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Haddad M, Vistorte AOR, Haddad GG, Ribeiro W, Ziebold C, Asevedo E, Evans-Lacko S, Ulloa O, Mari JDJ. Management of common mental disorders should take place in primary health or specialized care? Clinical decisions of psychiatrists from Latin American countries. PLoS One 2022; 17:e0265308. [PMID: 35381017 PMCID: PMC8982860 DOI: 10.1371/journal.pone.0265308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
The objective of our study was to explore clinical decisions of psychiatrists regarding the management of common mental disorders in primary care (PC) in four Latin Americans countries, through the application of clinical vignettes.
Methods
Using a cross-sectional design, we conducted a self-administered online questionnaire survey of psychiatrists from Bolivia, Brazil, Cuba, and Chile. The questionnaire covered sociodemographic and professional information. The psychiatrists’ clinical decisions were assessed through three clinical vignettes representing typical PC cases of depression, anxiety, and somatization.
Results
230 psychiatrists completed the online survey. Psychiatrists from Brazil were less likely to recognize depression as a mental disorder than those from Cuba (odds ratio (OR) = 0.30, 95% confidence interval (CI), 0.10 to 0.91, p < 0.04). Female gender (OR = 0.19, 95% CI, 0.04 to 0.91, p < 0.02) and older age (OR = 0.92, 95% CI, 0.87 to 0.97, p < 0.01) reduced the likelihood of agreement that depression cases should be treated by a Primary Care Physician (PCP). In the somatoform symptoms vignette, longer training duration increased the likelihood of agreement that treatment should be done by a psychiatrist instead of a PCP (OR = 1.19, 95% CI, 1.04 to 1.37, p < 0.01). In the anxiety vignette, females (OR = 2.38, 95% CI, 1.10 to 5.13, p < 0.01) and participants from Bolivia (compared with Cubans, OR = 4.19, 95% CI, 1.22 to 14.42, p < 0.02) were more likely to consider that these patients should be treated by a psychiatrist instead of a PCP.
Discussion
Most psychiatrist respondents agreed that patients with depression should be treated by PCPs and that somatoform and anxiety cases should be treated by psychiatrists. These results show that psychiatrists consider that they, and not PCPs, should treat patients with common mental disorders, regardless of the evidence showing that common mental disorders can be treated by primary care physicians in PC.
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Affiliation(s)
- Michel Haddad
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- * E-mail:
| | | | | | - Wagner Ribeiro
- London School of Economics and Political Science – Care Policy and Evaluation Centre, London, United Kingdom
| | - Carolina Ziebold
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Elson Asevedo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Global Mental Health Program, Columbia University, New York, New York, United States of America
| | - Sara Evans-Lacko
- London School of Economics and Political Science – Care Policy and Evaluation Centre, London, United Kingdom
- King’s College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | | | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
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Aitken-Saavedra J, Tarquinio SBC, da Rosa WLDO, Gomes APN, da Silva AF, Fernandez MDS, Moreira AG, Maturana-Ramirez A, Vasconcellos ACU. Salivary characteristics may be associated with burning mouth syndrome? J Clin Exp Dent 2021; 13:e542-e548. [PMID: 34188758 PMCID: PMC8223150 DOI: 10.4317/jced.58033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/20/2020] [Indexed: 01/03/2023] Open
Abstract
Background Burning mouth syndrome (BMS) it is characterized by burning and uncomfortable sensations with no clinical alterations or laboratory findings. The evaluation of the salivary characteristics of people with BMS can help the understanding of the pathogenesis of this condition. This case-control study aimed to trace the salivary profile of women with burning mouth syndrome (BMS).
Material and Methods 40 women with BMS and 40 control women were recruited. Unstimulated salivary flow rate (uSFR), pH, salivary cortisol levels, salivary viscosity, and oral health impact profile (OHIP-14 questioner) were determined. P< 0.05 was considered statistically significant.
Results For uSFR, mean values obtained for BMS and for control group respectively were 0.35 and 0.61 mL/min; for pH, 7.23 and 7.34; for cortisol levels, 0.36 and 0.15 μg/dL; for viscosity values, 31.1 and 45.01 mPas and for OHIP-14 scores, 21.7 and 5.7. To uSFR, cortisol levels, viscosity values and OHIP-14 scores, differences were statistically significant. Salivary cortisol levels and OHIP-14 scores were correlated positively (rho = 0.624; p< 0.05).
Conclusions BMS women have lower uSFR and salivary viscosity and higher salivary cortisol levels that were associated with worse quality of life, compared with the control group. Key words:Xerostomia, Burning mouth syndrome, Viscosity.
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Affiliation(s)
- Juan Aitken-Saavedra
- Department of Oral Pathology and Medicine, Faculty of Dentistry, University of Chile. Santiago, Chile.,Graduate Program in Dentistry, Federal University of Pelotas. Pelotas, Brazil
| | - Sandra-Beatriz-Chaves Tarquinio
- Graduate Program in Dentistry, Federal University of Pelotas. Pelotas, Brazil.,Diagnostic Center for Oral Diseases, School of Dentistry, Federal University of Pelotas, Brazil
| | - Wellington-Luiz-De Oliveira da Rosa
- Graduate Program in Dentistry, Federal University of Pelotas. Pelotas, Brazil.,Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas. Pelotas, Brazil
| | | | - Adriana-Fernandes da Silva
- Graduate Program in Dentistry, Federal University of Pelotas. Pelotas, Brazil.,Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas. Pelotas, Brazil
| | | | | | - Andrea Maturana-Ramirez
- Department of Oral Pathology and Medicine, Faculty of Dentistry, University of Chile. Santiago, Chile
| | - Ana-Carolina-Uchoa Vasconcellos
- Graduate Program in Dentistry, Federal University of Pelotas. Pelotas, Brazil.,Diagnostic Center for Oral Diseases, School of Dentistry, Federal University of Pelotas, Brazil
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Sun KS, Lam TP, Lam KF, Lo TL. Barriers and facilitators for psychiatrists in managing mental health patients in Hong Kong-Impact of Chinese culture and health system. Asia Pac Psychiatry 2018; 10. [PMID: 28371455 DOI: 10.1111/appy.12279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 01/02/2017] [Accepted: 02/27/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study investigated the barriers and facilitators for psychiatrists in managing mental health patients under a Chinese context and a mixed private-public health system. METHODS Two focus group interviews were conducted to explore the in-depth opinions of psychiatrists in Hong Kong. The themes identified from the focus groups were investigated in a questionnaire survey with data from 83 psychiatrists working in public and private sectors. RESULTS No insurance coverage of mental health problems, patients' poor compliance of medication, and stigma of seeing psychiatrists were rated as the top barriers in the survey. Some psychiatrists mentioned in focus groups that they might write down the associated physical symptoms of the patients rather than the mental disorder diagnoses on the medical certificate. They observed some patients suspecting that psychiatric drugs were prescribed to control their behavior and make them more muddleheaded. The survey also found that consultation time constraint, long patient waiting list, and difficulty in discharging patients to primary care mostly affected public psychiatrists rather than private ones. However, they perceived similar facilitators, including public campaign to promote positive results of help-seeking, adequate explanation by other health professionals to the patients before referrals, handling severe cases by casework approach, and having a regular primary care physician. DISCUSSION The top barriers are related to insufficient public awareness and negative attitudes towards mental illness and its treatment. Major solutions include promoting positive results of help seeking, enhancing collaboration with primary care physicians, and follow-up of severe cases by a casework approach.
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Affiliation(s)
- Kai Sing Sun
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Kwok Fai Lam
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China
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Vieta E, Sluth LB, Olsen CK. The effects of vortioxetine on cognitive dysfunction in patients with inadequate response to current antidepressants in major depressive disorder: A short-term, randomized, double-blind, exploratory study versus escitalopram. J Affect Disord 2018; 227:803-809. [PMID: 29673132 DOI: 10.1016/j.jad.2017.11.053] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/27/2017] [Accepted: 11/12/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is a heterogeneous disease characterized by emotional, physical and cognitive symptoms. This study explored the effects of vortioxetine versus escitalopram on outcomes of cognition, functioning and mood symptoms in depressed patients with inadequate response to current antidepressant treatment. METHODS In this parallel-group, active-comparator study, adult patients (18-65 years, N = 101) with MDD, with inadequate response to current antidepressant monotherapy, were randomized 1:1 to 8 weeks' double-blind treatment with flexible doses (10-20mg/day) of either vortioxetine or escitalopram. Primary and key secondary efficacy measures were the Digit Symbol Substitution Test (DSST), analyzed using a mixed model for repeated measurements, and the University of San Diego Performance-based Skills Assessment - Brief (UPSA-B), analyzed using analysis of covariance (last observation carried forward method). RESULTS At week 8, DSST and UPSA-B performance had improved in both treatment groups, with no statistically significant treatment differences. Numerical improvements across measures of cognition, functioning and mood symptoms generally favored vortioxetine. Most adverse events were mild or moderate, with nausea being the most common adverse event. LIMITATIONS This was an exploratory study with small sample sizes implying limited statistical power. CONCLUSION Although this explorative study did not meet primary endpoints, the results confirm vortioxetine in doses of 10-20mg/day as an efficacious and well-tolerated antidepressant switch treatment. The overall direction of numerical effect sizes across cognition endpoints support previous findings that vortioxetine specifically benefits cognitive function in MDD.
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Affiliation(s)
- Eduard Vieta
- Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
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Dumesnil H, Apostolidis T, Verger P. Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey. PLoS One 2018; 13:e0190565. [PMID: 29385155 PMCID: PMC5791973 DOI: 10.1371/journal.pone.0190565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/23/2017] [Indexed: 11/21/2022] Open
Abstract
Background French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates. Objectives This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression. Methods In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content. Results We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists, Conclusion Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area.
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Affiliation(s)
- Hélène Dumesnil
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Pierre Verger
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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Abstract
OBJECTIVE To identify and explore concepts important to patients with cognitive symptoms of major depressive disorder (MDD) and adapt an existing patient-reported outcome (PRO) measure to assess these symptoms. METHODS Four focus groups were conducted with MDD patients (n = 33) to elicit relevant concepts and determine whether one of several PRO scales could be used to assess cognitive symptoms of depression. Following selection and minor modification of the Perceived Deficits Questionnaire (PDQ), cognitive debriefing interviews were conducted with additional patients (n = 17) to further refine and adapt this measure for use in MDD. Minor revisions based on patient input yielded the PDQ for Depression (PDQ-D). RESULTS Focus group participants reported a variety of cognitive symptoms that were classified into 7 general categories: lack of focus and clear thought, memory problems, difficulty with lexical access, difficulty with divided attention, difficulty with decision making, difficulty thinking quickly, and difficulty learning new things. Limitations in work productivity were the most commonly reported impacts of cognitive symptoms. While suggesting a few modifications, focus group participants reacted positively to the PDQ based on the breadth, specificity, and relevance of the items. Cognitive debriefing participants indicated that the modified PDQ items were generally easy to understand and relevant to their experiences with MDD. CONCLUSION Because cognitive symptoms are burdensome to patients with MDD, their assessment is important to optimize treatment outcomes. The PDQ-D has the potential to supplement existing assessment methods, providing unique information important for both comprehensive evaluation of individuals with MDD and evaluation of new treatments.
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Sun KS, Lam TP, Lam KF, Lo TL. Managing common mental health problems: contrasting views of primary care physicians and psychiatrists. Fam Pract 2015; 32:538-44. [PMID: 26094114 DOI: 10.1093/fampra/cmv044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent studies have reported a lack of collaboration and consensus between primary care physicians (PCPs) and psychiatrists. OBJECTIVE To compare the views of PCPs and psychiatrists on managing common mental health problems in primary care. METHODS Four focus group interviews were conducted to explore the in-depth opinions of PCPs and psychiatrists in Hong Kong. The acceptance towards the proposed collaborative strategies from the focus groups were investigated in a questionnaire survey with data from 516 PCPs and 83 psychiatrists working in public and private sectors. RESULTS In the focus groups, the PCPs explained that several follow-up sessions to build up trust and enable the patients to accept their mental health problems were often needed before making referrals. Although some PCPs felt capable of managing common mental health problems, they had limited choices of psychiatric drugs to prescribe. Some public PCPs experienced the benefits of collaborative care, but most private PCPs perceived limited support from psychiatrists. The survey showed that around 90% of PCPs and public psychiatrists supported setting up an agreed protocol of care, management of common mental health problems by PCPs, and discharging stabilized patients to primary care. However, only around 54-67% of private psychiatrists supported different components of these strategies. Besides, less than half of the psychiatrists agreed with setting up a support hotline for the PCPs to consult them. CONCLUSIONS The majority of PCPs and psychiatrists support management of common mental health problems in primary care, but there is significantly less support from the private psychiatrists.
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Affiliation(s)
| | | | - Kwok Fai Lam
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong and
| | - Tak Lam Lo
- Department of Family Medicine and Primary Care, Kwai Chung Hospital, Hong Kong, China
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López-Cortacans G, Aragonès Benaiges E, Caballero Alías A, Piñol Moreso JL. [Effect of an educational intervention on the attitudes of the nurses of primary care on depression]. ENFERMERIA CLINICA 2015; 25:254-61. [PMID: 25956559 DOI: 10.1016/j.enfcli.2015.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/26/2015] [Accepted: 03/21/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe nurse attitudes toward depression, using a standardized questionnaire and to evaluate how a training workshop can modify or influence these attitudes. METHODS A prospective study based on the application of the Depression Attitude Questionnaire, before and six months after, participating in a training day on the nursing role in the management of depression in Primary Care. The sample consisted of 40 Primary Care nurses from 10 health centers in the province of Tarragona. RESULTS Nurses are in a neutral position when considering the management of depressed patients as a difficult task, or to feel comfortable in this task, but there is a high degree of acceptance of the claim that the time spent caring for depressed patients is rewarding. In general, there was little significant difference in the mean scores for the different items of the Depression Attitude Questionnaire, before and six months, after the training intervention. CONCLUSIONS The attitude towards the management of depression in Primary Care and to the role that nurses can play in this task is generally favorable. Fruitful training and organizational initiatives can be established in order to define and structure the nursing role in the management of depression in Primary Care.
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Affiliation(s)
- Germán López-Cortacans
- Enfermería especializada en salud mental, Centro de Salud Salou, Institut Català de la Salut.
| | - Enric Aragonès Benaiges
- Enfermería especializada en salud mental, Centro de Salud Salou, Institut Català de la Salut; Medicina Familiar, Centro de Salud Constantí, Institut Català de la Salut
| | | | - Josep Lluís Piñol Moreso
- Medicina Familiar y Epidemiología, Unidad de investigación, Atención Primaria Camp de Tarragona, Institut Català de la Salut
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Demyttenaere K, Donneau AF, Albert A, Ansseau M, Constant E, van Heeringen K. What is important in being cured from depression? Discordance between physicians and patients (1). J Affect Disord 2015; 174:390-6. [PMID: 25545606 DOI: 10.1016/j.jad.2014.12.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 01/06/2023]
Abstract
AIMS The comparison of what physicians and patients consider important in being cured from depression. METHODS 426 outpatients (in primary care and in psychiatric care) with a clinical diagnosis of major depression were included: at the start of antidepressant treatment, the importance of a range of items for being cured from depression (depressive, anxious and somatic symptoms, positive affect, functional impairment, quality of life) was assessed in physicians and patients separately and a ranking was made; after 3 months of treatment, the importance of these items for being cured from depression was re-assessed in the patients. RESULTS The items ranked top 10 by physicians mainly contain depressive symptoms while those ranked top 10 by patients mainly contain positive affect items and this attention to positive affect even increases at 3 months follow-up and is higher in patients with recurrent depression than in patients with a first episode of depression. Somatic symptoms consistently get the lowest ranking, as well in physicians as in patients. CONCLUSIONS Physicians differ significantly from patients in what they consider important for 'being cured from depression': physicians mainly focus on alleviation of depressive symptoms while patients mainly focus on the restoration of positive affect.
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Affiliation(s)
- Koen Demyttenaere
- University Psychiatric Centre, University of Leuven, Campus Gasthuisberg, Leuven, Belgium.
| | - Anne-Françoise Donneau
- Department of Medical Informatics and Biostatistics, University of Liège, CHU, Sart Tilman, Liège, Belgium
| | - Adelin Albert
- Department of Medical Informatics and Biostatistics, University of Liège, CHU, Sart Tilman, Liège, Belgium
| | - Marc Ansseau
- Department of Psychiatry and Medical Psychology, University and CHU of Liège, CHU, Sart-Tilman, Liège, Belgium
| | - Eric Constant
- Department of Psychiatry, Catholic University of Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Kees van Heeringen
- University Department of Psychiatry and Medical Psychology, Unit for Suicide Research, University of Ghent Hospital, Ghent, Belgium
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Subramaniam M, He VYF, Vaingankar JA, Abdin E, Chong SA. Prevalence of and factors related to the use of antidepressants and benzodiazepines: results from the Singapore Mental Health Study. BMC Psychiatry 2013; 13:231. [PMID: 24053713 PMCID: PMC3848789 DOI: 10.1186/1471-244x-13-231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 09/18/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prescription and use of antidepressants and benzodiazepines are common in the general population. Prescription of psychotropic drugs is a complex process: patient, physician and healthcare characteristics mediate, interact and influence it. The current study aimed to establish the prevalence and factors associated with the use of antidepressants (ADs) and benzodiazepines (BZDs) in Singapore. METHODS The Singapore Mental Health Study (SMHS) was a nationally representative survey of Singapore Residents aged 18 years and above. Face-to-face interviews were conducted from December 2009 to December 2010. The diagnoses of mental disorders were established using the Composite International Diagnostic Interview version 3.0 (CIDI-3.0). The pharmacoepidemiology section was used to collect information on medication use. RESULTS The overall prevalence estimates for ADs and BZDs use during the 12 months prior to the interview were 1.1% and 1.2% respectively. In all, 2.0% had used ADs and/or BZDs. 'Help seeking for emotional or mental health problems' was the most important predictor for the use of ADs and BZDs-help seekers were much more likely to use ADs (adjusted OR: 31.62, 95% CI: 13.36-74.83) and more likely to use BZDs than non--help seekers in the previous 12 months (adjusted OR: 34.38, 95% CI: 12.97-91.16). Only 27.6% of those with 12-month major depressive disorder (MDD) had sought formal medical help for their problems and ADs were being used by just over a quarter of this 'help-seeking group' (26.3%). CONCLUSIONS We found that the use of ADs and BZDs in our population was relatively low, and 'help-seeking' was the most important predictor of the use of ADs and BZDs. In concordance with research from other Western countries, use of ADs was low among those with 12-month MDD.
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Affiliation(s)
- Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore 539747, Singapore.
| | - Vincent YF He
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Rummel-Kluge C, Kluge M, Kissling W. Frequency and relevance of psychoeducation in psychiatric diagnoses: results of two surveys five years apart in German-speaking European countries. BMC Psychiatry 2013; 13:170. [PMID: 23777594 PMCID: PMC3698181 DOI: 10.1186/1471-244x-13-170] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 06/12/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Psychoeducation has been shown to reduce relapse rates in several psychiatric disorders. Studies investigating for which psychiatric diagnoses psychoeducation is offered and assessing its perceived relevance compared to other interventions are lacking. METHODS A two-part questionnaire addressing these questions was sent to the heads of all psychiatric hospitals in Germany, Austria and Switzerland. Results were compared with those from a similar survey 5 years earlier. RESULTS 289 of 500 (58%) institutions responded. Significantly (p = 0,02) more institutions (93%) offer any type of psychoeducation as compared to 5 years before (86%). Psychoeducation is mainly offered for schizophrenia (86%) and depression (67%) and less frequently for anxiety disorders (18%) and substance abuse (17%). For the following specific diagnoses it is offered by less than 10% of the institutions: Personality disorder, bipolar disorder, posttraumatic stress disorder, dementia, obsessive compulsive disorder, sleeping disorders, eating disorders, schizophrenia plus substance abuse, pain, attention deficit hyperactivity disorder and early psychosis. 25% offer diagnosis-unspecific psychoeducation. 'Pharmacotherapy' (99%), 'basic occupational therapy' (95%) and 'psychoeducation for patients' (93%) were the therapies being most often, 'light therapy' (24%) and 'sleep deprivation' (16%) the therapies being least often perceived as relevant by the respondents when asked about the value of different interventions offered in their hospitals. Art therapy (61%) and psychoanalytically oriented psychotherapy (59%), two therapies with a smaller evidence base than light therapy or sleep deprivation, were perceived as relevant by more than the half of the respondents. CONCLUSION Psychoeducation for patients is considered relevant and offered frequently in German-speaking countries, however, mostly only for schizophrenia and depression. The ranking of the perceived relevance of different treatment options suggests that the evidence base is not considered crucial for determining their relevance.
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Affiliation(s)
- Christine Rummel-Kluge
- Klinik und Poliklinik für Psychiatrie und Psychotherapie am Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
| | - Michael Kluge
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany
| | - Werner Kissling
- Klinik und Poliklinik für Psychiatrie und Psychotherapie am Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Abstract
Belgium, at the crossroads of different cultures, developed complex governmental structures hindering the development of comprehensive mental health policies. A total of 10.2% of the gross domestic product is spent on healthcare but only 6.1% of this total expenditure goes to mental health. Although mental healthcare is largely accessible and offers high levels of quality, it is questionable whether this can be maintained, given the economic climate. The collection of epidemiological data is problematic due to the different ways registration takes place within different care systems and the complexity of the state structure and its consecutive constitutional reforms. Coming from a largely hospital-driven psychiatric care, mental healthcare reforms of past decades have created more community-based care and new care pathways, still an on-going process. Psychiatry as a profession is currently challenged. Teaching mental health issues remains extremely limited within medical schools, resources for research are disproportionally limited, and working conditions less favourable, all this compared with other specialisms. Hence few graduates choose a career in psychiatry. Changing the public perception of what psychiatry is about, redefining the identity of psychiatrists as medical specialists, and their work have become important challenges for the next future.
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Affiliation(s)
- Marc H M Hermans
- Child and Adolescent Psychiatry, Fortuinstraat, Mechelen, Belgium.
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