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Bradford A, Meyer AND, Khan S, Giardina TD, Singh H. Diagnostic error in mental health: a review. BMJ Qual Saf 2024; 33:663-672. [PMID: 38575311 DOI: 10.1136/bmjqs-2023-016996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
Diagnostic errors are associated with patient harm and suboptimal outcomes. Despite national scientific efforts to advance definition, measurement and interventions for diagnostic error, diagnosis in mental health is not well represented in this ongoing work. We aimed to summarise the current state of research on diagnostic errors in mental health and identify opportunities to align future research with the emerging science of diagnostic safety. We review conceptual considerations for defining and measuring diagnostic error, the application of these concepts to mental health settings, and the methods and subject matter focus of recent studies of diagnostic error in mental health. We found that diagnostic error is well understood to be a problem in mental healthcare. Although few studies used clear definitions or frameworks for understanding diagnostic error in mental health, several studies of missed, wrong, delayed and disparate diagnosis of common mental disorders have identified various avenues for future research and development. Nevertheless, a lack of clear consensus on how to conceptualise, define and measure errors in diagnosis will pose a barrier to advancement. Further research should focus on identifying preventable missed opportunities in the diagnosis of mental disorders, which may uncover generalisable opportunities for improvement.
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Affiliation(s)
- Andrea Bradford
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Ashley N D Meyer
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Sundas Khan
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Traber D Giardina
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Hardeep Singh
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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2
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Aviles Gonzalez CI, Cerchiaro Fernandez DM, Guerra Munoz ME, Romero Ramirez R, Abarca Arias YM, Brasesco MV, Migliaccio GM, Romano F, Cossu G, Primavera D, Carta MG. Mental Health Professionals' Perception of Respect for Human Rights and Organizational Well-Being in Three Countries of South America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:214. [PMID: 38397703 PMCID: PMC10888642 DOI: 10.3390/ijerph21020214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/20/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
The respect for human rights in mental health care services significantly contributes to organizational well-being and is evolving into an actual benchmark of quality standards. This study assesses the perception of the respect for human rights for users and staff, as well as organizational and job satisfaction among mental health professionals in three South American countries, through the well-being at work and respect for human rights (WWRR) questionnaire and assesses whether there are significant differences. Seven mental health facilities in Argentina, Colombia, and Peru were involved in this observational study. The sample comprised 310 mental health professionals. The three countries exhibited differences in WWRR, particularly in the staff's satisfaction with resources for care (η2 = 0.166) and staff's satisfaction with organizational aspects (η2 = 0.113). Colombia had the lowest scores in these factors but the highest in the perception of the respect for human rights for users and staff, although this difference did not reach a statistical significance. Despite the progress made in recent years towards coercion-free medical standards and an increased focus on mental health polices in Latin American countries, there is a need to enhance the quality standards of mental health services, recognizing the value that the respect for human rights holds for the organizational well-being of both mental health users and professionals.
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Affiliation(s)
- Cesar Ivan Aviles Gonzalez
- Department of Nursing, Universidad Popular del Cesar, Valledupar 200001, Colombia
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
| | | | - Martha Esther Guerra Munoz
- Faculty of Administrative, Accounting, and Economic Sciences, Rectorate and Vice-Presidency for Research, Universidad Popular del Cesar, Valledupar 200001, Colombia
| | - Robert Romero Ramirez
- Faculty of Administrative, Accounting, and Economic Sciences, Rectorate and Vice-Presidency for Research, Universidad Popular del Cesar, Valledupar 200001, Colombia
| | | | | | - Gian Mario Migliaccio
- Department Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00118 Rome, Italy
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, Università La Sapienza, 00185 Rome, Italy
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy
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Washburn M, Gearing RE, Yu M, Brewer KB, Cruz PDL, Torres LR. Predictors of Stigma toward Alcohol Misuse in Mexico. Subst Use Misuse 2023; 58:1805-1812. [PMID: 37644694 DOI: 10.1080/10826084.2023.2247067] [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] [Indexed: 08/31/2023]
Abstract
Objective: This study explored factors associated with public stigma toward individuals misusing alcohol in Mexico. Methods: A randomized experimental vignette methodology was used to assess multiple domains of substance use-related stigma and their relationship to the gender of the vignette subject and the sociodemographic characteristics of respondents. Results: Although levels of stigma toward women who were misusing alcohol did not differ significantly from stigma toward men misusing alcohol, stigma levels and type of stigma reported varied with the sociodemographic characteristics of respondents. Education level, gender, self-stigma and openness to seeking mental health services were differentially associated with the three stigma domains. Conclusions: Accordingly, targeted community based stigma reduction efforts are needed to decrease stigma toward those misusing alcohol, and to support treatment initiation, ongoing treatment engagement and long term recovery efforts. Suggestions for future research on the relationship between substance use and stigma are offered.
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Affiliation(s)
- Micki Washburn
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Robin E Gearing
- University of Houston Graduate College of Social Work, Houston, Texas, USA
| | - Miao Yu
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Kathryne B Brewer
- Department of Social Work, University of New Hampshire, Durham, New Hampshire, USA
| | - Pedro de la Cruz
- Universidad Nacional Autonoma de Mexico Escuela Nacional de Trabajo Social, Avenida Universidad 3000, Mexico City, Mexico
| | - Luis R Torres
- School of Social Work, University of Texas Rio Grande Valley, Edinburg, Edinburg, Texas, USA
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Strudwick J, Gayed A, Deady M, Haffar S, Mobbs S, Malik A, Akhtar A, Braund T, Bryant RA, Harvey SB. Workplace mental health screening: a systematic review and meta-analysis. Occup Environ Med 2023; 80:469-484. [PMID: 37321849 PMCID: PMC10423530 DOI: 10.1136/oemed-2022-108608] [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: 08/16/2022] [Accepted: 03/30/2023] [Indexed: 06/17/2023]
Abstract
Workplaces are an important location for population mental health interventions. Screening to detect employees at risk of or experiencing mental ill health is increasingly common. This systematic review and meta-analysis examined the efficacy of workplace mental health screening programmes on employee mental health, work outcomes, user satisfaction, positive mental health, quality of life, help-seeking and adverse effects. PubMed, PsycINFO, EMBASE, CENTRAL, Global Index Medicus, Global Health and SciELO were searched (database inception-10 November 2022) and results screened by two independent reviewers. Controlled trials evaluating screening of workers' mental health as related to their employment were included. Random effects meta-analysis was performed to calculate pooled effect sizes for each outcome of interest. Grading of Recommendations Assessment, Development and Evaluation was conducted to evaluate the certainty of findings. Of the 12 328 records screened, 11 were included. These reported 8 independent trials collectively assessing 2940 employees. Results indicated screening followed by advice or referral was ineffective in improving employee mental health symptoms (n=3; d=-0.07 (95% CI -0.29 to 0.15)). Screening followed by facilitated access to treatment interventions demonstrated a small improvement in mental health (n=4; d=-0.22 (95% CI -0.42 to -0.02)). Limited effects were observed for other outcomes. Certainty ranged from low to very low. The evidence supporting workplace mental health screening programmes is limited and available data suggest mental health screening alone does not improve worker mental health. Substantial variation in the implementation of screening was observed. Further research disentangling the independent effect of screening alongside the efficacy of other interventions to prevent mental ill health at work is required.
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Affiliation(s)
- Jessica Strudwick
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
| | - Aimee Gayed
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Mark Deady
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Sam Haffar
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
| | - Sophia Mobbs
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
| | - Aiysha Malik
- Department of Mental Health and Substance Use, World Health Organization, Geneve, Switzerland
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Taylor Braund
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Samuel B Harvey
- Black Dog Institute, University of New South Wales, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
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Lauria-Horner B, Knaak S, Cayetano C, Vernon A, Pietrus M. An initiative to improve mental health practice in primary care in Caribbean countries. Rev Panam Salud Publica 2023; 47:e89. [PMID: 37363624 PMCID: PMC10289476 DOI: 10.26633/rpsp.2023.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/12/2023] [Indexed: 06/28/2023] Open
Abstract
Objectives The aim of this initiative was to assess whether a novel training program - Understanding Stigma and Strengthening Cognitive Behavioral Interpersonal Skills - could improve primary health care providers' confidence in the quality of mental health care they provide in the Caribbean setting by using the Plan-Do-Study-Act rapid cycle for learning improvement. Methods We conducted a prospective observational study of the impact of this training program. The training was refined during three cycles: first, the relevance of the program for practice improvement in the Caribbean was assessed. Second, pilot training of 15 local providers was conducted to adapt the program to the culture and context. Third, the course was launched in fall 2021 with 96 primary care providers. Pre- and post-program outcomes were assessed by surveys, including providers' confidence in the quality of the mental health care they provided, changes in stigma among the providers and their use of and comfort with the tools. This paper describes an evaluation of the results of cycle 3, the official launch. Results A total of 81 participants completed the program. The program improved primary care providers' confidence in the quality of mental health care that they provided to people with lived experience of mental health disorders, and it reduced providers' stigmatization of people with mental health disorders. Conclusions The program's quality improvement model achieved its goals in enhancing health care providers' confidence in the quality of the mental health care they provided in the Caribbean context; the program provides effective tools to support the work and it helped to empower and engage clients.
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Affiliation(s)
- Bianca Lauria-Horner
- Department of PsychiatryDalhousie UniversityHalifaxNova ScotiaCanadaDepartment of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephanie Knaak
- Mental Health Commission of Canada (MHCC)OttawaCanadaMental Health Commission of Canada (MHCC), Ottawa, Ottawa, Canada
| | - Claudina Cayetano
- Department of Noncommunicable Diseases and Mental HealthMental Health UnitPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Mental Health Unit, Pan American Health Organization, Washington, DC, United States of America
| | - Andrew Vernon
- Department of Noncommunicable Diseases and Mental HealthMental Health UnitPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Mental Health Unit, Pan American Health Organization, Washington, DC, United States of America
| | - Michael Pietrus
- Mental Health Commission of Canada (MHCC)OttawaCanadaMental Health Commission of Canada (MHCC), Ottawa, Ottawa, Canada
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Castro-Ramirez F, Paz-Pérez MA, McGuire TC, Rankin O, Alfaro MCG, Audirac AM, Campuzano MLG, Coady P, Núñez-Delgado M, Manana J, Hernández-de la Rosa C, Tambedou T, Vergara GA, Barranco LA, Cudris-Torres L, Nock MK, Naslund JA, Benjet C. A Qualitative Examination of the Impact of Suicidal Thoughts and Behavior on Help-Seeking Among University Students in Colombia and Mexico. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2023; 33:67-80. [PMID: 37680902 PMCID: PMC10482072 DOI: 10.1016/j.jbct.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
This study examined descriptions of suicidal thoughts and behavior (STB) to identify risk and protective factors that may present in clinical settings among university students from Latin America. Our focus was on answering the following key questions: How are suicidal thoughts and behavior described? What are reasons for wanting to die and for living? What impact do STBs have on motivations to seek or avoid psychological treatment? To this end, 55 qualitative interviews were completed with university students from Colombia and Mexico who recently endorsed emotional difficulties in the World Mental Health International College Student (WMH-ICS) surveys. Interviews were coded to identify themes specific to STBs. Findings revealed insight on symptom presentations and consequences of STBs. Participants described uncontrollable somatic symptoms during periods of high suicide risk, which serves as a relevant clinical marker for health providers. An important reason for living was to avoid suffering for family, which was protective against suicide and motivates familial involvement in treatment planning. Participants sought solutions to emotional problems after experiencing STBs, including psychological treatment. Cultural stigma of mental illness induced feelings of shame and burden, which led to avolition, avoidance, and nondisclosure of symptom severity. This study provides insight into the utility of evaluating cultural context in (a) detecting antecedents to STBs frequently reported as somatic symptoms, (b) identifying protective factors against suicide, and (c) recognizing how stigma of mental illness and suicide, shame avoidance, and familism might influence personal motivations to seek or avoid help for emotional distress.
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Affiliation(s)
| | | | | | - Osiris Rankin
- Department of Psychology, Harvard University, United States
| | | | | | | | - Parker Coady
- Department of Psychology, Harvard University, United States
| | | | | | | | - Tida Tambedou
- Department of Psychology, Harvard University, United States
| | | | | | | | - Matthew K Nock
- Department of Psychology, Harvard University, United States
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, United States
| | - Corina Benjet
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México City, México
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Gelaye B, López Jaramillo CA. The epidemiology of mental illness in low- and middle-income countries: Cross-cultural measurement, risk factors, and outcomes. J Affect Disord 2023; 323:30-32. [PMID: 36370914 DOI: 10.1016/j.jad.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA; The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Rafful C, López A, Contreras-Valdez JA, Morales M, Jiménez-Rivagorza L, Orozco R. Substance use stigma mechanisms scale: Factor structure, reliability, and validity in Mexican adults that use drugs. Drug Alcohol Depend 2022; 239:109598. [PMID: 35961267 DOI: 10.1016/j.drugalcdep.2022.109598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Studies among the Mexican population have suggested that stigma towards persons who use drugs (PWUD) may act as a barrier to treatment seeking and contribute to negative health consequences. However, there has not been a validated scale to measure this construct. This paper aims to validate the Substance Use Stigma Mechanisms Scale (SU-SMS) in a sample of Mexican adults who use drugs. This 18-item scale was developed to differentiate substance use stigma mechanisms and learn their impact on the health and wellbeing of persons who use drugs (PWUD) in the United States. METHODS A sample of 407 adults with a median age of 27 years old completed a web-based version in Spanish of the SU-SMS, the WHO-ASSIST screening instrument, as well as sociodemographic and substance-use-related characteristics. We performed exploratory factor analysis with weighted least squares and oblique rotation, and correlations within and between mechanisms of stigma, and substance use. RESULTS The Spanish translation of the SU-SMS has adequate internal consistency (Ω=0.92) and the same factor structure as the original scale. A five-factor solution with internalized, enacted, and anticipated stigma from family and healthcare workers showed adequate concurrent validity. Mechanisms of stigma were correlated between them, within sources, and negatively correlated with current substance use treatment. CONCLUSIONS The Spanish translation of the scale seems to be a valid and sensitive scale that can be used among Mexican PWUD.
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Affiliation(s)
- Claudia Rafful
- Faculty of Psychology, Universidad Nacional Autónoma de México, Mexico City, Mexico; Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - Andrea López
- Faculty of Psychology, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Missael Morales
- Faculty of Psychology, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Ricardo Orozco
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico.
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