BACKGROUND AND AIMS:There has been a resurgence of interest in using psilocybin to treat various mental health conditions. Although some adults in the United States (US) are using psilocybin, little is known about the epidemiology of its use, especially for microdosing (i.e., taking a fraction of a regular dose). This study aimed to present nationally representative survey results about people who microdose psilocybin in the US. METHODS:A probability-based and nationally representative survey of individuals living in the US was fielded from December 2023 to January 2024. A population estimate of how many US adults have microdosed, recency of microdosing, and intentions for microdosing was calculated using sample weights designed to produce national estimates. Multinomial logit models were used to identify predictors of microdosing status across demographic characteristics. RESULTS:Of 4253 respondents who completed the screener, 554 reported using psilocybin in their lifetime. Among the 12.1% of US adults who used psilocybin in their lifetime, 26.5% (95% Confidence Interval [CI]: 21.5-32.1%) reported they microdosed the last time they used, 57.5% (95% CI: 51.5-63.2) reported they did not microdose, and 14.6% (95% CI: 10.8-19.5) did not know or were unsure. Among the 3.1% of adults who used psilocybin in the past year, 46.9% (95% CI: 35.3-58.8) reported they microdosed the last time they used, 45.6% (95% CI: 34.2-57.5) reported they did not microdose, and 6.1% (95% CI: 2.8-12.8) did not know or were unsure. Compared with those who did not microdose the last time they used psilocybin, those who did were 12 percentage points (p = 0.002) more likely to have used psilocybin for improved physical health and 25 percentage points (p < 0.001) more likely to have used for improved mental health (including to address substance use disorders). Those who microdosed were also 27 percentage points (p < 0.001) less likely to report using psilocybin for fun or pleasure than those who did not microdose at last use. Individuals who used psilocybin more recently (in the past year) were 25 percentage points (standard error: 0.07; p < 0.001) more likely to report microdosing than those who used more than a year ago. CONCLUSIONS:At least 8.4 million US adults have microdosed psilocybin in their lifetime. Those who have used psilocybin within the past year are more likely to report microdosing the last time they used than those who have used psilocybin more than one year ago; however, approximately 15% respondents who used psilocybin in their lifetime were unsure whether they microdosed the last time they used. Improving physical and mental health are the top motivations for self-reported microdosing among US adults.

Faced with increasing suicide rates in the U.S. Army, efforts are underway to bolster noncommissioned officer (NCO) training as suicide prevention gatekeepers and also to support upstream prevention efforts more generally. This qualitative study examined the literature on best practices for non-clinical suicide prevention and training in the skills necessary to have difficult conversations to identify and address suicide risk factors (e.g. financial and relationship issues, mental health and substance use). We reviewed the empirical literature and conducted structured interviews with key Army leaders, trainers, and NCOs about the current Army training efforts. Interviews revealed multiple enhancements to training being made that are in line with best practices, but some gaps were noted as well. Based on our findings, we recommend that the Army increase the availability of training in how to have difficult conversations (especially "soft skills"), enhance support for skills-building after trainings occur through coaching, mentoring, and performance feedback, clarify that this type of soldier support is part of the NCO role, and more strongly promote the concept that soldier well-being is key to a ready and resilient force.

Purpose The Survey of Trauma, Resilience and Opportunity among Neighbourhoods in the Gulf (STRONG) is a longitudinal study assessing disaster exposures and outcomes of adults living along the US Gulf Coast. Initially conceived to examine effects of the Deepwater Horizon oil spill, five follow-up surveys have explored impacts of hurricanes and COVID-19.Participants A total of 2520 adults completed the baseline survey in 2016. Compared with the region, survey respondents were older, more likely to be female and less likely to be Hispanic.Findings to date As a longitudinal disaster cohort, STRONG provides a unique opportunity to examine disaster impacts. Research using STRONG data has explored how a wide range of disaster exposures are associated with behavioural health. Consistent with other disaster research, analyses with STRONG data suggest that resource loss is linked with worse behavioural health.

PURPOSE:Inhalant use, including "poppers" (e.g., alkyl nitrites), remains disproportionately common among sexual minority adults, yet national data on recent use patterns and behavioral health correlates are limited. METHODS:We analyzed nationally representative 2021-2023 National Survey on Drug Use and Health data, estimating prevalence of lifetime, past-year, and past-month inhalant use by sexual identity, sex, and age. Among sexual minority adults, we examined age-specific patterns and identified correlates of past-year use among gay males, bisexual males, and bisexual females (lesbian/gay female users excluded due to small sample size). RESULTS:Lifetime inhalant use was highest among gay males (39.4%) and bisexual males (28.9%), compared to 10.8% of heterosexual males and 5.8% of heterosexual females. Past-year inhalant use was reported by 10.8% of gay males, 5.1% of bisexual males, and 2.1% of bisexual females (<1% among heterosexual adults). Among sexual minority adults, age patterns of use diverged: prevalence was highest among middle-aged gay and bisexual males but was concentrated among younger bisexual females. Among past-year users, bisexual females were disproportionately young, socioeconomically disadvantaged, and had higher polysubstance use relative to gay and bisexual males. Multivariable models confirmed subgroup-specific correlates: cocaine and methamphetamine use and higher income among gay males; prescription stimulants and higher income among bisexual males; and polysubstance use and younger ages among bisexual females. CONCLUSIONS:While inhalant use remains concentrated among sexual minority males, bisexual females represent an understudied group with elevated use and distinct risk profiles, including polysubstance use.

Importance The 988 Suicide & Crisis Lifeline (998 Lifeline) receives millions of contacts annually. Adequate staffing of 988 Lifeline centers may be important for timely, high-quality service, but little information exists on current staffing levels or difficulties. Objectives To describe 988 Lifeline center staffing and assess staffing-related difficulties. Design, Setting, and Participants In this cross-sectional study, a survey was fielded between May 6 and July 25, 2025, to all 206 centers in the 988 Lifeline network in the US and territories. Eligible respondents were individuals in leadership positions (eg, executive directors, vice presidents). Main Outcomes and Measures The survey measured staffing levels, shift coverage, modalities (telephone, text, and/or chat), operation of non-988 lines (eg, 211, local lines), proportions of paid and volunteer staff, remote and/or in-person work arrangements, and 4 domains of staffing difficulty: adequate staffing for the volume of contacts, acquiring funding to hire, recruiting staff, and retaining staff. Responses were linked with administrative data on location, presence of state 988 telecommunications fees, and subnetwork services (eg, national backup, Spanish language). Results Leaders at 159 of the 206 centers completed the survey (77% response rate), 71% (102 of 144) reported that their center was understaffed, and 89% (141 of 159) indicated difficulty acquiring resources to hire. Leaders at centers offering remote work reported greater difficulty in obtaining these resources compared with centers without remote work (94% [89 of 95] vs 81% [50 of 62]; odds ratio [OR], 3.40; 95% CI, 1.21-9.68; P = .02) but less difficulty recruiting staff (76% [72 of 95] vs 89% [55 of 62]; OR, 0.39; 95% CI, 0.14-0.98; P = .04). Respondents from centers with all paid staff reported greater difficulty recruiting compared with centers using at least some volunteers (86% [102 of 118] vs 66% [27 of 41]; OR, 3.28; 95% CI, 1.42-7.60; P = .006). Leaders at centers handling only 988 contacts reported less difficulty retaining staff than those also handling non-988 lines (63% [17 of 27] vs 83% [109 of 132]; OR, 0.36; 95% CI, 0.14-0.92; P = .03). Wide 95% CIs indicate uncertainty in the magnitude of these results. Conclusions and Relevance In this cross-sectional survey study of 988 Lifeline leaders, results suggested that most centers struggled to find resources to keep the center fully staffed. If staffing challenges persist, centers could face risks to staff well-being and service quality. Financing and operational strategies that support recruitment and retention will be critical to sustaining the quality and accessibility of 988 Lifeline centers.

Housing cost burden (HCB), the share of a household's income dedicated to housing and related expenses, is a useful metric for understanding housing insecurity trends. The share of veteran households experiencing HCB-a spending ratio greater than 30 or 50 percent on housing needs-is considerably less than that of nonveterans, potentially because of the additional income veterans receive as compensation for their service, such as disability compensation, pensions, and so on. Research on HCB typically considers an aggregated measure of household income from all sources. This article uses the Survey of Income and Program Participation to understand how the share of households experiencing HCB differs when considering different income streams-for example, HCB relative to private income only, HCB relative to private income plus benefits from the U.S. Department of Veterans Affairs (VA), and so on. Including income from VA benefits, especially VA disability compensation, in the HCB calculation contributes drastically to housing security for veteran households. Adding income for non-VA public sources, such as Social Security benefits, provides additional housing security. These results highlight the importance of VA benefits and other nonwage income in combating housing insecurity for veteran households that depend on these benefits

Objective : To understand how 988 Lifeline centers are connected to the broader crisis care continuum—including 911, mobile crisis response, and community-based services. Methods : The authors conducted a cross-sectional survey of 988 Lifeline centers in the U.S. between May and July 2025. A total of 159 centers (78%) completed the survey, which assessed transfer to/from 911, coordination with mobile crisis teams, capacity for referrals, and tracking dispositions and outcomes. Exploratory bivariate analyses were conducted to understand the factors associated with transfers to/from 911 and mobile crisis response team dispatch capability. Results : Approximately 45% of centers reported bidirectional interoperability with 911. Among the 153 centers with a mobile crisis response team in their service region, 61% could dispatch the team directly. Exploratory bivariate analysis indicated that centers had higher odds of interoperating with 911 when mobile crisis services were present throughout their jurisdiction (OR = 2.10 [1.06, 4.20]) and could schedule appointments on callers’ behalf (OR = 2.88 [1.39, 6.23]). Conclusions : Variation remains in centers’ ability to interoperate with 911 and dispatch mobile crisis teams. Centers with these capabilities were associated with having multiple referral, dispatch, and coordination capacities. Improving integration between 988 and other crisis services requires strengthened partnerships, sustainable funding, and investments in technology and data-sharing infrastructure.

Preventing veteran suicide is a national priority for government, veteran advocacy groups, and the private sector. This attention has led many individuals and organizations to leverage their expertise to create, expand, or promote activities that they hope will prevent future deaths. While the number and array of diverse approaches reflect a nation committed to a common goal, they also can create confusion. Advances in technology also generate questions about the future of veteran suicide prevention. In this study, the authors analyze current and emerging activities to prevent veteran suicide. They introduce the RAND Suicide Prevention Activity Matrix, a framework that organizes current approaches, how they complement each other, how they might change, their evidence for preventing veteran suicide, and why they might (or might not) work. This framework places 26 categories of activities in a matrix based on whom the activity targets (the veteran directly, those who regularly interact with the veteran, or social influences) and what the activity is intended to accomplish (address social conditions, promote general well-being, address mental health symptoms, provide mental health supports, and prevent suicide crises). Entities committed to preventing veteran suicide and seeking to design evidence-informed, comprehensive suicide prevention strategies will benefit from the framework and evidence reviewed in this study, in addition to the recommendations the authors developed from these data.

The goal of this study was to examine the factors associated with Army noncommissioned officer (NCO) experiences, attitudes, and behaviors in their role of identifying potential suicide risk factors in their fellow soldiers. To better understand the perspectives of NCOs, an anonymous survey was administered to 2,468 Army NCOs. Descriptive statistics and linear regressions were conducted to compare subgroups of NCOs. Most (71%) Army NCOs have received many (11 or more) hours of suicide prevention training, but training in soft skills that may be important for the gatekeeper role was less consistently reported. Active Component soldiers reported greater confidence in their intervention skills (Cohen's d = 0.25) and fewer logistical barriers (e.g., time and space to talk) to intervening with at-risk soldiers (Cohen's d = 0.80) compared to Reserve and National Guard soldiers. Formal coursework in mental health areas like psychology or chaplaincy was associated with a greater level of confidence in intervention skills (Cohen's d = 0.23) and in more frequent intervention behavior (Cohen's d = 0.13). Army NCO trainings should be modified to better equip soldiers with the soft skills (e.g., active listening skills and verbally and nonverbally conveying nonjudgment/acceptance and empathy) needed to have effective conversations with soldiers about suicide risk factors and other sensitive topics. Strategies used within mental health education, which appears to be a strength for NCO gatekeepers, could be used to achieve this goal. Reserve and Guard NCOs may need additional supports and tailored trainings to better fit their operational context.

Do Americans see veterans as particularly deserving or simply as other members of their community? From a nationally representative survey fielded between June and September 2021 with over 2,000 respondents, we find that Americans state high levels of support for veterans and are willing to pay additional tax dollars to provide assistance programs. We find that most Americans support free health care, free college, and affordable housing for all Americans, and the support is notably stronger for programs for veterans. From a discrete choice experiment, we find that Americans are willing to pay hundreds of dollars in additional taxes to provide assistance programs to either veterans or to all community members, and Americans are willing to pay significantly more for certain programs for veterans. In addition, we look at differences in willingness to pay based on military and political affiliation and find significant differences in willingness to pay by political affiliation.

RAND researchers present findings from the qualitative arm of the America's Military and Veteran Caregivers: Hidden Heroes Emerging from the Shadows research project, sharing insights from interviews with U.S. military and veteran caregivers. Thirty-eight qualitative interviews were conducted between December 2023 and February 2024. In the interviewed caregivers' own words, they provided rich descriptions of their experiences, complementing the main study's survey findings with illustrative anecdotes that deepen our understanding of the challenges and joys of caregiving and elucidate opportunities to improve supportive services. Caregivers highlighted aiding care recipients with a broad array of activities of daily living and instrumental activities of daily living, often leveraging a variety of informal and formal supports. They often faced challenges, such as balancing caregiving with other priorities and commitments; managing care recipients' health-related conditions and needs; financial, emotional, and physical struggles; and difficulty accessing respite and navigating health care systems. Caregivers reflected on their identities, highlighting ways in which they are similar to and different from other caregivers; they generally said that they found caregiving to be rewarding. They also discussed the economic impacts of caregiving and pointed to opportunities for organizations to improve outreach and provision of services.

IntroductionRates of suicide in the Active Component of the military have significantly increased since 2010, with particularly high rates among Army service members. One element of the Army's approach to suicide prevention relies on noncommissioned officers (NCOs) as gatekeepers who have regular contact with soldiers. NCOs receive suicide prevention training, but there is limited evidence that such training leads to behavior change.MethodsWe surveyed 2468 Army NCOs participating in leadership development courses to determine (a) if training on suicide prevention and soft skills (e.g., active listening) was associated with gatekeeper behavior and use of soft skills; and (b) whether that association was explained by two potential barriers, stigma and perceptions of efficacy.ResultsBoth the number of suicide prevention training topics and soft skills trained were associated with increased gatekeeper behavior; these relationships were explained in part by lower stigma and higher efficacy for use of soft skills. The use of interactive training methods and receiving coaching after training were not associated with stigma or efficacy, though both methods were associated with more frequent use of soft skills.ConclusionResults suggest that the content and format of training is important to preparing NCOs to fulfill a gatekeeper role.

The authors produced new estimates of the number of adults caregiving in the United States today; investigated how those caring for wounded, ill, and injured service members and veterans compare with those caring for civilians and with non-caregivers; and share insights on the potential consequences of caregiving on caregiversapos health, their economic security, and their families' well-being. They also propose recommendations to strengthen caregiver support. The information in this study is derived from two sources. RAND researchers administered the 2023 RAND Caregiving Survey. The final analytic sample size was 2,946 respondents, including 513 military and veteran caregivers, and, for comparison, 1,205 civilian caregivers and 1,228 non-caregivers. RAND researchers also administered the 2022 RAND Veterans Survey, a survey of 1,100 veterans residing in the United States. There are 14.3 million military and veteran caregivers, representing 5.5 percent of the U.S. adult population. There are an additional 91.3 million civilian caregivers (35.0 percent of U.S. adults) caring for wounded, ill, or injured civilian adults. Across all caregivers, most (78 to 81 percent) spend between one and 30 hours per week providing care. Under 10 percent spend less than one hour per week, and 11 to 16 percent spend 31 hours or more per week caregiving. The estimated aggregate economic value generated by military/veteran caregiving activities, which are largely uncompensated, ranges from $119 billion to $485 billion per year. Military/veteran caregivers incur an estimated $8,583 in annual out-of-pocket costs associated with their caregiving responsibilities. Military/veteran caregivers forgo an estimated $4,522 in annual household income.

OBJECTIVE:This study estimated mental health service use among lesbian, gay, and bisexual (LGB) adults in the United States who reported having made a suicide attempt.METHODS:Data came from the pooled 2015-2019 National Surveys on Drug Use and Health. Of the 191,954 adult respondents, 1,946 reported a past-year suicide attempt. Survey-weighted descriptive and regression analyses were conducted to compare mental health service use among LGB and heterosexual adults.RESULTS:Three percent of LGB adults (N=598) reported having attempted suicide in the past year, compared with 0.5% of heterosexual adults (N=1,348). Mental health treatment use was significantly higher among LGB adults than among heterosexual adults (64% versus 56%) before analyses were adjusted for sociodemographic characteristics.CONCLUSIONS:Because suicide attempts and mental health use are elevated among LGB adults, clinicians must provide evidence-based approaches for identifying and managing suicide risk to LGB adults in an affirming manner.

The U.S. Army has a long history of preventing, detecting, and treating infectious diseases. Like other organizations and agencies involved in public health, the Army is increasingly interested in syndromic surveillance strategies-those designed to identify outbreaks before clinical data are available. Researchers use various methods to identify surveillance strategies across the globe, investigate these strategies' benefits and limitations, and recommend actions to aid the Army in their efforts to detect emerging epidemics and pandemics.

The U.S. DoD has identified firearm suicide prevention as a key operational priority. One vital approach to addressing firearm suicides is through promoting lethal means safety, which involves the voluntary use of secure storage for personally owned firearms and/or temporarily moving firearms out of the home during risk periods. Despite promising approaches to lethal means safety, critical gaps remain in research, programming, and communication among and across scientists, DoD programmatic leaders, front-line commanders, and service members. To address these gaps, the first-ever national "Firearm Suicide Prevention in the Military: Messaging and Interventions Summit" was convened in June 2022, bringing together DoD personnel and researchers with expertise in firearm suicide prevention and lethal means safety. The Summit identified 10 recommendations to enhance firearm suicide prevention messaging and interventions in the U.S. military, including (1) repeal or amend prohibitions on questioning service members about personal firearms; (2) develop, examine, and use common language for firearm injury prevention; (3) implement a universal approach to training on comprehensive firearm injury prevention; (4) encourage leadership across disciplines and levels; (5) aim for broad culture change; (6) support innovative research; (7) consider various outcome measures; (8) promote "cultural competence" for better communication; (9) reduce territorialism; and (10) develop creative partnerships. Ultimately, these recommendations can facilitate productive partnerships with a shared goal: to develop, test, and implement strategies that standardize lethal means safety and reduce firearm suicides and other firearm injuries or harm among service members.

Purpose: The study objective was to compare use of 12 specific inhalants among lesbian, gay, and bisexual (LGB) adults relative to heterosexual adults among a national sample. Methods: Data on 210,392 adults, including 15,007 LGB adults, were from the 2015 to 2019 National Survey on Drug Use and Health. For each inhalant type, logistic regression was used to characterize differences by sexual identity and gender. Unadjusted and demographic adjusted odds ratios are reported. Results: All LGB groups exhibited elevated use of multiple inhalant types (ranging from 5 for gay males to 12 for bisexual females). The largest disparities were for poppers among gay and bisexual males. Gay and bisexual males initiated use at older ages. Conclusion: Observed disparities among LGB adults included inhalants used in a sexual or club context (e.g., poppers) as well as types with particularly elevated fatality risk (e.g., butane, propane, aerosol sprays, and nitrous oxide).

INTRODUCTION:Rates of substance use and mental health conditions vary across military service branches, yet branches also differ notably in terms of demographics and deployment experiences. This study examines whether branch differences in substance use and mental health outcomes persist after adjustment for a comprehensive set of demographic and deployment-related factors. METHODS:Data on 16,699 Armed Forces Active Duty service members were from the 2015 Department of Defense Health Related Behaviors Survey. Service branch-specific prevalences were estimated for self-reports of heavy episodic drinking (HED), possible alcohol use disorder (AUD), current smoking, e-cigarette use, smokeless tobacco use, prescription drug misuse, probable post-traumatic stress disorder (PTSD), probable depression, and probable anxiety. Using logistic regression, we assessed whether branch differences persisted after adjusting for an extensive array of demographic factors (among full sample) and deployment/combat factors (among ever-deployed subgroup). RESULTS:HED, AUD, smoking, e-cigarette use, smokeless tobacco use, depression, and anxiety were highest in the Marine Corps; prescription drug misuse and PTSD were highest in the Army. HED, AUD, smoking, smokeless tobacco use, PTSD, depression, and anxiety were lowest in the Air Force; e-cigarette use and prescription drug misuse were lowest in the Coast Guard. Demographics and deployment/combat experiences differed across branches. After adjustment, service members in the Army, Marine Corps and Navy exhibited nearly 2-3 times the odds of multiple mental health conditions and substance use behaviors relative to the Air Force. CONCLUSION:Service branch differences were not fully explained by variation in demographics and deployment/combat experiences.

Background: Compared to heterosexual adults, lesbian, gay, and bisexual (LGB) adults have higher rates of any illicit drug use and any prescription drug misuse, yet disparities regarding specific drugs remain poorly characterized. Methods: We examined disparities by sexual identity and sex for 8 illicit and prescription drugs using 2015-2019 National Survey on Drug Use and Health data. Outcomes included past-year use/misuse of cocaine/crack, hallucinogens, inhalants, methamphetamine, heroin, prescription opioids, prescription stimulants, prescription tranquilizers/sedatives, and level of polydrug use/misuse (2 substances; 3+ substances). For each outcome, odds ratios relative to heterosexual adults of same sex were estimated using logistic regression controlling for demographics; significant estimates were interpreted as a disparity. Results: Among gay men, significant disparities were present for all drugs except prescription stimulants and heroin; inhalant use was particularly elevated. Bisexual women exhibited significant disparities for every drug examined, as did bisexual men (except heroin). Among lesbian/gay women, disparities were only present for prescription opioids and stimulants. Relative to heterosexual peers, use of 3+ substances was 3 times higher among gay men and bisexual women and 2 times higher among bisexual men. Conclusions: Consistent with minority stress theory, prevalences of illicit and prescription drug use/misuse were 2-3 times higher among LGB adults than heterosexual adults. Illicit drug use should not be perceived as only impacting gay/bisexual men - bisexual women had similar - or higher - prevalences of hallucinogen, cocaine, methamphetamine, and heroin use. Yet, in contrast to bisexual women, lesbian/gay women did not exhibit disparities for any illicit drugs.

Introduction: Lesbian, gay, and bisexual individuals have elevated suicide risk, but there is little information available about how this risk may vary by gender, age, and race/ethnicity. Methods: This study examined past-year suicide thoughts, plans, and attempts among adult respondents to the 2015-2019 National Surveys on Drug Use and Health (pooled N=191,954). Logistic regression was used to examine the differences between lesbian, gay, and bisexual and heterosexual adults for each outcome, once by gender and age category and once by gender and race/ ethnicity category, while controlling for core sociodemographic characteristics. Race/ethnicity and age differences were also estimated within sexual identity groups. Results: Suicide thoughts, plans, and attempts were more common among lesbian, gay, and bisexual adults in almost every age and race/ethnicity category relative to that among corresponding heterosexual adults. In some age and race/ethnicity categories, bisexual women were more likely to report suicidal thoughts than lesbian/gay women. Each outcome decreased significantly across age groups among women of all sexual identity groups and heterosexual men; yet, this age effect was less pronounced among gay and bisexual men. Black women had significantly lower rates of suicidal thoughts and plans than White women in all sexual identity groups. Conclusions: In light of consistently elevated rates of suicide thoughts and behaviors, lesbian, gay, and bisexual adults may expressly benefit from enhanced prevention, identification, and treatment of suicide risk. Additional research is needed to assess the associations between sexual identity and suicide mortality as well as to understand the heterogeneity in suicide risk among lesbian, gay, and bisexual youth, particularly by race/ethnicity.