Mental health troubles among Cameroonian adolescents perinatally infected with Human Immunodeficiency Virus

IntroductionAdolescents living with HIV are more likely to experience mental health challenges compared to their peers who do not have HIV. However, there is a lack of data regarding the mental health of adolescents living with HIV in Cameroon. Understanding risk factors and protective factors that influence mental health amongst adolescents is critical for effective programming. The purpose of this study was to estimate the prevalence and the factors associated with depression in adolescents infected with HIV and receiving ART in a Cameroonian referral hospital.MethodsThis was a cross-sectional study which enrolled adolescents perinatally infected with HIV, aged 10–19 years, on antiretroviral treatment and cared for at “Centre Mère et Enfant de la Fondation Chantal Biya”, Yaounde, Cameroon. Structured questionnaires, including validated French versions of the Coopersmith Child Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC) and the Coopersmith Self Esteem Inventory (SEI), were administered to the study participants by the healthcare providers.ResultsAll in all, 302 adolescents were recruited in the study at a median age of 15.2 years (interquartile range : 12.0 – 17.5), including 159 (52.7 %) girls. Both parents had died for 57 (18.9 %) adolescents ; only the father was alive for 64 (21.2 %) ; only the mother was alive for 48 (15.9 %), both parents were alive for 133 (44.0 %). This study found prevalence of 26.5 % for severe depression, 36.4 % for suicidal ideation, 29.1 % for high/very high anxiety, and 20.5 % for low self-esteem. No factor was found significantly associated with severe depression but there was a trend towards decreased risk of severe depression among adolescents whose mother was alive [OR= 0.4 (0.1–1.0), p = 0.084].ConclusionThis study found that elevated depression, anxiety, and low self-esteem symptoms were prevalent among Cameroonian adolescents perinatally infected with HIV. Services and systems should go beyond clinical management of HIV and address the psychosocial and mental health of adolescents. The indicators of mental health among adolescents infected with HIV should be included in HIV program reporting.     

Longitudinal associations between changes in screen-time and mental health outcomes in adolescents

IntroductionThe primary aim was to examine longitudinal associations between changes in screen-time and mental health outcomes among adolescents.MethodsAdolescents (N = 322, 65.5% females, mean age = 14.4 ± 0.6 years) reported screen-time and mental health at two time points over a school year. Multi-level linear regression analyses were conducted after adjusting for covariates.ResultsChanges in total recreational screen-time (β = −0.09 p = 0.048) and tablet/mobile phone use (β = −0.18, p < 0.001) were negatively associated with physical self-concept. Changes in total recreational screen-time (β = −0.20, p = 0.001) and computer use (β = −0.23, p = 0.003) were negatively associated with psychological well-being. A positive association was found with television/DVD use and psychological difficulties (β = 0.16, p = 0.015). No associations were found for non-recreational screen-time.ConclusionChanges in recreational screen-time were associated with changes in a range of mental health outcomes.     

The Protective Roles of Exercise and Maintenance of Daily Living Routines for Chinese Adolescents During the COVID-19 Quarantine Period

PurposeAdolescents are particularly vulnerable during the COVID-19 quarantine periods and may be at risk for developing psychological distress symptoms that extend beyond a crisis, including depression. This study examined adolescents’ postquarantine depressive symptoms associated with pandemic stressors. The primary aim was to identify potential protective factors that may buffer the association between the presence of COVID-19 cases in adolescents’ communities and their postquarantine depressive symptoms.MethodsAdolescents from public schools were recruited from Zhengzhou city, Henan, China (N = 1,487, M_age=13.14 years, 50% girls). Adolescents reported the presence of confirmed or suspected COVID-19 cases in their communities, their daily activities and routines during the 2-month quarantine period, and depressive symptoms after the quarantine period.ResultsThe presence of cases in adolescents’ communities during the quarantine contributed to more depressive symptoms in adolescents after the quarantine. This association was buffered by adolescents’ spending more time on physical activities and better maintenance of daily living routines during the quarantine period. The presence of community infection was also more strongly associated with depressive symptoms in older adolescents.ConclusionsThe presence of COVID-19 cases in communities contributed to adolescents’ poorer mental health, and the association was stronger for older adolescents. Spending time on physical activities and maintaining daily living routines during the quarantine appear to be practical strategies that can be used by adolescents to mitigate the association between pandemic stressors and their diminishing mental health.     

A Longitudinal,Randomized, Controlled Trial of Advance Care Planning for Teens With Cancer: Anxiety,Depression, Quality of Life,Advance Directives,Spirituality

PurposeTo test the feasibility, acceptability and safety of a pediatric advance care planning intervention, Family-Centered Advance Care Planning for Teens With Cancer (FACE-TC).MethodsAdolescent (age 14–20years)/family dyads (N = 30) with a cancer diagnosis participated in a two-armed, randomized, controlled trial. Exclusion criteria included severe depression and impaired mental status. Acceptability was measured by the Satisfaction Questionnaire. General Estimating Equations models assessed the impact of FACE-TC on 3-month post-intervention outcomes as measured by the Pediatric Quality of Life Inventory 4.0 Generic Core Scale, the Pediatric Quality of Life Inventory 4.0 Cancer-Specific Module, the Beck Depression and Anxiety Inventories, the Spiritual Well-Being Scale of the Functional Assessment of Chronic Illness Therapy–IV, and advance directive completion.ResultsAcceptability was demonstrated with enrollment of 72% of eligible families, 100% attendance at all three sessions, 93% retention at 3-month post-intervention, and 100% data completion. Intervention families rated FACE-TC worthwhile (100%), whereas adolescents' ratings increased over time (65%–82%). Adolescents' anxiety decreased significantly from baseline to 3 months post-intervention in both groups (β = −5.6; p = .0212). Low depressive symptom scores and high quality of life scores were maintained by adolescents in both groups. Advance directives were located easily in medical records (100% of FACE-TC adolescents vs. no controls). Oncologists received electronic copies. Total Spirituality scores (β = 8.1; p = .0296) were significantly higher among FACE-TC adolescents versus controls. The FACE-TC adolescents endorsed the best time to bring up end-of-life decisions: 19% before being sick, 19% at diagnosis, none when first ill or hospitalized, 25% when dying, and 38% for all of the above.ConclusionsFamily-Centered Advance Care Planning for Teens With Cancer demonstrated feasibility and acceptability. Courageous adolescents willingly participated in highly structured, in-depth pediatric advance care planning conversations safely.     

Process evaluation of an intervention to improve HIV treatment outcomes among children and adolescents

SETTING:Children and adolescents with HIV encounter challenges in initiation and adherence to antiretroviral therapy (ART). A community-based support intervention of structured home visits, aimed at improving initiation, adherence and treatment, was delivered by community health workers (CHWs) to children and adolescents newly diagnosed with HIV.OBJECTIVES:To 1) describe intervention delivery, 2) explore CHW, caregiver and adolescents’ perceptions of the intervention, 3) identify barriers and facilitators to implementation, and 4) ascertain treatment outcomes at 12 months’ post-HIV diagnosis.DESIGN:We drew upon: 1) semi-structured interviews (n = 22) with 5 adolescents, 11 caregivers and 6 CHWs, 2) 28 CHW field manuals, and 3) quantitative data for study participants (demographic information and HIV clinical outcomes).RESULTS:Forty-one children received at least a part of the intervention. Of those whose viral load was tested, 26 (n = 32, 81.3%) were virally suppressed. Interviewees felt that the intervention supported ART adherence and strengthened mental health. Facilitators to intervention delivery were convenience and rapport between CHWs and families. Stigma, challenges in locating participants and inadequate resources for CHWs were barriers.CONCLUSION:This intervention was helpful in supporting HIV treatment adherence among adolescents and children. Facilitators and barriers may be useful in developing future interventions.     

Adolescent E-Cigarette Onset and Escalation: Associations With Internalizing and Externalizing Symptoms

PurposeWe sought to evaluate if internalizing symptoms (i.e., anxiety and depression) and/or externalizing symptoms (i.e., impulsivity, sensation seeking, and substance use) were risk factors for the onset of 30-day e-cigarette use and escalation in the number of days used across the following 30 months among adolescents.MethodsAdolescents (N = 1,808) from public high schools outside Philadelphia, PA, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 30 months (spring 2019, end of 11th grade).ResultsA two-part latent growth curve model of e-cigarette use revealed significant positive associations between externalizing factors, past 30-day e-cigarette use, and the number of days of e-cigarette use only at wave 1 (p values <.05). Cigarette smoking was associated with a slowing in the rate of onset of 30-day e-cigarette use across the 30-month follow-up (β = ?.24, z = ?2.41, p = .02). Depression was associated with an increased rate of escalation in the number of days of e-cigarette use across the following 30 months (β = .01, z = 2.52, p = .01), whereas anxiety was associated with a decreased rate (β = ?.72, z = ?2.36, p = .02).ConclusionsThe findings highlight two groups of adolescents at risk for e-cigarette use: adolescents whose e-cigarette use reflects a higher-risk profile with early e-cigarette onset, and adolescents who have a lower-risk profile, at least initially, with later e-cigarette use onset. The timing and content of prevention efforts should be tailored to each group.     

On campus physical activity programming for post-secondary student mental health: Examining effectiveness and acceptability

AimProviding effective support for students with mental health concerns is a priority on post-secondary campuses. Recreational programming including physical activity is an evidence-informed approach that can be used to support mental health and well-being. Yet, limited research has examined effective and acceptable strategies for using campus-based physical activity programs to support the mental health of post-secondary students. Using a mixed-methods approach, the current study addressed the acceptability and effectiveness of a physical activity program for student mental health.MethodsIn collaboration with on-campus mental health services, a 6-week one-on-one and individualized physical activity program tailored towards students seeking mental health support was implemented. A pretest-posttest design was used to test the effectiveness of the program and participants (N = 68; M_age = 22.96 years, SD = 3.42; 82% female) completed self-report questionnaires to assess changes in symptoms of psychological distress, depression, and anxiety. Semi-structured interviews (N = 11) with program participants were conducted to explore the acceptability of the program and were analyzed using thematic analysis.ResultsPaired samples t-tests demonstrated a significant reduction in anxiety symptoms, depression symptoms, and psychological distress pre-post program (ps < .05). The generated themes suggested that the program is an acceptable and effective holistic approach for improving mental health among students.ConclusionsThe results provide implications for implementing on-campus physical activity programs as a mental health and well-being intervention. Implications for further understanding principle program design and delivery strategies are discussed.     

Disparities in HIV Education and Testing Between Metropolitan and Nonmetropolitan Adolescents and Young Adults in the U.S.

PurposeTo examine receipt of formal sexual health education on Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and receipt of HIV testing in adolescents and young adults (AYAs) residing in nonmetropolitan versus metropolitan areas.MethodsA secondary data analysis of the 2015–2017 National Survey of Family Growth of AYAs ages 15–24 years (N = 3,114). Logistic regression models predicted associations between nonmetropolitan versus metropolitan status and outcomes of interest (formal sexual health education on HIV/AIDS and HIV testing).ResultsMost AYAs (85.3%) reported receiving formal sexual health education on HIV/AIDS, while less than half (46.9%) indicated receiving HIV testing. Residing in a nonmetropolitan area was associated with a lower odds of reporting formal sexual health education on HIV/AIDS (OR = .47, CI = [.29, .77]) but not with HIV testing (OR = 1.33, CI = [.89, 2.01]).ConclusionsAYAs living in nonmetropolitan areas are less likely to receive formal sexual health education on HIV/AIDS.     

Impact of a web-based personally tailored physical activity intervention on depression,anxiety, stress and quality of life: Secondary outcomes from a randomized controlled trial

BackgroundFew studies have investigated the impact of web-based physical activity interventions on mental health outcomes. Therefore, this study examined the impact of a web-based personally tailored physical activity intervention on depression, anxiety, stress and quality of life.Methods501 participants were randomised into either a control group or a pooled intervention condition who received a 3-month web-based personally tailored physical activity intervention. Previously, this intervention has demonstrated to improve self-reported physical activity, but not device-measured physical activity. At baseline, 3- and 9-months, depression, anxiety and stress were assessed using the DASS21, and quality of life was assessed using the SF-12V2. General linear mixed models examined differences between groups over time.ResultsMost participants (>80%) reported normal levels of depression, anxiety or stress. Relative to baseline levels, significant reductions of depression, anxiety, stress and the SF12 mental health component were observed in the pooled intervention group at 3 and 9 months. Relative to the control group, significant reductions were observed in the pooled intervention group for depression and stress (3-months only) and anxiety (3- and 9-months), but not quality of life.ConclusionA web-based physical activity intervention can result in positive mental health outcomes, even in the absence of device-measured physical activity improvements. However, these findings need to be confirmed in future studies.Trial registration numberACTRN12615000057583.     

A Multisite Randomized Trial of a Motivational Intervention Targeting Multiple Risks in Youth Living With HIV: Initial Effects on Motivation,Self-Efficacy,and Depression

PurposeInterventions targeting multiple risk behaviors are needed for youth living with HIV (YLH). A randomized clinical trial compared Healthy Choices, a four session motivational intervention targeting two of the three risk behaviors (HIV medication adherence, sexual risk behavior and substance use) to multidisciplinary specialty care alone. This article presents intermediary outcomes available at 3-month follow-up, variables proposed to be precursors to behavior change (motivation, self-efficacy, and depression).MethodsYLH (N = 186) with at least one of the three problem behaviors were recruited from four sites in the Adolescent Trials Network and one non–Adolescent Trials Network site, and were assessed at baseline and 3 months.ResultsOf the 94 youth randomly assigned to the treatment condition, 84% received at least one session, 67% received at least two sessions, 56% received at least three sessions, and 49% completed all four sessions. In intent-to-treat analysis, only depression was significantly improved in the treatment group as compared with controls. However, in per-protocol analysis, youth receiving at least two sessions of the intervention also showed significant improvements in motivational readiness to change as compared with youth in the control condition.ConclusionResults suggest the potential benefits of clinic-based motivational interventions for YLH who access these interventions. Delivering interventions in the community using an outreach model may improve access. Analysis of subsequent time points will determine effects on actual behavior change.     

Percentage Body Fat by Dual-Energy X-Ray Absorptiometry Is Associated With Menstrual Recovery in Adolescents With Anorexia Nervosa

PurposeTo evaluate mediators of resumption of menses (ROM) in adolescents with anorexia nervosa (AN).MethodsAnthropometrics, body composition by dual-energy X-ray absorptiometry, hormonal studies, and responses to mental health screens were obtained at 6-month intervals for 18 months in 37 adolescents with AN randomized to the placebo arm of a double-blind treatment trial. Outcomes were compared between subjects with menstrual recovery and those without.ResultsTwenty-four subjects (65%) had ROM. Higher percentage body fat was associated with ROM (odds ratio, 1.19; 95% confidence interval, 1.06, 1.33; p < .01), as was body mass index and percent median body weight. Estradiol ≥30 ng/mL alone did not predict menses (p = .08) but was associated with ROM when coupled with percent mean body weight (odds ratio, 2.49; 95% confidence interval, 1.09, 5.65; p = .03). Changes in leptin, cortisol, and mental health were not associated with return of menses.ConclusionsPercentage body fat may be an additional, useful clinical assessment to follow in caring for adolescents with AN.     

The Influence of Relationship Power and Partner Communication on the Syndemic Factor among Hispanic Women

BackgroundThis study expands research on the substance abuse, intimate partner violence, human immunodeficiency virus (HIV), and depression syndemic theory for Hispanic women. We hypothesized relationship power and partner communication would be related to the syndemic.MethodsData were used from the baseline assessment of an effectiveness trial of SEPA (Salud/Health, Educación/Education, Prevención/Prevention, and Autocuidado/Self-care), an HIV/sexually transmitted infection risk reduction program for Hispanic women. Hispanic adult women (n = 320) completed measures (in Spanish or English) of relationship power, partner communication about HIV, and acculturation. The syndemic was defined with a factor model of substance abuse, intimate partner violence, risk for HIV/sexually transmitted infection, and depression using structural equation modeling.ResultsControlling for acculturation and education, relationship power was inversely related to the syndemic factor (β = −0.49, p < .001), but partner communication was not (β = 0.14, p = .054). Acculturation and education were also related to the syndemic factor. These variables combined accounted for more than one-half (53%) of the variance in the syndemic factor.ConclusionsFindings suggest the need to develop and test interventions that address the power dynamics of intimate relationships as a means of reducing health disparities among Hispanic women.     

Perinatal Depression and Anxiety in Women with and without Human Immunodeficiency Virus Infection

BackgroundUntreated depression and anxiety during the perinatal period have significant consequences on maternal and infant health; however, few studies have examined perinatal depression and perinatal anxiety in women with human immunodeficiency virus (HIV) infection. The current study prospectively examined the prevalence of prenatal and postpartum depression and anxiety, and emotional support from family and friends, as well as childhood sexual abuse in women with and without HIV infection.MethodsBetween July 2009 and January 2013, 258 pregnant women receiving care in a Philadelphia hospital were enrolled, with 162 completing both the prenatal and postpartum portions of the study. The Center for Epidemiological Studies–Depression Scale (CES-D), and the State-Trait Anxiety Inventory for Adults were used to measure depression and anxiety symptoms, respectively. An independent samples t test and multiple linear regressions were used to determine associations among depression, anxiety, and pregnancy-related variables.ResultsForty-nine participants (30%) were living with HIV; 113 (70%) were HIV negative. CES-D scores did not differ prenatally (p = .131) or postpartum (p = .156) between women with and without HIV. Prenatal state anxiety scores were higher in women with HIV (p = .02) but there were no differences postpartum (p = .432). In a multiple linear regression, trait anxiety predicted postpartum anxiety in the full sample (p < .001) and childhood sexual abuse predicted postpartum depression among women with HIV (p = .021).ConclusionsThese findings highlight the importance of identifying and treating perinatal depression and anxiety early in the prenatal period. Results also emphasize the need for providers to be aware of childhood sexual abuse as a potential correlate for depression in women with HIV.     

The impact of a comprehensive microfinance intervention on depression levels of AIDS-orphaned children in Uganda

PurposeBy adversely affecting family functioning and stability, poverty constitutes an important risk factor for children's poor mental health functioning. This study examines the impact of a comprehensive microfinance intervention, designed to reduce the risk of poverty, on depression among AIDS-orphaned youth.MethodsChildren from 15 comparable primary schools in Rakai District of Uganda, one of those hardest hit by HIV/AIDS in the country, were randomly assigned to control (n = 148) or treatment (n = 138) conditions. Children in the treatment condition received a comprehensive microfinance intervention comprising matched savings accounts, financial management workshops, and mentorship. This was in addition to traditional services provided for all school-going orphaned adolescents (counseling and school supplies). Data were collected at wave 1 (baseline), wave 2 (10 months after intervention), and wave 3 (20 months after intervention). We used multilevel growth models to examine the trajectory of depression in treatment and control conditions, measured using Children's Depression Inventory (Kovacs).ResultsChildren in the treatment group exhibited a significant decrease in depression, whereas their control group counterparts showed no change in depression.ConclusionsThe findings indicate that over and above traditional psychosocial approaches used to address mental health functioning among orphaned children in sub-Saharan Africa, incorporating poverty alleviation-focused approaches, such as this comprehensive microfinance intervention, has the potential to improve psychosocial functioning of these children.     

Health Indicators Associated with Falls Among Middle-aged and Older Women Enrolled in an Evidence-Based Program

BackgroundEvidence-based fall prevention programs primarily attract older women, who are increasingly burdened by fall-related injuries. However, little is known about the relationship between older female participants' baseline health status and self-reported falls over the course of fall prevention interventions. Using data from A Matter of Balance/Volunteer Lay Leader Model (AMOB/VLL) workshops, this study examines female participants' sociodemographics and health indicators associated with self-reported falls at baseline and postintervention.MethodsData were analyzed from 837 older women (M = 76.2 years) collected during the statewide AMOB/VLL dissemination in Texas. Longitudinal Poisson regression models, using the generalized estimating equation method, were used to investigate the associations of personal characteristics and health indicators with and reductions in the number of self-reported falls from baseline to postintervention.FindingsApproximately 21% of participants reported falling at baseline, and the number of reported falls significantly decreased from baseline to postintervention (β = -0.443). At baseline, more unhealthy physical days (β = 0.022), more unhealthy mental days (β = 0.018), and lower Falls Efficacy Scale scores (β = -0.052) were significantly associated with more falls reported at baseline. More falls at baseline was also associated with worse program attendance (β = -0.069). Greater improvements in Falls Efficacy Scale Scores (β = -0.069) and decreases in unhealthy physical health days (β = 0.026) over the course of the intervention were significantly associated with greater reductions in reported falls at postintervention, respectively.ConclusionsFindings have implications for identifying at-risk older women upon enrollment, expanding the reach of AMOB/VLL, and leveraging AMOB/VLL to refer participants to other evidence-based exercise, disease management, and mental health interventions.     

Asset ownership and health and mental health functioning among AIDS-orphaned adolescents: Findings from a randomized clinical trial in rural Uganda

This study evaluated an economic empowerment intervention designed to promote life options, health and mental health functioning among AIDS-orphaned adolescents in rural Uganda. The study used an experimental design in which adolescents (N = 267) were randomly assigned to receive an economic empowerment intervention or usual care for orphaned children. The study measured mental health functioning using 20 items of the Tennessee Self-Concept Scale (TSCS: 2)—a standardized measure for self-esteem—and measured overall health using a self-rated health measure. Data obtained at 10-month follow-up revealed significant positive effects of the economic empowerment intervention on adolescents' self-rated health and mental health functioning. Additionally, health and mental health functioning were found to be positively associated with each other. The findings have implications for public policy and health programming for AIDS-orphaned adolescents.     

Self-rated health among U.S. adolescents

PurposeThis article investigates the meaning of subjective health assessments for younger respondents by examining the temporal stability of self-rated health (SRH) among adolescents. Two competing understandings of SRH are tested: SRH as a spontaneous health assessment or as an enduring self-concept.MethodsUsing data from two waves of the National Longitudinal Study of Adolescent Health (n = 13,511), an intra-class correlation coefficient and a weighted Kappa estimate are calculated to assess the test-retest reliability for SRH. Self-rated health (T2) is then modeled as a function of SRH (T1), physical health (T1), and mental health (T1), and changes in physical and mental health (T2–T1).ResultsSRH is found to be moderately stable over repeated observations (K = .40; ρ = .55) among adolescents. Findings from multivariate analyses suggest that SRH (T2) is largely determined by SRH (T1) and less so by changes in physical or psychological health status (T2-T1).ConclusionsSRH among adolescents is in part a spontaneous health assessment but it is best understood as an enduring self-concept.     

Soft Drink Consumption and Mental Health in Adolescents: A Longitudinal Examination

PurposePrevious studies showed associations between soft drink consumption and mental health problems in adolescents, but the direction of these effects is unknown. This study examines the hypotheses that soft drink consumption predicts aggression and depressive symptoms over time and that these mental health problems predict soft drink consumption.MethodsInterviews were conducted with 5,147 children and their caregivers from three sites at child ages 11, 13, and 16. At each time point, youth reported on their frequency of consuming soft drinks, aggressive behavior, and depressive symptoms. An autoregressive cross-lagged path model tested reciprocal relationships between soft drink consumption, aggressive behavior, and depressive symptoms over time.ResultsMore frequent consumption of soft drinks was associated with more aggressive behavior at each time point and depressive symptoms at ages 11 and 13 (r = .04 to .18, p ≤ .002). After adjusting for covariates and stability of each behavior over time, soft drink consumption at ages 11 and 13 predicted more aggressive behavior at the next time point (β = .08 and .06, p < .001). Aggressive behavior at age 13 also predicted more soft drink consumption at age 16 (β = .06, p = .002). Soft drink consumption at age 13 predicted fewer depressive symptoms (β = ?.04, p = .007), but depressive symptoms did not predict soft drink consumption.ConclusionsMore frequent consumption of soft drinks may contribute to aggressive behavior in adolescents over time; there is some support for reciprocal relationships. There is no evidence for soft drink consumption contributing to adolescents' depression. Future research should examine longitudinal effects over shorter intervals.     

Gender Differences in Service Utilization among OEF/OIF Veterans with Posttraumatic Stress Disorder after a Brief Cognitive–Behavioral Intervention to Increase Treatment Engagement: A Mixed Methods Study

PurposeWomen veterans who served in Iraq and Afghanistan (Operation Enduring Freedom and Operation Iraqi Freedom [OEF/OIF]) have a moderately higher risk of developing posttraumatic stress disorder (PTSD) than male veterans. However, gender disparities in treatment engagement may prevent women veterans from initiating the care they need. Understanding gender differences in predictors of and barriers to treatment is essential to improving engagement and mental health outcomes. The purpose of this study was to examine gender differences in treatment utilization after a brief, cognitive–behavioral therapy (CBT) intervention among male and female OEF/OIF veterans.MethodsParticipants were assigned randomly to either the intervention or control conditions. Intervention participants received the telephone-based CBT intervention. Participants were 35 female and 238 male OEF/OIF veterans who screened positive for PTSD and had never initiated PTSD treatment. Participants were asked about treatment utilization, beliefs about PTSD treatment, and symptoms at months 1, 3, and 6 months subsequent to the baseline telephone assessment. The PTSD Checklist—Military Version was used to assess PTSD and the Patient's Health Questionnaire was used to assess symptoms of depression.FindingsFemale veterans who received an intervention were significantly more likely to have attended treatment over the 6-month follow-up period than male veterans who received an intervention (χ² = 7.91; df = 3; odds ratio, 3.93; p = .04).ConclusionsThe CBT intervention may be a critical mechanism to engage female veterans in treatment. Further research is needed to understand how to engage male veterans with PTSD in treatment.     

eHealth Interventions to Address HIV and Other Sexually Transmitted Infections,Sexual Risk Behavior,Substance Use,and Mental Ill-health in Men Who Have Sex With Men: Systematic Review and Meta-analysis

BackgroundMen who have sex with men experience disproportionately high levels of HIV and other sexually transmitted infections (STIs), sexual risk behavior, substance use, and mental ill-health. These experiences are interrelated, and these interrelations are potentiated by structural conditions of discrimination, stigma, and unequal access to appropriate health services, and they magnify each other and have intersecting causal pathways, worsening both risk for each condition and risk for the negative sequelae of each condition. eHealth interventions could address these issues simultaneously and thus have wide-ranging and greater effects than would be for any 1 outcome alone.ObjectiveWe systematically reviewed the evidence for the effectiveness of eHealth interventions in addressing these outcomes separately or together.MethodsWe searched 19 databases for randomized trials of interactive or noninteractive eHealth interventions delivered via mobile phone apps, internet, or other electronic media to populations consisting entirely or principally of men who have sex with men to prevent HIV, STIs, sexual risk behavior, alcohol and drug use, or common mental illnesses. We extracted data and appraised each study, estimated meta-analyses where possible by using random effects and robust variance estimation, and assessed the certainty of our findings (closeness of the estimated effect to the true effect) by using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).ResultsWe included 14 trials, of which 13 included active versus control comparisons; none reported mental health outcomes, and all drew from 12 months or less of follow-up postintervention. Findings for STIs drew on low numbers of studies and did not suggest consistent short-term (<3 months postintervention; d=0.17, 95% CI –0.18 to 0.52; I²=0%; 2 studies) or midterm (3-12 months postintervention, no meta-analysis, 1 study) evidence of effectiveness. Eight studies considering sexual risk behavior outcomes suggested a short-term, nonsignificant reduction (d=–0.14, 95% CI –0.30 to 0.03) with very low certainty, but 6 studies reporting midterm follow-ups suggested a significant impact on reducing sexual risk behavior (d=–0.12, 95% CI –0.19 to –0.05) with low certainty. Meta-analyses could not be undertaken for alcohol and drug use (2 heterogeneous studies) or for HIV infections (1 study for each of short-term or midterm follow-up), and alcohol outcomes alone were not captured in the included studies. Certainty was graded as low to very low for most outcomes, including all meta-analyses.ConclusionsTo create a comprehensive eHealth intervention that targets multiple outcomes, intervention evaluations should seek to generalize both mechanisms and components that are successfully used to achieve change in 1 outcome over multiple outcomes. However, additional evaluations of interventions seeking to address outcomes other than sexual risk behavior are needed before development and evaluation of a joined-up intervention.