Mental Health Service Use by Young People: The Role of Caregiver Characteristics

Aims

Many children and adolescents experiencing mental health problems do not receive appropriate care. Strategies to encourage appropriate access to services might be improved by a more detailed understanding of service use determinants within this group. In view of caregivers’ key role in young people’s pathways to care, this study aimed to advance understanding of caregiver-related characteristics that influence service use among young people.

Methods

We interviewed 407 primary caregivers of young people aged 9-18 years, recruited from a Greater London (United Kingdom) community sample. Caregivers reported on young people’s service use in health care sector and/or education settings, and caregivers’ intended stigmatising behaviours, help-seeking attitudes, and personal service use. Logistic regression analyses examined the relationship between these caregiver characteristics and young people’s service use, controlling for young people’s clinical and socio-demographic factors.

Results

Caregivers’ intended stigmatising behaviours in particular exerted a strong influence on young people’s service use within each service setting. The impact of this characteristic interacted with caregivers’ service use in influencing young people’s service use across health care and education settings and health care settings specifically. For young people’s service use within education settings, caregivers’ intended stigmatising behaviours score had a main effect.

Conclusions

This study highlights the key role caregivers’ attitudes and experiences hold in young people’s service use. The findings indicate that strategies aiming to bridge the gap between young people’s service needs and utilisation might be improved by targeting stigma amongst caregivers.     

“Selling” Value: The Influence of Language on Willingness-to-Accept

In behavioral economics, the “endowment effect” describes the robust finding that prices people are willing to accept (WTA) for a good exceed prices people are willing to pay (WTP) for the same good. The increase in WTA values is often explained by the sellers’ negative hedonic response to losing their item. Recent studies, however, show that subtle cues may change participants’ perspective, influencing their valuations. We hypothesized that implicit connotations of instructional language may be one of those cues. To test this hypothesis we manipulated the wording of instructions in two conditions: in the Sell condition, subjects were endowed with a set of pens and asked to select an amount of money for which they would sell the pens back and in the Take condition, subjects were endowed with the pens and asked to select an amount of money they would take for the pens. Participants in each condition also estimated the market value of the pens. Consistent with our hypothesis, WTA in the Sell condition was higher than in the Take condition, though there were no differences in market values between conditions. These findings show that instructional language does influence participant valuations. Furthermore, we suggest that those being asked to “sell” use their market estimations as the salient reference point in the transaction.     

Managing Minor Ailments; The Public’s Preferences for Attributes of Community Pharmacies. A Discrete Choice Experiment

Background

Demand for health services continues to rise. Greater use of community pharmacy services instead of medical services for minor ailments could help relieve pressure on healthcare providers in high-cost settings. Community pharmacies are recognised sources of treatment and advice for people wishing to manage these ailments. However, increasing the public’s use of pharmacy services may depend on attributes of pharmacies and their staff. This study aimed to determine the general public’s relative preferences for community pharmacy attributes using a discrete choice experiment (DCE).

Method

A UK-wide DCE survey of the general public was conducted using face-to-face computer-assisted personal interviews. Attributes and levels for the DCE were informed by a literature review and a cohort study of community pharmacy customers. The context for the experiment was a minor ailment scenario describing flu-like symptoms. The DCE choice sets described two hypothetical community pharmacy services; respondents were asked to choose which (if either) of the two pharmacies they would prefer to help them manage symptoms. Data from 1,049 interviews were analysed using an error components logit model. Willingness to pay (WTP), a monetary measure of benefit, was estimated for the different attribute levels.

Results

When seeking help or treatment for flu-like symptoms, respondents most valued a pharmacy service that would improve their understanding and management of symptoms (WTP = £6.28), provided by staff who are trained (WTP (pharmacist) = £2.63: WTP(trained assistant) = £3.22), friendly and approachable (WTP = £3.38). Waiting time, pharmacy location and availability of parking also contributed to respondents’ preferences. WTP for a service comprising the best possible combination of attributes and levels was calculated as £55.43.

Conclusion

Attributes of a community pharmacy and its staff may influence people’s decisions about which pharmacy they would visit to access treatment and advice for minor ailments. In line with the public’s preferences, offering community pharmacy services that help people to better understand and manage symptoms, are provided promptly by trained staff who are friendly and approachable, and in a local setting with easy access to parking, has the potential to increase uptake amongst those seeking help to manage minor ailments. In this way it may be possible to shift demand away from high-cost health services and make more efficient use of scarce public resources.     

环境价值评估中的WTP值和WTA值测算与非对称性——以广西北部湾经济区滨海生态环境保护为例

基于广西北部湾经济区4城市940位受访者的问卷调查结果,采用 logit模型对这些受访者保护滨海优良生态环境的最大支付意愿(WTP)和接受的最小赔偿意愿(WTA)进行了测算,其结果显示:5年内的WTP期望值为450.17元 a^-1 户^-1, WTA期望值为5772.71元 a^-1 户^-1,WTA/WTP比值为12.8倍,表现出非常明显的非对称性特征,但基本符合国内外在该领域的实证结果。通过对同一受访者支付意愿和接受赔偿意愿的交叉分析,可知WTP和WTA同时不为0的受访者有276人,占总抽样人次的29.4%,其WTA/WTP比值为12.54,与logit模型测算的WTA/WTP比值非常接近,从一侧面更准确地反映了这一群体对环境物品估值的差异性,同时也可反映logit模型测算的可靠性。基于行为经济学的前景理论分析,发现研究中的受访者存在厌恶损失效应、框架效应和对预期不确定风险的规避行为,同时受访者还存在明显的搭便车行为。通过对受访者的情境因素分析,发现其中2个情境因素对受访者选择WTP和WTA具有较大影响,主要表现为惩罚效应,尤其是经济收入满意度情境因素对受访者的经济行为影响显著,而另3个情境因素未表现出有规律性的影响。     

Economic Valuation of Health Care Services in Public Health Systems: A Study about Willingness to Pay (WTP) for Nursing Consultations

Background

Identifying the economic value assigned by users to a particular health service is of principal interest in planning the service. The aim of this study was to evaluate the perception of economic value of nursing consultation in primary care (PC) by its users.

Methods and Results

Economic study using contingent valuation methodology. A total of 662 users of nursing consultation from 23 health centers were included. Data on demographic and socioeconomic characteristics, health needs, pattern of usage, and satisfaction with provided service were compiled. The validity of the response was evaluated by an explanatory mixed-effects multilevel model in order to assess the factors associated with the response according to the welfare theory. Response reliability was also evaluated. Subjects included in the study indicated an average Willingness to Pay (WTP) of €14.4 (CI 95%: €13.2–15.5; median €10) and an average Willingness to Accept [Compensation] (WTA) of €20.9 (CI 95%: €19.6–22.2; median €20). Average area income, personal income, consultation duration, home visit, and education level correlated with greater WTP. Women and older subjects showed lower WTP. Fixed parameters explained 8.41% of the residual variability, and response clustering in different health centers explained 4–6% of the total variability. The influence of income on WTP was different in each center. The responses for WTP and WTA in a subgroup of subjects were consistent when reassessed after 2 weeks (intraclass correlation coefficients 0.952 and 0.893, respectively).

Conclusions

The economic value of nursing services provided within PC in a public health system is clearly perceived by its user. The perception of this value is influenced by socioeconomic and demographic characteristics of the subjects and their environment, and by the unique characteristics of the evaluated service. The method of contingent valuation is useful for making explicit this perception of value of health services.     

Beliefs about Lying and Spreading of Dishonesty: Undetected Lies and Their Constructive and Destructive Social Dynamics in Dice Experiments

Field experiments have shown that observing other people littering, stealing or lying can trigger own misconduct, leading to a decay of social order. However, a large extent of norm violations goes undetected. Hence, the direction of the dynamics crucially depends on actors’ beliefs regarding undetected transgressions. Because undetected transgressions are hardly measureable in the field, a laboratory experiment was developed, where the complete prevalence of norm violations, subjective beliefs about them, and their behavioral dynamics is measurable. In the experiment, subjects could lie about their monetary payoffs, estimate the extent of liars in their group and make subsequent lies contingent on information about other people’s lies. Results show that informed people who underestimate others’ lying increase own lying more than twice and those who overestimate, decrease it by more than half compared to people without information about others’ lies. This substantial interaction puts previous results into perspective, showing that information about others’ transgressions can trigger dynamics in both directions: the spreading of normative decay and restoring of norm adherence.     

Quality Index for Stereoscopic Images by Separately Evaluating Adding and Subtracting

The human visual system (HVS) plays an important role in stereo image quality perception. Therefore, it has aroused many people’s interest in how to take advantage of the knowledge of the visual perception in image quality assessment models. This paper proposes a full-reference metric for quality assessment of stereoscopic images based on the binocular difference channel and binocular summation channel. For a stereo pair, the binocular summation map and binocular difference map are computed first by adding and subtracting the left image and right image. Then the binocular summation is decoupled into two parts, namely additive impairments and detail losses. The quality of binocular summation is obtained as the adaptive combination of the quality of detail losses and additive impairments. The quality of binocular summation is computed by using the Contrast Sensitivity Function (CSF) and weighted multi-scale (MS-SSIM). Finally, the quality of binocular summation and binocular difference is integrated into an overall quality index. The experimental results indicate that compared with existing metrics, the proposed metric is highly consistent with the subjective quality assessment and is a robust measure. The result have also indirectly proved hypothesis of the existence of binocular summation and binocular difference channels.     

Exploring Twitter to Analyze the Public’s Reaction Patterns to Recently Reported Homicides in London

Crime is an ubiquitous part of society. The way people express their concerns about crimes has been of particular interest to the scientific community. Over time, the numbers and kinds of available communication channels have increased. Today, social media services, such Twitter, present a convenient way to express opinions and concerns about crimes. The main objective of this study is to explore people’s perception of homicides, specifically, how the characteristics and proximity of the event affect the public’s concern about it. The analysis explores Twitter messages that refer to homicides that occurred in London in 2012. In particular, the dependence of tweeting propensity on the proximity, in space and time, of a crime incident and of people being concerned about that particular incident are examined. Furthermore, the crime characteristics of the homicides are analysed using logistic regression analysis. The results show that the proximity of the Twitter users’ estimated home locations to the homicides’ locations impacts on whether the associated crime news is spread or not and how quickly. More than half of the homicide related tweets are sent within the first week and the majority of them are sent within a month of the incident’s occurrence. Certain crime characteristics, including the presence of a knife, a young victim, a British victim, or a homicide committed by a gang are predictors of the crime-tweets posting frequency.     

Local Perspectives on Environmental Insecurity and Its Influence on Illegal Biodiversity Exploitation

Environmental insecurity is a source and outcome of biodiversity declines and social conflict. One challenge to scaling insecurity reduction policies is that empirical evidence about local attitudes is overwhelmingly missing. We set three objectives: determine how local people rank risk associated with different sources of environmental insecurity; assess perceptions of environmental insecurity, biodiversity exploitation, myths of nature and risk management preferences; and explore relationships between perceptions and biodiversity exploitation. We conducted interviews (N = 88) with residents of Madagascar’s Torotorofotsy Protected Area, 2014. Risk perceptions had a moderate effect on perceptions of environmental insecurity. We found no effects of environmental insecurity on biodiversity exploitation. Results offer one if not the first exploration of local perceptions of illegal biodiversity exploitation and environmental security. Local people’s perception of risk seriousness associated with illegal biodiversity exploitation such as lemur hunting (low overall) may not reflect perceptions of policy-makers (considered to be high). Discord is a key entry point for attention.     

The Importance of Demonstratively Restoring Order

Contrary to what is often assumed, order is not the strongest context for encouraging normative behavior. The strongest context effect on normative behavior comes from cues that clearly convey other people’s respect for norms. Ironically, this show of respect necessitates some contrasting disrespect that is being restored. Using civic virtues (such as helping behavior) as a prototype of normative behavior, the three field experiments described in this paper reveal the impact of normative cues on civic virtues. Results show that the strongest effect on making people follow prosocial norms in public places emanates from seeing order being restored, rather than just order being present. The robust and surprisingly large effects show that observing other people’s respect for one particular norm (as evidenced in their restoring physical order) makes it more likely that the onlooker follows other norms as well. This implies that prosocial behavior has the highest chance of spreading when people observe order being restored. There are clear policy implications: create low cost “normative respect cues” wherever it is desirable to increase conformity to norms.     

A New Approach for Assessing Sleep Duration and Postures from Ambulatory Accelerometry

Interest in the effects of sleeping behavior on health and performance is continuously increasing–both in research and with the general public. Ecologically valid investigations of this research topic necessitate the measurement of sleep within people’s natural living contexts. We present evidence that a new approach for ambulatory accelerometry data offers a convenient, reliable, and valid measurement of both people’s sleeping duration and quality in their natural environment. Ninety-two participants (14–83 years) wore acceleration sensors on the sternum and right thigh while spending the night in their natural environment and following their normal routine. Physical activity, body posture, and change in body posture during the night were classified using a newly developed classification algorithm based on angular changes of body axes. The duration of supine posture and objective indicators of sleep quality showed convergent validity with self-reports of sleep duration and quality as well as external validity regarding expected age differences. The algorithms for classifying sleep postures and posture changes very reliably distinguished postures with 99.7% accuracy. We conclude that the new algorithm based on body posture classification using ambulatory accelerometry data offers a feasible and ecologically valid approach to monitor sleeping behavior in sizable and heterogeneous samples at home.     

A model of subjective report and objective discrimination as categorical decisions in a vast representational space

Subliminal perception studies have shown that one can objectively discriminate a stimulus without subjectively perceiving it. We show how a minimalist framework based on Signal Detection Theory and Bayesian inference can account for this dissociation, by describing subjective and objective tasks with similar decision-theoretic mechanisms. Each of these tasks relies on distinct response classes, and therefore distinct priors and decision boundaries. As a result, they may reach different conclusions. By formalizing, within the same framework, forced-choice discrimination responses, subjective visibility reports and confidence ratings, we show that this decision model suffices to account for several classical characteristics of conscious and unconscious perception. Furthermore, the model provides a set of original predictions on the nonlinear profiles of discrimination performance obtained at various levels of visibility. We successfully test one such prediction in a novel experiment: when varying continuously the degree of perceptual ambiguity between two visual symbols presented at perceptual threshold, identification performance varies quasi-linearly when the stimulus is unseen and in an ‘all-or-none’ manner when it is seen. The present model highlights how conscious and non-conscious decisions may correspond to distinct categorizations of the same stimulus encoded by a high-dimensional neuronal population vector.     

Circadian Rhythms in Socializing Propensity

Using large-scale interaction data from a virtual world, we show that people’s propensity to socialize (forming new social connections) varies by hour of the day. We arrive at our results by longitudinally tracking people’s friend-adding activities in a virtual world. Specifically, we find that people are most likely to socialize during the evening, at approximately 8 p.m. and 12 a.m., and are least likely to do so in the morning, at approximately 8 a.m. Such patterns prevail on weekdays and weekends and are robust to variations in individual characteristics and geographical conditions.     

Effects of Labeling and Group Category of Evaluators on Evaluations of Aggression

This study investigated whether the effect of labeling on people’s evaluation of aggression varies according to the group category of the evaluators (i.e., whether they are ingroup members or third parties). Two labeling strategies—the negative labeling of victims (NL strategy) and the positive labeling of aggressors (PL strategy)–were adopted. We conducted an experiment using the hot sauce paradigm, as a way to assess aggressive intent that includes behavioral measures of evaluations. The results suggested that the NL strategy causes ingroup members to evaluate aggression in a more positive light, while the PL strategy has the same effect but on third parties instead. Thus, labeling strategies may increase the severity of aggressors’ reaction and could also be a factor that can escalate a war or conflict.     

How Might People Near National Roads Be Affected by Traffic Noise as Electric Vehicles Increase in Number? A Laboratory Study of Subjective Evaluations of Environmental Noise

We face a likely shift to electric vehicles (EVs) but the environmental and human consequences of this are not yet well understood. Simulated auditory traffic scenes were synthesized from recordings of real conventional and EVs. These sounded similar to what might be heard by a person near a major national road. Versions of the simulation had 0%, 20%, 40%, 60%, 80% and 100% EVs. Participants heard the auditory scenes in random order, rating each on five perceptual dimensions such as pleasant–unpleasant and relaxing–stressful. Ratings of traffic noise were, overall, towards the negative end of these scales, but improved significantly when there were high proportions of EVs in the traffic mix, particularly when there were 80% or 100% EVs. This suggests a shift towards a high proportion of EVs is likely to improve the subjective experiences of people exposed to traffic noise from major roads. The effects were not a simple result of EVs being quieter: ratings of bandpass-filtered versions of the recordings suggested that people’s perceptions of traffic noise were specifically influenced by energy in the 500–2000 Hz band. Engineering countermeasures to reduce noise in this band might be effective for improving the subjective experience of people living or working near major roads, even for conventional vehicles; energy in the 0–100 Hz band was particularly associated with people identifying sound as ‘quiet’ and, again, this might feed into engineering to reduce the impact of traffic noise on people.     

Evaluation of Risk Perception and Risk-Comparison Information Regarding Dietary Radionuclides after the 2011 Fukushima Nuclear Power Plant Accident

In the wake of the 2011 Fukushima Daiichi Nuclear Power Station accident, to facilitate evidence-based risk communication we need to understand radiation risk perception and the effectiveness of risk-comparison information. We measured and characterized perceptions of dread risks and unknown risks regarding dietary radionuclides in residents of Fukushima, Tokyo, and Osaka to identify the primary factors among location, evacuation experience, gender, age, employment status, absence/presence of spouse, children and grandchildren, educational background, humanities/science courses, smoking habits, and various types of trustworthy information sources. We then evaluated the effects of these factors and risk-comparison information on multiple outcomes, including subjective and objective understanding, perceived magnitude of risk, perceived accuracy of information, backlash against information, and risk acceptance. We also assessed how risk-comparison information affected these multiple outcomes for people with high risk perception. Online questionnaires were completed by people (n = 9249) aged from 20 to 69 years in the three prefectures approximately 5 years after the accident. We gave each participant one of 15 combinations of numerical risk data and risk-comparison information, including information on standards, smoking-associated risk, and cancer risk, in accordance with Covello’s guidelines. Dread-risk perception among Fukushima residents with no experience of evacuation was much lower than that in Osaka residents, whereas evacuees had strikingly higher dread-risk perception, irrespective of whether their evacuation had been compulsory or voluntary. We identified location (distance from the nuclear power station), evacuation experience, and trust of central government as primary factors. Location (including evacuation experience) and trust of central government were significantly associated with the multiple outcomes above. Only information on “cancer risk from radiation and smoking risk” enhanced both subjective and objective understanding without diminishing trust in all participants and in the high dread-risk perception group; use of other risk-comparison information could lead the public to overestimate risk.     

Virtual Bystanders in a Language Lesson: Examining the Effect of Social Evaluation,Vicarious Experience,Cognitive Consistency and Praising on Students' Beliefs,Self-Efficacy and Anxiety in a Virtual Reality Environment

Bystanders in a real world''s social setting have the ability to influence people’s beliefs and behavior. This study examines whether this effect can be recreated in a virtual environment, by exposing people to virtual bystanders in a classroom setting. Participants (n = 26) first witnessed virtual students answering questions from an English teacher, after which they were also asked to answer questions from the teacher as part of a simulated training for spoken English. During the experiment the attitudes of the other virtual students in the classroom was manipulated; they could whisper either positive or negative remarks to each other when a virtual student was talking or when a participant was talking. The results show that the expressed attitude of virtual bystanders towards the participants affected their self-efficacy, and their avoidance behavior. Furthermore, the experience of witnessing bystanders commenting negatively on the performance of other students raised the participants’ heart rate when it was their turn to speak. Two-way interaction effects were also found on self-reported anxiety and self-efficacy. After witnessing bystanders’ positive attitude towards peer students, participants’ self-efficacy when answering questions received a boost when bystanders were also positive towards them, and a blow when bystanders reversed their attitude by being negative towards them. Still, inconsistency, instead of consistency, between the bystanders’ attitudes towards virtual peers and the participants was not found to result in a larger change in the participants’ beliefs. Finally the results also reveal that virtual flattering or destructive criticizing affected the participants’ beliefs not only about the virtual bystanders, but also about the neutral teacher. Together these findings show that virtual bystanders in a classroom can affect people’s beliefs, anxiety and behavior.     

Neurocomputational mechanism of controllability inference under a multi-agent setting

Controllability perception significantly influences motivated behavior and emotion and requires an estimation of one’s influence on an environment. Previous studies have shown that an agent can infer controllability by observing contingency between one’s own action and outcome if there are no other outcome-relevant agents in an environment. However, if there are multiple agents who can influence the outcome, estimation of one’s genuine controllability requires exclusion of other agents’ possible influence. Here, we first investigated a computational and neural mechanism of controllability inference in a multi-agent setting. Our novel multi-agent Bayesian controllability inference model showed that other people’s action-outcome contingency information is integrated with one’s own action-outcome contingency to infer controllability, which can be explained as a Bayesian inference. Model-based functional MRI analyses showed that multi-agent Bayesian controllability inference recruits the temporoparietal junction (TPJ) and striatum. Then, this inferred controllability information was leveraged to increase motivated behavior in the vmPFC. These results generalize the previously known role of the striatum and vmPFC in single-agent controllability to multi-agent controllability, and this generalized role requires the TPJ in addition to the striatum of single-agent controllability to integrate both self- and other-related information. Finally, we identified an innate positive bias toward the self during the multi-agent controllability inference, which facilitated behavioral adaptation under volatile controllability. Furthermore, low positive bias and high negative bias were associated with increased daily feelings of guilt. Our results provide a mechanism of how our sense of controllability fluctuates due to other people in our lives, which might be related to social learned helplessness and depression.     

Level of Young People Sexual and Reproductive Health Service Utilization and Its Associated Factors among Young People in Awabel District,Northwest Ethiopia

Background

Currently in Ethiopia, young people’s sexual and reproductive health services are limited and there is a growing issue of confidentiality and affordability of these health services. Moreover, the available services provided are not sensitive to the special needs of young people. Therefore, this study was aimed to assess young people’s sexual and reproductive health service utilization and its associated factors in Awabel district, Northwest Ethiopia.

Methods

A community based cross-sectional study was conducted among 781 randomly selected young people using a pre-tested structured questionnaires in Awabel district, Northwest Ethiopia. Data were entered into Epi data version 3.1 and analyzed using SPSS version 16.0 software.

Results

The mean age of respondents were 17.80 (+ 2.65) years. About 41% of young people had utilized sexual and reproductive health services. Young people from families of higher family expenditure, lived with mothers, participated in peer education and lived near to a Health Center were more likely to utilize sexual and reproductive health services. Furthermore, those who had a parental discussion on sexual and reproductive health (AOR (95% C.I): 2.23 (1.43, 3.46)) and ever had sexual intercourse (AOR (95% C.I): 1.88 (1.30, 2.71)) were more likely to utilize the service than their counterparts. On the other hand, those young people lived with their father and had a primary level of educational attainment was less likely to utilize the service.

Conclusion

Utilization of sexual and reproductive health services is low which needs a great attention where; if not intervened, young people might engage in risky sexual activities. Therefore, it needs a concerted effort from all the concerned bodies to improve their service utilization and thereby reduce the burden of young people’s disease and disabilities associated with sexual and reproductive health.