Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts.

OBJECTIVE: To synthesise results of mental health outcomes in cohorts before and during the covid-19 pandemic. DESIGN: Systematic review. DATA SOURCES: Medline, PsycINFO, CINAHL, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, medRxiv, and Open Science Framework Preprints. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies comparing general mental health, anxiety symptoms, or depression symptoms assessed from 1 January 2020 or later with outcomes collected from 1 January 2018 to 31 December 2019 in any population, and comprising ≥90% of the same participants before and during the covid-19 pandemic or using statistical methods to account for missing data. Restricted maximum likelihood random effects meta-analyses (worse covid-19 outcomes representing positive change) were performed. Risk of bias was assessed using an adapted Joanna Briggs Institute Checklist for Prevalence Studies. RESULTS: As of 11 April 2022, 94 411 unique titles and abstracts including 137 unique studies from 134 cohorts were reviewed. Most of the studies were from high income (n=105, 77%) or upper middle income (n=28, 20%) countries. Among general population studies, no changes were found for general mental health (standardised mean difference (SMD)change 0.11, 95% confidence interval -0.00 to 0.22) or anxiety symptoms (0.05, -0.04 to 0.13), but depression symptoms worsened minimally (0.12, 0.01 to 0.24). Among women or female participants, general mental health (0.22, 0.08 to 0.35), anxiety symptoms (0.20, 0.12 to 0.29), and depression symptoms (0.22, 0.05 to 0.40) worsened by minimal to small amounts. In 27 other analyses across outcome domains among subgroups other than women or female participants, five analyses suggested that symptoms worsened by minimal or small amounts, and two suggested minimal or small improvements. No other subgroup experienced changes across all outcome domains. In three studies with data from March to April 2020 and late 2020, symptoms were unchanged from pre-covid-19 levels at both assessments or increased initially then returned to pre-covid-19 levels. Substantial heterogeneity and risk of bias were present across analyses. CONCLUSIONS: High risk of bias in many studies and substantial heterogeneity suggest caution in interpreting results. Nonetheless, most symptom change estimates for general mental health, anxiety symptoms, and depression symptoms were close to zero and not statistically significant, and significant changes were of minimal to small magnitudes. Small negative changes occurred for women or female participants in all domains. The authors will update the results of this systematic review as more evidence accrues, with study results posted online (https://www.depressd.ca/covid-19-mental-health). REVIEW REGISTRATION: PROSPERO CRD42020179703.

Systematic review of mental health symptom changes by sex or gender in early-COVID-19 compared to pre-pandemic.

Women and gender-diverse individuals have faced disproportionate socioeconomic burden during COVID-19. There have been reports of greater negative mental health changes compared to men based on cross-sectional research that has not accounted for pre-COVID-19 differences. We compared mental health changes from pre-COVID-19 to during COVID-19 by sex or gender. MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), EMBASE (Ovid), Web of Science Core Collection: Citation Indexes, China National Knowledge Infrastructure, Wanfang, medRxiv (preprints), and Open Science Framework Preprints (preprint server aggregator) were searched to August 30, 2021. Eligible studies included mental health symptom change data by sex or gender. 12 studies (10 unique cohorts) were included, all of which reported dichotomized sex or gender data. 9 cohorts reported results from March to June 2020, and 2 of these also reported on September or November to December 2020. One cohort included data pre-November 2020 data but did not provide dates. Continuous symptom change differences were not statistically significant for depression (standardized mean difference [SMD] = 0.12, 95% CI -0.09-0.33; 4 studies, 4,475 participants; I2 = 69.0%) and stress (SMD = - 0.10, 95% CI -0.21-0.01; 4 studies, 1,533 participants; I2 = 0.0%), but anxiety (SMD = 0.15, 95% CI 0.07-0.22; 4 studies, 4,344 participants; I2 = 3.0%) and general mental health (SMD = 0.15, 95% CI 0.12-0.18; 3 studies, 15,692 participants; I2 = 0.0%) worsened more among females/women than males/men. There were no significant differences in changes in proportions above cut-offs: anxiety (difference = - 0.05, 95% CI - 0.20-0.11; 1 study, 217 participants), depression (difference = 0.12, 95% CI -0.03-0.28; 1 study, 217 participants), general mental health (difference = - 0.03, 95% CI - 0.09-0.04; 3 studies, 18,985 participants; I2 = 94.0%), stress (difference = 0.04, 95% CI - 0.10-0.17; 1 study, 217 participants). Mental health outcomes did not differ or were worse by small amounts among women than men during early COVID-19.

Effects of mental health interventions among people hospitalized with COVID-19 infection: A systematic review of randomized controlled trials.

OBJECTIVE: We evaluated the effects of mental health interventions among people hospitalized with COVID-19. METHODS: We conducted a systematic review and searched 9 databases (2 Chinese-language) from December 31, 2019 to June 28, 2021. Eligible randomized controlled trials assessed interventions among hospitalized COVID-19 patients that targeted mental health symptoms. Due to the poor quality of trials, we sought to verify accuracy of trial reports including results. RESULTS: We identified 47 randomized controlled trials from China (N = 42), Iran (N = 4) and Turkey (N = 1) of which 21 tested the efficacy of psychological interventions, 5 physical and breathing exercises, and 21 a combination of interventions. Trial information could only be verified for 3 trials of psychological interventions (cognitive behavioral, guided imagery, multicomponent online), and these were the only trials with low risk of bias on at least 4 of 7 domains. Results could not be pooled or interpreted with confidence due to the degree of poor reporting and trial quality, the frequency of what were deemed implausibly large effects, and heterogeneity. CONCLUSION: Trials of interventions to address mental health in hospitalized COVID-19 patients, collectively, are not of sufficient quality to inform practice. Health care providers should refer to existing expert recommendations and standard hospital-based practices. REGISTRATION: PROSPERO (CRD42020179703); registered on April 17, 2020.

Effects of COVID-19 Mental Health Interventions Among Children, Adolescents, and Adults Not Quarantined or Undergoing Treatment Due to COVID-19 Infection: A Systematic Review of Randomised Controlled Trials.

OBJECTIVES: Our objective was to assess the effects of mental health interventions for children, adolescents, and adults not quarantined or undergoing treatment due to COVID-19 infection. METHODS: We searched 9 databases (2 Chinese-language) from December 31, 2019, to March 22, 2021. We included randomised controlled trials of interventions to address COVID-19 mental health challenges among people not hospitalised or quarantined due to COVID-19 infection. We synthesized results descriptively due to substantial heterogeneity of populations and interventions and risk of bias concerns. RESULTS: We identified 9 eligible trials, including 3 well-conducted, well-reported trials that tested interventions designed specifically for COVID-19 mental health challenges, plus 6 other trials with high risk of bias and reporting concerns, all of which tested standard interventions (e.g., individual or group therapy, expressive writing, mindfulness recordings) minimally adapted or not specifically adapted for COVID-19. Among the 3 well-conducted and reported trials, 1 (N = 670) found that a self-guided, internet-based cognitive-behavioural intervention targeting dysfunctional COVID-19 worry significantly reduced COVID-19 anxiety (standardized mean difference [SMD] 0.74, 95% confidence interval [CI], 0.58 to 0.90) and depression symptoms (SMD 0.38, 95% CI, 0.22 to 0.55) in Swedish general population participants. A lay-delivered telephone intervention for homebound older adults in the United States (N = 240) and a peer-moderated education and support intervention for people with a rare autoimmune condition from 12 countries (N = 172) significantly improved anxiety (SMD 0.35, 95% CI, 0.09 to 0.60; SMD 0.31, 95% CI, 0.03 to 0.58) and depressive symptoms (SMD 0.31, 95% CI, 0.05 to 0.56; SMD 0.31, 95% CI, 0.07 to 0.55) 6-week post-intervention, but these were not significant immediately post-intervention. No trials in children or adolescents were identified. CONCLUSIONS: Interventions that adapt evidence-based strategies for feasible delivery may be effective to address mental health in COVID-19. More well-conducted trials, including for children and adolescents, are needed.

Delivering an Online Cognitive Behavioral Therapy Program to Address Mental Health Challenges Faced by Correctional Workers and Other Public Safety Personnel: Protocol for a Mixed Methods Study.

BACKGROUND: Public safety personnel have regular and often intense exposure to potentially traumatic events at work, especially workplace violence in the case of correctional workers. Subsequently, correctional workers are at higher risk of developing mental health problems such as posttraumatic stress disorder. Public safety personnel are up to 4 times more likely to experience suicidal ideation, suicidal attempts, and death by suicide compared to the general population. Despite this high prevalence, help-seeking behaviors from public safety personnel are low due to stigma and irregular work hours limiting access to care. Innovative treatments are needed to address these challenges. OBJECTIVE: This study will investigate the efficacy of an electronically delivered cognitive behavioral therapy (e-CBT) program tailored to correctional workers' mental health problems. METHODS: This study is composed of 4 phases. In phase 1, we will interview correctional workers individually and in focus groups to identify personal, social, and cultural factors affecting their mental health and barriers to care. Phase 2 will use the information gathered from the interviews to develop gender- and diagnosis-specific e-CBT modules. These will be presented to a new group of participants who will provide further feedback on their usability and accessibility. In phase 3, we will randomly assign participants to either an e-CBT or treatment as usual arm. The program will be evaluated with validated symptomatology questionnaires and interviews. Phase 4 will use this additional information to fine-tune the e-CBT modules for a larger-scale randomized controlled trial design comparing the e-CBT program to in-person CBT. All e-CBT modules will be delivered through a secure online platform. RESULTS: The study received ethics approval in December 2020, and participant recruitment began in March 2021. Participant recruitment has been conducted through targeted advertisements and physician referrals. To date, there have been 15 participants recruited for Phase 1, and it is expected to conclude in July 2021, with phase 2 beginning in September 2021. Complete data collection and analysis from all phases are expected to conclude by July 2023. Linear and binomial regression (for continuous and categorical outcomes, respectively) will be conducted along with interpretive qualitative methods. CONCLUSIONS: If proven efficacious and feasible, this e-CBT program can provide a high-quality and clinically validated resource to address the mental health problems of correctional workers. Additionally, findings can contribute to the development of innovative treatments for other public safety professions. TRIAL REGISTRATION: ClinicalTrials.gov NCT04666974; https://www.clinicaltrials.gov/ct2/show/NCT04666974. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30845.

Effects of a multi-faceted education and support programme on anxiety symptoms among people with systemic sclerosis and anxiety during COVID-19 (SPIN-CHAT): a two-arm parallel, partially nested, randomised, controlled trial.

BACKGROUND: No trials have tested multifaceted mental health interventions recommended by public health organisations during COVID-19. The objective of this trial was to evaluate the effect of the Scleroderma Patient-centered Intervention Network COVID-19 Home-isolation Activities Together (SPIN-CHAT) Program on anxiety symptoms and other mental health outcomes among people vulnerable during COVID-19 owing to a pre-existing medical condition. METHODS: The SPIN-CHAT Trial was a pragmatic, two-arm, parallel, partially nested, randomised, controlled trial (1:1 allocation to intervention or waitlist). Eligible participants with systemic sclerosis were recruited from the international SPIN COVID-19 Cohort. SPIN COVID-19 Cohort participants were eligible for the trial if they completed baseline measures and had at least mild anxiety symptoms, had not tested positive for COVID-19, and were not currently receiving mental health counselling. SPIN-CHAT is a 4-week (3 sessions per week) videoconference-based group intervention that provided education and practice with mental health coping strategies, and provided social support to reduce isolation. Groups included 6-10 participants. The primary outcome analysed in the intention-to-treat population was anxiety symptoms (PROMIS Anxiety 4a version 1.0) immediately post-intervention. This trial is registered with ClinicalTrials.gov, NCT04335279 and is complete. FINDINGS: Of participants who completed baseline measures between April 9, 2020, and April 27, 2020, 560 participants were eligible and 172 participants were randomly assigned to intervention (n=86) or waitlist (n=86). Mean age was 55·0 years (SD 11·4 years), 162 (94%) were women, and 136 (79%) identified as White. In intention-to-treat analyses, the intervention did not significantly reduce anxiety symptoms post-intervention (-1·57 points, 95% CI -3·59 to 0·45; standardised mean difference [SMD] -0·22 points) but reduced symptoms 6 weeks later (-2·36 points, 95% CI -4·56 to -0·16; SMD -0·31). Depression symptoms were significantly lower 6 weeks post-intervention (-1·64 points, 95% CI -2·91 to -0·37; SMD -0·31); no other secondary outcomes were significant. No adverse events were reported. INTERPRETATION: The intervention did not significantly improve anxiety symptoms or other mental health outcomes post-intervention. However, anxiety and depression symptoms were significantly lower 6 weeks later, potentially capturing the time it took for new skills and social support between intervention participants to affect mental health. Multi-faceted interventions such as SPIN-CHAT have potential to address mental health needs in vulnerable groups during COVID-19, yet uncertainty remains about effectiveness. FUNDING: Canadian Institutes of Health Research (CIHR; VR4-172745, MS1-173066); McGill Interdisciplinary Initiative in Infection and Immunity Emergency COVID-19 Research Fund; Scleroderma Canada, made possible by an educational grant for patient support programming from Boehringer Ingelheim; the Scleroderma Society of Ontario; Scleroderma Manitoba; Scleroderma Atlantic; Scleroderma Australia; Scleroderma New South Wales; Scleroderma Victoria; Scleroderma Queensland; Scleroderma SASK; the Scleroderma Association of BC; and Sclérodermie Québec.

Pathways to Recovery among Homeless People with Mental Illness: Is Impulsiveness Getting in the Way?

OBJECTIVE: This study investigates the association between impulsiveness and six dimensions of recovery among homeless people with mental illness. METHOD: The sample was composed of 418 participants of a randomized controlled trial of Housing First, a recovery-oriented program that provides immediate access to permanent housing. The reliable change index method was used to provide an estimate of the statistical and clinical significance of the change from baseline to 24 months (i.e., clinically meaningful improvement), on outcomes that pertain to recovery dimensions: psychiatric symptoms (clinical), physical health and substance use problems (physical), residential stability (functional), arrests (criminological), community integration (social), and hope and personal confidence (existential). We tested for the effect of impulsiveness, assessed with the Barratt Impulsiveness Scale-11, on clinically meaningful improvement on each specific outcome, adjusting for age, gender and intervention assignment, as both intervention arms were included in the analysis. RESULTS: For every increase in total impulsiveness score by one standard deviation, the odds of experiencing clinically meaningful improvement decreased by 29% (OR = 0.71, 95% CI, 0.55 to 0.91) on the clinical dimension and by 53% (OR = 0.47, 95% CI, 0.32 to 0.68) on the existential dimension. However, changes in outcomes pertaining to physical, functional, criminological, and social dimensions were not significantly influenced by impulsiveness. CONCLUSIONS: Findings highlight the importance of addressing impulsiveness in the context of recovery-oriented interventions for homeless people with mental illness. Further research may be required to improve interventions that are responsive to unique needs of impulsive individuals to support clinical and existential recovery.

Changing epidemiology of assault victims in an emergency department participating in information sharing with police: a time series analysis.

INTRODUCTION: Violent injury places a large burden on the NHS. We had implemented information sharing in our ED in 2007 and aimed to see which patient groups were most affected by information sharing, as this would provide clues as to how this complex intervention works. METHODS: Retrospective time series study of all the assault victims presenting for ED care between 2005 and 2014 at a single ED in England. RESULTS: 10 328 patients presented during the study period. There was a 37% decrease in the number of patients presenting after assault, consistent with national trends. The proportions of people arriving by ambulance, and the proportion of men did not change during the study period. There were no important changes in the age of our assault patients in this study. Greater, disproportionate, decreases in rates of violence were seen in patients who presented at the weekend up (incidence rate ratio (IRR)=0.57, 95% CI 0.50 to 0.64) versus weekdays (IRR=0.72; 95% CI 0.62 to 0.83) There were also disproportionately greater decreases over the study period in patients who were discharged with no hospital follow-up (IRR=0.51, 95% CI 0.45 to 0.56) versus those leading to either an inpatient admission (IRR=1.05, 95% CI 0.84 to 1.31) or outpatient follow-up (IRR=1.23, 95% CI 0.93 to 1.64). CONCLUSIONS: The epidemiology of violent injury at our institution has changed over the last 10 years and is most marked in a reduction of visits at the weekend, and in those who leave without follow up.

Mental Health Screening and Differences in Access to Care among Prisoners.

OBJECTIVE: Disparities in mental health care exist between regional and demographic groups. While screening is recommended as part of a correctional mental health strategy, little work has been done to explore whether it can narrow regional and demographic disparities in access to care. We compared treatment access rates by sex, race, age, and region in relation to screening results. METHODS: We conducted a retrospective cohort study using administrative data. All 7965 admissions to the prison system were followed for a median of 14 months. RESULTS: Males and non-Indigenous minority racial groups had lower rates of treatment regardless of screening results; they were less likely both to self-report needs and to receive treatment if these needs were reported. Regional differences revealed higher treatment rates in Atlantic Canada and Ontario, as well as higher rates of inmates self-reporting needs on screening who did not receive treatment in the Atlantic, Québec, and Pacific regions. There were minimal differences between inmates of different age groups. CONCLUSIONS: Findings suggest potential resource gaps and/or differences in the performance of screening to detect mental health needs across demographic and regional groups. Screening did not narrow, and may have widened, differences between groups.

Decision curve analysis as a framework to estimate the potential value of screening or other decision-making aids.

OBJECTIVES: There is an increasing debate about the impact of mental health screening. We illustrate the use of a decision making framework that can be applied when there is no sufficient data to support a traditional cost-benefit analysis. METHODS: We conducted secondary analyses of data from 459 male prisoners who were screened upon intake. We compared the potential benefit of different approaches (screening, history taking, and universal interventions) to allocating treatment resources using decision curve analysis. RESULTS: Screening prisoners for distress at typical levels of sensitivity (75%) and specificity (71%) were estimated to provide the greatest net benefit if between 2 and 5 false positives per detected illness are tolerable. History taking and self-harm screening provide the largest net benefit when only 1 or 2 false positives per detected illness would be tolerable. The benefits of screening were less among those without a recent psychiatric history, ethnic minorities, and those with fewer psychosocial needs. CONCLUSIONS: Although screening has potential to increase detection of treatment, important subgroup differences exist. Greater consideration of responses to positive screens or alternatives to screening are needed to maximize the impact of efforts to improve detection and treatment of mental illness.

Expanding the early and late starter model of criminal justice involvement for forensic mental health clients.

The early and late starter model provides one of the most enduring frameworks for understanding the developmental course and severity of violence and criminality among individuals with severe mental illness. We expanded the model to account for differences in the age of onset of criminal behavior and added a group with no prior contact with the justice or mental health systems. We sampled 1,800 men and women found Not Criminally Responsible on account of Mental Disorder in 3 Canadian provinces. Using a retrospective file-based study, we explored differences in criminal, health, demographic, and social functioning characteristics, processing through the forensic psychiatric system and recidivism outcomes of 5 groups. We replicated prior research, finding more typical criminogenic needs among those with early onset crime. Those with crime onset after mental illness were more likely to show fewer criminogenic needs and to have better outcomes upon release than those who had crime onset during adulthood, before mental illness. Individuals with no prior contact with mental health or criminal justice had higher functioning prior to their crime and had a lower risk of reoffending. Given little information is needed to identify the groups, computing the distribution of these groups within forensic mental health services or across services can provide estimates of potential intensity or duration of services that might be needed. This study suggests that distinguishing subgroups of forensic clients based on the sequence of onset of mental illness and criminal behavior and on the age of onset of criminal behavior may be useful to identify criminogenic needs and predict outcomes upon release. This updated framework can be useful for planning organization of services, understanding case mix, as well as patient flow in forensic services and flow of mentally disordered offenders in correctional services. (PsycINFO Database Record

Mental health treatment patterns following screening at intake to prison.

OBJECTIVE: While there is general consensus about the need to increase access to mental health treatment, it is debated whether screening is an effective solution. We examined treatment use by inmates in a prison system that offers universal mental health screening. METHOD: We conducted an observational study of 7,965 consecutive admissions to Canadian prisons. We described patterns of mental health treatment from admission until first release, death, or March, 2015 (median 14-month follow-up). We explored the association between screening results and time of first treatment contact duration of first treatment episode, and total number of treatment episodes. RESULTS: Forty-three percent of inmates received at least some treatment, although this was often of short duration; 8% received treatment for at least half of their incarceration. Screening results were predictive of initiation of treatment and recurrent episodes, with stronger associations among those who did not report a history prior to incarceration. Half of all inmates with a known mental health need prior to incarceration had at least 1 interruption in care, and only 46% of inmates with a diagnosable mental illness received treatment for more than 10% of their incarceration. CONCLUSION: Screening results were associated with treatment use during incarceration. However, mental health screening may have diverted resources from the already known highest need cases toward newly identified cases who often received brief treatment suggestive of lower needs. Further work is needed to determine the most cost-effective responses to positive screens, or alternatives to screening that increase uptake of services. (PsycINFO Database Record

Preventing Prison Suicide With Life-Trajectory-Based Screening.

We describe the application of a life-trajectory model of suicide to the prison setting and its implication for suicide risk detection. A model has been developed that describes two distinct trajectories culminating in suicide: one with large amounts of adversity early in life with a young age of suicide and another with chronic, gradually accumulating adversity with a later age of suicide. Support for applying the life-trajectory model to the prison population is found in prison-centric models of suicidal behavior and clinical profiles of individuals at high risk of suicide in prisons. We also describe how the life-trajectory model applies to two recent high-profile suicides within the Canadian prison system. Finally, we propose a screening tool based on the life-trajectory model to quantify an individual's adversity burden at intake and subsequently throughout incarceration. We describe how this proposed tool may improve detection of individuals with increased risk of suicide and describe the steps necessary for the development of this tool.

Justice involvement among homeless individuals with mental illnesses: Are self-report and administrative measures comparable?

Individuals with mental illnesses who experience homelessness have frequent interactions with the criminal justice system. Correctly measuring this involvement is essential to develop and evaluate the efficacy of intervention programs. Criminal justice involvement is typically assessed through administrative records or self-reported accounts. The aims of this study are to: 1) assess agreement between self-report and administrative data related to court appearances, and 2) identify individual characteristics that affect discrepancies between sources. Participants were 468 homeless persons with mental illness from the Montreal site of the At Home/Chez Soi randomized controlled trial, in Canada. Self-reported data was collected through an interviewer-administered questionnaire. Administrative data was collected through provincial and municipal court databases. Overall, agreement was good. Discrepancies were more common among those with a diagnosis of mood disorder with psychotic features, and those with a criminal history. Increased age and interviewer's perception of sincerity and interest increased likelihood of concordance. Generally, high agreement between self-report and administrative data suggests that either source can provide reliable information. Further work to understand predictors of discrepancies could further enhance the quality of data collected through these different sources.

Child abuse and the prevalence of suicide attempts among those reporting suicide ideation.

OBJECTIVE: Victims of child abuse may be at increased risk of acting on suicide ideation, although this has not been empirically tested. We estimated the risk of suicide attempts associated with child abuse among individuals who reported suicide ideation. METHODS: Secondary analysis of data from the population-based Canadian Community Health Survey Mental Health (n = 828). This population-based survey included various structured questionnaires, including the Composite International Diagnostic Interview to assess mental illness and suicidal thoughts and behaviours. RESULTS: Approximately 80 % of those who attempted suicide had a history of child abuse. Poor mental health, financial difficulties, poor coping skills, and reporting a suicide plan were also associated with an increased prevalence of attempting suicide; adjusted for these factors, child abuse was associated with a 1.77-fold increased prevalence (95 % CI 0.93, 3.36) of suicide attempts. CONCLUSIONS: Most individuals who attempt suicide experience child abuse, and worse health and social functioning. Adopting a life-course perspective to understand trajectories of suicide risk factors may inform prevention and treatment.

Yield and Efficiency of Mental Health Screening: A Comparison of Screening Protocols at Intake to Prison.

BACKGROUND: The value of screening for mental illness has increasingly been questioned in low prevalence settings due to high false positive rates. However, since false positive rates are related to prevalence, screening may be more effective in higher prevalence settings, including correctional institutions. We compared the yield (i.e. newly detected cases) and efficiency (i.e. false positives) of five screening protocols to detect mental illness in prisons against the use of mental health history taking (the prior approach to detecting mental illness). METHODS AND FINDINGS: We estimated the accuracy of the six approaches to detect an Axis I disorder among a sample of 467 newly admitted male inmates (83.1% participation rate). Mental health history taking identified only 41.0% (95% CI 32.1, 50.6) of all inmates with mental illness. Screening protocols identified between 61.9 and 85.7% of all cases, but referred between 2 and 3 additional individuals who did not have a mental illness for every additional case detected compared to the mental health history taking approach. In low prevalence settings (i.e. 10% or less) the screening protocols would have had between 4.6 and 16.2 false positives per true positive. CONCLUSIONS: While screening may not be practical in low prevalence settings, it may be beneficial in jails and prisons where the prevalence of mental illness is higher. Further consideration of the context in which screening is being implemented, and of the impacts of policies and clinical practices on the benefits and harms of screening is needed to determine the effectiveness of screening in these settings.

Diagnostic Error in Correctional Mental Health: Prevalence, Causes, and Consequences.

While they have important implications for inmates and resourcing of correctional institutions, diagnostic errors are rarely discussed in correctional mental health research. This review seeks to estimate the prevalence of diagnostic errors in prisons and jails and explores potential causes and consequences. Diagnostic errors are defined as discrepancies in an inmate's diagnostic status depending on who is responsible for conducting the assessment and/or the methods used. It is estimated that at least 10% to 15% of all inmates may be incorrectly classified in terms of the presence or absence of a mental illness. Inmate characteristics, relationships with staff, and cognitive errors stemming from the use of heuristics when faced with time constraints are discussed as possible sources of error. A policy example of screening for mental illness at intake to prison is used to illustrate when the risk of diagnostic error might be increased and to explore strategies to mitigate this risk.

Current organ allocation disadvantages kidney alone recipients over combined organ recipients.

BACKGROUND: The United Network for Organ Sharing began including the Kidney Donor Profile Index (KDPI) March 26, 2012 and began a new allocation scheme December 1, 2014. METHODS: Kidney donors from our organ procurement organization from March 2012 to December 2014 were reviewed. The KDPIs of all 919 kidney only transplants were compared with all 102 kidney/extrarenal transplants. RESULTS: The average KDPI for kidney alone allografts was 47 (range 1 to 100) (standard deviation = 25.83) vs 27 for kidney/extrarenal kidneys (range 1 to 82) (standard deviation = 20.16) (P < .001, t test). Multivariate analysis including in- vs out-of-state recipient, donor body mass index, and donation after cardiac death vs brain-dead donor showed significantly lower KDPI for kidney/extrarenal transplants. CONCLUSIONS: Kidney/extrarenal organs have decreased graft survival compared with kidneys transplanted alone. In this sample, 21% of lower KDPI kidneys were allocated as kidney/extrarenal organs. This disadvantages those waiting for a kidney alone. Attention to the outcomes of kidneys transplanted with extrarenal organs is needed.

Risk of violence by inmates with childhood trauma and mental health needs.

Inmates who experienced childhood trauma have higher rates of institutional violence. However, the potential intermediate roles of co-occurring mental health and substance use needs and early justice involvement have not previously been considered. The current study examined the relationships between trauma, mental health, substance abuse, youth criminal charges, and institutional violence during the first 180 days of incarceration. As secondary aims, we explored whether these associations differed by sex or differed for inmates of Aboriginal ethnicity. Secondary data from prison records for all 5,154 inmates admitted to a federal prison during 2011 were collected. Path analysis was used to estimate the direct and indirect associations between trauma and institutional violence. Approximately 45% of inmates reported childhood trauma, which was associated with a higher prevalence of co-occurring mental health and substance abuse needs, and youth criminal charges. Although mental health, substance abuse, and youth criminal charges interacted with one another in predicting violence, their associations were similar for those with and without histories of trauma. A direct association between trauma and institutional incidents remained (Relative Risk [RR] = 1.38, 95% CI [1.07, 1.78]) after accounting for indirect associations through these co-occurring risk factors. There was insufficient evidence to suggest that these associations differed between men and women or between Aboriginal and non-Aboriginal inmates. Given the high co-occurrence of multiple health and behavioral risk factors for inmates with traumatic histories, clarifying which factors are causally associated and reversible is needed to inform effective trauma informed care.