Distinct groups of firearm owners with differential risk for suicide in the United States: A latent class analysis.

Suicide is a leading cause of mortality and firearm suicide accounts for the majority of fatalities. Firearm owners are a diverse population and firearm-specific suicide prevention programs should be tailored to distinct at-risk firearm-owning groups. This study set out to identify groups of firearm owners with differential suicide risk having unique characteristics that could be used to customize suicide prevention efforts. We conducted a nationally-representative survey of 2646 firearm owners to assess individual suicide risk, suicide risk factors, and demographic characteristics. A Latent Class Analysis identified unique segments of firearm owners at increased risk of suicide with similar underlying suicide risk factors and demographic characteristics. We found almost one in ten (9.6%) of firearm owners were at increased risk of suicide with 25% reporting suicide ideation, 6.6% reporting suicide planning, and 1.8% reporting previous suicide attempts. We identified three unique groups of firearm owners with higher than average suicide risk. Relative to other groups of firearm owners, one at-risk group were more affluent with a history of adverse experiences and mental health challenges, a second group had more male veterans with high levels of alcohol consumption, and third group had more non-heterosexual women who experienced trauma. We conclude that there are three unique groups of firearm owners with higher than average suicide risk with very different characteristics. In addition to broad suicide prevention efforts, customized firearm suicide prevention programs should be developed individually for these different firearm-owning populations, taking into consideration the unique suicide risk factors and demographics of each group.

Performing an Organizational Health Literacy Assessment in a Shelter Serving People with Mental Illness.

BACKGROUND: Health literacy research and practice are constantly evolving. Recent inquiry has highlighted the burdensome literacy demands faced by people with serious mental illness (SMI). Systems, organizational operations, and structures can play a role in decreasing literacy demand, thereby reducing unnecessary challenges for people with SMI. Brief Description of Activity: An organizational health literacy assessment was conducted to explore literacy demands in one mental health shelter and revealed best practice action steps for improving the literacy environment. IMPLEMENTATION: The assessment included an exploration of the shelter environment using The Health Literacy Environment Activity Packet, First Impressions & Walking Interview, and a commonly used shelter document using the Simple Measure of Gobbledygook (SMOG), Suitability Assessment of Materials (SAM), and Centers for Disease Control and Prevention (CDC) Index. RESULTS: The literacy demands of the shelter environment and a frequently used document exceeded the literacy skills of people with SMI. Environment assessment revealed environmental facilitators (e.g., welcoming atmosphere) and barriers (e.g., unclear signage). Document assessment also revealed facilitating factors and barriers. SMOG scores ranged from 11.25 to 11.80 (median: 11.38), meaning 11th to 12th grade-level reading skills are required to understand, use, and take action on the document's content. A SAM score of 50% (adequate) and a CDC Index score of 42.1 (revise and improve) reveal materials contain both facilitating factors (e.g., chunked sections) and barriers (e.g., jargon, mismatched graphics) to use. LESSONS LEARNED: The mismatch between system demands and the literacy skills of people with SMI is more profound than that of the general United States population. Organizational health literacy assessments are achievable and useful for both immediate and long-term action aimed at understanding and improving the organizational health literacy of mental health spaces. Further work is needed to explore the role of behavioral health services in addressing the institutional and programmatic literacy demands that inhibit treatment and recovery. [HLRP: Health Literacy Research and Practice. 2022;6(3):e167-e174.] Plain Language Summary: An organizational health literacy assessment reveals how system demands can be changed to better serve intended users. Engaging in mental health, recovery, and treatment services requires complex literacy skills. Generally, the U.S. adult population does not have the skills to meet such demands, and this is especially true among public mental health service users.

Associations between health literacy, cognitive function and general literacy in people with schizophrenia attending community mental health clinics in Australia.

BACKGROUND: Health literacy (HL) has been defined as the ability of individuals to access, understand, and utilise basic health information. HL is crucial to patient engagement in treatment through supporting patient autonomy, informed consent and collaborative care. In people with physical disorders, poor HL is associated with poor health outcomes, but less is known about HL in people with severe mental illness. This study aimed to assess HL and investigate the associations between education, cognitive function, general literacy, and HL in participants with schizophrenia attending community mental health clinics. METHOD: Fifty-two outpatients with schizophrenia attending a public community mental health clinic in Adelaide, Australia completed the Test of Functional Health Literacy in Adults-Short Form (S-TOFHLA) along with tests of cognition, aural and reading literacy and numeracy including Digit Symbol Coding (DSC), verbal fluency, the Wechsler Adult Intelligence Scale (WAIS-IV), Woodcock-Johnson III (Part 4 and 9) and the Lipkus numeracy scale. Sixty-one percent of participants were male. Participants had a mean age of 41.2 (SD 9.9) years and a mean of 11.02 (SD 1.5) years of education. RESULTS: The majority of participants had very poor aural and verbal literacy and poorer literacy correlated with fewer years of education. On the S-TOFHLA, 81% of participants had adequate HL; 6% were marginal and 13% were inadequate. There was a positive correlation between education and HL, with those with more years of education scoring higher for HL. There was also a significant association between better HL and better working memory and attention. CONCLUSIONS: Consistent with previous research in schizophrenia, our participants had reduced educational attainment, aural and reading literacy and cognitive function compared to population norms. However, HL was better than expected given that previous research has found that people with psychiatric disorders tend to have lower HL, compared to the general population. This may reflect effective case management of our participants whilst attending the community clinics and supports ongoing research and intervention regarding HL in people living with mental illness.

Associations Between Work-Related Factors and Psychological Distress Among Construction Workers.

OBJECTIVE: Identify work-related factors associated with the mental health and well-being of construction workers. METHODS: We completed eight key informant interviews, six worker focus groups, and a survey, informed by the interviews and focus groups, of 259 construction workers on five construction sites. Negative binomial regressions examined associations between psychological distress and work-related factors including safety climate, work-to-family conflict, psychological demands, social support, harassment, and job security. RESULTS: Three themes emerged from the interviews and focus groups, job demands and structure, social support and workplace relations, and job precarity. From the survey higher psychological demands, higher work-to-family conflict, lower supervisor support, higher discrimination, and higher likelihood of losing a job were associated with higher psychological distress. When combined into a single model job demands and work-to-family conflict remained significant. CONCLUSIONS: Work-related factors were associated with high levels of distress.

Prevalence and Predictors of Limited Literacy in Public Mental Health Care.

Literacy is an important predictor of health care utilization and outcomes. We examine literacy among people seeking care in a state funded mental health clinic (Site 1) and a safety-net hospital clinic (Site 2). Limited literacy was defined as literacy at or below the 8th grade level. At Site 1, 53% of participants had limited reading literacy and 78% had limited aural literacy. At Site 2, 72% had limited reading and 90% had limited aural literacy. Regression analyses examined associations among limited literacy and psychiatric, neurocognitive and sociodemographic characteristics. Few associations among psychiatric and neurocognitive factors, and literacy were found. At Site 2, black and "other" race participants had higher odds for limited literacy compared to white participants suggesting that limited literacy may be an under-examined mechanism in understanding racial disparities in mental health. Work is needed to understand the relationships among literacy, mental health and mental health care.

What matters: Factors impacting the recovery process among outpatient mental health service users.

OBJECTIVE: Understanding factors that promote and hinder the recovery process for people living with serious mental illness remains of critical importance. We examine factors, including limited literacy, associated with mental health recovery among public mental health service users. METHOD: This study uses data from a mixed-methods, service-user informed project focused on the impact of limited literacy in the lives of people with serious mental illness. Data from structured interviews evaluate perceptions of recovery as assessed with the Recovery Assessment Scale (RAS). Regression models examine factors related to recovery controlling for sociodemographic factors, literacy, neurocognition, mental health status, perceived social support, and stigma. RESULTS: Despite bivariate relationships between RAS and limited literacy, the full models suggest that other factors account for this relationship. These include mental health status, higher social support, higher self-reported community status, and higher stigma consciousness, as well as race for some models. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Our findings that social support and perceptions of community status are associated with higher scores on the RAS echo prior work demonstrating the importance of social connection and context in mental health recovery. Though literacy was not a predictor of recovery, further research should examine the relationship between literacy and recovery given the deep literature on literacy on health outcomes. In order to better support people in the recovery process it is important that more research is done to examine the complex relationship between stigma consciousness and recovery as well as understand the racial disparities that exist within the recovery subscales. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mental Health Stigma and Wellbeing Among Commercial Construction Workers: A Mixed Methods Study.

OBJECTIVE: The aim of this study was to understand the relationship between mental health stigma and wellbeing in a sample of commercial construction workers. METHODS: A sequential quantitative to qualitative mixed methods study was conducted. First, 264 workers were surveyed and logistic regression examined the associations between mental health stigma and psychological distress, substance abuse, and sleep; then, data from eight key informant interviews and six focus groups with workers were analyzed thematically. RESULTS: Stigma was significantly associated with psychological distress and impaired sleep, but not with substance abuse. Key informants and workers discussed the prominence of stigma on worksites and how the masculine culture of the industry and job insecurity contributed to stigma. CONCLUSION: Stigma poses a barrier to addressing mental health among workers; peer support and improved human resources may be promising.

The need for trauma-sensitive language use in literacy and health literacy screening instruments.

The authors recently began a research study, funded by the National Institute of Mental Health, aimed at increasing the understanding of the ways in which limited literacy affects the lives of people with serious mental illness. In preparing for the study, the authors reviewed many health literacy screens and assessments for their appropriateness in public urban mental health settings. The Rapid Estimate of Adult Literacy in Medicine and the Test of Functional Health Literacy in Adults, perhaps the most frequently used assessments of health literacy, involve assessments that include lists of words that the test-taker must choose from or read. Each of these instruments includes language that is potentially triggering for trauma survivors, particularly those with posttraumatic stress disorder (PTSD). The research participants for the current project are consumers of mental health services, and thus, the authors believe it is essential to remove the problematic language, given that the likelihood of a diagnosis of PTSD and/or a history of abuse is higher than average among this population. However, the authors argue that this issue applies to anyone who administers these instruments, because sexual assault and abuse, as well as PTSD diagnoses, are certainly not confined to those who seek mental health services. The authors' aim is not only to call attention to the use of triggering language in existing literacy and health-related assessments and research instruments, but also to advocate that others take similar steps toward embracing more sensitive language by removing or replacing words that may cause unnecessary stress, anxiety, or pain to those who are at increased risk of retraumatization.

What the ANPRM missed: additional needs for IRB reform.

Institutional Review Boards are mandated to carry out the requirements of the Common Rule, and it is widely agreed that they are appropriate and necessary mechanisms to ensure the ethical conduct of human research. In this paper, we suggest that the changes proposed in ANPRM, although generally helpful, fail to take into consideration how IRBs actually review applications and therefore do not adequately address some of the problems that may be leading to ineffective human subject protection.