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BACKGROUND: The majority of Veterans Affair (VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status. METHODS: Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including PTSD, major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors. RESULTS: A total of 1730 subjects (55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information (n = 38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores; they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors (e.g., age, gender, marital status and education). CONCLUSIONS: Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.

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Como manejar crenças cognitivas que maximizam seu sofrimento físico e mental

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Users of social media often share their feelings or emotional states through their posts. In this study, we developed a deep learning model to identify a user's mental state based on his/her posting information. To this end, we collected posts from mental health communities in Reddit. By analyzing and learning posting information written by users, our proposed model could accurately identify whether a user's post belongs to a specific mental disorder, including depression, anxiety, bipolar, borderline personality disorder, schizophrenia, and autism. We believe our model can help identify potential sufferers with mental illness based on their posts. This study further discusses the implication of our proposed model, which can serve as a supplementary tool for monitoring mental health states of individuals who frequently use social media.

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BACKGROUND: A number of instruments for identifying mental health problems in children are available, but there is limited knowledge about how to successfully implement their use in routine practice. The Strengths and Difficulties Questionnaire (SDQ) is an instrument with sound psychometric properties. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. This paper aimed to describe a facilitation programme developed to support the introduction of SDQ in clinical practice and evaluate how nurses perceived the facilitation strategies used. Moreover, the dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed. METHODS: The mixed-methods process evaluation was guided by Moore et al.'s framework. Process data were excerpted from monitoring data, the trial database, research group documents, study materials, group interviews with nurses, and a survey on nurses' opinions and experiences of the screening method and the implementation process. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS: Facilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required. Although nurses described a variety of barriers at the organisational and individual level, they were in favour of using the SDQ in clinical practice and emphasised the importance of the facilitation strategies used for its implementation. While dose levels (77-91%) indicated that nurses essentially delivered the intervention as intended, parental response rates remained between 54 and 63% and population coverage at around 50%, throughout the intervention period. CONCLUSION: The facilitation program was perceived to support the implementation of the SDQ at the yearly check-ups in the child healthcare setting, but further efforts are required to reach all families.

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BACKGROUND: There have been recurring reports of web-based harassment and abuse among adolescents and young adults through anonymous social networks. OBJECTIVE: This study aimed to explore discussions on the popular anonymous social network Yik Yak related to social and mental health messaging behaviors among college students, including cyberbullying, to provide insights into mental health behaviors on college campuses. METHODS: From April 6, 2016, to May 7, 2016, we collected anonymous conversations posted on Yik Yak at 19 universities in 4 different states and performed statistical analyses and text classification experiments on a subset of these messages. RESULTS: We found that prosocial messages were 5.23 times more prevalent than bullying messages. The frequency of cyberbullying messages was positively associated with messages seeking emotional help. We found significant geographic variation in the frequency of messages offering supportive vs bullying messages. Across campuses, bullying and political discussions were positively associated. We also achieved a balanced accuracy of over 0.75 for most messaging behaviors and topics with a support vector machine classifier. CONCLUSIONS: Our results show that messages containing data about students' mental health-related attitudes and behaviors are prevalent on anonymous social networks, suggesting that these data can be mined for real-time analysis. This information can be used in education and health care services to better engage with students, provide insight into conversations that lead to cyberbullying, and reach out to students who need support.

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In this article, we present the main methodological principles of symptom networks in psychopathology. It is a topological approach linking entities from different scales of analysis of an individual (from genetics to behavior, via cerebral connectivity). They are an alternative to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and Research Domain Criteria (RDoC), but they do not exclude them. Symptom networks exceed or circumvent some limits of these classifications. Furthermore, they contribute to the stratification and organization of these nosologies. Behind the originality of its methodology, this program proposes a redefinition of mental illness which modifies the conception of psychiatry. But their future is still uncertain: they must take on an epistemological and methodological challenge. At the same time, they have to convince the community of mental health researchers and clinicians of their utility and value.

TITLE: Introduction aux réseaux de symptômes en psychopathologie. ABSTRACT: Nous présentons dans cet article les grands principes méthodologiques des réseaux de symptômes en psychopathologie. Ceux-ci pourraient constituer une approche alternative au manuel diagnostique et statistique des troubles mentaux (DSM) et aux Research Domain Criteria (RDoC), sans les exclure pour autant. Les réseaux de symptômes dépassent ou contournent certaines limites de ces classifications, mais leur avenir est encore incertain : ils devront relever des défis épistémologiques et méthodologiques, tout en parvenant à convaincre la communauté de chercheurs et de cliniciens en santé mentale de leur utilité et de leur qualité.

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Introduction: The WHO estimates that at least 20% of children and adolescents have at least one mental disorder before reaching the age of 18 years. (PNSE, 2015) Based on the studies of the Multifactorial Model of Teresa Lluch (1999), it was proposed for the present study the conception and validation of a positive mental health promotion program in the field of mental health nursing directed to adolescents who attend the 3rd cycle of studies. Objectives: Elaborate a positive mental health nursing program based on the Multifactorial Model of Teresa Lluch; Implement a positive mental health program within the framework of the primary health care services portfolio, in response to the guidelines of the national school health program (PNSE, 2015); to analyse the effectiveness of the positive mental health program in promoting adolescents' mental health in a school environment; to evaluate the positive mental health levels of adolescents in school settings. Methodology: Mixed, quasi-experimental (through a pilot study) and also observational-descriptive cross-sectional study focused on a Focus Group was chosen. Results: In the pilot group the mean positive mental health questionnaire pre-program, was 94.35, post-program had a decrease, and was at 92.61. Conclusions: Program implementation improved participants' positive mental health. Knowing that mental health is worked on the basis of continuity, it is believed that the time factor was limiting in this study. It would have been an added value to carry out a follow-up at the end of the academic year to analyse positive mental health questionnaire

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INTRODUCCIÓN: La entrada en prisión supone la necesidad de adaptación a una cultura penitenciaria que, en ocasiones, se encuentra alterada por el efecto de la prisionización. La sobreocupación de los reclusos con trastornos mentales y sus dificultades adaptativas en las instalaciones obstaculizan el equilibrio del ambiente carcelario e implica el empeoramiento del clima relacional de prisiones. MATERIAL Y MÉTODO: Se han revisado distintas bases de datos bibliográficas acerca de la influencia de la salud mental de los reclusos adultos en el clima relacional de prisiones y las intervenciones existentes al respecto publicadas en los últimos 15 años. Estos datos se han completado con los obtenidos en los índices bibliográficos online del Ministerio del Interior. RESULTADOS: Hay poca literatura acerca de la influencia de la salud mental en el clima relacional de prisiones y las intervenciones existentes. Aunque es cierto que responde a la realidad penitenciaria actual, donde los reclusos con problemas de salud mental poseen un mayor riesgo de estigmatización, pero también una mayor predisposición a la realización de malas conductas penitenciaras que ocasionan infracciones de reglas y la consecuente aplicación de sanciones disciplinarias que tienden a la segregación. DISCUSIÓN: El comportamiento disfuncional de este tipo de reclusos, así como el trato estigmatizado que reciben, impactan negativamente en el clima social penitenciario, generando estilos relacionales patológicos y distorsionando el ambiente de la prisión. Este hecho pone de relieve la necesidad de alcanzar una cantidad y calidad adecuada de programas e intervenciones que puedan prevenir y mitigar sus consecuencias

INTRODUCTION: Entry into prison involves adapting to a prison culture that is sometimes altered by the effect of imprisonment. Prisons are overcrowded and hold large numbers of inmates suffering from mental disorders and difficulties of adaptation, who affect the delicate equilibrium of the prison environment and can worsen the relational climate. MATERIAL AND METHOD: Several bibliographical databases on the influence of the mental health of adult inmates on the prison relationship climate and existing interventions in this regard that have been published in the last 15 years were reviewed. This data was complemented by other information obtained from the online bibliographic indexes of the Ministry of the Interior. RESULTS: There is little literature on the influence of mental health on the relational climate of prisons and existing interventions. However, what literature there is does respond to a current prison reality where inmates with mental health problems have an increased risk of victimization and also a greater predisposition to penitentiary misconduct that causes violations of rules and the consequent application of disciplinary sanctions that lead to segregation. DISCUSSION: The dysfunctional behaviour of such inmates, as well as the stigmatized treatment they receive, negatively impact the prison social climate, generating pathological relational styles and distorting the prison environment. This creates a need for an adequate number of programs and interventions of sufficient quality to prevent and mitigate their consequences

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BACKGROUND: The number of older people with unmet care and support needs is increasing substantially due to the challenges facing the formal and informal care system in the United Kingdom. Addressing these unmet needs is becoming one of the urgent public health priorities. In order to develop effective solutions to address some of these needs, it is important first to understand the care and support needs of older people. METHODS: A scoping review was conducted, using the Arksey and O'Malley original and enhanced framework, to understand the care and support needs of older people, focusing on those living at home with chronic conditions in the UK. The search was conducted using five electronic data bases, grey literature and reference list checks. The WHO International Classification of Functioning, Disability and Health (ICF) framework was used to analyse and categorise the literature findings. RESULTS: Forty studies were included in the final analysis- 32 from academic literature and 8 from grey literature. The review highlighted that older adults faced a range of physical, social and psychological challenges due to living with chronic conditions and required care and support in three main areas: 1) social activities and relationships; 2) psychological health; and 3) activities related to mobility, self-care and domestic life. The review also highlighted that many older people demonstrated a desire to cope with their illness and maintain independence, however, environmental factors interfered with these efforts including: 1) lack of professional advice on self-care strategies; 2) poor communication and coordination of services; and 3) lack of information on services such as care pathways. A gap in the knowledge was also identified about the care and support needs of two groups within the older population: 1) older workers; and 2) older carers. CONCLUSIONS: The review highlighted that older people living with chronic conditions have unmet care needs related to their physical and psychological health, social life, as well as the environment in which they live and interact. Findings of this review also emphasized the importance of developing care models and support services based around the needs of older people.

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El suicidio es un problema de salud pública a nivel mundial. La caracterización epidemiológica del mismo muestra diferencias en las tasas y medios empleados por hombres y mujeres de todas partes del mundo. Sin embargo, la discusión sobre la categoría "género" sostiene que no hay identidades universales de lo masculino y lo femenino, sino procesos sociales históricos que hacen que la sexualidad se viva de formas singulares por los seres humanos. Esta es la razón por la que el objetivo de este trabajo es identificar, a través de una revisión bibliográfica crítica, alcances y preguntas no resueltas por la investigación del suicidio desde una perspectiva de género. Es necesario responder estas preguntas para entender el suicidio como un fenómeno social. Esta aproximación crítica se propone ser una herramienta para cuestionar los procesos coercitivos de las sexualidades y potenciar las diferentes formas de vivencia de las mismas como procesos protectores de la salud mental

Suicide is a public health problem worldwide. Traditional epidemiology has shown differences in the rates and means used by men and women all around the world. However, the discussion on the gender category maintains that there are no universal identities of the masculine and feminine, but historical social processes that make human sexuality a singular experience. Therefore, through a critical literature review, this article aims to identify scopes and unresolved questions by research on suicide from a gender perspective. It is necessary to understand suicide as a social problem. This critical approach aims to be a tool to question the coercive processes of sexualities and to promote the different ways of experiencing them as protective processes of mental health

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BACKGROUND: Despite the reliance on administrative data in epidemiological studies, there is little information on the completeness of co-morbidities in administrative data coded from medical records. OBJECTIVE: The aim of this study was to quantify the agreement between the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) administrative coding of mental health, drug and alcohol co-morbidities and medical records in a severely injured patient population. METHOD: A random sample of patients (n = 500) captured by the Victorian State Trauma Registry and definitively managed at the state's adult major trauma services was selected for the study. Retrospective medical record review was conducted to collect data about documented co-morbidities. The agreement between ICD-10-AM data generated from routine hospital coding and medical record-based co-morbidities was determined using Cohen's κ and prevalence-adjusted bias-adjusted kappa (PABAK) statistics. RESULTS: The percentage of agreement between the medical record and ICD-10-AM coding for mental health, drug and alcohol co-morbidities was 72.8%, and the PABAK showed moderate agreement (PABAK = 0.46; 95% confidence interval (CI): 0.37, 0.54). There was no difference in agreement between unintentional injury patients (PABAK = 0.52; 95% CI: 0.42, 0.62) compared with intentional injury patients (PABAK = 0.36, 95% CI: 0.23, 0.49), and no change in agreement for patients admitted before (PABAK = 0.40; 95% CI: 0.30, 0.50) and after the introduction of mandatory co-morbidity coding (PABAK = 0.46; 95% CI: 0.37, 0.54). CONCLUSION: Despite documentation in the medical record, a large proportion of mental health, drug and alcohol conditions were not coded in ICD-10-AM. Acknowledgement of these limitations is needed when using ICD-10-AM coded co-morbidities in research studies and health policy development. IMPLICATIONS: This work has implications for researchers of drug and alcohol abuse; mental health; accidents and injuries; workers' compensation; health workforce; health services; and policy decisions for healthcare, emergency services, insurance industry, national productivity and welfare costings reliant on those research outcomes.

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OBJECTIVES: To ascertain the trajectories of mental health among women in Australia assessed in repeat waves from their early 70 s to the end of their lives or their mid 80 s. METHOD: Secondary analysis of data contributed by the 1921-26 cohort of the Australian Longitudinal Study of Women's Health Waves 1-6. Primary outcome was the 4-item SF-36 Vitality Subscale, which assesses mental health as life satisfaction, social participation, energy and enthusiasm. Structural, individual and intermediary factors were assessed using study-specific and standardised measures. Trajectories were identified using Growth Mixture Modelling and associations with baseline characteristics with Structural Equation Modelling. RESULTS: 12,432 women completed Survey One. Three mental health trajectories: stable high (77%); stable low (18.2%) and declining from high to low (4.8%) were identified. Compared to the stable high group, women in the stable low group were significantly less physically active, had more nutritional risks, more recent adverse life events, fewer social interactions and less social support, reported more stress and were more likely to have a serious illness or disability at Survey One. The declining group had similar characteristics to the stable high group, but were significantly more likely to report at baseline that they had experienced recent financial, physical and emotional elder abuse. These interact, but not directly with socioeconomic position and marital status. CONCLUSION: Mental health among older women is related to social relationships, general health, access to physical activity and healthy nutrition, coincidental adverse life events and experiences of interpersonal violence, in particular elder abuse.

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Resumen Este estudio tuvo por objetivo establecer la asociación de algunas variables de salud mental (burnout académico, ansiedad rasgo-estado y depresión) sobre la propensión al abandono de los estudios en estudiantes universitarios. Estudio de tipo observacional, analitico, trasversal. La muestra estuvo conformada por 252 estudiantes, distribuidos así: 23% (59) del programa de Enfermería, 39% (99) del programa de Medicina y 37% (94) del programa de Psicología, evaluados a través del Maslach Burnout Inventory-Student Survey, Ansiedad de Rasgo y de Estado, Inventario de Depresión de Beck, y cuestionario de Propensión al Abandono. Los resultados indican que la ansiedad estado (OR= 2.944 [1.712 - 5.065], p= 0.000) predice la propensión al abandono en universitarios. Se concluye que la ansiedad estado es un factor de riesgo para la propensión al abandono, por tanto, se recomienda el fortalecimiento de los recursos personales desde la autoeficacia y la incorporación de la familia desde el inicio de la vida universiaria.

Abstract The objective of this study was to establish the association of some mental health variables (academic burnout, traitstate anxiety and depression) on the propensity to drop out of studies in university students. Study of observational, analytical, transversal type. The sample consisted of 252 students, distributed as follows: 23% (59) of the Nursing program, 39% (99) of the Medicine program and 37% (94) of the Psychology program, evaluated through the Maslach Burnout Inventory-Student Survey, Trait and State Anxiety, Beck Depression Inventory, and Abandonment Propensity Questionnaire. The results indicate that state anxiety (OR = 2.944 [1.712 - 5.065], p = 0.000) predicts the dropout propensity in university students. We conclude that state anxiety is a risk factor for the propensity to drop out, so it is recommended to strengthen personal resources from self-efficacy and the incorporation of the family since the beginning of university life.

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The standard of practice for forensic interviews in criminal and delinquency cases, other than those conducted as part of brief preliminary screening evaluations or in emergency situations, should include a digital recording requirement. This standard should be adopted because of the greater availability of, and familiarity with, recording technology on the part of mental health professionals, the greater use and proven effectiveness of recording in other contexts of the criminal justice system, and the improvement in court presentation and accuracy of judicial determinations involving forensic assessments that recording will provide. The experience of practitioners with recording since professional associations last studied the issue should be taken into account, as informal data suggest it has been positive. Unfortunately, the legal system is unlikely to prompt this advance without its reconsideration by the forensic mental health professions, because current constitutional jurisprudence does not require recording and effectively makes it contingent upon request by examiners. Forensic evaluators thus have a valuable opportunity to educate the legal system on the utility and importance of this key reform, and so should adopt it as a best practice.

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BACKGROUND: The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association [APA], 2013) includes Other- and Unspecified- Trauma and Stressor-Related Disorders to capture subthreshold Posttraumatic Stress Disorder (PTSD) symptoms. However, the DSM-5 does not specify the number or type of symptoms needed to assign them. The purpose of the current study was to extend our understanding of subthreshold PTSD by comparing four commonly used definitions adapted to the DSM-5 PTSD criteria in an outpatient treatment-seeking sample. METHODS: Veterans (N = 193) presenting to PTSD clinics were assessed using the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). Participants reported a criterion A traumatic event, but did not meet criteria for threshold-PTSD. We hypothesized that the number of veterans captured would be highest when fewer specific criterion sets were required by the subthreshold definition. RESULTS: Our hypothesis was upheld in that the more criteria required by the subthreshold PTSD definition, the lower the number of veterans counted within the group. LIMITATIONS: The study consisted primarily of trauma treatment-seeking male veterans, with chronic PTSD symptoms. In addition, the sample size was small and was collected as part of routine clinical care. CONCLUSIONS: These results support previous contentions around careful decision making when defining what constitutes subthreshold PTSD in research and clinical work. It also points to the need for continued research to better understand the diagnostic and treatment implications of subthreshold PTSD.

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BACKGROUND: A development of a needs-led mental health classification system based on the Health of the National Outcome Scales (HoNOS) has previously been developed. AIMS: To extend the needs-based mental health (MH) clusters to accommodate the additional needs of people accessing UK intellectual disabilities health services. METHOD: Hierarchical cluster analysis was performed on assessment data from 18 National Health Service (NHS) provider organisations. The statistical results were clinically shaped through multi-disciplinary workshops. The resulting clusters were combined with six independently rated measures for a second data collection exercise. Based on these data, refinements were made before performing internal and external validity checks. RESULTS: Eight additional clusters for people with health needs associated with their intellectual disabilities were produced. Three described primarily physical health (PH) needs, four described needs arising from behaviours which challenged (with/without autism) whilst one described people with generally low needs. Together, these covered 83.4% of cases with only a 10% overlap. The clusters were replicable and had clinical utility and validity. CONCLUSIONS: It was possible to extend the needs-led mental health classification system to capture the additional needs of people accessing UK intellectual disability services.

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Comparing mental health systems across countries is difficult because of the lack of an agreed upon terminology covering services and related financing issues. Within the European Union project REFINEMENT, international mental health care experts applied an innovative mixed "top-down" and "bottom-up" approach following a multistep design thinking strategy to compile a glossary on mental health systems, using local services as pilots. The final REFINEMENT glossary consisted of 432 terms related to service provision, service utilisation, quality of care and financing. The aim of this study was to describe the iterative process and methodology of developing this glossary.

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Este artigo trata da atualização da Classificação Diagnóstica Zero a Três, que recebeu uma importante revisão, editada em 2016, ampliando seu escopo para o atual Zero a Cinco. São apresentadas as principais modificações efetuadas, destacando-se o possível enriquecimento aportado para as implicações clínicas referentes á valorização do desenvolvimento precoce, especialmente em seus complexos elementos interacionais

This article deals with the Diagnostic Classification Zero to Three that received an important revision, published in 2016, extending its scope to the current Zero to Five. The main modifications are presented, highlighting the possible enrichment provided for the clinical implications related to the valorization of early development, especially in its interactional complexes

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The authors propose a new approach to the definition of mental health, different than the definition proposed by the World Health Organization, which is established around issues of person's well-being and productivity. It is supposed to reflect the complexity of human life experience.

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