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Socioeconomic Correlates of Suicidal Ideation in Military Veterans: Examining the Interaction Between Homelessness and Financial Debt. 退伍军人自杀念头的社会经济相关因素:研究无家可归与经济债务之间的相互作用。
IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-08-07 DOI: 10.1007/s10597-024-01316-0
Chase M DuBois, Allison Falls, Bethzaida N Serrano, H Ryan Wagner, Jack Tsai, Eric B Elbogen

Studies in veterans have yet to examine interconnections between homelessness, financial debt, and suicidal ideation. We analyzed data from a nationally-representative study conducted in 2021 of low-income U.S. veterans (N = 1,004). Analyses revealed veterans who were younger, male, had a history of criminal arrests, met criteria for posttraumatic stress disorder (PTSD), reported greater loneliness, or had both a history of homelessness and higher debt were more likely to endorse suicidal ideation. We found an interaction between a history of homelessness and current debt: 40% of veterans with both past homelessness and higher debt reported suicidal ideation, whereas only 10% of veterans with either past homelessness or higher debt reported suicidal ideation. As past homelessness and current debt interacted to increase the odds of suicidal ideation in a national sample of veterans, these results inform policy and clinical decision-making for suicide prevention and in programs serving veterans experiencing homelessness.

针对退伍军人的研究尚未考察无家可归、金融债务和自杀意念之间的相互联系。我们分析了 2021 年对美国低收入退伍军人(N = 1,004 人)进行的一项具有全国代表性的研究的数据。分析结果显示,年龄较小、男性、有过刑事逮捕史、符合创伤后应激障碍(PTSD)标准、孤独感较强或有过无家可归史和较高债务的退伍军人更有可能有自杀倾向。我们发现无家可归史与当前债务之间存在相互作用:在既有无家可归史又有较高债务的退伍军人中,有 40% 的人有自杀倾向,而在既有无家可归史又有较高债务的退伍军人中,只有 10% 的人有自杀倾向。在一个全国性的退伍军人样本中,过去的无家可归史和当前的债务相互影响,增加了出现自杀念头的几率,这些结果为预防自杀的政策和临床决策以及为经历过无家可归的退伍军人提供服务的项目提供了参考。
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引用次数: 0
Phase-Based Care in Community Mental Health: A Cost-Effective Innovation Using Algorithms, Rating Scales and Treatment Teams for Depression Management. 社区心理健康中的分阶段护理:利用算法、评级量表和治疗小组进行抑郁症管理的成本效益创新。
IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-06-25 DOI: 10.1007/s10597-024-01303-5
Jules Rosen, Michelle Hoy

This retrospective, observational report describes an innovative quality improvement process, Phase-based Care (PBC), that eliminated wait times and achieved positive clinical outcomes in a community mental health center's (CMHC) mood disorder clinic without adding staff. PBC accomplishes this by eliminating the ingrained cultural practice of routinely scheduling stable patients at rote intervals of 1-3 months, regardless of clinical need or medical necessity. Based on four organizational transformations and using mathematical algorithms developed for this process, PBC re-allocates therapy and medical resources away from routinely scheduled appointments and front-loads those resources to patients in an acute phase of illness. To maintain wellness for patients in recovery, lower frequency and intensity approaches are used. This report describes the development of the PBC methodology focusing on the Rapid Recovery Clinic (RRC) comprised of 182 patients with a primary diagnosis of a mood disorder, the largest of the 14 PBC clinics created. Over an 18-month period, wait times were reduced from several months to less than one week and recovery rates, meaning no longer in an acute phase, were 63% and 78% at weeks 6 and 12, respectively for patients who engaged in the program.

这篇回顾性观察报告介绍了一种创新的质量改进流程--分阶段护理(PBC),该流程消除了社区心理健康中心(CMHC)情绪障碍诊所的等待时间,并在不增加人员的情况下取得了积极的临床效果。PBC 通过消除根深蒂固的文化习俗来实现这一目标,即不考虑临床需求或医疗必要性,以 1-3 个月的固定时间间隔为稳定的患者安排常规治疗。基于四次组织变革,并利用为这一过程开发的数学算法,PBC 重新分配了治疗和医疗资源,不再按常规安排预约,而是将这些资源前置到处于疾病急性期的患者身上。为了使处于康复期的病人保持健康,采用了频率和强度较低的方法。本报告介绍了 PBC 方法的发展情况,重点介绍了快速康复诊所(RRC)的情况,该诊所由 182 名主要诊断为情绪障碍的患者组成,是 14 家 PBC 诊所中规模最大的一家。在 18 个月的时间里,参与该计划的患者的等待时间从几个月缩短到不到一周,在第 6 周和第 12 周,康复率(即不再处于急性期)分别为 63% 和 78%。
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引用次数: 0
What Really Matters in the Implementation of Evidence-based Practices in Community Mental Health? Insight and Recommendations from Experts, Providers, and Clients. 在社区心理健康中实施循证实践的真正关键是什么?来自专家、服务提供者和客户的见解和建议。
IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-06-22 DOI: 10.1007/s10597-024-01307-1
Vanesa A Mora Ringle, Amber Calloway, Danielle Reich, Rebecca Oziel, Arielle Walzer, Sydne O'Connor, Amberlee Venti, Carrie Comeau, Tamra Williams, Torrey A Creed

Perceptions of evidence-based practices (EBPs) and implementation are inherent drivers of implementation outcomes. Most studies on implementation perceptions have focused on direct service providers, but clients and EBP experts may offer additional meaningful information about implementing EBPs in community settings. EBP providers (n = 21), EBP experts (n = 12), and clients who received EBPs (n = 6) participated in focus groups to ascertain their perceptions of and experiences with EBP implementation, as part of a program evaluation. Thematic analysis indicated that provider and expert perceptions of EBP implementation in community settings converged around themes of implementation supports and training and client outcomes, along with several subthemes. Client perceptions centered on themes regarding the importance of their personal experiences, their impressions of EBPs, as well as their recommendation for increasing public awareness and use of EBPs. Findings suggest that the perspectives of EBP providers and experts are closely aligned, focusing on system-level, individual-level, and training issues that impact EBP implementation within a public mental health system. The themes that were important to clients were primarily related to their experiences as recipients of an EBP which produced insightful recommendations for promoting EBPs in the community.

对循证实践(EBPs)和实施的认知是实施结果的内在驱动力。大多数关于实施感知的研究都集中在直接服务提供者身上,但客户和 EBP 专家可能会提供更多关于在社区环境中实施 EBPs 的有意义的信息。作为项目评估的一部分,EBP 提供者(21 人)、EBP 专家(12 人)和接受 EBP 的客户(6 人)参加了焦点小组,以确定他们对 EBP 实施的看法和经验。主题分析表明,医疗服务提供者和专家对社区环境中 EBP 实施的看法围绕着实施支持和培训以及客户结果这两个主题以及几个次主题。服务对象的看法集中在他们个人经历的重要性、他们对 EBPs 的印象以及他们对提高公众意识和使用 EBPs 的建议等主题上。研究结果表明,EBP 提供者和专家的观点是紧密一致的,都集中在系统层面、个人层面以及影响公共心理健康系统内 EBP 实施的培训问题上。对客户来说重要的主题主要与他们作为 EBP 的接受者的经历有关,这为在社区推广 EBP 提出了有见地的建议。
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引用次数: 0
Patterns of Mental Health Service Utilisation: A Population-Based Linkage of Over 17 Years of Health Administrative Records. 心理健康服务使用模式:基于人口的超过 17 年的卫生行政记录链接》(A Population-Based Linkage of Over 17 Years of Health Administrative Records)。
IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-06-12 DOI: 10.1007/s10597-024-01300-8
Crystal Man Ying Lee, Kevin Chai, Peter M McEvoy, Kyran Graham-Schmidt, Daniel Rock, Kim S Betts, Justin Manuel, Mathew Coleman, Shiv Meka, Rosa Alati, Suzanne Robinson

A cross-sectoral partnership was formed in 2021 in support of the recommendations in an audit on access to state-funded mental health services. In this first paper, we aimed to describe the demographic and service utilisation of adults with a mental health diagnosis in the Western Australian state-funded health system from 2005 to 2021. Inpatient, emergency department, specialised (ambulatory) community mental health service, and death records were linked in individuals aged ≥ 18 years with a mental health diagnosis in Western Australia. Altogether, 392,238 individuals with at least one mental health service contact between 1st January 2005 and 31st December 2021 were included for analysis. Females, Aboriginal and/or Torres Strait Islander people, and those who lived outside major cities or in the most disadvantaged areas were more likely to access state-funded mental health services. While the number of individuals who accessed community mental health services increased over time (from 28,769 in 2005 to 50,690 in 2021), the percentage increase relative to 2005 was notably greater for emergency department attendances (127% for emergency department; 76% for community; and 63% for inpatient). Conditions that contributed to the increase for emergency department were mainly alcohol disorder, reaction to severe stress and adjustment disorders, and anxiety disorders. Sex differences were observed between conditions. The pattern of access increased for emergency department and the community plus emergency department combination. This study confirmed that the patterns of access of state-funded mental health services have changed markedly over time and the potential drivers underlying these changes warrant further investigation.

2021 年,我们成立了一个跨部门合作伙伴关系,以支持对获得州政府资助的精神健康服务进行审计后提出的建议。在这第一篇论文中,我们旨在描述 2005 年至 2021 年期间西澳大利亚州政府资助的医疗系统中被诊断患有精神疾病的成年人的人口统计和服务利用情况。我们将西澳大利亚州年龄≥18 岁、被诊断患有精神疾病的人的住院、急诊、专科(门诊)社区精神健康服务和死亡记录联系起来。在 2005 年 1 月 1 日至 2021 年 12 月 31 日期间,共有 392,238 人至少接触过一次心理健康服务,这些人被纳入分析范围。女性、土著居民和/或托雷斯海峡岛民、居住在大城市以外或最贫困地区的人更有可能获得州政府资助的心理健康服务。随着时间的推移,获得社区心理健康服务的人数有所增加(从 2005 年的 28 769 人增加到 2021 年的 50 690 人),但与 2005 年相比,急诊室就诊人数的百分比增幅明显更大(急诊室就诊人数增幅为 127%;社区就诊人数增幅为 76%;住院病人就诊人数增幅为 63%)。导致急诊就诊人数增加的疾病主要是酒精紊乱、严重压力反应和适应障碍以及焦虑症。不同病症之间存在性别差异。急诊科和社区加急诊科的就诊模式都有所增加。这项研究证实,随着时间的推移,获得国家资助的心理健康服务的模式发生了显著变化,而这些变化背后的潜在驱动因素值得进一步研究。
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引用次数: 0
Exploring the Relationship Needs of Service Users During Crisis Interventions: A Qualitative Study. 探索危机干预期间服务使用者的关系需求:定性研究。
IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-10-29 DOI: 10.1007/s10597-024-01372-6
Larissa Steimle, Sebastian von Peter, Fabian Frank

People in crisis sometimes seek professional support, and the relationship between service users and professionals is crucial in overcoming the crisis. To understand the relationship needs of people in crisis, 29 semi-structured interviews with service users were conducted and analyzed using a grounded-theory approach. The findings reveal that people in crisis seek a professional who is there for them, recognizes the crisis as an emergency and a solvable situation, treats them with respect, and offers individual support. Furthermore, there needs to be a general fit between professionals, the support services, and service users for a supportive relationship to be established. However, two main aspects were discovered where service users differ depending on the resources they can access during the crisis: While people with access to many resources seek a rather distant and egalitarian relationship, those with access to fewer resources prefer more intimate and hierarchical relationships with professionals.

处于危机中的人有时会寻求专业人员的支持,而服务使用者与专业人员之间的关系对于克服危机至关重要。为了了解处于危机中的人对关系的需求,我们对服务使用者进行了 29 次半结构式访谈,并采用基础理论方法对访谈内容进行了分析。研究结果表明,危机中的人们需要专业人员陪伴他们,认识到危机是一种紧急情况,也是一种可以解决的情况,尊重他们,并为他们提供个别支持。此外,专业人员、支持服务和服务使用者之间需要有一个总体的契合点,这样才能建立起支持关系。然而,我们也发现了两个主要方面,即服务使用者因其在危机期间可获得的资源不同而存在差异:能够获得很多资源的人寻求一种比较疏远和平等的关系,而那些资源较少的人则更喜欢与专业人员建立比较亲密和等级森严的关系。
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引用次数: 0
Bridging the gap of Inequity in Implementation Science: Adaptations of Group EBPs for those with Serious Mental Illness in the Public Sector. 缩小实施科学中的不公平差距:针对公共部门严重精神疾病患者的团体 EBPs 调整。
IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-10-19 DOI: 10.1007/s10597-024-01371-7
Erika R Carr

There are many group EBPs that are now listed as effective treatments for those with serious mental illness (SMI). Despite this, there are few of these group EBPs that are being delivered consistently in the public sector, causing disparity. This article reviews the challenges that relate to implementation science and those with SMI receiving group EBPs to help them live a life of meaning as they define. The article discusses the need for adaptations of EBPs as individuals with complex concerns need different approaches to implementation science. Next, the article conveys what core constructs of group EBPs have to be maintained as they are and what elements of EBPs need adapting to empower those with SMI in engagement. This article provides knowledge of practical application of implementation science approaches while providing dialectical behavior group therapy and cognitive behavior group therapy for psychosis adaptations for those with SMI in a public sector inpatient setting.

目前,有许多团体 EBPs 被列为对严重精神疾病(SMI)患者的有效治疗方法。尽管如此,这些团体 EBPs 却很少在公共部门得到持续实施,从而造成了差异。本文回顾了与实施科学有关的挑战,以及那些接受团体 EBPs 以帮助他们过上有意义的生活的 SMI 患者。文章讨论了对 EBPs 进行调整的必要性,因为具有复杂问题的个体需要不同的实施科学方法。接下来,文章介绍了团体 EBPs 中哪些核心结构必须保持不变,哪些 EBPs 元素需要调整以增强 SMI 患者的参与能力。本文介绍了实施科学方法的实际应用知识,同时为公共部门住院环境中的 SMI 患者提供了针对精神病的辩证行为团体疗法和认知行为团体疗法的调整。
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引用次数: 0
Programmatic and Organizational Barriers and Facilitators to Addressing High-Risk Issues in Supportive Housing and Housing First Programs. 在支持性住房和住房优先计划中解决高风险问题的计划和组织障碍与促进因素。
IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-10-18 DOI: 10.1007/s10597-024-01373-5
Nick Kerman, Timothy de Pass, Sean A Kidd, Christina Mutschler, Abe Oudshoorn, John Sylvestre, Tim Aubry, Benjamin F Henwood, Frank Sirotich, Vicky Stergiopoulos

Risk management is an important component of service delivery in supportive housing and Housing First programs. However, there is no evidence on the implementation of risk management approaches in these settings. This qualitative study examined what service providers working in supportive housing and Housing First programs in Canada identify as the programmatic and organizational factors that affect the prevention and management of high-risk behaviours and challenges (e.g., overdose, suicide attempts, non-suicidal self-injury, falls and fall-related injuries, fire-setting, hoarding, apartment takeovers, violence, property damage, drug selling) in their programs. In-depth interviews were completed with a purposive sample of 32 service providers. Data were analyzed using an integrative approach that incorporated techniques from qualitative description and thematic analysis. Four thematic factors, which were comprised of various barriers and facilitators, that affected management of high-risk issues in supportive housing and Housing First programs were identified: [1] flexibility in addressing risk issues; [2] early identification of risk issues; [3] built environment and housing location; and [4] resource availability. Overall, the findings underscore how service providers aim to identify high-risk issues promptly, beginning as early as referral, and that their capacity to effectively do this and intervene accordingly is dynamically shaped by various aspects of the program model, environment, and availability of internal and external resources. Yet, the findings also highlight how risk management approaches may conflict with other programmatic goals and values, and the importance of considering these collectively. Systems-level changes to strengthen programs' capacity to prevent risk and implications for future research are discussed.

风险管理是支持性住房和住房优先计划中提供服务的重要组成部分。然而,目前还没有证据表明在这些环境中实施了风险管理方法。这项定性研究考察了在加拿大支持性住房和住房优先计划中工作的服务提供者认为哪些计划和组织因素会影响其计划中高风险行为和挑战(如用药过量、自杀未遂、非自杀性自伤、跌倒和与跌倒相关的伤害、纵火、囤积居奇、接管公寓、暴力、财产损失、贩毒)的预防和管理。对 32 名服务提供者进行了有目的的抽样深入访谈。数据分析采用了综合方法,融合了定性描述和专题分析的技术。确定了影响支持性住房和 "住房优先 "计划中高风险问题管理的四个主题因素,包括各种障碍和促进因素:[1] 解决风险问题的灵活性;[2] 早期识别风险问题;[3] 建筑环境和住房位置;以及 [4] 资源可用性。总体而言,研究结果强调了服务提供者如何致力于及时发现高风险问题,从转介开始,他们有效地做到这一点并采取相应干预措施的能力是由计划模式、环境以及内部和外部资源的可用性等各个方面动态决定的。然而,研究结果也强调了风险管理方法与其他计划目标和价值观的冲突,以及综合考虑这些因素的重要性。报告还讨论了为加强计划预防风险的能力而进行的系统层面的变革,以及对未来研究的影响。
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引用次数: 0
Peer Support Workers in Mental Health Services: A Qualitative Exploration of Emotional Burden, Moral Distress and Strategies to Reduce the Risk of Mental Health Crisis. 心理健康服务中的同伴支持工作者:对精神负担、道德压力和降低心理健康危机风险策略的定性研究。
IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-10-17 DOI: 10.1007/s10597-024-01370-8
Justyna Klingemann, Halina Sienkiewicz-Jarosz, Bartłomiej Molenda, Piotr Świtaj

This research aimed to explore the experience of emotional burden among peer support workers (PSWs) in mental health care in Poland. It also examined the issue of moral distress in relation to this professional group and identified institutional sources of support for the well-being of PSWs in the workplace. The data presented in the article are derived from fourteen qualitative in-depth individual interviews with PSWs employed in four mental health centres with different organisational structures. The narratives of PSWs revealed several experiences that could be considered to be moral distress. The inability to assist patients was found to be associated with both individual and institutional barriers. Furthermore, our findings suggest that organisations can implement a number of specific practices to ensure the wellbeing of PSWs, which dissemination would be beneficial to teams employing PSWs.

本研究旨在探讨波兰心理健康护理领域同伴互助工作者(PSWs)的情感负担经历。研究还探讨了与这一职业群体相关的道德困扰问题,并确定了在工作场所为同伴互助工作者的福祉提供支持的机构来源。文章中提供的数据来自对受雇于四个具有不同组织结构的心理健康中心的 PSW 进行的 14 次定性深入个人访谈。PSW 的叙述揭示了几种可被视为道德困扰的经历。我们发现,无法帮助病人与个人和机构的障碍都有关系。此外,我们的研究结果表明,各机构可以实施一些具体的做法来确保 PSW 的健康,这些做法的推广将有益于雇用 PSW 的团队。
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引用次数: 0
Taking what you get or Getting what you Need: A Qualitative Study on Experiences with Mental Health and Welfare Services in Long-Term Recovery in First-Episode Psychosis. 各取所需还是各取所需:关于首发精神病患者长期康复过程中精神健康和福利服务体验的定性研究》。
IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-10-16 DOI: 10.1007/s10597-024-01356-6
Gina Åsbø, Hanne Haavind, Sindre Hembre Kruse, Kristin Fjelnseth Wold, Wenche Ten Velden Hegelstad, Kristin Lie Romm, Mike Slade, Torill Ueland, Ingrid Melle, Carmen Simonsen

How people in long-term recovery (clinical and personal) in first-episode psychosis (schizophrenia and bipolar spectrum disorders) experience the mental health and welfare services they interact with is not frequently studied but has significant implications. We therefore aimed to explore which aspects of these services people with FEP evaluate as important for their long-term recovery. Twenty participants in clinical and/or personal recovery from two Norwegian long-term follow-up studies after FEP (TOP 10-year and TIPS 20-year) were sampled for this interview-based qualitative study. The research-team included service user experience. A deductive analysis based on personal accounts of recovery generated five service aspects. Few specific types of interventions were reported to promote recovery although medications, psychotherapy and employment support were mentioned. Participants valued services based in collaboration and that focused on their resources rather than limitations. The importance of long-term follow-up with a consistent aim was highlighted, as was the inclusion of caregivers and peers. Welfare services contributed to recovery by supporting basic needs and safety, but some experienced social exclusion when not participating in the labor market. This study is unique in exploring the role of services, including welfare, in long-term FEP recovery from service user perspectives. Participants evaluated that services played a more indirect role in long-term recovery by supporting their personal resources, although what they needed from services had frequently not been offered. Their expertise by experience contributes valuable knowledge. Better service coordination and consistent implementation of this knowledge are crucial to support recovery in FEP.

对首发精神病(精神分裂症和双相情感障碍)患者在长期康复(临床和个人)过程中如何体验与他们互动的精神健康和福利服务的研究并不多见,但却具有重要意义。因此,我们旨在探索 FEP 患者认为这些服务的哪些方面对他们的长期康复非常重要。在这项基于访谈的定性研究中,我们从挪威两项FEP长期跟踪研究(TOP 10年和TIPS 20年)中抽取了20名临床和/或个人康复参与者。研究团队将服务使用者的经验纳入其中。基于个人康复经历的演绎分析产生了五个服务方面。尽管提到了药物、心理治疗和就业支持,但很少有具体类型的干预措施被报告用于促进康复。参与者重视以合作为基础的服务,重视他们的资源而不是局限性。与会者强调了目标一致的长期跟踪的重要性,以及将照顾者和同伴纳入其中的重要性。福利服务通过支持基本需求和安全来促进康复,但有些人在不参与劳动力市场时会受到社会排斥。这项研究的独特之处在于从服务使用者的角度探讨了包括福利服务在内的各种服务在家庭护理方案的长期康复过程中发挥的作用。参加者评价说,服务通过支持他们的个人资源,在长期康复中发挥了更为间接的作用,尽管他们所需要的服务往往没有提供给他们。他们的专业经验提供了宝贵的知识。更好地协调服务并始终如一地落实这些知识,对于支持家庭保护计划的康复工作至关重要。
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引用次数: 0
Addressing the Needs of Hispanic Veterans who Live in Rural Areas to Improve Suicide Prevention Efforts. 满足居住在农村地区的西班牙裔退伍军人的需求,改进预防自杀工作。
IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-10-14 DOI: 10.1007/s10597-024-01361-9
I Magaly Freytes, Nathaniel Eliazar-Macke, Melanie Orejuela, Janet Lopez, Talia Spark, Bryann DeBeer, Magda Montague, Constance Uphold

Despite the alarming recent increase in suicide rates among Hispanic Veterans, suicide among this population remains relatively understudied and little is known about their needs and how to prevent suicide in this population. A mixed methods approach was utilized to conduct a needs assessment of community suicide prevention services and resources available to Hispanic Veterans living in rural areas in the Veterans Health Administration's Veterans Integrated Services Network (VISN) 8. Five themes related to the suicide prevention's needs and gaps in services were identified: (1) lack of adequate information; (2) disruptions in social support network; (3) limited or lack of access to services; (4) risky behaviors; and (5) natural disasters. Understanding the unique needs of Hispanic Veterans in rural communities and the gaps in services in these areas can help in the development of tailored suicide prevention efforts and potentially mitigate suicide disparities.

尽管拉美裔退伍军人的自杀率最近出现了惊人的增长,但对这一人群的自杀研究仍然相对不足,人们对他们的需求以及如何预防这一人群的自杀也知之甚少。我们采用混合方法,对居住在退伍军人健康管理局退伍军人综合服务网络(VISN)8 农村地区的西班牙裔退伍军人的社区自杀预防服务和资源进行了需求评估。评估确定了五个与预防自杀的需求和服务差距相关的主题:(1) 缺乏足够的信息;(2) 社会支持网络中断;(3) 获得服务的途径有限或缺乏;(4) 危险行为;以及 (5) 自然灾害。了解农村社区拉美裔退伍军人的独特需求以及这些地区的服务缺口,有助于制定有针对性的自杀预防措施,并有可能缩小自杀差异。
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引用次数: 0
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Community Mental Health Journal
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