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Cresswell-Smith J, Kauppinen T, Laaksoharju T, Rotko T, Solin P, Suvisaari J, Wahlbeck K, Tamminen N. Mental Health and Mental Wellbeing Impact Assessment Frameworks-A Systematic Review. Int J Environ Res Public Health 2022; 19:13985. [PMID: 36360865 PMCID: PMC9653904 DOI: 10.3390/ijerph192113985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
Mental health is largely shaped by the daily environments in which people live their lives, with positive components of mental health emphasising the importance of feeling good and functioning effectively. Promoting mental health relies on broad-based actions over multiple sectors, which can be difficult to measure. Different types of Impact Assessment (IA) frameworks allow for a structured approach to evaluating policy actions on different levels. A systematic review was performed exploring existing IA frameworks relating to mental health and mental wellbeing and how they have been used. A total of 145 records were identified from the databases, from which 9 articles were included in the review, with a further 6 studies included via reference list and citation chaining. Five different mental-health-related IA frameworks were found to be implemented in a variety of settings, mostly in relation to evaluating community actions. A Narrative Synthesis summarised key themes from the 15 included articles. Findings highlight the need for participatory approaches in IA, which have the dual purpose of informing the IA evaluation and advocating for the need to include mental health in policy development. However, it is important to ensure that IA frameworks are user-friendly, designed to be used by laypeople in a variety of sectors and that IA frameworks are operational in terms of time and monetary resources.
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Affiliation(s)
| | - Tapani Kauppinen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | | | - Tuulia Rotko
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Pia Solin
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | | | - Nina Tamminen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
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2
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Cresswell‐Smith J, Mäkikärki N, Appelqvist‐Schmidlechner K, Wahlbeck K. Finding the right words: Articulating the value of mental health promotion. A focus group study. J Community Psychol 2022; 50:2857-2874. [PMID: 35050498 PMCID: PMC9541557 DOI: 10.1002/jcop.22801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/24/2021] [Accepted: 01/03/2022] [Indexed: 06/14/2023]
Abstract
The Lapinlahti Hospital initiative in Helsinki has transformed a disused psychiatric hospital into an open site for mental health promotion. The current study uses qualitative methods to explore how the initiative may promote population mental health. The phenomenological study comprised of data from 7 focus group including 28 participants. Resulting data were thematically analysed to articulate how the initiative supports mental wellbeing in different ways. Mental health benefits were categorized into three themes; mental health value, civil values and common values which were comprised of nine subthemes; paradigm shift, social inclusion, personal meaning, regeneration, ambience, stigma, sustainability, democracy and environment. Mental health promotion emphasises the impact of daily environments in which people live their lives. Results from this study support the use of broad based actions which promote different components of mental wellbeing simultaneously. Psychiatric hospitals may offer historically meaningful sites for such actions.
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Affiliation(s)
- Johanna Cresswell‐Smith
- Equality Unit, Mental Health TeamFinnish Institute for Health and Welfare (THL)HelsinkiFinland
| | | | | | - Kristian Wahlbeck
- Mieli, Mental Health FinlandFinnish Institute for Health and Welfare (THL)HelsinkiFinland
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3
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Martín-María N, Lara E, Cresswell-Smith J, Forsman AK, Kalseth J, Donisi V, Amaddeo F, Wahlbeck K, Miret M. Instruments to evaluate mental well-being in old age: a systematic review. Aging Ment Health 2021; 25:1191-1205. [PMID: 32496810 DOI: 10.1080/13607863.2020.1774742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study is to identify and appraise existing instruments to evaluate mental well-being in old age. METHOD Systematic literature searches in PubMed, PsycINFO, ProQuest Research Library, AgeLine and CINAHL databases were performed. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to assess the measurement properties, reported according to the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) statement. For each measurement property, results were classified as positive, negative or indeterminate. The quality level of evidence was rated as high, moderate, low or very low following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS A total of 28 instruments were found. Most instruments evaluated different dimensions of mental well-being, including various subscales. The quality was adequate overall. Six instruments showed high quality (Perceived Well-Being Scale-PWB, Salamon-Conte Life Satisfaction in the Elderly Scale-SCLSES, Herth Hope Scale-HHS, Life Satisfaction Index Third Age-LSITA, Meaning in Life Scale-MLS, and SODdisfazione dell'Anziano-SODA), and other six a moderate level (Scale of Happiness of the Memorial University of Newfoundland-MUNSH, Six Scales of Psychological Well-Being-PWBS, Valuation Of Life-VOL, Life Satisfaction Scale for Chinese Elders-LSS-C, Meaningful Activity Participation Assessment-MAPA and Will To Life-WTL). CONCLUSION This review provides the first comprehensive synthesis of instruments assessing mental well-being in older populations. The PWB, SCLSES, HHS, LSITA, MLS and SODA were the most appropriated instruments. An instrument that specifically measures mental well-being in the oldest old age group (aged 80 plus) and that considers its multidimensional nature is needed.
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Affiliation(s)
- Natalia Martín-María
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Elvira Lara
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | | | - Anna K Forsman
- Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Vaasa, Finland
| | - Jorid Kalseth
- Department of Health Research, SINTEF Technology and Society, Trondheim, Norway
| | - Valeria Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Kristian Wahlbeck
- Mental Health Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Marta Miret
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
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Cresswell-Smith J, Donisi V, Rabbi L, Sfetcu R, Šprah L, Straßmayr C, Wahlbeck K, Ådnanes M. 'If we would change things outside we wouldn't even need to go in…' supporting recovery via community-based actions: A focus group study on psychiatric rehospitalization. Health Expect 2020; 24 Suppl 1:174-184. [PMID: 32909367 PMCID: PMC8137487 DOI: 10.1111/hex.13125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Psychiatric rehospitalization is a complex phenomenon in need of more person-centred approaches. The current paper aimed to explore how community-based actions and daily life influence mental health and rehospitalization. DESIGN, SETTING AND PARTICIPANTS The qualitative study included focus group data from six European countries including 59 participants. Data were thematically analysed following an inductive approach deriving themes and subthemes in relation to facilitators and barriers to mental health. RESULTS Barriers consisted of subthemes (financial difficulty, challenging family circumstances and stigma), and facilitators consisted of three subthemes (complementing services, signposting and recovery). The recovery subtheme consisted of a further five categories (family and friends, work and recreation, hope, using mental health experience and meaning). DISCUSSION Barriers to mental health largely related to social determinants of mental health, which may also have implications for psychiatric rehospitalization. Facilitators included community-based actions and aspects of daily life with ties to personal recovery. By articulating the value of these facilitators, we highlight benefits of a person-centred and recovery-focused approach also within the context of psychiatric rehospitalization. CONCLUSIONS This paper portrays how person-centred approaches and day-to-day community actions may impact psychiatric rehospitalization via barriers and facilitators, acknowledging the social determinants of mental health and personal recovery. PATIENT OR PUBLIC CONTRIBUTION The current study included participants with experience of psychiatric rehospitalization from six different European countries. Furthermore, transcripts were read by several of the focus group participants, and a service user representative participated in the entire research process in the original study.
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Affiliation(s)
| | - Valeria Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Laura Rabbi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Raluca Sfetcu
- National School of Public Health, Management and Professional Development, Bucharest, Romania.,Faculty of Psychology and Educational Sciences, SHU Bucharest, Bucharest, Romania
| | - Lilijana Šprah
- Research Centre of the Slovenian Academy of Sciences and Arts, Sociomedical Institute, Ljubljana, Slovenia
| | - Christa Straßmayr
- IMEHPS.research - Forschungsinstitut für Sozialpsychiatrie, Vienna, Austria
| | - Kristian Wahlbeck
- Finnish Institute for Health and Welfare (THL), Mental Health Unit, Helsinki, Finland
| | - Marian Ådnanes
- Department of Health Research, SINTEF Digital, Trondheim, Norway
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Evans-Lacko S, Courtin E, Fiorillo A, Knapp M, Luciano M, Park AL, Brunn M, Byford S, Chevreul K, Forsman A, Gulacsi L, Haro J, Kennelly B, Knappe S, Lai T, Lasalvia A, Miret M, O'Sullivan C, Obradors-Tarragó C, Rüsch N, Sartorius N, Švab V, van Weeghel J, Van Audenhove C, Wahlbeck K, Zlati A, McDaid D, Thornicroft G. The state of the art in European research on reducing social exclusion and stigma related to mental health: A systematic mapping of the literature. Eur Psychiatry 2020; 29:381-9. [DOI: 10.1016/j.eurpsy.2014.02.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022] Open
Abstract
AbstractStigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.
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Tedeschi F, Donisi V, Salazzari D, Cresswell-Smith J, Wahlbeck K, Amaddeo F. Clinical and organizational factors predicting readmission for mental health patients across Italy. Soc Psychiatry Psychiatr Epidemiol 2020; 55:187-196. [PMID: 31463615 DOI: 10.1007/s00127-019-01766-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aims of our study are: to explore rehospitalization in mental health services across Italian regions, Local Health Districts (LHDs), and hospitals; to examine the predictive power of different clinical and organizational factors. METHODS The data set included adult patients resident in Italy discharged from a general hospital episode with a main psychiatric diagnosis in 2012. Independent variables at the individual, hospital, LHD, and region levels were used. Outcome variables were individual-level readmission and LHD-level readmission rate to any hospital at 1-year follow-up. The association with readmission of each variable was assessed through both single- and multi-level logistic regression; descriptive statistics were provided to assess geographical variation. Relevance of contextual effects was investigated through a series of random-effects regressions without covariates. RESULTS The national 1-year readmission rate was 43.0%, with a cross-regional coefficient of variation of 6.28%. Predictors of readmission were: admission in the same LHD as residence, psychotic disorder, higher length of stay (LoS), higher rate of public beds in the LHD; protective factors were: young age, involuntary admission, and intermediate number of public healthcare staff at the LHD level. Contextual factors turned out to affect readmission only to a limited degree. CONCLUSIONS Homogeneity of readmission rates across regions, LHDs, hospitals, and groups of patients may be considered as a positive feature in terms of equity of the mental healthcare system. Our results highlight that readmission is mainly determined by individual-level factors. Future research is needed to better explore the relationship between readmission and LoS, discharge decision, and resource availability.
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Affiliation(s)
- Federico Tedeschi
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Policlinico "G.B. Rossi", University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy.
| | - V Donisi
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Policlinico "G.B. Rossi", University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
| | - D Salazzari
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Policlinico "G.B. Rossi", University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
| | - J Cresswell-Smith
- Mental Health Unit, National Institute for Health and Welfare (THL), P.O. Box 30, 00271, Helsinki, Finland
| | - K Wahlbeck
- Mental Health Unit, National Institute for Health and Welfare (THL), P.O. Box 30, 00271, Helsinki, Finland
| | - F Amaddeo
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Policlinico "G.B. Rossi", University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
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7
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Hazo JB, Brunn M, Wykes T, McDaid D, Dorsey M, Demotes-Mainard J, van der Feltz-Cornelis CM, Wahlbeck K, Knappe S, Meyer-Lindenberg A, Obradors-Tarragó C, Haro JM, Leboyer M, Chevreul K. European mental health research resources: Picture and recommendations of the ROAMER project. Eur Neuropsychopharmacol 2019; 29:179-194. [PMID: 30579654 DOI: 10.1016/j.euroneuro.2018.11.1111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 11/29/2022]
Abstract
As part of the Roamer project, we sought to have a picture of the available mental health research (MHR) funding, capacity-building and infrastructures resources and to establish consensus-based recommendations that would allow an increase of European MHR resources and enable better use and accessibility to them. The methods fell into three sections (i) a review of the literature, (ii) a mental health-related keywords search within the Cordis®, On-Course® and Meril® databases which contain information on European research funding, training and infrastructures. These reviews provided an overview that was presented to (iii) two experts workshops with 28 participants drawn from academic which identified gaps and produced recommendations. The literature review illustrates the debates in the scientific community on funding, training and infrastructures. The database searches estimated the fraction of health research resources available for mental health. Eight overarching goals for MHR resources were identified by the workshops; each of them was carried out with several practical recommendations. Resources for MHR are scarce considering the burden of mental disorders, the high rate of return of MHR and the under-investment of the field. The recommendations are urgently warranted to increase resources and their optimal access and use.
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Affiliation(s)
- Jean-Baptiste Hazo
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France; AP-HP, URC-Eco, DHU PePSY, F-75 004 Paris, France; Fondation FondaMental, French Scientific Foundation, Créteil, France; World Health Organization Collaborating Centre for Research and Training in Mental Health, CCOMS, Lille 59260, Hellemmes, France.
| | - Matthias Brunn
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France; AP-HP, URC-Eco, DHU PePSY, F-75 004 Paris, France; Fondation FondaMental, French Scientific Foundation, Créteil, France
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, South London and Maudsley NHS Foundation Trust, UK
| | - David McDaid
- PSSRU, London School of Economics and Political Science, London, UK
| | - Maya Dorsey
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France; AP-HP, URC-Eco, DHU PePSY, F-75 004 Paris, France; Fondation FondaMental, French Scientific Foundation, Créteil, France
| | | | - Christina M van der Feltz-Cornelis
- Department of Health Sciences, MHARG, University of York, York, United Kingdom; Tranzo Department, Tilburg University, Tilburg, The Netherlands
| | | | - Susanne Knappe
- Institut für Klinische Psychologie und Psychotherapie, Behaviorale Epidemiologie & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Andreas Meyer-Lindenberg
- Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, 68159 Mannheim, Germany
| | | | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Institut de Recerca Sant Joan de Déu, Sant Boi de llobregat, Universitat de Barcelona, Barcelona, Spain
| | - Marion Leboyer
- Fondation FondaMental, French Scientific Foundation, Créteil, France; AP-HP, Department of Psychiatry of Mondor Hospital, DHU PePSY, Paris-Est-Créteil University (UPEC), Créteil, France; INSERM, U955, Translational Psychiatry, Créteil, France
| | - Karine Chevreul
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France; AP-HP, URC-Eco, DHU PePSY, F-75 004 Paris, France
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Katschnig H, Straßmayr C, Endel F, Berger M, Zauner G, Kalseth J, Sfetcu R, Wahlbeck K, Tedeschi F, Šprah L. Using national electronic health care registries for comparing the risk of psychiatric re-hospitalisation in six European countries: Opportunities and limitations. Health Policy 2019; 123:1028-1035. [PMID: 31405616 DOI: 10.1016/j.healthpol.2019.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 05/19/2019] [Accepted: 07/09/2019] [Indexed: 11/30/2022]
Abstract
Psychiatric re-hospitalisation rates have been of longstanding interest as health care quality metric for planners and policy makers, but are criticized for not being comparable across hospitals and countries due to measurement unclarities. The objectives of the present study were to explore the interoperability of national electronic routine health care registries of six European countries (Austria, Finland, Italy, Norway, Romania, Slovenia) and, by using variables found to be comparable, to calculate and compare re-hospitalisation rates and the associated risk factors. A "Methods Toolkit" was developed for exploring the interoperability of registry data and protocol led pilot studies were carried out. Problems encountered in this process are described. Using restricted but comparable data sets, up to twofold differences in psychiatric re-hospitalisation rates were found between countries for both a 30- and 365-day follow-up period. Cumulative incidence curves revealed noteworthy additional differences. Health system characteristics are discussed as potential causes for the differences. Multi-level logistic regression analyses showed that younger age and a diagnosis of schizophrenia/mania/bipolar disorder consistently increased the probability of psychiatric re-hospitalisation across countries. It is concluded that the advantage of having large unselected study populations of national electronic health care registries needs to be balanced against the considerable efforts to examine the interoperability of databases in cross-country comparisons.
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Affiliation(s)
- Heinz Katschnig
- IMEHPS.research, Vienna, Austria; Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria.
| | | | | | | | | | | | - Raluca Sfetcu
- National School of Public Health, Management and Professional Development (SNSPMPDS), Bucharest, Romania
| | - Kristian Wahlbeck
- National Institute for Health and Welfare (THL), Mental Health Unit, Helsinki, Finland
| | - Federico Tedeschi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Lilijana Šprah
- Research Centre of the Slovenian Academy of Sciences and Arts (ZRC SAZU), Ljubljana, Slovenia
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Stenius-Ayoade A, Haaramo P, Kautiainen H, Sunikka S, Gissler M, Wahlbeck K, Eriksson JG. Morbidity and housing status 10 years after shelter use-follow-up of homeless men in Helsinki, Finland. Eur J Public Health 2019; 28:1092-1097. [PMID: 29584880 DOI: 10.1093/eurpub/cky038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Homelessness is associated with increased mortality, morbidity and social difficulties and periods of homelessness are sometimes prolonged or repeated. However, there are no long-term follow-up studies focusing upon housing status among homeless people. The aim of this study was to examine morbidity and housing outcomes and to identify factors predicting being independently housed 10 years after shelter use. Methods By combining data from several registers we followed all 552 homeless men who stayed in shelter in Helsinki during 2004 and determined their housing situation and morbidity 10 years later. Their situation was compared with an age-matched control group from the general population (N = 946). Using logistic regression analysis, we assessed the predictive effects of socioeconomic factors and health service use at baseline on becoming independently housed. Results By the end of the follow-up 52.0% of the formerly homeless study group had died, compared with 14.6% of the controls. At 10 years, 6.0% were independently housed, 37.5% lived in supported housing and 4.5% were still or again homeless. Psychiatric disorders, including substance use disorder, were present in 77.5% of the homeless, compared with 16.1% among the controls. Being married (OR 8.3, 95% CI 3.0 to 23.2) and having less than four shelter nights in year 2004 (OR 9.1, 95% CI 2.7 to 30.8) strongly predicted being independently housed 10 years later. Conclusions Homeless staying in shelters have high mortality and morbidity and most of those surviving, are in need of support in their everyday lives even years after the shelter period.
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Affiliation(s)
- Agnes Stenius-Ayoade
- Folkhälsan Research Center, Helsinki, Finland.,National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland.,Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland
| | - Peija Haaramo
- National Institute for Health and Welfare, Public Health Promotion Unit, Helsinki, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.,Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Sanna Sunikka
- Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland.,The Finnish Foundation for Supporting Ex-Offenders, Helsinki, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | | | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.,National Institute for Health and Welfare, Chronic Disease Prevention Unit, Helsinki, Finland
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10
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Stenius-Ayoade A, Haaramo P, Kautiainen H, Sunikka S, Gissler M, Wahlbeck K, Eriksson JG. Morbidity and housing status 10 years after shelter use—follow-up of homeless men in Helsinki, Finland. Eur J Public Health 2019; 29:190. [DOI: 10.1093/eurpub/cky058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Poor mental health has profound economic consequences. Given the burden of poor mental health, the economic case for preventing mental illness and promoting better mental health may be very strong, but too often prevention attracts little attention and few resources. This article describes the potential role that can be played by economic evidence alongside experimental trials and observational studies, or through modeling, to substantiate the need for increased investment in prevention. It illustrates areas of action across the life course where there is already a good economic case. It also suggests some further areas of substantive public health concern, with promising effectiveness evidence, that may benefit from economic analysis. Financial and economic barriers to implementation are then presented, and strategies to address the barriers and increase investment in the prevention of mental illness are suggested.
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Affiliation(s)
- David McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, United Kingdom; ,
| | - A-La Park
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, United Kingdom; ,
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12
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Forsman A, Jane-Llopis E, Schierenbeck I, Wahlbeck K. Psychosocial interventions for prevention of depression in older people. Hippokratia 2018. [DOI: 10.1002/14651858.cd007804.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Anna Forsman
- THL National Institute for Health and Welfare; Mental Health Promotion Unit; Sarjakatu 2 C Vaasa Finland 65320
- Nordic School of Public Health; Gothenburg Sweden
| | - Eva Jane-Llopis
- Radboud University Nijmegen; Academic Center for Social Sciences; PO Box 9104 Nijmengen Netherlands 6500 HE
| | - Isabell Schierenbeck
- University of Gothenburg; School of Global Studies; Box 121333 SE-402 42 Gothenburg Sweden
| | - Kristian Wahlbeck
- THL National Institute for Health and Welfare; Department of Mental Health and Substance Abuse Services; PO Box 220 Helsinki Finland FIN-00531
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Cetrano G, Salvador-Carulla L, Tedeschi F, Rabbi L, Gutiérrez-Colosía MR, Gonzalez-Caballero JL, Park AL, McDaid D, Sfetcu R, Kalseth J, Kalseth B, Hope Ø, Brunn M, Chevreul K, Straßmayr C, Hagmair G, Wahlbeck K, Amaddeo F. The balance of adult mental health care: provision of core health versus other types of care in eight European countries. Epidemiol Psychiatr Sci 2018; 29:e6. [PMID: 30328401 PMCID: PMC8061296 DOI: 10.1017/s2045796018000574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/17/2018] [Accepted: 09/10/2018] [Indexed: 12/02/2022] Open
Abstract
AIMS Although many mental health care systems provide care interventions that are not related to direct health care, little is known about the interfaces between the latter and core health care. 'Core health care' refers to services whose explicit aim is direct clinical treatment which is usually provided by health professionals, i.e., physicians, nurses, psychologists. 'Other care' is typically provided by other staff and includes accommodation, training, promotion of independence, employment support and social skills. In such a definition, 'other care' does not necessarily mean being funded or governed differently. The aims of the study were: (1) using a standard classification system (Description and Evaluation of Services and Directories in Europe for Long Term Care, DESDE-LTC) to identify 'core health' and 'other care' services provided to adults with mental health problems; and (2) to investigate the balance of care by analysing the types and characteristics of core health and other care services. METHODS The study was conducted in eight selected local areas in eight European countries with different mental health systems. All publicly funded mental health services, regardless of the funding agency, for people over 18 years old were identified and coded. The availability, capacity and the workforce of the local mental health services were described using their functional main activity or 'Main Types of Care' (MTC) as the standard for international comparison, following the DESDE-LTC system. RESULTS In these European study areas, 822 MTCs were identified as providing core health care and 448 provided other types of care. Even though one-third of mental health services in the selected study areas provided interventions that were coded as 'other care', significant variation was found in the typology and characteristics of these services across the eight study areas. CONCLUSIONS The functional distinction between core health and other care overcomes the traditional division between 'health' and 'social' sectors based on governance and funding. The overall balance between core health and other care services varied significantly across the European sites. Mental health systems cannot be understood or planned without taking into account the availability and capacity of all services specifically available for this target population, including those outside the health sector.
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Affiliation(s)
- G. Cetrano
- Social Care Workforce Research Unit, King's Policy Institute, King's College London, London, UK
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - L. Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
- PSICOST Research Association, Jerez de la Frontera, Spain
| | - F. Tedeschi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - L. Rabbi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M. R. Gutiérrez-Colosía
- PSICOST Research Association, Jerez de la Frontera, Spain
- Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain
| | | | - A.-L. Park
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - D. McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - R. Sfetcu
- Institute for Economic Forecasting, Bucharest, Romania
- Faculty of Psychology and Educational Sciences, University Spiru Haret, Bucharest, Romania
| | - J. Kalseth
- Department of Health Research, SINTEF, Trondheim, Norway
| | - B. Kalseth
- Department of Health Research, SINTEF, Trondheim, Norway
| | - Ø. Hope
- Department of Health Research, SINTEF, Trondheim, Norway
| | - M. Brunn
- Université Paris Diderot, Sorbonne, Paris, France
- Inserm, ECEVE, U1123, F-75 010, Paris, France
- AP-HP, URC-Eco, Paris, France
| | - K. Chevreul
- Université Paris Diderot, Sorbonne, Paris, France
- Inserm, ECEVE, U1123, F-75 010, Paris, France
- AP-HP, URC-Eco, Paris, France
| | | | - G. Hagmair
- IMEHPS.research, Vienna, Austria
- Department for Cultural Analysis, Universitaet Klagenfurt, Klagenfurt, Austria
| | - K. Wahlbeck
- Department of Mental Health, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - F. Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Abstract
SummaryMental health is crucial for public health and prosperity. Yet, mental health was first brought to the EU agenda only in late 1990s. To put mental health firmly on the political agenda, the focus was placed on the positive mental health at a population level. The European Pact for Mental Health and Wellbeing is the most recent mental health policy initiative of the European Commission. It aims at promotion of mental health and prevention of mental disorders, by putting emphasis on five priority areas: prevention of depression and suicide; youth and education; workplace settings; older people; and combating stigma and social exclusion. The Pact calls for co-operation between the EU Member States and the Commission, to identify best practices to tackle the problems in the priority areas and to develop recommendations and action plans. The Pact is currently being implemented by a series of conferences on the priority areas. The European Parliament called for a European Strategy on Mental Health in 2009, but it is unclear whether there is sufficient support for a strategy level document in the Member States and Commission. The implementation process is however expected to culminate in an overall reference framework for promoting mental capital during the Hungarian EU Presidency in 2011. Irrespective of the final outcome, the ongoing process has already increased awareness in Europe of the need for actions to promote mental health.
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15
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Sadeniemi M, Almeda N, Salinas-Pérez JA, Gutiérrez-Colosía MR, García-Alonso C, Ala-Nikkola T, Joffe G, Pirkola S, Wahlbeck K, Cid J, Salvador-Carulla L. A Comparison of Mental Health Care Systems in Northern and Southern Europe: A Service Mapping Study. Int J Environ Res Public Health 2018; 15:E1133. [PMID: 29857556 PMCID: PMC6024953 DOI: 10.3390/ijerph15061133] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/21/2018] [Accepted: 05/30/2018] [Indexed: 11/16/2022]
Abstract
Mental health services (MHS) have gone through vast changes during the last decades, shifting from hospital to community-based care. Developing the optimal balance and use of resources requires standard comparisons of mental health care systems across countries. This study aimed to compare the structure, personnel resource allocation, and the productivity of the MHS in two benchmark health districts in a Nordic welfare state and a southern European, family-centered country. The study is part of the REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care) project. The study areas were the Helsinki and Uusimaa region in Finland and the Girona region in Spain. The MHS were mapped by using the DESDE-LTC (Description and Evaluation of Services and Directories for Long Term Care) tool. There were 6.7 times more personnel resources in the MHS in Helsinki and Uusimaa than in Girona. The resource allocation was more residential-service-oriented in Helsinki and Uusimaa. The difference in mental health personnel resources is not explained by the respective differences in the need for MHS among the population. It is important to make a standard comparison of the MHS for supporting policymaking and to ensure equal access to care across European countries.
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Affiliation(s)
- Minna Sadeniemi
- Department of Social Services and Health Care, City of Helsinki, Southern Psychiatric Outpatient Clinic, Työpajankatu 14, FI-00099 Helsinki, Finland.
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (THL); Mannerheimintie 168, Helsinki FI-00270, Finland.
| | - Nerea Almeda
- PSICOST Research Association, Department of Psychology, Universidad Loyola Andalucía, C/Energía Solar 1, 41014 Sevilla, España.
| | - Jose A Salinas-Pérez
- PSICOST Research Association, Department of Quantitative Methods, Universidad Loyola Andalucía, C/Energía Solar 1, 41014 Sevilla, España.
| | - Mencía R Gutiérrez-Colosía
- PSICOST Research Association, Department of Psychology, Universidad Loyola Andalucía, C/Energía Solar 1, 41014 Sevilla, España.
| | - Carlos García-Alonso
- PSICOST Research Association, Department of Quantitative Methods, Universidad Loyola Andalucía, C/Energía Solar 1, 41014 Sevilla, España.
| | - Taina Ala-Nikkola
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (THL); Mannerheimintie 168, Helsinki FI-00270, Finland.
| | - Grigori Joffe
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
| | - Sami Pirkola
- University of Tampere School of Health Sciences, and Tampere University Hospital, Lääkärinkatu 1, Tampere FI-33014, Finland.
| | - Kristian Wahlbeck
- Unit for Mental Health, National Institute for Health and Welfare (THL); Mannerheimintie 168, Helsinki FI-00270, Finland.
| | - Jordi Cid
- Mental Health & Addiction Research Group, Institut d'Investigacions Biomèdiques de Girona (IdibGI)-Institut d'Assistència Sanitària, 17190 Salt Girona, Spain.
| | - Luis Salvador-Carulla
- VIDEA Lab, Centre for Mental Health Research, Australian National University, 63 Eggleston Rd, Acton ACT 2601, Australia.
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16
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Ala-Nikkola T, Pirkola S, Kaila M, Joffe G, Kontio R, Oranta O, Sadeniemi M, Wahlbeck K, Saarni SI. Identifying Local and Centralized Mental Health Services-The Development of a New Categorizing Variable. Int J Environ Res Public Health 2018; 15:ijerph15061131. [PMID: 29857540 PMCID: PMC6025394 DOI: 10.3390/ijerph15061131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/17/2018] [Accepted: 05/28/2018] [Indexed: 12/02/2022]
Abstract
The challenges of mental health and substance abuse services (MHS) require shifting of the balance of resources from institutional care to community care. In order to track progress, an instrument that can describe these attributes of MHS is needed. We created a coding variable in the European Service Mapping Schedule-Revised (ESMS-R) mapping tool using a modified Delphi panel that classified MHS into centralized, local services with gatekeeping and local services without gatekeeping. For feasibility and validity, we tested the variable on a dataset comprising MHS in Southern Finland, covering a population of 2.3 million people. There were differences in the characteristics of services between our study regions. In our data, 41% were classified as centralized, 37% as local without gatekeeping and 22% as local services with gatekeeping. The proportion of resources allocated to local services varied from 20% to 43%. Reclassifying ESMS-R is an easy way to compare the important local vs. centralized balance of MHS systems globally, where such data exists. Further international studies comparing systems and validating this approach are needed.
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Affiliation(s)
- Taina Ala-Nikkola
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.), Mannerheimintie 168, FI-00270 Helsinki, Finland.
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, FI-000014 Helsinki, Finland.
| | - Sami Pirkola
- University of Tampere School of Health Sciences and Tampere University Hospital, Lääkärinkatu 1, FI-33014 Tampere, Finland.
| | - Minna Kaila
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, FI-000014 Helsinki, Finland.
| | - Grigori Joffe
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
| | - Raija Kontio
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
- University of Turku, FI-20014 Turku, Finland.
- Lohja Hospital Area, Sairaalakatu 8, 08200 Lohja, Finland.
| | - Olli Oranta
- Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, FI-20520 Turku, Finland.
| | - Minna Sadeniemi
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.), Mannerheimintie 168, FI-00270 Helsinki, Finland.
- Department of Social Services and Health Care, City of Helsinki, FI-00099 Helsinki, Finland.
| | - Kristian Wahlbeck
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.), Mannerheimintie 168, FI-00270 Helsinki, Finland.
| | - Samuli I Saarni
- Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, FI-20520 Turku, Finland.
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18
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Stenius-Ayoade A, Haaramo P, Kautiainen H, Sunikka S, Gissler M, Wahlbeck K, Eriksson J. Morbidity and housing 10-years after shelter use, a study of homeless men in Helsinki, 2004-2010. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - P Haaramo
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - S Sunikka
- Kriminaalihuollon tukisäätiö, Helsinki, Finland
| | - M Gissler
- National Institute for Health and Welfare, Helsinki, Finland
| | - K Wahlbeck
- The Finnish Association for Mental Health, Helsinki, Finland
| | - J Eriksson
- National Institute for Health and Welfare, Helsinki, Finland
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19
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Hazo JB, Gandré C, Leboyer M, Obradors-Tarragó C, Belli S, McDaid D, Park AL, Maliandi MV, Wahlbeck K, Wykes T, van Os J, Haro JM, Chevreul K. National funding for mental health research in Finland, France, Spain and the United Kingdom. Eur Neuropsychopharmacol 2017. [PMID: 28647453 DOI: 10.1016/j.euroneuro.2017.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As part of the Roamer project, we aimed at revealing the share of health research budgets dedicated to mental health, as well as on the amounts allocated to such research for four European countries. Finland, France, Spain and the United Kingdom national public and non-profit funding allocated to mental health research in 2011 were investigated using, when possible, bottom-up approaches. Specifics of the data collection varied from country to country. The total amount of public and private not for profit mental health research funding for Finland, France, Spain and the UK was €10·2, €84·8, €16·8, and €127·6 million, respectively. Charities accounted for a quarter of the funding in the UK and less than six per cent elsewhere. The share of health research dedicated to mental health ranged from 4·0% in the UK to 9·7% in Finland. When compared to the DALY attributable to mental disorders, Spain, France, Finland, and the UK invested respectively €12·5, €31·2, €39·5, and €48·7 per DALY. Among these European countries, there is an important gap between the level of mental health research funding and the economic and epidemiologic burden of mental disorders.
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Affiliation(s)
- Jean-Baptiste Hazo
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France; AP-HP, URC-Eco, DHU Pepsy, F-75004 Paris, France; Foundation FondaMental, French National Science Foundation, Créteil, France.
| | - Coralie Gandré
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France; AP-HP, URC-Eco, DHU Pepsy, F-75004 Paris, France; Foundation FondaMental, French National Science Foundation, Créteil, France
| | - Marion Leboyer
- Foundation FondaMental, French National Science Foundation, Créteil, France; INSERM, U955, Psychiatry, Genetics, Translationnal Psychiatry, Créteil, France; AP-HP, H Mondor-A.Hospital, DHU PePSY, Chenevier, Psychiatry service, Créteil, France; Faculty of Medicine, Paris-Est-Créteil University (UPEC), Créteil, France
| | - Carla Obradors-Tarragó
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Stefano Belli
- School of Psychology, University of Lincoln, Lincoln, UK
| | - David McDaid
- PSSRU, London School of Economics and Political Science, London, UK
| | - A-La Park
- PSSRU, London School of Economics and Political Science, London, UK
| | - Maria Victoria Maliandi
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | | | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King׳s College London and South London and Maudsley NHS Foundation Trust, UK
| | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands; King׳s College London, King׳s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Universitat de Barcelona, Faculty of Medicine, Barcelona, Spain
| | - Karine Chevreul
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France; AP-HP, URC-Eco, DHU Pepsy, F-75004 Paris, France
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20
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Forsman AK, Nordmyr J, Matosevic T, Park AL, Wahlbeck K, McDaid D. Promoting mental wellbeing among older people: technology-based interventions. Health Promot Int 2017; 33:1042-1054. [DOI: 10.1093/heapro/dax047] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anna K Forsman
- Faculty of Education and Welfare Studies, Developmental Psychology, Åbo Akademi University, Vaasa, Finland
- Faculty of Education and Welfare Studies, Health Sciences, Åbo Akademi University, Vaasa, Finland
| | - Johanna Nordmyr
- Faculty of Education and Welfare Studies, Developmental Psychology, Åbo Akademi University, Vaasa, Finland
| | - Tihana Matosevic
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-La Park
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - David McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
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21
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Stenius-Ayoade A, Haaramo P, Kautiainen H, Gissler M, Wahlbeck K, Eriksson JG. Mortality and causes of death among homeless in Finland: a 10-year follow-up study. J Epidemiol Community Health 2017; 71:jech-2017-209166. [PMID: 28739837 DOI: 10.1136/jech-2017-209166] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/11/2017] [Accepted: 06/20/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Homelessness is associated with increased mortality, and some predictors of mortality have been previously identified. We examined the overall and cause-specific mortality among homeless men in Helsinki and the associations of social background and health service use with mortality. METHODS To assess cause-specific mortality in a competing risks framework, we performed a register-based, case-control study of 617 homeless men and an age-matched control group of 1240 men from the general population that were followed for 10 years between 2004 and 2014. Cox proportional hazards model was used to calculate HR for death and a competing risks model to calculate sub-HRs (sHR) for cause-specific death. RESULTS During the follow-up, 45.0% of the homeless died compared with 10.5% of controls (HR 5.38, 95% CI 4.39 to 6.59). The risk of death was particularly elevated for the homeless aged≤50 years (HR 10.3, 95% CI 7.0 to 15.2). External causes caused 34% of the deaths (sHR 11.2, 95% CI 6.8 to 18.2), but also deaths from medical causes were common (sHR 3.6, 95% CI 2.9 to 4.6). Age and somatic hospitalisation were significant predictors of death both among homeless and controls. Educational attainment, marital status, employment and psychiatric hospitalisation were significant predictors of mortality among the controls, but not among the homeless. CONCLUSIONS Homelessness is associated with a fivefold mortality compared with the controls, and especially homeless aged ≤50 years have an increased risk of death. Being homeless eliminates the protective effects of marriage, employment and education on mortality risk.
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Affiliation(s)
- Agnes Stenius-Ayoade
- Folkhälsan Research Center, Helsinki, Finland
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland
| | - Peija Haaramo
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- University of Eastern Finland, Kuopio, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | | | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
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22
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Sfetcu R, Musat S, Haaramo P, Ciutan M, Scintee G, Vladescu C, Wahlbeck K, Katschnig H. Overview of post-discharge predictors for psychiatric re-hospitalisations: a systematic review of the literature. BMC Psychiatry 2017; 17:227. [PMID: 28646857 PMCID: PMC5483311 DOI: 10.1186/s12888-017-1386-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND High levels of hospital readmission (rehospitalisation rates) is widely used as indicator of a poor quality of care. This is sometimes also referred to as recidivism or heavy utilization. Previous studies have examined a number of factors likely to influence readmission, although a systematic review of research on post-discharge factors and readmissions has not been conducted so far. The main objective of this review was to identify frequently reported post-discharge factors and their effects on readmission rates. METHODS Studies on the association between post-discharge variables and readmission after an index discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. Relevant articles published between January 1990 and June 2014 were included. A systematic approach was used to extract and organize in categories the information about post-discharge factors associated with readmission rates. RESULTS Of the 760 articles identified by the initial search, 80 were selected for this review which included a total number of 59 different predictors of psychiatric readmission. Subsequently these were grouped into four categories: 1) individual vulnerability factors, 2) aftercare related factors, 3) community care and service responsiveness, and 4) contextual factors and social support. Individual factors were addressed in 58 papers and were found to be significant in 37 of these, aftercare factors were significant in 30 out of the 45 papers, community care and social support factors were significant in 21 out of 31 papers addressing these while contextual factors and social support were significant in all seven papers which studied them. CONCLUSIONS This review represents a first attempt at providing an overview of post-discharge factors previously studied in association with readmission. Hence, by mapping out the current research in the area, it highlights the gaps in research and it provides guidance future studies in the area.
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Affiliation(s)
- R. Sfetcu
- National School of Public Health, Management and Professional Development, Bucharest, Romania ,grid.445726.6Psychology Department, Spiru Haret University, Bucharest, Romania
| | - S. Musat
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - P. Haaramo
- National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland
| | - M. Ciutan
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - G. Scintee
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - C. Vladescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania ,0000 0001 0504 4027grid.22248.3eVictor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - K. Wahlbeck
- National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland
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Stenius-Ayoade A, Haaramo P, Erkkilä E, Marola N, Nousiainen K, Wahlbeck K, Eriksson JG. Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland. BMC Health Serv Res 2017. [PMID: 28637455 PMCID: PMC5480200 DOI: 10.1186/s12913-017-2372-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Homelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland. Methods The study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs. Results During the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9–20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5–9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4–10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3–31.2) and SUDs (11.5, 95% CI 5.7–23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes. Conclusions Dual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary health care level emergency rooms are strongly associated with both dual diagnosis and SUDs. Active treatment for SUDs could reduce the amount of emergency visits made by homeless shelter users.
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Affiliation(s)
- Agnes Stenius-Ayoade
- Folkhälsan Research Center, Helsinki, Finland. .,National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland. .,Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland.
| | - Peija Haaramo
- National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland
| | - Elisabet Erkkilä
- Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland
| | - Niko Marola
- National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland
| | - Kirsi Nousiainen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | | | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland.,National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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Wahlbeck K, Cresswell-Smith J, Haaramo P, Parkkonen J. Interventions to mitigate the effects of poverty and inequality on mental health. Soc Psychiatry Psychiatr Epidemiol 2017; 52:505-514. [PMID: 28280872 DOI: 10.1007/s00127-017-1370-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To review psychosocial and policy interventions which mitigate the effects of poverty and inequality on mental health. METHODS Systematic reviews, controlled trials and realist evaluations of the last 10 years are reviewed, without age or geographical restrictions. RESULTS Effective psychosocial interventions on individual and family level, such as parenting support programmes, exist. The evidence for mental health impact of broader community-based interventions, e.g. community outreach workers, or service-based interventions, e.g. social prescribing and debt advice is scarce. Likewise, the availability of evidence for the mental health impact of policy level interventions, such as poverty alleviation or youth guarantee, is quite restricted. CONCLUSIONS The social, economic, and physical environments in which people live shape mental health and many common mental disorders. There are effective early interventions to promote mental health in vulnerable groups, but it is necessary to both initiate and facilitate a cross-sectoral approach, and to form partnerships between different government departments, civic society organisations and other stakeholders. This approach is referred to as Mental Health in All Policies and it can be applied to all public policy levels from local policies to supranational.
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Affiliation(s)
- Kristian Wahlbeck
- The Finnish Association for Mental Health, Maistraatinportti 4 A, 7th floor, 00240, Helsinki, Finland.
| | - Johanna Cresswell-Smith
- Mental Health Unit, National Institute for Health and Welfare (THL), PO Box 30, 00271, Helsinki, Finland
| | - Peija Haaramo
- Mental Health Unit, National Institute for Health and Welfare (THL), PO Box 30, 00271, Helsinki, Finland
| | - Johannes Parkkonen
- The Finnish Association for Mental Health, Maistraatinportti 4 A, 7th floor, 00240, Helsinki, Finland
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25
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Liu NH, Daumit GL, Dua T, Aquila R, Charlson F, Cuijpers P, Druss B, Dudek K, Freeman M, Fujii C, Gaebel W, Hegerl U, Levav I, Munk Laursen T, Ma H, Maj M, Elena Medina‐Mora M, Nordentoft M, Prabhakaran D, Pratt K, Prince M, Rangaswamy T, Shiers D, Susser E, Thornicroft G, Wahlbeck K, Fekadu Wassie A, Whiteford H, Saxena S. Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry 2017; 16:30-40. [PMID: 28127922 PMCID: PMC5269481 DOI: 10.1002/wps.20384] [Citation(s) in RCA: 399] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio-environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual-focused, health system-focused, and community level and policy-focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.
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Affiliation(s)
- Nancy H. Liu
- World Health OrganizationGenevaSwitzerland,University of CaliforniaBerkeleyCAUSA
| | | | - Tarun Dua
- World Health OrganizationGenevaSwitzerland
| | | | - Fiona Charlson
- Queensland Centre for Mental Health ResearchWacolQLDAustralia
| | - Pim Cuijpers
- Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | | | | | - Chiyo Fujii
- National Institute of Mental HealthTokyoJapan
| | | | | | | | | | - Hong Ma
- Institute of Mental HealthBeijingP.R. China
| | - Mario Maj
- Department of PsychiatryUniversity of Naples SUNNaplesItaly
| | | | | | | | | | - Martin Prince
- Institute of Psychiatry, King's College LondonLondonUK
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26
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Šprah L, Dernovšek MZ, Wahlbeck K, Haaramo P. Psychiatric readmissions and their association with physical comorbidity: a systematic literature review. BMC Psychiatry 2017; 17:2. [PMID: 28049441 PMCID: PMC5210297 DOI: 10.1186/s12888-016-1172-3] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/16/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Comorbidity between mental and physical disorder conditions is the rule rather than the exception. It is estimated that 25% of adult population have mental health condition and 68% of them suffer from comorbid medical condition. Readmission rates in psychiatric patients are high and we still lack understanding potential predictors of recidivism. Physical comorbidity could be one of important risk factors for psychiatric readmission. The aim of the present study was to review the impact of physical comorbidity variables on readmission after discharge from psychiatric or general inpatient care among patients with co-occurring psychiatric and medical conditions. METHODS A comprehensive database search from January 1990 to June 2014 was performed in the following bibliographic databases: Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. An integrative research review was conducted on 23 observational studies. RESULTS Six studies documented physical comorbidity variables only at admission/discharge and 17 also at readmission. The main body of studies supported the hypothesis that patients with mental disorders are at increased risk of readmission if they had co-occurring medical condition. The impact of physical comorbidity variables on psychiatric readmission was most frequently studied in in patients with affective and substance use disorders (SUD). Most common physical comorbidity variables with higher probability for psychiatric readmission were associated with certain category of psychiatric diagnoses. Chronic lung conditions, hepatitis C virus infection, hypertension and number of medical diagnoses were associated with increased risk of readmission in SUD; Charlson Comorbidity Index, somatic complaints, physical health problems with serious mental illnesses (schizophrenia, schizoaffective disorder, personality disorders); not specified medical illness, somatic complaints, number of medical diagnoses, hyperthyroidism with affective disorders (depression, bipolar disorder). Co-occurring physical and mental disorders can worsen patient's course of illness leading to hospital readmission also due to non-psychiatric reasons. CONCLUSIONS The association between physical comorbidity and psychiatric readmission is still poorly understood phenomenon. Nevertheless, that physical comorbid conditions are more common among readmitted patients than single admission patients, their association with readmission can vary according to the nature of mental disorders, characteristics of study population, applied concept of comorbidity, and study protocol.
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Affiliation(s)
- Lilijana Šprah
- Research Centre of the Slovenian Academy of Sciences and Arts, Sociomedical Institute, Novi trg 2, 1000 Ljubljana, Slovenia
| | - Mojca Zvezdana Dernovšek
- Research Centre of the Slovenian Academy of Sciences and Arts, Sociomedical Institute, Novi trg 2, 1000 Ljubljana, Slovenia
| | - Kristian Wahlbeck
- National Institute for Health and Welfare, Mental Health Unit, P.O. Box 30, 00271 Helsinki, Finland
| | - Peija Haaramo
- National Institute for Health and Welfare, Mental Health Unit, P.O. Box 30, 00271 Helsinki, Finland
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27
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Wahlbeck K, Hannukkala M, Parkkonen J, Valkonen J, Solantaus T. Promotion of mental health in the core of public health work. Duodecim 2017; 133:985-992. [PMID: 29239580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Positive trends achieved in health in Finland are not equally reflected mental health, hence mental health promotion deserves a central position. Mental health promotion refers to strengthening of psychological resources, and has been linked to increased well-being and life satisfaction. Health care has an important role in supporting a solid foundation of mental health and in preventing intergenerational transmission of problems. Mental health promotion requires strong involvement of non-health sectors. There are means for strengthening mental health skills also on the individual level. The gap between existing evidence on effectiveness and cost-effectiveness of mental health promotion and the lack of large scale implementation needs to addressed by future health and social policies.
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28
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Donisi V, Tedeschi F, Wahlbeck K, Haaramo P, Amaddeo F. Pre-discharge factors predicting readmissions of psychiatric patients: a systematic review of the literature. BMC Psychiatry 2016; 16:449. [PMID: 27986079 PMCID: PMC5162092 DOI: 10.1186/s12888-016-1114-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 11/05/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Readmission rate is considered an indicator of the mental health care quality. Previous studies have examined a number of factors that are likely to influence readmission. The main objective of this systematic review is to identify the studied pre-discharge variables and describe their relevance to readmission among psychiatric patients. METHODS Studies on the association between pre-discharge variables and readmission after discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management and OpenGrey. Relevant publications published between January 1990 and June 2014 were included. For each variable, the number of papers that considered it as a predictor of readmission and that found a significant association was recorded, together with the association direction and whether it was found respectively in bivariate and in multivariate analyses. RESULTS Of the 734 articles identified in the search, 58 papers were included in this review, mainly from the USA and concerning patients with severe mental disorders. Analysed variables were classified according to the following categories: patients' demographic, social and economic characteristics; patients' clinical characteristics; patients' clinical history; patients' attitude and perception; environmental, social and hospital characteristics; and admission and discharge characteristics. The most consistently significant predictor of readmission was previous hospitalisations. Many socio-demographic variables resulted as influencing readmission, but the results were not always homogeneous. Among other patients' clinical characteristics, diagnosis and measures of functional status were the most often used variables. Among admission characteristics, length of stay was the main factor studied; however, the results were not very consistent. Other relevant aspects resulted associated with readmission, including the presence of social support, but they have been considered only in few papers. Results of quality assessment are also reported in the review. The majority of papers were not representative of the general psychiatric population discharged from an inpatient service. Almost all studies used multivariate analytical methods, i.e., confounders were controlled for, but only around 60% adjusted for previous hospitalisation, the variable most consistently considered associated to readmission in the literature. CONCLUSIONS The results contribute to increase knowledge on pre-discharge factors that could be considered by researchers as well as by clinicians to predict and prevent readmissions of psychiatric patients. Associations are not always straightforward and interactions between factors have to be considered.
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Affiliation(s)
- V. Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - F. Tedeschi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - K. Wahlbeck
- National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland
| | - P. Haaramo
- National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland
| | - F. Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
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29
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Ala-Nikkola T, Pirkola S, Kaila M, Saarni SI, Joffe G, Kontio R, Oranta O, Sadeniemi M, Wahlbeck K. Regional Correlates of Psychiatric Inpatient Treatment. Int J Environ Res Public Health 2016; 13:ijerph13121204. [PMID: 27929403 PMCID: PMC5201345 DOI: 10.3390/ijerph13121204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/13/2016] [Accepted: 11/30/2016] [Indexed: 11/16/2022]
Abstract
Current reforms of mental health and substance abuse services (MHS) emphasize community-based care and the downsizing of psychiatric hospitals. Reductions in acute and semi-acute hospital beds are achieved through shortened stays or by avoiding hospitalization. Understanding the factors that drive the current inpatient treatment provision is essential. We investigated how the MHS service structure (diversity of services and balance of personnel resources) and indicators of service need (mental health index, education, single household, and alcohol sales) correlated with acute and semi-acute inpatient treatment provision. The European Service Mapping Schedule-Revised (ESMS-R) tool was used to classify the adult MHS structure in southern Finland (population 1.8 million, 18+ years). The diversity of MHS in terms of range of outpatient and day care services or the overall personnel resourcing in inpatient or outpatient services was not associated with the inpatient treatment provision. In the univariate analyses, sold alcohol was associated with the inpatient treatment provision, while in the multivariate modeling, only a general index for mental health needs was associated with greater hospitalization. In the dehospitalization process, direct resource re-allocation and substituting of inpatient treatment with outpatient care per se is likely insufficient, since inpatient treatment is linked to contextual factors in the population and the health care system. Mental health services reforms require both strategic planning of service system as a whole and detailed understanding of effects of societal components.
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Affiliation(s)
- Taina Ala-Nikkola
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.); Mannerheimintie 168, Helsinki FI-00270, Finland.
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, Helsinki FI-000014, Finland.
| | - Sami Pirkola
- University of Tampere School of Health Sciences, and Tampere University Hospital, Lääkärinkatu 1, Tampere FI-33014, Finland.
| | - Minna Kaila
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, Helsinki FI-000014, Finland.
| | - Samuli I Saarni
- Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, Turku FI-20520, Finland.
| | - Grigori Joffe
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
| | - Raija Kontio
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- University of Turku, Turku FI-20014, Finland.
| | - Olli Oranta
- Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, Turku FI-20520, Finland.
| | - Minna Sadeniemi
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.); Mannerheimintie 168, Helsinki FI-00270, Finland.
- Department of Social Services and Health Care, City of Helsinki, Helsinki FI-00099, Finland.
| | - Kristian Wahlbeck
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.); Mannerheimintie 168, Helsinki FI-00270, Finland.
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Urach C, Zauner G, Wahlbeck K, Haaramo P, Popper N. Statistical methods and modelling techniques for analysing hospital readmission of discharged psychiatric patients: a systematic literature review. BMC Psychiatry 2016; 16:413. [PMID: 27863514 PMCID: PMC5116202 DOI: 10.1186/s12888-016-1128-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 11/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric services have undergone profound changes over the last decades. CEPHOS-LINK is an EU-funded study project with the aim to compare readmission of patients discharged with psychiatric diagnoses using a registry-based observational record linkage study design and to analyse differences in the findings for five different countries. A range of different approaches is available for analysis of the available data. Although there are some studies that compare selected methods for evaluating questions on readmission, there are to our knowledge no published systematic literature reviews on commonly used methods and their comparison. This work shall therefore provide an overview of the methods in use, their evolution throughout history and new developments which can further improve the research quality in this area. METHODS Based on systematic literature reviews realized in the course of the CEPHOS-LINK study, this work is a systematic evaluation of mathematical (statistical and modelling) methods used in studies examining psychiatric readmission. The starting point were 502 papers, of which 407 were analysed in detail; Methods used were assigned to one of five categories with subcategories and analysed accordingly. Our particular interest next to survival analysis and regression models is modelling and simulation. RESULTS As population sizes and follow-up times in the included studies varied widely, a range of methods was applied. Studies with bigger sample sizes conducted survival and regression analysis more often than studies with fewer patients did. These latter relied more on classical statistical tests (e.g. t-tests and Student Newman Keuls). Statistical strategies were often insufficiently described, posing a major problem for the evaluation. Almost all cases failed to provide and explanation of the rationale behind using certain methods. CONCLUSION There is a discernible trend from classical parametric/nonparametric tests in older studies towards regression and survival analyses in more recent ones. Modelling and simulation were under-represented despite their high usability, as has been identified in other health applications and comparable research areas.
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Affiliation(s)
- Christoph Urach
- DWH Simulation Services, Neustiftgasse 57-59, 1070, Vienna, Austria. .,Institute of Analysis and Scientific Computing, Vienna University of Technology, Wiedner Hauptstraße 8 - 10, 1040, Vienna, Austria.
| | - Günther Zauner
- DWH Simulation Services, Neustiftgasse 57-59, 1070 Vienna, Austria
| | - Kristian Wahlbeck
- National Institute for Health and Welfare, Mental Health Unit, P.O. Box 30, 00271 Helsinki, Finland
| | - Peija Haaramo
- National Institute for Health and Welfare, Mental Health Unit, P.O. Box 30, 00271 Helsinki, Finland
| | - Niki Popper
- DWH Simulation Services, Neustiftgasse 57-59, 1070 Vienna, Austria ,Dexhelpp, Neustiftgasse 57-59, 1070 Vienna, Austria
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Kalseth J, Lassemo E, Wahlbeck K, Haaramo P, Magnussen J. Psychiatric readmissions and their association with environmental and health system characteristics: a systematic review of the literature. BMC Psychiatry 2016; 16:376. [PMID: 27821155 PMCID: PMC5100223 DOI: 10.1186/s12888-016-1099-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/30/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Psychiatric readmissions have been studied at length. However, knowledge about how environmental and health system characteristics affect readmission rates is scarce. This paper systemically reviews and discusses the impact of health and social systems as well as environmental characteristics for readmission after discharge from inpatient care for patients with a psychiatric diagnosis. METHODS Comprehensive literature searches were conducted in the electronic bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management and OpenGrey. In addition, Google Scholar was utilised. Relevant publications published between January 1990 and June 2014 were included. No restrictions regarding language or publication status were imposed. A qualitative synthesis of the included studies was performed. Variables describing system and environmental characteristics were grouped into three groups: those capturing regulation, financing system and governance; those capturing capacity, organisation and structure; and those capturing environmental variables. RESULTS Of the 734 unique articles identified in the original search, 35 were included in the study. There is a limited number of studies on psychiatric readmissions and their association with environmental and health system characteristics. Even though the review reveals an extensive list of characteristics studied, most characteristics appear in a very limited number of articles. The most frequently studied characteristics are related to location (local area, district/region/country). In most cases area differences were found, providing strong indication that the risk of readmission not only relates to patient characteristics but also to system and/or environmental factors that vary between areas. The literature also points in the direction of a negative association of institutional length of stay and community aftercare with readmission for psychiatric patients. CONCLUSION This review shows that analyses of system level variables are scarce. Furthermore they differ with respect to purpose, choice of system characteristics and the way these characteristics are measured. The lack of studies looking at the relationship between readmissions and provider payment models is striking. Without the link to provider payment models and other health system characteristics related to regulation, financing system and governance structure it becomes more difficult to draw policy implications from these analyses.
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Affiliation(s)
- Jorid Kalseth
- SINTEF Technology and Society, Health Research, P.O. Box 4760 Sluppen, NO-7465, Trondheim, Norway.
| | - Eva Lassemo
- SINTEF Technology and Society, Health Research, P.O. Box 4760 Sluppen, NO-7465 Trondheim, Norway
| | - Kristian Wahlbeck
- National Institute for Health and Welfare (THL), Mental Health Unit, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Peija Haaramo
- National Institute for Health and Welfare (THL), Mental Health Unit, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Jon Magnussen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Faculty of Medicine, P.O. Box 8905, MTFS, NO-7491 Trondheim, Norway
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Forsman AK, Nordmyr J, Park A, Matosevic T, McDaid D, Wahlbeck K. Technology-based interventions for mental health promotion in later life: An evidence review. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw172.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Haaramo P, Kalseth J, Marola N, Cresswell-Smith J, Wahlbeck K. System level factors as predictors of psychiatric rehospitalisation: A pilot study with Finnish data. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw170.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Ala-Nikkola T, Sadeniemi M, Kaila M, Saarni S, Kontio R, Pirkola S, Joffe G, Oranta O, Wahlbeck K. How size matters: exploring the association between quality of mental health services and catchment area size. BMC Psychiatry 2016; 16:289. [PMID: 27520368 PMCID: PMC4983042 DOI: 10.1186/s12888-016-0992-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/03/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The diversity of mental health and substance abuse services (MHS) available to service users is seen as an indicator of the quality of the service system. In most countries MHS are provided by a mix of public, private and third sector providers. In Finland, officially, the municipalities are responsible for organizing the services needed, but the real extent and roles of private and third sector service providers are not known. Our previous study showed that the catchment area population size was strongly associated with diversity of mental health services. It is not known whether this was due to some types of services or some provider types being more sensitive to the size effect than others. The aim of this study was to investigate the association between area population size and diversity of mental health services, i.e. which types of services and which service providers' contributions are sensitive to population size. METHODS To map and classify services, we used the ESMS-R. The diversity of services was defined as the count of main types of care. Providers were classified as public, private or third sectors. RESULTS The diversity of outpatient, residential and voluntary services correlated positively with catchment area population size. The strongest positive correlation between the size of population and services available was found in third sector activities followed by public providers, but no correlation was found for diversity of private services. The third sector and public corporations each provided 44 % of the service units. Third sector providers produced all self-help services and most of the day care services. Third sector and private companies provided a significant part (59 %) of the residential care service units. CONCLUSIONS Significant positive correlations were found between size of catchment area population and diversity of residential, outpatient and voluntary services, indicating that these services concentrate on areas with larger population bases. The third sector seems to significantly complement the public sector in providing different services. Thus the third sector be needs to be functionally integrated with other MHS services to achieve a diversified and integrated service system.
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Affiliation(s)
- Taina Ala-Nikkola
- University of Helsinki and Helsinki University Hospital, Psychiatry, Välskärinkatu 12, FI-00029, Helsinki, Finland. .,Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270, Helsinki, Finland.
| | - Minna Sadeniemi
- Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270 Helsinki, Finland ,Department of Social Services and Health Care, City of Helsinki, FI-00099 Helsinki, Finland ,Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, FI-00029 Helsinki, Finland
| | - Minna Kaila
- Department of Public Health, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-000014 Helsinki, Finland
| | - Samuli Saarni
- Turku University Central Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
| | - Raija Kontio
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, FI-00029 Helsinki, Finland
| | - Sami Pirkola
- University of Tampere and Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-33014 Tampere, Finland
| | - Grigori Joffe
- University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, FI-00029 Helsinki, Finland
| | - Olli Oranta
- Turku University Central Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
| | - Kristian Wahlbeck
- Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270 Helsinki, Finland
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Hemminki E, Merikukka M, Gissler M, Wahlbeck K, Savolainen J, Ristikari T, Aaltonen M. Antidepressant use and violent crimes among young people: a longitudinal examination of the Finnish 1987 birth cohort. J Epidemiol Community Health 2016; 71:12-18. [PMID: 27354489 DOI: 10.1136/jech-2016-207265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/04/2016] [Accepted: 06/05/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), has been questioned due to poor efficacy and safety. We examined whether young violent offenders were more likely antidepressant users prior to their first violent offence than other young persons. METHODS The study is a follow-up of children born in Finland in 1987 (n=59 120), linking national registers to each other using personal identity codes. Data on psychotropic drug use came from a register of reimbursed drugs and data on crimes from a register on court convictions (after the age of 14 years). Participants were followed until the age of 18 years, and for some analyses until the end of the follow-up (mean 21 years). To adjust for differences in background characteristics, regression analyses for antidepressant use were made, using the no-conviction group as the reference. RESULTS Proportions of young people convicted by the age of 18 years were: 5% of boys (1.7% for violent crimes) and 1% (0.5%) of girls. Antidepressant use (both overall and for SSRIs) prior to violent crime was more common among those convicted than among those without convictions. Among boys with repeated violent crimes, it was also more common than among boys with non-violent crimes. Adjustment for differences in background characteristics decreased the associations between antidepressant use and violent crime, but did not eliminate them. CONCLUSIONS The results add further evidence for caution in prescribing antidepressants among young persons. It also calls for a reanalysis of violence measures in the original trial data.
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Affiliation(s)
| | | | | | | | - Jukka Savolainen
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Mikko Aaltonen
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki Finland
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Brouwers EPM, Mathijssen J, Van Bortel T, Knifton L, Wahlbeck K, Van Audenhove C, Kadri N, Chang C, Goud BR, Ballester D, Tófoli LF, Bello R, Jorge-Monteiro MF, Zäske H, Milaćić I, Uçok A, Bonetto C, Lasalvia A, Thornicroft G, Van Weeghel J. Discrimination in the workplace, reported by people with major depressive disorder: a cross-sectional study in 35 countries. BMJ Open 2016; 6:e009961. [PMID: 26908523 PMCID: PMC4769412 DOI: 10.1136/bmjopen-2015-009961] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers' attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not). METHOD Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data. RESULTS Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment. CONCLUSIONS Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD.
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Affiliation(s)
- E P M Brouwers
- Department of Tranzo, Tilburg University, Tilburg, The Netherlands
| | - J Mathijssen
- Department of Tranzo, Tilburg University, Tilburg, The Netherlands
| | - T Van Bortel
- King's College London, Institute of Psychiatry, London, UK
| | - L Knifton
- Mental Health Foundation, Glasgow, UK
| | - K Wahlbeck
- National Institute for Health and Welfare, Vaasa, Finland
| | | | - N Kadri
- Ibn Rushd University Psychiatric Centre, Casablanca, Morocco
| | - Ch Chang
- Department of Psychiatry, Chi Mei Medical Centre, Tainan, Taiwan
| | - B R Goud
- St John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, India
| | - D Ballester
- Sistema de Saúde Mãe de Deus, Porto Alegre, Brazil
| | - L F Tófoli
- Universidade Federal do Ceara, Campus Sobral, Brazil
| | - R Bello
- Hospital Universitario de Caracas, Caracas, Venezuela
| | | | - H Zäske
- Heinrich-Heine Universitat Dusseldorf, Rheinische Kliniken Dusseldorf, Germany
| | - I Milaćić
- Faculty for Special Education and Rehabilitation, Belgrade, Serbia
| | - A Uçok
- Foundation of Psychiatry Clinic of Medical Faculty of Istanbul, Istanbul, Turkey
| | - C Bonetto
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - A Lasalvia
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
| | - G Thornicroft
- King's College London, Institute of Psychiatry, London, UK
| | - J Van Weeghel
- Department of Tranzo, Tilburg University, Tilburg, The Netherlands
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37
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Dom G, Samochowiec J, Evans-Lacko S, Wahlbeck K, Van Hal G, McDaid D. The Impact of the 2008 Economic Crisis on Substance Use Patterns in the Countries of the European Union. Int J Environ Res Public Health 2016; 13:ijerph13010122. [PMID: 26771628 PMCID: PMC4730513 DOI: 10.3390/ijerph13010122] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/29/2015] [Accepted: 01/04/2016] [Indexed: 11/16/2022]
Abstract
Background: From 2008 on, a severe economic crisis (EC) has characterized the European Union (E.U.). However, changes in substance use behavioral patterns as a result of the economic crisis in Europe, have been poorly reflected upon, and underlying mechanisms remain to be identified; Methods: In this review we explore and systematize the available data on the effect of the 2008 economic crisis on patterns of substance use and related disorders, within the E.U. countries; Results: The results show that effects of the recession need to be differentiated. A number of studies point to reductions in population’s overall substance use. In contrast, an increase in harmful use and negative effects is found within specific subgroups within the society. Risk factors include job-loss and long-term unemployment, and pre-existing vulnerabilities. Finally, our findings point to differences between types of substances in their response on economic crisis periods; Conclusions: the effects of the 2008 economic crisis on substance use patterns within countries of the European Union are two-sided. Next to a reduction in a population’s overall substance use, a number of vulnerable subgroups experience serious negative effects. These groups are in need of specific attention and support, given that there is a real risk that they will continue to suffer negative health effects long after the economic downfall has formally been ended.
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Affiliation(s)
- Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Antwerp 2640, Belgium.
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin 71-460, Poland.
| | - Sara Evans-Lacko
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, SE5 8AF, UK.
| | | | - Guido Van Hal
- Medical Sociology and Health Policy, Antwerp University, Antwerp 2640, Belgium.
| | - David McDaid
- Personal Social Services Research Unit, London School of Economics and Political Science, London WC2A 2AE, UK.
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38
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Lasalvia A, Van Bortel T, Bonetto C, Jayaram G, van Weeghel J, Zoppei S, Knifton L, Quinn N, Wahlbeck K, Cristofalo D, Lanfredi M, Sartorius N, Thornicroft G. Cross-national variations in reported discrimination among people treated for major depression worldwide: the ASPEN/INDIGO international study. Br J Psychiatry 2015; 207:507-14. [PMID: 26382952 DOI: 10.1192/bjp.bp.114.156992] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 01/15/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND No study has so far explored differences in discrimination reported by people with major depressive disorder (MDD) across countries and cultures. AIMS To (a) compare reported discrimination across different countries, and (b) explore the relative weight of individual and contextual factors in explaining levels of reported discrimination in people with MDD. METHOD Cross-sectional multisite international survey (34 countries worldwide) of 1082 people with MDD. Experienced and anticipated discrimination were assessed by the Discrimination and Stigma Scale (DISC). Countries were classified according to their rating on the Human Development Index (HDI). Multilevel negative binomial and Poisson models were used. RESULTS People living in 'very high HDI' countries reported higher discrimination than those in 'medium/low HDI' countries. Variation in reported discrimination across countries was only partially explained by individual-level variables. The contribution of country-level variables was significant for anticipated discrimination only. CONCLUSIONS Contextual factors play an important role in anticipated discrimination. Country-specific interventions should be implemented to prevent discrimination towards people with MDD.
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Affiliation(s)
- Antonio Lasalvia
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Tine Van Bortel
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Chiara Bonetto
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Geetha Jayaram
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Jaap van Weeghel
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Silvia Zoppei
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Lee Knifton
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Neil Quinn
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Kristian Wahlbeck
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Doriana Cristofalo
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Mariangela Lanfredi
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Norman Sartorius
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Graham Thornicroft
- Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK
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Wykes T, Haro JM, Belli SR, Obradors-Tarragó C, Arango C, Ayuso-Mateos JL, Bitter I, Brunn M, Chevreul K, Demotes-Mainard J, Elfeddali I, Evans-Lacko S, Fiorillo A, Forsman AK, Hazo JB, Kuepper R, Knappe S, Leboyer M, Lewis SW, Linszen D, Luciano M, Maj M, McDaid D, Miret M, Papp S, Park AL, Schumann G, Thornicroft G, van der Feltz-Cornelis C, van Os J, Wahlbeck K, Walker-Tilley T, Wittchen HU. Mental health research priorities for Europe. Lancet Psychiatry 2015; 2:1036-42. [PMID: 26404415 DOI: 10.1016/s2215-0366(15)00332-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 12/18/2022]
Abstract
Mental and brain disorders represent the greatest health burden to Europe-not only for directly affected individuals, but also for their caregivers and the wider society. They incur substantial economic costs through direct (and indirect) health-care and welfare spending, and via productivity losses, all of which substantially affect European development. Funding for research to mitigate these effects lags far behind the cost of mental and brain disorders to society. Here, we describe a comprehensive, coordinated mental health research agenda for Europe and worldwide. This agenda was based on systematic reviews of published work and consensus decision making by multidisciplinary scientific experts and affected stakeholders (more than 1000 in total): individuals with mental health problems and their families, health-care workers, policy makers, and funders. We generated six priorities that will, over the next 5-10 years, help to close the biggest gaps in mental health research in Europe, and in turn overcome the substantial challenges caused by mental disorders.
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Affiliation(s)
- Til Wykes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Stefano R Belli
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Carla Obradors-Tarragó
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Celso Arango
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - José Luis Ayuso-Mateos
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Matthias Brunn
- Fondation FondaMental, Créteil, France; URC Eco Ile-de-France (AP-HP), Paris, France
| | - Karine Chevreul
- Fondation FondaMental, Créteil, France; URC Eco Ile-de-France (AP-HP), Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM U955), and Department of Psychiatry, Henri Mondor Hospital, University Paris-Est-Créteil, Creteil, Paris, France
| | - Jacques Demotes-Mainard
- Institut National de la Santé et de la Recherche Médicale (INSERM U955), and Department of Psychiatry, Henri Mondor Hospital, University Paris-Est-Créteil, Creteil, Paris, France; ECRIN Coordination Office, Paris, France
| | - Iman Elfeddali
- Tilburg University, Tranzo Department, Tilburg, Netherlands; Department of Health Promotion, School of Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Sara Evans-Lacko
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Anna K Forsman
- The Nordic School of Public Health, Gothenburg, Sweden; National Institute for Health and Welfare, Vaasa, Finland
| | - Jean-Baptiste Hazo
- Fondation FondaMental, Créteil, France; URC Eco Ile-de-France (AP-HP), Paris, France
| | - Rebecca Kuepper
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Euron, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, and Center for Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France; Institut National de la Santé et de la Recherche Médicale (INSERM U955), and Department of Psychiatry, Henri Mondor Hospital, University Paris-Est-Créteil, Creteil, Paris, France
| | - Shôn W Lewis
- University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Donald Linszen
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Euron, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mario Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - David McDaid
- Personal Social Services Research Unit, LSE Health and Social Care, London School of Economics and Political Science, London, UK
| | - Marta Miret
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Szilvia Papp
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - A-La Park
- Personal Social Services Research Unit, LSE Health and Social Care, London School of Economics and Political Science, London, UK
| | - Gunter Schumann
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Euron, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Kristian Wahlbeck
- The Nordic School of Public Health, Gothenburg, Sweden; National Institute for Health and Welfare, Vaasa, Finland; Finnish Association for Mental Health, Helsinki, Finland
| | - Tom Walker-Tilley
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, and Center for Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
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Forsman AK, Fredén L, Lindqvist R, Wahlbeck K. Contribution of the Nordic School of Public Health to the public mental health research field: a selection of research initiatives, 2007-2014. Scand J Public Health 2015; 43:66-72. [PMID: 26311802 DOI: 10.1177/1403494814568599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The field of public mental health has been defined by an expert group convened by the Nordic School of Public Health (NHV) as encompassing the experience, occurrence, distribution and trajectories of positive mental health and mental health problems and their determinants; mental health promotion and prevention of mental disorders; as well as mental health system policies, governance and organization. The mental health priorities of the Nordic Council of Ministers in 2010 signalled a mutual Nordic exchange of knowledge in the following thematic areas: child and adolescent mental health; working life and mental health; mental health in older people; strengthening the role of primary care in mental health service provision; stronger involvement of users and carers; and reduction of use of coercion in psychiatric care. Efforts to realize these priorities included commissioning the Nordic Research Academy for Mental Health, an NHV-based network of research institutions with a common interest in mental health research across the Nordic countries, to develop, organize and follow-up projects on public mental health. The research initiatives included mental health policy analysis, register-based research and research focused on the users' perspective in a Nordic context, as well as EU-level research policy analysis. The public mental health research conducted at the NHV highlighted the complexity of mental health and emphasized that the broad determinants of mental health need to be increasingly addressed in both public health research and practice. For example, health promotion actions, improved access to health care, a healthy alcohol policy and prevention of suicides and violence are all needed to reduce the life expectancy gap - a red flag indicator of public health inequalities. By exchanging knowledge and best practice, the collaboration between the Nordic countries contributes to the welfare of the region. The expertise and traditions developed at the NHV are of significant importance in this work.
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Affiliation(s)
- Anna K Forsman
- Åbo Akademi University, Faculty of Education and Welfare Studies, Vaasa, Finland National Institute for Health and Welfare (THL), Vaasa, Finland
| | - Lars Fredén
- NU-Akademin Väst, University West, Trollhättan, Sweden
| | | | - Kristian Wahlbeck
- The Finnish Association for Mental Health, Helsinki, Finland National Institute for Health and Welfare, Helsinki, Finland
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Lahti M, Eriksson JG, Heinonen K, Kajantie E, Lahti J, Wahlbeck K, Tuovinen S, Pesonen AK, Mikkonen M, Osmond C, Barker DJP, Räikkönen K. Late preterm birth, post-term birth, and abnormal fetal growth as risk factors for severe mental disorders from early to late adulthood. Psychol Med 2015; 45:985-999. [PMID: 25191989 DOI: 10.1017/s0033291714001998] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Late preterm births constitute the majority of preterm births. However, most evidence suggesting that preterm birth predicts the risk of mental disorders comes from studies on earlier preterm births. We examined if late preterm birth predicts the risks of severe mental disorders from early to late adulthood. We also studied whether adulthood mental disorders are associated with post-term birth or with being born small (SGA) or large (LGA) for gestational age, which have been previously associated with psychopathology risk in younger ages. METHOD Of 12 597 Helsinki Birth Cohort Study participants, born 1934-1944, 664 were born late preterm, 1221 post-term, 287 SGA, and 301 LGA. The diagnoses of mental disorders were identified from national hospital discharge and cause of death registers from 1969 to 2010. In total, 1660 (13.2%) participants had severe mental disorders. RESULTS Individuals born late preterm did not differ from term-born individuals in their risk of any severe mental disorder. However, men born late preterm had a significantly increased risk of suicide. Post-term birth predicted significantly increased risks of any mental disorder in general and particularly of substance use and anxiety disorders. Individuals born SGA had significantly increased risks of any mental and substance use disorders. Women born LGA had an increased risk of psychotic disorders. CONCLUSIONS Although men born late preterm had an increased suicide risk, late preterm birth did not exert widespread effects on adult psychopathology. In contrast, the risks of severe mental disorders across adulthood were increased among individuals born SGA and individuals born post-term.
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Affiliation(s)
- M Lahti
- Institute of Behavioural Sciences, University of Helsinki,Finland
| | - J G Eriksson
- National Institute for Health and Welfare,Helsinki,Finland
| | - K Heinonen
- Institute of Behavioural Sciences, University of Helsinki,Finland
| | - E Kajantie
- National Institute for Health and Welfare,Helsinki,Finland
| | - J Lahti
- Institute of Behavioural Sciences, University of Helsinki,Finland
| | - K Wahlbeck
- National Institute for Health and Welfare,Helsinki,Finland
| | - S Tuovinen
- Institute of Behavioural Sciences, University of Helsinki,Finland
| | - A-K Pesonen
- Institute of Behavioural Sciences, University of Helsinki,Finland
| | - M Mikkonen
- National Institute for Health and Welfare,Helsinki,Finland
| | - C Osmond
- MRC Lifecourse Epidemiology Unit,University of Southampton,UK
| | | | - K Räikkönen
- Institute of Behavioural Sciences, University of Helsinki,Finland
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Westman J, Wahlbeck K, Laursen TM, Gissler M, Nordentoft M, Hällgren J, Arffman M, Ösby U. Mortality and life expectancy of people with alcohol use disorder in Denmark, Finland and Sweden. Acta Psychiatr Scand 2015; 131:297-306. [PMID: 25243359 PMCID: PMC4402015 DOI: 10.1111/acps.12330] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse mortality and life expectancy in people with alcohol use disorder in Denmark, Finland and Sweden. METHOD A population-based register study including all patients admitted to hospital diagnosed with alcohol use disorder (1,158,486 person-years) from 1987 to 2006 in Denmark, Finland and Sweden. RESULTS Life expectancy was 24-28 years shorter in people with alcohol use disorder than in the general population. From 1987 to 2006, the difference in life expectancy between patients with alcohol use disorder and the general population increased in men (Denmark, 1.8 years; Finland, 2.6 years; Sweden, 1.0 years); in women, the difference in life expectancy increased in Denmark (0.3 years) but decreased in Finland (-0.8 years) and Sweden (-1.8 years). People with alcohol use disorder had higher mortality from all causes of death (mortality rate ratio, 3.0-5.2), all diseases and medical conditions (2.3-4.8), and suicide (9.3-35.9). CONCLUSION People hospitalized with alcohol use disorder have an average life expectancy of 47-53 years (men) and 50-58 years (women) and die 24-28 years earlier than people in the general population.
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Affiliation(s)
- J Westman
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetStockholm, Sweden,Nordic Research Academy in Mental Health, Nordic School of Public HealthGothenburg, Sweden
| | - K Wahlbeck
- Nordic Research Academy in Mental Health, Nordic School of Public HealthGothenburg, Sweden,THL National Institute for Health and WelfareHelsinki, Finland
| | - T M Laursen
- National Centre for Register-Based Research, Aarhus UniversityAarhus, Denmark
| | - M Gissler
- Nordic Research Academy in Mental Health, Nordic School of Public HealthGothenburg, Sweden,THL National Institute for Health and WelfareHelsinki, Finland
| | - M Nordentoft
- Mental Health Centre Copenhagen, University of Copenhagen, Faculty of Health SciencesCopenhagen, Denmark
| | - J Hällgren
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetStockholm, Sweden
| | - M Arffman
- THL National Institute for Health and WelfareHelsinki, Finland
| | - U Ösby
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska InstitutetStockholm, Sweden,Center for Molecular Medicine, Karolinska InstitutetStockholm, Sweden
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Forsman AK, Wahlbeck K, Aaro LE, Alonso J, Barry MM, Brunn M, Cardoso G, Cattan M, de Girolamo G, Eberhard-Gran M, Evans-Lacko S, Fiorillo A, Hansson L, Haro JM, Hazo JB, Hegerl U, Katschnig H, Knappe S, Luciano M, Miret M, Nordentoft M, Obradors-Tarrago C, Pilgrim D, Ruud T, Salize HJ, Stewart-Brown SL, Tomasson K, van der Feltz-Cornelis CM, Ventus DBJ, Vuori J, Varnik A. Research priorities for public mental health in Europe: recommendations of the ROAMER project. Eur J Public Health 2015; 25:249-54. [DOI: 10.1093/eurpub/cku232] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Abstract
Public mental health deals with mental health promotion, prevention of mental disorders and suicide, reducing mental health inequalities, and governance and organization of mental health service provision. The full impact of mental health is largely unrecognized within the public health sphere, despite the increasing burden of disease attributable to mental and behavioral disorders. Modern public mental health policies aim at improving psychosocial health by addressing determinants of mental health in all public policy areas. Stigmatization of mental disorders is a widespread phenomenon that constitutes a barrier for help-seeking and for the development of health care services, and is thus a core issue in public mental health actions. Lately, there has been heightened interest in the promotion of positive mental health and wellbeing. Effective programmes have been developed for promoting mental health in everyday settings such as families, schools and workplaces. New evidence indicates that many mental disorders and suicides are preventable by public mental health interventions. Available evidence favours the population approach over high-risk approaches. Public mental health emphasizes the role of primary care in the provision of mental health services to the population. The convincing evidence base for population-based mental health interventions asks for actions for putting evidence into practice.
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Ponteva M, Henriksson M, Isoaho R, Laukkala T, Punamäki L, Wahlbeck K. [Update on Current Care Guidelines: Post-traumatic Stress Disorder]. Duodecim 2015; 131:558-559. [PMID: 26237898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The updated Current Care Guidelines for ASD and PTSD recommend psychosocial support and careful monitoring for acute stress reaction (ASR) and acute stress disorder (ASD). If symptoms require, short focused cognitive-behavioral psychotherapy can be used for ASD. Medication is rarely necessary. Trauma-focused psychotherapeutic interventions are the first-line treatment for post-traumatic stress disorder (PTSD). Antidepressant medication is an effective second-line treatment. Psychotherapeutic interventions and medication should often be combined. Specific groups, such as children, the elderly, and military and peacekeeping personnel need tailored interventions.
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Lahti M, Eriksson JG, Heinonen K, Kajantie E, Lahti J, Wahlbeck K, Tuovinen S, Pesonen AK, Mikkonen M, Osmond C, Räikkönen K. Maternal Grand Multiparity and the Risk of Severe Mental Disorders in Adult Offspring. PLoS One 2014; 9:e114679. [PMID: 25493431 PMCID: PMC4262418 DOI: 10.1371/journal.pone.0114679] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/12/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Previous studies have shown that maternal grand multiparity may predict an increased risk of mental disorders in young adult offspring, but whether such effects persist throughout adulthood remains unknown. The current study examined if maternal grand multiparity predicts the risks of severe mental disorders, suicides, suicide attempts and dementias throughout adult life. METHODS Our study sample comprised 13243 Helsinki Birth Cohort Study 1934-1944 participants (6905 men and 6338 women). According to hospital birth records, 341 offspring were born to grand multiparous mothers. From Finnish national hospital discharge and causes of death registers, we identified 1682 participants diagnosed with mental disorders during 1969-2010. RESULTS Maternal grand multiparity predicted significantly increased risks of mood disorders (Hazard Ratio = 1.64, p = 0.03), non-psychotic mood disorders (Hazard Ratio = 2.02, p = 0.002), and suicide attempts (Hazard Ratio = 3.94, p = 0.01) in adult offspring. Furthermore, women born to grand multiparous mothers had significantly increased risks of any severe mental disorder (Hazard Ratio = 1.79, p = 0.01), non-psychotic substance use disorders (Hazard Ratio = 2.77, p = 0.02) schizophrenia, schizotypal and delusional disorders (Hazard Ratio = 2.40, p = 0.02), mood disorders (Hazard Ratio = 2.40, p = 0.002), non-psychotic mood disorders (Hazard Ratio = 2.91, p<0.001), and suicide attempts (Hazard Ratio = 5.05, p = 0.01) in adulthood. The effects of maternal grand multiparity on offspring psychopathology risk were independent of maternal age and body mass index at childbirth, and of year of birth, sex, childhood socioeconomic position, and birth weight of the offspring. In contrast, no significant effects were found among men. CONCLUSIONS Women born to grand multiparous mothers are at an increased risk of severe mental disorders and suicide attempts across adulthood. Our findings may inform the development of preventive interventions for mental disorders.
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Affiliation(s)
- Marius Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Johan G. Eriksson
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
- Vaasa Central Hospital, Vaasa, Finland
- Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Kati Heinonen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland
- Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynaecology, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jari Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Kristian Wahlbeck
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland
- The Finnish Association for Mental Health, Helsinki, Finland
| | - Soile Tuovinen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | | | - Maiju Mikkonen
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Katri Räikkönen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
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Österman K, Björkqvist K, Wahlbeck K. Twenty-eight years after the complete ban on the physical punishment of children in Finland: trends and psychosocial concomitants. Aggress Behav 2014; 40:568-81. [PMID: 24810710 DOI: 10.1002/ab.21537] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 02/24/2014] [Indexed: 12/17/2022]
Abstract
In 1983 Finland became the second country in the world, after Sweden, to adopt a law prohibiting all kinds of physical punishment towards children, also by parents. The present investigation was carried out in 2011, 28 years after the law was adopted. Changes in exposure to various types of physical punishment towards respondents born between 1931 and 1996 are presented. A representative sample from Western Finland, consisting of 4,609 respondents (2,632 females, 1,977 males) between 15 and 80 years, filled in a paper-and-pencil questionnaire. A number of psychosocial concomitants were measured. The results showed a significant drop in reports of being slapped and beaten with an object among respondents who were born after the law was adopted. The decline in physical punishment was associated with a similar decline in the number of murdered children. Respondents who had been exposed to higher amounts of physical punishment than average scored significantly higher on alcohol abuse, depression, mental health problems, and schizotypal personality. Divorced respondents had been significantly more physically punished than others. Respondents who had attempted suicide during the last 12 months had been exposed to physical punishment during childhood significantly more often than those who had not attempted suicide.
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Affiliation(s)
- Karin Österman
- Department of Social Sciences; Åbo Akademi University; Vasa Finland
| | - Kaj Björkqvist
- Department of Social Sciences; Åbo Akademi University; Vasa Finland
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Zoppei S, Lasalvia A, Bonetto C, Van Bortel T, Nyqvist F, Webber M, Aromaa E, Van Weeghel J, Lanfredi M, Harangozó J, Wahlbeck K, Thornicroft G. Social capital and reported discrimination among people with depression in 15 European countries. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1589-98. [PMID: 24638892 DOI: 10.1007/s00127-014-0856-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/27/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Social capital is a protective factor for mental health. People with depression are vulnerable to discrimination and its damaging impact. No previous studies have explored the link between social capital and experienced or anticipated discrimination in people with depression. This study aims to test the hypothesis that levels of self-reported discrimination in people with depression are inversely associated with social capital levels. METHOD A total of 434 people with major depression recruited in outpatient settings across 15 European countries participated in the study. Multivariable regression was used to analyse relationships between discrimination and interpersonal and institutional trust, social support and social network. RESULTS Significant inverse association was found between discrimination and social capital in people with major depression. Specifically, people with higher levels of social capital were less likely to have elevated or substantially elevated levels of experienced discrimination. CONCLUSIONS Higher level of social capital may be closely associated with lower level of experienced discrimination among patients with major depression. It is important to explore these associations more deeply and to establish possible directions of causality in order to identify interventions that may promote social capital and reduce discrimination. This may permit greater integration in society and more access to important life opportunities for people with depression.
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Affiliation(s)
- Silvia Zoppei
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico "G.B. Rossi", P.le Scuro, 10, 37134, Verona, Italy,
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Mäkelä P, Raitasalo K, Wahlbeck K. Mental health and alcohol use: a cross-sectional study of the Finnish general population. Eur J Public Health 2014; 25:225-31. [PMID: 25192709 DOI: 10.1093/eurpub/cku133] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The connections between alcohol use, mental health problems and mental well-being have been under-researched. We examined the links between different aspects of alcohol use and positive and negative aspects of mental health, and the effect of protective social factors on these links. METHODS A cross-sectional general population survey of Finns aged 15-69 years was carried out in 2008 (n = 2725, response rate 74%). The included aspects of alcohol use were the frequency and volume of drinking, binge drinking and hazardous drinking using Alcohol Use Disorders Identification Test (AUDIT). The included aspects of mental health were subjective well-being (life satisfaction), self-efficacy (sense of mastery) and psychological distress using the General Health Questionnaire. The protective social factors examined were social support (loneliness, having a confidant) and socioeconomic status. RESULTS Binge drinking and, particularly, hazardous drinking were associated with different aspects of mental health. The proportion of respondents with poor mental well-being increased when binge drinking was more frequent than monthly, and when respondents scored ≥6 on the AUDIT scale. Abstainers reported poor sense of mastery and former drinkers additionally reported poor satisfaction with life. Frequency and volume of drinking did not have a consistent connection with mental health. These associations between alcohol use and mental health did not depend on the protective social factors. CONCLUSIONS Frequent binge drinking and alcohol problems are associated with poor mental health, especially with a lack of life satisfaction and psychological distress. This result applies equally to lower and higher social status groups.
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Affiliation(s)
- Pia Mäkelä
- 1 National Institute for Health and Welfare THL, Department of Alcohol, Drugs and Addiction, Helsinki, Finland
| | - Kirsimarja Raitasalo
- 1 National Institute for Health and Welfare THL, Department of Alcohol, Drugs and Addiction, Helsinki, Finland
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van der Feltz-Cornelis CM, van Os J, Knappe S, Schumann G, Vieta E, Wittchen HU, Lewis SW, Elfeddali I, Wahlbeck K, Linszen D, Obradors-Tarragó C, Haro JM. Towards Horizon 2020: challenges and advances for clinical mental health research - outcome of an expert survey. Neuropsychiatr Dis Treat 2014; 10:1057-68. [PMID: 25061300 PMCID: PMC4085314 DOI: 10.2147/ndt.s59958] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The size and increasing burden of disease due to mental disorders in Europe poses substantial challenges to its population and to the health policy of the European Union. This warrants a specific research agenda concerning clinical mental health research as one of the cornerstones of sustainable mental health research and health policy in Europe. The aim of this research was to identify the top priorities needed to address the main challenges in clinical research for mental disorders. METHODS The research was conducted as an expert survey and expert panel discussion during a scientific workshop. RESULTS Eighty-nine experts in clinical research and representing most European countries participated in this survey. Identified top priorities were the need for new intervention studies, understanding the diagnostic and therapeutic implications of mechanisms of disease, and research in the field of somatic-psychiatric comorbidity. The "subjectivity gap" between basic neuroscience research and clinical reality for patients with mental disorders is considered the main challenge in psychiatric research, suggesting that a shift in research paradigms is required. CONCLUSION Innovations in clinical mental health research should bridge the gap between mechanisms underlying novel therapeutic interventions and the patient experience of mental disorder and, if present, somatic comorbidity. Clinical mental health research is relatively underfunded and should receive specific attention in Horizon 2020 funding programs.
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Affiliation(s)
- Christina M van der Feltz-Cornelis
- Trimbos Instituut, Utrecht, the Netherlands
- Tilburg University, Tranzo Department, Tilburg, the Netherlands
- GGz Breburg, Tilburg, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Euron, Maastricht University Medical Center, Maastricht, the Netherlands
- Institute of Psychiatry, King’s College London, London, UK
| | - Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy and Center for Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | | | - Eduard Vieta
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy and Center for Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Shôn W Lewis
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Iman Elfeddali
- Tilburg University, Tranzo Department, Tilburg, the Netherlands
- Department of Health Promotion/School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Kristian Wahlbeck
- The Nordic School of Public Health, Gothenburg, Sweden
- National Institute for Health and Welfare, Helsinki, Finland
| | - Donald Linszen
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Euron, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Carla Obradors-Tarragó
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Universitat de Barcelona, Barcelona, Spain
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