Differences in Sexual Risk Behaviors Between College Students with Same-Sex and Opposite-Sex Experience: Results from a National Survey

The goal of this study was to identify differences in the sexual health behaviors (condom use and number of sexual partners) between college students with same-sex sexual experiences and those with only opposite-sex partners. Data from a random sample of American university students were gathered as part of the 1997 College Alcohol Study. Odds ratios were estimated for consistent condom use and multiple sex partners for students with same-sex or both-sex sexual partners compared to those with exclusively heterosexual contacts. Five percent of respondents reported ever having a same-sex partner. Significant differences in safer-sex practices were found between groups. Females with both-sex experience and males with both-sex or only same-sex experiences were more likely to report multiple recent sexual partners than their peers with only opposite-sex partners. Odds ratios of consistent condom use were lower for men with only same-sex experience than among those with only opposite-sex partners. Findings have implications for sexual health education on the college campus. Consistent condom use remains low among college students. Education programs should emphasize the importance of limiting the number of lifetime sex partners, especially among students with same-sex experiences.     

Mental health correlates of past homelessness in the National Comorbidity Study Replication

This study uses data from a nationally representative epidemiologic survey, the National Comorbidity Survey Replication, to investigate the association of mental health and substance use disorders, along with other factors, with past homelessness. Approximately 5% of the 5,251 adults reported having been homelessness. Multivariate analysis showed the strongest independent risk factors for past homelessness were past receipt of welfare payments (odds ratio [OR]=5.7), incarceration for 27 or more days (OR=3.9), exposure to personal violence (OR=2.7), lifetime substance use disorder (OR=2.4), and Black race (OR=2.1). Several non-substance use psychiatric disorders were also significantly, if less strongly (OR 1.4 to 1.6), associated with past homelessness. Past homelessness is associated with a broad array of sociodemographic, economic, and mental health problems. While the association of both substance use and psychiatric disorders with past homelessness was quite strong, non-substance use psychiatric disorders was not as strong an independent risk factor as substance abuse disorders.     

Mental Health and Suicidality Among Racially/Ethnically Diverse Sexual Minority Youths

Objectives. We examined the relationships among sexual minority status, sex, and mental health and suicidality, in a racially/ethnically diverse sample of adolescents.Methods. Using pooled data from 2005 and 2007 Youth Risk Behavior Surveys within 14 jurisdictions, we used hierarchical linear modeling to examine 6 mental health outcomes across 6 racial/ethnic groups, intersecting with sexual minority status and sex. Based on an omnibus measure of sexual minority status, there were 6245 sexual minority adolescents in the current study. The total sample was n = 72 691.Results. Compared with heterosexual peers, sexual minorities reported higher odds of feeling sad; suicidal ideation, planning and attempts; suicide attempt treated by a doctor or nurse, and self-harm. Among sexual minorities, compared with White youths, Asian and Black youths had lower odds of many outcomes, whereas American Native/Pacific Islander, Latino, and Multiracial youths had higher odds.Conclusions. Although in general, sexual minority youths were at heightened risk for suicidal outcomes, risk varied based on sex and on race/ethnicity. More research is needed to better understand the manner in which sex and race/ethnicity intersect among sexual minorities to influence risk and protective factors, and ultimately, mental health outcomes.Over the past 20 years, research has documented elevated suicidality1—defined as behavior related to contemplating, attempting, or completing suicide2—among sexual minority youths (an umbrella term, generally including those who identify as lesbian, gay, bisexual, or transgender [LGBT]; engage in same-sex sexual behavior; or have same-sex attractions). This research has consistently demonstrated substantial sexual orientation disparities in suicidality, with sexual minority youths having higher prevalence of suicidality than their heterosexual peers.3–6 A recent review of the literature indicated that sexual minority youths are at least twice as likely as heterosexual youths to contemplate suicide, and 2 to 7 times as likely to attempt suicide.7 A meta-analysis found that 28% of sexual minority youths had a history of suicidality, compared with 12% of their heterosexual peers.8Despite the development of knowledge about suicidality among sexual minority youths, little is known about suicidality in sexual minority youths of color. To the extent that existing researchers have explored racial/ethnic differences, analyses have rarely gone beyond dichotomous (White vs “youths of color”) or trichotomous (White vs Black vs Latino) comparisons. As a result, there exists scant literature exploring the full spectrum of racial/ethnic differences in suicidality among sexual minority youths.The literature on suicide in the general adolescent population demonstrates racial/ethnic differences in suicide ideation and attempts. For example, prevalence of suicide among Native American and Alaska Native youths is twice that of other youths,9 and Latino youths are more likely than either Black or White youths to have considered and attempted suicide.10 Differences are further moderated by participants’ gender: girls are more likely to consider suicide and attempt suicide than boys,10 although boys are more likely to complete suicide.11Studies that have considered racial/ethnic differences in suicidality among sexual minority youths have found differences, though the patterns have been inconsistent. A study based on Youth Risk Behavior Survey (YRBS) data from Massachusetts, reported that among self-identified lesbian, gay, or bisexual (LGB) youths3 Latinos were significantly more likely than Whites to report past-year suicide attempt. Another study found that same-sex–attracted Black and White youths were more likely than their other-sex–attracted peers to report suicidal ideation, whereas same-sex–attracted Latino and Asian/Pacific Islander youths did not differ from other-sex–attracted peers.12 In a nonprobability sample of urban LGBT youths,13 Black and White youths were more likely to report suicidal ideation than Latinos; however, Latinos reported the highest frequency of suicide attempts. A study of New York City adults found that Latino and Black LGB participants were more likely to report serious suicide attempts than were White LGB participants, with most reported attempts occurring during adolescence and young adulthood.14 These conflicting results suggest that there are important differences in suicidality at the intersections of sexual minority status and race/ethnicity, yet further study requires data of sufficient scale and scope to enable analyses of low-prevalence behaviors across small subgroups of youths.To address the need for information about suicidality among racially/ethnically diverse sexual minority populations, we assess suicidality patterns among youths based on sexual orientation, race/ethnicity, and sex. With this, we respond to calls for public health to utilize minority stress and intersectional frameworks as potential lenses through which to understand health and health disparities among sexual minority populations.15,16 Rather than treating social identities as separate and discrete phenomena, our inquiry allows that co-occurring minority identities operate together. An intersectional approach suggests that sexual identity–race–sex intersections are informed by unique cultural, historical, social, and political factors that differentially influence life experiences, including discrimination based on such identities.17–19 In turn, minority stress theory posits that discriminatory experiences predispose populations to stress and adverse mental health outcomes, including suicidality.20The focus on health differences among sexual minority youths across race/ethnicity and sex is vital to creating effective health interventions and programs. Such a focus is particularly relevant within the context of youth suicide, as risk and protective factors associated with suicidality vary across both racial/ethnic and sexual minority groups, and there is a need to better integrate these bodies of research.21     

Relationship Between Sexual Compulsivity and Sexual Risk Behaviors Among Chinese Sexually Active Males

Archives of Sexual Behavior - Compulsivity is defined as “an insistent, repetitive, intrusive, and unwanted urge to perform specific acts often in ritualized or routinized fashions.”...     

Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey

OBJECTIVES: This study examined the relationship between child sexual abuse (CSA) and subsequent onset of psychiatric disorders, accounting for other childhood adversities, CSA type, and chronicity of the abuse. METHODS: Retrospective reports of CSA, other adversities, and psychiatric disorders were obtained by the National Comorbidity Survey, a nationally representative survey of the United States (n = 5877). Reports were analyzed by multivariate methods. RESULTS: CSA was reported by 13.5% of women and 2.5% of men. When other childhood adversities were controlled for, significant associations were found between CSA and subsequent onset of 14 mood, anxiety, and substance use disorders among women and 5 among men. In a subsample of respondents reporting no other adversities, odds of depression and substance problems associated with CSA were higher. Among women, rape (vs molestation), knowing the perpetrator (vs strangers), and chronicity of CSA (vs isolated incidents) were associated with higher odds of some disorders. CONCLUSIONS: CSA usually occurs as part of a larger syndrome of childhood adversities. Nonetheless, CSA, whether alone or in a larger adversity cluster, is associated with substantial increased risk of subsequent psychopathology.     

The Relationship Between Thiamine Intake and Long Sleep Duration: Results From the Korea National Health and Nutrition Examination Survey

Objectives:Thiamine is thought to modify sleeping patterns, while alcohol use diminishes internal thiamine levels. We investigated the association between thiamine intake and sleep duration and explored possible heterogeneity in the effect according to alcohol use.Methods:In total, 15 384 participants aged 19-64 were obtained from the Korea National Health and Nutrition Examination Survey 2012-2016. Nutrient intake, including thiamine, was measured using a food frequency questionnaire. Sleep duration was measured by a self-reported questionnaire. The highest thiamine intake quartile was set as the reference group. Participants were divided into 3 groups, with 7-8 hours of daily sleep as a reference group and those who slept more or less than that as “oversleeping” and “insufficient sleeping,” respectively. Multivariate logistic regression was used, adjusting for socioeconomic, medical, and nutritional factors. Additionally, participants were stratified according to high-risk alcohol use defined by the World Health Organization standards on alcohol use.Results:Low thiamine intake was associated with oversleeping (Q3: odds ratio [OR], 1.06; 95% confidence interval [CI], 0.86 to 1.32; Q2: OR, 1.24; 95% CI, 0.99 to 1.55; Q1: OR, 1.49; 95% CI, 1.16 to 1.91) and showed a significant trend for higher ORs at lower intake levels (p-trend<0.001). The effect was stronger in the high-risk alcohol use group (Q1: OR, 1.78; 95% CI, 1.28 to 2.49).Conclusions:Low thiamine intake was associated with oversleeping, and alcohol use intensified that association. These results were found in a context where overt clinical symptoms due to thiamine deficiency are considered rare. More awareness of the potential relationship of thiamine intake with oversleeping and its related risks should be considered.     

The Relationship Between Sexual Abuse and Sexual Risk Among High School Students: Findings from the 1997 Massachusetts Youth Risk Behavior Survey

Objective: To assess whether adolescents with a history of sexual abuse were more likely than those with no such history to engage in sexual risk behaviors. Methods: Data for this study were obtained through the 1997 Massachusetts Youth Risk Behavior Survey, a self-report questionnaire administered to a representative sample of 9th through 12th graders (N = 4014) to assess a variety of adolescent risk behaviors. Only sexually experienced adolescents (n = 1610; female = 779, male = 831) were included in the present study. Logistic regression models were constructed to examine the relationship of sexual abuse history to sexual risk behaviors. Adolescents were considered as having a history of sexual abuse if they reported ever having had sexual contact against their will. Results: Almost one- third of sexually experienced adolescent girls (30.2%) and one-tenth (9.3%) of adolescent boys reported a history of sexual abuse. After controlling for related demographics and risk behaviors, sexually abused female students were significantly more likely than those without such a history to have had earlier first coitus (OR = 2.2, 95%CI = 1.46–3.47), to have had three or more sex partners ever (OR = 2.5, 95%CI = 1.71–3.68), and to have been pregnant (OR = 1.9, 95%CI = 1.21–2.92). Sexually abused male students were significantly more likely than those without such a history to have ever had multiple partners (OR = 3.2, 95%CI = 1.56–6.57), to have had multiple sex partners in the past 3 months (OR = 2.9, 95%CI = 1.71–3.68), and to have engaged in sex resulting in pregnancy (OR = 3.4,95%CI = 1.53–7.34). Conclusion: Both adolescent girls and boys with a history of sexual abuse report greater sexual risk-taking than those without such a history. However, although sexual abuse is more prevalent among girls than boys, the impact of sexual abuse on sexual risk appears to be even greater for boys. Programs addressing both sexual abuse and sexual risk must be made available to all adolescents.     

Results from the Scottish National HAI Prevalence Survey

A national point prevalence survey was undertaken over the period of one calendar year in Scotland from October 2005 to October 2006. The prevalence of healthcare-associated infection (HAI) was 9.5% in acute hospitals and 7.3% in non-acute hospitals. The highest prevalence of HAI in acute hospital inpatients was found in the following specialties: care of the elderly (11.9%), surgery (11.2%), medicine (9.6%) and orthopaedics (9.2%). The lowest prevalence was found in obstetrics (0.9%). The most common types of HAI in acute hospital inpatients were: urinary tract infections (17.9% of all HAI), surgical site infections (15.9%) and gastrointestinal infections (15.4%). In non-acute hospitals one in ten inpatients in two specialties (combined) - medicine (11.4%) and care of the elderly (7.8%) - was found to have HAI, and one in 20 inpatients in psychiatry (5.0%) had HAI. In non-acute hospital patients, urinary tract infections were frequent (28.1% of all HAI) and similarly skin and soft tissue infection (26.8% of all HAI). When combined, these two HAI types affected 4% of all the inpatients in non-acute hospitals. This is the first survey of its kind in Scotland and describes the burden of HAI at a national level.     

Sexual Behaviors of Middle School Students: 2009 Youth Risk Behavior Survey Results From 16 Locations

BACKGROUND: The potential negative consequences of engaging in sexual risk behaviors at a young age are well documented. Unfortunately, there is a dearth of information about the prevalence of sexual behaviors among middle school students. This article provides an overview of the sexual risk behaviors of middle school students from 16 districts and states throughout the country, and examines these risks by demographic variables. METHODS: In 2009, 10 states and 6 districts administered the Youth Risk Behavior Survey‐Middle School and included sexual behavior questions. Data were examined using the Centers for Disease Control and Prevention's Youth Online database. Frequencies were run for 4 sexual behaviors and an HIV/AIDS education question for each location. A series of t‐tests were calculated for these 5 items by gender, age, and race for each location. RESULTS: Data show that 5–20% of sixth graders and 14–42% of eighth graders have engaged in sexual intercourse. A concerning percentage of students have also engaged in other sexual risk behaviors and many are not receiving HIV/AIDS education. Additionally, there were significant differences by gender, race, and age. CONCLUSION: Consistent with previous studies, males, minorities, and older students are more likely to engage in sexual risk behaviors. There is also variation in the percentage of students engaging in sexual behaviors across locations. Sexual risk reduction education is important for middle school youth, particularly for minorities, males and those from southern and/or larger, urban cities as those are the populations with generally higher sexual risk behaviors.     

Women's Sexual Orientation and Health: Results from a Canadian Population-Based Survey

The current study sought to determine whether health status and health risk behaviors of Canadian women varied based on sexual identity. This was a cross-sectional analysis of data from the Canadian Community Health Survey: cycle 2.1, a national population-based survey designed to gather health data on a representative sample of over 135,000 Canadians including 354 lesbian respondents, 424 bisexual women respondents, and 60,937 heterosexual women respondents. Sexual orientation was associated with disparities in health status and health risk behaviors for lesbian and bisexual women in Canada. Bisexual women were more likely than lesbians or heterosexual women to report poor or fair mental and physical health, mood or anxiety disorders, lifetime STD diagnosis, and, most markedly, life-time suicidality. Lesbians and bisexual women were also more likely to report daily smoking and risky drinking than heterosexual women. In sum, sexual orientation was associated with health status in Canada. Bisexual women, in particular, reported poorer health outcomes than lesbian or heterosexual women, indicating this group may be an appropriate target for specific health promotion interventions.     

Examining the Temporal Relationship Between Criminal Justice Involvement and Sexual Risk Behaviors among Drug-Involved Men

Although criminal justice involvement has repeatedly been associated with human immunodeficiency virus (HIV)/sexually transmitted infection prevalence and sexual risk behaviors, few studies have examined whether arrest or incarceration uniquely contributes to sexually risky behavior. We examined the temporal relationship between criminal justice involvement and subsequent sexual HIV risk among men in methadone maintenance treatment in New York City. A random sample of 356 men was interviewed at baseline (time 1), 6-month (time 2), and 12-month (time 3) follow-ups. Propensity score matching, negative binomial, and multiple logistic regression were used to isolate and test the effect of time 2 arrest and incarceration on time 3 sexual risk behaviors. Incidence of time 2 criminal justice involvement was 20.1% for arrest and 9.4% for incarceration in the prior 6 months. Men who were arrested at time 2 demonstrated increased number (adjusted incidence rate ratio [IRR] = 1.62; 95% confidence intervals [CI] = 1.11, 2.37) and proportion (IRR = 1.36; 95% CI = 1.07, 1.72) of unprotected vaginal sex acts at time 3. Men incarcerated at time 2 displayed increased number (IRR = 2.07; 95% CI = 1.23, 3.48) and proportion (IRR = 1.45; 95% CI = 1.06, 1.99) of unprotected vaginal sex acts at time 3. Within this sample of drug-involved men, arrest and incarceration are temporally associated with and may uniquely impact successive sexual risk-taking. Findings underscore the importance of HIV prevention interventions among individuals with low-intensity criminal justice involvement. Developing prevention efforts aimed at short-term incarceration, community reentry, and alternatives to incarceration settings will address a large and under-researched segment of the criminal justice population. Alternative approaches to current criminal justice policy may result in public health benefits.     

HIV-Related Knowledge, Beliefs, and Behaviors Among High School Students in the United States: Results from a National Survey

The Secondary School Student Health Risk Survey measured the prevalence of sexual intercourse and illegal drug injection among a national probability sample of U.S. high school students and assessed their HIV-related knowledge and beliefs. Ninety-nine (81%) of the 122 selected schools and 8,098 (83%) of the eligible students participated. Nearly all high school students knew the major modes of HIV transmission. Three percent reported injecting illegal drugs, and 1% reported sharing needles used to inject drugs. In addition, 59% of students reported having sexual intercourse and, of students who reported having sexual intercourse, 40% reported having four or more sexual partners. HIV-related knowledge, beliefs, and behaviors among high school students suggest the need for school-based HIV education programs that help young people acquire the knowledge and skills to adopt and maintain behaviors that reduce risk of HIV infection and other related health problems.     

Substance Use and Mental Health Disorders Among Heterosexual Identified Men and Women Who Have Same-Sex Partners or Same-Sex Attraction: Results from the National Epidemiological Survey on Alcohol and Related Conditions

This study examined sexual orientation discordance, a mismatch between self-reported sexual identity and sexual behavior or sexual attraction, by describing the characteristics, substance use disorders, and mental health risks of heterosexual identified individuals who endorsed this pattern of sexual identification, behavior, and attraction. Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we created three groups based on participants’ reported sexual identity and either their sexual behavior or sexual attraction: heterosexual concordant, homosexual concordant, and heterosexual discordant. Bivariate models assessed the relationship of discordant status and demographic correlates, lifetime substance use disorders, and mental health diagnoses. Logistic regression models tested associations between both behavior discordance and attraction discordance and the likelihood of having lifetime disorders of substance use, major depression, and generalized anxiety. Results of this study provided evidence of varying levels of substance use and mental health disorder risk by gender, discordance status, and discordance type. Behavioral discordance was associated with increased risk of mental health and substance use disorder among women (compared to heterosexual concordance). Findings among men were less consistent with heightened risk of alcohol and inhalant use only. Attraction discordance was notably different from behavioral discordance. The odds of substance use and mental health disorders were the same or lower compared with both the heterosexual and homosexual concordance groups. Future research should begin to test theoretical explanations for these differences.     

Methamphetamine and Viagra Use: Relationship to Sexual Risk Behaviors

Recent studies show that Viagra and methamphetamine use are associated with unprotected anal intercourse among men who have sex with men (MSM). In Long Beach, California, we have reported on an association between Viagra use and the use of amphetamines during sex. The current research investigated the use of both Viagra and amphetamine in men in Long Beach, California. Data on 1,839 men recruited into HIV prevention and testing programs were collected using the Risk Behavior Assessment. A generalized logit model was constructed comparing ever having used both amphetamine and Viagra together and separately, as compared to never having used either (referent). Men who used both methamphetamine and Viagra showed a significantly higher prevalence of hepatitis B, syphilis, and HIV compared to those who used only one or neither drug. Of the 1,794 complete cases, 11.1% (199/1794) had used both amphetamine and Viagra. Of 20 potential risk and protective factors for use of amphetamine and Viagra, 12 were significant predictors: ever used gamma-hydroxybutyrate (GHB), ever used cocaine, ever used ecstasy, being infected with HIV, race = White compared to other, ever having hepatitis B, ever using crack, ever given money to have sex, living in a hotel, ever been in drug treatment, and ever using heroin. The protective factor was being heterosexual. Viagra use was associated with insertive, and methamphetamine was associated with receptive, anal intercourse. GHB use appears to play a more important role than previously thought.     

Work-family conflict and mental disorders in the United States: cross-sectional findings from The National Comorbidity Survey

BACKGROUND: Work-family conflict (WFC) may have negative effects on workers' health and productivity. The objective of this analysis was to assess the association between WFC and mental disorders that occurred in the past month. METHODS: Data from the U.S. National Comorbidity Survey were used. The 1-month prevalence of mental disorders was estimated by levels of WFC and by gender. RESULTS: Compared to participants who reported low WFC, those who reported high WFC had a significantly higher prevalence of mental and/or substance use related disorders in the past month. Working hours and domestic roles did not have significant impacts on the association between WFC and mental disorders, irrespective of gender. CONCLUSIONS: Work and family roles and the balance between the two are important for workers' mental health. The influence of WFC on mental health should be investigated in conjunction with important work environment characteristics in longitudinal studies.     

2011年—2014年青岛市市北区居民碘盐监测结果分析

目的了解2008—2018年上海市嘉定区碘盐使用现状及变化情况,为调整相应的干预措施提供依据。方法按照2008—2018年的《上海市碘盐监测实施方案》进行抽样,共采集3 795份居民户盐样进行盐碘监测,计算碘盐监测主要指标的年度变化百分比(APC),并采用Joinpoint软件进行趋势分析。结果2008—2018年,嘉定区非碘盐率、碘盐覆盖率、碘盐合格率和合格碘盐食用率分别为10.78%、89.22%、83.05%和74.10%。2008—2018年的非碘盐率和2008—2011年的合格碘盐食用率无明显变化趋势(P>0.05);2012—2018年的碘盐覆盖率、碘盐合格率和合格碘盐食用率均呈现下降趋势(P值均 < 0.05)。结论上海市嘉定区2008—2018年碘盐覆盖率、合格碘盐食用率总体呈现下降趋势。应继续坚持推行食盐加碘政策,加强对不合格碘盐的管理。     

A National Survey on Intimate Relationships,Sexual Activity,and Sexual Satisfaction Among Adults with Physical and Mental Disabilities

This study provides an overview and a better understanding of how physical and mental disabilities are associated with intimate relationships, sexual activity, and sexual satisfaction. Data were drawn from a national survey study with 15,073 participants in Denmark aged between 26 and 65 of whom 4102 reported a physical disability and 1174 a mental disability. Participants with a disability (physical, mental, or both) reported significantly lower levels of sexual activity and satisfaction than participants without a disability. Participants with a mental disability or both a mental and physical disability reported the lowest levels of sexual activity and satisfaction. Further analysis showed that having a partner, being female, and of a younger age were associated with higher levels of sexual activity and satisfaction among participants with a disability (physical, mental, or both).

     

The Relationship Between Violence Syndemics and Sexual Risk Behaviors Among African American Adolescents: Implications for Future Research

PurposeWe present a conceptual framework based on a review of the literature to highlight the interconnecting and reinforcing elements of a violence syndemic and how this syndemic influences sexual risk behaviors among African American heterosexual adolescents.MethodsWe review existing peer-reviewed published research from 2000 to 2020 that links a violence syndemic (i.e., racism and race-related stress, neighborhood and police violence, peer violence, and family violence and disruptions) to adolescent sexual risk behaviors. Empirical findings and theoretical underpinnings are used to document this relationship and illuminate the factors that mediate this relationship.ResultsEmpirical studies support the links between specific types of violence and sexual risk behaviors among African American adolescents. Further, existing studies point to the important relationships among the specific types of violence, supporting a violence syndemic approach.ConclusionsWhile more researchers are examining socio-ecological contextual factors as important predictors for sexual risk behaviors, there remains inadequate understanding about how violence types reinforce one another to heighten sexual risk behaviors among African American heterosexual adolescents. This article presents new directions for adolescent research, especially how a violence syndemic approach can be used to explain sexual risk, but also to refocus intervention design on the complex burdens experienced by this population.     

Overworking Among People with Psychiatric Disorders: Results from a Large Community Survey

Introduction Few studies have examined the characteristics of people with psychiatric disorders who work excessive hours compared to those with other health conditions, or compared to others with no health conditions or disabilities. Methods We conducted a secondary analysis of data files provided by the Australian Bureau of Statistics from a 2003 population survey (N = 23,851 in scope). We investigated candidate correlates of working excessive hours as the main dependent variable. Results Although, people with psychiatric disorders were less likely overall than healthy adults to work excessive hours, partnered males with dependant children, and males with higher educational attainment; were at greatest risk of working 49 or more hours per week. Conclusions People with psychiatric disorders have a substantial risk of over working, and this should be considered in their long term treatment and care.