Tag: Mental health

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Integrating evidence-based health approaches in U.S. healthcare settings: addressing the syndemics of poverty, health, and violence

Health disparities in the United States are not produced by single risk factors but by interacting social and biological conditions that cluster within structurally marginalized communities. Poverty, violence, and poor physical and mental health form a reinforcing system of disadvantage that traditional healthcare models—organized around isolated diseases—are poorly equipped to address. This perspective examines these dynamics through a syndemic framework, which conceptualizes co-occurring conditions as mutually interacting epidemics intensified by social inequality. Drawing on interdisciplinary evidence from public health, medicine, and social science, we describe how poverty-related stressors such as housing instability, food insecurity, and barriers to healthcare intersect with exposure to interpersonal and structural violence to amplify risks for depression, posttraumatic stress disorder, chronic disease, and premature mortality. These interactions produce compounded health burdens that are disproportionately experienced by marginalized populations. Despite increasing attention to social determinants of health, current healthcare responses remain fragmented. Health systems frequently identify risks through screening for social needs or trauma exposure but lack the institutional infrastructure, reimbursement mechanisms, and cross-sector partnerships required to address them effectively. We argue that advancing health equity requires moving beyond additive models of care coordination toward syndemic-informed healthcare systems that intervene simultaneously on clustered conditions and their shared upstream drivers. We outline key priorities for practice, policy, and research, including linking screening to actionable care pathways, strengthening partnerships between healthcare and social service systems, and expanding workforce training to include structural and syndemic competency.
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Establishing standards of care for forensic mental health: an international Delphi consensus-building study

ObjectivesThe present study aimed to establish a consensus on a definition of forensic mental health systems and services, and to identify principles and components of forensic mental health systems.MethodsA Delphi consensus-building process was employed among 23 experts in forensic mental health, defined by lived experience of forensic mental health services, professional, clinical or management practice in forensic settings, or academic research in the field. Items were rated on a 9-point Likert scale, with consensus defined as ≥75% of panelists rating an item between 7 and 9. Across three Delphi rounds, items were revised, merged, or added based on participant feedback. Data were collected anonymously using LimeSurvey, with reminders sent to maximize participation, followed by a structured consensus meeting to resolve remaining areas of disagreement.ResultsThe final consensus statement comprises three components: (1) a definition of forensic mental health services; (2) a general statement including 12 guiding principles; and (3) 43 core components organized across 10 thematic domains addressing models of care, pathways and processes, programs and activities, physical health, service user and peer involvement, evaluation and improvement, service integration, safe environments, restrictive practices, and other system-level considerations. While all items achieved consensus at the consensus meeting, areas of sustained discussion related to the integration of cultural expertise, the inclusion of a lived experience workforce, and the distinction between descriptive and aspirational elements of forensic mental health services.ConclusionsThis international consensus statement provides a structured framework for understanding forensic mental health systems. By articulating shared principles and core components while allowing flexibility across jurisdictions, the framework offers a foundation to support service development and evaluation across diverse jurisdictions.
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Case Report: Suicidality response to treatment for attention deficit hyperactivity disorder in adult females with autism spectrum disorder: three cases

BackgroundSuicidality, suicide attempts and non-suicidal self-injury occur more frequently in untreated attention deficit hyperactivity disorder (ADHD), and in females with autism spectrum disorder (ASD), especially in late adolescence and young adulthood. Diagnosis and treatment of the comorbid ADHD may rapidly improve coping skills, reducing impulsivity and suicidality.MethodsWe obtained IRB approval and written consent to publish the de-identified cases of three young adult females with recurrent suicidality and serious mental illness. Each met DSM-based diagnostic criteria for ASD and ADHD, but received no ADHD treatments on presentation. Presentations, treatment, side effects and precautions are discussed.ResultsEach responded remarkably to ADHD treatments, but with notable side effects especially in one case. Addition of ADHD medications led to rapid improvements in mood, suicidality and self-reported use of coping skills, enabling taper of antidepressants and antipsychotics.ConclusionsADHD diagnosis and treatment may rapidly improve treatment-resistant suicidality and mood, by improving executive functions, impulse control and use of coping skills; larger-scale studies are indicated to elaborate on our findings in these three cases. ASD and comorbid ADHD are important predisposing factors to suicidality that are commonly missed. ADHD treatment may provide remarkable response, described by patients as enabling greater functioning, confidence and use of coping skills when under stress. Suicidality assessment should include screenings for ADHD and ASD, especially in atypical cases. Prior maltreatment, executive dysfunction and impulsivity in females all raise suicide risks.
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Testing Conversational Agents as a Digital Companion

Conditions: Autism

Interventions: Behavioral: self-directed goal coaching

Sponsors: Friendi.fi Corporation; National Institute of Mental Health (NIMH); University of Louisville; Indiana University; Ball State University; University of Nebraska

Recruiting
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Can psychiatric genetics advance without incorporating a lifecourse perspective?

Psychiatric disorders unfold over the lifecourse, yet genomic studies of these conditions overwhelmingly rely on phenotypes collected at a single time point, often in adulthood. Genome-wide association studies (GWAS) of psychiatric conditions may therefore miss genetic variants with time-varied relevance to etiology, prevention and treatment, such as those that influence trajectories of symptoms and behaviors, age-at-onset, course of treatment response, and co-evolution of comorbidities. With recent advances in longitudinal biobanks and analytic tools, we posit that incorporating a lifecourse perspective in psychiatric genetics will enable critically relevant insights into each of these areas of investigation.

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[Comment] Youth mental health in central Asia: research needs

Little research has been published on mental health difficulties in young people (aged 10–24 years) living in central Asia,1 a region comprising Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. As researchers and representatives from academic, non-governmental, governmental, and UN organisations working in Kyrgyzstan and Uzbekistan and beyond, we are noting an increasing number of young people reporting emotional and behavioural symptoms in central Asia in published articles2 and from our own observations.

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Determinants of Digital Health Literacy Among Patients With Serious Mental Illness: Cross-Sectional Survey

Background: Individuals with serious mental illness increasingly use digital devices and the internet to access health information and services but often face challenges when navigating digital tools, which may limit the benefits they receive from online health resources and digital health care services. Objective: The objective of our study was to assess digital health literacy among individuals with serious mental illness and identify factors influencing this literacy. Methods: Participants were recruited, using convenience sampling, from 2 psychiatric clinics, 1 day-care center, and 4 halfway houses in Taipei, Taiwan, between May 2024 and February 2025. Self-reported data were collected using a survey that incorporated the eHealth Literacy Scale, the Attitudes Toward Computer/Internet Questionnaire, and the Mobile Device Proficiency Questionnaire. Generalized linear modeling was applied to identify factors associated with digital health literacy. Results: Among 255 participants included in the analysis, 83.5% (n=213) reported owning at least 1 digital device. Digital health literacy was significantly lower among individuals who reported greater perceived difficulty in using digital tools (=−1.533, 95% CI −2.350 to −0.717; <.001) and higher distrust in online information (=−0.986, 95% CI −1.916 to −0.056; =.04). By contrast, greater mobile device proficiency (=0.144, 95% CI 0.008‐0.281; =.04) and self-efficacy (=1.777, 95% CI 0.376‐3.177; =.01) were positively associated with digital health literacy. Conclusions: Despite widespread device ownership, digital health literacy was varied and generally suboptimal among patients with serious mental illness. Perceived difficulty and distrust emerged as major barriers; proficiency and self-efficacy facilitated higher literacy. These findings highlight the need for mental health professionals to integrate tailored digital skills training, confidence-building strategies, and ongoing support into digital health interventions for individuals with serious mental illnesses.