Iron deficiency, cognition, mental health and fatigue in women of childbearing age: a systematic review

It is known that Fe deficiency has a negative impact on cognitive function in children by altering brain energy metabolism and neurotransmitter function. It is unclear whether Fe deficiency has detrimental effects on cognition, mental health and fatigue in women of childbearing age. Our aim was to systematically review the literature to determine whether Fe deficiency in women of childbearing age affects cognition, mental health and fatigue, and whether a change in Fe status results in improvements in cognition, mental health and fatigue. Studies using Fe supplement interventions were reviewed to examine the effect of Fe deficiency in women of childbearing age (13–45 years) on their cognition, mental health and fatigue. English-language articles ranging from the earliest record to the year 2011 were sourced. The quality of retrieved articles was assessed and the Fe pathology, cognitive, mental health and fatigue data were extracted. Means and standard deviations from cognitive test data were included in meta-analyses of combined effects. Of the 1348 studies identified, ten were included in the review. Three studies showed poorer cognition and mental health scores and increased fatigue with Fe deficiency at baseline. Seven studies reported an improvement in cognitive test scores after Fe treatment. Results of three of these studies were included in meta-analyses of the effect of Fe supplement intervention on cognition. The results of the meta-analyses showed a significant improvement in Arithmetic scores after treatment (P < 0·01), but no effect on Digit Symbol, Digit Span or Block Design. While an improvement in cognition after Fe treatment was seen in seven out of ten studies, the evidence base is limited by poor study quality and heterogeneity across studies. Additional high-quality studies using consistent measures are warranted.

Physician health programmes and malpractice claims: reducing risk through monitoring

BACKGROUND

Physician health programmes (PHPs) are peer-assistance organizations that provide support to physicians struggling with addiction or with physical or mental health challenges. While the services they offer are setting new standards for recovery and care, they are not immune to public debate and criticism since some have concerns about those who are enrolled in, or have completed, such programmes and their subsequent ability to practice medicine safely.

AIMS

To examine whether medical malpractice claims were associated with monitoring by a PHP using a retrospective examination of administrative data.

METHODS

Data on PHP clients who were insured by the largest malpractice carrier in the state were examined. First, a business-model analysis of malpractice risk examined relative risk ratings between programme clients and a matched physician cohort. Second, Wilcoxon analysis examined differences in annual rates of pre- and post-monitoring claims for PHP clients only.

RESULTS

Data on 818 clients was available for analysis. After monitoring, those enrolled in the programme showed a 20% lower malpractice risk than the matched cohort. Furthermore physicians' annual rate of claims were significantly lower after programme monitoring among PHP clients (P < 0.01).

CONCLUSIONS

This is the only study examining this issue to date. While there are a variety of reasons why physicians present to PHPs, this study demonstrates that treatment and monitoring is associated with a lowered risk of malpractice claims and suggests that patient care may be improved by PHP monitoring.

Psychosocial aspects of child and adolescent obesity

In addition to counselling families about regular physical activity and healthy nutrition, clinicians need to identify and help them to address the psychosocial factors that may be contributing to their child's or adolescent's obesity. Affected individuals may suffer from depression, low self-esteem, bullying, and weight bias, experiences that can make achieving desired health outcomes more difficult. Clinicians should try to identify these underlying stressors and ensure that appropriate counselling is implemented.

Intersection of Stress, Social Disadvantage, and Life Course Processes: Reframing Trauma and Mental Health

This paper describes the intersection of converging lines of research on the social structural, psychosocial, and physiological factors involved in the production of stress and implications for the field of mental health. Of particular interest are the stress sensitization consequences stemming from exposure to adversity over the life course. Contemporary stress sensitization theory provides important clinical utility in articulating mechanisms through which these multiple levels exert influence on mental health. Stress sensitization models (a) extend understanding of neurobiological and functional contexts within which extreme stressors operate and (b) make clear how these can influence psychologically traumatic outcomes. The value of interventions that are sensitive to current contexts as well as life course profiles of cumulative stress are illustrated through recent treatment innovations.

Conceptual foundation for measures of physical function and behavioral health function for Social Security work disability evaluation

Physical and mental impairments represent the 2 largest health condition categories for which workers receive Social Security disability benefits. Comprehensive assessment of physical and mental impairments should include aspects beyond medical conditions such as a person's underlying capabilities as well as activity demands relevant to the context of work. The objective of this article is to describe the initial conceptual stages of developing new measurement instruments of behavioral health and physical functioning relevant for Social Security work disability evaluation purposes. To outline a clear conceptualization of the constructs to be measured, 2 content models were developed using structured and informal qualitative approaches. We performed a structured literature review focusing on work disability and incorporating aspects of the International Classification of Functioning, Disability and Health as a unifying taxonomy for framework development. Expert interviews provided advice and consultation to enhance face validity of the resulting content models. The content model for work-related behavioral health function identifies 5 major domains: (1) behavior control, (2) basic interactions, (3) temperament and personality, (4) adaptability, and (5) workplace behaviors. The content model describing physical functioning includes 3 domains: (1) changing and maintaining body position, (2) whole-body mobility, and (3) carrying, moving, and handling objects. These content models informed subsequent measurement properties including item development and measurement scale construction, and provided conceptual coherence guiding future empirical inquiry. The proposed measurement approaches show promise to comprehensively and systematically assess physical and behavioral health functioning relevant to work.

Development of an instrument to measure behavioral health function for work disability: item pool construction and factor analysis

OBJECTIVES

To develop a broad set of claimant-reported items to assess behavioral health functioning relevant to the Social Security disability determination processes, and to evaluate the underlying structure of behavioral health functioning for use in development of a new functional assessment instrument.

DESIGN

Cross-sectional.

SETTING

Community.

PARTICIPANTS

Item pools of behavioral health functioning were developed, refined, and field tested in a sample of persons applying for Social Security disability benefits (N=1015) who reported difficulties working because of mental or both mental and physical conditions.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

Social Security Administration Behavioral Health (SSA-BH) measurement instrument.

RESULTS

Confirmatory factor analysis (CFA) specified that a 4-factor model (self-efficacy, mood and emotions, behavioral control, social interactions) had the optimal fit with the data and was also consistent with our hypothesized conceptual framework for characterizing behavioral health functioning. When the items within each of the 4 scales were tested in CFA, the fit statistics indicated adequate support for characterizing behavioral health as a unidimensional construct along these 4 distinct scales of function.

CONCLUSIONS

This work represents a significant advance both conceptually and psychometrically in assessment methodologies for work-related behavioral health. The measurement of behavioral health functioning relevant to the context of work requires the assessment of multiple dimensions of behavioral health functioning. Specifically, we identified a 4-factor model solution that represented key domains of work-related behavioral health functioning. These results guided the development and scale formation of a new SSA-BH instrument.

Testing of a prototype Web based intervention for adolescent mothers on postpartum depression

PURPOSE

This article describes testing of a prototype Web site for adolescent mothers with postpartum depression; providing proof of concept.

METHODS

Participants (N=138) were recruited from a public school-based program for adolescent parents and completed the Mental Health Acceptability Scale, Stigma Scale for Receiving Psychological Help, and Attitudes Towards Seeking Professional Psychological Help Scale before, and after, the Web site intervention. They also provided feedback on the usability of the Web site.

RESULTS

Attitudes related to depression and treatment (ATSPPH) improved after viewing the Web site (p=.023). Feedback on the Web site indicated that it was easy to use (77%), reflecting highly acceptable score for product usability.

CONCLUSIONS

The data provide the foundation for the launch of the Web site from prototype to product and more comprehensive testing. The creation and testing of informational text messages will be added to the Web site to increase the interactivity and dose of the intervention.

The Correlation Between Psychiatric Disorders and Women's Lives

OBJECTIVE

Psychiatric disorders are important factors which affect the quality of life: employment rates, interpersonal and intrafamilial communications, marriage, child-bearing, parental skills and many other social - cognitive areas in different ways. Psychiatric disorders like schizophrenia, bipolar affective disorder and depressive disorder have a negative impact on women's lives. This study has compared the relationship between these mental illnesses and the liabilities of women's lives.

METHODS

For the purpose of this study, 61 schizophrenics, 35 bipolar and 40 unipolar female patients and 60 healthy controls from a university hospital of eastern Turkey were evaluated with SCID- I, a family environmental scale and a personal information questionnaire.

RESULTS

The women with psychiatric disorders had higher rates of unemployment, shorter durations of marriage and lower numbers of parity, as compared to their healthy counterparts, especially after the onset of their illnesses. The schizophrenia and bipolar groups are at risk due to the psychotropic medications which they take during pregnancy. The onset or the exacerbations of illnesses during the postpartum period are also seen more in the schizophrenia and the bipolar groups. However, the patients did not use medicines more than the healthy controls during lactation. The schizophrenia and bipolar groups seem to be failing in using reliable methods of contraception. This data is important due to the traditional and the socio-economical structure of eastern Turkey, which may interrelate with the results.

CONCLUSION

Women have to play various roles in life and they have various challenges which are related to these roles. The female psychiatric patients should be evaluated in the special perspective of 'being women', along with other clinical parameters. The evaluation of the social, cultural and the economic aspects and the collaborative teams of different clinical disciplines which are related to women's mental health would be beneficial.

The current state of mental health services in Canada's paediatric emergency departments

OBJECTIVE

To describe emergency mental health services in major paediatric centres across Canada.

METHODS

A cross-sectional study of mental health services in emergency departments (EDs) from all 15 Canadian tertiary care paediatric centres was conducted.

RESULTS

Fifteen individuals participated and were either a paediatric emergency physician with administrative responsibilities (60%) or an emergency mental health care provider (40%). Four participants reported that their ED used an evidence-based guideline, tool or policy, and one participant reported their ED based its services on published research evidence. Reported ED-based mental health resources included a crisis intervention team (five EDs), a mental health nurse (six EDs) and a social worker (five EDs). Thirteen participants reported on-site consultation with child psychiatry and six reported urgent follow-up as an adjunct service to ED care.

CONCLUSIONS

There is a wide variety of mental health care practices in Canadian paediatric EDs. Consideration of which resources are required to ensure evidence-based, effective services are provided to children and youth is necessary.

Vitamin D and common mental disorders in mid-life: cross-sectional and prospective findings

BACKGROUND & AIMS

The relationship between vitamin D and common mental disorders (CMDs) remains unclear. We aimed to determine if behaviours affecting vitamin D concentrations differ between individuals with or without CMDs and evaluate, cross-sectionally and prospectively, the extent to which the association between 25(OH)D and CMDs are explained by these behaviours.

METHODS

Data are from the 1958 British birth cohort (n = 7401). Behaviours were ascertained by questionnaire at age 45 years. CMDs (depression, anxiety, panic, phobia) were assessed using the Clinical Interview Schedule-Revised at 45 years and depression using Mental Health Inventory-5 at 50 years.

RESULTS

Participants with CMDs at 45 years differed from others on some but not all vitamin D related behaviours. There were inverse, cross-sectional associations at 45 years of 25(OH)D with depression and panic, which persisted after adjustment for vitamin D related behaviours (OR = 0.57, 95% CI: 0.40,0.81 and OR = 0.33, 95% CI: 0.40,0.81, respectively). Association between 25(OH)D and subsequent (50 years) risk of depression was non-linear (p = 0.01), with lower risk for participants with 25(OH)D between 50 and 85 nmol/l compared with those with lower or higher concentrations.

CONCLUSION

This study provides support for an association of low 25(OH)D concentrations with current and subsequent risk of depression in mid-adulthood.

Comparing the effects of methadone maintenance treatment, therapeutic community, and residential rehabilitation on quality of life and mental health of drug addicts

BACKGROUND

This study compared the effects of three drug addiction treatment methods on quality of life and mental health of drug addicts.

METHODS

In this study, 227 Iranian male drug addicts were selected from Mazandaran Province (northern Iran). They were randomized to be treated with methadone maintenance treatment, therapeutic community, or residential rehabilitation. The Short Form Health Survey (SF-36) and the General Health Questionnaire (GHQ) were completed by the subjects at the start and end of the study. The length of intervention and SF-36 and GHQ scores before and after treatment were compared between groups. All statistical analyses were performed in SPSS.

FINDINGS

Significant differences in quality of life and mental health scores were found between the three groups. We found that if drug addicts stay in the therapeutic community center for more than 6 months, this method will be the most effective intervention to improve quality of life and mental health of drug abusers.

CONCLUSION

Evaluation of different methods drug addiction treatment is very difficult. Therefore, further studies are required to better understand the effects of therapeutic community.

What to do to promote mental health of the society

BACKGROUND

According to the last existing documents, the prevalence rate of mental disorders is about 20% which is considered to be 14% of all country's burden of disease. In the fifth economical, social, and cultural development plan of the country in accordance with the 20 year vision, "healthy human being" and "comprehensive health" approaches and also improving of mental health indicators are emphasized. Aim of study was preparing national policy and interventions for promoting mental health.

METHODS

Using secondary data, analytical review of country's mental health programs, recommendations of WHO, descriptive situation of mental health and its trend during the last decade were drafted and a group of experts and stakeholders was formed following a sound stakeholder's analysis. After three Focus Group Discussions (FGDs), main points of the meetings, influencing factors of present situation, and oncoming strategies were agreed upon.

RESULTS

Based on different studies and the experts' opinions, the prevalence of mental disorders in the last decade has increased. Coverage of mental health programs in two last decades in the best could be equal to rural population. Urban areas have been deprived of these services. Analysis of mental health system of the country shows that internal environment is weak and the external one is concede to be in threat. Eight principal challenges in country's mental health are considered.

CONCLUSION

Improving current situation requires increasing internal capacity of mental health system and developing inter-sectoral cooperation. During next five years, the Ministry of Health, Iran should mainly focus on improving mental health services particularly in urban and peri-urban areas, promoting mental health literacy of different groups and minimizing mental health risk factors.

Executive functioning in context: Relevance for treatment and monitoring of phenylketonuria

This paper presents findings from studies of EF in individuals with early-treated PKU within the context of recent advances in neuropsychological theory and research. It focuses on means of assessment, contexts of assessment, and the best way to define and investigate EF. Several conclusions can be drawn based on the findings presented here. The first conclusion is that there is clear evidence for phenylalanine-related EF-deficits in early-treated PKU, particularly with respect to prepotent response inhibition and the manipulation or monitoring component of working memory. An important note, however, is that measurement of EF in PKU has become too fragmented, as different researchers and clinicians use different definitions of EF, and subsequently, different instruments to measure EF. This appears to be one of the most important causes of mixed results. A second conclusion is that there appears to be a need to incorporate at least one specific, relatively new taxonomy of EF in PKU-research, i.e. the taxonomy that distinguishes hot and cool EFs, where hot EF is associated with regulation of affect/emotions and motivation, or regulatory functions when the context contains such elements, while cool EF concerns decontextualized regulatory abilities. PKU in adults is increasingly associated with different mental health problems, despite supposedly good treatment standards and adherence throughout childhood and adolescence. Since hot EF is strongly associated with such mental health problems, it is recommended that the hot-cool taxonomy will feature more prominently in future PKU-studies.

How different are their experiences and outcomes? Comparing aged out and other child welfare involved youth

This paper adds to the growing body of research examining the experiences of youth aging out of the child welfare system. Through a comparison of youth aging out with two other groups of child welfare-involved youth-those whose families received child welfare services but were never placed out of home and those who were in out-of-home placement but did not age out-it presents a profile of their care careers and other system involvement (e.g., mental health, justice system). Analyses indicate that young people aging out of care have experienced significant amounts of time in out-of-home placement, a great deal of placement instability, and high levels of other system involvement. In general, their involvement is more extensive than that of the two comparison groups. However, the justice system involvement of youth who experienced out-of-home placement but did not age out is just as high as that of youth who have aged out. This finding highlights the importance of devoting resources not only to youth aging out of care but also to similarly-aged young people with prior child welfare involvement.

Sufism and mental health

Human experience in, health and disease, always has a spiritual dimension. pirituality is accepted as one of the defining determinants of health and it no more remains a sole preserve of religion and mysticism. In recent years, pirituality has been an area of research in neurosciences and both in the nderstanding of psychiatric morbidity and extending therapeutic interventions it seems to be full of promises. Sufism has been a prominent spiritual tradition in Islam deriving influences from major world religions, such as, Christianity and Hinduism and contributing substantially toward spiritual well-being of a large number of people within and outside Muslim world. Though Sufism started in early days of Islam and had many prominent Sufis, it is in the medieval period it achieved great height culminating in many Sufi orders and their major proponents. The Sufism aims communion with God through spiritual realization; soul being the agency of this communion, and propounding the God to be not only the cause of all existence but the only real existence. It may provide a vital link to understand the source of religious experience and its impact on mental health.

A parallel-group, randomised controlled trial of a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners: design and rationale

INTRODUCTION

Coping skills training interventions have been found to be efficacious in helping both patients and their partners manage the physical and emotional challenges they face following a cancer diagnosis. However, many of these interventions are costly and not sustainable. To overcome these issues, a self-directed format is increasingly used. The efficacy of self-directed interventions for patients has been supported; however, no study has reported on the outcomes for their partners. This study will test the efficacy of Coping-Together-a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners.

METHODS AND ANALYSIS

The proposed three-group, parallel, randomised controlled trial will recruit patients diagnosed in the past 4 months with breast, prostate, colorectal cancer or melanoma through their treating clinician. Patients and their partners will be randomised to (1) a minimal ethical care (MEC) condition-selected Cancer Council New South Wales booklets and a brochure for the Cancer Council Helpline, (2) Coping-Together generic-MEC materials, the six Coping-Together booklets and DVD, the Cancer Council Queensland relaxation audio CD and login to the Coping-Together website or (3) Coping-Together tailored-MEC materials, the Coping-Together DVD, the login to the website and only those Coping-Together booklet sections that pertain to their direct concerns. Anxiety (primary outcome), distress, depression, dyadic adjustment, quality of life, illness or caregiving appraisal, self-efficacy and dyadic and individual coping will be assessed before receiving the study material (ie, baseline) and again at 3, 6 and 12 months postbaseline. Intention-to-treat and per protocol analysis will be conducted.

ETHICS AND DISSEMINATION

This study has been approved by the relevant local area health and University ethics committees. Study findings will be disseminated not only through peer-reviewed publications and conference presentations but also through educational outreach visits, publication of lay research summaries in consumer newsletters and publications targeting clinicians.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12613000491763 (03/05/2013).

Impact of maternal mental health on pediatric asthma control

BACKGROUND

Asthma like other chronic diseases is a stressful condition not only for children but also for their parents. Caring for a child with asthma combines the demands of parenting with the emotional and physical burdens of the child's chronic illness. Some studies have assessed the relations between parental mental health and asthma severity in children. This study aims to evaluate the mental health of mothers of asthmatic children and associations between maternal mental health and childhood levels of asthma control.

MATERIALS AND METHODS

Eighty mothers with asthmatic children aged 7-12 yrs. completed a General Health Questionnaire (GHQ.28) containing questions about somatic symptoms, anxiety, social dysfunction, and severe depression. Level of asthma control in children was classified as "well controlled"," partly controlled" and "uncontrolled" by an asthma specialist.

RESULTS

The results showed that mothers of asthmatic children reported the depression symptoms significantly more than the community cut-off point (p<0.001); also GHQ scores were not significantly different in three levels of asthma control in children (i.e. well controlled, partly controlled and uncontrolled). The results revealed that caring for a child with asthma had an impact on the mother's mental health and depression was prevalent among mothers of asthmatic children. In addition, improving asthma control level did not promote maternal mental health.

CONCLUSION

Inclusion of mental health and quality of life of parents in the classification of pediatric asthma control may be helpful. Our findings suggest that the physician's awareness of maternal depression and the presence of a psychotherapist for diagnosing and treating depression in mothers of children with asthma may be important for guiding effective interventions.

Can familial factors account for the association of body mass index with poor mental health in men or women?

OBJECTIVE

This study examined if associations between body mass index (BMI) and mental and physical health were independent of genetic and familial factors.

METHOD

Data from 2831 twins (66% female) were used in an epidemiological co-twin control design with measures of BMI and mental and physical health outcomes. Generalized estimating equation regressions assessed relationships between BMI and health outcomes controlling for interdependency among twins and demographics. Within-pair regression analyses examined the association of BMI with health outcomes controlling for genetic and familial influences.

RESULTS

Adjusted analyses with individual twins found associations in women between BMI and perceived stress (P=.01) and depression (P=.002), and the link between BMI and depression (P=.03) was significant in men. All physical health outcomes were significantly related to BMI. Once genetic and familial factors were taken into account, mental health outcomes were no longer significantly associated with BMI. BMI in women remained related to ratings of physical health (P=.01) and body pain (P=.004), independent of genetic and familial influences.

CONCLUSION

These findings suggest that genetic and familial factors may account for the relationship between increased weight and poor mental health.

Quality of life in patients with gastroesophageal reflux disease in an Iranian population

AIM

The study was designed to evaluate quality of life (QOL) for Iranian patients with gastroesophageal reflux disease (GERD).

BACKGROUND

GERD is a common and chronic world-wide disease. Impact of GERD on QOL has been studied in many countries, but it has not been studied in Iranian population.

PATIENTS AND METHODS

Fifty five patients suffering from GERD and fifty five age and sex matched controls were enrolled. Patient inclusion criteria were based on clinical and endoscopic findings. All other major diseases having an impact on QOL had been excluded. All the subjects were asked to fill the validated translation of SF-36 and GHQ-28 questionnaires. Results of the SF-36 questionnaire was analyzed directly and after correction for the results obtained from the GHQ-28 tool.

RESULTS

GERD patients had lower QOL scores than controls. Correction of the results based the findings of GHQ-28 questionnaire did not change the results.

CONCLUSION

QOL in GERD patients is impaired and should be considered in clinical practice and implementing research studies upon GERD patients.

Mental health and social functioning in early treated Phenylketonuria: the PKU-COBESO study

This article presents a new Dutch multicenter study ("PKU-COBESO") into cognitive and behavioral sequelae of early and continuously treated Phenylketonuria (PKU) patients. Part of the study sample will consist of young adult PKU patients who have participated in a large neuropsychological study approximately 10 years ago, when they were 7-to-15-year-olds (Huijbregts et al., 2002 [1]). Their neurocognitive development will be mapped in association with their earlier and continued metabolic history, taking into account possible changes in, for instance, medication. A second part of the sample will consist of PKU patients between the ages of 7 and approximately 40 years (i.e., born in or after 1974, when neonatal screening was introduced in The Netherlands), who have not participated in the earlier neuropsychological study. Again, their cognitive functioning will be related to their metabolic history. With respect to aspects of cognition, there will be an emphasis on executive functioning. The concept of executive functioning will however be extended with further emphasis on the impact of cognitive deficits on the daily lives of PKU patients, aspects of social cognition, social functioning, and behavior/mental health (i.e., COgnition, BEhavior, SOcial functioning: COBESO). In addition to a description of the PKU-COBESO study, some preliminary results with respect to mental health and social functioning will be presented in this article. Thirty adult PKU patients (mean age 27.8, SD 6.4) and 23 PKU patients under the age of 18 years (mean age 11.0, SD 3.3) were compared to 14 (mean age 26.9 years, SD 5.9) and 7 matched controls (mean age 10.5, SD 2.6) respectively, with respect to their scores on the Adult Self-Report or Child Behavior Checklist (measuring mental health problems) and the Social Skills Checklist or Social Skills Rating System (measuring social skills). Whereas there were very few significant group differences (except for mental health problems in the internalizing spectrum for adult PKU patients), possibly due to the small control groups, several significant associations between mental health problems and Phe levels were observed for the PKU patients. Childhood Phe levels and internalizing problems for adult PKU patients were related; concurrent Phe was associated with both internalizing and externalizing behavioral problems for those under the age of 18. These preliminary results underline the importance of early dietary adherence.

Forced migration and mental health: prolonged internal displacement, return migration and resilience

Forced internal displacement has been rising steadily, mainly due to conflict. Many internally displaced people (IDP) experience prolonged displacement. Global research evidence suggests that many of these IDP are at high risk for developing mental disorders, adding weight to the global burden of disease. However, individual and community resilience may act as protective factors. Return migration may be an option for some IDP populations, especially when conflicts end, although return migration may itself be associated with worse mental health. Limited evidence is available on effects of resettlement or return migration following prolonged forced internal displacement on mental health. Also, the role of resilience factors remains to be clarified following situations of prolonged displacement. The public health impact of internal displacement is not clearly understood. Epidemiological and interventional research in IDP mental health needs to look beyond medicalised models and encompass broader social and cultural aspects. The resilience factor should be integrated and explored more in mental health research among IDP and a clearly focused multidisciplinary approach is advocated.

[Charisma and leadership: new challenges for psychiatry]

INTRODUCTION

New challenges arise in medicine, particularly in psychiatry. In the near future, psychiatrists' role may evolve into management of mental health care teams (GPs, nurses, psychologists…) thus creating the need for charisma and leadership. Charisma is defined as « a quality that allows it's possessor to exercise influence, authority over a group »; leadership as « the function, the position of chief, and by extension, a dominant position ».

AIM OF THE STUDY

To offer some reflections on charisma and leadership and the ways to develop them in three situations common in clinical practice: dual communication (between caregivers or with patients), oral communication (e.g., during a symposium) and managing a mental health care team.

METHOD

Medline (1966-hits) and Web of Science (1975-hits) were explored according to the PRISMA criteria. The research paradigm was [(psychiatrist OR physician) AND mental health AND (leadership OR charisma)].

RESULTS

Two hundred and eighty articles were found, but only 34 corresponded to our subject and were included in the qualitative analysis. The leader must first ask himself/herself about his/her vision of the future, so as to share it with passion with his/her mental health team. Charisma and leadership are based on several values, among which we can mention: providing understandable, personalized care for the patient, in continuity and confidentiality; adapting care to the general population's request, maintaining one's own physical and mental health, submitting one's daily practice to peer review, engaging in continuous improvement of one's practices in response to new requirements, and recognizing that research and instruction are part of an M.D's professional obligations. The clinician will work on ways to develop his/her own charisma, through interactions with peers and team members, the care of his/her appearance (especially for first meetings) and workplace, and through positive reinforcement (some cognitive-behavioral techniques like assertiveness have been proposed to enhance the charisma, e.g., visualization and affirmation). Leadership does not depend on hierarchical position and administrative responsibilities: leaders should learn to manage and harmonize the different types of personalities within his/her team, paying special attention to passive-aggressive attitudes. We recall here some techniques to improve charisma during oral communication, such as making relationships with people by calling them by their names, making reference to things and people that the audience can identify with (like sport or cooking), using one's own style without trying to imitate someone else, focusing on one major idea, being brief and using anecdotes, using silences effectively and finally having good non-verbal communication. The conclusion should never be neglected, as an audience especially remembers the beginning and the end of a presentation. Although some features are common to all charismatic leaders (dominance, self-confidence, high energy level), a recent theory of leadership (called contingency theory) seeks to examine how different leadership styles can adapt to circumstances. This theory focuses more on the vision, passion, determination and courage of the leader and depends not only on their intrinsic qualities. No research has indeed shown individual characteristics that differentiate leaders from followers. However, doctors have not been prepared in their training to acquire leadership skills that they can use to adapt to the circumstances of their clinical practice. The most important qualities expected of a leader according to the current leadership theorists are: listening, communication, stress management, development of other's capacities, feedback, introspection and risk taking. Moreover, leadership involves positive reinforcement of the team while maintaining the feeling of individual autonomy, and being able to take an innovative decision alone with shared optimism. There is no need to have great management responsibilities in order to succeed in leadership. We reiterate the importance for a charismatic leader to smile, to be able to mock oneself and to regulate one's emotions.

CONCLUSION

Charisma seems to be an essential dimension for effective leadership and team management. Beyond psychiatry, we believe these reflections to be useful for all branches of medicine.

Development of mental health indicators in Korea

OBJECTIVE

Promoting mental health and preventing mental health problems are important tasks for international organizations and nations. Such goals entail the establishment of active information networks and effective systems and indicators to assess the mental health of populations. This being said, there is a need in Korea develop ways to measure the state of mental health in Korea.

METHODS

THIS PAPER REVIEWS THE MENTAL HEALTH INDICATOR DEVELOPMENT POLICIES AND PRACTICES OF SEVEN ORGANIZATIONS, COUNTRIES, AND REGIONS: WHO, OECD, EU, United States, Australia, UK, and Scotland. Using Delphi method, we conducted two surveys of mental health indicators for experts in the field of mental health. The survey questionnaire included 5 domains: mental health status, mental health factor, mental health system, mental health service, and quality of mental health services. We considered 124 potential mental health indicators out of more than 600 from indicators of international organizations and foreign countries.

RESULTS

We obtained the top 30 mental health indicators from the surveys. Among them, 10 indicators belong to the mental health system. The most important five mental health indicators are suicide rate, rate of increase in mental disorder treatment, burden caused by mental disorders, adequacy of identifying problems of mental health projects and deriving solutions, and annual prevalence of mental disorders.

CONCLUSION

Our study provides information about the process for indicator development and the use of survey results to measure the mental health status of the Korean population. The aim of mental health indicator development is to improve the mental health system by better grasping the current situation. We suggest these mental health indicators can monitor progress in efforts to implement reform policies, provide community services, and involve users, families and other stakeholders in mental health promotion, prevention, care and rehabilitation.

Mental health in humanitarian settings: shifting focus to care systems

Mental health in low- and middle income countries has received increasing attention. This attention has shifted focus, roughly moving from demonstrating the burden of mental health problems, to establishing an evidence base for interventions, to thinking about care delivery frameworks. This paper reviews these trends specifically for humanitarian settings and discusses lessons learned. Notably, that mental health assessments need to go beyond measuring the impact of traumatic events on circumscribed psychiatric disorders; that evidence for effectiveness of interventions is still too weak and its focus too limited; and that development of service delivery in the context of instable community and health systems should be an area of key priority.

Innovations in Practice: Child and adolescent psychiatrists and primary care - innovative models of consultation in the United States

BACKGROUND

  There is a severe shortage of child and adolescent psychiatrists (CAPs) in the United States, an increasingly recognized high prevalence of mental disorders in young people, and widely supported goals to provide more mental health services in the primary care setting.

METHOD

  A number of innovative, state-wide or more local, publically funded programs have been developed in the United States over the last several years to respond to these challenges and to provide CAP consultation to primary care physicians (PCPs) who wish to address the mental health disorders of their patients in the primary care setting.

RESULTS

  A number of these programs and their approaches to consultation are described. An example of a clinical scenario that might be addressed using this model of CAP/PCP collaboration is offered.

CONCLUSIONS

  An innovative model of consultation to PCPs from CAPs appears able to facilitate the treatment of many young people with mental health disorders in the primary care setting.

Mental health of Medical Students in Different Levels of Training. Int J Prev Med. 2012;3:S107-S112. [PMID: 22826751 DOI: 10.1016/s0924-9338(12)75178-7]

OBJECTIVES

Medical education and training can directly contribute to the development of psychological distress in medical students. This can lead to catastrophic consequences such as impaired academic performance, impaired competency, medical errors and attrition from medical school. This study aimed to assess the prevalence of psychological morbidity among Iranian medical students.

METHODS

This was a cross-sectional study. Samples of medical students in different levels of training (basic science, clinical clerkship, internship, and residency stage) were entered into the study. The 12-item General Health Questionnaire (GHQ-12) was used to measure psychological morbidity. Both univariate and multivariate analyses were used to report on findings.

RESULTS

In all, 220 medical students were invited to take part in the study. Of these, 192 students agreed to fill in the questionnaire. The mean age of respondents was 25.4 (SD = 5.2) and 53% were female. Overall 49.5% of the students scored above the threshold on the GHQ-12 (score > 3.5). The results obtained from logistic regression analysis indicated that female gender and level of training were the most significant contributing factors to increased psychological distress [OR for female gender = 2.99; OR for the basic science group = 6.73].

CONCLUSIONS

Psychological distress appears to be common in medical students and significantly varies by gender and level of training. The psychological well-being of medical students needs to be more carefully addressed, and closer attention to eliminating the risk factors is critical to prevent consequent adverse outcomes.

Actions to alleviate the mental health impact of the economic crisis

The current global economic crisis is expected to produce adverse mental health effects that may increase suicide and alcohol-related death rates in affected countries. In nations with greater social safety nets, the health impacts of the economic downturn may be less pronounced. Research indicates that the mental health impact of the economic crisis can be offset by various policy measures. This paper aims to outline how countries can safeguard and support mental health in times of economic downturn. It indicates that good mental health cannot be achieved by the health sector alone. The determinants of mental health often lie outside of the remits of the health system, and all sectors of society have to be involved in the promotion of mental health. Accessible and responsive primary care services support people at risk and can prevent mental health consequences. Any austerity measures imposed on mental health services need to be geared to support the modernization of mental health care provision. Social welfare supports and active labour market programmes aiming at helping people retain or re-gain jobs can counteract the mental health effects of the economic crisis. Family support programmes can also make a difference. Alcohol pricing and restrictions of alcohol availability reduce alcohol harms and save lives. Support to tackle unmanageable debt will also help to reduce the mental health impact of the crisis. While the current economic crisis may have a major impact on mental health and increase mortality due to suicides and alcohol-related disorders, it is also a window of opportunity to reform mental health care and promote a mentally healthy lifestyle.

Which clinical variable influences health-related quality of life the most after spontaneous subarachnoid hemorrhage? Hunt and Hess scale, Fisher score, World Federation of Neurosurgeons score, Brussels coma score, and Glasgow coma score compared

OBJECTIVE

To determine the strength of the correlation between the Hunt and Hess scale, Fisher score, Brussels coma score, World Federation of Neurosurgeons score, and Glasgow coma score and health-related quality of life.

METHODS

Evaluable questionnaires from 236 patients (5.6 years [± standard deviation, 2.854 years] on average after hemorrhage) were included in the analysis. Quality of life was documented using the MOS-36 item short form health survey. Because of the ordinal nature of the variables, Kendall tau was used for calculation. Significance was established as P ≤ 0.05.

RESULTS

Weak and very weak correlations were found in general (r ≤ 0.28). The strongest correlations were found between the Glasgow coma score and quality of life (r = 0.236, P = 0.0001). In particular, the "best verbal response" achieved the strongest correlations in the comparison, at r = 0.28/P = 0.0001. The Fisher score showed very weak correlations (r = -0.148/P = 0.012). The Brussels coma score (r = -0.216/P = 0.0001), Hunt and Hess scale (r = -0.197/P = 0.0001), and the World Federation of Neurosurgeons score (r = -0.185/P = 0.0001) revealed stronger correlations, especially in terms of the physical aspects of quality of life.

CONCLUSIONS

The Glasgow coma scale revealed the strongest, and the Fisher score showed the weakest correlations. Thus the Fisher score, as an indicator of the severity of a hemorrhage, has little significance in terms of health-related quality of life.

Psychiatric disorders in low birthweight young adults. Prevalence and association with assessments at 11 years

OBJECTIVE

To compare mental health of 136 young adults without neurosensory handicaps born with low birthweight (LBW, birthweight less than 2,000 g) with 132 adults with normal birthweight (NBW).

METHOD

A cohort of moderate LBW and NBW young adults were assessed with the Mini-International Neuropsychiatric Interview (MINI) at 19 years and the Children Assessment Schedule (CAS) at 11 years of age.

RESULTS

At 19 years of age, 44 out of 136 (32%) LBW young adults were diagnosed with a psychiatric disorder compared to 10% NBW (OR: 2.8; 95% CI: 1.1, 4.5, P=0.02). Among the LBW young adults, affective-, anxiety-, ADHD- and antisocial personality disorders were most common, and nine subjects (20%) had more than one diagnosis. Of 97 LBW subjects examined both at 11 and 19 years of age, 54 (56%) were mentally healthy though out adolescence. This was half as many as for controls (OR: 0.6; 95% CI: 0.3 to 0.9).

CONCLUSION

Moderate LBW was associated with an increased risk of psychiatric disorders in young adulthood. Only half of LBW young adults stayed healthy throughout adolescence.

Turbulent times: effects of turbulence and violence exposure in adolescence on high school completion, health risk behavior, and mental health in young adulthood

Turbulent social environments are associated with health and developmental risk, yet mechanisms have been understudied. Guided by a life course framework and stress theory, this study examined the association between turbulent life transitions (including frequent residential mobility, school transitions, family structure disruptions, and homelessness) and exposure to violence during adolescence and high school completion, mental health, and health risk behaviors in young adulthood. Participants (n = 4834) from the U.S. National Longitudinal Survey of Youth, 1997 cohort were followed prospectively from age 12-14 years for 10 years. We used structural equation models to investigate pathways between turbulence and cumulative exposure to violence (CEV), and high school completion, mental health, and health risk behaviors, while accounting for early life socio-demographics, family processes, and individual characteristics. Results indicated that turbulence index was associated with cumulative exposure to violence in adolescence. Both turbulence index and cumulative exposure to violence were positively associated with higher health risk behavior, poorer mental health, and inversely associated with high school completion. These findings highlight the importance of considering the cumulative impact of turbulent and adverse social environments when developing interventions to optimize health and developmental trajectory for adolescents transitioning into adulthood.

Effect of cognitive behavioral therapy in mental health and hardiness of infertile women receiving assisted reproductive therapy (ART)

BACKGROUND

Infertility is a stressful event that can give rise to psychological difficulties. Now, a wide range of psychosocial interventions for infertile couples has been developed.

OBJECTIVE

Purpose of this study was to determine the effect of group cognitive behavioral therapy (CBT) to reduce stress, anxiety and depression of women undergoing assisted reproductive therapy (ART).

MATERIALS AND METHODS

This study was an experimental study (before and after study with control group) on infertile women who were referring to Gynecological clinics of Jahrom University of Medical Sciences to receive ART. 31 women who had criteria to enter the study were randomly divided into experimental group (n=15) and control group (n=16). The participants in the experimental group received 1 hour and 30 minute weekly session's group therapy in 15 week as intervention. For gathering data, depression, anxiety and stress scale (DASS) normalized Persian version and Ahvaz Hardiness Test (AHT) were used to assess psychological distress and psychological hardiness in pre-posttest.

RESULTS

There were significant differences in mean score of infertile psychological distress, anxiety, depression, and stress in experimental group pretest with posttest. Furthermore, the results indicated that there were significant differences between hardiness in two groups. The experimental group had higher scores in hardiness than control group (p=0.001).

CONCLUSION

It seems to be, that group therapy interventions, specially, cognitive behavioral therapy (CBT) can be useful and applicable to women who receiving ART.

Relationships among Daily Hassles, Social Support, Entrapment and Mental Health Status by Gender in University Students

PURPOSE

This study was designed to examine the relationships among daily hassles, social support, entrapment and mental health status in relation to gender in university students.

METHODS

Data were collected via a self-administered questionnaire from 118 male and 98 female college students in Kangwon province. Data were analyzed using SPSS/WIN 18.0 program for descriptive statistics, t-test, ANOVA, Pearson correlation, and stepwise multiple regression.

RESULTS

There were significant differences in daily hassles, entrapment and depression between male and female group. Also, there were significant relationship between entrapment and mental health status (i.e. depression, anxiety, hostility, somatization) in both groups. In male students, internal entrapment was the significant predictor of depression and anxiety, and external entrapment was the significant predictor of hostility and somatization whereas, in female students external entrapment was the significant predictor of depression, and internal entrapment was the significant predictor of anxiety, hostility and somatization.

CONCLUSION

These results suggest that entrapment is an important factor for psychological maladaptation due to stressful life events. Therefore, strategies that reduce perception of entrapment according to gender should be developed for psychological adaptation.

The psychological problems of north korean adolescent refugees living in South Korea

OBJECTIVE

As the number of North Korean adolescent refugees drastically increased in South Korea, there is a growing interest in them. Our study was conducted to evaluate the mental health of the North Korean adolescent refugees residing in South Korea.

METHODS

The subjects of this study were 102 North Korean adolescent refugees in Hangyeore middle and high School, the public educational institution for the North Korean adolescent refugees residing in South Korea, and 766 general adolescents in the same region. The Korean version of Child Behavior Check List (K-CBCL) standardized in South Korea was employed as the mental health evaluation tool.

RESULTS

The adolescent refugees group showed a significantly different score with that of the normal control group in the K-CBCL subscales for sociality (t=29.67, p=0.000), academic performance (t=17.79, p=0.000), total social function (t=35.52, p=0.000), social withdrawal (t=18.01, p=0.000), somatic symptoms (t=28.85, p=0.000), depression/anxiety (t=13.08, p=0.000), thought problems (t=6.24, p=0.013), attention problems (t=4.14, p=0.042), internalized problems (t=26.54, p=0.000) and total problems (t=5.23, p=0.022).

CONCLUSION

The mental health of the North Korean adolescent refugees was severe particularly in internalized problems when compared with that of the general adolescents in South Korea. This result indicates the need for interest in not only the behavior of the North Korean adolescent refugees but also their emotional problem.

Behavioral health integration: an essential element of population-based healthcare redesign

The fundamental aim of healthcare reform is twofold: to provide health insurance coverage for most of the citizens currently uninsured, thereby granting them access to healthcare; and to redesign the overall healthcare system to provide better care and achieve the triple aim (better health for the population, better healthcare for individuals, and at less cost). The foundation for this improved system will rest on a redesigned (i.e., sufficiently comprehensive and integrated) system of primary care, with which all other providers, services, and sites of care are associated. The Patient-Centered Medical Home (PCMH) and its congeners are the best current examples of the kind of primary care that can achieve the triple aim, if they can become sufficiently comprehensive and can adequately integrate services. This means fully integrating behavioral healthcare into the PCMH, a difficult task under the most favorable circumstances. Creating functioning accountable care organizations is an even more daunting task: this requires new principles of collaborating and financing and the current prototypes have generally failed to incorporate behavioral healthcare sufficient to meet even the basic needs of the target population. This paper will discuss (1) the case for and the difficulties associated with integrating behavioral healthcare into primary care at three levels: the practice, the state, and the nation; and (2) how this looks clinically, operationally, and financially.

Regional variation of racial disparities in mental health service use among older adults

PURPOSE

Given the paucity of research on the role of geography in mental health care, this study examined whether racial differences in mental health service use varied across geographic regions among older adults.

DESIGN AND METHODS

Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), blacks (n = 1,008) and whites (n = 1,870) aged 60 and older were selected for analysis. Logistic regression analyses were conducted.

RESULTS

Results showed significant racial disparities in mental health service use in the overall sample, as well as significant variation by region. Although no racial differences were observed in the Northeast, West, or Midwest regions, black elders in the South were significantly less likely than whites to use mental health services (odds ratios [OR], 2.08; 95% confidence interval [CI], 1.34-3.23).

IMPLICATIONS

The findings suggest that improving the access to mental health care in certain regions, the South in particular, may be essential to reduce racial disparities at the national level. Policy implications are discussed.

Amigas Latinas Motivando el ALMA (ALMA): Development and Pilot Implementation of a Stress Reduction Promotora Intervention

Use of mental health care services for psychological distress is limited among Latino immigrants. In geographic areas where migration has been rapid, mental health systems possess limited capacity to provide bilingual and bicultural assistance. The development of a bilingual and bicultural workforce is a necessary yet long-term solution. More immediate strategies, however, are needed to meet the needs of immigrant Latinos. This paper describes the development of a stress-reduction focused, lay health advisor training that targets individual behavior change among Latina immigrants. The theoretical foundation, curriculum components, and pilot implementation of the training are discussed. As natural leaders, Latina promotoras disseminated learned strategies and resources within their communities. The lay health advisor model is a salient method for disseminating information regarding mental health and stress reduction among Latinas.

Cultural adaptation of the Latin American version of the World Health Organization Composite International Diagnostic Interview (WHO-CIDI) (v 3.0) for use in Spain

OBJECTIVE

To develop a Spanish version of the WHO-Composite International Diagnostic Interview (WHO-CIDI) applicable to Spain, through cultural adaptation of its most recent Latin American (LA v 20.0) version.

METHODS

A 1-week training course on the WHO-CIDI was provided by certified trainers. An expert panel reviewed the LA version, identified words or expressions that needed to be adapted to the cultural or linguistic norms for Spain, and proposed alternative expressions that were agreed on through consensus. The entire process was supervised and approved by a member of the WHO-CIDI Editorial Committee. The changes were incorporated into a Computer Assisted Personal Interview (CAPI) format and the feasibility and administration time were pilot tested in a convenience sample of 32 volunteers.

RESULTS

A total of 372 questions were slightly modified (almost 7% of approximately 5000 questions in the survey) and incorporated into the CAPI version of the WHO-CIDI. Most of the changes were minor - but important - linguistic adaptations, and others were related to specific Spanish institutions and currency. In the pilot study, the instrument's mean completion administration time was 2h and 10min, with an interquartile range from 1.5 to nearly 3h. All the changes made were tested and officially approved.

CONCLUSIONS

The Latin American version of the WHO-CIDI was successfully adapted and pilot-tested in its computerized format and is now ready for use in Spain.

Epidemiological Study of Youth Mental Health Using Strengths and Difficulties Questionnaire (SDQ)

BACKGROUND

Prevention and treatment of youths` mental disorders are important, not just for to diminish their present problems but to improve their functions in adulthood. This study was performed to evaluate the mental health status of 6-18 years old youths in a community-based sample using the strength and difficulties questionnaire (SDQ).

METHODS

Parent of 2000 youths (6-18 years old) were selected from 250 clusters from different municipality areas of Isfahan, Iran and they responded to extended version of SDQ parent`s form. The mean score in each subscale and prevalence of symptom and relation with some demographic features were determined.

RESULTS

The total score of SDQ was 26%, means that 26% of youth had psychiatric problems. By determining the subscale score, it reveals that conduct disorder (34.7%) was the most common problem in youth followed by peer relationship problems (25.4%), emotional problems (24.5%), hyperactivity (23%) and impairment of prosocial behavior (5.7%).

CONCLUSION

Our findings showed that mental health of youth population in Isfahan especially the conduct problem needs more attention.

Is physical activity in natural environments better for mental health than physical activity in other environments?

Experimental evidence suggests that there may be synergy between the psychological benefits of physical activity, and the restorative effects of contact with a natural environment; physical activity in a natural environment might produce greater mental health benefits than physical activity elsewhere. However, such experiments are typically short-term and, by definition, artificially control the participant types, physical activity and contact with nature. This observational study asked whether such effects can be detected in everyday settings at a population level. It used data from the Scottish Health Survey 2008, describing all environments in which respondents were physically active. Associations were sought between use of each environment, and then use of environments grouped as natural or non-natural, and the risk of poor mental health (measured by the General Health Questionnaire (GHQ)) and level of wellbeing (measured by the Warwick Edinburgh Mental health and Wellbeing Score (WEMWBS). Results showed an independent association between regular use of natural environments and a lower risk of poor mental health, but not for activity in other types of environment. For example, the odds of poor mental health (GHQ ≥ 4) among those regularly using woods or forests for physical activity were 0.557 (95% CI 0.323-0.962), compared to non-users. However, regular use of natural environments was not clearly associated with greater wellbeing, whilst regular use of non-natural environments was. The study concludes that physical activity in natural environments is associated with a reduction in the risk of poor mental health to a greater extent than physical activity in other environments, but also that activity in different types of environment may promote different kinds of positive psychological response. Access to natural environments for physical activity should be protected and promoted as a contribution to protecting and improving population mental health.

Mental health and well-being in different levels of perceived discrimination

BACKGROUND

To compare mental health and well-being in different levels of the perceived discrimination among Iranian people living in Tehran.

METHOD

Using multi-stage sampling, 1255 subjects with the average age of 45 years and 9 months (including 672 women and 583 men) were selected and they completed all items of the general health questionnaire (GHQ), the social well-being inventory (SWI), personal well-being inventory (PWI), and a question to assess the perceived discrimination.

RESULTS

Data analysis by Kruskal-Wallis test revealed that there were significant differences between physical symptoms (χ(2)=5.93, P<0.05) and depression (χ (2)=15.70, P<0.05), the subscales of mental health in different levels of the perceived discrimination. Furthermore, comparing personal well-being scores and its subscales in different levels of the perceived discrimination showed significant differences in personal hygiene (χ(2)=7.20, P<0.05), and security in future (χ(2)=7.60, P<0.05). Emotional well-being (χ(2)=12.25, P<0.05), self-rule (χ(2)=7.45, P<0.05), personal growth (χ(2)=19.87, P<0.05), and psychological well-being (χ(2)= 9.09, P<0.05) were significantly different in different levels of the perceived discrimination, too. Moreover, comparing social well-being in different levels of the perceived discrimination indicated significant differences between social acceptance (χ (2)=14.91, P<0.05), and social participation (χ (2)= 10.91, P<0.05).

CONCLUSION

Therefore, people are more active in society, increases the possibility of encountering with discrimination and consequently the perception of that.

Internet-based intervention to promote mental fitness in mildly depressed adults: design of a randomized controlled trial

Background

Investing in mental well-being is considered a supplement to current mental health service delivery in which the treatment and prevention of mental disorders are core components. It may be possible for people to enhance their well-being by boosting their “mental fitness.”

Objective

Psyfit, an online, multi-component, fully automated self-help intervention, was developed with the aim of improving well-being and reducing depressive symptoms. The efficacy and cost-effectiveness of this intervention will be examined in a randomized controlled trial.

Methods

In this two-armed randomized controlled trial, a total of 290 participants will be assigned to use Psyfit (experimental condition) or to a 6-month waiting list (control condition). Adults with mild to moderate depressive symptoms interested in improving their mental fitness will be recruited from the general population through advertisements on the Internet and in newspapers. Online measurements by self-assessment will be made prior to randomization (pre-test), 2 months after baseline (post-test), and 6 months after baseline (follow-up).

Results

The primary outcome is well-being. Secondary outcomes are depressive symptoms, general health, vitality, and economic costs. Analysis will be conducted in accordance with the intention-to-treat principle.

Conclusions

This study will examine the efficacy and cost-effectiveness of an online intervention that aims to promote well-being in people with elevated levels of depressive symptoms. If shown to be effective, the intervention could prove to be an affordable and widely accessible intervention to improve well-being in the general population.

Trial Registration

The study is registered with the Netherlands Trial Register, part of the Dutch Cochrane Centre (NTR2126).

Applying an Educational-participatory Program based on the PRECEDE Model for Promoting Self-esteem and Mental Health of Students in Iran

BACKGROUND

The students' vulnerability to different problems can have an impact on their mental health. Regarding the lack of evidence on the effectiveness of interventional programs based on health education planning models in this area in developing countries, an educational-participatory program based on the PRECEDE model was used, to promote the medical science students' self-esteem and mental health status, in Iran.

METHODS

In this experimental study, 154 students from the universities of medical sciences in the north east of Iran were selected by stratified random sampling method. Then, they were randomly assigned to two groups of case and control. The questionnaires, including the enabling, reinforcing, and predisposing factors, the Rosenberg self-esteem scale, and the GHQ-28 were used for data collection. Then, an intervention plan, including focus group discussions and training of selected life skills, based on the PRECEDE model, was conducted for the case group.

RESULTS

The predisposing, reinforcing, and enabling factors, and the self-esteem and mental health of the students showed a significant difference between the case and control groups. The Pearson correlation coefficient showed that there was a correlation between mental health and knowledge (P =0.008), between self-esteem and knowledge (P =0.02), self-esteem and attitude (P =0.01), and mental health and attitude (P = 0.03).

CONCLUSION

Health promotion planning by using life skills training based on the PRECEDE model can result in participation and empowerment, in order to promote the self-esteem and mental health of the students.

Mental health of Medical Students in Different Levels of Training

OBJECTIVES

Medical education and training can directly contribute to the development of psychological distress in medical students. This can lead to catastrophic consequences such as impaired academic performance, impaired competency, medical errors and attrition from medical school. This study aimed to assess the prevalence of psychological morbidity among Iranian medical students.

METHODS

This was a cross-sectional study. Samples of medical students in different levels of training (basic science, clinical clerkship, internship, and residency stage) were entered into the study. The 12-item General Health Questionnaire (GHQ-12) was used to measure psychological morbidity. Both univariate and multivariate analyses were used to report on findings.

RESULTS

In all, 220 medical students were invited to take part in the study. Of these, 192 students agreed to fill in the questionnaire. The mean age of respondents was 25.4 (SD = 5.2) and 53% were female. Overall 49.5% of the students scored above the threshold on the GHQ-12 (score > 3.5). The results obtained from logistic regression analysis indicated that female gender and level of training were the most significant contributing factors to increased psychological distress [OR for female gender = 2.99; OR for the basic science group = 6.73].

CONCLUSIONS

Psychological distress appears to be common in medical students and significantly varies by gender and level of training. The psychological well-being of medical students needs to be more carefully addressed, and closer attention to eliminating the risk factors is critical to prevent consequent adverse outcomes.

The Efficiency of Mental Health Integration in Primary Health Care: a Ten-year Study

OBJECTIVES

This study was conducted on the estimation of the efficiency of mental health program in primary health care in Chaharmahal and Bakhtyari province, situated in center of the Islamic Republic of Iran, from 1999 to 2009.

METHODS

One of the important objectives of mental health program is screening of mental health disorders and follow up. According to the prescription of mental health program, General Practitioners (GPs) were appointed to screen under-covered individuals, treat patients and also follow-up the patients with mental health disorders who needs referring to psychiatric clinics. Diagnostic criteria of mental disorders were based on American Psychiatry Association (DSM IV1994). Patients were categorized in four groups as follows: 1 - Severe mental disorders, such as major depression, schizophrenia, bipolar disorders, etc., 2 - Mild mental disorders, such as neurosis, anxiety, etc., 3 - Convulsive disorders and 4 - Behavioral disorders. The convulsive disorders and their types were diagnosed by physical examination and electroencephalography. In order to screen mental retardation, intelligence scale (IQ) score < 70 was considered as mental retardation. During the 10 years (1999 to 2009) of conducting program, all new diagnosed cases were confirmed by psychiatrists. All data was recorded in health files by trained GPs and they were assessed and justified by psychiatrists.

RESULTS

During 10 years after conducting and stabilizing integrated mental health in primary health care, 13514 patients overall were newly detected and followed. Ten years incidence of total psychiatric disorders was estimated in about 15.9 per 1000 populations.

CONCLUSIONS

Integrated mental health care offers the opportunity to increase access and develop efficiency of the mental health cares.

The impact of political violence on psychosocial functioning of individuals and families: the case of palestinian adolescents

BACKGROUND

  The impact of political violence on the psychosocial functioning of adolescents and their families was compared for surveyed populations from two regions of Palestine.

METHOD

  A randomly-selected sample of 971 adolescents (521 from the West Bank and 450 from the Gaza Strip regions, 42% male/57% female) completed scales measuring traumatic event, post-traumatic stress disorder (PTSD), peer relations, mental health, aggression, and family functioning.

RESULTS

  (1) West Bank participants reported a significantly higher level of exposure to political violence and significantly more aggression, mental health symptoms, problems in family and social functioning; (2) Participants exposed to greater political violence reported higher levels of depression, hostility, paranoid ideation, and PTSD; (3) Economic status and level of parental education were related to reduced levels of mental health symptoms and greater family functioning; (4) There were gendered differences.

CONCLUSIONS

  The study provides a starting point to begin to compare the experiences and outcomes between Palestinian adolescents in the West Bank and Gaza Strip and a basis for considering implications for service delivery and policy makers concerned with the well being of Palestinian communities.

Arsenicosis: Is it a Protective or Predisposing Factor for Mental Illness?

OBJECTIVE

Chronic arsenic poisoning (Arsenicosis) is a global health risk, and it has been reported to improve the fitness, especially in altitudinal sickness in therapeutic dose. Scarcity of systematic study on psychiatric co-morbidities in Arsenicosis motivated us to conduct this research. The aim of this study was to estimate the co-morbid psychiatric disorders in patients with arsenicosis and to examine whether natural arsenic exposure and toxicity is protective or detrimental for mental health.

METHOD

Out of 1477 arsenicosis patients aged 18 to 65 years, 1169 were finally assessed after excluding those who were disinclined to participate or those who had any organ failure or prior psychiatric disorder in themselves or their first-degree relatives. We applied General Health Questionnaire-12 (GHQ-12) and Brief Psychiatric Rating Scale (BPRS) to screen psychiatric symptoms. Finally, 191 patients with BPRS score > 30 were structurally interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN).

RESULTS

Of the 1169 participants in our study, 18.99% of the arsenicosis patients had psychiatric ailments. Common psychiatric manifestations were depression (8.47%), mixed anxiety and depressive disorder (4.61%), adjustment disorder in the form of mixed anxiety and depressive reaction, and brief depressive reaction (2.22%), and suicidal attempts (1.53%).

CONCLUSION

Considering the higher prevalence of psychiatric ailments in arsenicosis compared to general population of the same territory, it is necessary to screen psychological disorders in them. Conducting studies with control groups to further evaluate the impact of arsenicosis on mental health is warranted.

The relationship between mental health and social solidarity among apartment residents in shahrekord, iran

OBJECTIVE

To examine the relationship between psychological well-being and social solidarity of apartment residents in Shahrekord, Iran.

METHODS

A sample of 200 apartment dwellers was selected randomly. Fessler Social Solidarity Inventory and General Health Questionnaire were used to gather data.

RESULTS

Using partial correlation test and having controlled the effect of age, sex and education, we found significant relationship between mental health and social solidarity (r = 0.47; p= 0.023). After controlling education and marital status, it was also revealed that women were in a better solidarity situation compared to men (p< 0.05).

CONCLUSION

There is a relation between the mental health and social solidarity of apartment residents in Sharekord. Good mental health accompanied with better social solidarity.

Comparison between the mental health of mothers of children with autism and control group

OBJECTIVE

The aim of this study was to compare the mental health of mothers of children with autism and those of control group.

METHODS

Sample of this study consists of 32 mothers of Children with Autistic disorder and 29 mothers of children without Autism; referring to hospitals of Ahvaz city using Convenience sampling. All subjects were asked to complete Demographic questionnaire and General HealthQuestionnaire (GHQ). Data were analyzed using Multivariate Analysis of variance (MANOVA).

RESULTS

RESULTSindicated that significant differences exist in mental health (F=5.69, P=0.02) and anxiety/ insomnia (F=4.82, P=0.03), between mothers of children with Autismand control group. There were not any other significant differences in the other subscales.

CONCLUSION

It is essential using some mental health improving interventions for mothers of children with Autistic disorder.

Evaluation of Mental Health and Related Factors among Patients with Beta-thalassemia Major in South East of Iran

OBJECTIVE

Beta-thalassemia major (β-TM) is a chronic, genetic and hematological disorder. Children and teenagers with chronic physical illnesses exemplified by thalassemia are vulnerable to emotional and behavioral problems. The aim of this study was to evaluate mental health and its related factors among young patients with beta-thalassemia major.

METHODS

In this cross-sectional observational descriptive-analytic study, we studied 164 patients suffering from Beta-thalassemia major with age range of 15-24 years who referred for treatment to Ali Ebn-e Abitaleb (AS) University Hospital in Zahedan, a city in South East of Iran, during 2009-2010. The demographic data and pattern of mental health were collected by standard general health questionnaire (GHQ-28).Data was analyzed using statistical software SPSS (version 17.0); Student t test and Chi-square (χ2) were used.

RESULTS

In this study, 96 (58.5%) patients were male; the mean age of all patients was 18.78 ±2.28. Based on data analysis, 83 patients (50.8%) suspected to have psychiatric disorders (58.8% of girls, 44.8% of boys). In addition, frequency of somatic symptoms, depression disorder, anxiety disorder and social dysfunction in all patients were 7.3%, 11.6%, 8.5% and 4.3% respectively. In illiterate patients, 70.4% suspected to have psychiatric disorder. Except for somatic disorder, other mental disorders were more frequent in girls. No significant association was found between mental state and gender, marital and literacy status and occupation.

CONCLUSION

In this study, due to high prevalence of psychological disorders in young patients with Beta-thalassemia major, especially in girls, we suggest implementing further educational psychological programs to decrease the frequency of disorders. Moreover, conducting more quantitative and comprehensive researches is suggested to evaluate specific effective factors in psycho-social health.

Comparison of Mental Health, Aggression and Hopefulness between Student Drug-Users and Healthy Students (A Study in Iran)

BACKGROUND

Addiction is a social problem and a destructive phenomenon; like other social diversions, addiction destroys the country's most valuable assets, which are obviously the youth and the adolescents. In this regard, this study has been performed with the aim of comparing the mental health, aggression, and hopefulness of student drug-users and healthy students.

METHODS

The study has been performed by descriptive-analytical method among students of Kerman's universities in Iran. The study sample contained 520 people who were selected using a stratified random sampling method. Three questionnaires including General Health Questionnaire (GHQ-28), Buss-Perry Aggression Questionnaire (BPAQ) and Miller Hopefulness questionnaire have been used for data gathering. In this study, the student drug-users are those who use a substance (cigarettes, hookah, alcohol, opium, etc.) at least once a week.

FINDINGS

Findings showed that out of the 520 people under-study, 34.62% (180 people) are drug users, by whom the percentages of different substances used are as following: Hookah: 38.33%; Cigarettes: 28.35%; Alcohol: 20.55%; Opium: 5.55%; Cannabis: 2.23%; Heroin: 1.12%; Crack: 0.55%; Glass: 1.66 % and Psychotropic Pills and Ecstasy: 1.66%. A significant difference was observed in comparing the mental health, aggression, and hopefulness of student drug-users and healthy students (P < 0.05), so that the student drug-users had lower mental health and hopefulness and showed more aggression than the healthy group.

CONCLUSION

Substance abuse endangers the mental health of people and drug-users show more aggression and are less hopeful.