Mental Health Disparities

Background
Adequately understanding and measuring pathways to care is a prerequisite for early detection and effective treatment of first-episode psychosis.

Method
We conducted a systematic review of studies on pathways to care in first-episode psychosis to establish what measures currently exist to assess pathways in first-episode psychosis and to compare these measures.

Results
We identified 15 studies which had used six different measures of pathways to care. Differences in aims, methodology and lack of psychometric data did not allow a direct comparison of pathways measures but certain common themes emerged.

Discussion
Pathways to care in first-episode psychosis are diverse and varied. There is no measure with established psychometric properties that has been devised on a well-developed theoretical or conceptual framework and had its psychometric properties established. The conflict between exploring the patient's narrative and journey through the healthcare system and developing an empirical measure of pathways with optimal outcomes has hindered the development of such a measure.

Keywords:
Pathways to care; First-episode psychosis; Schizophrenia; Duration of untreated psychosis; Early intervention in psychosis

"Objective: To estimate the cardiovascular mortality
among persons with bipolar disorder in Sweden
compared to the general population.
Design: Population register-based cohort study with
a 20-year follow-up.
Setting: Sweden.
Participants: The entire population of Sweden
(n=10.6 million) of whom 17 101 persons were
diagnosed with bipolar disorder between 1987 and
2006.
Main outcome measures: Mortality rate ratios
(MRR), excess mortality (excess deaths),
cardiovascular disorder (CVD) and specifically
cerebrovascular disease, coronary heart disease, acute
myocardial infarction, sudden cardiac deaths and
hospital admission rate ratio (ARR).
Results: Persons with bipolar disorder died of CVD
approximately 10 years earlier than the general
population. One third (38%) of all deaths in persons
with bipolar disorder were caused by CVD and almost
half (44%) by other somatic diseases, whereas suicide
and other external causes accounted for less than a
fifth of all deaths (18%). Excess mortality of both CVD
(n=824) and other somatic diseases (n=988) was
higher than that of suicide and other external causes
(n=675 deaths). MRRs for cerebrovascular disease,
coronary heart disease and acute myocardial infarction
were twice as high in persons with bipolar disorder
compared to the general population. Despite the
increased mortality of CVD, hospital admissions (ARR)
for CVD treatment were only slightly increased in
persons with bipolar disorder when compared to the
general population.
Conclusions: The increased cardiovascular mortality
in persons with bipolar disorder calls for renewed
efforts to prevent and treat somatic diseases in this
group. Specifically, our findings further imply that it
would be critical to ensure that persons with bipolar disorder receive the same quality care for CVD as persons without bipolar disorder."

No existing review has synthesized key questions about acculturation experiences among international migrant workers. This review aimed to explore (1) What are global migrant workers' experiences with acculturation and acculturative stress? (2) What are acculturative stress coping strategies used by migrant workers? And (3) how effective are these strategies for migrant workers in assisting their acculturation in the host countries? Peer-reviewed and gray literature, without time limitation, were searched in six databases and included if the study: focused on acculturative stress and coping strategies; was conducted with international migrant workers; was published in English; and was empirical. Eleven studies met the inclusion criteria. Three-layered themes of acculturation process and acculturative stress were identified as: individual layer; work-related layer; and social layer. Three key coping strategies were identified: emotion-focused; problem-focused; and appraisal-focus...

The task of studying the impact of social class on physical and mental health involves, among other things, the use of a conceptual toolbox that defines what social class is, establishes how to measure it, and sets criteria that help distinguish it from closely related concepts. One field that has recently witnessed a wealth of theoretical and conceptual research on social class is psychology, but geographers' and sociologists' attitude of diffidence toward this " positivistic " discipline has prevented them from taking advantage of this body of scholarship. This paper aims to highlight some of the most important developments in the psychological study of social class and social mobility that speak to the long-standing concerns of health geographers and sociologists with how social position, perceptions, social comparisons, and class-based identities impact health and well-being.
DOI: https://doi.org/10.1016/j.socscimed.2017.11.037

No existing review has synthesized key questions about acculturation experiences among international migrant workers. This review aimed to explore (1) What are global migrant workers' experiences with acculturation and ac-culturative stress? (2) What are acculturative stress coping strategies used by migrant workers? And (3) how effective are these strategies for migrant workers in assisting their acculturation in the host countries? Peer-reviewed and gray literature, without time limitation, were searched in six databases and included if the study: focused on acculturative stress and coping strategies; was conducted with international migrant workers; was published in English; and was empirical. Eleven studies met the inclusion criteria. Three-layered themes of acculturation process and accul-turative stress were identified as: individual layer; work-related layer; and social layer. Three key coping strategies were identified: emotion-focused; problem-focused; and appraisal-focused. These coping strategies were used flexibly to increase coping effectiveness and evidence emerged that a particular type of acculturative stress might be solved more effectively by a specific coping strategy. Migrant workers faced numerous challenges in their acculturative process. Understanding this process and their coping strategies could be used in developing research and interventions to improve the well-being of migrant workers.

In dismantling normative assumptions in psychiatry that rely primarily on scientific explanations for "mental illness", this study undertakes an interrogation of "mental illness" as a product of persistent psycho-social stressors impacting on mental health. Focussed on the imperial character of psychiatric knowledge, I demonstrate how ideological violence is inflicted upon African Canadian women by psychiatric diagnostic categories that serve to subjugate, denigrate, and regulate their belief systems and cultural traditions. My research reveals how the indoctrination of these women occurs within the context of racist, racialized, and Euro-Western definitions of mental health and well-being.

Assaporare le cose buone, le diverse fasi della vita, l'armonia; sorridere, ridere con le persone care e gli amici, pathos verso chi è sfortunato; condividere uno spettacolo, stare insieme in luoghi di civile bellezza. Imparare un lavoro che appassiona, esser contenti se riesce bene. A queste cose, a questo siamo chiamati. " Considerate la vostra semenza: fatti non foste a viver come bruti, ma per seguir virtute e canoscenza." Dante,verso 119 del canto XXVI dell'Inferno. Tradotto per il dopo pandemia: seguire un modo di stare al mondo socialmente e ambientalmente virtuoso, conoscere e riconoscere i limiti dell'attuale modello di sviluppo. A questo siamo chiamati. Per molti di noi questi compiti, questa concezione della vita, son da sempre naturali e giusti ma non per il personaggio infaticabile che è apparso circa cinque secoli fa con le sembianze del dio denaro, personaggio che premia il lavoro con la ricchezza, ne fa un compito e un dovere e afferma che chi diventa ricco sulla terra gode con ogni evidenza dei suoi favori. Il povero è in colpa: debito uguale peccato nell'etica del personaggio infaticabile. È l'etica del capitalista. Accumulare, costruire un grande deposito, disciplinatamente portare ogni briciola a quel deposito, al formicaio. Chi non partecipa a questo tipo di lavoro per scelta consapevole o perché non gli è materialmente possibile è rifiutato come essere improduttivo, negligente, persona che viene meno al proprio dovere morale, cicala secondo il parere dell'infaticabile personaggio-dio denaro. Cicala che ha valori morali diversi, vuol provare piacere e soddisfazione nel lavoro. Guarda che pretese ha questo fantasioso animaletto: invece di assoggettarsi a lavorare di più, sempre di più, con ferreo dominio di sé e dura disciplina, vuole cose buone, godere la vecchiaia dopo la gioventù, vuole compassione per chi è meno fortunato, vuole bellezza, divertirsi con gli amici, vivere in luoghi piacevoli, al sole. Sono pretese non certo confacenti all'aumento della produttività (la produttività misura l'efficienza del processo produttivo, cioè in estrema sintesi indica l'unità di prodotto per lavoratore od ora lavorata) e del profitto, inteso in senso capitalistico, nel senso in cui lo intende l'infaticabile personaggio, la formicuzza; per lui son pretese inaudite, desideri incompatibili con le dinamiche imposte dal mercato per esaudire i quali sarebbero i settori produttivi "forti", le regioni ricche a pagare. "Già di per sé rappresenta un debito quel fantasioso animaletto chiamato cicala, dato che ama investire in felicità invece che in denaro, dato che pensa che chi è in debito non sempre è in colpa; ci manca il suo cicaleccio sulla necessità di cambiare modello di sviluppo dopo la pandemia." dice il dio denaro. Ancora lui: "Ci mancano i ragionamenti sull'importanza dei rapporti umani, sulla serenità negli orti urbani, sul piacere di un pomeriggio al sole, sull'aria pulita per il minor traffico, sulla meraviglia del cinguettio dei passeri ritornati sulle piante in terrazza: cose che non valgono nulla." Invece son cose che valgono tanto, che non hanno prezzo, l'abbiamo capito meglio oggi, alla luce del desiderio di ritrovare umanità dopo la pandemia. Per l'infaticabile personaggio-formicuzza-dio denaro invece i desideri esistono solo in forma di interesse, meglio se si tratta di un interesse altamente remunerativo del capitale proprio investito, dato che: "il denaro va fatto fruttare, il deposito va accresciuto, la ricchezza va aumentata, è così che si è retti e ci si guadagna il paradiso".

A significant care need for service commissioners and providers of services for people with intellectual disabilities (ID) is presented by people with behaviours that challenge and/or have mental health problems, and ageing people with an ID. In addition family caregivers of both these populations can face many obstacles in their caring roles if adequate supports are not in place to help them. This rapid review was undertaken using a framework adapted from the NHS Centre for Reviews and Dissemination (CRD, 2009) and the Rapid Review Methodology (NHS, Wales 2006). The aims of the review are as follows. Aims and review questions – behaviours that challenge In relation to people who challenge the aim was to search for, evaluate and prioritise studies or other robust literature that have focussed on the following main review question. What services and support do people with ID who display behaviours that challenge and their caregivers require to meet their needs?

Lesbian, gay, bisexual, transgender, intersex and queer/questioning (LGBTIQ) people have elevated mental health needs due to the additional stigma, discrimination and violence they experience. To serve LGBTIQ clients’ needs appropriately, mental health practitioners require LGBTIQ cultural competence. Delphi methodology was used to identify what LGBTIQ cultural competence comprises in Thailand and how it can be developed. The participants were 14 LGBTIQ individuals who had used mental health services, and 13 mental health practitioners with expertise on LGBTIQ issues. First round of data collection (online survey/interviews) identified competencies and ways of developing them; the second round (online survey) measured agreement on each issue. Service user and practitioner participants’ ratings indicated overall agreement on most proposed competencies. LGBTIQ cultural competencies included understanding contemporary LGBTIQ identities and concepts, accepting and empathizing with LGBTIQ clients, recognizing and rejecting stereotypes, having skills of asking questions in a way that is sensitive to LGBTIQ clients, and advocating for social change. Providing assistance on issues specific to LGBTIQ clients (e.g., minority stress & gender transitioning) was also considered necessary, but the most important aspect seems to be building and maintaining a helpful therapeutic relationship. Non-clinical personal contacts or networks with LGBTIQ individuals and attending experiential training connecting life experiences with relevant concepts were some of the suggested LGBTIQ cultural competence development methods. The findings provide the first-ever overview on the prerequisites of appropriate mental health practice with LGBTIQ clients in Thailand. They indicate that with LGBTIQ clients, generic professional competence is insufficient for enabling the operation of common factors (e.g., empathy & therapeutic alliance) underlying positive psychotherapeutic change; LGBTIQ cultural competence is also required.

Shaun Gallagher has actively looked into the possibility that psychopathologies involving “thought insertion” might supply a counterexample to the Cartesian principle according to which one can always recognize one’s own thoughts as one’s own. Animated by a general distrust of a priori demonstrations, Gallagher is convinced that pitting clinical cases against philosophical arguments is a worthwhile endeavor. There is no doubt that, if true, a falsification of the immunity to error through misidentification would entail drastic revisions in how we conceive the boundary between self and other. However, I argue that (1) the idea of unearthing an exception to the Cartesian thesis is, on further reflection, not a realistic prospect and that (2) this casts doubt on the attempt to conjoin first-person phenomenology and third-person cognitive science in the service of philosophical debates.

This chapter is theoretical and will briefly discuss the role of environmental epigenetics, and the vulnerability to physical and mental health-related disease passed down from the horrors of African slavery and what this racial history means for generations of black people in the United States.

Multidisciplinary teams (MDTs) are conventionally recommended in mental health
care literature as an important way to offer holistic treatment provision to patients. This
study aims to explore multidisciplinary teamwork in contemporary mental health
settings, particularly what aids and hinders the process of multidisciplinary teamworking,
and the social work contribution in such teams. In order to attain an in-depth
exploration of these phenomena, a single case study design was employed. Within this
design, data were generated through semi-structured interviews and structured
observation of a mental health MDT in Ireland. These data were analysed using
interpretative phenomenological analysis. The research highlights how the concept of
mental illness is contested within this MDT, with the medical model dominant within
an environment of fluid working arrangements. Professional role blurring and
stereotyping were found to impact the division of labour on this team, with role
negotiation found to be an integral part of retaining a professional’s practice identity.
This research raises concerns for social work’s capacity to function within mental
health MDTs in Ireland, and highlights ways in which social work educators might
respond in order to empower Irish social workers to meet the challenges of mental
health multidisciplinary teamworking.

The two decade history of the ASA Section on the Sociology of Mental Health has coincided with a period of tremendous resurgence in the study of how neighborhoods and local places contribute to mental health—a topic that has become a popular focus for mental health sociologists. In considering the sociological contributions to this area of study, the present chapter has two aims. The first aim is to provide the reader with an appreciation of sociological research on local places and mental health. To achieve this, I discuss some important research streams of sociological inquiry on local places and mental health over the past 20 years as well as seminal scholarship that dates back to the start of sociology as a formal discipline. The second aim is to discuss future directions for research. In doing so, I identify several key conceptual and substantive issues that I argue are important for advancing sociology of mental health research on the consequences of local places—for mental and physical health.

The Health Disparities and Outcomes (HDO) model originally created to explain the complexity of obtaining healthcare in rural settings has been revised and updated using emerging theoretical models of adversity and inequity and two decades of empirical work by the authors. With a strong orientation to explaining population-based health inequities, the HDO is applied to individuals with Serious Mental Illness (SMI), to explain their high rates of morbidity and mortality compared to the general population. Individual-, community-, and system-level factors that reflect an understanding of life-long risk, accrued hazards associated with multiple and intersecting disadvantages, and difficulty obtaining healthcare that meets accepted standards are described. The revised HDO can be applied to populations with disproportionate health challenges to identify multi-level factors that affect illness trajectory and overall health outcomes.

Sexual harassment has been theorized as a stressor with consequences for the physical and mental health of its targets. Though social scientists have documented a negative association between sexual harassment and mental health, few longitudinal studies have investigated the association
between sexual harassment and depressive symptoms. Using longitudinal survey data from the Youth Development Study, combined with in-depth interviews, this article draws on Louise
Fitzgerald’s theoretical framework, stress theory, and the life course perspective to assess the impact of sexual harassment on depressive affect during the early occupational career. In support of Fitzgerald’s model, our findings confirm that sexual harassment is a stressor that is associated with increased depressive symptoms. Our quantitative results show that women and men who experience more frequent sexual harassment at work have significantly higher levels of depressed
mood than non-harassed workers, even after controlling for prior harassment and depressive symptoms. Moreover, we find evidence that sexual harassment early in the career has long-term effects on depressive symptoms in adulthood. Interviews with a subset of our survey respondents
point to a variety of coping strategies and reveal further links between harassment and other aspects of mental health, such as anger and self-doubt.

A PhD studentship is available for UK and EU citizens only. The studentship will attract an annual tax-free stipend of £14,777 for up to 3 years, subject to satisfactory progress and will cover the UK/EU tuition fees. You should hold a first degree equivalent to at least a UK upper second class honours degree in a relevant subject. This project would suit a student with a strong background in international health policy and systems. Candidate whose first language is not English must provide evidence that their English language is sufficient to meet the specific demands of their study, the Faculty minimum requirements are: • British Council IELTS-score of 6.5 overall, with no element less than 6.0 • TOEFL iBT-overall score of 92 with the listening and reading element no less than 21, writing element no less than 22 and the speaking element no less than 23.

Mortality in patients with schizophrenia is higher than in the general population. Mortality can be used as a criterion of effectiveness of care. From the National Finnish Hospital Discharge register, we identified all 18 006 patients aged between
15 and 64 years admitted for the first time with schizophrenia diagnosis to hospital in Finland between 1987 and 2002. The patients’ family backgrounds were identified from the Population Register, as were their deaths to the end of 2003 from the Register of Causes of Deaths. The causes of death were
classified as natural, unnatural or suicide. Separately, deaths during psychiatric hospitalization were identified. Associations between mortality and patients’ backgrounds or health care districts were analysed by the Cox regression analysis.

In all 2202 deaths or 12.2% of the whole sample were registered. Mortality was higher in men, the elderly, widows, and in those without children. Female gender and having children were two factors that protected from unnatural deaths and, as a separate issue, from suicides. Total mortality and natural or unnatural deaths varied significantly between health care districts although the effect of patients’ backgrounds had been taken into account. 13.6% of natural deaths, 22.6% of suicides and
7.1% of other unnatural deaths occurred during psychiatric hospital care. Natural deaths during
outpatient care varied significantly between health care districts.
Male gender and a lack of a close network of people increased the risk of mortality in patients with
schizophrenia. Differences in mortality between health care districts may be due to differences in
treatment practices and their effect on mortality in patients with schizophrenia.

What services and support do people with Intellectual disabilities who display behaviours that challenge and their caregivers require to meet their needs? What services and support do older people with learning disabilities and their caregivers require to meet their needs? This rapid review of evidence from the literature over the past decade was undertaken as part of the Bamford Review (2007) recommendations and commissioned by the Health & Social Care Research and Development Division of the Public Health Agency.

The document can be disseminated freely and shared with patients, clients and carers.

Objectives. We sought to understand how African American women's beliefs regarding depression and depression care are influenced by racism, violence, and social context. Methods. We conducted a focus group study using a community-based participatory research approach. Participants were low-income African American women with major depressive disorder and histories of violence victimization. Results. Thirty women participated in 4 focus groups. Although women described a vicious cycle of violence, depression, and substance abuse that affected their health, discussions about health care revolved around their perception of racism, with a deep mistrust of the health care system as a “White” system. The image of the “strong Black woman” was seen as a barrier to both recognizing depression and seeking care. Women wanted a community-based depression program staffed by African Americans that addressed violence and drug use. Conclusions. Although violence and drug use were central to our ...

There is a growing debate on the linkage between social networking platforms and mental health disorder, such as depressive behaviour or depression. However, the relationship between Instagram use and depression or depressive behaviour has not been exhaustively examined. This review aims to examine these two variables. Only peerreviewed journal articles that are published between October 2010 and December 2018 were sought in central and journal databases. Studies were selected based on predefined criteria and assessed for risk of bias and quality of evidence using GRADE. One thousand eight hundred fifty-six studies were the outcome of the search, out of which 9 meets all eligible criteria. Of the 9 studies, three-quarter was published between 2017 and 2018, covering five continents: (North America: 3; Asia: 2; Australia: 2; South America: 1, Europe: 1). The final included studies broadly examined young Instagram users between the age of 19 and 35. The synthesis affirmed a linkage between Instagram and symptoms of depression or depressive behaviour. Variables that moderate this relationship are social comparison, self-esteem built on validation and approval of others, social media dependence, gender, negative or insufficient feedback, poor self-rated attractiveness, Instagram broadcasting and loneliness, younger users and risk of anxiety, and the number of strangers that users follow. There is a strong relationship between Instagram use and mental health disorders such as depression or depressive behaviour; however, no in-depth direct causality is proven yet. Further studies are needed to unravel the direct causality puzzles.

Background: Excess mortality among patients with severe mental disorders has not previously been investigated in detail in large complete national populations. Objective: To investigate the excess mortality in different diagnostic categories due to suicide and other external causes of death, and due to specific causes in connection with diseases and medical conditions. In longitudinal national psychiatric case registers from Denmark, Finland, and Sweden, a cohort of 270,770 recentonset patients, who at least once during the period 2000 to 2006 were admitted due to a psychiatric disorder, were followed until death or the end of 2006. They were followed for 912,279 person years, and 28,088 deaths were analyzed. Life expectancy and standardized cause-specific mortality rates were estimated in each diagnostic group in all three countries. The life expectancy was generally approximately 15 years shorter for women and 20 years shorter for men, compared to the general population. Mortality due to diseases and medical conditions was increased two-to three-fold, while excess mortality from external causes ranged from three-to 77-fold. Mortality due to diseases and medical conditions was generally lowest in patients with affective disorders and highest in patients with substance abuse and personality disorders, while mortality due to suicide was highest in patients with affective disorders and personality disorders, and mortality due to other external causes was highest in patients with substance abuse. Conclusions: These alarming figures call for action in order to prevent the high mortality.

What services and support do people with Intellectual disabilities who display behaviours that challenge and their caregivers require to meet their needs? What services and support do older people with learning disabilities and their caregivers require to meet their needs? This rapid review of evidence from the literature over the past decade was undertaken as part of the Bamford Review (2007) recommendations and commissioned by the Health & Social Care Research and Development Division of the Public Health Agency.

The document can be disseminated freely and shared with patients, clients and carers.

African Americans experience mental health disadvantages relative to European Americans with respect to financial barriers, barriers to help seeking, and poorer quality services. This paper provides an overview of these mental health inequalities, and offers recommendations for addressing them.

INTRODUCTION: Substantial racial/ethnic disparities exist in the identification and management of major depression. Faith-Based Health Promotion interventions reduce disparities in health screenings for numerous medical conditions. However, the feasibility of systematically screening for depression in faith-based settings has not been investigated. The purpose of this study was to assess the feasibility of using a validated instrument to screen for depression in African-American churches.

METHODS: Participants were recruited between October and November 2012 at three predominantly African-American churches in New York City. A participatory research approach was used to determine screening days. The Patient Health Questionnaire-9 (PHQ-9) was administered to 122 participants. Positive depression screen was defined as a PHQ-9 score ≥10. Descriptive statistics were used to report sample characteristics, prevalence of participants who screened positive, and history of help seeking. Logistic regression analyses were conducted to determine the association of positive depression screen and sociodemographic characteristics. Initial analyses were conducted in 2013, with additional analyses in 2014.

RESULTS: The prevalence estimate for positive depression screen was 19.7%. More men (22.5%) screened positive than women (17.7%). Total household income was inversely related to positive depression screen. A similar percentage of respondents had previously sought help from primary care providers as from clergy.

CONCLUSIONS: It was feasible to screen for depression with the PHQ-9 in African-American churches. The prevalence of positive depression screen was high, especially among black men. Churches may be an important setting in which to identify depressive symptoms in this underserved population.

There is consistent evidence that the rate of emotional, social and behavioural problems found in children and adolescents in out-of-home placements or state care is substantially higher than that of children and adolescents living with their families. However, with a few small-scale studies as exceptions, to date there has been little research carried out into the mental health needs of adolescents living in state care in Northern Ireland. This study aimed to examine the mental health needs of young people aged between 10 and 15 years living in state care in Northern Ireland. Data were collected on 165 adolescents via an analysis of case file data, questionnaires and interviews with social workers. It was found that the 70.3% of the young people scored within the abnormal and borderline ranges of the Strengths and Difficulties Questionnaire (SDQ) total difficulties score indicating “high risk” for meeting the criteria for a psychiatric diagnosis. Over the course of 1 year living in state care, 10 of the 165 adolescents had attempted suicide and 14 had engaged in deliberate self-harm. Nevertheless, social workers still rated the vast majority (92%) of these young people's overall health as being “as good as”, or “better than” other young people in their age. It is concluded that as this group of young people have significant contact with health and social services, potential opportunities exist to develop the therapeutic potential of the experience of being “looked after” in state care. They are a uniquely vulnerable group and their care and treatment may be considered as a minority rights issue which deserves a higher profile in the human rights agenda.

There is a growing debate on the linkage between social networking platforms and mental health disorder, such as depressive behaviour or depression. However, the relationship between Instagram use and depression or depressive behaviour has not been exhaustively examined. This review aims to examine these two variables. Only peer-reviewed journal articles that are published between October 2010 and December 2018 were sought in central and journal databases. Studies were selected based on predefined criteria and assessed for risk of bias and quality of evidence using GRADE. 1,856 studies were the outcome of the search, out of which 9 meets all eligible criteria. Of the 9 studies, three-quarter was published between 2017 and 2018, covering five continents: (North America: 3; Asia: 2; Australia: 2; South America: 1, Europe: 1). The final included studies broadly examined young Instagram users between the age of 19 and 35. The synthesis affirmed a linkage between Instagram and symptoms o...

Drawing from Sorokin's hypothesis that socially mobile individuals are at greater risk of experiencing psychological distress than their non-mobile counterparts, we investigate whether intergenerational occupational mobility influences psychological distress, as measured by the Center for Epidemiologic Studies Depression (CES-D) scale. Using data for men from the Wisconsin Longitudinal Study (WLS) and Sobel's Diagonal Mobility Models, we find little evidence for

Drawing from Sorokin's hypothesis that socially mobile individuals are at greater risk of experiencing psychological distress than their non-mobile counterparts, we investigate whether intergenerational occupational mobility influences psychological distress, as measured by the Center for Epidemiologic Studies Depression (CES-D) scale. Using data for men from the Wisconsin Longitudinal Study (WLS) and Sobel's Diagonal Mobility Models, we find little evidence for Sorokin's hypothesis; mobile individuals are no more likely to be psychologically distressed than their non-mobile counterparts. In fact, one group of mobile men – those who left their farming origins – are actually less distressed than the sons who remain as farmers and non-mobile men in higher-ranked social classes. We speculate that this reflects the fact that farming became very arduous during the late 20th century and these mobile sons of farmers appreciate their improved life chances. Our findings suggest that the association between mobility and psychological distress varies across specific class backgrounds and is contingent upon the broader social and economic context.

All multiracial societies have to grapple with the benefits versus the costs of the integration of minorities into majority communities. Indeed, in relation to the costs of integration, it could be argued that integration and assimilation increases non-White people’s exposure to racialized experiences and racism, which in turn predisposes them to mental illness. As such, it is worth considering the case of the UK, where Black integration and assimilation is particularly intense, and where the high rates of schizophrenia in the African-Caribbean population have been an area of concern for over three decades. This paper argues that the interplay between racial minority status stress, racism-induced stress, and racial bias in diagnosis may be significant factors influencing the high Black incidence rate of schizophrenia in the UK.

Background
Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act 1983. There has been no systematic exploration of differences within and between ethnic groups, nor of the explanations put forward for this excess.

Aims
To systematically review detention and ethnicity, with meta-analyses of detention rates for BME groups, and to explore the explanations offered for ethnic differences in detention rates.

Method
Literature search and meta-analysis. Explanations offered were categorised, supporting literature was accessed and the strength of the evidence evaluated.

Results
In all, 49 studies met inclusion criteria; of these, 19 were included in the meta-analyses. Compared with White patients, Black patients were 3.83 times, BME patients 3.35 times and Asian patients 2.06 times more likely to be detained. The most common explanations related to misdiagnosis and discrimination against BME patients, higher incidence of psychosis and differences in illness expression. Many explanations, including that of racism within mental health services, were not supported by clear evidence.

Conclusions
Although BME status predicts psychiatric detention in the UK, most explanations offered for the excess detention of BME patients are largely unsupported.

ADHD problem recognition serves as the first step of help seeking for ethnic minority families, such as Latinos, who underutilize
ADHD services. The current mixed-method study explores underlying factors influencing recognition of ADHD problems
in a sample of 159 school-aged youth. Parent-teacher informant discrepancy results suggest that parent ethnicity, problem
domain, and child age influence ADHD problem recognition. Emerging themes from semi-structured qualitative interviews/
focus groups conducted with eighteen Spanish-speaking Latino parents receiving school-based services for attention and
behavior concerns support a range of recognized ADHD problems, beliefs about causes, and reactions to ADHD identification.
Findings provide recommendations for reducing disparities in ADHD problem recognition and subsequent help seeking.

dillon t. Browne, Human development and applied Psychology, ontario Institute for studies in education, University of toronto; dominic Verticchio, Hamilton children's aid society; aron shlonsky, Factor-Inwentash Faculty of social Work, University of toronto; lehana thabane, system-linked research Unit on Health and service Utilization, Faculty of Health sciences, McMaster University, and Biostatistics Unit, Father sean o'sullivan research centre, st Joseph's Healthcare, Hamilton; Jeffrey Hoch, Health Policy Management and evaluation, University of toronto; carolyn Byrne, Faculty of Health sciences, University of ontario Institute of technology. this research was supported by the ontario Ministry of children and Youth services and the Ministry of Health. We would also like to thank rose sokolowski, Maria Wong, and the Health and social service Utilization research Unit at McMaster University for their assistance with this project. correspondence concerning this article should be addressed to dillon Browne, ontario Institute for studies in education, University of toronto, 252 Bloor st. W., toronto, on M5s 1V5. email: [email protected] canadIan JoUrnal oF coMMUnItY Mental HealtH

Racial minority youth are disproportionally removed from their learning environment due to school discipline and placed in special education for emotional disturbance. These disparities continue to trouble families, educators, and policy makers, particularly within urban schools. Yet there is a paucity of research on how behavioral outcome disparities occur in different states. This study addresses this gap examining the extent and predictors of behavioral outcome disparities in Wisconsin. Using the entire state’s data, we conducted multilevel logistic regression analyses. The analyses showed that African American students were seven times and Native American and Latino students were two times more likely to receive exclusionary discipline. African American students and Native American students were two to three times more likely to be labeled as emotionally disturbed. Students’ race, gender, income, language, attendance, and academic proficiency were related to outcome disparities ...

Setting: Sweden. Participants: The entire population of Sweden (n=10.6 million) of whom 17 101 persons were diagnosed with bipolar disorder between 1987 and 2006. Main outcome measures: Mortality rate ratios (MRR), excess mortality (excess deaths), cardiovascular disorder (CVD) and specifically cerebrovascular disease, coronary heart disease, acute myocardial infarction, sudden cardiac deaths and hospital admission rate ratio (ARR). Results: Persons with bipolar disorder died of CVD approximately 10 years earlier than the general population. One third (38%) of all deaths in persons with bipolar disorder were caused by CVD and almost half (44%) by other somatic diseases, whereas suicide and other external causes accounted for less than a fifth of all deaths (18%). Excess mortality of both CVD (n=824) and other somatic diseases (n=988) was higher than that of suicide and other external causes (n=675 deaths). MRRs for cerebrovascular disease, coronary heart disease and acute myocardial infarction were twice as high in persons with bipolar disorder compared to the general population. Despite the increased mortality of CVD, hospital admissions (ARR) for CVD treatment were only slightly increased in persons with bipolar disorder when compared to the general population. Conclusions: The increased cardiovascular mortality in persons with bipolar disorder calls for renewed efforts to prevent and treat somatic diseases in this group. Specifically, our findings further imply that it would be critical to ensure that persons with bipolar disorder receive the same quality care for CVD as persons without bipolar disorder.

Clinicians recommend including carers or others in a supporting role in the therapy as an important adaptation of psychological therapies for people with intellectual disabilities. This nested qualitative study from a larger trial explored supporters' experiences of supporting people with intellectual disabilities receiving behavioural activation or guided self-help therapies for depression. Twenty-one purposively sampled supporters were interviewed. The semi-structured interviews were subject to framework analysis, covering expectations of therapy, views of therapy sessions, relationships with therapist and participant, and perceived changes. Supporters were positive about both therapies and reported both therapy-specific and nonspecific therapeutic factors that had significant positive impacts on people's lives. Most supporters reported their involvement contributed to the interventions' effectiveness, and helped establish closer relationships to the people they were s...