text:
If you or someone you know has a mental illness, you are not alone, and there are ways to get help. Use these resources to find help for you, a friend, or a family member in need.
Get Immediate Help
If you are in crisis, and need immediate support or intervention, call, or go the website of the National Suicide Prevention Lifeline
(1-800-273-8255). Trained crisis workers are available to talk 24 hours a day, 7 days a week. Your confidential and toll-free call goes to the nearest crisis center in the Lifeline national network. These centers provide crisis counseling and mental health referrals. If the situation is potentially life-threatening, call 911 or go to a hospital emergency room.
Find a Healthcare Provider or Treatment
For general information on mental health and to locate treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357). SAMHSA also has a Behavioral Health Treatment Locator on its website that can be searched by location.
National agencies and advocacy and professional organizations have information on finding a mental health professional and sometimes practitioner locators on their websites. Examples include but are not limited to:
National Education Alliance for Borderline Personality Disorder
University or medical school-affiliated programs may offer treatment options. Search on the website of local university health centers for their psychiatry or psychology departments.
You can also go to the website of your state or county government and search for the health services department.
Some federal agencies offer resources for identifying practitioners and assistance in finding low cost health services. These include:
Health Resources and Services Administration (HRSA): HRSA works to improve access to health care. The website has information on finding affordable healthcare, including health centers that offer care on a sliding fee scale.
Centers for Medicare & Medicaid Services (CMS): CMS has information on the website about benefits and eligibility for these programs and how to enroll.
The National Library of Medicine's MedlinePlus website also has lists of directories and organizations that can help in identifying a health practitioner.
Practitioner lists in health care plans can provide mental health professionals that participate with your plan.
Mental Health and Addiction Insurance Help: This website from the U.S. Department of Health and Human Services offers resources to help answer questions about insurance coverage for mental health care.


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1) UTI is an educational institution and cannot guarantee employment or salary.
2) For important information about the educational debt, earnings and completion rates of students who attended this program, and to review the applicable Gainful Employment disclosure, visit www.uti.edu/disclosures.
6) UTI graduates' achievements may vary. Individual circumstances and wages depend on personal credentials and economic factors. Work experience, industry certifications, the location of the employer and their compensation programs affect wages. UTI is an educational institution and cannot guarantee employment or salary.
Universal Technical Institute of Illinois, Inc. is approved to operate by the Private Business and Vocational Schools Division of the Illinois Board of Higher Education.
Universal Technical Institute of Illinois, Inc. is approved by the Division of Private Business and Vocational Schools of the Illinois Board of Higher Education.

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WhatsApp Messenger 12+
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iPhone Screenshots
Simple. Reliable. Secure. — WhatsApp from Facebook
WhatsApp Messenger is a FREE messaging app available for iPhone and other smartphones. WhatsApp uses your phone's Internet connection (4G/3G/2G/EDGE or Wi-Fi, as available) to let you message and call friends and family. Switch from SMS to WhatsApp to send and receive messages, calls, photos, videos, documents, and Voice Messages.
• NO FEES: WhatsApp uses your phone's Internet connection (4G/3G/2G/EDGE or Wi-Fi, as available) to let you message and call friends and family, so you don't have to pay for every message or call.* There are no subscription fees to use WhatsApp.
• MULTIMEDIA: Send and receive photos, videos, documents, and Voice Messages.
• FREE CALLS: Call your friends and family for free with WhatsApp Calling, even if they're in another country.* WhatsApp calls use your phone's Internet connection rather than your cellular plan's voice minutes. (Note: Data charges may apply. Contact your provider for details. Also, you can't access 911 and other emergency service numbers through WhatsApp).
• GROUP CHAT: Enjoy group chats with your contacts so you can easily stay in touch with your friends or family.
• WHATSAPP WEB: You can also send and receive WhatsApp messages right from your computer's browser.
• NO INTERNATIONAL CHARGES: There's no extra charge to send WhatsApp messages internationally. Chat with your friends around the world and avoid international SMS charges.*
• SAY NO TO USERNAMES AND PINS: Why bother having to remember yet another username or PIN? WhatsApp works with your phone number, just like SMS, and integrates seamlessly with your phone's existing address book.
• ALWAYS LOGGED IN: With WhatsApp, you're always logged in so you don't miss messages. No more confusion about whether you're logged in or logged out.
• QUICKLY CONNECT WITH YOUR CONTACTS: Your address book is used to quickly and easily connect you with your contacts who have WhatsApp so there's no need to add hard-to-remember usernames.
• OFFLINE MESSAGES: Even if you miss your notifications or turn off your phone, WhatsApp will save your recent messages until the next time you use the app.
• AND MUCH MORE: Share your location, exchange contacts, set custom wallpapers and notification sounds, broadcast messages to multiple contacts at once, and more!
*Data charges may apply. Contact your provider for details.
We're always excited to hear from you! If you have feedback, questions, or concerns, please email us at:
or follow us on twitter:
Note: WhatsApp is a telephony app, so iPod and iPad are not supported devices.
What's New
Version 2.20.31
* Dark mode is available for users on iOS 13. To get started, open Settings app > Display & Brightness > select "Dark".
* New search options allow you to filter by author and content type - so you can easily find that photo from mom.
Ratings and ReviewsSee All
Really Useful and Great App
This app is brilliant, it's free, there's unlimited free messages, the status section is fun and often useful! The only thing that I want to be changed (and it's something that I REALLY want to be changed) is that there is some way that WhatsApp can automatically delete chainmail, chain messages, creepy and scary things that tell you to pass them on etc. I have been sent many chainmails before and my friends have been sent quite a few scary voice mails that tell you to forward them. Some of the written chain mails are often scary. This really distresses/scares people which isn't great and some people that I know even deleted WhatsApp because of this. I know that this may be a lot to ask because the developers are not able to maybe do this right now, but if possible, please do something about this. I would say to try and ignore chainmail as well if you are a reader and not a developer. Some of the chainmail is lovely and kind but some of not most are horrible and need to be not passed on and stopped so that no one else is scared by them. STOP ALL THE CHAINMAIL! IT IS ALL FAKE! (The chainmail not this message 🤦🏼♀😂)
Many thanks
Pretty decent
Works well, fairly intuitive. Only problem I've had is a pretty significant time delay (can be upwards of two hours) between sending a message to a person in a different country and that message being received.
I often use WhatsApp to message friends in Italy, but, have noticed that my messages (on average) take a couple of hours to deliver, with the occasional extreme case of my messages taking a couple days to deliver. I assume this problem is due to a culmination of slow broadband/poor mobile data connection (which is a common problem where I live), a difficulty in data package transfer and (assumable) incompatibilities with similar networks in Italy.
Ultimately, it's a pretty decent app, and, it's not the end of the world in regards to the slow message delivery speed, as I appreciate that nothing is ever instantaneous, especially when it comes to tech and wireless information transfer. But, it can be frustrating when mid conversation your messages stop delivering, and you have to text the person normally to explain that you "aren't trying to be rude" and that you "are trying to reply to their messages", defeating the perceived purpose of the app.
Passcode protection, please?!
Considering many people use WhatsApp for private chats of a sensitive or adult nature, it really needs a passcode/password protection feature. Yes I know we can passcode protect our whole iPhones, but some of us don't remember to turn on our iPhone's passcode every single time we go out or meet up with other people... and yes it's possible to leave it on all the time, but personally I find it a little inconvenient to have to enter the passcode every single time I use my iPhone... and I use mine A LOT cos it's loaded with lots of art and photo editing apps, as well as Facebook and suchlike. And people don't keep their phones to themselves 100% of the time... eg, I'll often pass someone my iPhone to show them photos on it... so if someone was in a nosey mood, a few tiny little finger movements is all it would take for them to access my WhatsApp chats in all their glory. The consequences of having their private chats pried upon like this could be disastrous and absolutely traumatic for some people, such as those planning to escape domestic abuse, for example. So... PLEASE can we have passcode protection for WhatsApp?! Cheers x
- Provider
- WhatsApp Inc.
- Size
- Category
- Social Networking
- Compatibility
Requires iOS 9.0 or later. Compatible with iPhone.
- Languages
English, Arabic, Bengali, Catalan, Croatian, Czech, Danish, Dutch, Finnish, French, German, Greek, Gujarati, Hebrew, Hindi, Hungarian, Indonesian, Irish, Italian, Japanese, Korean, Malay, Marathi, Norwegian Bokmål, Persian, Polish, Portuguese, Romanian, Russian, Simplified Chinese, Slovak, Spanish, Swedish, Thai, Traditional Chinese, Turkish, Ukrainian, Urdu, Vietnamese
- Age Rating
- 12+
- Infrequent/Mild Medical/Treatment Information
- Infrequent/Mild Mature/Suggestive Themes
- Infrequent/Mild Horror/Fear Themes
- Infrequent/Mild Profanity or Crude Humor
- Location
- This app may use your location even when it isn't open, which can decrease battery life.
- Copyright
- © 2020 WhatsApp Inc.
- Price
- Free
Get all of your passes, tickets, cards, and more in one place.
Family Sharing
Up to six family members will be able to use this app with Family Sharing enabled.
Get things done within this app using just your voice.


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The Selection by Kiera Cass – Book Review
Title: The Selection
Author: Kiera Cass
Publication Date: April 24th, 2012
Shelves: Fiction; Romance; Unique story-line;
Format: Kindle (336 pages)
Rating: 10/10
The Selection is the first book of "The Selection" Series by Kiera Cass. For me it was a fantastic read considering the world the author creates. For example, this the story of 35 girl, selected to run for the conquest of marrying the Prince of the Royal Family.
Here you will find a new America, a country after 3 world wars where society was divided in cast, the first being the ones from the Royal Family followed by class as it goes down. Meanwhile the world suffers, The Royal family maintains a perfect image. During this selection, the girls will learn how to become royal. However, America Singer is being part of the second lower cast.
As a result of a mistake on her part, she is being chosen to compete by force. She doesn't care about any of this because she thinks she is already enamored with her son's neighbor, however, the boy is from a lower class. Consequently, that puts a dent in her plan.
Her struggle is with her family, because they take pride when one of their member is chosen for such an important selection. She has a chance to be queen, and bring food on her already starving and poor family. This is a very big deal considering people struggle to survive.
The Selection shows the contest and all their shenanigans until the next cut. However, America succeeds on gaining the attention of the young prince starting day 1, that is to say, from the first night!
Even if we know that being a romantic story she will eventually be with the man of her dreams, is he really the price or the boy she fantasied about growing up?
Make sure to check Kiera Cass' Website for news about her books.
Here is the reading order of the series.


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Grab the hottest Xbox One S bundle that includes Tekken 7, Project Cars 2, Killer Instinct Combo Breaker Pack, Mafia III Deluxe Edition, Fallout 4 and PUBG at Currys PC World and save more than £105.
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Save £130 off Samsung 32-Inch 4K Ultra HD LED Monitor
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Yep, you read right. Worth £24.99 usually but available for £14.99 right now.
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The new and improved Amazon devices have gone on sale from today. The improvements include improved design and sound quality for Amazon Echo Dot. The Amazon Echo Plus now features a classic fabric finish and Echo Show has been upgraded to a bigger and better 10-inch display with an improved sound and built-in smart home hub, meanwhile, Echo Sub will enable you to pair two compatible Echo devices for a stereo sound-like experience.
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Make your home smarter with Hive's smart thermostats. They are now discounted by 25% at Amazon, and you will also get an Amazon Echo Dot free of charge.
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Wondering what are the best broadband deals this month? Compare the best broadband, phone & TV deals in your area now with PCMag's comparisons tool. Just enter your postcode and they will do the job for you.


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6:20 AM: My alarm goes off. I probably hit snooze at least once, if not twice. I like for my feet to hit the floor by 6:40-50 because it makes it all easier for the entire family if I'm the first one up. Our mornings go smoother for getting the kids to school when I'm not dragging! Breakfast 1: I… Read More
10 Random Facts About Me
1. I used to blog when I first became a mom & did so for a while. I made an intentional choice to stop after my daughter was born. The fun was gone, it was a lot of work, & it was taking time away from my family. I'm grateful for the experiences I got from it (good & bad)… Read More


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Short Name: GaJh11.Lom3.2011 Surf NE 9
Period: Pliocene
Culture/Industry: Early Oldowan
Localization: North Turkana
Collection Date: 2012
Collector: Sonia Harmand
Provenance: Surface and Test trench
Material Culture: Lithic
Site Name: Lomekwi 3
Catalogue: # KNM-4409-2
3.3 million to 280 thousand years ago
Material Culture
Worked block: the world oldest stone tool from west Turkana
During the Pliocene, the warm and wet conditions of the Miocene gradually gave way to colder, drier climates. New open, grassy habitats began to open up, which provided opportunities for animals that were well suited to flourish in them. Many grassland-adapted species are found in the fossil record, including hominids, with whom we share common ancestry. Hominids were moving into the newly opened plains and using simple stone tool technology to process nuts.


text: The beneficial properties of Rudraksha seeds have been known since ancient times. Traditionally they have been used in Buddhism and Hinduism as accounts in the Yapamala or Japamala. These rosaries are still used in the practice of mantras. Rudraksha seeds (elaeocarpus ganitrus) are said to have electromagnetic properties that positively influence the mood of the practitioner who uses them to practice yoga or mantra recitation. Beyond that, rudraksha seeds are light and pleasant to carry. In SHORIOSPIRIT you can find a wide variety of necklaces and beaded Buddhist bracelets that use rudraksha combined with gems and other stones as the main component


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Transform your wedding into a regal celebration with this ornate fully beaded Adrianna Papell bridesmaid dress 40143. Made with a small, keyhole opening in the front and straps that meet with a V in the back. The tulle a-line skirt features net draping to add soft volume.
Colors displayed on your monitor may vary from the actual fabric color. Please view a fabric swatch in person, come in to our store, or call us to check availability on ordering a swatch from the designer. A $10 fee may apply.
Your dress is made to order - not custom made to your measurements. Measurements are taken simply to compare to the size chart to decide which size is closest to your measurements. Refer the style chosen to verify which measurements take top priority. For example: The natural waist and bust will be most important for a-line or ball gown style, while all your measurement especially the fullest part of the hips is crucial in fitted style. Be sure that each of your measurements fall in line with the size that you are order. These dresses are made according to the size chart and may have little to no seam allowance to let out. Please contact our bridesmaids stylist for further assistance if needed.
Keep in mind that dresses are made to a standard length. If you are between 5'8" and below you may have to accommodate the length through alterations. Order extra length if you are 5'8" or taller. Please contact our bridesmaids stylist for more information about length.
This item is made to order please allow 10-16 weeks for delivery. We strongly recommend that you order your dress 4 months before the event, or earlier. Plan accordingly to receive your order at least 2 weeks prior to the wedding/event.
Payment and Order Changes
Full payment for your order is required. Any changes must be made within 24 hours of purchase. We are unable to change sizes or cancel order after this time. No exceptions.
Return Policy
All of our special-order garments are made only after you order is placed, all sales are final. Dimitra Designs will provide the requested style, color, and length of dress in the size you have selected based on your review of the size chart. Dimitra Designs is not responsible should an incorrect size be ordered, please be sure to refer to the designer's size chart when ordering.


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Excellent for almost all types of B2B Online marketing for instance telesales, e mail and newsletter campaigns, direct-mail advertising, Instagram marketing and also even more. Completely free lifetime updates to your Aids Charities B2B Business Data List Instantaneous access to member's area upon checkout. GDPR Compliant B2B Companies In excess of 400 local business industries. Customized website harvesting services available.
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Newspapers Email Listing - Newspapers Industry Mailing Database
The Newspapers Market Mailing Database is available in an Excel documents with get in touch with information for all the newspaper as well as media firms worldwide, including the UK, Europe, UNITED STATES, Canada and Australia. Our Newspapers Email List is ideal for all forms of B2B marketing including newsletters as well as emails, telesales, social media sites.
Media Consumption!
The Newspapers Market Mailing Database can be found in an Excel documents with get in touch with information for all the newspaper as well as media firms in the globe, consisting of the UK, Europe, U.S.A., Canada and Australia. Our Newspapers Email Checklist is perfect for all kinds of B2B marketing consisting of e-newsletters and e-mails, telesales, social media sites.
We could be residing in the electronic age, and you would certainly be forgiven for thinking that newspapers were a passing away media. Despite over half of the youngest generation reading their information from social media as well as smart device apps, much of the older generation still stay with the tried and also evaluated methods of overtaking the world-- and also pencil and also paper is much from going anywhere! It may not be able to be updated in actual time, however it definitely has its uses!
Papers Email Checklist - Newspapers Sector Mailing Data Source
However why hold on to the old methods?
Our delivery of the media may have swiftly expanded over the last century, yet documents still have uses!
It's still very cheap to print, the technology having been perfected with the rise of modern innovation.
It maintains information and also present events available for those who or else can not use or are not familiar with clever technology such as phones.
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You see, if you hit the web for a checklist of papers in your nation, you could compile them all. Yet could you guarantee they matter? Could you make sure that you have the right get in touch with details? Could you even ensure you would certainly have access to the most effective highest possible members of team? Of training course not. Our competitors could sell you the dream, however we supply it. We have actually invested 5 years alongside the media. From the very best of sleuths and also investigative reporters, to one of the most attentive of editors and also chairmen. We're certain that our collection can overtake anything you might discover in other places!
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As a freelancer, you might not need to follow by the company regulations the large papers may need to, and also when you have actually taken care of to capture that story of the century, no editor can resist. Plug in the clients and send it. You do not need to give away the information, simply the number you want for the civil liberties!
Occasionally that tale simply isn't great enough undergoing the movements of being assessed by admin, and also corrected. Obtain it where it matters, and obtain it there quickly. Our data source includes a significant variety of email addresses as well as the capacity to get visit this page in touch with precisely who requires to see it! Obtain it in the inboxes of those closest to the printing machine where it deserves to be!
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go to the DMV. upon getting the car's VIN quantity, go to your neighborhood DMV. They will help you observe down the operator. in many states, the proprietor will probably be notified by certified mail you are seeking to attain his automobile's title. The sheriff during the county in which the motor vehicle is abandoned will also be notified.
The revamped chilly storage facility brings together the most cutting-edge storage and refrigeration engineering with innovative design concepts. From the usage of Superior hearth prevention programs to robotic racking and dual-phase temperatures, We now have managed to achieve a Aids Charities extremely productive facility that is certainly also Vitality-productive.
get ready to go ahead and take previous proprietor to little statements courtroom. The earlier owner might refuse to transfer the title for you, even when he has no intention of professing the vehicle. There are a selection of causes for this, the most likely of that's the initial owner is attempting to draw out Aids Charities the method to get extra money from you.
when a call for company is acquired, a law enforcement company Technician goes on the scene and investigates the criticism. One of a number of outcomes will manifest:
In the event your situation doesn't pan out in tiny statements courtroom, Aids Charities it is possible to attain a writ of execution from your county clerk which useful link you'll then carry on the sheriff's Business office.
you will have to ship him a Qualified letter requesting the title. If he ignores you, you can file for the title. connect with your neighborhood DMV and check with the things they endorse you do.
appear around your options in regards to an abandoned auto. the method for acquiring a title is different in Just about every point out. you should definitely determine what your legal rights are in regards to an abandoned auto in your point out. Should the motor vehicle was not uncovered on the assets, it'll probably be towed then held by an auto organization. When the proprietor doesn't reclaim the automobile just after a certain timeframe, as well as the automobile is value lower than a certain charge, the auto are going to be considered unclaimed. The timeframe and worth varies by condition. as soon as a car or truck is marked unclaimed, it can very likely be offered in a general public auction to the very best bidder.
In case the vehicle has not been moved within the deadline, the city may perhaps impound and/or dispose of it. in certain states, for example California, moving the motor vehicle basically implies driving it for one mile; and then the driver can return and park in the very same place for an additional seventy two hours.
wanting to know what to do about that aged automobile, RV, or truck that's been parked in your Avenue for more than every week now? Abandoned vehicles which can be previous and defeat up can don't just be an eyesore, they are able to acquire up worthwhile parking spaces in crowded residential spots.
find out if you are able to do so inside your point out. to be able to order the motor vehicle through the proprietor, you will have to draft a bill that features the date, your identify, the auto's calendar year, make, and identification amount, order price, as well as signature of the present owner.
each carcass is electronically stimulated, steam vacuumed and PH monitored to ensure the regular criteria of our beef.
With its excellent weather conditions, miles of sandy shorelines, and big sights, San Diego is thought around the globe as among the finest vacationer Places and a terrific spot for people to rest year spherical.
If you buy an unclaimed car or truck at an auction, you will get the automobile as well as title shortly just after your bid is collected.[two] in a few states, regardless of whether the auto is found on your own residence it'd even now be auctioned. This is generally In the event the car or truck is well worth over a particular amount. you'll want to constantly Get in touch with regional authorities prior to seeking to assert a title on an abandoned auto.[three] In other states, you can purchase the important link motor vehicle from the original operator if It is really observed in your house. The proprietor may additionally decide to simply transfer the title to you personally.
usually get started by speaking to your local DMV to view exactly what the rules Aids Charities are with your point out. polices range significantly with regard to the acquisition of abandoned vehicles.
you may merely need to Make contact with the Aids Charities condition to have it towed and scrapped if it isn't really well worth salvaging.
"My dwelling was trashed by homepage tenants I needed to evict for not spending rent. believed following a couple months every time they failed to return with the vehicle I could remove it. I'll do when you reported and go to the DMV. Thank you. great suggestions."..." extra AO Anthony Ondre


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I bought this bike in a local tvs showroom & it's ok. It's kinda fun for starter riders Looks is ok performance is ok Servicing & maintenance pretty cheap. I love the way this bike goes 0 to 60 Engine is really refined For pillions it's comfortable Cons = they should gi
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The idea behind the paleo diet is that the human digestive system can handle these unprocessed foods much better than it can digest modern-day products like dairy, grains, and sugars. Many people stand by this diet as an effective method for weight loss, cleaning eating, and overall healthy living. Though, as with many fad diets, this can be restrictive since you don't eat dairy or whole grains, so you should consult with your doctor before trying this or any other extreme diet.
Kelly is such a talented photographer. Her book makes me want to eat the food right off the page. Equally as good as the photography are her recipes. Kelly incorporates chocolate into each recipe so thoughtfully that we cooked from it all week and didn't feel chocolated-out! The book is packed with delicious recipes for treats, but it also has a handful of savory recipes with a chocolate twist. If you enjoy chocolate even half as much as I do, then this book is a must-have!
This burger is made with mushroom caps instead of a bun, and it is designed to mimic the flavors of a Philly steak sandwich, only in burger form. It is made from slices of sirloin, so it's using Green me, and of course has all of the necessary ingredients that go into a Philly steak, such as a bell peppers in multiple colors, and an onion. They're using lard to fry it all up in, so this is going to be one flavor-filled burger. Cutting out the bread is a facet of Paleo that many followers struggle with, but if you use substitutes like they are here, the process is easier.
This recipe gives you dinner party elegance in a 20-minute dish. We rely on sea bass, a tender, mild-flavored fish with a lovely buttery quality. There are several sustainable options to choose from (Atlantic black sea bass, for one), so ask questions at the fish counter to ensure you're making a responsible choice. You can also use cod, sablefish (also called black cod), striped bass, or barramundi with great results.
Skewered Lamb with Honey Glazed Carrots Pear And Bell Pepper Ground Beef Stir-Fry Garlic And Herb Steak Pepper Barbecue Sauce Grilled Steak Skewers Greek-Style Meatballs Simple Beef Shish Kabobs Steak Zucchini Boats Veal Rolls With Zucchini Skirt Steaks With Fresh Mango Salsa Swedish Style Meatballs Beef Sirloin With Fresh Herb Marinade Butternut Squash Lasagna Butternut Squash and Beef Stew Roast Beef with Portobello and Balsamic Sauce Korean Beef Short Ribs Meatball Bites With Spaghetti Squash Beef Sirloin Grilled In Spicy Tomato Sauce Steak and Cucumber Salad Ground Beef Tacos Aussie Burger BBQ Meatballs Balsamic Steak Rolls Pepper Steak Balsamic Roast Beef Taco-Stuffed Sweet Potatoes Taco pie Eggs Benedict burgers Beef Stroganoff
How does pre-order work? If you order now, ahead of the January 6 release date, you'll enjoy 25% savings off the cover price. Early bird gets the worm here! Then, when the book is finally released, it'll be automatically shipped to you. Bonus: Usually pre-ordered books arrive a few days before the actual release date, though that isn't a promise. Pre-orders are handled through Amazon, Barnes & Noble, iTunes, Google Play or IndieBound.
A chicken salad sandwich sounds great for lunch, but the sandwich part is out of the question if you're eating paleo. This recipe for a healthy alternative adds a fiber boost in the form of diced vegetables, like radishes and cabbage. If you pack along four or five large butter lettuce leaves, you can leave your fork at home and scoop up the chicken with them.
The Summer Eats collection of recipes is unlike anything we've seen in the world of Paleo. These are like gourmet meals done in Paleo fashion, so you'll feel like you're getting well-fed, but keeping healthy at the same time. She's gone for quality over quantity, so you won't be inundated with hundreds of recipes, and in fact she's providing just 16 recipes designed to knock your socks off. This is the type of recipe collection you'll want to have on hand when you want a special meal, but don't want to veer off your Paleo plan. She also provides recipes for clean cocktails, so you can enjoy a tasty beverage without packing on the calories and sugar.
Paleo Slow Cooking: 16 Delicious Slow Cooker Recipes For FamiliesDon't you just hate it when you see a great slow cooker recipe an...d realise that it is full of processed foods and really not good for your family? Well here are 16 delicious family slow cooker recipes that are completely Paleo and just PERFECT for being healthy with your family.Or maybe like the author, you're following the Whole30 and you are sick of doing seperate meals for your kids. In which case these Paleo slow cookeer recipes are just perfect! read more
An easy-to-follow plan for healthy weight loss!You're committed to the paleo lifestyle, but does that mean that you need to spend ...extra time creating special meals every night? Not with The Everything Weeknight Paleo Cookbook! Here, you'll find 300 flavorful, whole-food recipes for meals that will not only satisfy the entire family, but also fit into a busy schedule.Popular blogger and founder of cavegirlcuisine.com Michelle Fagone offers a variety of delicious recipes, such as:Clams casinoAvocado and shrimp saladHoney-mustard pork loinShredded chicken wrapsGinger-lime salmonBaked applesThe best part is, you'll be out of the kitchen in no time! Most recipes can be made in thirty minutes or fewer--some utilize the convenient slow cooker for hands-off cooking, while others are simple make-ahead meals. With these fresh and simple meals in your repertoire, you'll find it easy to transform your body as you enjoy the wholesome tastes of the paleolithic diet. read more
These mini pizzas are great to have as a snack, at a party, for watching the big game, as a lunch, or a dinner, depending on how many of them you eat at one time. They are made with a crust that is formed with almond flour, so they're Paleo friendly, and they are topped simply with tomato paste and some blue cheese, so you get the rich and tangy taste of blue cheese in each bite. You'll want to go with a goat's milk variety of blue cheese, if you go this route at all. Some Paleo eaters can handle small amounts of cheese on occasion.
Practical Paleo is more than just a recipe book. Instead, the book acts as a particularly effective introduction to the paleo diet, offering information and steps about what you can expect from the beginning all the way through. Some of this information may even be new to people who have been following paleo for a while, especially as there is a discussion about gut bacteria and various ways to live a paleo lifestyle effectively.
These mini cheesecakes might take some time to make, but it's totally worth it. You start by making a batch of chocolate cookies for the base, then create a cheesecake-like middle without using any dairy, and then top it off with coconut cream and cacao nibs for the finale. This is the type of dessert that will make you feel like you're not on a diet at all, and that goes in line with the Paleo mentality. Even though it's referred to as the Paleo Diet, it's more like a lifestyle and a way of being than something that you have to force yourself to do.
Our Paleo Meal Plan is for anyone interested in eating unprocessed, whole foods, and is willing to adhere to some fairly stringent restrictions. Paleo can fit into a variety of lifestyles, and can be a good choice for athletes, those looking to increase energy levels, or people who want to eliminate processed foods from their diet. If you need to restrict intake of protein or fat for health reasons, a paleo diet may not be right for you.
The recipes are incredible and the photography is gorgeous. I love how this book is organized in menus, and each menu gives you tips on how to prepare for the party efficiently. My other favorite part of this book is that most of the recipes use simple, fresh ingredients. If you are already a real-foodie, you likely have most of the ingredients on hand.CLICK HERE to order Gather.
This chicken salad keeps things light and has an eclectic mix of meat, fruit, and vegetables, so you'll feel great after eating it. While some might think that Paleo eating doesn't include salads, this is a misperception. In fact, you'll likely end up eating more salads than you ever did before so you can balance out a meal. This salad makes a great lunch, and will surely give you energy to help you through the rest of the day, without a sluggish after lunch feeling. Consider using baby spinach or baby kale leaves instead of ordinary lettuce for the base.
Guaranteed to be a fast favorite, this recipe plays on the sweet-savory match made in flavor heaven: pork + apples. Sautéed apples add a hint of sweetness and delightfully smooth texture to this hearty paleo pork dish. If you don't have access to Honeycrisp apples, use a pink lady, gala, or jazz apple instead. Dijon mustard counteracts the sweetness of the apple adding incredible depth of flavor that the whole family can enjoy.
These meatballs attempt to capture the taste of chicken enchiladas verde, so if you don't feel like making up a giant pan of Paleo friendly enchiladas, you can go with this meatball recipe and get a similar results. They are able to pull it off by using a pound of ground chicken, and you want to make sure that the chicken is organic. They are using almond flour to replace breadcrumbs that you'll usually find in meatball recipes to help hold it all together. They also have it topped with some salsa verde to complete the green enchilada mission.
Delicious smoothies--100% free of gluten, dairy, and refined sugar!Think Paleo and smoothies don't mix? Think again! Now, you can ...enjoy the quick burst of energy and nutrition that comes from the easy-to-make pre-/post-workout drink--without any of the gluten, dairy, or refined sugar! This cookbook shows you how to blend 150 Paleo smoothies right in your own home, so that you never have to worry about what else is in your drink. Whether you're interested in cleansing your body or just need an extra boost of energy after an intense workout, each section offers a delicious blend of all-natural fruits and vegetables that will keep you full throughout the day. Featuring step-by-step instructions and nutritional data, the recipes make a wide variety of tasty Paleo smoothies, including:Pineapple sunshine smoothieAcai boost smoothieVanilla coconut cream smoothieKale power smoothiePumpkin protein smoothieSweet apple pie smoothieYou don't have to give up the vitamin-packed smoothies you love just because you're on the Paleo diet--with Paleo Smoothies, you can have healthy, flavorful smoothies at every meal! read more
It was time well spent though. Taking time away from all your devices and things that compete for your time is extremely helpful and allows this space to think that you might not otherwise get. I highly recommend you do this if you can. It doesn't have to be on a beach either – your couch is a perfectly good place to do this, but with the tv off and your phone in another room. (This is also different than meditation. Meditation is trying to achieve the absence of thought, this encourages thought.)
Description: The Keto Cookbook is a cookbook for those using the diet to treat epilepsy and other neurologic conditions. The book contains 96 recipes grouped by breakfast and brunch, appetizers & snacks, lunch, dinner, and sweets and treats. The book includes a 16-page color insert illustrating each recipe. Since many children start the Keto Diet before they speak, the pictures of the meal and snack options allow children to choose what they want, helping overcome food refusal due to lack of variety of foods and/or child's loss of control over food options. This book provides parents and children with options that have been tested and are kid- and Registered Dietitian- approved.
For busy commuters, it is easy to get in the rut of eating hard boiled eggs every morning. This book will help you keep both your breakfasts and lunches exciting, even with a busy work schedule. The recipes are not only delicious and healthy, they are easy to make. In addition, Diana is a nutritional therapist and offers the reader tons of practical tips on how to follow a Paleo diet, including a guide for eating out!
It was time well spent though. Taking time away from all your devices and things that compete for your time is extremely helpful and allows this space to think that you might not otherwise get. I highly recommend you do this if you can. It doesn't have to be on a beach either – your couch is a perfectly good place to do this, but with the tv off and your phone in another room. (This is also different than meditation. Meditation is trying to achieve the absence of thought, this encourages thought.)
5day Almond Meal asparagus Avocado Bacon Bacon Weave Beef BREAKFAST Breakfast Sandwich Brussels Sprouts Casserole cheese Chicken Cocktails Crockpot Deep Fryer DESSERT Easter Faux Bread Faux Pasta Faux Potatoes Friendsgiving Fry-day Keto Grilling KITCHEN TOOLS lunch Mushrooms Pefect Ratio Pizza Pork Quick Snacks side dish snacks Sous Vide Spaghetti Squash Special Meals Spinach Steak Stunt Cooking Super Bowl tapas Thanksgiving vegetables Vitamix Vitamix Recipes
Disclaimer: This post may include affiliate links. This means I might receive a small amount of compensation if you purchase something through one of the links. This does not mean the price will be any greater for you, in fact, I might be able to negotiate even better prices and discounts for you. The compensation I receive helps me pay for the cost of running this blog and bringing you all of this free information. Thanks in advance for supporting me!
I am doing a low carbohydrate (but not totally Paleo) diet. There are a lot of great recipes in this book. I've already made about half a dozen of the meat dishes, several of the veggies and a dessert. The book is well laid out and truly has a wide variety of types of dishes. I've purchased several of these types of cookbooks, and by far this one is the best. Several co-workers have already ordered their own after looking through mine.


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Operating A Successful Online Business? Read This!
Make it a top priority in your home business to keep your current patrons happy and meet their needs. The effort required for repeat business from a happy customer is much less than that required to find and convert new customers. If your customers are happy, they will come back.
Home businesses require good planning, a strong basis and lots of information. The following article outlines critical elements of a business plan that will help guide you to success in your home business enterprise.
Give yourself short breaks throughout the day, but avoid getting absorbed into the personal activities that your household offers. Don't make long phone calls or work on home improvement projects. Rejuvenate and empower yourself with short activities that wake you up, like a brief stint with exercise or quick weeding of your garden.
If you want your online business to survive, you must have backup plans to put into place when things go wrong. Have backup plans for when your website goes down, not receiving much-needed supplies or equipment and anything else you can think of. If you plan ahead, you will not end up in a rut while trying to fix things.
If you are drawing a blank when trying to figure out what to sell, think about whether there is a need in your life that is going unfilled. Identifying a specific need is the first thing to do when creating a product to market to consumers. If there is a certain product that could be used in your life, then it's probable that others could also use it.
Wholesale Price
Understand the market you are entering before you start your home business. Though you may be well versed in your services and products, knowing what your market is and where their needs lie, will help you create the right sales and marketing plan that will bring them to your site. If you are including a web site, research how your target audience likes to interact with online options, and design the site accordingly.
Always know how much you are spending to make the products you sell, so that you do not end up losing money. To determine the wholesale price increase, multiply your cost by two. A standard price increase for retail would be the wholesale price multiplied by two. Establish an agreeable price point for both you and the consumer.
Take the time to talk to a business attorney around your area before you start your home business. You will have to follow your state laws when starting your business. After consulting the lawyer, you'll better understand the applicable laws and ensure you are complying with them. This will help keep you out of trouble with the government.
The Internet is a great resource for ideas when you're beginning a home business enterprise. Know that there are tons of home business scams online. Avoid paying for information that you can find for free on the web. These are lots of complex scams that want you to pay for high paying work that doesn't exist or pay some tuition for online classes that don't help. Don't fall for an offer that seems like it cannot possibly be true because it probably isn't.
Set a work schedule. With your hours clearly set, you know when to start and stop your work day. This keeps you from working every minute of the day. You should have scheduled free time just like you would if you had a job at an outside company. This is important to keep your life balanced, so you are not burned out by Friday afternoon.
Get in the habit of creating daily goals for your home based business. Though you may not get to some things, having goals does allow you to achieve more in the long run. Your family needs to be very clear about interrupting your time when you are working from home.
Pick a name that has meaning. Your brand represents your products, so creating a recognizable name makes it easier for your customers to relate to you. The brand name may have a great true life story that it is related to. As an added bonus, building a brand will help ensure customer loyalty.
Your home business enterprise should have a thorough business plan. You can change this or disregard it at any time. Do create a plan, though, as it will give you something to come back to if you aren't having success in your home business enterprise endeavor. Keep your business plan frequently updated.
Investors will be very interested in the operation and structure of your business before they contribute any money. Make sure you are geared in to what is going to generate the most earnings at any given moment.
Keep complete and accurate records of the finances in your business. If you end up audited by tax authorities like the IRS, you are going to have to show records and proof of your expenses and income. In addition, having good records helps you assess how well your business is performing at any time.
A good home business tip is to look as professional as you can. An unprofessional website will drive away customers. Spend some time looking over other professionally styled websites to get ideas for your own.
Manage your communications with your home based business customers to find the right balance between sharing pertinent information as necessary and sending too many messages. Allow your customers to decide whether they would like to receive newsletters and information about your specials and discounts. Use discretion when sharing information, because you don't want to bombard them with too much correspondence.
Are you launching a used book selling business? There are many sites you can use to sell your products. You'll likely want to utilize multiple sites. Each one should be rated based on their ease of use, reliability and the speed in which all of your concerns are addressed. The prices on the site don't always lead to lots of sales. Prices may be more on a highly reliable site.
Write your home business's objective. It should be a short description of the goals for your business and should describe your business in just a few sentences. When people ask about your company, tell them the objectives that you have already thought through. This is a great way to talk about your company in a confident yet concise way.
Make a work schedule for yourself, so that you will be less likely to slack during the day. Although you will be working from your home, you are still obligated to perform your job for your clients and keep their interest in mind.
Implement a good SEO strategy to help your site become more readily found by your potential customers. SEO is great for owners of home businesses because it can help them be more visible online. It is very possible to do SEO work alone, especially with the many resources available.
Ensure that your home business has a website set up. Many people don't buy much apart from food and gas offline, so no website probably means no orders. Just be sure you have a relevant domain name and that the content is well-organized.
While you may want to build relationships with customers, do not sacrifice profits in an effort to garner support. This lenience can hurt your initial business phase. Have a solid payment plan visible on all of your documents and do not waiver from it. It is also a good idea to include a clause for late penalties, within reason, for those who neglect their payment.
Build a business on a niche or concept you already understand. A lot of people that start home businesses think all they have to do is learn as they're going along. Yes, it's possible, but chances are you'll be more successful when you have some expertise in the industry you are choosing. Look to your personal strengths and build a business with those in mind.
As you decide on a home business, think of a job that you would love doing with or without pay. When you choose something you enjoy, you'll be passionate about it and potential customers will notice. Your love for your business will show through to your customers.
A carefully constructed business plan can ensure your success. Even if you don't have outside investors, you should have a business plan. When you have a plan, you will be able to follow the steps to get to success.
Try to keep a record of all out outcome and income. Make sure you stay on top of record keeping so you can get the most out of your tax deductions and also to help if you are audited.
Get a scanner for your receipts so you can monitor all your home business expenses without needing to keep a million boxes in your home office. Read the reviews on the different scanners on the market to find the one that will best suit your needs.
While long hours are part of starting a home based business, do not allow it to occupy every moment of your day. Take a break every once in awhile so you can relax! You will break down, just like an automobile, if you are constantly working without respite. Only work during those normal business hours, and then relax like any other person would.
When you first start a home business it's a great idea to talk to someone at your bank who is knowledgeable about business accounting and finances. You will need to set up a bank account specifically for your business complete with checks and possibly a dedicated credit line or business credit card.
Only entertainers really need to worry about having fancy websites. You don't want to use flashy graphics for the wrong type of site.
You can earn a tax break if you entertain clients. You can deduct expenses, like taking clients out to eat, on your taxes. Remember to save receipts for these meals. You are required to maintain receipts for meals over 75 dollars. You may also need to prove your expenses if audited.
Do not be afraid to branch out in your business. Have a brainstorming session and figure out what other services or products would complement what you're selling right now. One example would be to think over if you'd be better off creating your own product, or get paid by another company for selling their product.
Embark on a business related trip. Unlike a personal trip, you can deduct many of the associated expenses from your taxes when you take a business trip. When you plan your trip around a conference or class related to your business, you can still find opportunities to relax and unwind. This can help you deduct the trip legally and remain safe from the IRS.
You are now on your way towards having your own work from home business! This article does not claim that the process will be easy and there will be much hard work required, especially in the early stages, but it will get you headed in the right direction.
Membership fees are a good way to increase profits, if applicable. A subscription service could earn you a lot of money, if your website and your audience is suited to it.


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Depression is an eminently treatable disorder, although estimates of treatment efficacy have been inflated by publication bias. Patients with less severe depressions respond to even nonspecific interventions, whereas patients with more severe depressions require treatments that mobilize specific mechanisms. The cognitive and behavior therapies can be as efficacious as medications in the treatment of severe depression and have an enduring effect that medications lack. Medications may interfere with those enduring effects when added in combination and may prolong the life of the underlying episode when used alone. Thus the cognitive behavioral interventions might be the optimal first-line treatments for depression.
In the past several decades, increasing evidence supports the efficacy of psychotherapies for depression. The vast majority of findings from meta-analyses, randomized clinical trials (RCTs) and naturalistic studies have demonstrated that well-established psychotherapies (behavioural activation, problem-solving therapy, psychodynamic therapy, cognitive-behavioural therapy, interpersonal therapy and emotion-focused therapy) are superior to no-treatment and control conditions, and are in most cases equally effective in treating depression. However, despite this abundant support for psychotherapies, studies have also consistently shown high drop-out rates, high percentages of non-respondent patients who experience treatment failures, and mixed findings regarding the enduring effects of psychotherapy. Thus, there is a need to develop more personalised treatment models tailored to patients' needs. A new integrative sequential stepwise approach to the treatment of depression is suggested.
Although schizophrenia (SCZ) and bipolar disorder (BD) share elements of pathology (Ellison-Wright and Bullmore, 2009), the neural mechanisms underlying these disorders are still under investigation. Up until now, many neuroimaging studies investigated the brain structural differences of SCZ and BD compared with healthy controls (HC), trying to identify the possible neuroanatomical markers for the two disorders. However, just a few studies focused on the brain structural changes between the two diagnoses. The present review summarises the findings of the voxel-based grey matter (GM) comparisons between SCZ and BD, with the objective to highlight the possible consistent anatomical differences between the two disorders. While the comparisons between patients and HC highlighted overlapping areas of GM reduction in insula and anterior cingulate cortex, the SCZ–BD comparisons suggest the presence of more generalised GM deficits in SCZ compared with BD. Indeed, in a number of studies, SCZ patients showed lower GM volumes than BD patients in fronto-temporal cortex, thalamus, hippocampus and amygdala. Conversely, only a couple of studies reported GM deficits in BD compared with SCZ, both at the level of cerebellum. In summary, the two disorders exhibit both common and specific neuroanatomical characteristics, whose knowledge is mandatory to develop innovative diagnostic and treatment strategies.
To update and expand on a 2012 systematic review of the prevalence and risk of violence and the prevalence and risk of physical, mental and sexual health problems among trafficked people.
Systematic review and meta-analysis. Searches of 15 electronic databases of peer-reviewed articles and doctoral theses were supplemented by reference screening, citation tracking of included articles and expert recommendations. Studies were included if they reported on the prevalence or risk of violence while trafficked, or the prevalence or risk of physical, mental or sexual health outcomes among people who have been trafficked. Two reviewers independently screened papers for eligibility and appraised the quality of included studies.
Thirty-seven papers reporting on 31 studies were identified. The majority of studies were conducted in low and middle-income countries with women and girls trafficked into the sex industry. There is limited but emerging evidence on the health of trafficked men and the health consequences of trafficking into different forms of exploitation. Studies indicate that trafficked women, men and children experience high levels of violence and report significant levels of physical health symptoms, including headaches, stomach pain and back pain. Most commonly reported mental health problems include depression, anxiety and post-traumatic stress disorder. Although serological data on sexually transmitted infections are limited, women and girls trafficked for sexual exploitation self-report symptoms suggestive of a high prevalence of infections. Limitations of the review include methodological weaknesses of primary studies and some differences in definition and operationalisation of trafficking, which hinder comparability and generalisability of the results.
There is increasing evidence human trafficking is associated with high prevalence and increased risk of violence and a range of physical and mental health problems. Although more studies have emerged in recent years reporting on the health of trafficked men and people trafficked for forms of exploitation other than in the sex industry, further research is needed in this area. Appropriate interventions and support services to address the multiple and serious medical needs, especially mental health, of trafficked people are urgently needed.
This study examines relationships between childhood adversity and the presence of characteristic symptoms of schizophrenia. It was hypothesised that total adversity exposures would be significantly higher in individuals exhibiting these symptoms relative to patients without. Recent proposals that differential associations exist between specific psychotic symptoms and specific adversities was also tested, namely: sexual abuse and hallucinations, physical abuse and delusions, and fostering/adoption and delusions.
Data were collected through auditing 251 randomly selected medical records, drawn from adult patients in New Zealand community mental health centres. Information was extracted on presence and subtype of psychotic symptoms and exposure to ten types of childhood adversity, including five types of abuse and neglect.
Adversity exposure was significantly higher in patients experiencing hallucinations in general, voice hearing, command hallucinations, visions, delusions in general, paranoid delusions and negative symptoms than in patients without these symptoms. There was no difference in adversity exposure in patients with and without tactile/olfactory hallucinations, grandiose delusions or thought disorder. Indication of a dose–response relationship was detected, in that total number of adversities significantly predicted total number of psychotic symptoms. Although fostering/adoption was associated with paranoid delusions, the hypothesised specificity between sexual abuse and hallucinations, and physical abuse and delusions, was not found. The two adversities showing the largest number of associations with psychotic symptoms were poverty and being fostered/adopted.
The current data are consistent with a model of global and cumulative adversity, in which multiple exposures may intensify psychosis risk beyond the impact of single events. Implications for clinical intervention are discussed.
To compare trends in the estimated prevalence of mood and/or anxiety disorders identified from two data sources (self-report and administrative). Reviewing, synthesising and interpreting data from these two sources will help identify potential factors that underlie the observed estimates and inform public health action.
We used self-reported, diagnosed mood and/or anxiety disorder cases from the Canadian Community Health Survey (CCHS) across a 5-year span (from 2003 to 2009) to estimate the prevalence among the Canadian population aged ≥15 years. We also estimated the prevalence of mood and/or anxiety disorders using the Canadian Chronic Disease Surveillance System (CCDSS), which identified cases using ICD-9/-10-CA codes from physician billing claims and hospital discharge records during the same time period. The prevalence rates for mood and/or anxiety disorders were compared across the CCHS and CCDSS by age and sex for all available years of data from 2003 to 2009. Summary rates were age-standardised to the Canadian population as of 1 October 1991.
In 2009, the prevalence of mood and/or anxiety disorders was 9.4% using self-reported data v. 11.3% using administrative data. Prevalence rates obtained from administrative data were consistently higher than those from self-report for both men and women. However, due to an increase in the prevalence of self-reported cases, these differences decreased over time (rate ratios for both sexes: 1.6–1.2). Prevalence estimates were consistently higher among females compared with males irrespective of data source. While differences in the prevalence estimates between the two data sources were evident across all age groups, the reduction of these differences was greater among adolescent, young and middle-aged adults compared with those 70 years and older.
The overall narrowing of differences over time reflects a convergence of information regarding the prevalence of mood and/or anxiety disorders trends between self-report and administrative data sources. While the administrative data-based prevalences remained relatively stable, the self-reported prevalences increased over time. These observations may reflect positive societal changes in the perceptions of mental health (declining stigma) and/or increasing mental health literacy. Additional research using non-ecological data is required to further our understanding of the observed findings and trends, including a data linkage exercise permitting a comparison of prevalence estimates and population characteristics from these two data sources both separately and merged.
Little is understood about of the role of coping strategies in psychological well-being (PWB) and distress for the general population and different physical and psychiatric disease groups. A thorough examination of these relationships may provide evidence for the implementation of public mental health promotion and psychiatric disease prevention strategies aimed at improving the use of positive coping approaches or addressing the causes and maintainers of distress. The present study using a structural equation modelling (SEM) approach and nationally representative data on the Canadian population investigates the relationships among PWB, distress and coping strategies and identifies major factors related to PWB for both the general population and diverse-specific disease groups.
Data examined were from the Canadian Community Health Survey of Mental Health and Well-being (CCHS 1.2), a large national survey (n = 36 984). We applied exploratory factor analysis (EFA), confirmatory factor analysis and SEM to build structural relationships among PWB, distress and coping strategies in the general population.
Both SEM measurement and structure models provided a good fit. Distress was positively related to negative coping and negatively related to positive coping. Positive coping indicated a higher level of PWB, whereas negative coping was associated with a lower level of PWB. PWB was negatively related to distress. These same relationships were also found in the population subgroups. For the population with diseases (both physical and psychiatric diseases, except agoraphobia), distress was the more important factor determining subjective PWB than the person's coping strategies, whereas, negative coping had a major impact on distress in the general population. Strengths and limitations were also discussed.
Our findings have practical implications for public psychiatric disease intervention and mental health promotion. As previously noted positive/adaptive coping increased the level of PWB, whereas negative/maladaptive coping was positively related to distress and negatively related to PWB. Distress decreased the level of PWB. Our findings identified major correlates of PWB in both the general population and population subgroups. Our results provide evidence for the differential use of intervention tactics among different target audiences. In order to improve the mental health of the general population public mental health promotion should focus on strategies that reduce negative coping at a population level, whereas clinicians treating individual clients should make the reduction of distress their primary target to maintain or improve patients' PWB.
An increased mortality risk associated with mental disorder has been reported for patients, but there are few studies are based on random samples with interview-based psychiatric diagnoses. Part of the increased mortality for those with mental disorder may be attributable to worse somatic health or hazardous health behaviour – consequences of the disorder – but somatic health information is commonly lacking in psychiatric samples. This study aims to examine long-term mortality risk for psychiatric diagnoses in a general population sample and to assess mediation by somatic ill health and hazardous health behaviour.
We used a double-phase stratified random sample of individuals aged 18–65 in Stockholm County 1970–1971 linked to vital records. First phase sample was 32 186 individuals screened with postal questionnaire and second phase was 1896 individuals (920 men and 976 women) that participated in a full-day examination (participation rate 88%). Baseline examination included both a semi-structured interview with a psychiatrist, with mental disorders set according to the 8th version of the International Classification of Disease (ICD-8), and clinical somatic examination, including measures of body composition (BMI), hypertension, fasting blood glucose, pulmonary function and self-reported tobacco smoking. Information on vital status was obtained from the Total Population Register for the years 1970–2011. Associations with mortality were studied with Cox proportional hazard analyses.
A total of 883 deaths occurred among the participants during the 41-year follow-up. Increased mortality rates were found for ICD-8 functional psychoses (hazard ratio, HR = 2.22, 95% confidence interval (95% CI): 1.15–4.30); psycho-organic symptoms (HR = 1.94, 95% CI: 1.31–2.87); depressive neuroses (HR = 1.71, 95% CI: 1.23–2.39); alcohol use disorder (HR = 1.91, 95% CI: 1.40–2.61); drug dependence (HR = 3.71, 95% CI: 1.80–7.65) and psychopathy (HR = 2.88, 95% CI: 1.02–8.16). Non-participants (n = 349) had mortality rates similar to participants (HR = 0.98, 95% CI: 0.81–1.18). In subgroup analyses of those with psychoses, depression or alcohol use disorder, adjusting for the potential mediators smoking and pulmonary function, showed only slight changes in the HRs.
This study confirms the increased risk of mortality for several psychiatric diagnoses in follow-up studies on American, Finnish and Swedish population-based samples. Only a small part of the increased mortality hazard was attributable to differences in somatic health or hazardous health behaviour measured at baseline.
Understanding the time-course of post-traumatic stress disorder (PTSD), and the underlying events, may help to identify those most at risk, and anticipate the number of individuals likely to be diagnosed after exposure to traumatic events.
Data from two health surveys were combined to create a cohort of 1119 Australian military personnel who deployed to the Middle East between 2000 and 2009. Changes in PTSD Checklist Civilian Version (PCL-C) scores and the reporting of stressful events between the two self-reported surveys were assessed. Logistic regression was used to examine the association between the number of stressful events reported and PTSD symptoms, and assess whether those who reported new stressful events between the two surveys, were also more likely to report older events. We also assessed, using linear regression, whether higher scores on the Kessler Psychological Distress Scale or the Alcohol Use Disorder Identification Test were associated with subsequent increases in the PCL-C in those who had experienced a stressful event, but who initially had few PTSD symptoms.
Overall, the mean PCL-C scores in the two surveys were similar, and 78% of responders stayed in the same PCL-C category. Only a small percentage moved from having few symptoms of PTSD (PCL-C < 30) in Survey 1 to meeting the criteria for PTSD (PCL-C ≥ 50) at Survey 2 (1% of all responders, 16% of those with PCL-C ≥ 50 at Survey 2). Personnel who reported more stressful lifetime events were more likely to score higher on the PCL-C. Only 51% reported the same stressful event on both surveys. People who reported events occurring between the two surveys were more likely to record events from before the first survey which they had not previously mentioned (OR 1.48, 95% CI (1.17, 1.88), p < 0.001), than those who did not. In people who initially had few PTSD symptoms, a higher level of psychological distress, was significantly associated with higher PCL-C scores a few years later.
The reporting of stressful events varied over time indicating that while the impact of some stressors endure, others may increase or decline in importance. When screening for PTSD, it is important to consider both traumatic experiences on deployment and other stressful life events, as well as other mental health problems among military personnel, even if individuals do not exhibit symptoms of PTSD on an initial assessment.