As the number of older adults in low- and middle- income (LMIC) countries is expected to grow substantially over the next several decades, it is important to develop programs for the prevention of major depression in later life. These programs should be flexible enough to be adjusted to the needs of poorly resourced LMICs. The current report provides an overview of a “depression in later life” (DIL) study in Goa, India, as a promising and effective mental health prevention program, with the potential for implementation in other LMICs. DIL study uses unspecialized physicians and lay health counselors (LHCs) to deliver both scalable psychological intervention and low-intensity intervention, consistent with Institute of Medicine’s (IOM, 1994) indicated prevention approach. DIL intervention led to reduced incidence of Major Depressive Disorder in DIL-randomized participants and as such it is important in meeting the 2016-2030 United Nations Sustainable Development Goal of “Ensuring healthy lives and promoting the well-being for all at all ages."

Background: Women bear a heavier burden of the consequences related to prescription opioid use compared to their male counterparts; however, there has been little attention in the literature regarding prescription opioid use among women. We aimed to examine risk factors for prescription opioid use among women. Methods: Demographics, health status, and substance use data, including prescription opioid use, were collected through a community engagement program, HealthStreet, during a health needs assessment. Women older than 18 years were classified by opioid use: past 30-day, lifetime, but not past 30-day, or no lifetime prescription opioid use. Descriptive statistics and chi-square tests were calculated, and multinomial logistic regression was used to calculate adjusted odds ratios (aORs; confidence interval [CI]). Results: Among 5,549 women assessed, 15% reported past 30-day use and 41% reported lifetime use of prescription opioids. While prescription sedative use was the strongest risk factor for past 30-day use among younger women (aOR = 4.84; 95% CI, 3.59-6.51), past 6-month doctor visits was the strongest risk factor for past 30-day use among older women (aOR = 4.15; 95% CI, 2.62-6.60). Conclusions: We found higher rates of prescription opioid use in this community sample of women compared to national rates. Risk factors for recent prescription opioid use (past 30-day use) differed among older and younger women. Clinicians should be more vigilant about prescribing opioids as the medical profile for women may change through age, especially the co-prescribing of opioids and sedatives.

In the period between April 6, 1992 and December 14, 1995, an estimated 102,622 people were found to have died due to war-related causes in armed conflicts in Bosnia and Herzegovina. Of those killed in the war in Bosnia and Herzegovina it is estimated that 54% were civilians. The war profoundly affected the civilian population, which was subjected to mass killings, the systemic use of rape and sexual violence, and the physical and psychological torture inside concentration camps. This case study paper has four aims. First, it highlights the complexity and severity of the traumatic psychological effects of the war in Bosnia and Herzegovina on its citizens, including the effects of the war on the generation born during or shortly after the war. Second, the paper proposes a heuristic in the form of a broader theoretical approach; an ecological analysis of human development (Bronfenbrenner, 1989). This approach aims to provide a framework for research and the development of intervention strategies for the adolescent children of adult war survivors who have been affected by war-related trauma. Third, the paper presents a case vignette of an adolescent to demonstrate the application of the ecological framework to clinical practice with adolescents. Finally, we explore how the current cultural, political, and societal realities in Bosnia and Herzegovina affect the population in general and the children of war survivors in particular. The transition from a state of war to peace is a long and continuous process with residual effects of violent conflicts permeating the broader society and its inhabitants, even after the war’s official end over 23 years ago. The authors argue that roles of psychologists and other mental health providers should expand beyond traditional focus on intrapsychic problems. Rather, effective treatment strategies should also include recognition of and attenuation of the larger systemic stressors that patients experience on daily basis. This could be accomplished through collaboration among psychologists and patients, patients’ families, teachers, and community members, all of whom directly or indirectly affect patients’ treatment outcomes.

Abstract Background Non-medical use (NMU) of prescription opioids is of concern due to the opioid epidemic in the United States. Objective: We examined sex differences in the effect of age of first use of prescription opioids on prescription opioid NMU among 17- and 18-year olds. Methods: The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) recruited youth 10–18 years from 10 United States cities between 2008 and 2011 (n = 11,048). The cross-sectional survey included questions on past 30 day prescription opioid use (10,965 provided responses; 278 age 17 to 18 years who used opioids in past 30 days), with NMU defined as non-oral use and/or use of someone else’s opioids. Nonparametric survival analysis with lifetable estimates was used to examine age at first use. Binomial logistic regression was conducted predicting any NMU, adjusted for covariates. Results: Among 278 youth 17 to 18 years, a significant difference in age of first use between those with MU only and any NMU (p < .0001) was observed. Each one year increase in age resulted in a 33% decrease in the odds of any prescription opioid NMU compared to MU only, after controlling for covariates (Odds Ratio = 0.67, 95% Confidence Interval: 0.47,0.96). Sex differences in age at first use were not observed. Conclusions: Risk of past 30 day prescription opioid NMU decreased by a third for each one year increase in age of first use, after adjustment for other covariates. Use of prescription opioids in young adolescents may need to be limited where possible and researched further.

Purpose We examined ideas about how youth would mitigate non-medical use of prescription medications among their peers. Design/methodology/approach The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) interviewed 11,048 youth10-18 years of age between 2008 and 2011 from entertainment venues of 10 US urban, suburban, and rural areas. Using a mixed-methods approach, participants completed a survey culminating in open ended questions asking: 1) How should kids your age be told about prescription drugs and their effects?; 2) If you ran the world, how would you stop kids from taking other people's prescription medicines?; 3)Why do people use prescription stimulants without a prescription? Responses from a random sample of 900 children were analyzed using qualitative thematic analyses. Findings The random sample of 900 youth (52% female, 40% white, with a mean age was 15.1 years) believed they should be educated about prescription drugs and their negative effects at schools, at home by parents, through the media, and health professionals. Youth would stop kids from using other people's prescription drugs through more stringent laws that restricted use, and education about negative consequences of use. Peer pressure was the most common reason youth gave for using other's pills, though some reported using for curiosity. Originality/value This analysis shows the importance of considering youth's opinions on non-medical use of prescription medications, which are often overlooked. Studies should disseminate this data from youth to stop the illicit use of prescription drugs among teens and youth.

ABSTRACT Background Non-medical use of prescription drugs is a major public health concern in the United States. Prescription opioids and sedatives are among the most widely abused drugs and their combined use can be lethal. Increasingly rigid prescribing guidelines may contribute to the changing context of opioid use and increase drug diversion. Objective To examine gender differences in diversion of prescription opioids and sedatives among non-medical prescription opioid and sedative polysubstance users. We hypothesize that men will be more likely than women to engage in incoming diversion. Methods Data from the Prescription Drug Abuse, Misuse, and Dependence Study, a cross-sectional study focused on prescription drug users, were analyzed. Non-medical use was defined as use of a drug that was not prescribed or use in a way other than prescribed. Individuals who reported past 12-month non-medical opioid and sedative use were included; diversion was defined as incoming (obtaining drugs from a source other than a health professional) and outgoing (giving away/selling/trading prescription drugs). Results Among the 198 polysubstance users, 41.4% were female. Men were 2.85 times as likely as women to report incoming diversion (95% CI: 1.21–6.72). Women were more likely to obtain opioids from a healthcare professional; men were more likely to obtain sedatives from a roommate, coworker, or friend. Over half of men and women reported outgoing diversion opioids or sedatives. Conclusion Drug diversion highlights an important point of intervention. Current prevention efforts that target prescribers should be expanded to include users and diversion activities; these interventions should be gender-specific.