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Meng X. Access to mental health services in urban areas: examine the availability, affordability, and accessibility of mental health services in urban settings, particularly for individuals with intersecting marginalized identities. Curr Opin Psychiatry 2024; 37:185-190. [PMID: 38415764 DOI: 10.1097/yco.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW To offer an integrative overview of mental health services in urban areas across different social groups and underscore the challenges and potential solutions to improve access to mental health services in urban areas. RECENT FINDINGS The process of urbanization places a lot of toll on the current mental health services system. Challenges to both mental health and mental health services include the elevated risk of some mental and behavioral health issues, the increased demand for mental health services, and the intensification of mental health inequalities. The phenomenon of mental health inequalities is exacerbated in urban areas, with certain disadvantaged population groups more likely to report higher mental health issues and difficulties in accessing mental health services. Targeted and dedicated strategies are warranted to develop and allocate resources to address the mental health services needs among those simultaneously with multiple disadvantaged social and economic characteristics. SUMMARY Urbanization places a substantive burden on both mental health and mental health services and creates challenges to mental health services access. Integrative and multisectoral initiatives could shed light on effectively addressing the issues of access to mental health services in urban cities.
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Affiliation(s)
- Xiangfei Meng
- Department of Psychiatry, McGill University and Douglas Research Centre, Montreal, QC, Canada
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Torales J, Aveiro-Róbalo TR, Ríos-González C, Barrios I, Almirón-Santacruz J, González-Urbieta I, Caycho-Rodríguez T, Castaldelli-Maia JM, Ventriglio A. Discrimination, stigma and mental health: what's next? Int Rev Psychiatry 2023; 35:242-250. [PMID: 37267024 DOI: 10.1080/09540261.2023.2186218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 06/03/2023]
Abstract
Stigma and discrimination are a major ongoing problem in the field of mental health as these impact on patient outcomes, access to and acceptability of therapeutic interventions, their quality of life, general wellbeing, social inclusion and opportunities. Social stereotypes, culture and prejudices all contribute to continuing discrimination in mental health. Different settings where people function may also be sources of discrimination such as work and educational environments. The lack of knowledge and understanding of mental health/illness by individuals, their families, carers and policymakers as well as the social media reporting also impact on social attitudes to discrimination. It has been also described a relevant impact of stigma among specific social minorities reporting poor mental health such as elderly people, youths, sexual variants, persons with disability. Educational programs, raising awareness trainings and proper public policies may be developed in order to reduce stigma at social level with favourable outcomes for people with mental illness.
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Affiliation(s)
- Julio Torales
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Telmo Raúl Aveiro-Róbalo
- Department of Research Methodology, School of Medical Sciences, Universidad del Pacífico, Asunción, Paraguay
| | - Carlos Ríos-González
- National Institute of Health, Ministry of Health and Social Welfare, Asunción, Paraguay
| | - Iván Barrios
- Department of Statistics, School of Medical Sciences, National University of Asunción, Santa Rosa del Aguaray Campus, Santa Rosa del Aguaray, Paraguay
| | - José Almirón-Santacruz
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | | | | | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Fundação do ABC, Santo André, Brazil
- Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Lanza-León P, Pascual-Sáez M, Cantarero-Prieto D. Alleviating mental health disorders through doses of green spaces: an updated review in times of the COVID-19 pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:98-115. [PMID: 34821172 DOI: 10.1080/09603123.2021.2005780] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic has highlighted issues due to mental health disorders, in particular the serious consequences derived from lockdown measures. This paper aims to analyse the literature on the potential direct impact of the natural environment on mental health disorders. We have systematically reviewed the studies analysing green spaces and mental health included in this review using PubMed, Web of Science, Scopus and Cochrane Library. A retrospective time-frame is considered, covering the COVID-19 pandemic. We have found that exposure to, use and proximity to green spaces have a beneficial impact on mental health among elderly, students and patients with underlying pathologies. However, it has negative effects on the mental health of women and young adults. Exposure to and interaction with the natural environment can improve certain mental health disorders and should be taken into account for strategies and policies related to future threats to public health.
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Affiliation(s)
- Paloma Lanza-León
- Research Group of Health Economics and Health Service Management, Department of Economics, University of Cantabria - Idival, Santander, Spain
| | - Marta Pascual-Sáez
- Research Group of Health Economics and Health Service Management, Department of Economics, University of Cantabria - Idival, Santander, Spain
| | - David Cantarero-Prieto
- Research Group of Health Economics and Health Service Management, Department of Economics, University of Cantabria - Idival, Santander, Spain
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Urban Scaling of Health Outcomes: a Scoping Review. J Urban Health 2022; 99:409-426. [PMID: 35513600 PMCID: PMC9070109 DOI: 10.1007/s11524-021-00577-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/04/2022]
Abstract
Urban scaling is a framework that describes how city-level characteristics scale with variations in city size. This scoping review mapped the existing evidence on the urban scaling of health outcomes to identify gaps and inform future research. Using a structured search strategy, we identified and reviewed a total of 102 studies, a majority set in high-income countries using diverse city definitions. We found several historical studies that examined the dynamic relationships between city size and mortality occurring during the nineteenth and early twentieth centuries. In more recent years, we documented heterogeneity in the relation between city size and health. Measles and influenza are influenced by city size in conjunction with other factors like geographic proximity, while STIs, HIV, and dengue tend to occur more frequently in larger cities. NCDs showed a heterogeneous pattern that depends on the specific outcome and context. Homicides and other crimes are more common in larger cities, suicides are more common in smaller cities, and traffic-related injuries show a less clear pattern that differs by context and type of injury. Future research should aim to understand the consequences of urban growth on health outcomes in low- and middle-income countries, capitalize on longitudinal designs, systematically adjust for covariates, and examine the implications of using different city definitions.
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Menculini G, Albert U, Bianchini V, Carmassi C, Carrà G, Cirulli F, Dell'osso B, Fabrazzo M, Perris F, Sampogna G, Nanni MG, Pompili M, Sani G, Volpe U, Tortorella A. Did we learn something positive out of the COVID-19 pandemic? Post-traumatic growth and mental health in the general population. Eur Psychiatry 2022; 64:e79. [PMID: 35000665 PMCID: PMC8888429 DOI: 10.1192/j.eurpsy.2021.2263] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background When facing a traumatic event, some people may experience positive changes, defined as posttraumatic growth (PTG). Methods Understanding the possible positive consequences of the pandemic on the individual level is crucial for the development of supportive psychosocial interventions. The present paper aims to: 1) evaluate the levels of PTG in the general population; 2) to identify predictors of each dimension of post-traumatic growth. Results The majority of the sample (67%, N = 13,889) did not report any significant improvement in any domain of PTG. Participants reported the highest levels of growth in the dimension of “appreciation of life” (2.3 ± 1.4), while the lowest level was found in the “spiritual change” (1.2 ± 1.2). Female participants reported a slightly higher level of PTG in areas of personal strength (p < .002) and appreciation for life (p < .007) compared to male participants, while no significant association was found with age. At the multivariate regression models, weighted for the propensity score, only the initial week of lockdown (between 9-15 April) had a negative impact on the dimension of “relating to others” (B = −.107, 95% CI = −.181 to −.032, p < .005), while over time no other effects were found. The duration of exposure to lockdown measures did not influence the other dimensions of PTG. Conclusions The assessment of the levels of PTG is of great importance for the development of ad hoc supportive psychosocial interventions. From a public health perspective, the identification of protective factors is crucial for developing ad-hoc tailored interventions and for preventing the development of full-blown mental disorders in large scale.
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Affiliation(s)
- Giulia Menculini
- Department of Psychiatry, University of Perugia, Piazza Lucio Severi 1, 06132Perugia, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34128Trieste, Italy.,Department of Mental Health, Psychiatric Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina-ASUGI, 34128Trieste, Italy
| | - Valeria Bianchini
- Department of Life, Health and Environmental Sciences, Psychiatric Unit: Trattamenti Riabilitativi Psicosociali, Interventi Precoci, TRIP, Psychosocial Rehabilitation Treatment, Early Interventions University Unit, University of L'Aquila, 67100L'Aquila, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126Pisa, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milan Bicocca, 20126Milano, Italy
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, National Institute of Health, 00161Rome, Italy
| | - Bernardo Dell'osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, 20157Milan, Italy.,Department of Health Sciences, Aldo Ravelli Center for Neurotechnology and Brain Therapeutic, University of Milan, 20142Milan, Italy
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie, 80138Naples, Italy
| | - Francesco Perris
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie, 80138Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie, 80138Naples, Italy
| | - Maria Giulia Nanni
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, 44121Ferrara, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, University Cattolica del Sacro Cuore, 00168Rome, Italy.,Department of Psychiatry, Fondazione Policlinico Agostino Gemelli IRCCS, 00168Rome, Italy
| | - Umberto Volpe
- Clinical Psychiatry Unit, Department of Clinical Neurosciences, Università Politecnica delle Marche, 60121Ancona, Italy
| | - Alfonso Tortorella
- Department of Psychiatry, University of Perugia, Piazza Lucio Severi 1, 06132Perugia, Italy
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What Is the Role of Resilience and Coping Strategies on the Mental Health of the General Population during the COVID-19 Pandemic? Results from the Italian Multicentric COMET Study. Brain Sci 2021; 11:brainsci11091231. [PMID: 34573251 PMCID: PMC8466446 DOI: 10.3390/brainsci11091231] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
The effects of the COVID-19 pandemic on mental health are now well documented, however, few studies have been focused on the role of coping strategies and resilience in counterbalancing these detrimental effects. Data are derived from the COvid Mental hEalth Trial (COMET), a national multicentric trial carried out in the Italian general population. The final sample consisted of 20,720 participants, 53.1% (n = 11,000) of the sample reported low levels of resilience. Adaptive coping strategies and resilience levels did not have any significant protective impact on the levels of depressive, anxiety, and stress symptoms. Only self-distraction was a risk factor for poor mental health (Beta Coefficient, B = 0.1, 95% Confidence Interval, CI: 0.003 to 0.267 for stress symptoms; B = 0.2; 95% CI: 0.077 to 0.324 for anxiety symptoms and B = 0.2, 95% CI: 0.105 to 0.382 for depressive symptoms). High levels of resilience were predicted by adaptive coping strategies, such as acceptance (B = 1.8, CI 95% = 1.4–2.7). Exposure to the different weeks of lockdown, being infected by COVID-19, and being a healthcare professional did not influence the levels of resilience. Our findings should be carefully considered, since the low levels of resilience may represent the missing link between the pandemic and the current increase in mental health problems.
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Psychological Distress in Urbanizing China: How Does Local Government Effectiveness Matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042042. [PMID: 33669784 PMCID: PMC7922421 DOI: 10.3390/ijerph18042042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022]
Abstract
Despite growing literature identifying key individual, family, community, and environmental factors as causes for mental disorders during the process of urbanization, the role played by local government has not been taken into account. In this article, we investigate how the effectiveness of local government affects residents' levels of psychological distress in areas of China undergoing urbanization. We measure the effectiveness of local governments according to their success in promoting access to the social security system through the distribution of social security cards among citizens. We hypothesize that higher local government effectiveness will reduce residents' psychological distress by alleviating worries about medical expenses and elder care. Drawing on data from the 2018 Urbanization and Quality of Life Survey (N = 3229) conducted in 40 localities undergoing rural-urban transition, we estimate three-level mixed-effects regression models to test the research hypotheses, allowing random effects at the township/county and neighborhood levels while controlling for a series of individual attributes. The results demonstrate that local government effectiveness is negatively associated with residents' psychological distress: effective local governments alleviate worries about medical expenses and elder care, and thereby reduce psychological distress. The findings indicate that, to reduce residents' worries and psychological distress during the process of rural-urban transition, it is essential to improve local government effectiveness, particularly in promoting residents' access to the social security system. Beyond demonstrating how local government effectiveness matters for residents' psychological distress, our research also illustrates how to properly model locational parameters in analyses of individual well-being.
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Abstract
Rapid urbanization worldwide is associated to an increase of population in the urban settings and this is leading to new emerging mental health issues. This narrative mini-review is based on a literature search conducted through PubMed and EMBASE. A total of 113 articles published on the issue of urban mental health have been selected, cited, reviewed, and summarized. There are emerging evidences about the association between urbanization and mental health issues. Urbanization affects mental health through social, economic, and environmental factors. It has been shown that common mental syndromes report higher prevalence in the cities. Social disparities, social insecurity, pollution, and the lack of contact with nature are some of recognized factors affecting urban mental health. Further reserach studies and specific guidelines should be encouraged to help policy makers and urban designers to improve mental health and mental health care facilities in the cities; additional strategies to prevent and reduce mental illness in the urban settings should be also adopted globally.
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Carta MG, Angermeyer MC, Holzinger A. Mental health care in Italy: Basaglia's ashes in the wind of the crisis of the last decade. Int J Soc Psychiatry 2020; 66:321-330. [PMID: 32141359 DOI: 10.1177/0020764020908620] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The purpose is to highlight the legal and ethical principles that inspired the reform of mental health care in Italy, the only country to have closed its psychiatric hospitals. The article will also try to verify some macro-indicators of the quality of care and discuss the crisis that the mental health care system in Italy is experiencing. METHODS Narrative review. RESULTS The principal changes in the legislation on mental health care in Italy assumed an important role in the evolution of morals and common sense of the civil society of that country. We describe three critical points: first, the differences in implementation in the different Italian regions; second, the progressive lack of resources that cannot be totally attributed to the economic crisis and which has compromised application of the law; and finally, the scarce attention given to measurement of change with scientific methods. CONCLUSION Italy created a revolutionary approach to mental health care in a historical framework in which it produced impressive cultural expressions in many fields. At that time, people were accustomed to 'believing and doing' rather than questioning results and producing research, and this led to underestimating the importance of a scientific approach. With its economic and cultural crisis, Italy has lost creativity as well as interest in mental health, which has been guiltily neglected. Any future humanitarian approach to mental health must take the Italian experience into account, but must not forget that verification is the basis for any transformation in health care culture.
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Affiliation(s)
- Mauro G Carta
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | | | - Anita Holzinger
- Teaching Center, Medical University of Vienna, Vienna, Austria
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Affiliation(s)
- J-P Michel
- Jean-Pierre Michel, Medical University of Geneva, Switzerland,
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Bhugra D, Castaldelli-Maia JM, Torales J, Ventriglio A. Megacities, migration, and mental health. Lancet Psychiatry 2019; 6:884-885. [PMID: 31395525 DOI: 10.1016/s2215-0366(19)30294-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, São Paulo, Brazil; Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
| | - Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, Asunción, Paraguay
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia 71121, Italy.
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The relationship between neighborhood-level socioeconomic characteristics and individual mental disorders in five cities in Latin America: multilevel models from the World Mental Health Surveys. Soc Psychiatry Psychiatr Epidemiol 2019; 54:157-170. [PMID: 30173317 PMCID: PMC6849376 DOI: 10.1007/s00127-018-1595-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 08/20/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Our understanding of community-level predictors of individual mental disorders in large urban areas of lower income countries is limited. In particular, the proportion of migrant, unemployed, and poorly educated residents in neighborhoods of these urban areas may characterize group contexts and shape residents' health. METHODS Cross-sectional household interviews of 7251 adults were completed across 83 neighborhoods of Buenos Aires, Argentina; Medellín, Colombia; São Paulo, Brazil; Lima, Peru; and Mexico City, Mexico as part of the World Mental Health Survey Initiative. Past-year internalizing and externalizing mental disorders were assessed, and multilevel models were used. RESULTS Living in neighborhoods with either an above-average or below-average proportion of migrants and highly educated residents was associated with lower odds of any internalizing disorder (for proportion migrants: OR 0.75, 95% CI 0.62-0.91 for the bottom tertile and OR 0.79, 95% CI 0.67-0.94 for the top tertile compared to the middle tertile; for proportion highly educated: OR 0.76, 95% CI 0.64-0.90 for the bottom tertile and OR 0.58, 95% CI 0.37-0.90 for the top tertile compared to the middle tertile). Living in neighborhoods with an above-average proportion of unemployed individuals was associated with higher odds of having any internalizing disorder (OR 1.49, 95% CI 1.14-1.95 for the top tertile compared to the middle tertile). The proportion of highly educated residents was associated with lower odds of externalizing disorder (OR 0.54, 95% CI 0.31-0.93 for the top tertile compared to the middle tertile). CONCLUSIONS The associations of neighborhood-level migration, unemployment, and education with individual-level odds of mental disorders highlight the importance of community context for understanding the burden of mental disorders among residents of rapidly urbanizing global settings.
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