mental health research help

PLOS Mental Health, a new Open Access journal for research that leads to healthier lives by improving discussion, interdisciplinary collaboration and understanding of all aspects of mental health in individual, societal, and community contexts.

Get new content from plos mental health in your inbox, thank you you have successfully subscribed to the plos mental health newsletter., sorry, an error occurred while sending your subscription. please try again later..

Meet our Editors-in-Chief

Apply to join the PLOS Mental Health Editorial Board

Sign up for information and updates from plos mental health, be among the first to know when plos mental health opens for submissions, receive editorial board updates and more by joining our email list., publish with plos.

• Submission Instructions
• Submit Your Manuscript

Connect with Us

• PLOS Mental Health on Twitter
• PLOS on Facebook

Why the reliance on data? Findings and statistics from research studies can impact us emotionally, add credibility to an article, and ground us in the real world. However, the importance of research findings reaches far beyond providing knowledge to the general population. Research and evaluation studies — those studies that assess a program’s impact — are integral to promoting mental health and reducing the burden of mental illness in different populations.

Mental health research identifies biopsychosocial factors — how biological, psychological and social functioning are interacting — detecting trends and social determinants in population health. That data greatly informs the current state of mental health in the U.S. and around the world. Findings from such studies also influence fields such as public health, health care and education. For example, mental health research and evaluation can impact public health policies by assisting public health professionals in strategizing policies to improve population mental health.

Research helps us understand how to best promote mental health in different populations. From its definition to how it discussed, mental health is seen differently in every community. Thus, mental health research and evaluation not only reveals mental health trends but also informs us about how to best promote mental health in different racial and ethnic populations. What does mental health look like in this community? Is there stigma associated with mental health challenges? How do individuals in the community view those with mental illness? These are the types of questions mental health research can answer.

Data aids us in understanding whether the mental health services and resources that are available meet mental health needs. Many times the communities where needs are the greatest are the ones where there are limited services and resources available. Mental health research and evaluation informs public health professionals and other relevant stakeholders of the gaps that currently exist so they can prioritize policies and strategies for communities where gaps are the greatest.

Research establishes evidence for the effectiveness of public health policies and programs. Mental health research and evaluation help develop evidence for the effectiveness of healthcare policies and strategies as well as mental health promotion programs. This evidence is crucial for showcasing the value and return on investment for programs and policies, which can justify local, state and federal expenditures. For example, mental health research studies evaluating the impact of Mental Health First Aid (MHFA) have revealed that individuals taking the course show increases in knowledge about mental health, greater confidence to assist others in distress, and improvements in their own mental wellbeing. They have been fundamental in assisting organizations and instructors in securing grant funding to bring MHFA to their communities.

The findings from mental health research and evaluation studies provide crucial information about the specific needs within communities and the impacts of public education programs like MHFA. These studies provide guidance on how best to improve mental health in different contexts and ensure financial investments go towards programs proven to improve population mental health and reduce the burden of mental illness in the U.S.

In 2021, in a reaffirmation of its dedication and commitment to mental health and substance use research and community impact, Mental Health First Aid USA introduced MHFA Research Advisors. The group advises and assists Mental Health First Aid USA on ongoing research and future opportunities related to individual MHFA programs, including Youth MHFA, teen MHFA and MHFA at Work.

Through this advisory group and evaluation efforts at large, Mental Health First Aid USA will #BeTheDifference for mental health research and evaluation across communities in the US.

Learn more about MHFA Research Advisors and how you can share your research with us.

Get the latest MHFA blogs, news and updates delivered directly to your inbox so you never miss a post.

Share and help spread the word.

Related stories.

No related posts.

Mobile Menu Overlay

The White House 1600 Pennsylvania Ave NW Washington, DC 20500

White   House Report on Mental Health Research   Priorities

By: Arati Prabhakar and Ambassador Susan E. Rice

Everyone has someone in their life who is impacted by a mental health disorder or is facing such a challenge themselves. It is the high school student whose anxiety is so debilitating they can’t focus in class. Or the new parent who is struggling to rebalance their post-partum life with a baby and returning to work. Or the children whose father has been on and off treatment for schizophrenia and who struggles to maintain housing and a job.  Each problem exacerbates another. Our nation is facing a mental health crisis among people of all ages, and the COVID-19 pandemic has only made these problems worse.

The Biden-Harris Administration has taken unprecedented action to address our nation’s mental health crisis. In March 2022, President Biden announced a three-part strategy to transform how we understand, access, and treat mental health in America as part of his Unity Agenda. Additionally, we provided nearly $500 million to help states transition to the 988 Suicide and Crisis Lifeline, helping countless individuals get more timely access to confidential counseling and crisis care. Through the Bipartisan Safer Communities Act , we are awarding hundreds of millions in grants to strengthen youth and community mental health services. And, we are in the midst of building a more robust pipeline of mental health providers, expanding school-based mental health services, and training first responders how to support individuals with mental health challenges.

The actions we have taken to date are making a difference in communities across the country, but there is much more to do – and we need to know how to drive progress faster, better, and more effectively. Research and innovation are key to this challenge. We know that some tools work in some settings, but we need to figure out how to make them work everywhere and for all Americans. There are also some problems we don’t have the answers to. We need to improve how we prevent, diagnose, treat, and destigmatize mental health conditions – and research is key to doing so.

The White House Report on Mental Health Research Priorities is the first of its kind to outline an Administration-wide set of critical and timely needs and opportunities in mental health research. In releasing this report, we call upon our colleagues in government and beyond to build on these priorities and generate a new foundation of evidence to enable us all to move closer to a future where every American has access to the best available care – when and where they need it.

The White House Report on Mental Health Research Priorities can be accessed here .

Stay Connected

We'll be in touch with the latest information on how President Biden and his administration are working for the American people, as well as ways you can get involved and help our country build back better.

Opt in to send and receive text messages from President Biden.

• Departments
• Program Finder
• Admissions Services
• Course Directory
• Academic Calendar
• Hybrid Campus
• Lecture Series
• Convocation
• Strategy and Development
• Implementation and Impact
• Integrity and Oversight
• In the School
• In the Field
• In Baltimore
• Resources for Practitioners
• Articles & News Releases
• In The News
• Statements & Announcements
• At a Glance
• Student Life
• Strategic Priorities
• Inclusion, Diversity, Anti-Racism, and Equity (IDARE)
• What is Public Health?

Research and Practice

• Mental Health Diversity, Equity, and Inclusion
• Origins of Mental Health
• Job Openings
• Faculty Profiles
• PET Alumni Profiles - Postdocs
• PET Alumni Profiles - Predocs
• Trainee Profiles
• NIMH T32 Mental Health Services and Systems Training Grant
• Funded Training Program in Data Integration for Causal Inference in Behavioral Health
• Aging and Dementia Funded Training Program
• COVID-19 and Mental Health Research
• Mental Health Resources During COVID-19
• News and Media

Social Determinants of Mental and Behavioral Health

• Our Work in Action
• Global Mental Health
• Related Faculty
• Courses of Interest
• Training and Funding Opportunities
• Mental Health in the Workplace: A Public Health Summit

Autism and Developmental Disabilities

• Alumni Newsletters
• Alumni Updates
• Postdoctoral Fellows
• Doctor of Philosophy (PhD) Students in Mental Health
• Master of Health Science (MHS) Students in Mental Health
• In the News
• Past Seminars 2020-21 AY: Wednesday Seminar Series
• Make a Gift
• Available Datasets

Research Areas

The Department of Mental Health covers a wide array of topics related to mental health, mental illness, and substance abuse. We emphasize ongoing research that enriches and stimulates the teaching programs. All students and fellows are encouraged to participate in at least one research group. Faculty and students from multiple disciplines work together within and across several major research areas:

Faculty are working to understand the distribution, causes and consequences of autism and developmental disabilities as well as the impact of public health policy on children and families.

Global Mental Health faculty develop, implement and evaluate measures and interventions to assess and meet mental health needs of communities around the world, with a focus on developing nations.

Mental Health and Aging

Faculty in the Mental Health and Aging Research Area conduct observational and intervention research aimed at enhancing cognitive and mental well being in older adults.

Mental Health and COVID-19

Understanding how mental health evolves as a result of this serious global pandemic will inform prevention and treatment strategies moving forward. 

Mental Health in the Workplace

At the Bloomberg School of Public Health, which houses the only department of mental health in a school of public health, we have a unique ability to define both the problems and potential solutions.

Mental Health Services and Policy

Faculty in this area study mental health and behavioral health services and supports in communities, educational institutions and employment settings. They aim to reduce risk, and provide effective long-term treatment.

The Methods program area develops and applies innovative qualitative and quantitative methods for public mental health research, with a focus on statistical methods and economic models.

Prevention Research

The Prevention Research faculty develop, test, refine and bring to scale prevention programs directed at a range of mental health and behavioral problems in children, adolescents, adults and the elderly.

Psychiatric and Behavioral Genetic Epidemiology

Faculty in this area research genetic factors and how they interact with the physical and social environment to affect the risk for mental disorders.

Psychiatric Epidemiology

Faculty in this area study the occurrence and distribution of mental and behavioral disorders across people, space and time, and examine the causes to develop support and treatment strategies.

School-based Mental Health

The Department of Mental Health views the education and schools as a key public health context. Multiple faculty members partner with local school systems to develop, refine, and test preventive interventions for school-aged children and aim to promote mental health as well as positive social, emotional, and behavioral development.

Social Determinants of Mental & Behavioral Health Area emphasizes the role of multilevel social and structural factors in shaping mental and behavioral health, such as stigma, social networks, structural racism and policies on housing, drug control, and criminal justice domestically and internationally.

Substance Use Epidemiology

Faculty in this area study the etiology and natural history of substance use, and develop and evaluate interventions to prevent and control substance use disorders.

The Department of Mental Health has projects focused on various aspects of violence such as suicide, intimate partner violence , and youth violence. Faculty and students from multiple disciplines work together within and across several major research areas.

Centers and Institutes

The department houses several school-based centers, and has a significant role in many others across the school. These are described below. Centers help bring together faculty, students, and community partners across multiple departments and schools to meet their particular missions in pursuit of improving public mental health.

• Moore Center for the Prevention of Child Sexual Abuse
• Wendy Klag Center for Autism and Developmental Disabilities
• Center on Aging and Health
• Center for Mental Health and Addiction Policy Research
• Suicide Prevention

Our Students and Faculty Work in Action

The Johns Hopkins COVID-19 Mental Health Measurement Working Group developed key questions to add to existing large domestic and international surveys to measure the mental health impact of the pandemic.

Mental Health Research News

Top headlines, latest headlines.

• Reducing Stress of Adults With Dementia
• Transitioning Gender Not Linked to Depression
• Ancient Viral DNA: Psychiatric Disorders
• Heightened Sensitivity to PTSD in Autism
• Kids' Sleep Problems Linked to Later Psychosis
• Lifelong Toll of Abuse and Neglect in Childhood
• Psychedelic Drugs and Serotonin Receptors
• Patient-Centred Depression Care
• Chaotic Household and Mental Health Issues
• Treating Depression With Magnetic Fields

Earlier Headlines

Friday, may 31, 2024.

• Study Links Household Chaos With Sleep Quality Among Teens With ADHD Symptoms

Thursday, May 23, 2024

• Approximately One in Nine U.S. Children Diagnosed With ADHD, as New National Study Highlights an 'ever-Expanding' Public Health Concern

Thursday, May 2, 2024

• Low Intensity Light to Fight the Effects of Chronic Stress

Wednesday, May 1, 2024

• Women Are 40% More Likely to Experience Depression During the Perimenopause

Friday, April 26, 2024

• Air Pollution and Depression Linked With Heart Disease Deaths in Middle-Aged Adults

Wednesday, April 24, 2024

• Low Intensity Exercise Linked to Reduced Depression

Monday, April 22, 2024

• In Psychedelic Therapy, Clinician-Patient Bond May Matter Most

Tuesday, April 16, 2024

• Teen Stress May Raise Risk of Postpartum Depression in Adults

Monday, April 15, 2024

• Physical Activity Reduces Stress-Related Brain Activity to Lower Cardiovascular Disease Risk

Thursday, April 11, 2024

• Study Finds Increased Anxiety and PTSD Among People Who Remained in Ukraine
• Scientists Use Wearable Technology to Detect Stress Levels During Sleep
• AI Model Can Accurately Assess PTSD in Postpartum Women

Wednesday, April 10, 2024

• Brain Stimulation Treatment May Improve Depression, Anxiety in Older Adults

Monday, April 8, 2024

• Heart Disease, Depression Linked by Inflammation
• New Study Highlights the Benefit of Touch on Mental and Physical Health

Thursday, April 4, 2024

• Prairie Voles Display Signs of Human-Like Depression
• Feeding the Lonely Brain

Wednesday, April 3, 2024

• Researchers Map How the Brain Regulates Emotions

Monday, April 1, 2024

• New Initiative Improves Detection, Evaluation of Attention Deficit Hyperactivity Disorder
• Pilot Study Shows Ketogenic Diet Improves Severe Mental Illness

Thursday, March 28, 2024

• Positive Associations Between Premenstrual Disorders and Perinatal Depression
• For Younger Women, Mental Health Now May Predict Heart Health Later

Wednesday, March 27, 2024

• People With Depression See No Immediate Change from Common GP Assessment, Study Shows

Tuesday, March 26, 2024

• Large-Scale Animal Study Links Brain pH Changes to Wide-Ranging Cognitive Issues

Wednesday, March 20, 2024

• Treating Anxiety, Depression in People With Heart Disease Reduced ER Visits, Hospitalizations

Monday, March 18, 2024

• Study Eases Concern at Antipsychotics Use in Pregnancy

Thursday, March 14, 2024

• How Fear Unfolds Inside Our Brains

Wednesday, March 13, 2024

• Researchers Identify Brain Connections Associated With ADHD in Youth

Monday, March 11, 2024

• 'Study Drugs' Set the Stage for Other Drug Use and Mental Health Decline

Wednesday, March 6, 2024

• New Study May Broaden the Picture of the Consequences of Childhood Adversity

Monday, March 4, 2024

• It's Not Just You: Young People Look, Feel Older When They're Stressed

Friday, March 1, 2024

• Link Between Adversity, Psychiatric and Cognitive Decline
• Study Paves the Way for Better Diagnosis and Treatment of Endocrine Diseases

Tuesday, February 27, 2024

• Teens Benefit from 'forest Bathing' -- Even in Cities

Monday, February 26, 2024

• Gut-Brain Communication Turned on Its Axis
• Intervention Reduces Likelihood of Developing Postpartum Anxiety and Depression by More Than 70%
• Yoga Provides Unique Cognitive Benefits to Older Women at Risk of Alzheimer's Disease

Wednesday, February 21, 2024

• Maternal Mental Conditions Drive Climbing Death Rate in U.S., Evidence Review Finds

Tuesday, February 20, 2024

• Wildfires Linked to Surge in Mental Health-Related Emergency Department Visits
• Stress During Pregnancy Can Lead to Early Maturation of First-Born Daughters

Monday, February 19, 2024

• Understanding the Relationship Between Our Sleep, Body Clock and Mental Health

Thursday, February 15, 2024

• Burnout: Identifying People at Risk

Tuesday, February 13, 2024

• A Closer Look at Cannabis Use and Binge Eating

Thursday, February 8, 2024

• Benefits of Resistance Exercise Training in Treatment of Anxiety and Depression
• Ketamine's Promise for Severe Depression Grows, but Major Questions Remain

Wednesday, February 7, 2024

• Researchers Make Progress Toward Developing Blood Tests for Psychiatric and Neurological Disorders
• Stress Influences Brain and Psyche Via Immune System

Tuesday, February 6, 2024

• Bullied Teens' Brains Show Chemical Change Associated With Psychosis

Monday, February 5, 2024

• Are Body Temperature and Depression Linked? Science Says, Yes

Thursday, February 1, 2024

• Psychological Care Delivered Over the Phone Is an Effective Way to Combat Loneliness and Depression, According to a Major New Study

Wednesday, January 31, 2024

• Potential Link Between High Maternal Cortisol, Unpredicted Birth Complications

Tuesday, January 30, 2024

• Researchers Find Early Symptoms of Psychosis Spectrum Disorder in Youth Higher Than Expected

Wednesday, January 24, 2024

• Mood Interventions May Reduce Inflammation in Crohn's and Colitis

Thursday, January 18, 2024

• Relationships With Caring Adults Provide a Buffer Against Depression, Anxiety, Regardless of Adverse Childhood Experiences

Wednesday, January 17, 2024

• Therapy Versus Medication: Comparing Treatments for Depression in Heart Disease

Friday, January 12, 2024

• Psychotherapy Effective in Treating Post-Traumatic Stress Disorder Following Multiple Traumatic Events, Meta-Study Finds
• Stress, Via Inflammation, Is Linked to Metabolic Syndrome

Wednesday, January 10, 2024

• Feeling Depressed Linked to Short-Term Increase in Bodyweight
• Newly Identified Genes for Depression May Lead to New Treatments
• Reduced Drug Use Is a Meaningful Treatment Outcome for People With Stimulant Use Disorders, Study Shows

Monday, January 8, 2024

• Clear Link Between Autoimmune Disease and Perinatal Depression

Thursday, January 4, 2024

• Bipolar Disorder Linked to Early Death

Thursday, December 21, 2023

• Psychologist Publishes Most Thorough Compilation of Sleep and Emotion Research to Date
• Connection Between Light Levels and Mental Health -- Climate Change Could Also Have an Impact in the Future

Thursday, December 14, 2023

• Genetic 'protection' Against Depression Was No Match for Pandemic Stress

Wednesday, December 13, 2023

• Unravelling the Association Between Neonatal Proteins and Adult Health
• Body Dissatisfaction Linked With Depression Risk in Children

Tuesday, December 12, 2023

• Caregiving Can Be Stressful, but It Could Also Lower Risk of Depression

Thursday, December 7, 2023

• Discrimination During Pregnancy May Alter Circuits in Infants' Brains

Tuesday, December 5, 2023

• Depression, Constipation, and Urinary Tract Infections May Precede MS Diagnosis

Monday, December 4, 2023

• New Study Maps Ketamine's Effects on Brain

Wednesday, November 29, 2023

• AI May Aid in Diagnosing Adolescents With ADHD
• Mindfulness-Based Intervention Shows Promise for PTSD in Cardiac Arrest Survivors

Tuesday, November 28, 2023

• Understanding Subjective Beliefs Could Be Vital to Tailoring More Effective Treatments for Depression and ADHD

Monday, November 27, 2023

• Discrimination During Pregnancy Can Affect Infant's Brain Circuitry

Thursday, November 16, 2023

• A Small Molecule Blocks Aversive Memory Formation, Providing a Potential Treatment Target for Depression
• High Levels of Maternal Stress During Pregnancy Linked to Children's Behavior Problems
• New Studies of Brain Activity Explain Benefits of Electroconvulsive Therapy

Tuesday, November 14, 2023

• US Men Die 6 Years Before Women, as Life Expectancy Gap Widens
• Genetic Testing Could Greatly Benefit Patients With Depression, Save Health System Millions
• Reducing 'vivid Imagery' That Fuels Addiction Cravings

Monday, November 13, 2023

• Early-Life Stress Changes More Genes in Brain Than a Head Injury

Thursday, November 9, 2023

• Brain Imaging Identifies Biomarkers of Mental Illness
• Study Shows Link Between Mental and Physical Health

Monday, November 6, 2023

• Location of Strong Sense of Discomfort in Brain Found

Friday, November 3, 2023

• Paid Family Leave Boosted Postpartum Wellbeing, Breastfeeding Rates

Thursday, November 2, 2023

• New Clues to the Mechanism Behind Treatment-Resistant Depression

Wednesday, November 1, 2023

• Contraceptive Pill Users Less Likely to Report Depression

Monday, October 30, 2023

• The Genetic Heritage of the Denisovans May Have Left Its Mark on Our Mental Health

Thursday, October 26, 2023

• Youngest Children in Class With ADHD as Likely to Keep Diagnosis in Adulthood as Older Pupils, Find Scientists

Wednesday, October 25, 2023

• New Distractibility 'd Factor' May Be Linked With ADHD

Monday, October 23, 2023

• Researchers Use Pioneering New Method to Unlock Brain's Noradrenaline System
• Heated Yoga May Reduce Depression Symptoms, According to Recent Clinical Trial

Friday, October 20, 2023

• Pupil Response May Shed Light on Who Responds Best to Transcranial Magnetic Stimulation for Depression
• Consistent Lack of Sleep Is Related to Future Depressive Symptoms

Thursday, October 19, 2023

• Researchers Confirm Postpartum Depression Heritability, Home in on Treatment Mechanism
• Ketamine's Effect on Depression May Hinge on Hope
• Study Finds Men's Antidepressant Use Did Not Negatively Impact IVF Success

Tuesday, October 17, 2023

• Adults With ADHD Are at Increased Risk for Developing Dementia
• Study Reveals Health Impact of Eating Disorders
• LATEST NEWS
• Health & Medicine
• Diseases & Conditions
• Alzheimer's Research
• Amyotrophic Lateral Sclerosis
• Attention Deficit Disorder
• Back and Neck Pain
• Birth Defects
• Bladder Disorders
• Blood Clots
• COVID and SARS
• Cervical Cancer
• Bladder Cancer
• Multiple Myeloma
• Pancreatic Cancer
• Brain Tumor
• Colon Cancer
• Breast Cancer
• Ovarian Cancer
• Lung Cancer
• Mesothelioma
• Skin Cancer
• Prostate Cancer
• Cerebral Palsy
• Chikungunya
• Chronic Fatigue Syndrome
• Cold and Flu
• Crohn's Disease
• Cystic Fibrosis
• Dengue Fever
• Down Syndrome
• Eating Disorder Research
• Encephalitis
• Epilepsy Research
• Erectile Dysfunction
• Fibromyalgia
• Gastrointestinal Problems
• HIV and AIDS
• Headache Research
• Hearing Loss
• Heart Health
• Cholesterol
• Stroke Prevention
• Heart Disease
• Hormone Disorders
• Hypertension
• Infectious Diseases
• Insomnia Research
• Irritable Bowel Syndrome
• Kidney Disease
• Liver Disease
• Lung Disease
• Lyme Disease
• Mental Health Research
• Multiple Sclerosis Research
• Mumps, Measles, Rubella
• Muscular Dystrophy
• Osteoporosis
• Parkinson's Research
• Prostate Health
• Restless Leg Syndrome
• Sickle Cell Anemia
• Sleep Disorder Research
• Thyroid Disease
• Triglycerides
• Tuberculosis
• Medical Topics
• Accident and Trauma
• Alternative Medicine
• Birth Control
• Bone and Spine
• Chronic Illness
• Controlled Substances
• Dietary Supplements and Minerals
• Epigenetics
• Food Additives
• Foodborne Illness
• Foot Health
• Gene Therapy
• Health Policy
• Human Biology
• Immune System
• Joint Health
• Medical Imaging
• Nervous System
• Pain Control
• Personalized Medicine
• Pharmacology
• Psychology Research
• Wounds and Healing
• PHYSICAL/TECH
• ENVIRONMENT
• SOCIETY & EDUCATION
• The Embryo Assembles Itself
• Thawing Permafrost: Not A Tipping Point
• Climate Change Was No Problem for Sharks
• Fungus Breaks Down Ocean Plastic
• Kinship and Ancestry of the Celts
• How Statin Therapy May Prevent Cancer
• Origins of 'Welsh Dragons' Exposed
• Resting Brain: Neurons Rehearse for Future
• Observing Single Molecules
• A Greener, More Effective Way to Kill Termites

Trending Topics

Strange & offbeat.

Warning Signs and Symptoms

• Mental Health Conditions
• Common with Mental Illness
• Mental Health By the Numbers
• Individuals with Mental Illness

Family Members and Caregivers

• Kids, Teens and Young Adults
• Maternal & New Parent Mental Health
• Veterans & Active Duty
• Identity and Cultural Dimensions
• Frontline Professionals
• Mental Health Education
• Support Groups

NAMI HelpLine

• Publications & Reports
• Podcasts and Webinars
• Video Resource Library
• Justice Library
• Find Your Local NAMI
• Find a NAMIWalks
• Attend the NAMI National Convention
• Fundraise Your Way
• Create a Memorial Fundraiser
• Pledge to Be StigmaFree
• Awareness Events
• Share Your Story
• Partner with Us

Advocate for Change

• Policy Priorities
• NAMI Advocacy Actions
• Policy Platform
• Crisis Intervention
• State Fact Sheets
• Public Policy Reports

Register for NAMICon 2024

Join us in Denver, CO from June 4 to 6 along with hundreds of passionate and vibrant voices from around the world to elevate mental health.

2024 NAMI Next Gen Community of Practice

Do you want to get more involved in the national conversation about young adults and mental health? Apply to join NAMI’s Next Gen Community of Practice! Deadline to apply is June 9.

Volunteer with the NAMI HelpLine from your home computer!

We need you to make a difference by providing individuals and families with essential mental health information, resources, and support.

NAMICon 2024

Next Gen Community of Practice

Volunteer for the NAMI HelpLine

We're here to help

Nami is the national alliance on mental illness. we are the nation's largest grassroots mental health organization..

We are dedicated to building better lives for the millions of Americans affected by mental illness. Our Alliance includes more than 700 NAMI State Organizations and Affiliates who work in your community to raise awareness and provide support and education to those in need.

Find Support Now

1-800-950-6264

Chat or Text

Text "helpline" to 62640

In a crisis?

Call or Text 988

Call, Text or Chat with the HelpLine M-F, 10 a.m. - 10 p.m. ET | 988 crisis service available 24/7

Find Support

If you or someone you know is struggling, you are not alone. There are many support services and treatment options that may help.

Get Involved

Get involved and make a difference in the lives of Americans living with mental health conditions.

Policy change is one major way we can make a difference in the lives of people living with mental health conditions and their families.

Millions of people in the U.S. are affected by mental illness. It’s important to measure how common it is, so we can understand its impact — and so we can show that no one is alone.

More than 60,000 advocacy actions taken by NAMI advocates

Over 700 state and local affiliates nationwide

93% of HelpLine users surveyed would recommend the HelpLine to someone else

We need your support to continue the work

Join a NAMIWalk with Your Friends

Listen to Our Podcasts and Webinars

View The Latest

Podcasts & Webinars

You can make a difference

Together with our grassroots volunteers, we work every day to provide help and hope to millions of Americans.

Become a Fundraiser

While not everyone can give, anyone can fundraise. NAMI relies on contributions from supporters throughout the country to help us perform our critical work advocating, educating and spreading awareness.

Donate to NAMI

Your financial contribution to NAMI helps a create a world where all people affected by mental illness can experience hope, recovery, wellness and freedom from stigma.

Volunteer with the NAMI HelpLine from your home computer! We need you to make a difference by providing individuals and families with essential mental health information, resources, and support.

Participate in NAMI’s largest mental health awareness and fundraising event series, taking place in over 120 locations across the country.

Join the nation’s largest gathering of mental health advocates as we share, learn and network around important mental health issues. The NAMI National Convention offers engaging presenters, thought-provoking topics, the latest updates on research and much more.

The NAMI HelpLine provides the one-on-one help and information necessary to tackle tough challenges that you, your family or friends are facing. Call, Text or Chat with the HelpLine M-F, 10 a.m. - 10 p.m. ET 988 crisis service available 24/7

NAMI HelpLine is available M-F, 10 a.m. – 10 p.m. ET. Call 800-950-6264 , text “helpline” to 62640 , or chat online. In a crisis, call or text 988 (24/7).

• Open access
• Published: 30 May 2024

Barriers and facilitators to mental health treatment access and engagement for LGBTQA+ people with psychosis: a scoping review protocol

• Cláudia C. Gonçalves   ORCID: orcid.org/0000-0001-6767-0920 1 ,
• Zoe Waters 2 ,
• Shae E. Quirk 1 ,
• Peter M. Haddad 1 , 3 ,
• Ashleigh Lin 4 ,
• Lana J. Williams 1 &
• Alison R. Yung 1 , 5  

Systematic Reviews volume  13 , Article number:  143 ( 2024 ) Cite this article

92 Accesses

Metrics details

The prevalence of psychosis has been shown to be disproportionately high amongst sexual and gender minority individuals. However, there is currently little consideration of the unique needs of this population in mental health treatment, with LGBTQA+ individuals facing barriers in accessing timely and non-stigmatising support for psychotic experiences. This issue deserves attention as delays to help-seeking and poor engagement with treatment predict worsened clinical and functional outcomes for people with psychosis. The present protocol describes the methodology for a scoping review which will aim to identify barriers and facilitators faced by LGBTQA+ individuals across the psychosis spectrum in help-seeking and accessing mental health support.

A comprehensive search strategy will be used to search Medline, PsycINFO, Embase, Scopus, LGBTQ+ Source, and grey literature. Original studies of any design, setting, and publication date will be included if they discuss barriers and facilitators to mental health treatment access and engagement for LGBTQA+ people with experiences of psychosis. Two reviewers will independently screen titles/abstracts and full-text articles for inclusion in the review. Both reviewers will then extract the relevant data according to pre-determined criteria, and study quality will be assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Key data from included studies will be synthesised in narrative form according to the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews.

The results of this review will provide a comprehensive account of the current and historical barriers and facilitators to mental healthcare faced by LGBTQA+ people with psychotic symptoms and experiences. It is anticipated that the findings from this review will be relevant to clinical and community services and inform future research. Findings will be disseminated through publication in a peer-reviewed journal and presented at conferences.

Scoping review registration

This protocol is registered in Open Science Framework Registries ( https://doi.org/10.17605/OSF.IO/AT6FC ).

Peer Review reports

The prevalence of psychotic disorders in the general population has been estimated to be around 0.27–0.75% [ 1 , 2 ], with the lifetime prevalence of ever having a psychotic experience being estimated at 5.8% [ 3 ]. However, rates of psychotic symptoms and experiences are disproportionately high amongst LGBTQA+ populations, with non-heterosexual individuals estimated to be 1.99–3.75 times more likely to experience psychosis than their heterosexual peers [ 4 , 5 , 6 , 7 ]. Additionally, it has been estimated that transgender or gender non-conforming (henceforth trans) individuals are 2.46–49.7 times more likely than their cisgender peers (i.e. individuals whose gender identity is the same as their birth registered sex) to receive a psychotic disorder diagnosis [ 8 , 9 ]. The increased rates of psychotic experiences noted amongst gender and sexual minorities may be explained by evidence indicating that LGBTQA+ people are also exposed to risk factors for psychosis at a far greater rate than members of the general population, such as childhood adversity [ 10 , 11 , 12 ], minority stress [ 13 ], discrimination [ 14 ], and stigma [ 15 , 16 ]. Furthermore, there is added potential for diagnostic biases leading to over-diagnosing psychosis in gender diverse individuals, whose gender expression and dysphoria may be pathologized by mental health service providers [ 8 ].

Despite these concerning statistics, there is very little research examining the experiences of LGBTQA+ people with psychosis, and limited consideration of the unique needs these individuals may have in accessing and engaging with mental health services. While timely access to treatment has consistently been associated with better symptomatic and functional outcomes for people with psychosis [ 17 , 18 ], there are often delays to treatment initiation which are worsened for LGBTQA+ individuals [ 19 , 20 ]. These individuals face additional barriers to accessing adequate mental health support compared to cisgender/heterosexual people [ 19 ] and may need to experiment with several mental health services before finding culturally competent care [ 20 ]. This in turn may lead to longer duration of untreated psychosis. Additionally, there seems to be a lack of targeted support for this population from healthcare providers, with LGBTQA+ individuals with serious mental health concerns reporting higher rates of dissatisfaction with psychiatric services than their cisgender and heterosexual counterparts [ 7 , 14 , 21 ]. However, the extent of these differences varies across contexts [ 22 ], potentially due to improved education around stigma and LGBTQA+ issues within a subset of mental health services.

Nonetheless, stigma remains one of the highest cited barriers to help-seeking for mental health problems, particularly with regard to concerns around disclosure [ 23 ], which can be particularly challenging for people experiencing psychosis [ 24 , 25 ]. Stigma stress in young people at risk for psychosis is associated with less positive attitudes towards help-seeking regarding both psychiatric medication and psychotherapy [ 26 ], potentially partly due to fears of judgement and being treated differently by service providers [ 27 ]. This issue may be compounded for people who also belong to minoritized groups [ 23 , 28 ], particularly as LGBTQA+ individuals have reported experiencing frequent stigma and encountering uninformed staff when accessing mental healthcare [ 7 , 29 ]. Furthermore, stigma-fuelled hesitance to access services may be heightened for trans people [ 30 ] whose identities have historically been pathologized and conflated with experiences of psychosis [ 31 ].

Even when individuals manage to overcome barriers to access support, there are added challenges to maintaining adequate treatment engagement. In a large online study, half of trans and nearly one third of LGB participants reported having stopped using mental health services in the past because of negative experiences related to their gender identity or sexuality [ 20 ]. This can be particularly problematic as experiences of stigma predict poorer medication adherence in psychosis [ 32 ] which subsequently multiplies the risk for relapse and suicide [ 33 ]. While no research to date has explored non-adherence rates in people with psychosis who are LGBTQA+, concerns around suicidality are heightened for individuals who are gender and sexuality diverse [ 34 , 35 , 36 ].

Generally, there is rising demand for mental healthcare that specifically addresses the needs of gender and sexual minority individuals and promotes respect for diversity, equity, and inclusion [ 29 , 37 ]. This is particularly salient as positive relationships with staff are associated with better medication adherence for people with psychosis [ 38 ] and healthcare providers with LGBTQA+-specific mandates have demonstrated higher satisfaction rates for LGBTQA+ individuals [ 20 ]. Mental health services need to adapt treatment options to acknowledge minority stress factors for those with stigmatised identities and, perhaps more importantly, how these intersect and interact to increase inequalities in people from minoritized groups accessing and benefiting from treatment [ 37 , 39 ].

Additionally, gender affirming care needs to be recognised as an important facet of mental health treatment for many trans individuals, as it is associated with positive outcomes such as improvements in quality of life and psychological functioning [ 40 , 41 , 42 ] and reductions in psychiatric symptom severity and need for subsequent mental health treatment [ 8 , 43 ]. While there are additional barriers in access to gender affirming care for individuals with psychosis, this treatment has shown success in parallel with treatment to address psychosis symptom stabilisation [ 19 , 44 ]. The importance of affirmation is echoed by the finding that many negative experiences of LGBTQA+ participants with mental health services could be avoided simply by respecting people’s pronouns and using gender-neutral language [ 20 ].

To ensure timely access to appropriate treatment for LGBTQA+ people with psychosis, there is a need for improved understanding of the factors which challenge and facilitate help-seeking and engagement with mental health support. A preliminary search of Google Scholar, Medline, the Cochrane Database of Systematic Reviews, and PROSPERO was conducted and revealed no existing or planned reviews exploring benefits and/or obstacles to mental health treatment specific to this population. Therefore, the proposed review seeks to comprehensively search and appraise the existing literature to identify and summarise a range of barriers and facilitators to adequate mental health support faced by LGBTQA+ people with experiences of psychosis. This will allow for the mapping of the types of evidence available and identification of any knowledge gaps. Moreover, we hope to guide future decision-making in mental healthcare to improve service accessibility for LGBTQA+ individuals with psychosis and to set the foundations for future research that centres this marginalised population. Based on published guidance [ 45 , 46 , 47 ], a scoping review methodology was identified as the most appropriate approach to address these aims.

Selection criteria

This scoping review protocol has been developed in compliance with the JBI Manual for Evidence Synthesis [ 48 ] and, where relevant, the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist [ 49 ] (see Additional file 1). In the event of protocol amendments, the date, justification, and description for each amendment will be provided.

Due to the limited literature around the topic of this review, any primary original study design, setting, and publication date will be considered for inclusion. Publications written in English will be included, and articles in other languages may be considered pending time and cost constraints around translation. Publications will be excluded if the full text is not available upon request from authors.

The PCC (Population, Concept, Context) framework was used to develop the inclusion criteria for this scoping review:

This review will include individuals of any age who are LGBTQA+ and have had experiences of psychosis. For the purposes of this review, ‘LGBTQA+ individuals’ will be broadly defined as any individual that is not heterosexual and/or cisgender or anyone who engages in same-gender sexual behaviour. Studies may include participants who are cisgender and heterosexual if they separately report outcomes for LGBTQA+ individuals. Within this review, the term ‘psychosis’ includes (i) any diagnosis of a psychotic disorder, such as schizophrenia spectrum disorders, mood disorders with psychotic features, delusional disorders, and drug-induced psychotic disorders, (ii) sub-threshold psychotic symptoms, such as those present in ultra-high risk (UHR), clinical high risk (CHR), or at risk mental state (ARMS) individuals, and (iii) any psychotic-like symptoms or experiences. Studies may include participants with multiple diagnoses if they separately report outcomes for individuals on the psychosis spectrum.

This review will include publications which discuss potential barriers and/or facilitators to mental health help-seeking and/or engagement with mental health treatment. ‘Barriers’ will be operationalised as any factors which may delay or prevent individuals from accessing and engaging with appropriate mental health support. These may include lack of mental health education, experienced or internalised stigma, experiences of discrimination from health services, and lack of inclusivity in health services. ‘Facilitators’ will be operationalised as any factors which may promote timely help-seeking and engagement with sources of support. These may include improved access to mental health education, positive sources of social support, and welcoming and inclusive services. Mental health help-seeking will be broadly defined as any attempt to seek and access formal or informal support to address a mental health concern related to experiences of psychosis (e.g. making an initial appointment with a service provider, seeking help from a friend). Mental health treatment engagement will be broadly defined as adherence and active participation in the treatment that is offered by a source of support (e.g. attending scheduled appointments, taking medication as prescribed, openly communicating with service providers).

This review may include research encompassing any setting in which mental healthcare is provided. This is likely to include formal healthcare settings such as community mental health teams or inpatient clinics as well as informal settings such as LGBTQA+ spaces or informal peer support. Studies will be excluded if they focus exclusively on physical health treatment.

Search strategy

Database searches will be conducted in Medline, PsycINFO, Embase, Scopus, and LGBTQ+ Source. The full search strategy for this protocol is available (see Additional file 2). This strategy has been collaboratively developed and evaluated by a scholarly services health librarian. Searches will include subject headings relevant to each database and title/abstract keywords relating to three main concepts: (i) LGBTQA+ identity, (ii) experiences of psychosis, and (iii) mental health treatment. Keywords for each concept will be combined using the Boolean operator ‘OR’, and the three concepts will be combined using ‘AND’. This search strategy was appropriately translated for each of the selected databases. There will be no limitations on language or publication date at this stage to maximise the breadth of the literature captured. Publications returned from these searches will be exported to EndNote. Searches will be re-run prior to the final analysis to capture any newly published studies.

The database searches will be supplemented by searching the grey literature as per the eligibility criteria detailed above. These may include theses and dissertations, conference proceedings, reports from mental health services, and policy documents from LGBTQA+ groups. Google and Google Scholar will be searched using a combination of clauses for psychosis (Psychosis OR psychotic OR schizophrenia OR schizoaffective), treatment (treatment or “help-seeking”), and queer identity. The latter concept will have three clauses for three separate searches, with one including broad queer identity (LGBT), one specific to non-heterosexual individuals (gay OR lesbian OR homosexual OR bisexual OR queer OR asexual), and one specific to trans individuals (transgender OR transsexual OR transexual OR “non-binary” OR “gender minority”). Additionally, reference lists and citing literature will be manually searched for each paper included in the review to capture any articles and policy documents not previously identified.

Data selection

Search results will be imported into Covidence using EndNote, and duplicates will be eliminated. Titles and abstracts will be screened by the first and second authors according to pre-defined screening criteria, which will be discussed by the authors and piloted prior to screening. These criteria will consider whether the articles included LGBTQA+ participants with experiences of psychosis (as operationalised above) in relation to mental health help-seeking and/or treatment. Full texts of relevant articles will then be obtained and screened by the first and second reviewer in accordance with the full inclusion and exclusion criteria after initial piloting to maximise inter-rater reliability. Decisions on inclusion and exclusion will be blinded and recorded on Covidence. Potential discrepancies will be resolved through discussion, and when consensus cannot be reached, these will be resolved by the supervising author. The process of study selection will be documented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram [ 50 ].

Data extraction

Data extraction will be performed independently by two reviewers using Covidence. Prior to beginning final extraction, both reviewers will independently pilot the extraction tool using a sample of five included studies and discuss any necessary changes. Information extracted is planned to include the following: title, author name(s), year of publication, country in which the study was conducted, study design, sample size, population of focus (i.e. sexual minorities, gender minorities, or both), sample demographics (i.e. age, gender identity, and sexual orientation), setting (e.g. early intervention service, community mental health team, etc.), psychosis characteristics (e.g. diagnoses included, severity of symptoms, etc.), type of treatment (e.g. cognitive behavioural therapy, antipsychotic medication, etc.), and any barriers and/or facilitators identified according to the aforementioned operationalised definitions. Disagreements will be resolved through discussion between the two reviewers and, when necessary, final decisions will be made by a senior supervisor. Once extracted, information will be recorded in Excel. Lead authors of papers will be contacted by the primary review author in cases where there is missing or insufficient data.

Quality assessment

Due to the expected heterogeneity in the types of studies that may be included in this review (e.g. qualitative studies, randomised controlled trials, case control studies, case reports), the relevant revised Joanna Briggs Institute (JBI) critical appraisal checklists [ 51 ] will be used to assess risk of bias and study quality for each study design. Two reviewers will independently use these checklists to assess each paper that is included following the full-text screening. If there are discrepancies in article ratings, these will be resolved through discussion between the two authors. If no consensus is reached, discrepancies will be resolved by a senior supervisor. In line with the scoping nature of this review, low-quality studies will not be excluded from the synthesis.

Evidence synthesis

Data from included studies will be synthesised using a narrative synthesis approach in accordance with the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews [ 52 ]. A preliminary descriptive synthesis will be conducted by tabulating the extracted data elements from each study alongside quality assessment results and developing an initial description of the barriers and facilitators to (1) accessing and (2) engaging with mental health support that are identified in the literature. This initial synthesis will then be interrogated and refined to contextualise these barriers and facilitators in the setting, population, and methodology of each study to form the basis for an interpretative synthesis.

This review will not use a pre-existing thematic framework to categorise barriers and facilitators as it is expected that the factors identified will not neatly fit into existing criteria. Instead, these will be conceptualised according to overarching themes as interrelated factors, so that potentially complex interactions between barriers and facilitators within and across relevant studies may be explored through concept mapping. If most of the studies included are qualitative, there may also be scope for a partial meta-synthesis. To avoid oversimplifying the concept of ‘barriers and facilitators’ (see criticism by Bach-Mortensen & Verboom [ 53 ]), this data synthesis will be followed by a critical reflection of the findings through the lens of the socio-political contexts which may give rise to the barriers and facilitators identified, exploring the complexities necessary for any changes to be implemented in mental health services.

If the extracted data indicate that gender minority and sexual minority individuals experience unique or different barriers and/or facilitators to each other, these population groups will be analysed separately as opposed to findings being generalised across the LGBTQA+ spectrum. Furthermore, if there is scope to do so, analyses may be conducted to investigate how perceived barriers and facilitators for this population may have changed over time (i.e. according to publication date) as definitions of psychosis evolve and LGBTQA+ individuals gain visibility in clinical services.

The proposed review will add to the literature around mental health treatment for LGBTQA+ people with psychosis. It will provide a thorough account of the barriers and facilitators to accessing and engaging with support faced by this population and may inform future research and clinical practice.

In terms of limitations, this review will be constrained by the existing literature and may therefore not be sufficiently comprehensive in reflecting the barriers and facilitators experienced by subgroups within the broader LGBTQA+ community. Additionally, although broad inclusion criteria are necessary to capture the full breadth of research conducted in this topic, included studies are likely to be heterogeneous and varied in terms of their methodology and population which may complicate data synthesis.

Nonetheless, it is anticipated that the findings from this review will provide the most comprehensive synthesis to date of the issues driving low help-seeking and treatment engagement in people across the psychosis spectrum who are LGBTQA+. This review will likely also identify gaps in the literature which may inform avenues for future research, and the factors identified in this review will be considered in subsequent research by the authors.

Additionally, findings will be relevant to healthcare providers that offer support to people with psychosis who may have intersecting LGBTQA+ identities as well as LGBTQA+ organisations which offer support to LGBTQA+ people who may be experiencing distressing psychotic experiences. These services are likely to benefit from an increased awareness of the factors which may improve or hinder accessibility for these subsets of their target populations. Therefore, results from this review may inform decision-making around the implementation of service-wide policy changes.

The findings of this review will be disseminated through the publication of an article in a peer-reviewed journal and presented at relevant conferences in Australia and/or internationally. Additionally, the completed review will form part of the lead author’s doctoral thesis.

Availability of data and materials

Not applicable for this protocol.

Abbreviations

• At risk mental state

Clinical high risk for psychosis

Joanna Briggs Institute

Lesbian, gay, and bisexual

Lesbian, gay, bisexual, transgender, queer or questioning, asexual or aromantic, and more

Population, Concept, Context

Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols

Ultra-high risk for psychosis

Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease Study (GBD) Results. Seattle, WA: IHME, University of Washington. 2020. https://vizhub.healthdata.org/gbd-results/ . Accessed 26 May 2023

Moreno-Kustner B, Martin C, Pastor L. Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. PLoS One. 2018;13(4):e0195687. https://doi.org/10.1371/journal.pone.0195687 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

McGrath JJ, Saha S, Al-Hamzawi A, Alonso J, Bromet EJ, Bruffaerts R, et al. Psychotic experiences in the general population: a cross-national analysis based on 31 261 respondents from 18 countries. JAMA Psychiatry. 2015;72(7):697–705. https://doi.org/10.1001/jamapsychiatry.2015.0575 .

Article   PubMed   PubMed Central   Google Scholar  

Chakraborty A, McManus S, Brugha TS, Bebbington P, King M. Mental health of the non-heterosexual population of England. Br J Psychiatry. 2011;198(2):143–8. https://doi.org/10.1192/bjp.bp.110.082271 .

Article   PubMed   Google Scholar  

Gevonden M, Selten J, Myin-Germeys I, De Graaf R, Ten Have M, Van Dorsselaer S, et al. Sexual minority status and psychotic symptoms: findings from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS). Psychol Med. 2014;44(2):421–33. https://doi.org/10.1017/S0033291713000718 .

Article   CAS   PubMed   Google Scholar  

Jacob L, Smith L, McDermott D, Haro JM, Stickley A, Koyanagi A. Relationship between sexual orientation and psychotic experiences in the general population in England. Psychol Med. 2021;51(1):138–46. https://doi.org/10.1017/S003329171900309X .

Welch S, Collings SCD, Howden-Chapman P. Lesbians in New Zealand: their mental health and satisfaction with mental health services. Aust N Z J Psychiatry. 2000;34(2):256–63. https://doi.org/10.1080/j.1440-1614.2000.00710.x .

Barr SM, Roberts D, Thakkar KN. Psychosis in transgender and gender non-conforming individuals: a review of the literature and a call for more research. Psychiatry Res. 2021;306:114272. https://doi.org/10.1016/j.psychres.2021.114272 .

Hanna B, Desai R, Parekh T, Guirguis E, Kumar G, Sachdeva R. Psychiatric disorders in the U.S. transgender population. Ann Epidemiol. 2019;39:1–7. https://doi.org/10.1016/j.annepidem.2019.09.009 .

Schneeberger AR, Dietl MF, Muenzenmaier KH, Huber CG, Lang UE. Stressful childhood experiences and health outcomes in sexual minority populations: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2014;49:1427–45. https://doi.org/10.1007/s00127-014-0854-8 .

Stanton KJ, Denietolis B, Goodwin BJ, Dvir Y. Childhood trauma and psychosis: an updated review. Child Adolesc Psychiatr Clin N Am. 2020;29(1):115–29. https://doi.org/10.1016/j.chc.2019.08.004 .

Varese F, Smeets F, Drukker M, Lieverse R, Lataster T, Viechtbauer W, et al. Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophr Bull. 2012;38(4):661–71. https://doi.org/10.1093/schbul/sbs050 .

Mongelli F, Perrone D, Balducci J, Saccheti A, Ferrari S, Mattei G, et al. Minority stress and mental health among LGBT populations: an update on the evidence. Minerva Psichiatr. 2019;60(1):27–50. https://doi.org/10.23736/S0391-1772.18.01995-7 .

Article   Google Scholar  

Kidd SA, Howison M, Pilling M, Ross LE, McKenzie K. Severe mental illness in LGBT populations: a scoping review. Psychiatr Serv. 2016;67(7):779–83. https://doi.org/10.1176/appi.ps.201500209 .

Hatzenbuehler ML, Pachankis JE. Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth. Pediatr Clin North Am. 2016;63(6):985–97. https://doi.org/10.1016/j.pcl.2016.07.003 .

Rüsch N, Heekeren K, Theodoridou A, Müller M, Corrigan PW, Mayer B, et al. Stigma as a stressor and transition to schizophrenia after one year among young people at risk of psychosis. Schizophr Res. 2015;166(1–3):43–8. https://doi.org/10.1016/j.schres.2015.05.027 .

Howes OD, Whitehurst T, Shatalina E, Townsend L, Onwordi EC, Mak TLA, et al. The clinical significance of duration of untreated psychosis: an umbrella review and random-effects meta-analysis. World Psychiatry. 2021;20(1):75–95. https://doi.org/10.1002/wps.20822 .

McGorry PD. Early intervention in psychosis: obvious, effective, overdue. J Nerv Ment Dis. 2015;203(5):310–308. https://doi.org/10.1097/NMD.0000000000000284 .

Peta JL. The Oxford Handbook of Sexual and Gender Minority Mental Health. Oxford (GB): Oxford University Press; 2020. Chapter 11, Schizophrenia spectrum and other psychotic disorders among sexual and gender minority populations; 125-134. Available from: The Oxford Handbook of Sexual and Gender Minority Mental Health - Google Books. Accessed 01 Jun 2023

Simeonov D, Steele LS, Anderson S, Ross LE. Perceived satisfaction with mental health services in the lesbian, gay, bisexual, transgender, and transsexual communities in Ontario, Canada: an internet-based survey. Can J Commun Ment Health. 2015;34(1):31–44. https://doi.org/10.7870/cjcmh-2014-037 .

Avery AM, Hellman RE, Sudderth LK. Satisfaction with mental health services among sexual minorities with major mental illness. Am J Public Health. 2001;91(6):990–1. https://doi.org/10.2105/AJPH.91.6.990 .

Plöderl M, Mestel R, Fartacek C. Differences by sexual orientation in treatment outcome and satisfaction with treatment among inpatients of a German psychiatric clinic. PLoS ONE. 2022;17(1):e0262928. https://doi.org/10.1371/journal.pone.0262928 .

Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, et al. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2015;45(1):11–27. https://doi.org/10.1017/S0033291714000129 .

Pyle M, Morrison AP. “It’s just a very taboo and secretive kind of thing”: making sense of living with stigma and discrimination from accounts of people with psychosis. Psychosis. 2014;6(3):195–205. https://doi.org/10.1080/17522439.2013.834458 .

Wood L, Burke E, Byrne R, Pyle M, Chapman N, Morrison AP. Stigma in psychosis: a thematic synthesis of current qualitative evidence. Psychosis. 2015;7(2):152–65. https://doi.org/10.1080/17522439.2014.926561 .

Rüsch N, Heekeren K, Theodoridou A, Dvorsky D, Müller M, Paust T, et al. Attitudes towards help-seeking and stigma among young people at risk for psychosis. Psychiatry Res. 2013;210(3):1313–5. https://doi.org/10.1016/j.psychres.2013.08.028 .

Gronholm PC, Thornicroft G, Laurens KR, Evans-Lacko S. Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review. Psychol Med. 2017;47(11):1867–79. https://doi.org/10.1017/S0033291717000344 .

Rossman K, Salamanca P, Macapagal K. A qualitative study examining young adults’ experiences of disclosure and nondisclosure of LGBTQ identity to health care providers. J Homosex. 2017;64(10):1390–410. https://doi.org/10.1080/00918369.2017.1321379 .

Rees SM, Crowe M, Harris S. The lesbian, gay, bisexual and transgender communities’ mental health care needs and experiences of mental health services: an integrative review of qualitative studies. J Psychiat Mental Health Nurs. 2020;28(4):578–89. https://doi.org/10.1111/jpm.12720 .

Shipherd JC, Green KE, Abramovitz A. Transgender clients: identifying and minimizing barriers to mental health treatment. J Gay Lesbian Ment Health. 2010;14(2):94–108. https://doi.org/10.1080/19359701003622875 .

Hoening J, Kenna JC. The nosological position of transsexualism. Arch Sex Behav. 1974;3:273–87. https://doi.org/10.1007/BF01541490 .

Eliasson ET, McNamee L, Swanson L, Lawrie SM, Schwannauer M. Unpacking stigma: meta-analyses of correlates and moderators of personal stigma in psychosis. Clin Psychol Rev. 2021;89:102077. https://doi.org/10.1016/j.cpr.2021.102077 .

Lally J, MacCabe JH. Antipsychotic medication in schizophrenia: a review. Br Med Bull. 2015;114(1):169–79. https://doi.org/10.1093/bmb/ldv017 .

De Lange J, Baams L, van Bergen D, Bos HMW, Bosker RJ. Minority stress and suicidal ideation and suicide attempts among LGBT adolescents and young adults: a meta-analysis. LGBT Health. 2022;9(4):222–37. https://doi.org/10.1089/lgbt.2021.0106 .

Skerrett DM, Kolves K, De Leo D. Are LGBT populations at higher risk for suicidal behaviours in Australia? Research findings and implications. J Homosex. 2015;62(7):883–901. https://doi.org/10.1080/00918369.2014.1003009 .

Strauss P, Cook A, Winter S, Watson V, Toussaint DW, Lin A. Trans Pathways: the mental health experiences and care pathways of trans young people: summary of results. Perth, Australia: Telethon Kids Institute. 2017. trans-pathways-report.pdf (telethonkids.org.au). Accessed 16 June 2023

DeLuca JS, Novacek DM, Adery LH, Herrera SN, Landa Y, Corcoran CM, et al. Equity in mental health services for youth at clinical high risk for psychosis: considering marginalized identities and stressors. Evid Based Pract Child Adolesc Ment Health. 2022;7(2):176–97. https://doi.org/10.1080/23794925.2022.2042874 .

Day JC, Bentall RP, Roberts C, Randall F, Rogers A, Cattell D, et al. Attitudes toward antipsychotic medication: the impact of clinical variables and relationships with health professionals. Arch Gen Psychiatry. 2005;62(7):717–24. https://doi.org/10.1001/archpsyc.62.7.717 .

Coyne CA, Poquiz JL, Janssen A, Chen D. Evidence-based psychological practice for transgender and non-binary youth: defining the need, framework for treatment adaptation, and future directions. Evid Based Pract Child Adolesc Ment Health. 2020;5(3):340–53. https://doi.org/10.1080/23794925.2020.1765433 .

Baker KE, Wilson LM, Sharma R, Dukhanin V, McArthur K, Robinson KA. Hormone therapy, mental health, and quality of life among transgender people: a systematic review. J Endocr Soc. 2021;5(4):bvab011. https://doi.org/10.1210/jendso/bvab011 .

Hughto JMW, Reisner SL. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgend Health. 2016;1(1):21–31. https://doi.org/10.1089/trgh.2015.0008 .

Wernick JA, Busa S, Matouk K, Nicholson J, Janssen A. A systematic review of the psychological benefits of gender-affirming surgery. Urol Clin North Am. 2019;46(4):475–86. https://doi.org/10.1016/j.ucl.2019.07.002 .

Bränström R, Packanhkis JE. Reductions in mental health treatment utilization among transgender individuals after gender-affirming surgeries: a total population study. Am J Psychiatry. 2019;177(8):727–34. https://doi.org/10.1176/appi.ajp.2019.19010080 .

Meijer JH, Eeckhout GM, van Vlerken RHT, de Vries ALC. Gender dysphoria and co-existing psychosis: review and four case examples of successful gender affirmative treatment. LGBT Health. 2017;4(2):106–14. https://doi.org/10.1089/lgbt.2016.0133 .

Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. https://doi.org/10.1186/s12874-018-0611-x .

Munn Z, Pollock D, Khalil H, Alexander L, McInerney P, Godfrey CM, et al. What are scoping reviews? Providing a formal definition of scoping reviews as a type of evidence synthesis. JBI Evid Synth. 2022;20(4):950–2. https://doi.org/10.11124/JBIES-21-00483 .

Peters MDJ, Marnie C, Colquhoun H, Garritty CM, Hempel S, Horsley T, et al. Scoping reviews: reinforcing and advancing the methodology and application. Syst Rev. 2021;10(1):263. https://doi.org/10.1186/s13643-021-01821-3 .

Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis. JBI; 2024. https://synthesismanual.jbi.global . https://doi.org/10.46658/JBIMES-24-01

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;350: g7647. https://doi.org/10.1136/bmj.g7647 .

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;372:n71. https://doi.org/10.1136/bmj.n71 .

Barker TH, Stone JC, Sears K, Klugar M, Leonardi-Bee J, Tufanaru C, et al. Revising the JBI quantitative critical appraisal tools to improve their applicability: an overview of methods and the development process. JBI Evid Synth. 2023;21(3):478–93. https://doi.org/10.11124/JBIES-22-00125 .

Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews: a product from the ESRC methods programme. Lancaster University; 2006. https://doi.org/10.13140/2.1.1018.4643

Bach-Mortensen AM, Verboom B. Barriers and facilitators systematic reviews in health: a methodological review and recommendations for reviewers. Res Synth Methods. 2020;11(6):743–59. https://doi.org/10.1002/jrsm.1447 .

Download references

Acknowledgements

The authors would like to acknowledge the support of Ms Olivia Larobina, Scholarly Services Librarian (STEMM) at Deakin University, in the development of the search strategy.

CCG is funded by a Deakin University Postgraduate Research (DUPR) Scholarship. ZW is funded by a University of Western Australia Research Training Program (RTP) Scholarship. AL is supported by a National Health and Medical Research Council (NHMRC) Emerging Leaders Fellowship (2010063). LJW is supported by a NHMRC Emerging Leaders Fellowship (1174060). ARY is supported by a NHMRC Principal Research Fellowship (1136829). The funding providers had no role in the design and conduct of the study, or in the preparation, review, or approval of this manuscript.

Author information

Authors and affiliations.

Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia

Cláudia C. Gonçalves, Shae E. Quirk, Peter M. Haddad, Lana J. Williams & Alison R. Yung

Telethon Kids Institute, University of Western Australia, Perth, WA, 6009, Australia

University Hospital Geelong, Barwon Health, Geelong, VIC, 3220, Australia

Peter M. Haddad

School of Population and Global Health, University of Western Australia, Perth, WA, 6009, Australia

Ashleigh Lin

School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK

Alison R. Yung

You can also search for this author in PubMed   Google Scholar

Contributions

CCG is the guarantor. CCG conceptualised the review, developed the study design, and drafted the manuscript. CCG, ZW, and SQ collaborated with OL (Scholarly Services Librarian) to develop the search strategy. All authors critically reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cláudia C. Gonçalves .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

In the last 3 years, PMH has received honoraria for lecturing from Janssen, NewBridge Pharmaceuticals, and Otsuka and royalties from edited textbooks (Cambridge University Press, Oxford University Press).

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1. prisma-p 2015 checklist. completed prisma-p checklist for this systematic review protocol., 13643_2024_2566_moesm2_esm.docx.

Additional file 2. Search Strategy. Detailed search strategy for this systematic review, including search terms and relevant controlled vocabulary terms for each included database.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Gonçalves, C.C., Waters, Z., Quirk, S.E. et al. Barriers and facilitators to mental health treatment access and engagement for LGBTQA+ people with psychosis: a scoping review protocol. Syst Rev 13 , 143 (2024). https://doi.org/10.1186/s13643-024-02566-5

Download citation

Received : 04 July 2023

Accepted : 17 May 2024

Published : 30 May 2024

DOI : https://doi.org/10.1186/s13643-024-02566-5

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Treatment access
• Treatment engagement
• Facilitators
• Clinical high risk
• Ultra-high risk
• Psychotic experiences

Systematic Reviews

ISSN: 2046-4053

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

Why we don't exercise

We know that moving our bodies is good for us. So what keeps us from doing it?

For the better part of a year in 2017, I could barely will myself to leave my house. I was experiencing a prolonged depressive episode with daily, sometimes hourly, panic attacks, and I couldn't see the point in continuing on.

Many things helped me survive. Talking it through in therapy several times a week was like opening a pressure valve in my brain — it kept me functioning just enough to get by. Medication had mixed results — I felt less panicky, but also less joy, excitement, and other essential emotions. Crying to friends provided temporary catharsis. But it wasn't until I discovered Muay Thai, a form of kickboxing , that it felt as if day-to-day life might provide something other than hopelessness.

Every other form of healing I'd tried had focused my mind — its disordered thoughts and supposed chemical imbalances. What I hadn't tried was getting out of it altogether. When firm but well-meaning coaches yelled at me to fix my form, do five more pushups, and kick the bag until my shins were red and nearly bleeding, it jump-started my nervous system. It made me feel human again.

It's a trope to say you should not tell a depressed person to go outside, take a walk, or go for a run. Doing so would dismiss the severity and reality of their illness, like telling someone with a broken arm to go play catch. To some extent, this is true: It's probably not the best idea to tell someone struggling deeply with mental illness to simply suck it up and walk it off. But it's also true that when someone encouraged me to get out there and use my body, it was precisely what I needed at my lowest moment. I ended up at the gym only because my friends repeatedly encouraged me to come with them to a class until one day I finally did. It wasn't a cure-all, but it made me believe that a solution might exist.

Many of our collective crises — depression , anxiety , unhealthiness, and loneliness — are made worse by the same thing: our tendency toward a sedentary, shut-in lifestyle . We live in a society that makes it extremely difficult to find the time and space to be active. An abundance of research shows that exercise is good for depression , and yet most of the time when I hear people talk about the mental-health crisis — on TikTok, on X, and in real life — it is rarely mentioned. In my experience, it's much more common to hear people talk about finding the right diagnosis, the right medication, and the right kind of therapy than it is to see people encouraging their loved ones to get the heck outside.

Related stories

Many of us know exercise is good for us. All that's left is getting up off our asses.

The evidence is overwhelming that physical activity is good for both our bodies and our brains. A meta-review of studies that included 128,000 participants found that exercise of any kind significantly reduced symptoms of anxiety and depression . There are several theories as to why this is — exercise could increase the availability of neurotransmitters like dopamine in the brain, or it could help the brain form new neural pathways that are helpful to escaping cycles of depression. Either way, moving is good for our brains.

And the physical consequences of not moving enough are well-documented: heart disease, diabetes, high blood pressure, cancer, and a host of other maladies are linked to low physical activity. It is also bad for our mental health: A 2014 meta-analysis of more than 100,000 people found that increased sedentary time was positively correlated with rates of depression. A study from the beginning of COVID found that it was harder for people to stop being depressed if they spent too much time sitting.

Depression is a vicious cycle; it pits your brain against itself.

Despite the research, Americans have become less active over time. By one estimate, we're getting 27 fewer minutes of physical activity on average each day than we did 200 years ago. And for the past several decades, only about a quarter of American adults have met the recommended guidance of at least 20 minutes of exercise a day, according to the Centers for Disease Control and Prevention. One 2019 study found that we spent 82% of our time sedentary.

For kids, who need even more physical activity, the decline is stark. A 2022 Report Card on Physical Activity for Children and Youth gave the US a D- score, concluding that America, while never sufficiently supportive of physical activity, had become even worse at making the space and time for it. In 2007, an estimated 30% of adolescents completed the recommended 60 minutes of moderate-to-vigorous activity every day. By 2020 that number had fallen below 9%. Far fewer kids participate in team sports or walk or bike to school than did in the past, the report found. In Canada, as one study put it, pediatricians are so concerned about the decline in physical activity that they are encouraging parents to let kids engage in "thrilling and exciting forms of free play that involve uncertainty of outcome and a possibility of physical injury."

Instead of getting enough exercise, we're stuck lounging around on our phones. We've replaced real-world, bodily stimulation with mental stimulation from our screens. Meanwhile, our brains are rotting. In one study, nearly half of Americans ages 18 to 29 reported experiencing depression or anxiety in 2023. And over the past few decades, mental illness for teens and children has been on the rise.

Instead of looking at the situation and concluding that we all need to exercise more, some people are doing the opposite. Certain trends circulating social media emphasize not using your body: " hurkle-durkle ," aka "bed rotting," involves wrapping yourself in comfy clothes and bed linens and staying in bed way past the time you should be waking up. But while there is a time and place for doing nothing and relaxing, Americans aren't actually getting more rest. Much of the country is chronically underslept .

In this trend, I see the logic of depression — the sense that nothing can or will change so there's no point in trying. Much of America, it seems, has given up on trying to be active.

Over time, my year from hell faded from my mind. But eventually, my exercise routine went with it. I didn't need to work out to stay sane, I thought, and so I stopped committing to it. Then I moved away from the Muay Thai gym and completely fell out of the routine. After a few years, the depression caught up to me. It wasn't as catastrophic as before, more of a persistent ennui that was hard to shake. I tried to figure it out in therapy. I tried to intellectualize it. I tried to excuse it: There was no point in trying anything, life was just inherently bad, the political state of the world was scary, the outside world was too expensive. It wasn't working.

I've gotten to the point where exercise — being in my body, sweating — is more important to me than more mind-oriented forms of therapy.

Then one day, early in the pandemic when I was prone to languishing in my room for hours on end, a roommate suggested I come to the tennis court with them for an hour. I was immediately hooked. Playing tennis with friends several times a week wasn't just fun, and it didn't just help get me into shape — it became a main focal point of my life. It provided me with a new relationship to my body and mind. I'd forgotten that exercise, while not a cure for my mental illness, was a necessary precursor to my mental wellness. After years of intellectualizing my sadness and discomfort, I once again had something that got me into my body, got my endorphins going, and, most important, got me to stop thinking about anything other than where to place the ball on the other side of the court.

Depression is a vicious cycle; it pits your brain against itself. When I was at my worst, the usual advice of "don't tell a depressed person what to do" wasn't helpful to me because I needed someone to help me break that cycle by telling me to stop repeating the same patterns. What saved me was friends who helped me get out of the house, suggested I join the gym with them, or encouraged me to do anything to get me out of my head.

I still sometimes get depressed. I still struggle with mental health. But I now feel as if I have a reliable way to help myself out of it. I've gotten to the point where exercise — being in my body, sweating — is more important to me than more mind-oriented forms of therapy . It's not a magic cure, but I now see it as a fundamental baseline. If I'm not moving, nothing will help my sad state.

SSRI prescriptions continue to rise and more people are seeking therapy , but depression and anxiety rates remain sky-high. If you've tried nearly everything else, why not simply get moving?

P.E. Moskowitz runs  Mental Hellth , a newsletter on psychology, psychiatry, and modern society. They are also the author of the forthcoming book Rabbit Hole, a combination of memoir and reportage about the role drugs play in our happiness.

About Discourse Stories

Through our Discourse journalism, Business Insider seeks to explore and illuminate the day’s most fascinating issues and ideas. Our writers provide thought-provoking perspectives, informed by analysis, reporting, and expertise. Read more Discourse stories here .

More from Health

Most popular

• Main content

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Front Public Health

Mental Health Research During the COVID-19 Pandemic: Focuses and Trends

Yaodong liang.

1 Law School, Changsha University, Changsha, China

2 Department of Psychology, University of Toronto St. George, Toronto, ON, Canada

3 Centre for Mental Health and Education, Central South University, Changsha, China

Associated Data

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The COVID-19 pandemic has profoundly influenced the world. In wave after wave, many countries suffered from the pandemic, which caused social instability, hindered global growth, and harmed mental health. Although research has been published on various mental health issues during the pandemic, some profound effects on mental health are difficult to observe and study thoroughly in the short term. The impact of the pandemic on mental health is still at a nascent stage of research. Based on the existing literature, we used bibliometric tools to conduct an overall analysis of mental health research during the COVID-19 pandemic.

Researchers from universities, hospitals, communities, and medical institutions around the world used questionnaire surveys, telephone-based surveys, online surveys, cross-sectional surveys, systematic reviews and meta-analyses, and systematic umbrella reviews as their research methods. Papers from the three academic databases, Web of Science (WOS), ProQuest Academic Database (ProQuest), and China National Knowledge Infrastructure (CNKI), were included. Their previous research results were systematically collected, sorted, and translated and CiteSpace 5.1 and VOSviewers 1.6.13 were used to conduct a bibliometric analysis of them.

Authors with papers in this field are generally from the USA, the People's Republic of China, the UK, South Korea, Singapore, and Australia. Huazhong University of Science and Technology, Hong Kong Polytechnic University, and Shanghai Jiao Tong University are the top three institutions in terms of the production of research papers on the subject. The University of Toronto, Columbia University, and the University of Melbourne played an important role in the research of mental health problems during the COVID-19 pandemic. The numbers of related research papers in the USA and China are significantly larger than those in the other countries, while co-occurrence centrality indexes in Germany, Italy, England, and Canada may be higher.

We found that the most mentioned keywords in the study of mental health research during the COVID-19 pandemic can be divided into three categories: keywords that represent specific groups of people, that describe influences and symptoms, and that are related to public health policies. The most-cited issues were about medical staff, isolation, psychological symptoms, telehealth, social media, and loneliness. Protection of the youth and health workers and telemedicine research are expected to gain importance in the future.

Introduction

Although the impacts of the COVID-19 pandemic will be recorded in human medical history and in socio-economic history, various psychological consequences regarding mental health among populations cannot be ignored, including stress, anxiety, depression, frustration, insomnia, and so on. Researchers from universities, hospitals, communities, and medical institutions worldwide have been focusing on mental health problems during the pandemic. They have used questionnaire surveys, telephone-based surveys, online surveys, cross-sectional surveys, systematic reviews and meta-analysis, and systematic umbrella reviews to investigate mental health problems during the pandemic. Two years after the outbreak of the COVID-19, the pandemic has gradually subsided in some countries, while others have adopted a strategy of coexisting with the virus. If more deadly mutant strains do not appear in the future, it is very likely that the pandemic will not climax again. It is pertinent to summarize and study mental health research during the pandemic, because many psychological problems have arisen as a result, and there has been significant interest in research on such issues in the previous two years.

As an effective quantitative analysis method, bibliometrics can be used not only to assess the quality and quantity of published papers, but also to explore research focuses and trends, the distribution of authors and institutions, the impact of publications, journals, and different countries regarding research contributions to the theme. Due to the rapid growth in research in this area, there are now over 1,000 academic papers, and accordingly, it would appear necessary to investigate important, valid, and meaningful information from large databases to guide scientific research. The authors used CiteSpace and VOSviewers to determine the focuses and trends in this regard.

Data Analysis and Visualization

The authors searched the Web of Science (WOS), ProQuest Academic Database (ProQuest), and China National Knowledge Infrastructure (CNKI) to extract publications related to mental health and COVID-19. Their previous research results were systematically collected, sorted, and translated, and CiteSpace 5.1 and VOSviewers 1.6.13 were used to conduct a bibliometric analysis of them.

Data Source and Search Strategy

Our team selected 1,226 papers from 2019 to 2022 using three combinations of keywords, mental health and COVID-19, mental health and new coronavirus, and mental health and novel coronavirus, from the three academic paper databases, WOS, ProQuest, and CNKI. Two explanations are necessary here, the first is about the keywords and the second is about the databases. (1) The reason we used new or novel coronavirus as keywords was that the name COVID-19 has not been determined about 2 years ago. In order not to miss relevant research results, we also included these synonyms as keywords for the search. (2) Among the three databases, WOS and ProQuest, in which most of the English-language papers were published, are well-known to scholars all around the world. However, the CNKI database is not as popular as WOS or ProQuest given that most of the papers in CNKI were published in Chinese. We chose to use the CNKI data for the following three reasons: first, China was the most affected country during the COVID-19 outbreak and Chinese academic journals published significant research on mental health. Second, CNKI is the largest Chinese academic database. Third, after the outbreak, the Chinese government's virus clearance policy has been implemented and continues to date. Strict control has helped suppress the spread of the virus, but has also likely had mental health implications, given the severe reduction in social interactions. Therefore, we think that the Chinese database is appropriate and useful in this study.

About 50% of the articles were from the WOS, about 10% of the articles from ProQuest, and about 40% from CNKI. Basic information such as title, author, institution, country, abstract, keywords, methods, results, and conclusions of all articles, if not in English, are translated into English and analyzed using SiteSpaceII and VOSviewers. Since the keywords include COVID-19 and mental health, synonyms such as novel coronavirus and psychological distress spontaneously appeared while searching. Words that are closely related to the subject, such as public health, quarantine, and insomnia, were most frequently mentioned.

Most articles were published during the period from February 2020 to July 2022, including those pre-published online from April to July, and only one article that had been published in 2019 was included. Judging from the line chart above, since the volume of COVID-19 and mental health-related articles had already risen two times in June 2020 and June 2021 and then remained low until now, it is high time to conclude a previous study on COVID-19 and mental health, to sort out the foci of those studies, and to analyze and predict future trends ( Figure 1 ).

The volume of COVID-19 and mental health-related articles in 2020–2022.

Scholars from around the world have contributed to the study of mental health issues during the COVID-19 pandemic. The top 10 countries with the largest quantum of publications related to mental health during COVID-19 are the USA, People's Republic of China, England, Canada, Australia, India, Italy, Japan, Iran, and Germany. Wide and active participation of several countries has laid a solid foundation for its future development. Universities, hospitals, communities, and medical institutions around the world have conducted sample surveys of patients, students, community residents, medical workers, and other sample populations of considerable sample sizes since the outbreak. Survey and research methods include questionnaire survey, telephone-based survey, online survey, cross-sectional survey, systematic review and meta-analyses, and systematic umbrella review ( Table 1 ).

Top 20 countries.

Most papers are from the USA, the People's Republic of China, England, Australia, Canada, India, Italy, Iran, Japan, and Germany. Judging from the country or region co-occurrence graph, England and Canada are in the center of this graph, with India, Poland, Denmark, Spain, South Korea, Portugal, Italy, and Canada around them. England, Australia, Canada, Japan, Brazil, India, Iran, and Germany have done significant research work in this field. In addition, the number of related research papers in the USA and China is significantly larger than that in all other countries ( Figure 2 ).

Country or region co-occurrence.

In Table 2 , we can see that most names of the top 20 authors are Asian names, and they are mainly from China. Six of them published more than 10 articles by the end of 2021. In the extended ranking, we find that the authors who have published a large number of papers are generally from the USA, China, the UK, South Korea, Singapore, and Australia. The authors Griffiths MD, Cheung T, Xiang Y, Lin C, Wang Y, and Zhang L were very active in this field of study.

Top 20 authors.

In the abovementioned graphs, we can see six groups of related authors. The VOSviewer was used to describe the partnership between them. Though six colors were used to separate these groups, there were still lines connecting the groups to represent the partnership between them. We can take Cheung T and Xiang Y as the center of the largest group. Another group with Griffiths MD and Lin C as its center was also significant ( Figures 3 , ​ ,4 4 ).

Author co-occurrence.

Author co-occurrence groups.

The top five institutions are Huazhong University of Science and Technology, Hong Kong Polytechnic University, Shanghai Jiao Tong University, Columbia University, and the University of Toronto. Meanwhile, the top five institutions in centrality are the University of Macau, the University of Melbourne, Columbia University, Wuhan University, and the University of Toronto. It is worth mentioning that Huazhong University of Science and Technology and Wuhan University are located in the city of Wuhan, one of the areas most affected by the virus through the outbreak. The society and economy of the city temporarily stagnated at the time, and its medical system was once paralyzed. Eventually, Wuhan City's medical system was fully recovered. The University of Toronto, Columbia University, and the University of Melbourne have played an important role in the research of mental health problems during the COVID-19 pandemic ( Table 3 and Figure 5 ).

Top 20 institutions.

Institutions' co-occurrence.

As can be seen in Figure 6 , Huazhong University of Science and Technology has led Chinese universities and research institutions, such as Shanghai Jiao Tong University and Peking University, in conducting research on COVID-19 and mental health. Hong Kong Polytechnic University, Fudan University, and the University of Melbourne acted as bridges, connecting famous universities and research institutions in Europe, America, and other countries in the world, such as Kings College London and Harvard Medical School, to jointly study issues in this field. In particular, they conduct joint research, directly or indirectly, through Hong Kong Polytechnic University, which display the important communication and joint role of Hong Kong Polytechnic University.

Keyword clustering.

Judging from Table 4 , the most mentioned keywords, in addition to COVID-19 and mental health, can be roughly divided into three categories: (1) keywords representing specific groups of people, such as adolescents, young adults, doctors, nurses, medical staff, and healthcare workers; (2) keywords describing influences and symptoms, such as isolation, loneliness, anxiety, depression, stress, and insomnia; and (3) keywords related to public health policies, such as lockdown, social distancing, telehealth, telemedicine, and quarantine.

Keyword clustering I.

In Graph 7, we can judge that COVID-19, mental health, pandemic, and coronavirus are represented by larger red dots as their centrality indexes are naturally higher. In this bibliometric network map, other keywords emerged next to them and together formed this visualization bibliometric network. Occupational and sociodemographic characteristics are clustered together, while symptoms of mental health problems are clustered next to them. Specific groups of people and their typical symptoms and causes occupy certain areas on the map. For example, typical symptoms of university students and the possible causes of these symptoms are grouped together on the map. Similarly, quarantine policy and its influence are also classified in certain areas. In addition, research methods and solutions appeared sporadically on this map.

Table 5 shows eight groups of core keywords separated from keyword clustering I. Each of these groups contains three keywords, which proves that these keywords appear at the same time in a considerable part of the research, and are more closely related. Keyword ClusteringII cannot only present the outline of existing mental health research in academia, but also highlights the focus of research. In addition, SiteSpaceII and VOSviewers also gave us some clues about the research trends and further development.

Keyword clustering II.

Research Focuses

Medical staff.

The COVID-19 pandemic has exacerbated mental health problems among populations, especially medical staff, patients with COVID-19, chronic disease patients, and isolated people. Doctors, nurses, and other medical staff have significantly higher rates of insomnia than other populations ( 1 ). The researchers obtained the relevant demographic data through the WeChat questionnaire survey. Questions in the questionnaire are related to insomnia, depression, anxiety, and stress-related symptoms during the pandemic. Their research found that, since the outbreak, more than one-third of the medical staff suffered from symptoms of insomnia. Psychological intervention measures were necessary for those people ( 2 ). Research within medical institutions shows that the psychological pressure of medical staff in isolation wards was greater, but had also attracted greater attention from hospital administrators. The concern of hospital managers alleviated the pressure of medical staff to a certain extent. Further, concern for the public also reduced their psychological burden. In terms of anxiety about infection and fatigue factors, the research results showed that the psychological burden of nurses was heavier than that of doctors. Healthcare workers who lived with their own children showed more obvious fatigue and anxiety, which might be due to the fear of their children becoming infected. In terms of workload and work motivation, medical staff who have been working for more than 20 years have a heavier workload, but they can still maintain their enthusiasm to fight against the pandemic ( 3 ). Another survey showed that 73.4% of healthcare workers, mainly physicians, nurses, and auxiliary staff, reported post-traumatic stress symptoms during outbreaks, with symptoms persisting for up to 3 years in 10–40% of the cases. Depressive symptoms were reported in 27.5–50.7%, insomnia symptoms in 34–36.1%, and severe anxiety symptoms in 45% ( 4 ). A subgroup analysis revealed gender and occupational differences, with female health care practitioners and nurses exhibiting higher rates of affective symptoms compared to men and medical staff, respectively ( 5 ).

As a result, depressive symptoms (21%) and anxiety symptoms (19%) are higher during the COVID-19 pandemic compared to previous epidemiological data. About 16% of the subjects suffered from severe clinical insomnia during the lockdown. The pandemic and lockdown seemed to be particularly stressful for younger adults who were under 35 years old, women, people out of work, or those with low incomes ( 6 ). In the fight against the pandemic, China adopted measures to restrict population aggregation, such as the blockade of pandemic areas, individual patient isolation, and restrictions on the movement of people in non-pandemic areas. These measures effectively prevented the spread of the pandemic. At the same time, the use of health codes, grid-like community management, and the operational efficiency of infectious disease information networks have greatly improved. However, quarantine has also brought with it a number of problems, such as increasing psychological pressure on the population, affecting the daily lives of families, and hindering social and economic development ( 7 ). A large sample size study with wide coverage published in 2021 showed that young people quarantined at home in different provinces had different rates of anxiety and depression due to different severity of pandemic situations in different regions. The risk of anxiety and depression was statistically significantly higher in girls than in boys. The rate of anxiety and depression was affected by factors, such as gender, age, and area, as well as the existence of COVID-19 cases in the surrounding area ( 8 ).

Psychological Symptoms

The impact of the aforementioned isolation measures on mental health is only part of the impact of the COVID-19 on mental health. Psychological symptoms brought about by the pandemic have also been systematically sorted out by scholars. These studies show two clues. First, certain people have special psychological symptoms; second, psychological symptoms in different countries of the world are roughly the same. Several factors were associated with a higher risk of psychiatric symptoms or low psychological wellbeing, including female gender and poor self-related health ( 9 ). Relatively, severe symptoms of anxiety, depression, post-traumatic stress disorder, psychological distress, and stress were reported in the general population during the COVID-19 pandemic in China, Spain, Italy, Iran, the USA, Turkey, Nepal, and Denmark. Risk factors associated with measures of distress include female gender, younger age group, the presence of chronic or psychiatric illnesses, unemployment, student status, and frequent exposure to social media or news concerning COVID-19. The pandemic is associated with significant levels of psychological distress that, in many cases, will meet the threshold for clinical relevance. Mitigating the hazardous effects of COVID-19 on mental health is an international public health priority ( 1 ). Infectious disease pandemics often cause some people to act irrationally. The results of a survey based on psychological symptoms and irrational behaviors have drawn some conclusions. First, the vast majority of people remain in good physical and mental health, but some exhibit irrational behaviors. Second, women, elderly people, and those with confirmed cases showed more physical and mental symptoms and irrational behaviors. Finally, paradoxically, people with high education levels showed more mental symptoms, but fewer irrational behaviors ( 10 ).

Telemedicine

Just as the pandemic has enabled the rapid development of online education, the prospects of telemedicine are also favored by experts, observers, and investors. However, there are two restrictive aspects, namely, telemedicine equipment and telemedicine human resources. The application of 5G communication technology, telemedicine equipment, remote monitoring equipment, remote physical sign monitoring equipment, and medical artificial intelligence triage equipment all need to be urgently developed and improved. Jiangsu, a province in China, is a model province of the national project called “Internet + Medical and Health.” During the pandemic, the telemedicine by public hospitals in Jiangsu Province helped improve the efficiency of diagnosis and treatment, alleviating the pressure of offline diagnosis and treatment, and reducing the risk of cross-infection. Subsequently, medical staff were fully supportive of telemedicine. However, there was a shortage of medical staff in fever clinics, obstetrics and gynecology, pediatrics, and psychiatrists that provided telemedicine services, and they lacked corresponding incentive mechanisms ( 11 ). Effective mitigation strategies to improve mental health were developed by public health management experts. To control the rapid spread of COVID-19 and manage the crisis better, both developed and developing countries have been improving the efficiency of their health system by replacing a proportion of face-to-face clinical encounters with telemedicine solutions ( 12 ).

Social Media

There were rumors in various kinds of media during the COVID-19 pandemic. Although we can regard rumors as a disturbing error for psychological measurement, if they are not strictly controlled, their impact on people's mental health and behavior cannot be ignored. A study focusing on the spread of WeChat rumors has explored the psychological perception mechanism of audiences affected by rumor spreading in emergency situations. The study has significant results in the following terms: the form characteristics of the rumors in COVID-19, the ranking of susceptible age groups, the degree of dependence of the test subject on certain media and its psychological impact, and the follow-up behavior of the test subjects related to psychological variables ( 2 ). In 2021, another interesting study based on the data of TikTok videos released by three mainstream media in China showed that they inevitably caused some psychological trauma to the public. However, from the perspective of overall emotional orientation, short-format videos with positive reporting emotional tendencies had an advantage in attracting likes from TikTok users. Positive government responses to pandemic information were very important, and those responses could be recognized and praised by most social media users. Some of the TikTok videos, such as The Plasma of a Recovered Patient Cured 11 Other ICU Patients, The First COVID-19 Test Kit Passed Inspection, and A Frenchman Named Fred gave up Returning to Home to Join China's Anti-COVID-19 Battle, are extremely popular among social media users. Most social media users have been providing spiritual sustenance for people in the pandemic ( 13 ). When a public health crisis occurs, social media plays an important role in increasing public vigilance, helping the public identify rumors, and boosting public morale.

University Students and Loneliness

A study that assessed the adverse impact on the mental health of university students has drawn some conclusions. First, the severity of the outbreak has an indirect effect on negative emotions by affecting sleep quality. Second, a possible mitigation strategy to improve mental health includes ensuring suitable amounts of daily physical activity and deep sleep. Third, the pandemic has reduced people's aggressiveness, probably by making people realize the fragility and preciousness of life ( 14 ). Another research focused on social networks and mental health compared two cohorts of Swiss undergraduate students who were experiencing the crisis, and made an additional comparison with an earlier cohort who did not experience the pandemic. The researchers found that interaction and co-study networks had become sparser, and more students were studying alone. Stressors shifted from fear of missing out on social life to concern about health, family, friends, and their future ( 15 ). Young adults, women, people with lower education or lower income, the economically inactive, people living alone, and urban residents were at greater risk of being lonely during the pandemic. Being a student emerged as a higher than usual risk factor for loneliness during the lockdown ( 16 ). A study to explore the relationship between loneliness and stress among undergraduates in North America showed that the loneliness and stress among college students increased. On one hand, stress plays a key role in the deterioration of college students' mental health; on the other hand, reducing the loneliness of college students is expected to reduce the negative impact of stress on college students' mental health ( 17 ).

Research Trends

Due to the limited training sample of academic papers at present, it is difficult to predict the outcomes accurately. Though we cannot exactly predict the hot issues in the future, we can sort out some possible research trends in this field by analyzing existing research approaches. Psychological symptoms that affected people's mental health during the COVID-19 pandemic will be discovered further, especially those that probably continued to affect people's mental health even after the pandemic is controlled.

Studies on mild psychological symptoms, such as mild insomnia and anxiety, tend to decrease slowly, and in the case of severe problems caused by the pandemic, or severe psychological symptoms, such as clinical insomnia, depression, bipolar disorder, the corresponding in-depth research will continue. The impact of a global pandemic on the mental health of the global population must be profound and worthy of study. Due to the rapid development of COVID-19, many famous universities and research institutions have not had enough time to collect sufficient data and relevant research materials. The different effects on populations in different countries with different pandemic prevention policies are not yet fully displayed.

Regardless of how research on mental health develops, the COVID-19 pandemic has indeed brought us some new insights. As mentioned in many articles on mental health interventions for adolescents and college students, the mental health of specific populations and the development of telemedicine all deserve continued academic attention. Mental health intervention for adolescents and college students is a means to consider and prepare for the future. To ensure responsible and accountable behavior for future generations, we should all pay attention to the research and application of this method. Caring for specific groups of people, such as doctors, nurses, and other healthcare workers, and studying how to protect them in a global pandemic is a topic that global academia must study in the future, or we will lose protection the next time the virus sweeps the world. In addition, telemedicine is the trend in the future, and face-to-face diagnosis and treatment will undoubtedly increase the risk of cross-infection during the pandemic. Therefore, the development of telemedicine is an important way to avoid contact between the patients. The COVID-19 pandemic has accelerated the research and development of telemedicine.

Limitations

(1) Though we have selected three databases for analysis, there are still some databases that may be related to this field that are not covered in this study. (2) Since COVID-19-related research was started just 2 years ago, the results of the bibliometric analysis may vary after adding new data. (3) The citation frequency of articles is influenced by the time of publication, thus previously published articles should be cited more frequently than new ones. (4) Bibliometric data change over time, and different conclusions may be drawn over time. Therefore, this study should be updated in the future.

Conclusions

The most mentioned keywords, in addition to COVID-19 and mental health, can be roughly divided into three categories: keywords representing specific groups of people, keywords describing influences and symptoms, and keywords related to public health policies. The most mentioned issues were about medical staff, quarantine, psychological symptoms, telemedicine, social media, and loneliness. Mild psychological symptoms, such as insomnia, depression, and anxiety, tend to decrease slowly, while severe ones, such as severe clinical insomnia, depression, and bipolar disorder, are yet to be discovered. The importance of studies on the protection of youth medical staff and telemedicine studies will become even more significant in the future. While physical health is threatened by the pandemic, human mental health also suffers. Judging from the current situation of pandemic prevention and control, if severe prevention and control measures are taken, the impact of COVID-19 on the health of the social population is controllable; if a strategy of coexistence with the virus is adopted, as long as a new deadly mutation of COVID-19 does not emerge, the outcomes can be controllable. However, the impact of the pandemic on human mental health is not easy to predict. In addition to the abovementioned papers on mental health, the author also noted that some papers focused on neuromedicine pointed out that the virus might have some damage to the normal working mechanism of the human nervous system, but these studies are outside the scope of mental health research, at least for now. This study aims to summarize the observations, analysis, and research of scholars on mental health during the pandemic from 2020 to early 2022, with a view to provide more clues for future researchers. We hope that more researchers will build on our research to discover new research areas and new questions to help more countries, groups, and individuals affected by the COVID-19 pandemic.

Data Availability Statement

Author contributions.

YL was responsible for the concept and design, drafting this article, and bibliometric analysis. YL, LS, and XT were responsible for the revision and data collection. All authors contributed to this article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

The authors thank the study participants for their time and effort.

Personalize Your Experience

Log in or create an account for a personalized experience based on your selected interests.

Already have an account? Log In

Free standard shipping is valid on orders of $45 or more (after promotions and discounts are applied, regular shipping rates do not qualify as part of the $45 or more) shipped to US addresses only. Not valid on previous purchases or when combined with any other promotional offers.

Register for an enhanced, personalized experience.

Receive free access to exclusive content, a personalized homepage based on your interests, and a weekly newsletter with topics of your choice.

Home / Mental Health / Managing your mental health: when is it time to get help?

Managing your mental health: when is it time to get help?

Please login to bookmark.

Have you ever felt nervous about giving a speech in public or anxious about meeting a new group of people? It’s easy to wonder whether these symptoms are signs of a more serious mental health disorder, or a run-of-the-mill case of the nerves. The truth is, the differences can be hard to spot, and sometimes that answers are different for different people.

However, there are some great general guidelines and things to know when it comes to managing mental health and mental health disorders.

What is mental health?

Mental health is the overall wellness of how you think, regulate your feelings and behave. Everyone has ups and downs with mental health, however, sometimes a significant disturbance can lead to a deeper issue that needs more attention.

What is a mental disorder?

When patterns or changes in thinking, feeling or behavior cause distress or disrupt a person’s ability to function, a mental disorder may be present. Mental health disorders can affect how well you:

• Maintain personal or family relationships
• Function in social settings
• Perform at work or school
• Learn at a level expected for your age and intelligence
• Participate in other important activities

It’s important to note that there is no standard measure across cultures to determine whether a behavior is normal or part of a more serious disorder. Cultural norms and societal expectations are different everywhere, and so is how each culture defines mental health disorders. What might be normal in one society may be a cause for concern in another.

How are mental health disorders defined?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guide published by the American Psychiatric Association that explains the signs and symptoms of several hundred mental health conditions, including anxiety, depression, eating disorders, post-traumatic stress disorder and schizophrenia.

The DSM provides criteria for making a diagnosis based on the nature, duration and impact of signs and symptoms. It also describes the typical course of the disorder, risk factors and common co-existing conditions.

Another commonly used diagnostic guideline is the International Classification of Diseases (ICD) from the World Health Organization. Health insurance companies use the diagnostic coding system of the DSM and ICD in determining coverage and benefits and to reimburse mental health professionals.

How do mental health professionals diagnose disorders?

Psychiatrists, psychologists, clinical social workers or other mental health professionals can help diagnose the presence of a mental health condition. You can also talk to your primary care doctor to help start a diagnostic assessment or get a referral to a mental health specialist.

A diagnosis may be based on the following:

• A medical history of physical illness or mental health disorders in you or in your family
• A complete physical to identify or rule out a condition that may be causing symptoms
• Questions about your current concerns or why you’re seeking help
• Questions about how recent events or changes in your life — trauma, relationships, work, death of a friend or relative — have affected how you think, feel or behave
• Questionnaires or other formal tests that ask for your feedback on how you think, feel or behave in typical situations
• Questions about past and current alcohol and drug use
• A history of trauma, abuse, family crises or other major life events
• Questions about past or current thoughts about violence against yourself or others
• Questionnaires or interviews completed by someone who knows you well, such as a parent or spouse

When is it time to seek help?

Every mental health condition is different. However, in general, it might be a good idea to seek professional help if you experience:

• Marked changes in personality, eating or sleeping patterns
• An inability to cope with problems or daily activities
• Feeling of disconnection or withdrawal from normal activities
• Unusual or “magical” thinking
• Excessive anxiety
• Prolonged sadness, depression or apathy
• Thoughts or statements about suicide or harming others
• Substance misuse
• Extreme mood swings
• Excessive anger, hostility or violent behavior

When in doubt, seek help

It’s not uncommon for people who have mental health disorders to consider their signs and symptoms a normal part of life, or avoid treatment due to stigmatization. However, ignoring these types of issues won’t help you overcome them in the long run. Always remember: if you’re concerned about your mental health, don’t hesitate to seek advice.

You can start the process by consulting your primary care doctor or making an appointment with a psychiatrist, psychologist or other mental health professional. Be sure to choose a professional who is familiar with your culture and understands the cultural and social context that’s relevant to your experiences and life story.

Everyone’s journey is different, but with appropriate support you can identify mental health conditions and receive appropriate treatments such as medications, counseling, or both.

Discover more Mental Health content from articles, podcasts, to videos.

You May Also Enjoy

by Myra Wick, M.D., Ph.D.

by Jamie M. Bogle, Au.D., Ph.D., Sophie J. Bakri, M.D.

Privacy Policy

We've made some updates to our Privacy Policy. Please take a moment to review.

SCROLL TO SITE

SCROLL TO CURRENT LIST

The Forbes Health editorial team is independent and objective. To help support our reporting work, and to continue our ability to provide this content for free to our readers, we receive compensation from the companies that advertise on the Forbes Health site. This compensation comes from two main sources. First , we provide paid placements to advertisers to present their offers. The compensation we receive for those placements affects how and where advertisers’ offers appear on the site. This site does not include all companies or products available within the market. Second , we also include links to advertisers’ offers in some of our articles; these “affiliate links” may generate income for our site when you click on them.

The compensation we receive from advertisers does not influence the recommendations or advice our editorial team provides in our articles or otherwise impact any of the editorial content on Forbes Health. While we work hard to provide accurate and up-to-date information that we think you will find relevant, Forbes Health does not and cannot guarantee that any information provided is complete and makes no representations or warranties in connection thereto, nor to the accuracy or applicability thereof.

10 Best Online Therapy Services: Tried And Tested In 2024

Medically Reviewed

Key Takeaways:

• The top online therapy platforms range in price, from $65 to $145 per session. 
• Important factors to consider when selecting a provider include therapist credentials and specialities, insurance eligibility and privacy protocols. 
• We found that Brightside Health is a great pick; our reviewer found her therapist’s insights to be enlightening during her two-month trial of the service.

To determine the best online therapy options of 2024, the editorial team analyzed over 43 platforms across the market, factoring in cost, therapist credentials, insurance eligibility and other metrics.

Here are our top picks for the best online therapy services in 2024. This ranking represents therapy and psychologist visits only—psychiatry and medication management services may be available as a separate service or for an additional cost.

Why You Can Trust Forbes Health

The Forbes Health editorial team prioritizes the accuracy and integrity of the data collected. Our ranking is based on quantitative data and is free from conflicts of interest. We carefully fact check the information featured in our ranking and are committed to producing rankings and supplemental content about mental health treatment that readers can trust. You can read more about our editorial guidelines and our methodology for the rankings below.

• 43 telehealth platforms considered
• 35 metrics analyzed
• 4 months of analysis from Forbes Health editors
• Best Online Therapy That Takes Insurance
• Best Affordable Online Therapy
• Best Online Couples Therapy
• Best Online Therapy For ADHD
• Best Online Therapy For Anxiety
• Best Online Therapy For Depression
• BetterHelp Online Therapy Review
• Talkspace Online Therapy Review

Best Online Therapy Services of 2024

Brightside health, teladoc health, online-therapy.com, growing self, livehealth online, methodology: how we picked the best online therapy services of 2024, what is online therapy, how does online therapy work, the pros and cons of online therapy, how much does online therapy cost, does insurance cover online therapy, is online therapy effective, is online therapy safe for privacy, who benefits most from online therapy, who should avoid using online therapy, questions to ask before you sign up for online therapy, how to prepare for an online therapy session, is online therapy regulated, filing an online therapy complaint, what to look for in an online therapist, how to choose the best online therapy for you, summary: compare the best online therapy services of 2024, frequently asked questions (faqs), our top-rated online therapy services.

• Best Value: BetterHelp
• Best Online Therapy: Brightside Health
• Best Therapist Credentials: Teladoc Health
• Best for Insurance: Amwell
• Best for Additional Tools: Calmerry
• Best for Additional Medication Management: Cerebral
• Best Educational Resources: Online-Therapy.com
• Best for Finding In-Person Care: Sesame
• Best for Couples: Growing Self
• Most Affordable: LiveHealth Online

• Monthly fee: Varies, but around $260 for four video therapy sessions
• 34,000 active providers in network
• Session length: 30 to 45 minutes
• Does not accept insurance or Medicare
• Accepts HSA/FSA
• Types of therapy available: Individual, couples (through Regain), teen (through Teen Counseling)
• Modes of communication available: Messaging, live chat, audio and live video
• BBB rating: A-; Trustpilot rating: 4.5

BetterHelp particularly shines for its provider network, which consists of 34,000 providers, according to the company. All of its providers are licensed and experienced psychologists, marriage and family therapists, clinical social workers or licensed professional counselors who have a minimum of three years and 1,000 hours of experience, as well as a master’s or doctoral degree. Where BetterHelp does fall short is that it, notably, does not accept insurance. Still, $260 per month for four video therapy sessions comes out to $65 per session, which is a competitive rate for online therapy.

“Overall, I would rate my experience with BetterHelp as excellent. My therapist was skilled, empathetic and competent. She listened to my issues without judgment or criticism. BetterHelp allows customers to change therapists at any time and as many times as they find necessary. However, I stuck with the same therapist, and over the course of four video sessions, she offered suggestions on ways to alleviate or prevent anxiety and resolve recurring communication issues with one of my siblings…”

“I found my online video sessions with my therapist to be as helpful as my previous experiences with in-person therapy. My counselor made suggestions without pushing me to follow them and offered ways I could cope with anxiety, such as breathing exercises and journaling techniques for perceiving fears or worries in a more realistic and logical way.”

Learn more about her experience in our full BetterHelp review.

• Huge provider network consisting of 34,000 providers
• Offers a student discount ($180 per month)
• Offers the ability to stay anonymous with a nickname
• Flexibility with appointments on nights and weekends
• Offers four modes of communication: Messaging, live chat, audio and video sessions
• Offers therapy specifically geared toward individuals, teens, couples and more
• You cannot select your own therapist but you can request to be matched with a different therapist at your discretion
• Shorter sessions than others on this ranking
• Does not offer psychiatric care

• Monthly fee: $299 for four video therapy sessions
• 1,500 active providers in network
• Session length: 45 minutes
• Accepts 12 insurance providers, Medicare and Medicaid
• Accepts Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA)
• Types of therapy available: Individual, psychiatry, Crisis Care
• Modes of communication available: Anytime Messaging, live video
• BBB rating: A-; Trustpilot rating: 1.4

Brightside Health checks all of the boxes for a standout online therapy provider—it’s comprehensive, efficient and reasonably-priced. For its online therapy offering, Brightside charges $299 per month, which encompasses four monthly video therapy sessions, equating to $74.75 per session—a lower rate compared to other online providers on this list. The platform notes that it does not share client data with third-parties, and that it only employs fully-licensed therapists who have worked independently for at least one year and hold at least a master’s or doctoral degree in psychology or counseling. Brightside accepts 12 insurance providers as well as Medicare and Medicaid. With therapists available in all 50 states, this is an accessible online therapy provider for a variety of mental health needs, from mild anxiety to more specialized care, including psychiatry. It also offers an arsenal of tools to help support individuals in between sessions, including progress trackers, audio lessons and practice exercises.

“Within a few weeks, I started looking forward to our sessions—partly because they were an opportunity to slow down and focus on my frustrations, and partly because the psychologist’s insights were often illuminating. During our second session, after acknowledging that I have a lot of pressure on me coming from multiple directions, he noted that some of the challenges I’ve been facing aren’t changeable and that trying to change them can get in the way of using my focus and energy for things that are changeable. That observation instantly felt like an aha! moment…”

“After two months of online therapy, I’m ready to take a break and fly solo, using the new tools I now have, thanks to my psychologist. But I will return to Brightside the next time I need help.”

Learn more about her experience in our full Brightside review.

• Robust network of 1,500 providers with appointments available in 24 hours
• Unlimited messaging available
• Users can select their own therapist
• Accepts a number of insurance providers, including Medicare and Medicaid
• Offers Crisis Care for those at an elevated suicide risk (in certain states)
• Offers psychiatric care
• Lower Trustpilot rating
• One year of experience qualification for providers is lower than others on this ranking
• Does not offer audio-only or text-based therapy sessions

• $119 per video therapy session, billed per session
• Does not disclose how many providers are in its network
• Accepts insurance; does not accept Medicare
• Types of therapy available: Individual, medication management
• Modes of communication available: Live video
• BBB rating: B; Trustpilot rating: 4.8

Teladoc Health may be a great option for those looking for virtual therapy. Its network of credentialed health providers are available seven days a week, and those who are anxious, depressed, overwhelmed, experience mood swings or who are not feeling like themselves can see a specialist by video or talk to one on the phone. Medication management is available as a separate service for those who are currently taking or are curious about prescription medications to manage mental health concerns. Teladoc points out that it’s the only remote licensed care provider to receive four certifications from the National Committee for Quality Assurance for its physician-screening process, which is rigorous and includes peer references, licensure and a minimum of three years of experience, according to the company.

“I chose a therapist who specializes in anxiety and work-related stress, and scheduled my first appointment for three days later…I experienced reliable video and audio quality during my session. The therapist was highly-qualified and provided helpful advice and tactical next steps. After the appointment, I received a follow-up email and a PDF with tips on how to deal with stress. I’d consider using Teladoc for future therapy needs, as my session provided great value in an easy to navigate online experience.”

Learn more about her experience in our full Teladoc Health review.

• Accepts insurance
• Straightforward pricing model
• Ability to select your own therapist
• Appointments available on nights and weekends
• Providers go through a rigorous screening process
• A bit more expensive per session than others on this ranking
• Unclear how many insurance providers are accepted
• Does not accept Medicare
• Does not offer text therapy

• $109 to $129 per video therapy session, billed per session
• 350+ active providers in network
• Accepts 40 insurance providers and Medicare
• Unclear if it accepts HSA/FSA
• Types of therapy available: Individual, couples, psychiatry
• BBB rating: N/A; Trustpilot rating; 1.8

Amwell is an online therapy provider that shines for its acceptance of 40 insurance providers, which is more than many of the platforms on our ranking. Its network features providers who hold a master’s or doctorate-level license and have a minimum of two years of experience post-licensure. While Amwell may not have all the bells and whistles as other platforms on this ranking (it does not have text therapy, for example), its services are straightforward, with users billed per session, and offers the convenience of being able to select your own therapist along with appointment availability on nights and weekends.

“Though therapy isn’t always an enjoyable experience, I found the four sessions following my initial phone session very helpful…my therapist was very kind and shared just enough about her life that I felt connected to her, but not so much that she crossed professional boundaries. She was also an empathetic listener. She also taught me several concrete strategies to use to address the specific issues I was experiencing.”

Learn more about her experience in our full Amwell review.

• Accepts 40 insurance providers
• Accepts Medicare
• Smaller provider network
• Slightly more expensive per session than others on this ranking
• Does not offer therapy via text or chat
• Lacks additional tools and resources, such as worksheets and mood trackers

• Monthly fee: $360 for four live video therapy sessions and text therapy
• 1,000+ active providers in network
• Session length: 30, 60 or 90-minute sessions available
• Types of therapy available: Individual
• Modes of communication available: Messaging, live video
• BBB rating: A+; Trustpilot rating: 4.0

Calmerry stands out as an online therapy provider for being rich in features, including mood tracking, journaling and daily check-ins (with the ability to share with your counselor) and a library of courses, worksheets and journal prompts. It offers a monthly subscription for either text therapy or text therapy along with live video sessions. Calmerry’s network features licensed clinical psychologists, marriage and family therapists, clinical social workers and licensed professional counselors who hold either a master’s or doctorate degree and have at least one year of experience. For those who prefer a clear path of goals and action items, Calmerry may be a good fit—the platform provides a Therapy Plan with treatment goals, action items and milestones.

“As a veteran of therapy (in-person and online, one-on-one and group, individual and couples), I approached Calmerry with a clear idea of what to look for. I wanted cognitive behavioral therapy (CBT) to help me navigate transitions related to aging, wellness and caregiving.”

“In our first session, I launched right into the issues I wanted to address. My counselor provided a balance of empathetic compassion and thoughtful questions that challenged me to identify ways I can effect meaningful changes. It was apparent she’d studied my questionnaire, taken my text messages to heart and found medical and psychological resources. This objective information helped me see my situation in a new light.”

Learn more about her first-hand experience in our comprehensive Calmerry review.

• Offers text therapy
• Offers discounted rates for your first month ($295)
• Offers an array of resources including mood trackers and journaling tools
• Offers financial aid (up to 30% off) to those who qualify, according to the company
• Monthly fee is more expensive than others on this ranking
• Does not accept health insurance
• Cannot choose your own therapist (but you can request to change therapists)

• Monthly fee: $295 for up to five video therapy sessions
• 350 active providers in network
• Accepts health insurance but not Medicare
• Types of therapy available: Individual therapy, medication management
• Modes of communication available: Live video, messaging or phone
• BBB rating: B-; Trustpilot rating: 4.0

Cerebral is an online therapy service that’s simple and intuitive to use. It may be particularly convenient for those looking for prescription medication management along with talk therapy, as unlike other providers on this list, Cerebral combines medication management and therapy in a majority of its plans and offers three plan types to choose from: Medication and care counseling, medication and therapy or therapy only. If you need a prescription, the platform can mail it straight to your home for privacy and convenience. Cerebral offers a range of therapy modalities, including cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT) and eye movement desensitization and reprocessing (EMDR).

“I felt as though my therapist was well trained and empathetic. She listened intently, took notes, remembered what I said from session to session and was definitely focused on my goals. I found myself making small changes as a result of what we discussed or, more accurately, the questions she asked. This seems like how good therapists work—they don’t tell you what to do, but rather encourage you to see connections and set goals.”

“After six weeks of using Cerebral, I completed another assessment. The results showed I was a bit lower on both insomnia and anxiety scales.”

Learn more about her experience in our full Cerebral review.

• Ability to choose your own therapist
• Appointment availability on nights and weekends
• Ability to meet with your therapist up to five times per month
• Monthly mental health assessments act as check-ins on progress
• Bundled medication management plans available
• More expensive than others on this ranking
• Some of its therapists hold an associate level license (which means they are working toward independent licensure under the direction of a professional clinical supervisor)

• Monthly fee: $320 for one session per week (for standard plan)
• 200 active providers in network
• Types of therapy available: Individual, couples
• Modes of communication available: Live video, audio and chat
• BBB rating: Not available; Trustpilot rating: 2.8

Online-Therapy.com is a straightforward teletherapy option that may be a good fit for those who prefer the flexibility of having multiple ways to communicate with their provider, as it offers unlimited messaging along with live chat, audio and video sessions. It also offers a slate of helpful resources to provide support between sessions, including educational materials, journaling, activity plans and more. Its network of providers all hold a master’s or doctorate in mental health fields, and the platform requires they have a minimum of three years of experience or 2,000 hours of providing counseling services.

“My therapist was kind, empathetic and provided gentle, non-judgemental advice. They helped me to recognize unhelpful patterns and behaviors in my life and offered solutions from an outside perspective…while I was initially going to try out the program for only a month, I decided to subscribe for a second month because I connected with my therapist and saw improvements with their guidance.”

Learn more about her first-hand experience in our comprehensive Online-Therapy.com review.

• Offers unlimited messaging, as well as audio and live chat, in addition to video sessions
• Offers a 20% discount the first month
• Offers financial aid to students, veterans and low-income individuals who qualify, according to the company
• Basic subscription does not include live video sessions
• Shorter sessions consisting of 45 minutes
• Does not have an app

• Monthly fee: Varies by provider, but discounts available with $10.99 monthly membership
• 100+ providers in network
• Session length: Varies by provider
• Modes of communication available: Live video, in-person
• BBB rating: A-; Trustpilot rating: 4.0

Sesame stands out from other platforms on our ranking for offering the option to filter for in-person care (in addition to online therapy). Details such as session length and cost depend on the provider—and can vary widely on the platform. For this reason, Sesame serves as more of a directory of therapists than an online therapy platform in itself, showcasing both online and in-person providers available near you. It allows users to search for providers on its platform for a range of use cases, including online therapy sessions, mental health consults, psychiatric care or prescription refills. Additionally, for a monthly fee of $10.99, the Sesame Plus membership unlocks deep discounts for therapy sessions with providers in its network.

“Because I live in an area with a minimal amount of therapists, I didn’t have the best luck with Sesame. For those interested in trying Sesame, first ensure that there are therapists available in your area, as finding a provider in a timely manner is important when you’re in need of mental health treatment. You can do so by checking the company’s list of providers before you sign up.”

Learn more about her experience in our comprehensive Sesame review.

• Offers the ability to search for in-person care near you
• Monthly membership unlocks discounts per session
• Easy-to-use search function allows you to filter for specific use cases
• Many providers offer affordable rates per session
• Offers psychiatric care and medication management
• Session pricing varies, as providers set their own rates
• Does not offer additional resources like text therapy or worksheets
• Experience can vary widely by provider

Varies by provider, but Sesame Plus prices are as follows:

• $145 per video therapy session, billed per session
• 55 active providers in network
• Accepts out-of-network insurance coverage for those seeking therapy with a provider licensed in their state for a diagnosed mental health condition; does not accept Medicare
• Types of therapy available: Individual, life coaching, relationship counseling and coaching, dating coaching, parent coaching, career coaching and more
• Modes of communication available: Live video, in-person (in very limited locations)
• BBB rating: A+; Trustpilot rating: Not available

Growing Self online therapy may be a great option for those looking not only for online therapy, but for coaching and counseling services. Its platform features a variety of targeted counseling programs to address specific needs, such as career coaching, parent coaching and even “heartbreak recovery.” Growing Self’s network of providers consists of licensed marriage and family therapists, licensed counselors and those who are obtaining their licensure under supervision, according to the company. Additionally, it offers in-person counseling at locations in Colorado. This provider particularly shines for its therapy and counseling options geared toward couples, which include premarital counseling, marital counseling, dating coaching, breakup therapy, divorce counseling and more.

“I was matched with a doctoral-level professional, so the rate was $170 for a single session (a bit pricey, in my opinion). He was very nice, with a calming and intelligent demeanor, and I could tell he was listening keenly to what I had to say…”

“Overall, I had a positive experience with Growing Self, though I don’t believe their offerings are right for me at this point in time. If I were in the middle of a family or relationship crisis or had specific personal, romantic or professional growth goals, I would probably reach out again, though I would likely request a provider with lower rates.”

Find out more about her experience in our full Growing Self review.

• Coaching and counseling available for very targeted needs (such as affair recovery or long-distance couples counseling)
• Ability to select your own provider from a curated list
• Offers specific courses and classes for a variety of concerns
• Offers a library of resources including blogs, podcasts and quizzes
• Smaller network of providers than others on this list
• Requirements for providers are not as rigorous as others on this ranking
• Typically does not accept insurance

• $85 per session with a therapist, $100 per session with a psychologist
• Accepts insurance; unclear if it accepts Medicare
• Types of therapy available: Individual, psychiatry
• BBB rating: D+; Trustpilot rating; 1.2

One of the most affordable per-session providers on our ranking, LiveHealth Online offers licensed counselors, therapists and psychologists for depression, anxiety, stress, grief, relationships and more. Users have the option to choose their own therapist and schedule appointments based on personal availability. Sessions are typically 45 minutes long, and users have the opportunity to see the same therapist repeatedly, if they prefer. Psychiatric care is also offered through a separate service for those looking for assistance with medication management for a $185 initial consultation and $80 follow-up visits. While this platform may not offer as many additional features as others on our ranking, its straightforward, affordable approach to online therapy makes it an accessible option for many.

“I tried the psychology services provided by LiveHealth Online, and I loved how I was able to schedule an appointment with a therapist within the same week I registered on the platform. In fact, there are usually open appointments you can book within 24 hours, which makes it a great choice for someone trying to get into therapy quickly.”

“With that said, I did notice a number of drawbacks. The profiles provided for the therapists aren’t very detailed, so it’s difficult to gain a clear understanding of their expertise before meeting with them….my overall experience with the actual sessions wasn’t great, either.”

Read our full LiveHealth Online review to learn more about his first-hand experience.

• Affordable rates per session
• Users are able to choose their own therapist
• Offers psychiatry services with medication management, if needed
• Accepts some insurance plans
• Limited information about its services and provider network is available on its website
• Does not offer text or messaging therapy
• Does not offer additional tools or resources
• Does not provide information on HSA/FSA or Medicare acceptance

To determine the best online therapy providers of 2024, the Forbes Health editorial team distributed an in-depth survey to 43 online mental health providers with questions about their services including therapist qualifications, types of therapy offered, insurance acceptance, size of provider network and more. The Forbes Health editorial team also independently collected data on a variety of metrics, and in total, analyzed 35 metrics to determine its best online therapy ranking. Extra points were awarded to companies who were transparent and provided information about their services via the aforementioned survey.

All of our online therapy rankings take into account a general score that features the same methodology for all rankings (30%), a score specific to the use case we are analyzing for that specific ranking (60%) and a survey completion score (10%).

The general score is calculated as follows: 

• Size of provider network (15%) 
• Transparency of therapist background and credentials (10%) 
• Platform features, such as the ability to select your own provider, if you can switch providers, appointment availability on nights and weekends and whether you can message your therapist any time (34%)
• Privacy, including session privacy and third-party data sharing protocols (10%) 
• Inclusivity, including whether it offers gender-affirming care and offers providers who specialize in care surrounding minority group issues (10%) 
• Mobile app availability and number of reviews, along with the average review rating (9%) 
• Average third-party ratings, including ones from the Better Business Bureau and Trustpilot (12%)

Meanwhile, this specific ranking also takes into account the following methodology:

• Cost of initial consultation, if applicable (15%) 
• Session fee or monthly subscription fee (30%) 
• Number of sessions included in monthly subscription, if applicable (10%) 
• Whether it accept insurance, and the number of insurance providers accepted (20%)
• If it accepts Medicare (5%) 
• If it offers special discounts (5%)
• Availability in all 50 U.S. states (10%)
• The ability to stay anonymous (5%)

Read more about our methodology for the best online therapy providers. 

Please note: Providers on this list may not be shown in order of their star rating. The star rating is determined solely by the editorial team.

Online therapy provides a private, convenient and often affordable way to access mental health help without requiring you to visit a counseling center or therapist’s office in person. Instead, you can connect with your therapist via video call, phone call and/or text message conversation , depending on your needs and preferences.

Online therapy is a safe space in which you can address topics like depression , anxiety , stress , anger management, insomnia , panic attacks , eating disorders , trauma , relationship issues , life transitions, bereavement and more.

• Thousands of licensed therapists
• Insurance accepted. Most insured members only pay a $25 copay or less
• Flexible plans to meet your needs and lifestyle
• Seamlessly switch therapists, at no extra cost
• Save money while receiving high-quality care

Different online therapy platforms support different methods of therapy delivery, so first, consider the way(s) in which you would like to receive help.

Some online therapy platforms allow you to purchase one video therapy session at a time while others require a monthly subscription, which usually includes a single video therapy session a month and access to unlimited text messaging with your therapist. If ongoing communication with your therapist sounds beneficial to you, consider a platform with this subscription option. Just note that “unlimited messaging” means that you can text message your therapist as much as you like, but your therapist might respond only once or twice a day on weekdays.

Many online therapy services have their own mobile apps as well.

What’s the Difference Between Online Therapy and Counseling?

While therapy and counseling are often used interchangeably to refer to dialogue-based treatment for mental health conditions, there are differences in these two types of practices. “Therapist” is an umbrella term and does not necessarily reflect the training of the clinician—experts recommend seeking out the degree earned by the clinician in order to understand their level of training.

Typically, though, mental health counselors and therapists are each master’s-level health care professionals who are trained to evaluate an individual’s mental health and provide treatment, depending on their specific training. Counselors typically provide short-term treatment to alleviate symptoms and guide individuals through current concerns or events, such as relationship conflicts or the loss of a loved one. Therapists, on the other hand, may provide long-term treatment that addresses ongoing or chronic mental health concerns and symptoms like depression, anxiety or post-traumatic stress disorder.

Is Online Therapy Better Via Chat, Video or Phone?

“Each [communication] format plays a significant role in the total therapy process,” says Lisa Henderson, a licensed professional counselor expert at the American Counseling Association, a co-founder of Synchronous Health in Nashville and a Forbes Health Advisory Board member . “If you’re doing anything that’s what I would consider deep work—trying to resolve trauma, getting into the roots of addictions or eating disorders, anything where you’re doing a lot of processing—I prefer video. You need to be able to see and read body language.”

Meanwhile, Henderson says texting is fantastic for check-ins around skill building and using those new skills. “Texting is much better for the coaching side when I want to deviate away from the processing side.” Texting or check-ins between live sessions are often used in dialectical behavior therapy to reinforce the client’s practicing of evidence-based skills when they encounter difficult situations.

As far as phone calls go, Henderson suggests this format is best for navigating gray areas. “It’s harder to coach without getting into processing on the phone, but if it’s complicated and you need to work through why something didn’t work, then the phone would certainly be better than texting,” she adds.

The best online therapy platforms connect you with licensed providers, which can include psychologists, licensed marriage and family therapists, licensed clinical social workers and licensed professional counselors.

Mary Alvord, Ph.D., a psychologist in Maryland who teaches mental health professionals about telehealth, Jay Shore, Ph.D., a psychiatrist and director of telemedicine at the Helen and Arthur E. Johnson Depression Center at the University of Colorado Anschutz Medical Campus and Henderson offer these pros and cons for online therapy.

Circumvents mental health stigma. “For people whom stigma is a concern, especially if they live in a tight-knit community, parking their car outside a counseling center or therapy office can really violate their privacy,” says Henderson. “But online therapy is really discreet and can protect people’s privacy and confidentiality in ways that in-person [therapy] simply cannot.”

Convenience and safety. If you’re unable to travel safely during bad weather or can’t take time out of your workday to travel to and from a mental health professional’s office, a virtual visit can be a good substitute.

Sense of intimacy. Dr. Shore says some patients may prefer their familiar at-home surroundings versus an “artificial clinic environment.” Henderson echoes these sentiments. “In some ways, video is more intimate than being in the same room because we’re in each other’s space,” she says. “You might be in my office, but it’s in my home, so it feels like you’re in my home just as I am in your home. That really bridges a gap, as opposed to being on my turf when you come into my office.”

Similar outcomes. In-person and video visits hold the potential to deliver similar results, according to Dr. Shore. Henderson agrees: “We see just as much, if not more, improvement in online therapy settings. Apples to apples, in-person therapy versus telehealth, there’s really no difference between which one is more effective.”

Easier access. For people who live far from the nearest therapist’s office or counseling center, online therapy can provide a readily available alternative.

Little to no wait time. A virtual appointment may be able to begin on time while an in-office appointment may be delayed by paperwork and other bureaucratic hurdles.

Nonverbal communication. A therapist may not pick up on a patient’s nonverbal cues during a virtual appointment. Dr. Alvord explains that much of our communication is nonverbal . However, Henderson points out that the proximity of the camera lens during video appointments can provide more visual communication through facial expressions than in an in-person appointment where a greater physical distance exists between the therapist and the client.

Limited effectiveness for some. Certain patients, such as some children or people with autism spectrum disorder , may not respond well to virtual therapy, notes Dr. Alvord. Individuals with dementia or other cognitive issues also may not do well in virtual sessions without modifications, such as a caregiver being with the patient, explains Dr. Shore.

Technology . Some people’s homes may not be equipped with high speed internet service, or the patient may not be comfortable with technology, making virtual therapy difficult or even impossible to carry out.

• Prices vary and start at $65/week
• Users can be matched with one of over 35,000 licensed therapists in as little as 24 hours
• Over 4 million people have received support through BetterHelp
• Subscription includes a weekly one-on-one session and optional group session, journaling, worksheets, goal setting, and more
• Ability to switch therapists or cancel at any time

Online therapy costs vary based on the type of care needed and what your employer, insurance or health plan covers. For example, a telehealth service such as BetterHelp charges $60 to $90 weekly, while traditional therapy may be between $75 and $200 a session. However, there are also affordable online therapy options available.

Can You Get Online Therapy for Free?

A variety of telehealth companies have reduced-price therapy options. Additionally, you may be able to access free therapy through the following resources:

• College campuses for students
• Doctoral training program clinics for non-students
• Individualized Education Plan (IEP) for high school students
• The Trevor Project for LGBTQ young people
• U.S. Department of Health and Human Services for parents
• The Therapy Aid Coalition for health care professionals and first responders
• Free Black Therapy for Black and African American individuals
• U.S. Vets or the U.S. Department of Veterans Affairs for veterans

According to the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS), most insurance providers’ coverage includes some type of telehealth service, and private insurance coverage is required to reimburse telemedicine in 42 states and Washington, D.C. Many commercial health plans have also increased the number of telehealth services available in the wake of the COVID-19 pandemic.

Whether your insurance will cover online therapy specifically will depend on your specific insurance provider and plan.

Does Medicare Cover Online Therapy?

Certain telehealth services—including teletherapy—are covered by Medicare Part B . If you’re enrolled in Medicare Part B, you must pay your annual deductible and 20% of the Medicare-approved cost for your health care provider’s services before accessing the benefits offered by this coverage, as well as the benefits of a Medicare Advantage plan or Part D prescription drug plan (if you’re enrolled in them). Costs for many telehealth services are similar to those of in-person care.

Does Medicaid Cover Online Therapy?

Medicaid coverage for telehealth varies from state to state, and many states expanded their Medicaid coverage to include telehealth services, such as those that are asynchronous (happen online) or originate within the home, during the COVID-19 pandemic. Check the Medicaid website to see what your state may cover.

Some research shows that online therapy can be promising for depression and other behavioral outcomes [1] Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis . Cogn Behav Ther. 2009;38(4):196-205. . Research also shows that cognitive behavioral therapy (CBT) may be just as effective online as it is in person, but further studies are needed [2] Ruwaard J, Lange A, Schrieken B, Dolan CV, Emmelkamp P (2012). The Effectiveness of Online Cognitive Behavioral Treatment in Routine Clinical Practice . PLOS ONE 7(7): e40089. .

Additionally, studies have shown there is no difference in patient satisfaction between traditional in-person therapy and online therapy, but the number of times a person attends sessions makes a difference in their personal outcome [3] Does Online Therapy Work . ? National Center for Health Research. Accessed 2/27/2023. .

According to the American Psychological Association (APA), online therapy can also be more convenient, appear less expensive, feel more comfortable for patients and offer wider access for those unable to visit an office in person.

Privacy is likely a concern for any individuals accessing online health services. When it comes to online therapy in particular, feeling comfortable that your information is safe and secure is paramount. If your chosen online therapy provider uses a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform, you can feel certain that your communications are safe and secure. Most online therapy websites include information on what privacy measures they are taking to protect your confidential health information, which you can review to ensure you are comfortable with what a prospective online therapy provider is able to offer in terms of privacy.

Many people are likely to need some mental health support due to a myriad of issues, as well as the lasting effects of the COVID-19 pandemic. The number of adults with depression symptoms more than tripled between March 2020 and September 2020—from 8.5% to 27.8%—according to a study in JAMA [4] Ettman C, Abdalla S, Cohen G. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic . JAMA Network Open. 2020;3(9):e2019686. .

Certain disorders and issues may be better suited for virtual therapy than others. It’s usually appropriate and effective to address anxiety disorders, body image issues and guilt issues with online therapy. People seeking personal growth can benefit from the online therapy format as well, according to a study in the Journal of Clinical Psychology [5] A, Zack J, Speyer C. Online therapy: Review of relevant definitions, debates, and current empirical support . Journal of Clinical Psychology. 2004;60(3):269-83. .

Therapy Anywhere, Anytime

Save money, eliminate commute time, create a flexible plan, and seamlessly switch providers at no extra cost with Talkspace online therapy.

Individuals living with certain conditions may need more help than online therapy can provide. Some of these individuals and/or situations include:

• Individuals with suicidal ideation or intent to harm themselves or others
• Those with borderline personality disorder
• Those with thought disorders, which may include symptoms of delusions, hallucinations and disorganized thinking that are associated with disorders like schizophrenia
• Medical issues that aren’t well monitored

Before you commit to online therapy, ask yourself:

Are These Online Therapists Licensed?

Some sites market their services as therapy, but those claims may be false or misleading, says the American Psychological Association (APA), because some therapists may not be professionally licensed.

According to the APA, “therapist” and “psychotherapist” are not “legally protected” words in some states, meaning someone who promotes themselves as a therapist may not be licensed. Numerous online therapy providers promote the fact their therapists are licensed.

Is Online Therapy the Best Option for Me?

Online therapy may not be right for everyone in every situation. For example, online therapy may not be ideal for people with several mental disorders or who pose a threat to themselves or others, according to a Frontiers in Psychiatry study [6] Stoll J, Müller JA, Trachsel M. Ethical issues in online psychotherapy: A narrative review . Frontiers in Psychiatry. 2020;10:993. .

However, research suggests professionals and patients view telehealth favorably and that teletherapy can be effective. “I would say—and have heard some of my clients say, too—that in some ways, online therapy is even a little bit more comfortable than being in the same room,” says Henderson. “And that has implications on people feeling relaxed and opening up.”

Does My Insurance Cover Online Therapy?

If an online therapy provider accepts insurance, they can bill your insurer directly. You’ll still be responsible for your copays and deductibles. If the site doesn’t accept insurance, you may be able to submit your bills to the insurer for reimbursement, depending on your plan. You may also need a diagnosis in order to use insurance.

Meanwhile, you may be able to use your health savings account (HSA) or flexible savings account (FSA) to pay for online therapy.

Dr. Alvord and Dr. Shore provide these tips for getting ready for an online therapy session:

• Make sure you’re able to chat with your online therapist in a private space, perhaps even in a car if you’re at work or home and can’t find an otherwise suitable spot.
• If you’re undergoing therapy via video, be sure your surroundings are properly lit so the therapist can clearly see you. Check whether your computer, internet connection and other required technology are working properly ahead of your appointment.
• Limit disruptions during your therapy session. For instance, you can hang a sign on the door asking people not to come in during a certain period.

Prioritize Your Mental Health

Whether you’re dealing with grief, want to improve your coping strategies, or you’re just feeling down - BetterHelp makes starting therapy easy.

Sponsored Offer from BetterHelp

Regulation of online therapy sites and mobile apps—an area of mental health known as telebehavioral health or telemental health—is a bit of a hodgepodge.

Both the U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) regulate some, but not all, medical apps. The safety of medical apps “is an emerging public health issue,” say researchers in a 2020 study in the Journal of the American Medical Informatics Association [7] Saba A, Enrico C, Farah M. Safety concerns with consumer-facing mobile health applications and their consequences: a scoping review . Journal of the American Medical Informatics Association. 2020;27(2):330–340. . They called for the establishment of “vigilant regulatory frameworks” to govern these apps.

As the FDA “continues to develop a framework for oversight, industry professionals have noted that the agency has taken a hands-off approach for mental health apps in particular,” says researchers in The Regulatory Review , a publication by the University of Pennsylvania’s Program on Regulation [8] Regulating Mobile Medical Applications . The Regulatory Review. Accessed 3/18/2021. .

At the state level, regulation typically focuses on doctors who deliver telehealth services, but state agencies have stepped up their regulation of psychologists, counselors and other mental health professionals who use telehealth. For its part, the American Counseling Association emphasizes that counselors who offer telebehavioral services must adhere to state licensing requirements. Many online therapy sites stress that all of their therapists are licensed.

On top of state regulations, compliance with professional ethical standards and HIPAA may come into play with online therapy.

Online therapy also raises questions about regulation when a therapist is in one state and the patient is in another. Most of the time, therapists can only practice in the state they’re licensed, which means their client must be in the same state even if the sessions are virtual–an exception would be if they obtained some type of temporary or provisional permit with the state board where the client resides. This is important because therapists must abide by rules and regulations overseen by their specific licensing boards, and interstate cases can cause issues in investigating problems involving a therapist’s professional conduct.

If you need to lodge a complaint about an online therapy platform, first alert the site to your concerns. Next, you can reach out to the FDA and FTC. To file a complaint about a specific therapist, contact the agency in your state that’s in charge of licensing the therapist’s profession. Licensing rules vary for psychiatrists, psychologists, therapists and counselors.

Dr. Alvord suggests asking these questions when selecting an online therapist:

• What are the therapist’s qualifications? Is the therapist a mental health professional licensed in the state where they live or work? How many years have they been in practice?
• Does the therapist specialize in certain areas, topics or issues related to mental health? Do these specialties align with your needs? How many patients have they treated that have concerns similar to yours?
• What modality does the therapist practice (e.g., cognitive behavioral therapy, psychodynamic therapy, somatic experiencing therapy, etc.)? What specific tools do they have to treat your specific concerns?
• Will the therapist ask you to sign an informed consent agreement? Informed consent educates a patient about treatment risks, benefits and alternatives.
• What would the therapist’s backup plan be in case you’re experiencing a mental health emergency but can’t reach the therapist?
• Does the therapist’s platform comply with privacy security rules laid out by HIPAA?

When deciding which online therapy service is best for you, it’s important to consider what you want in a therapist, how you want to receive therapy and what the cost could be with or without insurance.

It can be challenging to compare online therapy platforms due to their wide range of plans and prices. Based on our research, here are several ways to identify the best online therapy for you:

• Decide the format in which you want to receive therapy. That might be a live video session, phone call, text messaging conversation, live text chat or a combination.
• Look at plan options that best match the amount of interaction you want. For example, if you want live video sessions, know how many you will get a month in the plan, how long they are (30 minutes versus 50 minutes) and how much it would cost to add extra video sessions in a month.
• Contact customer service to clarify the details if you’re unsure. For example, can you pause a subscription for a week or two? How do you change therapists if you’re not happy with your current provider?
• Understand the refund policy, which isn’t always clear on the website. In many cases, you can cancel your subscription at the end of a month but you won’t receive a refund for your unused days.
• Make sure you can access the type of provider you want. For example, if you want sessions with a psychiatrist , confirm the service has one available in your state.
• Ask if you can interview therapists to find the right fit. You’ll be sharing intimate details and working through deep issues with this person, so you want to be sure you’re comfortable with them and can build rapport well. You may want to ask them where they received their training, what therapeutic modalities they practice and what ideas they have about addressing your specific concerns.

What is the best online therapy platform?

The best online therapy brand is largely individual as not everyone seeking online therapy is looking for the same thing. Our ranking of best online therapy brands includes optimal choices in terms of access, plan variety, session length and more. Narrow down your options by researching which online therapy platform would best serve your specific needs.

What is the best online therapy service covered by insurance?

There are several online therapy services that accept insurance . The best match for you will depend on what kind of therapy you are seeking. If you have questions about what your insurance plan covers, you can contact the insurance company directly.

Are online therapists legit?

Not all “online therapists” are legit. To be safe, make sure your therapist has licensing in your state, such as a licensed marriage and family therapist or licensed clinical social worker. The best online therapy services will also have psychiatrists and/or psychologists available.

Can online therapy platforms prescribe medication?

Most therapists cannot prescribe medication, regardless of whether you meet with them online or in person—a psychiatrist is typically the prescriber for those medications. A couple of online therapy services we evaluated have plans that specifically include medication in the pricing: Cerebral and Brightside. Other online therapy services, such as Amwell, can connect you with professionals who can prescribe.

What are the potential risks of online therapy?

Potential risks of online therapy may include misunderstandings or miscommunications due to lack of non-verbal cues in teletherapy settings, technological difficulties and inability to detect and address emergency or crisis situations. Additionally, online therapy may not be suitable for all individuals or for those with severe mental health conditions.

Is online therapy confidential?

Telehealth and teletherapy practices must adhere to the same codes of ethics, regulations (federal and state) and professional standards as in-person treatment. These responsibilities include maintaining confidentiality and storing electronic patient records securely.

What should I do if I can’t afford therapy?

There are many options for affordable or free therapy. The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a host of resources for mental health support, including crisis support chat and recommendations for free or low-cost mental health care. Additionally, the National Alliance on Mental Illness (NAMI) provides information for mental health resources, including online support groups and a directory with recommended online mental health services.

• Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009;38(4):196-205.
• Ruwaard J, Lange A, Schrieken B, Dolan CV, Emmelkamp P (2012). The Effectiveness of Online Cognitive Behavioral Treatment in Routine Clinical Practice. PLOS ONE 7(7): e40089.
• Does Online Therapy Work. ? National Center for Health Research. Accessed 2/27/2023.
• Ettman C, Abdalla S, Cohen G. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Network Open. 2020;3(9):e2019686.
• A, Zack J, Speyer C. Online therapy: Review of relevant definitions, debates, and current empirical support. Journal of Clinical Psychology. 2004;60(3):269-83.
• Stoll J, Müller JA, Trachsel M. Ethical issues in online psychotherapy: A narrative review. Frontiers in Psychiatry. 2020;10:993.
• Saba A, Enrico C, Farah M. Safety concerns with consumer-facing mobile health applications and their consequences: a scoping review. Journal of the American Medical Informatics Association. 2020;27(2):330–340.
• Regulating Mobile Medical Applications. The Regulatory Review. Accessed 3/18/2021.
• A growing wave of online therapy. American Psychological. Accessed 3/18/2021.
• What is autism spectrum disorder?. American Psychiatric Association. Accessed 3/18/2021.
• What you need to know before choosing online therapy. American Psychological Association. Accessed 3/18/2021.
• Shah P, Thornton I, Turrin D, Hipskin J. Informed Consent. Treasure Island, FL: StatPearls Publishing; 2021.
• Professional Association Codes of Ethics and Guidelines On TeleMental Health, E-Therapy, Digital Ethics, & Social Media. Zur Institute website. Accessed 3/18/2021.
• Wantland DJ, Portillo CJ, Holzemer WL, Slaughter R, McGhee EM. The Effectiveness of Web-Based vs. Non-Web-Based Interventions: A Meta-Analysis of Behavioral Change Outcomes. J Med Internet Res 2004;6(4):e40.
• Private insurance coverage for telehealth. Health Resources and Services Administration (HRSA) - U.S. Department of Health and Human Services (HHS). Accessed 8/17/2022.
• What you need to know before choosing online therapy. American Psychological Association. Accessed 8/17/2022.
• Therapy vs. counseling: Is there a difference? Which is right for you?. Ohio State Health & Discovery. Accessed 10/6/2023.
• Types of Mental Health Professionals. National Alliance on Mental Illness. Accessed 10/6/2023.
• Psychotherapy vs. Counseling: Which Mental Health Treatment Is Right For You?. BetterHelp. Accessed 10/6/2023.
• Stoll J, Müller JA, Trachsel M. Ethical Issues in Online Psychotherapy: A Narrative Review. Front Psychiatry. 2020;10:993.

Next Up In Mind

• Best Online Therapy Platforms That Take Insurance
• Best Online Therapy For Couples
• Best Mental Health Apps
• BetterHelp Review
• Talkspace Review

Information provided on Forbes Health is for educational purposes only. Your health and wellness is unique to you, and the products and services we review may not be right for your circumstances. We do not offer individual medical advice, diagnosis or treatment plans. For personal advice, please consult with a medical professional.

Forbes Health adheres to strict editorial integrity standards. To the best of our knowledge, all content is accurate as of the date posted, though offers contained herein may no longer be available. The opinions expressed are the author’s alone and have not been provided, approved or otherwise endorsed by our advertisers.

Sarah is an experienced writer and editor enthusiastic about helping readers live their healthiest and happiest lives. Before joining Forbes Health, Sarah worked as a writer for various digital publications including LendingTree, theSkimm, CNBC and Bankrate. When she isn’t writing or editing, you can find Sarah with her nose in a book or enjoying the outdoors with her French bulldog, Honey.

Dr. Sabrina Romanoff is a Harvard-trained clinical psychologist, professor, researcher and frequent contributor to major media outlets. She works with individuals and couples in her private practice based in New York City. Dr. Romanoff specializes in the treatment of anxiety, depression and trauma. Her research has been presented at the Harvard Medical School Mysell Psychiatry Research Symposium and published in The Journal of Psychiatry Research. Dr. Romanoff served as a professor at Yeshiva University where she taught clinical psychology doctoral students principles of group theory and practice. As a media contributor, Dr. Romanoff is featured frequently on major print, television and radio media outlets to discuss trending topics related to her expert knowledge in personal and professional relationships, stress and high-functioning anxiety.

• - Google Chrome

Intended for healthcare professionals

• Access provided by Google Indexer
• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• News & Views
• Smartphones, social...

Smartphones, social media, and teenage mental health

• Related content
• Peer review
• Greg Hartwell , clinical assistant professor 1 ,
• Maeve Gill , specialty registrar in public health 2 ,
• Marco Zenone , research associate 3 ,
• Martin McKee , professor of European public health 1
• 1 London School of Hygiene and Tropical Medicine, London, UK
• 2 Royal Free Hospital NHS Foundation Trust, London, UK
• 3 Health Law Institute, University of Alberta, Canada
• Correspondence to: G Hartwell gregory.hartwell{at}lshtm.ac.uk

A precautionary public health response is needed

The tragic deaths of two UK teenagers continue to raise debate about the challenges that smartphones—and the unlimited access to social media they provide—may pose for adolescent mental health. 1 Molly Russell took her own life in 2017 aged 14 after being exposed on Instagram to what her father has described as a constant stream of “dark harmful material.” 1 Sixteen year old Brianna Ghey was murdered by two fellow pupils in 2023. Her mother believes that Brianna’s heavy mobile phone use increased her vulnerability before her death, and recently called for alerts on parents’ phones when their children use their own devices to search for violent material, as her daughter’s killers did. 1 2

This debate lies within broader concerns about the parlous state of adolescent mental health, with decreasing happiness reported among UK teenagers for a decade, alongside sharp increases in depression and anxiety, particularly among older girls. 3 4 These findings cannot easily be dismissed as artefact arising from changes to diagnostic criteria, reduced stigma, or greater willingness to seek help; they have coincided with marked rises in other measures such as teenage self-harm and suicidal behaviours, especially among teenage girls. 3 5

But can smartphones and social media be blamed? Population based data suggest a dose-response relationship between social media use and depressive symptoms in teenagers, especially girls. Systematic reviews report links to other harmful behaviours, 6 7 8 9 and heavy adolescent smartphone use has been associated with sleep deprivation and poorer socioemotional functioning. 9 10 Nonetheless, by age 12, smartphone ownership is near universal in the UK, and almost two thirds of 8-11 year olds already use social media. 11

Yet many macroeconomic, environmental, and social factors contribute to mental health at all ages. The relationships between social media, smartphones, and mental health are also vexed by a suite of potential confounders and questions of reverse causality. 12 13 Furthermore, young people are adept at harnessing technology’s power to make positive changes in their lives, connecting with peers across borders, mobilising youth movements, or advocating for social change. 14 15 Social media can facilitate engagement with health services, provide access to safe online spaces, and support help seeking in crises. 16

A precautionary response

So how should we protect children from harms linked to smartphones and social media, while maximising potential benefits? Three groups have roles to play: technology producers, parliamentarians who regulate them, and the public who use these products.

Firstly, the argument that social media firms simply provide a communication medium is wearing thin. The EU has launched various investigations into platforms’ addictiveness for young people, 17 while a US Senate committee recently condemned social media chief executives as having “blood on their hands,” 18 partly reflecting Meta’s research showing Instagram had toxic effects on girls. 19 Inevitably, these companies advocate self-regulation, yet we know this is ineffective. 20 21

Smartphones and social media should instead be seen as products to be regulated, like all commercial goods and services with potential to harm. 22 23 Restricting sales or advertising of cigarettes, vapes, alcoholic drinks, and gambling products is relatively uncontroversial, even though producers work to circumvent restrictions. Conversely, in the UK, the US, and elsewhere, social media access is permitted from age 13 across major platforms, a threshold with no health rationale, stemming instead from US legislation allowing collection of personal data from that age without parental consent. 24

Secondly, while parliamentarians must balance risks and benefits, the current UK government’s flagship Online Safety Act and Data Protection and Digital Information Bill have not allayed concerns. 2 25 Its non-statutory guidance recommending banning smartphones in schools also had a lukewarm reception 26 ; many schools already have such policies, and the guidance echoes a classic industry narrative emphasising individual responsibility, which shifts accountability for harm from policy makers or manufacturers to schools, parents, and pupils.

Thirdly, the public clearly have doubts about children and young people’s access to smartphones and social media, but parents also fear their children being excluded from online friendship groups and want to maintain contact for safety reasons. 11 Seeking to square this circle, an impromptu grassroots movement has recently grown across the UK calling on parents to collectively delay smartphone and social media uptake. 27 The UK’s children’s commissioner has voiced similar frustrations, while stressing the importance of involving young people themselves in shaping ways forward. 28

Debate will continue about exact associations between smartphones, social media, and mental health, 29 and further experimental research must be an urgent priority for funders and the academic community. But in the meantime, we must adopt the precautionary principle: measures to prevent harm should not be delayed where evidence is still contested. Health professionals and their organisations must act and advocate to ensure that smartphones and social media are framed clearly as commercial determinants of health; to guide advocacy efforts based on systematic syntheses of high quality evidence; and to amplify the voices of young people in research and policy. All will be critical if we are to facilitate technology’s potential positives while firmly safeguarding our young people’s mental health.

Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: MM is past president of the BMA. Further details of The BMJ policy on financial interests are here: https://www.bmj.com/sites/default/files/attachments/resources/2016/03/16-current-bmj-education-coi-form.pdf .

Provenance and peer review: Not commissioned; externally peer reviewed.

• ↵ Burns J, Crawford A. Brianna Ghey’s mother and Molly Russell’s father join forces to combat online harm. BBC News, 15 Feb 2024. https://www.bbc.com/news/uk-68309102
• ↵ Gillespie T. Brianna Ghey’s mum says mobile phones should be made specifically for children under 16 to protect them from online harms. Sky News, 15 Feb 2024. https://news.sky.com/story/brianna-gheys-mum-says-mobile-phones-should-be-made-specifically-for-children-under-16-to-protect-them-from-online-harms-13072291
• ↵ Royal College of Paediatrics and Child Health. State of child health. 2020. https://stateofchildhealth.rcpch.ac.uk/
• ↵ Children’s Society. The good childhood report. 2023. https://www.childrenssociety.org.uk/good-childhood
• Cybulski L ,
• Ashcroft DM ,
• Zilanawala A ,
• Thomson RM ,
• Henery PM ,
• Henderson M ,
• Katikireddi SV
• Blanchard L ,
• Conway-Moore K ,
• Abi-Jaoude E ,
• Naylor KT ,
• Pignatiello A
• ↵ Sapien Labs. Age of first smartphone/tablet and mental wellbeing outcomes. 2023. https://sapienlabs.org/whats_new/study-out-from-sapien-labs-links-age-of-first-smartphone-to-mental-wellbeing/
• ↵ Ofcom. Children and parents: media use and attitudes. 2023. https://www.ofcom.org.uk/__data/assets/pdf_file/0027/255852/childrens-media-use-and-attitudes-report-2023.pdf
• McCarthy S ,
• Cordedda C ,
• Kenworthy N ,
• ↵ Rankin J. EU investigates Facebook owner Meta over child safety and mental health concerns. Guardian 2024 May 16. https://www.theguardian.com/technology/article/2024/may/16/eu-investigates-facebook-owner-meta-over-child-safety-and-mental-health-concerns
• ↵ Gibson K. Mark Zuckerberg accused of having “blood on his hands” in fiery Senate hearing on internet child safety. CBS News, 31 Jan 2024. https://www.cbsnews.com/news/mark-zuckerberg-meta-x-child-exploitation/
• ↵ Wells G, Horwitz J, Seetharaman D. Facebook knows Instagram is toxic for teen girls, company documents show. Wall Street Journal 2021 Sep 14. https://www.wsj.com/articles/the-facebook-files-11631713039
• Stuckler D ,
• Monteiro C ,
• Lancet NCD Action Group
• Freudenberg N
• ↵ Federal Trade Commission. Complying with COPPA: frequently asked questions. 2020. https://www.ftc.gov/business-guidance/resources/complying-coppa-frequently-asked-questions
• ↵ Zeffman H. Bereaved parents’ anger at “broken” online safety promise. BBC News, 15 Dec 2023. https://www.bbc.com/news/uk-politics-67714572
• ↵ Department for Education. Mobile phones in schools. 2024. https://www.gov.uk/government/publications/mobile-phones-in-schools
• ↵ Banfield-Nwachi M. ‘It went nuts’: thousands join UK parents calling for smartphone-free childhood. Guardian 2024 Feb 17. https://www.theguardian.com/technology/2024/feb/17/thousands-join-uk-parents-calling-for-smartphone-free-childhood
• ↵ BBC. Woman’s hour, 8 Feb 2024. https://www.bbc.co.uk/programmes/m001w105
• ↵ Haidt J. Yes, social media really is a cause of the epidemic of teenage mental illness. After Babel, 2024. https://www.afterbabel.com/p/phone-based-childhood-cause-epidemic?utm_source=profile&utm_medium=reader2

• Alzheimer's disease & dementia
• Arthritis & Rheumatism
• Attention deficit disorders
• Autism spectrum disorders
• Biomedical technology
• Diseases, Conditions, Syndromes
• Endocrinology & Metabolism
• Gastroenterology
• Gerontology & Geriatrics
• Health informatics
• Inflammatory disorders
• Medical economics
• Medical research
• Medications
• Neuroscience
• Obstetrics & gynaecology
• Oncology & Cancer
• Ophthalmology
• Overweight & Obesity
• Parkinson's & Movement disorders
• Psychology & Psychiatry
• Radiology & Imaging
• Sleep disorders
• Sports medicine & Kinesiology
• Vaccination
• Breast cancer
• Cardiovascular disease
• Chronic obstructive pulmonary disease
• Colon cancer
• Coronary artery disease
• Heart attack
• Heart disease
• High blood pressure
• Kidney disease
• Lung cancer
• Multiple sclerosis
• Myocardial infarction
• Ovarian cancer
• Post traumatic stress disorder
• Rheumatoid arthritis
• Schizophrenia
• Skin cancer
• Type 2 diabetes
• Full List »

share this!

June 3, 2024

This article has been reviewed according to Science X's editorial process and policies . Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

trusted source

Mental health, lack of workplace support are leading factors driving nurses from jobs: Study

by New York University

Coworker and employer support are strong predictors of nurses planning to stay in their jobs, while symptoms of depression are linked to nurses planning to leave, according to a study conducted at the height of the COVID-19 pandemic by researchers at the NYU Rory Meyers College of Nursing.

The research, published in the Online Journal of Issues in Nursing , examines both pandemic-related factors and the overall work environment for nurses and can help organizational leaders improve their support for and retention of their nursing workforce.

"Coming out of the pandemic, the mental health of health care workers has been top of mind," said Amy Witkoski Stimpfel, assistant professor at NYU Rory Meyers College of Nursing and the study's senior author. "Our findings suggest that focusing on organizational support and mental health can improve nurses' well-being and increase the chances that they will stay in their jobs."

The intense working conditions during the COVID-19 pandemic exacerbated stress and burnout among nurses. Many left their jobs, stretching a workforce struggling with shortages even thinner. Inadequate nurse staffing and turnover are linked with a range of negative outcomes, including worse quality of care for patients, poor health for fellow nurses, and increased costs for health systems.

Witkoski Stimpfel and her co-author, NYU Meyers doctoral student Kathryn Leep-Lazar, wanted to understand what characteristics of a nurse's job, work environment, and mental health predict whether they intend to stay in their role. The researchers surveyed 629 U.S. nurses across 36 states during the summer of 2020—when many parts of the country were experiencing surges of COVID-19 cases and hospitalizations.

Witkoski Stimpfel and Leep-Lazar gathered information about the nurses' workplaces, including the type of setting, schedule, patients per nurse, and length of shift, as well as COVID-specific factors, such as whether nurses were caring for COVID patients and had adequate personal protective equipment (PPE). They also collected demographic information and measures of anxiety, sleep issues, and depression, comparing all of these factors with nurses' intent to stay in their jobs one year from now.

The researchers found that the strongest factor predicting whether nurses intended to remain in their roles was having support systems at work. Nurses who felt supported by their colleagues were nearly twice as likely to want to stay in their jobs compared with those who didn't feel as supported, while nurses who felt supported by their organization were 2.4 times more likely to say they would stay. Workplace support was an even stronger predictor of nurses' intentions to stay in their jobs than COVID-specific factors, including pandemic preparedness, PPE shortages, and whether nurses were directly caring for COVID-19 patients.

In contrast, symptoms of depression were associated with nurses planning to leave their jobs within the year. Nurses with mild symptoms of depression were 50% less likely to say they plan to stay in their jobs compared to those with minimal symptoms, while nurses with moderate or severe symptoms of depression were 73% less likely.

"We know that there is significant overlap between depression and occupational burnout, with both capturing feelings of fatigue and a lack of energy. It's possible that many of the nurses reporting depressive symptoms were in fact experiencing exhaustion and burnout from elevated workloads and long hours during the pandemic," added Witkoski Stimpfel.

"Considering that 60% of the nurses we surveyed reported some level of depression, organizational leaders need to be paying attention to the mental health of this critical workforce," said Leep-Lazar, the study's first author.

The researchers encourage employers to examine their mental health resources—such as employee assistance programs and therapy covered by employer-sponsored benefits—available to nurses. In addition to providing support for individual nurses, the researchers urge organizations to create healthy work environments that foster support among staff and have policies and practices that protect nurses against depression , burnout, and other poor mental health outcomes.

"The good news is that the factors we identified—workplace support and mental health —can be addressed through targeted efforts, some of which may already be in place," said Witkoski Stimpfel.

Explore further

Feedback to editors

Genetic changes identified as key to childhood lupus

9 minutes ago

New method offers faster, more accurate pathogen identification, even in complex DNA sequences

26 minutes ago

Oral nucleoside antiviral is progressing toward future pandemic preparedness

40 minutes ago

New machine learning method can better predict spine surgery outcomes

Airplane noise exposure may increase risk of chronic disease

White blood cell 'nets' could be early warning sign of major immunotherapy complication

New study shows vitamin C boosts DNA damage and cell death in melanoma cells

The importance of a disturbed lipid metabolism in Charcot-Marie-Tooth disease

Two-pronged attack strategy boosts immunotherapy in preclinical studies

False belief in MMR vaccine-autism link endures as measles threat persists, finds survey

2 hours ago

Related Stories

Another pandemic challenge for nurses: Sleep problems

Jan 27, 2022

New COVID-19 study links nurses' mental health to quality of care

Feb 16, 2022

COVID-19 increased mental health risks among nurses

May 19, 2022

New survey shows links between COVID-19 pandemic and B.C. nurses' mental health

Sep 30, 2020

US nurses working in critical care have been severely impacted by the COVID-19 pandemic

May 17, 2021

Burnout rate high among Michigan nurses, survey finds

Feb 15, 2024

Recommended for you

Study finds people of color disproportionately dropped from Medicaid

6 hours ago

More than meets the eye: Understanding how the brain controls social gaze

Telehealth can significantly reduce greenhouse gas emissions associated with cancer care, study finds

7 hours ago

Trial reveals benefits of 'stepped' palliative care for patients with advanced lung cancer

Study sheds new light on the contribution of dopamine to reinforcement learning

Jun 2, 2024

Mobile app effective in smoking cessation, triples chance of success

May 31, 2024

Let us know if there is a problem with our content

Use this form if you have come across a typo, inaccuracy or would like to send an edit request for the content on this page. For general inquiries, please use our contact form . For general feedback, use the public comments section below (please adhere to guidelines ).

Please select the most appropriate category to facilitate processing of your request

Thank you for taking time to provide your feedback to the editors.

Your feedback is important to us. However, we do not guarantee individual replies due to the high volume of messages.

E-mail the story

Your email address is used only to let the recipient know who sent the email. Neither your address nor the recipient's address will be used for any other purpose. The information you enter will appear in your e-mail message and is not retained by Medical Xpress in any form.

Newsletter sign up

Get weekly and/or daily updates delivered to your inbox. You can unsubscribe at any time and we'll never share your details to third parties.

More information Privacy policy

Donate and enjoy an ad-free experience

We keep our content available to everyone. Consider supporting Science X's mission by getting a premium account.

E-mail newsletter

Language selection

• Français fr

Integrated Youth Services Network of Networks

From: Canadian Institutes of Health Research

Backgrounder

The Government of Canada is committed to helping youth access the mental health care they need, where and when they need it. That is why it is providing up to $59 million to the Integrated Youth Services Network of Networks, or IYS-Net. This initiative will link together a web of provincial, territorial, and Indigenous networks to create a learning health system, where research evidence, data, and youths’ lived experiences are used to inform processes, policies, and practices to improve services.

June 3, 2024

The funding breaks down this way:

• Close to $9 million for six integrated youth services provincial networks in Québec, Ontario, Manitoba, New Brunswick, Nova Scotia, and Prince Edward Island, and the national Indigenous network.
• More than $21 million to expand IYS-Net to all provinces and territories.
• More than $10 million to enable the Indigenous IYS network to expand across Canada.
• Up to $18 million for an IYS Learning Health System Data Platform supported by the Centre for Addiction and Mental Health to allow the collection, processing and sharing of more timely, accurate, comprehensive, and diverse data sets on youth mental health and substance use.

Further details about the researchers receiving funding today:

This investment is made possible thanks to support from the Canadian Institutes of Health Research, Indigenous Services Canada, and additional support from the Graham Boeckh Foundation , the  Bell-GBF Partnership , RBC , the  McConnell Foundation , the  Hunter Family Foundation  and the  Medavie Foundation .

Page details

Supporting mental health for diverse ethnic groups wins research award

• May 24, 2024

Improving mental health support for individuals from diverse ethnic backgrounds is the focus of an award-winning dissertation research project.

University of Hawaiʻi at Mānoa PhD candidate in psychology , Duckhyun Jo’s doctoral research, has earned recognition as the 2023–24 Dr . Clifford K. Mirikitani, MD , JD & John M. Mirikitani, JD , PhD Outstanding Dissertation Award from the UH Mānoa Graduate Division .

Jo investigated a recently developed self-assessment tool for measuring psychological flexibility/inflexibility called the Multidimensional Psychological Flexibility Inventory ( MPFI ). Psychological flexibility is the ability to adapt to changing situations, handle stress, and stay true to your values, while psychological inflexibility is the difficulty in adapting, getting stuck in negative thoughts, and struggling to cope with challenges.

Acknowledged for its strong psychometric (science of measuring people’s thoughts, feelings, and abilities) support, MPFI distinguishes itself from other measures. However, there is limited research on its psychometric properties among underrepresented groups.

“Using psychometrically sound measures in mental health assessments ensures that the unique characteristics of Hawaiʻi ‘s racially diverse population are considered,” Jo said. “This fosters more effective, culturally sensitive, and equitable mental health practices and policies.”

Professor Akihiko Masuda, Jo’s supervisor, shared how meaningful and ambitious Jo’s dissertation is.

“The results of the first phase of research are very promising,” Masuda said. “It will promote evidence-based assessment for underrepresented populations in psychotherapy and behavioral health research and practice, including racially and ethnically diverse populations (e.g., Asian American and multiracial populations).”

Masuda added that Jo’s impressive academic achievements during graduate school include publishing 12 peer-reviewed papers and one book chapter. Among these, Jo is the first author of eight peer-reviewed papers.

Jo entered the doctoral program in the middle of the COVID-19 pandemic in 2020, but with the guidance of his mentor, he navigated the challenges of the time.

“ Dr . Masuda nurtured resilience within me,” Jo said. “This award is deeply meaningful as it recognizes my journey toward becoming a scholar, which I see as a continuous and ever-changing process, without a clear end point. I will cherish the lessons gained during my time spent in Hawaiʻi .”

The Department of Psychology is housed in UH Mānoa’s College of Social Sciences .

Related Posts:

• PhD student earns award with psychotherapy research…
• Non-invasive detection of breast cancer earns PhD…
• Special ops cost: Mental/physical health focus of UH…
• previous post: Reevaluating maternity care: Professor’s Fulbright journey in Nepal
• next post: Kauaʻi HS senior surprised with free tuition in #TakeMeToMānoa contest

If required, information contained on this website can be made available in an alternative format upon request. Get Adobe Acrobat Reader

About Calendar COVID-19 Updates Directory Emergency Information For Media MyUH Work at UH

Gagana Samoa

Kapasen Chuuk

Kajin Majôl

ʻŌlelo Hawaiʻi

• Administrative

Transforming the understanding and treatment of mental illnesses.

Información en español

Celebrating 75 Years! Learn More >>

• Science News
• Meetings and Events
• Social Media
• Press Resources
• Email Updates
• Innovation Speaker Series

Research Highlights

April 29, 2024 • Research Highlight

In this NIMH-supported study, researchers investigated the neural underpinnings of sensory hypersensitivity in SCN2A-associated autism.

April 5, 2024 • Research Highlight

A new study by NIMH researchers demonstrated the effectiveness, feasibility, and safety of exposure-based cognitive behavioral therapy for severe irritability and temper outbursts in children. The positive results set the foundation to continue exploring exposure therapy as a potential treatment for childhood irritability.

March 25, 2024 • Research Highlight

Research funded by NIMH found a link between a low level of social interest among people with psychotic disorders and brain regions in the social motivation system.

January 18, 2024 • Research Highlight

An NIMH-supported study of the 3D genome revealed widespread silencing of genes with important roles in brain function in fragile X syndrome and related disorders.

January 3, 2024 • Research Highlight

NIMH researchers found racial and ethnic disparities in rates of psychotic disorders, which were associated with co-occurring medical conditions and negative health outcomes.

December 18, 2023 • Research Highlight

This clinical trial found that MST is equally effective at reducing depression symptoms as ECT, but with fewer side effects.

November 3, 2023 • Research Highlight

Evidence-based practices for suicide prevention effectively reduced suicidal behaviors among adults seen for care in emergency departments.

October 24, 2023 • Research Highlight

In a study funded by the National Institute of Mental Health and published in JAMA Psychiatry, Gail Daumit, M.D., of Johns Hopkins University, A. Eden Evins, M.D., of Massachusetts General Hospital and Harvard Medical School, and colleagues developed a tobacco smoking cessation intervention for people with serious mental illness.

July 26, 2023 • Research Highlight

In this NIMH-funded study, researchers developed a compound that blocked an enzyme critical for forming HIV particles, which stopped the virus from correctly forming and becoming infectious.

July 19, 2023 • Research Highlight

Hospital visits for urgent mental health care increased among children and teens in the second year of the COVID-19 pandemic, according to an NIMH-supported study.