Gynaecological cancer survivorship has been addressed in only a limited body of research. After completion of treatment, women with gynaecological cancer face many challenges. It is pertinent that we understand the wellbeing and morbidity issues of this group of survivors, as well as their supportive care needs and use. With this understanding, it will be possible to better target health care initiatives and services to those gynaecological cancer survivors who require help. Accordingly, the objectives of this study were to determine the prevalence of site-specific morbidities, support being utilised, and unmet needs, as well as to determine the correlates of supportive care needs and use. To address this, a cross-sectional mail survey of 1774 Queensland gynaecological cancer survivors three months to five years post-diagnosis was conducted in 2004 (56.5% response rate, n=802 of 1420 eligible participants). Women were recruited from the Queensland Gynaecological Cancer Registry, which covered approximately 85% of all gynaecological cancer patients in Queensland at the time of this study. The questionnaire measured a range of factors to reflect a social-ecological perspective. This broader perspective was utilised to extend the current understanding which is limited to a biopsychosocial approach. Main outcomes were measured with standardised and validated instruments where possible, including the Supportive Care Needs Survey, Functional Assessment of Cancer Therapy, Duke-UNC Functional Social Support Questionnaire and the Active Australia Survey. The results of this survey showed that while quality of life was high on average (median 91, range 30-108), some women experienced debilitating site-specific conditions. Ten percent reported being diagnosed with lower limb lymphoedema and eight percent of women reported that their gynaecological cancer had made sexual relations too difficult or too uncomfortable. Women accessed multiple sources of support within their communities including a variety of support services (54%) and complementary therapies (29%). Characteristics associated with use of support services include: younger age, being retired, having been diagnosed with a gynaecological cancer other than uterine, having had open bowel resection, having been treated at multiple centres, being in remission, being obese. On average, women reported having excellent social support (median 37, range 8-40). Some women made changes to healthier behaviours following their cancer diagnosis, such as increasing their fruit and vegetable intake (23%) or physical activity levels (10%) or decreasing their alcohol consumption (24%) or cigarette smoking (10%); however, nearly half (44%) of women decreased their physical activity level. A population comparison of health behaviours between gynaecological cancer survivors and Queensland women highlighted the significantly lower level of sufficient physical activity and higher level of obesity in the cancer survivor population, as well as the low levels of adequate vegetable intake in both populations. Forty-three percent of gynaecological cancer survivors reported having at least one moderate or high level unmet supportive care need. In particular, needing help with fear about the cancer spreading, concerns about the worries of those close to them, uncertainty about the future, lack of energy/tiredness, and not being able to do things they used to do, were most important to this group. These leading need items were all within the psychological and physical/daily living supportive care domains. Some unmet sexuality and health system/information needs were also reported. Groups with higher odds of unmet needs included those women who more recently completed treatment, whose disease was still present, who had children still living in the home, who had diagnosed lymphoedema, who experienced treatment-related menopause, who were unable to work due to illness and who lived in rural and remote regions of Queensland. These results indicate that women with gynaecological cancer in Queensland are doing quite well overall; however, there is still room for improvement in a few key areas of public health importance. In line with the social-ecological model, resources need to be targeted at all levels of support including personal, social, health care and broader organisational, community, policy and media levels. In particular, the following recommendations are made: 1. Assistance with the particular reported unmet psychological and physical/daily living needs is a priority. Support services should be tailored to the identified groups of survivors who had higher odds of unmet needs, both in terms of development of written materials that reflect these groups' circumstances and implementation of programs or workshops specific to these groups. In particular, the development of a number of programs or workshops are recommended that discuss the specific psychological and physical/ daily living outcomes of women who a) live with cancer, b) live with children after cancer treatment, c) live with lymphoedema, d) have had treatment-related menopause or e) are unable to work due to illness, and how and where women can get help with managing these. These programs should be implemented by support organisations in the period closely following treatment completion and should consider technologies such as video-conferencing to reach women who are in rural and remote areas. 2. More specific written information for cancer survivors about things they can do to help themselves get well is needed, in lay-person friendly format. This information should address the value of particular dietary items, complementary therapies and types of physical activities that are safe and beneficial to cancer survivors' quality of life. 3. An evidenced-based physical activity intervention, targeting overweight and obese gynaecological cancer survivors is recommended, to reduce the weight issues of this population. 4. To facilitate the triage of cancer survivors to appropriate health care information and other support initiatives, cancer survivors' awareness of the Queensland Cancer Fund needs to be raised substantially. Practitioner education and discharge planning directives are recommended to ensure information about the Queensland Cancer Fund is disseminated. 5. To address the substantially unmet information and physical/ daily living needs specific to lymphoedema sufferers, it is recommended that self-management information and referral information for suppliers and services for lymphoedema management be given to women in high lymphoedema risk groups, as part of the hospital discharge procedure, as well as when symptoms are diagnosed, to ensure a continuum of care is maintained. 6. Clinical practice guidelines for cancer care and, correspondingly, support programs, need to expand from acute care to managing the long-term psychological, physical and sexual health consequences. Several topics for research are likely to be important in the future, including more specific research into why uterine cancer survivors reported higher odds of unmet psychological needs and yet were less likely to use support services, what specific help women with unmet needs would prefer, the effects of lower limb lymphoedema on survivors' quality of life, and why there isn't greater use of existing support services, especially among women with morbidity such as lymphoedema and issues associated with treatment-related menopause.

The current study examines the prevalence and severity of psychiatric symptoms in incarcerated youth. A random sample of youth ages 13-17 who were referred for mental health services (n = 120) and not referred for services (n = 120) at a juvenile detention facility were studied. Psychopathology was evaluated using the Diagnostic Interview Schedule for Children and the Child Behavior Checklist. Ninety-six percent of referred youth and 69% of non-referred youth had one or more psychiatric diagnoses. Co-morbidity was common in both groups. The findings suggest that youths in the juvenile justice system have noteworthy psychopathology that often remains unidentified.

The purpose of this study was to determine the factors that influence university students use of health services for mental or emotional reasons. Currently accepted models of health service use may not apply to university students due to their unique socio-demographic characteristics and health challenges. The Andersen and Newman model of health service utilization was used as a conceptual framework. The first hypothesis was that many factors that influence use of services in the general population would also apply to the university student population. The second hypothesis was that some student-specific factors would also influence health service utilization for mental or emotional reasons. <p>Data for this study was collected in a survey designed for a larger health needs assessment of University of Saskatchewan undergraduate students. The dependant variable was the use of services for mental or emotional reasons within the past year. Information was also collected for 26 independent variables. A logistic regression was used to determine which of these were related to the dependant variable. <p>The final model of health service utilization for mental/emotional reasons among university students included six independent variables: 1) perceived need for professional help (for emotional problems), 2) previous depression diagnosis, 3) past/present suicide ideation, 4) sexual assault victimization, 5) presence of a family doctor, and 6) gender.<p>The results of this study indicate that many of the factors that influence service use for mental/emotional reasons in the student population are the same as those that exist in the general population. The results also suggest that student-specific factors, such as college, years in university, or academic performance do not influence health service use for mental/emotional reasons. Implications of these findings are discussed.

The purpose of this study was to determine the factors that influence university students use of health services for mental or emotional reasons. Currently accepted models of health service use may not apply to university students due to their unique socio-demographic characteristics and health challenges. The Andersen and Newman model of health service utilization was used as a conceptual framework. The first hypothesis was that many factors that influence use of services in the general population would also apply to the university student population. The second hypothesis was that some student-specific factors would also influence health service utilization for mental or emotional reasons. <p>Data for this study was collected in a survey designed for a larger health needs assessment of University of Saskatchewan undergraduate students. The dependant variable was the use of services for mental or emotional reasons within the past year. Information was also collected for 26 independent variables. A logistic regression was used to determine which of these were related to the dependant variable. <p>The final model of health service utilization for mental/emotional reasons among university students included six independent variables: 1) perceived need for professional help (for emotional problems), 2) previous depression diagnosis, 3) past/present suicide ideation, 4) sexual assault victimization, 5) presence of a family doctor, and 6) gender.<p>The results of this study indicate that many of the factors that influence service use for mental/emotional reasons in the student population are the same as those that exist in the general population. The results also suggest that student-specific factors, such as college, years in university, or academic performance do not influence health service use for mental/emotional reasons. Implications of these findings are discussed.

Despite growing evidence that anxiety can be a significant problem in late-life, information regarding the use of mental health services by older adults for anxiety is lacking. The current research project consists of three studies focusing on this issue. The first study examines the rates of mental health service use among older adults with anxiety disorders and high levels of anxiety symptoms, as well as individual characteristics associated with this use. The second study examines various aspects of social support as correlates of anxiety disorders in older adults, and the role of social support as an enabling resource for mental health service use. Finally, the third study examines three important outcomes of service use among older adults: treatment satisfaction, perceived treatment effectiveness, and dropout. The data for these studies came from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), a national population-based survey that includes 12,792 respondents aged 55+ years. This research found that older adults with significant anxiety were less likely to use services than those with mood disorders, and that indicators of need for services were the strongest predictors of use. Lower levels of functional social support were related to the presence of anxiety disorders among older adults, and lower levels of perceived emotional/informational support and positive social interactions predicted greater use of services for adults throughout the lifespan. Finally, older adults were generally satisfied with services, perceived them as helpful, and were likely to remain in treatment. Analyses indicated that individual characteristics likely play only a small role in these outcomes. In general, this project provides new and important information that can inform policy, clinical work, and future research regarding late-life anxiety.

Despite growing evidence that anxiety can be a significant problem in late-life, information regarding the use of mental health services by older adults for anxiety is lacking. The current research project consists of three studies focusing on this issue. The first study examines the rates of mental health service use among older adults with anxiety disorders and high levels of anxiety symptoms, as well as individual characteristics associated with this use. The second study examines various aspects of social support as correlates of anxiety disorders in older adults, and the role of social support as an enabling resource for mental health service use. Finally, the third study examines three important outcomes of service use among older adults: treatment satisfaction, perceived treatment effectiveness, and dropout. The data for these studies came from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), a national population-based survey that includes 12,792 respondents aged 55+ years. This research found that older adults with significant anxiety were less likely to use services than those with mood disorders, and that indicators of need for services were the strongest predictors of use. Lower levels of functional social support were related to the presence of anxiety disorders among older adults, and lower levels of perceived emotional/informational support and positive social interactions predicted greater use of services for adults throughout the lifespan. Finally, older adults were generally satisfied with services, perceived them as helpful, and were likely to remain in treatment. Analyses indicated that individual characteristics likely play only a small role in these outcomes. In general, this project provides new and important information that can inform policy, clinical work, and future research regarding late-life anxiety.

Background: The proportion of people with mental disorders in treatment is relatively small in low and middle income countries. However, little is known about patterns of recent service use in a country like South Africa. Methods: A nationally representative household survey of 4,351 adult South Africans was carried out. Twelve-month DSM-IV disorders were determined using the WHO composite international diagnostic interview (CIDI). Prevalence and correlates of treatment were assessed among respondents with anxiety, mood and substance use disorders. Results: One-fourth (25.5%) of respondents with a 12-month disorder had received treatment in the past 12 months either from a psychiatrist (3.8%), nonpsychiatrist mental health specialist (2.9%), general medical provider (16.6%), human services provider (6.6%), or complementary-alternative medical (CAM) provider (5.9%). Only 27.6% of severe cases had received any treatment. In addition, 13.4% of respondents with no disorder had accessed services in the past year. Blacks were significantly more likely than other racial groups to access the CAM sector while Whites were more likely to have seen a psychiatrist. Conclusions: The majority of South Africans with a 12-month mental disorder have unmet treatment needs. In addition to a greater allocation of resources to mental health services, more community outreach and awareness initiatives are needed.

We describe the mental health referral rate among youth in a correction facility, examine how sociodemographic and criminal history characteristics relate to referral, and explore how these variables and diagnostic class differ by referral source. Data were abstracted from case records. The referral rate was low (6%). Non-Latino youth, repeat offenders, and violent offenders were more likely to be referred compared to all detained youth. Referral source also varied by violent offense history and diagnosis type. Future studies examining access to mental health services should take into account a detained youth 's sociodemographic, criminal history, and clinical characteristics.

Mental and behavioral health difficulties are prevalent among children, and research suggests that the vast majority of these children do not receive needed services. Treatment disparities are even larger among rural youth given the scarcity of qualified specialty mental health providers, increased barriers to care, and greater mental health-related stigma compared to their urban counterparts. Many parents seek help and resources from their child’s primary care provider (PCP); however, the comprehensive management of psychosocial and behavioral concerns are often not feasible in traditional primary care settings. Integrating behavioral health services into pediatric primary care clinics has the potential to increase access to needed services, improve comprehensiveness and quality of care for patients, and reduce burdens on PCPs. Research on integrated behavioral health (IBH) models have indicated that it is a cost-effective service leading to improved treatment outcomes compared to usual primary care and that parents and physicians are generally satisfied and interested in this service delivery model. However, little is known about parents’ attitudes toward IBH and factors that may influence the acceptability of this type of care. Previous research has identified several factors associated with parent acceptability of mental health services for their child including symptom severity, attitudes toward child therapy, parenting stress, stigma, perceived barriers to care, and past experiences with services. However, it is unclear how these factors influence attitudes toward IBH, especially in rural areas. The current study examined parents’ attitudes toward co-located and integrated models of care, identified factors that affect acceptability of IBH, and explored differences between rural and urban parents’ attitudes. Results demonstrated that both rural and urban parents hold generally favorable attitudes toward IBH models and that parent attitudes toward general child therapy was strongly associated with IBH acceptability. Demographic variables (e.g., parent age, child age, minority status, socioeconomic status), need characteristics (e.g., parenting stress, child psychosocial symptoms), and other enabling factors (e.g., mental health-related stigma, prior service use, barriers to care) were not predictive of parent IBH acceptability. Urban parents rated co-located models of care as more acceptable and reported higher levels of parent psychosocial symptoms, stigma, and barriers to care compared to rural parents. These findings support efforts to continue integrating behavioral health services into pediatric primary care and highlight parent therapy attitudes as an important target for intervention to improve parent IBH acceptability. Findings also shed light on the need for more mixed-method research to understand the impact rural identity has on the acceptability and use of behavioral health services.

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