Integrating Mental Health Services into the Primary Health Care System: The Need for Reform in Iran

Alarming findings of psycho-socio-spiritual interventions on physical, mental, and social health for children with cancer and their families in low- and middle-income countries: a meta-analysis

Background

Children residing in low- and middle-income countries (LMICs) are at a higher risk of cancer. The provision of psycho-socio-spiritual care to address stressors accompanying a cancer diagnosis is largely unknown in these countries, and evidence on psycho-socio-spiritual interventions in LMICs remains unexplored.

Objective

This meta-analysis aimed to synthesize findings on psycho-socio-spiritual interventions for children and families with cancer in LMICs in comparison with those from resource-rich developing nations.

Design

This study employs a prospective comprehensive meta-analysis approach.

Settings

The study covers low- and middle-income countries and resource-rich developing countries as per the World Bank classification.

Participants

The participants came from a total of 18 studies that recruited 3,072 children (0-18) with cancer or their family members and carers who were included in this meta-analysis.

Methods

A systematic search of five databases PubMed, PsycINFO, CINAHL, Cochrane Databases, and a gray literature ProQuest was conducted to identify all possible hits. Following screening, data were extracted on a comprehensive list of variables to allow pooled and moderation analysis. The meta-analysis was performed via CMA-v2, the quality of the included studies was assessed via the Cochrane software "Risk of Bias-v2.0 (RoB2)", and PRISMA and AMSTAR 2 guidelines were followed throughout.

Results

A highly significant OR of 4.933 (95% CI: 3.423-7.108, p < 0.0001) indicated approximately fivefold improvement in children and families with cancer in 11 LMICs as a result of the psycho-socio-spiritual interventions. Four more LMICs showed evidence of qualitative psycho-socio-spiritual services for children with cancer. The quality of evidence was rated as 2B in most of the eligible studies. We established a model that can test >400,000 combinations of factors.

Conclusions

The childhood oncology community has been alerted on the lack of equitable holistic care for children and families with cancer in 126 out of the 137 LMICs and to seize the opportunity to target the underserved populations through development, adaptation, and investment in psycho-socio-spiritual care. Our model can aid in future studies and policy making.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023460114.

Beyond the Smog: Unveiling the Invisible Toll of Air Pollution on the People's Mental Well-Being in Lahore, Pakistan

Background

The manuscript investigates the significant detrimental impact of air pollution, particularly smog, on the mental health of residents in Lahore, Pakistan. Research highlights various ways in which pollutants contribute to mental health issues, including increased risks of depression and anxiety, and direct impacts on cognitive function.

Aims

This study aims to establish a link between air quality and its psychological impact on the inhabitants of Lahore. It seeks to advocate for effective interventions to mitigate the adverse effects of air pollution on mental health.

Methods

This study examined existing literature on the Internet to understand the link between air pollution and mental health. This manuscript aimed to provide a foundation for developing evidence-based solutions within the current healthcare landscape.

Results

Searching for "smog," "mental health," and "air pollution" yielded these results, a strong association between increasing levels of air pollution in Lahore and its impact on residents' mental well-being. Despite ongoing efforts to mitigate air pollution, the persistent smog burden in Lahore highlights the need for more effective and decisive interventions to improve air quality and safeguard the population's mental health.

Conclusion

This study serves as a preliminary investigation into the intricate relationship between air pollution and mental health. It emphasizes the need for further research to comprehensively understand this critical issue and proper policy implications and potential interventions are required to mitigate the adverse effects of air pollution on mental health.

Mental health crisis situations: the nurse's work in Primary Health Care

OBJECTIVE

to analyze the nurses' work in Primary Health Care in the face of mental health crisis situations.

METHOD

this is a descriptive-exploratory study with a qualitative approach, supported by the theoretical-interpretive frameworks of behavior analysis and historical-dialectical materialism. The data was collected through a semi-structured interview with twelve Primary Health Care nurses and analyzed using the deductive technique proposed by the Theorical Domains Framework, the methodological reference adopted.

RESULTS

the data analyzed made it possible to draw up two themes: "Nurses' work: material and social determinants" and "Nurses' subjective conditions in the face of mental health crisis situations". Nurses' work was guided by the protocol execution of "technical" steps related to clinical psychiatry, with an understanding of the crisis as a "psychiatric outbreak".

CONCLUSION

the study made it possible to analyze the nurse's work in crisis situations, describing the objective and subjective contradictions, their understanding of the crisis phenomenon and the emotional repercussions of this work on the professionals. This situation raises the need for action, organization and political-social mobilization of the nursing category in the fight against the asylum model of care and the consolidation of the Psychiatric Reform perspective.

BACKGROUND

(1) Manicomial protocol action to identify and reduce crisis symptoms.

BACKGROUND

(2) Reducing the experience of crisis as a psychopathological phenomenon.

BACKGROUND

(3) Use of theoretical-critical references aligned with the proposals of psychosocial care.

BACKGROUND

(4) Internationally validated methodological and analytical framework.

BACKGROUND

(5) The need for political and social action on the nursing profession's part.

Global, regional, and national time trends in incidence for depressive disorders, from 1990 to 2019: an age-period-cohort analysis for the GBD 2019

BACKGROUND

Even with advances in primary health care, depressive disorders remain a major global public health problem. We conducted an in-depth analysis of global, regional and national trends in depressive disorders incidence over the past 30 years.

METHODS

Data on the incidence of depressive disorders were obtained by sex (female, male, and both), location (204 countries), age (5-84 years), year (1990-2019) from the Global Burden of Disease Study (GBD) 2019. Further, age-period-cohort modeling was used to estimate the net drift, local drift, age, period and cohort effects between 1990 and 2019.

RESULTS

In 2019, although the incidence of depressive disorders has increased by 59.3% to 290 million (95% UI: 256, 328), the age-standardized incidence rate has decreased by 2.35% to 3588.25 per 100,000 people (3152.71, 4060.42) compared to 1990. There was an emerging transition of incidences from the young and middle-aged population to the old population. From 1990 to 2019, the net drift of incidence rate ranged from -0.54% (-0.61%, -0.47%) in low-middle Socio-demographic Index (SDI) regions to 0.52% (0.25%, 0.79%) in high SDI regions. Globally, the incidence rate of depressive disorders increases with age, period effects showing a decreasing risk and cohort effects beginning to decline after the 1960s.

CONCLUSIONS

Our current findings reflect substantial health disparities and potential priority-setting of depressive disorders incidence in the three dimensions of age, period and cohort across SDI regions, countries. The scope of healthcare to improve the progression of depressive disorders events can be expanded to include males, females of all ages.

Prevalence of mental disorders among middle-aged population of primary healthcare centers in Northeastern Iran

BACKGROUND

Primary healthcare centers (PHCs) serve as the cornerstone of accessible medical services in society, playing a crucial role in screening, detecting, and treating various health issues. This study aimed to investigate the prevalence of psychiatric disorders in middle-aged individuals who refer to PHCs and the potential of PHCs in diagnosing mental disorders.

METHODS

This cross-sectional study was implemented at PHCs under the supervision of Mashhad University of Medical Sciences (MUMS) in northeast Iran in 2018. The enrolled subjects were middle-aged adults who had electronic medical records in SINA, an integrated health management system, and the electronic medical records of MUMS. The prevalence of psychiatric disorders by type and their relationship with demographic information was evaluated by a Chi-square test using SPSS 22.

RESULTS

This study involved 218,341 middle-aged participants. Prevalence of psychiatric disorders was 8.59%, and depression (53.72%) and anxiety (42.02%) were the most common psychiatric disorders in both males and females. The prevalence of mental disorders was significantly higher in females than in males (88.18% vs. 18.81%; P < 0.0001). Indeed, a significant higher prevalence of depression, anxiety, somatoform, childhood psychiatric disorder, and bipolar disorders was observed in females compared to males (P < 0.05). In addition, individuals between the age of 45-60 years, and those from rural areas showed more prevalence of mental disorders than others, but these differences were not significant.

CONCLUSIONS

Considering the previous studies in Iran, the prevalence of mental disorders among patients presenting to PHCs was noticeably lower than expected rates. It seems probable that this huge difference is due to poor screening and detection of mental illness in PHCs of MUMS. It is recommended that health policymakers pursue specific measures to make PHCs more helpful for people with mental health problems in the community.

Mental Health and Prevention of Substance Use Programs in Iran: Component of the National Action Plan for Prevention and Control of Non-communicable Diseases

Background: Mental disorders have a high prevalence and significant burden among all health conditions across the world and in Iran. Therefore, some targets in the field of mental health and substance and alcohol use prevention have been included in the National Action Plan for Prevention and Control of Non-communicable Diseases and Related Risk Factors. Methods: Keeping in mind the key priorities, important strategies have been considered for attaining the main targets in this field. These strategies fall under four categories of governance, prevention and reduction of risk factors, health care, and surveillance, and monitoring and evaluation strategies. Conclusion: The success of mental health and substance and alcohol use prevention programs in Iran can be partly related to the evidence-based approach adopted and also to the commitment of high-rank officials of the Ministry of Health and Medical Education to the principal strategy of increasing access to the general population to basic mental health services, among all other non-communicable diseases.