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Brooke-Sumner C, Machisa MT, Sikweyiya Y, Mahlangu P. Group-format, peer-facilitated mental health promotion interventions for students in higher education settings: a scoping review protocol. BMJ Open 2024; 14:e080629. [PMID: 38830731 PMCID: PMC11149131 DOI: 10.1136/bmjopen-2023-080629] [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: 10/06/2023] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Young people in higher education face various stressors that can make them vulnerable to mental ill-health. Mental health promotion in this group therefore has important potential benefits. Peer-facilitated and group-format interventions may be feasible and sustainable. The scoping review outlined in this protocol aims to map the literature on group-format, peer-facilitated, in-person interventions for mental health promotion for higher education students attending courses on campuses in high and low/middle-income countries. METHODS AND ANALYSIS Relevant studies will be identified through conducting searches of electronic databases, including Medline, CINAHL, Scopus, ERIC and PsycINFO. Searches will be conducted using Boolean operators (AND, OR, NOT) and truncation functions appropriate for each database. We will include a grey literature search. We will include articles from student participants of any gender, and published in peer-reviewed journals between 2008 and 2023. We will include English-language studies and all study types including randomised controlled trials, pilot studies and descriptive studies of intervention development. A draft charting table has been developed, which includes the fields: author, publication date, country/countries, aims, population and sample size, demographics, methods, intervention type, comparisons, peer training, number of sessions/duration of intervention, outcomes and details of measures. ETHICS AND DISSEMINATION No primary data will be collected from research participants to produce this review so ethics committee approval is not required. All data will be collated from published peer-reviewed studies already in the public domain. We will publish the review in an open-access, peer-reviewed journal accessible to researchers in low/middle-income countries. This protocol is registered on Open Science Framework (https://osf.io/agbfj/).
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Affiliation(s)
- Carrie Brooke-Sumner
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu Natal, Durban, South Africa
| | - Mercilene T Machisa
- School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu Natal, Durban, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Yandisa Sikweyiya
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinky Mahlangu
- School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu Natal, Durban, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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Papola D, Prina E, Ceccarelli C, Cadorin C, Gastaldon C, Ferreira MC, Tol WA, van Ommeren M, Barbui C, Purgato M. Psychological and social interventions for the promotion of mental health in people living in low- and middle-income countries affected by humanitarian crises. Cochrane Database Syst Rev 2024; 5:CD014300. [PMID: 38770799 PMCID: PMC11106803 DOI: 10.1002/14651858.cd014300.pub2] [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] [Indexed: 05/22/2024]
Abstract
BACKGROUND Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low- and middle-income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well-being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health. OBJECTIVES To assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were mental well-being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well-being, functioning, and prosocial behaviour. MAIN RESULTS We included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration was 18 weeks (minimum 10, maximum 32 weeks). Trials were generally funded by grants from academic institutions or non-governmental organisations. For children and adolescents, there was no clear difference between psychosocial interventions and control conditions in improving mental well-being and prosocial behaviour at study endpoint (mental well-being: standardised mean difference (SMD) 0.06, 95% confidence interval (CI) -0.17 to 0.29; 3 RCTs, 3378 participants; very low-certainty evidence; prosocial behaviour: SMD -0.25, 95% CI -0.60 to 0.10; 5 RCTs, 1633 participants; low-certainty evidence), or at medium-term follow-up (mental well-being: mean difference (MD) -0.70, 95% CI -2.39 to 0.99; 1 RCT, 258 participants; prosocial behaviour: SMD -0.48, 95% CI -1.80 to 0.83; 2 RCT, 483 participants; both very low-certainty evidence). Interventions may improve functioning (MD -2.18, 95% CI -3.86 to -0.50; 1 RCT, 183 participants), with sustained effects at follow-up (MD -3.33, 95% CI -5.03 to -1.63; 1 RCT, 183 participants), but evidence is very uncertain as the data came from one RCT (both very low-certainty evidence). Psychosocial interventions may improve mental well-being slightly in adults at study endpoint (SMD -0.29, 95% CI -0.44 to -0.14; 3 RCTs, 674 participants; low-certainty evidence), but they may have little to no effect at follow-up, as the evidence is uncertain and future RCTs might either confirm or disprove this finding. No RCTs measured the outcomes of functioning and prosocial behaviour in adults. AUTHORS' CONCLUSIONS To date, there is scant and inconclusive randomised evidence on the potential benefits of psychological and social interventions to promote mental health in people living in LMICs affected by humanitarian crises. Confidence in the findings is hampered by the scarcity of studies included in the review, the small number of participants analysed, the risk of bias in the studies, and the substantial level of heterogeneity. Evidence on the efficacy of interventions on positive mental health outcomes is too scant to determine firm practice and policy implications. This review has identified a large gap between what is known and what still needs to be addressed in the research area of mental health promotion in humanitarian settings.
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Affiliation(s)
- Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Global Program Expert Group on Mental Health and Psychosocial Support, SOS Children's Villages, Milan, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Madalena C Ferreira
- Public Health Unit, Médio Ave Local Health Unit, Vila Nova de Famalicão, Portugal
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mark van Ommeren
- Department of Mental Health, Brain Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Harte P, Barry MM. A scoping review of the implementation and cultural adaptation of school-based mental health promotion and prevention interventions in low-and middle-income countries. Glob Ment Health (Camb) 2024; 11:e55. [PMID: 38751723 PMCID: PMC11094552 DOI: 10.1017/gmh.2024.48] [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: 11/25/2023] [Revised: 02/13/2024] [Accepted: 03/25/2024] [Indexed: 05/18/2024] Open
Abstract
Effective school-based mental health promotion and prevention interventions in low-and middle-income countries (LMICs) can positively impact the mental health and well-being of large numbers of young people. This scoping review aimed to investigate the implementation of effective mental health promotion and prevention interventions in LMIC schools. A scoping review of the international literature was conducted and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Medline, PsycInfo, Scopus, Embase, CINAHL and Cochrane were searched for peer-reviewed literature published from 2014 to 2022. PsycExtra, Google Scholar and the websites of key organisations were searched for relevant grey literature. Study selection focussed on mental health promotion interventions, including the development of social and emotional skills and mental health literacy, and prevention interventions, including anti-bullying and skill-based interventions for "at-risk" students. Twenty-seven studies evaluating 25 school-based interventions in 17 LMICs were included in the review. Fifteen interventions were developed in the implementing country and 10 were adapted from high-income countries (HICs) or other settings. Findings from the studies reviewed were generally positive, especially when interventions were implemented to a high quality. Universal life-skills interventions were found to increase social and emotional skills, decrease problem behaviours and positively impact students' mental health and well-being. Mental health literacy interventions increased mental health knowledge and decreased stigma among students and school staff. Outcomes for externally facilitated anti-bullying interventions were less positive. All 19 effective studies reported on some aspects of programme implementation, and 15 monitored implementation fidelity. Eleven studies outlined the programme's underpinning theoretical model. Only four studies reported on the cultural adaptation of programmes in detail. Including young people in the adaptation process was reported to facilitate natural cultural adaptation of programmes, while input from programme developers was considered key to ensuring that the core components of interventions were retained. The review findings indicate increasing evidence of effective mental health interventions in LMIC schools. To facilitate the sustainability, replication and scaling-up of these interventions, greater attention is needed to reporting on intervention core components, and the processes of implementation and cultural adaptation in the local setting.
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Affiliation(s)
- Patricia Harte
- WHO Collaborating Centre for Health Promotion Research, University of Galway, Galway, Ireland
| | - Margaret M. Barry
- WHO Collaborating Centre for Health Promotion Research, University of Galway, Galway, Ireland
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Greene MC, Kane J, Alto M, Giusto A, Lovero K, Stockton M, McClendon J, Nicholson T, Wainberg ML, Johnson RM, Tol WA. Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries. Cochrane Database Syst Rev 2023; 5:CD013350. [PMID: 37158538 PMCID: PMC10167787 DOI: 10.1002/14651858.cd013350.pub2] [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: 05/10/2023]
Abstract
BACKGROUND Harmful alcohol use is defined as unhealthy alcohol use that results in adverse physical, psychological, social, or societal consequences and is among the leading risk factors for disease, disability and premature mortality globally. The burden of harmful alcohol use is increasing in low- and middle-income countries (LMICs) and there remains a large unmet need for indicated prevention and treatment interventions to reduce harmful alcohol use in these settings. Evidence regarding which interventions are effective and feasible for addressing harmful and other patterns of unhealthy alcohol use in LMICs is limited, which contributes to this gap in services. OBJECTIVES To assess the efficacy and safety of psychosocial and pharmacologic treatment and indicated prevention interventions compared with control conditions (wait list, placebo, no treatment, standard care, or active control condition) aimed at reducing harmful alcohol use in LMICs. SEARCH METHODS We searched for randomized controlled trials (RCTs) indexed in the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, the Cochrane Clinical Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, Embase, PsycINFO, CINAHL, and the Latin American and Caribbean Health Sciences Literature (LILACS) through 12 December 2021. We searched clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, Web of Science, and Opengrey database to identify unpublished or ongoing studies. We searched the reference lists of included studies and relevant review articles for eligible studies. SELECTION CRITERIA All RCTs comparing an indicated prevention or treatment intervention (pharmacologic or psychosocial) versus a control condition for people with harmful alcohol use in LMICs were included. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 66 RCTs with 17,626 participants. Sixty-two of these trials contributed to the meta-analysis. Sixty-three studies were conducted in middle-income countries (MICs), and the remaining three studies were conducted in low-income countries (LICs). Twenty-five trials exclusively enrolled participants with alcohol use disorder. The remaining 51 trials enrolled participants with harmful alcohol use, some of which included both cases of alcohol use disorder and people reporting hazardous alcohol use patterns that did not meet criteria for disorder. Fifty-two RCTs assessed the efficacy of psychosocial interventions; 27 were brief interventions primarily based on motivational interviewing and were compared to brief advice, information, or assessment only. We are uncertain whether a reduction in harmful alcohol use is attributable to brief interventions given the high levels of heterogeneity among included studies (Studies reporting continuous outcomes: Tau² = 0.15, Q =139.64, df =16, P<.001, I² = 89%, 3913 participants, 17 trials, very low certainty; Studies reporting dichotomous outcomes: Tau²=0.18, Q=58.26, df=3, P<.001, I² =95%, 1349 participants, 4 trials, very low certainty). The other types of psychosocial interventions included a range of therapeutic approaches such as behavioral risk reduction, cognitive-behavioral therapy, contingency management, rational emotive therapy, and relapse prevention. These interventions were most commonly compared to usual care involving varying combinations of psychoeducation, counseling, and pharmacotherapy. We are uncertain whether a reduction in harmful alcohol use is attributable to psychosocial treatments due to high levels of heterogeneity among included studies (Heterogeneity: Tau² = 1.15; Q = 444.32, df = 11, P<.001; I²=98%, 2106 participants, 12 trials, very low certainty). Eight trials compared combined pharmacologic and psychosocial interventions with placebo, psychosocial intervention alone, or another pharmacologic treatment. The active pharmacologic study conditions included disulfiram, naltrexone, ondansetron, or topiramate. The psychosocial components of these interventions included counseling, encouragement to attend Alcoholics Anonymous, motivational interviewing, brief cognitive-behavioral therapy, or other psychotherapy (not specified). Analysis of studies comparing a combined pharmacologic and psychosocial intervention to psychosocial intervention alone found that the combined approach may be associated with a greater reduction in harmful alcohol use (standardized mean difference (standardized mean difference (SMD))=-0.43, 95% confidence interval (CI): -0.61 to -0.24; 475 participants; 4 trials; low certainty). Four trials compared pharmacologic intervention alone with placebo and three with another pharmacotherapy. Drugs assessed were: acamprosate, amitriptyline, baclofen disulfiram, gabapentin, mirtazapine, and naltrexone. None of these trials evaluated the primary clinical outcome of interest, harmful alcohol use. Thirty-one trials reported rates of retention in the intervention. Meta-analyses revealed that rates of retention between study conditions did not differ in any of the comparisons (pharmacologic risk ratio (RR) = 1.13, 95% CI: 0.89 to 1.44, 247 participants, 3 trials, low certainty; pharmacologic in addition to psychosocial intervention: RR = 1.15, 95% CI: 0.95 to 1.40, 363 participants, 3 trials, moderate certainty). Due to high levels of heterogeneity, we did not calculate pooled estimates comparing retention in brief (Heterogeneity: Tau² = 0.00; Q = 172.59, df = 11, P<.001; I2 = 94%; 5380 participants; 12 trials, very low certainty) or other psychosocial interventions (Heterogeneity: Tau² = 0.01; Q = 34.07, df = 8, P<.001; I2 = 77%; 1664 participants; 9 trials, very low certainty). Two pharmacologic trials and three combined pharmacologic and psychosocial trials reported on side effects. These studies found more side effects attributable to amitriptyline relative to mirtazapine, naltrexone and topiramate relative to placebo, yet no differences in side effects between placebo and either acamprosate or ondansetron. Across all intervention types there was substantial risk of bias. Primary threats to validity included lack of blinding and differential/high rates of attrition. AUTHORS' CONCLUSIONS In LMICs there is low-certainty evidence supporting the efficacy of combined psychosocial and pharmacologic interventions on reducing harmful alcohol use relative to psychosocial interventions alone. There is insufficient evidence to determine the efficacy of pharmacologic or psychosocial interventions on reducing harmful alcohol use largely due to the substantial heterogeneity in outcomes, comparisons, and interventions that precluded pooling of these data in meta-analyses. The majority of studies are brief interventions, primarily among men, and using measures that have not been validated in the target population. Confidence in these results is reduced by the risk of bias and significant heterogeneity among studies as well as the heterogeneity of results on different outcome measures within studies. More evidence on the efficacy of pharmacologic interventions, specific types of psychosocial interventions are needed to increase the certainty of these results.
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Affiliation(s)
- M Claire Greene
- Program on Forced Migration and Health, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeremy Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle Alto
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Kathryn Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Melissa Stockton
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Jasmine McClendon
- Department of Psychiatry, UC Davis Medical Center, Sacramento, CALIFORNIA, USA
| | - Terriann Nicholson
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, USA
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Closing the treatment gap for alcohol use disorders in low- and middle-income countries. Glob Ment Health (Camb) 2023; 10:e3. [PMID: 36843876 PMCID: PMC9947611 DOI: 10.1017/gmh.2022.57] [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: 07/18/2022] [Revised: 09/14/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022] Open
Abstract
The alcohol-attributable disease burden is greater in low- and middle-income countries (LMICs) as compared to high-income countries. Despite the effectiveness of interventions such as health promotion and education, brief interventions, psychological treatments, family-focused interventions, and biomedical treatments, access to evidence-based care for alcohol use disorders (AUDs) in LMICs is limited. This can be explained by poor access to general health and mental health care, limited availability of relevant clinical skills among health care providers, lack of political will and/or financial resources, historical stigma and discrimination against people with AUDs, and poor planning and implementation of policies. Access to care for AUDs in LMICs could be improved through evidence-based strategies such as designing innovative, local and culturally acceptable solutions, health system strengthening by adopting a collaborative stepped care approach, horizontal integration of care into existing models of care (e.g., HIV care), task sharing to optimise limited human resources, working with families of individuals with AUD, and leveraging technology-enabled interventions. Moving ahead, research, policy and practice in LMICs need to focus on evidence-based decision-making, responsiveness to context and culture, working collaboratively with a range of stakeholders to design and implement interventions, identifying upstream social determinants of AUDs, developing and evaluating policy interventions such as increased taxation on alcohol, and developing services for special populations (e.g., adolescents) with AUDs.
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Danylova T, Vovk A, Hoian I, Kholodynska S, Honcharenko K, Ishchenko O, Bezhnar A. PHILOSOPHY AND MENTAL HEALTH. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1866-1873. [PMID: 37740983 DOI: 10.36740/wlek202308122] [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: 09/25/2023]
Abstract
OBJECTIVE The aim: The paper aims to examine the relationship between philosophy and mental health. PATIENTS AND METHODS Materials and methods: The authors used integrative anthropological approach, interpretive research paradigm, hermeneutical approach. The data collection was carried out using Scopus, Web of Science, PubMed, Google Scholar databases. Research papers were identified according to search terms: "mental health", "philosophy", "Ancient philosophy", "Epicureanism", "Stoicism", "Eastern philosophy", "Buddhism", "Taoism", "psychology", "psychotherapy", "anxiety", "depression", "happiness", "mindfulness", "meaning in life". CONCLUSION Conclusions: Attempts to cope with life challenges, frustration, fear, anxiety, stress should not be isolated endeavors, but they need to be placed in a wider philosophical context, as far as every issue, including mental health issues, has a philosophical perspective at its core. Such experience can cultivate human strength, self-confidence, awareness, empathy. In times of uncertainty, when we do not know where to go, when we do not understand who we are and what is our purpose on earth, philosophy helps us to find our way. In the most difficult times, philosophy acts as a guiding star and consolation reconciling us with what we are unable to change.
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Affiliation(s)
- Tetiana Danylova
- NATIONAL ACADEMY OF EDUCATIONAL SCIENCES OF UKRAINE, KYIV, UKRAINE; INSTITUTE OF PHILOSOPHY AND SOCIOLOGY OF THE POLISH ACADEMY OF SCIENCES, WARSAW, POLAND
| | - Anatoliy Vovk
- NATIONAL UNIVERSITY OF LIFE AND ENVIRONMENTAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | - Ihor Hoian
- VASYL STEFANYK PRECARPATHIAN NATIONAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
| | | | | | | | - Anna Bezhnar
- TARAS SHEVCHENKO NATIONAL UNIVERSITY OF KYIV, KYIV, UKRAINE
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Investing for population mental health in low and middle income countries-where and why? Int J Ment Health Syst 2022; 16:38. [PMID: 35953845 PMCID: PMC9366832 DOI: 10.1186/s13033-022-00547-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 06/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Policy makers intent on improving population mental health are required to make fundamental decisions on where to invest resources to achieve optimal outcomes. While research on the effectiveness and efficiency of interventions is critical to such choices, including clinical outcomes and return on investment, in the “real world” of policy making other concerns invariably also play a role. Politics, history, community awareness and demands for care, understanding of etiology, severity of condition and local circumstances are all critical. Policy makers should not merely rely on previous allocations, but need to take active decisions regarding the proportion of resources that should be allocated to particular interventions to achieve optimum outcomes. Given that scientific evidence is only one of the reasons informing such decisions, it is necessary to have clear and informed reasons for allocations and for making cases for new mental health investments. Main body Investment allocations are unlikely to ever be an exact science. Alternatives therefore need to be rationally weighed up and reasoned decisions made based on this. Using prevalence data and the distribution of mental health resources in South Africa as a backdrop and proxy, investment proposals are made for LMICs with due consideration given to inter alia the social determinants of mental health, the needs and potential benefits of investments in people with severe verses common mental disorder, mental health promotion and disease prevention and to other areas that may impact on population mental health, such as management. Conclusion Based on a range of arguments, it is proposed that mental health investments should follow the following approach. A mental health-in-all-policies method must be adopted. There should be no more than a 20% gap in the humane and human rights oriented care, treatment and rehabilitation of people with severe mental disorder. A minimum additional amount of 10% of the amount spent on severe mental disorder should be allocated to treating people with common mental disorder. Screening for mental disabilities should take place within all chronic care services. A minimum of 3% of the budget spent on severe mental disorder should be spent on promotion and prevention programmes. An additional 1% of the allocation for severe mental disorder should be provided for managing/driving the mental health programme.
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Giang LM, Trang NT, Diep NB, Thuy DTD, Thuy DT, Hoe HD, Van HTH, Truc TT, Nguyen HH, Lai NL, Linh PTD, Vi VTT, Reback CJ, Leibowitz A, Li L, Lin C, Li M, Do Van Dung, Shoptaw S. An adaptive design to screen, treat, and retain people with opioid use disorders who use methamphetamine in methadone clinics (STAR-OM): study protocol of a clinical trial. Trials 2022; 23:342. [PMID: 35461300 PMCID: PMC9034071 DOI: 10.1186/s13063-022-06278-w] [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: 10/21/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methamphetamine use could jeopardize the current efforts to address opioid use disorder and HIV infection. Evidence-based behavioral interventions (EBI) are effective in reducing methamphetamine use. However, evidence on optimal combinations of EBI is limited. This protocol presents a type-1 effectiveness-implementation hybrid design to evaluate the effectiveness, cost-effectiveness of adaptive methamphetamine use interventions, and their implementation barriers in Vietnam. METHOD Design: Participants will be first randomized into two frontline interventions for 12 weeks. They will then be placed or randomized to three adaptive strategies for another 12 weeks. An economic evaluation and an ethnographic evaluation will be conducted alongside the interventions. PARTICIPANTS We will recruit 600 participants in 20 methadone clinics. ELIGIBILITY CRITERIA (1) age 16+; (2) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores ≥ 10 for methamphetamine use or confirmed methamphetamine use with urine drug screening; (3) willing to provide three pieces of contact information; and (4) having a cell phone. OUTCOMES Outcomes are measured at 13, 26, and 49 weeks and throughout the interventions. Primary outcomes include the (1) increase in HIV viral suppression, (2) reduction in HIV risk behaviors, and (3) reduction in methamphetamine use. COVID-19 response: We developed a response plan for interruptions caused by COVID-19 lockdowns to ensure data quality and intervention fidelity. DISCUSSION This study will provide important evidence for scale-up of EBIs for methamphetamine use among methadone patients in limited-resource settings. As the EBIs will be delivered by methadone providers, they can be readily implemented if the trial demonstrates effectiveness and cost-effectiveness. TRIAL REGISTRATION ClinicalTrials.gov NCT04706624. Registered on 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624.
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Affiliation(s)
- Le Minh Giang
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Thu Trang
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam.
| | - Nguyen Bich Diep
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Dao Thi Dieu Thuy
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Dinh Thanh Thuy
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Han Dinh Hoe
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | | | - Thai Thanh Truc
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hoa H Nguyen
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Ly Lai
- South Vietnam HIV and Addiction Technology Transfer Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Pham Thi Dan Linh
- South Vietnam HIV and Addiction Technology Transfer Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Vu Thi Tuong Vi
- South Vietnam HIV and Addiction Technology Transfer Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Cathy J Reback
- Friends Research Institute, Friends Community Center, Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, USA
| | - Arleen Leibowitz
- Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, USA
| | - Li Li
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, USA
| | - Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, Jane & Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, USA
| | - Michael Li
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, Los Angeles, USA
| | - Do Van Dung
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Steve Shoptaw
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, Los Angeles, USA
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Kamacooko O, Bagiire D, Kasujja FX, Mirembe M, Seeley J, King R. Prevalence of probable depression and factors associated with mean Hopkins Symptom Checklist (HSCL) depression score among young women at high risk aged 15-24 years in Kampala, Uganda. PLoS One 2022; 17:e0270544. [PMID: 35771894 PMCID: PMC9246240 DOI: 10.1371/journal.pone.0270544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In populations at high risk of HIV infection, rates of depression can be elevated with far-reaching effects on overall well-being. There is limited research on depression among young women engaged in high-risk sexual behaviour in low and middle-income settings. We investigated the prevalence, correlates and factors associated with mean HSCL depression score among young women at high risk (aged 15-24 years old) in Kampala, Uganda. METHODS We conducted a baseline analysis of a randomized controlled trial. Probable depression was measured using the 15-item Hopkins Symptoms Checklist for depression (HSCL). This checklist has been validated in Ugandan populations, and our reliability test gave a Cronbach alpha coefficient of 0.89. The test was administered to all the participants. Participants whose HSCL mean score was greater than 1.75 were categorized as having probable depression. Socio-demographics and behaviour data were collected and factors associated with mean HSCL depression score were analysed using multiple linear regression. RESULTS Data was available for 600 participants, mean age 20.4 (SD±2.44) years. The prevalence of probable depression was 56% (95% CI, 52%-60%). Probable depression symptoms were most prevalent among those who reported ever-experiencing violence from a sexual partner (64.7%), those aged between 20-24 years (58.2%) and those who reported more than 10 sexual exposures in the month prior to the interview (56.8%). At the adjusted analysis level, condom use during their last sexual intercourse prior to the survey decreased probable depression symptoms by 0.147 units compared to those who never used condoms (β = -0.147, 95% CI -0.266-0.027). Having experienced physical violence by a sexual partners increased mean HSCL depression score by 0.183 units compared to those who have never experienced violence (β = 0.183, 95% CI 0.068-0.300). Participants who reported ever using drugs of addiction had their mean HSCL depression scoreincrease by 0.20 units compared to those who have never used (β = 0.20,95% CI 0.083-0.317). CONCLUSIONS Probable depression is high in this population and increased mean HSCL depression score is related to violence. Periodic screening for depression and interventions targeting depression, partner violence and risky sexual behaviours are recommended.
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Affiliation(s)
| | | | | | | | - Janet Seeley
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rachel King
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
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10
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Jailobaeva K, Horn R, Arakelyan S, Diaconu K, Kamara A, Ager A. Social determinants of psychological distress in Sierra Leone. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1781-1793. [PMID: 35441330 PMCID: PMC9375741 DOI: 10.1007/s00127-022-02278-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Growing evidence demonstrates that daily stressors such as family violence, unemployment, and living conditions play an important part in causing psychological distress. This paper investigates the impact of distressing events and day-to-day living conditions on psychological distress in the fragile context of Sierra Leone. METHODS A cross-sectional survey was conducted with 904 adults (454 men, 450 women) in 5 districts of Sierra Leone. The survey questionnaire comprised the Sierra Leone Psychological Distress scale and measures of demographic variables and personal characteristics, current life circumstances and potentially distressing events. RESULTS Multiple regression results identified three factors to be the greatest contributors to psychological distress: family conflict (β = 0.185, p < 0.001) and inability to afford basic needs (β = 0.175, p < 0.001). Gender differences were evident: factors predicting men's psychological distress included severe sickness or injury (β = 0.203, p < 0.001) and being unable to afford basic needs (β = 0.190, p < 0.001); for women, predicting factors were family conflict (β = 0.212, p < 0.001), perceived poor health (β = 0.192, p < 0.001) and inability to afford basic needs (β = 0.190, p < 0.001). CONCLUSION Initiatives to promote good mental health and psychosocial wellbeing in Sierra Leone should focus on enhancing income-generating and employment opportunities, promoting access to education, and strengthening family relationships.
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Affiliation(s)
- Kanykey Jailobaeva
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK.
| | - Rebecca Horn
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Stella Arakelyan
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Karin Diaconu
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Ajaratu Kamara
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK ,College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Alastair Ager
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
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11
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Leventhal KS, Cooper PL, DeMaria LM, Priyam P, Shanker H, Andrew G, Leventhal S. Promoting wellbeing and empowerment via Youth First: Exploring psychosocial outcomes of a school-based resilience intervention in Bihar, India. Front Psychiatry 2022; 13:1021892. [PMID: 36465290 PMCID: PMC9712804 DOI: 10.3389/fpsyt.2022.1021892] [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: 08/17/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
Youth worldwide are struggling with increased mental health concerns. As youth in low- and middle-income countries make up more than 20% of the world's population, finding ways to improve their psychosocial wellbeing is crucial. CorStone's Youth First program is a school-based psychosocial resilience program that seeks to improve the mental, physical, social, and educational wellbeing of early adolescents. The program is delivered via trained government schoolteachers who facilitate students' learning and development in small groups using a discussion and activity-based curriculum. In August 2021, a study among 322 adolescents was conducted to investigate and compare program participants' and non- participants' understanding and use of inter- and intra-personal psychosocial skills. Focus group discussions were held with students in eight intervention schools and four comparable schools not receiving the intervention (control). Through the focus group discussions, students provided their opinions, thoughts, and ideas about vignettes describing challenges that youth in their communities frequently face, including early marriage and financial pressures. Analysis integrated qualitative and quantitative approaches, consisting of an iterative thematic analysis process followed by quantizing data and conducting t-tests. Youth who had received Youth First had greater awareness of problems, perspective-taking, problem-solving strategies, helping approaches, awareness of their own strengths, and visions for the future, when compared with the control group. Findings provide insights into potential outcomes for measurement in future evaluations of mental health promotion and prevention programs among youth in low- and middle-income countries.
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Affiliation(s)
- Katherine S Leventhal
- CorStone, Baltimore, MD, United States.,Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Lisa M DeMaria
- International Division, Mathematica, Princeton, NJ, United States
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12
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Mental health support for children and adolescents with hearing loss: scoping review. BJPsych Open 2021. [PMCID: PMC8693903 DOI: 10.1192/bjo.2021.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Children with hearing loss are at increased risk of mental health conditions, including behavioural problems, but there is limited evidence about available mental health support. Aims We aimed to map the evidence on mental health support for children and adolescents with hearing loss. Method Medline, Embase, PsycINFO and grey literature databases were searched until April 2021. Articles of any study design were eligible if they described an intervention supporting the mental health of children with hearing loss. No restrictions were placed on geography or publication date. Four reviewers independently screened results by title, abstract and full text. Study characteristics and outcome data were extracted, with results narratively synthesised. Results From 5629 search results, 27 articles were included. A large majority of the studies (81%, n = 22) were from high-income settings, with two-thirds (67%, n = 18) conducted in the USA. Less than half (41%, n = 11) of the articles adopted experimental research designs, and the majority of studies included small samples. The interventions presented were diverse, with the majority either therapy based (30%, n = 8) or skills training (30%, n = 8). Interventions included ice-skating, parent–child interaction therapy and resilience training. When measured, interventions demonstrated at least some evidence of effectiveness, although this was not always assessed with gold-standard methodology. Conclusions The evidence is lacking in breadth, study quality and geographical spread. That said, what is available indicates a range of effective approaches to support the mental health of children with hearing loss. Additional research is needed to improve the breadth of evidence on mental health support for this population.
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13
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Sparling TM, Cheng B, Deeney M, Santoso MV, Pfeiffer E, Emerson JA, Amadi FM, Mitu K, Corvalan C, Verdeli H, Araya R, Kadiyala S. Global Mental Health and Nutrition: Moving Toward a Convergent Research Agenda. Front Public Health 2021; 9:722290. [PMID: 34722437 PMCID: PMC8548935 DOI: 10.3389/fpubh.2021.722290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
Both malnutrition and poor mental health are leading sources of global mortality, disease, and disability. The fields of global food security and nutrition (FSN) and mental health have historically been seen as separate fields of research. Each have undergone substantial transformation, especially from clinical, primary care orientations to wider, sociopolitical approaches to achieve Sustainable Development Goals. In recent years, the trajectories of research on mental health and FSN are further evolving into an intersection of evidence. FSN impacts mental health through various pathways such as food insecurity and nutrients important for neurotransmission. Mental health drives FSN outcomes, for example through loss of motivation and caregiving capacities. They are also linked through a complex and interrelated set of determinants. However, the heterogeneity of the evidence base limits inferences about these important dynamics. Furthermore, interdisciplinary projects and programmes are gaining ground in methodology and impact, but further guidance in integration is much needed. An evidence-driven conceptual framework should inform hypothesis testing and programme implementation. The intersection of mental health and FSN can be an opportunity to invest holistically in advancing thinking in both fields.
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Affiliation(s)
- Thalia M Sparling
- Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA), London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bryan Cheng
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | - Megan Deeney
- Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA), London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marianne V Santoso
- Department of Anthropology, Northwestern University, Evanston, IL, United States
| | - Erin Pfeiffer
- Independent Consultant, Winston-Salem, NC, United States
| | | | | | - Khadija Mitu
- Department of Anthropology, University of Chittagong, Chittagong, Bangladesh
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | - Ricardo Araya
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Suneetha Kadiyala
- Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA), London School of Hygiene and Tropical Medicine, London, United Kingdom
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14
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Task sharing in psychotherapy as a viable global mental health approach in resource-poor countries and also in high-resource settings. GLOBAL HEALTH JOURNAL 2021. [DOI: 10.1016/j.glohj.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Fatani S, Bakke D, Halpape K, D'Eon M, El-Aneed A. Development and validation of patient-community pharmacist encounter toolkit regarding substance misuse: Delphi procedure. J Am Pharm Assoc (2003) 2021; 62:176-186. [PMID: 34538771 DOI: 10.1016/j.japh.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/15/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pharmacists' roles and services for patients with substance use are not well defined and inconsistent from site to site. Several barriers have been identified that hinder pharmacists' care for people who use substances, such as a lack of training and resources. Clinical practice tools can aid in transferring evidence-based approaches to the practice sphere. OBJECTIVES The aim of the study was to develop a substance misuse management toolkit for community pharmacists to help them manage their encounters with people who use substances. METHODS A focused literature review was conducted and 2 needs assessment studies, one for community pharmacists and one for patients informed the development of the toolkit. The toolkit is an adaption of the screening, brief intervention, and referral to treatment (SBIRT) approach, which is one of the most well-defined and effective strategies for substance use management. However, SBIRT is a novel care model in community pharmacy settings. Therefore, a substance misuse management toolkit with 20 items was created for community pharmacists incorporating evidence-based strategies and clinical algorithms. Delphi procedure was used to validate the toolkit. RESULTS Two rounds of questions were sent to experts in the field of substance misuse, some of whom were pharmacists. In both rounds, these experts were asked to rate the appropriateness and clarity of items in the toolkit and provide comments and suggestions. Items with a median rating of 7 or more out of 10 were included in the toolkit. In the second round, the experts were asked to rerate the revised version and provide additional feedback. After the second round, agreement was reached for almost all items of the toolkit. CONCLUSION A Delphi procedure was successfully used to provide evidence of the validity of the new guiding toolkit for community pharmacists. The toolkit will be implemented and evaluated to provide additional evidence of validity in practice.
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16
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Singh G, Sharma M, Kumar GA, Rao NG, Prasad K, Mathur P, Pandian JD, Steinmetz JD, Biswas A, Pal PK, Prakash S, Sylaja PN, Nichols E, Dua T, Kaur H, Alladi S, Agarwal V, Aggarwal S, Ambekar A, Bagepally BS, Banerjee TK, Bender RG, Bhagwat S, Bhargava S, Bhatia R, Chakma JK, Chowdhary N, Dey S, Dirac MA, Feigin VL, Ganguli A, Golechha MJ, Gourie-Devi M, Goyal V, Gupta G, Gupta PC, Gupta R, Gururaj G, Hemalatha R, Jeemon P, Johnson CO, Joshi P, Kant R, Kataki AC, Khurana D, Krishnankutty RP, Kyu HH, Lim SS, Lodha R, Ma R, Malhotra R, Malhotra R, Mathai M, Mehrotra R, Misra UK, Mutreja P, Naghavi M, Naik N, Nguyen M, Pandey A, Parmar P, Perianayagam A, Prabhakaran D, Rath GK, Reinig N, Roth GA, Sagar R, Sankar MJ, Shaji KS, Sharma RS, Sharma S, Singh R, Srivastava MVP, Stark BA, Tandon N, Thakur JS, ThekkePurakkal AS, Thomas SV, Tripathi M, Vongpradith A, Wunrow HY, Xavier D, Shukla DK, Reddy KS, Panda S, Dandona R, Murray CJL, Vos T, Dhaliwal RS, Dandona L. The burden of neurological disorders across the states of India: the Global Burden of Disease Study 1990-2019. Lancet Glob Health 2021; 9:e1129-e1144. [PMID: 34273302 PMCID: PMC8295043 DOI: 10.1016/s2214-109x(21)00164-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND A systematic understanding of the burden of neurological disorders at the subnational level is not readily available for India. We present a comprehensive analysis of the disease burden and trends of neurological disorders at the state level in India. METHODS Using all accessible data from multiple sources, we estimated the prevalence or incidence and disability-adjusted life-years (DALYs) for neurological disorders from 1990 to 2019 for all states of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We assessed the contribution of each neurological disorder to deaths and DALYs in India in 2019, their trends in prevalence or incidence and DALY rates over time, and heterogeneity between the states of India. We also assessed the Pearson correlation coefficient between Socio-demographic Index (SDI) of the states and the prevalence or incidence and DALY rates of each neurological disorder. Additionally, we estimated the contribution of known risk factors to DALYs from neurological disorders. We calculated 95% uncertainty intervals (UIs) for the mean estimates. FINDINGS The contribution of non-communicable neurological disorders to total DALYs in India doubled from 4·0% (95% UI 3·2-5·0) in 1990 to 8·2% (6·6-10·2) in 2019, and the contribution of injury-related neurological disorders increased from 0·2% (0·2-0·3) to 0·6% (0·5-0·7). Conversely, the contribution of communicable neurological disorders decreased from 4·1% (3·5-4·8) to 1·1% (0·9-1·5) during the same period. In 2019, the largest contributors to the total neurological disorder DALYs in India were stroke (37·9% [29·9-46·1]), headache disorders (17·5% [3·6-32·5]), epilepsy (11·3% [9·0-14·3]), cerebral palsy (5·7% [4·2-7·7]), and encephalitis (5·3% [3·7-8·9]). The crude DALY rate of several neurological disorders had considerable heterogeneity between the states in 2019, with the highest variation for tetanus (93·2 times), meningitis (8·3 times), and stroke (5·5 times). SDI of the states had a moderate significant negative correlation with communicable neurological disorder DALY rate and a moderate significant positive correlation with injury-related neurological disorder DALY rate in 2019. For most of the non-communicable neurological disorders, there was an increase in prevalence or incidence from 1990 to 2019. Substantial decreases were evident in the incidence and DALY rates of communicable neurological disorders during the same period. Migraine and multiple sclerosis were more prevalent among females than males and traumatic brain injuries were more common among males than females in 2019. Communicable diseases contributed to the majority of total neurological disorder DALYs in children younger than 5 years, and non-communicable neurological disorders were the highest contributor in all other age groups. In 2019, the leading risk factors contributing to DALYs due to non-communicable neurological disorders in India included high systolic blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index. For communicable disorders, the identified risk factors with modest contributions to DALYs were low birthweight and short gestation and air pollution. INTERPRETATION The increasing contribution of non-communicable and injury-related neurological disorders to the overall disease burden in India, and the substantial state-level variation in the burden of many neurological disorders highlight the need for state-specific health system responses to address the gaps in neurology services related to awareness, early identification, treatment, and rehabilitation. FUNDING Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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17
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Jacobs Y, Myers B, van der Westhuizen C, Brooke-Sumner C, Sorsdahl K. Task Sharing or Task Dumping: Counsellors Experiences of Delivering a Psychosocial Intervention for Mental Health Problems in South Africa. Community Ment Health J 2021; 57:1082-1093. [PMID: 33161458 PMCID: PMC8217044 DOI: 10.1007/s10597-020-00734-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022]
Abstract
Given task-sharing mental health counselling to non-specialist providers is a recognised strategy to increase service capacity, ensuring that their training, supervision, and support needs are met is necessary to facilitate the sustainable delivery of a high-quality service. Using in-depth interviews, we qualitatively explored the experiences of 18 facility-based counsellors (FBCs) tasked with delivering a counselling intervention within chronic disease services offered within primary care facilities participating in the project MIND cluster randomised controlled trial. Findings show that project MIND training with a strong emphasis on role playing and skills rehearsal improved FBCs' confidence and competence, complemented by highly structured supervision and debriefing provided by a registered counsellor, were key strategies for supporting the implementation of task-shared mental health counselling. FBCs perceived many benefits to providing mental health counselling in primary healthcare but systemic interventions are needed for sustained implementation.
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Affiliation(s)
- Y Jacobs
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - B Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - C van der Westhuizen
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - C Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - K Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
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Brick K, Cooper JL, Mason L, Faeflen S, Monmia J, Dubinsky JM. Training-of-Trainers Neuroscience and Mental Health Teacher Education in Liberia Improves Self-Reported Support for Students. Front Hum Neurosci 2021; 15:653069. [PMID: 34220469 PMCID: PMC8249721 DOI: 10.3389/fnhum.2021.653069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/14/2021] [Indexed: 12/25/2022] Open
Abstract
Education programs have been central to reestablishing social norms, rebuilding public educational institutions, and addressing public attitudes toward mental illness in Liberia following a protracted civil war and the Ebola epidemic. The aim of this study was to determine if a program combining an understanding of neuroscience with mental health literacy content could increase teachers’ awareness of students’ mental health issues and produce changes in teacher attitudes and classroom practices. A tiered Training-of-Trainers approach was employed. The first workshop trained 24 Liberian secondary science teachers in the neurobiology of learning, memory, emotions, stress and adolescent brain development. A Leadership Team formed from eight of the Tier I participants then adapted the curriculum, added in more mental health literacy content and led four Tier II workshops and four follow-up Refresher sessions. Participants completed a neuroscience knowledge test and surveys assessing stigma, general perceptions of people with mental illness, and burnout. A subset of Tier II teachers participated in a structured interview at the Refresher time point. Teachers in both tiers acquired basic neuroscience knowledge. Tier I, but not Tier II teachers significantly improved their surveyed attitudes toward people with mental illness. No changes were found in overall teacher burnout. Despite these survey results, the interviewed Tier II teachers self-reported behavioral changes in how they approached their teaching and students in their classrooms. Interviewees described how they now understood social and emotional challenges students might be experiencing and recognized abnormal behaviors as having a biopsychosocial basis. Teachers reported reduced use of verbal and corporal punishment and increased positive rewards systems, such as social and emotional support for students through building relationships. Refresher discussions concurred with the interviewees. In contrast to previous teacher mental health literacy programs which did not bring about a change in helping behaviors, this pilot program may have been successful in changing teacher knowledge and self-reported behaviors, improving teacher–student relationships and decreasing harsh discipline. The combination of basic neuroscience concepts with training on how to recognize mental health issues and refer students should be investigated further as a strategy to promote teacher mental health literacy.
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Affiliation(s)
- Kara Brick
- Carter Center Mental Health Program, Monrovia, Liberia.,Peace Corps Liberia, Monrovia, Liberia
| | | | - Leona Mason
- Carter Center Mental Health Program, Monrovia, Liberia
| | | | - Josiah Monmia
- Carter Center Mental Health Program, Monrovia, Liberia
| | - Janet M Dubinsky
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
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Culbreth R, Masyn KE, Swahn MH, Self-Brown S, Kasirye R. The interrelationships of child maltreatment, alcohol use, and suicidal ideation among youth living in the slums of Kampala, Uganda. CHILD ABUSE & NEGLECT 2021; 112:104904. [PMID: 33385928 PMCID: PMC7855690 DOI: 10.1016/j.chiabu.2020.104904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 05/14/2023]
Abstract
BACKGROUND Youth living in the slums of Kampala face many adversities, such as dire environmental conditions, poverty, and lack of government infrastructure. OBJECTIVE The purpose of this study is to examine the interplay of alcohol use and child maltreatment on suicidal ideation among youth living in the slums of Kampala, Uganda. PARTICIPANTS AND SETTING The study sample includes service-seeking youth who were attending Uganda Youth Development Link (UYDEL) drop-in centers in spring 2014 (n = 1134). METHODS Indicators of child maltreatment included parental physical abuse, parental neglect, and sexual abuse. Problematic alcohol use was specified using a hybrid structural equation mixture model that distinguished current drinking status with the frequency and intensity of use among current drinkers. This novel approach is more flexible than restricting our analysis to only drinkers or analyzing only current drinking status. The primary outcome of interest was suicidal ideation. All associations controlled for gender and age, and all associations were estimated simultaneously. All analyses were conducted in SAS 9.4 and Mplus 7.4. RESULTS The overall prevalence of suicidal ideation was 23.5 % (n = 266). Overall, current drinking status (OR: 1.80; 95 % CI: 1.31, 2.46), the child maltreatment sum score (OR: 1.88; 95 % CI: 1.48, 2.39), and sexual abuse (OR: 2.88; 95 % CI: 1.52, 5.47) were statistically significantly associated with reporting suicidal ideation. CONCLUSIONS This study highlights a population that would potentially benefit from prevention efforts not only aimed at suicide prevention but also harm reduction in terms of alcohol use and experiences of child maltreatment.
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Affiliation(s)
- Rachel Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 4019, Atlanta, GA, 30302-4019, United States.
| | - Katherine E Masyn
- Population Health Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, United States
| | - Monica H Swahn
- Population Health Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, United States
| | - Shannon Self-Brown
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, United States
| | - Rogers Kasirye
- Uganda Youth Development Link, P.O. Box 12659, Kampala, Uganda
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Qureshi O, Endale T, Ryan G, Miguel-Esponda G, Iyer SN, Eaton J, De Silva M, Murphy J. Barriers and drivers to service delivery in global mental health projects. Int J Ment Health Syst 2021; 15:14. [PMID: 33487170 PMCID: PMC7827991 DOI: 10.1186/s13033-020-00427-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research in global mental health (GMH) has previously documented how contextual factors like political instability, poverty and poorly-funded health infrastructure continue to compromise effective and equitable mental health service delivery. There is a need to develop more feasible and evidence-based solutions through implementation research. This paper, one in a series pertaining to implementation in GMH projects worldwide, focuses on implementation factors influencing mental health service delivery. METHODS This is a qualitative study carried out as part of a Theory of Change-driven evaluation of Grand Challenges Canada's (GCC's) Global Mental Health portfolio. Purposive sampling was used to recruit twenty-nine GCC grantees for interviews. A semi-structured interview schedule was used to guide the interviews which were recorded and subsequently transcribed. Transcripts were double-coded and analyzed in NVivo 11 using framework analysis. This paper reports results related to detection and treatment of mental illness, mental health promotion and prevention of mental illness. RESULTS Key barriers included: lack of appropriate human resources and expertise for service delivery; lack of culturally appropriate screening tools and interventions; and difficulties integrating services with the existing mental health system. Formative research was a key driver facilitating the cultural adaptation of mental health detection, treatment, promotion and preventative approaches. Recruiting local providers and utilizing mHealth for improving screening, monitoring and data management were also found to be successful approaches in reducing workforce burden, improving sustainability, mental health literacy, participant engagement and uptake. CONCLUSIONS The study identifies a number of key barriers to and drivers of successful service delivery from the perspective of grantees implementing GMH projects. Findings highlight several opportunities to mitigate common challenges, providing recommendations for strengthening systems- and project-level approaches for delivering mental health services. Further, more inclusive research is required to inform guidance around service delivery for successful implementation, better utilization of funding and improving mental health outcomes among vulnerable populations in low-resource settings.
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Affiliation(s)
- Onaiza Qureshi
- Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College, Colombia University, 525 W 120th St, New York, NY 10027 USA
| | - Grace Ryan
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Georgina Miguel-Esponda
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Srividya N. Iyer
- Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, QC H3A 0G4 Canada
- Douglas Research Centre, 6875 Boulevard LaSalle, Montreal, QC H4H 1R3 Canada
| | - Julian Eaton
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
- CBM UK, 8 Oakington Business Park, Dry Drayton Rd, Oakington, CB24 3DQ UK
| | - Mary De Silva
- Health of Population Health, Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE UK
| | - Jill Murphy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC V6T 2A1 Canada
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Sanfilippo KRM, McConnell B, Cornelius V, Darboe B, Huma HB, Gaye M, Ceesay H, Ramchandani P, Cross I, Glover V, Stewart L. Community psychosocial music intervention (CHIME) to reduce antenatal common mental disorder symptoms in The Gambia: a feasibility trial. BMJ Open 2020; 10:e040287. [PMID: 33234641 PMCID: PMC7684808 DOI: 10.1136/bmjopen-2020-040287] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/20/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Examine the feasibility of a Community Health Intervention through Musical Engagement (CHIME) in The Gambia to reduce common mental disorder (CMD) symptoms in pregnant women. DESIGN Feasibility trial testing a randomised stepped-wedge cluster design. SETTING Four local antenatal clinics. PARTICIPANTS Women who were 14-24 weeks pregnant and spoke Mandinka or Wolof were recruited into the intervention (n=50) or control group (n=74). INTERVENTION Music-based psychosocial support sessions designed and delivered by all-female fertility societies. Sessions lasted 1 hour and were held weekly for 6 weeks. Delivered to groups of women with no preselection. Sessions were designed to lift mood, build social connection and provide health messaging through participatory music making. The control group received standard antenatal care. OUTCOMES Demographic, feasibility, acceptability outcomes and the appropriateness of the study design were assessed. Translated measurement tools (Self-Reporting Questionnaire (SRQ-20); Edinburgh Postnatal Depression Scale (EPDS)) were used to assess CMD symptoms at baseline, post-intervention and 4-week follow-up. RESULTS All clinics and 82% of women approached consented to take part. A 33% attrition rate across all time points was observed. 72% in the intervention group attended at least three sessions. Audio and video analysis confirmed fidelity of the intervention and a thematic analysis of participant interviews demonstrated acceptability and positive evaluation. Results showed a potential beneficial effect with a reduction of 2.13 points (95% CI (0.89 to 3.38), p<0.01, n=99) on the SRQ-20 and 1.98 points (95% CI (1.06 to 2.90), p<0.01, n=99) on the EPDS at the post-intervention time point for the intervention group compared with standard care. CONCLUSION Results demonstrate that CHIME is acceptable and feasible in The Gambia. To our knowledge, CHIME is the first example of a music-based psychosocial intervention to be applied to perinatal mental health in a low- and middle-income country context. TRIAL REGISTRATION NUMBER Pan African Clinical Trials Registry (PACTR201901917619299).
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Affiliation(s)
| | - Bonnie McConnell
- School of Music, The Australian National University, Canberra, New South Wales, Australia
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Buba Darboe
- The Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Hajara B Huma
- The Ministry of Health and Social Welfare, Banjul, The Gambia
- The National Centre for Arts and Culture, Banjul, The Gambia
| | - Malick Gaye
- The Ministry of Health and Social Welfare, Banjul, The Gambia
- The National Centre for Arts and Culture, Banjul, The Gambia
| | - Hassoum Ceesay
- The National Centre for Arts and Culture, Banjul, The Gambia
| | | | - Ian Cross
- Centre for Music & Science, Faculty of Music, University of Cambridge, Cambridge, UK
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lauren Stewart
- Psychology Department, Goldsmiths, University of London, London, UK
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Heijdra Suasnabar JM, Hipple Walters B. Community-based psychosocial substance use disorder interventions in low-and-middle-income countries: a narrative literature review. Int J Ment Health Syst 2020; 14:74. [PMID: 33062049 PMCID: PMC7542947 DOI: 10.1186/s13033-020-00405-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mental health and substance use disorders (SUDs) are the world's leading cause of years lived with disability; in low-and-middle income countries (LIMCs), the treatment gap for SUDs is at least 75%. LMICs face significant structural, resource, political, and sociocultural barriers to scale-up SUD services in community settings. AIM This article aims to identify and describe the different types and characteristics of psychosocial community-based SUD interventions in LMICs, and describe what context-specific factors (policy, resource, sociocultural) may influence such interventions in their design, implementation, and/or outcomes. METHODS A narrative literature review was conducted to identify and discuss community-based SUD intervention studies from LMICs. Articles were identified via a search for abstracts on the MEDLINE, Academic Search Complete, and PsycINFO databases. A preliminary synthesis of findings was developed, which included a description of the study characteristics (such as setting, intervention, population, target SUD, etc.); thereafter, a thematic analysis was conducted to describe the themes related to the aims of this review. RESULTS Fifteen intervention studies were included out of 908 abstracts screened. The characteristics of the included interventions varied considerably. Most of the psychosocial interventions were brief interventions. Approximately two thirds of the interventions were delivered by trained lay healthcare workers. Nearly half of the interventions targeted SUDs in addition to other health priorities (HIV, tuberculosis, intimate partner violence). All of the interventions were implemented in middle income countries (i.e. none in low-income countries). The political, resource, and/or sociocultural factors that influenced the interventions are discussed, although findings were significantly limited across studies. CONCLUSION Despite this review's limitations, its findings present relevant considerations for future SUD intervention developers, researchers, and decision-makers with regards to planning, implementing and adapting community-based SUD interventions.
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Affiliation(s)
- Jan Manuel Heijdra Suasnabar
- Trimbos Institute, Utrecht, The Netherlands
- London School of Hygiene and Tropical Medicine, Public Health for Development, London, UK
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McNeish R, Tran Q. Leadership that promotes successful implementation of community-based mental health interventions. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1500-1511. [PMID: 32176322 DOI: 10.1002/jcop.22343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 06/10/2023]
Abstract
Community-based interventions (CBIs) have become an effective approach to promote mental well-being. To increase organizational capacity and effectively deliver CBIs, leadership is crucial. The current study aims to identify leadership qualities that are facilitators of CBI implementation. This paper presents evaluation findings from a national effort emphasizing CBIs for improving the mental well-being of men and boys in 16 local communities. The study utilized a mixed-method design, including both examining each grantee as a case study and conducting a cross-site evaluation. Findings revealed five leadership qualities that contributed to CBIs' success: personal vision, value-based leadership, relationship-oriented leadership, task-oriented leadership, and leadership development. The results outline strategies for strengthening organizational capacity through these leadership qualities. This study adds to the limited literature on leadership qualities that strengthen organizational capacity to successfully implement CBIs and can serve as a guide for funders, program planners, and evaluators.
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Affiliation(s)
- Roxann McNeish
- Department of Child and Family Studies, University of South Florida, Tampa, Florida
| | - Quynh Tran
- Department of Child and Family Studies, University of South Florida, Tampa, Florida
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Davidson L. A Key, Not a Straitjacket: The Case for Interim Mental Health Legislation Pending Complete Prohibition of Psychiatric Coercion in Accordance with the Convention on the Rights of Persons with Disabilities. Health Hum Rights 2020; 22:163-178. [PMID: 32669798 PMCID: PMC7348443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The practice of coercion on the basis of psychosocial disability is plainly discriminatory. This has resulted in a demand from the Committee on the Rights of Persons with Disabilities (the CRPD Committee) for a paradigm shift away from the traditional biomedical model and a global ban on compulsion in the psychiatric context. However, that has not occurred. This paper considers conflicting pronouncements of the CRPD Committee and other United Nations bodies. Assuming the former's interpretations of the Convention on the Rights of Persons with Disability (CRPD) are accurate, involuntary psychiatric detention and enforced treatment on the basis of psychosocial disability are prima facie discriminatory and unlawful practices. However, dedicated mental health legislation both permits discrimination and protects and enhances rights. This paper proposes a practical way out of the present impasse: the global introduction of interim "holding" legislation lacking full compliance with the CRPD. While imperfect, such a framework would facilitate a move toward a complete ban on psychiatric coercion. The paper outlines four essential ingredients that any interim legislation ought to contain, including clear timebound targets for full CRPD implementation. It concludes by urging the CRPD Committee to take the unprecedented step of issuing a general comment providing reluctant "permission" for the progressive realization of respect for articles 12 and 14 of the CRPD.
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Affiliation(s)
- Laura Davidson
- London Barrister and a noted authority on human rights, mental health, mental capacity, and disability law
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Mekonnen H, Medhin G, Tomlinson M, Alem A, Prince M, Hanlon C. Impact of child emotional and behavioural difficulties on educational outcomes of primary school children in Ethiopia: a population-based cohort study. Child Adolesc Psychiatry Ment Health 2020; 14:22. [PMID: 32467725 PMCID: PMC7231403 DOI: 10.1186/s13034-020-00326-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 05/05/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The relationship between child emotional and behavioural difficulties (EBD) and educational outcomes has not been investigated in prospective, community studies from low-income countries. METHODS The association between child EBD symptoms and educational outcomes was examined in an ongoing cohort of 2090 mother-child dyads. Child EBD was measured when the mean age of children was 6.5 years, SD 0.04 (T0) and 8.4, SD 0.5 years (T1) using the Strength and Difficulties Questionnaire (SDQ). Educational outcomes were obtained from maternal report (drop-out) at T1 and from school records at when the mean age of the children was 9.3 (SD 0.5) years (T2). RESULT After adjusting for potential confounders, child EBD symptoms at T1 were associated significantly with school absenteeism at T2: SDQ total score: Risk Ratio (RR) 1.01; 95% confidence interval (CI) 1.01, 1.02; SDQ high score (≥ 14) RR 1.36; 95% CI 1.24, 1.48; emotional subscale RR 1.03; 95% CI 1.01, 1.04; hyperactivity subscale RR 1.03; 95% CI 1.02, 1.04 and peer problems subscale (RR 1.02; 95% CI 1.00, 1.04). High SDQ (β = - 2.89; 95% CI - 5.73, - 0.06) and the conduct problems sub-scale (β = - 0.57; 95% CI - 1.02, - 0.12) had a significant negative association with academic achievement. There was no significant association between child EBD and school drop-out. CONCLUSION Prospective associations were found between child EBD symptoms and increased school absenteeism and lower academic achievement, suggesting the need for child mental health to be considered in interventions targeting improvement of school attendance and academic achievement in low-income countries.
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Affiliation(s)
- Habtamu Mekonnen
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,grid.411903.e0000 0001 2034 9160Department of Psychology, College of Education and Behavioural Sciences, Jimma University, Jimma, Ethiopia
| | - Girmay Medhin
- grid.7123.70000 0001 1250 5688Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mark Tomlinson
- grid.11956.3a0000 0001 2214 904XDepartment of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Atalay Alem
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Martin Prince
- grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charlotte Hanlon
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ,grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7123.70000 0001 1250 5688Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Aldridge LR, Garman EC, Luitel NP, Jordans MJD. Impact of a district mental health care plan on suicidality among patients with depression and alcohol use disorder in Nepal. PLoS One 2020; 15:e0231158. [PMID: 32255802 PMCID: PMC7138320 DOI: 10.1371/journal.pone.0231158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/17/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Large scale efforts to expand access to mental healthcare in low- and middle-income countries have focused on integrating mental health services into primary care settings using a task sharing approach delivered by non-specialist health workers. Given the link between mental disorders and risk of suicide mortality, treating common mental disorders using this approach may be a key strategy to reducing suicidality. METHODS AND FINDINGS The Programme for Improving Mental Health Care (PRIME) evaluated mental health services for common mental disorders delivered by non-specialist health workers at ten primary care facilities in Chitwan, Nepal from 2014 to 2016. In this paper, we present the indirect impact of treatment on suicidality, as measured by suicidal ideation, among treatment and comparison cohorts for depression and AUD using multilevel logistic regression. Patients in the treatment cohort for depression had a greater reduction in ideation relative to those in the comparison cohort from baseline to three months (OR = 0.16, 95% CI: 0.05-0.59; p = 0.01) and twelve months (OR = 0.31, 95% CI: 0.08-1.12; p = 0.07), with a significant effect of treatment over time (p = 0.02). Among the AUD cohorts, there were no significant differences between treatment and comparison cohorts in the change in ideation from baseline to three months (OR = 0.64, 95% CI: 0.07-6.26; p = 0.70) or twelve months (OR = 0.46, 95% CI: 0.06-3.27; p = 0.44), and there was no effect of treatment over time (p = 0.72). CONCLUSION The results provide evidence integrated mental health services for depression benefit patients by accelerating the rate at which suicidal ideation naturally abates over time. Integrated services do not appear to impact ideation among people with AUD, though baseline levels of ideation were much lower than for those with depression and may have led to floor effects. The findings highlight the importance of addressing suicidality as a specific target-rather than an indirect effect-of treatment in community-based mental healthcare programs.
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Affiliation(s)
- Luke R. Aldridge
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Emily C. Garman
- Alan J F Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Mark J. D. Jordans
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Dalky HF, Abu-Hassan HH, Dalky AF, Al-Delaimy W. Assessment of Mental Health Stigma Components of Mental Health Knowledge, Attitudes and Behaviors Among Jordanian Healthcare Providers. Community Ment Health J 2020; 56:524-531. [PMID: 31760548 PMCID: PMC10923396 DOI: 10.1007/s10597-019-00509-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 11/19/2019] [Indexed: 01/13/2023]
Abstract
Health care providers (HCPs)' stigma perception can determine their behaviors and attitudes toward providing mental health services. This study aimed to assess stigma components of knowledge, attitude, and behavior among HCPs in Jordan. A cross sectional descriptive study using a convenience sample of 541 HCPs utilized. The Mental Health Knowledge Schedule (MAKS), the Mental Illness: Clinicians' Attitudes Scale (MICA) and the Reported and Intended Behavior Scale (RIBS) were used to evaluate HCPs' perceived stigma. Mean scores on RIBS were lowest and at mid-point for MAKS and MICA. Results revealed significantly that HCPs perceived stigma demonstrated in greater negative attitudes correlated with less knowledge (r = .18, .17; p = .01, .009) for both physicians and nurses. And between attitudes and reported intended behavior (r = .13, p = .025) among nurses. This make them less likely to deal with mental health problems in primary healthcare centers. The reported stigma in this context is possibly due to lack of training, inadequate experience, and cultural dynamics. Indeed, awareness programs are important to prepare those HCPs to provide mental health care in these settings shall they are asked to.
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Affiliation(s)
- Heyam F Dalky
- Faculty of Nursing, Jordan University of Science & Technology, P.O Box 3030, Irbid, 22110, Jordan.
| | - Hana H Abu-Hassan
- School of Medicine, University of Jordan, Amman, Jordan
- Family Medicine Department, UCSD, San Diego, CA, USA
| | - Alaa Fawwaz Dalky
- Faculty of Medicine, Jordan University of Science & Technology, P.O Box 3030, Irbid, 22110, Jordan
| | - Wael Al-Delaimy
- Division of Global Health, Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
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Efficacy of psychosocial interventions for mental health outcomes in low-income and middle-income countries: an umbrella review. Lancet Psychiatry 2020; 7:162-172. [PMID: 31948935 DOI: 10.1016/s2215-0366(19)30511-5] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/04/2019] [Accepted: 11/20/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mental health conditions are leading causes of disability worldwide. Psychosocial interventions for these conditions might have a key role in their treatment, although applicability of findings to poor-resource settings might be a challenge. We aimed to evaluate the strength and credibility of evidence generated in low-income and middle-income countries (LMICs) on the efficacy of psychosocial interventions for various mental health outcomes. METHODS We did an umbrella review of meta-analyses of randomised studies done in LMICs. Literature searches were done in Medline, Embase, PsychINFO, CINAHL, Cochrane Library, and Epistemonikos from Jan 1, 2010, until May 31, 2019. Systematic reviews of randomised studies investigating the efficacy of psychosocial interventions for mental health conditions in LMICs were included. Systematic reviews of promotion, prevention, and protection interventions were excluded, because the focus was on treatment interventions only. Information on first author, year of publication, outcomes, number of included studies, and reported summary meta-analytic estimates was extracted from included meta-analyses. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects, and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was assessed using quantitative umbrella review criteria, and credibility of evidence using the GRADE approach. This study is registered with PROSPERO, number CRD42019135711. FINDINGS 123 primary studies from ten systematic reviews were included. The evidence on the efficacy of psychosocial interventions in adults with depression in humanitarian settings (standardised mean difference 0·87, 95% CI 0·67-1·07; highly suggestive association, GRADE: moderate) and in adults with common mental disorders (0·49, 0·36-0·62; highly suggestive association, GRADE: moderate) was supported by the most robust evidence. Highly suggestive strength of association was found for psychosocial interventions in adults with schizophrenia for functional outcomes, in adults with depression, and in adults with post-traumatic stress disorder in humanitarian settings. In children in humanitarian settings, and in children with disruptive behaviour, psychosocial interventions were supported by suggestive evidence of efficacy. INTERPRETATION A relatively large amount of evidence suggests the benefit of psychosocial interventions on various mental health outcomes in LMICs. However, strength of associations and credibility of evidence were quite variable, depending on the target mental health condition, type of population and setting, and outcome of interest. This varied evidence should be considered in the development of clinical, policy, and implementation programmes in LMICs and should prompt further studies to improve the strength and credibility of the evidence base. FUNDING University of Verona.
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Kuringe E, Materu J, Nyato D, Majani E, Ngeni F, Shao A, Mjungu D, Mtenga B, Nnko S, Kipingili T, Mongi A, Nyanda P, Changalucha J, Wambura M. Prevalence and correlates of depression and anxiety symptoms among out-of-school adolescent girls and young women in Tanzania: A cross-sectional study. PLoS One 2019; 14:e0221053. [PMID: 31419238 PMCID: PMC6697336 DOI: 10.1371/journal.pone.0221053] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/29/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, adolescent girls and young women (AGYW) who are out of school are at higher risk of depressive and anxiety disorders compared to their school attending peers. However, little is known about the prevalence and risk factors for these conditions among out-of-school AGYW. This study examines the prevalence of depression and anxiety and associated factors in a community sample of out-of-school AGYW in Tanzania. METHODS A cross-sectional analysis of baseline data from an on-going cluster randomized controlled trial in North-West Tanzania was conducted. A total of 3013 out-of-school AGYW aged 15 to 23 years from 30 clusters were included. Anxiety and depression were assessed using the Patient Health Questionnaire (PHQ-4), a tool comprising of PHQ-2 and Generalized Anxiety Disorders (GAD-2) screeners. Data were collected using Audio Computer-Assisted Self-Interview (ACASI). A random-effects logistic regression was fitted for binary outcomes and an ordinal logistic regression model with robust variance was used to adjust for clustering at the village level. Logistic regression and ordinal logistic regression were used to explore the associations between mental disorders symptoms and other factors. RESULTS The prevalence of depressive (PHQ-2 ≥ 3) and anxiety (GAD-2 ≥ 3) symptoms among out-of-school AGYW were 36% (95% CI 33.8%-37.3%) and 31% (95% CI 29.0%-32.3%) respectively. Further, using the PHQ-4 tool, 33% (95% CI 30.8%-34.2%) had mild, 20% (95% CI 18.3%-21.1%) moderate and 6% (95% CI 5.5%-7.2%) had severe symptoms of anxiety and depression. After adjusting for other covariates, two factors most strongly associated with having anxiety symptoms were violence experience from sexual partners (AOR = 1.63, 95% CI: 1.36-1.96) and HIV positive status (AOR = 1.54, 95% CI: 1.03-2.31). Likewise, living alone, with younger siblings or others (AOR = 2.51, 95% CI: 1.47-4.29) and violence experience from sexual partners (AOR = 1.90, 95% CI: 1.59-2.27) were strongly associated with depression symptoms. Having savings (AOR = 0.81, 95% CI: 0.70-0.95) and emotional support (AOR = 0.82, 95% CI: 0.67-0.99) were protective against depression and anxiety, respectively. CONCLUSION Depressive and anxiety symptoms are prevalent among out-of-school AGYW in Tanzania. The findings emphasize the need to strengthen preventive interventions and scale-up mental health disorder screening, referral for diagnosis and management.
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Affiliation(s)
- Evodius Kuringe
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Jacqueline Materu
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Daniel Nyato
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Esther Majani
- Sauti Project, Jhpiego Tanzania—an affiliate of Johns Hopkins University, Dar es Salaam, Tanzania
| | - Flaviana Ngeni
- Sauti Project, Jhpiego Tanzania—an affiliate of Johns Hopkins University, Dar es Salaam, Tanzania
| | - Amani Shao
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Deusdedit Mjungu
- Sauti Project, Jhpiego Tanzania—an affiliate of Johns Hopkins University, Dar es Salaam, Tanzania
| | - Baltazar Mtenga
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Soori Nnko
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | | | - Aminiel Mongi
- Sauti Project, Jhpiego Tanzania—an affiliate of Johns Hopkins University, Dar es Salaam, Tanzania
| | - Peter Nyanda
- Sauti Project, Jhpiego Tanzania—an affiliate of Johns Hopkins University, Dar es Salaam, Tanzania
| | - John Changalucha
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Mwita Wambura
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
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Ayuso-Mateos JL, Miret M, Lopez-Garcia P, Alem A, Chisholm D, Gureje O, Hanlon C, Jordans M, Kigozi F, Lund C, Petersen I, Semrau M, Shidhaye R, Thornicroft G. Effective methods for knowledge transfer to strengthen mental health systems in low- and middle-income countries. BJPsych Open 2019; 5:e72. [PMID: 31530323 PMCID: PMC6688465 DOI: 10.1192/bjo.2019.50] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Emerald project's focus is on how to strengthen mental health systems in six low- and middle-income countries (LMICs) (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda). This was done by generating evidence and capacity to enhance health system performance in delivering mental healthcare.A common problem in scaling-up interventions and strengthening mental health programmes in LMICs is how to transfer research evidence, such as the data collected in the Emerald project, into practice. AIMS To describe how core elements of Emerald were implemented and aligned with the ultimate goal of strengthening mental health systems, as well as their short-term impact on practices, policies and programmes in the six partner countries. METHOD We focused on the involvement of policy planners, managers, patients and carers. RESULTS Over 5 years of collaboration, the Emerald consortium has provided evidence and tools for the improvement of mental healthcare in the six LMICs involved in the project. We found that the knowledge transfer efforts had an impact on mental health service delivery and policy planning at the sites and countries involved in the project. CONCLUSIONS This approach may be valid beyond the mental health context, and may be effective for any initiative that aims at implementing evidence-based health policies for health system strengthening.
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Affiliation(s)
- Jose L. Ayuso-Mateos
- Professor of Psychiatry, Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid; and Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Maria Miret
- Journalist, Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, Spain
| | - Pilar Lopez-Garcia
- Associate Professor, Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid; Instituto de Investigación Sanitaria Princesa (IIS Princesa); and Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Atalay Alem
- Professor of Psychiatry, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Dan Chisholm
- Programme Manager for Mental Health, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Oye Gureje
- Professor of Psychiatry and Director, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Nigeria; and Professor Extraordinary, Department of Psychiatry, Stellenbosch University, South Africa
| | - Charlotte Hanlon
- Reader, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; and Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Mark Jordans
- Reader, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Fred Kigozi
- Senior Consultant Psychiatrist, Butabika National Referral Mental Hospital, Uganda
| | - Crick Lund
- Professor of Public Mental Health, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Professor of Global Mental Health and Development, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Inge Petersen
- Research Director and Professor, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Maya Semrau
- Research Fellow, Global Health and Infection Department, Brighton and Sussex Medical School; and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rahul Shidhaye
- Clinical Psychiatrist, Public Health Foundation of India; and CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands
| | - Graham Thornicroft
- Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Psychiatry, King's College London, UK
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Thornicroft G, Semrau M. Health system strengthening for mental health in low- and middle-income countries: introduction to the Emerald programme. BJPsych Open 2019; 5:e66. [PMID: 31685066 PMCID: PMC6688463 DOI: 10.1192/bjo.2019.9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 01/09/2023] Open
Abstract
This paper gives an overview of the Emerald (Emerging mental health systems in low- and middle-income countries) programme and introduces the subsequent seven papers in this BJPsych Open thematic series. The aims of the Emerald research programme were to improve mental health outcomes in six low- and middle-income countries (LMICs), namely Ethiopia, India, Nepal, Nigeria, South Africa and Uganda, by building capacity and by generating evidence to enhance health system strengthening in these six countries. The longer-term aim is to improve mental healthcare, and so contribute to a reduction in the large treatment gap that exists for mental disorders. This series includes papers describing the following components of the Emerald programme: (a) capacity building; (b) mental health financing; (c) integrated care (d) mental health information systems; and (e) knowledge transfer. We also include a cross-cutting paper with recommendations from the Emerald programme as a whole. The inclusion of clear mental-health-related targets and indicators within the United Nations Sustainable Development Goals now intensifies the need for strong evidence about both how to provide effective treatments, and how to deliver these treatments within robust health systems.
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Affiliation(s)
- Graham Thornicroft
- Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Maya Semrau
- Research Fellow in Implementation Research, Centre for Global Health Research, Brighton and Sussex Medical School; and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 730] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Harris MG, Bharat C, Glantz MD, Sampson NA, Al‐Hamzawi A, Alonso J, Bruffaerts R, Caldas de Almeida JM, Cia AH, Girolamo G, Florescu S, Gureje O, Haro JM, Hinkov H, Karam EG, Karam G, Lee S, Lépine J, Levinson D, Makanjuola V, McGrath J, Mneimneh Z, Navarro‐Mateu F, Piazza M, Posada‐Villa J, Rapsey C, Tachimori H, Have M, Torres Y, Viana MC, Chatterji S, Zaslavsky AM, Kessler RC, Degenhardt L. Cross-national patterns of substance use disorder treatment and associations with mental disorder comorbidity in the WHO World Mental Health Surveys. Addiction 2019; 114:1446-1459. [PMID: 30835879 PMCID: PMC7408310 DOI: 10.1111/add.14599] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/03/2018] [Accepted: 02/22/2019] [Indexed: 01/29/2023]
Abstract
AIMS To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity. DESIGN Cross-sectional, representative household surveys. SETTING Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative. PARTICIPANTS A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence). MEASUREMENTS Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12 months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socio-economic characteristics. Pooled estimates reflect country sample sizes rather than population sizes. FINDINGS Of respondents with past-year SUD, 11.0% [standard error (SE) = 0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE = 1.6 versus 6.8%, SE = 0.7), as was MAT (84.0%, SE = 2.5 versus 68.3%, SE = 3.8) and treatment by health-care professionals (88.9%, SE = 1.9 versus 78.8%, SE = 3.0) among treated SUD cases. Adjusting for socio-economic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR) = 2.34; 95% confidence interval (CI) = 1.71-3.20], MAT among SUD cases (OR = 2.75; 95% CI = 1.90-3.97) and MAT among treated cases (OR = 2.48; 95% CI = 1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in high- than low-/middle-income countries. CONCLUSIONS Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high.
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Affiliation(s)
- Meredith G. Harris
- School of Public HealthThe University of Queensland Herston QLD Australia
- Queensland Centre for Mental Health ResearchThe Park Centre for Mental Health QLD Australia
| | - Chrianna Bharat
- National Drug and Alcohol Research CentreUniversity of New South Wales Sydney Australia
| | - Meyer D. Glantz
- Department of Epidemiology, Services, and Prevention Research (DESPR)National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH) Bethesda MD USA
| | - Nancy A. Sampson
- Department of Health Care PolicyHarvard Medical School Boston MA USA
| | - Ali Al‐Hamzawi
- College of Medicine, Al‐Qadisiya University, Diwaniya Governorate Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM‐Hospital del Mar Medical Research Institute Barcelona Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF) Barcelona Spain
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum–Katholieke Universiteit Leuven (UPC‐KUL), Campus Gasthuisberg Leuven Belgium
| | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa Lisbon Portugal
| | | | | | - Silvia Florescu
- National School of Public Health, Management and Development Bucharest Romania
| | - Oye Gureje
- Department of PsychiatryUniversity College Hospital Ibadan Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat Barcelona Spain
| | - Hristo Hinkov
- National Center of Public Health and Analyses Sofia Bulgaria
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of MedicineBalamand University Beirut Lebanon
- Department of Psychiatry and Clinical PsychologySt George Hospital University Medical Center Beirut Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC) Beirut Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical PsychologySt George Hospital University Medical Center, Balamand University, Faculty of Medicine Beirut Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC) Beirut Lebanon
| | - Sing Lee
- Department of PsychiatryChinese University of Hong Kong Tai Po Hong Kong
| | - Jean‐Pierre Lépine
- Hôpital Lariboisière‐Fernand Widal, Assistance Publique Hôpitaux de Paris, Universités Paris Descartes‐Paris Diderot;INSERM UMR‐S 1144 Paris France
| | | | - Victor Makanjuola
- Department of Psychiatry, College of MedicineUniversity of Ibadan; University College Hospital Ibadan Nigeria
| | - John McGrath
- Queensland Centre for Mental Health ResearchThe Park Centre for Mental Health Wacol QLD Australia
- Queensland Brain Institute, University of Queensland St Lucia QLD Australia
- National Centre for Register‐Based ResearchAarhus University Aarhus Denmark
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social ResearchUniversity of Michigan Ann Arbor MI USA
| | - Fernando Navarro‐Mateu
- UDIF‐SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB‐Arrixaca, CIBERESP‐ Murcia Murcia Spain
| | | | - José Posada‐Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences Bogota Colombia
| | - Charlene Rapsey
- Department of Psychological MedicineUniversity of Otago, Dunedin School of Medicine Otago New Zealand
| | - Hisateru Tachimori
- National Institute of Mental Health, National Center for Neurology and Psychiatry Kodaira Tokyo Japan
| | - Margreet Have
- Trimbos‐Instituutthe Netherlands Institute of Mental Health and Addiction Utrecht the Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental HealthCES University Medellin Colombia
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public HealthFederal University of Espírito Santo Vitoria Brazil
| | - Somnath Chatterji
- Department of Information, Evidence and ResearchWorld Health Organization Geneva Switzerland
| | - Alan M. Zaslavsky
- Department of Health Care PolicyHarvard Medical School Boston MA USA
| | - Ronald C. Kessler
- Department of Health Care PolicyHarvard Medical School Boston MA USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research CentreUniversity of New South Wales Sydney NSW Australia
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Greene MC, Kane J, Johnson RM, Tol WA. Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries. Hippokratia 2019. [DOI: 10.1002/14651858.cd013350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Claire Greene
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 North Broadway, Rm. 888 Baltimore Maryland USA 21205
- Columbia University/New York State Psychiatric Institute; Department of Psychiatry; 40 Haven Avenue New York New York USA 10005
| | - Jeremy Kane
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 North Broadway, Rm. 888 Baltimore Maryland USA 21205
| | - Renee M Johnson
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 North Broadway, Rm. 888 Baltimore Maryland USA 21205
| | - Wietse A Tol
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 North Broadway, Rm. 888 Baltimore Maryland USA 21205
- HealthRight International; Peter C. Alderman Program for Global Mental Health; New York USA
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Raviola G, Naslund JA, Smith SL, Patel V. Innovative Models in Mental Health Delivery Systems: Task Sharing Care with Non-specialist Providers to Close the Mental Health Treatment Gap. Curr Psychiatry Rep 2019; 21:44. [PMID: 31041554 DOI: 10.1007/s11920-019-1028-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Most people do not have access to adequate mental health care, and lack of skilled human resources is a major factor. We provide a narrative review of approaches to implementing task sharing-engaging non-specialist providers-to deliver mental health care. RECENT FINDINGS There is strong evidence both for the effectiveness of task sharing as a means of delivering care for a range of conditions across settings and for the effectiveness of non-specialist providers and health workers in delivering elements of culturally adapted psychosocial and psychological interventions for common and severe mental disorders. Key approaches to facilitate task sharing of care include balanced care, collaborative care, sustained training and supervision, use of trans-diagnostic interventions based on a dimensional approach to wellness and illness, and the use of emerging digital technologies. Non-specialist providers and health workers are well positioned to deliver evidence-based interventions for mental disorders, and a variety of delivery approaches can support, facilitate, and sustain this innovation. These approaches should be used, and evaluated, to increase access to mental health services.
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Affiliation(s)
- Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Stephanie L Smith
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
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Pirkis J, Rossetto A, Nicholas A, Ftanou M, Robinson J, Reavley N. Suicide Prevention Media Campaigns: A Systematic Literature Review. HEALTH COMMUNICATION 2019; 34:402-414. [PMID: 29190128 DOI: 10.1080/10410236.2017.1405484] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Suicide prevention media campaigns are gaining traction as a means of combatting suicide. The current review set out to synthesize information about the effectiveness of these campaigns. We searched four electronic databases for studies that provided evidence on the effectiveness of media campaigns. We focused on studies that described an evaluation of the effectiveness of an entire campaign or a public service announcement explicitly aimed at suicide prevention. We identified 20 studies of varying quality. Studies that looked at whether campaign exposure leads to improved knowledge and awareness of suicide found support for this. Most studies that considered whether campaign materials can achieve improvements in attitudes toward suicide also found this to be the case, although there were some exceptions. Some studies found that media campaigns could boost help-seeking, whereas others suggested that they made no difference or only had an impact when particular sources of help or particular types of help-seeking were considered. Relatively few studies had sufficient statistical power to examine whether media campaigns had an impact on the ultimate behavioral outcome of suicides, but those that did demonstrated significant reductions. Our review indicates that media campaigns should be considered in the suite of interventions that might be used to prevent suicide. Evidence for their effectiveness is still amassing, but there are strong suggestions that they can achieve positive results in terms of certain suicide-related outcomes. Care should be taken to ensure that campaign developers get the messaging of campaigns right, and further work is needed to determine which messages work and which ones do not, and how effective messages should be disseminated. There is an onus on those developing and delivering campaigns to evaluate them carefully and to share the findings with others. There is a need for evaluations that employ rigorous designs assessing the most pertinent outcomes. These evaluations should explore the nature of given campaigns in detail - in particular the messaging contained within them - in order to tease out which messages work well and which do not. They should also take into account the reach of the campaign, in order to determine whether it would be reasonable to expect that they might have their desired effect.
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Affiliation(s)
- Jane Pirkis
- a Centre for Mental Health, Melbourne School of Population and Global Health , The University of Melbourne
| | - Alyssia Rossetto
- a Centre for Mental Health, Melbourne School of Population and Global Health , The University of Melbourne
| | - Angela Nicholas
- a Centre for Mental Health, Melbourne School of Population and Global Health , The University of Melbourne
| | - Maria Ftanou
- a Centre for Mental Health, Melbourne School of Population and Global Health , The University of Melbourne
| | - Jo Robinson
- b Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne
| | - Nicola Reavley
- a Centre for Mental Health, Melbourne School of Population and Global Health , The University of Melbourne
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Frantz I, Foran HM, Lachman JM, Jansen E, Hutchings J, Băban A, Fang X, Gardner F, Lesco G, Raleva M, Ward CL, Williams ME, Heinrichs N. Prevention of child mental health problems in Southeastern Europe: a multicentre sequential study to adapt, optimise and test the parenting programme 'Parenting for Lifelong Health for Young Children', protocol for stage 1, the feasibility study. BMJ Open 2019; 9:e026684. [PMID: 30782760 PMCID: PMC6352775 DOI: 10.1136/bmjopen-2018-026684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Families in low-income and middle-income countries (LMICs) face multiple challenges (eg, poverty and adverse childhood experiences) that increase the risk for child mental health problems, while the context may provide them with few resources. Existing prevention-oriented parenting programmes have been shown to be effective in reducing child behaviour problems and associated risk factors. This project has the overall goal of adapting, implementing and testing a parenting intervention in three Southeastern European LMIC and uses the Multiphase Optimisation Strategy and dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. It is implemented over three phases: (1) preparation, (2) optimisation and (3) evaluation. The preparation phase, the subject of this paper, involves the adaptation and feasibility piloting of the parenting programme. METHODS AND ANALYSIS This protocol describes the assessment of an evidence-informed indicated prevention programme for families with children aged 2-9 years (Parenting for Lifelong Health for Young Children) for implementation in FYR of Macedonia, Republic of Moldova and Romania. In this phase, officials, experts, parents and practitioners are interviewed to explore their views of suitability and needs for further adaptation. In addition, a small pre-post pilot study will test the feasibility of the programme and its implementation as well as the evaluation measures in the three countries with 40 families per country site (n=120). Quantitative data analysis will comprise a psychometric analysis of measures, testing pre-post differences using ANCOVA, χ2 tests and regression analysis. For qualitative data analysis, a thematic approach within an experiential framework will be applied. ETHICS AND DISSEMINATION The ethics review board of the Alpen-Adria University Klagenfurt and ethical review boards in the three LMIC sites have approved the study. TRIAL REGISTRATION NUMBER NCT03552250.
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Affiliation(s)
- Inga Frantz
- Institute for Psychology, Technische Universität Braunschweig, Braunschweig, Germany
| | - Heather M Foran
- Institute for Psychology, Alpen-Adria-University Klagenfurt, Klagenfurt, Austria
| | - Jamie M Lachman
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Elena Jansen
- Institute for Psychology, Alpen-Adria-University Klagenfurt, Klagenfurt, Austria
| | | | - Adriana Băban
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Xiangming Fang
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Galina Lesco
- Health for Youth Association, Chișinău, Republic of Moldova
| | - Marija Raleva
- Institute for Marriage, Family and Systemic Practice – ALTERNATIVA, Skopje, Macedonia
| | - Catherine L Ward
- Department of Psychology, University of Cape Town, Rondebosch, South Africa
| | | | - Nina Heinrichs
- Institute for Psychology, Technische Universität Braunschweig, Braunschweig, Germany
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Alosaimi FD, AlAteeq DA, Bin Hussain SI, Alhenaki RS, Bin Salamah AA, AlModihesh NA. Public Awareness, Beliefs, And Attitudes Toward Bipolar Disorder In Saudi Arabia. Neuropsychiatr Dis Treat 2019; 15:2809-2818. [PMID: 31579220 PMCID: PMC6773966 DOI: 10.2147/ndt.s209037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To examine public's knowledge, beliefs, and attitudes toward bipolar disorder (BP) in Saudi Arabia (SA). METHODS A cross-sectional survey was performed in 2016 in Riyadh, SA. The survey included sociodemographic characteristics and BP awareness scale. RESULTS Of 416 participants, 49.5% had prior knowledge of BP, mainly from internet and social media, and 57% considered it to be common in SA. About half believed BP is caused by a neurophysiological or neurochemical imbalance and that it can be treated with psychiatric medications. Supernatural causes, weak faith, and weakness of character were considered causes of BP by 55%, 48%, and 40% of participants, respectively. Recreational activities and head bandaging by traditional therapists were considered viable treatment options by 55% and 41% of participants, respectively. Students and healthcare professionals scored significantly higher on awareness scale. Regarding attitude, a majority believed that persons with BP can work effectively (86%), have to pull themselves together to get over it (47%), and consider it a shame to mention that someone in a family is affected by BP (32%). Regarding relationships, 22% were not willing to maintain a friendship and 39.3% were not willing to marry someone with BP. CONCLUSIONS This study revealed suboptimal public awareness towards BP in SA. It identified several misconceptions and negative attitudes toward patients with BP. Further studies are needed to investigate potential public interventions to improve literacy of BP.
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Affiliation(s)
- Fahad D Alosaimi
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | - Deemah A AlAteeq
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sarah I Bin Hussain
- Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Riham S Alhenaki
- Department of Pediatrics, King Abdullah Specialized Children's Hospital, KAMC, MNGHA, Riyadh, Saudi Arabia
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Scorza P, Poku O, Pike KM. Mental health: taking its place as an essential element of sustainable global development. BJPsych Int 2018; 15:72-74. [PMID: 30524122 PMCID: PMC6277948 DOI: 10.1192/bji.2017.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
As of 2015, with the adoption of the Sustainable Development Goals (SDGs), the United Nations has a new roadmap for development that will guide global and national agendas for the next 15 years. Mental health was explicitly included in the SDGs, for the first time being recognised as an essential component of development. This is a major achievement that has taken decades of unrelenting advocacy. Still, mental health lacks clear, measurable indicators within the SDGs, threatening its progress in the realm of global development. The task now is for the global mental health community to actively work within health systems, and with other sectors, to integrate mental health interventions and indicators into programmes aimed at other goals and targets. In this way, the direct impact of mental health on development and the impact of mental health on other development goals will be recognised and quantified.
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40
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An Exploration of the Relational Autonomy of People with Substance Use Disorders: Constraints and Limitations. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-9957-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Turner J, Pigott H, Tomlinson M, Jordans MJ. Developmental assistance for child and adolescent mental health in low- and middle-income countries (2007-2014): Annual trends and allocation by sector, project type, donors and recipients. J Glob Health 2018. [PMID: 29302326 PMCID: PMC5737098 DOI: 10.7189/07.020901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Globally, mental disorders are the leading cause of disability among children and adolescents. To date, there has been no estimate of developmental assistance supporting mental health projects that target children and adolescents (DAMH–CA). This study aimed to identify, describe and analyse DAMH–CA with respect to annual trends (2007–2014), sector, project type, recipient regions, and top donor and recipient countries, and estimate annual DAMH–CA per child/adolescent by region. Methods Developmental assistance for all projects focused on children and adolescent mental health between 2007 and 2014 was identified on the Organisation for Economic Co–operation and Development’s (OECD) Creditor Reporting System, and analysed by target population, sector, project type, donors, and recipients. The study did not include governmental or private organisation funds, nor funding for projects that targeted the community or those that included mental health but not as a primary objective. Results Between 2007 and 2014, 704 projects were identified, constituting US$ 88.35 million in DAMH–CA, with an average of 16.9% of annual development assistance for mental health. Three quarters of DAMH–CA was used to fund projects in the humanitarian sector, while less than 10% was directed at mental health projects within the education, HIV/AIDS, rights, and neurology sectors. DAMH–CA was predominantly invested in psychosocial support projects (US$ 63.24 million, 72%), while little in absolute and relative terms supported capacity building, prevention, promotion or research, with the latter receiving just US$ 1.2 million over the eight years (1.4% of total DAMH–CA). For 2014, DAMH–CA per child/adolescent was US$ 0.02 in Europe, less than US$ 0.01 in Asia, Africa, and Latin America and the Caribbean, and US$ 0 in Oceania. Conclusions To mitigate the growing burden of mental and neurological disorders, increased financial aid must be invested in child and adolescent mental health, especially with respect to capacity building, research and prevention of mental disorder projects. The present findings can be used to inform policy development and guide resource allocation, as current developmental assistance is described by sector and project type, thereby facilitating the identification of specific areas of investment need.
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Affiliation(s)
- Jasmine Turner
- Department of Research and Development, War Child Holland, the Netherlands.,Independent consultant, Accra, Ghana.,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Hugo Pigott
- Department of Research and Development, War Child Holland, the Netherlands.,Independent consultant, Accra, Ghana
| | - Mark Tomlinson
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Jd Jordans
- Department of Research and Development, War Child Holland, the Netherlands.,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Sithey G, Li M, Wen LM, Kelly PJ, Clarke K. Socioeconomic, religious, spiritual and health factors associated with symptoms of common mental disorders: a cross-sectional secondary analysis of data from Bhutan's Gross National Happiness Study, 2015. BMJ Open 2018; 8:e018202. [PMID: 29453295 PMCID: PMC5857675 DOI: 10.1136/bmjopen-2017-018202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Common mental disorders (CMDs) are a major cause of the global burden of disease. Bhutan was the first country in the world to focus on happiness as a state policy; however, little is known about the prevalence and risk factors of CMDs in this setting. We aim to identify socioeconomic, religious, spiritual and health factors associated with symptoms of CMDs. DESIGN AND SETTING We used data from Bhutan's 2015 Gross National Happiness (GNH) Survey, a multistage, cross-sectional nationwide household survey. Data were analysed using a hierarchical analytical framework and generalised estimating equations. PARTICIPANTS The GNH Survey included 7041 male and female respondents aged 15 years and above. MEASURES The 12-item General Health Questionnaire was used to measure symptoms of CMDs. We estimated the prevalence of CMDs using a threshold score of ≥12. RESULTS The prevalence of CMDs was 29.3% (95% CI 26.8% to 31.8%). Factors associated with symptoms of CMDs were: older age (65+) (β=1.29, 95% CI 0.57 to 2.00), being female (β=0.70, 95% CI 0.45 to 0.95), being divorced or widowed (β=1.55, 95% CI 1.08 to 2.02), illiteracy (β=0.48, 95% CI 0.21 to 0.74), low income (β=0.37, 95% CI 0.15 to 0.59), being moderately spiritual (β=0.61, 95% CI 0.34 to 0.88) or somewhat or not spiritual (β=0.76, 95% CI 0.28 to 1.23), occasionally considering karma in daily life (β=0.53, 95% CI 0.29 to 0.77) or never considering karma (β=0.80, 95% CI 0.26 to 1.34), having poor self-reported health (β=2.59, 95% CI 2.13 to 3.06) and having a disability (β=1.01, 95% CI 0.63 to 1.40). CONCLUSIONS CMDs affect a substantial proportion of the Bhutanese population. Our findings confirm the importance of established socioeconomic risk factors for CMDs, and suggest a potential link between spiritualism and mental health in this setting.
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Affiliation(s)
- Gyambo Sithey
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mu Li
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Li Ming Wen
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Health Promotion Unit, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Patrick J Kelly
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kelly Clarke
- Institute for Global Health, University College London, London, UK
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Thornicroft G, Semrau M. Mental health capacity building in low and middle income countries: the Emerald Programme. Epidemiol Psychiatr Sci 2018; 27:1-2. [PMID: 29322940 PMCID: PMC6999037 DOI: 10.1017/s2045796017000592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/24/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- G. Thornicroft
- Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, de Crespigny Park, London SE5 8AF, UK
| | - M. Semrau
- Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, de Crespigny Park, London SE5 8AF, UK
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Vancampfort D, Hallgren M, Firth J, Rosenbaum S, Schuch FB, Mugisha J, Probst M, Van Damme T, Carvalho AF, Stubbs B. Physical activity and suicidal ideation: A systematic review and meta-analysis. J Affect Disord 2018; 225:438-448. [PMID: 28858658 DOI: 10.1016/j.jad.2017.08.070] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/07/2017] [Accepted: 08/20/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND A potential approach to suicide prevention that has not been closely examined, but which holds promise in terms of widespread dissemination without major side-effects, is physical activity (PA). This systematic review and meta-analysis set out to: (a) explore associations between PA and suicidal ideation (SI) levels, and (b) investigate the effect of PA interventions on SI. METHODS Major electronic databases were searched from inception up to 05/2017 to identify quantitative studies reporting an association between PA and SI. A quantitative correlates synthesis and random effects meta-analysis were conducted. RESULTS Fourteen of 21 studies in adults (67%) (n = 130,737), 7/14 (50%) in adolescents (n = 539,170) and 2/3 (67%) in older adults (n = 50,745) found a significant negative association between PA- and SI-levels. Pooled adjusted meta-analysis of 14 effect sizes over eight studies and 80,856 people found that those who were "active" versus those who were "inactive" were less likely to have SI (OR = 0.87, 95%CI = 0.76-0.98). Additionally, meeting PA guidelines conferred a significant protective effect against SI (OR = 0.91, 95%CI = 0.51-0.99, P = 0.03; N studies = 3, n people = 122,395), while not meeting guidelines was associated with increased SI (OR = 1.16, 95%CI = 1.09-1.24, P < 0.001; N = 4, n = 78,860). Data from the intervention studies (N = 3, n = 121) was mixed and limited. LIMITATIONS Our findings are based mainly on cross-sectional studies, while the majority of studies did not include a rigorous physical activity assessment. CONCLUSIONS The current study suggests that higher PA levels are associated with lower SI. However, the associations observed need to be confirmed in prospective observational studies and controlled trials.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven - University of Leuven, University Psychiatric Centre, Leuven-Kortenberg, Belgium.
| | - Mats Hallgren
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Joseph Firth
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; NICM, School of Science and Health, University of Western Sydney, Australia
| | - Simon Rosenbaum
- School of Psychiatry, UNSW Sydney, Australia; Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
| | - Felipe B Schuch
- Unilasalle, Canoas, Brazil; Escola de Educação Física, Fisioterapia e Dança, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - James Mugisha
- Kyambogo University, Kampala, Uganda; Butabika National Referral and Mental Health Hospital, Kampala, Uganda
| | - Michel Probst
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Tine Van Damme
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
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Turner J, Pigott H, Tomlinson M, Jordans MJD. Developmental assistance for child and adolescent mental health in low– and middle–income countries (2007–2014): Annual trends and allocation by sector, project type, donors and recipients. J Glob Health 2017; 7:020901. [DOI: 10.7189/jogh.07.020901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Petersen I, Marais D, Abdulmalik J, Ahuja S, Alem A, Chisholm D, Egbe C, Gureje O, Hanlon C, Lund C, Shidhaye R, Jordans M, Kigozi F, Mugisha J, Upadhaya N, Thornicroft G. Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies. Health Policy Plan 2017; 32:699-709. [PMID: 28369396 PMCID: PMC5406762 DOI: 10.1093/heapol/czx014] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 01/08/2023] Open
Abstract
Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries.
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Affiliation(s)
- Inge Petersen
- School of Nursing and Public Health and School of Applied Human Sciences, University of Kwazulu-Natal, Howard College, Mazisi Kunene Road, Glenwood, Durban 4001, South Africa
| | - Debbie Marais
- Undergraduate Research Office, Research Development and Support Division, Faculty of Medicine & Health Sciences, University of Stellenbosch, P.O. Box 241, Cape Town 8000, South Africa
| | - Jibril Abdulmalik
- Department of Psychiatry, University of Ibadan, Queen Elizabeth Road, Ibadan 1205, Nigeria
| | - Shalini Ahuja
- Public Health Foundation of India, Plot Number 47, Sector 44, Gurgaon, Delhi 122002, India
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Tikur Anbessa Hospital, Addis Ababa, P.O. 9086, Ethiopia
| | - Dan Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Catherine Egbe
- School of Nursing and Public Health and School of Applied Human Sciences, University of Kwazulu-Natal, Howard College, Mazisi Kunene Road, Glenwood, Durban 4001, South Africa
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Queen Elizabeth Road, Ibadan 1205, Nigeria
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Tikur Anbessa Hospital, Addis Ababa, P.O. 9086, Ethiopia.,Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Crick Lund
- Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town 7700, South Africa
| | - Rahul Shidhaye
- Public Health Foundation of India, Plot Number 47, Sector 44, Gurgaon, Delhi 122002, India
| | - Mark Jordans
- Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Department of Research and Development, HealthNet TPO, Lizzy Ansinghstraat 163, Amsterdam, RG 1073, Netherlands
| | - Fred Kigozi
- Butabika National Referral and Teaching, Mental Hospital, P.O. Box 7017, Kampala, Uganda
| | - James Mugisha
- Butabika National Referral and Teaching, Mental Hospital, P.O. Box 7017, Kampala, Uganda
| | - Nawaraj Upadhaya
- Transcultural Psychosocial Organization (TPO), Kathmandu, CPC 612, Nepal
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK
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Affiliation(s)
- Hala Kerbage
- Faculty of Medicine, Department of Psychiatry, Saint-Joseph University, Beirut, Lebanon
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48
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Stubbs B, Veronese N, Vancampfort D, Thompson T, Kohler C, Schofield P, Solmi M, Mugisha J, Kahl KG, Pillinger T, Carvalho AF, Koyanagi A. Lifetime self-reported arthritis is associated with elevated levels of mental health burden: A multi-national cross sectional study across 46 low- and middle-income countries. Sci Rep 2017; 7:7138. [PMID: 28769081 PMCID: PMC5541038 DOI: 10.1038/s41598-017-07688-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 07/12/2017] [Indexed: 12/11/2022] Open
Abstract
Population-based studies investigating the relationship of arthritis with mental health outcomes are lacking, particularly among low- and middle-income countries (LMICs). We investigated the relationship between arthritis and mental health (depression spectrum, psychosis spectrum, anxiety, sleep disturbances and stress) across community-dwelling adults aged ≥18 years across 46 countries from the World Health Survey. Symptoms of psychosis and depression were established using questions from the Mental Health Composite International Diagnostic Interview. Severity of anxiety, sleep problems, and stress sensitivity over the preceding 30 days were self-reported. Self-report lifetime history of arthritis was collected, including presence or absence of symptoms suggestive of arthritis: pain, stiffness or swelling of joints over the preceding 12-months. Multivariable logistic regression analyses were undertaken. Overall, 245,706 individuals were included. Having arthritis increased the odds of subclinical psychosis (OR = 1.85; 95%CI = 1.72–1.99) and psychosis (OR = 2.48; 95%CI = 2.05–3.01). People with arthritis were at increased odds of subsyndromal depression (OR = 1.92; 95%CI = 1.64–2.26), a brief depressive episode (OR = 2.14; 95%CI = 1.88–2.43) or depressive episode (OR = 2.43; 95%CI = 2.21–2.67). Arthritis was also associated with increased odds for anxiety (OR = 1.75; 95%CI = 1.63–1.88), sleep problems (OR = 2.23; 95%CI = 2.05–2.43) and perceived stress (OR = 1.43; 95%CI = 1.33–1.53). Results were similar for middle-income and low-income countries. Integrated interventions addressing arthritis and mental health comorbidities are warranted to tackle this considerable burden.
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Affiliation(s)
- Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, United Kingdom. .,Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom. .,Institute of clinical Research and Education in Medicine (IREM), Padova, Italy. .,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom.
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy.,Institute of clinical Research and Education in Medicine (IREM), Padova, Italy
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.,KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
| | - Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - Cristiano Kohler
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Patricia Schofield
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Marco Solmi
- KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium.,Department of Neurosciences, University of Padova, Padova, Italy
| | - James Mugisha
- Kyambogo University, Kampala, Uganda.,Butabika National Referral and Mental Health Hospital, Kampala, Uganda
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover Medical School, Hannover, Germany
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - Andre F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain.,Instituto de Salud Carlos III, Centro de InvestigaciónBiomédicaenRed de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid, 28029, Spain
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Wainberg ML, Scorza P, Shultz JM, Helpman L, Mootz JJ, Johnson KA, Neria Y, Bradford JME, Oquendo MA, Arbuckle MR. Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective. Curr Psychiatry Rep 2017; 19:28. [PMID: 28425023 PMCID: PMC5553319 DOI: 10.1007/s11920-017-0780-z] [Citation(s) in RCA: 278] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. RECENT FINDINGS Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.
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Affiliation(s)
- Milton L Wainberg
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA.
| | - Pamela Scorza
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - James M Shultz
- Center for Disaster and Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine, Miami, FL, 33160, USA
| | - Liat Helpman
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Jennifer J Mootz
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Karen A Johnson
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Yuval Neria
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Jean-Marie E Bradford
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 200, Philadelphia, PA, 19104-3309, USA
| | - Melissa R Arbuckle
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
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