Epidemiology and Psychiatric Sciences

ObjectiveAlthough trauma-focused psychotherapies are effective for posttraumatic stress disorder (PTSD), recovery under routine outpatient conditions remains variable. We examined whether participation in a structured Specialty Care (SC) model integrating clinician specialization, flexible treatment density, and coordinated navigation was associated with accelerated PTSD recovery compared with standard outpatient care. MethodsWe conducted a retrospective matched cohort study (2024-2025) of U.S. adults with active PTSD symptoms (PTSD Checklist for DSM-5 score [&ge;]31) receiving care through an employer-sponsored digital mental health platform. Access to SC was determined by employer benefit design. Propensity-score matching with weighting balanced cohorts on baseline severity and demographics. Primary outcomes included longitudinal PTSD symptom trajectories and time to recovery, remission, and reliable improvement. Secondary outcomes assessed depressive symptoms (PHQ-9). Linear mixed-effects and Cox proportional hazards models were applied. ResultsThe matched sample included 356 SC and 9,409 standard care participants. SC participants received higher treatment intensity, including greater session volume and faster early follow-up, and greater care navigation engagement. SC participation was associated with steeper PTSD symptom decline ({beta} = -1.3 per log-week, p < .001) and a higher likelihood of recovery (hazard ratio = 1.31; 95% CI, 1.10-1.57). At 12 weeks, predicted recovery was 29% in SC versus 23% in standard care. Depressive symptoms improved in both groups, without significant differences in time to categorical recovery. ConclusionsUnder routine outpatient conditions, a structured SC model was associated with accelerated PTSD recovery, suggesting that reorganization of outpatient delivery may improve real-world outcomes.

Objective. To estimate lifetime and 12 month mental health contact gaps among Peruvian adults with survey-defined mental disorders, and to describe inequalities in contact, perceived need for care, and mental health service use. Methods. We analyzed the information for adults of the 2022 Peruvian National Mental Health Survey, a cross-sectional household survey. The primary outcome was the survey-weighted proportion of adults with a 12 month mental disorder who reported no contact with an included source of mental health-related care during that period; the lifetime contact gap was descriptive. Perceived need was assessed using two derived 12 month perceived-need measures based on direct ENSM variables and service contact routing items. Analyses incorporated weights, strata, and clusters. Adjusted prevalence ratios were estimated using survey weighted Poisson models. Results. The dataset contained information on 13,840 individuals; 13,833 had complete survey-design information. Contact gap denominators were 3,927 for lifetime disorders and 1,649 for 12-month disorders. The lifetime and 12-month contact gaps were 61.0% (95% CI 58.4-63.7) and 84.5% (95% CI 81.5-87.6), respectively. Rural estimates exceeded urban estimates in both periods; after adjustment, poverty and rural residence were associated with the lifetime gap, and extreme poverty with the 12-month gap. Among individuals meeting survey-based criteria for one or more 12-month mental disorders, 37.3% (95% CI 33.4-41.4) reported self-perceived need, whereas 25.6% (95% CI 21.8-29.8) reported that need had been identified by others. Annual psychological and psychiatric service use was 3.7% and 1.1%, respectively. Conclusions. Mental health contact gaps were high, particularly for one or more 12-month mental disorders, and were associated with social and territorial variables. These contact measures do not establish adequate, continuous, or effective treatment, which needs to be addressed to understand the impact of the Peruvian mental health reform.

BackgroundMental health disparities persist as a significant public health concern in the United States, with certain populations experiencing disproportionate burdens of mental illness and barriers to care. This systematic review aims to synthesize current evidence on mental health disparities across various demographic groups and identify key factors contributing to these inequities. MethodsWe conducted a comprehensive search of peer-reviewed literature published between 2010 and 2024 using PubMed, PsycINFO, and Scopus databases. Studies examining mental health outcomes, access to care, and treatment efficacy across racial/ethnic, socioeconomic, gender, sexual orientation, and geographic groups in the US were included. Two independent reviewers screened articles, extracted data, and assessed study quality. ResultsOf 2,345 initially identified studies, 127 met inclusion criteria. Consistent disparities were observed across multiple domains, with racial/ethnic minorities, low-income individuals, LGBTQ+ populations, and rural residents experiencing higher rates of mental health disorders, lower access to quality care, and poorer treatment outcomes. Key contributing factors included systemic racism, socioeconomic barriers, stigma, lack of culturally competent care, and inadequate insurance coverage. ConclusionThis review highlights persistent and multifaceted mental health disparities in the US. Addressing these inequities requires comprehensive policy interventions, increased funding for community-based mental health services, improved cultural competence in healthcare delivery, and targeted research to develop effective, culturally-tailored interventions for underserved populations.

The COVID-19 pandemic led to unprecedented global lockdowns aimed at controlling the spread of the virus. While effective in reducing transmission, these lockdowns have had significant repercussions on mental health. This study examines the prevalence and incidence of mental health problems during the COVID-19 lockdowns, comparing countries that implemented strict lockdown measures with those that did not. Using statistical analysis, we demonstrate that lockdowns are associated with a statistically significant increase in mental health issues. These findings suggest that public health policies during pandemics must balance the physical and mental health needs of the population.

SummaryO_ST_ABSBackgroundC_ST_ABSThe aim of this systematic review was to synthesise evidence on the effectiveness and cost-effectiveness of interventions to support the recovery of people living with psychosis and their families in low-income and middle-income countries (LMICs). MethodsWe searched nine databases for articles published from January 2001 to January 2024 without language restrictions. Studies were eligible if they enrolled people living with psychosis or family members, and tested a psychoeducational, psychological, social, economic or service intervention or delivery or implementation strategy aimed at improving outcomes of people with psychosis. Eligible studies were required to compare outcomes with an alternative condition, using any prospective evaluation study design in a LMIC setting. We extracted summary data from published papers and appraised risk of bias using the Effective Public Health Practice Project tool. We prioritised the reporting of recovery-orientated outcomes including social inclusion, personal recovery, reduced stigma and discrimination and human rights protections. We conceptualised the person living with psychosis in their context (individual, family, organisation and community) based on the socio-ecological model of disability and highlighted studies intervening and measuring outcomes across multiple socio-ecological levels. Protocol registration: PROSPERO (CRD42022330298). FindingsA total of 310 individual studies including data from 34,435 participants in 37 countries were included. Aggregate data from a further five meta-analyses, comprising data from 130 individual studies were also included. The majority of studies (77%) were conducted in upper middle-income countries. There was a dominance of studies evaluating impacts of interventions on individual-level mental health and functioning and a paucity of studies measuring the recovery-orientated outcomes prioritised by people living with psychosis. There were modest effects for comprehensive interventions involving family, psychosocial rehabilitation and care close to home provided by trained specialists however their scalability in resource-limited settings is unclear. Over half the studies were considered to have a high risk of bias. InterpretationThere is a need for studies that evaluate scalable interventions supporting recovery with comprehensive and contextualised outcome measures and for greater investment in strengthening capacity to conduct rigorous psychosis research across LMICs. FundingNone. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSRecent World Health Organization (WHO) guidance on human rights-based, recovery-orientated community mental health care featured markedly few case studies of good practice for people with psychosis in low-income and middle-income countries (LMICs). Systematic reviews of interventions for psychosis in LMICs have been narrow in focus and reporting outcomes, and limited to English language publications. Added value of this studyThis systematic review is the most comprehensive synthesis to date of psychosis interventions in LMICs. Inclusion is not restricted by publication language. We highlight studies reporting recovery-oriented outcomes prioritised by people living with psychosis and impacts of interventions across levels of the socio-ecological model of disability. While being particularly relevant to LMICs, our findings also contribute a useful perspective for high income settings. Implications of all the available evidenceMost interventions were targeted at the individual and focused on mental health and functioning outcomes, with few evaluations of impact on social inclusion and other valued outcomes. There is some evidence in support of specialist-delivered comprehensive interventions involving family, psychosocial rehabilitation and care close to home, but effect sizes were small-to-modest, and many intervention types and delivery agents have not been adequately tested, especially in LICs and rural settings. There is a clear need to develop comprehensive and contextualised measures for recovery-orientated outcomes and to invest in strengthening capacity to conduct rigorous research on interventions for psychosis in LMICs.

BackgroundQualitative research has identified factors affecting transition from child mental health services (CAMHS) to adult mental health services (AMHS) but it is unclear which of these factors may lead to disengagement from the young persons view. MethodsN= 272 participants (mean age = 20+/-2.31, 81% females) who had experience with the UK mental healthcare system (patients, carers, health workers) attempted the survey but only participants who had been treated in CAMHS were included in this study, resulting in a total N=144 (mean age = 19.8+/-2.3, 83% female). This study used a cross-sectional, quantitative survey assessing 12 pre-transition, 16 peri-transition, and 11 post-transition variables. The Client Attachment to Therapist Scale (CATS) was used to measure client attachment to CAMHS and AMHS therapists. ResultsSuccessful transition from CAMHS to AMHS was significantly predicted by using a helpful care plan, continuity of treatment between CAMHS and AMHS, and being engaged in a transition service. However, few clients were aware of transition services at the time of transition. Transition satisfaction was significantly predicted by the same variables. In addition, GP support during the transition, and a more secure attachment to AMHS therapists were associated with higher transition satisfaction. ConclusionsThe results suggest clients transition process might be significantly improved by focusing on useful individualised care plans, and ensuring continuity of treatment. Transition success and satisfaction could also be improved by making clients aware of and engaging them in transition services, involving GPs, and working on a secure attachment on the AMHS side.

BackgroundBehavioral and cognitive disorders are significant public health concerns, often influencing housing stability and residential outcomes. Access to stable housing is a key determinant of mental health recovery, yet disparities persist across demographic and socioeconomic groups. This study examines the association between behavioral and cognitive disorders and residential status at discharge from mental health facilities. MethodsUsing the 2022 Mental Health Client-Level Data from the Substance Abuse and Mental Health Services Administration (SAMHSA), this cross-sectional study analyzed the relationship between primary behavioral and cognitive disorders, such as ADHD, Oppositional Defiant Disorder (ODD), and Personality Disorders, and residential status upon discharge. Descriptive statistics were used to summarize demographic characteristics, while logistic regression models were employed to assess associations between disorders and residential outcomes, adjusting for age, race, employment status, education, substance use, and gender. ResultsOf the 6,957,919 individuals analyzed, 3.7% experienced homelessness, 11.4% resided in alternative settings (e.g., foster care, residential treatment, correctional facilities), and 84.9% lived in private residences. Individuals with behavioral and cognitive disorders were significantly less likely to reside in private residences compared to those without such disorders (AOR = 0.876, 95% CI: 0.866- 0.887, p < 0.0001). Additional factors such as substance use (AOR = 0.798, 95% CI: 0.787-0.809, p < 0.0001), unemployment (AOR = 2.60, 95% CI: 2.578-2.624, p < 0.0001), and lower education levels (AOR = 1.543, 95% CI: 1.526-1.561, p < 0.0001) further predicted non-private residential outcomes. Racial and gender disparities were also looked at, with African Americans being 34% more likely to experience non-private residential placements compared to white individuals (AOR = 1.340, 95% CI: 1.323-1.358, p < 0.0001). Additionally, males had greater odds of experiencing homelessness or alternative housing compared to females (AOR = 1.192, 95% CI: 1.176-1.208, p < 0.0001). ConclusionThe findings highlight the intersection of mental health disorders, socioeconomic factors, and housing stability. Individuals with behavioral and cognitive disorders face significant barriers to stable housing, exacerbated by substance use, unemployment, and racial disparities. These results reinforce the need for integrated mental health and housing interventions, with a focus on culturally competent policies to improve residential stability for vulnerable populations.

BackgroundThe COVID-19 pandemic has accelerated the adoption of telehealth services in mental healthcare. This systematic review aims to evaluate the effectiveness of telehealth interventions for mental health conditions compared to traditional face-to-face treatment. MethodsWe searched major electronic databases (PubMed, PsycINFO, CINAHL, and Cochrane Library) for randomized controlled trials published between 2010 and 2023. Studies comparing telehealth interventions to face-to-face treatment for adults with mental health disorders were included. Two independent reviewers assessed study quality and extracted data. Meta-analyses were conducted where appropriate. ResultsThirty-five studies met the inclusion criteria, encompassing 4,827 participants across various mental health conditions. Telehealth interventions demonstrated non-inferiority to face-to-face treatment for depression (standardized mean difference [SMD] = -0.03, 95% CI [-0.15, 0.09]) and anxiety disorders (SMD = -0.06, 95% CI [-0.19, 0.07]). For post-traumatic stress disorder, telehealth showed a small but significant advantage (SMD = -0.21, 95% CI [-0.37, -0.05]). Patient satisfaction and therapeutic alliance were comparable between telehealth and face-to-face interventions. However, dropout rates were slightly higher in telehealth conditions (risk ratio = 1.27, 95% CI [1.11, 1.46]). ConclusionThis review suggests that telehealth interventions are generally as effective as face-to-face treatment for common mental health disorders. While promising, these findings should be interpreted cautiously due to heterogeneity in study designs and interventions. Future research should focus on long-term outcomes, cost-effectiveness, and strategies to improve engagement in telehealth settings.

ABSRACTO_ST_ABSObjectiveC_ST_ABSParity between physical and mental health for insured individuals is protected by federal law but unfulfilled, in part, because deficiencies are notoriously difficult to document. MethodsWe implemented real-time, systematic clinical documentation of gaps in access to mental health services for an outpatient cohort representing 2,149 children discharged from Childrens Healthcare of Atlanta emergency departments for behavioral crisis May-Dec 2024. ResultsSixty percent of patients discharged to the community with clear recommendations for expedited follow up were not receiving any service at 30-75-days. For those internally referred to the systems outpatient psychiatric practice, the documentation system confirmed medical necessity and captured accessibility or non-accessibility for each element of evidence-based care of each patients treatment plan. ConclusionFeasible revisions of electronic health record documentation, coupled with clinical accountability pathways can enable health systems to assume responsibility for continuous, real-time epidemiologic estimation of gaps in the adequacy of provider networks to meet the mental health needs of insured children. HighlightsWe modeled health-system-based surveillance of gaps in access to medically necessary mental health care for children, toward fulfillment of federal mental health parity law. Health system-based monitoring of unmet needs was feasible and generated real-time epidemiologically-relevant estimates of gaps in community capacity for mental health services

Latinos continue to experience disparities in access to treatment for mental health, and these appear to be worsening with time. This meta-analysis identified and compared studies (N=20): (1) Across Latino origin groups, (2) Across immigration-related characteristics, and (3) with non-Latino groups. For the first comparison, results consistently showed Puerto Ricans had the highest rate of utilization compared to their Mexican, Cuban, Central American, and Other counterparts. For the second comparison, U.S-born Latinos had higher utilization and mental health costs for services, as well as higher rate of depression/anxiety symptomatology compared to their immigrant counterparts. For the third comparison, results were not as consistent but trended towards lower/less rates by Latinos compared to non-Latino whites. More research is needed on the different Latino groups and across the acculturation spectrum if we are to understand disparities from differences in risk and service use among this heterogeneous group.

BackgroundExposures to stress and traumatic events plays a significant role in triggering or precipitating anxiety. Nonetheless, these are often examined at the individual level, while societal-environmental exposures and their association with anxiety disorders are under-researched, especially in the Israeli context. This study leverages 19 years of longitudinal data from a large healthcare organization to examine the impact of national security instability on short-term anxiolytic purchases in Israel. MethodsWe conducted a retrospective cohort study using electronic medical records of over 1.1 million individuals from 2006 to 2024, examining rates of first-time and renewed use of anxiolytic medications of the benzodiazepines group during periods of armed conflict, including military operations and wars. Cox proportional hazards models were used to assess associations, adjusting for confounders such as age, sex, socioeconomic status, socioreligious sector, residence and previous psychiatric treatment. ResultsThe risk for first purchase of an anxiety-relief short terms medication during military operations was 28% higher (HR 1.28, 95% CI: 1.21-1.34) compared to periods of relative national stability, after adjustments, and 44% higher during the Second Lebanon War (HR 1.44, 95% CI 1.27-1.62). The events of October 7th were the most significant armed conflict increasing the risk for anxiety-related reaction necessitating treatment throughout the 19-years follow-up, with individuals at 317% increased risk for treatment initiation compared to periods of relative national stability (HR 4.17, 95% CI 3.97-4.38). Alongside a baseline increased risk for initiating anti-anxiety treatment, women experienced an additional elevated risk for anxiolytic therapy during times of national security threats, with 26% additional increased risk during military operations and an 81% increased risk following the events of October 7th. Residents of northern Israel had an increased risk of purchasing anxiolytics during the Second Lebanon War (HR 1.39, 95% CI: 1.12-1.72), while during military operations it was the residents of southern Israel who faced an increased risk for anxiolytic usage, with an HR of 1.18 (95% CI: 1.05-1.33). Conversely, the residential region did not significantly influence anti-anxiety treatment patterns following October 7th among residents of southern or northern Israel, compared to individuals living in central Israel, indicating a broader national impact beyond regional differences. ConclusionsNational armed conflicts significantly influence anxiolytic medication use in Israel, with the October 7th war showing the most pronounced effect. These findings highlight the need for comprehensive mental health interventions during times of national crisis, focusing on both short-term relief and long-term mental health support to prevent dependency and improve mental health outcomes in the wake of national crises.

BackgroundThe prevalence of common mental disorders in resettled refugee populations is nearly three times higher than in the general population. The World Health Organization (WHO) recommends Problem Management Plus (PM+), a brief non-specialist delivered intervention for reducing common mental disorders. To identify key factors to optimise implementation, we conducted a qualitative cross-sectional study to investigate contextual determinants shaping PM+ implementation during a nationwide scale-up of PM+ in Switzerland. MethodsWe conducted in-depth key informant interviews in the German-speaking and French-speaking parts of Switzerland (September 2023 and January 2025). Design and analysis of interviews was guided by the Consolidated Framework for Implementation Research. Themes were added both inductively and deductively and categorised into challenges and opportunities for wide-spread PM+ service delivery. FindingsWe interviewed 30 stakeholders: 12 policymakers, 5 government leaders, 5 specialists and implementers, and 8 non-specialist peer-providers. Whilst stakeholders were enthusiastic about the value of PM+, several limitations to its routine delivery were noted. These related to limited quality standards and control for non-specialist delivered interventions that prevented formal categorisation within the health system. Endorsement by professional associations including best-practice standards was thought to facilitate such formalised recognition. Prioritising mental health indicators within Cantonal integration programs was perceived to facilitate funding via the national integration agenda. All stakeholders pointed towards blended co-financing pathways to ensure to the longer-term sustainability of PM+ in Switzerland. InterpretationThe routine delivery of PM+ within health and integration systems presented substantial challenges and opportunities. Longer term sustainability of PM+ may be feasible with blended financing, tailored Cantonal health and integration agendas, and established quality control standards for PM+ delivery that included formal recognition of non-specialists within the mental health system.

BackgroundColombias PAPSIVI program is the worlds largest psychosocial support service for victims of armed conflict providing support for over half a million civilians. However, service delivery has only previously been examined in small studies, making it difficult to understand to what extent PAPSIVI delivers interventions that are adequately targeted to individuals with the most serious exposures to the armed conflict, and to what extent attendees remain engaged with interventions. MethodsWe investigated how different conflict exposures related to PAPSIVI intervention assignment and engagement. We linked anonymised national data from the register of victims of the Colombian armed conflict to data from N = 534,818 PAPSIVI attenders. Analysis used logistic and linear regression with cluster robust standard errors, adjusted for a range of potential confounders. ResultsIntervention types were broadly provided in line with PAPSIVI guidelines, with victims experiencing torture, sexual violence, and forced recruitment more likely to receive individual sessions, while community-level impacts received community interventions. Female sex, ethnic minority status, and receiving state-subsidised healthcare were associated with higher intervention engagement. Those with previous mental health diagnoses had increased odds of attending individual or family sessions but lower odds of group or community sessions, consistent with recommendations for more intensive intervention for those with higher mental health needs. 29% of individual session attendees only received a single session, potentially indicating early dropout or unsuitable service provision for a proportion of attendees. ConclusionsThis study provides insights into support provision for civilian victims of conflict indicating that psychosocial support provision can be managed effectively at very large scales.

BackgroundBrazil is home to 50 million children and adolescents, whose mental health needs require context-sensitive research. Although scientific output is growing in the country, publications are scattered and often inaccessible. MethodsThis systematic review compiles prevalence estimates, assessment instruments, and interventions for child and adolescent mental health in Brazil (PROSPERO registration: CRD42023491393). We searched international (PubMed, Web of Science, PsycINFO, Google Scholar) and national (Scielo, Lilacs, Brazilian Digital Library of Theses and Dissertations) databases up to July 2024. Reference lists, reviews, and experts were consulted. Extraction followed Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) and Cochrane manuals. ResultsThis review appraises 734 studies on 2,576 prevalence estimates, 908 studies on 912 instruments, and 192 studies on 173 intervention trials. Point prevalence of any mental disorder ranged from 10.8% (age 12) to 19.9% (ages 7 to 14), although a nationally-representative study is lacking. There is a rise of self-harm notifications, reaching 133.1 in 2019 (per 100,000 aged 10-19). Indigenous youth face suicide rates of 11 (age 10 to 14), far exceeding national averages (0.652). There is severe violence exposure (21% of adolescents reported domestic physical violence in the previous month), disproportionately impacting Black youth and heightening risks for depression and substance use. Reliable instruments exist for assessing psychopathology, yet most lack psychometric and cross-cultural validation. Interventions remain under-implemented; the largest trials adapted international substance-use prevention programs, showing null effects. High-quality studies are mainly funded by public investment. DiscussionThis compilation provides accessible data for professionals, facilitating translation of science to practice. Brazilian sociocultural challenges impact youth mental health, with public health priorities including violence, systemic racism, and indigenous youth suicide. National research must develop culturally-sensitive resources for mental health, including scalable interventions focused on social minorities. FundingThe Stavros Niarchos Foundation.

Task-sharing approaches have shown promise in low-resource settings, yet few culturally adapted interventions have been systematically evaluated for forcibly displaced populations. Since 2016, over 1.7 million Venezuelans have migrated to Peru, facing significant barriers to healthcare and elevated risks of anxiety, depression, and post-traumatic stress disorder (PTSD). This protocol describes COMPASS (Cognitive-behavioral Open-source Mental-health Program Adapted for migrants, Sustainably delivered by lay providers and Supported by evidence). COMPASS is a transdiagnostic, open-source cognitive behavioral therapy program co-designed with forcibly displaced populations. This protocol describes the procedures for an ongoing randomized pilot trial with n = 90 forcibly displaced Venezuelan people (Clinicaltrials.gov: NCT06635486). COMPASS guides, or lay providers, trained through an intensive apprenticeship model, will deliver 6-12 weekly remote sessions. Primary outcomes include changes in anxiety, depression, and PTSD symptoms, assessed with validated Spanish-language measures. Secondary outcomes include feasibility (recruitment, retention, fidelity) and acceptability (therapist and participant ratings). Exploratory outcomes will examine integration, migration experiences, and demographic moderators of intervention effectiveness. Analyses will follow the intention-to-treat principle, using descriptive statistics and regression models to evaluate symptom trajectories across baseline, post-intervention, and 3- and 6-month follow-ups. This study represents the first effectiveness evaluation of an open-source, lay-delivered CBT program tailored for forcibly displaced people in Peru. Findings will inform feasibility, acceptability, and preliminary effectiveness of COMPASS, with potential to expand scalable, culturally relevant mental health services for forcibly displaced populations in resource-constrained settings worldwide.

Objectives: To assess whether higher state-level community-based U.S. Immigration and Customs Enforcement (ICE) arrest rates are associated with adverse mental health outcomes among Hispanic and non-Hispanic adults in the United States. Design: Retrospective analysis using individual-level data from the 2023 and 2024 Behavioral Risk Factor Surveillance System (BRFSS) linked to monthly state-level ICE arrest records from the Deportation Data Project. Two-way fixed effects models assessed associations between mental health outcomes and ICE arrests, net of secular trends, state-specific time invariant factors, and individual covariates. Setting/participants: The sample included 534,099 US adults aged 18 years or older residing in all 50 states and the District of Columbia surveyed between September 2023 and December 2024. Analyses exploited within-state month-to-month variation in enforcement intensity with state and year-month fixed effects. Outcome measures: Number of poor mental health days in the past 30 days; any poor mental health days (binary); mental health status (3-level categorical); frequent mental distress ([&ge;]14 poor mental health days); and a composite indicator combining depressive disorder diagnosis with frequent mental distress. Results: Among 534,099 respondents (approximately 10% Hispanic), higher ICE arrest rates were significantly associated with worse mental health among Hispanic adults, including 0.19 additional poor mental health days per month (p < 0.05), a 2.2% higher likelihood of reporting any poor mental health days (p < 0.01), and a 2.4% increase in composite mental health problems (p < 0.01). Associations were concentrated among Hispanic women and those with a high school diploma or less. Among non-Hispanic adults, estimates were small and precisely centered around zero across outcomes. Similar findings obtained in difference-in-differences event study models, models including lagged exposures, and models with leave-one-out state exclusions. Conclusion: Higher community-based immigration enforcement was associated with worse mental health outcomes among Hispanic adults but not among non-Hispanic adults. Contemporary enforcement strategies may have broader psychological spillover effects within Hispanic communities, and mental health may be an underrecognized social cost of interior immigration enforcement.

ObjectivesPeople impacted by the criminal-legal system face significant challenges to securing and sustaining permanent housing. This study was designed to assess housing outcomes of an integrated intervention that offered housing, medical, and behavioral health services to individuals with criminal-legal system involvement. MethodsAfter a baseline needs assessment, participants were linked to services and completed quarterly study visits for up to 12 months. We used descriptive statistics to assess frequency and multivariate logistic regression to assess correlates of being housed at last follow-up. ResultsBetween June 2019 and November 2023, 187 participants were enrolled in Project CHANGE from an area with high incarceration and overdose rates. At baseline, 43% of participants were unstably housed, 37% were homeless, and the remaining resided in a shelter or institution. At the time of last follow-up, 49 participants (26.2%) reported improved housing outcomes, and an additional 121 participants (64.7%) housing situation did not worsen. In multivariate models, individuals who were older (AOR 1.1; 95% CI 1.0-1.1), unstably housed at baseline (AOR 7.2; 95% CI 3.3-16.0), and enrolled in the study for longer (AOR 1.1; 95% CI 1.1-1.3) had higher odds of being housed at last follow-up, whereas those with high severity substance use had lower odds of being housed (AOR 0.3; 95% CI 0.1-0.6.) ConclusionsIn this comprehensive program, integrated housing/health services were time- and cost-intensive to deliver but led to positive housing outcomes. People involved in the criminal-legal system face unique barriers to housing, particularly when compounded by substance use.

ImportanceThe US population faces stressors associated with suicide brought on by the COVID-19 pandemic. Understanding the relationship between stressors and suicidal ideation may inform policies and programs to prevent suicide. ObjectiveTo evaluate the relationship between stressors and suicidal ideation during the COVID-19 pandemic. DesignWe compared suicidal ideation in 2017-2018 to suicidal ideation in 2020. We estimated the association between stressors and suicidal ideation in bivariable and multivariable Poisson regression models with robust variance. SettingUnited States ParticipantsParticipants were from two, nationally representative surveys of US adults: The 2017-2017 National Health and Nutrition Examination Survey and the 2020 COVID-19 and Life Stressors Impact on Mental Health and Well-being study (conducted March 31 to April 13), analyzed April 28 to September 30, 2020. ExposuresEconomic precarity as measured through job loss or difficulty paying rent and social isolation based on reporting "feeling alone." Main outcome measureSuicidal ideation based on reporting "Thoughts that you would be better off dead or of hurting yourself in some way" over the past two weeks. ResultsSuicidal ideation increased more than fourfold, from 3.4% in the 2017-2018 NHANES to 16.3% in the 2020 CLIMB survey, and from 5.8% to 26.4% among participants in low-income households. Suicidal ideation was more prevalent among people facing difficulty paying rent (31.5%), job loss (24.1%), and loneliness (25.1%), with each stressor associated with suicidal ideation in bivariable models. In the multivariable model, difficulty paying rent was associated with suicidal ideation (aPR: 1.5, 95% CI: 1.2 to 2.1), while losing a job was not (aPR: 0.9, 95% CI: 0.6 to 1.2). Feeling alone was associated with suicidal ideation (aPR: 1.9, 95% CI: 1.5 to 2.4). Conclusions and relevanceSuicidal ideation increased more than fourfold during the COVID-19 pandemic. Difficulty paying rent and loneliness were most associated with suicidal ideation. Policies and programs to support people experiencing economic precarity and loneliness may contribute to suicide prevention.

IntroductionMozambique is home to 18 million children and adolescents largely underrepresented in mental health research. We conducted a systematic review of evidence-based resources addressing this population. MethodsWe included prevalence estimates, assessment instruments, and interventions on mental health-related outcomes in Mozambican samples aged 0-19. We searched PubMed, Web of Science, PsycINFO, CINAHL, Google Scholar, African Index Medicus, and local catalogues. Extraction followed COSMIN and Cochrane manuals (PROSPERO: CRD420251016208). ResultsThe search yielded 58 prevalence studies, 26 reports on 35 instruments, and 7 trials. Most research focused on psychosocial adversities and neurodevelopment in vulnerable populations. The prevalence of mental disorders were estimated in two surveys in Nampula (ADHD: 13.4%; N=748, 6-18 years) and Maputo (anxiety disorders: 17.5%; major depression episode: 8.5%; disruptive behavior disorder: 6.6%; ADHD: 3.3%; N=486, 12-19 years). Nationally-representative adolescent surveys report health determinants (physical/emotional violence anually: 24.86%; girls suffering intimate partner violence: 21.11%; lifetime sexual abuse: 16.55%). National suicide rates were highest among 15-19-year-olds (1.53 per 100,000). Only three instruments were culturally-adapted with reliable psychometrics, enabling screening of anxiety and general symptoms. Unadapted tools performed poorly. One randomized trial reported a cost-effective intervention for neurodevelopment among high-poverty preschoolers. DiscussionChildren and adolescents in Mozambique face significant psychosocial adversity, with a high estimated burden of mental disorders. Prevalence data remains limited to two localized samples. There are few tools evaluating mental conditions, and culturally-sensitive approaches are warranted. It is essential to strengthen local academic capacity.

One-to-one peer support is widely used in mental health services, but the components associated with better outcomes remain unclear. We systematically reviewed randomised controlled trials and conducted additive component network meta-analyses to identify which components of one-to-one peer support worker interventions were associated with outcomes for adults using mental health services. CINAHL Ultimate, Embase, MEDLINE, PsycINFO, CENTRAL, ClinicalTrials.gov and ISRCTN were searched, supplemented by citation tracking, previous reviews and expert consultation. Interventions were coded for seven components: Training and development, Maintaining peer support worker wellbeing, Relationship-building, Social support, Emotional support, Practical support and Cultural adaptation. The review followed PRISMA-NMA reporting guidance and was registered with PROSPERO (CRD42022355291). Thirty-six trials randomised 6,645 participants across nine countries. Only quality of life and recovery yielded estimable component effects at one or more follow-up points. For quality of life, Practical support had a positive incremental estimate at 3 months (standardised mean difference 0.52, 95% confidence interval 0.17 to 0.87); no component showed clear evidence of benefit at 6 months; and at 12 months Social support had a positive estimate (1.57, 0.12 to 3.01), whereas Maintaining peer support worker wellbeing had a negative estimate (-1.66, -3.05 to -0.28). These estimates were not consistent across follow-up points. For recovery, Relationship-building had positive estimates at 6 months (0.90, 0.03 to 1.78) and 12 months (0.50, 0.29 to 0.72). Networks were sparse and often disconnected, and additivity could not be tested in disconnected networks. Current trials do not permit definitive prioritisation of peer-support components. Relationship-building was the most consistent candidate component, but all findings remain provisional. Future trials should prospectively specify, manipulate and measure component delivery.