Echoes from the past: How America's major moments shaped mental health policies through a young adult lens.

This commentary examines key mental health policies across four transformative historical periods in America: the aftermath of World War II (1939-1946), the Civil Rights Movement (1954-1968), the Great Recession (2007-2009), and the COVID-19 pandemic (2020-2023). The post-WWII era established today's foundational mental health system, emphasizing military personnel, as reflected in the National Mental Health Act of 1946. During the Civil Rights Movement, the focus shifted toward community equality, leading to the Community Mental Health Act of 1963. The economic challenges of the Great Recession, especially affecting young adults, prompted a deep dive into the Affordable Care Act. The social isolation and economic suffering from the COVID-19 pandemic led to the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The article highlights the need for a more inclusive policy development approach, one that recognizes and integrates the unique perspectives of young adults in shaping mental health policies and discourse. It concludes with recommendations to guide future policy evolution for enhanced mental health and societal well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Impact of Digital Mental Health Services on Loneliness and Mental Health: Results from a Prospective, Observational Study.

BACKGROUND: Loneliness has increased since the COVID-19 pandemic and negatively impacts mental health. This study examined relationships between loneliness and mental health among adults using a digital mental health platform. METHODS: A purposive sample of 919 participants (97% response rate) who were newly enrolled in the platform completed a survey on loneliness, depression, anxiety, well-being, stress, social support, and comorbidities at baseline and 3 months. Platform engagement was tracked during this period. We examined baseline differences between lonely and non-lonely participants; associations between loneliness, mental health symptoms, and comorbidities; and changes in loneliness and mental health through engagement in any form of care. RESULTS: At baseline, 57.8% of the sample were categorized as lonely. Loneliness was associated with younger age, fewer years of education, and the presence of a comorbidity (p values < .05). Baseline loneliness was associated with greater depression, anxiety, and stress and lower well-being and social support (ps < .001). The percentage of lonely participants decreased at follow-up (57.6% to 52.9%, p = .03). Those who improved in loneliness improved in mental health symptoms, well-being, and social support (ps < .001). Lonely participants who engaged in any form of care reported a greater reduction in loneliness than those who did not engage (p = .04). CONCLUSIONS: This study confirms previous findings of the high prevalence of loneliness among adults and risk factors for increased loneliness. Findings highlight the potential of digital platforms to reach lonely individuals and alleviate loneliness through remote mental health support.

Centering mental health in society: A human rights approach to well-being for all.

Applying a human rights lens to mental health and well-being will improve the systems that govern and operate U.S. society. Achieving this requires learning from successful approaches and scaling up the implementation of effective strategies that promote equity by actively addressing determinants and barriers across systems that impede overall health. As a country, the U.S. has shown significant success in innovation but has failed at taking successful programs and initiatives to scale. Having endured over a year of loss in education, social connection, and routines, the COVID-19 pandemic illuminated America's deeply rooted structural inequities that have worsened population mental health and well-being. Integrating mental health into institutions and systems, while recovering and rebuilding, must be at the forefront to provide a path for transformation. Three recommendations are derived from the strategies and initiatives described throughout this article that offer tangible steps for achieving wellbeing as a human right: 1. Embed mental health within and across all systems, and expand its definition across the continuum; 2. Prioritize prevention and health promotion through person-centered and community-driven strategies; and 3. Expand the diversification and training of the mental health workforce across sectors. The inequities addressed in this article are not the products of a global pandemic. Instead, they result from historical oppression, injustice, and inaction, exacerbated by the current context. Embedding a human rights approach to mental health in the United States is fundamental to individual and community well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Disruptive behaviour in the operating room is under-reported: an international survey.

PURPOSE: The purpose of this study was to investigate the reporting habits of clinicians who have been exposed to disruptive behaviour in the operating room (OR) and assess their satisfaction with management's responses to this issue. METHODS: Ethics committee approval was obtained. This was a pre-specified sub-study of a larger survey examining disruptive behaviour, which was distributed to OR clinicians in seven countries. Using Likert-style questions, this study ascertained the proportion of disruptive intraoperative behaviour that clinicians reported to management, as well as their degree of satisfaction with management's responses. Binomial logistic regression identified socio-demographic, exposure-related, and behavioural predictors that a clinician would never report disruptive behaviour. RESULTS: Four thousand, seven hundred and seventy-five respondents were part of the sub-study. Disruptive behaviour was under-reported by 96.5% (95% confidence interval [CI], 95.9 to 97.0) of respondents, and never reported by 30.9% (95% CI, 29.6 to 32.2) of respondents. Only 21.0% (95% CI, 19.8 to 22.2) of respondents expressed satisfaction with management's responses. Numerous socio-demographic, exposure-related, and behavioural predictors of reporting habits were identified. Socio-demographic groups who had higher odds of never reporting disruptive behaviour included younger clinicians, clinicians without management responsibilities, both anesthesiologists and surgeons (compared with nurses), biological females, and heterosexuals (all P < 0.05). CONCLUSIONS: Disruptive behaviour was under-reported by nearly all clinicians surveyed, and only one in five were satisfied with management's responses. For healthcare systems to meaningfully address the issue of disruptive behaviour, management must create reporting systems that clinicians will use. They must also respond in ways that clinicians can rely on to affect necessary change.

Abusive behaviour in Canadian and US operating rooms.

BACKGROUND: Disruptive intraoperative behaviour has detrimental effects on clinicians, institutions, and patients. Abusive behaviour is an egregious form of disruptive behaviour that has a particular risk of detrimental consequences. The prevalence of abusive behaviour in the operating room (OR) is uncertain. We therefore examined the prevalence and frequency of exposure to abusive behaviour in a cohort of Canadian and US OR clinicians. METHODS: This was a sub-study of an international survey examining disruptive behaviour in the OR. It included a cohort of clinicians from Canada and the United States who were recruited from six perioperative associations and two institutions. Clinicians were asked about their intraoperative exposure to three abusive behaviours: physical assault, verbal threats, and intimidating invasion of their personal space. From the responses, we derived the proportion of clinicians who experienced or witnessed abuse (i.e., prevalence) and the number of abusive events experienced by all respondents (i.e., frequency). RESULTS: Of the 7,465 clinicians who responded to the original international survey, 2,875 were part of this abuse sub-study (United States =1,010, Canada = 1,865). In the preceding year, 667 clinicians (23.2%; 95% confidence interval [CI], 21.6 to 24.8) personally experienced abuse, while 1,121 clinicians (39.0%; 95% CI, 37.2 to 40.8) witnessed colleagues being abused. In total, the group of respondents reported experiencing 14,237 abusive events in the preceding year. CONCLUSIONS: Both the number of clinicians who are exposed to abusive behaviour and the large number of reported events are concerning. Since these events can undermine team-work and affect patients, coworkers, and institutions, efforts are needed to further evaluate and manage the problem.

RéSUMé: CONTEXTE: Les comportements peropératoires perturbateurs ont des effets délétères tant sur les cliniciens que sur les institutions et les patients. Un comportement dit abusif est une forme flagrante de comportement perturbateur qui comporte un risque particulier de conséquences délétères. La prévalence des comportements abusifs en salle d'opération (SOP) est inconnue. Nous avons donc examiné la prévalence et la fréquence d'exposition à des comportements abusifs d'une cohorte de cliniciens de SOP canadiens et américains. MéTHODE: Il s'agit d'une sous-étude d'un sondage international examinant les comportements perturbateurs en SOP. Notre étude a inclus une cohorte de cliniciens du Canada et des États-Unis recrutés dans six associations périopératoires et deux institutions. On a interrogé les cliniciens à propos de leur exposition peropératoire à trois comportements abusifs : les agressions physiques, les menaces verbales et l'invasion intimidante de leur espace personnel. À partir de leurs réponses, nous avons dérivé la proportion de cliniciens ayant été victimes ou témoins d'abus (soit la prévalence) et le nombre d'événements abusifs subis par tous les répondants (soit la fréquence). RéSULTATS: Parmi les 7465 cliniciens ayant répondu au sondage international original, 2875 ont pris part à cette sous-étude sur les abus (États-Unis =1010, Canada = 1865). Au cours de l'année précédant le sondage, 667 cliniciens (23,2 %; intervalle de confiance [IC] 95 %, 21,6 à 24,8) ont personnellement subi des abus, alors que 1121 cliniciens (39,0 %; IC 95 %, 37,2 à 40,8) ont été témoins d'abus à l'égard de collègues. Au total, le groupe de répondants a été exposé à 14 237 événements abusifs au cours de l'année précédente. CONCLUSION: Tant le nombre de cliniciens exposés à des comportements abusifs que le nombre important d'événements rapportés sont inquiétants. Étant donné que ces événements peuvent nuire au travail d'équipe et affecter les patients, les collègues et les institutions, des efforts sont nécessaires afin d'évaluer ce problème et de le régler.

An Examination of the Association Between Post-traumatic Growth and Stress Symptomatology in Cardiac Outpatients.

This study examined the association between post-traumatic growth (PTG), post-traumatic stress disorder (PTSD), and trauma-related factors in cardiac outpatients. Participants recruited from four cardiology clinics between November 2014 and July 2015 (N = 52, 69.2% men, Mage = 65 years) completed self-assessments of PTG and PTSD along with demographic, cardiac health index, and trauma-related factors. In total, 75% of the sample endorsed their cardiac event as traumatic, while 17.2% reported their cardiac event as their 'worst trauma'; those endorsing the latter did not significantly differ from those endorsing 'other traumas' as their worst. Chi-square analyses indicated that the lifetime traumas of experiencing loss or abandonment, witnessing trauma, and experiencing a natural disaster were significantly related to PTG factors of new possibilities, relating to others, and spirituality. Bivariate correlations on all PTSD symptom clusters and factors of PTG revealed the strongest associations between the PTG factors of spiritual change and appreciation of life. Lifetime PTSD symptoms, duration of negative reactions, and re-experiencing symptoms were found to be significantly associated with higher PTG, and a unique independent effect emerged with avoidance symptoms. Our results suggest that PTG may be associated with particular facets of PTSD symptomatology.

Trauma Exposure, DSM-5 Post-Traumatic Stress Disorder, and Sexual Risk Outcomes.

INTRODUCTION: The current study examined associations between DSM-5 post-traumatic stress disorder (PTSD) and three sexual risk outcomes: presence of a sexually transmitted disease/infection, frequency of condom use, and sex with a known user of injection drugs. METHODS: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013, analyzed 2017), a nationally representative survey of non-institutionalized U.S. adults aged ≥18 years. Sexual outcomes and trauma exposure were assessed via self-report, and PTSD was assessed using a validated structured interview. Logistic and multinomial regression analyses examined associations between PTSD, PTSD symptom clusters, trauma type, and each sexual outcome. RESULTS: Lifetime PTSD was associated with increased odds of having a past-year sexually transmitted disease/infection and sex with a known injection drug user (AOR=1.54 and 1.74, respectively); fewer intrusion symptoms were associated with sometimes/fairly often condom use relative to very often. Reporting of adult sexual assault, assaultive violence, and other trauma as one's worst event was associated with increased odds of a past-year sexually transmitted disease/infection (AOR range, 1.69-4.56), whereas child maltreatment was associated with using condoms never/almost never in the past 12 months (AOR=1.40). No other significant findings emerged. CONCLUSIONS: The current study demonstrates an association between certain trauma exposures, PTSD symptoms, and an increased likelihood of sexual risk outcomes. Clinicians working with individuals with PTSD symptoms, particularly those who have been exposed to interpersonal trauma, should screen for the presence of these sequelae.