Functioning mediates help-seeking for mental problems in the general population

Investigating the use of support in secondary school: the role of self-reliance and stigma towards help-seeking

Purpose: Adolescents are the least likely to seek help for their mental health problems. School may be an important route to improve early recognition of adolescents with mental health problems in need for support, but little is known about the barriers to school support.Materials and methods: Data were collected in a longitudinal cohort study of Dutch adolescents (age 12-16) in secondary school (n = 956). We assessed the relation between level of psychosocial problems at the beginning of the school year (T1) and the support used in school at the end of that school year (T2), whether the willingness to talk to others (measured at T1) mediates this relation, and whether stigma towards help-seeking (T1) moderates this mediation.Results: Adolescents with more psychosocial problems were more likely to use support in school and were less willing to talk to others about their problems, but the willingness to talk to others was not a mediator. Stigma moderated the relationship between psychosocial problems and willingness to talk to others.Conclusions: Most adolescents with psychosocial problems get support in Dutch secondary school regardless of their willingness to talk to others about their problems. However, perceiving stigma towards help-seeking makes it less likely for someone to talk about their problems.

Health service and psychotropic medication use for mental health conditions among healthcare workers active during the Spain Covid-19 Pandemic - A prospective cohort study using web-based surveys

Little is known about healthcare workers' (HCW) use of healthcare services for mental disorders. This study presents data from a 16-month prospective cohort study of Spanish HCW (n = 4,809), recruited shortly after the COVID-19 pandemic onset, and assessed at four timepoints using web-based surveys. Use of health services among HCW with mental health conditions (i.e., those having a positive screen for mental disorders and/or suicidal thoughts and behaviours [STB]) was initially low (i.e., 18.2 %) but increased to 29.6 % at 16-month follow-up. Service use was positively associated with pre-pandemic mental health treatment (OR=1.99), a positive screen for major depressive disorder (OR=1.50), panic attacks (OR=1.74), suicidal thoughts and behaviours (OR=1.22), and experiencing severe role impairment (OR=1.33), and negatively associated with being female (OR = 0.69) and a higher daily number of work hours (OR=0.95). Around 30 % of HCW with mental health conditions used anxiolytics (benzodiazepines), especially medical doctors. Four out of ten HCW (39.0 %) with mental health conditions indicated a need for (additional) help, with most important barriers for service use being too ashamed, long waiting lists, and professional treatment not being available. Our findings delineate a clear mental health treatment gap among Spanish HCW.

Item response theory analysis of the University Personality Inventory in medical students

AIM

Young adulthood has been recognized as an important period for the transition from adolescence to adulthood. The University Personality Inventory (UPI), a mental health questionnaire for young adulthood, is widely used to screen university students in East Asia. However, dichotomous systems do not allow respondent choose responses other than two options on each symptom. This study employed item response theory (IRT) to examine the properties and performance of UPI items for mental health problems.

METHODS

Japanese medical students (n = 1185) participated in this study, and the UPI was completed at the time of university admission. The two-parameter IRT model was used to assess the measurement characteristics of the UPI items.

RESULTS

Among all participants, 35.4% (420/1185) had total UPI score of 21 or more, and 10.6% (126/1185) indicated that they had the idea of wanting to die (item 25). For further IRT analysis, unidimensionality was confirmed by exploratory factor analysis, in which the primary factor accounted for 39.6% of the variance. The scale has sufficient discrimination power. In the test characteristic curves, the rising slopes of the lines were between θ 0 and 2.

CONCLUSION

The UPI is useful to assess mild or moderate mental health problems, while precision may decline among individuals experiencing both little and extremely high levels of stress. Our findings provide a basis for identifying people who have mental health concerns.

Psychometric properties of the Kessler psychological scales in a Swiss young-adult community sample indicate poor suitability for community screening for mental disorders

AIM

The Kessler psychological distress scales (K10 and K6) are used as screening tools to assess psychological distress related to the likely presence of a mental disorder. Thus, we studied the psychometric properties of their German versions in a Swiss community sample to evaluate their potential usefulness to screen for mental disorders or relevant mental problems in the community and, relatedly, for low threshold transdiagnostic German-speaking services.

METHODS

The sample consisted of 829 citizens of the Swiss canton Bern of age 19-43 years. K10/K6 were validated against mini-international neuropsychiatric interview (M.I.N.I.) diagnoses, questionnaires about health status and quality of life. Receiver operating characteristic (ROC) curve analyses were used to test for general discriminative ability and to select optimal cut-offs of the K10 and K6 for non-psychotic full-blown and subthreshold mental disorders.

RESULTS

Cronbach's alphas were 0.81 (K10) and 0.70 (K6). ROC analyses indicated much lower optimal thresholds than earlier suggested; 10 for K10 and 6 for K6. At these thresholds, against M.I.N.I. diagnoses, Cohen's κ (≤0.173) and correspondence rates (≤58.14%) were insufficient throughout. Values were higher at the earlier suggested threshold, yet, at the cost of sensitivity that was below 0.5 in all but three, and below 0.3 in all but six cases.

CONCLUSIONS

For the lack of sufficient validity and sensitivity, respectively, our findings suggest that both K10 and K6 would only be of limited use in a low-threshold transdiagnostic mental health service for young adults in Switzerland and likely other German-speaking countries.

Influence of mental health literacy on help-seeking behaviour for mental health problems in the Swiss young adult community: a cohort and longitudinal case-control study

Poor knowledge about mental health disorders and their treatment likely contributes to the large treatment gap reported for mental health problems. Therefore, we studied the association between mental health literacy (MHL) and active help-seeking in a community sample. Participants were recruited from an add-on questionnaire study to the 'Bern Epidemiological At-Risk' (BEAR) study on 16-40-year-old community subjects of the Swiss canton Bern. At baseline, data of N = 1504, and at 3-year follow-up, data of N = 535 were available. Based on an unlabelled case vignette (on depression or schizophrenia), MHL was assessed by the questionnaire of Angermeyer and colleagues. Cross-sectional and longitudinal baseline predictors of help-seeking were analysed using path analyses. Additionally, sensitivity analyses of the prospective model were computed for sex, vignette, and baseline mental health problems/disorders. Cross-sectionally, help-seeking was associated with non-endorsement of biogenetic causal explanations, presence of mental health problems/disorders, help-seeking before baseline, poorer functioning, and lower health satisfaction. The prospective model was similar; yet, help-seeking at follow-up was associated with endorsements of the causal explanation 'biogenetics' and, additionally, 'childhood trauma' but not the presence of baseline mental health problems/disorders. Sensitivity analyses revealed a significant impact on sex, vignette, and mental health problems/disorders. For example, actual functional problems were predictive in males, while health satisfaction was predictive in females. Our findings indicate that future studies on drivers of help-seeking should assess very large community samples with case vignettes on different mental disorders to examine appropriate subgroups and their likely interaction to address group-specific factors in awareness campaigns.

Utility and validity of the Brief Psychiatric Rating Scale (BPRS) as a transdiagnostic scale

The Brief Psychiatric Rating Scale (BPRS) was originally conceived to assess psychopathology in several psychiatric disorders, making it an appropriate candidate to be used as a transdiagnostic instrument. We analyzed the utility and validity of the BPRS in a diagnostically heterogeneous sample of 600 psychiatric inpatients. As a comparator, we chose the mini-ICF-APP, a scale used to measure functioning and impairment across the diagnostic spectrum. Both scales had good internal consistency. The BPRS and the mini-ICF-APP showed a moderate correlation, with good levels of agreement. We were able to identify general symptoms present across the diagnostic spectrum, influencing severity and a cluster of symptoms specific for each diagnosis. Our results show the utility and validity of the BPRS as a transdiagnostic assessment tool that could easily be introduced in routine clinical work.

Professional help-seeking behaviour for mental health problems among veterinarians in Norway: a nationwide, cross-sectional study (The NORVET study)

Background

Veterinarians have a relatively high prevalence of mental health problems; however, research on professional help-seeking is limited. The main purpose of the present study was to investigate the prevalence of mental health problems and professional help-seeking behaviour for such problems, and the independent factors associated with help-seeking behaviour among veterinarians in Norway.

Method

This cross-sectional study included all veterinarians in Norway (response rate 75%, 70% women). Logistic regression was used to calculate odds ratios (OR) for professional help-seeking for mental health problems. Analyses were controlled for socio-demographic, individual (personality trait reality weakness, SCL-5, attitudes toward mental illness), and work-related factors (work field, job stress).

Results

The prevalence of self-reported mental health problems in need of treatment was 30% (746/2494), significantly higher among women than men (36% vs. 15%). Fifty-four percent had sought professional help, women significantly more often (56%) than men (41%). Among veterinarians with serious suicidal thoughts, 50% (69/139) had sought help. Veterinarians most frequently related mental health problems to work problems (47%), women significantly more often (49%) than men (34%). Factors significantly associated with help-seeking were being female, OR = 2.11 (95% CI: 1.24–3.60), working with production animals, OR = 0.35 (0.13–0.98), public administration, OR = 2.27 (1.15–4.45), academia/research, OR = 4.78 (1.99–11.47) or ‘other’ fields, OR = 2.79 (1.23–6.32), and attitudes toward mental illness, OR = 1.32 (1.03–1.68).

Conclusions

Thirty percent of veterinarians in Norway reported mental health problems in need of treatment, and only half of them had sought professional help. A low degree of help-seeking was also seen among those with serious suicidal thoughts. Being female, positive attitudes toward treatment of mental illness, working in public administration, academia/research and ‘other’ field were associated with more help-seeking, while working in production animal practice was associated with less help-seeking. Interventions to increase help-seeking behaviour for mental health problems among veterinarians are warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13710-y.

Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: "From Dusk Till Dawn"

INTRODUCTION

Day and time of admission influence treatment outcomes and prognosis in several medical specialties; this seems related to resources' ability. It is largely unknown whether this also applies to mental health services. We investigate the relationship between time of admission, patients' demographic and clinical profile, and treatment outcomes.

METHODS

Demographic and clinical profiles of admitted and discharged patients to a general psychiatric ward between January 1st, 2013 and December 31st, 2020, were analyzed. In addition, we used the last year (i.e., 2020) to monitor rehospitalization. Time of admission was defined as weekdays (working day, weekend) and dayshifts (daytime, dusk, and dawn).

RESULTS

During the study period, 12,449 patient admissions occurred. The mean age of the sample was 48.05 ± 20.90 years, with 49.32% (n = 6,140) females. Most admissions (n = 10,542, 84%) occurred on working days. Two-fifths of admissions (39.7%, n = 4,950) were compulsory, with a higher rate outside daytime hours. Patients had slight differences in the clinical profile, resulting from evaluating the different items of the Health of Nation Outcome Scale (HoNOS). Patients admitted on night shifts, weekends, and holidays showed a shorter length of stay; patients compulsorily admitted during daytime (disregarding the day of the week) had a longer length of stay. All patient groups achieved a robust clinical improvement (i.e., an HoNOS score reduction of around 50%), with similar readmission rates.

DISCUSSION

The main finding of our study is the relationship between "daytime hours" and fewer compulsory admissions, a result of the interplay between demographics, clinical characteristics, and out-of-clinic service availability (such as ambulatory psychiatric- psychological praxis; day-clinic; home-treatment). The differing clinical profile, in turn, determines differences in treatment selection, with patients admitted after office hours experiencing a higher rate of coercive measures. The shorter length of stay for out-of-office admissions might result from the hospitalization as an intervention. These results should encourage the implementation of outpatient crisis-intervention services, available from dusk till dawn.

Help-Seeking Behavior and Treatment Barriers in Anxiety Disorders: Results from a Representative German Community Survey

Although effective therapies exist, treatment rates of anxiety disorders (AD) are low, raising the question why affected individuals do not receive treatment. We provide data from the nationally representative German Health Interview and Examination Survey-2011 (DEGS1) on the help-seeking behavior and perceived treatment barriers of 650 subjects with Diagnostic and Statistical Manual of Mental Disorders' (DSM-IV AD). Only 26% of all cases with AD in the community reported having had contact with mental health services because of their anxiety problems in their lifetime. 16% were currently receiving professional help, most frequently by psychotherapists (8%), psychiatrists (5%) and general practitioners (5%). 40% of all cases never even considered seeking help and 31% reported barriers to treatment, such as self-reliance (18%) or beliefs that treatments were ineffective (9%), unavailable (8%) or too stigmatizing (7%). Measures to increase treatment rates should thus target individual as well as public attitudes and health literacy to increase awareness of and access to evidence-based interventions.

Predictors of help-seeking behaviour in people with mental health problems: a 3-year prospective community study

BACKGROUND

The majority of people with mental illness do not seek help at all or only with significant delay. To reduce help-seeking barriers for people with mental illness, it is therefore important to understand factors predicting help-seeking. Thus, we prospectively examined potential predictors of help-seeking behaviour among people with mental health problems (N = 307) over 3 years.

METHODS

Of the participants of a 3-year follow-up of a larger community study (response rate: 66.4%), data of 307 (56.6%) persons with any mental health problems (age-at-baseline: 16-40 years) entered a structural equation model of the influence of help-seeking, stigma, help-seeking attitudes, functional impairments, age and sex at baseline on subsequent help-seeking for mental health problems.

RESULTS

Functional impairment at baseline was the strongest predictor of follow-up help-seeking in the model. Help-seeking at baseline was the second-strongest predictor of subsequent help-seeking, which was less likely when help-seeking for mental health problems was assumed to be embarrassing. Personal and perceived stigma, and help-seeking intentions had no direct effect on help-seeking.

CONCLUSIONS

With only 22.5% of persons with mental health problems seeking any help for these, there was a clear treatment gap. Functional deficits were the strongest mediator of help-seeking, indicating that help is only sought when mental health problems have become more severe. Earlier help-seeking seemed to be mostly impeded by anticipated stigma towards help-seeking for mental health problems. Thus, factors or beliefs conveying such anticipated stigma should be studied longitudinally in more detail to be able to establish low-threshold services in future.

Naturalistic follow-up study of rehospitalization rates and assigned disability status of patients with first-episode schizophrenia spectrum psychosis in South East Latvia: preliminary results

BACKGROUND

Patients with first-episode schizophrenia spectrum psychosis (FEP) are at risk of not visiting an out-patient psychiatrist and are assigned disability status within a short period after diagnosis.

OBJECTIVE

The aim of this study was to conduct a naturalistic follow-up of FEP patients to explore their use of mental healthcare services and the rate of assigned disability status after FEP.

METHODS

This was the first study in Latvia to include all consecutive patients with FEP admitted to the largest regional hospital in South East Latvia, Daugavpils Psychoneurological Hospital (DPNH). Patients received standard treatment in a real-world environment. The mean follow-up time was 33 months (Min = 20 months, Max = 40 months).

RESULTS

From the 94 consecutive FEP patients admitted to DPNH (1 January 2016 to 31 December 2017), 68 participated and provided informed consent to be followed up. During the first 12 months after discharge from the acute psychiatric ward, 23% (n = 14) never visited a psychiatrist, and 6.5% (n = 4) had a single visit to get prescription for medication. Furthermore, 36.1% (n = 22) had a rehospitalization during the first 12 months. At the end of follow-up period, 34.4% (n = 21) of patients were assigned disability status within a median time of 8 months (IQR 4.5‒20.0).

CONCLUSION

Approximately, one-third of patients did not continue treatment as out-patients after FEP. One-third of FEP patients were assigned disability status. We suggest that Latvia needs improved treatment options for FEP patients, such as early intervention.

Trends in prevalence of depression in Germany between 2009 and 2017 based on nationwide ambulatory claims data

BACKGROUND

Studies based on health insurance funds unanimously indicate a rise in administrative prevalence of depression, while population surveys with standardized diagnostic procedures do not. We describe recent trends in the prevalence of depressive disorders as diagnosed in routine care from 2009-2017 in Germany.

METHODS

We used nationwide ambulatory claims data from all residents with statutory health insurance, covering 87% of the total population. Cases were defined as persons with at least one documented diagnosis of depression (ICD-10-GM codes: F32, F33 or F34.1). The administrative prevalence was computed for each year according to age, sex, degree of urbanization and severity of depression diagnosis.

RESULTS

The prevalence increased from 12.5% in 2009 to 15.7% in 2017 (+26%). Overall, women were twice as likely as men to receive a diagnosis, although the prevalence increased more strongly in men compared to women (+40% vs. +20%). Age- and sex-stratified analyses revealed the highest prevalence increase in adolescents and young men at the ages of 15-19 years (+95%) and 20-25 years (+72%). Rural areas with a low population density showed the highest rise in administrative prevalence (+34%), while big urban municipalities showed the lowest (+25%).

LIMITATIONS

Administrative claims data rely on diagnoses coded for billing purposes and thus depend on coding practice as well as patients' help seeking behavior.

CONCLUSIONS

Depressive disorders are of increasing importance in ambulatory health care in Germany. Parts of the increase may be attributed to changing cultural constructions of mental health along with the expansion of mental health care supply.

Minding the treatment gap: results of the Singapore Mental Health Study

PURPOSE

To establish the 12-month treatment gap and its associated factors among adults with mental disorders in the Singapore resident population using data from the second Singapore Mental Health Study and to examine the changes since the last mental health survey conducted in 2010.

METHODS

6126 respondents were administered selected modules of the Composite International Diagnostic Interview, to assess major depressive disorder (MDD), dysthymia, bipolar disorder, generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD) and alcohol use disorder (AUD) (which included alcohol abuse and dependence). Past year treatment gap was defined as the absolute difference between the prevalence of a particular mental disorder in the past 12 months preceding the interview and those who had received treatment for that disorder.

RESULTS

The prevalence of overall 12-month treatment gap in this population was high (78.6%). A multiple logistic regression analysis revealed significantly higher odds of treatment gap among those diagnosed with OCD (compared to those with MDD) and in those with a comorbid chronic physical disorder; while those who had primary education and below and those who were unemployed were less likely to have a treatment gap as compared to those with post-secondary education and those employed, respectively.

CONCLUSIONS

The high treatment gap in the population is concerning and highlights the need to promote help-seeking and uptake of treatment. Given the unique demographic characteristics, i.e., those with higher education and employed were more likely not to seek treatment, targeted interventions in the educational and workplace settings should be implemented.

Associations of psychosis-risk symptoms with quality of life and self-rated health in the Community

BACKGROUND

Understanding factors related to poor quality of life (QoL) and self-rated health (SRH) in clinical high-risk (CHR) for psychosis is important for both research and clinical applications. We investigated the associations of both constructs with CHR symptoms, axis-I disorders, and sociodemographic variables in a community sample.

METHODS

In total, 2683 (baseline) and 829 (3-year follow-up) individuals of the Swiss Canton of Bern (age-at-baseline: 16-40 years) were interviewed by telephone regarding CHR symptoms, using the Schizophrenia Proneness Instrument for basic symptoms, the Structured Interview for Psychosis-Risk Syndromes for ultra-high risk (UHR) symptoms, the Mini-International Neuropsychiatric Interview for current axis-I disorders, the Brief Multidimensional Life Satisfaction Scale for QoL, and the 3-level EQ-5D for SRH.

RESULTS

In cross-sectional structural equation modelling, lower SRH was exclusively significantly associated with higher age, male gender, lower education, and somatoform disorders. Poor QoL was exclusively associated only with eating disorders. In addition, both strongly interrelated constructs were each associated with affective, and anxiety disorders, UHR and, more strongly, basic symptoms. Prospectively, lower SRH was predicted by lower education and anxiety disorders at baseline, while poorer QoL was predicted by affective disorders at baseline.

CONCLUSIONS

When present, CHR, in particular basic symptoms are already distressful for individuals of the community and associated with poorer subjective QoL and health. Therefore, the symptoms are clinically relevant by themselves, even when criteria for a CHR state are not fulfilled. Yet, unlike affective and anxiety disorders, CHR symptoms seem to have no long-term influence on QoL and SRH.

Prevalence of mental disorders and associated disability: Results from the cross-sectional CZEch mental health Study (CZEMS)

INTRODUCTION

We aimed to estimate the prevalence of current mental disorders in the Czech population, and to identify associated disability.

METHODS

We conducted a representative cross-sectional household survey of the Czech adult, community-dwelling population. We used the Mini International Neuropsychiatric Interview (M.I.N.I.), WHO Disability Assessment Schedule (WHODAS) 2.0, and Self-Identification as Mentally Ill (SELFI) scale alongside sociodemographic and other covariates. We reached 75% response rate. Descriptive statistics of the sample were assessed and median (M) disability levels with interquartile range (IQR) according diagnosis were calculated on a scale ranging from 12 to 50. Linear regression models were used to identify factors associated with disability.

RESULTS

In our sample of 3 306 participants, 21.9% experienced a mental disorder in 2017. Prevalence rates for mood, anxiety, alcohol use, non-alcohol substance use, and psychotic disorders corresponded to 5.5%, 7.3%, 10.8%, 2.9%, and 1.5% respectively. Alcohol dependence was identified in 6.6%, and major depression in 4.0% of the sample. Disability in the general population was significantly lower (M = 12; IQR = 12, 17) than in those with mood (M = 20; IQR = 14; 29), anxiety (M = 18; IQR = 13; 26), alcohol use (M = 14; IQR = 12; 18), non-alcohol substance use (M = 15; IQR = 12; 19), or psychotic disorders (M = 22; IQR = 16.4; 29.4).

CONCLUSIONS

People with mental disorders have considerably elevated disability in comparison to mentally healthy participants. The prevalence of mental disorders in the Czech Republic is mostly in line with European prevalence rates but it is lower for anxiety disorders and two times higher for alcohol use disorders.