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The COVID-19 pandemic and nationally mandated restrictions to control the virus have been associated with increased mental health issues. However, the differential impact of the pandemic and lockdown on groups of individuals, and the personal characteristics associated with poorer outcomes are unknown. Data from 21 938 adults in England who participated in a stratified cohort study were analysed. Trajectories of depression and anxiety symptoms were identified using growth mixture modelling. Multinomial and logistic regression models were constructed to identify sociodemographic and personality-related risk factors associated with trajectory class membership. Four trajectories of depression and five for anxiety were identified. The most common group presented with low symptom severity throughout, other classes were identified that showed: severe levels of symptoms which increased; moderate symptoms throughout; worsening mental health during lockdown but improvements after lockdown ended; and for anxiety only, severe initial anxiety that decreased quickly during lockdown. Age, gender, ethnicity, income, previous diagnoses, living situation, personality factors and sociability were associated with different trajectories. Nearly 30% of participants experienced trajectories with symptoms in the clinical range during lockdown, and did not follow the average curve or majority group, highlighting the importance of differential trajectories. Young, female, outgoing and sociable people and essential workers experienced severe anxiety around the announcement of lockdown which rapidly decreased. Younger individuals with lower incomes and previous mental health diagnoses experienced higher and increasing levels of symptoms. Recognising the likely symptom trajectories for such groups may allow for targeted care or interventions.

Objective To examine the mortality experience of psychiatric patients in Western Australia compared with the general population.Design Population based study.Setting Western Australia, 1985-2005.Participants Psychiatric patients (292 585) registered with mental health services in Western Australia.Main outcome measures Trends in life expectancy for psychiatric patients compared with the Western Australian population and causes of excess mortality, including physical health conditions and unnatural causes of death.Results When using active prevalence of disorder (contact with services in previous five years), the life expectancy gap increased from 13.5 to 15.9 years for males and from 10.4 to 12.0 years for females between 1985 and 2005. Additionally, 77.7% of excess deaths were attributed to physical health conditions, including cardiovascular disease (29.9%) and cancer (13.5%). Suicide was the cause of 13.9% of excess deaths.Conclusions Despite knowledge about excess mortality in people with mental illness, the gap in their life expectancy compared with the general population has widened since 1985. With most excess deaths being due to physical health conditions, public efforts should be directed towards improving physical health to reduce mortality in people with mental illness, in addition to ongoing efforts to prevent suicide.

BackgroundIn England between 2010 and 2013, just over one million recipients of the main out-of-work disability benefit had their eligibility reassessed using a new functional checklist—the Work Capability Assessment. Doctors and disability rights organisations have raised concerns that this has had an adverse effect on the mental health of claimants, but there are no population level studies exploring the health effects of this or similar policies.MethodWe used multivariable regression to investigate whether variation in the trend in reassessments in each of 149 local authorities in England was associated with differences in local trends in suicides, self-reported mental health problems and antidepressant prescribing rates, while adjusting for baseline conditions and trends in other factors known to influence mental ill-health.ResultsEach additional 10 000 people reassessed in each area was associated with an additional 6 suicides (95% CI 2 to 9), 2700 cases of reported mental health problems (95% CI 548 to 4840), and the prescribing of an additional 7020 antidepressant items (95% CI 3930 to 10100). The reassessment process was associated with the greatest increases in these adverse mental health outcomes in the most deprived areas of the country, widening health inequalities.ConclusionsThe programme of reassessing people on disability benefits using the Work Capability Assessment was independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing. This policy may have had serious adverse consequences for mental health in England, which could outweigh any benefits that arise from moving people off disability benefits.

Previous research on pandemics and emergencies has shown that such events often widen health inequalities in society and have a greater impact on socially disadvantaged groups. No review has so far looked at the impact of inequality factors on mental health outcomes during the novel coronavirus outbreak (COVID-19). The aim of the current review was therefore to assess the impact of inequality factors on mental health outcomes during COVID-19. After registration on PROSPERO, a systematic review was conducted for papers published up to July 31, 2020, using the databases Google Scholar, PsycINFO, PubMed (MEDLINE), and Web of Science. The following inequality factors were considered: education, income, employment, occupation, material and social deprivation, age, immigrant status, sexual orientation, functional health, cultural/racial background, sex, gender, and place of residence. Out of 1,931 references, 117 studies (300,061 participants) were included. Female sex, being of a younger age, financial insecurity, lack of access to clear messaging/information about the pandemic, proximity to large infection sites, having existing physical and/or psychological health conditions, and being subjected to abuse/stigma because of one's identity as a member of an ethnic or sexual marginalized group predicted mental health inequalities. More research is required on how inequality affects mental health in less studied vulnerable populations, such as ethnic, sexual, and gender marginalized participants, as well as how inequality factors interact to affect mental health in the long term. Recommendations for researchers, mental health practitioners, and public health authorities for mitigating adverse mental health outcomes in vulnerable populations are outlined. Public Significance Statement The findings of this review suggest that several inequality factors, such as female sex, younger age, financial insecurity, having existing chronic health conditions, and being in an ethnic or sexual marginalized group predict worse mental health outcomes during the ongoing COVID-19 pandemic. There is an urgent need for mental health services to support vulnerable populations at this time, to reduce mental health inequalities and improve long-term psychological functioning. Des recherches antérieures sur les pandémies et les urgences ont montré que de tels événements augmentent souvent les inégalités en matière de santé dans la société et ont une incidence plus grave sur les groupes socialement défavorisés. À ce jour, aucune étude n'a examiné l'incidence des facteurs d'inégalité sur les résultats en matière de santé mentale lors de l'épidémie du nouveau coronavirus (COVID-19). L'objectif de la présente étude était donc d'évaluer l'incidence des facteurs d'inégalité sur les résultats en matière de santé mentale pendant la COVID-19. Après inscription sur PROSPERO, un examen systématique a été effectué pour les articles publiés jusqu'au 31 juillet 2020, en utilisant les bases de données Google Scholar, PsycINFO, PubMed (MEDLINE) et Web of Science. Les facteurs d'inégalité suivants ont été pris en considération : éducation, revenu, emploi, profession, privation matérielle et sociale, âge, statut d'immigrant, orientation sexuelle, santé fonctionnelle, origine culturelle/raciale, sexe, genre et lieu de résidence. Sur 1 931 références, 117 études (300 061 participants) ont été incluses. Le sexe féminin, le jeune âge, l'insécurité financière, le manque d'accès à des messages/renseignements clairs sur la pandémie, la proximité d'importants sites d'infection, les conditions de santé physique et/ou psychologique existantes et le fait d'être victime d'abus/stigmatisation en raison de son identité en tant que membre d'un groupe ethnique ou sexuel marginalisé ont permis de prédire les inégalités en matière de santé mentale. Des recherches supplémentaires sont nécessaires sur la manière dont les inégalités affectent la santé mentale dans les populations vulnérables moins étudiées, telles que les participants marginalisés sur le plan ethnique, sexuel et sexospécifique, ainsi que sur la manière dont les facteurs d'inégalité interagissent pour affecter la santé mentale à long terme. Des recommandations sont formulées à l'intention des chercheurs, des praticiens de la santé mentale et des autorités de santé publique pour atténuer les effets néfastes sur la santé mentale des populations vulnérables.

Background The use of global health items permits an efficient way of gathering general perceptions of health. These items provide useful summary information about health and are predictive of health care utilization and subsequent mortality. Methods Analyses of 10 self-reported global health items obtained from an internet survey as part of the Patient-Reported Outcome Measurement Information System (PROMIS) project. We derived summary scores from the global health items. We estimated the associations of the summary scores with the EQ-5D index score and the PROMIS physical function, pain, fatigue, emotional distress, and social health domain scores. Results Exploratory and confirmatory factor analyses supported a two-factor model. Global physical health (GPH; 4 items on overall physical health, physical function, pain, and fatigue) and global mental health (GMH; 4 items on quality of life, mental health, satisfaction with social activities, and emotional problems) scales were created. The scales had internal consistency reliability coefficients of 0.81 and 0.86, respectively. GPH correlated more strongly with the EQ-5D than did GMH (r = 0.76 vs. 0.S9). GPH correlated most strongly with pain impact (r = —0.75) whereas GMH correlated most strongly with depressive symptoms (r = —0.71). Conclusions Two dimensions representing physical and mental health underlie the global health items in PROMIS. These global health scales can be used to efficiently summarize physical and mental health in patient-reported outcome studies.

We examine long-term neighborhood effects on low-income families using data from the Moving to Opportunity (MTO) randomized housing-mobility experiment. This experiment offered to some public-housing families but not to others the chance to move to less-disadvantaged neighborhoods. We show that ten to 15 years after baseline, MTO: (i) improves adult physical and mental health; (ii) has no detectable effect on economic outcomes or youth schooling or physical health; and (iii) has mixed results by gender on other youth outcomes, with girls doing better on some measures and boys doing worse. Despite the somewhat mixed pattern of impacts on traditional behavioral outcomes, MTO moves substantially improve adult subjective well-being.

Background Precisely defining the different applications of patient-reported outcome measures (PROs) in clinical practice can be difficult. This is because the intervention is complex and varies amongst different studies in terms of the type of PRO used, how the PRO is fed back, and to whom it is fed back. Methods A theory-driven approach is used to describe six different applications of PROs in clinical practice. The evidence for the impact of these applications on the process and outcomes of care are summarised. Possible explanations for the limited impact of PROs on patient management are then discussed and directions for future research are highlighted. Results The applications of PROs in clinical practice include screening tools, monitoring tools, as a method of promoting patient-centred care, as a decision aid, as a method of facilitating communication amongst multidisciplinary teams (MDTs), and as a means of monitoring the quality of patient care. Evidence from randomised controlled trials suggests that the use of PROs in clinical practice is valuable in improving the discussion and detection of HRQoL problems but has less of an impact on how clinicians manage patient problems or on subsequent patient outcomes. Many of the reasons for this may lie in the ways in which PROs fit (or do not fit) into the routine ways in which patients and clinicians communicate with each other, how clinicians make decisions, and how healthcare as a whole is organised. Conclusions Future research needs to identify ways in with PROs can be better incorporated into the routine care of patients by combining qualitative and quantitative methods and adopting appropriate trial designs.

Purpose To assess the impact of providing healthcare professionals with feedback on patient-reported outcome measures (PROMs). Methods This is a systematic review including controlled studies investigating the effectiveness of PROMs feedback, specifically examining the impact at a group-level and a patient-level. Results Only one study provided feedback at a group-level as a measure of professional performance, which found no intervention effect. At a patient-level, sixteen studies were identified and only one study found an overall significant difference in the PROM score. However, an additional six studies found a significant result favouring the intervention group for a particular subgroup or domain. The studies which demonstrated the greatest impact primarily used PROMs as a management tool in an outpatient setting on a specialised patient population. In contrast, there was weak evidence supporting with the use of PROMs as a screening tool. The studies which found a positive effect had a lower quality score on average. Conclusions The effectiveness of PROMs feedback seems to be related to the function of the PROM. However, the evidence regarding the impact of PROMs feedback on patient outcomes is weak, and methodological issues with studies are frequent. The use of PROMs as a performance measure is not well investigated. Future research should focus on the appropriate application of PROMs by testing specific hypothesis related to cause and effect. Qualitative research is required to provide a deeper understanding of the practical issues surrounding the implementation of PROMs and the methodological issues associated with the effective use of the information.