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Xu F, Cheng P, Xu J, Wang X, Jiang Z, Zhu H, Fan H, Wang Q, Gao Q. Influencing factors of length of stay among repeatedly hospitalized patients with mood disorders: a longitudinal study in China. Ann Gen Psychiatry 2024; 23:15. [PMID: 38664741 PMCID: PMC11046813 DOI: 10.1186/s12991-024-00497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Patients with mood disorders usually require repeated and prolonged hospitalization, resulting in a heavy burden on healthcare resources. This study aims to identify variables associated with length of stay(LOS) of repeatedly hospitalized patients with mood disorders and to provide information for optimizing psychiatry management and healthcare resource allocation. METHODS Electronic medical records (EMRs) of repeatedly hospitalized patients with mood disorders from January 2010 to December 2018 were collected and retrospectively analyzed. Chi-square and t-test were adopted to investigate the differences in characteristics between the two groups of short LOS and long LOS. Generalized estimating equation (GEE) was conducted to investigate potential factors influencing LOS. RESULTS A total of 2,009 repeatedly hospitalized patients with mood disorders were enrolled, of which 797 (39.7%) had a long LOS and 1,212 (60.3%) had a short LOS. Adverse effects of treatment, continuous clinical manifestation, chronic onset type, suicide attempt, comorbidity and use of antidepressants were positively associated with long LOS among all repeatedly hospitalized patients with mood disorders (P < 0.050). For patients with depression, factors associated with long LOS consisted of age, monthly income, adverse effects of treatment, continuous clinical manifestation, suicide attempt and comorbidity (P < 0.050). Whereas, for patients with bipolar disorder (BD), adverse effects of treatment, four or more hospitalizations and use of antidepressants contributed to the long LOS (P < 0.050). Influencing factors of LOS also vary among patients with different effectiveness of treatment. CONCLUSION The LOS in repeatedly hospitalized patients with mood disorders was influenced by multiple factors. There were discrepancies in the factors affecting LOS in patients with different diagnoses and effectiveness of treatment, and specific factors should be addressed when evaluating the LOS.
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Affiliation(s)
- Feng Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing, 100069, China
| | - Peixia Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing, 100069, China
| | - Jiaying Xu
- Capital Medical University Affiliated Beijing Anding Hospital, Beijing, China
| | - Xiaonan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing, 100069, China
| | - Zhen Jiang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing, 100069, China
| | - Huiping Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing, 100069, China
| | - Hua Fan
- Capital Medical University Affiliated Beijing Anding Hospital, Beijing, China
| | - Qian Wang
- Capital Medical University Affiliated Beijing Anding Hospital, Beijing, China
| | - Qi Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing, 100069, China.
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Gronholm PC, Ali S, Brohan E, Thornicroft G. Discrimination reported by people with schizophrenia: cross-national variations in relation to the Human Development Index. Epidemiol Psychiatr Sci 2023; 32:e66. [PMID: 37985933 PMCID: PMC10689058 DOI: 10.1017/s2045796023000781] [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: 04/20/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
AIMS Mental health related stigma and discrimination is a universal phenomenon and a contributor to the adversity experienced by people with schizophrenia. Research has produced inconsistent findings on how discrimination differs across settings and the contextual factors that underpin these differences. This study investigates the association between country-level Human Development Index (HDI) and experienced and anticipated discrimination reported by people with schizophrenia. METHODS This study is a secondary data analysis of a global cross-sectional survey completed by people living with schizophrenia across 29 countries, between 2005 and 2008. Experienced and anticipated discrimination were assessed using the Discrimination and Stigma Scale (DISC-10). Countries were classified according to their 2006 HDI. Negative binomial and Poisson regression analyses with a robust standard errors approach were conducted to investigate associations between country-level HDI and discrimination. RESULTS In the regression analyses, no evidence was found for a linear association between HDI and experienced or anticipated discrimination. Further exploratory analyses showed a significant non-linear association between HDI ratings and experienced discrimination. Participants in "high" and "very high" HDI countries reported more experienced discrimination compared to those in "medium" HDI countries. CONCLUSIONS HDI does, to some extent, appear to be associated with how far discrimination is experienced across different contexts. More high-quality cross-national research, including research focused on "medium" and "low" countries, is needed to substantiate these findings and identify underlying factors that may explain the pattern observed for experienced discrimination, including generating new datasets that would enable for these analyses to be repeated and contrasted with more recent data. An in-depth understanding of these factors will further aid the adaptation of cross-cultural and context specific anti-stigma interventions in future.
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Affiliation(s)
- P. C. Gronholm
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - S. Ali
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - E. Brohan
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - G. Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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3
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Akinola OA, Tele A, McAuliffe E, Ebuenyi ID. Exploring the correlates of mental healthcare approaches and employment status among persons with depression and anxiety: A secondary data analysis of a global survey. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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Leung T, Musili M, Eastes K, Oyungu E, McHenry MS. Creating the Map of Interactive Services Aiding and Assisting Persons With Disabilities (MSAADA) Project: Tutorial for the Novel Use of a Store Locator App. Interact J Med Res 2022; 11:e37036. [PMID: 36480245 PMCID: PMC9782326 DOI: 10.2196/37036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/27/2022] [Accepted: 10/27/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND An estimated 15% of the global population is living with a disability. In Kenya, children with disabilities remain among the most vulnerable populations, experiencing substantial barriers to wellness and inclusion. Smartphone ownership and internet access have been increasing across sub-Saharan Africa, including in Kenya. Despite these advances, online or mobile resources remain limited and difficult to find and navigate. OBJECTIVE This paper aims to describe the novel use of a store locator app to develop an interactive map of organizations that provide medical, educational, and socioeconomic resources to individuals with disabilities in Kenya. The target audience is individuals with disabilities, medical professionals, and organization leaders. METHODS A comprehensive list of organizations, government county offices, educational assessment and resource centers, and institutions was compiled. Organizations were contacted via email, WhatsApp, or in person for semistructured interviews. Based on the services offered, each organization was assigned categorical search tags. The data were entered into a third-party store locator app. The resulting map was inserted into a page on the Academic Model Providing Access to Healthcare (AMPATH) website. RESULTS The Map of Interactive Services Aiding and Assisting Persons With Disabilities (MSAADA; this abbreviation is also Swahili for "help") was launched in July 2020 in both English and Swahili. The map included 89 organizations across Kenya. Of these, 51 were reached for an interview (for a 57% response rate). Interviewees cited limited paid staff and dependence on grant-based funding as primary challenges to growth and sustainability. CONCLUSIONS MSAADA is an interactive, virtual map that aims to connect individuals with disabilities, medical professionals, and organization leaders to resources in Kenya. The novel use of a store locator app to compile resources in remote settings has the potential to improve access to health care for a wide variety of specialties and patient populations. Innovators in global health should consider the use of store locator apps to connect individuals to resources in regions with limited mapping.
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Affiliation(s)
| | | | - Kaytlin Eastes
- Center for Global Health, Indiana University, Indianapolis, IN, United States
| | - Eren Oyungu
- Department of Medical Physiology, Moi University School of Medicine, Eldoret, Kenya.,Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Megan S McHenry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Academic Model Providing Access to Healthcare, Eldoret, Kenya
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van Beukering IE, Smits SJC, Janssens KME, Bogaers RI, Joosen MCW, Bakker M, van Weeghel J, Brouwers EPM. In What Ways Does Health Related Stigma Affect Sustainable Employment and Well-Being at Work? A Systematic Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:365-379. [PMID: 34487290 PMCID: PMC9576674 DOI: 10.1007/s10926-021-09998-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 05/26/2023]
Abstract
PURPOSE Studies are increasingly showing that health related stigma is a barrier to employment, but it is not known how. The aim of this systematic review is to identify, appraise and analyse studies that have directly or indirectly addressed ways in which stigma affects sustainable employment and well-being at work of people with disabilities. METHODS Using a multiphase screening process, this review is based on a comprehensive literature search (2000-2019) carried out in six electronic databases: Embase, Web of Science, Medline Ovid, Cochrane CENTRAL, PsycINFO and Google Scholar. RESULTS 7.263 publications were identified; 96 studies were found eligible to be included in the review. 72% of the studies were conducted in North America or Europe. Few studies directly assessed how stigma affects the employment of people with disabilities. Most studies highlighted that attitudes and behaviour of employers formed a barrier to employment, as well as anticipated stigma and self-stigma in people with health problems. However, the findings also showed that the attitudes and behaviour of co-workers, health care professionals, reintegration professionals, customers, and family and friends could act as a barrier to employment although these influences are under-researched. Although many similarities were seen in the relevant findings of studies about both physical and mental disabilities, several nuances were found. CONCLUSION Stigma hampers sustainable employment and well-being in multiple ways. Whereas the number of publications on this topic is rapidly increasing, the roles of health care professionals, reintegration professionals, co-workers, customers, and family and friends particularly warrant more attention.
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Affiliation(s)
- I E van Beukering
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
- Inspectorate SZW, Den Haag, The Netherlands.
- , P.O. Box 90513, 5000 LE, Tilburg, The Netherlands.
| | - S J C Smits
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Summa College, Eindhoven, The Netherlands
| | - K M E Janssens
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - R I Bogaers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Brain Research and Innovation Centre, Ministry of Defense, Den Haag, The Netherlands
| | - M C W Joosen
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - M Bakker
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - J van Weeghel
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Phrenos Center of Expertise, Utrecht, The Netherlands
| | - E P M Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Ebuenyi ID, Gitonga I, Tele A, Syurina EV. Unemployment in women with psychosocial disabilities during the COVID-19 pandemic: Lessons from Tana River County, Kenya. JOURNAL OF INTERNATIONAL DEVELOPMENT 2022; 34:1018-1027. [PMID: 35571229 PMCID: PMC9088452 DOI: 10.1002/jid.3638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/22/2022] [Accepted: 01/30/2022] [Indexed: 06/15/2023]
Abstract
In low-income settings, the informal economy is a practical alternative to work and employment for persons with disabilities. However, the COVID-19 pandemic negatively affected the informal economy. This study aimed to explore the experiences of women with psychosocial disabilities in Kenya during the pandemic. We found that the pandemic worsened their experiences of work and employment, and they did not receive any social welfare or support from the government. Our findings suggest that pandemic management must adopt inclusive and context-sensitive approaches that support persons with psychosocial disabilities. Social welfare and protection for persons with disabilities are relevant for socio-economic empowerment and inclusion.
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Affiliation(s)
- Ikenna D. Ebuenyi
- IRIS Centre, School of Nursing, Midwifery and Health SystemsUniversity College DublinDublinIreland
- Assisting Living and Learning (ALL) Institute, Department of PsychologyMaynooth UniversityMaynoothIreland
- Ikuze AfricaNairobiKenya
| | - Isaiah Gitonga
- Assisting Living and Learning (ALL) Institute, Department of PsychologyMaynooth UniversityMaynoothIreland
- Ikuze AfricaNairobiKenya
| | | | - Elena V. Syurina
- Faculty of Science, Athena InstituteVrije UniversiteitAmsterdamThe Netherlands
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Gitonga I, Syurina EV, Tele A, Ebuenyi ID. Improving work and employment opportunities for women with psychosocial disabilities: an action research protocol. Pan Afr Med J 2021; 38:323. [PMID: 34285746 PMCID: PMC8265266 DOI: 10.11604/pamj.2021.38.323.28509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
In Kenya, employment rates for persons with disabilities are very low and those with psychosocial disabilities have even more dismal rates of employment. This situation has negative impact on the individual’s recovery, quality of life, mental and physical health. The systemic exclusion of persons with psychosocial disabilities in work and employment disproportionately affects women. The aim of this study is to test the feasibility of disability inclusion training to improve work and employment opportunities for women with psychosocial disabilities in Tana River County, Kenya. The study will adopt a mixed methods research design using action research approach. A sample of women with psychosocial disabilities will be trained using a researcher designed disability inclusion training manual, while employers and other stakeholders will be trained on inclusive employment. Trainings will be tailored to suit different employers and for different types of psychosocial disabilities. Interactive learning and linking sessions involving the two groups and process evaluations will be conducted at different time points to measure the impact of the intervention. Findings from this pilot study will inform future research on work and employability programs for rural women with psychosocial disabilities. The study protocol was approved by Maseno University Ethics Review Committee (MUERC/00851/20). Findings from this study will be disseminated through conference presentations and scientific publications in peer reviewed journals.
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Affiliation(s)
- Isaiah Gitonga
- Ikuze Africa, Nairobi, Kenya.,Assisting Living and Learning Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
| | | | | | - Ikenna Desmond Ebuenyi
- Ikuze Africa, Nairobi, Kenya.,Assisting Living and Learning Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
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Perspectives of mental healthcare providers on pathways to improved employment for persons with mental disorders in two lower middle-income countries. Int J Ment Health Syst 2020; 14:26. [PMID: 32256689 PMCID: PMC7106860 DOI: 10.1186/s13033-020-00354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/10/2020] [Indexed: 11/14/2022] Open
Abstract
Background Mental disorders affect employment and the ability to work, and mental healthcare providers are important in the promotion of health and employment for affected individuals. The objective of this study is to explore the perspectives of mental healthcare providers on pathways to improved employment for persons with mental disorders in two lower middle-income countries. Methods Our study participants included mental healthcare providers (psychiatrists, occupational physicians, psychologists, and social care workers) from Kenya and Nigeria. Qualitative interviews and a focus group discussion were conducted with 15 professionals in Kenya and online questionnaires were completed by 80 professionals from Nigeria. Results The study participants suggested that work is important for the recovery and wellbeing of persons with mental disorders. A complex interplay of factors related to the health of persons with mental disorders and the socioeconomic system in their setting were identified as barriers to their work ability and employment. Participants proposed four pathways to improved employment: including information on reducing stigma, better healthcare, policy advocacy in employment, and government commitment to healthcare and social welfare. Public education to reduce stigma and better healthcare were the highest reported facilitators of employment. Conclusions Persons with mental disorders require multilevel support and care in obtaining and retaining employment. A better mental healthcare system is essential for the employment of persons with mental disorders.
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Ebuenyi ID, Guxens M, Ombati E, Bunders-Aelen JFG, Regeer BJ. Employability of Persons With Mental Disability: Understanding Lived Experiences in Kenya. Front Psychiatry 2019; 10:539. [PMID: 31417437 PMCID: PMC6683784 DOI: 10.3389/fpsyt.2019.00539] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/12/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction: Globally, mental illness affects social and occupational functioning. We aimed to highlight the barriers to employment experienced by persons with mental disabilities in Kenya and how they manage to find work against all the odds. Materials and Methods: Using a mixed-method study design, we purposely sampled persons with mental illness through networks of persons with psychosocial disabilities (Users and Survivors of Psychiatry and Africa Mental Health Foundation, Kenya). Qualitative data were obtained through in-depth interviews (n = 14) and four focus group discussions (n = 30), while a researcher-designed questionnaire was used to obtain quantitative data (n = 72). Results: We identified five major clusters of barriers to employment: mental illness factors, social exclusion and stigma, work identity crisis, non-accommodative environment, and socioeconomic status. Factors that facilitated employment include self-awareness and acceptance, self-employment, provision of reasonable accommodation, improved health services, addressing discriminatory laws and practices, and social development programs and support. Participants considered psychiatric illness the highest barrier to employment (63.2%), while supportive family/friends were considered the highest facilitator of employment (54.5%). Conclusion: The employment experiences of persons with mental disabilities are influenced by various interrelated factors in their social environment. Proactive social support and affirmative action by government may improve their employment opportunities and quality of life.
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Affiliation(s)
- Ikenna D Ebuenyi
- Athena Institute, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Mònica Guxens
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Joske F G Bunders-Aelen
- Athena Institute, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Barbara J Regeer
- Athena Institute, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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