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Gao Y, Burns R, Leach L, Chilver MR, Butterworth P. Examining the mental health services among people with mental disorders: a literature review. BMC Psychiatry 2024; 24:568. [PMID: 39164690 PMCID: PMC11334396 DOI: 10.1186/s12888-024-05965-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/15/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Mental disorders are a significant contributor to disease burden. However, there is a large treatment gap for common mental disorders worldwide. This systematic review summarizes the factors associated with mental health service use. METHODS PubMed, Scopus, and the Web of Science were searched for articles describing the predictors of and barriers to mental health service use among people with mental disorders from January 2012 to August 2023. The initial search yielded 3230 articles, 2366 remained after removing duplicates, and 237 studies remained after the title and abstract screening. In total, 40 studies met the inclusion and exclusion criteria. RESULTS Middle-aged participants, females, Caucasian ethnicity, and higher household income were more likely to access mental health services. The use of services was also associated with the severity of mental symptoms. The association between employment, marital status, and mental health services was inconclusive due to limited studies. High financial costs, lack of transportation, and scarcity of mental health services were structural factors found to be associated with lower rates of mental health service use. Attitudinal barriers, mental health stigma, and cultural beliefs also contributed to the lower rates of mental health service use. CONCLUSION This systematic review found that several socio-demographic characteristics were strongly associated with using mental health services. Policymakers and those providing mental health services can use this information to better understand and respond to inequalities in mental health service use and improve access to mental health treatment.
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Affiliation(s)
- Yunqi Gao
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
| | - Richard Burns
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Liana Leach
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Miranda R Chilver
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Peter Butterworth
- School of Psychology, Deakin University, Melbourne, Australia
- Department of Health, Economics, Wellbeing and Society, Australian National University, Canberra, Australia
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García-Pacheco JÁ, Torres Ortega MDL, Borges G. The burden of mental disorders in Mexico, 1990-2019: Mental and neurological disorders, substance use, suicides, and related somatic disorders. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2024; 17:64-70. [PMID: 34246817 DOI: 10.1016/j.rpsm.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/14/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mental, neurological, substance use, suicide, and related somatic disorders (MNSS, for the Spanish acronym) have a negative impact on the quality-of-life of people and the Mexican economy, but updated information is lacking. The objective of this work is to analyze the disability adjusted life years (DALYs) of the MNSS in Mexico by sex, age, state, and degree of marginalization between 1990 and 2019. METHODS The data and methodology of the «Global Burden of Disease Group» (GBD) are used. The GBD calculates DALYs as the sum of two components: years of life lost due to premature mortality (YLL) and years lived with disability (YLD). Likewise, the data on the degree of marginalization from the National Population Council in Mexico are used. RESULTS MNSS represented 16.3% of the disease burden in the Mexican population in 2019. The trend of the age-standardized rates of DALYs of the MNSS has increased little from 1990 to 2019. The highest increase has been for women. Mental (depression) and neurological (headache) disorders contribute the most to the disease burden among MNSS. In the interior of the country, Baja California Sur presented the highest increase in the period. DISCUSSION The results show a complex panorama of the MNSS and its subtypes by sex, age groups and territory. More resources are needed to improve mental health care.
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Affiliation(s)
| | | | - Guilherme Borges
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico city, Mexico.
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Pan C, Liu L, Cheng S, Yang X, Meng P, Zhang N, He D, Chen Y, Li C, Zhang H, Zhang J, Zhang Z, Cheng B, Wen Y, Jia Y, Liu H, Zhang F. A multidimensional social risk atlas of depression and anxiety: An observational and genome-wide environmental interaction study. J Glob Health 2023; 13:04146. [PMID: 38063329 PMCID: PMC10704948 DOI: 10.7189/jogh.13.04146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Background Mental disorders are largely socially determined, yet the combined impact of multidimensional social factors on the two most common mental disorders, depression and anxiety, remains unclear. Methods We constructed a polysocial risk score (PsRS), a multidimensional social risk indicator including components from three domains: socioeconomic status, neighborhood and living environment and psychosocial factors. Supported by the UK Biobank cohort, we randomly divided 110 332 participants into the discovery cohort (60%; n = 66 200) and the replication cohort (40%; n = 44 134). We tested the associations between 13 single social factors with Patient Health Questionnaire (PHQ) score, Generalized Anxiety Disorder Scale (GAD) score and self-reported depression and anxiety. The significant social factors were used to calculate PsRS for each mental disorder by considering weights from the multivariable linear model. Generalized linear models were applied to explore the association between PsRS and depression and anxiety. Genome-wide environmental interaction study (GWEIS) was further performed to test the effect of interactions between PsRS and SNPs on the risk of mental phenotypes. Results In the discovery cohort, PsRS was positively associated with PHQ score (β = 0.37; 95% CI = 0.35-0.38), GAD score (β = 0.27; 95% CI = 0.25-0.28), risk of self-reported depression (OR = 1.29; 95% CI = 1.28-1.31) and anxiety (OR = 1.19; 95% CI = 1.19-1.23). Similar results were observed in the replication cohort. Emotional stress, lack of social support and low household income were significantly associated with the development of depression and anxiety. GWEIS identified multiple candidate loci for PHQ score, such as rs149137169 (ST18) (Pdiscovery = 1.08 × 10-8, Preplication = 3.25 × 10-6) and rs3759812 (MYO9A) (Pdiscovery = 3.87 × 10-9, Preplication = 6.21 × 10-5). Additionally, seven loci were detected for GAD score, such as rs114006170 (TMPRSS11D) (Pdiscovery = 1.14 × 10-9, Preplication = 7.36 × 10-5) and rs77927903 (PIP4K2A) (Pdiscovery = 2.40 × 10-9, Preplication = 0.002). Conclusions Our findings reveal the positive effects of multidimensional social factors on the risk of depression and anxiety. It is important to address key social disadvantage in mental health promotion and treatment.
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Alarcón Garavito GA, Burgess R, Dedios Sanguinetti MC, Peters LER, Vera San Juan N. Mental health services implementation in Colombia-A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001565. [PMID: 38055705 DOI: 10.1371/journal.pgph.0001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 10/02/2023] [Indexed: 12/08/2023]
Abstract
Colombia's mental health services have a complex history shaped by 60 years of armed conflict, a predominantly clinical approach to mental health, and social factors such as inequities and stigma. The 1990 Caracas declaration proposed a shift towards decentralised community mental health services and interventions based on the recovery approach and emphasis on social determinants of mental health in the Americas. Colombia has adopted these approaches in its legal and practical framework in recent years, but implementation has been uneven. This systematic review aims to contribute to mental health services understanding in Colombia by examining the barriers and facilitators to the implementation of mental health services in Colombia. A search was conducted to explore available peer-reviewed studies on Colombian mental health services across five databases (Medline, PubMed, Scopus, Scielo and BVS) on quantitative and qualitative research papers published in the last ten years and without language restrictions. The Consolidated Framework for Implementation Research (CFIR) was used to structure the analysis and identify barriers and facilitators during the implementation of mental health services. We adapted the CFIR to attend to gender, race and age informed by the Socio-Political Economy of Global Mental Health framework, given the importance of these factors to the Colombian health landscape. Finally, narrative synthesis was used to summarise the data. 1 530 records were identified, and 12 articles met all inclusion criteria and were included in the analysis. 8 papers described substance use disorders services, 11 involved multidisciplinary healthcare professionals, and 7 were implemented at a local scale. The primary barriers to implementation were the lack of coordination, high workloads, and low funding. Facilitators included the use of protocols, and the involvement of communities, stakeholders, users, and external champions. Findings suggest the continued importance of community and recovery approaches and efforts to improve coordination between multi-sector actors involved in the mental health spaces (e.g., public, and private organisations, users and their families).
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Affiliation(s)
- Germán Andrés Alarcón Garavito
- Institute for Global Health-University College London, London, United Kingdom
- School of Government-Universidad de los Andes, Bogotá, Colombia
| | - Rochelle Burgess
- Institute for Global Health-University College London, London, United Kingdom
| | | | - Laura E R Peters
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
- College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, Corvallis, OR, United States of America
| | - Norha Vera San Juan
- Institute for Global Health-University College London, London, United Kingdom
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Medina-Ranilla J, Espinoza-Pajuelo L, Mazzoni A, Roberti J, García-Elorrio E, Leslie HH, García PJ. A systematic review of population and patient perspectives and experiences as measured in Latin American and Caribbean surveys. Health Policy Plan 2023; 38:1225-1241. [PMID: 37803966 DOI: 10.1093/heapol/czad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023] Open
Abstract
High-quality health systems must provide accessible, people-centred care to both improve health and maintain population trust in health services. Furthermore, accurate measurement of population perspectives is vital to hold health systems accountable and to inform improvement efforts. To describe the current state of such measures in Latin America and the Caribbean (LAC), we conducted a systematic review of facility and population-based assessments that included patient-reported experience and satisfaction measures. Five databases were searched for publications on quantitative surveys assessing healthcare quality in Spanish- or Portuguese-speaking LAC countries, focusing on the domains of processes of care and quality impacts. We included articles published since 2011 with a national sampling frame or inclusion of multiple subnational regions. We tabulated and described these articles, identifying, classifying and summarizing the items used to assess healthcare quality into the domains mentioned earlier. Of the 5584 publications reviewed, 58 articles met our inclusion criteria. Most studies were cross-sectional (95%), assessed all levels of healthcare (57%) and were secondary analyses of existing surveys (86%). The articles yielded 33 unique surveys spanning 12 LAC countries; only eight of them are regularly administered surveys. The most common quality domains assessed were satisfaction (in 33 out of 58 articles, 57%), evidence-based/effective care (34%), waiting times (33%), clear communication (33%) and ease of use (31%). Items and reported ratings varied widely among instruments used, time points and geographical settings. Assessment of patient-reported quality measures through population- and facility-based surveys is present but heterogeneous in LAC countries. Satisfaction was measured frequently, although its use in accountability or informing quality improvement is limited. Measurement of healthcare quality in LAC needs to be more systematic, regular, comprehensive and to be led collaboratively by researchers, governments and policymakers to enable comparison of results across countries and to effectively inform policy implementation.
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Affiliation(s)
- Jesús Medina-Ranilla
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
| | - Laura Espinoza-Pajuelo
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
| | - Agustina Mazzoni
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Javier Roberti
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Ezequiel García-Elorrio
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Hannah Hogan Leslie
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th St., Floor 4, San Francisco, CA 94143, United States
| | - Patricia Jannet García
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
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Iwanaga M, Yamaguchi S, Sato S, Nakanishi K, Nishiuchi E, Shimodaira M, So Y, Usui K, Fujii C. Service intensity of community mental health outreach among people with untreated mental health problems in Japan: A retrospective cohort study. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e138. [PMID: 38867832 PMCID: PMC11114434 DOI: 10.1002/pcn5.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/19/2023] [Accepted: 08/18/2023] [Indexed: 06/14/2024]
Abstract
Aim This study aimed to clarify the association between treatment status (untreated or treated) at the start of community mental health outreach services and service intensity. Methods This retrospective cohort study was conducted using the Tokorozawa City mental health outreach service users' data. Treatment status at the start of service (exposure variable) and the service intensity (outcome variables) were taken from clinical records. Poisson regression and linear regression analyses were conducted. The frequency of medical or social service use 12 months after service initiation was also calculated. This study was approved by the Research Ethics Committee at the National Center of Neurology and Psychiatry (No. A2020-081). Results Of 89 people, 37 (42%) were untreated. Family members in the untreated group were more likely to be targets or recipients of services than in the treated group (b = 0.707, p < 0.001, Bonferroni-adjusted p < 0.001). Compared to the treated group, the untreated group received fewer services themselves (b = -0.290, p = 0.005), and also fewer services by telephone (b = -0.252, p = 0.012); by contrast, they received more services at the health center (b = 0.478, p = 0.031) and for family support (b = 0.720, p = 0.024), but these significant differences disappeared after Bonferroni adjustment. At least 11% of people in the untreated group were hospitalized and 35% were outpatients 12 months after service initiation. Conclusion Family involvement may be a key service component for untreated people. The service intensity with and without treatment may vary by service location.
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Affiliation(s)
- Mai Iwanaga
- Department of Community Mental Health & Law, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Sosei Yamaguchi
- Department of Community Mental Health & Law, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Sayaka Sato
- Department of Community Mental Health & Law, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Kiyoaki Nakanishi
- Department of Community Mental Health & Law, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Erisa Nishiuchi
- Department of Community Mental Health & Law, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Michiyo Shimodaira
- Department of Community Mental Health & Law, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Yugan So
- Department of Community Mental Health & Law, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Kaori Usui
- Department of Community Mental Health & Law, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Chiyo Fujii
- Department of Community Mental Health & Law, National Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
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Anderson DJ, Aucoin A, Toups CR, Cormier D, McDonald M, Hasoon J, Viswanath O, Kaye AD, Urits I. Lower Urinary Tract Symptoms in Depression: A Review. Health Psychol Res 2023; 11:81040. [PMID: 37465591 PMCID: PMC10351871 DOI: 10.52965/001c.81040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Lower Urinary Tract Symptoms (LUTS) are frequently present in the general population as patients age with approximately a third of individuals experiencing LUTS during their lifetime. LUTS can be further defined as having any of the following symptoms: urinary hesitancy, straining, nocturia, increased urination frequency, and dysuria. LUTS has the potential for patients to contribute their symptoms to what can normally occur as we age. This can lead to a decrease in patients seeking care and could negatively impact patients' health-related quality of life (HRQL). In conjunction with LUTS, we obtained from our analysis that LUTS and depression are closely related and worsening depressive symptoms may increase the severity of LUTS. We also discerned three categories of factors that can yield major depression namely adversity, internalizing, and externalizing factors. Within these categories, trauma, social support, genetic factors, and minimal education appeared to increase the risk of depression in patients. With the recent increase in mental health awareness and more access to mental health care amid the COVID-19 Pandemic, further screening, and collaboration between providers to treat both urological and psychiatric symptoms could improve patient outcomes. It is important for providers to have an increased understanding of the mental and physical impact both LUTS and depression can have on patients' wellbeing. This has the potential to help patients be more open about their symptoms with the aim of better addressing LUTS and depression to positively impact their HRQL.
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Affiliation(s)
| | - Alise Aucoin
- Department of Anesthesiology Louisiana State University Health
| | - Colton R Toups
- Department of Anesthesiology Louisiana State University Health
| | - Devin Cormier
- Department of Anesthesiology Louisiana State University Health
| | | | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Alan D Kaye
- Department of Anesthesiology Louisiana State University Health
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Lauria-Horner B, Knaak S, Cayetano C, Vernon A, Pietrus M. An initiative to improve mental health practice in primary care in Caribbean countries. Rev Panam Salud Publica 2023; 47:e89. [PMID: 37363624 PMCID: PMC10289476 DOI: 10.26633/rpsp.2023.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/12/2023] [Indexed: 06/28/2023] Open
Abstract
Objectives The aim of this initiative was to assess whether a novel training program - Understanding Stigma and Strengthening Cognitive Behavioral Interpersonal Skills - could improve primary health care providers' confidence in the quality of mental health care they provide in the Caribbean setting by using the Plan-Do-Study-Act rapid cycle for learning improvement. Methods We conducted a prospective observational study of the impact of this training program. The training was refined during three cycles: first, the relevance of the program for practice improvement in the Caribbean was assessed. Second, pilot training of 15 local providers was conducted to adapt the program to the culture and context. Third, the course was launched in fall 2021 with 96 primary care providers. Pre- and post-program outcomes were assessed by surveys, including providers' confidence in the quality of the mental health care they provided, changes in stigma among the providers and their use of and comfort with the tools. This paper describes an evaluation of the results of cycle 3, the official launch. Results A total of 81 participants completed the program. The program improved primary care providers' confidence in the quality of mental health care that they provided to people with lived experience of mental health disorders, and it reduced providers' stigmatization of people with mental health disorders. Conclusions The program's quality improvement model achieved its goals in enhancing health care providers' confidence in the quality of the mental health care they provided in the Caribbean context; the program provides effective tools to support the work and it helped to empower and engage clients.
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Affiliation(s)
- Bianca Lauria-Horner
- Department of PsychiatryDalhousie UniversityHalifaxNova ScotiaCanadaDepartment of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephanie Knaak
- Mental Health Commission of Canada (MHCC)OttawaCanadaMental Health Commission of Canada (MHCC), Ottawa, Ottawa, Canada
| | - Claudina Cayetano
- Department of Noncommunicable Diseases and Mental HealthMental Health UnitPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Mental Health Unit, Pan American Health Organization, Washington, DC, United States of America
| | - Andrew Vernon
- Department of Noncommunicable Diseases and Mental HealthMental Health UnitPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Mental Health Unit, Pan American Health Organization, Washington, DC, United States of America
| | - Michael Pietrus
- Mental Health Commission of Canada (MHCC)OttawaCanadaMental Health Commission of Canada (MHCC), Ottawa, Ottawa, Canada
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Zhang W, Singh SP, Clement A, Calfee RP, Bijsterbosch JD, Cheng AL. Improvements in Physical Function and Pain Interference and Changes in Mental Health Among Patients Seeking Musculoskeletal Care. JAMA Netw Open 2023; 6:e2320520. [PMID: 37378984 PMCID: PMC10308248 DOI: 10.1001/jamanetworkopen.2023.20520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/23/2023] [Indexed: 06/29/2023] Open
Abstract
Importance Among patients seeking care for musculoskeletal conditions, there is mixed evidence regarding whether traditional, structure-based care is associated with improvement in patients' mental health. Objective To determine whether improvements in physical function and pain interference are associated with meaningful improvements in anxiety and depression symptoms among patients seeking musculoskeletal care. Design, Setting, and Participants This cohort study included adult patients treated by an orthopedic department of a tertiary care US academic medical center from June 22, 2015, to February 9, 2022. Eligible participants presented between 4 and 6 times during the study period for 1 or more musculoskeletal conditions and completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures as standard care at each visit. Exposure PROMIS Physical Function and Pain Interference scores. Main Outcomes and Measures Linear mixed effects models were used to determine whether improvements in PROMIS Anxiety and PROMIS Depression scores were associated with improved PROMIS Physical Function or Pain Interference scores after controlling for age, gender, race, and PROMIS Depression (for the anxiety model) or PROMIS Anxiety (for the depression model). Clinically meaningful improvement was defined as 3.0 points or more for PROMIS Anxiety and 3.2 points or more for PROMIS Depression. Results Among 11 236 patients (mean [SD] age, 57 [16] years), 7218 (64.2%) were women; 120 (1.1%) were Asian, 1288 (11.5%) were Black, and 9706 (86.4%) were White. Improvements in physical function (β = -0.14; 95% CI, -0.15 to -0.13; P < .001) and pain interference (β = 0.26; 95% CI, 0.25 to 0.26; P < .001) were each associated with improved anxiety symptoms. To reach a clinically meaningful improvement in anxiety symptoms, an improvement of 21 PROMIS points or more (95% CI, 20-23 points) on Physical Function or 12 points or more (95% CI, 12-12 points) on Pain Interference would be required. Improvements in physical function (β = -0.05; 95% CI, -0.06 to -0.04; P < .001) and pain interference (β = 0.04; 95% CI, 0.04 to 0.05; P < .001) were not associated with meaningfully improved depression symptoms. Conclusions and Relevance In this cohort study, substantial improvements in physical function and pain interference were required for association with any clinically meaningful improvement in anxiety symptoms, and were not associated with any meaningful improvement in depression symptoms. Patients seeking musculoskeletal care clinicians providing treatment cannot assume that addressing physical health will result in improved symptoms of depression or potentially even sufficiently improved symptoms of anxiety.
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Affiliation(s)
- Wei Zhang
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Som P. Singh
- University of Missouri–Kansas City School of Medicine, Kansas City
| | - Amdiel Clement
- Washington University School of Medicine, St Louis, Missouri
| | - Ryan P. Calfee
- Division of Hand and Wrist, Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Janine D. Bijsterbosch
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Abby L. Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri
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Hartinger SM, Yglesias-González M, Blanco-Villafuerte L, Palmeiro-Silva YK, Lescano AG, Stewart-Ibarra A, Rojas-Rueda D, Melo O, Takahashi B, Buss D, Callaghan M, Chesini F, Flores EC, Gil Posse C, Gouveia N, Jankin S, Miranda-Chacon Z, Mohajeri N, Helo J, Ortiz L, Pantoja C, Salas MF, Santiago R, Sergeeva M, Souza de Camargo T, Valdés-Velásquez A, Walawender M, Romanello M. The 2022 South America report of The Lancet Countdown on health and climate change: trust the science. Now that we know, we must act. LANCET REGIONAL HEALTH. AMERICAS 2023; 20:100470. [PMID: 37125022 PMCID: PMC10122119 DOI: 10.1016/j.lana.2023.100470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Stella M. Hartinger
- Centro Latino Americano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
- Corresponding author. Av. Honorio Delgado 430, San Martín de Porres, 15102, Lima, Peru.
| | - Marisol Yglesias-González
- Centro Latino Americano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luciana Blanco-Villafuerte
- Centro Latino Americano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Yasna K. Palmeiro-Silva
- Pontificia Universidad Católica de Chile, Santiago, Chile
- University College London, London, UK
| | - Andres G. Lescano
- Centro Latino Americano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Oscar Melo
- Centro Interdisciplinario de Cambio Global, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Daniel Buss
- Pan American Health Organization, Washington, DC, USA
| | - Max Callaghan
- Mercator Research Institute on Global Commons and Climate Change, Berlin, Germany
| | | | - Elaine C. Flores
- Centro Latino Americano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
- Centre on Climate Change and Planetary Health, LSHTM, London, UK
| | | | | | | | | | | | | | | | - Chrissie Pantoja
- Duke University, Durham, NC, USA
- Universidad del Pacífico, Lima, Peru
| | | | - Raquel Santiago
- Universidade de São Paulo, São Paulo, Brazil
- Universidade Federal de Goiás, Goiás, Brazil
| | | | | | - Armando Valdés-Velásquez
- Centro Latino Americano de Excelencia en Cambio Climático y Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
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Zhang W, Singh SP, Clement A, Calfee RP, Bijsterbosch JD, Cheng AL. Relationships between improvement in physical function, pain interference, and mental health in musculoskeletal patients. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.12.23285824. [PMID: 36824736 PMCID: PMC9949185 DOI: 10.1101/2023.02.12.23285824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Importance Among patients seeking care for musculoskeletal conditions, there is mixed evidence regarding whether traditional, structure-based care is associated with improvement in patients' mental health. Objective To determine whether improvements in physical function and pain interference are associated with meaningful improvements in anxiety and depression symptoms among patients seeking musculoskeletal care. Design Retrospective cohort study from June 22, 2015 to February 9, 2022. Setting Orthopedic department of a tertiary care US academic medical center. Participants Consecutive sample of adult patients who presented to the musculoskeletal clinic 4 to 6 times during the study period and completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures as standard care at each visit. Exposure PROMIS Physical Function and Pain Interference scores. Main Outcomes and Measures Linear mixed effects models were used to determine whether: 1) PROMIS Anxiety and 2) PROMIS Depression scores improved as a function of improved PROMIS Physical Function or Pain Interference scores, after controlling for age, gender, race, and PROMIS Depression (for the Anxiety model) and PROMIS Anxiety (for the Depression model). Clinically meaningful improvement was defined as ≥3.0 points for PROMIS Anxiety and ≥3.2 points for PROMIS Depression. Results Among 11,236 patients (mean [SD] age 57 [16] years), 9,706 (86%) were White, and 7,218 (64%) were women. Improvements in physical function (β=-0.14 [95% CI -0.15- -0.13], p<0.001) and pain interference (β=0.26 [0.25-0.26], p<0.001) were each associated with improved anxiety symptoms. To reach a clinically meaningful improvement in anxiety symptoms, an improvement of ≥21 [20-23] PROMIS points on Physical Function or ≥12 [12-12] points on Pain Interference would be required. Improvements in physical function (β=-0.05 [- 0.06- -0.04], p<0.001) and pain interference (β=0.04 [0.04-0.05], p<0.001) were not associated with meaningfully improved depression symptoms. Conclusions and Relevance In this cohort study, substantial improvements in physical function and pain interference were required for association with any clinically meaningful improvement in anxiety symptoms and were not associated with any meaningful improvement in depression symptoms. Among patients seeking musculoskeletal care, musculoskeletal clinicians and patients cannot assume that addressing physical health will result in improved symptoms of depression or potentially even sufficiently improved symptoms of anxiety. Key Points Question: Among patients seeking musculoskeletal care, are improvements in physical function and pain interference associated with meaningful changes in symptoms of anxiety and depression?Findings: In this large cohort study, improvement by ≥2.3 population-level standard deviations (SD) on PROMIS Physical Function or ≥1.2 SD on PROMIS Pain Interference were required for any association with meaningful improvement in anxiety symptoms. Improvements in physical function and pain interference were not associated with meaningfully improved depression symptoms.Meaning: Musculoskeletal clinicians and patients cannot assume that exclusively addressing the physical aspect of a musculoskeletal condition will improve symptoms of depression or potentially even anxiety.
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Development of the PREMIUM Computerized Adaptive Testing for Measuring the Quality of Information Delivered to Patients with Severe Mental Illnesses. J Clin Med 2022; 11:jcm11226687. [PMID: 36431164 PMCID: PMC9696867 DOI: 10.3390/jcm11226687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Measuring the quality of information delivered to patients with severe mental illness (SMI), i.e., schizophrenia, bipolar disorders, and major depressive disorders, is essential to improve their quality of care. In this work, we described the different steps of the validation of the PREMIUM computerized adaptive testing (CAT) for measuring the quality of information delivered to patients with SMI. The PREMIUM item bank regarding information included 25 items. A total of 499 patients with schizophrenia (53%), bipolar disorders (26%), and major depressive disorders (22%) were recruited from numerous in- and outpatient settings in France. Unidimensionality, local independence, and monotonicity were verified for 19 items of the item bank. The psychometric properties were satisfactory for both internal (RMSEA = 0.069, CFI = 0.969, TLI = 0.963) and external validity (in particular, significant associations were found with age, educational level, and social functioning). The CAT exhibited satisfactory accuracy and precision (standard error of measurement <0.55 and root mean square error <0.3), with an average administration of eight items. This CAT may be used by healthcare professionals in psychiatric settings to accurately assess the patients’ experience with information.
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Schladitz K, Weitzel EC, Löbner M, Soltmann B, Jessen F, Schmitt J, Pfennig A, Riedel-Heller SG, Gühne U. Demands on Health Information and Clinical Practice Guidelines for Patients from the Perspective of Adults with Mental Illness and Family Members: A Qualitative Study with In-Depth Interviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114262. [PMID: 36361142 PMCID: PMC9659184 DOI: 10.3390/ijerph192114262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 05/21/2023]
Abstract
(1) Background: "Patient health information" promote health literacy. "Patient guidelines" as a sub group reflect the current evidence about illnesses and treatment options adapted to the needs of laypersons. Little is known about factors promoting and hindering their use by people affected by mental illness and their relatives. (2) Methods: Telephone interviews (N = 15; n = 4 adults affected by mental illness, n = 5 relatives, n = 6 both applicable) were conducted according to the Sørensen model of health literacy. Data were recorded, transcribed and content-analyzed following Mayring. (3) Results: Health information is used regularly by individuals affected by mental illness and their relatives, but "patient guidelines" are largely unknown. Yet, there is a great willingness to use them. Main barriers are a lack of statistical knowledge, the complexity of health-related topics and cognitive impairment sometimes accompanying mental illnesses. Target group-oriented adaptation as well as transparent and even-handed presentation of (dis-)advantages of treatment options can increase trust. (4) Conclusions: Health information and guidelines can help affected persons and relatives to make treatment decisions by conveying unbiased, up-to-date knowledge. Target group-specific adaptations should be made for psychiatric illnesses and features specific to mental illnesses compared to physical illnesses should be included. Clinical practice guidelines must be distributed more widely to increase their impact.
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Affiliation(s)
- Katja Schladitz
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-97-15481
| | - Elena C. Weitzel
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Bettina Soltmann
- Institute of Clinical Psychology and Psychotherapy, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01062 Dresden, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Köln, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare (ZEGV), Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01069 Dresden, Germany
| | - Andrea Pfennig
- Institute of Clinical Psychology and Psychotherapy, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01062 Dresden, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
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Mauro PM, Gutkind S, Rivera-Aguirre A, Gary D, Cerda M, Santos EC, Castillo-Carniglia A, Martins SS. Trends in cannabis or cocaine-related dependence and alcohol/drug treatment in Argentina, Chile, and Uruguay. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103810. [PMID: 35939947 PMCID: PMC9912990 DOI: 10.1016/j.drugpo.2022.103810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 07/09/2022] [Accepted: 07/19/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND In the context of changing cannabis and other drug policy and regulation, concerns may arise regarding drug treatment access and use. We assessed cannabis/cocaine-related dependence and treatment in Argentina, Chile, and Uruguay. METHODS Nationally representative cross-sectional household surveys of people ages 15-64 in Argentina (4 surveys, 2006-2017), Chile (7 surveys, 2006-2018), and Uruguay (4 surveys, 2006-2018) were harmonized. We estimated weighted prevalences of cannabis or cocaine-related (cocaine or cocaine paste) dependence, based on meeting 3+ past-year ICD-10 dependence criteria. We estimated weighted prevalences of past-year alcohol/drug treatment use (Argentina, Chile) or use/seeking (Uruguay) among people with past-year cannabis/cocaine-related dependence. We tested model-based prevalence trends over time and described individual-level treatment correlates by country. RESULTS Cannabis/cocaine dependence prevalence increased in the region starting in 2010-2011, driven by cannabis dependence. Adjusted cannabis dependence prevalence increased from 0.7% in 2010 to 1.5% in 2017 in Argentina (aPD=0.8, 95% CI= 0.3, 1.2), from 0.8% in 2010 to 2.8% in 2018 in Chile (aPD=2.0, 95% CI= 1.4, 2.6), and from 1.4% in 2011 to 2.4% in 2018 in Uruguay (aPD=0.9, 95% CI= 0.2, 1.6). Cocaine-related dependence increased in Uruguay, decreased in Argentina, and remained stable in Chile. Among people with past-year cannabis/cocaine dependence, average alcohol/drug treatment use prevalence was 15.3% in Argentina and 6.0% in Chile, while treatment use/seeking was 14.7% in Uruguay. Alcohol/drug treatment prevalence was lower among people with cannabis dependence than cocaine-related dependence. Treatment correlates included older ages in all countries and male sex in Argentina only. CONCLUSION Alcohol/drug treatment use among people with cannabis/cocaine-related dependence remained low, signaling an ongoing treatment gap in the context of growing cannabis dependence prevalence in the region. Additional resources may be needed to increase treatment access and uptake. Future studies should assess contributors of low treatment use, including perceived need, stigma, and service availability.
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Affiliation(s)
- Pia M Mauro
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA.
| | - Sarah Gutkind
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA
| | - Ariadne Rivera-Aguirre
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York NY 10016 USA; Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile
| | - Dahsan Gary
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA
| | - Magdalena Cerda
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York NY 10016 USA
| | - Erica Chavez Santos
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA; University of Washington School of Public Health, 3980 15th Ave NE, Seattle, WA 98195 USA
| | - Alvaro Castillo-Carniglia
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York NY 10016 USA; Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Chile; Society and Health Research Center, Facultad de Ciencias Sociales y Artes, Universidad Mayor, Badajoz 130, Room 1306, Las Condes, Santiago, Chile; Millennium Nucleus on Sociomedicine (SocioMed), Chile
| | - Silvia S Martins
- Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA
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Rafful C, López A, Contreras-Valdez JA, Morales M, Jiménez-Rivagorza L, Orozco R. Substance use stigma mechanisms scale: Factor structure, reliability, and validity in Mexican adults that use drugs. Drug Alcohol Depend 2022; 239:109598. [PMID: 35961267 DOI: 10.1016/j.drugalcdep.2022.109598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Studies among the Mexican population have suggested that stigma towards persons who use drugs (PWUD) may act as a barrier to treatment seeking and contribute to negative health consequences. However, there has not been a validated scale to measure this construct. This paper aims to validate the Substance Use Stigma Mechanisms Scale (SU-SMS) in a sample of Mexican adults who use drugs. This 18-item scale was developed to differentiate substance use stigma mechanisms and learn their impact on the health and wellbeing of persons who use drugs (PWUD) in the United States. METHODS A sample of 407 adults with a median age of 27 years old completed a web-based version in Spanish of the SU-SMS, the WHO-ASSIST screening instrument, as well as sociodemographic and substance-use-related characteristics. We performed exploratory factor analysis with weighted least squares and oblique rotation, and correlations within and between mechanisms of stigma, and substance use. RESULTS The Spanish translation of the SU-SMS has adequate internal consistency (Ω=0.92) and the same factor structure as the original scale. A five-factor solution with internalized, enacted, and anticipated stigma from family and healthcare workers showed adequate concurrent validity. Mechanisms of stigma were correlated between them, within sources, and negatively correlated with current substance use treatment. CONCLUSIONS The Spanish translation of the scale seems to be a valid and sensitive scale that can be used among Mexican PWUD.
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Affiliation(s)
- Claudia Rafful
- Faculty of Psychology, Universidad Nacional Autónoma de México, Mexico City, Mexico; Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico
| | - Andrea López
- Faculty of Psychology, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Missael Morales
- Faculty of Psychology, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Ricardo Orozco
- Center for Global Mental Health, National Institute of Psychiatry, Mexico City, Mexico.
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Calibration and Validation of a PREMIUM-DT Item Bank to Measure the Experience of Drug Therapy for Patients with Severe Mental Illness. J Clin Med 2022; 11:jcm11154278. [PMID: 35893366 PMCID: PMC9331305 DOI: 10.3390/jcm11154278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 07/20/2022] [Indexed: 12/04/2022] Open
Abstract
The aim of this study was to (1) calibrate an item bank to measure patients’ experience of drug therapy for adult patients with SMIs and (2) develop computerized adaptive testing (CAT) to improve its use in routine practice. This is a cross-sectional, multicentric study involving 541 patients with schizophrenia, bipolar disorder, and major depressive disorder. Analyses based on classical test and item response theories were performed. After 7 highly inter-correlated items and 4 items with low factor loadings were removed, the remaining 26 items were sufficiently unidimensional (RMSEA = 0.069, CFI = 0.969, TLI = 0.963) and showed adequate fit to the generalized partial credit model. There was no differential item functioning by gender, age, care setting, or diagnosis from moderate- to large-magnitude. The mean score was 46.0 ± 16.9 and was significantly higher for patients reporting good medication adherence. The resulting PREMIUM-DT item bank has strong psychometric properties, and CAT facilitates widespread use in clinical settings (an average of 8 items administered, corresponding to a reliability of >0.90). Our results suggest that practical information and information about the side effects of psychotropic treatments and how to cope with them should be targeted as a priority to improve patients’ experience of drug therapy.
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Dropout from treatment for mental disorders in six countries of the Americas: A regional report from the World Mental Health Surveys. J Affect Disord 2022; 303:168-179. [PMID: 35151675 DOI: 10.1016/j.jad.2022.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/20/2021] [Accepted: 02/09/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To estimate structural and attitudinal reasons for premature discontinuation of mental health treatment, socio-demographic and clinical correlates of treatment dropout due to these reasons, and to test country differences from the overall effect across the region of the Americas. METHODS World Health Organization-World Mental Health (WMH) surveys were carried out in six countries in the Americas: Argentina, Brazil, Colombia, Mexico, Peru and USA. Among the 1991 participants who met diagnostic criteria (measured with the Composite International Diagnostic Interview (WMHCIDI)) for a mental disorder and were in treatment in the prior 12-months, the 236 (12.2%) who dropped out of treatment before the professional recommended were included. FINDINGS In all countries, individuals more frequently reported attitudinal (79.2%) rather than structural reasons (30.7%) for dropout. Disorder severity was associated with structural reasons; those with severe disorder (versus mild disorder) had 3.4 (95%CI=1.1-11.1) times the odds of reporting a structural reason. Regarding attitudinal reasons, those with lower income (versus higher income) were less likely to discontinue treatment because of getting better (OR=0.4; 95%CI= 0.2-0.9). Country specific variations were found. LIMITATIONS Not all countries, or the poorest, in the region were included. Some estimations couldn´t be calculated due to cell size. Causality cannot be assumed. CONCLUSION Clinicians should in the first sessions address attitudinal factors that may lead to premature termination. Public policies need to consider distribution of services to increase convenience. A more rational use of resources would be to offer brief therapies to individuals most likely to drop out of treatment prematurely.
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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: 2] [Impact Index Per Article: 1.0] [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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Treatment Gap of Mental Disorders in São Paulo Metropolitan Area, Brazil: Failure and Delay in Initiating Treatment Contact After First Onset of Mental and Substance Use Disorders. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00814-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Quality of life among people who use drugs living in poor urban communities in the Philippines. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 93:103160. [PMID: 33721576 DOI: 10.1016/j.drugpo.2021.103160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/08/2021] [Accepted: 02/03/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The quality of life (QOL) and mental health of people who use drugs (PWUD) in the Philippines, especially those living in poor urban communities, are highly concerning due to the situations surrounding drug use and the ongoing hard-line antidrug policy. This study aimed to investigate the QOL and mental health status of PWUD, compare them with a comparison group with no history of drug use, and identify factors associated with QOL among Filipino PWUD. METHODS A cross-sectional study was conducted with recruitment from a community-based rehabilitation programme and poor urban communities in Muntinlupa in 2018. QOL was measured using the WHOQOL-BREF, while psychological distress and posttraumatic stress disorder (PTSD) were measured using the Kessler Psychological Distress Scale (K-6) and the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), respectively. Multivariable linear regressions with each WHOQOL-BREF domain as a dependent factor were conducted to establish three predictions: age- and gender-adjusted QOL means, factors associated with QOL among PWUD, and interaction of lifetime drug use with each covariate. RESULTS In total, 272 PWUD and 402 comparison participants were recruited. Most PWUD were current drug users (53%), primarily of methamphetamine (70%). Among PWUD, the prevalence of moderate to severe psychological distress was 70%, and probable PTSD was 28%-both rates higher than those among the comparison group. All four QOL domain scores (physical, psychological, social, and environmental) of PWUD were lower than those of the comparison group. Multivariable regressions showed that psychological distress, current drug use, selling drugs, experiencing discrimination, and being never-married were associated with lower QOL. Higher individual income, household resources, social activity participation, and service use for drug use problems were associated with higher QOL among PWUD. Stratified and interaction analyses revealed that the QOL of PWUD was more sensitive to changes in individual income relative to the QOL of comparison group. CONCLUSION A comprehensive intervention addressing psychological distress reduction, economic empowerment, and social inclusion-complementary to abstinence-oriented programmes-may improve the well-being of Filipino PWUD.
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Moreno Velásquez I, Castelpietra G, Higuera G, Castro F, Gómez B, Motta J, Goti R. Suicide trends and self-harm in Panama: results from the National Mortality Registry and hospital-based data. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1513-1524. [PMID: 32556380 DOI: 10.1007/s00127-020-01895-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to (1) to investigate mortality trends due to suicide in Panama at the national and regional levels from 2001 to 2016, (2) to describe the sociodemographic and clinical characteristics of admitted patients with non-fatal self-harm from 2009 to 2017 in a regional hospital, and (3) to examine the association between mental health diagnoses and intentional self-harm, lethality, self-harm repetition and all-cause mortality within this population. METHODS Using the national mortality registry, annual percentage changes (APC) with 95% confidence intervals (CI) were estimated to evaluate suicide trends over time. Self-harm cases were assessed by trained psychiatrists at a referral hospital through interviews. Logistic regression models were used to estimate the association between mental diagnosis with intent-to-die and lethality, expressed as odds ratios (OR) and 95% CI. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% CI for self-harm repetition and all-cause mortality. RESULTS The trend of suicide in women declined, with an APC of - 4.8, 95% CI - 7.8, - 1.7, while the trend began to decline from 2006 in men; APC - 6.9, 95% CI - 8.9, - 4.9. Self-harm repetition over 12 months was 1.8%. Having a mental health diagnosis was associated with intentional self-harm (OR 1.5; 95% CI 1.0-2.4) and self-harm repetition (HR 2.7, 95% CI 1.3-5.8). Medication overdose was the preferred method for self-harm, while intentional self-harm by hanging was the preferred method for suicide. CONCLUSIONS Strategies for prevention and early intervention after self-harm deserve attention. Our findings highlight the importance of data to inform action.
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Affiliation(s)
| | - Giulio Castelpietra
- Primary Care Services Area, Central Health Directorate, Venezia Giulia, Region Friuli, Trieste, Italy
| | - Gladys Higuera
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Franz Castro
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Beatriz Gómez
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Jorge Motta
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Ricardo Goti
- Department of Mental Health, Ministry of Health, Panama City, Panama.,Centro de Salud de Curundú, Ministry of Health, Panama City, Panama
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Al‐Habeeb A, Altwaijri YA, Al‐Subaie AS, Bilal L, Almeharish A, Sampson NA, Liu H, Kessler RC. Twelve-month treatment of mental disorders in the Saudi National Mental Health Survey. Int J Methods Psychiatr Res 2020; 29:e1832. [PMID: 32519421 PMCID: PMC7507396 DOI: 10.1002/mpr.1832] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/12/2020] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To estimate treatment rates of 12-month mental disorders in the Saudi National Mental Health Survey (SNMHS). METHODS The SNMHS is a face-to-face community epidemiological survey in a nationally representative household sample of citizens ages 15-65 in the Kingdom of Saudi Arabia (KSA) (n = 4,004). The World Health Organization Composite International Diagnostic Interview (CIDI) was used to produce estimates of 12-month prevalence and treatment of common DSM-IV mental disorders. RESULTS About one eighth (13.7%) of respondents with a 12-month DSM-IV/CIDI disorder received 12-month treatment. The highest proportion of treatment occurred in the general medical sector (53.0%). Close to half (45.2%) of patients received treatment rated at least minimally adequate using standard treatment guidelines. Although serious disorders were significantly more likely to be treated (20.2%) than mild or moderate disorders (8.5-10.7%), no association was found between disorder severity and probability of receiving adequate treatment. Sociodemographic correlates were for the most part nonsignificant. CONCLUSIONS A high level of unmet need for treatment of mental disorders exists in KSA. Further analyses of the SNMHS data might provide insights into modifiable barriers to treatment and policy options to address the problem of unmet need for treatment.
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Affiliation(s)
| | - Yasmin A. Altwaijri
- King Salman Center for Disability ResearchRiyadhSaudi Arabia
- Biostatistics, Epidemiology and Scientific Computing DepartmentKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine King Saud UniversityRiyadhSaudi Arabia
| | - Abdullah S. Al‐Subaie
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine King Saud UniversityRiyadhSaudi Arabia
- Edrak Medical CenterRiyadhSaudi Arabia
| | - Lisa Bilal
- King Salman Center for Disability ResearchRiyadhSaudi Arabia
- Biostatistics, Epidemiology and Scientific Computing DepartmentKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine King Saud UniversityRiyadhSaudi Arabia
| | - Amani Almeharish
- Biostatistics, Epidemiology and Scientific Computing DepartmentKing Faisal Specialist Hospital and Research CentreRiyadhSaudi Arabia
| | - Nancy A. Sampson
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Howard Liu
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Ronald C. Kessler
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
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