Emergency department utilization for substance use disorders and mental health conditions during COVID-19

Background As the emergency department (ED) has evolved into the de-facto site of care for a variety of substance use disorder (SUD) presentations, trends in ED utilization are an essential public health surveillance tool. Changes in ED visit patterns during the COVID-19 pandemic may reflect changes in access to outpatient treatment, changes in SUD incidence, or the unintended effects of public policy to mitigate COVID-19. We use a national emergency medicine registry to describe and characterize trends in ED visitation for SUDs since 2019. Methods We included all ED visits identified in a national emergency medicine clinical quality registry, which included 174 sites across 33 states with data from January 2019 through June 2021. We defined SUD using ED visit diagnosis codes including: opioid overdose and opioid use disorder (OUD), alcohol use disorders (AUD), and other SUD. To characterize changes in ED utilization, we plotted the 3-week moving average ratio of visit counts in 2020 and 2021 as compared to visit counts in 2019. Findings While overall ED visits declined in the early pandemic period and had not returned to 2019 baseline by June 2021, ED visit counts for SUD demonstrated smaller declines in March and April of 2020, so that the proportion of overall ED visits that were for SUD increased. Furthermore, in the second half of 2020, ED visits for SUD returned to baseline, and increased above baseline for OUD ever since May 2020. Conclusions We observe distinct patterns in ED visitation for SUDs over the course of the COVID-19 pandemic, particularly for OUD for which ED visitation barely declined and now exceeds previous baselines. These trends likely demonstrate the essential role of hospital-based EDs in providing 24/7/365 care for people with SUDs and mental health conditions. Allocation of resources must be directed towards the ED as a de-facto safety net for populations in crisis.

Overlooked and unaddressed: A narrative review of mental health consequences of child marriages

Child Marriage (before the age of 18) affects over 12 million young women globally, annually. Despite acknowledgement of the negative impacts of the practice on reproductive health, mental health consequences are largely overlooked. Given the ability for poor mental health to intensify other health and social challenges, understanding the mental health consequences linked to child marriage is vital. Our study is the first to examine how mental health is approached in current literature on child marriage. Our conceptual framework was informed by a rapid assessment of key issues in the field. Systematic searches of papers published between 2000–2020 were completed on four electronic databases with no language restrictions. Our protocol was registered on Prospero (CRD42019139685). Articles were assessed using PRISMA guidelines, and their quality assessed using the Joanna Briggs Institute Critical Appraisal Tools. Of the 4,457 records identified, 21 papers meeting inclusion criteria were analysed using narrative synthesis. The final sample included 5 qualitative, 1 mixed-methods and 15 quantitative studies (14 cross-sectional and 1 longitudinal study) reporting on data from 12 countries, largely in the global south. Intimate partner violence, poverty, challenges in childbirth and isolation were identified as social factors linked to emotional distress by those married as children. Depression was the most reported mental disorder. Anxiety, phobias, psychological distress, substance misuse, negative well-being and anti-social personality disorder were reported less frequently. Findings highlight that while significant emotional distress and specific mental health conditions are linked to child marriage, gaps in our understanding remain. Future studies are needed to; clarify directionality in these relationships; understand the mental health needs of young men, LGBTQI communities and those in humanitarian settings. Given the well documented cyclical relationship between social determinants and mental health conditions, we outline a series of community-oriented interventions which blend psychological, social and structural support to promote mental health and wellbeing in the contexts of child marriage.

Journey of Data Collection: My Experience Narrative of Working with Destitute Children Residing at Children’s Home

This article represents a narrative description of my data collection journey and the experience of working with children residing at Child Care Institution (CCI) like children’s home. It outlines my experience in a creative language and also draws attention to the challenges I faced, be it seeking permission from the concerned authorities or visiting the children’s home to actually working with the children. The procedures to access these children are quite lengthy and strenuous. Overall, this article highlights my experiences as a researcher, working with the children, the lessons I learnt and dealing with challenges imposed by COVID-19. In conclusion, through this experience article, I intend to make my fellow researchers aware of the procedures and challenges involved in dealing with this population, data collection process, which could benefit them to prepare accordingly, and to recommend to the caretakers and stakeholders the need for research in this area and promote activities to enhance mental health conditions.

Mental health of clinic-attending Syrian refugee women in Jordan: associations between social ecological risks factors and mental health symptoms

Background The mental health of refugee women is often affected by multiple risk factors in their social ecology. Assessing these risk factors is foundational in determining potential areas for intervention. We used the social ecological model to examine risk factors associated with self-reported mental health symptoms among clinic-attending Syrian refugee women in Jordan. We hypothesize that individual (older age, unmarried, have more children under 18, difficulty reading/writing with ease), interpersonal (intimate partner violence [IPV]), community and societal level risk factors (greater number of postmigration stressors), will be associated with depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms. Methods We surveyed 507 women using a cross-sectional clinic-based systematic sampling approach between April and November 2018. We used multivariable regressions to examine associations between different risk factors in the social ecology on depression, anxiety, and PTSD. Additional multivariable regressions explored associations between specific postmigration stressors and mental health conditions. Results We found rates of depression among our sample to be 62.92%; anxiety 57.46%; and PTSD 66.21%. Our hypothesis was partially supported. At the individual level, age was directly associated with anxiety (aOR 1.04, 95% CI [1.02, 1.06]) and PTSD (aOR 1.03, 95% CI [1.01, 1.06]), while marriage decreased odds for depression (aOR 0.41, 95% CI [0.19, 0.92]) and PTSD (aOR 0.36, 95% CI [0.15, 0.87]). IPV was associated with depression (aOR 2.78, 95% CI [1.72, 4.47]); anxiety (aOR 3.30, 95% CI [2.06, 5.27]); and PTSD (aOR 5.49, 95% CI [3.09, 9.76]). Each additional community and societal risk factor (postmigration stressor) increased the odds for depression (aOR 1.32, 95% CI [1.22, 1.42]), anxiety (aOR 1.28, 95% CI [1.19, 1.39]), and PTSD (aOR 1.46, 95% CI [1.33, 1.60]). Conclusion Understanding social ecological risk factors associated with mental health conditions of Syrian refugee women is vital to addressing their mental health needs. IPV and postmigration stressors are consistently impactful with all mental health conditions. IPV resulted in the largest odds increase for all mental health conditions. Multilevel interventions are needed to address mental health risk factors at multiple levels of the social ecology.

They Learn from Home: Deschooled Learning, Preventive Behavior, and Mental Health of Students during COVID-19 Lockdown in Bangladesh

Background: In the age of extreme importance of schooling education, deschooled learning has received less importance. The purpose of this study is to explore deschooled learning and its effectiveness on preventive behaviors and mental health conditions of students in Bangladesh.Methods: This study was designed following the quantitative method, and 1,085 responses were collected from social media platforms, using the snowball sampling technique. Binary logistic regression was used to measure and infer the proposed association.Results: As per fully-adjusted regression models, the individuals who had more deschooled learning were 1.667 times (95% CI= 1.191, 2.332; P= 0.01) and 1.426 times (95% CI= 1.038, 1.958; P= 0.05) more likely to prevent contact from symptomatic and asymptomatic carriers, respectively. Moreover, the persons with higher deschooled learning were more likely to have better mental health conditions including less fear (B= -0.462; 95% CI= -0.955, 0.030; P= 0.1), lower anxiety (B= -0.482; 95% CI= -0.844, -0.119; P= 0.01), and more perceived vulnerability (B= 1.292; 95% CI= 0.497, 2.087; P= 0.01). Conclusion: This study adds that policymakers may formulate health plans and policies for initiating informal health literacy (IHL) that may help increase deschooled learning and informal knowledge among individuals especially during a pandemic situation (like COVID-19) and help them to be safe by adopting preventive behaviors and maintaining better mental health conditions in low-income settings like Bangladesh.

Is Telehealth an Effective Way to Increase Accessibility to Counseling Services?

Providing telehealth is often a means to increase the accessibility to and availability of clinical mental healthcare services. Due to the COVID-19 pandemic, telehealth has been globally implemented into healthcare systems. Today, almost 390 million individuals have at least one mental illness. There are many challenges to seeking clinical mental healthcare, including availability and accessibility, anonymity, finances and insurance, stigma, and travel and transportation. Due to these barriers, many individuals have untreated mental health conditions, which can burden healthcare systems. By utilizing innovative delivery models such as telehealth technologies, the disparities experienced by individuals when attempting to seek clinical mental healthcare services can decrease.

Evidence-Based Virtual Reality Use for Mental Health Conditions

The advancements in immersive technologies have impacted various sectors, with mental healthcare being one of them. The subsequent interaction between immersive technologies, particularly virtual reality and mental health, has created interesting effects that call for a closer look. This chapter intends to provide a comprehensive picture of mental health conditions, namely anxiety and related disorders, post-traumatic stress disorder, and major depressive disorder, as tackled by VR-based therapy. The focus is on its effectiveness and how the results compare to the traditional modes of treatment in terms of efficacy. The impact of user experience towards this approach of intervention and the importance of ethical consideration when VR intersects with the field of mental health are addressed.

Adopting the Power of Strengths Based Approaches

People with psychiatric and mental health conditions along with other disabilities have endured a long trajectory of inequalities and missed opportunities that have resulted in less than ideal conditions. This longstanding viewpoint has translated into and affected operations and treatment of students in the special education sector. A central factor that is significantly involved in this pervasive and prevalent issue is the mindset of deficit thinking which states that there is something inherently wrong with students who have exceptionalities. Such mindset leads to misaligned treatment and instruction and exacerbates developmental concerns. Key contributors in deficit thinking in the exceptional education arena involve a variety of methodologies that would benefit from changes in humanistic approaches. This chapter discusses key issues that comprise deficit thinking, principles and values that enhance the experience toward success in exceptional education. Discussion of potential solutions are also explored.