceptability, and safety criteria were met. Participants provided mean scores of ≥3.5 (out of 5) on ease of use (mean 3.7, SD 1.1), relevancy (mean 3.9, SD 1.0), helpfulness (mean 3.5, SD 0.9), and overall experience (mean 3.9, SD 0.8). Moreover, 98% (91/93) of participants reported a positive experience using MOST+, 82% (70/93) reported that using MOST+ helped them feel better, 86% (76/93) felt more socially connected using it, and 92% (86/93) said they would recommend it to others. No serious adverse events or inappropriate use were detected, and 97% (90/93) of participants reported feeling safe. There were statistically significant improvements in 8 of the 11 secondary outcomes assessed: psychological distress (d=-0.39; P<.001), perceived stress (d=-0.44; P<.001), psychological well-being (d=0.51; P<.001), depression (d=-0.29; P<.001), loneliness (d=-0.23; P=.04), social support (d=0.30; P<.001), autonomy (d=0.36; P=.001), and self-competence (d=0.30; P<.001). There were significant correlations between system use, perceived helpfulness, and a number of secondary outcome variables.ConclusionsMOST+ is a feasible, acceptable, and safe online clinical service for young people with mental ill-health. The high level of perceived helpfulness, the significant improvements in secondary outcomes, and the correlations between indicators of system use and secondary outcome variables provide initial support for the therapeutic potential of MOST+. MOST+ is a promising and scalable platform to deliver standalone e-mental health services as well as enhance the growing international network of face-to-face youth mental health services.
| S-EPMC7453330 | biostudies-literature
Project description:Similar to concentrations of crime, mental health calls have been found to concentrate at a small number of places, but few have considered the context of places where mental health calls occur. The current study examines the influence of the physical and social context of street segments, particularly the role of service providers, land use features of the street and nearby area, and characteristics of residents on the likelihood of a mental health crisis call to the police occurring on the street. The findings demonstrate that the social context, such as offending and drug use among residents, levels of social cohesion and community involvement, and drug and violent crime influenced the occurrence of mental health crisis calls. Findings from this study make theoretical and practical contributions to a number of disciplines by improving our understanding of where mental health crisis calls occur and why they are found at specific places.
| S-EPMC6791365 | biostudies-literature
Project description:BACKGROUND:The onset of mental health problems peaks between adolescence and young adulthood; however, young people face barriers to treatment and are often reluctant to seek professional help. Many are instead seeking support and information regarding their mental health via the Web, especially via social networking sites (SNSs), and hence, there is a promising opportunity to use SNSs to deliver or integrate with youth-focused online mental health interventions. Previous reviews have evaluated the effectiveness of SNSs for specific disorders in young people; however, none of the reviews have covered the breadth of SNS-based youth mental health interventions available across all mental health issues. OBJECTIVE:This review aimed to systematically identify available evidence regarding the use of SNS-based interventions to support the mental health of young people aged up to 25 years, to evaluate their effectiveness, suitability, and safety, and identify gaps and opportunities for future research. METHODS:The PubMed and PsycINFO databases were searched using Medical Subject Headings terms and exploded keywords and phrases. Retrieved abstracts (n=974) were double screened, yielding 235 articles for screening at the full-text level. Of these, 9 articles met the review inclusion criteria. Given the small number of studies, and the variety of outcome measures used, a quantitative meta-analysis was not possible. RESULTS:The 9 articles (quantitative studies, qualitative studies, and descriptions of the iterative design process) covered 5 separate interventions. Of the 5 interventions, 2 interventions used purpose-built platforms based on the moderated online social therapy (MOST) model, 2 used Facebook, and 1 evaluated a purpose-built mobile app. The 2 MOST interventions targeted specific mental health issues (depression and psychosis), whereas the others focused on improving mental health literacy, social support, and general well-being. Only 3 quantitative studies were identified, and all used a pre-post design (without a control group) to establish proof of concept. Of the outcome variables assessed, there were significant improvements in mental health knowledge and number of depressive symptoms but no improvement in anxiety or psychosis symptoms. Acceptability of and engagement with the SNS platforms were generally high, as were perceptions of usefulness and safety. Moderation by clinical experts was identified as a key component of the more successful interventions. When offered a choice, users showed a preference for mobile apps over Web-based interfaces. CONCLUSIONS:The evidence reviewed suggests young people find SNS-based interventions highly usable, engaging, and supportive. However, future studies need to address the current lack of high-quality evidence for their efficacy in reducing mental health symptoms. Given young people are already turning to SNSs to engage in knowledge seeking and peer-to-peer support, SNS-based youth mental health interventions provide an opportunity to address some of the barriers young people face in accessing qualified mental health support and information.
| S-EPMC6315265 | biostudies-literature
Project description:BackgroundThere are high rates of mental health needs in children in the United Kingdom, and parents are increasingly seeking help for their children's needs. However, there is not enough access to child and adolescent mental health services and parents are seeking alternative forms of support and information, often from web-based sources. Mumsnet is the largest web-based parenting forum in the United Kingdom, which includes user-created discussions regarding child mental health.ObjectiveThis qualitative investigation aimed to explore the emergent themes within the narratives of posts regarding child mental health on Mumsnet and to extrapolate these themes to understand the purpose of Mumsnet for parents of children and young people with mental health needs.MethodsA total of 50 threads from Mumsnet Talk Child Mental Health were extracted. Following the application of inclusion and exclusion criteria, 41 threads were analyzed thematically using the framework approach, a form of qualitative thematic analysis.ResultsIn total, 28 themes were extracted and organized into 3 domains. These domains were emotional support, emotional expression, and advice and information. The results suggested that parents of children with mental health needs predominantly use Mumsnet to offer and receive emotional support and to suggest general advice, techniques, and resources that could be applied outside of help from professional services.ConclusionsThis paper discusses the future of health information seeking. Future research is required to establish initiatives in which web-based peer-to-peer support and information can supplement professional services to provide optimum support for parents of children with mental health needs.
| S-EPMC7499161 | biostudies-literature
Project description:INTRODUCTION:People with serious mental illnesses experience excess morbidity and premature mortality resulting from preventable conditions. The goal was to examine disparities in preventive care that might account for poor health outcomes. METHODS:In this retrospective cohort study, adults (N=803,276) served by Kaiser Permanente Northwest and federally qualified health centers/safety-net community health clinics were categorized into five groups: schizophrenia spectrum disorders, bipolar disorders/affective psychoses, anxiety disorders, nonpsychotic unipolar depression, and reference groups with no evidence of these specific mental illnesses. The primary outcome was overall preventive care-gap rate, the proportion of incomplete preventive services for which each patient was eligible in 2012-2013. Secondary analyses examined Kaiser Permanente Northwest data from 2002 to 2013. Data were analyzed in 2015. RESULTS:Controlling for patient characteristics and health services use, Kaiser Permanente Northwest mean care-gap rates were significantly lower for bipolar disorders/affective psychoses (mean=18.6, p<0.001) and depression groups (mean=18.6, p<0.001) compared with the reference group. Schizophrenia (mean=19.4, p=0.236) and anxiety groups (mean=19.9, p=0.060) did not differ from the reference group (mean=20.3). In community health clinics, schizophrenia (mean=34.1, p<0.001), bipolar/affective psychosis (mean=35.7, p<0.001), anxiety (mean=38.5, p<0.001), and depression groups (mean=36.3, p<0.001) had significantly lower care-gap rates than those in the reference group (mean=40.0). Secondary analyses of diabetes and dyslipidemia screening trends in Kaiser Permanente Northwest showed diagnostic groups consistently had fewer care gaps than patients in the reference group. CONCLUSIONS:In vastly different settings, individuals with serious mental illnesses received preventive services at equal or better rates than the general population.
| S-EPMC5736432 | biostudies-literature
Project description:ObjectivePrevious population-based studies have found that delusional-like experiences (DLEs) are prevalent in the community, and are associated with a wide range of mental health disorders. The aim of the study was to investigate mental health service use by people with DLEs.MethodsSubjects were drawn from the Australian National Survey of Mental Health and Wellbeing 2007 of 8 841 community residents aged between 16 and 85 years. The Composite International Diagnostic Interview (CIDI) was used to identify DLEs. Service utilization was assessed using a module that elicited information about hospital admissions, consultations with various health professionals, and prescription medication use. This study focussed on service use for mental health problems. We used logistic regression to examine the association, adjusting for potential confounding factors.ResultsOf 8 773 included participants, 8.4% (n = 776) positively endorsed one or more DLEs. With respect to consultations for mental health needs, individuals who endorsed DLEs were more likely to consult health professionals compared with those who did not endorse DLEs. Individuals with DLEs were also more likely to use prescription medicine. When we repeated the main analysis in a subgroup excluding any CIDI diagnosis of mental health disorders the results remained largely unchanged.ConclusionsDLEs are common in the general population, and individuals with DLEs have an increased rate of accessing services for their mental health needs. Individuals endorsing both DLEs and increased help-seeking may identify a group of vulnerable people who have increased risk of developing psychotic illnesses later in life. This needs closer scrutiny in longitudinal prospective studies.
| S-EPMC3749219 | biostudies-literature
Project description:BackgroundSelf-reported psychotic experiences (PEs) are associated with psychopathology of all kinds, not just psychoses. However, systematic reviews on the relevance of this for health services are unavailable. Furthermore, whether association with service use is confounded by other psychopathology is unknown, and is relevant to prevention and treatment.ObjectivesLiterature examining associations between PEs and service use was systematically reviewed. Study quality and the direction and extent of any associations were assessed, and meta-analysis conducted.MethodsSystematic review and meta-analysis was carried out as per PRISMA guidelines. A search of electronic databases was performed based on free-text and structured terms. Included studies were evaluated by two raters using a structured tool and estimates extracted for reporting.ResultsThirteen studies were returned. We found two prospective studies, and a minority of studies accounted for concurrent psychopathology, limiting our ability to test our main hypotheses. Five studies reported associations by different types of service use. Almost all studies assessed service use by self-report. Meta-analysis suggested that people who reported PEs were around twice as likely to report service use compared to those who did not (pooled OR for all included studies: 2.20,95% confidence intervals (95%CI): 1.66,2.91).ConclusionsThere was consistent evidence of association between PEs and mental health service use at the general population level. However, evidence for causation was poor due to a limited number of studies. Whether increased service use in this group is solely attributable to PEs, and therefore whether interventions aimed at limiting/preventing PEs might be effective, requires studies focusing on the relationships between PEs, psychopathology and service use.
| S-EPMC6001621 | biostudies-literature