Widespread collapse, glimpses of revival: a scoping review of mental health policy and service development in Central Asia

Historical evolution of healthcare systems of post-soviet Russia, Belarus, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan, Armenia, and Azerbaijan: A scoping review

This scoping review addresses the transformation and development of new healthcare systems in nine countries -Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Russia, Tajikistan, Turkmenistan, and Uzbekistan over the period following the collapse of the Soviet Union from 1991 to the present. This assessment focuses on maternal and child health, mental health, communicable diseases, and non-communicable diseases in an effort to highlight the changes in the healthcare status of these nine countries under scrutiny. Considering that all the post-Soviet nations are officially recognized members of the World Health Organization (WHO) and have demonstrated their commitment to attaining the WHO's objectives, the evaluation of healthcare system progress and improvement was carried out utilizing indicators provided by the WHO. This review reveals that the evolution of healthcare systems could be considered sustainable, given that average life expectancy has returned to the level it was in 1991- the year of the USSR's breakup, and people's health has improved since the turn of the twenty-first century. To enhance the potential success of future healthcare reforms, however, governments must monitor implementation of the reform process, evaluate the achievement of objectives, and make necessary adjustments. The success of future healthcare changes will depend on the active involvement of the government, medical community, and patient community, as well as obtaining the support of local health authorities. This study may help identify successful and failed strategies, guiding future healthcare changes and investments.

A scoping review of autism research conducted in Central Asia: Knowledge gaps and research priorities

LAY ABSTRACT

Very little is known about the status of autism research in Central Asia. Through the library databases, we identified and reviewed 11 scientific studies conducted with autistic people and their families in five Central Asian countries-Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. Of the 11 studies, 10 were conducted in Kazakhstan and 1 in Uzbekistan. Within these limited number of research studies, different topics such as diagnosis, risk factors of autism, biology, and various service and intervention areas were addressed. We identified several knowledge gaps and research priorities to address the needs of autistic people, their families, and professionals in Central Asia.

Impact of Mental Health Legislation on Public Interest and Awareness of Common Mental Disorders: Insights From an Infodemiological Study of Search Volumes From 2004 to 2021 in the Philippines

ABSTRACT

This study explored online public interest using search volumes for various mental disorders using an infodemiological design. Google Trends search volumes for schizophrenia, bipolar disorder, major depressive disorder, anxiety disorder, and substance abuse from January 2004 to December 2021 in the Philippines were described and compared. In addition, interrupted time series and mean comparisons were done to determine the impact of the Philippine Mental Health Act. Findings show that public interest was highest for major depressive disorder, followed by anxiety disorder, substance abuse, bipolar disorder, and schizophrenia. Among them, public interest in schizophrenia, major depressive disorder, bipolar disorder, and substance abuse improved following the Act's legislation. The uneven stigma of mental disorders and the incomplete implementation and unequal focus of Philippine mental health promotion programs can explain these findings. Thus, mental disorders with low public interest should be given attention in mental health awareness activities.

World Psychiatric Association-Asian Journal of Psychiatry Commission on Psychiatric Education in the 21st century

Psychiatric practice faces many challenges in the first quarter of 21st century. Society has transformed, as have training requirements and patient expectations, underlining an urgent need to look at educational programmes. Meanwhile, awareness has grown around psychiatric disorders and there are evolving workforce trends, with more women going to medical school and specialising in psychiatry. Trainee psychiatrists carry different expectations for work-life balance and are increasingly becoming conscious of their own mental health. A tendency to see health as a commodity and the litigious nature of society has elicited additional pressures for healthcare professionals. Cartesian mind-body dualism has created further complexity and this can often be frustrating for patients and care-partners alike. In many cultures across Asia and beyond, patients can present with physical symptoms to express underlying psychological distress with increasing physical investigations. Simultaneously, in various countries, a shift from asylums to community-based interventions and then home treatments have changed psychiatric care in remarkable ways. These changes have added to pressures faced by mental healthcare professionals. However, trainees and other mental healthcare professionals continue to receive similar training as they did a generation ago. The tensions and differences in ideology/orientation between different branches of psychiatry have made responses to patient needs challenging. Recognising that it is difficult to predict the future, this World Psychiatric Association-Asian Journal of Psychiatry Commission makes recommendations that could help institutions and individuals enhance psychiatric education. This Commission draws from existing resources and recent developments to propose a training framework for future psychiatrists.

Stigma towards mental illness in Asian nations and low-and-middle-income countries, and comparison with high-income countries: A literature review and practice implications

Background

Stigma related to mental illness (and its treatment) is prevalent worldwide. This stigma could be at the structural or organizational level, societal level (interpersonal stigma), and the individual level (internalized stigma). Vulnerable populations, for example, gender minorities, children, adolescents, and geriatric populations, are more prone to stigma. The magnitude of stigma and its negative influence is determined by socio-cultural factors and macro (mental health policies, programs) or micro-level factors (societal views, health sectors, or individuals' attitudes towards mentally ill persons). Mental health stigma is associated with more serious psychological problems among the victims, reduced access to mental health care, poor adherence to treatment, and unfavorable outcomes. Although various nationwide and well-established anti-stigma interventions/campaigns exist in high-income countries (HICs) with favorable outcomes, a comprehensive synthesis of literature from the Low- and Middle-Income Countries (LMICs), more so from the Asian continent is lacking. The lack of such literature impedes growth in stigma-related research, including developing anti-stigma interventions.

Aim

To synthesize the available mental health stigma literature from Asia and LMICs and compare them on the mental health stigma, anti-stigma interventions, and the effectiveness of such interventions from HICs.

Materials and Methods

PubMed and Google Scholar databases were screened using the following search terms: stigma, prejudice, discrimination, stereotype, perceived stigma, associate stigma (for Stigma), mental health, mental illness, mental disorder psychiatric* (for mental health), and low-and-middle-income countries, LMICs, High-income countries, and Asia, South Asian Association for Regional Cooperation/SAARC (for countries of interest). Bibliographic and grey literature were also performed to obtain the relevant records.

Results

The anti-stigma interventions in Asia nations and LMICs are generalized (vs. disorder specific), population-based (vs. specific groups, such as patients, caregivers, and health professionals), mostly educative (vs. contact-based or attitude and behavioral-based programs), and lacking in long-term effectiveness data. Government, international/national bodies, professional organizations, and mental health professionals can play a crucial in addressing mental health stigma.

Conclusion

There is a need for a multi-modal intervention and multi-sectoral coordination to mitigate the mental health stigma. Greater research (nationwide surveys, cultural determinants of stigma, culture-specific anti-stigma interventions) in this area is required.

Indirect social contact interventions to reduce mental health-related stigma in low- and middle-income countries: systematic review

AIMS

Mental health-related stigma and discrimination are a complex and widespread issue with negative effects on numerous aspects of life of people with lived experience of mental health conditions. Research shows that social contact is the best evidence-based intervention to reduce stigma. Within the context of a rapid development of remote technology, and COVID-19-related restrictions for face-to-face contact, the aim of this paper is to categorise, compare and define indirect social contact (ISC) interventions to reduce stigma and discrimination in mental health in low- and middle-income countries (LMICs).

METHODS

MEDLINE, Global Health, EMBASE, PsychINFO, Cochrane Central Register of Control Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a strategy including terms related to 'stigma and discrimination', 'intervention', 'indirect social contact', 'mental health' and 'low- and middle-income countries'. Relevant information on ISC interventions was extracted from the included articles, and a quality assessment was conducted. Emerging themes were coded using a thematic synthesis method, and a narrative synthesis was undertaken to present the results.

RESULTS

Nine studies were included in the review overall. One study was ineffective; this was not considered for the categorisation of interventions, and it was considered separately for the comparison of interventions. Of the eight effective studies included in synthesis, interventions were categorised by content, combination of stigma-reducing strategies, medium of delivery, delivery agents, target condition and population, as well as by active or passive interaction and follow-up. Most of the interventions used education and ISC. Recovery and personal experience were important content components as all studies included either one or both. Cultural adaptation and local relevance were also important considerations.

CONCLUSIONS

ISC interventions were effective in overall terms for both the general public and healthcare providers, including medical students. A new definition of ISC interventions in LMICs is proposed. More research and better reporting of intervention details are needed to explore the effectiveness of ISC strategies in LMICs, especially in regions where little relevant research has been conducted.

Googling "mental health" after mental health legislation and during the COVID-19 pandemic: an infodemiological study of public interest in mental health in the Philippines

BACKGROUND

Public interest in mental health in the Philippines can change after the Mental Health (MH) act approval and during the COVID-19 pandemic. To determine these changes, online searches in Google can be analyzed as an alternative measure.

AIMS

To determine the trends of public interest in mental health before and after the MH act approval and during the COVID-19 pandemic.

METHOD

Aggregated search volumes for mental health using the keyword, "Mental Health (Topic)" were gathered from Google Trends. Search volume indices (SVIs), and related queries were analyzed. SVIs from the different periods were compared using means, t test, ANOVA, and ARIMA.

RESULTS

Public interest in mental health increased after the MH Act approval and during the COVID-19 pandemic. The top and rising related queries revolved around mental health definitions, translations, factors, services, policy, adverse mental state, and its context during the pandemic.

CONCLUSIONS

These increased public interests may stem from aspirations for mental health after legislation and higher mental health needs during the pandemic. Related queries may indicate that the public may be using online information to search for mental health services and concepts. Thus, there is a need to improve reliable and trustworthy online mental health information and services.

Mental health services in Scandinavia and Eurasia: comparison of financing and provision

The aim of this study was to compare financial and human resources for mental health services in selected Scandinavian and Eurasian countries. A cross-sectional descriptive and analytical approach was adopted to analyse questionnaire data provided by members of the Ukraine-Norway-Armenia Partnership Project. We compared Scandinavia (Sweden and Norway) and Eurasia (Armenia, Georgia, Kyrgyzstan and Ukraine). Health expenditure in Eurasia was generally below 4% of gross domestic product, with the exception of Georgia (10.2%), compared with 11% in Scandinavia. Inpatient hospital care commonly exceeded 50% of the mental health budget. The central governments in Eurasia paid for over 50% of the health expenditure, compared to 2% in Scandinavia. The number of mental health personnel per head of population was much smaller in Eurasia than Scandinavia. Financial and human resources were limited in Eurasia and mainly concentrated on institutional services. Health activities were largely managed by central governments. Community-based mental healthcare was poorly implemented, compared to Scandinavia, especially for children and adolescents.

Outpatient Services for People with Mental Disorders in the Kyrgyz Republic: What Is Next?: Состояние внебольничной помощи в Кыргызстане: что дальше?

The outpatient care service for patients with mental disorders in the Kyrgyz Republic is currently experiencing various difficulties. These are largely due to a number of organizational and socio-economic problems at the state level. Treatment of patients with mental disorders is still provided in state mental health centres, while psychosocial services at the community level are only now beginning to be developed. This article describes the directions of mental health care, as well as ongoing efforts to provide outpatient care for people with mental disorders. The actions of a few prolific nongovernmental organizations (NGOs) are proving insufficient to meet the needs of patients. There is currently a gradual and visible movement toward the development of the private sector in the field of mental healthcare. In order to overcome organizational difficulties, support from government structures and certain initiatives to create legislative grounds are needed.

Effects of Social Capital and Leisure Participation on Self-Rated Health of Urban Residents in Southwest China

Background: Leisure provides opportunities for urban and rural residents to relax, recover their vitality, and improve their personal growth, development, and well-being. However, the impact of the leisure participation process, types, obstacles, participation motivation, and satisfaction on health is not very clear, especially the impact of leisure behavior on health, and is worthy of in-depth discussion.

Objective: The objective of this study was to explore the impact of social capital and leisure participation on the self-rated health of urban residents in China so as to provide an important reference for national health promotion activities.

Methods: the questionnaire on the relationship between social capital, leisure behavior, and self-rated health was compiled by ourselves. The residents participating in leisure and fitness in 25 residential fitness centers in Chengdu were investigated in the morning and evening, and the obtained data were processed by exploratory and confirmatory factor analysis.

Results: (1) Social capital had no direct influence on leisure hindrance; leisure motivation and leisure participation had no direct influence on self-rated health. (2) Leisure satisfaction has a direct positive impact on self-rated health, while leisure hindrance has a significant negative impact on self-rated health. (3) Social capital has a direct positive impact on leisure satisfaction, and social capital has a direct positive impact on self-rated health. Leisure satisfaction plays an intermediary role in the path of social capital affecting self-rated health, and the intermediary force exceeds the direct impact of social capital on self-rated health.

Conclusion: The effect of leisure satisfaction on self-rated health is higher than that of social capital, and it plays an intermediary role in the impact path of social capital on self-rated health. Therefore, how to make urban community residents with different backgrounds obtain leisure satisfaction through leisure activities is an important topic of national health promotion.

Mental health care in Eastern Europe and Central Asia: An analysis of needs and a call for greater investment

Over the past decade, there has been increased attention to global mental health, which emphasizes improving access to quality mental health care in order to reduce the worldwide treatment gap. However, Eastern European and Central Asian countries and their specific mental health needs have largely been under-emphasized, evidenced by a dearth in literature and funding. Here, we provide an overview of the mental health needs in Ukraine and its challenges with quality care provision as a key example in highlighting these gaps, then broaden our discussion to include parallels with other countries in the Eastern European and Central Asian region. We describe the unique strengths relative to mental health care provision that are present in Eastern Europe and Central Asia and suggest the importance of post-graduate training, regional collaboration, and capacity building specific to research management as strategies to address the current challenges. We stress that greater investment from funders, government, and the global mental health community are needed to improve the current mental health situation in Ukraine, specifically, and Eastern Europe and Central Asia, broadly. We argue that greater attention to Eastern Europe and Central Asia is needed to fully advance the agenda of the global mental health field.

Development of public stigma toward people with mental health problems in Czechia 2013-2019

Background

We aimed to assess the changes in public stigma towards people with mental health problems in Czechia; and to investigate the association between these and the exposure to the ongoing mental health care reform and one of its implementation projects focused on reducing stigma.

Methods

We analyzed data from three cross-sectional surveys representative of the Czech adult population. We used linear regression models to compare population attitudes and desire for future contact with people with mental health problems between the 2013/2014 baseline and the 2019 follow-up. In our 2019 sample, we employed linear regression models to assess the relationship between exposure to mental health care reform and nation-wide anti-stigma campaign, and population stigmatizing attitudes and intended behavior. We utilized a propensity score matching procedure to mitigate potential bias.

Results

The 2013, 2014, and 2019 datasets consisted of 1797, 1810, and 1077 participants, respectively. Population attitudes improved significantly between 2014 and 2019 (B = 0.99, 95% CI = 0.06; 1.93), but we did not detect a change in population desire for future contact with people with mental health problems. Exposure to the nationwide anti-stigma campaign or mental health care reform was associated with more favorable attitudes (B = 4.25, 95% CI = 2.07; 6.42 and B = 7.66, 95% CI = 3.91; 11.42), but not with higher desire for future contact with people with mental health problems.

Conclusions

Mental health care reform and its nation-wide anti-stigma project seems to have a positive impact on population attitudes, but not on desire for future contact with people with mental health problems.