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Rusli KDB, Chua WL, Ang WHD, Ang SGM, Lau Y, Liaw SY. A hybrid systematic narrative review of instruments measuring home-based care nurses' competency. J Adv Nurs 2024; 80:2647-2671. [PMID: 37849066 DOI: 10.1111/jan.15904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/21/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
AIM The aim of the study was to identify and synthesize the contents and the psychometric properties of the existing instruments measuring home-based care (HBC) nurses' competencies. DESIGN A hybrid systematic narrative review was performed. REVIEW METHODS The eligible studies were reviewed to identify the competencies measured by the instruments for HBC nurses. The psychometric properties of instruments in development and psychometric testing design studies were also examined. The methodological quality of the studies was evaluated using the Medical Education Research Study Quality Instrument and COSMIN checklist accordingly. DATA SOURCES Relevant studies were searched on CINAHL, MEDLINE (via PubMed), EMBASE, PsychINFO and Scopus from 2000 to 2022. The search was limited to full-text items in the English language. RESULTS A total of 23 studies reporting 24 instruments were included. 12 instruments were adopted or modified by the studies while the other 12 were developed and psychometrically tested by the studies. None of the instruments encompassed all of the 10 home-based nursing care competencies identified in an earlier study. The two most frequently measured competencies were the management of health conditions, and critical thinking and problem-solving skills, while the two least measured competencies were quality and safety, and technological literacy. The content and structural validity of most instruments were inadequate since the adopted instruments were not initially designed or tested among HBC nurses. CONCLUSION This review provides a consolidation of existing instruments that were used to assess HBC nurses' competencies. The instruments were generally not comprehensive, and the content and structural validity were limited. Nonetheless, the domains, items and approaches to instrument development could be adopted to develop and test a comprehensive competency instrument for home-based nursing care practice in the future. IMPACT This review consolidated instruments used to measure home-based care nurses' competency. The instruments were often designed for ward-based care nurses hence a comprehensive and validated home-based nursing care competency instrument is needed. Nurses, researchers and nursing leaders could consider the competency instruments identified in this review to measure nurses' competencies, while a home-based nursing care competency scale is being developed. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was required in this review.
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Affiliation(s)
- Khairul Dzakirin Bin Rusli
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Seng Giap Marcus Ang
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Ying Lau
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Mokhtar Ahmed SM, Mohamed Zain EMI, Osman OS. Knowledge, attitudes, and practices toward depression among physicians in Sudan. Brain Behav 2023; 13:e3321. [PMID: 37926906 PMCID: PMC10726890 DOI: 10.1002/brb3.3321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES The present study assessed the knowledge, attitudes, and practices of physicians in Sudan regarding depression. METHODS A cross-sectional study was conducted among physicians who practiced at public and private health facilities in Sudan in December of 2022. An online Google form questionnaire was administered that included knowledge, practice, and sociodemographic sections of the depression attitude questionnaire. The link to the questionnaire was sent to a convenience sample of physicians through a variety of methods including social media. RESULTS A total of 407 physicians completed the questionnaire. The majority (81.1%) had no formal training on mental health after graduation. A total of 43.0% reported difficulties in differentiating between unhappiness and clinical depression, although 48.6% indicated that they could differentiate between chemical and psychological causes for depression. Half (50.4%) did not feel comfortable dealing with depressed patients. Nearly 70% indicated that psychotherapy was a better option for treating these patients than antidepressants, but only 45.7% had any mental health services at their health facility. Physicians with prior mental health training (both pre- and postgraduate training) were more likely to provide treatment options for depressed patients. CONCLUSIONS This study indicates a moderate knowledge among physicians about depression, but also significant concern regarding poor attitudes and practices held toward the treatment of depression, and a lack of training. These findings highlight the urgent need for the training of physicians in the diagnosis and treatment of depression in Sudan.
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Affiliation(s)
| | | | - Osama Saeed Osman
- Gadarif Regional Institute of Endemics Diseases (GRIED)Gadarif UniversityGadarifSudan
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Mandlate F, Greene MC, Pereira LF, Sweetland AC, Kokonya D, Duarte CS, Cournos F, Oquendo MA, Wainberg ML, Sidat M, Sevene E, Mello MF. Lay HIV counselors' knowledge and attitudes toward depression: A mixed-methods cross-sectional study at primary healthcare centers in Mozambique. Front Public Health 2022; 10:919827. [PMID: 36249253 PMCID: PMC9554257 DOI: 10.3389/fpubh.2022.919827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/31/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Depression is the most common mental disorder among people living with HIV/AIDS and has a negative impact on HIV treatment outcomes. Training lay HIV counselors to identify and manage depression may contribute to improved patient access and adherence to treatment, and reduce stigma and discrimination among lay health workers toward both HIV and depression. The purpose of this study was to assess the current knowledge and attitudes of lay HIV counselors toward managing depression in primary care in Mozambique. Methods We conducted a mixed-methods cross-sectional study to assess depression-related knowledge and attitudes among lay HIV counselors in 13 primary healthcare facilities in Mozambique. We used the quantitative Depression Attitude Questionnaire (DAQ) scale, followed by open-ended questions to further explore three key DAQ domains: the nature of depression, treatment preferences, and professional attitudes or reactions. Results The sample included 107 participants (77.6% female, mean age: 32.3 years, sd = 7.4). Most (82.2%) had less than a high/technical school education. Findings suggested that some HIV counselors had knowledge of depression and described it as a cluster of psychological symptoms (e.g., deep sadness, anguish, apathy, isolation, and low self-esteem) sometimes leading to suicidal thoughts, or as a consequence of life stressors such as loss of a loved one, abuse, unemployment or physical illness, including being diagnosed with HIV infection. HIV counselors identified talking to trusted people about their problems, including family and/or counseling with a psychotherapist, as the best way for patients to deal with depression. While acknowledging challenges, counselors found working with patients with depression to be rewarding. Conclusion Lay health counselors identified HIV and psychosocial issues as key risk factors for depression. They believed that the treatment approach should focus on social support and psychotherapy.
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Affiliation(s)
- Flavio Mandlate
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - M. Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Luis F. Pereira
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Annika C. Sweetland
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Donald Kokonya
- School of Medicine, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Cristiane S. Duarte
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Francine Cournos
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Mohsin Sidat
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Esperança Sevene
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Marcelo F. Mello
- Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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Halcomb E, McInnes S, Patterson C, Moxham L, Bird S. Australian general practice nurse involvement in mental health: A descriptive survey. Collegian 2022. [DOI: 10.1016/j.colegn.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ni CH, Guo SL, Chao CY, Wang CH, Susanty S, Chuang YH. Nurses' Late-Life Depression Knowledge and Attitudes Toward Depression: A Cross-Sectional Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020945179. [PMID: 32723125 PMCID: PMC7391434 DOI: 10.1177/0046958020945179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression in older population is more common now. Due to increasing numbers of older patients in hospitals, nurses have more opportunities to care for these patients. Therefore, nurses should have correct knowledge of late-life depression and more favorable attitudes about depression. The study aimed to understand hospital nurses' knowledge level of late-life depression and attitudes about depression. A cross-sectional research design was used. A convenience sample of 307 nurses from 3 hospitals in Taiwan was recruited. Nurses scored 55.15% in the Late-Life Depression Quiz. The average score of the Revised Depression Attitude Questionnaire was 71.76 (SD = 6.13). The study also found that hospital nurses had more favorable attitudes about depression when their late-life depression knowledge was higher; their interest level in providing care for older patients with depression was greater; they had ever taken care of older patients with depressive symptoms or depression; they had never received in-service training on depression in the past year; and they had ever attended lectures about depression in school. Hospital nurses' knowledge about late-life depression was limited, and they had neutral to slightly favorable attitudes about depression in Taiwan. It is suggested to carefully examine and evaluate in-service training related to depression for nurses in hospitals. In addition, developing appropriate interventions to increase hospital nurses' knowledge level of late-life depression and attitudes toward depression is recommended.
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Affiliation(s)
- Cheng-Hua Ni
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan.,Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Shu-Liu Guo
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan.,Department of Nursing, Center of Faculty Development, Department of Education, Taipei Medical University Hospital, Taiwan
| | - Chia-Yu Chao
- Nursing Department, Taipei Veterans General Hospital, Taiwan
| | - Chia-Hui Wang
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan
| | - Sri Susanty
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan.,Faculty of Medicine, Halu Oleo University, Indonesia
| | - Yeu-Hui Chuang
- School of Nursing, College of Nursing, Taipei Medical University, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taiwan
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Shoji M, Fujiwara A, Onda M. Creation and validation of a semi-quantitative instrument to assess the confidence of pharmacists in medication consultation for patients with depression: The pharmacists' confidence scale about medication consultation for depressive patients (PCMCD). Pharm Pract (Granada) 2020; 17:1628. [PMID: 31897261 PMCID: PMC6935550 DOI: 10.18549/pharmpract.2019.4.1628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/20/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives To develop a semi-quantitative instrument to assess pharmacists' confidence in medication counseling for patients with depression, The Pharmacists' Confidence scale about Medication Consultation for Depressive patients (PCMCD), and investigated its validity. Methods Following discussions with practicing pharmacists, we developed a 12-item questionnaire to assess pharmacists' confidence in medication counseling for patients with depression. We launched web-based cross-sectional survey during November and December 2018 to 77 pharmacists employed at drug chain stores in Kansai area. Factor analysis was performed to evaluate the configuration concept validity. The least-squares method was used for factor extraction, and the resulting factors were subjected to direct oblimin rotation, with a factor loading cut-off of 0.4. To assess internal consistency, Cronbach's alpha values were calculated for each of the extracted factors (subscales). A multiple regression analysis was performed using simultaneous forced entry, with the scores obtained for each subscale as dependent variables and responder attributes as independent variables in order to investigate the factors associated with each subscale. Results During the factor analysis procedure, four questions were excluded by the cut-off rule. Eventually, a model with three subscales was identified, with a cumulative sum of squared loadings being 61.9%. The subscales were termed "relationship building," "comprehension of condition," and "information provision" based on the nature of the questions relevant for each of them. The Cronbach's alpha values for these subscales were 0.92, 0.73, and 0.72, respectively. The average inter-item correlation was 0.378. In addition, multiple regression analysis revealed that there were significant correlations between pharmacist career and both relationship building and information provision. Conclusions The PCMCD model demonstrated a satisfactory construct validity and internal consistency. This model will provide an excellent tool for assessing pharmacists' confidence in depression care.
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Affiliation(s)
- Masaki Shoji
- PhD. Assistant Professor. Department of Social and Administrative Pharmacy, Osaka University of Pharmaceutical Sciences. Osaka (Japan).
| | - Atsuko Fujiwara
- BPharm. General manager of Division of Planning and management of pharmacists training. Apis Pharmacy. Osaka (Japan).
| | - Mitsuko Onda
- PhD. Professor. Department of Social and Administrative Pharmacy, Osaka University of Pharmaceutical Sciences. Osaka (Japan).
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Lee C, Tseng H, Wu L, Chuang Y. Multiple brief training sessions to improve nurses’ knowledge, attitudes, and confidence regarding nursing care of older adults with depression in long‐term care facilities. Res Nurs Health 2019; 43:114-121. [DOI: 10.1002/nur.21997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 11/13/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Chia‐Chi Lee
- Foryu Postpartum Nursing Care CenterTaipei Taiwan
- School of Nursing, College of NursingTaipei Medical UniversityTaipei Taiwan
| | - Huei‐Chi Tseng
- Department of NursingTaipei Medical University‐Shuang Ho HospitalNew Taipei City Taiwan
| | - Lee‐Pin Wu
- Department of NursingWan Fang Hospital, Taipei Medical UniversityTaipei Taiwan
| | - Yeu‐Hui Chuang
- School of Nursing, College of NursingTaipei Medical UniversityTaipei Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice ApplicationWan Fang Hospital, Taipei Medical UniversityTaipei Taiwan
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8
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Yan S, Wuan EKM, Peh ALH, Tay ATS, Ho SCW, Saffari SE, Teo DCL. Impact of Experience-Based, Longitudinal Psychiatry Training on Family Medicine Residents' Attitudes Toward Depression and Psychiatry in Singapore: a Prospective Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:6-12. [PMID: 30443864 DOI: 10.1007/s40596-018-1006-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The primary aim of this study was to evaluate the impact of an experience-based, longitudinal psychiatry training program in a Family Medicine residency on residents' attitudes toward depression and psychiatry. The secondary aim was to identify background predictor variables of changes in attitudes. METHODS Pre- and post-training surveys were prospectively conducted on attitudes toward depression and psychiatry on Family Medicine residents undergoing an experience-based, longitudinal psychiatry training program. The primary outcome measures were pre- and post-training Depression Attitude Questionnaire (DAQ) and Modified Attitudes to Psychiatry Scale (mAPS) scores. Regression analysis was carried out to determine background variables predictive of improvement in DAQ and/or mAPS scores post-training. RESULTS Sixty-three Family Medicine residents (100% response rate) responded to the pre-training surveys. All 63 subjects completed the post-training surveys (100% retention rate). There was significant improvement in DAQ and mAPS scores post-training, indicating better attitudes toward depression and psychiatry. Significant improvement was observed in 8 out of 13 DAQ items and 3 out of 4 mAPS domains. Regression models showed having a previous 3-month elective psychiatry inpatient posting was a predictor of less improvement in mAPS scores. CONCLUSIONS Our experience-based, longitudinal psychiatry training program significantly improved Family Medicine residents' attitudes toward depression and psychiatry. Experiential and situated learning in communities of practice, as well as educational continuity with longitudinal supervision, coaching, and modeling may have contributed to this improvement.
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Affiliation(s)
- Shi Yan
- Duke-NUS Medical School, Singapore, Singapore
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Chuang YH, Kuo LM. Nurses' confidence in providing and managing care for older persons with depressive symptoms or depression in long-term care facilities: A national survey. Int J Ment Health Nurs 2018; 27:1767-1775. [PMID: 29797638 DOI: 10.1111/inm.12483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 02/04/2023]
Abstract
The prevalence of depressive symptoms among older residents in long-term care facilities (LTCFs) is high. Nurses are the main healthcare providers in LTCFs and also the persons responsible for detecting changes in residents' mental function and providing subsequent care. Therefore, it is necessary to understand nurses' knowledge, attitudes, and confidence regarding care for older residents with depressive symptoms or depression. This study aimed to understand nurses' level of knowledge of late-life depression, attitudes towards depression, and confidence levels in caring for older adults with depressive symptoms or depression in LTCFs. A cross-sectional descriptive and correlational research design was used. A nationwide self-report survey was conducted in 2016. Ultimately, 556 valid questionnaires were returned. The study found that LTCF nurses' knowledge about late-life depression was poor, and they also lacked confidence in managing and caring for older persons with depressive symptoms or depression, but nurses' attitudes towards depression were neutral or slightly positive. Moreover, nurses who had greater confidence in providing care for older persons with depression were those with more positive attitudes towards depression, a greater interest level in taking care of older adults with depression, less late-life depression knowledge, longer nursing experience in LTCFs, and a greater interest level in late-life depression issues, and who had read late-life depression pamphlets or taken courses or classes in late-life depression. The findings suggest an urgent need to develop strategies to improve nurses' late-life depression knowledge and increase their confidence in providing care to older residents with depressive symptoms or depression.
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Affiliation(s)
- Yeu-Hui Chuang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Li-Min Kuo
- Department of Gerontological Health Care, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Mental health nursing placement: A comparative study of non-traditional and traditional placement. Nurse Educ Pract 2018; 33:4-9. [DOI: 10.1016/j.nepr.2018.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 03/04/2018] [Accepted: 08/18/2018] [Indexed: 11/17/2022]
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Wei Y, McGrath P, Hayden J, Kutcher S. The quality of mental health literacy measurement tools evaluating the stigma of mental illness: a systematic review. Epidemiol Psychiatr Sci 2018; 27:433-462. [PMID: 28462747 PMCID: PMC6999021 DOI: 10.1017/s2045796017000178] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/26/2017] [Indexed: 01/08/2023] Open
Abstract
AIMS Stigma of mental illness is a significant barrier to receiving mental health care. However, measurement tools evaluating stigma of mental illness have not been systematically assessed for their quality. We conducted a systematic review to critically appraise the methodological quality of studies assessing psychometrics of stigma measurement tools and determined the level of evidence of overall quality of psychometric properties of included tools. METHODS We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library and ERIC databases for eligible studies. We conducted risk-of-bias analysis with the Consensus-based Standards for the Selection of Health Measurement Instruments checklist, rating studies as excellent, good, fair or poor. We further rated the level of evidence of the overall quality of psychometric properties, combining the study quality and quality of each psychometric property, as: strong, moderate, limited, conflicting or unknown. RESULTS We identified 117 studies evaluating psychometric properties of 101 tools. The quality of specific studies varied, with ratings of: excellent (n = 5); good (mostly on internal consistency (n = 67)); fair (mostly on structural validity, n = 89 and construct validity, n = 85); and poor (mostly on internal consistency, n = 36). The overall quality of psychometric properties also varied from: strong (mostly content validity, n = 3), moderate (mostly internal consistency, n = 55), limited (mostly structural validity, n = 55 and construct validity, n = 46), conflicting (mostly test-retest reliability, n = 9) and unknown (mostly internal consistency, n = 36). CONCLUSIONS We identified 12 tools demonstrating limited evidence or above for (+, ++, +++) all their properties, 69 tools reaching these levels of evidence for some of their properties, and 20 tools that did not meet the minimum level of evidence for all of their properties. We note that further research on stigma tool development is needed to ensure appropriate application.
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Affiliation(s)
- Y. Wei
- Faculty of Graduate Studies, Interdisciplinary PhD, Dalhousie University, Halifax, Nova Scotia, Canada
| | - P. McGrath
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - J. Hayden
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S. Kutcher
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Mulango ID, Atashili J, Gaynes BN, Njim T. Knowledge, attitudes and practices regarding depression among primary health care providers in Fako division, Cameroon. BMC Psychiatry 2018; 18:66. [PMID: 29534695 PMCID: PMC5850974 DOI: 10.1186/s12888-018-1653-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Mental health and mental illness are often overlooked in the management of patients in our health services. Depression is a common mental disorder worldwide. Recognising and managing mental illnesses such as depression by primary health care providers (PHCPs) is crucial. This study describes the knowledge, attitudes and practices (KAP) of PHCPs regarding depression in Fako Division. METHODS A cross-sectional study was conducted among PHCPs (general practitioners, nurses, pharmacy attendants and social workers) in public-owned health facilities in the four health districts in Fako Division. Participants were selected by a consecutive convenience sampling. A structured questionnaire including the Depression Attitude Questionnaire (DAQ) was used to collect information about their socio-demographic characteristics, professional qualifications and KAP about depression. RESULTS The survey had a response rate of 56.7%. Most of the 226 participants (92.9%) were aware that depression needs medical intervention. Only 1.8% knew a standard tool used to diagnose depression. Two-thirds agreed that majority of the cases of depression encountered originate from recent misfortune. About 66% felt uncomfortable working with depressed patients. Also, 45.1% of PHCPs did not know if psychotropic drugs were available at pharmacies within their health area. Very few (15.2%) reported to have prescribed psychotropic drugs. Less than half (49.1%) of the participants had prior formal training in mental health. CONCLUSION PHCPs in Fako Division tend to have limited knowledge and poor attitudes regarding depression. Practices towards diagnosis and management of depression tend to be inadequate. There is an urgent need to train PHCPs in mental health in general and depression diagnosis and management in particular.
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Affiliation(s)
| | - Julius Atashili
- 0000 0001 2288 3199grid.29273.3dMedicine Programme, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Bradley N. Gaynes
- 0000000122483208grid.10698.36Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina USA
| | - Tsi Njim
- Health and Human Development Research Group, Douala, Littoral Region Cameroon ,0000 0004 1936 8948grid.4991.5Nuffield Department of Health, Centre for Global Health and Tropical Medicine, University of Oxford, Oxfordshire, UK
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Manzanera R, Lahera G, Álvarez-Mon MÁ, Alvarez-Mon M. Maintained effect of a training program on attitudes towards depression in family physicians. Fam Pract 2018; 35:61-66. [PMID: 28985370 DOI: 10.1093/fampra/cmx071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Family doctors' (FD) attitudes likely play an important role in the recognition and management of depression. OBJECTIVE The purpose of the study was to prospectively analyse the short-term and long-term impact of a specifically designed training program on attitudes towards depression among FDs. METHODS A prospective, educational intervention, single group pre- and post-test study with three assessments (pre, post, and 6-month follow-up) was conducted. Participants included 1322 certified FDs who had enrolled voluntarily in a structured postgraduate training in depression. This course was mainly practical and guided by case reports and real clinical experiences. The course was based on Patient's Unmet Needs and Doctors Educational Needs (PUNS & DENS) methodology. Primary outcome was assessed through the Depression Attitudes Questionnaire (DAQ). In total, 970 subjects completed the pre-post assessments, and 787 also completed the 6-month follow-up. RESULTS After training, FDs positively changed their attitudes towards the management of depression. A significant change was observed in 18 of 20 items of the DAQ. The distinction between unhappiness and depression was initially found to be difficult in 41% of FDs. After the course, the percentage was reduced to 27%. Agreement with the statement that 'psychotherapy is an exclusive practice of specialists' strikingly changed from 57% to 23%. Minimal differences were noted between the post-training assessment and the 6-month follow-up. CONCLUSIONS Attitudes towards depression in FDs can be modified by a structured training program, and this change is maintained over the long term. A short training in psychotherapy (cognitive-behavioural, problem-solving based and psycho-educative oriented) significantly increases the confidence of FDs in treating depression.
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Affiliation(s)
| | - Guillermo Lahera
- Department of Medicine and Medical Specialties, University of Alcalá, CIBERSAM, Madrid, Spain
| | | | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain
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Janlöv AC, Johansson L, Clausson EK. Mental ill-health among adult patients at healthcare centres in Sweden: district nurses experiences. Scand J Caring Sci 2017; 32:987-996. [PMID: 29131370 DOI: 10.1111/scs.12540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mental ill-health among the general population is increasing in Sweden. Primary Health Care (PHC) and Healthcare Centres (HCC), where district nurses (DNs) work, bear the basic responsibility for treatment of mental ill-health, while severe mental ill-health fall under the responsibility of psychiatric specialist care. The increased prevalence of mental ill-health in the community means that DNs increasingly encounter people with mental health problems - not least as a comorbidity. How well DNs are equipped to deal with mental ill-health is currently unclear. AIM The purpose of this study was to explore district nurses' experience of encountering and dealing with mental ill-health among adult patients at healthcare centres. DESIGN A qualitative explorative approach was used to capture the experiences of the phenomena under study. METHODS Individual interviews were conducted with 10 DNs working at six HCCs. The interviews were transcribed and analysed by qualitative content analysis. RESULTS The result emerged as several subcategories captured by three categories: (i) having competence - a prerequisite for feeling confident; (ii) nursing mental ill-health requires time and commitment; and (iii) working in an organisation without preparedness, encompassed by the synthesising theme; nursing mental ill-health requires specific competence and organisational support. CONCLUSION Working as a DN requires formal and informal competence when encountering patients with complex health needs. The findings revealed that the DNs could feel insecure regarding how to deal with patients with mental ill-health due to lack of knowledge. Assessment of patients with mental ill-health is time- and energy-consuming and calls for improved teamwork at HCCs as well as effective collaboration with psychiatric specialist care and other care givers. The DNs responsibility to fulfil their work considering the increasing number of mental ill-health among people that seeks help at HCCs needs to be acknowledged and met by the PHC organisation.
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Affiliation(s)
- Ann-Christin Janlöv
- Department of Health and Society, Kristianstad University, Kristianstad, Sweden
| | - Linda Johansson
- Department of Health and Society, Kristianstad University, Kristianstad, Sweden
| | - Eva K Clausson
- Department of Health and Society, Kristianstad University, Kristianstad, Sweden
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Adewuya AO, Adewumi T, Ola B, Abosede O, Oyeneyin A, Fasawe A, Idris O. Primary health care workers' knowledge and attitudes towards depression and its management in the MeHPric-P project, Lagos, Nigeria. Gen Hosp Psychiatry 2017; 47:1-6. [PMID: 28807132 DOI: 10.1016/j.genhosppsych.2017.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/01/2017] [Accepted: 04/02/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to evaluate the knowledge, perceived challenges and attitude of primary health care (PHC) workers in Lagos to depression and its management in the PHC. METHODS Health workers (n=607) from 49 "flagship" PHCs in Lagos were evaluated for their level of knowledge, experience, competence, attitude and perceived challenges to managing depression in the primary care using a case vignette. RESULTS More than half (56.2%) of the health workers correctly diagnosed depression. The most endorsed causative factors were "Psycho-social" (77.3%), but "spiritual factors" were endorsed by 36.2%. While only 39.4% agreed that the depressed patient is best managed in a PHC, 86.2% would support treating the patient in their PHC if their capacity is enhanced. Top identified challenges were "heavy work schedule" (68.5%) and "lack of competence of the PHC staff" (67.5%). Over 42% had poor attitude towards depressed patient. Having a mental health training was the major factor that predicted good knowledge (OR 4.52, 95%CI 2.96-7.00) and good attitude (OR 2.17, 95% CI 1.48-3.17). CONCLUSIONS For successful scale up of mental health services in LMICs, the design of mental health training curriculum for PHC workers should consider their knowledge, experience, competence level, perception and attitudes.
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Affiliation(s)
- Abiodun O Adewuya
- Department of Behavioural Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria; Centre for Mental Health Research and Initiative (CEMHRI), Ikeja, Lagos, Nigeria.
| | - Tomilola Adewumi
- Centre for Mental Health Research and Initiative (CEMHRI), Ikeja, Lagos, Nigeria
| | - Bolanle Ola
- Department of Behavioural Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Olayinka Abosede
- Department of Community Health and Primary Health Care, Lagos University College of Medicine, Idi-Araba, Lagos, Nigeria
| | | | | | - Olajide Idris
- Lagos State Ministry of Health, Alausa, Ikeja. Lagos, Nigeria
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Ihalainen-Tamlander N, Vähäniemi A, Löyttyniemi E, Suominen T, Välimäki M. Stigmatizing attitudes in nurses towards people with mental illness: a cross-sectional study in primary settings in Finland. J Psychiatr Ment Health Nurs 2016; 23:427-37. [PMID: 27500395 DOI: 10.1111/jpm.12319] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 01/23/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Stigma related to mental illnesses is a great burden on societies globally. Factors associated with nurses' attitudes towards people with mental illness in health-care settings are discrepant. Stigmatized attitudes among staff members towards patients with mental illness have widely been studied in various specialized health care contexts, but less often in primary health-care settings. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE?: Nurses' attitudes towards people with mental illness in general were positive in primary care health settings. Younger nurses expressed feeling afraid of mentally ill patients. They not only lacked a feeling of safety around these patients but were also often of the opinion that people with mental illness should be segregated from the general population. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Systematic and continuous mental health on-the-job training for primary care nurses is recommended to strengthen the positive attitudes of young nurses towards patients. Young nurses especially should be prevented from developing stigmatized attitudes towards patients with mental problems and to ensure a skilled workforce for the future in this demanding area of health care. ABSTRACT Introduction Despite the development of mental health services in many countries, nurses working in different health care specialties may still have concerns and negative attitudes towards people with mental illness. Aim To describe nurses' attitudes towards people with mental illness and examine factors associated with their attitudes in primary care health centres. Method The data were collected from nursing staff (N = 264, response rate 84%) in 15 primary care health centres in two Finnish cities (spring 2014) with a self-report questionnaire (Attribution Questionnaire-27, Corrigan 2003) and analysed by descriptive statistics and multiway covariance analysis. Results Nurses' attitudes towards people with mental illness were generally positive. The nurses mostly reported willingness to help and feelings of concern and sympathy towards these patients. However, younger nurses or those without additional mental health training expressed a fear of patients. Discussion Special attention should be paid to nursing education and on-the-job training to prevent young nurses from developing stigmatized attitudes towards patients. Implications for practice Higher confidence in nursing staff could ensure a skilled work force in areas of mental health in the future, prevent young nurses from developing a fear of patients at work and support positive attitudes towards patients with mental problems.
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Affiliation(s)
| | - A Vähäniemi
- Department of Nursing Science, University of Turku, Turku, Finland
| | - E Löyttyniemi
- Department of Biostatistics, University of Turku, Turku, Finland
| | | | - M Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,Hong Kong Polytechnic University, Hong Kong Special Administrative Region
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López-Cortacans G, Aragonès Benaiges E, Caballero Alías A, Piñol Moreso JL. [Effect of an educational intervention on the attitudes of the nurses of primary care on depression]. ENFERMERIA CLINICA 2015; 25:254-61. [PMID: 25956559 DOI: 10.1016/j.enfcli.2015.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/26/2015] [Accepted: 03/21/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe nurse attitudes toward depression, using a standardized questionnaire and to evaluate how a training workshop can modify or influence these attitudes. METHODS A prospective study based on the application of the Depression Attitude Questionnaire, before and six months after, participating in a training day on the nursing role in the management of depression in Primary Care. The sample consisted of 40 Primary Care nurses from 10 health centers in the province of Tarragona. RESULTS Nurses are in a neutral position when considering the management of depressed patients as a difficult task, or to feel comfortable in this task, but there is a high degree of acceptance of the claim that the time spent caring for depressed patients is rewarding. In general, there was little significant difference in the mean scores for the different items of the Depression Attitude Questionnaire, before and six months, after the training intervention. CONCLUSIONS The attitude towards the management of depression in Primary Care and to the role that nurses can play in this task is generally favorable. Fruitful training and organizational initiatives can be established in order to define and structure the nursing role in the management of depression in Primary Care.
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Affiliation(s)
- Germán López-Cortacans
- Enfermería especializada en salud mental, Centro de Salud Salou, Institut Català de la Salut.
| | - Enric Aragonès Benaiges
- Enfermería especializada en salud mental, Centro de Salud Salou, Institut Català de la Salut; Medicina Familiar, Centro de Salud Constantí, Institut Català de la Salut
| | | | - Josep Lluís Piñol Moreso
- Medicina Familiar y Epidemiología, Unidad de investigación, Atención Primaria Camp de Tarragona, Institut Català de la Salut
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Haddad M, Menchetti M, McKeown E, Tylee A, Mann A. The development and psychometric properties of a measure of clinicians' attitudes to depression: the revised Depression Attitude Questionnaire (R-DAQ). BMC Psychiatry 2015; 15:7. [PMID: 25653089 PMCID: PMC4321322 DOI: 10.1186/s12888-014-0381-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is a common mental disorder associated with substantial disability. It is inadequately recognised and managed, and clinicians' attitudes to this condition and its treatment may play a part in this. Most research in this area has used the Depression Attitude Questionnaire (DAQ), but analyses have shown this measure to exhibit problems in psychometric properties and suitability for the health professionals and settings where depression recognition may occur. METHODS We revised the DAQ using a pooled review of findings from studies using this measure, together with a Delphi study which sought the opinions of a panel of relevant experts based in the UK, USA, Australia, and European countries (n = 24) using 3 rounds of questioning to consider attitude dimensions, content, and item wording. After item generation, revision and consensus (agreement >70%) using the Delphi panel, the revised DAQ (R-DAQ) was tested with 1193 health care providers to determine its psychometric properties. Finally the test-retest reliability of the R-DAQ was examined with 38 participants. RESULTS The 22-item R-DAQ scale showed good internal consistency: Cronbach's alpha coefficient was 0.84; and satisfactory test-retest reliability: intraclass correlation coefficient was 0.62 (95% C.I. 0.37 to 0.78). Exploratory factor analysis favoured a three-factor structure (professional confidence, therapeutic optimism/pessimism, and a generalist perspective), which accounted for 45.3% of the variance. CONCLUSIONS The R-DAQ provides a revised tool for examining clinicians' views and understanding of depression. It addresses important weaknesses in the original measure whilst retaining items and dimensions that appeared valid. This revised scale is likely to be useful in examining attitudes across the health professional workforce and beyond the confines of the UK, and may be valuable for the purpose of evaluating training that aims to address clinicians' attitudes to depression. It incorporates key dimensions of attitudes with a modest number of items making it applicable to use in busy clinical settings.
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Affiliation(s)
- Mark Haddad
- Centre for Mental Health Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK.
| | - Marco Menchetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Eamonn McKeown
- Centre for Health Services Research, City University London, London, UK.
| | - André Tylee
- Section of Primary Care Mental Health, Health Services and Population Research Department, King's College London, London, UK.
| | - Anthony Mann
- Section of Primary Care Mental Health, Health Services and Population Research Department, King's College London, London, UK.
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James BO, Jenkins R, Lawani AO, Omoaregba JO. Depression in primary care: the knowledge, attitudes and practice of general practitioners in Benin City, Nigeria. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2012.10874176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- BO James
- Department of Clinical Services, Federal Psychiatric Hospital, Benin City, Nigeria
| | - R Jenkins
- Section of Mental Health Policy, Health Service and Population Research Department, David Goldberg Centre, Institute of Psychiatry, King's College, London, United Kingdom
| | - AO Lawani
- Department of Clinical Services, Federal Psychiatric Hospital, Benin City, Nigeria
| | - JO Omoaregba
- Department of Clinical Services, Federal Psychiatric Hospital, Benin City, Nigeria
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Coppens E, Van Audenhove C, Iddi S, Arensman E, Gottlebe K, Koburger N, Coffey C, Gusmão R, Quintão S, Costa S, Székely A, Hegerl U. Effectiveness of community facilitator training in improving knowledge, attitudes, and confidence in relation to depression and suicidal behavior: results of the OSPI-Europe intervention in four European countries. J Affect Disord 2014; 165:142-50. [PMID: 24882192 DOI: 10.1016/j.jad.2014.04.052] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Community facilitators (CFs), such as teachers, nurses and social workers, are well placed as gatekeepers for depression and suicidal behavior, but not properly prepared to provide preventive and supportive services. The current study aimed: (1) to improve CFs' attitudes toward depression, knowledge on suicide, and confidence to detect suicidal behavior in four European countries and (2) to identify specific training needs across regions and CF groups. METHODS A standardized training program was provided to 1276 CFs in Germany, Hungary, Ireland, and Portugal. Attitudes toward depression, knowledge about suicide, and confidence in identifying suicidal persons were assessed before training, after training, and at three to six months follow-up. Additionally, several participants' characteristics were registered. RESULTS At baseline, CFs showed relatively favorable attitudes toward depression, but limited knowledge on suicide, and little confidence to identify suicidal behavior. Basic skills strongly differed across CF groups and countries. For example, in Germany, carers for the elderly, nurses, teachers, and managers were most in need of training, while in Portugal pharmacists and the clergy appeared to be important target groups. Most importantly, the training program improved the competencies of CF groups across countries and these improvements were sustained after three to six months. CFs with low basic skills benefited most of the training. LIMITATIONS The observed training effects could be influenced by other external factors as our results are based upon a pre-post comparison with no control group. CONCLUSIONS Gatekeeper trainings in community settings are successful in improving knowledge, reshaping attitudes, and boosting the confidence of gatekeepers. The most effective strategy to achieve the preferred objectives is to target those CF groups that are most in need of training and to tailor the content of the training program to the individual needs of the target group.
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Affiliation(s)
- Evelien Coppens
- LUCAS, Centre for Care Research and Consultancy, University of Leuven, Leuven, Belgium
| | - Chantal Van Audenhove
- LUCAS, Centre for Care Research and Consultancy, University of Leuven, Leuven, Belgium.
| | - Samuel Iddi
- Biostatistics and Statistical Bioinformatics Centre, University of Leuven, Leuven, Belgium; Department of Statistics, University of Ghana, Ghana
| | - Ella Arensman
- National Suicide Research Foundation & Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Katrin Gottlebe
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Nicole Koburger
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Claire Coffey
- National Suicide Research Foundation & Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Ricardo Gusmão
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal; Serviço de Psiquiatria, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Sónia Quintão
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Susana Costa
- CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas da Universidade NOVA de Lisboa, Lisboa, Portugal
| | - András Székely
- Institute of Behavioral Sciences, Semmelweis University Budapest, Budapest, Hungary
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
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Van Daele T, Vansteenwegen D, Hermans D, Van den Bergh O, Van Audenhove C. Home nurses and patient depression. Attitudes, competences and the effects of a minimal intervention. J Adv Nurs 2014; 71:126-35. [DOI: 10.1111/jan.12476] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Tom Van Daele
- Policy Research Centre Welfare, Health and Family & Research Group on Health Psychology; University of Leuven; Belgium
- Applied Psychology Thomas More University College; Antwerp Belgium
| | - Debora Vansteenwegen
- Centre for the Psychology of Learning and Experimental Psychopathology; University of Leuven; Belgium
- ISW Limits; Leuven Belgium
| | - Dirk Hermans
- Centre for the Psychology of Learning and Experimental Psychopathology; University of Leuven; Belgium
| | | | - Chantal Van Audenhove
- Policy Research Centre Welfare, Health and Family & Research Group on Health Psychology; University of Leuven; Belgium
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Bennett M, Walters K, Drennan V, Buszewicz M. Structured pro-active care for chronic depression by practice nurses in primary care: a qualitative evaluation. PLoS One 2013; 8:e75810. [PMID: 24069451 PMCID: PMC3772088 DOI: 10.1371/journal.pone.0075810] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 08/22/2013] [Indexed: 12/21/2022] Open
Abstract
PURPOSE This qualitative study explored the impact and appropriateness of structured pro-active care reviews by practice nurses for patients with chronic or recurrent depression and dysthymia within the ProCEED trial. ProCEED (Pro-active Care and its Evaluation for Enduring Depression) was a United Kingdom wide randomised controlled trial, comparing usual general practitioner care with structured 'pro-active care' which involved 3 monthly review appointments with practice nurses over 2 years for patients with chronic or recurrent depression. METHOD In-depth interviews were completed with 41 participants: 26 patients receiving pro-active care and 15 practice nurses providing this care. Interview transcripts were analysed thematically using a 'framework' approach. RESULTS Patients perceived the practice nurses to be appropriate professionals to engage with regarding their depression and most nurses felt confident in a case management role. The development of a therapeutic alliance between the patient and nurse was central to this model and, where it appeared lacking, dissatisfaction was felt by both patients and nurses with a likely negative impact on outcomes. Patient and nurse factors impacting on the therapeutic alliance were identified and nurse typologies explored. DISCUSSION Pro-active care reviews utilising practice nurses as case managers were found acceptable by the majority of patients and practice nurses and may be a suitable way to provide care for patients with long-term depression in primary care. Motivated and interested practice nurses could be an appropriate and valuable resource for this patient group. This has implications for resource decisions by clinicians and commissioners within primary care.
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Affiliation(s)
- Madeleine Bennett
- Research Department of Primary Care & Population Health, University College London, Royal Free Hospital, London, United Kingdom
| | - Kate Walters
- Research Department of Primary Care & Population Health, University College London, Royal Free Hospital, London, United Kingdom
| | - Vari Drennan
- Faculty of Health & Social Care Sciences, St. George’s University of London & Kingston University, London, United Kingdom
| | - Marta Buszewicz
- Research Department of Primary Care & Population Health, University College London, Royal Free Hospital, London, United Kingdom
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Casini F, Sighinolfi C, Tedesco P, Bandieri PV, Bologna M, Colombini N, Curcetti C, Magnani M, Morini M, Serio A, Tarricone I, Berardi D, Menchetti M. Primary care physicians' perspective on the management of anxiety and depressive disorders: a cross-sectional survey in Emilia Romagna Region. BMC FAMILY PRACTICE 2013; 14:75. [PMID: 23758941 PMCID: PMC3688370 DOI: 10.1186/1471-2296-14-75] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 05/29/2013] [Indexed: 11/28/2022]
Abstract
Background Evidences from literature suggest that Primary Care Physicians’ (PCPs) knowledge and attitude about psychological and pharmacological treatments of anxiety and depressive disorders could influence their clinical practice. The aim of the study is double: 1) to assess PCPs’ opinions about antidepressants (ADs) and psychotherapy for the management of anxiety and depressive disorders; 2) to evaluate the influence of PCPs’ gender, age, duration of clinical practice, and office location on their opinions and attitudes. Methods This cross-sectional multicentre survey involved 816 PCPs working in four Local Health Units of the Emilia Romagna Region. Participating PCPs were asked to complete a questionnaire during educational meetings between October 2006 and December 2008. Results The response rate was 65.1%. Eighty-five percent of PCPs agreed on the effectiveness of ADs for depressive disorder whereas lower agreement emerged for anxiety disorder and on psychotherapy for both anxiety and depression. Forty percent of PCPs reported to feel “very/extremely confident” in recognizing depression and 20.0% felt equally confident in treating it with pharmacotherapy. Considering anxiety disorder, these proportions increased. Female PCPs and those located in the rural/mountain areas reported to adopt more psycho-educational support compared to male and suburban colleagues. Conclusions Our results suggest that an effort should be made to better disseminate recent evidences about the management of anxiety and depressive disorders in Primary Care. In particular, the importance of psychological interventions and the role of drugs for anxiety disorder should be addressed.
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Affiliation(s)
- Federica Casini
- Institute of Psychiatry, University of Bologna, Viale C, Pepoli 5, IT-40123 Bologna, Italy
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Adaptation and psychometric evaluation of the Italian version of the depression attitude questionnaire (DAQ). Epidemiol Psychiatr Sci 2013; 22:93-100. [PMID: 22793494 PMCID: PMC6998379 DOI: 10.1017/s2045796012000224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aims. To validate the Italian version of the 'depression attitude questionnaire' (DAQ), to assess its psychometric properties and to evaluate the primary care physicians' (PCPs) opinion and attitude towards depression. Methods. An Italian version of the DAQ was created and then administered to a representative sample of PCPs working in the Emilia-Romagna region. Results. The findings derived from the Italian version of the DAQ indicated a three-factor solution (professional confidence, negative viewpoint and biological stance), broadly similar to previous studies and with acceptable fit indices. Our results showed that the PCPs consider depression as an increasingly important issue for their daily clinical practice. A large majority of them believed in the effectiveness of antidepressants and considered psychopharmacological treatment as appropriate for the PCPs to undertake. However, most PCP respondents thought that psychotherapy should be left to the specialists. Our findings suggest a prevalent orientation to the biochemical aspects of depression and the use of antidepressant treatment. Conclusions. The PCPs' attitude and opinion towards depression is an important aspect of their understanding and response to this common and disabling condition. The Italian version of the DAQ appears to be an appropriate and useful instrument to assist the understanding of the PCPs' views and potential need for further professional development.
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Ohtsuki T, Kodaka M, Sakai R, Ishikura F, Watanabe Y, Mann A, Haddad M, Yamada M, Inagaki M. Attitudes toward depression among Japanese non-psychiatric medical doctors: a cross-sectional study. BMC Res Notes 2012; 5:441. [PMID: 22894761 PMCID: PMC3434090 DOI: 10.1186/1756-0500-5-441] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 08/10/2012] [Indexed: 11/26/2022] Open
Abstract
Background Under-recognition of depression is common in many countries. Education of medical staff, focusing on their attitudes towards depression, may be necessary to change their behavior and enhance recognition of depression. Several studies have previously reported on attitudes toward depression among general physicians. However, little is known about attitudes of non-psychiatric doctors in Japan. In the present study, we surveyed non-psychiatric doctors’ attitude toward depression. Methods The inclusion criteria of participants in the present study were as follows: 1) Japanese non-psychiatric doctors and 2) attendees in educational opportunities regarding depression care. We conveniently approached two populations: 1) a workshop to depression care for non-psychiatric doctors and 2) a general physician-psychiatrist (G-P) network group. We contacted 367 subjects. Attitudes toward depression were measured using the Depression Attitude Questionnaire (DAQ), a 20-item self-report questionnaire developed for general physicians. We report scores of each DAQ item and factors derived from exploratory factor analysis. Results We received responses from 230 subjects, and we used DAQ data from 187 non-psychiatric doctors who met the inclusion criteria. All non-psychiatric doctors (n = 187) disagreed with "I feel comfortable in dealing with depressed patients' needs," while 60 % (n = 112) agreed with "Working with depressed patients is heavy going." Factor analysis indicated these items comprised a factor termed "Depression should be treated by psychiatrists" - to which 54 % of doctors (n = 101) agreed. Meanwhile, 67 % of doctors (n = 126) thought that nurses could be useful in depressed patient support. The three factors derived from the Japanese DAQ differed from models previously derived from British GP samples. The attitude of Japanese non-psychiatric doctors concerning whether depression should be treated by psychiatrists was markedly different to that of British GPs. Conclusions Japanese non-psychiatric doctors believe that depression care is beyond the scope of their duties. It is suggested that educational programs or guidelines for depression care developed in other countries such as the UK are not directly adaptable for Japanese non-psychiatric doctors. Developing a focused educational program that motivates non-psychiatric doctors to play a role in depression care is necessary to enhance recognition and treatment of depression in Japan.
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Affiliation(s)
- Tsuyuka Ohtsuki
- Center for Suicide Prevention, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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Karantzas GC, Davison TE, McCabe MP, Mellor D, Beaton P. Measuring carers' knowledge of depression in aged care settings: the Knowledge of Late Life Depression Scale-Revised. J Affect Disord 2012; 138:417-24. [PMID: 22284014 DOI: 10.1016/j.jad.2012.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 12/02/2011] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
Abstract
BACKGROUND Aged care staff is increasingly relied upon to assist with the recognition and treatment of depression in older care recipients. However, there exist few reliable and comprehensive measures that assess aged care staffs' knowledge about late life depression. The Knowledge of Late-Life Depression Scale is one such scale. In this study we modified this measure in an attempt to improve its psychometric properties so that it can be used with confidence in research and practise. Our modifications to the original measure resulted in the Knowledge of Late-Life Depression Scale-Revised. METHOD Aged care staff (N=149) from 20 low level care facilities and community care facilities in Melbourne, Australia, completed the Knowledge of Late-Life Depression Scale-Revised. RESULTS Using Confirmatory Factor Analysis and reliability analysis, the Knowledge of Late-Life Depression Scale-Revised was found to demonstrate three robust and internally consistent factors. These factors were: symptoms of depression, facts about depression, and myths of depression. The revised measure was found to yield superior psychometric properties compared to the original measure. LIMITATIONS Replication studies are required, especially with other aged carer samples to ensure that the factor structure and internal consistency of the measure are supported across different aged care contexts in Australia and elsewhere. CONCLUSIONS The Knowledge of Late-Life Depression-Revised is a measure that can be used by researchers and agencies to assess the knowledge of depression among professional care staff. The measure is expected to be especially useful as an assessment tool for training and educational purposes.
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Haddad M, Menchetti M, Walters P, Norton J, Tylee A, Mann A. Clinicians' attitudes to depression in Europe: a pooled analysis of Depression Attitude Questionnaire findings. Fam Pract 2012; 29:121-30. [PMID: 21926052 DOI: 10.1093/fampra/cmr070] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression in primary care is common but under-recognized and suboptimally managed. Health professionals' attitudes are likely to play an important part in their recognition and management of depression. OBJECTIVES To pool findings from studies using the Depression Attitude Questionnaire (DAQ) to provide greater detail of clinicians' attitudes and the measure's psychometric properties. METHODS Electronic databases and grey literature were searched for relevant studies. Data from eligible studies were requested and pooled analysis conducted. RESULTS Twenty studies were eligible and data were obtained from 12 of these involving GPs (n = 1543) and nurses (n = 984). Responses showed strong disagreement that depression is due to ageing or weakness. European GPs were more positive about depression treatments than UK GPs; nurses were more favourable about psychotherapy than GPs. UK GPs especially strongly opposed notions that depression is best managed by psychiatrists. Trends over time indicated increasing acknowledgement of psychological therapies and the nurse's role in depression management. Factor analysis indicated that many DAQ items fitted weakly within an overall model. The most parsimonious solution involved two factors: a positive view of depression and its treatment response and professional confidence in depression management. CONCLUSIONS Individual DAQ items appear to measure key aspects of clinicians' attitudes to depression, and item responses indicate important differences between professions and geographical settings as well as changes over time. There are problems with the DAQ as a scale: its internal consistency is weak, and several items appear specific to particular professions or service structures, indicating that this questionnaire should be revised.
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Affiliation(s)
- M Haddad
- Section of Primary Care Mental Health, Health Service and Population Research Department, Institute of Psychiatry at King's College London, London SE5 8AF, UK.
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Scheerder G, Van Audenhove C, Arensman E, Bernik B, Giupponi G, Horel AC, Maxwell M, Sisask M, Szekely A, Värnik A, Hegerl U. Community and health professionals' attitude toward depression: a pilot study in nine EAAD countries. Int J Soc Psychiatry 2011; 57:387-401. [PMID: 20223779 DOI: 10.1177/0020764009359742] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Community facilitators (CFs), such as pharmacists, policemen, teachers and clergy, may be an important community resource for patients with depression in addition to (mental) health professionals. However, they are ill prepared for such a role and little is known about their attitudes toward depression, which may affect practice. AIM To investigate CFs' attitudes toward depression and compare them to those of (mental) health professionals and nurses. METHOD Attitudes were assessed in participants (n = 2,670) of training programmes about depression in nine countries of the European Alliance Against Depression (EAAD). The EAAD questionnaire included attitudes toward depression and its treatment, perceived causes, preferred treatment options, and knowledge of depression symptoms. RESULTS CFs and nurses had a more negative attitude toward patients with depression and toward antidepressants, and more limited knowledge of depression symptoms than (mental) health professionals. CFs more frequently supported non-standard treatment for depression. Nurse assistants clearly differed from registered nurses with their attitudes being among the least favourable and their knowledge the most limited of all groups. CONCLUSIONS CFs and nurses had less favourable attitudes and more limited knowledge regarding depression when compared to mental health professionals and doctors. This may negatively affect professional collaboration, challenge optimal treatment and stigmatize patients. CFs' and nurses' knowledge and attitudes may be similar to those of the general population and be related to a lack of training in mental health issues.
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Aragonès E, Piñol JL, López-Cortacans G, Hernández JM, Caballero A. [Attitudes and opinions of family doctors on depression: application of the Depression Attitudes Questionnaire (DAQ)]. Aten Primaria 2011; 43:312-8. [PMID: 21232826 DOI: 10.1016/j.aprim.2010.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 04/21/2010] [Accepted: 05/10/2010] [Indexed: 10/18/2022] Open
Abstract
AIM To describe the attitudes of General Practitioners (GPs) towards depression in Primary Health Care Centres. DESIGN Cross-sectional study based on the application of a standard questionnaire. SETTING AND PARTICIPANTS A total of 112 GPs from all of the 20 Primary Health Care Centres in the Tarragona-Reus Primary Care Area (Catalan Health Institute). MEASUREMENTS A Spanish adaptation of Depression Attitudes Questionnaire was used. RESULTS A total of 88.4% of doctors agreed there was an increase in the number of depressive patients in recent years. Around half of the GPs thought that depression in Primary Health Care Centres are due to the adversities of life, but 72.3% considers that there is a biological root in severe depressions. A large majority (81.2%) of doctors believed that antidepressants used in Primary Care are efficient and the majority values psychotherapy as a useful therapeutic option. There is an agreement in the role of nursing staff when attending depressed patients. The role of psychiatric referral when a satisfactory result is not obtained in Primary Care is recognised. Although 64.3% of doctors consider that dealing with depressed patients is hard work, but 57.1% feel comfortable and only 19.7% think it is an unpleasant job. CONCLUSIONS In general, there is a favourable predisposition to deal with depression in Primary Care where training and organisational initiatives can be introduced to improve clinical outcomes of depression in Primary Care.
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Affiliation(s)
- Enric Aragonès
- Grupo de Investigación Salud Mental en Atención Primaria, Atención Primaria Tarragona-Reus, Institut Català de la Salut, Reus, Tarragona, España.
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Norton JL, Pommié C, Cogneau J, Haddad M, Ritchie KA, Mann AH. Beliefs and attitudes of French family practitioners toward depression: the impact of training in mental health. Int J Psychiatry Med 2011; 41:107-22. [PMID: 21675343 PMCID: PMC3596352 DOI: 10.2190/pm.41.2.a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study, in a sample of French Family Practitioners (FPs), beliefs and attitudes toward depression and how they vary according to training received in mental health. METHODS The Depression Attitude Questionnaire (DAQ) was completed by 468 FPs from all regions of France, recruited by pharmaceutical company representatives to attend focus groups on the management of depression in general practice. RESULTS A three-factor model was derived from the DAQ, accounting for 37.7% of the total variance. The correlations between individual items of each component varied from 0.4 to 0.65, with an overall internal consistency of 0.47 (Cronbach's alpha). FPs had an overall neutral position on component 1, professional ease, a positive view on the origins of depression and its amenability to change (component 2), and a belief in the necessity of medication and the benefit of antidepressant therapy (component 3). Training in mental health, specifically through continuing medical education and postgraduate psychiatric hospital training, was significantly and positively associated with both professional ease and a medication approach to treating depression. CONCLUSION This study is the first description of the beliefs and attitudes of French FPs toward depression using a standardized measure, the DAQ, despite the instrument's limited psychometric properties. It shows the positive effect of training in mental health on attitudes toward depression.
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Affiliation(s)
- Joanna L. Norton
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière 39 AV Charles Flahault BP 34493 -Pav 42 Calixte Cavalier 34093 CEDEX 5 Montpellier,FR,* Correspondence should be addressed to: Joanna Norton
| | - Christelle Pommié
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière 39 AV Charles Flahault BP 34493 -Pav 42 Calixte Cavalier 34093 CEDEX 5 Montpellier,FR
| | - Joël Cogneau
- IRMG, Institut de Recherche en Médecine Générale
Institut de recherche en médecine générale105 rue de Javel 75015 Paris,FR
| | - Mark Haddad
- Health Services and Population Research Department
Institute of psychiatryNIHR Biomedical Research CentreKings CollegeLondon SE5 8AF,GB
| | - Karen A. Ritchie
- Neuropsychiatrie : recherche épidémiologique et clinique
INSERM : U1061Université Montpellier IHôpital La Colombière 39 AV Charles Flahault BP 34493 -Pav 42 Calixte Cavalier 34093 CEDEX 5 Montpellier,FR
| | - Anthony H. Mann
- Health Services and Population Research Department
Institute of psychiatryNIHR Biomedical Research CentreKings CollegeLondon SE5 8AF,GB
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Abstract
BACKGROUND The prevalence of depression among older people receiving care is high, yet the rate of treatment of this disorder is low. One way to improve the pathway to care is to train care staff to recognize the symptoms of depression and raise their confidence in responding to them. In this study we evaluated the efficacy of the beyondblue Depression Training Program to achieve this aim. METHODS Staff (N = 148) from low level care facilities and community care facilities in metropolitan Melbourne completed the beyondblue Depression Training Program, while staff in other facilities (N = 96) acted as controls. Pre-program, post-program and follow-up questionnaire data were collected and referrals for depression by staff were recorded. RESULTS Training improved carers' knowledge about depression, their self-efficacy in responding to signs of depression and their attitudes towards working with depressed aged care recipients. In addition, training increased the number of referrals for depression made by carers. CONCLUSION Training aged care staff in depression can improve the pathways to care for depressed care recipients, and has the potential to improve the quality of life of older people.
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Haddad M, Butler GS, Tylee A. School nurses’ involvement, attitudes and training needs for mental health work: a UK-wide cross-sectional study. J Adv Nurs 2010; 66:2471-80. [DOI: 10.1111/j.1365-2648.2010.05432.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Which physician and practice characteristics are associated with adherence to evidence-based guidelines for depressive and anxiety disorders? Med Care 2010; 48:240-8. [PMID: 20125045 DOI: 10.1097/mlr.0b013e3181ca27f6] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research on quality of care for depressive and anxiety disorders has reported low rates of adherence to evidence-based depression and anxiety guidelines. To improve this care, we need a better understanding of the factors determining guideline adherence. OBJECTIVE To investigate how practice- and professional-related factors are associated with adherence to these guidelines. DESIGN Cross-sectional cohort study. PARTICIPANTS A total of 665 patients with a composite interview diagnostic instrument diagnosis of depressive or anxiety disorders, and 62 general practitioners from 21 practices participated. MEASURES Actual care data were derived from electronic medical record data. The measurement of guideline adherence was based on performance indicators derived from evidence-based guidelines. Practice-, professional-, and patient-related characteristics were measured with questionnaires. The characteristics associated with guideline adherence were assessed by multivariate multilevel regression analysis. RESULTS A number of practice and professional characteristics showed a significant univariate association with guideline adherence. The multivariate multilevel analyses revealed that, after controlling for patient characteristics, higher rates of guideline adherence were associated with stronger confidence in depression identification, less perceived time limitations, and less perceived barriers for guideline implementation. These professional-related determinants differed among the overall concept of guideline adherence and the various treatment options. CONCLUSIONS This study showed that rates of adherence to guidelines on depressive and anxiety disorders were not associated with practice characteristics, but to some extent with physician characteristics. Although most of the identified professional-related determinants are very difficult to change, our results give some directions for improving depression and anxiety care.
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Scheerder G, De Coster I, Van Audenhove C. Community pharmacists' attitude toward depression: A pilot study. Res Social Adm Pharm 2009; 5:242-52. [DOI: 10.1016/j.sapharm.2008.08.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 08/27/2008] [Accepted: 08/27/2008] [Indexed: 11/27/2022]
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Ross CA, Goldner EM. Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: a review of the literature. J Psychiatr Ment Health Nurs 2009; 16:558-67. [PMID: 19594679 DOI: 10.1111/j.1365-2850.2009.01399.x] [Citation(s) in RCA: 219] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this paper was to review the existing literature pertaining to stigma, negative attitudes and discrimination towards mental illness, specifically as viewed through the lens of the nursing profession. The results of the literature review were synthesized and analysed, and the major themes drawn from this were found to correspond with Schulze's model identifying three positions that healthcare workers may assume in relation to stigma of mental illness: 'stigmatizers', 'stigmatized' and 'de-stigmatizers'. In this paper, the nursing profession is examined from the perspectives of the first two major themes: the 'stigmatizers' and 'stigmatized'. Their primary sub-themes are identified and discussed: (1) Nurses as 'the stigmatizers': (a) nurses' attitudes in general medical settings towards patients with psychiatric illness and (b) psychiatric nurses; (2) Nurses as 'the stigmatized': (a) nurses who have mental illness and (b) stigma within the profession against psychiatric nurses and/or psychiatry in general. The secondary and tertiary sub-themes are also identified and reviewed.
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Affiliation(s)
- C A Ross
- BSN Program, Faculty of Health Sciences, Douglas College, Coquitlam, BC, Canada.
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Brooker C. The Chief Nursing Officer's review of mental health nursing in England an ode to ‘motherhood and apple pie’? Int J Nurs Stud 2007; 44:327-30. [PMID: 17291509 DOI: 10.1016/j.ijnurstu.2007.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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