Advancing mental health equality: a mapping review of interventions, economic evaluations and barriers and facilitators

The relationship between insomnia and multidimensional frailty in community-dwelling older adults: A systematic review

OBJECTIVE

To examine the relationship between insomnia and multidimensional frailty among community-dwelling older adults.

METHOD

We conducted a comprehensive search in the Pubmed, Web of Science, and Embase databases up to May 15, 2024. The included cross-sectional studies were using the Joanna Briggs Institute's Evidence-Based Health Care Center's checklist for analytical cross-sectional studies; the longitudinal study used the Newcastle-Ottawa Scale for risk of bias assessment.

RESULTS

Out of 1571 studies, 14 were selected. The results indicate a positive relationship between insomnia and cognitive frailty, social frailty, and psychological frailty in community-dwelling older adults. However, the relationship between insomnia and total or physical frailty is unclear.

CONCLUSION

This study made an association between insomnia and cognitive frailty, social frailty, and psychological frailty in community-dwelling older adults. Due to the limited quality and quantity of the included studies, more high-quality cohort studies are required to verify the above conclusion.

Investigating the acceptability of a culturally adapted acceptance and commitment therapy group for UK Vietnamese communities: A practice-based feasibility study

Acceptance and Commitment Therapy (ACT) is an empirically supported psychotherapy that offers promise for the mental health of minoritised ethnic populations. Given the diversity of those presenting to inner-city services and barriers to accessing appropriate mental healthcare, we sought to develop a culturally syntonic ACT intervention for UK Vietnamese refugee communities in a practice-based partnership project between a National Health Service and local third-sector service in East London. The aim was to explore the feasibility, acceptability and impact of the adapted intervention to inform culturally inclusive clinical practice and future research. We outline key aspects of Vietnamese belief systems and culture, and consider how these might influence the optimisation of group-based ACT. We then present a mixed-method evaluation of the seven-session adapted ACT group for 11 participants (9 male and 5 female, aged between 44 and 73 years). Individual-level change analyses indicated clinically significant improvements in psychological flexibility for the minority of participants and a mixed pattern for impact on well-being. A thematic analysis and descriptive approach examined acceptability, feasibility and narratives of impact. Participants reported positive feedback on group experience, relevance and usefulness, and emergent themes indicate that the group facilitated key acceptance, commitment and behaviour-change processes, promoted social connections and increased engagement in meaningful life activities in relation to new perspectives and values-based action. Limitations are outlined, but overall, findings suggest preliminary support for the potential beneficial effect of the adapted ACT group as a feasible, culturally acceptable therapeutic approach for UK Vietnamese communities that is worthy of further investigation.

Mental health service use and cost by Australian women in metropolitan and rural areas

INTRODUCTION

The use and costs of mental health services by rural and remote Australian women are poorly understood.

OBJECTIVE

To examine the use of the Better Access Scheme (BAS) mental health services across geographical areas.

DESIGN

Observational epidemiology cohort study using a nationally representative sample of 14 247 women from the Australian Longitudinal Study on Women's Health born 1973-1978, linked to the Medical Benefits Schedule dataset for use of BAS services from 2006 to 2015. The number and cost of BAS services were compared across metropolitan and regional/remote areas for women using the mental health services.

FINDINGS

31% of women accessed a BAS mental health service, 12% in rural populations. Overall, 90% of women with estimated high service need had contact with professional services (83% rural vs 92% metropolitan regions). Mean mental health scores were lower for women accessing a BAS service in remote areas compared with metropolitan, inner and outer regional areas (61.9 vs 65.7 vs 64.8 vs 64.2, respectively). Higher proportion of women in remote areas who were smokers, low/risky drinkers and underweight were more likely to seek treatment. Compared with metropolitan areas, women in inner, outer regional and remote areas accessed a lower mean number of services in the first year of diagnosis (6.0 vs 5.0 vs 4.1 vs 4.2, respectively). Actual mean overall annual costs of services in the first year of diagnosis were higher for women in metropolitan areas compared with inner, outer regional or remote areas ($733.56 vs $542.17 vs $444.00 vs $459.85, respectively).

DISCUSSION

Women in rural/remote areas not accessing services need to be identified, especially among those with the highest levels of distress. In remote areas, women had greater needs when accessing services, although a substantial proportion of women who sought help through the BAS services lived in metropolitan areas.

CONCLUSION

Regardless of lower cost to services in rural/remote areas, geographic and economic barriers may still be major obstacles to accessing services.

How co-locating public mental health interventions in community settings impacts mental health and health inequalities: a multi-site realist evaluation

BACKGROUND

Public mental health interventions are non-clinical services that aim to promote wellbeing and prevent mental ill health at the population level. In England, the health, social and community system is characterised by complex and fragmented inter-sectoral relationships. To overcome this, there has been an expansion in co-locating public mental health services within clinical settings, the focus of prior research. This study evaluates how co-location in community-based settings can support adult mental health and reduce health inequalities.

METHODS

A qualitative multi-site case study design using a realist evaluation approach was employed. Data collection took place in three phases: theory gleaning, parallel testing and refining of theories, and theory consolidation. We collected data from service users (n = 32), service providers (n = 32), funders, commissioners, and policy makers (n = 11), and members of the public (n = 10). We conducted in-depth interviews (n = 65) and four focus group discussions (n = 20) at six case study sites across England, UK, and two online multi-stakeholder workshops (n = 20). Interview guides followed realist-informed open-ended questions, adapted for each phase. The realist analysis used an iterative, inductive, and deductive data analysis approach to identify the underlying mechanisms for how community co-location affects public mental health outcomes, who this works best for, and understand the contexts in which co-location operates.

RESULTS

Five overarching co-location theories were elicited and supported. Co-located services: (1) improved provision of holistic and person-centred support; (2) reduced stigma by creating non-judgemental environments that were not associated with clinical or mental health services; (3) delivered services in psychologically safe environments by creating a culture of empathy, friendliness and trust where people felt they were being treated with dignity and respect; (4) helped to overcome barriers to accessibility by making service access less costly and more time efficient, and (5) enhance the sustainability of services through better pooling of resources.

CONCLUSION

Co-locating public mental health services within communities impacts multiple social determinants of poor mental health. It has a role in reducing mental health inequalities by helping those least likely to access services. Operating practices that engender inter-service trust and resource-sharing are likely to support sustainability.

A happy home? Socio-economic inequalities in depressive symptoms and the role of housing quality in nine European countries

BACKGROUND

This study examines the prevalence of and socio-economic inequalities in depressive symptoms in nine high-income European countries, focusing in particular on the role of housing quality.

METHODS

Using the European Social Survey, a concentration index of depressive symptoms in each country is estimated. The role of housing quality is assessed by examining the risk factors associated with the concentration index, using the Recentred Influence Function method. To contextualise the housing quality results, other predictors of inequalities in depressive symptoms inequalities are also quantified and discussed.

RESULTS

Our results indicate that inequalities in depressive symptoms are concentrated among poorer respondents both in each country and in total. Austria and Belgium have the lowest inequalities and France has the highest. No geographic pattern is evident. Housing problems are associated with higher inequalities in six of the nine countries in the sample. While no association is evident for indicators of socio-economic status such as years of education and income, financial strain is significant.

CONCLUSIONS

This study is the first to estimate the degree of socio-economic inequality in depressive symptoms across European countries. The association between poor housing and poorer inequalities suggests that housing has a role to play lowering depressive symptoms inequalities.

Understanding inequalities in access to adult mental health services in the UK: a systematic mapping review

BACKGROUND

Population groups experience differential access to timely and high-quality mental healthcare. Despite efforts of recent UK policies to improve the accessibility of mental health services, there remains a lack of comprehensive understanding of inequalities in access to services needed to do this. This systematic mapping review aimed to address this gap by identifying which population groups continue to be poorly served by access to adult mental health services in the UK, how access has been measured, and what research methods have been applied.

METHODS

Seven electronic databases were searched from January 2014 up to May 2022. Primary research studies of any design were included if they examined access to adult NHS mental health services in the UK by population groups at risk of experiencing inequalities. Study characteristics, measures of access, inequalities studied, and key findings were extracted. A best-fit framework approach was used, applying Levesque's Conceptual Framework for Healthcare Access to synthesise measures of access, and applying a template derived from Cochrane Progress-Plus and NHS Long Term Plan equality characteristics to synthesise key findings associated with inequalities.

RESULTS

Of 1,929 publications retrieved, 152 studies of various types were included. The most frequently considered dimensions of inequality were gender, age, and ethnicity, whilst social capital, religion, and sexual orientation were least frequently considered. Most studies researched access by measuring "healthcare utilisation", followed by studies that measured "healthcare seeking". Key barriers to access were associated with individuals' "ability to seek" (e.g. stigma and discrimination) and "ability to reach" (e.g. availability of services). Almost half of the studies used routinely collected patient data, and only 16% of studies reported patient and public involvement.

CONCLUSIONS

Little appears to have changed in the nature and extent of inequalities, suggesting that mental health services have not become more accessible. Actions to reduce inequalities should address barriers to population groups' abilities to seek and reach services such as stigma-reducing interventions, and re-designing services and pathways. Significant benefits exist in using routinely collected patient data, but its limitations should not be ignored. More theoretically informed research, using a holistic measurement of access, is needed in this area.

REVIEW REGISTRATION

https://doi.org/10.17605/OSF.IO/RQ5U7 .

Efficacy of culturally adapted interventions for common mental disorders in people of Chinese descent: a systematic review and meta-analysis

BACKGROUND

Evidence suggests that culturally adapted psychological interventions have some benefits in treating diverse ethnic groups. However, the effect of such cultural adaptions specifically in Chinese ethnic groups has not been thoroughly reviewed. We aimed to systematically assess the evidence for the efficacy of different cultural adaptations in treating common mental disorders in people of Chinese descent (ie, ethnic Chinese populations).

METHODS

In this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, CNKI, and WANFANG to identify randomised controlled trials published in English and Chinese from database inception to March 10, 2023. We included trials of culturally adapted psychological interventions in people of Chinese descent (with at least 80% of Han Chinese descent) aged 15 years or older with a diagnosis or subthreshold symptoms of common mental disorders, including depression, anxiety disorders, and post-traumatic stress disorder. We excluded studies that included participants with severe mental disorders (eg, schizophrenia, bipolar disorder), neurodevelopmental disorders, or dementia. Study selection and data extraction were done by two independent reviewers, who extracted data for study characteristics, cultural adaptations, and summary efficacy. The primary outcome was post-intervention change in symptoms (both self-reported and clinician-rated). We used random-effects models to calculate standardised mean differences. Quality was assessed using the Cochrane risk of bias tool. The study is registered with PROSPERO (CRD42021239607).

FINDINGS

We identified 32 791 records, 67 of which were included in our meta-analysis (60 done in mainland China, four in Hong Kong, and one each in Taiwan, Australia, and the USA). We included 6199 participants (mean age 39·32 years [range 16-84]), of whom 2605 (42%) were male and 3247 (52%) were female. Culturally adapted interventions had medium effect sizes in terms of reducing both self-reported (Hedges' g 0·77 [95% CI 0·61-0·94]; I² 84%) and clinician-rated (0·75 [0·54-0·96]; 86%) symptom severity across all disorders at end of treatment, irrespective of adaptation types. We noted no difference in efficacy between culturally modified interventions and culturally specific interventions. Subgroup analyses showed considerable heterogeneity. Inadequate reporting in included studies largely restricted risk-of-bias appraisals across all domains.

INTERPRETATION

Psychological interventions can be transported across cultures with appropriate modifications. Adaptations to interventions can be made by modifying evidence-based interventions, or in culturally specific ways that are rooted in the sociocultural context. However, findings are limited by the insufficient reporting of interventions and cultural adaptations.

FUNDING

None.

TRANSLATION

For the Chinese translation of the abstract see Supplementary Materials section.

Mental health problems in children with intellectual disability

Intellectual disability ranks in the top ten causes of disease burden globally and is the top cause in children younger than 5 years. 2-3% of children have an intellectual disability, and about 15% of children present with differences consistent with an intellectual disability (ie, global developmental delay and borderline intellectual functioning). In this Review, we discuss the prevalence of mental health problems, interventions to address these, and issues of access to treatment and services. Where possible, we take a global perspective, given most children with intellectual disability live in low-income and middle-income countries. Approximately 40% of children with intellectual disability present with a diagnosable mental disorder, a rate that is at least double that in children without intellectual disability. Most risk factors for poor mental health and barriers to accessing support are not unique to people with intellectual disability. With proportionate universalism as the guiding principle for reducing poor mental health at scale, we discuss four directions for addressing the mental health inequity in intellectual disability.

Interventions to improve social circumstances of people with mental health conditions: a rapid evidence synthesis

BACKGROUND

Poor social circumstances can induce, exacerbate and prolong symptoms of mental health conditions, while having a mental health condition can also lead to worse social outcomes. Many people with mental health conditions prioritise improvement in social and functional outcomes over reduction in clinical symptoms. Interventions that improve social circumstances in this population should thus be considered a priority for research and policy.

METHODS

This rapid evidence synthesis reports on randomised controlled trials of interventions to improve social circumstances across eight social domains (Housing and homelessness; money and basic needs; work and education; social isolation and connectedness; family, intimate and caring relationships; victimisation and exploitation; offending; and rights, inclusion and citizenship) in people with mental health conditions. Economic evaluations were also identified. A comprehensive, stepped search approach of the Cochrane library, MEDLINE, Embase, PsycINFO, Web of Science and Scopus was conducted.

RESULTS

One systematic review and 102 randomised controlled trials were included. We did not find RCT evidence for interventions to improve family, intimate and caring relationships and only one or two trials for each of improving money and basic needs, victimisation and exploitation, and rights, inclusion and citizenship. Evidence from successful interventions in improving homelessness (Housing First) and employment (Individual Placement and Support) suggests that high-intensity interventions which focus on the desired social outcome and provide comprehensive multidisciplinary support could influence positive change in social circumstances of people with mental health conditions. Objective social isolation could be improved using a range of approaches such as supported socialisation and social skills training but interventions to reduce offending showed few benefits. Studies with cost and cost-effectiveness components were generally supportive of interventions to improve housing and vocational outcomes. More research is needed to ensure that social circumstances accompanied by high risks of further exacerbation of mental health conditions are adequately addressed.

CONCLUSIONS

Although there is a large body of literature examining how to support some aspects of life for people with mental health conditions, more high-quality evidence is required in other social domains. Integration into mental health services of interventions targeting social circumstances could significantly improve a number of social outcomes.

The effectiveness of adapted psychological interventions for people from ethnic minority groups: A systematic review and conceptual typology

This review assessed the efficacy of adapted psychological interventions for Black and minority ethnic (BME) groups. A conceptual typology was developed based on adaptations reported in the literature, drawing on the common factors model, competence frameworks and distinctions between types of cultural adaptations. These distinctions were used to explore the efficacy of different adaptations in improving symptoms of a range of mental health problems for minority groups. Bibliographic searches of MEDLINE, Embase, PsycINFO, HMIC, ASSIA, CENTRAL, CDSR and CINAHL spanned the period from 1965 to December 2020. Adaptations to interventions were categorised: i) treatment specific: therapist-related, ii) treatment-specific: content-related and iii) organisation-specific. Meta-analyses of RCTs found a significant effect on symptom reduction when adapted interventions were compared to non-adapted active treatments (K = 30, Hedge's g = -0.43 [95% CI: -0.61, -0.25], p < .001). Studies often incorporated multiple adaptations, limiting the exploration of the comparative effectiveness of different adaptation types, although inclusion of organisation-specific adaptations may be associated with greater benefits. Future research, practitioner training and treatment and service development pertaining to adapted care for minority groups may benefit from adopting the conceptual typology described.

Prevalence of Mental Disorders by Socioeconomic Status in Australia: A Cross-Sectional Epidemiological Study

PURPOSE

To present the prevalence of 3 broad categories of mental disorder (anxiety-related, affective and other disorders) by socioeconomic status and examine the associated socioeconomic risk factors of mental disorders in Australia.

DESIGN

A population-based, cross-sectional national health survey on mental health and its risk factors across Australia.

SETTING

National Health Survey (NHS), 2017-2018 conducted by the Australian Bureau of Statistics (ABS).

PARTICIPANTS

Under aged: 4,945 persons, Adult: 16,370 persons and total: 21,315 persons.

MEASURES

Patient-reported mental disorder outcomes.

ANALYSIS

Weighted prevalence rates by socioeconomic status (equivalised household income, education qualifications, Socio-Economic Index for Areas (SEIFA) scores, labor force status and industry sector where the adult respondent had their main job) were estimated using cross-tabulation. Logistic regression utilizing subsamples of underage and adult age groups were analyzed to test the association between socioeconomic status and mental disorders.

RESULTS

Anxiety-related disorders were the most common type of disorders with a weighted prevalence rate of 20.04% (95% CI: 18.49-21.69) for the poorest, 13.85% (95% CI: 12.48-15.35) for the richest and 16.34% (95% CI: 15.7-17) overall. The weighted prevalence rate for mood/affective disorders were 20.19% (95% CI: 18.63-21.84) for the poorest, 9.96% (95% CI: 8.79-11.27) for the richest, and 13.57% (95% CI: 12.99-14.17) overall. Other mental disorders prevalence were for the poorest: 9.07% (95% CI: 7.91-10.39), the richest: 3.83% (95% CI: 3.14-4.66), and overall: 5.93% (95% CI: 5.53-6.36). These patterns are also reflected if all mental disorders were aggregated with the poorest: 30.97% (95% CI: 29.15-32.86), the richest: 19.59% (95% CI: 18.02-21.26), and overall: 23.93% (95% CI: 23.19-24.69). The underage logistic regression model showed significant lower odds for the middle (AOR: 0.75, 95% CI: 0.53 -1.04, p < 0.1), rich (AOR: 0.71, 95% CI: 0.5-0.99, p < 0.05) and richest (AOR: 0.6, 95% CI: 0.41-0.89, p < 0.01) income groups. Similarly, in the adult logistic model, there were significant lower odds for middle (AOR: 0.84, 95% CI: 0.72-0.98, p < 0.05), rich (AOR: 0.73, 95% CI: 0.62-0.86, p < 0.01) and richest (AOR: 0.76, 95% CI: 0.63-0.91, p < 0.01) income groups.

CONCLUSION

The prevalence of mental disorders in Australia varied significantly across socioeconomic groups. Knowledge of different mental health needs in different socioeconomic groups can assist in framing evidence-based health promotion and improve the targeting of health resource allocation strategies.

Immunological and Psychological Efficacy of Meditation/Yoga Intervention Among People Living With HIV (PLWH): A Systematic Review and Meta-analyses of 19 Randomized Controlled Trials

BACKGROUND

An expanding number of mind-body therapies are being used to reduce the psychological burden of peoples living with human immunodeficiency virus (HIV). However, the effects on the immune system and mental health varied among studies.

PURPOSE

This meta-analysis was conducted to summarize the randomized controlled trials to draw comprehensive conclusions regarding the psycho-immunological efficacy.

METHODS

Random-effects models were used to assess the outcome of interest. Egger's tests were used to identify publication bias. Subgroup and meta-regression were used to explore potential moderators. This review was registered on the PROSPERO database (CRD42019148118).

RESULTS

Nineteen randomized controlled trials with a total sample size of 1,300 were included in this meta-analysis. Regarding immune system outcome, mind-body therapy significantly improved CD4 T-cell counts (Cohen's d = 0.214, p = .027) and maintained (0.427, p = .049). In addition, baseline CD4 T-cell counts and years since HIV diagnosis significantly moderated the efficacy of mind-body practices on CD4 improvement (all ps < .001). Regarding mental health outcome, mind-body therapy significantly reduced stress, depression, and anxiety symptoms (0.422, p < .001; 0.506, p < .001, and 0.709, p < .001, respectively) while improving quality of life (0.67, p < .001).

CONCLUSIONS

Meditation/yoga intervention could result in potential benefits with regard to improved CD4 T-cell counts immediately after the intervention and at long-term follow-up, while also improving their mental health. The cost-effective meditation/yoga intervention should be integrated into routine care for people living with HIV, especially for those with lower CD4 baseline and fewer years since diagnosis.