Adolescents in crisis: A geographic exploration of help-seeking behavior using data from Crisis Text Line.

Nearly 3 out of 4 all lifelong mental disorders occur by the age of twenty-four. Remote crisis support holds great potential in filling a critical gap in complementing and expanding access to mental health services for acute episodes of mental distress in adolescents and young adults; yet little is understood about the individual factors that influence help-seeking behavior in this group. Recent evidence suggests technology-based mental health services have high acceptability among youth and may be used to treat anxiety and depression. The objective of this study was to examine county-level help-seeking behavior among adolescents and young adults using Crisis Text Line (CTL). CTL is a free, text-based crisis counseling service that has been available nationally since 2013. Spatial error regression was used to (1) identify the individual-level factors that correlate with help-seeking behavior for depression, anxiety, and suicidal thoughts and (2) to explore the geographic trends in text-based help-seeking behavior between adolescents and young adults across the rural-urban continuum. Increased rates of text-based help-seeking occurred in counties with higher mean household incomes, higher divorce rates, and lower residential stability. Rurality was the strongest predictor for low rates of help-seeking, and this finding is particularly concerning in light of elevated rates of suicide among rural counties. Rural communities, particularly those with low support-seeking behavior and comparatively high suicide rates, should be the target of future research and outreach.

Long-term impact of environmental public health disaster on health system performance: experiences from the Graniteville, South Carolina chlorine spill.

OBJECTIVES: In the aftermath of an environmental public health disaster (EPHD) a healthcare system may be the least equipped entity to respond. Preventable visits for ambulatory care-sensitive conditions (ACSCs) may be used as a population-based indicator to monitor health system access postdisaster. The objective of this study was to examine whether ACSC rates among vulnerable subpopulations are sensitive to the impact of a disaster. METHODS: We conducted a retrospective analysis on the 2005 chlorine spill in Graniteville, South Carolina using a Medicaid claims database. Poisson regression was used to calculate change in monthly ACSC visits at the disaster site in the postdisaster period compared with the predisaster period after adjusting for parallel changes in a control group. RESULTS: The adjusted rate of a predisaster ACSC hospital visit for the direct group was 1.68 times the rate for the control group (95% confidence interval [CI] 1.47-1.93), whereas the adjusted ACSC hospital rate postdisaster for the direct group was 3.10 times the rate for the control group (95% CI 1.97-5.18). For ED ACSC visits, the adjusted rate among those directly affected predisaster were 1.82 times the rate for the control group (95% CI 1.61-2.08), whereas the adjusted ACSC rate postdisaster was 2.81 times the rate for the control group (95% CI 1.92-5.17). CONCLUSIONS: Results revealed that an increased demand on the health system altered health services delivery for vulnerable populations directly affected by a disaster. Preventable visits for ACSCs may advance public health practice by identifying healthcare disparities during disaster recovery.

Epidemiologic methods lessons learned from environmental public health disasters: Chernobyl, the World Trade Center, Bhopal, and Graniteville, South Carolina.

BACKGROUND: Environmental public health disasters involving hazardous contaminants may have devastating effects. While much is known about their immediate devastation, far less is known about long-term impacts of these disasters. Extensive latent and chronic long-term public health effects may occur. Careful evaluation of contaminant exposures and long-term health outcomes within the constraints imposed by limited financial resources is essential. METHODS: Here, we review epidemiologic methods lessons learned from conducting long-term evaluations of four environmental public health disasters involving hazardous contaminants at Chernobyl, the World Trade Center, Bhopal, and Graniteville (South Carolina, USA). FINDINGS: We found several lessons learned which have direct implications for the on-going disaster recovery work following the Fukushima radiation disaster or for future disasters. INTERPRETATION: These lessons should prove useful in understanding and mitigating latent health effects that may result from the nuclear reactor accident in Japan or future environmental public health disasters.