1. Any selected mental or alcohol disorder is comprised of: major depressive episode, post traumatic stress disorder, general anxiety disorder, panic disorder, and alcohol abuse or dependence. However, these disorders cannot be added to create this rate because the disorders are not mutually exclusive, meaning that people may have a profile consistent with one or more of these disorders.
All statistical analyses were undertaken using the statis- tical software package STATA (version 10.0) . The majority of the data reported are descriptive statistics (percentages with their 95% confidence intervals). To compare barriers to care amongst regulars, reserves, and veterans, and those with and without mentalhealth pro- blems, unadjusted and adjusted odds ratios are pre- sented together with their 95% confidence intervals. Odds ratios were derived using logistic regression analy- sis and were adjusted for socio-demographic (age, sex, marital status, educational status) and military (rank, Service, deployment status, role) characteristics that were associated with at least one barrier to care state- ment and the key variable such as serving status or mentalhealth diagnosis. Responses to each barrier to care questions were grouped into ‘ agree ’ (strongly agree and agree) and ‘ disagree ’ (strongly disagree and dis- agree). Responses of ‘ neither agree nor disagree ’ were excluded from the analysis . The number reporting ‘ neither agree nor disagree ’ ranged from 26 (for ‘ don ’ t have adequate transport ’ ) to 188 (for ‘ my bosses would blame me for the problem’). All analyses took account of the sample weights by using the survey (svy) com- mands in STATA.
1581 2014 American National Survey on Drug Use and Health, (NSDUH) . There are 14,555 respondents in the first survey, and adolescents are over-sampled. The propor- tion of the sample 21 or younger is 32.6%. There are two endogenous variable of inter- est. These are “self-reported physical health” and “self-reported mentalhealth”. Both of these variables are categorical with five outcomes running from poor to excellent. Ex- planatory variables include current smoking behavior whose three categories are smoking cigarettes every day, occasionally, or not at all. Age of first daily use of alcohol and marijuana are included. Alcohol use is described by an eight category variable de- scribing drinking behavior over the last twelve months. This runs from daily or almost daily to less than once a month. The residual category is never. Marijuana use is de- scribed by a frequency variable over the last three months. The categories run from daily or almost daily to once or twice. The residual category is never. The other availa- ble variables are age, gender and province of residence.
The results of this study add to an existing body of literature on factors correlated with the expression of PCS by demonstrating that mentalhealth problems are the strongest factor associated with PCS in individuals with a deployment related mTBI. The question as to why this association exists remains a matter of conjecture. A recent review on the etiology of persistent PCS examined the plausibility of several explanations . One of these is that the association is an artefact of symptom overlap between PCS and comorbid psychiatric conditions . While this likely is a contributing factor to effect sizes observed in the literature, our study still observed a strong association of mentalhealth problems with PCS even after removing the most highly overlapping mentalhealth symptoms (depression, anxiety) in our PCS definition. Similarly, another study of military veterans found that in-theatre PTSD was more associated with health out- comes then mTBI even after excluding irritability and difficulty concentrating from their PTSD measure . Another hypothesis is that mTBI acts as a “third common-causal variable” by producing both PCS and psychiatric disorders . Theoretically, neurochemical changes that develop in the acutely injured brain could contribute to the development of later psychiatric path- ology in the form of depression, PTSD, and generalized anxiety disorder. However, it is unclear whether the devel- opment of a psychiatric syndrome is the pathophysiologic consequence of brain injury or is a manifestation of a generalized psychological response to trauma and/or the resulting disability . Although each of these explana- tions may account for some of the variation in the expres- sion of persistent PCS, the likely stronger explanation is that psychological factors play an important role in the earliest stages of recovery from mTBI . This is based on evidence that psychological distress is fairly common in the initial days after an mTBI and correlates with initial PCS severity [69,70] and is among the best acute stage predictors of late PCS outcome .
This study has some limitations. It is a secondary cross-sectional survey; the time to the second point of post-exposure was limited to two months and did not allow for a control group or randomization. Further, the slightly high attrition (35%) at 2-month follow-up re- quires caution in interpreting the data from this time point. The improvement in attitudes although statisti- cally robust was based on a small absolute score im- provement, which raises a question about how much improvement in attitude scale scores may be needed to translate into de-stigmatized behaviors. This problem of interpreting changes in attitudes scores is not unique to this study and future research will need to consider how to determine the relationship between significant changes in attitude scale scores and meaningful changes in attitudes and behavior. Costs of the application were not addressed, but were minimal and the approach lends itself to the creation of teacher training teams that may provide sustainable and cost-effective capacity that is ad- ministratively easy to implement. We are aware of these limitations and a randomized control trial and further evaluations that may effectively address them are currently underway.
Individuals living on Indian reserves, Crown Land or institutional residence, fulltime members of the Canadian armed forces and residents of certain remote regions were excluded from the sampling frame due to limited accessibil- ity. These groups account for less than 2% of the Canadian population, and it is not likely that their inclusion would have had a significant effect on the overall results.
the two main types of social capital (bonding and bridg- ing), OOM trust would arise from bonding relations given their closed nature and emphasis on family values [29,103]. However, their mutual aid program, care for the elderly/disabled, legendary “barn raisings” etc. have an international reach that provide OOMs with bridg- ing-like benefits normally acquired by members of main- stream populations through participation in volunteer organizations (e.g., information, advice, work opportuni- ties). Other evidence suggests that OOM trust may be more generalized and include bridging relations. For example, the research team received an extremely posi- tive response from the OOMs, including endorsement of the research agenda and unsolicited offers of help that facilitated community engagement and enabled analyses not otherwise possible. Also, OOMs reported higher lev- els of trust in our survey for both 1) family/friends, and 2) strangers and first time acquaintances (who would be mainly non-OOMs). These results are consistent with studies finding that informal network trust is a prototype for generalized trust . High levels of generalized trust among OOMs may seem surprising, given their cultural separation and resistance to change because of a fear it will disrupt group unity . However, the local context is also recognized as uniquely supportive, with the OOMs held in high regard by Waterloo’s secular community and its many Mennonite groups [47,61]. This supportive environment is thought to contribute to the high degree of tolerance of outsiders demonstrated by Waterloo OOMs, a feature rarely seen in Gemeinschaft cultures . High trust levels among OOMs may also originate from religious doctrine. Reference [91, p. 145] notes that OOMs “believe in loving others as ourselves, even our enemies. It is our conviction that by living in this manner, we are only doing what is expected of Christians”. Such unconditional love would be difficult to sustain without generalized trust. Regarding the mechanisms underlying the protective effect of high trust on mentalhealth, it has been postulated that social influ- ence and social support impact health through behav- ioural and psychological pathways such as stress reduc- tion and promotion of a strong sense-of-place [33,103, 106]. Reference  theorizes that the psychological pathway is particularly relevant to trust. The low stress levels, high trust and sense-of-place levels, and health linkages of these in OOMs do not contradict the theory of a psychological pathway linking trust with health.
Second, teachers face many unique challenges and have a significant amount of pressure not experienced in other occupations. To start, teachers must understand the different academic abilities of each student in their class and tailor lesson plans accordingly, within the boundaries of the strict curriculum guidelines mandated of them (Darling-Hammond, 2000). This becomes difficult when teachers are trying to manage multiple students’ individualized challenges, such as intellectual disabilities, externalizing behaviours (e.g., aggression, hyperactivity), language barriers (i.e., English as Second Language), social concerns, mental illnesses etc. (Rothi, Leavey & Best, 2008). To add to the complexity, in today’s classroom, there often is not just one student that requires specialized support, but rather upwards of 7 students out of a maximum of 30 students in each classroom (Research and Assessment Services, 2015). This highlights the necessity for teachers to be knowledgeable and competent in facilitating learning in tailored ways and supporting students in ways that are above and beyond their general job descriptions with very little support. In a recent survey of teachers in Ontario, Canada the majority of teachers (79%) stated they “changed the way they interacted with students they perceived as having emotional or behavioural issues to reach the students more effectively” (Research and
The sample was equally distributed in the study area among the various neighbourhoods. Data was collected randomly from June to December 2009 by specially trained interviewers. Only one person per target house- hold was selected using procedures and criteria contained in the National Population HealthSurvey . For pur- poses of recruitment, the interviewers had phone contacts with individuals who agreed to participate in the study within the week during which they were recruited, in order to schedule a face-to-face meeting either at the par- ticipant’s home or in an office designated for that purpose at the psychiatric hospital. Most interviews, however, were conducted at the participant ’ s home. The face-to-face interview was conducted once a consent form was signed, and lasted from a minute and a half to three hours depending on whether a mental disorder was detected or not. Interviewers used portable computers. The research was approved by relevant ethics boards.
Rosenheck found respondents with fair or poor SRMH were older, less likely to have a high school education, and had more self-reported mental or physical condi- tions . In 2000, O’Donell examined SRMH among veterans and non-veterans and found lower SRMH for the latter but this group difference was eliminated on controlling for demographic, socioeconomic, and health- related factors . In 2005, Cohen and Patten found a gender effect among Alberta medical residents; more males reported excellent SRMH than female residents. Overall 17% of residents reported fair or poor SRMH compared to 8% in national community healthsurvey . In 2006, Shields found that low satisfaction with job was related to fair or poor SRMH . In 2008, Zuvekas and Flieshman found poorer SRMH among those who had a lower income, were less educated, female, or aged 41–60 . In 2010, De Castro examined NLAAS data finding that employment frustration was associated with low SRMH even after controlling for gender, age, ethnicity, education, occupation, income, whether immigrated for employment, years in the United States, English proficiency, and a gen- eral measure for everyday discrimination . In 2010, Maximova et al. examined resettlement experiences of Canadian refugees and found that having employment and access to settlement services were associated with improve- ments in SRMH while time spent in a refugee camp and having held a professional job in home country were asso- ciated with a decline in SRMH .
Mentalhealth clinicians from the Operational Stress In- jury clinics, CanadianForcesmentalhealth services, and the broader Canadian community are eligible to partici- pate in the study if they: attend a CPT workshop; are licensed as a mentalhealth clinician and are able to practice independently; currently provide psychotherapy to patients with PTSD; consent to be randomized to one of the study conditions; and are willing to solicit patient participation. Eligible patient participants are: diagnosed with PTSD; and consent to have their sessions audio- recorded and listened to by a fidelity rater and potentially other clinicians teaching and learning CPT. Patients are permitted to continue other psychothera- peutic interventions if they are not specifically focused on treating PTSD symptoms. Ineligible patients include those not eligible for CPT based on the state of research evidence, including those with: current uncontrolled psychotic or bipolar disorder; substance dependence; imminent suicidality or homicidality that requires acute care; and significant cognitive impairment (although mild to moderate traumatic brain injury is permitted).
Climate change is increasing population exposure to weather-related hazards, such as extreme precipitation events, storms and flooding [1,2]. In the UK, the government has identified flooding as posing particularly high risks to people and communities . Alongside damage to homes and businesses, there is disruption to domestic utilities and transport links . Exposure to extreme weather events such as flooding results in ‘psychological casualties’ , with significant impacts on mentalhealth. Capturing the mentalhealth impacts of extreme weather events such as storms and floods presents many research challenges. Large representative surveys are required to compare the mentalhealth of exposed and non-exposed populations in analyses with measures of other factors (for example, an individual’s financial circumstances) that may explain associations between storm or flood exposure and mental ill-health. A review of evidence on the mentalhealth of flood-exposed populations found that the large majority (77%) of studies did not include a comparison group and noted a lack of attention to potential confounders like socioeconomic status . Additionally, robust studies require detailed measures of people’s mentalhealth, including treated and untreated mentalhealth disorders, based on clinically validated diagnostic criteria. Only well-resourced health surveys are equipped to collect such information for large population surveys .
The following year, following on the success of the ALIR, one of the authors of this report developed an UK Life in Recovery (UKLIR) survey (Best, Albertson, et al., 2015). The UKLIR resulted in 802 successful completions. The average length of time UK respondents had been in recovery was 8.3 years (with a wide range of 0-54 years), with an average age of initiating the recovery journey being 38.4 years (range of 15 to 69 years). The authors found that "the longer recovery can be sustained, the more the benefits are accrued to the individual, their families and their communities. … this survey echoes the findings of prior recovery surveys in Australia and the US, adding to a growing body of evidence suggesting that while recovery can be a broad and differentiated experience, it is one that should be celebrated, acknowledged and supported across communities" (Best, Albertson, et al., 2015, p36).
Population determinants of health and disease are more likely to vary across countries than within countries, but it is impossible to generalize the strength and direction of associations across populations and time . There- fore, a global approach is considered fundamental to ‘public health epidemiology’ because it allows identification of international patterns that lead to hypothesis generation, essential to scientific progress . In addition, these studies generally estimated the association by using only one socioeconomic factor with clinical indicators of dental disease. Few studies have tackled both subjective (health) and objective or normative (disease) aspects . Some have focused on low to middle income countries, with few cross-national comparisons [13–18]. Hence, the aim of this paper is to compare the magnitude of socioeconomic in- equality in oral health and dental disease using representa- tive datasets of adults in Australia, Canada, New Zealand and the United States.
We surveyed those individuals with celiac disease who were members of the Celiac Association which could have resulted in selection bias. Not all individuals with celiac disease will choose to become or remain members. One potential limitation of our survey is that we did not have a control group of non-celiac subjects however, the purpose of the survey was to describe the clinical charac- teristics of the celiac population. Another limitation is that this was a cross-sectional survey and so we did not evaluate quality of life in a longitudinal fashion. The data is self-reported which could result in bias, however we feel that this was less of an issue given the confidentiality measures that were taken. The accuracy of some of the data such as bone density measurement is subject to recall bias. We attempted to minimize social response bias by ensuring confidentiality.
As was suggested in  the health impacts of the number of cigarettes smoked per day and BMI were quali- tatively very similar in their significant adverse associations with self-reported health, having coronary heart disease or diabetes. The results in this table for doctor visits are even clearer and show that obesity is now sig- nificantly more important than smoking in determining the frequency of this type of contact with the health sys- tem. For both men and women, individuals who are obese (BMI of at least 30) have more visits to their GP or family doctor than daily smokers. This is evident when daily smokers with BMI less than 25 are compared to non-smokers with BMI of at least 30. For 8 of the 10 age groups the number of doctor visits was more for res- pondents with a BMI at least thirty than for normal weight daily smokers. The two exceptions are males aged 20 - 29 and females aged 40 - 49.
The significant association between missing tooth number and OHIP scores was in agreement with pre- vious studies [2,20,25,26], which suggest a patient with more missing teeth is likely to suffer from more OHR- QoL impairments. However, and also in agreement with previous studies, the correlation between the key charac- teristics of physical oral health and how subjects per- ceive their oral health is not substantial. The prevalence and severity of oral impacts also increased by usage of removable dentures, which is associated with a signifi- cant elevation of the OHIP score, as previously reported [12,23,27]. It should be noted that the number of miss- ing teeth, which itself has a significant effect on OHR- QoL, is larger in those who use removable dentures. Therefore, the presence of removable partial dentures does not necessarily cause impaired OHRQoL. It is just an indicator of impaired OHRQoL. In fact, removable dentures may improve perceived oral health in subjects with missing teeth because of its effect on oral functions such as chewing, speaking, appearance and psychosocial well-being - our study because of its cross-sectional design cannot evaluate the directionality of the denture status-OHRQoL relationship. Tooth loss ’ impact on OHRQoL can be compensated best with fixed partial dentures or implant dentures. When the number of teeth drops below a certain level and the tooth loss can- not be treated by fixed partial dentures, very likely the removable dentures, even if done to the highest stan- dard in the profession and even if the dentures’ quality impact on the OHRQoL  is maximized, cannot com- pletely recover lost OHRQoL due to tooth loss. There is a significant cut off point of OHRQoL when a patient moves from the situation where he or she has intact dentition or missing teeth are replaced by fixed partial dentures to the situation where subjects use removable dentures . The clinical implication for military per- sonnel as well as nonmilitary subjects - is that tooth loss should be prevented as much as possible but when it happens, a major deterioration of oral health can be avoided when the magnitude of the tooth loss can still be compensated with fixed prosthodontics and extensive tooth loss, and the use of removable partial denture can be avoided.
mentalhealth care is provided by the employer, which means there is an increased risk of having one ’ s superiors find out about one ’ s health status (e.g., if an individual needs to be sent home for a medical reason while on training or deployed). Confidentiality issues appear to be a top concern for members as a recent qualitative study examining barriers to care among military health care pro- viders found concerns about confidentiality was one of the top system-level barriers . Also, there is a general focus on being strong and tough within the military , which may enhance negative opinions of those who have a physical or mentalhealth issue and are no longer able to do the same tasks they were once able to do. Last, due to the high physical and mental demands of the job and the strict fitness and health standards, physical and mentalhealth issues have a substantial impact on job performance . This may be problematic, as a study by McLaughlin, Bell, and Stringer  found work impact was the only sig- nificant predictor among a set of variables (e.g., onset con- trollability, social impact of disability) to consistently predict stigma and acceptance. That is, the more one’s health issue impacted one’s work, the more stigma and less acceptance were reported by colleagues.
This study aims to examine the relationship between mentalhealth literacy and depression, in a population of Chinese adolescents. The results suggest that an inad- equate mentalhealth literacy level is significantly associ- ated with moderate to severe level of depression as measured by the Depression sub-scale of the DASS. The point estimate prevalence of an adequate mentalhealth literacy obtained from this study is low in comparison to those reported in the literature, particularly studies con- ducted in Australia by Jorm et al. [22,25] In one of their earlier studies in 2005 found that almost half of the respondents could not identify depression correctly . However, in a later study in 2011 the rate of correct rec- ognition of depression was found to be about 75% . Similar results on the recognition of depression symp- toms were also found in another study carried out in Australia more recently. It was reported that 70% of higher education students were able to recognise depres- sion in a vignette . In comparison, only 23.4% of re- spondents in this study correctly identified the vignette as depression. The low rate of correct identification of depression could be related to the fact that the respon- dents were younger and might have less personal experi- ence of depressive mood. It could also be related to the possibility that there is a lack of mentalhealth education specifically designed to target young people in the geo- graphic locality where the survey took place. In terms of the results obtained on the relationship between mental Table 1 Frequency (%) of the characteristics of study
Data were downloaded from Survey Monkey  to SPSS version 20  for analysis. Descriptive statistics were used to profile participants and quantify responses regarding experience of influences on recruitment and perceptions of impact. Frequency data were tabulated for categorical variables and means (M) and standard de- viations (SD) calculated for continuous data. Free text responses were entered onto Microsoft Word and sub- ject to thematic analysis using the framework approach  which supported examination of responses relevant to research objectives and matters arising in respon- dents’ comments. The first step in the qualitative ana- lysis was to populate an initial frame comprising cells representing ‘research objective by participant’ with data from open questions, with multiple allocations possible. New cells were created as required to accommodate data. Once all data were allocated to cells, constant com- parison and analytic questioning were employed to dis- cern patterns and exceptions in the data. The frame was iteratively developed to support exploration of data-based questions generated as analysis progressed (for example, to examine the ways ‘culture’ impacted recruitment) and relationships between the themes. Finally quantitative and qualitative findings were triangulated to construct the nar- rative account presented below, which includes verbatim quotations in “italics”. Analysis was supported throughout by individual and team reflexivity as developing findings were subject to intellectual and critical scrutiny . This scrutiny was underpinned by a pragmatic commitment to developing findings which could be usefully applied to real world problems.