Health behaviors and psychological distress: changing associations between 1997 and 2016 in the United States Abstract Objectives Smoking rates have declined with a slower pace among those with psychological distress compared to those without. We examined whether other health behaviors (heavy alcohol consumption, physical inactivity, short sleep duration) showed similar trends associated with psychological distress. We also examined differences by age and birth cohort. Methods Data were from the annually repeated cross-sectional U.S. National Health Interview Surveys (NHIS) of 1997–2016 (total n = 603,518). Psychological distress was assessed with the 6-item Kessler Psychological Distress Scale (K6). Results Psychological distress became more strongly associated with smoking (OR 1.09 per 10 years; 95% CI 1.07, 1.12), physical inactivity (OR 1.08; 1.05, 1.11), and short sleep (OR 1.12; 1.06, 1.18), but less strongly associated with heavy alcohol consumption (OR 0.93; 0.89, 0.98). The associations of smoking and alcohol consumption attenuated with age, whereas the association with physical inactivity strengthened with age. Compared to older birth cohorts, smoking became more strongly associated with psychological distress among younger birth cohorts up to those born in the 1980s. Conclusions The strength of associations between psychological distress and health behaviors may vary by time period, age, and birth cohort.

Prenatal maternal stress and risk of neurodevelopmental disorders in the offspring: a systematic review and meta-analysis Abstract Purpose Exposure to prenatal stress has been reported to affect the risk of adverse neurodevelopmental outcomes in the offspring; however, there is currently no clear consensus. The aim of this systematic review and meta-analysis was to examine the existing literature on the association between prenatal stress and autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) in the offspring. Methods Based on a registered protocol, we searched several electronic databases for articles in accordance with a detailed search strategy. We performed this study following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Results Prenatal stress was significantly associated with an increased risk of both ASD (pooled OR 1.64 [95% CI 1.15–2.34]; I2 = 90%; 15 articles) and ADHD (pooled OR 1.72 [95% CI 1.27–2.34]; I2 = 85%; 12 articles). Conclusions This study suggests that prenatal stress may be associated with ASD and ADHD; however, several limitations in the reviewed literature should be noted including significant heterogeneity and there is a need for carefully controlled future studies in this area.

Childhood bullying victimization, self-labelling, and help-seeking for mental health problems Abstract Purpose Previous research found sustained high levels of mental health service use among adults who experienced bullying victimization during childhood. This could be due to increased psychopathology among this group, but other factors, such as self-perception as having a mental health problem, might contribute to increased service use. Additionally, the relationship between informal help-seeking for mental health problems and bullying victimization is incompletely understood. Methods The present study examined associations between the frequency of bullying victimization and both formal service use and informal help-seeking for mental health problems independent from psychopathology. Data on bullying victimization, service use, informal help-seeking for mental health problems, psychopathology, and self-labelling as a person with mental illness were collected among 422 young people aged 13–22 years. Results In logistic regression models, controlling for past and current psychopathology and using no bullying victimization as the reference category, we identified a greater likelihood of mental health service use among persons who experienced frequent bullying victimization, as well as a greater likelihood of seeking informal help among persons who experienced occasional victimization. Increased self-identification as a person with mental illness completely mediated the positive association between frequent bullying victimization and mental health service use. Conclusions Our findings suggest that services to support persons who experienced frequent bullying victimization should focus on improving empowerment and self-perception. Additionally, there might be unserved need for formal support among those who experienced occasional bullying victimization.

Impact of substance use and other risk factor exposures on conviction rates by people with a psychotic illness and other mental disorders Abstract Purpose To examine the impact of substance use and other risk factors on conviction rates in people with a psychotic illness (PI) and other mental disorders (OMD) compared to those with no mental illness (NMI). Methods This research is part of a longitudinal record-linked whole-population study of 467,945 children born in Western Australia (WA) between 1980 and 2001. This cohort was identified through linkages between the WA psychiatric case register, WA corrective services data and other state-wide registers. We assessed 184,147 individuals born during 1983–1991 to explore the impact of exposure to a variety of risk factors on conviction rates. Results People with PI and OMD had higher conviction rates than those with NMI, with unadjusted incidence rate ratios (IRR) of 3.98 (95% CI 3.67–4.32) for PI and 3.18 (95% CI 3.03–3.34) for OMD. Adjusting for substance use reduced the rates by 60% in PI and 30% in OMD: IRRs 1.59 (95% CI 1.45–1.74) and 2.24 (2.12–2.37), respectively. Minimal change was seen when adjusting for other potential risk factors (including socio-demographics, victimisation and parental offending), with adjusted IRRs 1.58 (95% CI 1.43–1.74) for PI and 1.90 (95% CI 1.80–2.02) for OMD. Conclusions Our analysis shows people with a mental illness have higher rates of conviction than those with NMI. Substance use has a major impact on this rate. Results suggest the need for a greater investment in programs addressing the issue of comorbid substance use with a view to reduce the rate of convictions in this population.

Defining disengagement from mental health services for individuals experiencing first episode psychosis: a systematic review Abstract Background Individuals affected by psychotic disorders frequently disengage from mental health services, although reports of this rate in the literature have ranged from 6 to 60%. One of the potential explanations for the large variation is that studies have adopted different definitions. Without a universal definition it is challenging to compare rates and factors leading to disengagement across studies. This systematic review aims to identify and compare how disengagement from psychosis services has been defined, measured and operationalised in the literature to date. Methods A systemic literature search of the PubMed, PsycINFO and CINAHL databases was completed following the PRISMA guidelines for systematic reviews. Results 1506 Studies were identified, of which 30 were eligible to be included. It was found that disengagement was operationalized as either a categorical or continuous variable across studies, with 18 studies classifying it as a categorical, binary variable. Only four studies applied a time period over which disengagement was said to occur, and only four studies used an instrument to measure or predict disengagement. Few studies considered similar factors in their definition, when this occurred it was because the papers came from the same research group. Discussion To truly understand the phenomenon of disengagement, studies need to have a comparable outcome variable. The need for consensus on a gold standard definition of disengagement that considers the full breadth of its complexity remains. A potential process for establishing a definition that includes set parameters, agreed upon terminology and time periods of assessment is discussed.

Minding the treatment gap: results of the Singapore Mental Health Study Abstract Purpose To establish the 12-month treatment gap and its associated factors among adults with mental disorders in the Singapore resident population using data from the second Singapore Mental Health Study and to examine the changes since the last mental health survey conducted in 2010. Methods 6126 respondents were administered selected modules of the Composite International Diagnostic Interview, to assess major depressive disorder (MDD), dysthymia, bipolar disorder, generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD) and alcohol use disorder (AUD) (which included alcohol abuse and dependence). Past year treatment gap was defined as the absolute difference between the prevalence of a particular mental disorder in the past 12 months preceding the interview and those who had received treatment for that disorder. Results The prevalence of overall 12-month treatment gap in this population was high (78.6%). A multiple logistic regression analysis revealed significantly higher odds of treatment gap among those diagnosed with OCD (compared to those with MDD) and in those with a comorbid chronic physical disorder; while those who had primary education and below and those who were unemployed were less likely to have a treatment gap as compared to those with post-secondary education and those employed, respectively. Conclusions The high treatment gap in the population is concerning and highlights the need to promote help-seeking and uptake of treatment. Given the unique demographic characteristics, i.e., those with higher education and employed were more likely not to seek treatment, targeted interventions in the educational and workplace settings should be implemented.

Depressive symptoms, suicidal ideation, and mental health care-seeking in central Mozambique Abstract Purpose There is scant research on depressive symptoms (DS), suicidal ideation (SI), and mental health care-seeking in Mozambique. Methods Generalized estimating equations were used to assess factors associated with DS, SI, and mental health care-seeking among 3080 individuals interviewed in a representative household survey in Sofala and Manica provinces, Mozambique. Results 19% (CI 17–21%) of respondents reported DS in the past year and 17% (CI 15–18%) lifetime SI. Overall, only 10% (CI 8–11%) of respondents ever sought any care for mental illness, though 26% (CI 23–29%) of those reporting DS and/or SI sought care. 90% of those who sought care for DS received treatment; however, only 46% of those who sought care for SI received treatment. Factors associated with DS and SI include: female gender, divorced/separated, widowed, and > 55 years old. Respondents in the bottom wealth quintile reported lower DS, while those in upper wealth quintiles reported higher prevalence of SI. Individuals with DS or SI had significantly elevated measures of disability—especially in doing household chores, work/school activities, standing for long periods, and walking long distances. Factors associated with care-seeking include: female gender, rural residence, divorced/separated, and > 45 years old. Individuals in lower wealth quintiles and with no religious affiliation had lower odds of seeking care. Conclusions DS and SI are prevalent in central Mozambique and treatment gaps are high (68% and 89%, respectively). An urgent need exists for demand- and supply-side interventions to optimize the delivery of comprehensive community-based mental healthcare in Mozambique.

Forced migration-related traumatic experiences and collective memory in Ezidi asylum-seekers coming to Diyarbakir province from Shingal region Abstract Purpose The purpose of this study was to investigate the collective memory of Ezidi asylum-seekers who migrated from Iraq to Turkey in 2014. Methods Kurdish-speaking Ezidi participants of 25–65 years of age (ten male and ten female) who have arrived to Fidanlık Camp in Diyarbakır, Turkey from the Iraqi Shingal region have been included in the study. Data were collected through semi-structured in depth interviews and qualitative content analysis was conducted on the collected data. Results The word “edict”, which was used to define violent attacks, had a significant importance in all participants’ memories. The collective memory observed in the Ezidi society leads a collective fear. Homelessness and religious discrimination are other concerns observed in the population. Conclusion In conclusion, due to the depth and strength of the oral narrative tradition in the Kurdish culture, a significant collective memory is formed within the Ezidi society. Accumulation of previous negative events may prevent Ezidis to form a healthy identity. Traumas of the Ezidis should be investigated in more detail, and studies with larger scopes should be conducted in the future.

Identifying typologies among persons admitted to hospital for non-fatal intentional self-harm in Victoria, Australia Abstract Purpose The aim of this study was to determine whether people who have been hospitalised as the result of non-fatal self-harm form meaningful groups based on mechanism of injury, and demographic and mental health-related factors. Methods A retrospective analysis of 18,103 hospital admissions for self-harm in Victoria, Australia over the 3-year period 2014/2015–2016/2017 recorded on the Victorian Admitted Episodes Dataset (VAED). The VAED records all hospital admissions in public and private hospitals in Victoria. The primary analysis used a two-step method of cluster analysis. Initial analysis determined two distinct groups, one composed of individuals who had a recorded mental illness diagnosis and one composed of individuals with no recorded mental illness diagnosis. Subsequent cluster analysis identified four subgroups within each of the initial two groups. Results Within the diagnosed mental illness subgroups, each subgroup was characterised by a particular mental disorder or a combination of disorders. Within the no diagnosis of mental illness groups, the youngest group was also the most homogenous (all females who self-poisoned), the oldest group had a high proportion of rural/regional residents, the group with the highest proportion of males also had the highest proportion of people who used cutting as the method of self-harm, and the group with the highest proportion of metropolitan residents also had the highest proportion of people who were married. Conclusions Preventative interventions need to take into account that those who are admitted to hospital for self-harm are a heterogeneous group.

Case-finding for common mental disorders in primary care using routinely collected data: a systematic review Abstract Purpose Case-finding for common mental disorders (CMD) in routine data unobtrusively identifies patients for mental health research. There is absence of a review of studies examining CMD-case-finding accuracy in routine primary care data. CMD-case definitions include diagnostic/prescription codes, signs/symptoms, and free text within electronic health records. This systematic review assesses evidence for case-finding accuracy of CMD-case definitions compared to reference standards. Methods PRISMA-DTA checklist guided review. Eligibility criteria were outlined prior to study search; studies compared CMD-case definitions in routine primary care data to diagnostic interviews, screening instruments, or clinician judgement. Studies were quality assessed using QUADAS-2. Results Fourteen studies were included, and most were at high risk of bias. Nine studies examined depressive disorders and seven utilised diagnostic interviews as reference standards. Receiver operating characteristic (ROC) planes illustrated overall variable case-finding accuracy across case definitions, quantified by Youden’s index. Forest plots demonstrated most case definitions provide high specificity. Conclusion Case definitions effectively identify cases in a population with good accuracy and few false positives. For 100 anxiety cases, identified using diagnostic codes, between 12 and 20 will be false positives; 0–47 cases will be missed. Sensitivity is more variable and specificity is higher in depressive cases; for 100 cases identified using diagnostic codes, between 0 and 87 will be false positives; 4–18 cases will be missed. Incorporating context to case definitions may improve overall case-finding accuracy. Further research is required for meta-analysis and robust conclusions.