PLOS mental health最新文献

This study investigated how nighttime temperatures influence suicidal help-seeking behavior via theorized pathways: sleep disruption, impulsivity, social isolation, and unmet basic needs. We analyzed 11,684 suicide hotline risk assessments (Louisiana, USA). Distributed lag nonlinear models quantified temperature associations with standardized suicide risk factors during minimum temperature extremes (≤10th, ≥ 90th percentiles). Natural language processing on counselor notes identified help-seeking crisis contexts; generalized additive models examine associations between crisis contexts and temperature exposure. Stratified demographic analyses provide exploratory insights into mechanistic pathways across populations. Suicide-related help-seeking increased dramatically with rising nighttime temperatures: 19% at the 90th percentile (PR = 1.19, 95% CI: 1.10-1.29), 55% at the 95th percentile (PR = 1.55, 95% CI: 1.44-1.68), and 166% at the 99th percentile (PR = 2.66, 95% CI: 2.42-2.92); an estimated absolute increase of 19 suicide calls per 100 crisis calls in the two days following hot nights. These increases were accompanied by sleep difficulties (+146% at 99th percentile), expressed intent to die (+163% at 99th percentile), availability of lethal means (+145% at 99th percentile), and few future plans (+224% at 99th percentile). Crises related to mental health (+20.9%) and basic needs (+59.9%) increased at the 90th percentile; sleep was more prevalent at cold temperatures (+68.1% at 10th; -31.9% at 90th). Youth, women, and Black clients were associated with mental health mentions at high temperatures; youth were also associated with increases in isolation. Black clients and men mentioned substance use more during high temperatures. Temperature extremes exacerbate suicide risk pathways, notably sleep disruption, substance use and impulsivity, essential needs stress, and social isolation. Results are most applicable to other humid subtropical climates with similar sociodemographics and should be interpreted as exploratory due to high demographic missingness. Findings inform proactive interventions, such as temperature-triggered staffing protocols and integration of basic needs support into suicide prevention during extreme weather events.

The Kuwaiti Bidoon are a group of people affected by statelessness. Estimates suggest thousands of Kuwaiti Bidoon have forcibly migrated to the United Kingdom (UK); however, little is known about their experiences of mental health. This study aimed to explore the mental health experiences of statelessness among Kuwaiti Bidoon people living in the UK, and their experiences of accessing mental health services (where indicated).Participants were five Kuwaiti Bidoon people currently living in the UK. All participants attended a semi-structured interview. Experiences relating to statelessness and mental health were investigated using Interpretative Phenomenological Analysis. Participants shared the multifaceted impacts of statelessness on their lives, including mental health struggles stemming from their marginalisation and uncertain legal status. Three major themes were generated from the interview data: The Legacy of Statelessness; Hopes and Dreams of a Future; Victims of a System. Hope and optimism arise for some when migrating to the UK, while others reported challenges and distress associated with the state of 'limbo' arising from processes to regularise their legal status. Some participants reported barriers to accessing effective mental health support, which was sometimes connected to their legal status. This study raises awareness of the context for UK-based Bidoon people and furthers understanding of the long-term negative mental health consequences of statelessness. Further research directions, recommendations for improvements to healthcare and statutory service provision for stateless or displaced people (such as ensuring accessibility, acceptability and delivery of culturally sensitive care), and the need for broader policy change are discussed.

Multiple studies have associated antipsychotic use with increased mortality among individuals with dementia, but evidence in Latin America remains limited. We conducted a retrospective cohort study among outpatients aged 60 years and older receiving care within a large health maintenance organization in Argentina. Participants underwent cognitive evaluation resulting in dementia diagnosis between January 2017 and December 2021. The main exposure was the new-use of antipsychotics after dementia diagnosis. We fitted multivariable Cox proportional hazards models for the association between new-use of antipsychotics and all-cause mortality to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI), adjusted for demographics, behavioral factors, and comorbidities. To evaluate dose-response patterns, we used standardized daily doses of antipsychotics (SDD) measured every three months and modelled using restricted cubic splines. Overall, we included 1,326 patients ≥60 years with a new dementia diagnosis, of whom 325 (25%) started antipsychotic treatment during follow-up. Median follow-up time in the entire cohort was 963 (interquartile range: 452-1,333) days and 184/1,326 (14%) of patients died during follow-up. Overall, female sex was most prevalent, and a quarter of patients had completed their secondary education. New-users of antipsychotics had a higher hazard of all-cause mortality compared with non-users (aHR = 2.66, 95%CI: 1.93, 3.67), after adjusting for potential confounders. In secondary analyses, we found no evidence of higher mortality with increasing cumulative antipsychotic exposure. Compared with non-use, the aHRs were inconsistent across cumulative dose levels: 30 SDD (aHR = 2.51, 95%CI: 1.69, 3.74), 90 SDD (aHR = 3.88, 95%CI: 2.30, 6.53), and 365 SDD (aHR = 2.20, 95%CI: 1.22, 3.96). In conclusion, in this retrospective cohort with predominantly female participants with low educational attainment in Argentina, new-use of antipsychotics was associated with higher risk of all-cause mortality among patients with dementia. These findings highlight the importance of minimizing the use of antipsychotics in patients with dementia when feasible.

Rates of poor mental health among children and young people are rising globally, with physical health professionals increasingly expected to respond to psychiatric needs. Despite this shift, limited research has explored how these professionals experience and manage mental health presentations, particularly in paediatric settings. This study examines the challenges and opportunities faced by staff supporting young people with mental health needs on paediatric hospital wards, within a system that often treats physical and mental health separately. We conducted a secondary analysis of 31 one-off semi-structured interviews, conducted with 16 mental health and 15 physical health professionals. Using reflexive thematic analysis, themes were iteratively refined in dialogue with NHS collaborators, a senior qualitative researcher, and interview participants to ensure analytic rigour and relevance. Professionals reported a widening gap between the complexity of young patients' mental health needs and the limited expertise available on physical health wards. Three themes emerged: (1) "We all feel out of our depth," reflecting feelings of being underprepared and overwhelmed; (2) "A mental health waiting room," highlighting wards being used as temporary spaces while patients await psychological care; and (3) "We're the place to keep them safe," revealing a primary focus on immediate risk management. Physical health professionals reported feeling unprepared to support young patients with mental health needs, often managing self-harm, suicidality, and eating disorders without specialist training. Both physical and mental health professionals emphasized a need for trauma-informed, non-stigmatizing communication and emotional support for staff. Barriers to integrated care within these two trusts included digital system incompatibility, understaffing, and limited psychiatric liaison. Findings highlight the urgency of cross-disciplinary training, supervision, and structural investment to support compassionate, coordinated care for young people with complex mental and physical health needs.

While there is much research suggesting that there is an association between the experience of boredom and the use of substances, the mechanisms which govern this relationship are largely unknown. This study was employed to generate an enhanced understanding of the relationship between boredom and substance use among persons who are unhoused living in high-income nations. A secondary analysis of 18 qualitative interviews from persons experiencing homelessness was conducted utilizing reflexive thematic analysis. Sen's Capabilities Approach was used as a framework to guide this abductive analysis. The central essence of participant interviews was: "idle hands here are the devil's playground". Within this essence, two themes were generated: 1) the contextual conditions influencing substance use; and 2) substances as an escape from boredom The experience of boredom was identified by participants as a factor that increased the propensity to engage in substance use. Numerous mechanisms influencing this relationship were identified. This study illustrates the importance of providing unhoused persons with opportunities to engage in meaningful activities to alleviate the boredom that factors so heavily into their lives. The findings of this research emphasize the importance of addressing boredom among persons experiencing homelessness and may be used to better inform policy, practice, and future research endeavors.

Long COVID is associated with significant physical and mental health burden, resulting in substantial quality of life limitations. The lived experience of individuals with long COVID is a vital consideration in evaluating the impact of the condition. Thirty-four adults with self-reported long COVID participated in a semi-structured in-depth interview study. An interview guide assessed physical and mental health symptoms, changes to plans, goals, and beliefs, and social impacts of long COVID. Participants were an average age of 51.6 years (SD = 17.0), and most identified as female (61.8%), white (97.1%), and not Hispanic or Latino/a/e (97.1%). Two coders read each interview while creating a codebook. The coders individually coded each interview transcript with themes emerging from the coded interviews. Each code reached an agreement level of at least 80%, with a Kappa (RK) score range of 0.90 to 0.98 in each interview, indicating adequate interrater reliability. Five themes emerged from the thematic analysis: decreased autonomy, decreased trust, changes in worldview, social impacts, and uncertainty. Individuals with long COVID reported heterogenous experiences, with often significant changes to daily functional abilities and outlook on life. Considering the unique lived experiences of individuals with long COVID will be important in developing a complete understanding of the condition and its implications.

Adolescent boys and young men (ABYM) in South Africa face a high burden of unmet mental health needs but are often overlooked in research and practice. Economic and racial inequalities, masculine norms, and limited access to targeted mental health promotion services may hinder their ability to understand psychological distress, seek support, and engage with psychosocial services. This qualitative study explored how ABYM in Alexandra, South Africa, perceive and experience mental health, to inform future interventions. Semi-structured interviews were conducted with 24 participants, including 12 adolescent boys (ages 15-19) and 12 male youth mentors and staff from a local adolescent health organization. Interviews were analyzed using reflexive thematic analysis. Participants were often unfamiliar with the term mental health but described distress through everyday language grounded in social and emotional experience. Their conceptualizations of mental health were shaped by family and community environments, gendered expectations, and a mix of psychological and supernatural explanations. Rigid masculine norms associated mental health challenges with weakness, discouraged emotional expression and help-seeking, and placed early and significant pressure on boys to succeed in school or sports to make money and fulfil the male provider role. Despite these pressures, many participants expressed personal views that challenged dominant norms, for example, valuing emotional expression and open conversations with trusted adults or peers about mental health. However, stigma and a lack of youth- and male-friendly services remained significant barriers to accessing formal support. Our findings highlight the need for gender-sensitive, culturally grounded mental health programming for ABYM. Interventions should involve youth in design and delivery, build on familiar coping strategies, normalize emotional expression among boys, and promote the attributes of good mental health. Embedding support within community or recreational settings may reduce stigma, improve engagement, and strengthen adolescent boys' mental health and well-being in low-resource urban contexts.

People with forced migration backgrounds, such as refugees, experience disproportionate mental health conditions related to complexities associated with acculturation, separation from family, traumatic events due to war or persecution and precarious journeys in their effort to find protection and care. Intersecting social determinants of refugee mental health include navigating and finding health care resources, employment, housing and social support. Because of the complexity of health and social needs that refuges experience, there is a need for robust integration of mental health services across services such as settlement organizations and primary health care services. Robust service integration to address mental health for refugees can benefit from a theory-driven approach to understanding integrated mental health service delivery. This study engaged in deliberative dialogues with multidisciplinary interest group holders from settlement services, primary health care, mental health, a survivor advocacy group and a policy analyst (N = 24) to understand how services work to promote refugee mental health in a Canadian context. Adopting a participatory realist approach, we developed an initial program theory on the integration of refugee mental health across services. We found trust, connection, proactivity and moral commitment to be key mechanisms that enabled better integrated mental health care across refugee clients, providers and services. Mechanisms which hindered integration included alienation, stagnation, burnout and fragmentation. Findings indicate that, when funding is allocated to settlement programs, supports like cross-cultural brokers, community health workers and navigators can then be implemented. These resources then address social determinants of refugee mental health and trigger positive mechanisms for equitable, just policy approaches to integrate services for refugee mental health.

Public Safety Personnel (PSP) such as police officers, firefighters, and paramedics are at an increased risk of post-traumatic stress disorder (PTSD) due to frequent exposure to potentially psychologically traumatic events. Return-to-work trajectories can be challenging, as treatment programs are often not tailored to PSP, leading to long-term disability. To better support PSP, the work disability insurance authority in Ontario, Canada commissioned a mental health treatment program for PSP who receive benefits for a diagnosis of PTSD. Staff in this program received specialized training by a credible PSP organization (Wounded Warriors Canada) for working with PSP. We conducted a formative evaluation of this pilot program. Qualitative, semi-structured interviews were conducted with service providers (n = 11) and PSP clients who had completed the program (n = 19). The aim was to understand whether and how the program met client needs, how it could be improved, and how this could inform other mental health treatment programs for PSP. Using descriptive qualitative methods, we found that participants reflected positively on the program's appropriateness, acceptability, and effectiveness. Credibility was a central concern across all three domains. Having a program that was exclusive to PSP allowed staff to tailor their treatment approach to unique PSP needs, which offered credibility as a PSP treatment program, and it made it possible for PSP to be in an environment where they felt safe.

Healthcare providers are at a high risk of occupational stress, psychological distress, and mental health issues due to unique job demands. The unprecedented negative impact of the COVID-19 pandemic on healthcare further amplified the risk. We aimed to find out the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) in doctors during the COVID-19 pandemic, and explore various associated factors. We conducted a cross-sectional survey among clinicians across tertiary care hospitals in Lahore, Pakistan through online forms/ paper-based questionnaires, using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) Scale, and The Impact of Events Scale-Revised (IES-R) from July-November 2021. Doctors aged 20-60 years working at the public-sector hospitals of Lahore were included through non-probability convenience sampling. The non-parametric Mann-Whitney U and Chi-square test of independence were applied for inferential data analysis in SPSS version 26 at α = 0.05. Of 304 participants, the majority were males (54.6%), from medicine and allied departments (76.9%), junior staff (72%), and front-line workers (75%). 9.5% had a history of psychiatric illness. The prevalence of depression was 25%, anxiety 31.9%, PTSD 15.8%, severe depression 13.8%, and severe anxiety 7.2%. The total median (IQR) scores of depression, anxiety, and PTSD were 5(2-9.5), 4(0-7), and 10(1-23), respectively. Females and junior staff had comparatively severe symptoms of anxiety and depression. Psychiatric history was linked to severe depression (p = 0.003) and PTSD (p=<0.001) but not anxiety (p = 0.136). There were no statistically significant differences in the anxiety and PTSD severity across departments, and between front-line/second-line work. We found high levels of depression, anxiety, and PTSD in our physician sample, even during the 4th COVID-19 wave. This has implications for emphasizing the significance of the mental well-being of healthcare providers and identifying effective interventions to prioritize it even after the pandemic.