Mental Health Literacy Interventions in Young People: a Narrative Review.

INTRODUCTION: Health literacy is defined as the "ability to obtain, process and understand basic health information and to access health services in order to make informed choices". The concept of Mental Health Literacy (MHL) has been introduced in recent years in order to promote mental health. MHL refers to knowledge and beliefs about mental disorders that facilitate their recognition, management, and prevention. A low level of MHL represents a fundamental barrier to seeking mental health care. METHODS: For this review we followed a narrative approach. Papers published between 2013 and 2024 were screened for inclusion. Only 24 articles met the inclusion criteria, all of them were included in the review. RESULTS: Among the 24 articles included, schools represented a particularly important context for interventions, as adolescents spend much of their time in school and school staff are often the point of reference for young people seeking help and advice. School-based interventions aimed at improving MHL and reducing stigma have the potential to prevent mental disorders and promote mental well-being, ultimately reducing their health, social, and economic burden. CONCLUSIONS: Schools are a key setting for mental health interventions, given the significant time adolescents spend there and their reliance on school staff for support. Enhancing MHL and reducing stigma through school-based programs can prevent mental disorders and promote well-being. Both live and digital interventions have shown effectiveness, though long-term impacts need more study.

Assessment of social stigma among multiple sclerosis patients in Saudi Arabia: A cross-sectional study.

OBJECTIVES: To assess the social stigma towards multiple sclerosis in Saudi Arabia. METHODS: A descriptive cross-sectional online survey study was done in Saudi Arabia. It targets social stigma among multiple sclerosis patients in Saudi Arabia. This questionnaire was filled out by patients using Google Forms, and the questionnaire was designed to measure the demographic data and social Stigma using a validated RSS-MS scale. RESULTS: After we applied the exclusion criteria, we received 381 MS patients who completed the study questionnaire. The results of the study showed that there are regions in the Kingdom of Saudi Arabia where the societal stigma towards multiple sclerosis is high compared to other regions in the Northern region (25.5±10.0) and the lowest among Eastern region patients (17.3±7.2). The study also, showed that unmarried people have a higher stigma compared to married patients (21.0±8.3 vs. 18.9±8.0, respectively; p=.011). CONCLUSION: Our study showed the extent of societal stigma towards patients with multiple sclerosis in the Kingdom of Saudi Arabia. We recommend more psychological and social support for patients with multiple sclerosis and more volunteer campaigns for the disease.

Differences in body dissatisfaction between individuals with and without stigma toward obesity: A study of preadolescents and adolescents.

INTRODUCTION: Previous studies have focused on understanding the biopsychosocial implications of obesity stigma and have made proposals to minimize its negative consequences, as well as recommendations to eliminate or reduce this stigma; however, knowing which individuals stigmatize obesity and why will allow us to have a broader picture of stigmatization and thus help in planning interventions with greater impact. OBJECTIVE: The aims were to describe the stigmatization toward obesity in preadolescents and adolescents and to determine whether there are differences in body dissatisfaction, abnormal eating behaviors and self-esteem among those with and without stigma toward obesity. METHODS: A total of 307 preadolescents and 349 adolescents answered a set of questionnaires that evaluated abnormal eating behaviors, body dissatisfaction, self-esteem and stigma. RESULTS: Fifty-nine percent of the participants stigmatized individuals with obesity, with preadolescents having the greatest stigma levels. Differences were observed only in body dissatisfaction, where the group of preadolescents who stigmatized individuals with obesity and the group of adolescents who did not stigmatize individuals with obesity reported higher levels of body dissatisfaction. CONCLUSION: Obesity is stigmatized at early ages, regardless of sex; however, preadolescents with stigma toward obesity and adolescents without stigma toward obesity have greater body dissatisfaction, indicating that body dissatisfaction plays a crucial role in the stigmatization of obesity. LEVEL OF EVIDENCE: Level V, cross-sectional analytical study.

Measuring internalized health-related stigma across health conditions: development and validation of the I-HEARTS Scale.

BACKGROUND: Health-related stigma and its internalization among individuals with chronic health conditions contribute to impaired mental and physical health and quality of life. Research on health-related stigma has been siloed, with disease-specific measures that may not capture the experiences of individuals with multiple health conditions and that prevent comparisons across health conditions. The current study aimed to develop and test a transdiagnostic measure of internalized health-related stigma for use among adults with different physical health conditions. METHODS: An existing measure of internalized mental health stigma was adapted to assess stigma due to chronic physical health conditions following COSMIN procedures, with input from advisory boards of community members living with a range of stigmatized health conditions (obesity, type 1 and type 2 diabetes, skin diseases, HIV, chronic pain, and cancers) and of health professionals who specialized in these conditions. The new Internalized Health-Related Stigma (I-HEARTS) Scale was tested in an online sample of 300 adults with these health conditions, recruited from ResearchMatch. Additional psychosocial measures of mental health and quality of life were administered, and participants provided information about their health conditions and demographic characteristics. Exploratory factor analysis and tests of reliability and validity were conducted to determine the psychometric properties of the I-HEARTS Scale, and k-means clustering and receiver of characteristic curve analysis were used to determine a clinically meaningful cutoff score indicating high levels of internalized stigma. RESULTS: Factor analysis results yielded a 25-item scale with a 3-factor solution, with subscales of Perceived and Anticipated Stigma, Stereotype Application and Self-Devaluation, and Stigma Resistance. Psychometric properties for internal consistency, inter-item and item-total correlations, and test-retest reliability were strong. Certain demographics (e.g., younger age) and characteristics related to health conditions (e.g., greater symptom severity) were associated with higher levels of internalized stigma. I-HEARTS Scale scores correlated moderately to strongly with related but distinct psychosocial measures, and a cutoff score of 3.40 or higher on the 1-7 rating scale was determined to indicate clinically meaningful levels of internalized stigma. CONCLUSIONS: The I-HEARTS Scale is a reliable and valid measure for the assessment of internalized health-related stigma among adults with varied stigmatized chronic health conditions. STUDY PRE-REGISTRATION: https://osf.io/84c5d/?view_only=87238512f6d6475c87f8f64280a8a15f .

Cleft Lip and/or Palate: Children's Experiences of Stigma in Colombia.

OBJECTIVE: Given prior craniofacial research reporting higher risk for negative social interactions, this study aimed to explore experiences of stigma described by children with cleft lip and/or palate (CL/P). DESIGN: Qualitative interviews were conducted with children in three sessions (totaling 90-180 min) using creative activities in their homes and/or and walking interviews in their neighborhood. Interview transcriptions were interpreted primarily with thematic analysis following theoretical frameworks of the stigmatization process and self-stigma concept. SETTING: Participants were recruited through Operation Smile Colombia. Interviews took place at children's homes and neighborhoods within three Colombian regions (Boyacá, Bogotá and Cundinamarca). PARTICIPANTS: Children (N = 12) with CL/P aged between 6-12 years were interviewed. RESULTS: Themes fit within the stigmatization process, starting with labeling and stereotyping, such as a range of mockery, and group separation by peers highlighting their not belonging and being socially 'other'. Status loss themes included negative appraisals of cleft-related differences and being perceived as 'ill' and 'imperfect'. Social exclusion themes reflected limited social interactions and loneliness. Self-stigma themes included shame about speaking with peers and anticipation of negative social interactions. CONCLUSIONS: The study results suggest that the process of stigmatization and self-stigma adversely affect social interactions for children with a cleft in multiple ways. Healthcare practitioners and policy makers can help address the potential consequences of stigma by implementing interventions at micro, meso and macro levels.

Developing the IDCaRe team: an integrated and culturally-affirming approach to improving health engagement for HIV-positive veterans.

BACKGROUND: Veterans Health Administration (VHA) has been at the forefront of offering integrated and patient-centered care to address the complex needs of more than 30,000 Veterans with HIV in the United States of America. These Veterans present with diverse cultural identities, personal values, and goals pertinent to their care, and they are often managing multiple comorbid chronic conditions, mental health diagnoses, and psychosocial stressors alongside HIV. The quality of their care has often been affected by stigma, minority stress, and the quality of the patient-provider relationship and associated collaborations over treatment approaches and goals, which has a direct effect on outcomes. OBJECTIVE: At San Francisco VA Health Care System, the Infectious Disease Care and Resilience (IDCaRe) team was established to improve outcomes for Veterans with acute needs or persistent difficulties in care delivery and efficacy. METHOD: A five-step model to address complex needs in HIV care was adapted from existing literature and evidence base, combined with a culturally-aligned, interdisciplinary care orientation. This model was implemented with patients determined to be at high-risk for poor health engagement. A representative composite case study demonstrates the process. RESULTS: Three Veterans underwent the intervention with results presented. Lessons learned and future discussions are also discussed. CONCLUSION: The IDCaRe model has promise as an integrated, patient-centered, behaviorally-grounded intervention for improving HIV-related care outcomes for Veterans with complex needs.

Stigma of coronavirus disease 2019 among hospitalized children and their parents: A prospective cohort study.

BACKGROUND: The stigma associated with coronavirus disease 2019 (COVID-19) is a global problem that causes psychosomatic distress, including depression, anxiety, and loneliness. However, few studies have investigated the stigma of COVID-19 and the associated mental health impact on children or parents. METHODS: We conducted a prospective cohort study at the National Center for Child Health and Development in Tokyo, Japan, between November 2021 and October 2022. Children (4-17 years of age) with COVID-19 and parents of hospitalized children (0-17 years of age) with COVID-19 were enrolled in the study. Children with special health-care needs were excluded. The questionnaires on stigma and mental health (depression, anxiety, and loneliness) were administered during hospitalization and at the 1 month follow-up evaluation after discharge. RESULTS: During the study period, 47 children and 111 parents were included. Thirty-eight children (81%) and 105 parents (95%) answered the questionnaires at the 1 month follow up, respectively. Approximately 70% of participants were categorized as a high-stigma group. In children, subjective stigma was associated with loneliness during hospitalization (mean difference [MD] 2.32; 95% confidence interval [CI], 0.11-4.52) and depression at the 1 month follow up (MD 2.44; 95% CI, 0.40-4.48). In parents, presumed stigma was associated with depression, anxiety, and loneliness at 1 month follow up (MD 2.24, 1.68, and 1.15; 95% CI, 0.58-3.89, 0.11-3.25, and 0.08-2.21). CONCLUSION: Our findings suggest that the stigma associated with COVID-19 continues to affect mental health for more than a month after discharge, and the effects of stigma on mental health differed between the children and parents.

Experiences of abortion care in Australia: a qualitative study examining multiple dimensions of access.

BACKGROUND: The United Nations' Sustainable Development Goals identify universal access to sexual and reproductive health services as a global priority. Yet barriers to abortion access remain, including legal restrictions, cost, stigma, and limited services and information. The aim was to identify barriers to and facilitators of abortion care access experienced in Australia. METHODS: This qualitative phenomenological study examined abortion access in Australia, where abortion is decriminalised, from March 2020 to December 2022. We used social media and flyers in clinics to recruit adults who had sought abortion care, then interviewed them in-depth. We mapped participant experiences to five dimensions of access identified by Levesque et al.'s patient-centred access to healthcare framework: approachability, acceptability, availability and accommodation, affordability, and appropriateness. RESULTS: The 24 participants lived across Australia and sought abortion during the COVID-19 pandemic. Approachability: Before seeking abortion, most did not know where to access information about the service and where to obtain it. Acceptability: Many were uncomfortable disclosing their abortion to family or friends; they reported that healthcare providers demonstrated varying levels of support. Availability and accommodation: Regional participants travelled far and faced long wait-times, exacerbated by pandemic restrictions. Affordability: Participants described financial stress paying for the service, travel, and related expenses. Appropriateness: Most participants expected judgemental care. Experiences varied widely: many participants experienced unempathetic, rushed, or judgemental interactions with healthcare staff, and many also reported at least one non-judgmental and supportive interaction on the same pathway to care. DISCUSSION: Abortion seekers experienced varying obstacles when seeking care. The findings illustrate the need for population- and system-level initiatives such as: providing accurate information about and normalising abortion; implementing system-level strategies to reduce wait times, travel, and costs, especially for rural populations; and developing regulatory and quality improvement initiatives to increase the workforce and its readiness to provide high-quality, non-judgemental abortion care. Challenges seeking care during pandemic restrictions illustrate the importance of social support during care and choice between abortion modalities and service types. Consumer voices can help understand the diverse pathways to abortion care and inform solutions to overcome the multidimensional barriers to access.

Reasons for not seeking alcohol treatment among a sample of Florida adults with HIV who perceived the need for treatment.

BACKGROUND: A minority of people who need alcohol treatment receive it. Unhealthy alcohol use is common among people with HIV (PWH) and can lead to negative health outcomes. The aims of this multi-methods study are to (1) quantitatively describe the prevalence, psychosocial characteristics, and demographic traits of a sample of PWH currently receiving HIV care in Florida who had a self-reported need for alcohol treatment but did not seek care and (2) qualitatively explore reasons why PWH did not seek treatment. METHODS: PWH enrolled in the Florida Cohort Study between October 2020 and February 2023 who had drinking history (N = 487) completed a cross-sectional survey that asked if there was a time when they recognized they needed help for their drinking but did not seek it. If yes, they were asked an open-ended follow-up question about reasons why they did not seek care. Demographic and behavioral differences between those who did and did not endorse a time when they needed alcohol treatment were determined using multivariable logistic regression, while qualitative data were analyzed with thematic analysis based in the Social-Ecological Model to assess reasons for not seeking care at the individual, social, and systems levels. RESULTS: A quarter of PWH (n = 129) with lifetime drinking indicated a time they needed care but did not seek it. Patients who endorsed a time where they perceived the need for treatment but did not seek it were more likely to endorse current at-risk drinking and a history of ever trying to reduce their drinking or formally seek professional alcohol treatment. The most common reasons participants did not seek care were individual level factors and included shame, denial, fear, wanting to do it on their own, not feeling ready, and not wanting to seek care. CONCLUSIONS: PWH experienced barriers largely at the individual level that prevented them from seeking alcohol treatment despite a recognized need, though many eventually sought care. Providers and public health professionals should consider helping to address various barriers, particularly internal barriers, when designing interventions to help PWH seek care.

Depression and stigma experience among patients with tuberculosis in urban and rural settings.

BACKGROUND: Tuberculosis is one of the leading causes of morbidity and mortality in the globe. The most common infectious disease-related death in the world is tuberculosis. In 2020, an estimated 9.9 million people became ill with tuberculosis (TB), translating to 127 cases per 100,000 people. The stigma associated with tuberculosis (TB) causes people to put off seeking treatment and adhering to their treatment regimen. India has the highest prevalence of tuberculosis in the world. Depression and stigma oftem co-exist in people with tuberculosis. OBJECTIVE: To estimate the prevalence of depression and stigma experience among patients with tuberculosis, and to determine the association of socio-demographic variables and stigma experience with depression in urban and rural field practice areas. METHODOLOGY: This is a cross-sectional study where purposive sampling method was adopted. A house-to-house and phone interview was conducted using a pre-designed, pre-tested questionnaire. Depression was assessed using the PHQ-9 and stigma experience was assessed using the Stigma Scale for Chronic Illness - 8 items (SSCI -8 Items). SPSS version 25 was used (licensed to the institution)for analysis. Descriptive statistics was used to calculate proportions, mean, standard deviation. Inferential statistics like Chi-square analysis/Fisher's exact analysis were used to find the association between various socio-demographic variables with the depression among patients with tuberculosis and association between stigma experience and depression. (Yates continuity Highlights correction applied wherever required) p < 0.5 was considered to be statistically significant. RESULTS: The overall prevalence of depression was 57.8%. The association between number of family members and type of tuberculosis with depression was statistically significant. 28.6% did not experience stigma, while 71.6% did. The association between depression score and stigma experience was not statistically significant. CONCLUSION: More than half of the study's participants had depression and had encountered stigma. There was significant association between depression scores with family size and type of tuberculosis.

Cross-cultural reliability of Van Rie TB perceived Stigma Scale among TB survivors in North India.

BACKGROUND: As India progresses towards TB elimination five years ahead of Sustainable Development Goals (SDG), Community-based perceptions of tuberculosis stigma become particularly relevant in the context of TB elimination efforts. This study aims to assess the cross-cultural reliability of 'Community Perspectives Van Rie TB Stigma Scale' which can been used for screening and rapid evaluation of prevalent stigma themes in community. METHODS: A community based cross-sectional study was conducted in North India among 400 TB survivors to assess the cross-cultural reliability of 'Community Perspective Van Rie TB stigma Scale'. Cronbach Alpha and McDonald's Omega were used for reliability analysis. RESULTS: Cronbach ɑ value for the Van Rie TB Stigma Scale was 0.826 and McDonald's ω is 0.832 indicative of good reliability of the TB Stigma Scale. CONCLUSION: The study is one the first studies to assess the cross-cultural reliability of Community Perspective of Van Rie TB Stigma Score in India. The reliability analysis indicates that the 'Community Perspectives Van Rie TB Stigma Scale' can be used in the Indian settings for screening of TB associated stigma.

High stigma prevalence and associated factors among TB patients in Southern Afghanistan: A multi-center cross-sectional study.

BACKGROUND: TB stigma represents a growing threat to TB care. Understanding TB stigma distribution and associating factors is crucial for effective TB control in Afghanistan. OBJECTIVES: To profile the prevalence of TB-related stigma and its associating factors among TB patients in Southern Afghanistan. METHODS: In this multi-center cross-sectional study, we randomly recruited 603 adult TB patients from 2 major TB treatment sites in Southern Afghanistan. A score of >8 on the Stigma Scale for Chronic Illness-8 items (SSCI-8 items) was considered as positive for TB-related stigma. We fitted a binary logistic regression model. RESULTS: Out of the 603 TB patients included in this study, 88.3% (95%CI: 85.8-90.9%) had TB-related stigma using the SSCI-8 cutoff (>8). Being in the age group 18-40 years, rural residence, no formal education, severe perception of illness, lack of TB knowledge, and symptoms of depression had positive associations with TB stigma. CONCLUSION: A considerable percentage (88.3%) of patients had TB stigma. We identified potential risk factors that could serve as a benchmark for guiding policy efforts and interventions that aim to reduce stigma among TB patients in Afghanistan.

"A cross-sectional study to assess stigma associated with tuberculosis in patients, family members, and health care staff in central India."

BACKGROUND: Stigma poses significant challenges to tuberculosis control efforts worldwide. India, bearing a substantial burden of tuberculosis cases, grapples with pervasive stigmatizing attitudes towards the disease, hindering timely diagnosis and treatment. This study aims to assess the prevalence and manifestations of tuberculosis-related stigma, shedding light on a critical yet overlooked aspect of tuberculosis management. METHODS: After obtaining informed consent, 314 participants were taken and stratified equally into three groups: patients, family members, and healthcare workers. A pre-designed questionnaire was used to calculate prevalence and assess tuberculosis stigma across various domains. Data were compiled in MS-Excel and analyzed using EPI-Info 7 by the CDC. RESULTS: Among all 314 participants, the prevalence of stigma in this study was 26.75%. A statistically significant correlation was found between stigma experienced and marital status (p = 0.013) and level of knowledge regarding tuberculosis (p < 0.001). Among the patients of tuberculosis, the odds of facing stigma are 13.25 (C.I. 95% 4.14, 42.41) times higher in females and 3 (C.I. 95% 1.005, 8.95) times higher in patients with unsatisfactory knowledge about tuberculosis compared to males and patients with satisfactory knowledge, respectively. CONCLUSION: Tuberculosis is stigmatized due to its deviation from societal norms. Societal norms dictate what is deemed acceptable or unacceptable. Females with tuberculosis encounter more stigma than males, and knowledge about tuberculosis affects stigma significantly. Patients mostly experience enacted and perceived stigma, while family members face perceived and secondary stigma. Healthcare workers tend to exhibit secondary stigma.

Perceived causes and stigmatization of tuberculosis among Apatani tribe of Arunachal Pradesh.

BACKGROUND: Tuberculosis (TB) is a pressing public health issue in many developing countries, with India having the highest number of cases. Lack of awareness and stigmatization of TB remains a significant barrier to addressing this challenge. This paper examines the perceived causes and stigma associated with TB among Apatani tribe of Arunachal Pradesh. METHODS: The study employed a mixed research approach, involving 106 TB patients (both pulmonary and extrapulmonary), both current and retrospective cases, from the Apatani tribe in Ziro valley, Arunachal Pradesh. Participants were selected from all the seven traditionally divided villages using purposive sampling. Semi-structured pre-tested schedules were used to conduct interviews with the patients. RESULTS: Among participants, 29.24% attributed TB to transmission, 34.91% had alternative explanations, and 35.85% remained uncertain about the causes. Notably, more Pulmonary TB patients reported transmission as the cause. A 10.75% higher likelihood of having misconceptions was observed among males. Literate individuals had 13.27% greater chance of being aware, although, higher education levels did not consistently follow this trend. Perceived stigmatization was evident mainly due to the contagious nature of the disease. CONCLUSION: A significant knowledge gap was evident among TB patients, with very few having a clear understanding of the causes of this disease. Gender differences in this regard were minimal. Literate individuals were more likely to understand the causes. Additionally, perceived stigmatization was a notable concern in the study.

LGBTQIA+ inclusion in the global health policy agenda: A critical discourse analysis of the Lancet Commission report archive.

CONTEXT: LGBTQIA+ people worldwide experience discrimination, violence, and stigma that lead to poor health outcomes. Policy plays a crucial role in ensuring health equity and safety for LGBTQIA+ communities. Given Lancet Commissions' substantial impact on health policy across domains, we aimed to determine how LGBTQIA+ communities and their care needs are incorporated throughout Lancet Commission reports and recommendations. METHODS: Using critical discourse analysis, we analyzed 102 Commissions for inclusion of and reference to LGBTQIA+ communities using 36 key terms. Three levels of analysis were conducted: 1) micro-level (overview of terminology use); 2) meso-level (visibility and placement of LGBTQIA+ references); and 3) macro-level (outlining characterizations and framing of references with consideration of broader social discourses). FINDINGS: 36 of 102 (35%) Commissions referenced LGBTQIA+ communities with 801 mentions in total. There were minimal (9/36) references made in the "Executive Summary," "Recommendations," and/or "Key Messages" sections of reports. LGBTQIA+ communities were most frequently discussed in reports related to HIV/AIDS and sexual and reproductive health. Few Commissions related to public health, or chronic conditions (9/60) referenced LGBTQIA+ communities. Some reports made non-specific or unexplained references; many discussed the LGBTQIA+ population without specific reference to sub-groups. LGBTQIA+ communities were often listed alongside other marginalized groups without rationale or a description of shared needs or experiences. We identified framings (legal, vulnerability, risk) and characterizations (as victims, as blameworthy, as a problem) of LGBTQIA+ communities that contribute to problematizing discourse. CONCLUSIONS: LGBTQIA+ people were rarely included in the Commissions, resulting in an inadvertent marginalization of their health needs. Policy initiatives must consider LGBTQIA+ groups from a strengths-based rather than problematizing perspective, integrating evidence-based approaches alongside community-based stakeholder engagement to mitigate inequities and promote inclusive care and policymaking.

Applying the theoretical domains framework to identify determinants to mental healthcare use among older African Americans with type 2 diabetes: a qualitative study.

OBJECTIVES: There is a paucity of research focused on enhancing access to mental healthcare for older African Americans with type 2 diabetes (T2D), who may be at risk for or living with comorbid depression. This study aims to identify barriers and facilitators to mental healthcare utilisation among this population, guided by the theoretical domains framework (TDF). DESIGN: This qualitative study involved 30 interviews with older African American adults diagnosed with T2D. The interview questions were aligned with TDF domains to capture participant perspectives on barriers and facilitators to mental healthcare use. SETTING: Interviews were conducted via telephone by a licensed clinician trained in social work. Each session lasted 60-90 min and was transcribed and analysed. PARTICIPANTS: The study included 30 African American adults (15 males and 15 females), aged 60 and above, living in an urban area in the Midwest. PRIMARY AND SECONDARY OUTCOMES: The primary outcome was the identification of themes from participant responses, analysed using thematic content techniques and categorised into TDF constructs. Demographic data served as the secondary outcome. RESULTS: Nine key themes were identified, categorised under major TDF domains and constructs. Significant barriers included (1) systemic racism ('knowledge'), (2) normalisation of depressive symptoms ('beliefs about consequences'), (3) perceived stigma ('beliefs about consequences') and 4) costs of medications and healthcare ('environmental context and resources'). Facilitators to seeking mental healthcare included (1) empowerment ('beliefs about capabilities'), (2) perceived benefits of mental health exams ('beliefs about consequences'), (3) positive provider experiences ('reinforcement'), (4) recognition of depressive symptoms as a motivator ('goals') and (5) support networks ('social influences'). CONCLUSION AND IMPLICATIONS: Key findings highlight that fostering positive patient-provider relationships and enhancing self-recognition of depressive symptoms can significantly encourage mental healthcare utilisation among older African Americans with T2D. These findings suggest that future interventions should focus on strengthening these relationships and improving self-awareness to better mental health outcomes.

Long COVID and Health Inequalities: What's Next for Research and Policy Advocacy?

INTRODUCTION: Organised by the 'Qualitative Long Covid Network', a workshop for qualitative Long COVID (LC) researchers, LC charity representatives and people with LC took place in June 2023, where research on the intersectional inequalities affecting LC prevalence, recognition and care was shared and discussed. METHODS: Five key themes were drawn up from presentations, discussions and reflections during the workshop, which are presented in this study. RESULTS: The following five themes are discussed: the unfairness of LC, difficulties in accessing care, mistrust of the healthcare system, a lack of understanding of LC and experiences of stigma and discrimination. Factors that widen or narrow inequalities related to LC were identified. CONCLUSION: A call to action is proposed to investigate and address inequalities through a robust LC research agenda that speaks with conviction to policy and decision-makers. We argue that there needs to be a strong investment in research and evidence-based policy and practice to mitigate the worst effects of the condition and address the inequalities in experience, treatment and support, which are experienced more often and more acutely by some of society's most vulnerable and disadvantaged individuals. PATIENT AND PUBLIC (PPI) CONTRIBUTION: Projects included in this article had PPI ongoing activity to inform their research. A member of the CONVALESCENCE PPI group presented at the QLC Network 'Long Covid and Health Inequalities' workshop, as did members of Long COVID Kids, Long COVID Support and Long COVID SOS charities. They were all invited to be co-authors of this article.

Why Does the History of Circadian Rhythms Matter for Sleep Today?

A paradigm shift in circadian science is underway, exposing ethical tensions from a legacy of pervasive neglect of circadian disorders. This article canvasses ethical questions about stigma, justice, and accommodation that should be formally recognized to reconceive circadian care. Responding to these questions first requires confronting medicine's long-standing history of ableism in how circadian disorders are understood. This article also examines historical origins of the clinical and ethical need to expand diagnostic and therapeutic care access for patients with circadian disorders. Finally, this article recommends how to create space within the disabilities movement for persons with circadian disorders.