Queer conversations: improving access to, and quality of, mental health services for same-sex-attracted clients

Lesbian, gay and bisexual (LGB) people have a higher prevalence of psychiatric problems. This is considered as a consequence of marginalisation of homosexuality. Despite much research and literature on lesbian and gay mental health, important questions remain largely unexplored regarding public mental health services (PMHS) for LGB. Two such questions are: Do clients feel able to disclose issues regarding sexual orientation to psychiatric services? How do PMHS services enable or hinder this? Foucauldian discourse analysis was used to explore these questions. Interviews were conducted with 13 same-sex-attracted male clients and 12 LGB staff in PMHS in New Zealand. Findings were that staff in PMHS rarely ask clients about sexual orientation. Correspondingly many clients report considerable difficulty disclosing their sexual orientation in PMHS, even when it is relevant to their mental health issues. The social and systemic conditions which create this barrier to effective treatment for LGB clients are explored. Practical suggestions are made for how staff in PMHS can raise the topic of sexual orientation with clients thereby improving access to and quality of treatment to LGB clients

Dynamic Resting-State Functional Connectivity in Major Depression

Major depressive disorder (MDD) is characterized by abnormal resting-state functional connectivity (RSFC), especially in medial prefrontal cortical (MPFC) regions of the default network. However, prior research in MDD has not examined dynamic changes in functional connectivity as networks form, interact, and dissolve over time. We compared unmedicated individuals with MDD (n=100) to control participants (n=109) on dynamic RSFC (operationalized as SD in RSFC over a series of sliding windows) of an MPFC seed region during a resting-state functional magnetic resonance imaging scan. Among participants with MDD, we also investigated the relationship between symptom severity and RSFC. Secondary analyses probed the association between dynamic RSFC and rumination. Results showed that individuals with MDD were characterized by decreased dynamic (less variable) RSFC between MPFC and regions of parahippocampal gyrus within the default network, a pattern related to sustained positive connectivity between these regions across sliding windows. In contrast, the MDD group exhibited increased dynamic (more variable) RSFC between MPFC and regions of insula, and higher severity of depression was related to increased dynamic RSFC between MPFC and dorsolateral prefrontal cortex. These patterns of highly variable RSFC were related to greater frequency of strong positive and negative correlations in activity across sliding windows. Secondary analyses indicated that increased dynamic RSFC between MPFC and insula was related to higher levels of recent rumination. These findings provide initial evidence that depression, and ruminative thinking in depression, are related to abnormal patterns of fluctuating communication among brain systems involved in regulating attention and self-referential thinking

Large network inference: new insights in health economics

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Large Network Inference: New Insights in Health Economics

This chapter reviews graphical modeling techniques for estimating large covariance matrices and their inverse. The chapter provides a selective survey of different models and estimators proposed by the graphical modeling literature and offers some practical examples where these methods could be applied in the area of health economics