Pub Date : 2025-12-29DOI: 10.1016/j.ssmmh.2025.100580
Nicole Black, Danusha Jayawardana, David W. Johnston, Trong-Anh Trinh
Rising out-of-pocket costs for psychotherapy in Australia have heightened concerns about financial barriers to mental healthcare, particularly for lower-income households, who disproportionately experience psychological distress. Using nation-wide linked administrative records of income and healthcare use, we estimate the magnitude of income-related inequity in psychotherapy use among 5.4 million individuals diagnosed with a mental health condition, and examine how such inequity has evolved over the decade from 2014 to 2023. Our findings show that income-related inequity is substantial, consistently higher among children than among adults, and has nearly doubled over the decade. By 2023, only 32% of low-income children and 40% of low-income adults accessed psychotherapy within three months of receiving a mental health treatment plan, compared with 55% among both high-income children and adults. We rule out changes in complexity of mental health disorders and the introduction of telehealth services as key drivers. We find no discernible difference by gender or age subgroups. Examination of antidepressant use reveals a growing gap in the opposite direction, with lower-income individuals increasingly reliant on medication without psychotherapy, relative to higher-income individuals. This suggests a shift towards lower-cost treatment pathways among disadvantaged groups. Our findings highlight the need for policies to address the increasing costs and other barriers to accessing psychotherapy, especially for lower-income households.
{"title":"The growing divide: Income inequities in access to mental healthcare in Australia","authors":"Nicole Black, Danusha Jayawardana, David W. Johnston, Trong-Anh Trinh","doi":"10.1016/j.ssmmh.2025.100580","DOIUrl":"10.1016/j.ssmmh.2025.100580","url":null,"abstract":"<div><div>Rising out-of-pocket costs for psychotherapy in Australia have heightened concerns about financial barriers to mental healthcare, particularly for lower-income households, who disproportionately experience psychological distress. Using nation-wide linked administrative records of income and healthcare use, we estimate the magnitude of income-related inequity in psychotherapy use among 5.4 million individuals diagnosed with a mental health condition, and examine how such inequity has evolved over the decade from 2014 to 2023. Our findings show that income-related inequity is substantial, consistently higher among children than among adults, and has nearly doubled over the decade. By 2023, only 32% of low-income children and 40% of low-income adults accessed psychotherapy within three months of receiving a mental health treatment plan, compared with 55% among both high-income children and adults. We rule out changes in complexity of mental health disorders and the introduction of telehealth services as key drivers. We find no discernible difference by gender or age subgroups. Examination of antidepressant use reveals a growing gap in the opposite direction, with lower-income individuals increasingly reliant on medication without psychotherapy, relative to higher-income individuals. This suggests a shift towards lower-cost treatment pathways among disadvantaged groups. Our findings highlight the need for policies to address the increasing costs and other barriers to accessing psychotherapy, especially for lower-income households.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100580"},"PeriodicalIF":2.6,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-22DOI: 10.1016/j.ssmmh.2025.100585
Thea Mink , Madeleine Patrick , Amelia Conrad , Tanvir Ahmed , Srishty Arun , Vinod Ramanarayanan , Niladri Chakraborti , Y. Malini Reddy , Abhilaasha Nagarajan , Tanushree Bhan , Sheela S. Sinharoy , Bethany A. Caruso
Recent research has identified linkages between women's sanitation experiences, like safety and privacy, and their mental health. Our study examined associations between sanitation-related empowerment resources (Bodily Integrity, Safety and Security, Privacy, and Time) and mental health outcomes (well-being, depression, and anxiety). We conducted a secondary analysis of cross-sectional data collected in 2021–2022 from household surveys of women in Bangladesh, India, Senegal, and Uganda (n = 2285). Primary exposures were sanitation-related empowerment resources measured using the Agency, Resources, and Institutional Structures for Sanitation-related Empowerment (ARISE) Scales. Three outcomes were assessed: subjective well-being (World Health Organization Well-being Index, WHO-5), anxiety (General Anxiety Disorder measure, GAD-2), and depression (Patient Health Questionnaire, PHQ-2). Linear regressions of WHO-5 scores and negative binomial regressions of PHQ-2 and GAD-2 scores on the four sanitation-related empowerment resources were conducted.
Mean scores for the outcomes were: well-being = 17.2 (SD = 5.9), depression = 1.1 (SD = 1.4), and anxiety = 1.0 (SD = 1.4). Mean scores for primary exposures were: Bodily Integrity = 3.7 (SD = 0.4), Safety and Security = 3.5 (SD = 0.4), Privacy = 3.8 (SD = 0.5), and Time = 3.1 (SD = 0.5). Higher Privacy was associated with higher well-being scores in both regional samples with higher Time additionally associated with higher well-being scores in Bangladesh and India. In Bangladesh and India, higher Bodily Integrity and Time were associated with lower depression scores, and higher Bodily Integrity, Safety and Security, and Time were associated with lower anxiety scores. In Senegal and Uganda, higher Bodily Integrity, Safety and Security, and Privacy were associated with lower depression scores, and higher Privacy was associated with lower anxiety scores. Our findings provide evidence of associations between women's sanitation-related resources of Bodily Integrity, Safety and Security, Privacy, and Time and mental health. Sanitation initiatives should aim to enhance and evaluate women's experiences of these resources given their potential to benefit women's mental health and well-being.
{"title":"Sanitation-related empowerment resources are associated with women's well-being, anxiety, and depression: findings from Bangladesh, India, Senegal, and Uganda","authors":"Thea Mink , Madeleine Patrick , Amelia Conrad , Tanvir Ahmed , Srishty Arun , Vinod Ramanarayanan , Niladri Chakraborti , Y. Malini Reddy , Abhilaasha Nagarajan , Tanushree Bhan , Sheela S. Sinharoy , Bethany A. Caruso","doi":"10.1016/j.ssmmh.2025.100585","DOIUrl":"10.1016/j.ssmmh.2025.100585","url":null,"abstract":"<div><div>Recent research has identified linkages between women's sanitation experiences, like safety and privacy, and their mental health. Our study examined associations between sanitation-related empowerment resources (Bodily Integrity, Safety and Security, Privacy, and Time) and mental health outcomes (well-being, depression, and anxiety). We conducted a secondary analysis of cross-sectional data collected in 2021–2022 from household surveys of women in Bangladesh, India, Senegal, and Uganda (n = 2285). Primary exposures were sanitation-related empowerment resources measured using the Agency, Resources, and Institutional Structures for Sanitation-related Empowerment (ARISE) Scales. Three outcomes were assessed: subjective well-being (World Health Organization Well-being Index, WHO-5), anxiety (General Anxiety Disorder measure, GAD-2), and depression (Patient Health Questionnaire, PHQ-2). Linear regressions of WHO-5 scores and negative binomial regressions of PHQ-2 and GAD-2 scores on the four sanitation-related empowerment resources were conducted.</div><div>Mean scores for the outcomes were: well-being = 17.2 (SD = 5.9), depression = 1.1 (SD = 1.4), and anxiety = 1.0 (SD = 1.4). Mean scores for primary exposures were: Bodily Integrity = 3.7 (SD = 0.4), Safety and Security = 3.5 (SD = 0.4), Privacy = 3.8 (SD = 0.5), and Time = 3.1 (SD = 0.5). Higher Privacy was associated with higher well-being scores in both regional samples with higher Time additionally associated with higher well-being scores in Bangladesh and India. In Bangladesh and India, higher Bodily Integrity and Time were associated with lower depression scores, and higher Bodily Integrity, Safety and Security, and Time were associated with lower anxiety scores. In Senegal and Uganda, higher Bodily Integrity, Safety and Security, and Privacy were associated with lower depression scores, and higher Privacy was associated with lower anxiety scores. Our findings provide evidence of associations between women's sanitation-related resources of Bodily Integrity, Safety and Security, Privacy, and Time and mental health. Sanitation initiatives should aim to enhance and evaluate women's experiences of these resources given their potential to benefit women's mental health and well-being.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100585"},"PeriodicalIF":2.6,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-20DOI: 10.1016/j.ssmmh.2025.100584
Jennifer S. Hirsch , Gloria Fortuna , Jessie V. Ford , Alicia Jen , Jessica L. Weissman , Aarushi H. Shah , Fraidy Reiss
{"title":"Forced marriage, divorce, and the ecology of marital self-determination: findings from research with Orthodox Jews in New York","authors":"Jennifer S. Hirsch , Gloria Fortuna , Jessie V. Ford , Alicia Jen , Jessica L. Weissman , Aarushi H. Shah , Fraidy Reiss","doi":"10.1016/j.ssmmh.2025.100584","DOIUrl":"10.1016/j.ssmmh.2025.100584","url":null,"abstract":"","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100584"},"PeriodicalIF":2.6,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-19DOI: 10.1016/j.ssmmh.2025.100579
Carmen H. Logie , Ofir Sivan , Rachel Leggett , Moses Okumu , Miranda Loutet , Frannie MacKenzie , Simon Odong Lukone , Nelson Kisubi , Lesley Gittings , Peter Kyambadde , Caetano Dorea , Manjulaa Narasimhan
Extreme weather events (EWE) contribute to heightened psychosocial stressors through complex pathways, including by worsening resource insecurities. Refugee settlements globally are disproportionately exposed to EWE compared with host national populations, yet refugees' experiences of resource insecurity-related psychosocial stressors in low-income humanitarian settings are understudied. Our study focused on understanding the lived experiences of psychosocial stressors in the context of EWE and resource insecurity among refugee youth in Bidi Bidi Refugee Settlement, Uganda. This qualitative study involved 32 walk-along interviews with a purposive sample of refugee youth aged 16–24 (16 men, 16 women); youth led the interviewer to 1–3 places where they obtained food, water, and/or sanitation resources, discussed the place's meaning and impact on wellbeing, and took photos. We also conducted 12 in-depth interviews with key informants with expertise in refugee youth wellbeing, EWE, and/or resource security. We conducted framework thematic analysis informed by resource scarcity and water insecurity-related distress frameworks. Participant narratives reflected four key themes regarding linkages between EWE, resource insecurities, and psychosocial distress: 1) material deprivation and uncertainty (sub-themes: drought-related food and water insecurity; flooding-related infrastructure and agricultural damage); 2) shame of social failure (sub-themes: sanitation insecurity stressors; unemployment and food insecurity distress and related substance use); 3) interpersonal conflict, including multi-level violence (sub-themes: increased violence; concerns about crime and theft); and 4) coping and asset management strategies (sub-themes: social and economic infrastructure; social capital; household relations). Together findings suggest the need for integrating psychosocial support within social and economic opportunities and poverty reduction with refugee youth.
{"title":"Psychosocial stressors related to extreme weather events and multiple resource insecurities: qualitative insights from refugee youth in an Ugandan humanitarian setting","authors":"Carmen H. Logie , Ofir Sivan , Rachel Leggett , Moses Okumu , Miranda Loutet , Frannie MacKenzie , Simon Odong Lukone , Nelson Kisubi , Lesley Gittings , Peter Kyambadde , Caetano Dorea , Manjulaa Narasimhan","doi":"10.1016/j.ssmmh.2025.100579","DOIUrl":"10.1016/j.ssmmh.2025.100579","url":null,"abstract":"<div><div>Extreme weather events (EWE) contribute to heightened psychosocial stressors through complex pathways, including by worsening resource insecurities. Refugee settlements globally are disproportionately exposed to EWE compared with host national populations, yet refugees' experiences of resource insecurity-related psychosocial stressors in low-income humanitarian settings are understudied. Our study focused on understanding the lived experiences of psychosocial stressors in the context of EWE and resource insecurity among refugee youth in Bidi Bidi Refugee Settlement, Uganda. This qualitative study involved 32 walk-along interviews with a purposive sample of refugee youth aged 16–24 (16 men, 16 women); youth led the interviewer to 1–3 places where they obtained food, water, and/or sanitation resources, discussed the place's meaning and impact on wellbeing, and took photos. We also conducted 12 in-depth interviews with key informants with expertise in refugee youth wellbeing, EWE, and/or resource security. We conducted framework thematic analysis informed by resource scarcity and water insecurity-related distress frameworks. Participant narratives reflected four key themes regarding linkages between EWE, resource insecurities, and psychosocial distress: 1) material deprivation and uncertainty (sub-themes: drought-related food and water insecurity; flooding-related infrastructure and agricultural damage); 2) shame of social failure (sub-themes: sanitation insecurity stressors; unemployment and food insecurity distress and related substance use); 3) interpersonal conflict, including multi-level violence (sub-themes: increased violence; concerns about crime and theft); and 4) coping and asset management strategies (sub-themes: social and economic infrastructure; social capital; household relations). Together findings suggest the need for integrating psychosocial support within social and economic opportunities and poverty reduction with refugee youth.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100579"},"PeriodicalIF":2.6,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.ssmmh.2025.100582
Xinxin Zhu , Yi Yang , Helen Wright , Lydia Gabriela Speyer , Marie Allitt , Ingrid Obsuth , Patrick Errington , Aja Louise Murray
There has been considerable recent debate surrounding the effects of social media use and adolescents' mental health. A key source of controversy is whether observed associations might be confounded by ‘third variables’ (which influence both social media use and mental health). To address this, we used counterfactual analysis to account for measured confounding. This approach provides estimates of causal effects by comparing observed outcomes with those that would be expected under an alternative exposure condition. We employed it to evaluate the link between social media use (including messaging and visiting social networking websites) at ages 11 and 14 and later mental health issues (including emotional symptoms, self-harm, and/or suicide attempts) at ages 14 and 17. Data was from the UK Millennium Cohort Study (MCS), a nationally representative sample. The study was conducted with the input of a young persons' advisory group, who informed our prioritization of the study research question, helped interpret findings, and identify study limitations. Inverse probability of treatment weighting (IPTW) analyses indicated no significant effects of social media use frequency at age 11 (defined as use on most days) or time spent at age 14 (≥2 h per weekday) on emotional problems or self-harm at age 14 or 17, respectively (analytic n = 3036–4419). The only exception was significant association between higher time spent on social media at age 14 and lifetime suicide attempts at age 17. These findings highlight the importance of considering potential confounders when examining social media use effects. Given that frequency and time-based measures are unlikely to capture the complexity of this association, we recommend future research also apply similar approaches utilizing more nuanced measures.
{"title":"The association between social media use and mental health symptoms in middle adolescence: A counterfactual analysis","authors":"Xinxin Zhu , Yi Yang , Helen Wright , Lydia Gabriela Speyer , Marie Allitt , Ingrid Obsuth , Patrick Errington , Aja Louise Murray","doi":"10.1016/j.ssmmh.2025.100582","DOIUrl":"10.1016/j.ssmmh.2025.100582","url":null,"abstract":"<div><div>There has been considerable recent debate surrounding the effects of social media use and adolescents' mental health. A key source of controversy is whether observed associations might be confounded by ‘third variables’ (which influence both social media use and mental health). To address this, we used counterfactual analysis to account for measured confounding. This approach provides estimates of causal effects by comparing observed outcomes with those that would be expected under an alternative exposure condition. We employed it to evaluate the link between social media use (including messaging and visiting social networking websites) at ages 11 and 14 and later mental health issues (including emotional symptoms, self-harm, and/or suicide attempts) at ages 14 and 17. Data was from the UK Millennium Cohort Study (MCS), a nationally representative sample. The study was conducted with the input of a young persons' advisory group, who informed our prioritization of the study research question, helped interpret findings, and identify study limitations. Inverse probability of treatment weighting (IPTW) analyses indicated no significant effects of social media use frequency at age 11 (defined as use on most days) or time spent at age 14 (≥2 h per weekday) on emotional problems or self-harm at age 14 or 17, respectively (analytic n = 3036–4419). The only exception was significant association between higher time spent on social media at age 14 and lifetime suicide attempts at age 17. These findings highlight the importance of considering potential confounders when examining social media use effects. Given that frequency and time-based measures are unlikely to capture the complexity of this association, we recommend future research also apply similar approaches utilizing more nuanced measures.</div></div>","PeriodicalId":74861,"journal":{"name":"SSM. Mental health","volume":"9 ","pages":"Article 100582"},"PeriodicalIF":2.6,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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