Lessons Learned From a Quad-State Postdisaster Project: Developing Accessible and Sustainable Integrated Mental and Physical Health Care Services.

The Mental and Behavioral Health (MBH) Capacity Project had a mission shared among 4 states to support MBH sustainability along the Gulf Coast. Integration of mental health into undersourced primary health clinics was an important goal of the project. The findings from the collaborative evaluation demonstrate long-term outcomes including the following: community has greater capacity and sustainability for quality health care; better informed and connected communities; and individuals are more informed, connected, and resilient. Lessons learned indicate that improved population health outcomes are possible even in low-income, high-stress regions through intentional and collaborative efforts integrating MBH into primary cares settings.

Student's Perceptions of School Safety: It Is Not Just About Being Bullied.

This study examined the relationship of students' perceptions of school safety and school avoidance related to feeling unsafe with predictor variables: bullying victimization, student/teacher/parent/administration relations, rule clarity and consistency, school physical environment (negative and positive), and student's belongingness. In a public high school sample ( n = 585), 24.7% of students felt unsafe and 14.4% avoided school due to feeling unsafe during the past month. Being female and experiencing bullying was associated with feeling unsafe. However, after accounting for demographics and bullying victimization, perceptions of safety increased when students reported positive student and teacher relations, consistent rules, a clean school that is also crowded/noisy, and a sense of school belonging. Avoiding school because of safety concerns was related to decreased school belonging and teacher/student relationships, but not bullying. Focusing on enhancing the school climate/environment, facilitating student belongingness, and reducing bullying are ways school nurses can help promote safer schools.

The Prevalence and Mental and Physical Health Correlates of Posttraumatic Stress Disorder Symptoms in Vulnerable and Underresourced Primary Care Patients Referred to a Behavioral Health Provider.

CONTEXT: The prevalence of trauma exposure among vulnerable, impoverished patients seeking primary care services is considerable. However, assessment of trauma-related symptoms is rare, even among behavioral health patients receiving primary care services within integrated health care centers. OBJECTIVE: To determine the prevalence of clinically noteworthy trauma-related symptoms and their associations with other co-occurring mental and physical symptoms as well as self-reported resiliency. PARTICIPANTS: Primary care patients (n = 120) referred to behavioral health services (76.7% black/African American; 70.8% female). SETTING: Federally qualified health center. MAIN OUTCOME MEASURES: Abbreviated Posttraumatic Stress Disorder Checklist-Civilian, 2-item version; Patient Health Questionnaire (PHQ)-15: physical health symptoms; PHQ-9: depression symptoms; Generalized Anxiety Disorder Scale, 7-item; Connor-Davidson Resilience Scale, 2-items. RESULTS: Seventy-three percent (n = 88) of provider-referred behavioral health patients screened positive for potential posttraumatic stress disorder. Patients most likely to meet criteria for posttraumatic stress disorder reported significantly higher levels of stress, depression, anxiety, and suicide ideation as well as more severe headaches, chest pains, dizziness, and poorer health care. CONCLUSIONS: Results support the need for a trauma-informed integrated approach to health care within primary care settings, particularly those serving vulnerable populations. Integrated health care services foster an environment in which patient access to and satisfaction with services is maximized while overall well-being is enhanced. Adding resiliency-enhancing strategies to patients' integrated health care treatment plans might also be health-promoting. PTSD symptoms can be assessed as part of routine integrated practice via a 2-item screener. Information obtained from trauma screening provides the health care team with useful contextual information about patients' physical and behavioral health symptoms.

Adolescents Transitioning to High School: Sex Differences in Bullying Victimization Associated With Depressive Symptoms, Suicide Ideation, and Suicide Attempts.

Adolescents transitioning to high school may be at greater risk of depression and suicide if they are victims of bullying behavior. This study explored sex differences in bullying victimization (physical, verbal/social, and cyberbullying) and the impact on depressive symptoms and suicidal behaviors in ninth-grade students ( N = 233). Females reported significantly more verbal/social and cyberbullying than male students. There were no significant sex differences in physical bullying; male students who reported physical bullying victimization were more likely to experience depressive symptoms. Verbal/social bullying predicted depressive symptoms in males and females. Females who reported being victims of cyberbullying were more likely to report depressive symptoms, suicide ideation, and suicide attempts. Eighteen students reported suicide attempts, and each also experienced verbal/social bullying. School nurses are positioned to reach out to transitioning students, screen for mental health issues, provide a safe place to talk about bullying experiences, and promote positive mental health.