Despite a large number of African-born individuals residing in the United States, there is a significant disparity in how this community accesses and utilizes mental health treatment. Low screening rates for common mental health concerns is one crucial part of ongoing inequities in mental healthcare access. Willingness to engage in screening is negatively impacted by a lack of culturally responsive ways to make screening more acceptable and stigma with mental health. This study therefore aimed to examine the perceived acceptability and utility of community-developed patient vignettes created to increase willingness to be screened for common mental health concerns. Employing a qualitative approach, a community advisory board (CAB) (n = 5) was enlisted to co-develop vignettes outlining an African community member's symptoms of anxiety and subsequent help-seeking behavior. Two focus groups of community members (n = 18) provided qualitative feedback on the vignettes and shared their general attitudes towards mental health and recommendations for mental health screening and treatment in the African community. Using a hybrid inductive and deductive qualitative descriptive approach and classifying responses based on the socioecological model, four major themes emerged from the data: (1) between support and strain: the role of family; (2) reducing stigma: community voices as education; (3) culture as a barrier and a bridge; and (4) the importance of stories that reflect lived experience. Overall, participants were receptive to the culturally-responsive mental health vignettes and provided fruitful suggestions for how these stories can be used to reduce stigma and increase willingness to seek screening and treatment in African-born residents of the United States.
Research in Western samples has repeatedly demonstrated a link between exposure to nature and natural stimuli and improved health. We sought to test these relationships in a sample of Indigenous Wixárika, whose traditional worldview is nature-based and conceives of all life as interconnected, in contrast to Western norms. A total of 127 Wixárika adults (68.5% female, mean age = 33.6 years) were recruited from Guadalajara and a rural community, as part of a larger study on Wixárika health. Participants completed surveys including a Connectedness to Nature (CNS) scale, self-reported mental and physical health, and frequency of participation in traditional ceremonies, a proxy of adherence to a traditional worldview. Firth logistic regression was used to model the effects of CNS and ceremony participation on both health measures. Rural participants had worse health, but greater CNS scores (p < 0.001 for both) and more frequent ceremony participation than urban participants. Higher CNS scores were associated with better mental health (OR = 4.94, 95% CI = 1.60-16.45, p = 0.005) in rural participants, with no effect on either health measure in urban participants. Results partially supported our prediction that greater CNS would be associated with better health. Notably, the only statistically significant relationship was in rural Wixáritari. The effects of CNS on health may diminish in generally healthy individuals (i.e., Guadalajara residents). Future work should probe this possibility further. This work calls attention to potential discrepancies in the health/nature nexus in non-Western contexts and the need to explore different cultural understandings of nature.
People with mental disorders (PMD) not only face difficulties related to their mental health problems, but also suffer from the stigma and discrimination associated with them. Research on social stigma in the educational setting has been mainly focused on health sciences students. The main objective was to compare the level of social stigma toward PMD among university students, categorized by their fields of study. Additionally, the analysis considered gender, knowledge about mental health, familiarity, and contact. A cross-sectional study was conducted among all first-year undergraduate students during the 2023-24 course at the University of Valencia, who were enrolled in five study fields: Engineering and Architecture (EA), Arts and Humanities (AH), Social and Legal Sciences (SL), Sciences (SC) and Health Sciences (HS). All students completed online an initial questionnaire with socio-demographic items, as well as the following questionnaires: The Mental Health Knowledge Schedule (MAKS), the Reported and Intended Behaviour Scale (RIBS), the Scale of Community Attitudes toward Mental Illness (CAMI), and the Attribution Questionnaire (AQ-27). The final sample comprised 2,693 students. The EA students scored highest in authoritarianism and social restrictiveness, and lowest in benevolence and CMHI. Students from SL had higher levels of public stigma than those from AH, SC and HS. Considering only women, EA had the highest scores in authoritarianism. EA men had lower benevolence and lower CMHI. These findings suggest that anti-stigma programs conducted at higher education institutions, in addition to traditional health sciences students, should target students from other study fields. This paper goes a step further by proposing that university curricula should include activities to improve understanding of mental health problems and reduce social stigma associated with PMD.
Latiné populations in the United States face a persistent health and mental health burden, in part driven by stressors associated with social determinants of health. In response, it is critical to develop a nuanced understanding of Latiné communities' perceptions of government- and community-based social safety-net services, both as distinct and interacting systems, designed to support health and social needs of Latiné adults. We conducted semi-structured interviews with Latiné adults (N = 13) in English and Spanish to explore perceptions of and experiences with government-sponsored and community-based safety-net services, as well as the implications for health and wellbeing. A thematic analysis approach was used to identify emergent themes. Themes highlight shared and unique factors that enable and inhibit access to safety-net services from government- and community-based systems. Awareness of safety-net services and their benefits facilitated access to both systems, but knowledge of rights surrounding eligibility enabled access to government-based services in particular. In contrast, limited awareness of service availability and concerns about quality of services created barriers to access across both community- and government-based services. Unique to government-based services, complex and burdensome application processes, mistrust, and stigma associated with using public assistance were highlighted as barriers. Findings provide critical insights to improve Latiné communities' access to safety-net systems to support health and wellbeing. Our results highlight the need to: strengthen communication strategies to inform resource awareness and counteract misinformation; rebuild trust between government institutions and communities; reduce stigma and shame surrounding safety-net service utilization; simplify bureaucratic processes for using government safety-nets; and foster connections between community and government systems to enhance access to services that address upstream social determinants of health. These strategies represent steps towards building more accessible safety-net systems to support the health and wellbeing of Latiné communities.
Adverse childhood experiences (ACEs), toxic stress, relational insecurity, and structural adversity are major public-health concerns for children and adolescents, but ACE evidence should not be treated as an individual diagnostic score or deterministic prognosis. This Hypothesis and Theory article proposes developmental literacy and epistemic dignity as linked upstream constructs for primary child protection. Developmental literacy is defined as developmentally staged and disability-inclusive neurobiopsychosocial knowledge and skills concerning bodies, emotions, stress, attachment, co-regulation, play, nutrition, safety, rights, boundaries, non-violent care, and help-seeking. Epistemic dignity refers to the supported capacity and right of children-including preverbal, disabled, neurodivergent, and communication-diverse children-to have bodily, emotional, relational, play-based, and communicative signals interpreted with seriousness, humility, and appropriate response. Drawing on research on ACEs and positive childhood experiences (PCEs), nurturing care, relational health, health-promoting schools, social and emotional learning, mental-health literacy, sexuality/safety education, child participation, epistemic injustice, disability studies, implementation science, and critiques of ACE and trauma-informed practice, the article develops a universal, proportionate, relationally safe, anti-bias, and non-coercive public-health framework. It argues that early-childhood services, schools, pediatric/public-health touchpoints, caregiver support, and community systems can provide age-appropriate developmental knowledge without turning schools into clinics, teachers into trauma detectors, or children into individual risk scores. The framework does not recommend routine individual ACE-score screening in schools as a default practice; it supports ethically governed, service-linked pathways for recognizing distress and unmet support needs. Coercive reproductive control is treated only as a rejected comparator because it targets reproductive status rather than modifiable developmental environments, support access, and institutional trust. The article concludes with safeguards and testable hypotheses for evaluating developmental literacy, epistemic dignity, relational safety, accessibility, help-seeking, response quality, caregiver support, referral continuity, and unintended harms.
To describe levels of barriers to mental health and substance use services and to examine the associations, if any, between these barriers and substance use and mental health stigma among Hispanic/Latine adults receiving services for HIV prevention or HIV treatment. We conducted a cross-sectional survey as part of a mixed-method, community-based statewide study among Hispanic/Latine individuals served by HIV service delivery organizations in Texas, United States, between September 2022 and May 2023 (n = 300). Participants completed a computer-based survey at collaborating organizations. Analyses included descriptive statistics and linear regression modeling. Demographic and background characteristics were significantly associated with differences in reported barriers to mental health and substance use services. Mental health-related stigma was significantly associated with barriers to mental health services. Strategies to reduce barriers, tailored to specific demographic subgroups, and interventions to address mental health-related stigma should be prioritized by HIV service delivery organizations serving Hispanic/Latine communities.
People living with mental illness experience poorer oral health than the general population, influenced by medication-related effects, behavioural risk factors, and structural barriers to dental care. Oral health behaviours and psychological determinants such as motivation and perceived competence are central to prevention and self-care, yet remain under-described in this population. This cross-sectional study included sixty-three adults receiving mental health care in community settings and rehabilitation-focused inpatient programmes. Data were collected during a single session and included self-reported oral hygiene behaviours, oral health knowledge, motivation and perceived competence, alongside clinically assessed oral health status. Motivation and perceived competence were assessed using the Self-Regulation Questionnaire for Oral Health and the Perceived Competence Scale. A brief oral health education session was delivered as part of routine care and was not evaluated as an intervention. Participants reported inconsistent oral hygiene practices, including low rates of daily interdental cleaning (11.5%) and dental attendance within the previous year (34.4%), alongside variable oral health knowledge. Clinical assessments indicated widespread oral tissue changes and suboptimal oral hygiene. Motivation for oral hygiene was predominantly autonomous, and perceived competence scores were high. Higher oral health knowledge, autonomous motivation and perceived competence were associated with more favourable oral hygiene indicators. Adults living with mental illness demonstrated substantial unmet preventive oral health needs despite high motivation and perceived competence. These findings highlight a discrepancy between reported motivation and observed oral health behaviours and may inform future oral health promotion within mental health services and primary health care settings.
Background and objectives: Social media use has become pervasive among the general population, with growing concern regarding its potential effects on mental health and sleep. While existing studies report associations between social media engagement and psychological outcomes, limited attention has been given to users' self-perceived impact. To assess the self-perceived impact of social media use on mental health and sleep-related outcomes among healthy adolescents and adults aged 16-50 years old, and to identify associated demographic and behavioral factors. Methods: A cross-sectional survey was conducted among residents of Jeddah, Saudi Arabia, aged 16-50 years without a history of psychiatric or chronic sleep disorders, using a structured online questionnaire. Perceived mental health impact was assessed using a six-item study-specific questionnaire evaluating participants' subjective perceptions regarding emotional and psychological responses to social media exposure. Higher perceived impact was defined as a composite score of 12-24 points on the study-specific scale. Data included sociodemographic characteristics, patterns of social media use, perceived mental health impact assessed through a 6-item Likert scale, and sleep-related outcomes. Associations were evaluated using chi-square tests and logistic regression analysis. Results: Most participants reported daily social media use exceeding 3 h, with 44.9% engaging in late-night use and 87.6% using devices within 30 min before sleep. Overall, 18.6% exhibited higher perceived mental health impact. Higher odds were observed among younger participants, students, and single individuals. Snapchat and YouTube use, and late-night engagement were independently associated with increased perceived impact. Approximately one-third reported insomnia after social media use, and 44.3% perceived improved sleep with reduced usage. Conclusions: Social media use is widely prevalent and commonly perceived to negatively affect mental well-being and sleep, particularly with intensive and late-night use. Self-awareness of these effects may represent a valuable leverage point for prevention, supporting the need for targeted digital wellness strategies and public health interventions.
Shortage of qualified mental health professionals and limited access to specialized care, coupled with a high burden of mental health problems, particularly anxiety and depression, is a growing public health concern in Bangladesh. A possible solution being tested is the utilization of existing community resources. Availability of a psychometrically valid and reliable screening tool for early detection of mental health problems is of paramount importance. The present study aimed at testing the psychometric properties of the Bangla version of the ultra-brief PHQ-4. Employing practicing mental health professionals as data collectors, this cross-sectional study used data from 357 adults from an urban and two rural communities of Bangladesh. Confirmatory factor analysis indicated excellent model fit for the two-factor structure of the Bangla PHQ-4 (χ2 = 0.103 at p > .01, RMSEA = 0.000, CFI = 1.000, TLI = 1.007, and SRMR = .006) for the total sample. The model demonstrated factorial invariance for sex, age, and mental health state. The scale demonstrated high internal consistency (McDonald's ω = .869) and strong construct validity, evidenced by high correlation with the SRQ-20 (r = .747), K-6 (r = .820), self-rated mental health state (r = -.677), and interviewer-rated mental health state (r = -.680). The scale also demonstrates excellent diagnostic accuracy (AUC = .906), and acceptable sensitivity (82%) and specificity (83%) using a cutoff score ≥ 6. This study provided evidence of satisfactory psychometric properties of the Bangla PHQ-4 in terms of factor structure, group level invariance, internal consistency, and construct validity in Bangladeshi rural and urban community samples.
Research on arts engagement and mental health has expanded rapidly in recent years, and a growing body of evidence suggests that participation in artistic and cultural activities is associated with improved well-being, reduced psychological distress, and stronger social connectedness. However, theoretical explanations remain insufficiently integrated. Existing studies identify a wide range of possible mechanisms, including emotional expression, stress reduction, social interaction, identity formation, and meaning-making, yet these processes are often discussed in parallel rather than synthesized within a coherent explanatory framework. In addition, the literature frequently conflates everyday arts engagement with community-based programmes and formal therapeutic interventions, making it difficult to determine what is distinctive about arts engagement as a mental health resource in ordinary social life. In response to these limitations, this article offers a conceptual review and develops a social psychological framework for understanding how arts engagement may influence mental health. It focuses primarily on everyday and community-facing forms of arts engagement in ordinary social life, while drawing selectively on therapeutic and programme-based literature to clarify conceptual boundaries and mechanisms. The article argues that arts engagement should be understood not merely as a leisure activity or cultural exposure, but as a socially organized practice through which individuals gain access to psychosocial resources. To advance this argument, it proposes a four-layer framework comprising socially scaffolded affect regulation, connectedness and belonging, social identity, collective meaning, and the social cure, and agency, recognition, and narrative repair. By integrating these processes within a single conceptual model, the article clarifies how arts engagement may influence mental health, under what conditions these effects are most likely to emerge, and why a social psychological perspective provides a valuable framework for understanding these associations.
Mental health disorders such as depression, anxiety, and stress are prevalent in the general population, with various socio-demographic factors potentially influencing their prevalence. This study aimed to assess the prevalence of Depression, Anxiety, and Stress Scale - 21 Items and identify associated risk factors within the general population in Asir, Saudi Arabia. This cross-sectional study, conducted from April 27, 2025, to September 28, 2025, assessed depression, anxiety, and stress using the Depression, Anxiety, and Stress Scale - 21 Items and identified risk factors in the Asir region of Saudi Arabia. Data from 392 participants were collected through an anonymous online survey and analyzed using descriptive statistics and logistic regression. The study included 392 participants, with 55.1% females and 44.9% males. The largest age group was 18 to 30 years (27.3%). Most participants were nonsmokers (84.2%), 46.7% were employed, and 52% had graduate-level education. A majority were married (61.5%), and 32.9% earned <5000 Saudi Arabian Riyal per month. In terms of mental health, 36.5% were classified as normal for depression, 21.7% for anxiety, and 55.4% for stress. Depression was more common in single individuals (odds ratio [OR] = 4.999, P = .011) and those with 3 to 5 children (OR = 2.232, P = .060). Anxiety was higher in divorced/widowed individuals (OR = 3.828, P = .016) and the unemployed (OR = 2.033, P = .017). Stress was more prevalent in single (OR = 6.304, P = .007) and divorced/widowed individuals (OR = 2.994, P = .094), and those with 3 to 5 children (OR = 3.417, P = .030). Females had lower odds of anxiety (OR = 0.543, P = .021). Age, education, smoking, and income showed limited or nonsignificant associations with mental health outcomes. The study found high levels of depression, anxiety, and stress, with unemployment, being single or divorced, and having more children as significant risk factors. These findings highlight the need for targeted mental health interventions, accessible services, stigma reduction, and preventive strategies addressing social and economic influences on mental well-being.
Background/Objectives: The COVID-19 pandemic had a negative effect on early intervention (EI) delivery to children with developmental delays or disabilities. This study aimed to compare school readiness of children who received, or attempted to receive, EI before, during, and after the COVID-19 pandemic stay-at-home order. Methods: A prospective cohort study was conducted with a single state-funded center that delivers federally mandated EI. School readiness assessments were performed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV). Fisher's Exact tests, and Kruskal-Wallis ANOVA were performed to compare scores in children who began EI in the three time periods related to the COVID-19 pandemic. Results: A total of 56 children were enrolled in this study, the timing of EI start was available in 43, and 22 were able to complete all assessments. Statistically significant differences were found in WPPSI-IV Verbal Comprehension Index T scores (100 ± 15) across the COVID-19 phases, with the lowest scores arising during the pandemic (76.2 ± 9.3); the highest scores, pre-pandemic (98.0 ± 6.2); and intermediate scores, post-pandemic (81.5 ± 10.1, p < 0.05). Many children exhibited mental health concerns, with 29/56 (52%) being referred to community-based mental health services. Conclusions: In this study, lower scores were reported for markers of school readiness in children who received or attempted to receive EI during the COVID-19 stay-at-home orders compared to those pre- and post-pandemic. High mental health needs were identified, particularly among children with mild-moderate symptoms of autism or those who underwent EI during the COVID-19 stay-at-home orders.
This narrative review synthesizes findings from U.S.-based peer-reviewed studies published between January 2020 and May 2025 on peer and non-specialist delivered perinatal mental health support programs for racially, ethnically and culturally diverse populations. Eight quantitative studies demonstrated improvements in depression, anxiety, and parenting outcomes through mechanisms including behavioral activation, cognitive behavior therapy, increased social support, and self-efficacy. Structured peer and non-specialist delivered programs, emphasized social support and culturally resonant approaches, with higher session "dose" linked to grater improvement in mental health outcomes. Trauma-informed models and multi-component interventions integrating culturally adapted cognitive behavior therapy and navigation also reported positive outcomes. Qualitative findings reinforced these mechanisms, with participants highlighting the importance of cultural resonance, trust, and emotional connection. However, no studies conducted formal mediation analyses. Peer‑ and non‑specialist‑delivered perinatal mental health supports show promise in improving outcomes among racially, ethnically, and culturally diverse populations in the U.S. These models draw on behavioral, psychosocial, and relational approaches, however more research is needed to establish effectiveness, guide dissemination, and identify mechanisms of change. Implementation science is critical for advancing scalable models of training and supervision, while policy innovation is needed to create sustainable funding and reimbursement pathways to embed these roles into routine perinatal care. Future efforts should intentionally employ participatory research approaches, ensure cultural relevance, and strengthen partnerships with community‑based organizations to support implementation and maximize equity, feasibility and acceptability.
Extended periods of transit have become a defining feature of migration, driven by restrictive externalization policies globally and under-resourced health and social protection systems in transit countries. Migrants in transit-individuals actively migrating between their place of origin and intended destination-are disproportionately exposed to violence, exploitation, and other adversities that increase their risk for mental health problems. Migrants in transit remain underserved by systems ill-equipped to support mobile populations. To investigate the factors influencing access to mental health and psychosocial support (MHPSS) among migrants in transit, this study used a community-participatory system dynamics approach in Colombia, a key transit country in the Americas. We facilitated 10 group model building workshops in migrant shelters situated along key migration routes to co-develop causal loop and stock-and-flow diagrams illustrating the dynamic processes shaping access to MHPSS. Results revealed three critical delays in the care continuum: barriers to MHPSS awareness, seeking help, and initiating MHPSS. These delays are driven by structural barriers such as legal status, mobility, discrimination, and costs, but may be mitigated through community outreach, leveraging social networks to disseminate information and provide direct support, increasing access to information, providing basic needs and services along migration routes, and improving inter-agency coordination. Findings underscore the urgent need for flexible, low-threshold MHPSS delivery models responsive to migrants' mobility and realities. This study identifies actionable leverage points for multisectoral policy and program innovation to reduce inequities in access to MHPSS for migrants in transit, a growing but underserved population in Latin America and globally.
This study aimed to conduct an exploratory investigation to compare the monthly implementation frequency of community-based group exercises between mildly affected communities (original communities) and severely affected communities (temporary communities) in a municipality affected by the Great East Japan Earthquake in 2011. A cross-sectional survey was conducted from February to March 2014, in Otsuchi town, one of the municipalities most severely damaged by the earthquake. Participants were 85 leaders who were in charge of either an original or a temporary community. The questions pertained to the participants themselves and the frequency of community-based group exercises conducted in their communities in January 2014. Of the 85 community leaders invited, 32 (37.6%) provided usable responses. Community-based group exercises in temporary communities were more frequent than in original communities. The community residents themselves hosted group exercises more frequently in temporary communities than did those in original communities. These exploratory findings suggest that residents in temporary communities may have demonstrated greater initiative in organizing community-based group exercises than those in original communities. This may be attributed to the severity of the disaster's impact and the support for community organizing provided during the recovery phase. Community and public health professionals need to actively promote community organizational activities after a disaster to decrease the likelihood of mental and physical health problems.
Mental health (MH) and substance use (SU) problems are prevalent among people in contact with the criminal justice system, many of whom serve all (or part) of their sentence in the community. Barriers to help-seeking in this population contribute to insufficient support, and later serious adverse outcomes for individuals and society. We aimed to understand variation in the relational context surrounding people in contact with the criminal justice system, and how these differences influence help-seeking for MH or SU problems. We interviewed 50 people in contact with the criminal justice system in a mixed-methods social network analysis study. We collected data about participants' social networks, help-seeking experiences, perceived societal stigma and perceived usefulness of MH and SU support. We developed a network typology by synthesising these data, and explored relationships between network types and help-seeking for MH or SU problems. We demonstrated the feasibility of our exploratory approach to developing a typology of social networks among people in contact with the criminal justice system in the community. Five network types were differentiated by structure, composition, network members' characteristics, and culture. These could be applied to explore influences on a range of behaviours. Knowledge and attitudes towards MH, SU, and help-seeking across the network and within the wider community were important influences on individual help-seeking behaviour. Interventions to encourage help-seeking, and other behaviours, among people in contact with the criminal justice system should consider network type and relational context. Introducing diverse contacts who can provide alternative perspectives may be useful for changing network culture towards different behaviours and facilitating individual change. Tailored messaging and delivery methods are required to increase awareness of MH and SU problems, and of when, where and how to seek help across the networks of people in contact with the criminal justice system. Further research could test our exploratory approach in larger samples and across contexts, examine the impact of network change over time, and rigorously develop and test relationally informed and context-responsive interventions.
Digital inclusion has been recognised as a potential strategy to mitigate loneliness and social isolation among older adults. However, limited studies have explored comprehensive interventions targeting digital access, use, literacy and social participation. This study aims to investigate the effectiveness of the Digital Inclusion for Active Living (DIAL) program in reducing loneliness and social isolation among community-dwelling older adults. A quasi-experimental study was conducted with older adults. Participants were assigned to either an intervention group (receiving the 6-month DIAL program, integrating digital skills training, social networking support and health education) or a control group. Primary outcomes were loneliness measured with the 20-item University of California, Los Angeles (UCLA) Loneliness Scale, and social isolation measured with the Lubben Social Network Scale-6. Secondary outcomes included digital inclusion and social capital. Data were collected at baseline, 3 months and 6 months. The intention-to-treat principle was used to compare the effects of intervention between the two groups. This trial is registered with ChiCTR registry (ChiCTR2400081199, registration date: 20 February 2024). Between 11 March 2024, and 30 September 2024, 126 eligible participants (63 per group) were assessed. The mean age of participants was 70.1 years (SD = 6.24), and 54 (42.9%) were men. The intervention group showed significant reduction in loneliness (B = -0.894, 95% CI = -1.55, -0.24) and improved social network scores (B = 0.394, 95% CI = 0.01, 0.77) versus controls. Time-group interactions revealed sustained improvements in loneliness (B = -2.032, 95% CI = -3.50, -0.56) and social isolation (B = 1.000, 95% CI = 0.28, 1.72) for the intervention group. Secondary outcomes demonstrated increased digital inclusion, social capital and reduced problematic Internet use. The DIAL program was associated with alleviating loneliness and social isolation while enhancing digital inclusion and social capital among older adults. A multifaceted approach combining digital access, literacy and social engagement may improve mental health in ageing populations. Future research should employ randomised trials with larger, more diverse samples to confirm long-term benefits.
Longitudinal research examining community reintegration among military veterans with invisible injuries remains limited, despite widespread recognition that post-separation adjustment encompasses multiple interconnected domains including mental health, physical health, social functioning, and overall well-being. This study investigated associations between changes in reintegration outcomes and changes in health-related quality of life, social support, and flourishing over a two-year period among U.S. military veterans with invisible injuries who separated from service within the previous five years. Seventy-five veterans diagnosed with invisible injuries (post-traumatic stress disorder, anxiety, depression, traumatic brain injury, or adjustment disorder) completed assessments at baseline, 6, 12, 18, and 24 months. Reintegration was measured using the Military to Civilian Questionnaire (M2C-Q) and Community Reintegration of Injured Service Members computer-adaptive test (CRIS-CAT). Health and well-being outcomes included the Veterans RAND Health Survey (VR-12), Patient Health Questionnaire-15 (PHQ-15), Multidimensional Scale of Perceived Social Support (MSPSS), and Secure Flourishing Index (SFI). Mixed-effects models examined associations between changes in reintegration measures and psychosocial outcomes while controlling for demographic characteristics and PTSD symptoms. M2C-Q scores remained stable across waves (F(4,236) = 1.73, p = .14), while CRIS-CAT Participation scores improved significantly (F(4,238) = 10.10, p < .001). Improvements in community participation (CRIS-CAT) were positively associated with subsequent secure flourishing and physical health quality of life. Reductions in reintegration difficulties (M2C-Q) positively influenced social support, secure flourishing, somatic symptoms, and mental health quality of life. Social support and secure flourishing increased significantly between 6 and 24 months, while physical and psychological symptoms remained relatively stable throughout the study period. Findings demonstrate that improvements in community participation and reductions in reintegration difficulties precede positive changes in psychosocial outcomes and physical symptoms. The relative stability of reintegration challenges alongside improvements in community participation suggests these constructs may represent distinct aspects of veteran adjustment. Results suggest the potential for interventions targeting community engagement and social connection during the critical transition period, emphasizing holistic approaches that address both functional participation and subjective reintegration experiences to enhance long-term veteran well-being.
Inflation, recognized as a social determinant of health (SDOH), significantly affects the daily lives of individuals through the rising costs of food, housing, and other basic needs, all of which are public health concerns. Since the COVID-19 pandemic, inflation has become a prominent concern in the U.S. and has been linked to increased stress and poor mental health among adults. While data on inflation is tracked routinely, how it is discussed publicly is understudied. Social media platforms provide insights into how inflation is framed and experienced by the public, and these assessments may be used to determine public health needs and policy advocacy. In this study, we conducted a time-bound, platform-specific case study of inflation-related discourse on X (formerly Twitter). Analysis revealed a predominance of negative sentiments (68.5%) including frustration and distrust. Posts primarily concerned monetary policy/government spending (31.6%), Federal Reserve interest rates/financial markets (24.5%), and U.S. presidential politics (12.9%). The users did not explicitly discuss personal-level hardships, and the discussions largely focused on macro-level issues framed in polarized political perspectives. These patterns matter for public health because institutional trust shapes support for social and health policies. Our study findings suggest a fragmented social environment that may exacerbate community-wide anxiety and challenge health promotion efforts and the need for public health surveillance through surveys or personal interviews to identify and address the psychological burden of inflation.
India experiences a wide mental health (MH) treatment gap, with around 0.73 psychiatrists per 100,000 people, and a massive unmet need for common MH disorders. Task shifting and sharing (TS/S), which is moving tasks from specialists to less-specialised providers, offers a solution but lacks systematic implementation guidance. Unlike more procedural clinical tasks, MH care can involve multiple entry points, varied task types, and contexts where, often, trust outweighs credentials. This paper describes TS/S models in Indian MH space, identifying implementation lessons. We undertook a qualitative assessment, using interviews, focus groups, and observations, studying four organisations (cases): with models of CHW-led screening and rehabilitation across 700 villages in rural Gujarat, multi-level community teams operating 80 clinics in coastal Kerala, corporate peer MH first aiders serving 200,000 + employees, and a planned security force nurse counsellor programme. Data were analysed through SHIFT-SHARE v1.0, a new six-stage guiding framework for TS/S implementation, complemented by alignment measures that we developed for cross-case comparison. Organisations developed novel approaches like deconstructing cognitive behavioural therapy (CBT) into shiftable components, engaging traditional healers as collaborative partners, and cross-subsidisation models for sustainability. However, monitoring and evaluation emerged as the weakest link across cases, and funding structures often failed to recognise clinical services, medication, and supervision as important components of TS/S. MH TS/S differs from procedural task transfer: success needs philosophical alignment among providers, community-suitable capacity building, and outcome measures looking at recovery beyond symptoms. Effective MH TS/S means redesigning services around trust and accessibility instead of delegating professional tasks downward.