Use of Digital Technology to Provide or Enhance the Delivery of Interventions for Adolescents

Adolescence is a critical period for the onset of mental health disorders, yet only about one-third of affected adolescents receive mental healthcare. Barriers to such care include poor access, stigma, and the lack of availability of proper resources to identify and treat mental health disease. Thus, the delivery of mental health services via new technologies may help mitigate some of these barriers. Digital technology–based interventions show promise for the treatment of various mental health conditions in adolescents. This chapter provides an overview of computer- and Internet-based therapeutic programs, texting programs using mobile phones, and serious games as they apply to a variety of conditions including depression/anxiety, eating disorders, and tobacco smoking, as well as mental healthcare utilization. The unique needs of adolescents are discussed in relation to the scaling of digital technologies and future directions for technology-enhanced mental healthcare.

Validation of the Health-Related Felt Stigma and Concealment Questionnaire

Objective Stigma is associated with many health conditions, including chronic pain. Research on health-related stigma is limited by the lack of validated instruments that distinguish among various stigma-related constructs. We aimed to develop and validate such a measure for pediatric functional abdominal pain (FAP). Felt stigma (FS) was defined as comprising both perceived and internalized stigma. Stigma concealment (SC) was defined as efforts by stigmatized individuals to prevent others from learning of their condition. Methods Using a theory-driven approach, we adapted items from existing self-report measures of stigma to construct the health-related FS and Concealment Questionnaire (FSC-Q). Patients with FAP (N = 179, ages 11–17) completed the preliminary FSC-Q and health-related measures hypothesized to be associated with stigma. Cognitive interviewing and exploratory factor analysis (EFA) informed the final version of the measure. Results EFA identified a 2-factor model comprised of FS and SC. The FS and SC scales exhibited good internal consistency and construct validity. Consistent with study hypotheses, both factors were significantly associated with anxiety, depression, pain catastrophizing, pain threat, physical symptoms, and pain interference/disability. Higher FS was associated with higher mental healthcare utilization. The subset of participants meeting criteria for irritable bowel syndrome (IBS) reported higher FS and SC compared with those without IBS. Conclusion The FSC-Q may help advance research on health-related stigma in FAP and other chronic health conditions by allowing for assessment of distinct stigma-related constructs.

O3E.4 Layoffs and the mental health and safety of remaining workers: a quasi-experimental study of the U.S. aluminum industry

BackgroundRelatively few studies have examined the effects of layoffs on remaining workers, although the effects of layoffs and downsizing events may extend beyond those employees who lose their jobs.MethodsWe examined the effects of layoffs on mental healthcare utilization and injury risk among workers at 30 U.S. plants between 2003 and 2013. We defined layoffs as reductions in the hourly workforce of 20% or more at each plant. Using a difference-in-differences approach, we compared the change in outcomes during layoffs versus the same three-month period one year previously, accounting for secular trends with control plants.ResultsOur study population included 15 502 workers and seven layoff events between 2003 and 2012. Layoffs were associated with decreases in reported injuries (−0.006, 95% CI −0.013, 0.001), and increased probability of outpatient visits (0.010, 95% CI 0.003, 0.017) and prescriptions (0.014, 95% CI −0.0006, 0.027) for mental health. Among men, injury risk decreased more substantially (−0.010, 95% CI −0.018,–0.001) and among women the increase in outpatient visits was more pronounced (0.017, 95% CI 0.003, 0.031). Most notably, the observed increase in prescription utilization appeared attributable primarily to increased frequency of opioid prescriptions (0.016 95% CI 0.005–0.027).ConclusionOur results indicate an association between layoffs and remaining workers’ mental health and safety. However, decreased injury may reflect changes in reporting practices, and changes mental healthcare utilization may reflect changes in care-seeking. Future research on concordance of service utilization and underlying health and safety may yield valuable insight into the experiences employed workers in the wake of layoffs.

How ‘healthy’ are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations

Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.