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This study investigated disparities in dual diagnosis (comorbid substance use and depressive/anxiety disorders) among US adults by nativity and racial–ethnic origin and socioeconomic, cultural, and psychosocial factors that may account for the observed disparities.

The study drew on data from two waves of the National Epidemiological Survey on Alcohol and Related Conditions. Racial–ethnic categories included African, Asian/Pacific Islander, European, Mexican, Puerto Rican, and other Hispanic/Latino. Substance use and depressive/anxiety disorders were assessed per DSM-IV. A four-category measure of comorbidity was constructed: no substance use or psychiatric disorder; substance use disorder only; depressive/anxiety disorder only; and dual diagnosis. The data were analyzed using multinomial logistic regression.

The prevalence of dual diagnosis was low but varied by nativity, with the highest rates among Europeans and Puerto Ricans born in US states, and the lowest among Mexicans and Asians/Pacific Islanders. The nativity and racial–ethnic effects on likelihood of having dual diagnosis remained significant after all adjustments.

The limitations included measures of immigrant status, race–ethnicity, and stress and potential misdiagnosis of mental disorder among ethnic minorities.

This new knowledge will help to guide public health and health care interventions addressing immigrant mental and behavioral health gaps.

This study addressed the research gap in regard to the prevalence and correlates of dual diagnosis among immigrants and racial–ethnic minorities. The study used the most current and comprehensive data addressing psychiatric conditions among US adults and examined factors rarely captured in epidemiologic surveys (e.g., acculturation).

Sex and gender are regarded as critical structural determinants of mental health and mental illness. Mental illness is a complex phenomenon, and risky behaviour and substance use commonly occur simultaneously or subsequent to one another. A gendered vulnerability in biological, environmental, and behavioural risk factors has been registered in the development and escalation of mental illness. Studies have found that women who use drugs experience greater physical and mental health repercussions than men. Women who use drugs present higher rates of depression and anxiety, suicidal tendencies, isolation and general psychological distress. This chapter addresses the most common mental illnesses associated with women who use drugs: depression, anxiety, trauma-related disorders, and eating disorders.

Purpose: In the current work, we provide a portrait of heavy alcohol use, cigarette smoking, mental health, and suicide ideation by sexual orientation among a large sample of US adults aged 25 years and older.

Design/methodology/approach: We produce a repository of information on sexual orientation, substance use, mental well-being, and suicide ideation for adults aged 25 years and older using Behavioral Risk Factor Surveillance System (BRFSS) surveys for nine US states from 2011 to 2018. We establish baseline differences on these outcomes for gay, lesbian, and bisexual (GLB), relative to heterosexual, adults and then use regression techniques to adjust the estimates for important sociodemographic, socioeconomic, and relationship status variables.

Findings: Disparities by sexual orientation across substance use, mental health, and suicide ideation are concerning, some alarmingly so. Bisexuals, particularly women, face pronounced challenges across outcomes. Sexual minority men and women report significantly more poor mental health days and much higher odds of suicide ideation. To illustrate, gay men, lesbians, and bisexual men and women, relative to their heterosexual counterparts, have odds of seriously contemplating taking their own lives that are two to four times higher even after adjusting for relevant controls.

Originality/value: Existing knowledge connecting GLB identity and mental well-being has focused largely on adolescent and young adults. We provide a representative study on older adult differences across four different behavioral health outcomes by sexual orientation. The scale of the disparities we report here, and their implications for overall well-being across groups, deserves national attention and action.

There is limited research on the mental health of pregnant women in prison in England, mother and baby unit (MBU) applications and associated factors. Eighty-five pregnant women were interviewed in eight different prisons in England, UK. Schedules for the Clinical Assessment of Neuropsychiatry (SCAN) and Edinburgh Postnatal Depression Scale (EPDS) were used to assess mental health; Severity of Dependence Questionnaire (SOD-Q) for drug misuse; Alcohol Use Identification Test (AUDIT) for hazardous drinking and the Structured Clinical Interview for DSM-IV (SCID-II) to identify personality disorder. About 51% of participants had depression and 57% had anxiety. Those with prior social services involvement, diagnosis of personality disorder or history of suicidality were less likely to be admitted to MBUs. The high levels of depression and anxiety can have negative impacts on both the mother and her unborn child. Factors which influence MBU admission suggest those who might benefit most from MBU placement are least likely to be admitted. Other countries offer feasible alternatives to imprisonment for pregnant women and mothers which could be implemented in England.

Adolescent alcohol consumption has declined in most high-income countries over the last decade; however, the prevalence of drinking under the legal age of 18 years remains high. There are several confounding factors related to alcohol use inclusive of gender, poverty, parental education, parental alcohol use and parental mental health difficulties. In addition, young people placed under the care of the state are disproportionately affected by alcohol misuse.

Longitudinal research has shown a linear risk between alcohol consumption and educational performance. Adolescents that have heavy alcohol consumption are associated with lower enrolment in post-secondary education, potentially reduced earnings and heightened job instability.

Universal interventions are one potential way to provide education regarding problematic alcohol use and its consequences. A recent Cochrane review identified that school-based interventions have potential to provide adolescents with the necessary knowledge, skills and opportunities for young people to remain alcohol free and decrease the risk of multiple risk-taking behaviours.

The NCS was based on multistage area probability sample of people age 15–54 in the non-institutionalized civilian population of the coterminous U.S., with a supplemental sample of students living in campus group housing (Kessler et al., 1994). The survey was carried out face-to-face in the homes of respondents by professional interviewers employed by the Survey Research Center (SRC) at the University of Michigan. The survey was carried out between September 1990 and February 1992. The response rate was 82.6%, with a total of 8,098 respondents participating in the survey. A supplemental non-response survey was carried out to adjust for non-response bias, with a random sample of initial non-respondents offered a financial incentive to complete a short form of the diagnostic interview. A non-response adjustment weight was constructed for the main survey data to compensate for elevated rates of disorders found among the initial non-respondents in this non-response survey. Significance tests were made using design-based methods because of this weighting and clustering of the data (Kish & Frankel, 1970; Koch & Lemeshow, 1972; Woodruff & Causey, 1976). More details about design and weighting procedures are reported elsewhere (Kessler, Little et al., 1995).

Drawing on the social cognitive theory, this study investigated the effect of mentors' drinking norms on their protégés' alcohol misuse by focusing on the mediating role of conformity drinking motives and the moderating role of moral disengagement. We conducted a three-wave survey of 148 mentor–protégé dyads and found that mentors' drinking norms were positively related to their protégés' alcohol misuse and that this relationship was fully mediated by conformity drinking motives. Moreover, the moderated mediation model revealed that moral engagement strengthens the main effects of mentors' drinking norms on conformity drinking motives and the indirect effects of mentors' drinking norms on protégés' alcohol misuse via enhanced conformity drinking motives. The theoretical and practical implications are discussed.