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Hyseni Duraku Z, Davis H, Hamiti E. Mental health, study skills, social support, and barriers to seeking psychological help among university students: a call for mental health support in higher education. Front Public Health 2023; 11:1220614. [PMID: 37920583 PMCID: PMC10619655 DOI: 10.3389/fpubh.2023.1220614] [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: 05/10/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Poor mental health among youths is a complex worldwide issue. Many countries with medium-to-low levels of development, particularly those in Southern Europe, have not introduced appropriate mental health and educational strategies to identify the key factors influencing wellbeing, promote psychological wellbeing, and prevent poor mental health among youths. In response to these trends, we sought to uncover insights for developing interventions for youth mental wellbeing. We assessed mental health, study skills, barriers to seeking psychological help, and perceived social support among Kosovar university students, and investigated their experiences with professional mental health services and their needs and perceptions regarding the importance of professional mental health services on campus. Methods The study used a parallel mixed-methods design. Participants included 234 university students. Quantitative data were gathered through validated questionnaires, including the Depression, Anxiety, and Stress Scale, Multidimensional Scale of Perceived Social Support, Academic Anxiety Scale, Study Skills Assessment Questionnaire, and the Barriers to Seeking Psychological Help Scale. Qualitative data on the students' experiences with mental health services and their perceptions regarding the importance of professional university mental health services were explored through open-ended questions. Results Most students experienced anxiety and depression, more than half were stressed, and most reported poor or moderate study skills. Lack of trust in mental health professionals was a major barrier to seeking psychological help, followed by difficulties in self-disclosure. Perceived social support and academic anxiety were significant predictors of barriers to seeking psychological help. The participants believed that mental health and academic support from the university would help improve their mental wellbeing, study skills, self-esteem, self-perception, and attitudes toward social support; raise awareness regarding mental health; and help them overcome personal and academic challenges. Discussion Our findings highlight the need for more comprehensive and accessible mental health services on campuses. By providing adequate support and resources to address various personal and academic factors that contribute to mental health issues in university students, universities can enhance students' academic success and personal growth.
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Affiliation(s)
- Zamira Hyseni Duraku
- Department of Psychology, University of Prishtina “Hasan Prishtina”, Pristina, Kosovo
| | - Holly Davis
- University Counseling Service, The University of Iowa, Iowa City, IA, United States
| | - Era Hamiti
- Department of Psychology, University of Prishtina “Hasan Prishtina”, Pristina, Kosovo
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Moitra M, Owens S, Hailemariam M, Wilson KS, Mensa-Kwao A, Gonese G, Kamamia CK, White B, Young DM, Collins PY. Global Mental Health: Where We Are and Where We Are Going. Curr Psychiatry Rep 2023; 25:301-311. [PMID: 37256471 PMCID: PMC10230139 DOI: 10.1007/s11920-023-01426-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE OF REVIEW To summarize recent findings in global mental health along several domains including socioeconomic determinants, inequities, funding, and inclusion in global mental health research and practice. RECENT FINDINGS Mental illness continues to disproportionately impact vulnerable populations and treatment coverage continues to be low globally. Advances in integrating mental health care and adopting task-shifting are accompanied by implementation challenges. The mental health impact of recent global events such as the COVID-19 pandemic, geo-political events, and environmental change is likely to persist and require coordinated care approaches for those in need of psychosocial support. Inequities also exist in funding for global mental health and there has been gradual progress in terms of building local capacity for mental health care programs and research. Lastly, there is an increasing effort to include people with lived experiences of mental health in research and policy shaping efforts. The field of global mental health will likely continue to be informed by evidence and perspectives originating increasingly from low- and middle-income countries along with ongoing global events and centering of relevant stakeholders.
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Affiliation(s)
- Modhurima Moitra
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, 98195, USA.
| | - Shanise Owens
- Department of Public Health, Department of Obstetrics, Gynecology and Reproductive Biology, Charles Stewart Mott, Michigan State University, East Lansing, USA
| | - Maji Hailemariam
- Department of Global Health, University of Washington, Seattle, USA
| | - Katherine S Wilson
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Augustina Mensa-Kwao
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Gloria Gonese
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Christine K Kamamia
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Belinda White
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Dorraine M Young
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Pamela Y Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, 98195, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
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Neill R, Shawar YR, Ashraf L, Das P, Champagne SN, Kautsar H, Zia N, Michlig GJ, Bachani AM. Prioritizing rehabilitation in low- and middle-income country national health systems: a qualitative thematic synthesis and development of a policy framework. Int J Equity Health 2023; 22:91. [PMID: 37198596 DOI: 10.1186/s12939-023-01896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND There is a large and growing unmet need for rehabilitation - a diverse category of services that aim to improve functioning across the life course - particularly in low- and middle-income countries. Yet despite urgent calls to increase political commitment, many low- and middle-income country governments have dedicated little attention to expanding rehabilitation services. Existing policy scholarship explains how and why health issues reach the policy agenda and offers applicable evidence to advance access to physical, medical, psychosocial, and other types of rehabilitation services. Drawing from this scholarship and empirical data on rehabilitation, this paper proposes a policy framework to understand national-level prioritization of rehabilitation in low- and middle-income countries. METHODS We conducted key informant interviews with rehabilitation stakeholders in 47 countries, complemented by a purposeful review of peer-reviewed and gray literature to achieve thematic saturation. We analyzed the data abductively using a thematic synthesis methodology. Rehabilitation-specific findings were triangulated with policy theory and empirical case studies on the prioritization of other health issues to develop the framework. RESULTS The novel policy framework includes three components which shape the prioritization of rehabilitation on low- and middle-income countries' national government's health agendas. First, rehabilitation lacks a consistent problem definition, undermining the development of consensus-driven solutions which could advance the issue on policy agendas. Second, governance arrangements are fragmented within and across government ministries, between the government and its citizens, and across national and transnational actors engaged in rehabilitation service provision. Third, national legacies - particularly from civil conflict - and weaknesses in the existing health system influences both rehabilitation needs and implementation feasibility. CONCLUSIONS This framework can support stakeholders in identifying the key components impeding prioritization for rehabilitation across different national contexts. This is a crucial step for ultimately better advancing the issue on national policy agendas and improving equity in access to rehabilitation services.
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Affiliation(s)
- Rachel Neill
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA.
| | - Yusra Ribhi Shawar
- Department of International Health, Johns Hopkins University Blomberg School of Public Health, Baltimore, MD, USA
- Paul H. Nitze School of Advanced International Studies, Johns Hopkins University, Washington, DC, USA
| | - Lamisa Ashraf
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Priyanka Das
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Sarah N Champagne
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Hunied Kautsar
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Georgia J Michlig
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
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Powell TM, Qushua N. A qualitative study of a mental health awareness intervention for Jordanian and resettled Syrian refugees in host communities. Int J Soc Psychiatry 2023; 69:161-172. [PMID: 35083938 DOI: 10.1177/00207640221074808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mental health disorders significantly contribute to the global burden of disease, however, prevention and treatment programs are often inaccessible in low- and middle-income countries. AIMS The goal of this qualitative evaluation was to examine participants experiences of the healthy community clinic (HCC-MH), an integrated mental health awareness intervention delivered in primary care clinics to Jordanians and resettled Syrians in a border community in Jordan. METHODS Four focus group discussions (FGDs) with Jordanians and Syrians (N = 21) who participated in the HCC-MH were conducted. FGDs examined knowledge, acceptability, and applicability of the intervention. Open coding and the constant comparison method were used to identify themes that emerged from the FGDs. RESULTS Six central themes emerged from the data including : (1) awareness; (2) behavior changes; (3) reduction in stigma; (4) connecting physical and mental health; (5) relationships; and (6) coping. Notably, female participants stated participation in the intervention fostered awareness of their own emotional needs, which led to positive lifestyle and behavior changes. Participants also described how the information provided in the intervention normalized emotional distress and aided understanding of the interconnection between physical and mental health. The amplification of healthy coping strategies to reduce stress and distress was also a prominent theme. CONCLUSIONS Findings are discussed within the cultural and contextual setting of the study, and implications for mental health awareness interventions in complex settings are provided.
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Affiliation(s)
- Tara M Powell
- School of Social Work, University of Illinois Urbana Champaign, USA
| | - Najat Qushua
- Brown School, Washington University, St Louis, MO, USA
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Agents of Change for Mental Health: A Survey of Young People's Aspirations for Participation Across Five Low- and Middle-Income Countries. J Adolesc Health 2023; 72:S96-S104. [PMID: 35279363 PMCID: PMC9747181 DOI: 10.1016/j.jadohealth.2021.10.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 08/19/2021] [Accepted: 10/26/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Effective intervention, policy, and research in mental health and well-being (MHWB) require young people to be understood not only as beneficiaries, but also as active agents in codesigning and implementing initiatives. To identify pathways for young people's participation in promoting MHWB in low- and middle-income countries (LMICs), this study surveyed young people's aspirations for engagement, their spheres of influence, capacity building needs, and key barriers to participation. METHODS Using U-Report, United Nations Children's Emergency Fund's social messaging tool and data collection platform, we distributed a short quantitative survey to a nonrepresentative, but large sample of young people aged 15-29 across five LMICs: Nigeria, Brazil, Jamaica, South Africa, and Burundi. RESULTS A total of 42,689 young people responded, with representation from most or all provinces within each country. Participants' average age was 23.8 years (SD = 3.77). Young people's core aspirations were to join a mental health awareness project and to support their peers. Participants considered schools and community settings to be the most important spheres for engagement. Lack of information about mental health was the main perceived barrier to participation, and mental health classes the main training need. DISCUSSION In many countries, MHWB is not taught or discussed in schools and youth-led mental health interventions are rare. Findings from this study reveal clear aspirations for participatory engagement to promote MHWB among young people in LMICs. To support meaningful participation, policymakers and youth service providers must ensure that young people have access to mental health literacy training and opportunities to raise awareness in schools or community settings.
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Loch AA, Lopes-Rocha AC, Fekih-Romdhane F, van de Bilt MT, Salazar de Pablo G, Fusar-Poli P. Inequality and barriers in psychosis prevention: A systematic review on clinical high-risk for psychosis studies from developing countries. Front Psychiatry 2023; 14:1148862. [PMID: 37113551 PMCID: PMC10126325 DOI: 10.3389/fpsyt.2023.1148862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Background The clinical high-risk for psychosis (CHR) paradigm is one of the best studied preventive paradigms in psychiatry. However, most studies have been conducted in high-income countries. It is unclear if knowledge from such countries applies to low and middle-income countries (LAMIC), and if there are specific limitations hindering CHR research there. Our aim is to systematically review studies on CHR from LAMIC. Methods A multistep PRISMA-compliant literature search was performed in PubMed and Web of Science for articles published until 1/03/2022, conducted in LAMIC, addressing the concept and correlates of CHR. Study characteristics as well as limitations were reported. Corresponding authors of the included studies were invited to answer an online poll. Quality assessment was done with the MMAT. Results A total of 109 studies were included in the review: none from low-income countries, 8 from lower middle-income countries, and 101 from upper middle-income countries. The most frequent limitations were small sample size (47.9%), cross-sectional design (27.1%), and follow-up issues (20.8%). Mean quality of included studies was of 4.4. Out of the 43 corresponding authors, 12 (27.9%) completed the online poll. They cited further limitations as few financial resources (66.7%), no involvement of population (58.2%) and cultural barriers (41.7%). Seventy five percent researchers reported that CHR research should be conducted differently in LAMIC compared to high-income countries, due to structural and cultural issues. Stigma was mentioned in three out of five sections of the poll. Discussion Results show the discrepancy of available evidence on CHR in LAMIC, given the shortage of resources in such countries. Future directions should aim to increase the knowledge on individuals at CHR in such settings, and to address stigma and cultural factors that may play a role in the pathways toward care in psychosis. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=316816, CRD42022316816.
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Affiliation(s)
- Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
- Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), São Paulo, Brazil
- *Correspondence: Alexandre Andrade Loch,
| | - Ana Caroline Lopes-Rocha
- Laboratorio de Neurociencias (LIM 27), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- Department of Psychiatry Ibn Omrane, The Tunisian Center of Early Intervention in Psychosis, Razi Hospital, Tunis, Tunisia
| | - Martinus Theodorus van de Bilt
- Laboratorio de Neurociencias (LIM 27), Faculdade de Medicina, Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
- Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), São Paulo, Brazil
| | - Gonzalo Salazar de Pablo
- Early Psychosis - Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Universidad Complutense, Madrid, Spain
| | - Paolo Fusar-Poli
- Early Psychosis - Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Dalforno RW, Wengert HI, Kim LP, Jacobsen KH. Anxiety and school absenteeism without permission among adolescents in 69 low- and middle-income countries. DIALOGUES IN HEALTH 2022; 1:100046. [PMID: 38515899 PMCID: PMC10953857 DOI: 10.1016/j.dialog.2022.100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/27/2022] [Accepted: 09/13/2022] [Indexed: 03/23/2024]
Abstract
Background Anxiety disorders are common among adolescents. In high-income countries, anxiety is a known contributor to truancy and school refusal, but this association has been understudied in low- and middle-income countries (LMICs). Methods We used complex samples analysis to examine the association between self-reported worry-induced insomnia (an indicator of anxiety) and unauthorized school absenteeism among 268,142 adolescents from 69 LMICs that participated in the Global School-based Student Health Survey (GSHS). Results The median proportion of students who reported experiencing symptoms of anxiety most or all of the time during the previous year was 11.4% (range: 3.6%-28.2%); in 44 of the 69 countries, girls had a significantly higher prevalence of anxiety than boys. The percentage of students reporting school absence without permission during the past month was 30.2% (range: 14.7%-56.0%); in 40 countries, boys were significantly more likely than girls to report that they had missed school without permission. In 53 countries, adolescents who reported frequent anxiety were significantly more likely to miss school than adolescents reporting infrequent anxiety; in most of those countries, the association was significant for both girls and boys. Conclusion School-based interventions that help children and adolescents learn how to manage stress and refer students with symptoms of psychiatric disorders to healthcare services that can provide formal diagnosis and clinical treatment may be useful for improving both mental health and school attendance, thus contributing to achievement of Sustainable Development Goals related to both health (SDG 3.4) and education (SDG 4.1).
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Affiliation(s)
- Ryan W. Dalforno
- Pepperdine University, 24255 Pacific Coast Highway, Malibu, CA 90263, USA
| | | | - Loan Pham Kim
- Pepperdine University, 24255 Pacific Coast Highway, Malibu, CA 90263, USA
| | - Kathryn H. Jacobsen
- Department of Health Studies, University of Richmond, 231 Richmond Way, Richmond, VA 23173, USA
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Online social network individual depression detection using a multitask heterogenous modality fusion approach. Inf Sci (N Y) 2022. [DOI: 10.1016/j.ins.2022.07.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Alzaghoul AF, McKinlay AR, Archer M. Post-traumatic stress disorder interventions for children and adolescents affected by war in low- and middle-income countries in the Middle East: systematic review. BJPsych Open 2022; 8:e153. [PMID: 35938530 PMCID: PMC9380009 DOI: 10.1192/bjo.2022.552] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Millions of children and adolescents are exposed to wars, affecting their psychological well-being. This review focuses on psychosocial interventions in low and middle-income countries (LMICs) in the Middle East, where mental health services are limited. AIMS Our primary aim was to evaluate the effectiveness of trial-assessed psychosocial interventions in reducing post-traumatic stress disorder (PTSD) symptoms in children and adolescents aged ≤18 years who were exposed to war in LMICs in the Middle East. Changes in other psychological conditions and symptoms were evaluated where reported. METHOD PubMed, Cochrane Library and Ovid were searched without year restriction, in December 2021. Previous review reference lists were also checked. Only studies published in English were included. Each study was evaluated for risk of bias and results are presented as a narrative synthesis. RESULTS Three group-based interventions were identified and evaluated across six studies: 'Teaching Recovery Techniques', 'Writing for Recovery' and 'Advancing Adolescents'. Two studies took place in post-war settings, and four in a context of ongoing conflict. Positive experiences and improved social skills were indicated following most interventions, but Teaching Recovery Techniques was the only programme associated with a statistically significant reduction in PTSD score. Differences in follow-up interval limited comparability of outcomes. CONCLUSIONS This review highlights a paucity of evidence for effective treatment options for children and adolescents affected by war from LMICs in the Middle East. Promising indications of reductions in PTSD symptoms, specifically from Teaching Recovery Techniques, require further rigorous evaluation and long-term follow-up.
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Affiliation(s)
- Aseel F Alzaghoul
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Alison R McKinlay
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, UK
| | - Marc Archer
- Centre for Mental Health and Wellbeing, Department of Psychology, Faculty of Behavioural Sciences, HELP University, Malaysia
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Verma P, Sahoo KC, Mahapatra P, Kaur H, Pati S. A systematic review of community-based studies on mental health issues among tribal populations in India. Indian J Med Res 2022; 156:291-298. [PMID: 36629189 PMCID: PMC10057360 DOI: 10.4103/ijmr.ijmr_3206_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background & objectives Globally, mental disorders are rising with increasing urbanization. India has the world's second-largest tribal population and it is critical to appreciate the mental health problems in this population. However, the extent of mental health issues among tribal populations is unknown. Against this background, we systematically reviewed community-based studies on mental health issues among tribal populations in India. Methods Online databases PubMed, Embase, ProQuest databases and Google Scholar were searched and articles published between January 1990 and May 2021 including primary community-based quantitative observational studies focused exclusively on tribal population were retrieved. PRISMA guidelines were followed and this review was registered on PROSPERO (CRD42020178099). Results A total of 935 articles were identified, of which 63 were selected for full-text review, and finally, 11 studies were included. Seven studies examined alcohol use disorder with a pooled prevalence of 40 per cent. Two studies reported on suicidal attempts. A few studies mentioned anxiety, depression and other mental health conditions. Interpretation & conclusions : This systematic review established that a few community-based primary studies were conducted on mental health issues among tribal populations over the last three decades. Among these, fewer studies focused exclusively on tribal communities. The studies differed in their study design and the tools used. The findings of these investigations highlighted a limited range of mental health issues, primarily alcoholism, anxiety, depression and suicide.
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Affiliation(s)
- Priyanka Verma
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Harpreet Kaur
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
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Rahmani F, Roshangar F, Gholizadeh L, Asghari E. Caregiver burden and the associated factors in the family caregivers of patients with schizophrenia. Nurs Open 2022; 9:1995-2002. [PMID: 35347867 PMCID: PMC9190687 DOI: 10.1002/nop2.1205] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/20/2022] [Accepted: 02/17/2022] [Indexed: 02/03/2023] Open
Abstract
Aim Our study aimed to investigate the caregiving burden and its associated factors in family caregivers of patients with schizophrenia. Design Correlational study. Method Using the convenience sampling method, 215 caregivers were recruited from outpatient clinics affiliated with a tertiary referral psychiatric hospital in Iran. The caregiving burden was measured by the Zarit Burden Interview (ZBI‐22), and associations between caregiving burden and potential factors were examined using multiple regression analysis. We used the STROBE checklist to report the results. Results Family caregivers of patients with schizophrenia reported a high level of caregiving burden, with 38.2% of the caregivers perceiving severe burden relating to their role. In the regression analysis, age, gender, educational level, income, job loss due to caregiving, relationship with patient, disease duration and frequency of caregiving were statistically significant predictors of caregiving burden. The regression model explained 54.4% of the variance of caregiving burden.
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Affiliation(s)
- Farnaz Rahmani
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariborz Roshangar
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Gholizadeh
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Elnaz Asghari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Greene MC, Huang TTK, Giusto A, Lovero KL, Stockton MA, Shelton RC, Dos Santos P, Saúte F, Wainberg ML. Leveraging Systems Science to Promote the Implementation and Sustainability of Mental Health and Psychosocial Interventions in Low- and Middle-Income Countries. Harv Rev Psychiatry 2021; 29:262-277. [PMID: 34241978 PMCID: PMC9162158 DOI: 10.1097/hrp.0000000000000306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT Advancements in global mental health implementation research have revealed promising strategies for improving access to evidence-based mental health care. These advancements have not translated, however, into a reduced prevalence of mental disorders. In this review we examine the relationships between determinants (i.e., barriers and facilitators) and outcomes of mental health services in low- and middle-income countries to identify opportunities for improving the population-level impact and sustainability of innovations in global mental health. We identified three key implementation and services outcomes that influenced the prevalence of mental disorders in the 56 included review articles: supply (access, implementation), demand (help seeking, utilization), and quality (effectiveness, quality of care) of mental health services. Determinants of these outcomes revealed seven themes: community stakeholder engagement; cultural relevance; stigma; human resource capacity; organization of services; governance, policy, and financing; and sociopolitical and community context. We developed a causal loop diagram to illustrate the relationships among these determinants and outcomes. The causal loop diagram revealed the central role of community stakeholder engagement in bridging implementation and patient outcomes, the importance of addressing stigma and social determinants of mental health, and the need to complement supply-side implementation strategies with approaches to equilibrate demand and improve the quality of services. Applying systems science methodologies to global mental health research presents an opportunity to examine the complex relationships among community and health system factors that influence implementation of evidence-based interventions in order to identify sustainable approaches to improve the population-level impact of mental health services in low- and middle-income countries.
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Affiliation(s)
- M Claire Greene
- From the Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health (Dr. Greene) and Department of Sociomedical Science (Dr. Shelton), Columbia University Mailman School of Public Health; Center for Systems and Community Design and Department of Health Policy and Management, City University of New York Graduate School of Public Health and Health Policy (Dr. Huang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons & New York State Psychiatric Institute (Drs. Giusto, Lovero, Stockton, and Wainberg); Mental Health Department, Center for Applied Psychology and Psychometric Tests, Mozambique Ministry of Health (Dr. dos Santos); Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique (Dr. Saúte)
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Rajabzadeh V, Burn E, Sajun SZ, Suzuki M, Bird VJ, Priebe S. Understanding global mental health: a conceptual review. BMJ Glob Health 2021; 6:bmjgh-2020-004631. [PMID: 33758013 PMCID: PMC7993328 DOI: 10.1136/bmjgh-2020-004631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/14/2022] Open
Abstract
Background Mental health disorders are viewed as a global concern requiring globally led approaches to address them. Since the publication of the 2007 Lancet series on global mental health (GMH), the term has become widespread. Over the last two decades, GMH has become increasingly affiliated with policy reform, academic courses, funding bodies and research. However, it is not always obvious how those working in the field of GMH are using the term, resulting in a lack of clarity. Therefore, work is needed to synthesise the current understanding(s) of GMH to help characterise its meaning. Aim To synthesise the literature and identify the different ways GMH is understood. Method A conceptual review, using a systematic search and a content analysis, was conducted to develop a conceptual framework of the different conceptual understandings of GMH. Results We developed a conceptual framework of four understandings of GMH. These understandings of GMH are as follows: an area of research generating findings to establish a GMH evidence-base; implementation of research into practice; improving the mental health environment; learning from and supporting low-and-middle-income countries (LMICs). Conclusion Our review proposes a simple framework, clarifying the key characteristics of the GMH landscape. The findings highlight the diversity of usage of the term in the literature, as well as present the wide scope that comprises the field of GMH. Referring to this framework may help those engaged with GMH to be more specific with which aspect of the field they are concerned with.
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Affiliation(s)
- Vian Rajabzadeh
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Erin Burn
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Sana Z Sajun
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Mimi Suzuki
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Victoria Jane Bird
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
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14
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Yitbarek K, Birhanu Z, Tucho GT, Anand S, Agenagnew L, Ahmed G, Getnet M, Tesfaye Y. Barriers and Facilitators for Implementing Mental Health Services into the Ethiopian Health Extension Program: A Qualitative Study. Risk Manag Healthc Policy 2021; 14:1199-1210. [PMID: 33776497 PMCID: PMC7989539 DOI: 10.2147/rmhp.s298190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The Ethiopian Ministry of Health has integrated mental health services into the community health service, but it has not yet been implemented. Therefore, this study aimed to explore the barriers and facilitators of mental health service implementation in the Ethiopian community health program. METHODS A qualitative case study was conducted in the Ethiopian primary health care system in 2019. We have conducted about eight key informant interviews with policymakers, service managers, and service providers. The interviews were tape-recorded, transcribed, translated, and analyzed manually using the World Health Organization building blocks framework. RESULTS The Health Ministry of Ethiopia has recently included mental health services into the health extension package but not yet implemented as part of integrated services. The identified barriers were low political commitment, shortage of resources, non-functional referral system, lack of interest from private health service organizations, attitudinal problems from both the society and service providers, and lack of consistent reporting system of the mental health problems. However, the well-designed primary health care system, trained health extension workers, changing political commitment and attitude of the community could facilitate the mental health service implementation. CONCLUSION A series of activities are expected, especially from the healthcare system managers to implement, follow, and evaluate mental health services implementation at the health extension programs.
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Affiliation(s)
- Kiddus Yitbarek
- Departemnt of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Department of Health Behaviors and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Gudina Terefe Tucho
- Department of Environmental Health and Technology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Susan Anand
- Department of Nursing, Faculty Health Sciences, Jimma University, Jimma, Ethiopia
| | - Liyew Agenagnew
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Gutema Ahmed
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Masrie Getnet
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Yonas Tesfaye
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
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Mohsin S, Waqas A, Atif N, Rabbani MW, Ali Khan S, Bilal S, Sharif M, Bibi A, Sikander S. Accuracy of Community Informant Led Detection of Maternal Depression in Rural Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1075. [PMID: 33530396 PMCID: PMC7908615 DOI: 10.3390/ijerph18031075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 01/27/2023]
Abstract
Maternal depression is a global mental health and a public health priority. Despite the priority its active detection is still a challenge. We tested the accuracy of an adapted version of Community Informant Detection Tool for Maternal Depression (CIDT-MD) in rural settings of Pakistan. Using a single stage design, trained community informants (lady health workers and lay peers) identified women (pregnant and/or with children) with symptoms of probable depression using CIDT-MD. This was immediately followed by diagnostic interviews of all the women using the Structured Clinical Interview for the Diagnostic and Statistical Manual (SCID-V) for current major depressive episode by trained assessors, blinded to the outcome of CIDT-MD. Data were analyzed using Statistical Package for Social Sciences (Version 25.0, IBM Corp., Armonk, NY, USA) and FACTOR software (Version. 10.3.01, Virgili University, Tarragona, Spain). Descriptive statistics, factor analysis, validity, reliability and known group validity was conducted to evaluate the psychometric properties of the adapted CIDT-MD. In all, 425 women, with mean age of 28 years (SD = 4.7), participated. Nearly 10% were illiterate, while the rest (90%) had an education ranging from eight to 15 years of schooling. The majority (73.2%) of the participants had 1-3 children while only 17.4% had >3 children. The sensitivity and specificity of CIDT-MD in detecting depressive symptoms was 97.5% (95% CI: 94.2-99.1) and 82.4% (95% CI: 77.8-86.4) respectively. It's positive predictive value (PPV), 77.3% (95% CI: 72.9-81.2) and the negative predictive value (NPV) was 98.17% (95% CI: 95.7-99.2). While factor analysis revealed high inter-item correlation for most items (0.62-0.77) with an adequately fair Kaiser-Meyer-Olkin (KMO) sampling adequacy (0.73), significant Bartlett's test of sphericity (p < 0.001). Uni-dimensionality for the CIDT-MD based on one-dimensional congruence (0.97), explained common variance (0.85), excellent internal consistency (0.90), good criterion validity (Area Under Curve = 81%), tester-test reliability (0.87-0.89) and statistically significant known group analysis (p < 0.001). The adapted version of the Community Informant Detection Tool for Maternal Depression is a valid and a reliable tool for active case detection of maternal depression in rural settings of Pakistan.
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Affiliation(s)
- Shamaila Mohsin
- Department of Community Medicine, Army Medical College, University of Medical Sciences, Punjab 46000, Pakistan
- Department of Public Health, Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan;
| | - Ahmed Waqas
- Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK;
- Human Development Research Foundation, Punjab 46000, Pakistan; (N.A.); (S.B.); (M.S.); (A.B.)
| | - Najia Atif
- Human Development Research Foundation, Punjab 46000, Pakistan; (N.A.); (S.B.); (M.S.); (A.B.)
| | - Muhamamd Waqas Rabbani
- Department of Behavioral Sciences, Shifa College of Medicine, Tameer-e-Millat University, Islamabad 44000, Pakistan;
| | - Shahzad Ali Khan
- Department of Public Health, Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan;
| | - Samina Bilal
- Human Development Research Foundation, Punjab 46000, Pakistan; (N.A.); (S.B.); (M.S.); (A.B.)
| | - Maria Sharif
- Human Development Research Foundation, Punjab 46000, Pakistan; (N.A.); (S.B.); (M.S.); (A.B.)
| | - Amina Bibi
- Human Development Research Foundation, Punjab 46000, Pakistan; (N.A.); (S.B.); (M.S.); (A.B.)
| | - Siham Sikander
- Department of Public Health, Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan;
- Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK;
- Human Development Research Foundation, Punjab 46000, Pakistan; (N.A.); (S.B.); (M.S.); (A.B.)
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Womersley JS, Martin L, van der Merwe L, Seedat S, Hemmings SMJ. Genetic variation in neuropeptide Y interacts with childhood trauma to influence anxiety sensitivity. ANXIETY STRESS AND COPING 2021; 34:450-464. [PMID: 33491492 DOI: 10.1080/10615806.2021.1876225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Anxiety sensitivity (AS) refers to a fear of the negative implications of anxiety, and arises due to gene-environment interactions. We investigated whether genetic variation in two neuropeptides implicated in the stress response, neuropeptide Y (NPY) and pituitary adenylate cyclase-activating polypeptide receptor 1, interacted with childhood trauma (CT) to influence AS. DESIGN AND METHODS This cross-sectional study examined the CT x genetic variant effects on AS in 951 adolescents who self-identified as Xhosa or South African Colored (SAC) ethnicity. RESULTS In Xhosa females, the NPY rs5573 A allele and rs3037354 deletion variant were associated with increased (p = 0.035) and decreased (p = 0.034) AS, respectively. The interaction of CT and the NPY rs5574 A allele increased AS in SAC female participants (p = 0.043). The rs3037354 deletion variant protected against AS with increased CT in SAC male participants (p = 0.011). CONCLUSIONS The NPY rs5574 A allele and rs3037354 deletion variant interact with CT to act as risk and protective factors, respectively, for AS in an ethnicity- and sex- differentiated manner. Our results reaffirm the role of NPY and gene-environment interactions in anxiety-related behaviors and reinforce the need for psychiatric genetics studies in diverse populations.
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Affiliation(s)
- Jacqueline Samantha Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lindi Martin
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lize van der Merwe
- Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sian Megan Joanna Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
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Mohsin S, Atif N, Rabbani W, Tariq A, Khan SA, Tariq M, Sikander S. Cultural Adaptation of Community Informant Tool for Detection of Maternal Depression in Rural Pakistan. Front Psychiatry 2021; 12:598857. [PMID: 33868040 PMCID: PMC8047053 DOI: 10.3389/fpsyt.2021.598857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/02/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Evidence indicates that mental health issues like depression, epilepsy, and substance misuse can be detected with reasonable accuracy in resource-poor settings. The Community Informant Detection Tool (CIDT) is one such approach used for detecting mental health problems, including depression. We adapted this community informant approach for detecting maternal depression in Pakistan. Methods: Adaptation of Community Informant Detection Tool for Maternal Depression (CIDT-MD) involved five steps. First, a scoping review of the literature was conducted to select an appropriate tool for adaptation. Second, in-depth interviews were conducted to explore the idioms of depression and distress, perceived causes, and the effects of maternal depression among currently depressed and recovered mothers (n = 11), mothers in law (n = 6), and Primary Care Providers (Primary Care Physicians and Lady Health Supervisors) (n = 6). Third, case vignettes and illustrations were created with input from a panel of mental health experts, incorporating the idioms of depression and distress used, causes, and effects for each symptom described. Fourth, to assess the comprehensibility of the illustrations and level of understanding, Focus Group Discussions (n = 4) were done with purposely selected community health workers (Lady Health Workers and Lay Peers, n = 28) trained in delivering maternal depression intervention. The final step was reflection and inputs by a panel of mental health experts on all steps to finalize the content of the tool. Results: Context-specific cultural adaptation in the presentation and format of CIDT-MD was conducted successfully. Lady Health Workers (LHW) and Lay Peers (LP) were found to be the most appropriate persons to use the tool and function as the informants. The adapted tool with all its vignettes and illustrations was found to be easily understandable, comprehensible, and culturally appropriate, meaningful, and contextually relevant by the community health workers and peers working in the relevant settings. They easily relate to and identify potentially depressed such women lining up with the tool. Lastly, the coding of the tool was found easy to follow as well. Conclusion: The Community Informant Detection Tool for Maternal Depression (CIDT-MD) is a culturally acceptable, easy to use, and comprehensible tool for detecting maternal depression in community settings of Pakistan. The community informants found the content and approach highly relevant to the local needs.
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Affiliation(s)
- Shamaila Mohsin
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Najia Atif
- Human Development Research Foundation, Islamabad, Pakistan
| | - Waqas Rabbani
- Department of Behavioural Sciences, Shifa College of Medicine, Islamabad, Pakistan
| | - Ahmaren Tariq
- Human Development Research Foundation, Islamabad, Pakistan
| | - Shahzad Ali Khan
- Global Health Department, Health Services Academy, Islamabad, Pakistan
| | | | - Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan.,Global Health Department, Health Services Academy, Islamabad, Pakistan.,Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
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18
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Koirala R, Søegaard EGI, Ojha SP, Hauff E, Thapa SB. Trauma related psychiatric disorders and their correlates in a clinical sample: A cross-sectional study in trauma affected patients visiting a psychiatric clinic in Nepal. PLoS One 2020; 15:e0234203. [PMID: 32541999 PMCID: PMC7295578 DOI: 10.1371/journal.pone.0234203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/20/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Nepal, like many other low-income countries, has a great burden of mental health issues but few resources to meet them. In addition, Nepal has endured several traumatic events in recent decades but the impact on mental health has not been studied in clinical settings. This study explores trauma-related psychiatric disorders and their correlates. METHODS 100 patients with a history of trauma who visited the outpatient psychiatry clinic at a University hospital in Kathmandu were assessed. The Composite International Diagnostic Interview 2.1 (CIDI) was used to evaluate lifetime and current depressive disorder, generalized anxiety disorder (GAD) and lifetime post-traumatic stress disorder (PTSD). Current PTSD was evaluated using PSTD Checklist-Civilian Version (PCL-C). RESULTS The median number of lifetime traumatic events was two. Natural disaster was the most common trauma type (84%) compared to other types of trauma. Rape was reported as the most traumatizing. Current PTSD was found in 15%, depression in 33% and GAD in 38% of the patients. The lifetime rates were PTSD 83%, depression 45% and GAD 40%. There was high comorbidity between the disorders. The 31 to 45 years age group, above high school education level and trauma types other than earthquake were independently associated with current PTSD. Marital status and upper socioeconomic status (SES) compared to upper-middle SES were independently associated with lifetime PTSD. Both lifetime and current depression rates were independently associated with the upper SES compared to upper-middle SES. Place of living, education above high school and lower-middle SES were significantly associated with lifetime and current GAD. CONCLUSION PTSD, depression and GAD were prevalent in a trauma exposed patient population visiting a psychiatric clinic in Nepal. High rates of comorbidities and several risk factors were identified. Our findings highlight the need for addressing trauma related disorders in clinical settings in developing countries.
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Affiliation(s)
- Rishav Koirala
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Brain and Neuroscience Center, Kathmandu, Nepal
- * E-mail:
| | - Erik Ganesh Iyer Søegaard
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Saroj Prasad Ojha
- Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Edvard Hauff
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Suraj B. Thapa
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Triliva S, Ntani S, Giovazolias T, Kafetsios K, Axelsson M, Bockting C, Buysse A, Desmet M, Dewaele A, Hannon D, Haukenes I, Hensing G, Meganck R, Rutten K, Schønning V, Van Beveren L, Vandamme J, Øverland S. Healthcare professionals' perspectives on mental health service provision: a pilot focus group study in six European countries. Int J Ment Health Syst 2020; 14:16. [PMID: 32165920 PMCID: PMC7060571 DOI: 10.1186/s13033-020-00350-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 02/29/2020] [Indexed: 12/11/2022] Open
Abstract
Background The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it. Methods Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners. Results The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative ‘chain of care’. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence. Conclusions The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people’s needs throughout their lives is an essential aspect of optimal care provision.
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Affiliation(s)
- Sofia Triliva
- 1Department of Psychology, University of Crete, 74100 Rethymno, Crete, Greece
| | - Spyridoula Ntani
- 1Department of Psychology, University of Crete, 74100 Rethymno, Crete, Greece
| | | | | | - Malin Axelsson
- 2Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Claudi Bockting
- 3Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.,4Institute for Advanced Studies, University of Amsterdam, Amsterdam, The Netherlands
| | - Ann Buysse
- 5Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- 6Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Alexis Dewaele
- 5Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Dewi Hannon
- 5Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Inger Haukenes
- 7Research Unit for General Practice, NORCE-Norwegian Research Centre, Bergen, Norway.,8Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gunnel Hensing
- 9Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Reitske Meganck
- 6Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Kris Rutten
- 10Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Viktor Schønning
- 9Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,11Division of Mental and Physical Health, Norwegian Institute of Public Health & Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Laura Van Beveren
- 10Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Joke Vandamme
- 5Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Simon Øverland
- 11Division of Mental and Physical Health, Norwegian Institute of Public Health & Department of Psychosocial Science, University of Bergen, Bergen, Norway
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Yoder - van den Brink HN. Reflections on "Building Back Better" Child and Adolescent Mental Health Care in a Low-Resource Postemergency Setting: The Case of Sierra Leone. Front Psychiatry 2019; 10:758. [PMID: 31736794 PMCID: PMC6834689 DOI: 10.3389/fpsyt.2019.00758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/20/2019] [Indexed: 12/30/2022] Open
Abstract
Over the past three decades, Sierra Leone has experienced two major humanitarian crises: an armed conflict (1991-2002) and an Ebola virus disease outbreak (2014-2015). In addition to these country-wide crises, the capital Freetown experienced a mudslide affecting thousands of people in 2017. In response to these emergencies, donors and aid organizations showed an increased interest in supporting and implementing mental health and psychosocial support interventions. Despite these efforts, the mental health infrastructure of the country remains frail. Specifically, systemic improvements in the implementation of evidence-based mental health care for children and adolescents appear to be lacking. In this article, the Interactive Systems Framework for Dissemination and Implementation is used as a tool to analyze issues related to the development of a sustainable, contextually relevant child and adolescent mental health-care delivery system. The author draws on her long-term experience as a child mental health specialist in Sierra Leone. Observations and hypotheses are tested and supplemented by formal and informal reports and national and international literature. The three systems described by the Interactive Systems Framework are explored in the context of Sierra Leone: (1) Synthesis and Translation, (2) Support, and (3) Delivery. Interaction between the three Systems is discussed as critical to the successful dissemination and implementation of interventions. Ample attention is given to contextual factors that are believed to be paramount to the development of child and adolescent mental health care in Sierra Leone. The article concludes with a reflection on the usefulness of the Interactive Systems Framework in the dissemination and implementation of child and adolescent mental health-care interventions in low-resource, postemergency settings. It is suggested that, in addition to funding and policies, the child and adolescent mental health system in Sierra Leone could benefit from the development of contextually relevant interventions, improvement of capacity-building efforts, and acknowledgment of the role of community-based practitioners in the delivery of services. Local mental health experts, especially those trained in child and adolescent mental health, should be empowered to work together with culturally competent expatriate professionals to improve child and adolescent mental health care in Sierra Leone.
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Affiliation(s)
- Hélène N.C. Yoder - van den Brink
- Department of Sociology and Anthropology, Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, Netherlands
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21
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Myers B, Breuer E, Lund C, Petersen Williams P, van der Westhuizen C, Brooke-Sumner C, Naledi T, Stein DJ, Sorsdahl K. Assessing capability for implementing mental health counselling within primary care facilities in a middle-income country: A feasibility study. J Psychiatr Ment Health Nurs 2019; 26:163-174. [PMID: 30983052 DOI: 10.1111/jpm.12519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 01/20/2023]
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Integrating mental health counselling into primary care services is a recommended strategy for reducing the mental health treatment gap in low- and middle-income countries. To support this strategy, potential barriers to counselling integration must be identified and addressed. Organizational preparedness for implementation may influence the extent to which the introduction of counselling is successful. Features of primary care facilities associated with preparedness for the implementation of mental health counselling have not been explored. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study uses a novel approach to explore variations in preparedness of primary care services to implement counselling and factors potentially associated with these variations. Findings suggest there is considerable variation in the preparedness of facilities to implement counselling. Organizational factors such as resource availability, management style and facility environment are potentially associated with capability for implementing mental health counselling. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Health planners could use this method to identify poorly functioning services that may benefit from additional interventions to build preparedness for counselling implementation. Future research should examine whether differences in facility preparedness impact on the implementation and outcomes of this service. Abstract Introduction Differences in primary care facilities' preparedness for implementing mental health counselling may affect the implementation process but have rarely been studied. Aim To assess the feasibility of using a novel methodological approach to explore variations in capability for implementing mental health counselling and factors potentially associated with this variation among primary care services in the Western Cape, South Africa. Methods Staff from 26 facilities participated in discussions about their facility's mental health implementation capability. Three researchers conducted observations of the facility's environment, staff-patient interactions and resources. We used qualitative comparative analysis to identify factors potentially associated with implementation capability. Results Facilities appeared to vary in their capability for implementing counselling services. The availability of person-centred health services, a therapeutic environment and sufficient human resources may be requirements for implementation preparedness. Other factors that seem to support preparedness include the availability of confidential space for counselling and an adequately managed facility. Discussion This study identified several features of well-functioning primary care facilities. Facilities with these features may be better prepared to implement a new counselling service. Implications for practice This method may identify facilities that are poorly prepared for implementation that could benefit from preparedness-building interventions. Whether differences in preparedness affect counselling outcomes is yet to be established.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Division of Addiction Psychiatry, Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Erica Breuer
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Petal Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Division of Addiction Psychiatry, Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Claire van der Westhuizen
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Carrie Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Tracey Naledi
- Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,SAMRC Unit on Anxiety and Stress Disorders, Tygerberg, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Rossouw J, Yadin E, Alexander D, Seedat S. Prolonged exposure therapy and supportive counselling for post-traumatic stress disorder in adolescents: task-shifting randomised controlled trial. Br J Psychiatry 2018; 213:587-594. [PMID: 29991358 DOI: 10.1192/bjp.2018.130] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Empirical evidence on the effectiveness of evidence-based treatments for adolescents with post-traumatic stress disorder (PTSD) in low-resource settings is needed.AimsTo evaluate the comparative effectiveness of prolonged exposure and supportive counselling in adolescents with PTSD. METHOD Sixty-three adolescents (13-18 years) with PTSD were randomly assigned to receive either of the interventions comprising 7-14 sessions of treatment (trial registration in the Pan African Clinical Trials Registry: PACTR201511001345372). The primary outcome measure was PTSD symptom severity, as independently assessed on the Child PTSD Symptom Scale at pre-treatment, post-treatment, and at 3- and 6-month follow-up. RESULTS Participants receiving prolonged exposure experienced greater improvement on the PTSD symptom severity scale than those receiving supportive counselling (between group differences at post-intervention, mean 12.49, 95% CI 6.82-18.17, P<0.001; d = 1.22). A similar effect size was maintained at 3-month (d = 0.85) and 6-month (d = 1.02) follow-up assessments. CONCLUSIONS Adolescents with PTSD experienced greater benefit from prolonged exposure treatment when provided by non-specialist health workers (nurses) in a community setting.Declaration of interestNone.
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Affiliation(s)
- Jaco Rossouw
- Part-time Researcher,Department of Psychiatry,Stellenbosch University,South Africa
| | - Elna Yadin
- Clinic Faculty Member,Department of Psychiatry,University of Pennsylvania,USA
| | - Debra Alexander
- Head of Clinical Psychology,Department of Psychiatry,Stellenbosch University,South Africa
| | - Soraya Seedat
- Executive Head,Department of Psychiatry,Stellenbosch University,South Africa
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Minoletti A, Soto-Brandt G, Sepúlveda R, Toro O, Irarrázaval M. [Mental health response capacity in primary care in Chile: a contribution to Alma-AtaCapacidade de resposta da atenção primária em saúde mental no Chile: uma contribuição de Alma-Ata]. Rev Panam Salud Publica 2018; 42:e136. [PMID: 31093164 PMCID: PMC6385793 DOI: 10.26633/rpsp.2018.136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 08/09/2018] [Indexed: 11/24/2022] Open
Abstract
This article identifies strategies that have contributed to the development of mental health response capacity in primary care in Chile and analyzes some lessons learned from this process. It highlights the formulation of national mental health plans, the gradual development of an information system, the investment of additional resources, the creation of programs and guidelines, human resources development, the positioning of mental health in integrated health service delivery networks, support for biopsychosocial child development, the family and community care model, and the strengthening of leadership and partnerships between health and human services.Its indicators of response capacity are the increase in resources for mental health in primary care, both financial and staffing (that is, the number of professionals and the training provided to them), and the expansion of mental health treatment in primary care settings, notably the rate of people in treatment for mental illness and the support provided for child development.The article analyzes different factors that have contributed to advances in primary care delivery of mental health services, together with some weaknesses in this process. It concludes by demonstrating the feasibility of progress toward the goals of Alma-Ata to other countries in the Region, gradually implementing substantial changes in mental health response capacity in primary care. To this end, it recommends an improvement in the quality and quantity of research in this area through methodologies that permit comparisons between countries in the Region.
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Affiliation(s)
- Alberto Minoletti
- Unidad de Salud Mental, Instituto de Salud Poblacional (Escuela de Salud Pública Dr. Salvador Allende), Facultad de Medicina, Universidad de Chile, Santiago, Chile.
| | - Gonzalo Soto-Brandt
- Departamento de Modelo Atención, División de Atención Primaria, Subsecretaría de Redes Asistenciales, Ministerio de Salud. Santiago, Chile.
| | - Rafael Sepúlveda
- Unidad de Salud Mental, Instituto de Salud Poblacional (Escuela de Salud Pública Dr. Salvador Allende), Facultad de Medicina, Universidad de Chile, Santiago, Chile.
| | - Olga Toro
- Unidad de Salud Mental, Instituto de Salud Poblacional (Escuela de Salud Pública Dr. Salvador Allende), Facultad de Medicina, Universidad de Chile, Santiago, Chile.
| | - Matías Irarrázaval
- Departamento de Psiquiatría Norte, Facultad de Medicina, Hospital Clínico, Universidad de Chile. Santiago, Chile.
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Rossouw J, Yadin E, Alexander D, Seedat S. Prolonged exposure therapy and supportive counselling for posttraumatic stress disorder in adolescents in a community-based sample, including experiences of stakeholders: study protocol for a comparative randomized controlled trial using task-shifting. BMC Psychiatry 2018; 18:288. [PMID: 30189857 PMCID: PMC6127988 DOI: 10.1186/s12888-018-1873-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 08/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a dearth of empirical evidence on the effectiveness of pharmacological and non-pharmacological treatments for adolescents with posttraumatic stress disorder (PTSD) in developing countries. The primary aim of the study is to examine the effects of prolonged exposure therapy compared with supportive counseling for adolescents with PTSD delivered by nurses trained as counselors. METHODS/DESIGN A single-blind randomized clinical trial comprising 90 adolescents with PTSD using a permuted block design will be utilized. Nurses previously naïve to prolonged exposure and supportive counselling will be trained to provide these treatments at the adolescents' high schools. Data collection will last from March 2014 to December 2017 and annually thereafter, dependent on the availability of funding. Participants will receive seven to fourteen 60 min sessions of prolonged exposure treatment (n = 45) or supportive counselling (n = 45). All assessments will be conducted before treatment, at mid-treatment, immediately after treatment completion, at 3-, 6-, and 12-month follow-up, and annually thereafter. It is hypothesized that PE-A will be superior to SC in reducing PTSD symptoms at post-treatment as measured by the CPSS-I administered by an independent evaluator. It is further hypothesized that PE-A treatment gains will be maintained at 3-, 6- and 12-month follow-ups and annually thereafter. DISCUSSION While early indications are that PE-A is an effective treatment for PTSD in adolescents, this study will help determine the effectiveness of PE-A in a South African, community setting (school-based) when task-shifted to nurses, as compared to SC. TRIAL REGISTRATION Pan African Clinical Trials Registry: PACTR201511001345372 , retrospectively registered 11 November 2015.
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Affiliation(s)
- Jaco Rossouw
- Stellenbosch University, Stellenbosch, Western Cape South Africa
- Centre for Cognitive-Behaviour Therapy, 67 Visagie Street, Monte Vista, Cape Town, Western Cape 7460 South Africa
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
| | - Debra Alexander
- Stellenbosch University, Stellenbosch, Western Cape South Africa
| | - Soraya Seedat
- Stellenbosch University, Stellenbosch, Western Cape South Africa
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Abstract
PURPOSE OF REVIEW The present review provides an overview of key issues and concepts on the provision of mental healthcare to refugees with mental health conditions. RECENT FINDINGS Several barriers to mental healthcare for refugees have been described, and principles for good mental care in this group have been framed. Evidence for specific interventions for refugees is available for trauma-related mental health problems. The best evidence is available for psychosocial interventions for the treatment of posttraumatic stress disorder. SUMMARY The worldwide increase in the number of refugees and the substantial burden of psychological distress and mental health problems associated with this condition has led to an increased research and policy interest for optimizing the provision of effective mental healthcare. To date, with the exception of trauma-related conditions, there is almost no evidence on the efficacy of psychosocial interventions for anxiety and depressive conditions, and there is no information on how mental healthcare should be embedded into existing health and social care services. Existing research and implementation activities will hopefully contribute to better characterize the effective components and elements of mental healthcare programmes for refugees.
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Stubbs B, Vancampfort D, Firth J, Hallgren M, Schuch F, Veronese N, Solmi M, Gaughran F, Kahl KG, Rosenbaum S, Ward PB, Carvalho AF, Koyanagi A. Physical activity correlates among people with psychosis: Data from 47 low- and middle-income countries. Schizophr Res 2018. [PMID: 28637633 DOI: 10.1016/j.schres.2017.06.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND People with schizophrenia engage in low levels of physical activity (PA). However, few large-scale studies have investigated the factors that may influence PA participation in individuals with psychosis and data from low- and middle-income countries (LMICs) is especially scarce. Thus, we investigated PA correlates in a large sample of people with a psychosis diagnosis across 47 LMICs. METHODS Cross-sectional data from the World Health Survey, restricting to those with a self-reported lifetime diagnosis of schizophrenia/psychotic disorder, was analyzed. PA was assessed by the International Physical Activity Questionnaire (IPAQ) and participants were dichotomized into those that do and do not (low PA) meet the minimum recommended PA weekly targets (≥150min). A range of socio-demographic, health behavior, and mental and physical health variables were examined using random effects logistic regression. RESULTS Overall 2407 people (mean 42.0years, 41.5% males) with schizophrenia/psychosis were included. The prevalence of low PA was 39.2% (95%CI=37.0%-41.2%). Male sex (odds ratio (OR)=1.33), increasing age, unemployment (vs. employed OR=2.50), urban setting (vs. rural OR=1.75), inadequate fruit consumption (vs. adequate fruit intake OR=3.03), depression (OR=1.33), sleep/energy disturbance, and mobility limitations were significantly associated with low PA. Marital status, education, wealth, smoking, vegetable and alcohol consumption, anxiety, cognition, pain, and chronic medical conditions were not significant correlates. CONCLUSION PA is influenced by a range of factors among people with psychosis. These correlates should be considered in interventions aiming to facilitate PA in psychotic individuals living in LMICs.
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Affiliation(s)
- Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom.
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven, Kortenberg, Belgium
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom; NICM, School of Science and Health, University of Western Sydney, Australia
| | - Mats Hallgren
- Department of Public Health Sciences, Karolinksa Institute, Stockholm, Sweden
| | - Felipe Schuch
- Unilasalle, Canoas, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Nicola Veronese
- Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy
| | - Marco Solmi
- Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy; National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover Medical School, Hannover, Germany
| | - Simon Rosenbaum
- School of Psychiatry, UNSW Australia, The Black Dog Institute, University of New South Wales, Prince of Wales Hospital, Sydney, Australia
| | - Philip B Ward
- School of Psychiatry, UNSW, Sydney, Australia; Schizophrenia Research Institute, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Andre F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
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van de Water T, Rossouw J, Yadin E, Seedat S. Impediments and catalysts to task-shifting psychotherapeutic interventions for adolescents with PTSD: perspectives of multi-stakeholders. Child Adolesc Psychiatry Ment Health 2017; 11:48. [PMID: 28947915 PMCID: PMC5609026 DOI: 10.1186/s13034-017-0187-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This qualitative study was nested within a randomized controlled trial (RCT) where two psychotherapeutic interventions (supportive counselling and prolonged exposure for adolescents) were provided by supervised nurses (who served as 'nurse counsellors') to adolescents with PTSD in school settings. This paper describes the perspectives of nurse counsellors (NCs) and school liaisons (SLs). SLs were teachers or administrative personnel at the schools who coordinated the study visits of participants with the NCs. We focus on the impediments and catalysts to and recommendations for treatment implementation. METHODS NCs (n = 3) and SLs (n = 3) who participated in the RCT during 2014 were purposively recruited by telephone and participated in face-to-face semi-structured in-depth interviews that were recorded and doubly transcribed. Thematic content analysis was applied using Atlas.ti software to identify emerging themes. This paper describes the impediments and catalysts to provide psychotherapy by task-shifting in a community setting across three sub-themes: personal, community, and collaborative care. RESULTS Although nurses were initially resistant to supervision it was central to personally coping with complex interventions, managing traumatic content, and working apart from a multi-disciplinary team. Delivering the interventions in the community presented multiple logistical impediments (e.g. transport, communication, venue suitability) which required creative solutions. In light of resource shortages, networking is central to effective delivery and uptake of the interventions. Collaboration between government departments of health and education may have a major impact on providing school-based psychotherapy through task-shifting. CONCLUSIONS Impediments to implementation are not insurmountable. This article provides recommendations to maximize the success of task-shifting interventions should they be rolled out.
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Affiliation(s)
- Tanya van de Water
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Jaco Rossouw
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Stubbs B, Veronese N, Vancampfort D, Thompson T, Kohler C, Schofield P, Solmi M, Mugisha J, Kahl KG, Pillinger T, Carvalho AF, Koyanagi A. Lifetime self-reported arthritis is associated with elevated levels of mental health burden: A multi-national cross sectional study across 46 low- and middle-income countries. Sci Rep 2017; 7:7138. [PMID: 28769081 PMCID: PMC5541038 DOI: 10.1038/s41598-017-07688-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 07/12/2017] [Indexed: 12/11/2022] Open
Abstract
Population-based studies investigating the relationship of arthritis with mental health outcomes are lacking, particularly among low- and middle-income countries (LMICs). We investigated the relationship between arthritis and mental health (depression spectrum, psychosis spectrum, anxiety, sleep disturbances and stress) across community-dwelling adults aged ≥18 years across 46 countries from the World Health Survey. Symptoms of psychosis and depression were established using questions from the Mental Health Composite International Diagnostic Interview. Severity of anxiety, sleep problems, and stress sensitivity over the preceding 30 days were self-reported. Self-report lifetime history of arthritis was collected, including presence or absence of symptoms suggestive of arthritis: pain, stiffness or swelling of joints over the preceding 12-months. Multivariable logistic regression analyses were undertaken. Overall, 245,706 individuals were included. Having arthritis increased the odds of subclinical psychosis (OR = 1.85; 95%CI = 1.72–1.99) and psychosis (OR = 2.48; 95%CI = 2.05–3.01). People with arthritis were at increased odds of subsyndromal depression (OR = 1.92; 95%CI = 1.64–2.26), a brief depressive episode (OR = 2.14; 95%CI = 1.88–2.43) or depressive episode (OR = 2.43; 95%CI = 2.21–2.67). Arthritis was also associated with increased odds for anxiety (OR = 1.75; 95%CI = 1.63–1.88), sleep problems (OR = 2.23; 95%CI = 2.05–2.43) and perceived stress (OR = 1.43; 95%CI = 1.33–1.53). Results were similar for middle-income and low-income countries. Integrated interventions addressing arthritis and mental health comorbidities are warranted to tackle this considerable burden.
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Affiliation(s)
- Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, United Kingdom. .,Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom. .,Institute of clinical Research and Education in Medicine (IREM), Padova, Italy. .,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom.
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy.,Institute of clinical Research and Education in Medicine (IREM), Padova, Italy
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.,KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
| | - Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - Cristiano Kohler
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Patricia Schofield
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Marco Solmi
- KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium.,Department of Neurosciences, University of Padova, Padova, Italy
| | - James Mugisha
- Kyambogo University, Kampala, Uganda.,Butabika National Referral and Mental Health Hospital, Kampala, Uganda
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover Medical School, Hannover, Germany
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - Andre F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain.,Instituto de Salud Carlos III, Centro de InvestigaciónBiomédicaenRed de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid, 28029, Spain
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Javadi D, Feldhaus I, Mancuso A, Ghaffar A. Applying systems thinking to task shifting for mental health using lay providers: a review of the evidence. Glob Ment Health (Camb) 2017; 4:e14. [PMID: 29230310 PMCID: PMC5719475 DOI: 10.1017/gmh.2017.15] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This paper seeks to review the available evidence to determine whether a systems approach is employed in the implementation and evaluation of task shifting for mental health using lay providers in low- and middle-income countries, and to highlight system-wide effects of task-shifting strategies in order to better inform efforts to strength community mental health systems. METHODS Pubmed, CINAHL, and Cochrane Library databases were searched. Articles were screened by two independent reviewers with a third reviewer resolving discrepancies. Two stages of screens were done to ensure sensitivity. Studies were analysed using the World Health Organization's building blocks framework with the addition of a community building block, and systems thinking characteristics to determine the extent to which system-wide effects had been considered. RESULTS Thirty studies were included. Almost all studies displayed positive findings on mental health using task shifting. One study showed no effect. No studies explicitly employed systems thinking tools, but some demonstrated systems thinking characteristics, such as exploring various stakeholder perspectives, capturing unintended consequences, and looking across sectors for system-wide impact. Twenty-five of the 30 studies captured elements other than the most directly relevant building blocks of service delivery and health workforce. CONCLUSIONS There is a lack of systematic approaches to exploring complexity in the evaluation of task-shifting interventions. Systems thinking tools should support evidence-informed decision making for a more complete understanding of community-based systems strengthening interventions for mental health.
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Affiliation(s)
- D. Javadi
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | - I. Feldhaus
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - A. Mancuso
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A. Ghaffar
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
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Comorbidity of depression and diabetes: an application of biopsychosocial model. Int J Ment Health Syst 2016; 10:74. [PMID: 27980612 PMCID: PMC5135819 DOI: 10.1186/s13033-016-0106-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/25/2016] [Indexed: 02/06/2023] Open
Abstract
Background Type 2 diabetes (T2D) is one of the most psychologically demanding chronic medical illness in adult. Comorbidity between diabetes and depression is quite common, but most studies were based on developed country sample. Limited data exists to document biopsychosocial predictors of depressive symptoms in Ethiopian patients. Therefore, the aim of the study was to describe the association of depressive symptoms and T2D and explore the potential underlying associated biopsychosocial risk factors. Methods Institution based cross-sectional study was conducted on 276 patient with T2D at diabetic clinic, Black Lion General Specialized Hospital in Ethiopia. Patients were selected using systematic random sampling technique. Depressive symptoms score, which constructed from a validated nine-item Patient Health Questionnaire (PHQ-9), was an outcome variable. Finally, significant associated factors were identified using multiple linear regression analysis with backward elimination procedure. Statistical Package for Social Science (SPSS) version 22.0 (IBM SPSS Corp.) was used to perform all analysis. Results Total of 264 patient data was analyzed with 95.7% response rate. Patients mean (SD) current age and age at diagnosis was 55.9 (10.9) and 43.9 (10.9) years, respectively. Patients waist circumference (mean ± SD) was 98.9 ± 11.1 cm. The average PHQ-9 score was 4.9 (SD 4.1) and fasting blood glucose was 166.4 (SD 73.2). Marital status (divorced), occupation (housewife), diabetic complication (nephropathy), negative life event in the last six months, and poor social support significantly associated with increased mean PHQ-9 score after adjustment for covariates. Whereas not fearing diabetic-related complication and death significantly lower mean PHQ-9 score. Conclusion Biopsychosocial variables including marital status, negative life event in the last 6 months, occupation, diabetic complication, and poor social support significantly increase average depressive symptoms score. Evidence-based intervention focusing on these identified biopsychosocial factors are necessary to prevent the development of depressive symptoms. Electronic supplementary material The online version of this article (doi:10.1186/s13033-016-0106-2) contains supplementary material, which is available to authorized users.
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Stubbs B, Koyanagi A, Thompson T, Veronese N, Carvalho AF, Solomi M, Mugisha J, Schofield P, Cosco T, Wilson N, Vancampfort D. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries. Gen Hosp Psychiatry 2016; 43:63-70. [PMID: 27796261 DOI: 10.1016/j.genhosppsych.2016.09.008] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Back pain (BP) is a leading cause of global disability. However, population-based studies investigating its impact on mental health outcomes are lacking, particularly among low- and middle-income countries (LMICs). Thus, the primary aims of this study were to: (1) determine the epidemiology of BP in 43 LMICs; (2) explore the relationship between BP and mental health (depression spectrum, psychosis spectrum, anxiety, sleep disturbances and stress). METHODS Data on 190,593 community-dwelling adults aged ≥18 years from the World Health Survey (WHS) 2002-2004 were analyzed. The presence of past-12 month psychotic symptoms and depression was established using questions from the Composite International Diagnostic Interview. Anxiety, sleep problems, stress sensitivity, and any BP or chronic BP (CBP) during the previous 30 days were also self-reported. Multivariable logistic regression analyses were undertaken. RESULTS The overall prevalence of any BP and CBP were 35.1% and 6.9% respectively. Significant associations with any BP were observed for subsyndromal depression [OR (odds ratio)=2.21], brief depressive episode (OR=2.64), depressive episode (OR=2.88), psychosis diagnosis with symptoms (OR=2.05), anxiety (OR=2.12), sleep disturbance (OR=2.37) and the continuous variable of stress sensitivity. Associations were generally more pronounced for chronic BP. CONCLUSION Our data establish that BP is associated with elevated mental health comorbidity in LMICs. Integrated interventions that address back pain and metal health comorbidities might be an important next step to tackle this considerable burden.
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Affiliation(s)
- Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom.
| | - Ai Koyanagi
- Research and Development Unit, ParcSanitariSant Joan de Déu, Universitat de Barcelona, FundacióSant Joan de Déu, Dr. Antoni Pujadas, 42, SantBoi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de InvestigaciónBiomédicaen Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| | - Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - Nicola Veronese
- Geriatrics Division, Department of Medicine-DIMED, University of Padova, Italy; Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy
| | - Andre F Carvalho
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Marco Solomi
- Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy; Department of Neurosciences, University of Padova, Padova, Italy
| | - James Mugisha
- Kyambogo University, Kampala, Uganda; Butabika National Referral and Mental Health Hospital, Kampala, Uganda
| | - Patricia Schofield
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Theodore Cosco
- MRC Unit for Lifelong Health & Ageing, University College London, 33 Bedford Place, London WC1B 5JU, United Kingdom
| | - Nicky Wilson
- Physiotherapy Service, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
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