Objective: The COVID-19 pandemic initially doubled the rates of food insecurity across the United States, and tripled rates among households with children. Despite the association among food insecurity, chronic disease and psychological distress, narratives depicting the experiences of already-food insecure populations are notably underrepresented in the literature. This study assessed the impact of COVID-19 on clients of a food pantry who were also enrolled in the Supplemental Nutrition Assistance Program (SNAP). Design: A qualitative study probing the effects of the pandemic on daily living, food needs, food buying, and food insecurity. Interview transcripts were analyzed using a combined deductive and inductive approach. Setting: Interviews were conducted via telephone between May-June of 2020. Participants: Equal numbers of English- and Spanish-speaking clients (n=40 total). Results: Three main findings emerged: (1) The pandemic increased economic distress, such as from job loss or increased utility bills due to sustained home occupancy; (2) The pandemic increased food needs, food prices and food shortages. In combination with economic stressors, this led to greater food insecurity; (3) Increased economic stress and food insecurity contributed to increased psychological stress, such as from fear of infection, isolation, and children being confined at home. Conclusions: Despite federal legislation and state and local programs to alleviate food insecurity, COVID-19 exacerbated economic hardship, food insecurity, and psychological distress among urban SNAP and food pantry clients. Additional research is needed to identify the most effective policies and programs to ameliorate the short- and long-term health and economic inequities exacerbated by the pandemic.

This article considers the impact of the global mental health discourse on India's traditional healing systems. Folk mental health traditions, based in religious lifeways and etiologies of supernatural affliction, are overwhelmingly sought by Indians in times of mental ill-health. This is despite the fact that the postcolonial Indian state has historically considered the popularity of these indigenous treatments regressive, and claimed Western psychiatry as the only mental health system befitting the country's aspirations as a modern nation-state. In the last decade however, as global mental health concerns for scaling up psychiatric interventions and instituting bioethical practices in mental health services begin to shape India's mental health policy formulations, the state's disapproving stance towards traditional healing has turned to vehement condemnation. In present-day India, traditional treatments are denounced for being antithetical to global mental health tenets and harmful for the population, while biomedical psychiatry is espoused as the only legitimate form of mental health care. Based on ethnographic research in the Hindu healing temple of Balaji, Rajasthan, and analysis of India's mental health policy environment, I demonstrate how the tenor of the global mental health agenda is negatively impacting the functioning of the country's traditional healing sites. I argue that crucial changes in the therapeutic culture of the Balaji temple, including the disappearance of a number of key healing rituals, are consequences of global mental health-inspired policy in India which is reducing the plural mental health landscape.

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Objective: This study elicited factors that shaped treatment decision-making for young adults and their key supporters after an initial hospitalization for psychosis to generate hypotheses about how to improve service engagement. Methods: This prospective, longitudinal, ethnographic study (using home visits, interviews, and hospital-based fieldwork) asked what mattered to 18 primarily racial/ethnic minority young adults and 19 of their self-identified key supporters (N=37) as they made decisions about treatment during the 12-week "critical period" after an initial hospitalization for psychosis. The analytical approach used inductive coding and constructivist grounded theory methods to analyze interview transcripts and fieldnotes from home visits and generate hypotheses about key factors that seemed to affect treatment decision-making. Factors were ranked in order of frequency across all participants (overall, young adults only, and key supporters only). Results: Among the 37 total participants (young adults and key supporters), over two-thirds were concerned with: getting back to normal, insufficient mental health care on offer, police involvement in their pathway to care, feeling worse, and needing help with repairing strained relationships. More than half were concerned with: affected young adults being able to live independently, paying for mental health care, distrusting mental health diagnoses, how to manage social pressure to use substances, feeling disempowered by hospitalization experiences, and transportation challenges.

Background and Aims: The value of HCC surveillance is determined by the balance between benefits and harms; however, no studies have enumerated psychological harms. Approach and Results: We fielded surveys measuring psychological harms to patients with cirrhosis in a multicenter randomized trial of HCC surveillance outreach. All patients with positive or indeterminate surveillance results and matched patients with negative results were invited to complete surveys measuring (1) depression through the Patient Health Questionnaire-ninth version, (2) anxiety through State-Trait Anxiety Inventory, (3) HCC-specific worry through Psychological Consequences Questionnaire, and (4) decisional regret. Patients were classified into 4 groups: true positive (TP), false positive (FP), indeterminate, and true negative (TN). Multivariable longitudinal regression analysis using the generalized estimating equation method was performed to compare the means of measures across groups. We conducted 89 semistructured interviews in a subset of patients stratified by health system and test results. Of 2872 patients in the trial, 311 completed 1+ follow-up survey (63 FP, 77 indeterminate, 38 TP, and 133 TN). Moderate depression decreased in TN patients, increased in TP, and had intermittent but mild increases in those with FP and indeterminate results. High anxiety temporarily increased in patients with TP results but resolved over time and was stable in those with FP and indeterminate results. Decisional regret was low and did not differ across groups. In semistructured interviews, patients reported apprehension, anxiety, emotional distress, and coping related to HCC surveillance. Conclusions: Psychological harms of HCC surveillance appear mild but differ by test result. Future research should determine the impact of psychological harms on the value of HCC surveillance programs.