1
|
Pedro LMR, de Oliveira MF, Pereira MD, da Fonseca AD, Canavarro MC. Factors Associated with Prospective Acceptability and Preferences for Unified Transdiagnostic Cognitive-Behavioral Treatments and Group Therapy in the Portuguese General Population. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:857-876. [PMID: 38839662 DOI: 10.1007/s10488-024-01391-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
Group transdiagnostic cognitive-behavioral therapy (CBT) offers a promising solution for limited mental health access in Portugal. Understanding barriers to patient adherence is crucial for successful implementation. This study aimed to characterize the prospective acceptability and preferences for unified transdiagnostic CBT and group therapy in the Portuguese general population and explore their correlates. A sample of 243 participants (18-88 years old), recruited online, completed an online survey collecting information on sociodemographic and clinical characteristics, acceptability of transdiagnostic CBT treatments, specifically of Unified Protocol (UP), acceptability of group therapy, therapeutic format preferences, beliefs about group therapy and help-seeking attitudes. Most participants were receptive to and perceived as useful both unified transdiagnostic CBT and group therapy. Overall, participants presented significantly more favorable attitudes than unfavorable attitudes toward unified transdiagnostic CBT and group therapy (p < .001). Multivariate analyses revealed that (1) favorable attitudes toward transdiagnostic treatments were negatively associated with being employed and positively associated with living in an urban area, and higher efficacy scores; (2) unfavorable attitudes toward transdiagnostic treatments were positively associated with being married/cohabitating and negatively associated with vulnerability scores; (3) being female, living in an urban area, and higher efficacy and myth scores emerged as positive predictors of favorable attitudes toward group therapy; and (4) efficacy and vulnerability scores and help-seeking propensity emerged as negative predictors of unfavorable attitudes toward group therapy. These findings highlight the importance of delineating strategies to increase knowledge and acceptance of unified transdiagnostic CBT and group therapy in the Portuguese population, addressing specific individual characteristics.
Collapse
Affiliation(s)
- Liliana Maria Rodrigues Pedro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal.
| | | | - Marco Daniel Pereira
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
| | - Ana Dias da Fonseca
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
| |
Collapse
|
2
|
Armoon B, Grenier G, Fleury MJ. Perceived Higher Unmet Care Needs among Adults in Permanent Supportive Housing. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:843-856. [PMID: 38819494 DOI: 10.1007/s10488-024-01390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
This study is original in that it assesses various types of care needs, barriers to care, and factors associated with higher unmet needs among 308 permanent supportive housing (PSH) residents in Quebec (Canada). Data from structured interviews that featured the Perceived Need for Care Questionnaire were collected from 2020 to 2022, controlling for the COVID-19 pandemic period. Eight types of care (e.g., information, counseling) were accounted for. Based on the Behavioral Model for Vulnerable Populations, predisposing, need, and enabling factors associated with higher unmet care needs were assessed using a negative binomial regression model. The study found that 56% of adult PSH residents, even those who had lived in PSH for 5 + years, had unmet care needs. Twice as many unmet needs were due to structural (e.g., care access) rather than motivational barriers. Living in single-site PSH, in healthier neighborhoods, having better quality of life and self-esteem, and being more satisfied with housing and outpatient care were associated with fewer unmet care needs. PSH residents with co-occurring mental disorders (MD) and substance use disorders (SUD), and with moderate or severe psychological distress were likely to have more unmet needs. Better access to care, counseling and integrated treatment for co-occurring MD-SUD might be improved, as well as access to information on user rights, health and available support. Welfare benefits could be increased, with more peer support and meaningful activities, especially in single-site PSH. The quality of the neighborhoods where PSH are located might also be better monitored.
Collapse
Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montréal, Québec, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Montréal, Québec, Canada.
- Department of Psychiatry, McGill University, Montréal, Québec, Canada.
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montréal, QC, H4H 1R3, Canada.
| |
Collapse
|
3
|
Huff NR, Dunderdale L, Kellogg AJ, Isbell LM. Factors related to help-seeking and service utilization for professional mental healthcare among young people: An umbrella review. Clin Psychol Rev 2024; 114:102504. [PMID: 39395209 DOI: 10.1016/j.cpr.2024.102504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 09/12/2024] [Accepted: 09/18/2024] [Indexed: 10/14/2024]
Abstract
The aim of this umbrella review is to summarize evidence on factors that influence help-seeking and service utilization for professional mental healthcare among young people ages 0-30. The CINAHL, Cochrane, Epistemonikos, MEDLINE, PsycINFO, PubMed, and Web of Science databases were searched in December 2023 for systematic reviews in English. The search yielded 26 eligible reviews, all of which are medium or high quality. Primary study overlap was rare. Using an established framework, we organize intrapersonal (n = 37), interpersonal (n = 14), institutional (n = 9), community (n = 7), and public policy (n = 6) factors. The most frequently reviewed factor at each level is trust of professionals (intrapersonal), close others' support for treatment (interpersonal), cost (institutional), availability (community), and insurance (public policy). Stigma is widely referenced (18 reviews) and classified as multi-dimensional. Narrative synthesis reveals population-specific variability (e.g., rural, racial/ethnic minority, refugees, immigrants) in the importance of many factors. To develop interventions and healthcare systems sensitive to young people's needs, we recommend promoting stigma-reduction campaigns, and targeting trustworthiness, affordability, anonymity, accessibility, and mental health literacy. Identifying commonalities and differences across populations and contexts assists in the design of nuanced and efficient treatment delivery systems for young people, who are at a critical time for their mental health.
Collapse
Affiliation(s)
- Nathan R Huff
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America.
| | - Laura Dunderdale
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Alexander J Kellogg
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Linda M Isbell
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| |
Collapse
|
4
|
Domínguez T, Puebla DP, Fresán A, Sheinbaum T, Nieto L, Robles R, López SR, de la Fuente-Sandoval C, Lara Muñoz MDC, Barrantes-Vidal N, Celada-Borja CA, Rosel-Vales M, Saracco R. Why do some Mexicans with psychosis risk symptoms seek mental health care and others do not? Psychiatry Res 2024; 342:116199. [PMID: 39341179 DOI: 10.1016/j.psychres.2024.116199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 09/09/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024]
Abstract
Help-seeking barriers differ according to the sociocultural context and country-specific mental healthcare system. More research is needed in low-middle-income countries, where early psychosis programs are still scarce, and the mental health care gap is wide. This study aims to explore predisposing, enabling, and need factors associated with mental health service utilization in 481 Mexicans self-reporting psychosis risk symptoms, as well as differences between those who were currently mental health service users (MHSU) and those who were not (non-MHSU). Participants responded to self-reported measures through an online survey. The factors associated with an increased probability of using mental health services were having an occupation, having a medium/high socioeconomic status, an intention to seek help from a mental health professional, fewer help-seeking barriers, moderate/severe anxious symptoms, higher distress associated with psychosis risk symptoms and social functioning impairment. Findings provide relevant information for designing more effective strategies to improve help-seeking, early identification, and timely treatment delivery in Mexico. The need to generate strategies focused on reducing stigma, enhancing psychosis literacy in the community, and increasing the identification of emerging signs of psychosis in primary healthcare professionals is highlighted, mainly when co-occurring with other psychiatric symptoms.
Collapse
Affiliation(s)
- Tecelli Domínguez
- Centro de Investigación en Salud Mental Global, Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz"-UNAM, Mexico City, Mexico.
| | | | - Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Tamara Sheinbaum
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Lourdes Nieto
- Centro de Investigación en Salud Mental Global, Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz"-UNAM, Mexico City, Mexico
| | - Rebeca Robles
- Centro de Investigación en Salud Mental Global, Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz"-UNAM, Mexico City, Mexico
| | - Steven R López
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | | | | | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain; Fundació Sanitària Sant Pere Claver, Spanish Mental Health Research Network (CIBERSAM), Spain
| | - César Augusto Celada-Borja
- Clínica de Esquizofrenia, Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Mauricio Rosel-Vales
- Clínica de Esquizofrenia, Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Ricardo Saracco
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Mexico City, Mexico
| |
Collapse
|
5
|
Gao Y, Burns R, Leach L, Chilver MR, Butterworth P. Examining the mental health services among people with mental disorders: a literature review. BMC Psychiatry 2024; 24:568. [PMID: 39164690 PMCID: PMC11334396 DOI: 10.1186/s12888-024-05965-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/15/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Mental disorders are a significant contributor to disease burden. However, there is a large treatment gap for common mental disorders worldwide. This systematic review summarizes the factors associated with mental health service use. METHODS PubMed, Scopus, and the Web of Science were searched for articles describing the predictors of and barriers to mental health service use among people with mental disorders from January 2012 to August 2023. The initial search yielded 3230 articles, 2366 remained after removing duplicates, and 237 studies remained after the title and abstract screening. In total, 40 studies met the inclusion and exclusion criteria. RESULTS Middle-aged participants, females, Caucasian ethnicity, and higher household income were more likely to access mental health services. The use of services was also associated with the severity of mental symptoms. The association between employment, marital status, and mental health services was inconclusive due to limited studies. High financial costs, lack of transportation, and scarcity of mental health services were structural factors found to be associated with lower rates of mental health service use. Attitudinal barriers, mental health stigma, and cultural beliefs also contributed to the lower rates of mental health service use. CONCLUSION This systematic review found that several socio-demographic characteristics were strongly associated with using mental health services. Policymakers and those providing mental health services can use this information to better understand and respond to inequalities in mental health service use and improve access to mental health treatment.
Collapse
Affiliation(s)
- Yunqi Gao
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
| | - Richard Burns
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Liana Leach
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Miranda R Chilver
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Peter Butterworth
- School of Psychology, Deakin University, Melbourne, Australia
- Department of Health, Economics, Wellbeing and Society, Australian National University, Canberra, Australia
| |
Collapse
|
6
|
Zhou M, Lageborn CT, Sjölander A, Larsson H, D'Onofrio B, Landén M, Lichtenstein P, Pettersson E. Psychiatric Diagnoses in Parents and Psychiatric, Behavioral, and Psychosocial Outcomes in Their Offspring: A Swedish Population-Based Register Study. Am J Psychiatry 2024; 181:761-773. [PMID: 39086283 DOI: 10.1176/appi.ajp.20230353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
OBJECTIVE Associations were examined between six psychiatric diagnoses in parents and a broad range of psychiatric and nonpsychiatric outcomes in their offspring. METHODS All individuals born in Sweden between 1970 and 2000 were linked to their biological parents (N=3,286,293) through Swedish national registers. A matched cohort design, with stratified Cox regression and conditional logistic regression analyses, was used examine associations between six psychiatric diagnoses in the parents and 32 outcomes in their offspring. All children, including those exposed and those not exposed to parents with psychiatric diagnoses, were followed from their date of birth to the date of emigration from Sweden, death, or December 31, 2013, when the offspring were 14-44 years old. RESULTS In terms of absolute risk, most children who had parents with psychiatric diagnoses were not diagnosed in specialist care themselves, and the proportion of offspring having any of the 16 types of psychiatric conditions ranged from 22.17% (of offspring exposed to parental depression) to 25.05% (of offspring exposed to parental drug-related disorder) at the end of follow-up. Nevertheless, in terms of relative risk, exposure to any of the six parental psychiatric diagnoses increased probabilities of the 32 outcomes among the offspring, with hazard ratios that ranged from 1.03 to 8.46 for time-to-event outcomes and odds ratios that ranged from 1.29 to 3.36 for binary outcomes. Some specificities were observed for parental diagnoses of psychosis and substance-related disorders, which more strongly predicted psychotic-like and externalizing-related outcomes, respectively, in the offspring. CONCLUSIONS The intergenerational transmission of parental psychiatric conditions appeared largely transdiagnostic and extended to nonpsychiatric outcomes in offspring. Given the broad spectrum of associations with the outcomes, service providers (e.g., psychiatrists, teachers, and social workers) should consider clients' broader psychiatric family history when predicting prognosis and planning interventions or treatment.
Collapse
Affiliation(s)
- Mengping Zhou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Christine Takami Lageborn
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Brian D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (Zhou, Lageborn, Sjölander, Larsson, Landén, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden (Landén)
| |
Collapse
|
7
|
Saunders E, Pevie NW, Bedford S, Gosselin J, Harris N, Rash JA. Moms in motion: Predicting healthcare utilization patterns among mothers in Newfoundland and Labrador. PLoS One 2024; 19:e0304815. [PMID: 38980863 PMCID: PMC11233017 DOI: 10.1371/journal.pone.0304815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/18/2024] [Indexed: 07/11/2024] Open
Abstract
Mothers have a significant influence on family dynamics, child development, and access to family services. There is a lack of literature on the typical Canadian maternal experience and its influence on access to services for mothers despite recognizing the importance of mothers. A cross-sectional study was conducted to address this research gap that employed Andersen's Behavioral Model of Health Service Use in conjunction with a feminist lens. A total of 1,082 mothers who resided in Newfoundland and Labrador (NL) participated in a province-wide survey in 2017 and reported on their wellbeing, family life, and healthcare utilization. Stepwise binomial logistic regressions and linear regressions were used to predict initiation and continued service utilization within the preceding 12 months, respectively. Mothers who participated in this survey were older, and were more likely to be in a relationship than those in the Canadian census, while no difference was observed in annual income. Approximately half of mothers accessed services for themselves over the previous 12-months, with the overwhelming majority accessing services for their children. Medical services were the most likely to be utilized, and mental health and behavioural services were the most likely services to be needed, but not available. Sociodemographic (e.g., age, education attainment), familial relationships and role satisfaction, health need, and health practices predicted maternal initiation and continued use of services, with a larger number of variables influencing maternal service initiation as compared to continuous use of services. Sociodemographic (e.g., maternal age, community population), maternal social support, health need, and maternal health practices predicted maternal access of at least one child service while family relationships, health need, and maternal health practices predicted maternal use of a range of child services conditional on initial access. These results can support the provincial health system to better support access to care by acknowledging the interdependent nature of maternal and child health care utilization. They also highlight the importance of equitable healthcare access in rural locations. Results are discussed in terms of their clinical relevance to health policy.
Collapse
Affiliation(s)
- Emily Saunders
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Noah W. Pevie
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Shannon Bedford
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Julie Gosselin
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Nick Harris
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Joshua A. Rash
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| |
Collapse
|
8
|
Arahanthabailu P, Praharaj SK, Purohith AN, Yesodharan R, Rege S, Appaji R. Exploring barriers to seek mental health services among patients with severe mental illness and their caregivers in a modified assertive community treatment program: A qualitative thematic analysis. Indian J Psychiatry 2024; 66:621-629. [PMID: 39257514 PMCID: PMC11382755 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_314_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 09/12/2024] Open
Abstract
Background Affordability, lack of public mental healthcare facilities, inadequate insurance coverage, and stigma and discrimination are barriers to mental healthcare utilization in India. There is limited research on these barriers and the factors influencing the use of mental health services. Aim To explore the barriers to seeking mental healthcare for individuals with severe mental illness and their caregivers in a modified assertive community treatment program. Methods In a qualitative study using a descriptive thematic analysis, we conducted in-depth interviews with 19 adults, including seven individuals with severe mental illness and twelve caregivers. All the participants had been in the modified assertive community treatment program for at least two years. Using thematic analysis, we identified and grouped codes into subthemes and then clustered into themes. Results Three major themes on barriers to seeking mental health services emerged: service-related factors, societal-related factors, and illness-related factors. Service-related factors included affordability, accessibility and geographical disparity, and noncoverage under insurance schemes. Societal-related factors included social stigma and discrimination, lack of mental health service knowledge and seeking other forms of treatment, and poor social support. Illness-related factors included poor insight into the illness and no relief from the symptoms despite medication. Conclusions Barriers to seeking mental healthcare can be categorized as service-related, societal-related, and illness-related. Identifying these factors will improve mental health service delivery.
Collapse
Affiliation(s)
- Praveen Arahanthabailu
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Samir K Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abhiram N Purohith
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Renjulal Yesodharan
- Department of Psychiatric (Mental Health) Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sumita Rege
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rashmi Appaji
- Department of Psychiatry, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India
| |
Collapse
|
9
|
Penner KE, Roy R, Hanlon-Dearman AC, Cheung K, Katz C, Schleider JL, Roos LE, Cameron EE. "Bottom of My Own List:" Barriers and Facilitators to Mental Health Support Use in Caregivers of Children with Neurodevelopmental Support Needs. J Autism Dev Disord 2024:10.1007/s10803-024-06409-z. [PMID: 38907781 DOI: 10.1007/s10803-024-06409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/24/2024]
Abstract
This study investigated barriers and facilitators to mental health service use (e.g., interventions, educational programs) in caregivers of children with neurodevelopmental disorders and/or neurodevelopmental problems, as they experience high levels of distress and low help-seeking behaviour. Caregivers of children aged 0 to 12 with neurodevelopmental disorders and/or neurodevelopmental problems (N = 78) completed a mixed-method online survey about their mental health and service use. Caregiver-reported psychological distress and mental health service use were positively correlated. Most participants (66.2%) were above the clinical cut-off score for anxiety, depression, or caregiving stress; of these participants, 45.7% had not accessed mental health services for themselves within the past year. Lack of time and difficulties arranging childcare were noted barriers; patient-oriented suggestions for service improvement were provided. The findings add novel information on factors to increase mental health service use in this population. Recommendations for clinical practice for those practitioners who provide services for children with neurodevelopmental disorders and/or neurodevelopmental problems are included.
Collapse
Affiliation(s)
- Kailey E Penner
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
| | - Rachel Roy
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
| | - Ana C Hanlon-Dearman
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Rehabilitation Centre for Children (RCC), Specialized Services for Children and Youth (SSCY) Centre, Winnipeg, MB, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Kristene Cheung
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
- Manitoba FASD Centre, SSCY Centre, Winnipeg, MB, Canada
| | - Cara Katz
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | | | - Leslie E Roos
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Emily E Cameron
- Department of Psychology, University of Manitoba, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada.
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
| |
Collapse
|
10
|
Zerr A, McCabe K, Zhang D, Yeh M. Parent Explanatory Model Personalization as a Method of Reducing Risk for Poor Engagement and Outcomes in PCIT among Culturally Diverse Families. J Clin Med 2024; 13:3541. [PMID: 38930070 PMCID: PMC11204725 DOI: 10.3390/jcm13123541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Evidence supports the efficacy of Behavioral Parent Training (BPT) interventions such as Parent-Child Interaction Therapy (PCIT) for treating child behavior problems; however, treatment engagement and outcomes vary across ethnic groups. Risk for poor treatment engagement and outcomes may be attributed in part to misalignment between parent explanatory model components (PEMs) and the traditional BPT model, including treatment expectations, etiological explanations, parenting styles, and family support for treatment. The present study aims to examine whether personalized treatment adaptations addressing these PEM-BPT misalignments reduce risk for poor treatment engagement and outcomes. Methods: The authors previously utilized the PersIn framework to develop a personalized version of PCIT (MY PCIT) that assesses these PEMs in order to identify families at risk for poor treatment engagement and outcomes. Families were identified as high risk (due to PEM-BPT misalignment) and low risk (meaning those without identified PEM-BPT misalignment) for specific PEMs. Families at elevated risk then received tailored treatment materials designed to improve alignment between the parental explanatory model and the PCIT treatment explanatory model. A recent pilot trial of MY PCIT demonstrated positive treatment outcomes; however, the extent to which adaptations were successful in reducing the underlying risk factors has not yet been examined. Results: Findings demonstrate that the personalization approach was effective in reducing indicators of risk, and that families who were initially at high and low risk during pre-treatment reported similar levels of treatment engagement and outcomes by post-treatment. Conclusions: The findings suggest that this personalized approach has the potential to reduce risk associated with poor treatment engagement and outcomes for culturally diverse families.
Collapse
Affiliation(s)
- Argero Zerr
- Department of Psychology, California State University Channel Islands, 1 University Dr., Camarillo, CA 93012, USA
| | - Kristen McCabe
- Department of Psychological Sciences, University of San Diego, 5998 Alcala Park, San Diego, CA 92110, USA
- Child and Adolescent Services Research Center, San Diego, CA 92123, USA
| | - Dongbowei Zhang
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
| | - May Yeh
- Child and Adolescent Services Research Center, San Diego, CA 92123, USA
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| |
Collapse
|
11
|
Mortier P, Conde S, Alayo I, Amigo F, Ballester L, Cirici Amell R, Guinart D, Contaldo SF, Ferrer M, Leis A, Mayer MA, Portillo-Van Diest A, Puértolas-Gracia B, Ramírez-Anguita JM, Peña-Salazar C, Sanz F, Kessler RC, Palao D, Pérez Sola V, Mehlum L, Qin P, Vilagut G, Alonso J. Premature Death, Suicide, and Nonlethal Intentional Self-Harm After Psychiatric Discharge. JAMA Netw Open 2024; 7:e2417131. [PMID: 38922620 PMCID: PMC11208976 DOI: 10.1001/jamanetworkopen.2024.17131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/13/2024] [Indexed: 06/27/2024] Open
Abstract
Importance There is a need for representative research on serious adverse outcomes following discharge from psychiatric hospitalization. Objective To compare rates of premature death, suicide, and nonlethal intentional self-harm after psychiatric discharge with rates in the general population and investigate associations of these outcomes with relevant variables associated with the index psychiatric hospitalization. Design, Setting, and Participants This retrospective cohort study included all residents from Catalonia, Spain (7.6 million population), who had psychiatric hospitalizations between January 1, 2014, and December 31, 2018, and were older than 10 years at the index (first) hospitalization. Follow-up was until December 31, 2019. Statistical analysis was performed from December 1, 2022, through April 11, 2024. Exposures Socioeconomic status, psychiatric diagnoses, duration of index hospitalization, and number of previous psychiatric hospitalizations. Main Outcomes and Measures Postdischarge premature death (ie, all-cause death before age 70 years) and suicide (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code range X60-X84), identified using mortality data, and postdischarge nonlethal intentional self-harm, identified using electronic health record and self-harm case register data. Standardized mortality ratios (SMRs) compared rates of premature death and suicide between the cohort and the general population. Fully adjusted, multivariable, cause-specific Cox proportional hazards regression models for the 3 outcomes were fitted. Results A total of 49 108 patients discharged from psychiatric hospitalization were included (25 833 males [52.6%]; mean [SD] age at discharge, 44.2 [18.2] years). During follow-up, 2260 patients (4.6%) died prematurely, 437 (0.9%) died by suicide, and 4752 (9.7%) had an episode of nonlethal intentional self-harm. The overall SMR for premature death was 7.5 (95% CI, 7.2-7.9). For suicide, SMR was 32.9 (95% CI, 29.9-36.0) overall and was especially high among females (47.6 [95% CI, 40.2-54.9]). In fully adjusted sex-stratified hazard models, postdischarge premature death was associated with cognitive disorders (adjusted hazard ratio [AHR], 2.89 [95% CI, 2.24-3.74] for females; 2.59 [95% CI, 2.17-3.08] for males) and alcohol-related disorders (AHR, 1.41 [95% CI, 1.18-1.70] for females; 1.22 [95% CI, 1.09-1.37] for males). Postdischarge suicide was associated with postdischarge intentional self-harm (AHR, 2.83 [95% CI, 1.97-4.05] for females; 3.29 [95% CI, 2.47-4.40] for males), with depressive disorders (AHR, 2.13 [95% CI, 1.52-2.97]) and adjustment disorders (AHR, 1.94 [95% CI, 1.32-2.83]) among males, and with bipolar disorder among females (AHR, 1.94 [95% CI, 1.21-3.09]). Postdischarge intentional self-harm was associated with index admissions for intentional self-harm (AHR, 1.95 [95% CI, 1.73-2.21] for females; 2.62 [95% CI, 2.20-3.13] for males) as well as for adjustment disorders (AHR, 1.48 [95% CI, 1.33-1.65] for females; 1.99 [95% CI, 1.74-2.27] for males), anxiety disorders (AHR, 1.24 [95% CI, 1.10-1.39] for females; 1.36 [95% CI, 1.18-1.58] for males), depressive disorders (AHR, 1.54 [95% CI, 1.40-1.69] for females; 1.80 [95% CI, 1.58-2.04] for males), and personality disorders (AHR, 1.59 [95% CI, 1.46-1.73] for females; 1.43 [95% CI, 1.28-1.60] for males). Conclusions and Relevance In this cohort study of patients discharged from psychiatric hospitalization, risk for premature death and suicide was significantly higher compared with the general population, suggesting individuals discharged from psychiatric inpatient care are a vulnerable population for premature death and suicidal behavior.
Collapse
Affiliation(s)
- Philippe Mortier
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Susana Conde
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Itxaso Alayo
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
- Biosistemak Institute for Health Systems Research, Barakaldo, Bizkaia, Spain
| | - Franco Amigo
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Laura Ballester
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Roser Cirici Amell
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Daniel Guinart
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM, ISCIII), Madrid, Spain
- Mental Health Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Psychiatry, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | | | - Montserrat Ferrer
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Angela Leis
- Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Miguel Angel Mayer
- Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ana Portillo-Van Diest
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Beatriz Puértolas-Gracia
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Juan Manuel Ramírez-Anguita
- Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Carlos Peña-Salazar
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
- Mental Health and Intellectual Disability Services, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Neurology Department, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Ferran Sanz
- Research Program on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Instituto Nacional de Bioinformatica–ELIXIR-ES (IMPaCT-Data-ISCIII), Barcelona, Spain
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Diego Palao
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM, ISCIII), Madrid, Spain
- Department of Mental Health, Hospital Universitari Parc Taulí; Institut d’Investigació i Innovació Parc Taulí (I3PT), Unitat de Neurociències Traslacional I3PT-INc Universitat Autònoma de Barcelona, Sabadell, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Víctor Pérez Sola
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM, ISCIII), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gemma Vilagut
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
| | - Jordi Alonso
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III (CIBERESP, ISCIII), Madrid, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| |
Collapse
|
12
|
Huang H, Huynh B, Nidey N, Huang H. Meaningful Engagement in Depression and Anxiety Collaborative Care: Associations With Systematic Case Review. J Acad Consult Liaison Psychiatry 2024; 65:254-260. [PMID: 38309684 DOI: 10.1016/j.jaclp.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Collaborative care (CC) is an evidence-based model of care for treating behavioral health conditions in primary care settings. The CC team consists of a primary care provider, behavioral health care manager (CM), and a consultant psychiatrist who collaborate to create treatment plans. To date, there is limited data on factors associated with meaningful engagement in CC programs. OBJECTIVE To identify the proportion of patients who were meaningfully engaged and to investigate the factors associated with meaningful engagement in a CC program. METHODS Data was collected from a CC program implemented across 27 adult primary care clinics in a Midwestern, U.S. academic medical system. Logistic regression (n = 5218) was used to estimate the odds of receiving meaningful engagement. RESULTS Data was collected from 6437 individuals with 68% being female and a mean age of 45 years old (standard deviation 17.6). Overall, 57% of patients were meaningfully engaged; however, this proportion differed based on demographic and clinical factors. Among modifiable clinical factors, systematic case reviews between the CM and psychiatrist (odds ratio: 10.2, 95% confidence interval: 8.6-12.1) and warm handoffs (odds ratio: 1.3, 95% confidence interval: 1.1-1.5) were associated with a higher likelihood of receiving meaningful engagement. CONCLUSIONS The presence of systematic case reviews between the behavioral health CM and the consultant psychiatrist was highly associated with meaningful engagement. When implementing such programs, high fidelity to the core principles including regularly scheduled systematic case reviews should be pursued.
Collapse
Affiliation(s)
- Heather Huang
- Department of Psychiatry, University of Wisconsin Hospitals and Clinics, Madison, WI.
| | - Brandon Huynh
- Department of Psychiatry, University of Wisconsin Hospitals and Clinics, Madison, WI
| | - Nichole Nidey
- College of Public Health, University of Iowa, Iowa City, IA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA
| |
Collapse
|
13
|
Subramaniam DS, Zhang Z, Timmer Z, DeMarco EC, Poirier MP, Hinyard LJ. Palliative Care and Mental Health among Pancreatic Cancer Patients in the United States: An Examination of Service Utilization and Health Outcomes. Healthcare (Basel) 2024; 12:842. [PMID: 38667604 PMCID: PMC11050506 DOI: 10.3390/healthcare12080842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Palliative care (PC) utilization remains low among pancreatic cancer patients. This study explores the association of PC with mental health service and pharmacotherapy utilization among pancreatic cancer patients. METHODS Retrospective analysis was conducted on a sample of patients in the United States with newly diagnosed pancreatic cancer using Electronic Health Record data from Optum's Integrated Claims-Clinical data set. Subsequent diagnoses of anxiety and depression and PC consultation encounters were determined using ICD-9/10 codes. Adjusted associations of mental health treatments with PC and patient characteristics were quantified using multiple logistic regression. RESULTS Among newly diagnosed pancreatic cancer patients (n = 4029), those with PC consultations exhibited a higher prevalence of anxiety (33.9% vs. 22.8%) and depression (36.2% vs. 23.2%). Mental health service use and pharmacotherapy varied, with the highest utilization among patients having both anxiety and depression. Treatment pattern was also influenced by age (aOR 1.832 for age <55 vs. 65-70 years). Notably, PC consultations showed no significant effect on the likelihood of documented treatment. DISCUSSION Our study emphasizes underutilization of PC and MH treatment for pancreatic cancer patients. These findings imply a crucial need for further investigation into palliative care's role in addressing mental health concerns among pancreatic cancer patients.
Collapse
Affiliation(s)
- Divya S. Subramaniam
- Department of Health and Clinical Outcomes Research, Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine, St. Louis, MO 63108, USA (Z.T.); (M.P.P.)
| | | | | | | | | | | |
Collapse
|
14
|
Flores MW, Mullin B, Sharp A, Kumar A, Moyer M, Cook BL. Examining Racial/Ethnic Disparities in Tobacco Dependence Treatment Among Medicaid Beneficiaries Using Fifty State Medicaid Claims, 2009-2014. J Racial Ethn Health Disparities 2024; 11:755-763. [PMID: 37326794 DOI: 10.1007/s40615-023-01558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/17/2023]
Abstract
In the USA, low-income racial/ethnic minority groups experience higher smoking rates and greater smoking-related disease burden than their White counterparts. Despite the adverse effects, racial/ethnic minorities are less likely to access tobacco dependence treatment (TDT). Medicaid is one of the largest payers of TDT in the USA and covers predominantly low-income populations. The extent of TDT use among beneficiaries from distinct racial/ethnic groups is unknown. The objective is to estimate racial/ethnic differences in TDT use among Medicaid fee-for-service beneficiaries. Using a retrospective study design and 50 state (including the District of Columbia) Medicaid claims (2009-2014), we employed multivariable logistic regression models and predictive margin methods to estimate TDT use rates among adults (18-64) enrolled (≥ 11 months) in Medicaid fee-for-service programs (January 2009-December 2014) by race/ethnicity. The population included White (n = 6,536,004), Black (n = 3,352,983), Latinx (n = 2,264,647), Asian (n = 451,448), and Native American/Alaskan Native (n = 206,472) beneficiaries. Dichotomous outcomes reflected service use in the past year. Any TDT use was operationalized as any smoking cessation medication fill, any smoking cessation counseling visit, or any smoking cessation outpatient visit. In secondary analyses, we disaggregated TDT use into three separate outcomes. Results suggested that Black (10.6%; 95% CI = 9.9-11.4%), Latinx (9.5%; 95% CI = 8.9-10.2%), Asian (3.7%; 95% CI = 3.4-4.1%), and Native American/Alaskan Native (13.7%; 95% CI = 12.7-14.7%) beneficiaries had lower TDT use rates compared to White beneficiaries (20.6%). Similar racial/ethnic treatment disparities were identified across all outcomes. By identifying significant racial/ethnic disparities in TDT use between 2009 and 2014, this study provides a benchmark against which to measure recent interventions in state Medicaid programs improving equity in smoking cessation interventions.
Collapse
Affiliation(s)
- Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Brian Mullin
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
| | - Amanda Sharp
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Center for Mindfulness & Compassion, Cambridge Health Alliance, Cambridge, MA, USA
| | - Anika Kumar
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Heller School of Social Policy, Brandies University, Waltham, MA, USA
| | - Margo Moyer
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
15
|
Mortier P, Vilagut G, García-Mieres H, Alayo I, Ferrer M, Amigo F, Aragonès E, Aragón-Peña A, Asúnsolo Del Barco Á, Campos M, Espuga M, González-Pinto A, Haro JM, López Fresneña N, Martínez de Salázar AD, Molina JD, Ortí-Lucas RM, Parellada M, Pelayo-Terán JM, Pérez-Gómez B, Pérez-Zapata A, Pijoan JI, Plana N, Polentinos-Castro E, Portillo-Van Diest A, Puig T, Rius C, Sanz F, Serra C, Urreta-Barallobre I, Kessler RC, Bruffaerts R, Vieta E, Pérez-Solá V, Alonso J. Health service and psychotropic medication use for mental health conditions among healthcare workers active during the Spain Covid-19 Pandemic - A prospective cohort study using web-based surveys. Psychiatry Res 2024; 334:115800. [PMID: 38387166 DOI: 10.1016/j.psychres.2024.115800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/30/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024]
Abstract
Little is known about healthcare workers' (HCW) use of healthcare services for mental disorders. This study presents data from a 16-month prospective cohort study of Spanish HCW (n = 4,809), recruited shortly after the COVID-19 pandemic onset, and assessed at four timepoints using web-based surveys. Use of health services among HCW with mental health conditions (i.e., those having a positive screen for mental disorders and/or suicidal thoughts and behaviours [STB]) was initially low (i.e., 18.2 %) but increased to 29.6 % at 16-month follow-up. Service use was positively associated with pre-pandemic mental health treatment (OR=1.99), a positive screen for major depressive disorder (OR=1.50), panic attacks (OR=1.74), suicidal thoughts and behaviours (OR=1.22), and experiencing severe role impairment (OR=1.33), and negatively associated with being female (OR = 0.69) and a higher daily number of work hours (OR=0.95). Around 30 % of HCW with mental health conditions used anxiolytics (benzodiazepines), especially medical doctors. Four out of ten HCW (39.0 %) with mental health conditions indicated a need for (additional) help, with most important barriers for service use being too ashamed, long waiting lists, and professional treatment not being available. Our findings delineate a clear mental health treatment gap among Spanish HCW.
Collapse
Affiliation(s)
- Philippe Mortier
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Gemma Vilagut
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Helena García-Mieres
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Itxaso Alayo
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Biosistemak Institute for Health Systems Research, Barakaldo, Bizkaia, Spain
| | - Montse Ferrer
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Franco Amigo
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Enric Aragonès
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Barcelona, Spain; Atenció Primària Camp de Tarragona, Institut Català de la Salut, Spain
| | - Andrés Aragón-Peña
- Epidemiology Unit, Regional Ministry of Health, Community of Madrid, Madrid, Spain; Fundación Investigación e Innovación Biosanitaria de AP, Comunidad de Madrid, Madrid, Spain
| | - Ángel Asúnsolo Del Barco
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, United States
| | - Mireia Campos
- Service of Prevention of Labor Risks, Medical Emergencies System, Generalitat de Catalunya, Spain
| | - Meritxell Espuga
- Occupational Health Service. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana González-Pinto
- BIOARABA, Hospital Universitario Araba-Santiago, UPV/EHU, Vitoria-Gasteiz, Spain; CIBER Salud Mental (CIBERSAM), Madrid, Spain
| | - Josep M Haro
- CIBER Salud Mental (CIBERSAM), Madrid, Spain; Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | | | - Juan D Molina
- CIBER Salud Mental (CIBERSAM), Madrid, Spain; Villaverde Mental Health Center, Clinical Management Area of Psychiatry and Mental Health, Psychiatric Service, Hospital Universitario 12 de Octubre, Madrid, Spain; Research Institute Hospital 12 de Octubre (i+12), Madrid, Spain; Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Rafael M Ortí-Lucas
- Service of Preventive Medicine and Quality of Attention, University Clinical Hospital of Valencia, Valencia, Spain
| | - Mara Parellada
- CIBER Salud Mental (CIBERSAM), Madrid, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Maria Pelayo-Terán
- CIBER Salud Mental (CIBERSAM), Madrid, Spain; Servicio de Psiquiatría y Salud Mental. Hospital el Bierzo, Gerencia de Asistencia Sanitaria del Bierzo (GASBI). Gerencia Regional de Salud de Castilla y Leon (SACYL). Ponferrada, León, Spain; Area de Medicina Preventiva y Salud Pública. Universidad de León, León, Spain
| | - Beatriz Pérez-Gómez
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; National Center of Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - José Ignasio Pijoan
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Clinical Epidemiology Unit-Hospital Universitario Cruces/ OSI EEC, Bilbao, Spain/ Biocruces-Bizkaia Health Research Institute, Spain
| | - Nieves Plana
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - Elena Polentinos-Castro
- Research Unit Primary Care Management, Madrid Health Service, Madrid, Spain; Department of Medical Specialities and Public Health. King Juan Carlos University, Madrid, Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud RICAPPS-(RICORS). Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ana Portillo-Van Diest
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Teresa Puig
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Department of Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Cristina Rius
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Ferran Sanz
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain; Research Progamme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, MELIS, Universitat Pompeu Fabra, Barcelona, Spain; Instituto Nacional de Bioinformatica - ELIXIR-ES, Barcelona, Spain
| | - Consol Serra
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain; CiSAL-Centro de Investigación en Salud Laboral, Hospital del Mar Research Institute/UPF, Barcelona, Spain
| | - Iratxe Urreta-Barallobre
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Donostia University Hospital, Clinical Epidemiology Unit, San Sebastián, Spain; Biodonostia Health Research Institute, Clinical Epidemiology, San Sebastián, Spain
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronny Bruffaerts
- Center for Public Health Psychiatry, Universitair Psychiatrisch Centrum, KU Leuven, Leuven, Belgium
| | - Eduard Vieta
- CIBER Salud Mental (CIBERSAM), Madrid, Spain; Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Víctor Pérez-Solá
- CIBER Salud Mental (CIBERSAM), Madrid, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Jordi Alonso
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| |
Collapse
|
16
|
Sultana T. Intersectional Effect of Gender, Race, and Socioeconomic Status in Mental Health Service Utilization: Evidence from the Canadian Community Health Survey 2015-2016. Community Ment Health J 2024; 60:589-599. [PMID: 38041771 DOI: 10.1007/s10597-023-01213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
This study examined the intersectional effects of gender, race, and socioeconomic status (SES) on mental health service utilization (MHSU) employing the intersectionality framework. Data was extracted from Canadian Community Health Survey 2015-2016 with a total of 85,619 sample. Covariate adjusted prevalence ratio (aPR) and the predicted probability of MHSU from intersectional analyses were estimated using Poisson regression with robust variance. The prevalence of MHSU was 15.04% overall, 19.61% among women, 10.27% among men, 21.56% among white women and 11.12% among white men. The study observed overall significant intersectional effect of SES by gender and race on MHSU. For instance, white men with the lowest income were more likely to have MHSU compared to their counterparts. Similarly, the predicted probability of MHSU decreased with the increase of SES that varied by gender and race. Two-way and three-way interactions also confirmed statistical significance (p-interaction < 0.05) of intersectional effect of gender, race, and SES. The observed socioeconomic differences in MHSU across gender and racial groups can be explained by intersectionality.
Collapse
Affiliation(s)
- Toufica Sultana
- General Education Cell, Eastern University, Dhaka, Bangladesh.
- South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh.
- Department of Sociology, University of Saskatchewan, Saskatoon, Canada.
| |
Collapse
|
17
|
Brown DMY, Lerner I, Cairney J, Kwan MY. Independent and Joint Associations of Physical Activity and Sleep on Mental Health Among a Global Sample of 200,743 Adults. Int J Behav Med 2024:10.1007/s12529-024-10280-8. [PMID: 38532194 DOI: 10.1007/s12529-024-10280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Previous research has demonstrated that both sleep and physical activity (PA) are independently associated with various indicators of mental health among adults. However, their joint contribution to mental health has received limited attention. The present study used cross-sectional data from the Mental Health Million Project to examine the independent and joint effects of sleep and PA on mental health among a global sample of adults, and whether these effects differ among individuals receiving mental health treatment. METHOD The sample included 200,743 participants (33.1% young adults, 45.6% middle-aged adults, 21.3% older adults; 57.6% females, 0.9% other) from 213 countries, territories, and archipelagos worldwide that completed a comprehensive 47-item assessment of mental health including both problems (i.e., ill-being) and assets (i.e., well-being): the Mental Health Quotient. Participants also reported their weekly frequency of PA and adequate sleep, and mental health treatment status. A series of generalized linear mixed models were computed. RESULTS Independent dose-response associations were observed, whereby greater amounts of PA and adequate sleep were each associated with better mental health. In addition, a synergistic interaction was observed in which the positive correlation of PA with mental health was strengthened with greater frequency of adequate sleep. These benefits were less pronounced among adults receiving mental health treatment. CONCLUSION While findings suggest sleep can help to offset the negative influence of a physically inactive lifestyle (and vice versa), our results point to a "more is better" approach for both behaviors when it comes to promoting mental health.
Collapse
Affiliation(s)
- Denver M Y Brown
- Department of Psychology, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX, USA.
| | - Itamar Lerner
- Department of Psychology, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX, USA
| | - John Cairney
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Matthew Y Kwan
- Department of Child and Youth Studies, Brock University, St. Catherines, Canada
| |
Collapse
|
18
|
Lawrence-Sidebottom D, Huffman LG, Beam AB, Guerra R, Parikh A, Roots M, Huberty J. Rates of Trauma Exposure and Posttraumatic Stress in a Pediatric Digital Mental Health Intervention: Retrospective Analysis of Associations With Anxiety and Depressive Symptom Improvement Over Time. JMIR Pediatr Parent 2024; 7:e55560. [PMID: 38412001 PMCID: PMC10933721 DOI: 10.2196/55560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND More than 2 out of 3 children and adolescents in the United States experience trauma by the age of 16 years. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been an increasing uptake of digital mental health interventions (DMHIs) among youths, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youths participating in DMHIs and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youths. OBJECTIVE This study aims to use retrospective data from youths participating in a DMHI to (1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms; (2) determine whether trauma exposure and elevated PTS symptoms impact the improvement of comorbid anxiety and depressive symptoms throughout participation in care; and (3) determine whether participation in a non-posttraumatic DMHI is linked to reductions in PTS symptoms. METHODS This study was conducted using retrospective data from members (children ages 6 to 12 years) involved in a pediatric collaborative care DMHI. Participating caregivers reported their children's trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments. RESULTS Among eligible participants (n=966), 30.2% (n=292) reported at least 1 traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n=119), 73% (n=87) exhibited elevated anxiety symptoms and 50% (n=59) exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety but not depressive symptoms (anxiety: F2,287=26.11; P<.001). PTS symptoms also decreased significantly throughout care, with 96% (n=79) of participants showing symptom reductions. CONCLUSIONS This study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and nontrauma-exposed youths, among participants in a pediatric collaborative care DMHI. Youths with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma while also highlighting the critical need to assess symptoms of PTS in children seeking treatment.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jennifer Huberty
- Bend Health Inc, Madison, WI, United States
- FitMinded Inc LLC, Phoenix, AZ, United States
| |
Collapse
|
19
|
Vickery A. Exploring the Characteristics of Men Aged 55+ Who Use Mental Health Community Care and Support Services: A Secondary Analysis of the Adult Psychiatric Morbidity Study in England. J Aging Health 2024:8982643241227251. [PMID: 38235737 DOI: 10.1177/08982643241227251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
ObjectivesThe aim of this study is to understand the demographic and situational characteristics of men over 55 who have used a community support service. Method: Hierarchical multivariable logistic regression was conducted using anonymised data from the Adult Psychiatric Morbidity Study 2014. Results: Need factors such as having a common mental disorder (CMD), poor general health and having counselling/therapy were the most relevant to use of a community support service. It was more common for older men (85+), single men, and those who reported experiencing several traumatic life events to have used a community support service. Discussion: The results are critically discussed by considering the roles of gender, ageing, and social support, which might influence the use of community support services. There is a need for more awareness of categories such as age and previous service use, and how they might influence community support help seeking.
Collapse
Affiliation(s)
- Alex Vickery
- Cardiff School of Education and Social Policy, Cardiff Metropolitan University, Bristol, UK
| |
Collapse
|
20
|
Nagel LC, Tesky VA, Schall A, Müller T, König J, Pantel J, Stangier U. Compliance with CBT referral in nursing home residents diagnosed with depression: Results from a feasibility study. Heliyon 2024; 10:e23379. [PMID: 38148800 PMCID: PMC10750160 DOI: 10.1016/j.heliyon.2023.e23379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Objectives Patient-level factors that influence compliance with a recommendation for CBT in nursing home residents diagnosed with depression were identified. Methods Within a cluster-randomized trial on stepped care for depression in nursing homes (DAVOS-study, Trial registration: DRKS00015686), participants received an intake interview administered by a licensed psychotherapist. If psychotherapy was required, patients were offered a referral for CBT. Sociodemographic characteristics, severity of depression, loneliness, physical health, antidepressant medication, prior experience with psychotherapy, and attitudes towards own aging were assessed. A binary regression determined predictors of compliance with referral. Results Of 123 residents receiving an intake interview, 80 were recommended a CBT. Forty-seven patients (58.8 %) followed the recommendation. The binary logistic regression model on compliance with recommended CBT was significant, χ2(9) = 21.64, p = .010. Significant predictors were age (Odds Ratio (OR) = 0.9; 95 % Confidence Interval (CI) = 0.82, 0.99; p = .024) and depression (OR = 1.33; 95 % CI = 1.08, 1.65; p = .008). Conclusion Within the implemented setting compliance rate was comparable to other age groups. Future interventions should include detailed psychoeducation on the benefits of psychotherapy on mild depressive symptoms in older age and evidence-based interventions to address the stigma of depression. Interventions such as reminiscence-based methods or problem-solving could be useful to increase compliance with referral, especially in very old patients (80+). Language barriers and a culturally sensitive approach should be considered when screening residents.
Collapse
Affiliation(s)
| | | | - Arthur Schall
- Department of General Medicine, Goethe University, Frankfurt, Germany
| | - Tanja Müller
- Frankfurt Forum for Interdisciplinary Ageing Research, Goethe University, Frankfurt, Germany
| | - Jochem König
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Johannes Pantel
- Department of General Medicine, Goethe University, Frankfurt, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology, Goethe University, Frankfurt, Germany
| |
Collapse
|
21
|
Theis S, Bitterlich N, von Wolff M, Stute P. Measuring Quality of Life: Incorporating Objectively Measurable Parameters within the Cross-Sectional Bern Cohort Study 2014 (BeCS-14). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:94. [PMID: 38248557 PMCID: PMC10815394 DOI: 10.3390/ijerph21010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
Up until now, the measurement of Quality of Life (QoL) was based on validated subjective rating tools rather than objective measurement. To become more independent of the self-assessment of probands, a way to objectively measure QoL should be found. A monocenter, cross-sectional, observational, non-interventional trial was performed from 2012 to 2014 at Inselspital Bern to evaluate the bio-functional status (BFS), a complex, generic, non-invasive, sex- and age-validated assessment tool, in a wide range of areas. A standardized battery of assessments was performed on 464 females and 166 males, ages 18 to 65 (n = 630). In addition to the survey of the BFS, participants replied-among others-to the validated questionnaire SF-36 for health-related QoL (n = 447, subgroup 1). Since the accepted cut-off value for BFA calculation is age ≥ 35 years, subgroup 2 included 227 subjects (all participants aged ≥ 35 years out of subgroup 1). In order to be able to compare the eight SF-36 subscales to BFS parameters, a comparable score set of single BFS items had to be constructed. Subsequently, we aimed to statistically identify BFS item combinations that best represented each SF-36 subscale. All eight SF-36 subscales were significantly represented by various different combinations of BFS items. A total of 24 single BFS items significantly correlated with SF-36 subscales, of which 15 were objective and nine were subjective. All eight SF-36 subscales were significantly represented by various different combinations of BFS items leading to stronger correlations (range five to nine BFS items), and overall, sex and age did not affect these associations, but in the SF-36 subscales 'bodily pain' (sex) and 'role limitations due to physical health problems' (age in men). To our knowledge, we are the first to correlate a validated set of 34 objective and 9 subjective parameters with subjectively evaluated SF-36 subscales. This first study on the objectifiability of the SF-36 questionnaire demonstrated that questions on quality of life can be answered independently of a subjective assessment by subjects in future scientific studies.
Collapse
Affiliation(s)
- Susanne Theis
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Division of Gynecological Endocrinology and Reproductive Medicine, Langenbeckstr. 1, 55131 Mainz, Germany;
| | - Norman Bitterlich
- Independent Researcher, Draisdorfer Str. 21, 09114 Chemnitz, Germany;
| | - Michael von Wolff
- University Clinic Bern, Division of Gynecological Endocrinology and Reproductive Medicine, University Women’s Hospital, Inselspital Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland;
| | - Petra Stute
- University Clinic Bern, Division of Gynecological Endocrinology and Reproductive Medicine, University Women’s Hospital, Inselspital Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland;
| |
Collapse
|
22
|
da Conceição V, Mesquita E, Gusmão R. Effects of a stigma reduction intervention on help-seeking behaviors in university students: A 2019-2021 randomized controlled trial. Psychiatry Res 2024; 331:115673. [PMID: 38113809 DOI: 10.1016/j.psychres.2023.115673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Stigma is one of the most frequently identified help-seeking barriers, but there is a lack of research on the effects of stigma reduction interventions on actual mental health help-seeking behaviors during crucial academic years. This research explores the effects of stigma on university students' mental health care help-seeking behaviors before and during the pandemic. METHODS A randomized control trial spanned from 2019 to 2021 at the University of Porto, along five evaluation moments, with students into one control group and two intervention groups-the interventions aimed to reduce depression stigma. RESULTS Among the 702 participants (mean age 18.87, 59.4 % female), the intervention groups significantly increased help-seeking behaviors. In 2020, the intervention groups, having reduced stigma, continued to demonstrate to be more prompt to seek mental health help. In 2021, 22 months, the effects of the intervention on help-seeking were no longer significant; however, participants in the intervention groups showed less severe symptomatology. CONCLUSION Stigma reduction interventions have a pronounced effect on enhancing help-seeking behaviors among university students, even during times of crisis. This study advocates for prioritizing stigma reduction in academic settings, highlighting its value in promoting mental health access during crucial academic and life challenges.
Collapse
Affiliation(s)
- Virgínia da Conceição
- EPIUnit - Institute of Public Health, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
| | - Edgar Mesquita
- EPIUnit - Institute of Public Health, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Ricardo Gusmão
- EPIUnit - Institute of Public Health, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Portugal
| |
Collapse
|
23
|
Soleimanvandiazar N, Mohaqeqi Kamal SH, Basakha M, Karim S, Ahmadi S, Ghaedamini Harouni G, Sajjadi H, Setareh Forouzan A. Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241229622. [PMID: 38339828 PMCID: PMC10859068 DOI: 10.1177/00469580241229622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
Unequal utilization in healthcare can potentially affect the right to health. Access to healthcare services and achieving positive health outcomes and health equity are essential principles in promoting human rights. This study aims to assess and analyze socioeconomic-related inequalities in outpatient health services utilization (OHSU) among various socio-demographic subgroups to inform policies that foster health equity. Data were collected through a cross-sectional survey of 1200 households in Tehran, Iran. Inequality in OHSU among the socio-demographic subgroups was calculated by concentration, Wagstaff, and Erigers indices. Decomposition was used to identify the factors contributing to inequality in OHSU. Marginal effect and elasticity were used to calculate the relative absolute shares of socio-demographic variables in the inequality. The rate of OHSU was 63.61% (CI: 60-66.80) which concentrated among households with better socioeconomic status. Based on the results, living in an affluent neighborhood (Relative share (RS): 85.48) and having a disabled member in the household (RS: 6.58) were the most important factors in the concentration of OHSU in favor of the privileged groups. In contrast, very low levels of health knowledge (RS: -83.79) and having basic insurance coverage (RS: -3.92) concentrated OHSU in favor of the lower socioeconomic households. The study was conducted based on survey data, and this may lead to some limitations. Given that this study was a cross-sectional study, we were unable to establish causal relationships between explanatory variables and outpatient health service utilization and its relevant predictors. Households with disabled member(s), as well as a member(s) with chronic diseases, may experience severe inequalities in access to healthcare services. Policies that facilitate access to health services for these households can play a significant role in improving health equity.
Collapse
Affiliation(s)
| | | | - Mehdi Basakha
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Sina Ahmadi
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Homeira Sajjadi
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | |
Collapse
|
24
|
Sanabria-Mazo JP, Colomer-Carbonell A, Fernández-Vázquez Ó, Noboa-Rocamora G, Cardona-Ros G, McCracken LM, Montes-Pérez A, Castaño-Asins JR, Edo S, Borràs X, Sanz A, Feliu-Soler A, Luciano JV. A systematic review of cognitive behavioral therapy-based interventions for comorbid chronic pain and clinically relevant psychological distress. Front Psychol 2023; 14:1200685. [PMID: 38187407 PMCID: PMC10766814 DOI: 10.3389/fpsyg.2023.1200685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Chronic pain frequently co-occurs with clinically relevant psychological distress. A systematic review was conducted to identify the efficacy of cognitive behavioral therapy-based interventions for patients with these comorbid conditions. Methods The systematic search was carried out in Medline, PsycINFO, Web of Science, and Scopus up to March 18th, 2023. Four reviewers independently conducted screenings, extraction, and quality assessment. Results Twelve randomized controlled trials and one non-randomized controlled trial involving 1,661 participants that examined the efficacy of Cognitive Behavioral Therapy (nine studies), Mindfulness-based Interventions (three studies), Acceptance and Commitment Therapy (one study), and Behavioral Activation Therapy for Depression (one study) were included. Compared to treatment as usual, six out of eight studies of traditional Cognitive Behavioral Therapy reported significant differences in the reduction of depressive symptoms at post-treatment (d from 1.31 to 0.18) and four out of six at follow-up (d from 0.75 to 0.26); similarly, five out of six reported significant differences in the reduction of anxiety symptoms at post-treatment (d from 1.08 to 0.19) and three out of four at follow-up (d from 1.07 to 0.27). Overall, no significant differences between traditional Cognitive Behavioral Therapy and treatment as usual were reported at post-treatment and follow-up in the studies exploring pain intensity and pain catastrophizing. Conclusion The available evidence suggests that traditional Cognitive Behavioral Therapy may produce significant benefits for the improvement of depression, anxiety, and quality of life, but not for pain intensity and pain catastrophizing. More evidence is needed to determine the effects of MBI, ACT, and BATD. Systematic review registration PROSPERO, CRD42021219921.
Collapse
Affiliation(s)
- Juan P. Sanabria-Mazo
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ariadna Colomer-Carbonell
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Óscar Fernández-Vázquez
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Georgina Noboa-Rocamora
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Gemma Cardona-Ros
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | | | | | - Sílvia Edo
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Xavier Borràs
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Antoni Sanz
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Albert Feliu-Soler
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan V. Luciano
- Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
| |
Collapse
|
25
|
Yimer TM, Chan GCK, Belete H, Hides L, Leung J. Treatment-seeking behavior and barriers to mental health service utilization for depressive symptoms and hazardous drinking: The role of religious and traditional healers in mental healthcare of Northwest Ethiopia. Glob Ment Health (Camb) 2023; 10:e92. [PMID: 38179466 PMCID: PMC10765018 DOI: 10.1017/gmh.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/24/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024] Open
Abstract
Understanding mental healthcare seeking and associated factors is essential for planning mental health services. This study aimed to assess treatment seeking and barriers to care for depressive symptoms and hazardous drinking in a community sample of Northwest Ethiopia. A cross-sectional study was conducted to screen 1,728 participants for depressive symptoms (n = 414) and hazardous drinking (n = 155). Participants were asked whether they had sought mental healthcare. We also assessed the barriers to seeking mental healthcare. Logistic regression was used to identify associated factors. Among people with depressive symptoms, 14.3%, 15.5%, and 19.6% sought treatment from healthcare settings, non-healthcare settings, or any sources, respectively. Religious places (39.5%) were the most helpful treatment sources. People with low levels of internalized stigma (adj OR = 3.00 [1.41, 6.42]) and positive attitudes towards mental illness (adj OR = 2.84 [1.33, 6.07]) were nearly threefold more likely to seek depression treatment. No participants with hazardous drinking sought treatment from healthcare settings, and only 1.3% had sought help from families/friends. Over 97% of participants with depressive symptoms and hazardous drinking reported at least one barrier to treatment-seeking from a healthcare setting. Religious and traditional healers were as important as healthcare settings for treatment-seeking.
Collapse
Affiliation(s)
- Tesfa Mekonen Yimer
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gary CK Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Habte Belete
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| |
Collapse
|
26
|
Chakrapani V, Bharat S. Mental health in India: Sociocultural dimensions, policies and programs - An introduction to the India Series. SSM - MENTAL HEALTH 2023; 4:100277. [PMID: 38807921 PMCID: PMC7616029 DOI: 10.1016/j.ssmmh.2023.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
|
27
|
Bagade T, Mersha AG, Majeed T. The social determinants of mental health disorders among women with infertility: a systematic review. BMC Womens Health 2023; 23:668. [PMID: 38093258 PMCID: PMC10720205 DOI: 10.1186/s12905-023-02828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Infertility is associated with mental health disorders in women, even if a successful pregnancy resolves infertility. However, the link between social determinants of health (SDoH) and mental health in women with infertility is not well understood. We aimed to investigate the determinants thoroughly so that mental health screening and services can be tailored to suit women with infertility who are vulnerable to mental health disorders. METHODOLOGY All observational studies that included women participants of reproductive age with infertility and assessed social determinants associated with mental health disorders were searched using a combination of keywords from MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science databases and published in English. Two reviewers conducted screening, data extraction, quality assessment and risk of bias. The protocol was registered on PROSPERO (number CRD42022343962). RESULTS The systematic review included 32 studies out of 3405 screened articles from January 1st 2010 to 16th October 2023. Compared to women without infertility, the prevalence of mental health disorders, including anxiety, depression, psychological distress, and stress, is high among women with infertility, with the severity being influenced by social determinants-those with higher education, employment, higher personal or family income, private health insurance, higher social support, stronger religious beliefs, and higher spiritual well-being reported better mental health outcomes. CONCLUSION The study highlights the need for early detection, tailored interventions, and integrated and comprehensive support systems to address the mental health needs of women with infertility and improve their well-being.
Collapse
Affiliation(s)
- Tanmay Bagade
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, 2285, Australia.
| | - Amanual Getnet Mersha
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, 2285, Australia
| | - Tazeen Majeed
- School of Medicine and Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW, 2285, Australia
| |
Collapse
|
28
|
Garg R, Chavan BS, Das S, Puri S, Banavaram AA, Benegal V, Rao GN, Varghese M, Gururaj G. Treatment gap for mental and behavioral disorders in Punjab. Indian J Psychiatry 2023; 65:1269-1274. [PMID: 38298876 PMCID: PMC10826874 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_839_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/03/2022] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Background and Aims There is no data on the treatment gap and health care utilization for mental disorders from Punjab. The present study reports on the same by using the data collected during the National Mental Health Survey. Settings and Design Multisite, multistage, stratified, random cluster sampling study conducted in four districts, namely Faridkot, Moga, Patiala, and Ludhiana (for urban metro areas). Data were collected from October 2015 to March 2016. Materials and Methods Mini International Neuropsychiatric Interview 6.0.0 and Adapted Fagerstrom Nicotine Dependence Scale were used to diagnose mental and behavioral disorders and tobacco use disorder, respectively. Pathways Interview Schedule of the World Health Organization was applied to persons having any disorder to assess treatment gap and health care utilization. Exploratory focused group discussions (FGDs) were conducted to understand the community perceptions regarding mental and behavioral disorders. Results The treatment gap for mental and behavioral disorders was 79.59%, and it was higher for common mental disorders than severe mental disorders and higher for alcohol and tobacco use disorders as compared to opioid use disorders. The median treatment lag was 6 months. Only seven patients out of 79 were taking treatment from a psychiatrist, and the average distance traveled by the patient for treatment was 37.61 ± 45.5 km. Many attitudinal, structural, and other barriers leading to high treatment gaps were identified during FGDs in the community, such as stigma, poor knowledge about mental health, deficiency of psychiatrists, and distance from the hospital. Conclusions Vertical as well as horizontal multisectoral integration is required to reduce the treatment gap and improve healthcare utilization. Increasing mental health literacy, providing high-quality mental health services at the primary-healthcare level and human resources development are the need of the hour.
Collapse
Affiliation(s)
- Rohit Garg
- Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Bir Singh Chavan
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Subhash Das
- Department of Psychiatry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Sonia Puri
- Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Arvind A. Banavaram
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
29
|
Desmet K, Bracke P, Deproost E, Goossens PJJ, Vandewalle J, Vercruysse L, Beeckman D, Van Hecke A, Kinnaer LM, Verhaeghe S. Associated factors of nurse-sensitive patient outcomes: A multicentred cross-sectional study in psychiatric inpatient hospitals. J Psychiatr Ment Health Nurs 2023; 30:1231-1244. [PMID: 37409521 DOI: 10.1111/jpm.12951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 06/06/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
WHAT IS ALREADY KNOWN?: The nurse-patient relationship in mental health care is an important focus of mental health nursing theories and research. There is limited evidence about which factors influence nurse-sensitive patient outcomes of the nurse-patient relationship. This hinders the development, planning, delivering, and quality assurance of the nurse-patient relationship in nursing practice and nursing education. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our best knowledge, this is the first study to examine associations between nurse-sensitive patient outcomes of the nurse-patient relationship and a range of patient characteristics and relationship-contextual factors. In this study, we found that gender, age, hospital characteristics, nurse availability when needed, nurse contact, and nurse stimulation were associated with the scores on the nurse-sensitive patient outcome scale. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Having insight into the factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship can help nurses, nursing students, nursing management and also patients to enhance the nurse-patient relationship, trying to influence outcomes of nursing care. ABSTRACT: Introduction The lack of evidence on patient characteristics and relational-contextual factors influencing nurse-sensitive patient outcomes of a nurse-patient relationship is a possible threat to the quality and education of the nurse-patient relationship. Aim To measure nurse-sensitive patient outcomes of the nurse-patient relationship and to explore the associations between nurse-sensitive patient outcomes and a range of patient characteristics and relational-contextual factors. Method In a multicenter cross-sectional study, 340 inpatients from 30 units in five psychiatric hospitals completed the Mental Health Nurse-Sensitive Patient Outcome Scale. Descriptive, univariate and Linear Mixed Model analyses were conducted. Results Overall, patient-reported outcomes were moderate to good. Female participants, nurse availability when needed, more nurse contact and nurse stimulation were associated with higher outcomes. Age differences were observed for some of the outcomes. Outcomes also varied across hospitals but were not related to the number of times patients were hospitalized or to their current length of stay in the hospital. Discussion The results may help nurses to become more sensitive and responsive to factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship. Implications The nurse-sensitive results can support nurses in designing future nurse-patient relationships.
Collapse
Affiliation(s)
- Karel Desmet
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- AZ Damiaan, Ostend, Belgium
| | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Eddy Deproost
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Centre for Psychiatry and Psychotherapy Clinic Sint-Jozef, Pittem, Belgium
| | - Peter J J Goossens
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Dimence Mental Health Center for Bipolar Disorder, Deventer, the Netherlands
| | | | - Lieke Vercruysse
- Centre for Psychiatry and Psychotherapy Clinic Sint-Jozef, Pittem, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- School of Health Sciences, Örebro University, Örebro, Sweden
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
- Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Lise-Marie Kinnaer
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Nursing, VIVES University College, Roeselare, Belgium
- Faculty of Medicine and Life Science, University Hasselt, Hasselt, Belgium
| |
Collapse
|
30
|
Tanner B, Kurdyak P, de Oliveira C. Adult Psychiatric Hospitalizations in Ontario, Canada Before and During the COVID-19 Pandemic. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:925-932. [PMID: 37006178 PMCID: PMC10657583 DOI: 10.1177/07067437231167386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
OBJECTIVE The impacts of the COVID-19 pandemic on psychiatric hospitalizations in Ontario are unknown. The purpose of this study was to identify changes to volumes and characteristics of psychiatric hospitalizations in Ontario during the COVID-19 pandemic. METHODS A time series analysis was done using psychiatric hospitalizations with admissions dates from July 2017 to September 2021 identified from provincial health administrative data. Variables included monthly volumes of hospitalizations as well as proportions of stays <3 days and involuntary admissions, overall and by diagnosis (mood, psychotic, addiction, and other disorders). Changes to trends during the pandemic were tested using linear regression. RESULTS A total of 236,634 psychiatric hospitalizations were identified. Volumes decreased in the first few months of the pandemic before returning to prepandemic volumes by May 2020. However, monthly hospitalizations for psychotic disorders increased by ∼9% compared to the prepandemic period and remained elevated thereafter. Short stays and involuntary admissions increased by approximately 2% and 7%, respectively, before trending downwards. CONCLUSION Psychiatric hospitalizations quickly stabilized in response to the COVID-19 pandemic. However, evidence suggested a shift towards a more severe presentation during this period.
Collapse
Affiliation(s)
- Bryan Tanner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Canada
- Institute of Mental Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Canada
- Institute of Mental Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| |
Collapse
|
31
|
Singh V, Sutar RF, Gupta S, Pakhare AP, Kokane AM, Aravind BA, Gururaj G, Varghese M, Benegal V, Rao GN. A study of disability and socio-economic impact of mental morbidities from the state of Madhya Pradesh, India. Indian J Psychiatry 2023; 65:1297-1306. [PMID: 38298882 PMCID: PMC10826863 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_841_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/22/2022] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Background Disability associated with mental illness has a disproportionate impact on the work, social, and family responsibilities of an individual toward society. The evidence for disability in mental illnesses would help the clinician, caregivers, policymakers, and various stakeholders to come up with sustainable solutions not only to help fill the existing gaps in care but also to develop new avenues as per the specific needs of the population of Madhya Pradesh (MP). Aim To estimate the burden of disability related to mental illnesses in the state of MP. Materials and Methods A multi-site cross-sectional study was conducted in 2015-16 as part of National Mental Health Survey among adults above 18 years of age. Samples were selected using multi-stage, stratified, random cluster sampling based on probability proportionate to size. Six tehsils with one urban metro out of four districts from a total of 50 districts were selected in the state of MP. The Sheehan Disability Scale and socio-economic impact of illness (from selected questions from WHO-Disability Assessment Schedule-2.0) were used to assess mental morbidity and the subjective reporting of disability. Results The weighted prevalence of disability (n = 1011) was found as 10.2%, 13.1%, and 13.9%, respectively, in work/school, social life, and family/home domains. The weighted prevalence of moderate to extreme disability in the same domains was, respectively, 5.1%, 6.7%, and 7.3%. The presence of common mental disorders (CMDs) increases the odds of self-reported disability in work [odds ratio (OR) 2.48, 95% CI 1.35 to 4.59], social life (OR 2.74, 95% CI 1.50 to 5.07), and family domains (OR 3.03, 95% CI1.62 to 5.74). When combined with common mental disorders, tobacco use disorder further escalates the odds of self-reported disability in all three domains [OR 7.10, confidence interval (CI) 3.15 to 16.37; 4.93, CI 2.19 to 11.28; and 7.10, CI 2.78 to 19.25]. Currently, non-working persons had a higher disability in social life and family life domains (P = 0.003 and P = 0.021), respectively. Conclusion We report a substantial magnitude of disability in social, work, and family life domains. Participants having CMDs, female gender, and those non-working had more disabilities and would require targeted interventions.
Collapse
Affiliation(s)
- Vijender Singh
- Department of Psychiatry, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Roshan F. Sutar
- Department of Psychiatry, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Suruchi Gupta
- Department of Community and Family Medicine, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Abhijit P. Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Arun M. Kokane
- Department of Community and Family Medicine, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - B. A. Aravind
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, WHO Collaborative Centre for Injury Prevention and Safety Promotion, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
32
|
Pirard P, Motreff Y, Stene LE, Rabet G, Vuillermoz C, Vandentorren S, Baubet T, Messiah A. Initiation of multiple-session psychological care in civilians exposed to the November 2015 Paris terrorist attacks. Arch Public Health 2023; 81:207. [PMID: 38031202 PMCID: PMC10685664 DOI: 10.1186/s13690-023-01206-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Terrorist attacks can induce post-traumatic stress disorder (PTSD) and depression, which require multiple-session psychological care (MSPC). This study aims at investigating MSPC initiation and associated factors. METHODS Data were collected from a web-based survey of civilians 8-12 months after their exposure to the November 2015 Paris terrorist attacks. Depression and partial and full PTSD were assessed using the Hospital Anxiety and Depression Scale and the PCL-5 checklist, respectively. Questionnaires collected data on socio-demographic variables, exposure to the attacks, psychological treatment history, social isolation, somatic problems, having received an outreach psychological support (OPS), consultations with a general practitioner, contact with an association for victims, MSPC initiation and, if not, reasons for not having initiated it. Logistic regressions were used to examine factors associated with MSPC initiation. RESULTS Among the 450 respondents, 154 reported having initiated a MSPC after the attacks. Of the 134 who provided the MSPC initiation date, 50% did so during the first month. Among the respondents with at least one of the considered psychological disorders, 53% declared not having initiated yet a MSPC. The primary three reasons for not having initiated a MSPC among people with PTSD were "did not feel the need", "it was not the right time to talk about it", and "not offered". For people with at least one psychological disorder, MSPC initiation was associated with the number of somatic problems, type of exposure (witness, threatened, indirectly exposed), prior psychological treatment, being a woman, being in a relationship, having consulted a psychiatrist or a psychologist, having received an OPS, and being in contact with association for victims. CONCLUSION The organization of adequate psychological care after a terror attack must take into account the need for healthcare that may emerge several months after the attack, and that witnesses seem less likely to receive MSPC than persons directly threatened despite their psychological disorder. Associations for victims and OPS seem to facilitate access to MSPC. Furthermore, our findings highlight the need to train physicians to screen for psychological disorders in persons exposed to terrorist attacks who present with somatic disorders.
Collapse
Affiliation(s)
- Philippe Pirard
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France.
- Team MOODS, Inserm-CESP, Université Paris-Saclay, UVSQ, 94807, Villejuif, France.
| | - Yvon Motreff
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, F75012, France
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Gabrielle Rabet
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
| | - Cécile Vuillermoz
- Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, F75012, France
| | - Stéphanie Vandentorren
- Santé Publique France, French National Public Health Agency, Saint-Maurice, F-94415, France
- UMR 1219, Bordeaux Population Health Research Center, PHARes Team, University of Bordeaux, Bordeaux, France
| | - Thierry Baubet
- Université Sorbonne Paris Nord, UTRPP EA 4403, Villetaneuse, France
- AP-HP, Hôpital Avicenne, Bobigny, France
- Resources and Resilience National Centre (CN2R), LilleParis, France
| | - Antoine Messiah
- Team MOODS, Inserm-CESP, Université Paris-Saclay, UVSQ, 94807, Villejuif, France
| |
Collapse
|
33
|
Brattmyr M, Lindberg MS, Lundqvist J, Solem S, Hjemdal O, Anyan F, Havnen A. Symptoms and prevalence of common mental disorders in a heterogenous outpatient sample: an investigation of clinical characteristics and latent subgroups. BMC Psychiatry 2023; 23:804. [PMID: 37924053 PMCID: PMC10623879 DOI: 10.1186/s12888-023-05314-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROM) provide clinicians with information about patients' perceptions of distress. When linked with treatment and diagnostic registers, new information on common mental health disorders (CMHD) and service use, may be obtained, which might be useful clinically and for policy decision-making. This study reports the prevalence of CMHD and their association with PROM severity. Further, subgroups of self-reported symptoms of depression and anxiety were examined, and their association with clinician-assessed mental disorders, functional impairment, and service use. METHODS In a cohort study of 2473 (63% female) outpatients, CMHD was examined with pre-treatment scores of self-reported depression and anxiety, and the number of assessments and psychotherapy appointments one year after treatment start. Factor mixture modelling (FMM) of anxiety and depression was used to examine latent subgroups. RESULTS Overall, 22% of patients with a CMHD had an additional comorbid mood/anxiety disorder, making the prevalence lower than expected. This comorbid group reported higher symptoms of anxiety and depression compared to patients with non-comorbid disorders. FMM revealed three classes: "anxiety and somatic depression" (33%), "mixed depression and anxiety" (40%), and "cognitive depression" (27%). The anxiety and somatic depression class was associated with older age, being single and on sick leave, higher probability of depressive-, anxiety-, and comorbid disorders, having more appointments and higher functional impairment. Although the cognitive depression class had less somatic distress than the mixed depression and anxiety class, they reported more functional impairment and had higher service use. CONCLUSION The results show that higher levels of somatic symptoms of depression could both indicate higher and lower levels of functional impairment and service use. A group of patients with high somatic depression and anxiety was identified, with severe impairment and high service needs. By gaining insights into CMHD factors' relation with clinical covariates, self-reported risk factors of depression and anxiety could be identified for groups with different levels of aggravating life circumstances, with corresponding service needs. These could be important symptom targets in different groups of patients.
Collapse
Affiliation(s)
- Martin Brattmyr
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway.
| | - Martin Schevik Lindberg
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway
- Mental Health Care Services, Trondheim Municipality, Norway
| | - Jakob Lundqvist
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway
| | - Frederick Anyan
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway
- Division of Psychiatry, Nidaros Community Mental Health Centre, St. Olavs University Hospital, Trondheim, Norway
| |
Collapse
|
34
|
Ni J, Yan Y, Du W, Tian Y, Fan L. Depressive symptoms, alone or together with physical comorbidity, are predictive of healthcare use and spending in older adults. J Psychosom Res 2023; 174:111482. [PMID: 37734253 DOI: 10.1016/j.jpsychores.2023.111482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Depressive symptoms and physical comorbidity are common health problems in older adults and are both posing increasingly considerable challenges to global healthcare systems. This study investigated the relationships of depressive symptoms, alone or together with physical comorbidity, with healthcare utilization and spending among older adults, as well as examined sex differences. METHODS We used data of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 and enrolled 6519 participants. Depressive symptoms was operationalized following the Center for Epidemiological Studies Depression Scale and physical comorbidity was assessed according to the presence of 11 physical non-communicable diseases. The relationships of depressive symptoms and comorbidity with healthcare outcomes were examined using mixed-effects regression models. RESULTS Compared with the neither depressive symptoms nor physical comorbidity category, older adults classified as depressive symptoms-only, physical comorbidity-only or both conditions were all associated with elevated risks for healthcare use and spending (all OR/IRR > 1; all p < 0.001). Depressive symptoms and physical comorbidity in combination consistently led to higher risks for studied endpoints than either condition alone (outpatient visit: OR = 3.50, outpatient visit number: IRR = 3.39, inpatient visit: OR = 3.35, hospitalization days: IRR = 2.82, catastrophic health expenditure: OR = 1.70; all p-trend < 0.001). Stratification analyses revealed similar relationships irrespective of sex. CONCLUSION Depressive symptoms and physical comorbidity are separately and jointly associated with increased healthcare utilization and spending among Chinese older adults. These two conditions in combination lead to highest risks than either condition alone. Early screen for depressive symptoms, alone or together with physical comorbidity, may offer implications for appropriate policy interventions.
Collapse
Affiliation(s)
- Jinmeng Ni
- School of Public Health, Southeast University, Nanjing 210009, China
| | - Yuhan Yan
- Department of Geriatrics, General Hospital of Eastern Theater Command, Nanjing 210000, China
| | - Wei Du
- School of Public Health, Southeast University, Nanjing 210009, China
| | - Yong Tian
- School of Public Health, Southeast University, Nanjing 210009, China
| | - Lijun Fan
- School of Public Health, Southeast University, Nanjing 210009, China.
| |
Collapse
|
35
|
Ponnuchamy L, Kumar SS, Majhi G, Venkataraman P. Quality of life, social support, and pathways of care among persons with psychiatric disorders-A cross-sectional study. Ind Psychiatry J 2023; 32:S32-S41. [PMID: 38370934 PMCID: PMC10871395 DOI: 10.4103/ipj.ipj_192_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/14/2023] [Accepted: 06/23/2023] [Indexed: 02/20/2024] Open
Abstract
Background Patients with psychiatric disorders have varied psychosocial realities embedded in the community context. Help-seeking behavior is extremely crucial in determining the prognosis and outcome of interventions. Objectives (1) To assess the levels of quality of life, perceived social support, and decision to first seek help. (2) To assess the association of socio-demographic variables with these domains. Materials and Methods A cross-sectional descriptive survey with 100 psychiatric patients in a tertiary care setting employed three scales, namely WHOQOL-BREF, PSSS, and WHO Pathways Encounter form. Results Patients had higher levels of quality of life and perceived social support. The majority of patients chose health professionals over faith healers at the onset of symptoms, had higher reliance on family members, and continued with hospital visits till the third follow-up. Sex, occupation, and marital status were associated with perceived social support, and duration of illness was associated with help-seeking behavior. Conclusions Community-based interventions must include holistic services and reduce the gap between onset and first contact, leading to higher quality of life and perceived social support.
Collapse
Affiliation(s)
- Lingam Ponnuchamy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sachin S Kumar
- Psychiatric Counsellor, Central Prison, Parapana Agrahara, Bengaluru, Karnataka, India
| | - Gobinda Majhi
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Prabhu Venkataraman
- Department of Medical Research, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India
| |
Collapse
|
36
|
Maheen H, King T. Employment-related mental health outcomes among Australian migrants: A 19-year longitudinal study. Aust N Z J Psychiatry 2023; 57:1475-1485. [PMID: 37211808 PMCID: PMC10619185 DOI: 10.1177/00048674231174809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Migrants experience various stressors at different stages of migration based on their country of origin, ethnic backgrounds, migration context and host country. Employment is one important post-settlement factor associated with mental health among migrant groups. The study investigates whether the country of origin modifies the association between employment and mental health for Australian migrants. METHODS Nineteen waves of data from the Household Income and Labour Dynamics in Australia Survey were used. Using fixed-effects regression, we examined the effects of within-person changes in employment status on mental health outcomes as measured by the Mental Health Inventory (MHI-5), controlling for time-varying confounders and stratified by sex and examined effect modification by country of origin. RESULTS The relationship between unemployment and mental health was modified by country of origin for men but not women. Unemployed men from Asian (β = -4.85, p < 0.001), African and Middle Eastern (β = -3.61, p < 0.05) countries had lower mental health scores compared to employed Australian-born men. For men, there was evidence of effect modification of the association between employment and mental health by country of origin, with the combined effect of being unemployed and being a migrant from an Asian country was almost three points lower than the summed independent risks of these factors (β = -2.72; p = 0.01). Also, for men, the combined mental health effect of not being in the labour force and coming from a non-English-speaking European country was greater than the summed effects of these factors (β = -2.33; p < 0.001). CONCLUSION Tailored employment-support programmes may be beneficial for migrants from ethnic minorities, particularly those from Asian, African and Middle Eastern countries in Australia. Further research is needed to understand why the mental health of migrant men from these countries is particularly vulnerable to unemployment.
Collapse
Affiliation(s)
- Humaira Maheen
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| |
Collapse
|
37
|
de Pauli AJC, Baldassarini CR, de Almeida JCP, de Oliveira JL, Fiorati RC, Ventura CAA, de Souza J. Expansion of Psychosocial Care Centers and their relationship with health and human rights. Rev Bras Enferm 2023; 76:e20220662. [PMID: 37820147 PMCID: PMC10561945 DOI: 10.1590/0034-7167-2022-0662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 03/27/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE To analyze the factors associated with the expansion of the number of Brazilian Psychosocial Care Centers (CAPS) considering aspects related to the general health scenario and the institutionalization of human rights. METHODS An analytical document-based study, developed between February 2020 and May 2022, whose secondary data on the 27 Brazilian capitals were collected on platforms in the public domain, based on the time series from 2015 to 2020. Indicators were listed based on health system infrastructure and quality of life. For data analysis, descriptive statistics, Pearson's correlation test and Student's t test were used. RESULTS The capitals that expanded the number of CAPS in the analyzed period were the ones that presented the greatest political-legal framework for the protection of human rights. CONCLUSION The results suggest that the greater the commitment of governments in favor of human rights, the greater the investment for CAPS expansion.
Collapse
|
38
|
Tunks A, Berry C, Strauss C, Nyikavaranda P, Ford E. Patients' perspectives of barriers and facilitators to accessing support through primary care for common mental health problems in England: A systematic review. J Affect Disord 2023; 338:329-340. [PMID: 37348656 DOI: 10.1016/j.jad.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Common mental disorders (CMDs) are prevalent throughout the population. Psychological therapy is often sought via primary care; however, equitable access is not commonplace. This review aims to investigate the barriers and facilitators adults experiencing CMDs perceive when accessing evidence-based psychological treatment in England. METHODS A qualitative systematic review with meta-synthesis was conducted (PROSPERO CRD42020227039). Seven electronic databases were searched for papers from 2008 to October 2022. RESULTS Searches identified 30 studies from which three themes were developed with seven subthemes. Stigma and patients' perceptions and understandings of CMDs impacted their help-seeking decision-making and engagement with services. This meant that services were not used as a first resort for help-seeking. Upon reaching services, patients appeared to perceive primary care as not prioritising mental health problems, nor as being the place where they would be supported, particularly as healthcare professionals did not appear to know about CMDs and therapy was seen as difficult to access. The interaction between healthcare professional and patients was seen as pivotal to whether patients accessed support or not. LIMITATIONS The review is limited to research conducted within England. Additionally, it only explores access barriers prior to treatment experiences. CONCLUSION Knowledge, attitudinal, systemic and relational barriers and facilitators were identified. Future research should focus on developing stigma reduction initiatives. Clinical implications include provision of standardised training across primary care HCP (healthcare professionals).
Collapse
Affiliation(s)
- Alice Tunks
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| | - Clio Berry
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| | - Clara Strauss
- School of Psychology, University of Sussex, United Kingdom; Sussex Partnership NHS Foundation Trust, United Kingdom.
| | - Patrick Nyikavaranda
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| | - Elizabeth Ford
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| |
Collapse
|
39
|
Lowther-Payne HJ, Ushakova A, Beckwith A, Liberty C, Edge R, Lobban F. Understanding inequalities in access to adult mental health services in the UK: a systematic mapping review. BMC Health Serv Res 2023; 23:1042. [PMID: 37773154 PMCID: PMC10542667 DOI: 10.1186/s12913-023-10030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Population groups experience differential access to timely and high-quality mental healthcare. Despite efforts of recent UK policies to improve the accessibility of mental health services, there remains a lack of comprehensive understanding of inequalities in access to services needed to do this. This systematic mapping review aimed to address this gap by identifying which population groups continue to be poorly served by access to adult mental health services in the UK, how access has been measured, and what research methods have been applied. METHODS Seven electronic databases were searched from January 2014 up to May 2022. Primary research studies of any design were included if they examined access to adult NHS mental health services in the UK by population groups at risk of experiencing inequalities. Study characteristics, measures of access, inequalities studied, and key findings were extracted. A best-fit framework approach was used, applying Levesque's Conceptual Framework for Healthcare Access to synthesise measures of access, and applying a template derived from Cochrane Progress-Plus and NHS Long Term Plan equality characteristics to synthesise key findings associated with inequalities. RESULTS Of 1,929 publications retrieved, 152 studies of various types were included. The most frequently considered dimensions of inequality were gender, age, and ethnicity, whilst social capital, religion, and sexual orientation were least frequently considered. Most studies researched access by measuring "healthcare utilisation", followed by studies that measured "healthcare seeking". Key barriers to access were associated with individuals' "ability to seek" (e.g. stigma and discrimination) and "ability to reach" (e.g. availability of services). Almost half of the studies used routinely collected patient data, and only 16% of studies reported patient and public involvement. CONCLUSIONS Little appears to have changed in the nature and extent of inequalities, suggesting that mental health services have not become more accessible. Actions to reduce inequalities should address barriers to population groups' abilities to seek and reach services such as stigma-reducing interventions, and re-designing services and pathways. Significant benefits exist in using routinely collected patient data, but its limitations should not be ignored. More theoretically informed research, using a holistic measurement of access, is needed in this area. REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/RQ5U7 .
Collapse
Affiliation(s)
- Hayley J Lowther-Payne
- Lancaster Medical School, Faculty of Health and Medicine, Health Innovation Campus, Lancaster University, Sir John Fisher Drive, Lancaster, Lancashire, LA1 4AT, UK.
| | - Anastasia Ushakova
- Lancaster Medical School, Faculty of Health and Medicine, Health Innovation Campus, Lancaster University, Sir John Fisher Drive, Lancaster, Lancashire, LA1 4AT, UK
| | - Adelaide Beckwith
- Lancashire and South Cumbria NHS Foundation Trust, Sceptre Point, Sceptre Way, Bamber Bridge, Preston, Lancashire, PR5 6AW, UK
| | - Catherine Liberty
- Division of Health Research, Faculty of Health and Medicine, Health Innovation Campus, Lancaster University, Sir John Fisher Drive, Lancaster, LA1 4AT, Lancashire, UK
| | - Rhiannon Edge
- Lancaster Medical School, Faculty of Health and Medicine, Health Innovation Campus, Lancaster University, Sir John Fisher Drive, Lancaster, Lancashire, LA1 4AT, UK
| | - Fiona Lobban
- Division of Health Research, Faculty of Health and Medicine, Health Innovation Campus, Lancaster University, Sir John Fisher Drive, Lancaster, LA1 4AT, Lancashire, UK
| |
Collapse
|
40
|
Giustini M, Luzi I, Spinelli A, Andreozzi S, Bucciarelli M, Buoncristiano M, Nardone P, Ciardullo S. Exploring changes in children's well-being due to COVID-19 restrictions: the Italian EpaS-ISS study. Ital J Pediatr 2023; 49:118. [PMID: 37705014 PMCID: PMC10498567 DOI: 10.1186/s13052-023-01521-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND While existing research has explored changes in health behaviours among adults and adolescents due to the COVID-19 outbreak, the impact of quarantine on young children's well-being is still less clear. Moreover, most of the published studies were carried out on small and non-representative samples. The aim of the EpaS-ISS study was to describe the impact of the COVID-19 pandemic on the habits and behaviours of a representative sample of school children aged mainly 8-9 years and their families living in Italy, exploring the changes in children's well-being during the COVID-19 pandemic compared to the immediately preceding time period. METHODS Data were collected using a web questionnaire. The target population was parents of children attending third-grade primary schools and living in Italy. A cluster sample design was adopted. A Well-Being Score (WBS) was calculated by summing the scores from 10 items concerning the children's well-being. Associations between WBS and socio-demographic variables and other variables were analysed. RESULTS A total of 4863 families participated. The children's WBS decreased during COVID-19 (median value from 31 to 25; p = 0.000). The most statistically significant variables related to a worsening children's WBS were: time of school closure, female gender, living in a house with only a small and unliveable outdoor area, high parents' educational level and worsening financial situation. CONCLUSIONS According to parents ' perception, changes in daily routine during COVID-19 negatively affected children's well-being. This study has identified some personal and contextual variables associated with the worsening of children's WBS, which should be considered in case of similar events.
Collapse
Affiliation(s)
- Marco Giustini
- Environment and Health Department, Italian National Institute of Health, Rome, Italy.
| | - Ilaria Luzi
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Angela Spinelli
- Formerly National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Silvia Andreozzi
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Mauro Bucciarelli
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | | | - Paola Nardone
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Silvia Ciardullo
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| |
Collapse
|
41
|
Rens E, Portzky G, Morrens M, Dom G, Van den Broeck K, Gijzen M. An exploration of suicidal ideation and attempts, and care use and unmet need among suicide-ideators in a Belgian population study. BMC Public Health 2023; 23:1741. [PMID: 37679752 PMCID: PMC10483782 DOI: 10.1186/s12889-023-16630-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Suicidal ideation, or thinking about death and suicide, is common across all layers of society. The aim of this paper is to add to the understanding of suicidal ideation in the general population, as well as help-seeking behaviors and perceived unmet mental health needs among those who report suicidal thoughts. METHODS The research is part of a representative population-based survey study of mental wellbeing in Antwerp (Flanders, Belgium) carried out in 2021. A total of 1202 participants between 15 and 80 years old answered the Ask Suicide-Screening Questions (ASQ), and an additional question about suicide plans. Participation was by invitation only and possible online or via a postal paper questionnaire. Univariate and multivariate logistic regression analyses were used to explore the association between both current suicidal ideation and self-reported lifetime suicide attempt with the sociodemographic factors age, gender, educational level, origin and financial distress. Moreover, formal care use for mental health was examined among those experiencing suicidal ideation, and logistic regression analyses were used to assess associated sociodemographic factors. Finally, perceived unmet mental health needs were assessed among suicide ideators. RESULTS The point-prevalence of suicidal ideation was 8.6% and was higher among younger age groups and individuals reporting financial distress. The lifetime-prevalence of suicide attempts is 6.5% and was higher in younger people and individuals with a primary educational level and with financial distress. About half (45.6%) of those with suicidal ideation consulted a professional for mental health problems in the past twelve months. Men and those with a primary educational level were less likely to seek help. Half of suicide ideators without care use perceived some need for mental health care, and a third of suicide ideators who used care perceived the obtained help as insufficient, resulting in a population prevalence of 3.6% suicide ideators with a fully or partially perceived unmet need. CONCLUSIONS The prevalence of suicide attempts, suicidal ideation and unmet needs among suicide-ideators is high in this Belgian sample. Mental health care need perception in suicide ideators needs further investigation.
Collapse
Affiliation(s)
- Eva Rens
- Department of Family and Population Health (FAMPOP), University of Antwerp, 2610, Antwerp, Belgium.
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, 2610, Antwerp, Belgium.
| | - Gwendolyn Portzky
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, 9000, Ghent, Belgium
| | - Manuel Morrens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, 2610, Antwerp, Belgium
- University Psychiatric Centre Duffel, 2570, Duffel, Belgium
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, 2610, Antwerp, Belgium
- Multiversum Psychiatric Hospital, 2530, Boechout, Belgium
| | - Kris Van den Broeck
- Department of Family and Population Health (FAMPOP), University of Antwerp, 2610, Antwerp, Belgium
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, 2610, Antwerp, Belgium
| | - Mandy Gijzen
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, 9000, Ghent, Belgium
| |
Collapse
|
42
|
Jing F, Li Z, Qiao S, Ning H, Zhou S, Li X. Association between immigrant concentration and mental health service utilization in the United States over time: A geospatial big data analysis. Health Place 2023; 83:103055. [PMID: 37311276 PMCID: PMC10527759 DOI: 10.1016/j.healthplace.2023.103055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
Immigrants (foreign-born United States [US] citizens) generally have lower utilization of mental health services compared with US-born counterparts, but extant studies have not investigated the disparities in mental health service utilization within immigrant population nationwide over time. Leveraging mobile phone-based visitation data, we estimated the average mental health utilization in contiguous US census tracts in 2019, 2020, and 2021 by employing two novel outcomes: mental health service visits and visit-to-need ratio (i.e., visits per depression diagnosis). We then investigated the tract-level association between immigration concentration and mental health service utilization outcomes using mixed-effects linear regression models that accounted for spatial lag effects, time effects, and covariates. This study reveals spatial and temporal disparities in mental health service visits and visit-to-need ratio among different levels of immigrant concentration across the US, both before and during the pandemic. Tracts with higher concentrations of Latin American immigrants showed significantly lower mental health service utilization visits and visit-to-need ratio, particularly in the US West. Tracts with Asian and European immigrant concentrations experienced a more significant decline in mental health service utilization visits and visit-to-need ratio from 2019 to 2020 than those with Latin American concentrations. Meanwhile, in 2021, tracts with Latin American concentrations had the least recovery in mental health service utilization visits. The study highlights the potential of geospatial big data for mental health research and informs public health interventions.
Collapse
Affiliation(s)
- Fengrui Jing
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA; Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA.
| | - Zhenlong Li
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA; Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
| | - Shan Qiao
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Huan Ning
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA; Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
| | - Suhong Zhou
- School of Geography and Planning, Sun Yat-sen University, Guangzhou, 510275, China
| | - Xiaoming Li
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| |
Collapse
|
43
|
Bishop L, Almquist YB, Pitkänen J, Martikainen P. Offspring hospitalization for substance use and changes in parental mental health: A Finnish register-based study. ADVANCES IN LIFE COURSE RESEARCH 2023; 57:100561. [PMID: 38054862 DOI: 10.1016/j.alcr.2023.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 12/07/2023]
Abstract
Prior research indicates that parental psychiatric disorders increase their offspring's risk of substance use problems. Though the association is likely bidirectional, the effects of an adult child's substance use on parental mental health remain understudied. We examined parents' psychotropic medication use trajectories by parental sex and educational attainment before and after a child's alcohol- or narcotics-attributable hospitalization. We identified Finnish residents, born 1979-1988, with a first hospitalization for substance use during emerging adulthood (ages 18-29, n = 12,851). Their biological mothers (n = 12,283) and/or fathers (n = 10,765) were followed for the two years before and after the hospitalization. Psychotropic medication use was measured in three-month periods centered around the time of child's hospitalization, and the probability of psychotropic medication use at each time point was assessed using generalized estimating equations logit models. Among mothers, the prevalence of psychotropic medication use increased during the year before, peaked during the 0-3 months after hospitalization, and remained at a similarly elevated level until the end of follow-up. The prevalence among fathers increased gradually and linearly across follow-up, with minimal changes evident either directly before or after the hospitalization. Parents' educational attainment did not modify these trajectories. Our results highlight the importance of considering linked lives when quantifying substance use-attributable harms and underscore the need for future research examining the intergenerational spillover effects of substance use in both directions, particularly in mother-child dyads.
Collapse
Affiliation(s)
- Lauren Bishop
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland; Max Planck-University of Helsinki Center for Social Inequalities in Population Health, 00014 Helsinki, Finland; Department of Public Health Sciences, Stockholm University, 10691 Stockholm, Sweden; International Max Planck Research School for Population, Health and Data Science, Max Planck Institute for Demographic Research, 18057 Rostock, Germany.
| | - Ylva B Almquist
- Department of Public Health Sciences, Stockholm University, 10691 Stockholm, Sweden
| | - Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland; Max Planck-University of Helsinki Center for Social Inequalities in Population Health, 00014 Helsinki, Finland; International Max Planck Research School for Population, Health and Data Science, Max Planck Institute for Demographic Research, 18057 Rostock, Germany
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland; Max Planck-University of Helsinki Center for Social Inequalities in Population Health, 00014 Helsinki, Finland; Max Planck Institute for Demographic Research, 18057 Rostock, Germany
| |
Collapse
|
44
|
Onwubu SC, Sibiya MN, Makgobole MU. Mental Health Challenges during COVID-19 Pandemic: Experiences of Primary Healthcare Nurses in Durban, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6683. [PMID: 37681823 PMCID: PMC10488164 DOI: 10.3390/ijerph20176683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
The COVID-19 pandemic had a significant impact on the mental health of individuals globally, and primary healthcare (PHC) nurses play a critical role in providing mental healthcare services. However, limited research has explored the experiences of PHC nurses in providing mental healthcare services during the COVID-19 pandemic. This study explored the experiences of PHC nurses in providing mental healthcare services during the pandemic in Durban, South Africa. The aim was to identify the challenges faced by healthcare providers and the potential for innovative approaches to improve access to care. A qualitative, exploratory design guided the study, and data were collected through in-depth interviews with twelve PHC nurses purposively selected. Thematic analysis was used to analyze the data. Findings from interviews with PHC nurses reveal that the pandemic exacerbated existing challenges, including medication adherence issues, fear and uncertainty among patients, vaccine hesitancy, decreased clinic visits, and the mental and emotional toll on both patients and healthcare workers. PHC nurses adapted their services by increasing outreach efforts, prioritizing patient care, and utilizing technology and non-governmental organizations' (NGOs) support. Challenges included reduced patient visits, complexities in healthcare provision, and a lack of adequate support. Positive changes observed include increased mental health awareness among healthcare professionals and younger generations. Recommendations include implementing outreach and awareness campaigns, providing accurate information about COVID-19 and vaccinations, and promoting cultural sensitivity in mental healthcare provision.
Collapse
Affiliation(s)
| | - Maureen Nokuthula Sibiya
- Division of Research, Innovation and Engagement, Mangosuthu University of Technology, Umlazi 4031, South Africa;
| | | |
Collapse
|
45
|
Neumann A, König HH, Bokermann J, Hajek A. Determinants of Patient Use and Satisfaction With Synchronous Telemental Health Services During the COVID-19 Pandemic: Systematic Review. JMIR Ment Health 2023; 10:e46148. [PMID: 37594785 PMCID: PMC10474517 DOI: 10.2196/46148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/03/2023] [Accepted: 05/31/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Several recent studies examined patient use and satisfaction with synchronous telemental health services in response to the widespread implementation during the COVID-19 pandemic. However, a systematic review of recent literature on the determinants of these outcomes is missing. OBJECTIVE The aim of this systematic review was to give an extensive overview of the literature on and highlight the influential determinants of patient use and satisfaction with synchronous telemental health services during the COVID-19 pandemic. METHODS This review satisfied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO. Peer-reviewed, quantitative studies that observed the determinants of patient use or satisfaction with synchronous telemental health services during the COVID-19 pandemic were included. PubMed, PsycInfo, and Web of Science database searches were conducted in August 2022 for English and German language studies published from 2020 onward. Key steps were performed by 2 reviewers. Determinants were synthesized into major categories informed by the dimensions of the widely used and established Unified Theory of Acceptance and Use of Technology. RESULTS Of the 20 included studies, 10 studies examined determinants of patient use, 7 examined determinants of patient satisfaction, and 3 observed both outcomes. The quality of the studies was mainly good or fair. There was substantial heterogeneity in the study designs, methods, and findings. Sociodemographic characteristics and health-related determinants were mostly considered. Some of the major dimensions of the Unified Theory of Acceptance and Use of Technology were neglected in recent studies. Although most findings were mixed or nonsignificant, some indications for potential relationships were found (eg, for sex, age, and symptom severity). CONCLUSIONS The findings revealed potential target groups (eg, female and young patients with mild symptoms) for future postpandemic telemental health interventions. However, they also identified patient groups that were harder to reach (eg, older patients with severe symptoms); efforts may be beneficial to address such groups. Future quantitative and qualitative research is needed to secure and expand on recent findings, which could help improve services. TRIAL REGISTRATION PROSPERO CRD42022351576; https://tinyurl.com/yr6zrva5.
Collapse
Affiliation(s)
- Ariana Neumann
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josephine Bokermann
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
46
|
Sucich J, Breitbart V, Williams S, Sanichar N, Candelaria-Arce E, Frankle WG, Davison-Duffy S. Prevalence of Childhood Trauma in a Community-Based Mental Health Clinic. Community Ment Health J 2023; 59:1136-1149. [PMID: 36752932 DOI: 10.1007/s10597-023-01094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/12/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023]
Abstract
A large number of individuals in the US have experienced childhood trauma. However, little is known about the prevalence of trauma in a diverse patient population entering treatment in a community mental health center. To assess early trauma in this population, the Adverse Childhood Experience (ACEs) questionnaire was administered to 856 participants over a nine-month period. 40% reported four or more ACEs. Among high scorers, emotional abuse, physical abuse and emotional neglect were the most prevalent ACE experiences. High mean ACE sum scores were observed among patients with PTSD, depression, impulse disorder and substance use disorder. Having a higher ACE sum score was associated with a greater number of co-occurring psychiatric disorders. Characterizing ACEs by patient sociodemographic attributes and psychiatric diagnoses extracted from the electronic medical records (EMR) can benefit therapeutic interventions. These findings indicate a need for creating more trauma-informed settings with knowledgeable, trained staff.
Collapse
Affiliation(s)
- James Sucich
- The Family Health Centers at NYU Langone, Brooklyn, NY, USA.
- NYU Lagone Health, Sunset Terrace Family Health Center, 514 49th St. Brooklyn, 11220, New York, NY, USA.
| | | | - Sharifa Williams
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Navin Sanichar
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | | | - W Gordon Frankle
- NYU Lagone Health, Sunset Terrace Family Health Center, 514 49th St. Brooklyn, 11220, New York, NY, USA
| | | |
Collapse
|
47
|
Khanijahani A, Tomassoni L. Socioeconomic and Racial/Ethnic Disparities in Recovery from Childhood Behavioral or Conduct Problems: Evidence from a Nationally Representative Sample of 3-17 Years Old US Children. J Immigr Minor Health 2023; 25:744-754. [PMID: 36576672 DOI: 10.1007/s10903-022-01444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/29/2022]
Abstract
Our study provides nationally-generalizable evidence on the racial/ethnic and socioeconomic disparities in diagnosis and recovery from childhood behavioral or conduct problems. We pooled data from 4 years (2016-2019) of the National Survey of Children's Health (NSCH) for 3 to 17 years old US children (N = 114,476). We performed several logistic regression models using complex survey data analysis statistical methodologies to estimate nationally representative and generalizable results in the Stata MP 16 program. About 20.1% of 3-17 years old US children previously diagnosed with behavioral or conduct problems no longer had the current diagnosis (were recovered). Hispanic children [Odds ratio (OR) 0.77, 95% Confidence Interval (CI) 0.65-0-95], immigrant children or children of immigrant parents (first or second generation immigrant children), and children from high-income families [200-399% Federal Poverty Level (FPL)] were about 23%, 38%, and 21% less likely than non-Hispanic White children, children of US native parents, and children with a family income of below 100% FPL to be currently diagnosed with behavioral or conduct problems, respectively. Conversely, Non-Hispanic Black and Hispanic children were about 50% and 40% more likely than non-Hispanic White children to recover from a past diagnosis. Moreover, children from higher-income families (at or above 300% of FPL) were between 1.59 to 1.79 times more likely than those from low-income families (below 100% FPL) to recover from a past diagnosis. Racial/ethnic and socioeconomic disparities in diagnosing appear to persist in recovering from behavioral or conduct problems.
Collapse
Affiliation(s)
- Ahmad Khanijahani
- Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, 600 Forbes Avenue Pittsburgh, Pittsburgh, PA, 15282, USA.
| | - Larisa Tomassoni
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
48
|
Byansi W, Ssewamala FM, Neilands TB, Mwebembezi A, Nakigozi G. Patterns of and Factors Associated With Mental Health Service Utilization Among School-Going Adolescent Girls in Southwestern Uganda: A Latent Class Analysis. J Adolesc Health 2023; 72:S24-S32. [PMID: 37062580 PMCID: PMC10270327 DOI: 10.1016/j.jadohealth.2022.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/19/2022] [Accepted: 09/28/2022] [Indexed: 04/18/2023]
Abstract
PURPOSE The study aimed to improve understanding of patterns of multiple family group intervention engagement and associated factors among adolescent girls in a low-resource country, Uganda. METHODS The data used in this analysis were part of a larger cluster randomized controlled trial consisting of 1260 adolescent girls across 47 public secondary schools. The sample in the current study consisted of 317 adolescent girls (ages 14-17 at enrollment) recruited from senior one and senior two classes across 12 secondary schools in the southwestern region of Uganda. Participants in this study participated in the multiple family group intervention-a 16-week manualized intervention. Attendance data from 16 sessions were used to identify the heterogeneity of intervention engagement using latent class analysis modeling. Logistic regression analysis was conducted to assess the association between predisposing, enabling, need factors, and mental health utilization patterns. RESULTS On average, participants attended 10 sessions (standard deviation = 5.90), 34.38% (N = 109) completed all 16 sessions, and 13.56% (N = 43) did not attend any of the sessions. Two attendance groups were identified: low and high attendants using latent class analysis. In addition, two family-level factors, the number of adults and the number of children in the family, were associated with an increase in the utilization of mental health services. DISCUSSION Findings suggest that enhancing family support systems may be useful in promoting mental health utilization among adolescent girls with the potential to improve self-esteem, reduce feelings of inadequacy, and ultimately achieve better mental health outcomes.
Collapse
Affiliation(s)
- William Byansi
- School of Social Work, Boston College, Chesnut Hill, Massachusetts.
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Torsten B Neilands
- School of Medicine, University of California San Francisco, San Francisco, California
| | | | | |
Collapse
|
49
|
Pitkänen J, Remes H, Aaltonen M, Martikainen P. Moderating role of sociodemographic factors in parental psychiatric treatment before and after offspring severe self-harm. J Affect Disord 2023; 327:145-154. [PMID: 36758868 DOI: 10.1016/j.jad.2023.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Parental psychiatric disorders are known risk factors for adolescent self-harm. Although this association is likely to have a bidirectional element, evidence on changes in parental psychiatric treatment following offspring self-harm is scarce. METHODS Finnish children born in 1987-1996 with a hospital-treated episode of self-harm between the ages 13 and 19 years (N = 3636) were identified using administrative register data, and their biological mothers (N = 3432) and fathers (N = 3167) were followed two years before and after the episode. Data on purchases of psychotropic medication, specialized psychiatric treatment and psychiatric sickness allowances were used to examine psychiatric treatment among parents. Differences by parental education, employment and living arrangements were assessed, and offspring self-harm was compared with offspring accidental poisonings and traffic accidents. RESULTS Psychiatric treatment peaked among mothers during the three-month period after offspring self-harm, after which the treatment prevalence decreased but remained slightly elevated relative to the time preceding offspring self-harm. Higher levels of education and being employed increased the likelihood of treatment right after the episode. Among fathers, changes in treatment were negligible. Treatment trajectories around the comparison events of accidents were similar in shape but more muted than among the parents whose children had self-harmed. LIMITATIONS General practitioner visits or other data from primary health care were not available. CONCLUSION Mothers receive increased psychiatric treatment after stressful offspring events. Our results indicate that prevention of self-harm and accidents would be beneficial not only for those directly concerned but also for their family members.
Collapse
Affiliation(s)
- Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland; International Max Planck Research School for Population, Health and Data Science, Rostock, Germany.
| | - Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
| | - Mikko Aaltonen
- Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Law School, University of Eastern Finland, Joensuu, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland; Max Planck Institute for Demographic Research, Rostock, Germany; Department of Public Health Sciences, Stockholm University, Sweden
| |
Collapse
|
50
|
Vasiliadis HM, Spagnolo J, Fleury MJ, Gouin JP, Roberge P, Bartram M, Grenier S, Shen-Tu G, Vena JE, Wang J. Mental health service use and associated predisposing, enabling and need factors in community living adults and older adults across Canada. BMC Health Serv Res 2023; 23:357. [PMID: 37046270 PMCID: PMC10091342 DOI: 10.1186/s12913-023-09335-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES Using Andersen's model of health care seeking behavior, we examined the predisposing, enabling, and need factors associated with mental health service use (MHSU) during the first wave of the COVID-19 pandemic across Canada. METHODS The sample included n = 45,542 participants in the 5 established regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath) and who responded to the CanPath COVID-19 health survey (May-December 2020), with complete data on MHSU. Multivariable logistic regression analyses were carried out to study MHSU as a function of predisposing, enabling, and need factors. Analyses were stratified by regional cohort. RESULTS Among the need factors, individuals reporting moderate/severe symptoms of depression and anxiety and poorer self-rated mental health were more likely to report MHSU. Among the enabling factors, receipt of informational/financial/practical support was associated with increased MHSU. While income was not consistently associated with MHSU, reported decrease in income was marginally associated with reduced MHSU. Among the predisposing factors, identifying as female or other gender minority was associated with increased MHSU, as was the presence of past-year cannabis use. In contrast, older age and alcohol consumption were associated with reduced MHSU. CONCLUSION Need factors were consistently associated with MHSU. Although income inequities in MHSU were not observed, changes such as reduced income during the pandemic may lead to barriers in accessing mental health services. Future research should focus on better identifying contextual enabling factors and policies that overcome financial barriers to MHSU.
Collapse
Affiliation(s)
- Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, 2500, boul. de l'Université, J1K 2R1, Sherbrooke (Québec), Canada.
- Centre de recherche Charles-Le Moyne, 150, place Charles‑Le Moyne, C. P. 200, J4K 0A8, Longueuil (Québec), Canada.
| | - Jessica Spagnolo
- Département des sciences de la santé communautaire, Université de Sherbrooke, 2500, boul. de l'Université, J1K 2R1, Sherbrooke (Québec), Canada
- Centre de recherche Charles-Le Moyne, 150, place Charles‑Le Moyne, C. P. 200, J4K 0A8, Longueuil (Québec), Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, 6875 boul., H4H 1R3, LaSalleVerdun (Québec), Canada
- McGill University, 845 Sherbrooke St W, H3A 0G4, Montreal (Québec), Canada
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, 7141 Sherbrooke West, H4B 1R6, Montreal (Québec), Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4545 Queen Mary Rd, H3W 1W6, Montreal (Québec), Canada
| | - Pasquale Roberge
- Département de médecine familiale et d'urgence, Université de Sherbrooke, 2500, boul. de l'Université, J1K 2R1, Sherbrooke (Québec), Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, 12e Avenue N Porte 6, J1H 5N4, Sherbrooke (Québec), Canada
| | - Mary Bartram
- Mental Health Commission of Canada, 350 Albert St #1210, K1R 1A4, Ottawa (Ontario), Canada
- School of Public Policy & Administration, Carleton University, 1125 Colonel By Drive, K1S 5B6, Ottawa (Ontario), Canada
| | - Sébastien Grenier
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4545 Queen Mary Rd, H3W 1W6, Montreal (Québec), Canada
- Département de psychologie, Université de Montréal, 90, avenue Vincent d'Indy, H2V 2S9, Montréal (Québec), Canada
| | - Grace Shen-Tu
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, 1820 Richmond Road SW, T2T 5C7, Calgary (Alberta), Canada
| | - Jennifer E Vena
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, 1820 Richmond Road SW, T2T 5C7, Calgary (Alberta), Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, B3H 1V7, Halifax (Nova Scotia), Canada
| |
Collapse
|