Guideline Recommendations on Behavioral and Psychological Symptoms of Dementia: A Systematic Review.

OBJECTIVE: To synthesize recommendations on assessing and managing behavioral and psychological symptoms of dementia (BPSDs) in existing clinical practice guidelines on dementia care to learn from and adapt recommendations to a Canadian context and language for describing BPSDs. DESIGN: Systematic review. SETTING AND PARTICIPANTS: Moderate to high-quality clinical practice guidelines on dementia care that made 1 or more recommendations on BPSD assessment or management. METHODS: We searched MEDLINE, Embase, JBI EBM, PsycINFO, AgeLine, and gray literature for clinical practice guidelines on dementia care making recommendations on BPSD, published between January 1, 2011, and October 13, 2022. Two independent reviewers conducted study screening and data abstraction. Four independent reviewers completed quality appraisal using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool; included guidelines had a mean overall AGREE II score ≥4. RESULTS: Our systematic review identified 23 moderate to high-quality clinical practice guidelines (264 recommendations). The mean overall quality score on the AGREE II tool ranged from 4 to 6.5. Recommendations were clearly presented (mean clarity of presentation score 73.5%), but guideline applicability was not consistently addressed (mean applicability score 39.3%). BPSD was the most prevalent term describing neuropsychiatric symptoms (number of guidelines [n] = 14). People with lived experience contributed to 6 guidelines (26.1%). Ten guidelines (43.5%) described 1 or more health equity considerations. Guidelines made recommendations for assessing and managing agitation (n = 12), aggression (n = 10), psychosis (n = 11), depression (n = 9), anxiety (n = 5), apathy (n = 6), inappropriate sexual behavior (n = 3), nighttime behavior (n = 5), and eating disturbances (n = 3). There was substantial variability in recommendation statements, evidence quality assigned to each statement, and strength of recommendations. CONCLUSIONS AND IMPLICATIONS: There are several moderate to high-quality clinical practice guidelines making recommendations on BPSD assessment and management, but variability in recommendation statements across guidelines and insufficient consideration of guideline applicability may hamper guideline dissemination and implementation in clinical practice.

Effect of Nordic Sensi® Chair on Behavioral and Psychological Symptoms of Dementia in Nursing Homes Residents: A Randomized Controlled Trial.

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are present in most people with dementia (PwD), including Alzheimer's disease. There is consensus that non-pharmacological therapies represent the first line of treatment to address BPSD. OBJECTIVE: We explore the efficacy of the use of a rocking chair (Nordic Sensi® Chair, NSC) in the treatment of BPSD in nursing home residents with moderate and severe dementia. METHODS: We carried out a 16-week randomized, single-blind, controlled, clinical trial with PwD admitted to nursing homes. Participants were assigned to a treatment group (n = 40) that received three times a week one session per day of 20 minutes in the NSC and a control group (n = 37). The Neuropsychiatric Inventory-Nursing Home (NPI-NH) was used as primary efficacy outcome. Occupational distress for the staff was evaluated using the NPI-NH Occupational Disruptiveness subscale (NPI-NH-OD). Statistical analyses were conducted by means of a Mixed Effects Model Analysis. RESULTS: Treatment with the NSC was associated with a beneficial effect in most of BPSD, as reflected by differences between the treatment and control group on the NPI-NH total score (mean change score -18.87±5.56 versus -1.74±0.67, p = 0.004), agitation (mean change score -2.32±2.02 versus -0.78±1.44, p = 0.003) and irritability (mean change score -3.35±2.93 versus -1.42±1.31, p = 0.004). The NPI-NH-OD total score also improved the most in the treatment group (mean change score -9.67±7.67 versus -7.66±6.08, p = 0.003). CONCLUSIONS: The reduction in overall BPSD along with decreased caregiver occupational disruptiveness represent encouraging findings, adding to the potential of nonpharmacological interventions for nursing home residents living with dementia.

Economic outcomes associated with diagnosed behavioral symptoms among patients with dementia in the United States: a health care claims database analysis.

BACKGROUND: Behavioral symptoms are common in patients with dementia. However, there is limited evidence of their economic burden. Among commercially insured patients with dementia in the United States, this study assessed the prevalence of diagnosed behavioral symptoms and whether healthcare resources utilization and costs were associated with these symptoms. METHODS: This retrospective observational study was conducted using the IBM® MarketScan® Commercial Claims and Encounters and Medicare Supplemental database from October 1, 2015, to September 30, 2019. Diagnoses of dementia and behavioral symptoms were identified using the International Classification of Diseases, 10th Modification codes. To test differences in patient characteristics among those with and without diagnosed behavioral symptoms, t-tests were used for continuous variables, and chi-square tests were used for categories. Generalized linear models were used to compare healthcare resource utilization and costs between patients with and without diagnosed behavioral symptoms, adjusted for baseline characteristics. RESULTS: Of the 62,901 patients with dementia included in the analysis, 16.5% had diagnosed behavioral symptoms 12 months post dementia diagnosis. Patients with diagnosed behavioral symptoms used more health care resources (mean annual pharmacy visits per patient: 39.83 vs. 33.08, mean annual outpatient visits per patient: 24.20 vs. 16.94, mean annual inpatient visits per patient: 0.98 vs. 0.47, mean annual ER visits per patient: 2.45 vs. 1.21) and incurred higher cost of care than those without diagnosed behavioral symptoms (mean annual total health care costs per patients: $63,268 versus $33,383). Inpatient care was the most significant contributor to total costs (adjusted annual mean cost per patient: $28,195 versus $12,275). CONCLUSION: Behavioral symptoms were significantly associated with higher healthcare resource utilization and costs among patients with dementia. Further research is warranted to address the unmet medical needs of this patient population.

Managing Behavioral and Psychological Symptoms of Dementia (BPSD) in the Era of Boxed Warnings.

PURPOSE OF REVIEW: To provide a comprehensive overview on the evaluation and management of behavioral and psychological symptoms of dementia (BPSD) using evidence from literature. RECENT FINDINGS: Evidence indicates efficacy for some non-pharmacological techniques including education of caregivers and cognitive stimulation therapy and pharmacological agents like antidepressant and antipsychotics for the management of BPSD. The use of antipsychotics has generated controversy due to the recognition of their serious adverse effect profile including the risk of cerebrovascular adverse events and death. BPSD is associated with worsening of cognition and function among individuals with dementia, greater caregiver burden, more frequent institutionalization, overall poorer quality of life, and greater cost of caring for these individuals. Future management strategies for BPSD should include the use of technology for the provision of non-pharmacological interventions and the judicious use of cannabinoids and interventional procedures like ECT for the management of refractory symptoms.

Korean Family Caregivers' Experiences With Managing Behavioral and Psychological Symptoms of Dementia: Keeping Harmony in Daily Life.

Behavioral and psychological symptoms of dementia (BPSD) are symptoms of dementia that family caregivers find difficult to manage. Competence in managing BPSD differs according to individual family caregiver. The current study investigated the competence in managing BPSD, focusing on family caregivers who were recognized as managing them well. Twenty-four Korean family caregivers (83% female, mean age = 67 years) living with persons with dementia (PWD) were interviewed. Four themes were derived from the content analysis: Entering and Looking into the World of PWD, Keeping Daily Life in Harmony With BPSD, Becoming an Expert in BPSD, and Balancing Between Caregiving and Myself. Family caregivers minimized the impact of BPSD and maintained life balance. As a result, they were able to continue a harmonious life with PWD. [Research in Gerontological Nursing, 15(3), 141-150.].

The Role of Telemedicine in the Management of the Behavioral and Psychological Symptoms of Dementia: A Systematic Review.

The first-line management of behavioral and psychological symptoms of dementia (BPSD) is based on nonpharmacologic interventions such as the provision of guidance and medical support to caregivers. However, accessibility to specialized care and medical resources is often scarce. The ongoing COVID-19 pandemic has compromised the delivery of outpatient care (notably in order to minimize the risk of disease transmission), thus making it essential to provide other means of accessing care for these patient populations. The use of telemedicine (TM) may be a means of increasing access to specialist care for patients with disabilities and poor access to health services, such as those with BPSD. The aim of this study is to provide a review of the literature on the use of TM for treatment and follow-up of patients with BPSD and their caregivers. We searched the PUBMED, EMBASE and CINAHL for articles published between January 1st, 2000, and December 31st, 2020, on the applicability of TM support for people with BPSD and their caregivers. We included open-label studies, qualitative studies, and randomized controlled trials . We did not include studies on the use of TM during the COVID-19 pandemic. A total of 22 publications were included and reviewed. TM was found to 1) be acceptable and feasible for both patients and caregivers, 2) decrease the frequency and intensity of BPSD, and 3) improve the caregiver's perceived wellbeing and mental health. Videoconferencing was effective for patient-centered interventions in nursing homes. Telephone-based interventions were more relevant when they were targeted at caregivers. The published studies are lacking in scope and high-quality studies are now needed to confirm these findings and assess TM's cost-effectiveness and ability to improve the management of patients with BPSD. In view of the ongoing COVID-19 pandemic, remote solutions for assessing and monitoring individuals with BPSD are urgently needed - particularly those living in rural areas and so-called "medical deserts."

A randomized trial of online single-session interventions for adolescent depression during COVID-19.

The COVID-19 pandemic has potentially increased the risk for adolescent depression. Even pre-pandemic, <50% of youth with depression accessed care, highlighting needs for accessible interventions. Accordingly, this randomized controlled trial (ClinicalTrials.gov: NCT04634903 ) tested online single-session interventions (SSIs) during COVID-19 in adolescents with elevated depression symptoms (N = 2,452, ages 13-16). Adolescents from all 50 US states, recruited via social media, were randomized to one of three SSIs: a behavioural activation SSI, an SSI teaching that traits are malleable and a supportive control. We tested each SSI's effects on post-intervention outcomes (hopelessness and agency) and three-month outcomes (depression, hopelessness, agency, generalized anxiety, COVID-19-related trauma and restrictive eating). Compared with the control, both active SSIs reduced three-month depressive symptoms (Cohen's d = 0.18), decreased post-intervention and three-month hopelessness (d = 0.16-0.28), increased post-intervention agency (d = 0.15-0.31) and reduced three-month restrictive eating (d = 0.12-17). Several differences between active SSIs emerged. These results confirm the utility of free-of-charge, online SSIs for high-symptom adolescents, even in the high-stress COVID-19 context.

Feasibility trial of a brief scalable psychological intervention for Syrian refugee adolescents in Jordan.

Background: Most refugees are less than 18 years and at heightened risk of common mental disorders (CMDs) relative to other youth. Limited evidence exists for psychosocial programsfor youth in low-resource settings. Early Adolescent Skills for Emotions (EASE) was developed by the World Health Organization to address this gap. Objectives: This study tested the safety, feasibility, and trial procedures of the EASE intervention among Syrian refugee youth in preparation for a definitive randomized controlled trial (RCT). Methods: A feasibility RCT was conducted in Amman, Jordan with Syrian children aged 10-14 years who reported psychological distress. Following community screening, youth and their caregivers were randomized to receive either the EASE intervention or enhanced treatment as usual (ETAU). EASE comprised seven group sessions teaching children coping skills, and caregivers received three group sessions to augment the youth sessions. Assessments were conducted at baseline and 1 week following the last EASE session (8 weeks following baseline). Following the trial, a qualitative process evaluation with staff and beneficiaries took place. Primary outcomes were safety and feasibility indicators, and distress was measured by the Paediatric Symptom Checklist. Results: In November 2018, 179 children were screened; 61 (33%) met criteria for distress (34.1%), two were excluded for suicidal risk, and 59 were randomized (EASE = 33, ETAU = 26). Of those who received EASE, 26 children (79%) completed the intervention. Group attendance was high and no adverse events were reported in either arm. Psychological distress did not show signs of abating in either group over time. Conclusion: This feasibility trial demonstrated the safety and acceptability of the intervention. Important lessons were learnt regarding entry criteria into the study and engagement of caregivers in the intervention. A fully powered randomized controlled trial will be conducted to evaluate the efficacy of EASE.

Antecedentes: La mayoría de los refugiados tienen menos de 18 años y corren un mayor riesgo de padecer trastornos mentales comunes (TMC) en comparación con otros jóvenes. Existe limitada evidencia de programs psicosociales para jóvenes en entornos de bajos recursos. El program denominado Early Adolescent Skills for Emotions (EASE, por sus siglas en inglés) fue desarrollado por la Organización Mundial de la Salud con el objetivo de abordar esta brecha.Objetivos: Este estudio probó la seguridad, viabilidad y los procedimientos de la intervención EASE entre los jóvenes refugiados sirios en preparación para un ensayo controlado aleatorizado (RCT) definitivo.Métodos: Se realizó un RCT de viabilidad en Amman, Jordania, con niños sirios de 10 a 14 años que reportaron angustia psicológica. Después de la evaluación comunitaria, los jóvenes y sus cuidadores fueron asignados al azar para recibir la intervención EASE o el tratamiento como de costumbre mejorado (ETAU por sus siglas en ingles). EASE comprendió siete sesiones grupales para enseñar a los niños habilidades de afrontamiento, y los cuidadores recibieron tres sesiones grupales para potenciar las sesiones para jóvenes. Las evaluaciones se realizaron al inicio y una semana después de la última sesión de EASE (8 semanas después del inicio). Después del ensayo, se llevó a cabo una evaluación cualitativa del proceso con el personal y los beneficiarios. Los resultados principales fueron los indicadores de seguridad y viabilidad, y la angustia se midió mediante la lista de verificación de síntomas pediátricos.Resultados: En noviembre de 2018, se examinaron 179 niños; 61 (33%) cumplieron los criterios de angustia (34,1%), dos fueron excluidos por riesgo de suicidio y 59 fueron aleatorizados (EASE = 33, ETAU = 26). De los que recibieron EASE, 26 niños (79%) completaron la intervención. La asistencia al grupo fue alta y no se informaron eventos adversos en ninguno de los brazos. La angustia psicológica no mostró signos de disminuir a lo largo del tiempo en ninguno de los grupos.Conclusión: Este ensayo de viabilidad demostró seguridad y aceptabilidad de la intervención. Se aprendieron importantes lecciones con respecto a los criterios de ingreso al estudio y la participación de los cuidadores en la intervención. Se llevará a cabo un ensayo controlado aleatorizado totalmente potenciado para evaluar la eficacia de EASE.

Recent-Onset Altered Mental Status: Evaluation and Management.

Potential precipitating factors for the recent onset of altered mental status (AMS) include primary central nervous system insults, systemic infections, metabolic disturbances, toxin exposure, medications, chronic systemic diseases, and psychiatric conditions. Delirium is also an important manifestation of AMS, especially in older people who are hospitalized. Clinicians should identify and treat reversible causes of the AMS, some of which require urgent intervention to minimize morbidity and mortality. A history and physical examination guide diagnostic testing. Laboratory testing, chest radiography, and electrocardiography help diagnose infections, metabolic disturbances, toxins, and systemic conditions. Neuroimaging with computed tomography or magnetic resonance imaging should be performed when the initial evaluation does not identify a cause or raises concern for intracranial pathology. Lumbar puncture and electroencephalography are also important diagnostic tests in the evaluation of AMS. Patients at increased risk of AMS benefit from preventive measures. The underlying etiology determines the definitive treatment. When intervention is needed to control patient behaviors that threaten themselves or others, nonpharmacologic interventions are preferred to medications. Physical restraints should rarely be used and only for the shortest time possible. Medications should be used only when nonpharmacologic treatments are ineffective.

Importance of the therapeutic relationship: efficacy of functional analytic psychotherapy with different problems / La importancia de la relación terapéutica: la eficacia de la psicoterapia analítica funcional en distintos problemas

Functional Analytical Psychotherapy (FAP) is a third generation and contextual therapy. It is based on therapeutic interaction, verbal and emotional client-therapist relationships. It also uses functional analysis of behaviour, and live on-going modification of clinical problem behaviours. The aim of this research was to study the efficacy of FAP with different types of psychological problems (anxiety, depression, obsession, sexual, personality, emotional control). An intra-group design (10 participants, 36 years old average) was used with pre-post and follow-up measurements. Different questionnaires have been used as common assessment tools for all clinical cases. The results showed a statistically significant change in all the standardised questionnaires, with a considerable size effect (d from -2.01 to -3.80) and maintained one year later. Also, as clinical change, the participants had improved in their daily lives. We conclude on the efficacy of FAP, focusing on the therapeutic relationship, regardless of diagnostic categories. (AU)

La Psicoterapia Analítica Funcional (FAP) es una terapia contextual y de tercera generación que se basa en la interacción terapéutica y las relaciones verbales y emocionales cliente-terapeuta. También utiliza el análisis funcional del comportamiento y la modificación en vivo de los comportamientos clínicos problemáticos. El objetivo de esta investigación es estudiar la eficacia de la FAP ante diferentes tipos de problemas psicológicos (ansiedad, depresión, obsesión, sexual, personalidad, control emocional). Se utilizó un diseño intragrupo (10 participantes, con un promedio de edad de 36 años) con mediciones previas, posteriores y de seguimiento. Se han utilizado diferentes cuestionarios como herramientas de evaluación comunes para todos los casos clínicos. Los resultados mostraron un cambio estadísticamente significativo en todos los cuestionarios estandarizados, con un efecto de tamaño considerable (d de -2.01 a -3.80) que se mantenía un año más tarde. Además, como cambio clínico, los participantes habían mejorado en su vida diaria. Concluimos sobre la eficacia de la FAP, centrándonos en la relación terapéutica, independientemente de las categorías diagnósticas. (AU)

The doll therapy as a first line treatment for behavioral and psychologic symptoms of dementia in nursing homes residents: a randomized, controlled study.

BACKGROUND: Patients living with dementia are severely affected by the development of behavioral and psychologic symptoms (BPSD) which represent a burden for patients and caregivers. The use of psychotropic drugs in the control of BPSD is widely diffused, however the use of a first line non-pharmacologic approach is highly recommended. Here we evaluate the effect of doll therapy (DT) in the management of BPSD, on the reduction of caregiver burden and delirium incidence in nursing home residents by a randomized controlled trial. METHODS: We enrolled fifty-two nursing homes residents living with dementia and BPSD. Subjects were randomized to DT (26) or standard treatment (ST, 26), we measured BPSD, caregiver burden and delirium with standard clinical scales at baseline, after 45 and 90 days. In order to evaluate the presence of BPSD we used Neuropsychiatric Inventory (NPI) scale and the A.Di.CO scale, the caregiver burden was measured by the Greutzner scale and delirium by the Confusion Assessment Method (CAM) scale. RESULTS: DT was more effective in reducing agitation and aggressiveness as respect to ST. Moreover DT globally reduced the presence of BPSD as dysphoria, wandering and apathy. We observed a significant reduction of the professional caregiver burden and the incidence of delirium was significantly reduced in subjects treated with DT. CONCLUSIONS: We show that DT is more effective that ST in the control of BSPD in patients affected by moderate to severe dementia. Moreover we suggest that DT may effective in reducing the incidence of delirium. TRIAL REGISTRATION: Retrospectively registered in ClinicalTrials.gov the 10th June 2, 2021 trial registration number NCT04920591.

Schools on the front lines: School based health centers amidst COVID-19.

School based health centers (SBHCs) are often at the front line of medical and mental health services for students in the schools they serve. Citywide school closures in New York City in March 2020 and ongoing social distancing procedures resulted in significant changes in SBHC services as well as access to these services. Furthermore, the combination of COVID-19 related stressors and the increased likelihood of adverse childhood events experienced by urban youth creates conditions for the exacerbation of mental health concerns among youth in metropolitan areas. The following article will explore the role of SBHCs as community agents focused on prevention and reduction of mental health concerns prior and during the current pandemic, as well as existing health disparities experienced by urban youth populations. The authors will also discuss research examining mental health concerns already present in global populations affected by COVID-19 as it may foreshadow the challenges to be faced by U.S. urban youth. Lastly, the authors describe recommendations, practice implications, and opportunities for preventative strategies and therapeutic interventions in school based health settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Posttraumatic Distress Symptoms and Their Response to Treatment in Adults With Prolonged Grief Disorder.

OBJECTIVE: Posttraumatic stress disorder and prolonged grief disorder (PGD) arise following major life stressors and may share some overlapping symptomatology. This study aimed to examine the presence and response to treatment of posttraumatic stress symptoms (PTSS) in bereaved adults with a primary diagnosis of PGD. METHODS: A randomized controlled trial of 395 adults with PGD (defined as an Inventory of Complicated Grief score ≥ 30 plus confirmation on structured clinical interview) randomly assigned participants to either complicated grief treatment (CGT) with citalopram, CGT plus placebo, citalopram, or placebo between March 2010 and September 2014. This secondary analysis examined the presence of PTSS (per the Davidson Trauma Scale) at baseline and change in PTSS with treatment using longitudinal mixed-effects regression and examined the role of violent compared to nonviolent deaths (loss type). RESULTS: High levels of PTSS were present at baseline, regardless of loss type, and were associated with increased functional impairment (P < .001). CGT with placebo demonstrated efficacy for PTSS compared to placebo in both threshold (OR = 2.71; 95% CI, 1.13-6.52; P = .026) and continuous (P < .001; effect size d = 0.47) analyses, and analyses were suggestive of a greater effect for CGT plus citalopram compared to citalopram alone (threshold analysis: OR = 2.84; 95% CI, 1.20-6.70; P = .017; continuous analysis: P = .053; d = 0.25). In contrast, citalopram did not differ from placebo, and CGT plus citalopram did not differ from CGT plus placebo. CONCLUSIONS: Bereavement-related PTSS are common in bereaved adults with PGD in the context of both violent and nonviolent death and are associated with poorer functioning. CGT shows efficacy for PTSS, while the antidepressant citalopram does not. TRIAL REGISTRATION: : ClinicalTrials.gov identifier: NCT01179568.

Reliability and Validity Testing of the Quantified Quality of Interaction Schedule.

BACKGROUND AND PURPOSE: The purpose of this study was to test the reliability and validity of the Quality of Interactions Schedule (QuIS) using a quantification scoring approach. METHODS: Baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) study was used. RESULTS: A total of 553 residents participated. There was evidence of inter-rater reliability with Kappa scores of .86 to 1.00 and internal consistency based on the Rasch analysis (item reliability of .98). There was some support for validity based on item fit and hypothesis testing as resistiveness to care was significantly associated with total QuIS scores. CONCLUSION: This study supports the use of the quantified QuIS to evaluate the quality of interactions over time and to test interventions to improve interactions.

Gender differences in presentation and management of behavioral and psychological symptoms associated with dementia among nursing home residents with moderate to severe dementia.

Lack of identification and management of behavioral and psychological symptoms of dementia (BPSD) can negatively impact female residents. The purpose of this secondary data analysis was to explore gender differences in presentation and management of BPSD and quality of interactions between residents and staff. A total of 553 residents from 55 nursing homes were included. Males exhibited more apathy and sexually inappropriate behavior and females exhibited more anxiety and sadness. Anxiety and sexually inappropriate behavior were more likely to be addressed in care plans for males than females. There was no difference in how staff interacted with males or females.

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action.

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Variation of Behavioral Health Care by Behavioral Health Symptom Profile Among a Diverse Group of Pregnant and Parenting Mothers.

This study examines the association between behavioral health symptoms and use of behavioral health care (BHC; i.e., past year counseling and/or regular use of psychiatric medication) among a diverse group of mothers of toddlers. Data were from the Fragile Families and Child Wellbeing study (N = 4205 mothers). The association between symptom profiles (i.e., depressive, anxiety, and alcohol and drug dependence) and use of BHC was estimated with logistic regression models. Potential moderation by race/ethnicity was examined. Complex symptom profiles, older age, functional limitations, prior behavioral health symptoms, and having Medicaid were associated with increased BHC use. While BHC use varied by symptom profile (but not by race/ethnicity), BHC use was low across profiles. Pregnant women and women of color were most likely to have unmet needs, underscoring the need to improve screening and management systems for these populations.

Mobilizing an institutional supportive response for healthcare workers and other staff in the context of COVID-19: The Yale experience.

The burden of the COVID-19 pandemic upon healthcare workers necessitates a systematic effort to support their resilience. This article describes the Yale University and Yale New Haven Health System effort to unite several independent initiatives into a coherent integrated model for institutional support for healthcare workers. Here, we highlight both opportunities and challenges faced in attempting to support healthcare workers during this pandemic.