Are the estimated needs for mental health care among adolescents from different socioeconomic backgrounds met equally in Sweden? A longitudinal survey-registry linkage study.

Evidence of inequality in the utilisation of mental health care (MHC) by adolescents in Nordic countries is mixed. This study aims to investigate if there are socioeconomic differences in the utilisation of MHC, while accounting for adolescents' mental health status. We analysed a cohort of 3517 adolescents, followed from 7 to 9th grade (ages 13-16), to examine the association between parental socioeconomic position (SEP: education and disposable income), adolescents' estimated needs, and the utilisation of MHC (defined as visits to secondary psychiatric care or receipt of psychotropic medication). Logistic and negative binomial regression models, with mental health status as moderator, were used to predict utilisation during each grade. Lower SEP predicted higher odds of utilising MHC in adolescents with no/mild symptoms (e.g., odds ratio, OR = 1.33, 95% CI 1.04-1.72, lower vs highest education), but not in those with moderate-to-severe symptoms (estimates close to one and non-significant). This pattern was largely explained by treatment of attention deficit hyperactivity disorder/autism spectrum disorders (ADHD/ASD) in boys. For girls with severe symptoms, lower SEP predicted reduced odds of utilising MHC for other mental disorders (OR = 0.48, 95% CI 0.25-0.92, lower education), and fewer outpatient visits when in contact with such care, although non-significant (incidence rate ratio, IRR = 0.51, 95% CI 0.25-1.05, lowest vs highest income). Our findings suggest a more equitable use of MHC for treating ADHD/ASD, but not other mental disorders such as depression and anxiety, particularly among girls.

Functioning, symptom expression and risk along the psychosis continuum.

BACKGROUND: The psychosis continuum implies that subclinical psychotic experiences (PEs) can be differentiated from clinically relevant expressions since they are not accompanied by a 'need for care'. METHODS: Using data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 34 653), the current study examined variation in functioning, symptomology and aetiological risk across the psychosis phenotype [i.e. variation from (i) no PEs, 'No PEs' to (ii) non-distressing PEs, 'PE-Experienced Only' to (iii) distressing PEs, 'PE-Impaired' to (iv) clinically defined psychotic disorder, 'Diagnosed']. RESULTS: A graded trend was present such that, compared to those with no PEs, the Diagnosed group had the poorest functioning, followed by the PE-Impaired then PE-Experienced Only groups. In relation to symptom expression, the PE-Impaired group were more likely than the PE-Experienced Only and the Diagnosed groups to endorse most PEs. Predictors of group membership tended to vary quantitatively rather than qualitatively. Trauma, current mental health diagnoses (anxiety and depression) and drug use variables differentiated between all levels of the continuum, with the exception of the extreme end (PE-Impaired v. Diagnosed). Only a few variables distinguished groups at the upper end of the continuum: female sex, older age, unemployment, parental mental health hospitalisation and lower likelihood of having experienced physical assault. CONCLUSIONS: The findings highlight the importance of continuum-based interpretations of the psychosis phenotype and afford valuable opportunities to consider if and how impairment, symptom expression and risk change along the continuum.

[Support needs of care dependent individuals : Survey of general and specific needs for information, assistance and support of care dependent individuals and their relatives]. / Unterstützungsbedarfe pflegeempfangender Menschen : Erhebung allgemeiner und spezieller Informations­, Hilfe- und Unterstützungsbedarfe pflegeempfangender Menschen und ihrer Angehörigen.

BACKGROUND: In 2009, statutory regulations on information and counselling regarding nursing care needs, performed by so-called care advisors have been implemented for persons in need of long-term care and their relatives. In order to adequately prepare these care advisors, contemporary needs and requirements must be determined. The aim of the study was to determine the different needs of persons in need of long-term care and their relatives. METHOD: Care advisors were interviewed via an online survey tool using a standardized questionnaire. A 5-point Likert scale was used to determine the needs regarding information and advice on 16 specific topics. In general, overall needs regarding information and advice of care recipients and relatives were recorded using a 10-point scale (1 low and 10 high). Using classification and regression trees (CRT) and random forest, the correlation between the individual main topics and the general need for advice was analyzed. RESULTS: The participating care advisors (n = 276) rated the general demand for information of people in need of care and their relatives with a mean of 7.8 and 9.2, respectively. For those in need of care, the strongest association of general information needs was the topic of housing advice For the relatives, the topic social law aspects and benefits was the most relevant association. CONCLUSION: The general demand for information was rated very high. Since differences became obvious between those in need of care and their relatives, it is necessary to adjust care advice for these two groups.

Children's use of psychosocial care in a population-based longitudinal study: less likely for girls, children with a non-Western background and children with a high quality of life.

Knowledge on determinants of children's psychosocial care use is important to improve their access to care. This study examined the independent contributions of need and predisposing factors to psychosocial care use in 9-year-old children, guided by the Gateway Provider Model. Data of the Generation R Study, a prospective cohort of children born in Rotterdam, the Netherlands, were analysed using multivariable logistic regression (n = 4714). Need (quality of life, presence and type of emotional/behavioural problems) and predisposing factors (sex, ethnic background and maternal educational level) were measured using parent questionnaires at multiple time points between ages 1.5 and 9 years. Psychosocial care use was parent-reported at 9 years old (9.6% among children with Western background, 7.3% among children with non-Western background). Having emotional/behavioural problems at 5 and 9 years old was associated with more care use, while having a higher quality of life, being a girl and having a Moroccan/Turkish or other non-Western background were associated with less care use. Externalising and internalising problems, as well as several types of problems, at 5 and 9 years old were associated with psychosocial care use. Stratified analyses revealed that, in children with non-Western backgrounds, only a poorer psychosocial quality of life was associated with psychosocial care use. To conclude, girls with a Western background and children with a non-Western background were less likely to receive care compared to their peers. Children with parent-reported emotional/behavioural problems at 5 and 9 years old and decreased quality of life at 5 years old were more likely to receive psychosocial care use at 9 years old. Our findings hold relevance for preventive policies.

[Knowledge and perceptions of the population on services in case of need for long-term care: A standardized telephone survey]. / Kenntnisse und Sichtweisen der Bevölkerung zu Leistungen bei Pflegebedarf.

Knowledge and perceptions of the population on services in case of need for long-term care: A standardized telephone survey Abstract. Background: In the absence of professional support, family caregivers rarely recognize their own overload situations and therefore make inadequate use of support services in the event of a need for care. Aim: The study investigates the care of people in need for care, the level of knowledge about and stress factors in the assumption of care from the point of view of informal caregivers and non-caregivers. Methods: A cross-sectional study was conducted using standardized Computer Assisted Telephone Interviews (CATI) with persons aged 18 and older in Saxony. Descriptive and bivariate statistics were calculated. Results: Care provided by an outpatient care service or by family caregivers was rated significantly better by 259 informal caregivers compared with 342 non-caregivers among 601 participants (N = 601). Further, informal caregivers and non-caregivers had different knowledge about the closest place for long-term care counseling and about compensation payments from the pension insurance. Conclusions: In individual areas of the queried counseling services and relief options, the response behavior of family caregivers differed significantly from the other participants. It can be assumed that family caregivers have a slight information advantage of family caregivers in the use of support services.

Clinical and theoretical relevance of responses to analogues of psychotic experiences in people with psychotic experiences with and without a need-for-care: an experimental study.

BACKGROUND: Certain ways of responding to psychotic experiences (PEs) appear more commonly associated with clinical distress (e.g. avoidance) and other ways with benign or positive outcomes (e.g. reappraisal and acceptance). Past research has largely been limited to retrospective self-report. We aimed to compare clinical and non-clinical individuals on experimental analogues of anomalous experiences. METHOD: Response styles of two groups with persistent PEs (clinical n = 84; non-clinical n = 92) and a control group without PEs (n = 83) were compared following experimental analogues of thought interference (Cards Task, Telepath) and hearing voices (Virtual Acoustic Space Paradigm). RESULTS: The non-clinical group with PEs were less likely to endorse unhelpful response styles, such as passive responding or attempts to avoid, suppress, worry about or control mental experiences, compared with the clinical group on all three tasks. The clinical group were more likely to endorse unhelpful response styles compared with controls on two out of three tasks (Cards Task and Telepath). The non-clinical group performed similarly to controls on unhelpful responding across all tasks. There were no group differences for helpful response styles, such as cognitive reappraisal or mindful acceptance of experiences. CONCLUSIONS: In line with cognitive models of psychosis, the findings suggest that the way in which individuals respond to unusual experiences may be an important factor in understanding clinical distress, supporting the therapeutic rationale of targeting potentially unhelpful patterns of response.

Barriers to mental health care for Australian children and adolescents in 1998 and 2013-2014.

OBJECTIVE: To assess changes in barriers to mental health care for children and adolescents over 16 years. METHODS: We used data from two nationally representative surveys of Australian children and adolescents (4-17 years old), conducted in 1998 (N = 4509) and 2013-2014 (N = 6310). Barriers to care were assessed among parents who had reported a perceived partially met or unmet need for their child in the past 6 months in 1998, and the past 12 months in 2013-2014; barriers were similarly assessed among adolescents in relation to themselves. We addressed measurement inconsistencies between surveys by harmonising barriers to accommodate differences in wording and performing sensitivity analyses among those with a 1-month disorder to equalise the timeframes in which barriers were assessed. To assess change, we examined whether the rank order of the three most commonly endorsed barriers changed and whether the 95% confidence intervals (CI) around their estimates overlapped. RESULTS: Similar proportions of parents reported a partially met or unmet need in 1998 (12.9%, 95% CI = [11.7, 14.0]) as in 2013-2014 (14.3%, 95% CI = [13.2, 15.3]), but the ratio of unmet to partially met need decreased from 3:1 in 1998 to 1:1 in 2013-2014. Top three parent-endorsed barriers ('self-reliance', 'unsure where to get help', and 'cost') were the same at both time points; 'self-reliance' decreased from 65.9% (95% CI = [61.1%, 70.7%]) to 34.9% (95% CI = [31.5%, 38.3%]). Top two adolescent-endorsed barriers ('self-reliance' and 'concerned what others might think') were the same at both time points, the third differed, but none of them decreased. CONCLUSION: Perceived unmet need for mental health care for children and adolescents may have decreased between 1998 and 2013-2014, but the gap in receiving sufficient care may have increased. Despite investments in community awareness and treatment during this period, key barriers seemed largely unchanged. For parents, the decrease in self-reliance may reflect a positive shift in beliefs about the potential benefits of treatment.

Can markers of biological age predict dependency in old age?

Recent research has shown that markers of biological age, such as leukocyte telomere length (LTL), epigenetic clocks and the frailty index (FI) are predictive of mortality and age-related diseases. However, whether these markers associate with the need for care in old age, thereby having utility in reflecting dependency, is unclear. This study was undertaken to analyze whether LTL, two epigenetic clocks-the DNA methylation age (DNAmAge) and DNAm PhenoAge-and the FI are associated with the need for regular care in up to 604 individuals (aged 48-94 years) participating in the Swedish Adoption/Twin Study of Aging. Need for regular care was defined as receiving formal or informal help in daily routines at least once per week. Logistic regression adjusted for age, sex and education was used in the analysis. The predictive accuracies, assessed as the area under the curve (AUC) for the significant biological age measures were further compared to the accuracies of the limitations in activities of daily living (ADL) and instrumental ADL (IADL). Neither LTL nor the epigenetic clocks were associated with the need for care, whereas the FI was; odds ratio for 10% increase in FI 3.54 (95% confidence interval 2.32-5.41). The FI also demonstrated higher predictive accuracy than the ADL score (FI AUC 0.80 vs. ADL score AUC 0.62; p < 0.001 for equality of the AUCs), whereas the difference between FI AUC (0.80) and IADL score AUC (0.75) was not significant (p = 0.238). The FI might thus be a useful marker for the need for care.

Associations between education and need for care among community dwelling older adults in Iceland.

BACKGROUND: Older adults in Iceland have good access to social services that support them in maintaining an independent life, although receiving informal care is common for community living older adults in Iceland. The aim of this study was to examine whether the need for care as well as receiving formal and informal care is associated with education among older adults in Iceland. METHODS: Among a national sample of 782 Icelandic community dwelling old adults (mean age 76.9 ± 7.4 years, 55% women), a telephone survey was conducted. The survey included questions on: socioeconomic status, social network, health status, activities of daily living and formal/informal care. RESULTS: A full data set was available for 720 subjects and among these, 349 (48.5%) had no need for care, 197 (27.4%) received informal care only, 31 (4.3%) received formal care only, and 143 (19.9%) received both type of care. Participants with higher education were significantly less likely to need care (OR 0.67, 95% CI, 0.47-0.97, p = 0.031) when compared with those who had primary education. Categorisation by age showed that this difference was only significant in participants younger than 80 years. Education was not related to formal care, but adults with higher education were less likely to receive informal care compared with older adults who had primary education (OR: 0.65, 95%CI: 0.46, 0.93, p = 0.018). CONCLUSIONS: People with higher education were significantly less likely to need care and this association was mainly present among those aged below 80 years. Further, in participants that needed care, the likelihood of receiving informal care was lower in highly educated participants, but no differences in formal care were observed between educational levels.

Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries.

BACKGROUND: Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. METHODS: Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for "problems with emotions, nerves, mental health, or use of alcohol or drugs." Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits). RESULTS: Of 51,547 respondents (response = 71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12-month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries. CONCLUSIONS: Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.

Patients' and practice nurses' perceptions of depression in patients with type 2 diabetes and/or coronary heart disease screened for subthreshold depression.

BACKGROUND: Comorbid depression is common in patients with type 2 diabetes (DM2) and/or coronary heart disease (CHD) and is associated with poor quality of life and adverse health outcomes. However, little is known about patients' and practice nurses' (PNs) perceptions of depression. Tailoring care to these perceptions may affect depression detection and patient engagement with treatment and prevention programs. This study aimed to explore patients' and PNs' perceptions of depression in patients with DM2/CHD screened for subthreshold depression. METHODS: A qualitative study was conducted as part of a Dutch stepped-care prevention project. Using a purposive sampling strategy, data were collected through semi-structured interviews with 15 patients and 9 PNs. After consent, all interviews were recorded, transcribed verbatim and analyzed independently by two researchers with Atlas.ti.5.7.1 software. The patient and PN datasets were inspected for commonalities using a constant comparative method, from which a final thematic framework was generated. RESULTS: Main themes were: illness perception, need for care and causes of depression. Patients generally considered themselves at least mildly depressed, but perceived severity levels were not always congruent with Patient Health Questionnaire 9 scores at inclusion. Initially recognizing or naming their mental state as a (subthreshold) depression was difficult for some. Having trouble sleeping was frequently experienced as the most burdensome symptom. Most experienced a need for care; psycho-educational advice and talking therapy were preferred. Perceived symptom severity corresponded with perceived need for care, but did not necessarily match help-seeking behaviour. Main named barriers to help-seeking were experienced stigma and lack of awareness of depression and mental health care possibilities. PNs frequently perceived patients as not depressed and with minimal need for specific care except for attention. Participants pointed to a mix of causes of depression, most related to negative life events and circumstances and perceived indirect links with DM2/CHD. CONCLUSION: Data of the interviewed patients and PNs suggest that they have different perceptions about (subthreshold) depressive illness and the need for care, although views on its causes seem to overlap more.

Long-Term Care Needs in the Context of Poverty and Population Aging: the Case of Older Persons in Myanmar.

Myanmar is one of the poorest and least healthy countries in Southeast Asia. As elsewhere in the region, population aging is occurring. Yet the government welfare and health systems have done little to address the long-term care (LTC) needs of the increasing number of older persons thus leaving families to cope on their own. Our study, based on the 2012 Myanmar Aging Survey, documents the LTC needs of persons aged 60 and older and how they are met within the context of the family. Nearly 40% of persons in their early 60s and 90% of those 80 and older reported at least one physical difficulty. Spouses and children constitute the mainstay of the financial and instrumental support of elderly including those with LTC needs. Nearly two-thirds of older persons reported receiving assistance with daily living activities. More than three quarters coreside with children, a living arrangement that in turn is strongly associated with receiving regular assistance in daily living. Daughters represent almost half and spouses, primarily wives, one-fourth of primary caregivers. Unmet need for care as well as inadequate care decline almost linearly with increased household wealth. Thus elderly in the poorest households are most likely to experience gaps in LTC. Given mounting concerns regarding health disparities among Myanmar's population, this pattern of inequality clearly needs to be recognized and addressed. This needs attention now rather than later given that reduced family size and increased migration pose additional challenges for family caregiving of frail elderly in the coming decades.

Trends of relative and absolute socioeconomic equity in access to coronary revascularisations in 1995-2010 in Finland: a register study.

BACKGROUND: Resources for coronary revascularisations have increased substantially since the early 1990s in Finland. At the same time, ischaemic heart disease (IHD) mortality has decreased markedly. This study aims to examine how these changes have influenced trends in absolute and relative differences between socioeconomic groups in revascularisations and age group differences in them using IHD mortality as a proxy for need. METHODS: Hospital Discharge Register data on revascularisations among Finns aged 45-84 in 1995-2010 were individually linked to population registers to obtain socio-demographic data. We measured absolute and relative income group differences in revascularisation and IHD mortality with slope index of inequality (SII) and concentration index (C), and relative equity taking need for care into account with horizontal inequity index (HII). RESULTS: The supply of procedures doubled during the years. Socioeconomic distribution of revascularisations was in absolute and relative terms equal in 1995 (Men: SII = -12, C = -0.00; Women, SII = -30, C = -0.03), but differences favouring low-income groups emerged by 2010 (M: SII = -340, C = -0.08; W: SII = -195, C = -0.14). IHD mortality decreased markedly, but absolute and relative differences favouring the better-off existed throughout study years. Absolute differences decreased somewhat (M: SII = -760 in 1995, SII = -681 in 2010; W: SII = -318 in 1995, SII = -211 in 2010), but relative differences increased significantly (M: C = -0.14 in 1995, C = -0.26 in 2010; W: C = -0.15 in 1995, C = -0.25 in 2010). HII was greater than zero in each year indicating inequity favouring the better-off. HII increased from 0.15 to 0.18 among men and from 0.10 to 0.12 among women. We found significant and increasing age group differences in HII. CONCLUSIONS: Despite large increase in supply of revascularisations and decrease in IHD mortality, there is still marked socioeconomic inequity in revascularisations in Finland. However, since changes in absolute distributions of both supply and need for coronary care have favoured low-income groups, absolute inequity can be claimed to have decreased although it cannot be quantified numerically.

Factors associated with preferences for long-term care settings in old age: evidence from a population-based survey in Germany.

BACKGROUND: Long-term care is one of the most pressing health policy issues in Germany. It is expected that the need for long-term care will increase markedly in the next decades due to demographic shifts. The purpose of this study was to investigate the factors associated with preferences for long-term care settings in old age individuals in Germany. METHODS: Based on expert interviews and a systematic review, a questionnaire was developed to quantify long-term care preferences. Data were drawn from a population-based survey of the German population aged 65 and over in 2015 (n = 1006). RESULTS: In multiple logistic regressions, preferences for home care were positively associated with providing care for family/friends [OR: 1.6 (1.0-2.5)], lower self-rated health [OR: 1.3 (1.0-1.6)], and no current need of care [OR: 5.5 (1.2-25.7)]. Preferences for care in relatives' homes were positively associated with being male [OR: 2.0 (1.4-2.7)], living with partner or spouse [OR: 1.8 (1.3-2.4)], having children [OR: 1.6 (1.0-2.5)], private health insurance [OR: 1.6 (1.1-2.3)], providing care for family/friends [OR: 1.5 (1.1-2.0)], and higher self-rated health [OR: 1.2 (1.0-1.4)]. Preferences for care in assisted living were positively associated with need of care [OR: 1.9 (1.0-3.5)] and higher education [for example, University, OR: 3.5 (1.9-6.5)]. Preferences for care in nursing home/old age home were positively associated with being born in Germany [OR: 1.8 (1.0-3.1)] and lower self-rated health [OR: 1.2 (1.0-1.4)]. Preferences for care in a foreign country were positively associated with lower age [OR: 1.1 (1.0-1.2)] and being born abroad [OR: 5.5 (2.7-11.2)]. CONCLUSIONS: Numerous variables used are sporadically significant, underlining the complex nature of long-term care preferences. A better understanding of factors associated with preferences for care settings might contribute to improving long-term care health services.

[10-year anniversary of the Long-term Care Charter : Time to take stock]. / 10 Jahre Pflege-Charta : Zeit, Bilanz zu ziehen.

Ten years ago, the Charter for People in Need of Long-term Care was published in Germany. The Charter contains a series of basic rights for people in need of long-term care. At the initiative of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ), this was developed in a complex consensus process together with the Federal Ministry of Health (BMG) and representatives from all areas of care. Since then, the Charter has gained practical relevance in various areas of care and has entered into legislation. The article looks at the dissemination and impact of the Charter following a review of the social and legal environment. Further implementation requirements and the revision of the charter are discussed.

Development of risk assessment scales for Needed Support/Long-Term Care certification: A longitudinal study using the Kihon Checklist and medical assessment data.

Objectives　This study aimed to develop risk assessment scales for predicting the incidence of Needed Support/Long-Term Care certification, by aggregating data from the Kihon Checklist, medical assessments, and long-term care insurance certification during a follow-up period (a maximum of 4 years and 2 months) conducted in a municipality.Methods　This retrospective cohort study included 72,127 older adults aged 65 years or older living in K City (an ordinance-designated city) who responded to the Kihon Checklist in 2011. We linked their medical assessment data (examined/unexamined, blood pressure, and five blood biochemical items) from 2011 and information on the incidence of long-term care insurance certification from 2011 to 2015 to the Kihon Checklist data (the 12 essential items and seven optional items from the Needs Survey). We constructed four Cox proportional hazards models as follows: 1) age, sex, and the Needs Survey's 12 essential items; 2) model 1 plus seven optional items; 3) model 2 plus examined/unexamined at medical assessment; and 4) model 3 plus blood pressure and five blood biochemical items, as independent variables. Recent requirement for Support/Long-Term Care certification was included as an outcome with stepwise forward selection. We assigned scores for each item based on the non-standardized regression coefficients obtained (B) and the sum of those scores was used to establish the risk assessment scales for predicting Needed Support/Long-Term Care certification from each model. A receiver operating characteristic (ROC) analysis was conducted to estimate the sensitivity and specificity in order to compare predictive validity of the scales.Results　During the follow-up period, 11,039 (15.3%) individuals required a new incidence of a Needed Support/Needed Long-Term Care certification. A risk assessment scale of 0-55 was established based on age, sex, and the 10 essential items from the Needs Survey's. The incidence of certification were 3.2%, 14.7%, 31.6%, 56.7%, and 75.0% at scores of 10, 20, 30, 40, and 50, respectively. The area under the ROC curve (AUC) was 0.783, and the sensitivity and the specificity were 0.705 and 0.731, respectively (cut-off: 21/22). These values remained almost unchanged despite the addition of optional and medical assessment items (AUC: 0.786-0.787, sensitivity: 0.721-0.730, and specificity: 0.710-0.717).Conclusion　Although the medical assessment data was not aggregated, the scale developed from the Kihon Checklist's 10 items (included in the Needs Survey's essential items) is useful for predicting the incidence of Needed Support/Long-Term Care certification. The scale, which evaluates the risk of needed support/long-term care at individual and community levels, was developed using the existing Kihon Checklist data or the Needs Survey's data collected subsequently by municipalities.

Appraisals of psychotic experiences: an experimental investigation of symptomatic, remitted and non-need-for-care individuals.

BACKGROUND: Appraisals are suggested to play a determining role in the clinical outcome of psychotic experiences (PEs). We used experimental tasks that mimic PEs to investigate appraisals in individuals with PEs with and without a 'need-for-clinical-care', and psychosis patients whose symptoms have remitted. We predicted that patients would appraise the tasks as threatening regardless of current symptom level, while non-clinical and control groups would appraise them as non-threatening. METHOD: Appraisals following three anomalous experiences-inducing tasks [Telepath, Cards task, Virtual acoustic space paradigm (VASP)] were examined in 71 individuals: symptomatic (n = 18) and remitted (n = 16) psychosis patients; non-clinical group with PEs (n = 16); controls without PEs (n = 21). RESULTS: As predicted, symptomatic patients endorsed more threatening appraisals for all tasks than non-clinical and control groups, who did not differ from each other. However, remitted patients were less likely to endorse threatening appraisals of the Cards and Telepath than their symptomatic counterparts, although they did not differ in global ratings of how striking, threatening and distressing they found the tasks. Moreover, remitted participants endorsed more threatening appraisals of the Telepath and VASP than non-clinical participants, and of the VASP than controls. Remitted participants also rated all three tasks as globally more threatening than the non-clinical group and controls. CONCLUSIONS: Clinical outcome may not necessarily be driven by the presence of symptoms, with threatening appraisals of PEs representing a key factor. The remitted group's intermediate appraisal scores imply that the relationship between appraisal and clinical outcome is not straightforward, and potential mediating factors need to be determined.

Perceived Need for and Perceived Sufficiency of Mental Health Care in the Canadian Armed Forces: Changes in the Past Decade and Comparisons to the General Population.

OBJECTIVES: Failure to perceive need for care (PNC) is the leading barrier to accessing mental health care. After accessing care, many individuals perceive that their needs were unmet or only partially met, an additional problem related to perceived sufficiency of care (PSC). The Canadian Armed Forces (CAF) invested heavily in workplace mental health in the past decade to improve PNC/PSC; yet, the impact of these investments remains unknown. To assess the impact of these investments, this study 1) captures changes in PNC/PSC over the past decade in the CAF and 2) compares current PNC/PSC between the CAF and civilians. METHODS: Data were drawn from the 2013 and 2002 CAF surveys and the 2012 civilian mental health survey (total N = ∼40 000), conducted by Statistics Canada using similar methodology. Exclusions were applied to the civilian sample to make them comparable to the military sample. Prevalence rates for No need, Need met, Need partially met, and Need unmet categories across service types (Information, Medication, Counselling and therapy, Any services) were calculated and compared between 1) the 2 CAF surveys and 2) the 2013 CAF and 2012 civilian surveys after sample matching. RESULTS: Reports of Any need and Need met were higher in the CAF in 2013 than in 2002 by approximately 6% to 8% and 2% to 8%, respectively, and higher in the CAF than in civilians by 3% to 10% and 2% to 8%, respectively. CONCLUSIONS: These results suggest that investments in workplace mental health, such as those implemented in the CAF, can lead to improvements in recognizing the need for care (PNC) and subsequently getting those needs met (PSC).

[Who exactly are these "persons with limitations in daily living skills"? : Survey of insured persons based on health insurance data]. / Wer sind eigentlich diese "Personen mit eingeschränkter Alltagskompetenz"? : Versichertenbefragung auf Basis von Kassendaten.

BACKGROUND: In recent years German long-term care insurance coverage has gradually been extended to include services for people with limitations in daily living skills. Until now, however, it was unclear who exactly people with limited daily living skills are. AIM: The study aimed to characterize people with limited daily living skills who use additional support services as defined by § 45b of the Social Services Code XI (SGB XI). MATERIAL AND METHODS: This study was based on a survey of 1284 people with limited daily living skills who used additional support services (§ 45b SGB XI). The data were analyzed descriptively. RESULTS: The average recipient was 81 years old, mainly in care level I and the majority of them were exclusively cared for by relatives. Of these recipients 61 % were diagnosed with dementia, 73.4 % had medium cognitive impairments while more than half could no longer carry out the instrumental activities of daily living (IADL). CONCLUSION: Statistics on people with limited daily living skills should be included in publications and reports so that the need for care and assistance can be estimated more precisely.

Economics of the Iceberg: Informal Care Provided to French Elderly with Dementia.

OBJECTIVES: Dementia has a substantial effect on patients and their relatives, who have to cope with medical, social, and economic changes. In France, most elderly people with dementia live in the community and receive informal care, which has not been well characterized. METHODS: Using a sample of 4680 people aged 75 years and older collected in 2008 through a national comprehensive survey on health and disability, we compared the economic value of the care received by 513 elderly people with dementia to that received by a propensity score- matched set of older people without dementia. RESULTS: More than 85% of elderly people with dementia receive informal care; the estimation of its economic value ranges from €4.9 billion (proxy good method) to €6.7 billion (opportunity cost method) per year. CONCLUSIONS: The informal care provided to people with dementia has substantial annual costs; further work should be done to examine the social and economic roles foregone as a result of this care.