Despite the inability to control for other variables and limitations, the results of this study suggest that sample selection could introduce biases and that studies relating psychiatric symptomatology and menstrual cycle phases need to use hormonal determinations. New studies are needed to verify that suicide attempts are more frequent during the follicular phase (particularly during the menstrual phase).

Background: The impact of the 2019 coronavirus pandemic on the mental health of millions worldwide has been well documented, but its impact on prevention and treatment of mental and behavioral health conditions is less clear. The COVID-19 pandemic also created numerous challenges and opportunities to implement health care policies and programs under conditions that are fundamentally different from what has been considered to be usual care. Methods: We conducted a qualitative study to determine the impact of the COVID-19 pandemic on implementation of evidence-based policy and practice by State Mental Health Authorities (SMHA) for prevention and treatment of mental health problems in children and adolescents. Semi-structured interviews were conducted with 29 SMHA representatives of 21 randomly selected states stratified by coronavirus positivity rate and rate of unmet services need. Data analysis with SMHA stakeholders used procedures embedded in the Rapid Assessment Procedure—Informed Community Ethnography methodology. Results: The need for services increased during the pandemic due primarily to family stress and separation from peers. States reporting an increase in demand had high coronavirus positivity and high unmet services need. The greatest impacts were reduced out-of-home services and increased use of telehealth. Barriers to telehealth services included limited access to internet and technology, family preference for face-to-face services, lack of privacy, difficulty using with young children and youth in need of substance use treatment, finding a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform, training providers and clients, and reimbursement challenges. Policy changes to enable reimbursement, internet access, training, and provider licensing resulted in substantially fewer appointment cancellations or no-shows, greater family engagement, reduction in travel time, increased access for people living in remote locations, and increased provider communication and collaboration. States with high rates of coronavirus positivity and high rates of unmet need were most likely to continue use of telehealth post-pandemic. Despite these challenges, states reported successful implementation of policies designed to facilitate virtual services delivery with likely long-term changes in practice. Conclusions: Policy implementation during the pandemic provided important lessons for planning and preparedness for future public health emergencies. Successful policy implementation requires ongoing collaboration among policy makers and with providers.

Youth experiencing homelessness have been shown to experience high levels of both trauma and substance use. However, prior work has yet to consider how substance use, posttraumatic stress disorder (PTSD) symptoms, and homelessness are temporally, or reciprocally, associated over time. The current study uses symptom-driven and experience-driven models to examine the reciprocal relationships between substance use, PTSD symptoms, and homelessness among a large sample of adolescents receiving substance use treatment in the United States. Adolescents (n ϭ 20,069; M age ϭ 15.6; 74% male) completed baseline, 3-, 6-, and 12-month assessments. Autoregressive latent trajectory with structured residual (ALT-SR) models were used to examine within-and between-person relationships. We found continued support for prior work at the between-person level of analysis. At the within-person level, during the treatment phase, PTSD emerged as a key mechanism predicting both return to use and increased days of homelessness posttreatment. Further, greater substance use at treatment completion was associated with greater PTSD symptoms and homelessness, prospectively. The current study extends the previous work to consider individual level processes in conjunction with overarching event level predictors of homelessness. We found that PTSD symptomology is a driving factor that influences, both directly and indirectly, experiences of homelessness posttreatment. Interventions may wish to incorporate trauma informed approaches for youth entering treatment as this may mitigate long-term experiences of homelessness and return to substance use.

This study used Washington statewide administrative data to document the prevalence and trend of trauma history, suicidality, and mental health problems among all youth ordered to probation for the first time between 2011 and 2015. We also examined the extent to which trauma and mental health problems were associated with youth suicide risk during this time. Methods: More than 16,500 youth started probation (2011e2015) and received a standardized risk assessment. We used descriptive statistics to assess the prevalence of trauma history, suicidality, mental health problems, and overall risk to reoffend. We then used multilevel logistic regression models (youth within counties) to assess each measure's association with suicidality. Results: About 80% of the youth had a history of at least one traumatic experience. As fewer youth started probation for the first time each year, the prevalence of trauma, suicidality, mental health problems, and overall risk to reoffend increased. Trauma, mental health, and overall risk were significantly associated with suicide risk among probation youth. Conclusions: This epidemiological study is expected to motivate discussion around the best ways to integrate trauma-informed care and suicide prevention in the juvenile justice system.