Is there a case for mental health promotion in the primary care setting? A systematic review

The Capacities of Primary Health Care in Hungary: A Problem Statement

In the establishment, development, and provision of equal access to the health care system, the operation of adequate primary health care is essential and has undergone significant transformation in the most developed countries over the past decades. The central and eastern European countries, including Hungary, are struggling with the disadvantages of the traditional model of primary health care, based on independent general practitioner and family paediatrician practices: the ability of the system is extremely limited to meet emerging needs and is facing a chronic human resource crisis. In the current study, the functions, legislation, and challenges of the Hungarian primary health care system, as well as the basic interrelations of the development of vacant general practitioner and family paediatrician districts were examined, and the government measures for the sake of solving the occurrence of the vacancy and improving access in the lagging areas. (The situation of the other fields of primary health care—e.g., dental care, child care officer care, etc.—was not subject of the analysis.). The basic characteristics of the vacant districts (type by supplied age group, bounding region, population size, length of vacancy) were primarily examined by the analysis of categorical and metric variables, with the use of cross-tabulation and nonparametric correlation, while the discovery of soft interrelations was supported by an expert interview conducted with the professionals of the Primary Health Care Department of the National Health Care Services Centre. In Hungary, the fundamentals of primary health care are made up of the individual practices of general practitioners and paediatricians, and there is a growing concern about the permanent vacancy of the districts, and the fact that the system is less suitable for meeting the needs of the population. The ever-increasing number of vacant general practitioner and family paediatrician districts due to the growing shortage of professionals because of aging and emigration poses the burden of substitution on the physicians in existing practices, that concerns the access of more than a half million people to health care, almost 70 percent of which live in settlements with a population less than 5000 inhabitants.

Promotion of women's mental health: the influence of physical health and the environment

OBJECTIVE

To describe the results of a group of women's mental health promotion conducted by nurses.

METHOD

This is a quantitative study of the pre- and post-test type. The participants were women aged between 20 and 64 years old attending a Primary Care Unit. We used the Sarason Social Support Questionnaire, the World Health Organization Quality of Life Assessment questionnaire, and the Rosenberg Self-Esteem Scale. Data were collected before, immediately after and three months after the intervention.

RESULTS

improvement in the physical and environmental quality of life was identified. However, there was no measurable change in the other indicators adopted.

CONCLUSION

the ludic activities and the Body Mapping technique were promising for improving the physical and environmental domain of quality of life, constituting important tools for nursing care and interventions related to mental health in basic care.

Consumer perceptions of community pharmacy-based promotion of mental health and well-being

ISSUE ADDRESSED

With nearly half of all Australians likely to experience a mental illness, increasing community-based mental health promotion is warranted. Community pharmacies are accessible health care destinations that effectively provide a range of public health services. This study explored consumer opinions of mental health promotion in the community pharmacy setting, the activities they have observed and the perceived role/s of pharmacy staff in this area.

METHODS

A survey was informed by five interviews with pharmacy consumers and a literature review. Adult pharmacy consumers were recruited nationwide via a Research Panel company between December 2018 and January 2019. Survey data were descriptively analysed and associations confirmed by chi-square analysis.

RESULTS

Data were analysed from 537 of the 577 respondents; 34.3% of participants had a lived experience of mental illness. Just under a quarter of participants (23.3%) had observed mental health promotion in community pharmacy. Pharmacy was viewed as a suitable environment for this promotion by most respondents (n = 446/516), particularly those with lived experience, with a preference for in-store leaflets, posters and linking with existing national mental health organisations/campaigns. Lack of privacy and the busy pharmacy environment were identified as barriers for promotion in this setting.

CONCLUSION

There is a clear potential for mental health promotion within community pharmacies, although the uptake and impact of such activities require further investigation. SO WHAT?: These findings highlight a missed opportunity for pharmacists to engage with consumers about mental health and well-being, even though community pharmacies are accessible health care destinations.

The Social Support Buffering Effect in the Relationship Between Perceived Stress and Alcohol Use Among Brazilian Women

This cross-sectional study interviewed Brazilian women regularly attending primary care to investigate whether the relationship between social support and alcohol use is direct or is mediated by stress, in order to support the development of recommendations related to health prevention and mental health promotion actions. The results suggest that social support affects the outcome alcohol use in the women studied by buffering the effect of stress. Based on these results, recommendations are made for amplifying the social support network that prevents stress-induced alcohol use.

The role of social support in the psychological illness of women

OBJECTIVE

to analyze the relationship between perception of social support and emotional and physical symptoms associated with psychiatric conditions among women.

METHOD

a cross-sectional, quantitative study was carried out with a randomized random sample of 141 women attended at a Family Health Unit of the city of Ribeirão Preto/SP. A sociodemographic questionnaire, the Social Support Questionnaire and the Self-Report Questionnaire were used.

RESULTS

there was no association between sociodemographic characteristics and mental disorder, but between aspects such as low income and schooling. The exercise of professions culturally considered as of low prestige gave rise to some reflections related to gender inequality. There was a significant difference in the satisfaction scores between the women who reported or not the symptoms of tiredness and sadness and the number of supporters among those who reported or not the symptom of fatigue. Spouses and children were the most mentioned supporters, and having mental disorder was significantly associated with having no friends in the support network.

CONCLUSION

issues related to gender equity and satisfaction with social support are important aspects of care. For the promotion of mental health, efforts must be made to make women feel more connected and supported by the supporters available in their social environment.

Predictors of change in depressive symptoms over time: Results from the Australian Longitudinal Study on Women's Health

BACKGROUND

Depressive symptoms fluctuate over time, and are most common amongst women in early adulthood. Understanding predictors of changes in depressive symptoms among young women may inform health promotion and early intervention.

METHODS

Data were collected at three-yearly intervals from 2000 (Survey 2) to 2012 (Survey 6) from the Australian Longitudinal Study on Women's Health. The sample comprised 7663 women, aged 22-27 in 2000, who reported any indicator of poor mental health at any wave. Generalised linear mixed models identified predictors of change in depressive symptoms (CESD-10) over each three-year period.

RESULTS

Depressive symptoms reduced over time. In a fully adjusted model, greater reduction in symptoms was predicted by higher initial symptoms, time, higher social support, and higher self-rated general health. Slower reduction was predicted by lower education, difficulty managing on income, high or zero alcohol consumption, stress, and history of childhood sexual assault or partner violence. Motherhood predicted an increase in depressive symptoms at Survey 2 (2000), but a decrease at Survey 5 (2009).

LIMITATIONS

Although sampling was nationally representative, there is a slight bias towards Australian-born and more educated women. Further, although validated measures are used, all data are self-report.

CONCLUSIONS

Fluctuations in depressive symptoms among young women are related to fixed and time-varying factors spanning multiple health and social domains. A range of factors, including education and financial resources, promotion of positive social support systems, and encouragement of health promoting lifestyles, might serve to promote young women's mental health and thus to reduce pressure on clinical services.

Evaluation of a Brief Intervention for Promoting Mental Health among Employees in Social Enterprises: A Cluster Randomized Controlled Trial

Evidence on the effectiveness of workplace mental health promotion for people with disabilities is limited. This study aimed to evaluate the effectiveness of a brief mental health promotion intervention in social enterprises. It had a non-blinded cluster randomized controlled trial design with follow-up one and four months after the intervention. In total 196 employees agreed to participate (86 intervention and 110 control). Empowerment was the main outcome; secondary outcomes were resilience, palliative behavior, determinants of four coping strategies of mental health, quality of life, and life satisfaction. A brief participant satisfaction survey was conducted after the intervention. No significant intervention effect on empowerment was found. However, at one month follow-up, significant favorable effects were found on perceived social support for coping strategies for mental health and on palliative behavior. At four months follow-up, favorable intervention effects were found on quality of life, but unfavorable effects were found on unjustified worrying. In addition, the intervention was well received by the employees. This brief intervention might be a promising first step to improve mental health in people with disabilities working in social enterprises. Nevertheless, additional monitoring by professionals and managers working in the organizations might be needed to maintain these effects.

Mental health assessment in health checks of participants aged 30-49 years: A large-scale cohort study

Mental distress is an independent risk factor for illness related impairment. Awareness of mental health (MH) allows prevention, but early detection is not routinely performed in primary care. This cohort study incorporated MH assessment in a health promoting programme. We described the level of poor MH among health check participants, explored the potential for early intervention, and the potential for reducing social inequality in MH. The study was based on 9767 randomly selected citizens aged 30-49 years invited to a health check in Denmark in 2012-14. A total of 4871 (50%) were included; 49% were men. Poor MH was defined as a mental component summary score of ≤ 35.76 in the SF-12 Health Survey. Data was obtained from national health registers and health check. Participants with poor MH (9%) were more socioeconomic disadvantaged and had poorer health than those with better MH. Two thirds of men (64%) and half of women (50%) with poor MH had not received MH care one year before the health check. Among those with (presumably) unrecognized MH problems, the proportion of participants with disadvantaged socioeconomic characteristics was high (43-55%). Four out of five of those with apparently unacknowledged poor MH had seen their GP only once or not at all during the one year before the health check. In conclusion, MH assessment in health check may help identify yet undiscovered MH problems.