Mental health, poverty and development

Systematic Review on the Impact of Various Types of Universal Basic Income on Mental Health in Low- and Middle-Income Countries

In the past two decades, a significant surge in interest in investigating mental disorders and challenges faced by low- and middle-income countries in the realm of mental health has been observed. Various types of universal basic income (UBI) programs have already demonstrated significant impacts on individuals' mental health in high-income countries. Therefore, this review focuses on the situation in low- and middle-income countries. A literature review was conducted using seven electronic databases. Empirical studies of any design that implemented different types of UBI interventions in middle- and low-income countries and applied any type of mental health measures were searched for. After systematically reviewing 6822 articles, 13 empirical studies examining the relationship between various types of UBI interventions and different aspects of mental health in developing countries were identified. The collective findings of the studies suggest that UBI programs have significant positive effects on the mental health of individuals from developing countries, with the potential mediating role of unconditionality and payment frequency being noteworthy. However, these implications are limited due to the small number of studies conducted in this area and their methodological constraints. Further research with rigorous design is needed, particularly focusing on experimental control and length of follow-up periods.

Reconciling a Broken Heritage: Developing Mental Health Social Work in Guyana

Guyana's colonial past has left a trail of economic instability, racial polarization, and physical and mental trauma. Despite the progress made since Guyana's independence in 1966, the remnants of this colonial past continue to shape present-day Guyana. As a result, violence and trauma continue to impact the mental health of the population. This is manifest in endemic problems of domestic violence and racialized social divisions which have created the conditions for rates of suicide which are amongst the highest in the world. The formal mental health provision which exists in Guyana is based primarily on an individualized and largely biomedical model of care. Despite valuable attempts to develop this provision, the difficulty of physically accessing this for some people and the stigma which surround this means that the capacity of this system to address the serious problems which exist is limited. It is also the case that in times of emotional and psychic distress, and in the context of Guyana being a very religious country, many people turn to traditional supernatural healers and remedies for support. In this paper, we discuss what is known as "Obeah", noting that while this is widely practiced, it remains something of a taboo subject in Guyana. We consider the reasons why these practices and beliefs continue to be influential. However, what neither these biomedical or supernatural perceptions of mental health are able to address is the sociogenic nature of Guyana's mental health issues, which we argue emerges out of the historic trauma of Guyana's experience of colonialism and the violence which it engendered. We argue that profound forms of mental distress which exist in Guyana call for an integrative and holistic practice model that contextualizes these problems through a sociogenic lens. Social workers, working collaboratively with other health-related professions, can occupy a critical role in integrating these different conceptions through developing a rights-based model of mental health where the causes of mental ill-health are understood as socially determined.

Prevalence and incidence of depressive symptoms in pharmacy students: A systematic review

BACKGROUND

Pharmacy students are at high risk of developing depressive symptoms that can adversely influence their professional future. However, there are no summarized data on the subject.

OBJECTIVE

To summarize the prevalence and incidence of depressive symptoms in pharmacy students.

METHODS

A literature search was performed using PubMed, PsycINFO, CINAHL, LILACS, and SCOPUS databases until January 2022. We included observational studies that assessed the prevalence or incidence of depressive symptoms among pharmacy students using a validated screening instrument. Two independent investigators performed the study selection, data extraction, and quality assessment using the Joanna Briggs Institute (JBI) checklist for prevalence studies. The estimate of depressive symptoms was summarized as a narrative synthesis using structured tables.

RESULTS

Of the 695 records retrieved in the search, 19 studies met the eligibility criteria. All were cross-sectional studies, published between 2009 and 2022. The number of pharmacy students ranged from 30 to 610. Most studies were conducted in Asia (n = 9) and the Americas (n = 7), and included only public university students (n = 12). The studies used several instruments to screen students for depressive symptoms, mainly Patient Health Questionnaire-9 (n = 7), Beck Depression Inventory (n = 5), and Depression, Anxiety, and Stress Scale 21 (n = 4). Most studies (n = 15) evaluated only the prevalence of depressive symptoms. The estimate of overall, mild, moderate, and severe depressive symptoms ranged from 4.8% to 78.8%, 9.1% to 42.1%, 5.8% to 30.0%, and 0% to 50.0%, respectively. Regarding methodological quality, the score ranged from 4 to 7 out of 9 points according to the JBI checklist.

CONCLUSION

A high proportion of depressive symptoms were observed in pharmacy students. This finding points to the urgent need to develop strategies for screening, early identification of symptoms, and intervention to improve the mental health of students.

Stakeholders' perspectives on the development of an Africa-focused postgraduate diploma to address public mental health training needs in Africa: a qualitative study

BACKGROUND

Despite the significant contribution of mental health conditions to the burden of disease, there is insufficient evidence from Africa to inform policy, planning and service delivery. Thus, there is a need for mental health research capacity building, led by African public mental health researchers and practitioners, to drive local research priorities. The aim of African mental health Researchers Inspired and Equipped (ARISE) was to develop a one-year postgraduate diploma (PGDip) in public mental health to address the current gaps in public mental health training.

METHODS

Thirty-six individual interviews were conducted online with three groups of participants: course convenors of related PGDips in South Africa, course convenors of international public mental health degree programmes and stakeholders active in public mental health in Africa. The interviewers elicited information regarding: programme delivery, training needs in African public mental health, and experiences of facilitators, barriers and solutions to successful implementation. The transcribed interviews were analysed by two coders using thematic analysis.

RESULTS

Participants found the Africa-focused PGDip programme acceptable with the potential to address public mental health research and operational capacity gaps in Africa. Participants provided several recommendations for the PGDip, including that: (i) the programme be guided by the principles of human rights, social justice, diversity and inclusivity; (ii) the content reflect African public mental health needs; (iii) PGDip faculty be skilled in teaching and developing material for online courses and (iv) the PGDip be designed as a fully online or blended learning programme in collaboration with learning designers.

CONCLUSIONS

The study findings provided valuable insight into how to communicate key principles and skills suited to the rapidly developing public mental health field while keeping pace with changes in higher education. The information elicited has informed curriculum design, implementation and quality improvement strategies for the new postgraduate public mental health programme.

Reprioritising global mental health: psychoses in sub-Saharan Africa

Arthur Kleinman's 2009 Lancet commentary described global mental health as a "moral failure of humanity", asserting that priorities should be based not on the epidemiological and utilitarian economic arguments that tend to favour common mental health conditions like mild to moderate depression and anxiety, but rather on the human rights of those in the most vulnerable situations and the suffering that they experience. Yet more than a decade later, people with severe mental health conditions like psychoses are still being left behind. Here, we add to Kleinman's appeal a critical review of the literature on psychoses in sub-Saharan Africa, highlighting contradictions between local evidence and global narratives surrounding the burden of disease, the outcomes of schizophrenia, and the economic costs of mental health conditions. We identify numerous instances where the lack of regionally representative data and other methodological shortcomings undermine the conclusions of international research carried out to inform decision-making. Our findings point to the need not only for more research on psychoses in sub-Saharan Africa, but also for more representation and leadership in the conduct of research and in international priority-setting more broadly-especially by people with lived experience from diverse backgrounds. This paper aims to encourage debate about how this chronically under-resourced field, as part of wider conversations in global mental health, can be reprioritised.

A Qualitative Exploration of Causes of Depression among Persons Living with HIV Receiving Antiretroviral Therapy in Uganda: Implications for Policy

Introduction

Depression is the fourth leading cause of the global disease burden and worsens the outcome of comorbidities including HIV/AIDS. Depression is particularly problematic among persons living with HIV in sub-Saharan Africa where scarcity of cost-effective interventions is compounded by inadequate understanding of the disease. We examine risk factors for depression among persons living with HIV undergoing antiretroviral treatment in Uganda and discuss policy implications.

Methods

A qualitative study using a narrative approach was conducted, the formative phase of a large study to develop a model for integrating depression management into routine HIV care in Uganda. Participants were purposively sampled at four public health facilities in Mpigi District. In-depth interviews were conducted with four clinicians, three supervisors, and 11 persons living with HIV and suffering from depression, as were three focus group discussions with lay health workers. Exit interviews were conducted with 17 persons living with HIV who completed/interrupted depression treatment but had not been interviewed. Only data collected from persons living with HIV and lay health workers were analysed for the purpose of this paper. A narrative thematic approach was used in data analysis. Findings. There were several pathways through which lack of family social support reportedly led to depression: worries about disclosure in discordant relationships, false perceptions of social support, stigmatisation and discrimination, and domestic violence. Economic/poverty and other causes were identified, but their role was less significant or moderated by family social support.

Conclusion

Family social support plays a dominant role-both directly and indirectly-in influencing depression risk. We propose the mainstreaming of formal psychosocial support and a shift from individual to family-focused counselling that targets both persons living with HIV and their family.

A Systematic Literature Review of the Impact of Climate Change on the Global Demand for Psychiatric Services

Climate Change (CC) imposes important global health risks, including on mental health (MH). They are related mostly to psychological suffering caused by climate-related events and to the heat-vulnerability caused by psychiatric disorders. This growing burden may press MH services worldwide, increasing demand on public and private systems in low-, middle-, and high-income countries. According to PRISMA, two independent reviewers searched four databases for papers published before May 2022 that associated climate-related events with healthcare demand for psychiatric conditions. Of the 7432 papers retrieved, we included 105. Only 29 were carried out in low- and middle-income countries. Twelve related the admission numbers to (i) extreme events, while 93 to (ii) meteorological factors-mostly heat. Emergency visits and hospitalizations were significantly higher during hot periods for MH disorders, especially until lag 5-7. Extreme events also caused more consultations. Suicide (completed or attempted), substance misuse, schizophrenia, mood, organic and neurotic disorders, and mortality were strongly affected by CC. This high healthcare demand is evidence of the burden patients may undergo. In addition, public and private services may face a shortage of financial and human resources. Finally, the increased use of healthcare facilities, in turn, intensifies greenhouse gas emissions, representing a self-enforcing cycle for CC. Further research is needed to better clarify how extreme events affect MH services and, in addition, if services in low- and middle-income countries are more intensely demanded by CC, as compared to richer countries.

Psychological distress among people living with chronic medical illness and the general population, Northwest Ethiopia: A comparative cross-sectional study

BACKGROUND

Psychological distress is often linked to and negatively affects the outcomes of chronic medical conditions; however, data on psychological distress and its predictors among individuals with chronic medical illnesses are scarce in developing countries like Ethiopia. The main objective of this study was to assess the magnitude and predictors of psychological distress among people living with chronic medical illness and the general population.

METHODS

A comparative cross-sectional study was conducted in Mecha demographic research center, Northwest Ethiopia. The participants were selected from the general population and outpatient departments. Kessler-10 (K-10) was used to assess psychological distress.

RESULT

The magnitude of psychological distress among people living with chronic medical illness and those from the general population was 62.0% and 35.1%, respectively. The odds of psychological distress in people living with chronic medical illness was three times more than the one in the general population. Divorced marital status, family history of chronic medical illness, and low social support were statistically significantly associated with psychological distress in both groups.

CONCLUSION

The magnitude of psychological distress was significantly higher among people living with chronic medical illness. Routine screening of such cases for psychological distress during their visits for their medical illness helps take appropriate therapeutic interventions.

Mental disorders and lack of social support among refugees and Ugandan nationals screening for HIV at health centers in Nakivale refugee settlement in southwestern Uganda

Background

Exposure to potentially traumatic events and daily stressors in humanitarian settings puts refugees and asylum seekers (henceforth collectively referred to as refugees) at increased risk for mental disorders. Little is known about how mental disorder prevalence compares between refugees and national populations who live in the same settings and are exposed to many of the same daily challenges. We aimed to compare the proportions of refugees and Ugandan nationals screening positive for mental disorders in a Ugandan refugee settlement to inform targeted health interventions. Given displacement’s disruptive effect on social networks and the importance of social support for mental health, we also aimed to assess social support.

Methods

Refugees and Ugandan nationals voluntarily testing for HIV at health centers in Nakivale Refugee Settlement were screened for post-traumatic stress disorder (PTSD CheckList-6 – Civilian Version [PCL-6]), depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (General Anxiety Disorder-7 [GAD-7]), and lack of social support (Brief Social Support Scale [BS6]). The association between refugee versus Ugandan national status and the four outcomes was assessed using log-binomial regression.

Results

Screening surveys were completed by 5,513 participants, including 3,622 refugees and 1,891 Ugandan nationals. A positive screen for PTSD, depression, anxiety and lack of social support was found for 2,388 (44%), 1,337 (25%), 1,241 (23%) and 631 (12%) participants, respectively. Refugee status was associated with a higher prevalence of a positive screen for PTSD (prevalence ratio (PR)=1.15; 95% confidence interval (CI)=1.08-1.23), depression (PR=1.22; 95% CI=1.11-1.36), anxiety (PR=1.28; 95% CI=1.14-1.42), and lack of social support (PR=1.50; 95% CI=1.27-1.78). When adjusted for the other outcomes, the higher prevalence of a positive screen for PTSD, anxiety and lack of social support for refugees remained statistically significant.

Conclusions

Elevated symptoms of mental disorders are found among refugees and Ugandan nationals testing for HIV in Nakivale Refugee Settlement. The significant association between refugee status and PTSD, anxiety and lack of social support symptoms highlights the distinct needs of this population. To determine the prevalence of mental disorders in these populations, comprehensive assessment, including psychological and neuropsychological testing, is needed.

Psychosocial factors associated with dispositional hope, agency thinking, and pathways thinking in a homeless adult population

Adults facing homelessness often perceive themselves to be at the bottom of society, which has implications for their current and future well-being. Snyder's hope theory, which posits that agency thinking and pathways thinking are necessary for achieving a hopeful outlook on life, may be helpful for understanding drivers of well-being among individuals experiencing homelessness. In this study, we examined dispositional hope, perceived goal attainment, social support, and perceived standing in society among 123 adults experiencing homelessness who were attending a support group at a daytime drop-in center in the United States. Participants completed self-report measures related to the aforementioned variables of interest. We discovered that higher levels of self-reported goal attainment, independent of the type of goal identified, were significantly associated with total hope and both its subscales, that social support was significantly associated with total hope and pathways thinking, and that perceived standing in society was significantly associated with total hope and agency thinking.

Examining the association between the COVID-19 pandemic and self-harm death counts in four Canadian provinces

Governments implemented lockdowns and other physical distancing measures to stop the spread of SARS-CoV-2 (COVID-19). Resulting unemployment, income loss, poverty, and social isolation, coupled with daily reports of dire news about the COVID-19 pandemic, could serve as catalysts for increased self-harm deaths (SHD). This ecological study examined whether observed SHD counts were higher than predicted SHD counts during the pandemic period in the Canadian provinces of Alberta, British Columbia, Ontario, and Québec. The study also explored whether SHD counts during the pandemic were affected by lockdown severity (measured using the lockdown stringency index [LSI]) and COVID-19 case numbers. We utilized publicly available SHD data from January 2018 through November 2020, and employed AutoRegressive Integrated Moving Average (ARIMA) modelling, to predict SHD during the COVID-19 period (March 21 to November 28, 2020). We used Poisson and negative binomial regression to assess ecological associations between the LSI and COVID-19 case numbers, controlling for seasonality, and SHD counts during the COVID-19 period. On average, observed SHD counts were lower than predicted counts during this period (p < 0.05 [except Alberta]). Additionally, LSI and COVID-19 case numbers were not statistically significantly associated with SHD counts.

Farmers’ Suicides and Psychosocial Intervention

Farmers’ suicides in India, exemplifying the agrarian crisis, have been a contemporary cause of grave concern. The Vidarbha Psychosocial Support and Care Program (VPSCP) in western India is an example of a psychosocial intervention being implemented to address the psychological consequences of adverse circumstances triggered by the agrarian distress of farmers through a multi-pronged strategy of delivery of mental health care services to those in need dovetailed with livelihood/employment support schemes. This article, which forms part of a larger evaluation carried out on the impact and effectiveness of the VPSCP, focuses primarily on the process and functioning of the programme; its strengths and challenges through the perspectives of key stakeholders; and perceptions of psychosocial stress in the community. Although firmer linkages with the government health care programme and with employment support/welfare schemes is needed, the VPSCP can be taken as a viable template for the integration of socio-economic determinants and mental health concerns in the agrarian context in order to reduce the incidence of suicide.

Low-Income Turkish Mothers' Conceptions and Experiences of Family Life

The current qualitative study explores women's conceptions of the normative family and their day-to-day family lives. To that aim, we conducted five focus group interviews in two low-income neighborhoods of Istanbul. The sample included 43 women (42 biological mothers and a grandmother) who had at least one child between ages 3 and 8 in their care. Participants were 35.64 years old on average (SD = 4.74) and were all married. Women had approximately two children (SD = 0.72) whose mean age was 7.92 years old (SD = 3.11). Each focus group was semi-structured, lasted for 1-1.5 h, and included 5-12 participants. Thematic analysis of the focus group interview data, moderator memos, and observer's notes revealed five defining features of healthy family functioning: cohesion, healthy child, parenting, conflict, control, and family organization. Overall, women prioritized motherhood over their other social identities and idealized the happy family, which contradicted their actual lived experiences in the family system. We discuss how women's depictions of all family processes revolved around cultural constructs of gender, socio-economic status, and independence/interdependence. The findings of this study shed light on future interventions for low-income women and their families in Turkey.

Non-communicable diseases among women survivors of intimate partner violence: Critical review from a chronic stress framework

A neurobiological framework of chronic stress proposes that the stress-response system can be functionally altered by the repeated presentation of highly stressful situations over time. These functional alterations mainly affect brain processing and include the dysregulation of the hypothalamic-pituitary-adrenal axis and associated processes. In the present critical review, we translate these results to inform the clinical presentation of women survivors of intimate partner violence (IPV). We approach IPV as a scenario of chronic stress where women are repetitively exposed to threat and coping behaviours that progressively shape their neurobiological response to stress. The changes at the central and peripheral levels in turn correlate with the phenotypes of non-communicable diseases. The reviewed studies clarify the extent of the impact of IPV on women's health in large (N > 10,000) population-based designs, and provide observations on experimental neuroendocrine, immune, neurocognitive and neuroimaging research linking alterations of the stress-response system and disease. This evidence supports the prevention of violence against women as a fundamental action to reduce the prevalence of non-communicable diseases.

Prevalence of attention-deficit/hyperactivity disorder in people with mood disorders: A systematic review and meta-analysis

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) in mood disorders is associated with unfavorable outcomes, including more frequent mood episodes, and increased risk of suicide. The reported prevalence of ADHD in individuals with mood disorders varies widely.

METHODS

We searched PsycInfo and PubMed for articles published before September 21^st , 2020, using search terms for ADHD and mood disorders. We included original data on the prevalence of ADHD in individuals with bipolar disorder (BD) or major depressive disorder (MDD). We estimated the prevalence of ADHD, by developmental period and disorder using random-effects meta-analyses. We also compared the rate of ADHD in people with MDD and BD, and with and without mood disorders.

RESULTS

Based on 92 studies including 17089 individuals, prevalence of ADHD in BD is 73% (95% CI 66-79) in childhood, 43% (95% CI 35-50) in adolescence, and 17% (95% CI 14-20) in adulthood. Data from 52 studies with 16897 individuals indicated that prevalence of ADHD in MDD is 28% (95% CI 19-39) in childhood, 17% (95% CI 12-24) in adolescence, and 7% (95% CI 4-11) in adulthood. ADHD was three times more common in people with mood disorders compared to those without and 1.7 times more common in BD compared to MDD.

CONCLUSION

People with mood disorders are at a significant risk for ADHD. ADHD should be assessed and treated in individuals with BD and MDD. Comprehensive assessment strategies are needed to address challenges of diagnosing ADHD alongside mood disorders.

[IMAGEN and beyond: novel population neuroscientific strategies for clinical and global cohorts in the STRATIFY and GIGA consortia]

Cohort studies provide the possibility to more precisely define treatment and preventive approaches to mental diseases, when genetic and personal influences as well as sociocultural and environmental factors and their interactions are taken into account. This article presents cohort research approaches, which are dedicated to this aim and reports the lessons learnt and achievements made in the IMAGEN cohort study and the resulting further developments. Specifically, we focus on novel assessment instruments, the implementation of larger clinical and geographic ranges and innovative forms of data analysis.

Controlled Study of the Impact of a Virtual Program to Reduce Stigma Among University Students Toward People With Mental Disorders

Stigma toward mental disorders is one of today's most pressing global issues. The Covid-19 pandemic has exacerbated the barriers to social inclusion faced by individuals with mental disorders. Concurrently, stigma reduction interventions, especially those aimed at university students, have been more difficult to implement given social distancing and campus closures. As a result, alternative delivery for programs contributing to stigma reduction is required, such as online implementation. This paper reports the results of a controlled study focused on an online multi-component program on reducing stigma toward mental illness that included project-based learning, clinical simulations with standardized patients and E-Contact with real patients. A total of 40 undergraduate students from the Universidad del Desarrollo in Santiago, Chile, participated in the study. They were randomly divided between an intervention and control group. The intervention group participated in the online multi-component program, while the control group participated in an online educational program on cardiovascular health. We assessed the impact of the program by using the validated Spanish-language versions of the Attribution Questionnaire AQ-27 and the Questionnaire on Student Attitudes toward Schizophrenia with both groups, before and after the intervention. In addition, an ad hoc Likert scale ranging from 0 to 5 was used with the intervention group in order to assess the learning strategies implemented. Following the intervention, the participants belonging to the intervention group displayed significantly lower levels of stereotypes, perception of dangerousness, and global score toward people with schizophrenia (p < 0.001). In addition, participants presented lower levels of dangerousness-fear, avoidance, coercion, lack of solidarity, and global score (p < 0.001). The control group displayed no statistically significant differences in the level of stigma before and after the evaluation, for all of the items assessed. Finally, the overall assessment of each of the components of the program was highly positive. In conclusion, the study shows that online programs can contribute to reducing stigma toward mental disorders. The program assessed in this study had a positive impact on all the dimensions of stigma and all of the components of the program itself were positively evaluated by the participants.

Household poverty, schooling, stigma and quality of life in adolescents with epilepsy in rural Uganda

BACKGROUND

Epilepsy remains a leading chronic neurological disorder in Low- and Middle-Income Countries. In Uganda, the highest burden is among young rural people. We aimed to; (i) describe socio-economic status (including schooling), and household poverty in adolescents living with epilepsy (ALE) compared to unaffected counterparts in the same communities and (ii) determine the factors associated with the overall quality of life (QoL).

METHODS

This was a cross-sectional survey nested within a larger study of ALE compared to age-matched healthy community children in Uganda. Between Sept 2016 to Sept 2017, 154 ALE and 154 healthy community controls were consecutively recruited. Adolescents recruited were frequency and age-matched based on age categories 10-14 and 15-19 years. Clinical history and standardized assessments were conducted. One control participant had incomplete assessment and was excluded. The primary outcome was overall QoL and key variables assessed were schooling status and household poverty. Descriptive and multivariable linear regression analysis were conducted for independent associations with overall QoL.

RESULTS

Mean (SD) age at seizure onset was 8.8 (3.9) years and median (IQR) monthly seizure burden was 2 (1-4). Epilepsy was associated with living in homes with high household poverty; 95/154 (61.7%) ALE lived in the poorest homes compared to 68/153 (44.5%) of the healthy adolescents, p = 0.001. Nearly two-thirds of ALE had dropped out of school and only 48/154 (31.2%) were currently attending school compared to 136/153 (88.9%) of healthy controls, p < 0.001. QoL was lowest among ALE who never attended school (p < 0.001), with primary education (p = 0.006) compared to those with at least secondary education. Stigma scores [mean(SD)] were highest among ALE in the poorest [69.1(34.6)], and wealthy [70.2(32.2)] quintiles compared to their counterparts in poorer [61.8(31.7)], medium [68.0(32.7)] and wealthiest [61.5(33.3)] quintiles, though not statistically significant (p = 0.75). After adjusting for covariates, ALE currently attending school had higher overall QoL compared to their counterparts who never attended school (β = 4.20, 95%CI: 0.90,7.49, p = 0.013). QoL scores were higher among ALE with ≥secondary education than those with no or primary education (β = 10.69, 95%CI: 1.65, 19.72).

CONCLUSIONS

ALE in this rural area are from the poorest households, are more likely to drop out of school and have the lowest QoL. Those with poorer seizure control are most affected. ALE should be included among vulnerable population groups and in addition to schooling, strategies for seizure control and addressing the epilepsy treatment gap in affected homes should be specifically targeted in state poverty eradication programs.

Regulation of Reactive Oxygen Species-Mediated Damage in the Pathogenesis of Schizophrenia

The biochemical integrity of the brain is paramount to the function of the central nervous system, and oxidative stress is a key contributor to cerebral biochemical impairment. Oxidative stress, which occurs when an imbalance arises between the production of reactive oxygen species (ROS) and the efficacy of the antioxidant defense mechanism, is believed to play a role in the pathophysiology of various brain disorders. One such disorder, schizophrenia, not only causes lifelong disability but also induces severe emotional distress; however, because of its onset in early adolescence or adulthood and its progressive development, consuming natural antioxidant products may help regulate the pathogenesis of schizophrenia. Therefore, elucidating the functions of ROS and dietary antioxidants in the pathogenesis of schizophrenia could help formulate improved therapeutic strategies for its prevention and treatment. This review focuses specifically on the roles of ROS and oxidative damage in the pathophysiology of schizophrenia, as well as the effects of nutrition, antipsychotic use, cognitive therapies, and quality of life on patients with schizophrenia. By improving our understanding of the effects of various nutrients on schizophrenia, it may become possible to develop nutritional strategies and supplements to treat the disorder, alleviate its symptoms, and facilitate long-term recovery.

"If somebody could just understand what I am going through, it would make all the difference": Conceptualizations of trauma in homeless populations experiencing severe mental illness

Exposure to violence, vulnerability due to lack of shelter, alienation due to stigma, the experiences of severe mental illness (SMI) and subsequent institutionalization, make homeless persons with SMI uniquely susceptible to trauma exposure and subsequent mental health consequences. This study aims to contribute to the development of culturally sensitive interventions for identifying and treating trauma in a population of homeless persons with SMI in Tamil Nadu, India by understanding the manifestations of trauma and its associated consequences in this population. Free-listing exercises followed by in-depth interviews were conducted with a convenience sample of 26 user-survivors who have experienced homelessness or were at risk of homelessness, and suffered from SMI. Topics explored included events considered to be traumatic, pathways to trauma, associated emotional, physical and social complaints, and coping strategies. Results indicate discrepancies in classification of traumatic events between user-survivors and the Diagnostic and Statistical Manual of Mental Disorders. Traumatic experiences, particularly relating to social relationships and poverty, mentioned by user-survivors did not match traditional conceptualizations of trauma. Positive coping strategies for trauma included being mentally strong, knowledge and awareness, whereas the main negative coping strategy is avoidance. User-survivors attributed their experiences of homelessness and SMI to past traumas. Differing views of trauma between user-survivors and mental health professionals can lead to misdiagnosis and under-recognition of trauma in this population of homeless persons with SMI.

The Impact of Ghana's National Health Insurance on Psychological Distress

BACKGROUND

Poor mental health is among the growing number of noncommunicable diseases in low- and middle-income countries. Despite poor mental health accounting for an already considerable and growing burden of disease in many low- and middle-income countries, policy action to confront the challenge has been limited, at both international and national levels. Recently, several low- and middle-income countries have embarked on the journey toward universal health coverage by expanding their public health insurance provision, with the ultimate objective of improving population health, in addition to other health system objectives. Mental health interventions typically may not have been specifically covered in the publicly funded benefit package, and this raises the question of whether, and if so, by how much, the expansion of public health insurance may have directly or indirectly contributed to improved mental health.

OBJECTIVE

We assessed the impact of Ghana's implementation of national health insurance on psychological distress.

METHODS

Our study used the first wave of the 2009-2010 Ghana Social Economic Panel survey, including 10,007 respondents. We employed instrumental variable and propensity score matching methods to estimate the causal impact of health insurance on psychological distress, measured by the Kessler Psychological Distress Scale (K10). Higher K10 values indicate greater psychological distress.

RESULTS

The median K10 score in Ghana was 16 (P < 0.001), with a minimum of 10 (P < 0.001) and a maximum of 45 (P < 0.001). The results from the instrumental variable estimations, without matching, indicated that the K10 score for the insured was 11.8% lower (P < 0.001) than that of the uninsured. After running the instrumental variable regression on the matched sample, the K10 score for the insured was 10.6% (P < 0.001) lower than that of the uninsured. Similarly, the estimates based on propensity score matching indicated that the insured had a lower K10 score (- 0.023; P < 0.05). Furthermore, the beneficial impact of health insurance on psychological distress is larger for wealthier than poorer insurance members and varies across regions in Ghana. The findings were robust to the various estimation methods.

CONCLUSION

This study suggests that having health insurance is associated with reduced psychological distress and hence improved mental health, even though mental illness treatment or prevention were at best only partially covered by the National Health Insurance Scheme in Ghana.

Is health literacy associated with mental health literacy? Findings from Mental Health Literacy Scale

PURPOSE

This study aims to measure associated factors of Mental Health Literacy (MHL) among Minnesotans by using the Mental Health Literacy Scale and Andersen's Health Behavior Model.

DESIGN AND METHODS

This study utilized cross-sectional survey data with 732 participants.

FINDINGS

Participants in higher education groups showed higher MHL levels than those who have less education. Non-Latino Whites had higher MHL levels than any other racial group. Participants who engaged in social groups had higher MHL levels. Interestingly, the relationship between health literacy and MHL was the most substantial factor.

PRACTICE IMPLICATIONS

Interventions aiming to improve health literacy seems beneficial to increase MHL. In addition, a variety of programs should be implemented, such as social programs that target those with less social group interaction.

Economics and mental health: the current scenario

Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill-health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget-holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost-effectiveness analysis, cost-utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification-plus-treatment; risk-reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community-based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.

Drug Use Disorders and Violence: Associations With Individual Drug Categories

We conducted a systematic review that examined the link between individual drug categories and violent outcomes. We searched for primary case-control and cohort investigations that reported risk of violence against others among individuals diagnosed with drug use disorders using validated clinical criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We identified 18 studies published during 1990–2019, reporting data from 591,411 individuals with drug use disorders. We reported odds ratios of the violence risk in different categories of drug use disorders compared with those without. We found odds ratios ranging from 0.8 to 25.0 for most individual drug categories, with generally higher odds ratios among individuals with polydrug use disorders. In addition, we explored sources of between-study heterogeneity by subgroup and meta-regression analyses. Cohort investigations reported a lower risk of violence than case-control reports (odds ratio =  2.7 (95% confidence interval (CI): 2.1, 3.5) vs. 6.6 (95% CI: 5.1, 8.6)), and associations were stronger when the outcome was any violence rather than intimate partner violence (odds ratio = 5.7 (95% CI: 3.8, 8.6) vs. 1.7 (95% CI: 1.4, 2.1)), which was consistent with results from the meta-regression. Overall, these findings highlight the potential impact of preventing and treating drug use disorders on reducing violence risk and associated morbidities.

Exploring mental health nursing practice in Indonesian rural area

Purpose

Mental health should be getting more attention, as mental health problems are increasing and they pose a significant health burden. Government plays an important role in supporting the implementation of mental health program. The purpose of this paper is to overview the implementation of mental health programs in North Toraja Regency, South Sulawesi Province, Indonesia.

Design/methodology/approach

This paper presents an audit conducted to examine the practice of mental health staff delivering mental health programs in community centers in one sub-district area in Indonesia and describes key areas of work, including promotive, preventative, curative and rehabilitation intervention. Responds from the respondents then was compared to guidelines for mental health practice in community based on Mental Health Law No. 18 (2014). The respondents were all mental health program staff (26 staff) from all community health centers (26 Puskesmas) in the North Toraja region, South Sulawesi (each Puskesmas has one staff responsible for mental health program).

Findings

This study explored programs and services provided for community mental health programs and roles of health staff in implementing programs and delivering services in one rural area. Although most health staff had provided mental health services according to the government guidelines, this study did not identify what the staff actually did in performing this work. Health staff cannot work alone in providing healthcare services, thus support from other sectors and from government is needed to deliver more effective healthcare to people with mental health disorders in the community. For further study, qualitative design is needed to explore more about the actual practice of the mental health staff in Puskesmas.

Originality/value

There is no published information regarding this topic in Indonesia to date. This information is really important for the government to evaluate the implementation of mental health program in Indonesia. However, these findings may only apply in this area, thus cannot be generalized for other regions in Indonesia, even if similar condition occurs in other areas.

What’s citizenship got to do with mental health? Rationale for inclusion of citizenship as part of a mental health strategy

Purpose

People with lived experience of mental health problems (MHPs) are often marginalised and have difficulty achieving community inclusion. Citizenship, a relatively novel concept in mental health, provides a means of understanding what is necessary for marginalised individuals and groups to gain a sense of belonging within their communities. By exploring the “what, why, how and who” of citizenship, the purpose of this paper is to provide a rationale for the inclusion of citizenship as part of a person-centred and holistic mental health strategy.

Design/methodology/approach

A community-based participatory research (CBPR) approach, with peer researchers, was adopted to develop a model of citizenship within a Scottish context. The aim of the model is to link the concept of citizenship with specific strategies that systems, agencies and individuals can use within mental health policy and practice to promote greater inclusion and participation. Concept mapping was used as part of a mixed-methods participatory methodology and data were then analysed using multivariate statistical methods of multidimensional scaling and hierarchical cluster analysis.

Findings

It is argued that using a CBPR approach, utilising concept mapping, encourages the development of a model of citizenship that is entirely grounded in the perspectives and lived experiences of people with MHPs. The need for adequate resources, preparatory work, training, research management and reflexive practice are key to the success of a CBPR approach with peer researchers.

Originality/value

Working with peer researchers and key stakeholder groups is central to a CBPR approach and the implementation of a model of citizenship within mental health policy and practice. Developing a model of citizenship derived specifically from the experiences of people with lived experience is likely to promote their inclusion. It provides a means of challenging the structural deficits and inequalities that cause distress and prevent people with lived experience of MHPs of recovering their citizenship.

Socioeconomic position and depression in South African adults with long-term health conditions: a longitudinal study of causal pathways

AIMS

There is convincing evidence that lower socioeconomic position is associated with increased risk of mental disorders. However, the mechanisms involved are not well understood. This study aims to elucidate the causal pathways between socioeconomic position and depression symptoms in South African adults. Two possible causal theories are examined: social causation, which suggests that poor socioeconomic conditions cause mental ill health; and social drift, which suggests that those with poor mental health are more likely to drift into poor socioeconomic circumstances.

METHODS

The study used longitudinal and cross-sectional observational data on 3904 adults, from a randomised trial carried out in 38 primary health care clinics between 2011 and 2012. Structural equation models and counterfactual mediation analyses were used to examine causal pathways in two directions. First, we examined social causation pathways, with language (a proxy for racial or ethnic category) being treated as an exposure, while education, unemployment, income and depression were treated as sequential mediators and outcomes. Second, social drift was explored with depression treated as a potential influence on health-related quality of life, job loss and, finally, income.

RESULTS

The results suggest that the effects of language on depression at baseline, and on changes in depression during follow-up, were mediated through education and income but not through unemployment. Adverse effects of unemployment and job loss on depression appeared to be mostly mediated through income. The effect of depression on decreasing income appeared to be mediated by job loss.

CONCLUSIONS

These results suggest that both social causation and social selection processes operate concurrently. This raises the possibility that people could get trapped in a vicious cycle in which poor socioeconomic conditions lead to depression, which, in turn, can cause further damage to their economic prospects. This study also suggests that modifiable factors such as income, employment and treatable depression are suitable targets for intervention in the short to medium term, while in the longer term reducing inequalities in education will be necessary to address the deeply entrenched inequalities in South Africa.

"Happy feet": evaluating the benefits of a 100-day 10,000 step challenge on mental health and wellbeing

BACKGROUND

An increased awareness of the health benefits of walking has emerged with the development and refinement of accelerometer equipment. Evidence is beginning to highlight the value of promoting walking, particularly focusing on the Japanese mark of obtaining 10,000 steps per day. Workplace based step challenges have become popular to engage large cohorts in increasing their daily physical activity in a sustainable and enjoyable way. Findings are now highlighting the positive health effects of these medium-term programs (typically conducted over a few months) in terms of cardiovascular health, reducing diabetes risk and improving lifestyle factors such as weight and blood pressure. As yet, research has not focused on whether similar improvements in psychological health and wellbeing are present.

METHODS

This study investigated the impact of a 100-day, 10,000 step program on signs of depression, anxiety and stress as well as general wellbeing using standardised psychological scales.

RESULTS

The results indicated a small but consistent effect on all of these measures of mental health over the term of the program. This effect appeared irrespective of whether a person reached the 10,000 step mark.

CONCLUSIONS

These results highlight improved mental health and wellbeing in people undertaking this 100-day 10,000 step program and indicates the efficacy and potential of these programs for a modest, yet important improvement in mental health. Notably, targets reached may be less important than participation itself.

Psychotropic drugs prescription in undocumented migrants and indigent natives in Italy

To evaluate psychotropic drug use in undocumented migrants and natives in the same conditions of poverty. We studied drug dispensation by a nongovernmental organization during the year 2014. Drugs were identified according to the Anatomical Chemical Therapeutic classification and their quantity was measured in defined daily doses (DDD). We determined the percentage of patients taking at least one medicine with psychotropic activity in relation to the total number of patients receiving medicines of any class. We also calculated the individual DDD for psychoactive drugs. The percentage of natives receiving this type of medicine is significantly higher than that of undocumented migrants. Individual DDDs for each class of psychotropic drug are comparable in Italians and undocumented migrants and, among the latter, no difference was found in relation to ethnicity. Our findings describe for the first time the use of psychotropic medicines by undocumented migrants. On this basis, we hypothesize that poverty is more important than migration and ethnicity in generating the need for this type of pharmacological treatment. Both natives and undocumented migrants show poor adherence to treatment. This situation should be considered when programming health interventions in this field for the very poor and undocumented migrants.

State, trait, and dental anxiety in caregivers of individuals with disabilities

PURPOSE

The aim of this study was to compare state anxiety, trait anxiety, and dental anxiety in caregivers of patients with special needs and caregivers of pediatric patients without special needs at dental clinics.

MATERIALS AND METHODS

A quantitative, cross-sectional study was conducted. Data were collected using a semistructured questionnaire. All respondents were older than 18 years of age. Individuals with cognitive impairment and those taking anxiolytics, antidepressants, or sleep-inducing medication were excluded from the study. The sample consisted of 55 caregivers of patients with special needs and 55 caregivers of pediatric dental patients. A questionnaire was administered to determine the sociodemographic profile of the patients based on the 2015 Brazilian Economic Classification Criteria. Anxiety regarding dental treatment was measured using the dental anxiety scale. The state-trait anxiety inventory was used to identify state and trait anxiety levels.

RESULTS

Caregivers of individuals with disabilities had a similar level of anxiety as caregivers of pediatric dental patients. Most caregivers of individuals with disabilities were mothers with an older age and a greater frequency of trait anxiety, especially when these mothers had health problems. State anxiety was associated with a lower education level.

CONCLUSIONS

Higher dental anxiety levels were found among caregivers with a higher level of trait anxiety, independently of the type of patient to which care was given.

Regional aspects of long-term public sector psychiatric care in the Eastern Cape

Objectives

The objective of this research was to determine regional aspects (such as clinical, geographic and socio-demographic) influencing the use of public sector long-term psychiatric services in the Eastern Cape. This is important in improving service delivery, to assist policy developers with evidence-based research and in providing equitable and efficient resource utilisation.

Methodology

A situational analysis of Tower Psychiatric Hospital and Psychosocial Rehabilitation Centre (TPHPRC) in the Eastern Cape was conducted. Patient administrative data were utilised to determine geographic origin, date and age at admission, gender and diagnosis as of December 2015. The number of admissions from each region for the years 2010-2015 was also extracted from these data.

Results

As of December 2015, there were a total of 390 patients at TPHPRC. Of these, 87% were male patients. The average age at admission for male and female patients was 36 years and 44 years, respectively. Of the patients, 53% originated from the western regions and 57% of female patients presented with a dual diagnosis. The highest number of admissions was in 2015, with the majority originating from Port Elizabeth.

Conclusion

Despite higher access to public psychiatric care in the western region, the majority of patients originated from there. Contributing factors to this include diagnoses, insufficient bed numbers and the absence of admission criteria and referral pathways. It is recommended that the provincial Department of Health set up a task team to determine a standardised working framework for all public sector psychiatric institutions. This should be informed by national policies, legislation and provincial norms and indicators.

Mental health care and delivery system at Temeke hospital in Dar es Salaam, Tanzania

BACKGROUND

Low and middle income countries face many challenges in meeting mental health needs in their regions. Treatment of patients with mental disorders is inadequate in most of these countries and majority of individuals with severe mental disorders remain untreated. The bad news is that mental health problems in these countries are on the rise due to socioeconomic challenges being faced. Regardless of guidelines and directives provided by WHO for organizing mental health services, these countries continue to face many challenges in the effort to cater for mental health needs. Such challenges include lack of human resource for mental health especially at primary health care level, inadequate training of human resource for mental health, misplacement of human resource for mental health, lack of drugs, wrong priorities, problematic insurance coverage for mental disorders, and stigma. This study aimed at exploring mental health care and delivery system at Temeke district hospital, and how services were organized to meet the increasing mental health needs of its population.

METHODS

A qualitative study was conducted at Temeke hospital in Dar es Salaam, involving 7 in-depth interviews with mental health care providers, 7 in-depth interviews with mentally ill patients, and 2 focus group discussions with caregivers. A convenient sampling procedure was used to select participants for the study. All interviews were audio-recorded in Kiswahili and transcribed. A qualitative Content Analysis was used to analyze data after translation with the aid of Nvivo 10 software.

RESULTS

Three main themes were identified. These were resource challenges, environmental/system challenges, and satisfaction with mental health services. Temeke health facility faced resource and environmental/system challenges, and there were mixed feelings on satisfaction with services. Funding and priority issues were found to mainly affect delivery of appropriate services to clients.

CONCLUSION

Health facilities that provide mental health services in the community need to be well equipped with necessary resources to meet the vast needs of people they serve. Having a political will, improving the health systems governance for mental health, and priority setting, are necessary to address the challenges experienced in the delivery of mental health services.

Relationship Between Sexual Abuse in Childhood and the Occurrence of Mental Illness in Adulthood: A Matched Case-Control Study in Nigeria

This study aimed to examine the relationship between exposure to childhood sexual abuse (CSA) and the occurrence of mental illness in adulthood in Nigeria. An age- and gender-matched case-control study was conducted in the University of Port Harcourt Teaching Hospital, Nigeria, from January to March 2014. Cases were defined as individuals aged 18 to 60 years diagnosed with mental illness while controls were aged 18 to 60 years who did not have mental illness. The study had 304 subjects comprised of 152 case-control pairs. This case-control study showed a statistically significant association between exposure to CSA and occurrence of mental illness in adulthood (pair-matched odds ratio = 3.25, 95% CI = [1.70, 6.21]). The association between CSA and mental illness was still significant (adjusted odds ratio = 3.11, 95% CI = [1.67, 5.82]) after controlling for family functionality. A robust CSA prevention and treatment strategy that considers the victim and the perpetrator in Nigeria is hereby advocated. This could be achieved by the collaborative efforts of the government of Nigeria and non-governmental organizations.

Legal protection of the right to work and employment for persons with mental health problems: a review of legislation across the world

The right to work and employment is indispensable for social integration of persons with mental health problems. This study examined whether existing laws pose structural barriers in the realization of right to work and employment of persons with mental health problems across the world. It reviewed disability-specific, human rights legislation, and labour laws of all UN Member States in the context of Article 27 of the UN Convention on the Rights of Persons with Disabilities (CRPD). It wes found that laws in 62% of countries explicitly mention mental disability/impairment/illness in the definition of disability. In 64% of countries, laws prohibit discrimination against persons with mental health during recruitment; in one-third of countries laws prohibit discontinuation of employment. More than half (56%) the countries have laws in place which offer access to reasonable accommodation in the workplace. In 59% of countries laws promote employment of persons with mental health problems through different affirmative actions. Nearly 50 years after the adoption of the International Covenant on Economic, Social, and Cultural Rights and 10 years after the adoption of CRPD by the UN General Assembly, legal discrimination against persons with mental health problems continues to exist globally. Countries and policy-makers need to implement legislative measures to ensure non-discrimination of persons with mental health problems during employment.

Mental health service provision in low and middle-income countries: recent developments

PURPOSE OF REVIEW

The study discusses key issues and concepts of how to provide basic mental health services for people with mental disorders in low and middle-income countries (LAMICs).

RECENT FINDINGS

In the last years a considerable gap between mental healthcare needs and available services in LAMICs has been documented. The transformation of hospital-based to community-based mental health and the building of accessible services in low-resource settings require mental health training of primary care providers, task-sharing/task-shifting models, involvement of families and peers and basic models of community rehabilitation. Several international initiatives have been set up to increase the evidence base and test the feasibility, acceptability, and effectiveness of these approaches which are not new but which have been implemented in only a small amount of LAMICs. A combination of interventions on different levels (governance, legislation, providers, and community) is necessary.

SUMMARY

It remains to be shown how the recent global mental health movement, beyond increasing international financial resources, will be helpful in finding locally and culturally sensitive solutions to reduce the mental health gap in LAMICs. Although concepts of a well designed mix of services are available, solutions to reduce implementation barriers must be local, and implementation strategies may vary considerably and still lack a sufficient evidence base.

Perceived barriers on utilization of mental health services among adults in Dodoma Municipality – Tanzania

Purpose

– The purpose of this paper is to determine perceived barriers to utilization of mental health services among adults in Dodoma Municipality, Tanzania. To improve the use of mental health services, identifying related perceived barriers is a key step.

Design/methodology/approach

– A concurrent mixed method model was used. Data were collected through face-to-face interviews (n=152) using a structured survey questionnaire. In addition in-depth interviews were conducted (n=10). The quantitative data were analyzed by using Epi info version 2002. Content analysis was used for analyzing qualitative data.

Findings

– The majority of respondents opted to use modern mental health facilities for mental illness treatment. They also used spiritual healing and other forms traditional methods including herbal medicines. The most frequently identified causes of mental illness were: drug abuse, being cursed and witchcraft, demons or evil spirit possession. The reported significant perceived barriers were stigma, economic, lack of transport, witchcraft, lack of awareness of mental health services, unemployment, and negative believes about professional cure.

Originality/value

– The option for mental health service utilization is influenced by the existing barriers on community and clients’ perception. There is a need for mental health professionals and policy makers to integrate mental health into primary care. Mutual sharing of knowledge between mental health professionals and tradition healers is warranted. Further research on the attitudes toward mental health professional services and on effectiveness of traditional healers’ services is indicated.