Background: College students have unique risk factors that may negatively affect their mental health and academic success. According to data, 75% of mental illnesses develop before age 25, making colleges ideal locations for mental health promotion programs. However, stigma and lack of knowledge of mental health resources act as barriers for them to seek professional help. Mental Health First Aid (MHFA) is an evidence-based training program that teaches students in higher education settings how to recognize the symptoms of emerging mental illnesses or to assist young adults in a mental health crisis and help lessen the severity and impact of mental illnesses. This study evaluated the effectiveness of the MHFA training program among undergraduate students at a minority-serving urban university that was funded by the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Mental Health Awareness Training (MHAT) grant.

Method: A mixed-methods study was conducted using data from the MHFA training that was delivered in a blended format (instructor-led remote session) to undergraduate students. Data were collected between January and March 2023. Three outcomes were measured: knowledge of mental illness, stigmatizing attitudes, and help-seeking behaviors. Outcomes were measured at the pretest and posttest. Effect sizes of changes from pre- to post-course were measured using Cohen’s d. Analyses were carried out using Statistical Package for Social Sciences. Four focus group discussions were carried out for a deeper understating of students’ perceptions of the program’s effectiveness.

Results: Statistically significant improvements in knowledge of signs and symptoms of different mental illnesses and self-confidence in promoting help-seeking were observed among students at post-tests. Major themes were identified to assess MHFA’s efficacy related to a 5-step action plan, called ALGEE, which encompasses the skills, resources, and knowledge. Qualitative comments show that students who completed the training were more likely to use person-first language destigmatizing mental illness.

Conclusion: Results indicate MHFA is likely to improve mental health awareness and reduce stigma among college students. This study adds new evidence to the literature on the MHFA program’s effectiveness in mental health promotion, in particular in minority-serving institutions.

Background/context: The rise of mental health distress among American Muslims is a growing concern, where stigma, fear of discrimination in healthcare, and a lack of culturally competent services have been shown to impede access to mental health services. American Muslims report a high degree of trauma from experiences of familial conflict, war, immigration/ displacement, and a socio-political landscape that has intensified longstanding negative perceptions and acts of discrimination directed at all Muslims in the U.S. (aka islamophobia). Muslim adults are more likely to report a history of suicide attempts than other religious groups, and despite religious prohibitions, alcohol/illicit drug use, gambling, and premarital sex remain common among Muslims, which increases risk of mental distress. Today, these mental health issues are further exacerbated by the COVID-19 pandemic, where preliminary studies have shown that feelings of isolation, anxiety and depression are higher among American Muslims than the general public.

Description: Mental Health First Aid (MHFA) is a promising intervention that has been used in other immigrant communities to prepare individuals to recognize and respond to mental health warning signs. The objective of the implementation and evaluation of the MHFA program as administered by American Muslim Health Professionals (AMHP) has been to provide this training in a culturally relevant manner that is responsive to the community's needs through certified MHFA instructors from within the Muslim community who train community members to be able to identify and triage individuals who might be suffering from mental health issues and provide frontline mental health assistance, while also learning to assess their own needs and administer self-care. Since 2019, AMHP has trained over 1,500 faith and community members across the US.

Lessons Learned: Emerging evaluation themes include the following essential constructs; Creating a safe space, Being culturally & linguistically responsive; Contextualization of mental health concepts, Championing mental health from within the community

Recommendations: With American Muslims being one of the most racially, ethnically, and socio-economically diverse communities in the country, an intersectional approach that acknowledges the cultural context of American Muslims and their diverse lived experiences is key to implementing support programs and improving mental health outcomes.

Background/Aims: Nearly 50-million adults experience mental illness each year in the United States. Over half of these adults do not receive treatment. A barrier to addressing the mental health crisis is lack of asking, reporting and/or recording of diagnosable mental health issues within electronic health records (EHR). First, we compared self-reported diagnosis of anxiety and depression in a survey with diagnoses in the EHR. Second, we examined if the number of reported symptoms of anxiety and depression were associated with likelihood of diagnosis in the EHR. Third, we studied racial differences in self-reported mental illness symptoms and diagnosis.

Methods: The sample contained women of child-bearing age who were enrolled in the CARE Program, a behavioral change intervention for women at high-risk for adverse pregnancy outcomes in Indiana. We linked the CARE survey data collected at the time of program enrollment with EHR. The sample was limited to women who had healthcare utilization at least once within the year prior to enrollment(N=131). We calculated Cohen’s kappa to assess agreement between self-reported diagnosis of anxiety and depression and clinical records. We used chi-square to test if those who reported more symptoms (measured by HAM-A and HAM-D) were more likely to have a diagnosis in the EHR. We used logistic regression to analyze racial differences.

Results: Of the 131 women, 102 reported a clinical diagnosis of anxiety, but only 38 women had an anxiety diagnosis in the EHR. The concordance between self-reported diagnosis and clinical diagnosis of anxiety and depression was low (kappa<0.05). However, women who reported more symptoms of anxiety and depression were more likely to have a diagnosis in the EHR. White women were more likely than Black women to self-report a diagnosis of anxiety or depression by a health professional. In contrast, Black women reported a higher number of symptoms of anxiety or depression than White women (p<0.05).

Conclusions: Results suggests that EHR do not capture all cases of mental illness, and Black women are impacted more than White women. Improved diagnosis and documentation of depression and anxiety in EHR could help increase the number of patients who receive treatment.

Background. The Centers for Disease Control and Prevention recognizes financial exploitation of older adults as a public health concern. One in 18 older adults in the US become victims of financial exploitation every year and only 25% recover their lost assets. The result is financial stress that may have mental health implications. The objective of this study was to explore the effects of financial exploitation on mental health and the impact of free specialized legal services, the most common intervention.

Methods. A mixed-method approach was utilized to analyze data obtained from participants located in a Midwest micropolitan area. Two groups were compared - one comprised of older adults who received free specialized legal services (n=22) and another who were victims of financial exploitation but did not receive free specialized legal services (n=17). A semi-structured interview guide that included 14 questions about financial stress, and two standard instruments, Kessler Psychological Distress Scale (K10) and Perceived Stress Scale (PSS), were used to collect data for this study.

Results. A significant association was found between financial stress and psychological distress (χ2=6.302, P < .05), regardless of receiving free specialized legal services. Thirty-four percent of participants scored above 30 on the K10, indicating the presence of severe mental health disorders, a rate much higher than the 4.2% typically found among US adults. The older adults who did not receive free specialized legal services experienced higher rates of any psychological distress (64%) as indicated by a score of 20 or more on the K10, compared to those who did receive services (57%). The difference was not statistically significant. Six themes emerged from qualitative analyses, including client attributes, social support, lack of knowledge, and desire to prevent future victimization – all of which were associated to K10 scores.

Conclusions. Our findings demonstrate the prevalence of mental health issues related to financial exploitation. The current norm is to treat financial exploitation as a legal issue. Our findings indicate there are substantial mental health implications that are not well recognized or treated. Qualitative data indicate pre-existing mental health vulnerabilities and fear of future victimization are drivers of psychological distress.

Background:

In isolation, intimate partner violence (IPV), suicidal thoughts and behaviors (STB), and drug use are significant public health issues. The relationships between IPV and both STBs and drug use have been well documented separately. However, the complex relationship between the three issues together as one phenomenon are comparably less understood. This is particularly apparent among adolescents despite being strong indicators of negative health outcomes in adulthood. The main objective of this project is to discuss the prevalence of their co-occurrence and to identify associated factors.

Methods:

We analysed data from the 2019 Youth Risk Behavioral Surveillance System, which is conducted by the Center for Disease Control and Prevention. Analyses for the project limited to adolescents who have reported ever being in a dating relationship and were in grades 9-12 (8,725). Logistic regression was used to identify factors significantly associated with individuals who have experienced IPV, reported any STBs, and initiated at least one drug. IPV includes being forced to do sexual things you did not want and/or being physically hurt on purpose by someone you were dating or going out with. STBs include considered attempting suicide, made a plan to attempt suicide, and/or actually attempted suicide. Drug use includes reporting use of either marijuana, opioids, cocaine, inhalants, heroin, methamphetamine, ecstasy, misuse of pain medication, and/or hallucinogens.

Results:

Approximately 12.71% of adolescents who have ever dated reported any IPV, 50.86% reported initiating at least one drug, and 25.17% reported experiencing at least one STB. Among those, 5.12% experienced all three. Higher odds of experiencing all three were reported among respondents who identified as female (AOR=2.18) and sexual minorities (AOR=3.14).

Conclusions:

These findings suggest the need for additional prevention strategies among high-risk populations particularly sexual minorities. Results highlight the importance of understanding the complex relationships between IPV, drug use, and suicide. However, in order to fully understand the etiology of their co-occurrence, documentation of the timing of each is necessary.

Background/Context: Our study was a unique attempt at evaluating the feasibility of integrating the World Health Organization (WHO) developed psychosocial intervention called Problem Management Plus (PM+) within an evidence-based, mentor-led, social, health and economic empowerment program aiming to create safe spaces. The program was directed to urban, informal settlement-dwelling, out-of-school adolescents ages 15-19 years from Kenya. We describe and discuss the processes around design and implementation of this innovative intervention and present a summary of our lessons learned in implementing this integrated program in the backdrop of the ongoing global pandemic of COVID-19.

Description: Tracking and evaluating the reflective and participatory processes around curriculum adaptation, training, integration, and supervision occurred to bridge the mental health gap using multi-disciplinary and community-based research approaches. Iterative data collection procedures were carried out to specifically reflect on the experiences of understanding delivery, application and implementation of the program by youth mentors who were supervised closely and trained in PM+ and mental health care principles. In addition, real-time site monitoring was conducted using PowerBi as a tool and weekly research team meetings. Results informed on the feasibility and acceptability of the integrated safe spaces intervention as it proved to cater to the distinctive needs of the target population.

Lessons Learned: We point to lessons such as importance of adaptation of the intervention, importance of working cohesively in multidisciplinary teams, building strong and trusting partnerships and multidisciplinary dialogues as well as continuous supervision and capacity building.

Recommendations/Implications: Out-of-school- adolescent face multiple challenges and a youth mentor-led group program can help promote mental health. The good practice of the differently specialized and widely experienced teams routinely checking in, ensured that activities targeted the quality improvement of the intervention and is recommended in similar future programs.

Background: Suicide is a growing concern in West Virginia (WV) as it represents the highest suicide rate in the Appalachian Region. The high poverty rate in WV has led to disproportionate economic deprivation, which is a known predictor of suicide and measured through area-level deprivation indices at the ecological level. Various indices exist to quantify area-level economic deprivation and have been used to explore factors contributing to suicide. These indices have not been utilized to measure recent suicide rates in the United States. This study aims to explore the relationship between county-level Townsend Deprivation Index (TDI) scores and WV county suicide rates.

Methods: TDI scores were calculated following Townsend’s methodology using variables from the 2020 5-year American Community Survey (ACS) estimates. Final TDI scores were calculated by summing standardized ACS variables: percentage of population unemployed, renting homes, without a motor vehicle, and with overcrowded households. Higher scores indicate higher deprivation. County adult suicide rates from 2010-2020 were collected from the Centers of Disease Control’s Wonder Multiple Cause of Death and were merged with corresponding county TDI scores. A negative binomial regression analysis was conducted to test the association between county TDI scores and suicide rates. Additional negative binomial models were used to examine the relationship between the standardized individual ACS variables comprising the TDI and county suicide rate.

Results: WV had a mean crude suicide rate of 40.80 (SD=10.31) per 100,000 deaths and mean TDI score of -2.85 (Median=-2.55; SD=3.03). On average, among the respective populations across counties, 8.06% were without a motor vehicle, 23.20% rented their home, 1.96% were unemployed, and 0.08% lived in overcrowded households. County TDI scores had a significantly positive association with county-level suicide. As a county’s TDI score increased, the county’s suicide rate increased (0.04, p<.001). Results from the individual ACS variable models show a significantly positive relationship between overcrowded households and suicide (0.04, p<0.05).

Conclusion: The TDI could potentially be used to predict suicide in WV. Future studies should examine the different deprivation indices to identify the index that is most culturally and geographically appropriate as a predictor of suicide among the Appalachian population.

Background: COVID-19's emergence in 2020 altered the dynamics of societal norms leading to a new reality of increased mortality and financial strain. Individuals with dementia, older adults, and marginalized racial/ethnic communities were identified as vulnerable to being disproportionately impacted by the COVID-19 pandemic. The unequal overrepresentation of non-White communities in Covid-19 infections and deaths demonstrated that the pandemic widened pre-existing healthcare inequalities and did not impact all racial groups equally. In Louisiana, the Black community made up 76.9% of COVID-19 cases and accounted for 70.6% of the total deaths, but only comprised 31% of the total population (Tirupathi et al., 2020). The existing literature led to the following research question: What approaches should be implemented to alleviate the impact of COVID-19 and improve the mental health conditions of the Black community?

Method: Databases such as Pubmed, Google Scholar, and APA PsycNet were used. Keywords included COVID-19, African/Black Americans, older adults, mental health, dementia, and racial health disparities. Articles were used to identify themes and understand the psychological impact of COVID-19 on the Black community.

Results: The results revealed that the mental health conditions of African/ Black Americans should be acknowledged during the pandemic and moving forward. Ibrahimi et al. (2020) used the Social Ecological Model (SEM) to demonstrate how systemic racism led to inequities impacting Black people's mental health during COVID-19. This article illustrated how structural conditions such as discrimination, health inequalities, and lack of access worsened the pandemic's impact on the Black community. As a result, more African Americans suffer from increased stress, anxiety, and depression. The literature revealed that although the Black community is experiencing higher COVID-related hospitalizations & death rates, they reported lower mental health treatment seeking than other races (Penner et al., 2022).

Conclusion: Covid-19 exacerbated historical health inequities in marginalized communities and impacted their psychological well-being. Using social justice to reframe mental health literacy and accessibility through health communication was recommended to improve the mental health conditions in the Black community. This research highlights the importance of advocating for vulnerable populations severely impacted by the pandemic.

Background: Although some research has reported an association between moral injury and behavioral health outcomes (i.e., substance use and suicidality) among veterans, no studies have examined whether these associations are different in samples of veterans with and without traumatic brain injury (TBI) despite compelling reasons for the interrelationship.

Methods: A national survey of veterans was conducted, yielding 252 veterans with TBI and 1,235 veterans without TBI. Participants were asked questions about moral injury, suicidality, substance use, and other sociodemographic variables. Multivariable linear regression analysis was used to examine the previously described relationships.

Results: Increasing severity of moral injury was associated with higher scores on the substance use tool (b = 0.02, p = 0.04), although the magnitude of effect was not different from those without TBI (Z = -0.57, p = 0.72). Increasing severity of moral injury was positively associated with suicidal behavior scores (b = 0.10, p < 0.01). The strength of this relationship was stronger in veterans with TBI than those without TBI (Z = 1.78, p = 0.04).

Conclusions: Rehabilitation programs that treat veterans for TBI may need to consider the evaluation of moral injury given its association with adverse events in this population.