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BACKGROUND: Suicide poses a major public health challenge, claiming around 650 lives annually in Norway. There is limited understanding of mental healthcare utilization patterns preceding suicide, particularly relating to socioeconomic status (SES). This study analyzes mental health service use among Norwegian citizens aged 20-64 from 2009 to 2021, emphasizing disparities related to SES. METHODS: This is a population-wide registry-based study. We include mental health consultations with both primary and specialist healthcare services, and investigate patterns of service use regarding educational attainment, employment status and income and compare this to the population in general. All suicides in the period (N = 4731) are included in the study. The aim is to investigate potential discrepancies in service use the year and month preceding suicide, seeking to enhance targeted preventive interventions. RESULTS: Our results show significant variations in healthcare use for mental health problems the last year preceding suicide, according to the components of SES, for both men and women. Those with higher education utilize the mental healthcare services prior to suicide to a higher degree than men and women with high school education or less, whereas employed men and men with high income level have significantly lower mental healthcare usage prior to suicide both the last year and month compared to the non-employed men and men with low-income level. Employed women also had a lower mental healthcare usage, whereas the results regarding income are not significant for women. CONCLUSION: Mental healthcare use prior to suicide varies across the SES components. Notably, the SES groups exhibit heterogeneity, with gendered patterns. Targeted interventions for low consultation rates among employed men, and men with high income and lower education are needed, while women, and men in at-risk groups, such as the non-employed and those with low income, demonstrate higher mental healthcare utilization, warranting comprehensive suicide prevention measures.

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INTRODUCTION: Contemporary evidence notes the COVID-19 pandemic greatly impacted the utilization of physical and mental health services worldwide. The present study was therefore designed to evaluate the changes in the utilization of mental health services during the first year of the COVID-19 pandemic compared to previous years as well as to estimate the moderating role age had on these changes. MATERIALS AND METHODS: Psychiatric data was collected from n = 928,044 individuals living in Israel. Rates of receipt of psychiatric diagnoses and purchases of psychotropic medication were extracted for the first year of the COVID-19 pandemic and for two comparison years. The odds of receiving a diagnosis or of purchasing a psychotropic medication during the pandemic were compared to control years using uncontrolled logistic regression models and controlled and logistic regression that accounted for differences between ages. RESULTS: There was a general reduction of about 3-17% in the odds of receiving a psychiatric diagnosis or purchasing psychotropic medications during the pandemic year compared to control years. The bulk of tests conducted showed that reduction in the rates of receiving diagnoses and purchasing medications during the pandemic were evident or more profound in the older age groups. An analysis of a combined measure conclusive of all other measures revealed decreased rates of utilizing any service examined during 2020, with rates decreasing as age increases up to a decrease of 25% in the oldest age group (80-96). DISCUSSION AND CONCLUSION: Changes in utilization of mental health services reveal the interplay between psychological distress that has been documented to increase during the pandemic and people's reluctance to seek professional assistance. This appears to be especially prominent among the vulnerable elderly, who may have received even less professional help for their emerging distress. The results obtained in Israel are likely to be replicated in other countries as well, given the global impact of the pandemic on adults' mental health and individuals' readiness to utilize mental healthcare services. Future research on the long-term impact of the pandemic on utilization of mental healthcare services is warranted, with an emphasis on the response of different populations to emergency situations.

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Background: Migration is a worldwide occurrence that carries significant implications for healthcare systems, and it entails challenges to mental healthcare. The Andersen Behavioral Model is widely used by researchers to determine healthcare service utilization among many populations, including migrants. Our study aimed to explore the ways of using the Andersen Health System Utilization Framework in the literature to discover the utilization of mental healthcare by migrants. Methods: This scoping review was based on Arksey and O'Malley's framework. A comprehensive search was performed across five electronic databases. Results: A total of 12 articles from January 1992 to July 2023 identified various versions of the Andersen Behavioral Model to provide an overview of mental health services utilization among migrants. The analysis identified four significant trends in the literature. First, there is a predominant focus on individual characteristics over contextual factors. Second, researchers tend to integrate multiple versions of the Andersen Behavioral Model, and the most is the version from 1995. Third, additional factors specific to migrant populations are incorporated into the model, but the categorization is sometimes unclear. Finally, the majority of studies have used a quantitative approach and are based in North America, suggesting a focus on the significance of mental health in migrant communities in that context. Conclusion: In summary, our scoping review calls for further research using the Andersen Behavioral Model to study mental healthcare utilization among migrants. Notable findings include the adaptation of the model to migrant populations, a focus on individual characteristics, a need for more diverse research methods, and the proposal of a new conceptual model to guide research and policy development in this field.

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Objective: To assess differences in internalized stigma of mental illness based on demographic characteristics and mental healthcare utilization among college students. Participants: Students with self-reported mental illness (n = 128) were recruited via random sampling. Methods: Participants completed an online survey, including questions related to demographic characteristics and mental healthcare utilization. The survey also included the Internalized Stigma of Mental Illness (ISMI) scale. Data were analyzed using descriptive and inferential statistics. Results: Students accessing mental healthcare (pharmacological and/or psychotherapeutic) reported higher ISMI scores than students who did not access services during past year. Students with sexual minority statuses also reported higher ISMI scores than their heterosexual counterparts. Conclusions: Results highlight differences in internalized stigma based on demographics characteristics and mental healthcare utilization among college students. More research is needed to better understand intersectional stigma. Further, universities need tailored and specific interventions to address internalized stigma among students with diverse backgrounds and needs.

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Policies have potential to help families obtain behavioral healthcare for their children, but little is known about evidence for specific policy approaches. We reviewed evaluations of select policy levers to promote accessibility, affordability, acceptability, availability, or utilization of children's mental and behavioral health services. Twenty articles met inclusion criteria. Location-based policy levers (school-based services and integrated care models) were associated with higher utilization and acceptability, with mixed evidence on accessibility. Studies of insurance-based levers (mental health parity and public insurance) provided some evidence for affordability outcomes. We found no eligible studies of workforce development or telehealth policy levers, or of availability outcomes.

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BACKGROUND: Healthcare costs are skyrocketing, with mental health treatment amongst the most expensive, especially when hospitalization is involved. According to the Mental Health Commission of Canada, one in five Canadians is living with a mental disorder in any given year, at an annual cost of $50 billion. In light of this societal burden, alternative approaches are being evaluated, such as brief psychotherapy by phone, peer support, and, as part of the emerging field of nutritional mental health, treatment with micronutrients (minerals and vitamins). Effectiveness of micronutrients has been demonstrated for many types of psychiatric symptoms, in about 45 studies of formulas that are either multinutrient (e.g., several B vitamins) or broad-spectrum (usually over 20 minerals and vitamins). Although this literature demonstrates therapeutic benefits, the potential economic impact of micronutrient treatment has been evaluated in only one case study of childhood psychosis. METHODS: The current case study was initiated to evaluate mental health-related hospitalization costs from 1997 to 2003 for a female adult diagnosed with various mood and psychotic symptoms. She was treated for the first 5 years with conventional methods and then subsequently with a broad-spectrum micronutrient formula. RESULTS: The patient's annual mental health hospitalization costs during conventional treatment averaged $59,864 across 5 years (1997-2001), with a peak annual cost of about $140,000. Since transitioning to broad-spectrum micronutrients, she has incurred no provincial hospitalization costs for mental health care, though her self-funded costs are currently $720/year for the micronutrients. CONCLUSION: Further exploration of the treatment of mental health problems with broad-spectrum micronutrient formulas has the potential to make two significant contributions: improved mental health, and decreased costs for governments.

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OBJECTIVE: Pain symptoms have been associated with a number of psychiatric disorders, particularly mood and anxiety disorders as well as personality disorders. However, to our knowledge, no study to date has examined pain symptoms in terms of participants' past mental healthcare utilization--the focus of the present study. METHODS: Using a cross-sectional approach and a self-report survey methodology in a sample of 242 consecutive internal medicine outpatients, we examined pain symptoms at assessment, over the past month, and over the past year as well as pain catastrophizing in relationship to 4 mental healthcare variables (i.e., ever seen a psychiatrist, ever been in a psychiatric hospital, ever been in counseling, and ever been on medication for "nerves"). RESULTS: Only three of the four mental-healthcare-utilization variables were analyzed due to response rate (i.e., ever been hospitalized in a psychiatric hospital was infrequently endorsed and not analyzed), and each demonstrated statistically significant relationships with self-reported pain levels at all three time-points and with pain catastrophizing at the p<.001 level. CONCLUSIONS: In this study, primary care outpatients with histories of mental health treatment evidenced statistically significantly higher levels of pain as well as statistically significantly higher levels of pain catastrophizing than their peers.

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Aggression and violence in the medical setting appear to be on the increase. In support of this impression, a number of studies have documented surprising rates of such behavior toward trainees as well as physicians-in-practice. However, to date, these studies have focused on the experiences and reports of professionals, not patient offenders. In a series of investigations, we examined aggressive and disruptive office behaviors from the perspective of the perpetrators-the patients. Findings from these studies indicate that disruptive office behaviors by patients appear to be related to borderline personality symptomatology, alcohol/drug misuse, prescription medication abuse, and higher rates of past mental healthcare utilization. The results of these studies suggest a rudimentary psychological profile for the aggressive patient in the primary care setting.

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BACKGROUND: According to the scant empirical literature, largely in studies of offenders, there appears to be a general but diffuse relationship between various psychiatric disorders and criminal behavior. In this study, we examined mental healthcare utilization, a general measure of psychiatric dysfunction, in relationship to a history of criminal behavior in a sample of internal medicine outpatients. METHOD: In a consecutive sample of 376 internal medicine outpatients being seen predominantly by resident providers, we examined the relationship between 27 illegal behaviors (charges, not convictions) as delineated by the Federal Bureau of Investigation's crime cataloguing schema and four items related to mental healthcare utilization (i.e., ever been seen by a psychiatrist, ever been hospitalized in a psychiatric hospital, ever been in counseling, ever been on medication for your "nerves"). RESULTS: Twenty-two percent of the sample reported a history of having been charged with at least one criminal behavior. With the exception of ever having been on "nerve" medication, the remaining mental-healthcare-utilization variables demonstrated statistically significant relationships with the number of illegal behaviors reported. However, overall correlations were relatively weak. CONCLUSIONS: Using both a sample and methodology that is unique to the current literature, we found relationships between past mental health treatment and history of criminal behavior.

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Disturbances in sleep are empirically associated with a number of different psychiatric disorders. In this pilot study, we examined whether four general queries about mental healthcare utilization ("Have you ever been seen by a psychiatrist?," "Have you ever been hospitalized in a psychiatric hospital?," "Have you ever been in counseling?," and "Have you ever been on medication for your nerves?") would evidence correlations with various aspects of sleep disturbance as measured by the Pittsburgh Sleep Quality Index. In a cross-sectional sample of convenience, we surveyed 75 internal medicine outpatients. We asked participants about the four preceding mental healthcare variables as well as sleep experiences using the Pittsburgh Sleep Quality Index. Prior to statistical analyses, we assigned one point to each mental healthcare utilization variable endorsed and developed a composite score (0-4). In analyses, while the mental-healthcare-utilization composite score was not related to overall sleep quality (i.e., the Global Pittsburgh Sleep Quality Index Score), it was statistically significantly related to the Pittsburgh Sleep Quality Index component of Sleep Disturbance (p<.01). This suggests that while individuals with greater mental healthcare utilization do not evidence differences in overall sleep quality compared to those with low utilization, they do report more disturbances in sleep.

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Abstract Objective. The objective of this study was to determine whether there is a relationship between the past utilization of four mental health services (i.e. ever been seen by a psychiatrist, ever been in a psychiatric hospital, ever been in counseling, ever been on psychotropic medication) and different types of driving citations during one's lifetime. Methods. Using a consecutive, cross-sectional, primary care sample, we surveyed participants about their past use of four mental health services and lifetime incidence of 29 different types of driving citations (charges, not convictions). Results. The total number of different types of moving violations was statistically significantly related to a history of psychiatric hospitalization. The total number of different types of non-moving violations was statistically significantly related to all mental health services variables. Conclusions. In this study, general non-specific queries about the past utilization of mental health services were correlated with both moving violations (past psychiatric hospitalization) and non-moving violations (all mental health services variables). These findings suggest that patients who have received mental health treatment are at a higher risk for being cited for driving violations than those who have not received mental health treatment. However, among the mental health variables under study, only past psychiatric hospitalization was associated with moving violations.