Rural and urban women's perceptions of barriers to health, mental health, and criminal justice services: implications for victim services

The purpose of this study was to examine rural and urban women's perceptions of barriers to health and mental health services as well as barriers to criminal justice system services. Eight focus groups were conducted, two in a selected urban county (n = 30 women) and two in each of three selected rural counties (n = 98 women). Results were classified into a barrier framework developed in the health service utilization literature which suggests there are four main dimensions of barriers: affordability, availability, accessibility, and acceptability. Results indicate that: (1) women face many barriers to service use including affordability, availability, accessibility, and acceptability barriers; (2) it takes an inordinate level of effort to obtain all kinds of services; however, women with victimization histories may face additional barriers over and above women without victimization histories; (3) barriers to health and mental health service utilization overlap with barriers to utilizing the criminal justice system; and (4) there are many similarities in barriers to service use among rural and urban women; however, there are some important differences suggesting barriers are contextual. Future research is needed to further clarify barriers to service use for women with victimization histories in general, and specifically for rural and urban women. In addition, future research is needed to better understand how women cope with victimization in the context of the specific barriers they face in their communities.     

Access barriers to mental health services for older adults from diverse populations: perspectives of leaders in mental health and aging

This project is based on the results of telephone surveys with 52 local, state, and national informed respondents including policymakers, county leaders, planners, and advocates in mental health and aging with a particular focus on the states of California and Florida. This article addresses challenges to access to mental health services for diverse older adults including barriers related to race and ethnicity, socioeconomic status, location, age, gender, immigrant status, language, sexual orientation, and diagnosis. The article also highlights broad themes that emerged including (1) the importance of outreach and transportation tailored to diverse elders, and (2) recruitment of diverse staff and training related to diversity. The article concludes with policy and practice recommendations to reduce these disparities in access to mental health services for diverse populations of older adults.     

Perceived need for care and mental health service utilization among college students with suicidal ideation

ABSTRACT

Objective: This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. Participants: Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. Methods: Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified. Results: Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization. Conclusions: Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.     

Perceptions of transition-related health and mental health services among transgender adults

The opportunity to live authentically is critical for the well-being of transgender individuals. For many this requires accessing transition-related services. Current knowledge of transition-related care is limited. This study aims to elucidate experiences and needs of transgender individuals (N = 65) related to (a) therapeutic support, (b) medical care, and (c) aspects of living authentically in order to inform the development and delivery of trans-affirmative services. Findings reveal challenges accessing health care providers with trans-specific competency; gaps between critical aspects of transition-related care and receipt of services; and heterogeneity of experiences and needs. Recommendations for improving transgender-affirmative services are provided.     

Intimate partner violence,trauma, and mental health need among female community college students

ABSTRACT

Objective: The impact of interpersonal violence on college students has received considerable attention, yet no studies have been conducted among community college students, who comprise 40% of all American college students, and have unique risk factors and needs. Community College students are more likely to be women, people of color, working, parenting, and first generation college students. Participants: Data were collected from a simple random sample from four community colleges (n=435). Methods: A cross-sectional quantitative survey was used to assess the extent of intimate partner violence, trauma exposure, sexual violence, and associated mental health consequences among female students. Results: Over 27% of participants reported IPV in the past year, while 25% reported sexual assault and 34% reported other uncomfortable sexual experiences in their lifetime. Nearly 20%of participants were currently reporting PTSD symptoms. Conclusions: Community Colleges should work with service providers to build their capacity to respond to students' needs.     

Gender differences in mental health consequences of exposure to political violence among Israeli adolescents

This study examined the role played by gender differences in the relation between political violence exposure and mental health during adolescence. Understanding these differences is particularly pertinent during the period of adolescence characterized as it is by processes of identity formation and gender role consolidation. Participants were 154 high school students recruited from two high schools in central Israel (78 males, 76 females; average age 16.54), who completed the Political Life Events Scale for measurement of political violence exposure, the Brief Symptom Inventory-18 for assessment of psychological symptoms and disorders, a risk-taking behavior scale, and the Posttraumatic Stress Symptom Scale — Interview (PSS-I) for assessment of posttraumatic stress symptoms. Results reflected high levels on many psychological indicators. The dose–response hypothesis was partially confirmed with adolescents' higher reported political violence exposure related only to higher levels of somatization and greater severity of posttraumatic stress symptoms. Contrary to the literature, only a few gender differences emerged and these showed mixed patterns. Females showed higher levels of anxiety than males, and males showed higher levels of risk-taking behavior. Females exposed to low political violence exposure showed significantly less substance abuse than males but those with high exposure reported significantly higher levels of substance abuse, equivalent to those of males. Findings show a complex constellation of gender effects on relations between political violence exposure and different psychopathological outcomes. Findings of this study indicate the necessity for more refined examination of gender differences in psychological processes in reaction to living in conditions of protracted conflict and war.     

Former system youth with mental health needs: Routes to adult mental health care, insight, emotions, and mistrust

Objective

Public health concern surrounding the mental health needs of former system youth is escalating. We know very little about mental health service utilization on the other side of the developmental transition to adulthood. The purpose of this study was to explore the mental health service use experiences among former system youth with childhood histories which included mental disorder, use of publicly-funded mental health services, and use of additional public systems of care.

Methods

In-depth face-to-face interviews were conducted with 60 participants currently struggling with mental health difficulties regarding their service use experiences over the transition. Participants were recruited from one Midwestern state. Multi-phase analysis was conducted utilizing immersion/crystallization, constant comparison and concept matrices.

Results

Few participants received continuous mental health care across the transition, with the majority experiencing interruptions or discontinuation of care. Important facilitators of service use emerged, such as physicians, former caseworkers and family. Health clinics and parenting programs emerged as potential entrée points for reconnecting disengaged young adults to mental health services. Insight, mistrust, and emotions emerged as novel factors associated with service utilization among young adults.

Conclusions

Mental health service utilization remains a complicated phenomenon over the developmental transition to adulthood. Future research is needed that closely examines the associations between insight, emotion, mistrust and service use among young adults.     

Gender disparities in adult health: an examination of three measures of morbidity

Recent examinations of gender differences in physical health suggest that women's disadvantage may be smaller than previously assumed, varying by health status measure and age. Using data from the 1997-2001 National Health Interview Surveys, we examine gender-by-age differences in life-threatening medical conditions, functional limitations, and self-rated health and consider whether potential mediating mechanisms (e.g., socioeconomic status, behavioral factors) operate uniformly across health measures. The results show that the gender gap is smallest for life-threatening medical conditions and that men do increasingly worse with age. For self-rated health, men are more likely to report excellent health at younger ages, but with increasing age this gap closes. Only for functional limitations do we find a consistent pattern of female disadvantage: Women report more functional limitations than men, and the gap increases with age. The ability of explanatory mechanisms to account for these patterns varies by the health measure examined.     

A survey of homework use, experience of barriers to homework, and attitudes about the barriers to homework among couples and family therapists

Homework is a therapeutic process that has strong theoretical and empirical basis, but existing research has focused on "compliance" rather than considering the broader and more clinically meaningful construct of "engagement." Absent in the literature is empirical study of the barriers to engagement or study of homework use among couple and family therapists (CFTs). The current study investigates the frequency and type of homework, as well as the influence of homework compliance, quality of compliance, and experience of barriers to compliance on CFTs' attitudes and beliefs toward barriers to homework completion for couples and families. Results indicated CFTs (N=226 AAMFT Clinical members) use homework more often with couples than with families, and CFTs report greater homework compliance and quality of compliance for couples when compared to families. A path analysis examining compliance, quality of compliance, and barriers to compliance as predictors of attitudes/beliefs toward barriers revealed no significant findings. A discussion presents implications for future research and practice for homework in couple and family therapy.     

Microaggressions,perceptions of campus climate,mental health,and alcohol use among first-year college students of color

Depressive and anxiety symptoms are increasingly common, and problematic alcohol use remains prevalent in college. To expand on prior research on mostly white samples, we surveyed first-year students of color from our predominately white university (Southeastern US) to identify risk factors for mental health symptoms and potentially co-occurring problematic alcohol use. Results showed significant associations between microaggressions and poor campus climate (hypothetical predictors) with depressive, anxiety, somatic symptoms (hypothetical outcomes) that were indirectly linked through perceived stress, poor sleep, and academic burnout (hypothetical mediators). Poor campus climate, academic burnout, and using alcohol to cope were the most relevant to alcohol use disorder symptoms. Results support efforts to address and reduce racial microaggressions and promote a positive campus climate for all.     

Chronic care,integrated care,and mental health: Moving the needle now

Healthcare reform is currently a hot topic in the United States, and the Chronic Care Model has frequently been cited as the foundation of recent attempts to integrate mental health and physical health care. However, challenges exist to fully integrated care that have delayed adequately meeting the multiple needs of mental health service recipients. This article highlights multiple changes that can be incorporated into mental health care now, derived from the Chronic Care Model, to better meet clients’ physical and mental health needs. These changes include focusing on population-level data and incorporating technology and multidisciplinary teams in treatment and prevention efforts.     

Traversing gender,sexual orientation,and race-ethnicity: Sexual victimization in a population-based sample of older adults

This research examined the intersectionality of gender, sexual orientation, and race-ethnicity, and its impact on lifetime sexual victimization among a population-based sample of older adults. Data for this study came from the 2011–2014 waves of the Behavioral Risk Factor Surveillance System. The final sample to be used for analysis included 8.862 individuals ages 50 years and over to examine whether and to what extent lesbian, gay, and bisexual older adults differ from heterosexual older adults in experiencing lifetime sexual victimization, and whether the effect of sexual orientation on experiencing lifetime sexual victimization differs across racial-ethnic groups. Logistic regression analysis revealed that lesbian women were 2.59 times more likely and bisexual women 2.15 times more likely both relative to heterosexual women to experience lifetime sexual victimization. When examining whether race-ethnicity imparts additional risk, the findings revealed that non-White heterosexual individuals were 29.6% less likely relative to White heterosexual individuals to experience lifetime sexual victimization, while non-White women, generally, were 2.29 times more likely relative to White men to experience lifetime sexual victimization. Our findings affirm the importance of the intersectionality of sexual orientation and gender when examining lifetime sexual victimization of older adults, adding to the emerging body of research that examines the complexities of older adult lives from multifaceted perspectives.     

Translating collaborative models of mental health care for older adults: using Iowa's experience to inform national efforts

The Patient Protection and Affordable Care Act supports the translation of collaborative models of mental health care, but how the act will affect older adults remains unclear. The authors examined a sample of older Medicare beneficiaries and evaluated how individual characteristics, local service supplies, and other contextual features corresponded with the identification of older persons with psychiatric diagnoses and their access to specialty mental health care providers. Older adults presented a variety of psychiatric disorders, and their access and use of specialty mental health care related to age; sex; diagnosis; supply of mental health, health, and long-term care providers; and whether an older person lived in a rural area. Translation of collaborative models should consider a range of psychiatric conditions, adjust for varying local provider supplies, and consider the challenges in establishing collaborative care within rural areas.     

Traditional versus Western perceptions of mental illness: women of Moroccan origin treated in an Israeli mental health center

This paper focuses on the problems encountered in providing Westernized psychiatric treatment to a population with traditional healing beliefs. The sample comprised women of Moroccan origin living in Israel undergoing treatment for psychiatric disorders (N=38), and their treating psychiatrists (N=9). Ethnographic interviews were conducted among both groups. The results revealed that the symptoms, perceptions of the illness, and problems encountered in the therapeutic relationship differed across three age groups, young women (20–30 years), more mature women (31–42 years), and older women (43–60 years). While cultural conflict appeared to affect the development of mental illness in each group, this was most pronounced among women in the middle age range. Moreover, problems in the therapeutic alliance were greatest in this age group. The data from the therapists indicated that they maintained a Western perspective in both their understanding and diagnoses of these patients' illnesses. The different perspectives of the therapists and each of the three groups of women are discussed. It is concluded that professionals treating traditional populations must avoid imposing Western standards, and consider the treatment in the context of cultural beliefs. The developmental stages of the individual, and the stage of acculturation must also be taken into account if treatment is to be effective.     

Self-reported health problems,health care utilisation and unmet health care needs of elderly men and women in an urban municipality and a rural area of Bhaktapur District of Nepal

The study aimed to identify the felt common health problems, utilisation of health services and unmet needs of urban and rural elderly people of Bhaktapur district, Nepal. It was a cross sectional population study of people aged 60 years or more where 204 respondents were interviewed in 2009. The common felt problems were pain and swelling of joints (65.7%), indigestion (63.7%), excessive tiredness (38.2%) and hypertension (35.8%). Pain and swelling of joints (72.5%) and back pain (40.4%) were higher in rural elderly population whereas indigestion (67.6%) and hypertension (37.85%) were higher in urban population. Pain and swelling of joints (66.7%) and indigestion (69.6%) were higher in males, and hypertension (50.0%), back pain (38.2%) and chronic bronchitis/asthma (39.2%) were higher in females. The unmet needs varied between different health problems. In general women had more unmet needs than men, where 80 unmet needs were identified for the 102 men compared with 105 for the 102 women, and these unmet needs increased dramatically with age. This approach yields new insights into the health care needs of the elderly and will be helpful to health care planners.     

The influence of family environment on mental health need and service use among vulnerable children

Children in child welfare are especially likely to have unmet mental health needs. The role of family factors in children's use of mental health services was examined in a longitudinal sample of 1075 maltreated or at-risk children. Vulnerable family environment (poor family functioning, low social support, and caregiver psychological distress) is an important predictor of children's mental health needs. It also predicts them not having these needs met.     

Problem drinking among at-risk college students: The examination of Greek involvement,freshman status,and history of mental health problems

ABSTRACT

Objective: Scarce research has examined the combined effect of mental health difficulties and demographic risk factors such as freshman status and Greek affiliation in understanding college problem drinking. The current study is interested in looking at the interaction among freshman status, Greek affiliation, and mental health difficulties. Participants and Methods: Undergraduate students (N = 413) from a private and public Midwestern university completed a large online survey battery between January 2009 and April 2013. Data from both schools were aggregated for the analyses. Results: After accounting for gender, age, and school type, the three-way interaction indicated that the highest drinking levels were reported in freshman students who reported a history of mental health problems although were not involved in Greek life. Conclusions: Findings are discussed in the context of perceived social norms, as well as alcohol-related screenings and intervention opportunities on college campuses.     

HIV among people with mental illness: contributing factors, prevention needs, barriers, and strategies

1. Findings suggest that PWMI, including those with serious mental illness, are sexually active although some individuals, including mental health professionals, perceive them to be asexual or not sexually active. 2. PWMI may be particularly susceptible to HIV risk-related behaviors due to poor judgment, limited impulse control, deficits in problem-solving skills, and suicidal intent and self-destructive behavior. 3. Nurses, due to their close interaction with PWMI, are in key positions to document HIV risk-related behaviors and to advocate for integrating HIV risk reduction strategies into the therapeutic milieu.