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Vandoni M, D'Avanzo B, Barbato A. The transition towards community-based mental health care in the European Union: Current realities and prospects. Health Policy 2024; 144:105081. [PMID: 38749354 DOI: 10.1016/j.healthpol.2024.105081] [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: 01/08/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/27/2024]
Abstract
The shift of mental health care from mental institutions to community-based services has been implemented differentially throughout the EU. However, because a comprehensive overview of the current mental health provision in member states is lacking, it is challenging to compare services across nations. This study investigates the extent of implementation of community-based mental health services within the EU using data collected from the WHO Mental Health Atlas. Results show that, although great cross-country variation exists in the implementation of community-based services, mental hospitals remain the prominent model of care in most countries. A few countries endorsed a balanced care model, with the co-occurrence of community services and mental hospitals. However, missing data, low quality of data and different service definitions hamper the possibility of a thorough analysis of the status on deinstitutionalization. Although policies on the closing and downsizing of mental institutions have been endorsed by the EU, the strong presence of mental hospitals slows down the shift towards community-based mental health care. This study highlights the need for an international consensus on definitions and a harmonization of indicators on mental health services. Together with the commitment of member states to improve the quality of data reporting, leadership must emerge to ensure quality monitoring of mental health-related data, which will help advance research, policies and practices.
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Affiliation(s)
- Maria Vandoni
- Laboratory of Quality Evaluation of Care and Services, Mario Negri Institute of Pharmacological Research IRCCS, Via Mario Negri 2, Milan 20156, Italy.
| | - Barbara D'Avanzo
- Laboratory of Quality Evaluation of Care and Services, Mario Negri Institute of Pharmacological Research IRCCS, Via Mario Negri 2, Milan 20156, Italy
| | - Angelo Barbato
- Laboratory of Quality Evaluation of Care and Services, Mario Negri Institute of Pharmacological Research IRCCS, Via Mario Negri 2, Milan 20156, Italy
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Susanti H, Brooks H, Keliat BA, Bradshaw T, Wulandari D, Fadilah R, Diorarta R, Suherman, Bee P, Lovell K, Renwick L. Stakeholder perspectives of family interventions for schizophrenia in Indonesia: a qualitative study. BMC Psychiatry 2024; 24:59. [PMID: 38254095 PMCID: PMC10804701 DOI: 10.1186/s12888-024-05504-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Mental illnesses comprise the single largest source of health-related economic burden globally and low-and middle-income countries (LMICs) are disproportionately affected. Many individuals with schizophrenia do not receive evidence-based, psychosocial interventions as these are largely unavailable, undeveloped, and under-researched in LMICs. Involving service-users and carers in the design of interventions is crucial to ensure stakeholder needs are adequately addressed by the intervention and to aid successful implementation. We aimed to explore the views and perspectives of different stakeholder groups about the delivery, format, and content of family interventions for people living with schizophrenia in Indonesia as a first step towards developing evidence-based, acceptable family interventions. This study used a qualitative design comprising single stakeholder focus groups. Data were analysed separately using the framework approach incorporating deductive and inductive coding within an existing heuristic framework. 51 participants consented to take part in this study comprising six stakeholder consultation groups including service-users (n = 15), caregivers (n = 15) and healthcare professionals (n = 21). Service users were diagnosed with schizophrenia. Caregivers comprised parents (n = 10, 67%), brothers (n = 2, 13%), sister (n = 1, 7%) and husbands (n = 2, 13%). Healthcare professionals were working as nurses (n = 6, 29%), doctors (n = 5, 23%) or cadre's (n = 10, 48%). Caregiver and service-user respondents had limited knowledge or experience of structured family interventions. There was strong support for such interventions, however, for effective delivery a number of challenges exist in terms of widespread stigmatised views, low expectations for involvement in sharing decisions about care and treatment, views that healthcare professionals are expert and have the authority to delegate tasks to families such as responsibility for ensuring medication adherence and understanding the need to balance the needs of both service-users and families when there are conflicting agendas for treatment. These findings can support the development of evidence-based family interventions for families of those with schizophrenia in Indonesia, as user-informed interventions enhance engagement, satisfaction, and adherence to family interventions.
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Affiliation(s)
- Herni Susanti
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Helen Brooks
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Budi-Anna Keliat
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Tim Bradshaw
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Dewi Wulandari
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Rizky Fadilah
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Raphita Diorarta
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Suherman
- Faculty of Nursing, Universitas Indonesia, Kota Depok, Indonesia
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Laoise Renwick
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK.
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Bitta MA, Baariu J, Grassi S, Kariuki SM, Lennox B, Newton CRJC. Effectiveness of participatory video in lowering stigma against people with mental, neurological and substance use disorders in Kenya. BJPsych Open 2023; 9:e215. [PMID: 37955040 PMCID: PMC10753966 DOI: 10.1192/bjo.2023.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Globally, stigma associated with mental, neurological and substance use (MNS) disorders is rampant and a barrier to good health and overall well-being of people with these conditions. Person-centred digital approaches such as participatory video may reduce stigma, but evidence on their effectiveness in Africa is absent. AIMS To evaluate the effectiveness of participatory video in reducing mental health-related stigma in a resource-limited setting. METHOD We evaluated the effectiveness of using participatory video and face-to-face interaction between people with MNS disorders and a target audience in lowering stigma among 420 people living in Kilifi, Kenya. Changes in knowledge, attitudes and behaviour (KAB) were measured by comparing baseline scores with scores immediately after watching the participatory videos and 4 months after the intervention. Sociodemographic correlates of stigma scores were examined using multivariable linear regression models. RESULTS Compared with baseline, KAB scores significantly improved at both time points, suggesting reduced stigma levels. At 4 months, the changes in scores were: knowledge (β = 0.20, 95% CI 0.16-0.25; P < 0.01), liberal attitude (β = 1.08, 95% CI 0.98-1.17; P < 0.01), sympathetic attitude (β = 0.52, 95% CI 0.42-0.62; P < 0.01), tolerant attitude (β = 0.72, 95% CI 0.61-0.83; P < 0.01) and behaviour (β = 0.37, 95% CI 0.31-0.43; P < 0.01). Sociodemographic variables were significantly correlated with KAB scores; the correlations were not consistent across the domains. CONCLUSIONS Participatory video is a feasible and effective strategy in improving knowledge, attitudes and intended behaviour in a resource-limited setting. Further studies are required to understand the mechanisms through which it lowers stigma and to examine long-term sustainability and the effectiveness of multicomponent interventions.
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Affiliation(s)
- Mary A. Bitta
- Clinical Research-Neurosciences, KEMRI/Wellcome Trust Research Program, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya; and Department of Psychiatry, University of Oxford, Oxford, UK
| | - Judy Baariu
- Clinical Research-Neurosciences, KEMRI/Wellcome Trust Research Program, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Simone Grassi
- Documentary Institute of Eastern Africa, Nairobi, Kenya
| | - Symon M. Kariuki
- Clinical Research-Neurosciences, KEMRI/Wellcome Trust Research Program, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK; and Department of Public Health, Pwani University, Kilifi, Kenya
| | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
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Brimblecombe N. Analysis of changes in the national mental health nursing workforce in England, 2011-2021. J Psychiatr Ment Health Nurs 2023; 30:994-1004. [PMID: 36999883 DOI: 10.1111/jpm.12922] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/16/2023] [Accepted: 03/08/2023] [Indexed: 04/01/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Nurses work in mental health services around the world, constituting the largest professional group. Nurses have been identified as being potentially able to carry out a much wider range of functions than are typically allowed in practice, when provided with suitable training. There are long-term concerns regarding shortages of mental health nurses in England and many other countries. Workforce data is rarely subject to analysis in peer-reviewed journals. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides a case study of the workforce patterns of a national mental health nurse (MHN) workforce overtime allowing comparison with other countries and specialities. MHN numbers reduced from 2011 to 2017, then increased to near the 2011 level by 2021, not meeting ambitious national plans for increasing numbers. The mental health nursing proportion of the total NHS nursing workforce decreased through this period. Advanced practice roles and skills are widely, but unevenly, distributed and are provided by a small proportion of nurses. The proportion of nurses working in community settings has increased to constitute more than half of all nurses for the first time. The ratio of support workers to nurses increased in inpatient settings and will continue to change. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Historical challenges in recruiting MHNs suggest that future plans to expand the profession are overly optimistic. To support the development of advanced practice roles and new skill sets, clearer research evidence of impact is required and clearer national guidance regarding best practice models. Good workforce data are essential to inform good workforce planning. ABSTRACT: Introduction Data regarding changes in characteristics of the MHN workforce is commonly cited in governmental publications, but is rarely analysed in peer-reviewed journals, despite ongoing concerns regarding high vacancy rates within mental health services. Aim The aim of the study was to characterize changes in the MHN workforce, implementation of new nursing roles/skills and alignment with national policy. Method Analysis of nationally published workforce data, peer-reviewed publications and governmental policy/planning documents. Results Nurse numbers declined from 2011 to 2017, subsequently returning to near 2011 levels, but remaining below national targets. Nurses in community settings increased to constitute more than half of all nurses, whilst inpatient numbers declined, although more slowly than bed numbers. The ratio between nurses and support workers changed due to more support workers in inpatient settings. New advanced skills and roles for nurses have increased, but are unevenly distributed, constituting a small proportion of the total workforce. Implications for Practice This paper provides a case study against which comparisons may be made with the nursing workforce in other countries and specialities. Even clear policy commitment to nursing growth may not deliver planned changes in numbers and introducing new roles may have uneven impact, especially in the absence of a robust evidence base.
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Krupchanka D, Formanek T, Shield K, Rehm J, Heymans MW, Fleischmann A, Degenhardt L, Gawad T, Poznyak V. International monitoring of capacity of treatment systems for alcohol and drug use disorders: Methodology of the Service Capacity Index for Substance Use Disorders. Int J Methods Psychiatr Res 2023; 32:e1950. [PMID: 36564954 PMCID: PMC10485318 DOI: 10.1002/mpr.1950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/13/2022] [Accepted: 09/29/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES We aimed to develop a Service Capacity Index for Substance Use Disorders (SCI-SUD) that would reflect the capacity of national health systems to provide treatment for alcohol and drug use disorders, in terms of the proportion of available service elements in a given country from a theoretical maximum. METHODS Data were collected through the WHO Global Survey on Progress with Sustainable Development Goals (SDG) Health Target 3.5, conducted between December 2019 and July 2020 to produce the SCI-SUD, based on 378 variables overall. RESULTS The SCI-SUD was directly derived for 145 countries. We used multiple imputation to produce comparable SCI-SUD estimates for countries that did not submit data (40 countries) or had very high level of missingness (9 countries). The final SCI-SUD demonstrates considerable consistency and internal stability and is strongly associated with the macro-level economic, healthcare-related and epidemiologic (such as prevalence rates) variables. CONCLUSION The presented methodology represents a step forward in monitoring the global situation in regard to the development of treatment systems for SU disorders, however, further work is warranted to improve the external validity of the measure (e.g., in-depth data generation in countries) and ensure its feasibility for regular reporting (e.g., reducing the number of variables).
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Affiliation(s)
- Dzmitry Krupchanka
- Department of Mental Health and Substance UseAlcohol, Drugs and Addictive Behaviours UnitWorld Health OrganizationGenevaSwitzerland
| | - Tomas Formanek
- Department of Public Mental HealthNational Institute of Mental HealthKlecanyCzech Republic
- Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Kevin Shield
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research InstituteCentre for Addiction and Mental Health (CAMH)TorontoOntarioCanada
- Management and Evaluation; & Department of PsychiatryDalla Lana School of Public HealthInstitute of Health PolicyUniversity of Toronto (UofT)TorontoOntarioCanada
- PAHO/WHO Collaborating Centre at CAMHTorontoOntarioCanada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research InstituteCentre for Addiction and Mental Health (CAMH)TorontoOntarioCanada
- Management and Evaluation; & Department of PsychiatryDalla Lana School of Public HealthInstitute of Health PolicyUniversity of Toronto (UofT)TorontoOntarioCanada
- PAHO/WHO Collaborating Centre at CAMHTorontoOntarioCanada
| | - Martijn W. Heymans
- Department of Epidemiology and Data ScienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamNetherlands
| | - Alexandra Fleischmann
- Department of Mental Health and Substance UseAlcohol, Drugs and Addictive Behaviours UnitWorld Health OrganizationGenevaSwitzerland
| | - Louisa Degenhardt
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
| | - Tarek Gawad
- National Rehabilitation CentreAbu DhabiUnited Arab Emirates
- Psychiatry DepartmentFaculty of MedicineCairo UniversityGizaEgypt
| | - Vladimir Poznyak
- Department of Mental Health and Substance UseAlcohol, Drugs and Addictive Behaviours UnitWorld Health OrganizationGenevaSwitzerland
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Tadesse A, Huang J. Women's Participation in a Savings Group and Depression: a Community-Based Financial Capability Intervention in Mozambique. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2022; 10:49-59. [PMID: 36337380 PMCID: PMC9628344 DOI: 10.1007/s40609-022-00251-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 05/05/2023]
Abstract
Background As one of the fastest growing community-based financial capability approaches, village savings and loan group (VSLG) is an organized group and formal entity that creates opportunities for participants to save and access financial assets. VSLG has potentially positive impacts on increasing women's financial resources and social support and further improves their mental health. Participation in a VSLG not only increases women's opportunities for asset-building and income generation, but also facilitates trust and promotes social capital development. However, few studies have examined the association between the VSLG participation and women's depression status. To fill the knowledge gap, we examined the association between the VSLG participation and depressive symptoms among low-income women in Mozambique. Methods The data was collected as part of the VSLG program evaluation. The study applied a posttest-only comparison group quasi-experimental design and sampled female VSLG participants and non-participants from three sub-villages in the Sofala province, Mozambique. A multi-stage sampling technique was employed, and a total of 205 women were randomly selected, including 105 VSLG participants and 100 non-participants. Depressive symptoms were measured using the short version of the Edinburgh Depression Scale (EDS) with a summative score ranging from 7 to 28. Using the cutoff value at a score of 14, we created a dichotomous depression indicator. Linear and logit models were used to examine the associations of the VSLG participation and the participation duration with the depression score and the presence of depression controlling for demographic variables. Results The VSLG participants had a statistically lower mean depression score of 12.2 (SD = 4.4) compared to non-participants (15.0, SD = 4.0, p < .001). The regression analysis suggested that the VSLG participants had a mean depression score of 2.7 lower than the non-participants (p < .001). Nearly 60% of the non-participants reported the presence of depression; however, this percentage is 31% for participants (p < .001). The multivariate logit model indicated the odds of the presence of depression for participants are .34 of that for non-participants. Similar results were obtained when the VSLG program duration was used as an independent variable. Conclusions Study findings showed a positive association between the VSLG participation and women's mental health. Future research should further explore the intervention mechanisms and assess how the VSLG participation affects women's mental health. Findings also provided important insights into developing community-based financial capability interventions to improve low-income women's mental health.
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Affiliation(s)
- Aweke Tadesse
- Saint Louis University, 3550 Lindell Blvd., Tegeler Hall 309, St. Louis, MO 63103 USA
| | - Jin Huang
- Saint Louis University, 3550 Lindell Blvd., Tegeler Hall 309, St. Louis, MO 63103 USA
- Center for Social Development, Washington University in St. Louis, St. Louis, MO 63112 USA
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Mundt AP, Langerfeldt SD, Maphisa JM, Sourabié O, Yongsi BN, Serri ER, Bukasa Tshilonda JC, Te JH, Bitta MA, Mathe L, Liwimbi O, Dos Santos PF, Atilola O, Jansen S, Diegane Tine JA, Akran C, Jalloh A, Kagee A, Van Wyk ES, Forry JB, Imasiku ML, Chigiji H, Priebe S. Changes in rates of psychiatric beds and prison populations in sub-Saharan Africa from 1990 to 2020. J Glob Health 2022; 12:04054. [PMID: 36056592 PMCID: PMC9440375 DOI: 10.7189/jogh.12.04054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Psychiatric bed numbers (general, forensic, and residential) and prison populations have been considered indicators of institutionalization. The present study aimed to assess changes of those indicators across sub-Saharan Africa (SSA) from 1990 to 2020. Methods We retrospectively obtained data on psychiatric bed numbers and prison populations from 46 countries in SSA between 1990 and 2020. Mean and median rates, as well as percentage changes between first and last data points were calculated for all of SSA and for groups of countries based on income levels. Results Primary data were retrieved from 17 out of 48 countries. Data from secondary sources were used for 29 countries. From two countries, data were unavailable. The median rate of psychiatric beds decreased from 3.0 to 2.2 per 100 000 population (median percentage change = -16.1%) between 1990 and 2020. Beds in forensic and residential facilities were nonexistent in most countries of SSA in 2020, and no trend for building those capacities was detected. The median prison population rate also decreased from 77.8 to 71.0 per 100 000 population (-7.8%). There were lower rates of psychiatric beds and prison populations in low-income and lower-middle income countries compared with upper-middle income countries. Conclusions SSA countries showed, on average, a reduction of psychiatric bed rates from already very low levels, which may correspond to a crisis in acute psychiatric care. Psychiatric bed rates were, on average, about one twenty-fifth of countries in the Organization for Economic Co-operation and Development (OECD), while prison population rates were similar. The heterogeneity of trends among SSA countries over the last three decades indicates that developments in the region may not have been based on coordinated policies and reflects unique circumstances faced by the individual countries.
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Affiliation(s)
- Adrian P Mundt
- Medical Faculty, Universidad Diego Portales, Santiago, Chile
- Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | | | - J Maphisa Maphisa
- Department of Psychology, University of Botswana, Gaborone, Botswana
| | - Oumar Sourabié
- Psychiatrist, Regional Center Hospital of Fada N'gourma, Fada N'gourma, Burkina Faso
| | - Blaise Nguendo Yongsi
- Institute for Training & Research in Population Studies, University of Yaoundé, Yaoundé, Cameroon
| | - Enzo Rozas Serri
- Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | - Jeronimo H Te
- West African Epidemiology Network on Drug Use (WENDU), Bissau, Guinea-Bissau
| | - Mary A Bitta
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- KEMRI-Welcome Trust Research Program, Kilifi, Kenya
| | | | - Olive Liwimbi
- Zomba Mental Hospital, Ministry of Health, Zomba, Malawi
| | | | - Olayinka Atilola
- Lagos State University College of Medicine (LASUCOM), Lagos, Nigeria
| | - Stefan Jansen
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean A Diegane Tine
- Institute of Health and Development, Cheikh Anta Diop University, Dakar, Senegal
| | | | - Abdul Jalloh
- Sierra Leone Psychiatric Teaching Hospital, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Ashraf Kagee
- Alan Fisher Centre for Public Mental Health, University of Cape Town, Cape Town
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Elizabeth S Van Wyk
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Jimmy B Forry
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Mental Health and Psychiatry, Faculty of Clinical Medicine and Dentistry, Kampala, International University-Western Campus, Bushenyi, Uganda
- Department of Psychiatry, Mubende Regional Referral Hospital, Mubende, Uganda
| | | | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
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Implementing and Sustaining Brief Addiction Medicine Interventions with the Support of a Quality Improvement Blended-eLearning Course: Learner Experiences and Meaningful Outcomes in Kenya. Int J Ment Health Addict 2022; 20:3479-3500. [PMID: 35634518 PMCID: PMC9126625 DOI: 10.1007/s11469-022-00781-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/25/2022] Open
Abstract
Quality improvement methods could assist in achieving needed health systems improvements to address mental health and substance use, especially in low-middle-income countries (LMICs). Online learning is a promising avenue to deliver quality improvement training. This Computer-based Drug and Alcohol Training Assessment in Kenya (eDATA-K) study assessed users’ experience and outcome of a blended-eLearning quality improvement course and collaborative learning sessions. A theory of change, developed with decision-makers, identified relevant indicators of success. Data, analyzed using descriptive statistics and thematic analysis, were collected through extensive field observations, the eLearning platform, focus group discussions, and key informant interviews. The results showed that 22 community health workers and clinicians in five facilities developed competencies enabling them to form quality improvement teams and sustain the new substance-use services for the 8 months of the study, resulting in 4591 people screened, of which 575 received a brief intervention. Factors promoting course completion included personal motivation, prior positive experience with NextGenU.org’s courses, and a certificate. Significant challenges included workload and network issues. The findings support the effectiveness of the blended-eLearning model to assist health workers in sustaining new services, in a supportive environment, even in a LMIC peri-urban and rural settings.
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Orozco R, Vigo D, Benjet C, Borges G, Aguilar-Gaxiola S, Andrade LH, Cia A, Hwang I, Kessler RC, Piazza M, Posada-Villa J, Rafful C, Sampson N, Stagnaro JC, Torres Y, Viana MC, Medina-Mora ME. Barriers to treatment for mental disorders in six countries of the Americas: A regional report from the World Mental Health Surveys. J Affect Disord 2022; 303:273-285. [PMID: 35176342 PMCID: PMC11345908 DOI: 10.1016/j.jad.2022.02.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mental health treatment is scarce and little resources are invested in reducing the wide treatment gap that exists in the Americas. The regional barriers are unknown. We describe the barriers for not seeking treatment among those with mental and substance use disorders from six (four low- and middle-income and two high-income) countries from the Americas. Regional socio-demographic and clinical correlates are assessed. METHODS Respondents (n = 4648) from seven World Mental Health surveys carried out in Argentina, Brazil, Colombia, Mexico, Peru, and the United States, who met diagnostic criteria for a 12-month mental disorder, measured with the Composite International Diagnostic Interview, and who did not access treatment, were asked about treatment need and, among those with need, structural and attitudinal barriers. Country-specific deviations from regional estimates were evaluated through logistic models. RESULTS In the Americas, 43% of those that did not access treatment did not perceive treatment need, while the rest reported structural and attitudinal barriers. Overall, 27% reported structural barriers, and 95% attitudinal barriers. The most frequent attitudinal barrier was to want to handle it on their own (69.4%). Being female and having higher severity of disorders were significant correlates of greater perceived structural and lower attitudinal barriers, with few country-specific variations. LIMITATIONS Only six countries in the Americas are represented; the cross-sectional nature of the survey precludes any causal interpretation. CONCLUSIONS Awareness of disorder or treatment need in various forms is one of the main barriers reported in the Americas and it specially affects persons with severe disorders.
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Affiliation(s)
- Ricardo Orozco
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Corina Benjet
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Guilherme Borges
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, United States of America
| | - Laura H Andrade
- Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alfredo Cia
- Anxiety Disorders Center, Buenos Aires, Argentina
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Marina Piazza
- Departamento Académico de Salud Pública, Administración y Ciencias Sociales, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogotá, Colombia
| | - Claudia Rafful
- Faculty of Psychology, UNAM, Center for Global Mental Health Research, National Institute of Psychiatry
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - María Carmen Viana
- Department of Social Medicine and Post-Graduate Program in Public Health, Psychiatric Epidemiology Research Center (CEPEP), Federal University of Espírito Santo (UFES), Vitória, Brazil
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Lattie EG, Stiles-Shields C, Graham AK. An overview of and recommendations for more accessible digital mental health services. NATURE REVIEWS PSYCHOLOGY 2022; 1:87-100. [PMID: 38515434 PMCID: PMC10956902 DOI: 10.1038/s44159-021-00003-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 03/23/2024]
Abstract
Mental health concerns are common, and various evidence-based interventions for mental health conditions have been developed. However, many people have difficulty accessing appropriate mental health care and this has been exacerbated by the COVID-19 pandemic. Digital mental health services, such as those delivered by mobile phone or web-based platforms, offer the possibility of expanding the reach and accessibility of mental health care. To achieve this goal, digital mental health interventions and plans for their implementation must be designed with the end users in mind. In this Review, we describe the evidence base for digital mental health interventions across various diagnoses and treatment targets. Then, we explain the different formats for digital mental health intervention delivery, and offer considerations for their use across key age groups. We discuss the role that the COVID-19 pandemic has played in emphasizing the value of these interventions, and offer considerations for ensuring equity in access to digital mental health interventions among diverse populations. As healthcare providers continue to embrace the role that technology can play in broadening access to care, the design and implementation of digital mental healthcare solutions must be carefully considered to maximize their effectiveness and accessibility.
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Affiliation(s)
- Emily G. Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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11
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Mundt AP, Rozas Serri E, Siebenförcher M, Alikaj V, Ismayilov F, Razvodovsky YE, Hasanovic M, Marinov P, Frančišković T, Cermakova P, Harro J, Sulaberidze L, Kalapos MP, Assimov M, Nurmagambetova S, Ibishi NF, Molchanova E, Taube M, Chihai J, Dedovic J, Gosek P, Tataru N, Golenkov A, Lecic-Tosevski D, Randjelovic D, Izakova L, Švab V, Vohidova M, Kerimi N, Sukhovii O, Priebe S. Changes in national rates of psychiatric beds and incarceration in Central Eastern Europe and Central Asia from 1990-2019: A retrospective database analysis. LANCET REGIONAL HEALTH-EUROPE 2021; 7:100137. [PMID: 34557842 PMCID: PMC8454862 DOI: 10.1016/j.lanepe.2021.100137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Numbers of psychiatric beds (general, forensic, and residential) and prison populations have been considered to be indicators of institutionalisation of people with mental illnesses. The present study aimed to assess changes of those indicators across Central Eastern Europe and Central Asia (CEECA) over the last three decades to capture how care has developed during that historical period. Methods We retrospectively obtained data on numbers of psychiatric beds and prison populations from 30 countries in CEECA between 1990 and 2019. We calculated the median of the percent changes between the first and last available data points for all CEECA and for groups of countries based on former political alliances and income levels. Findings Primary national data were retrieved from 25 out of 30 countries. Data from international registries were used for the remaining five countries. For all of CEECA, the median decrease of the general psychiatric bed rates was 33•8% between 1990 and 2019. Median increases were observed for forensic psychiatric beds (24•7%), residential facility beds (12•0%), and for prison populations (36•0%). Greater reductions of rates of psychiatric beds were observed in countries with lower per capita income as well as in countries that were formerly part of the Soviet Union. Seventeen out of 30 countries showed inverse trends for general psychiatric beds and prison populations over time, indicating a possible shift of institutionalisation towards correctional settings. Interpretation Most countries had decreased rates of general psychiatric beds, while there was an increase of forensic capacities. There was an increase in incarceration rates in a majority of countries. The large variation of changes underlines the need for policies that are informed by data and by comparisons across countries. Funding Agencia Nacional de Investigación y Desarrollo in Chile, grant scheme FONDECYT Regular, grant number 1190613.
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Affiliation(s)
- Adrian P Mundt
- Medical Faculty, Universidad Diego Portales, Santiago, Chile; Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Enzo Rozas Serri
- Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile; Medical Faculty, Universidad Diego Portales, Santiago, Chile
| | - Mathias Siebenförcher
- Department of Psychiatry and Psychotherapy Campus Mitte, Charité Universitätsmedizin Berlin, Germany
| | - Valbona Alikaj
- Department of Neuroscience, Faculty of Medicine, Medical University, Tirana, Albania
| | | | | | - Mevludin Hasanovic
- Department of Psychiatry, University Clinical Centre Tuzla, Medical Faculty, University of Tuzla, Bosnia and Herzegovina
| | - Petar Marinov
- Association of Experts in Mental Health, Sofia, Bulgaria; Standing Committee for Professional Standards and By-Laws of the Bulgarian Psychiatric Association, Sofia, Bulgaria; Sofia University "St. Kliment Ohridski", Thrakian University St. Zagora, Bulgaria
| | | | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University Prague, Czech Republic; Second Faculty of Medicine, Charles University Prague, Czech Republic
| | - Jaanus Harro
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, and Chair of Neuropsychopharmacology, Institute of Chemistry, University of Tartu, Tartu, Estonia
| | | | | | - Marat Assimov
- Department of Communication Skills of the Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Nazmie F Ibishi
- Clinic of Psychiatry, University Clinical Centre of Kosovo, Pristina, Kosovo
| | | | - Māris Taube
- Department of Psychiatry, Riga Stradin's University, Riga, Latvia
| | - Jana Chihai
- Psychiatry, Narcology and Medical Psychology Department, State Medical and Pharmaceutical University Nicolae Testemitanu, Chisinau, Moldova
| | - Jovo Dedovic
- Forensic Psychiatry Unit - Special Psychiatric Hospital Kotor, Kotor, Montenegro
| | - Paweł Gosek
- Institute of Psychiatry and Neurology • Department of Forensic Psychiatry, Warsaw, Poland
| | - Nicoleta Tataru
- Senior consultant psychiatrist, Psychiatry Ambulatory Clinic, Oradea, România
| | - Andrei Golenkov
- Psychiatry and Medical Psychology, Chuvash State University, Cheboksary, Russia
| | | | | | - Lubomira Izakova
- Department of Psychiatry, Comenius University in Bratislava, Faculty of Medicine, Bratislava, Slovak Republic
| | - Vesna Švab
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Nina Kerimi
- Consultant, United Nations Office on Drugs and Crime (UNODC), Programme Office in Turkmenistan, Ashgabat, Turkmenistan
| | - Oleksii Sukhovii
- Center for Mental Health and Monitoring of Drugs and Alcohol MoH of Ukraine
| | - Stefan Priebe
- Unit of Social and Community Psychiatry, Queen Mary University of London, UK
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12
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Yamada C, Siste K, Hanafi E, Ophinni Y, Beatrice E, Rafelia V, Alison P, Limawan A, Shinozaki T, Matsumoto T, Sakamoto R. Relapse prevention group therapy via video-conferencing for substance use disorder: protocol for a multicentre randomised controlled trial in Indonesia. BMJ Open 2021; 11:e050259. [PMID: 34489288 PMCID: PMC8422497 DOI: 10.1136/bmjopen-2021-050259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Substance use disorder (SUD) is a leading contributor to the global burden of disease. In Indonesia, the availability of formal treatment for SUD falls short of the targeted coverage. A standardised therapeutic option for SUD with potential for widespread implementation is required, yet evidence-based data in the country are scarce. In this study, we developed a cognitive behavioural therapy (CBT)-based group telemedicine model and will investigate effectiveness and implementability in a multicentre randomised controlled trial. METHODS A total of 220 participants will be recruited from the social networks of eight sites in Indonesia: three hospitals, two primary healthcare centres and three rehabilitation centres. The intervention arm will participate in a relapse prevention programme called the Indonesia Drug Addiction Relapse Prevention Programme (Indo-DARPP), a newly developed 12-week module based on CBT and motivational interviewing constructed in the Indonesian context. The programme will be delivered by a healthcare provider and a peer counsellor in a group therapy setting via video-conferencing, as a supplement to participants' usual treatments. The control arm will continue treatment as usual. The primary outcome will be the percentage increase in days of abstinence from the primarily used substance in the past 28 days. Secondary outcomes will include addiction severity, quality of life, motivation to change, psychiatric symptoms, cognitive function, coping, and internalised stigma. Assessments will be performed at baseline (week 0), post-treatment (week 13), and 3 and 12 months post-treatment completion (weeks 24 and 60). Retention, participant satisfaction, and cost-effectiveness will be assessed as the implementation outcomes. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by the Ethics Committees of Universitas Indonesia and Kyoto University. The results will be disseminated via academic journals and international conferences. Depending on trial outcomes, the treatment programme will be advocated for adoption as a formal healthcare-based approach for SUD. TRIAL REGISTRATION NUMBER UMIN000042186.
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Affiliation(s)
- Chika Yamada
- Department of Environmental Coexistence, Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Kristiana Siste
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Enjeline Hanafi
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Youdiil Ophinni
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
| | - Evania Beatrice
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Vania Rafelia
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Peter Alison
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Albert Limawan
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ryota Sakamoto
- Department of Environmental Coexistence, Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
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Abstract
The article describes the risks for the mental health and wellbeing of urban-dwellers in relation to changes in the spatial structure of a city that could be caused by the COVID-19 pandemic. A year of lockdown has changed the way of life in the city and negated its principal function as a place of various meetings and social interactions. The danger of long-term isolation and being cut-off from an urban lifestyle is not only a challenge facing individuals, but it also creates threats on various collective levels. Hindered interpersonal relations, stress, and the fear of another person lower the quality of life and may contribute to the development of mental diseases. Out of fear against coronavirus, part of the society has sought safety by moving out of the densely populated city centres. The dangerous results of these phenomena are shown by research based on the newest literature regarding the influence of COVID-19 and the lockdown on mental health, urban planning, and the long-term spatial effects of the pandemic such as the urban sprawl. The breakdown of the spatial structure, the loosening of the urban tissue, and urban sprawl are going to increase anthropopressure, inhibit access to mental health treatment, and will even further contribute to the isolation of part of the society. In addition, research has shown that urban structure loosening as a kind of distancing is not an effective method in the fight against the SARS-COV pandemic. Creating dense and effective cities through the appropriate management of development during and after the pandemic may be a key element that will facilitate the prevention of mental health deterioration and wellbeing. It is also the only possibility to achieve the selected Sustainable Development Goals, which as of today are under threat.
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14
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Bairy BK, Ganesh A, Kaur S, Chand PK, Kumar CN, Manjunatha N, Math SB, Sinha NK, Arora S. Capacity Building in Mental Health for Bihar: Overview of the 1-Year Blended Training Program for Nonspecialist Medical Officers. J Neurosci Rural Pract 2021; 12:329-334. [PMID: 33927523 PMCID: PMC8064863 DOI: 10.1055/s-0041-1722842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective
The aim of this study is to give an experiential overview of a 1-year blended training program for nonspecialist medical officers (primary care doctors; PCDs) of Bihar State of India. The training program was aimed to enable PCDs identify, diagnose, and treat commonly presenting psychiatric disorders in primary care
Methods
PCDs had a brief onsite orientation program to psychiatric practice at National Institute of Mental Health and Neuro-Sciences (NIMHANS), followed by 10 months of online blended training. The online program followed the NIMHANS Virtual Knowledge- Extension for Community Healthcare Outcomes (ECHO) model, that is, a hub and spokes model of training
Results
Twenty-two PCDs participated in this program. Eleven of them got accredited at the end. The onsite orientation consisted of exposure to various psychiatry facilities at NIMHANS, in addition to learning psychiatric history taking and mental status examination. The ECHO model of online learning consisted of fortnightly sessions, lasting 2 hours each. There were 20 such sessions. Each session consisted of a didactic lecture by the psychiatrist followed by a case discussion. The cases were presented by PCDs, moderated by the hub specialists (NIMHANS). At the end of the training, participants rated an average of 4.5/5 on the mode, content and relevance of training and increase in knowledge due to the training. Around 23,000 patients were cared for during the said 1 year by the trained PCDs.
Conclusion
Training PCDs in a manner that enables retaining the learnt skills is feasible. However, rigorous evaluation protocols are needed in order to test this in a systematic fashion.
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Affiliation(s)
- Bhavya K Bairy
- NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Aurobind Ganesh
- NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sandeepa Kaur
- NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Prabhat Kumar Chand
- NIMHANS Digital Academy, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Sanjeev Arora
- University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
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15
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Qureshi O, Endale T, Ryan G, Miguel-Esponda G, Iyer SN, Eaton J, De Silva M, Murphy J. Barriers and drivers to service delivery in global mental health projects. Int J Ment Health Syst 2021; 15:14. [PMID: 33487170 PMCID: PMC7827991 DOI: 10.1186/s13033-020-00427-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research in global mental health (GMH) has previously documented how contextual factors like political instability, poverty and poorly-funded health infrastructure continue to compromise effective and equitable mental health service delivery. There is a need to develop more feasible and evidence-based solutions through implementation research. This paper, one in a series pertaining to implementation in GMH projects worldwide, focuses on implementation factors influencing mental health service delivery. METHODS This is a qualitative study carried out as part of a Theory of Change-driven evaluation of Grand Challenges Canada's (GCC's) Global Mental Health portfolio. Purposive sampling was used to recruit twenty-nine GCC grantees for interviews. A semi-structured interview schedule was used to guide the interviews which were recorded and subsequently transcribed. Transcripts were double-coded and analyzed in NVivo 11 using framework analysis. This paper reports results related to detection and treatment of mental illness, mental health promotion and prevention of mental illness. RESULTS Key barriers included: lack of appropriate human resources and expertise for service delivery; lack of culturally appropriate screening tools and interventions; and difficulties integrating services with the existing mental health system. Formative research was a key driver facilitating the cultural adaptation of mental health detection, treatment, promotion and preventative approaches. Recruiting local providers and utilizing mHealth for improving screening, monitoring and data management were also found to be successful approaches in reducing workforce burden, improving sustainability, mental health literacy, participant engagement and uptake. CONCLUSIONS The study identifies a number of key barriers to and drivers of successful service delivery from the perspective of grantees implementing GMH projects. Findings highlight several opportunities to mitigate common challenges, providing recommendations for strengthening systems- and project-level approaches for delivering mental health services. Further, more inclusive research is required to inform guidance around service delivery for successful implementation, better utilization of funding and improving mental health outcomes among vulnerable populations in low-resource settings.
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Affiliation(s)
- Onaiza Qureshi
- Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College, Colombia University, 525 W 120th St, New York, NY 10027 USA
| | - Grace Ryan
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Georgina Miguel-Esponda
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Srividya N. Iyer
- Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, QC H3A 0G4 Canada
- Douglas Research Centre, 6875 Boulevard LaSalle, Montreal, QC H4H 1R3 Canada
| | - Julian Eaton
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
- CBM UK, 8 Oakington Business Park, Dry Drayton Rd, Oakington, CB24 3DQ UK
| | - Mary De Silva
- Health of Population Health, Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE UK
| | - Jill Murphy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC V6T 2A1 Canada
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16
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Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N, Cannon M, Correll CU, Byrne L, Carr S, Chen EYH, Gorwood P, Johnson S, Kärkkäinen H, Krystal JH, Lee J, Lieberman J, López-Jaramillo C, Männikkö M, Phillips MR, Uchida H, Vieta E, Vita A, Arango C. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry 2020; 7:813-824. [PMID: 32682460 PMCID: PMC7365642 DOI: 10.1016/s2215-0366(20)30307-2] [Citation(s) in RCA: 872] [Impact Index Per Article: 218.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023]
Abstract
The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.
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Affiliation(s)
- Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Merete Nordentoft
- CORE-Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region, Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolas Crossley
- Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nev Jones
- Department of Psychiatry, University of South Florida, Tampa, FL, USA
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Louise Byrne
- School of Management, College of Business, RMIT University, Melbourne, VIC, Australia; Program for Recovery and Community Health, School of Medicine, Yale, New Haven, CT, USA; School of Medicine, Yale, New Haven, CT, USA
| | - Sarah Carr
- School of Social Policy and Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Eric Y H Chen
- Department of Psychiatry and State Key Laboratory on Cognitive and Brain Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Philip Gorwood
- Institute of Psychiatry and Neuroscience of Paris, University of Paris, INSERM U1266, Paris, France; GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, Paris, France
| | - Sonia Johnson
- Division of Psychiatry (National Insitute for Health Research Mental Health Policy Research Unit), University College London, London, UK
| | - Hilkka Kärkkäinen
- Global Alliance of Mental Illness Advocacy Networks-Europe, Brussels, Belgium
| | - John H Krystal
- Department of Psychiatry, School of Medicine, Yale, New Haven, CT, USA; Yale New Haven Hospital, New Haven, CT, USA
| | - Jimmy Lee
- North Region and Department of Psychosis, Institute of Mental Health, Singapore; Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jeffrey Lieberman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, NY, USA
| | - Carlos López-Jaramillo
- Department of Psychiatry, School of Medicine, University of Antioquia, Medellín, Colombia
| | | | - Michael R Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
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17
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Ara T, Rahman MM, Hossain MA, Ahmed A. Identifying the Associated Risk Factors of Sleep Disturbance During the COVID-19 Lockdown in Bangladesh: A Web-Based Survey. Front Psychiatry 2020; 11:580268. [PMID: 33093839 PMCID: PMC7527420 DOI: 10.3389/fpsyt.2020.580268] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Bangladesh, a developing country with a lower-middle-income and one of the world's most densely populated areas, has been severely affected by COVID-19. This global epidemic is not only affecting the physical health of the patients but also causing severe psychological effects among those who have not yet been infected. Sleep disturbance is one of the key symptoms of major depression and one of the proven risk factors for suicide. The objective of this study is to identify the risk factors associated with sleep disturbance which has developed as a general impact of COVID-19 and new normal life during the lockdown (a measure to control the spread of COVID-19) in Bangladesh. METHODS Demographic characteristics, COVID-19, and lockdown related information have been collected from 1,128 individuals by conducting a web-based survey. Respondent's perspective regarding sleep disturbance during COVID-19 lockdown is considered as the outcome of interest which is dichotomous. Descriptive statistics methods have been applied to explore the distribution of respondent's demographic characteristics. Pearson's chi-square tests have been performed to relate the sleep disturbance status of the respondents to their demographic, personal, and COVID-19 related information. Furthermore, a multivariable logistic regression model has been adopted to identify the significant association of sleep disturbance with the demographic, COVID-19, and lockdown related information of respondents during the COVID-19 lockdown in Bangladesh. FINDINGS The prevalence of sleep disturbance during the COVID-19 lockdown is found to be higher among participants aged 31-40 years. Gender disparity has also been observed in favor of male participants, whereas no significant regional heterogeneity has been found. Working from home or doing online classes during the lockdown has been found as a potential predictive factor of sleep disturbance. Losing a job has been considered as an adverse economic effect of COVID-19, which also induces sleep disturbance. Perception regarding the risk of getting infected and anxiety triggered the chance of developing sleep disturbance. The sleeping schedule is also found as a risk factor for sleep disturbance. CONCLUSION Evidence-based policies are required to combat psychological challenges that have arisen due to COVID-19, primarily targeting the groups who are largely suffering from sleep disturbance.
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Affiliation(s)
- Tasnim Ara
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Md Mahabubur Rahman
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Md Abir Hossain
- Department of Chemical and Food Engineering, Dhaka University of Engineering and Technology, Gazipur, Bangladesh
| | - Amir Ahmed
- Department of Nutrition and Food Engineering, Daffodil International University, Dhaka, Bangladesh
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18
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Nuri NN, Sarker M, Ahmed HU, Hossain MD, Beiersmann C, Jahn A. Experience and perceived quality of care of patients and their attendants in a specialized mental hospital in Bangladesh. Int J Ment Health Syst 2019; 13:46. [PMID: 31285752 PMCID: PMC6588888 DOI: 10.1186/s13033-019-0303-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/19/2019] [Indexed: 12/03/2022] Open
Abstract
Background A person’s perception of health service quality depends on his or her expectations and priorities. If the perception of care is good, then it eventually enhances future health service utilization, adherence to treatment and desired outcomes. Understanding a patient’s perspective is key for delivering a better quality patient-centred health care service. This study explored experience and perception of patients and their attendants of mental health care services at the National Institute of Mental Health (NIMH) which is the only national level mental health institute in Bangladesh. NIMH is located in the capital city and provides specialized mental health care services for the whole population. Methods A facility-based cross-sectional study was conducted using a mixed-method design at the NIMH. A total of 40 respondents (patients, or their attendants if the patient was minor or unable to respond due to lack of mental stability) visiting the outpatient department (OPD) of NIMH were selected by purposive sampling. For each of the ten ICD 10 categories (10th revision of International Classification of Diseases by the World Health Organization [WHO]) for mental disorders, four patients were chosen. Finally, 13 patients and 27 attendants (on behalf of 17 minor patients and 10 adult patients unable to respond) participated in the interview. Results The respondents rated 34 short statements clustered around four dimensions of care (accessibility, interpersonal communications, condition of the waiting and consultation rooms, and general quality of OPD services) and we interpreted those scores as follows: 7.6–10 very satisfied/very good quality, 5.1–7.5 satisfied/good quality, 2.6–5.0 dissatisfied/poor quality and 1.0–2.5 completely dissatisfied/very poor quality. For accessibility and interpersonal communications, the patients perceived care as very good (average scores on a Likert scale of 1–10 were 8.3 and 7.6, respectively). The respondents considered the condition of the waiting and consultation rooms and general quality of OPD care as good (average scores 5.8 and 7.1, respectively). NIMH had serious lack of resources in terms of functional medical equipment and physicians appointed, which negatively impacted on the service quality. Conclusions Patients receiving services from the NIMH OPD had a positive perception of the quality of care in general. But, at an individual level, some respondents expressed dissatisfaction. Our findings are informative for quality improvement and client-oriented care service planning at NIMH, Bangladesh.
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Affiliation(s)
- Nazmun Nahar Nuri
- 1Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, INF 130/3, 69120 Heidelberg, Germany
| | - Malabika Sarker
- 2James P. Grant School of Public Health, BRAC University, 66 Mohakhali, Dhaka, 1212 Bangladesh
| | - Helal Uddin Ahmed
- National Institute of Mental Health, Sher-e-Bangla Nagar, Dhaka, 1200 Bangladesh
| | - Mohammad Didar Hossain
- Foundation for Advancement of Innovations in Technology and Health, 1/15A Iqbal Road, Dhaka, 1207 Bangladesh
| | - Claudia Beiersmann
- 1Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, INF 130/3, 69120 Heidelberg, Germany
| | - Albrecht Jahn
- 1Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, INF 130/3, 69120 Heidelberg, Germany
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Process Evaluation of a Pilot Intervention for Psychosocial Rehabilitation for Service Users with Schizophrenia in North West Province, South Africa. Community Ment Health J 2018; 54:1089-1096. [PMID: 30094739 DOI: 10.1007/s10597-018-0318-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
This study investigated a non-specialist delivered programme for psychosocial rehabilitation for service users with schizophrenia in a low-resource South African setting. Forty-four service users with schizophrenia living in the community, receiving ongoing medication through primary care, participated in a structured support group. Quantitative measures (WHODAS 12 item, Brief Psychiatric Rating Scale and Internalized Stigma of Mental Illness Inventory) were assessed at baseline and 12 months. Sixteen service users were interviewed on their experiences. WHODAS data showed a small reduction. ISMI assessment showed a statistically significant reduction. Qualitative data revealed: improved self-esteem and increased illness knowledge, reduced risk taking, reduced social isolation and improved pro-social behavior, improved financial management and engagement in income generation activities as well as improved acceptance by the community. This study provides preliminary evidence on the benefits of this programme that warrant further study incorporating experimental methods.
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Abstract
In 1978 Italy implemented Law Number 180, the reform law that blocked all new admissions to public mental hospitals. After 40 years without mental hospitals, we aim at understanding the consequences of the Italian reform in terms of mental health care facility and staff availability. We compared the organization of the Italian mental health system with that of countries belonging to the Group of 7 (G7) major advanced economies. Italy has nearly 8 psychiatrists, 20 nurses, 2 social workers and less than 3 psychologists per 100,000 population, while for example in France there were 22 psychiatrists, in Japan 102 nurses, in the United States 18 social workers, and in Canada and France more than 45 psychologists per 100,000 population. In terms of inpatient facilities, no beds in mental hospitals were available in Italy, while in the other G7 countries mental hospital beds ranged from 8 in the United Kingdom to 204 in Japan per 100 000 population. In Italy there were fewer beds for acute care in general hospitals but more beds in community residential facilities than in the other G7 countries. Service use data showed variability in the provision of mental health care throughout the country. Soon after the implementation of the Italian reform the absolute number of compulsory admissions progressively declined, from more than 20,000 in 1978 to less than 9000 in 2015. Alongside the progressive decline of psychiatric beds imposed by Law 180, the age-adjusted suicide rate remained stable, ranging from 7·1/100,000 population in 1978 to 6·3/100,000 population in 2012. The population of psychiatric patients placed in Italian forensic psychiatric hospitals progressively declined. During the last 40 years without mental hospitals, Italy has seen a progressive consolidation of a community-based system of mental health care. We highlighted, however, reasons for concern, including a decreasing staffing level, a potential use of community residential facilities as long-stay residential services, a still too high variability in service provision across the country, and lack of national data on physical restraints. At a national level, the resources allocated to mental health care are lower in Italy than in other high-income countries.
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Nuri NN, Sarker M, Ahmed HU, Hossain MD, Beiersmann C, Jahn A. Pathways to care of patients with mental health problems in Bangladesh. Int J Ment Health Syst 2018; 12:39. [PMID: 30034515 PMCID: PMC6052552 DOI: 10.1186/s13033-018-0218-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health systems in Bangladesh are not fully organized to provide optimal care services to patients with mental health problems. There is both a lack of resources and a disproportional distribution of the available resources. To design an equitable health system and plan interventions to improve access to care, a better understanding of mental health care-seeking behavior and care pathways are crucial. METHODS A facility-based cross-sectional study was conducted using a mixed-method design at the National Institute of Mental Health (NIMH), in Bangladesh. A total of 40 patients (or their attendants) visiting the outpatient department of NIMH were selected by purposive sampling. RESULTS As their first contact point for care services, 27.5% of the patients consulted a psychiatric care provider, 30% went to non-medical provider, and the majority, 42.5%, went to non-psychiatric medical care providers. Only 32.5% of the patients had been advised to go to NIMH by a private physician, hospital personnel or psychiatrist. Among all individual categories of providers, private psychiatrists were the most frequent caregivers (n = 12), followed by traditional healers (n = 9). A total of 70% of the patients had chosen a provider within 20 km. In three out of four of the cases, the family had decided on the first provider. From the start of the symptoms the median delay in the first contact with any provider was 6 months, and in reaching any psychiatric care provider was 1 year. The most common reasons for a delay in seeking care were a lack of knowledge about mental health problems, a lack of information about the place for appropriate care, and not considering the problem as serious enough to seek care. Each of those reasons were mentioned by one in every four respondents. CONCLUSIONS The majority of the patients with mental health problems in Bangladesh access various categories of providers before reaching a psychiatric care provider, and use a diverse range of pathways and loops, which results in a delay or missing appropriate care. We hope that our findings are useful for planning interventions to improve access to mental health care in general, in Bangladesh, and improving referral policies and structures in particular.
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Affiliation(s)
- Nazmun Nahar Nuri
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, INF 130/3, 69120 Heidelberg, Germany
| | - Malabika Sarker
- James P. Grant School of Public Health, BRAC University, 66 Mohakhali, Dhaka, 1212 Bangladesh
| | - Helal Uddin Ahmed
- National Institute of Mental Health, Sher-e-Bangla Nagar, Dhaka, 1200 Bangladesh
| | - Mohammad Didar Hossain
- Foundation for Advancement of Innovations in Technology and Health, 1/15A Iqbal Road, Dhaka, 1207 Bangladesh
| | - Claudia Beiersmann
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, INF 130/3, 69120 Heidelberg, Germany
| | - Albrecht Jahn
- Institute of Public Health, Ruprecht-Karls-Universität Heidelberg, INF 130/3, 69120 Heidelberg, Germany
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Berry JG, Gay JC, Joynt Maddox K, Coleman EA, Bucholz EM, O'Neill MR, Blaine K, Hall M. Age trends in 30 day hospital readmissions: US national retrospective analysis. BMJ 2018; 360:k497. [PMID: 29487063 PMCID: PMC5827573 DOI: 10.1136/bmj.k497] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To assess trends in and risk factors for readmission to hospital across the age continuum. DESIGN Retrospective analysis. SETTING AND PARTICIPANTS 31 729 762 index hospital admissions for all conditions in 2013 from the US Agency for Healthcare Research and Quality Nationwide Readmissions Database. MAIN OUTCOME MEASURE 30 day, all cause, unplanned hospital readmissions. Odds of readmission were compared by patients' age in one year epochs with logistic regression, accounting for sex, payer, length of stay, discharge disposition, number of chronic conditions, reason for and severity of admission, and data clustering by hospital. The middle (45 years) of the age range (0-90+ years) was selected as the age reference group. RESULTS The 30 day unplanned readmission rate following all US index admissions was 11.6% (n=3 678 018). Referenced by patients aged 45 years, the adjusted odds ratio for readmission increased between ages 16 and 20 years (from 0.70 (95% confidence interval 0.68 to 0.71) to 1.04 (1.02 to 1.06)), remained elevated between ages 21 and 44 years (range 1.02 (1.00 to 1.03) to 1.12 (1.10 to 1.14)), steadily decreased between ages 46 and 64 years (range 1.02 (1.00 to 1.04) to 0.91 (0.90 to 0.93)), and decreased abruptly at age 65 years (0.78 (0.77 to 0.79)), after which the odds remained relatively constant with advancing age. Across all ages, multiple chronic conditions were associated with the highest adjusted odds of readmission (for example, 3.67 (3.64 to 3.69) for six or more versus no chronic conditions). Among children, young adults, and middle aged adults, mental health was one of the most common reasons for index admissions that had high adjusted readmission rates (≥75th centile). CONCLUSIONS The likelihood of readmission was elevated for children transitioning to adulthood, children and younger adults with mental health disorders, and patients of all ages with multiple chronic conditions. Further attention to the measurement and causes of readmission and opportunities for its reduction in these groups is warranted.
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Affiliation(s)
- Jay G Berry
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - James C Gay
- Monroe Carell Jr Children's Hospital at Vanderbilt Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | - Eric A Coleman
- Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Emily M Bucholz
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Margaret R O'Neill
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA 02115, USA
| | - Kevin Blaine
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA 02115, USA
| | - Matthew Hall
- Children's Hospital Association, Lenexa, KS 66219, USA
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Starace F, Mungai F, Barbui C. Does mental health staffing level affect antipsychotic prescribing? Analysis of Italian national statistics. PLoS One 2018; 13:e0193216. [PMID: 29466422 PMCID: PMC5821351 DOI: 10.1371/journal.pone.0193216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 01/23/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In mental healthcare, one area of major concern identified by health information systems is variability in antipsychotic prescribing. While most studies have investigated patient- and prescriber-related factors as possible reasons for such variability, no studies have investigated facility-level characteristics. The present study ascertained whether staffing level is associated with antipsychotic prescribing in community mental healthcare. METHODS A cross-sectional analysis of data extracted from the Italian national mental health information system was carried out. For each Italian region, it collects data on the availability and use of mental health facilities. The rate of individuals exposed to antipsychotic drugs was tested for evidence of association with the rate of mental health staff availability by means of univariate and multivariate analyses. RESULTS In Italy there were on average nearly 60 mental health professionals per 100,000 inhabitants, with wide regional variations (range 21 to 100). The average rate of individuals prescribed antipsychotic drugs was 2.33%, with wide regional variations (1.04% to 4.01%). Univariate analysis showed that the rate of individuals prescribed antipsychotic drugs was inversely associated with the rate of mental health professionals available in Italian regions (Kendall's tau -0.438, p = 0.006), with lower rates of antipsychotic prescriptions in regions with higher rates of mental health professionals. After adjustment for possible confounders, the total availability of mental health professionals was still inversely associated with the rate of individuals exposed to antipsychotic drugs. DISCUSSION The evidence that staffing level was inversely associated with antipsychotic prescribing indicates that any actions aimed at decreasing variability in antipsychotic prescribing need to take into account aspects related to the organization of the mental health system.
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Affiliation(s)
- Fabrizio Starace
- Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Francesco Mungai
- Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- * E-mail:
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Fu X, Li ZJ, Yang CJ, Feng L, Sun L, Yao Y, Huang YT. The prevalence of depression in rheumatoid arthritis in China: A systematic review. Oncotarget 2017; 8:53623-53630. [PMID: 28881836 PMCID: PMC5581135 DOI: 10.18632/oncotarget.17323] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/20/2017] [Indexed: 12/30/2022] Open
Abstract
This systematic review is to explore the prevalence of depression in patients with rheumatoid arthritis (RA) in China. Articles of prevalence rates for depression in adult RA patients published before October 2015 were identified from PubMed, Embase, The Cochrane Library, CNKI, CBM, VIP, and Wanfang database and other internet databases. Relevant journals and the recommendations of expert panels were also searched manually. Two independent reviewers searched and assessed the literature. Therelevant data were applied with Meta-Analyst 3.13 software, and the forest plot and funnel plot were performed. 21 studies with a total of 4447 patients were selected to be enrolled in this study. The prevalence of depression by analyzing the effect size was 48% [95% CI (41%, 56%)]. The prevalence of minor depression and dysthymic disorder was 30% [95%CI (23%, 38%)], and the moderate or major depression was 18% [95%CI (11%, 29%)], respectively. Subgroup analysis showed that the depression rate of female RA patients was higher than male. The depression rate in the central and western areas were higher than that of the eastern region of China, the prevalence level estimated by the Geriatric Depression Scale (GDS) was higher than estimated by other tools. Sensitivity analysis showed that the pooled effect size had good stability and reliability, To be conclusive, the prevalence rate of depression in RA patients is 48%, which suggesting that medical staff should pay more attention to depression in adult patients with RA.
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Affiliation(s)
- Xin Fu
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Zhi-Jun Li
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Chun-Jun Yang
- Department of Nursing, Tianjin Medical University General Hospital, Tianjin, China
| | - Liangshu Feng
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun, China
| | - Lemeng Sun
- Cancer Center, First Hospital of Jilin University, Changchun, China
| | - Yang Yao
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu-Ting Huang
- Children's Research Institute, Children's National Medical Center, Washington, DC, USA
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Sood M, Krishnan V. Preventive psychiatry in clinical practice. INDIAN JOURNAL OF SOCIAL PSYCHIATRY 2017. [DOI: 10.4103/ijsp.ijsp_48_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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