Perceived Need for a Faith-Based Trauma-Focused Treatment in a Sample of Forcibly Displaced Muslims.

Forcibly displaced Muslims, including refugees, internally displaced persons, and asylum seekers who have fled their homes to escape violence, conflict, and persecution, often have inequitable access to quality mental health services, despite substantial trauma exposure and high rates of posttraumatic stress disorder (PTSD). Understanding factors associated with domains of perceived need (i.e., community, individual, friends/family) for culturally-responsive, trauma-focused mental health interventions among forcibly displaced Muslims may provide insight into those most likely to seek psychological treatment. A sample of 108 forcibly displaced Muslims endorsed moderate to high perceived need across all three domains for a trauma healing group tailored for Muslim refugees. PTSD severity related to perceived individual need, regardless of locus of displacement. Among participants with minimal PTSD symptoms, those who were externally displaced had higher perceived community and friends or family need than those who were internally displaced. Findings highlight a need for culturally responsive, trauma-focused mental health services to facilitate access to mental health care for forcibly displaced Muslims.

Perceived need for care and stigma experiences among individuals with methamphetamine-related admissions to inpatient mental health wards.

BACKGROUND: There are gaps in our understanding of treatment needs among people who use methamphetamine. We examined the demographics, perceived treatment needs, barriers to accessing care, and stigma experienced by an inpatient sample of people who use methamphetamine. METHODS: This study surveyed a convenience sample of patients admitted to psychiatry wards with a history of methamphetamine use in Winnipeg, Canada, between May 1 and July 31, 2019. The Perceived Need for Care Questionnaire (PNCQ-9) was used to assess treatment needs and barriers to care, and the Substance Use Stigma Mechanisms Scale (SU-SMS) was used to assess enacted, anticipated, and internalized stigma. Prevalence rates of perceived need, stigma, and demographic variables were determined. RESULTS: A total of 103 potential participants were identified, with 34 completing the survey. The most common age group was 21-30 years of age (41.2%); an approximate equal number of men and women; and almost all were single and never married (91.1%). Rates of perceived need for care were very high across all treatment types, including 91% identifying a need for medication treatment for their mental health or substance use. Despite the majority receiving care across the seven types of care described in the PNCQ-9, most felt they did not receive enough care. Unmet need for care was therefore high in many categories, including rates of 87% for counselling and skills training. The most common barriers to having needs met were a desire to self-manage substance use, and not receiving care after asking for help. Almost all participants reported experiencing stigma (94%). Stigma from family was endorsed significantly more than stigma from health care providers (p = 0.005). CONCLUSIONS: The average hospitalized person who uses methamphetamine in this sample is young, single, and has not completed any post-secondary education. High rates of perceived treatment need suggest an awareness of problems with methamphetamine, yet most interventions are perceived as inadequate. People who used methamphetamine felt highly stigmatized, particularly by their family members. Trial registration Registered with the Health Research Ethics Board at the University of Manitoba (Number HS22605 (H2019:072), renewed February 14, 2022).

Annual use and perceived need for mental health and substance treatment among people in remission from substance use disorders in the United States.

BACKGROUND: Receiving specialty substance treatment or general mental health treatment during remission from substance use disorders (SUD) may reduce odds of SUD recurrence, but little is known about prevalence of treatment or perceptions of treatment need among remitted people in the United States. SAMPLE: Participants in the National Survey on Drug Use and Health, years 2018-2020, were considered remitted if they ever had an SUD (i.e., self-reported history of "problems with alcohol or drugs", or lifetime history of treatment for SUD) but did not meet DSM-IV criteria for substance abuse or dependence during the prior year (n = 9,295). ANALYSES: Annual prevalence was estimated for any SUD treatment (e.g., mutual-help groups), any mental health (MH) treatment (e.g., private therapy), self-reported perceived need for SUD treatment, and self-reported unmet need for MH treatment. Generalized linear models examined effects of socio-demographics, mental illness, past-year substance use, and self-identified recovery status on outcomes. FINDINGS: MH treatment was more common than SUD treatment (27.2% [25.6%, 28.8%] v. 7.8% [7.0%, 8.6%], respectively). Unmet need for mental health treatment was reported by 9.8% [8.8%, 10.9%], but only 0.9% [0.6%, 1.2%] perceived need for substance treatment. Age, sex, marital status, education, health insurance, mental illness, and prior year alcohol use were among the factors associated with variation in outcomes. CONCLUSION: Most people who maintained clinical remission from substance use disorders in the U.S. during the prior year did so without treatment. Remitted people report substantial unmet need for mental health treatment, but not specialized substance use treatment.

Mental Health Needs and Services Utilization among Undergraduate and Graduate Students in Texas during the COVID-19 Pandemic.

COVID-19 created a global crisis, exacerbating disparities in social determinants of health (SDOH) and mental health (MH). Research on pandemic-related MH and help-seeking is scarce, especially among high-risk populations such as college/university students. We examined self-rated MH and psychological distress, the perceived need for MH services/support, and the use of MH services across the SDOH among college/university students during the start of the pandemic. Data from the COVID-19 Texas College Student Experiences Survey (n = 746) include full- and part-time undergraduate/graduate students. Regressions examined self-rated MH, psychological distress, perceived need, and service use across SDOH, controlling for pre-pandemic MH, age, gender, and race/ethnicity. Economic stability was associated with higher risk of poor MH and need for MH services/support. Aspects of the social/community context protected student MH, especially among foreign-born students. Racial discrimination was associated with both greater psychological distress and use of services. Finally, beliefs related to the sufficiency of available institutional MH resources shaped perceived need for and use of services. Although the worst of the pandemic is behind us, the inequitable distribution of the SDOH among students is unwavering. Demand for MH support is high, requiring higher education institutions to better mobilize MH services to meet the needs of students from diverse social contexts.

Sociobehavioural Factors Associated With Child Oral Health During COVID-19.

OBJECTIVES: The aim of this study was to identify the sociobehavioural factors that influenced children's oral health during the COVID-19 pandemic. METHODS: The online cross-sectional study was conducted in Al Jouf Province in the northern region of Saudi Arabia. A total of 960 parents of children aged 5 to 14 years were invited by multistage stratified random sampling. Descriptive, multinomial, and multiple logistic regression analyses were performed to estimate odds ratios and determine the relationship between independent and dependent variables. P < .05 was considered statistically significant. RESULTS: Of the 960 participants, 693 (72.1%) reported that their child had 1 or more untreated dental decay. The children of uneducated parents were 1.6-fold more likely to have 1 or more untreated dental decay (adjusted odds ratio [AOR], 1.66; 95% CI, 0.74-3.73; P < .001). The children of unemployed parents were 4.3-fold more likely to have a financial burden for a child dental visit (AOR, 4.34; 95% CI, 2.73-6.89; P < .001). Parents from a rural area were 26.3-fold more likely to have spent a lag period of over 2 years since their child's last dental visit (AOR, 26.34; 95% CI, 7.48-92.79; P < .001). Nursery-level children were 5.4-fold more likely to need immediate care (AOR, 5.38; 95% CI, 3.01-9.60; P < .001). CONCLUSIONS: The present study demonstrated a very high prevalence of 1 or more untreated dental decay in our cohort. Children of rural areas, uneducated, unemployed, widow/divorced, low- and middle-income parents and nursery school children were linked to poorly predictive outcomes of child oral health during the pandemic.

Mental health differences between multiracial and monoracial college students in the United States: Emerging racial disparities.

BACKGROUND: Multiracial individuals appear to be at higher risk for mental health problems; however, more research is needed to confirm these racial disparities among young adult college populations. METHODS: We analyzed data from the Health Minds Study (N = 99728 young adult college students aged 18-34), collected online across 140 college campuses from September 2020 to June 2021. We used multivariable logistic regression to examine associations between multiracial identity and several mental health outcomes, including mental and behavioral health (depression, anxiety, languishing, perceived need, loneliness), self-injurious behaviors (non-suicidal self-injury, suicidal ideation, suicide plan, suicide attempt), and history of lifetime psychiatric disorders, adjusting for age and gender. RESULTS: Almost a tenth of the weighted sample were multiracial. Multiracial students had greater odds of all mental and behavioral health outcomes, self-injurious behaviors (though only marginally significant for suicide attempt), and most lifetime psychiatric disorders. CONCLUSION: Multiracial young adult college students were more likely to have mental health problems than their monoracial counterparts, calling for targeted preventive interventions on college campuses to address these mental health disparities.

Challenges and unmet needs of mothers of preschool children with autism spectrum disorders in Tunisia: a qualitative study.

Introduction: Autism spectrum disorder (ASD) is a life-changing condition, not only for the child but also for the mother and the usual caregiver. In fact, a child recently diagnosed with ASD is a real challenge to mothers´ adaptation, involves their resources, and gives rise to a set of needs. This study explores the unmet needs and experiences of mothers of ASD children in the Tunisian context. Methods: a qualitative phenomenological design was chosen for this study and a semi-structured interview was used for eight mothers raising an autistic preschooler child. Results: the results indicate significant denial and rejection following the announcement of the diagnosis. To cope with this, reliance on religion has helped foster acceptance. Although informal support (from family and friends) has sometimes been mentioned, an increased need for training, social and financial support has been expressed and is a major concern given the high cost of TSA services. Conclusion: this study provides a deeper understanding of mothers' needs following the announcement of the diagnosis of ASD. These unmet needs should be taken into account when designing interventions strategies for children with ASD to help mothers cope and parent a child with ASD.

Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care.

BACKGROUND: Giving birth in health facilities with skilled birth attendants (SBAs) is one of the key efforts promoted to reduce preventable maternal deaths in sub-Saharan Africa. However, research has revealed large socioeconomic status (SES) disparities in facility-based childbirth. We seek to extend the literature on the factors underlying these SES disparities. Drawing on the Disparities in Skilled Birth Attendance (DiSBA) framework, we examined the contribution of three proximal factors-perceived need, accessibility, and quality of care-that influence the use of SBAs. METHODS: We used data from a survey conducted in Migori County, Kenya in 2016, among women aged 15-49 years who gave birth nine weeks before the survey (N = 1020). The primary outcome is facility-based childbirth. The primary predictors are wealth, measured in quintiles calculated from a wealth index based on principal component analysis of household assets, and highest education level attained. Proposed mediating variables include maternal perceptions of need, accessibility (physical and financial), and quality of care (antenatal services received and experience of care). Logistic regression with mediation analysis was used to investigate the mediating effects. RESULTS: Overall, 85% of women in the sample gave birth in a health facility. Women in the highest wealth quintile were more likely to give birth in a facility than women in the lowest quintile, controlling for demographic factors (adjusted odds ratio [aOR]: 2.97, 95% CI: 1.69-5.22). College-educated women were five times more likely than women with no formal education or primary education to give birth in a health facility (aOR: 4.96; 95% CI: 1.43-17.3). Women who gave birth in health facilities had higher perceived accessibility and quality of care than those who gave birth at home. The five mediators were estimated to account for between 15% and 48% of the differences in facility births between women in the lowest and higher wealth quintiles. CONCLUSION: Our results confirm SES disparities in facility-based childbirth, with the proximal factors accounting for some of these differences. These proximal factors - particularly perceived accessibility and quality of care - warrant attention due to their relationship with facility-birth overall, and their impact on inequities in this care.

Examining rural-urban disparities in perceived need for health care services among adults with disabilities.

Purpose: The purpose of this study is to parse out differences between unmet need and perceived need for health care services among rural and urban adults with disabilities in the United States. While unmet need focuses primarily on environmental factors such as access to health insurance or provider availability, perceived need relates to personal choice. This distinction between unmet and perceived need is largely ignored in prior studies, but relevant to public health strategies to improve access and uptake of preventive care. Methods: Using Wave 2 data from the National Survey on Health and Disability, we explored rural and urban differences in unmet and perceived health care needs among working-age adults with disabilities for acute and preventive services. Findings: Although we found no significant differences in unmet needs between rural and urban respondents, we found that perceived needs for dental care and mental health counseling varied significantly across geography. Using logistic regression analysis and controlling for observable participant characteristics, we found that respondents living in noncore counties relative to metropolitan counties were more likely to report not needing dental care (OR 1.89, p = 0.028), and not needing mental health counseling services (OR 2.15, p ≤ 0.001). Conclusion: These findings suggest additional study is warranted to understand perceived need for preventive services and the levers for addressing rural disparities.

Clinical Need, Perceived Need, and Treatment Use: Estimating Unmet Need for Mental Health Services in the Adult Population.

Estimates of unmet need for mental health services in the adult population are too high because many recover without treatment. Untreated recovery suggests that individuals accurately perceive professional help as unnecessary and do not pursue it. If so, perceived need for treatment should predict service use/nonuse more strongly than the presence or seriousness of disorder. With National Comorbidity Survey-Replication data, respondents who recovered from prior disorder by the current year (N = 1,054) were compared to currently unrecovered respondents with less serious (N = 999) and more serious disorders (N = 294). Perceived need covaried positively with the presence and seriousness of disorder and linked to far higher odds of treatment use than disorder seriousness, supporting perceptual accuracy. Two-thirds of respondents who perceived a treatment need obtained care; only one-third had unmet need. Need perceptions may better estimate a treatment gap and prompt research on individuals' self-assessments and treatment decision-making.

Healthcare Avoidance before and during the COVID-19 Pandemic among Australian Youth: A Longitudinal Study.

BACKGROUND: Access to healthcare for young people is essential to ensure they can build a foundation for a healthy life. However, during the COVID-19 pandemic, many people avoided seeking healthcare, adversely affecting population health. We investigated the factors associated with the avoidance of healthcare for Australian young people when they reported that they needed healthcare. We were able to compare healthcare avoidance during the COVID-19 pandemic with healthcare avoidance prior to COVID-19. METHODS: We used two recent data collection waves from the Longitudinal Study of Australian Children (LSAC)-Wave 9C1 during the COVID-19 pandemic in 2020, and Wave 8 data which were collected in 2018. The primary outcome of this study revealed the avoidance of healthcare among those who perceived the need for care. Bivariate analyses and multiple logistic regression models were employed to identify the factors associated with the avoidance of healthcare during the COVID-19 and pre-COVID-19 periods. RESULTS: In the sample of 1110 young people, 39.6% avoided healthcare during the first year of the COVID-19 pandemic even though they perceived that they had a health problem that required healthcare. This healthcare avoidance was similar to the healthcare avoidance in the pre-COVID-19 pandemic period (41.4%). The factors most strongly associated with healthcare avoidance during the COVID-19 pandemic were female gender, an ongoing medical condition, and moderately high psychological distress. In comparison, prior to the pandemic, the factor associated with healthcare avoidance was only psychological distress. The most common reason for not seeking healthcare was thinking that the problem would spontaneously resolve itself (55.9% during COVID-19 vs. 35.7% pre-COVID-19 pandemic). CONCLUSIONS: A large proportion of youths avoided healthcare when they felt they needed to seek care, both during and before the COVID-19 pandemic.

Clinically assessed and perceived unmet mental health needs, health care use and barriers to care for mental health problems in a Belgian general population sample.

BACKGROUND: Mental health problems often remain undetected and untreated. Prior research suggests that this is mainly due to a lack of need-perception and attitudinal barriers. The aim of this study is to examine unmet mental health needs using both a clinically assessed and a self-perceived approach in a Belgian province. METHODS: A cross-sectional survey study with a weighted representative sample of 1208 individuals aged 15 - 80 years old was carried out in 2021 in the province of Antwerp (Belgium). Mental health needs were defined as a positive symptom screening for depression (PHQ-9), anxiety (GAD-7) or alcohol abuse (AUDIT-C and CAGE), combined with experiencing significant dysfunction in daily life. Also 12-month health care use for mental health problems, self-perceived unmet mental health needs and reasons for not seeking (extra) help were assessed. Logistic regression analyses were used to explore the predictors of mental health problems, health care use, and objective and subjective unmet mental health needs. RESULTS: One in five participants had a positive screening on one of the scales, of whom half experienced dysfunction, leading to a prevalence of 10.4% mental health needs. Among those, only half used health care for their mental health, resulting in a population prevalence of 5.5% clinically assessed unmet mental health needs. Fourteen percent of the total sample perceived an unmet mental health need. However, more women and younger people perceived unmet needs, while clinically assessed unmet needs were higher among men and older people. One in six of the total sample used health care for their mental health, most of whom did not have a clinically assessed mental health need. Motivational reasons were most often endorsed for not seeking any help, while a financial barrier was the most important reason for not seeking extra help. CONCLUSIONS: The prevalence of unmet mental health needs is high. Assessed and perceived (unmet) mental health needs are both relevant and complementary, but are predicted by different factors. More research is needed on this discrepancy.

Suicidal Ideation and Mental Health Help-Seeking Behaviors Among Older Chinese Adults During the COVID-19 Pandemic.

OBJECTIVE: To examine prevalence and correlates of suicidal ideation in older Chinese adults (OCAs) during the COVID-19 pandemic, as well as mental health help-seeking behaviors of suicidal OCAs. BACKGROUND: Few data on suicidal behaviors of older adults during the pandemic are available. METHODS: In this cross-sectional survey, 1159 OCAs completed an online self-administered questionnaire between 23 February and 25 March 2020. A standardized single question and the 12-item General Health Questionnaire were used to assess the presence of suicidal ideation and common mental health problems (CMHPs), respectively. Suicidal ideators were further asked about their perceived need for mental health care and help-seeking from mental health workers. RESULTS: 4.1% of the OCAs experienced suicidal ideation during the past 2 weeks. Among the suicidal OCAs, 31.9% perceived a need for mental health care but only 10.6% had sought help from mental health workers. Factors significantly associated with suicidal ideation were a marital status of "others" (OR=2.39, P = .021), disagreement regarding the successful containment of the pandemic (OR=2.43, P = .022), physical health problems (OR=2.23, P = .012), and CMHPs (OR=4.99, P < .001). CONCLUSIONS: During the COVID-19 pandemic, OCAs constitute a subpopulation that needs mental health services for suicidal problems but tends not to seek mental health help. Mental health services for OCAs may include mental health education, periodic evaluation of risk of suicide, expanded psychosocial support, and, when necessary, psychological crisis intervention and psychiatric treatment.

Roles of Psychological Distress and Social Support in the Relationship Between Childhood Maltreatment and Perceived Needs for Mental Health Care.

Childhood maltreatment is a major public health issue worldwide. It increases a range of health-risk behaviors, psychological and physical problems, which are associated with an increased need for mental health services in adulthood. Identification of mediating factors in the relationship between maltreatment and seeking mental health care may help attenuate the negative consequences of childhood maltreatment and promote more appropriate treatment. This study aims to examine whether the relationship between childhood maltreatment and perceived need for mental health care is mediated by psychological distress and/or moderated by social support. Data from the Canadian Community Health Survey-Mental Health 2012 are analyzed. A total of 8,993 participants, who had complete information on childhood maltreatment and diagnoses of mental disorders or psychological distress, are included in this study. Structural equation modeling and the PROCESS macro were used to identify relationships among childhood maltreatment, perceived needs for mental health care, and psychological distress. Hierarchical linear regression was then used to verify the moderated mediation model. We found that psychological distress partially mediated the effect of childhood maltreatment on perceived needs for mental health care in adulthood. Social support played an important role in terms of moderating the relationship between maltreatment and perceived needs for care. For those with a history of childhood maltreatment, those who perceived a low level of social support were more likely to have higher levels of psychological distress and perceived need for mental health care. This is the first study to identify the separate and combined roles of psychological distress and social support in the relationship between childhood maltreatment and perceived need for mental health care. Selective prevention strategies should focus on social support to improve mental health services among people with a history of childhood maltreatment.

Clinical Interpretation of Self-Reported Pain Scores in Children with Acute Pain.

OBJECTIVE: To identify self-reported pain scores that best represent categories of no pain, mild, moderate, and severe pain in children, and a pain score that accurately represents a child's perceived need for medication, that is, a minimum pain score at which a child would want an analgesic. STUDY DESIGN: Prospective cross-sectional cohort study of children aged 6-17 years presenting to a pediatric emergency department with painful and nonpainful conditions. Pain was measured using the 10-point Verbal Numerical Rating Scale. Receiver operating characteristic -based methodology was used to determine pain scores that best differentiated no pain from mild pain, mild pain from moderate pain, and moderate pain from severe pain. Descriptive statistics were used to determine the perceived need for medication. RESULTS: We analyzed data from 548 children (51.3% female, 61.9% with a painful condition). The scores that best represent categories of pain intensity are as follows: 0-1 for no pain; 2-5 for mild pain; 6-7 for moderate pain; and 8-10 for severe pain. The area under the curve for the cut points differentiating each category ranged from 0.76 to 0.88. The median pain score representing the perceived need for medication was 6 (IQR, 4-7; range, 0-10). CONCLUSIONS: We identified population-level self-reported pain scores in children associated with categories of pain intensity that differ from scores conventionally used. Implementing our findings may provide a more accurate representation of the clinical meaning of pain scores and reduce selection bias in research. Our findings do not support the use of pain scores in isolation for clinical decision making or the use of a pain score threshold to represent a child's perceived need for medication.

Perceived Need for Mental Health Care and Associated Factors and Outcomes in Older Adults Consulting in Primary Care.

OBJECTIVE: To assess the individual and health system factors and health-related outcomes associated with perceived need for mental health care in older adults consulting in primary care. METHOD: This longitudinal cohort study was conducted among 771 cognitively intact older adults aged ≥65 years recruited in primary care practices in Quebec between 2011 and 2013 and followed 4 years later. Predisposing, enabling and need factors were based on Andersen's framework on help-seeking behaviors. Health-related outcomes included course of common mental disorders (CMDs), change in quality of life and societal costs. Perceived need for care (PNC) was categorized as no need, met and unmet need. Multinomial regression analyses were conducted to assess the association between study variables and PNC in the overall and the subsample of participants with a CMD at baseline. RESULTS: As compared with individuals reporting no need, those with an unmet need were more likely to have cognitive decline and lower continuity of care; while those with a met need were more likely to report decreased health-related quality of life. As compared with individuals with an unmet need, those reporting a met need were more likely to report ≥ 3 physical diseases and an incident and persistent CMD, and less likely to show cognitive decline. In participants with a CMD, individuals reporting a met as compared with no need were more likely to be categorized as receiving minimally adequate care and a persistent CMD. Need for care was not associated with societal costs related to health service use. CONCLUSIONS: Overall, physicians should focus on individuals with cognitive impairment and lower continuity of care which was associated with unmet mental health need. Improved follow-up in these populations may improve health care needs and outcomes.

Disparities in substance use disorder treatment use and perceived need by sexual identity and gender among adults in the United States.

BACKGROUND: Substance use disorder (SUD) treatment use is low in the United States. We assessed differences in treatment use and perceived need by sexual identity (i.e., lesbian, gay, bisexual, heterosexual) and gender among adults with a past-year SUD. METHODS: We pooled data from the 2015-2019 National Survey on Drug Use and Health for adults (18+) who met past-year DSM-IV SUD criteria and self-reported sexual identity (n = 21,926). Weighted multivariable logistic regressions estimated odds of past-year: 1) any SUD treatment; 2) specialty SUD treatment; 3) perceived SUD treatment need by sexual identity, stratified by gender and adjusted for socio-demographics. RESULTS: Any past-year SUD treatment use was low among adult men (heterosexual [10.4 %], gay [15.5 %], and bisexual [7.1 %]) and women (heterosexual [9.9 %], gay/lesbian [11.9 %], and bisexual [13.2 %]). Patterns were similar for specialty SUD treatment and perceived treatment need. Adjusted odds of any SUD treatment use were higher among gay men (aOR = 1.65 [95 % Confidence Interval 1.10-2.46]) and bisexual women (aOR = 1.31 [1.01-1.69]) than their heterosexual peers. Compared to their heterosexual counterparts, adjusted odds of perceived SUD treatment need were higher among bisexual women (aOR = 1.65 [1.22-2.25]), gay men (aOR = 1.76 [1.09-2.84]), and bisexual men (aOR = 2.39 [1.35-4.24]). CONCLUSIONS: Most adults with SUD did not receive treatment. Gay men and bisexual women were more likely to receive treatment and reported higher perceived SUD treatment need than heterosexual peers. Facilitating treatment access and engagement is needed to reduce unmet needs among marginalized people who perceive SUD treatment need.

Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey.

BEACKGROUND: Older adults with mental health problems may benefit from psychotherapy; however, their perceived need for treatment in relation to rates of non-utilization of outpatient psychotherapy as well as the predisposing, enabling, and need factors proposed by Andersen's Model of Health Care Utilization that account for these differences warrant further investigation. METHODS: We used two separate cohorts (2014 and 2019) of a weighted nationwide telephone survey in Germany of German-speaking adults with N = 12,197 participants. Across the two cohorts, 12.9% (weighted) reported a perceived need for treatment for mental health problems and were selected for further analyses. Logistic Generalized Estimation Equations (GEE) was applied to model the associations between disposing (age, gender, single habiting, rural residency, general health status), enabling (education, general practitioner visit) non-utilization of psychotherapy (outcome) across cohorts in those with a need for treatment (need factor). RESULTS: In 2014, 11.8% of 6087 participants reported a perceived need for treatment due to mental health problems. In 2016, the prevalence increased significantly to 14.0% of 6110 participants. Of those who reported a perceived need for treatment, 36.4% in 2014 and 36.9%in 2019 did not see a psychotherapist - where rates of non-utilization of psychotherapy were vastly higher in the oldest age category (59.3/52.5%; 75+) than in the youngest (29.1/10.7%; aged 18-25). Concerning factors associated with non-utilization, multivariate findings indicated participation in the cohort of 2014 (OR 0.94), older age (55-64 OR 1.02, 65-74 OR 1.47, 75+ OR 4.76), male gender (OR 0.83), lower educational status (OR 0.84), rural residency (OR 1.38), single habiting (OR 1.37), and seeing a GP (OR 1.39) to be related with non-utilization of psychotherapy; general health status was not significantly associated with non-utilization when GP contact was included in the model. CONCLUSION: There is a strong age effect in terms of non-utilization of outpatient psychotherapy. Individual characteristics of both healthcare professionals and patients and structural barriers may add to this picture. Effective strategies to increase psychotherapy rates in those older adults with unmet treatment needs are required.

My job impacts my sleep: signs and symptoms of insomnia among healthcare workers.

Potential insomnia in healthcare workers is a public health concern as it may degrade the quality of patient care. We examined the prevalence of insomnia symptoms in healthcare workers and their perceived need for a sleep intervention. Participants were 62 nurses working full-time at a U.S. hospital. These nurses were asked about background characteristics, perceived stress, sleep concerns, and need for a sleep intervention. They also participated in 14-d ecological momentary assessment (EMA) and actigraphy sleep study. A qualitative analysis showed that the majority (92%) of participants reported at least one sleep concern with insomnia-related concerns being most prevalent (68%). Quantitative analyses indicated that those with insomnia-related concerns had higher perceived stress overall and lower EMA sleep sufficiency and sleep quality. Moreover, participants with insomnia concerns had shorter actigraphy-measured nap duration prior to non-workdays than those without. Nearly all (95%) expressed interest in participating in a sleep intervention; an online format and mindfulness contents were most preferred. Our results suggest a high prevalence of insomnia symptoms and a high interest in a sleep intervention in nurses. Information obtained from this study could be used to deliver a tailored sleep intervention for nurses whose role in public health is essential.

Service demand for psychological interventions among Australian adults: a population perspective.

BACKGROUND: Psychological interventions (PIs) are good practice treatment for both subthreshold and diagnosed mental disorders. Australia has implemented major reforms to expand the provision of subsidised psychological services for individuals with a diagnosed mental disorder. But there are gaps in knowledge about demand for PIs (i.e., use of and perceived need for PIs) across the population. This study uses nationally representative survey data from the 2007 Australian National Survey of Mental Health and Wellbeing to analyse demand for PIs. It also provides a method for analysing survey data to estimate demand for PIs when new survey data becomes available, along with suggestions to inform future survey development. METHODS: Nationally representative community survey respondents (n = 8841, 16-85 years) indicated their perceived need for nine types of help for mental health problems in the past 12 months, including three PIs (cognitive behavioural therapy, psychotherapy, and counselling), and whether these needs were unmet, partially met, or fully met. Types of help were grouped as: PIs only; PIs plus other; and other only. Chi-square analyses were used to examine the association between type of intervention, sociodemographic and clinical factors, and type of professional consulted; multinomial logistic regression models were used to examine predictors of type of intervention(s) received. RESULTS: 7.9% (95%CI: 7.2-8.6) received PIs. Receipt of PIs was positively associated with higher education and consulting a mental health specialist. Twice as many respondents received PIs plus medication as compared to PIs only (4.2% vs. 2.0%). Almost half (45.4, 95%CI 36.5-54.6) incurred out-of-pocket costs for treatment. The most common reason for partially met need for PIs was cost (24.8, 95%CI 17.2-34.3); for unmet need, it was preference for self-management (33.9, 95%CI 21.2-49.5). Perceived unmet need for PIs only (3.1, 95%CI 2.1-4.6) or PIs plus other interventions (5.2, 95%CI 3.9-6.9%) was lower than for other interventions only (22.8, 95%CI 18.7-27.6). CONCLUSIONS: Continued reforms in Australia means that on-going monitoring of demand for PIs, using nationally representative data, is required. This study provides a baseline for comparison of the long-term effects of these reforms; this comparison may be undertaken using data from the third iteration of Australia's NSMHWB, due for completion in 2021-22.