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Bhugra D, Liebrenz M, Ventriglio A, Ng R, Javed A, Kar A, Chumakov E, Moura H, Tolentino E, Gupta S, Ruiz R, Okasha T, Chisolm MS, Castaldelli-Maia J, Torales J, Smith A. World Psychiatric Association-Asian Journal of Psychiatry Commission on Public Mental Health. Asian J Psychiatr 2024; 98:104105. [PMID: 38861790 DOI: 10.1016/j.ajp.2024.104105] [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: 11/02/2023] [Revised: 04/22/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.
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Affiliation(s)
- Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neurosciences, Kings College, London SE5 8AF, United Kingdom.
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | | | - Roger Ng
- World Psychiatric Association, Geneva, Switzerland
| | | | - Anindya Kar
- Advanced Neuropsychiatry Institute, Kolkata, India
| | - Egor Chumakov
- Department of Psychiatry & Addiction, St Petersburg State University, St Petersburg, Russia
| | | | | | - Susham Gupta
- East London NHS Foundation Trust, London, United Kingdom
| | - Roxanna Ruiz
- University of Francisco Moaroquin, Guatemala City, Guatemala
| | | | | | | | | | - Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
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Marshall CA, Cooke A, Holmes J, Bengall J, Aryobi S, Phillips B, Lysaght R, Gewurtz R. "It's like your days are empty and yet there's life all around": A mixed methods, multi-site study exploring boredom during and following homelessness. PLoS One 2024; 19:e0302900. [PMID: 38781159 PMCID: PMC11115236 DOI: 10.1371/journal.pone.0302900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE To identify experiences of boredom and associations with psychosocial well-being during and following homelessness. METHODS Using a convergent, mixed-methods explanatory design, we conducted quantitative interviews with 164 participants) (n = 102 unhoused; n = 62 housed following homelessness) using a 92-item protocol involving demographic components and seven standardized measures of psychosocial well-being. A sub-sample (n = 32) was approached to participate in qualitative interviews. Data were analyzed by group (unhoused; housed). Quantitative data were analyzed using descriptive statistics designed to generate insights into boredom, meaningful activity engagement, and their associations with psychosocial well-being during and following homelessness. Qualitative data were analyzed using thematic analysis. Quantitative and qualitative findings were integrated at the stage of discussion. RESULTS Quantitative analyses revealed small to moderate correlations between boredom and increased hopelessness (rs = .376, p < .01), increased drug use (rs = .194, p < .05), and lowered mental well-being (rs = -.366, p < .01). There were no statistically significant differences between unhoused and housed participants on any standardized measures. Hierarchical regression analyses revealed that housing status was not a significant predictor of boredom or meaningful activity engagement (p>.05). Qualitative interviews revealed profound boredom during and following homelessness imposing negative influences on mental well-being and driving substance use. CONCLUSIONS Boredom and meaningful activity are important outcomes that require focused attention in services designed to support individuals during and following homelessness. Attention to this construct in future research, practice, and policy has the potential to support the well-being of individuals who experience homelessness, and to contribute to efforts aimed at homelessness prevention.
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Affiliation(s)
- Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Abrial Cooke
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Julia Holmes
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jordana Bengall
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Suliman Aryobi
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Brooke Phillips
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Rosemary Lysaght
- School of Rehabilitation Science, Queen’s University, Kingston, Ontario, Canada
| | - Rebecca Gewurtz
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Sansone N, Tyano S, Melillo A, Schouler-Ocak M, Galderisi S. Comparing the World Psychiatric Association and European Psychiatric Association Codes of Ethics: Discrepancies and shared grounds. Eur Psychiatry 2024; 67:e38. [PMID: 38712570 DOI: 10.1192/j.eurpsy.2024.1748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Codes of ethics provide guidance to address ethical challenges encountered in clinical practice. The harmonization of global, regional, and national codes of ethics is important to avoid gaps and discrepancies. METHODS We compare the European Psychiatric Association (EPA) and the World Psychiatric Association (WPA) Codes of Ethics, addressing main key points, similarities, and divergences. RESULTS The WPA and EPA codes are inspired by similar fundamental values but do show a few differences. The two codes have a different structure. The WPA code includes 4 sections and lists 5 overarching principles as the basis of psychiatrists' clinical practice; the EPA code is articulated in 8 sections, lists 4 ethical principles, and several fundamental values. The EPA code does not include a section on psychiatrists' education and does not contain specific references to domestic violence and death penalty. Differences can be found in how the two codes address the principle of equity: the EPA code explicitly refers to the principle of universal health care, while the WPA code mentions the principle of equity as reflected in the promotion of distributive justice. CONCLUSIONS We recommend that both WPA and EPA periodically update their ethical codes to minimize differences, eliminate gaps, and help member societies to develop or revise national codes in line with the principles of the associations they belong to.Minimizing differences between national and international codes and fostering a continuous dialogue on ethical issues will provide guidance for psychiatrists and will raise awareness of the importance of ethics in our profession.
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Affiliation(s)
- Noemi Sansone
- University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Samuel Tyano
- Department of Psychiatry, Tel Aviv University Medical School, Tel Aviv, Israel
| | | | - Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
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Macfarlane S, Haigh F, Woodland L, Goodger B, Larkin M, Miller E, Parcsi L, Read P, Wood L. Critical Success Factors for Intersectoral Collaboration: Homelessness and COVID-19 - Case Studies and Learnings from an Australian City. Int J Integr Care 2024; 24:19. [PMID: 38828122 PMCID: PMC11141504 DOI: 10.5334/ijic.7653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction The COVID-19 pandemic disproportionally impacted people experiencing homelessness, including people sleeping rough, people in temporary accommodation and those living in boarding houses. This paper reports on intersectoral responses across six health and social care agencies in Inner Sydney, New South Wales, Australia. Prior to the pandemic the six agencies had established an Intersectoral Homelessness Health Strategy (IHHS), in recognition of the need for intersectoral collaboration to address the complex health needs of people experiencing homelessness. Description The governance structure of the IHHS provided a platform for several innovative intersectoral responses to the pandemic. A realist informed framework was used to select, describe, and analyse case studies of intersectoral collaboration. Discussion The resultant six critical success factors (trust, shared ways of working, agile collaboration, communication mechanisms, authorising environment, and sustained momentum), align with the existing literature that explores effective intersectoral collaboration in complex health or social care settings. This paper goes further by describing intersectoral collaboration 'in action', setting a strong foundation for future collaborative initiatives. Conclusion While there is no single right approach to undertaking intersectoral collaboration, which is highly context specific, the six critical success factors identified could be applied to other health issues where dynamic collaboration and integration of healthcare is needed.
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Affiliation(s)
| | - Fiona Haigh
- Centre for Primary Health Care and Equity (CPHCE), University of New South Wales Sydney, Australia
- Health Equity Research and Development Unit (HERDU), A unit of Clinical Services Integration and Population Health, Sydney Local Health District, Sydney, Australia
| | - Lisa Woodland
- South Eastern Sydney Local Health District, Sydney, Australia
| | - Brendan Goodger
- Central Eastern Sydney Primary Health Network, Sydney, Australia
| | | | - Erin Miller
- Sydney Local Health District, Sydney, Australia
| | - Lisa Parcsi
- Sydney Local Health District, Sydney, Australia
| | - Phillip Read
- South Eastern Sydney Local Health District, Sydney, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Lisa Wood
- Institute for Health Research, University of Notre Dame, Freemantle, Australia
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Serchen J, Hilden DR, Beachy MW. Meeting the Health and Social Needs of America's Unhoused and Housing-Unstable Populations: A Position Paper From the American College of Physicians. Ann Intern Med 2024; 177:514-517. [PMID: 38408358 DOI: 10.7326/m23-2795] [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: 02/28/2024] Open
Abstract
Access to safe and stable housing has both a direct and indirect effect on health. Experiencing homelessness and housing instability can induce stress and trauma, worsening behavioral health and substance use. The absence of safe and stable living conditions can make it challenging to rest, recuperate, and recover from health ailments and can pose barriers to treatment adherence. Homelessness and housing instability is associated with high rates of numerous diseases and chronic conditions. Its cyclical relationship with other social drivers of health can exacerbate health disparities. As a result, unhoused persons experience unique health challenges and require a health care system and professionals designed to meet their distinct needs. Physicians and other health professionals have a role in educating themselves about the needs of unhoused patients as well as making themselves aware of community and government resources available to these populations. Policymakers must support health professionals in these efforts by supporting the data infrastructure needed to facilitate these referrals to resources, supporting research into best practices for caring for these populations, and investing in community-based organization capacity. Policy action is needed to address the underlying drivers of homelessness, including a dearth of affordable housing, while also addressing the short-term need for safe shelter now. In this position paper, the American College of Physicians (ACP) recognizes the need to address universal access to housing to fulfill one's right to health. ACP offers several recommendations to prevent homelessness and promote the necessary health care and social needs of unhoused populations.
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Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S.)
| | | | - Micah W Beachy
- Nebraska Medicine-University of Nebraska Medical Center, Omaha, Nebraska (M.W.B.)
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Beaugard CA, Khudairi F, Yesufu O, Farina A, Laks J. "I don't think of it as a shelter. I say I'm going home": a qualitative evaluation of a low-threshold shelter for women who use drugs. Harm Reduct J 2024; 21:44. [PMID: 38374063 PMCID: PMC10877776 DOI: 10.1186/s12954-024-00930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/06/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In 2021-2022, encampments in a downtown Boston neighborhood reached record heights, increasing the visibility of drug use and homelessness in the city. In response, the city planned a "sweep" (i.e., eradication of encampments) and requested support from social services and medical providers to pilot low-threshold shelters. Low-threshold shelters reduce barriers to staying in traditional congregate shelters with more flexible regulations, longer-term bed assignments, and secured storage for contraband (e.g., drugs, weapons) instead of forced disposal. One homeless service provider opened a harm reduction-focused shelter for women who use drugs. This report describes the low-threshold shelter design and program evaluation. METHODS This program evaluation had two primary aims: (1) to examine guests' beliefs about shelter policies and practices; and (2) to understand the staff's experiences working in a low-threshold model. We conducted semi-structured qualitative interviews with 16 guests and 12 staff members during the summer 2022. Interviews were thematically analyzed. RESULTS Guests expressed overwhelming approval for the shelter's policies, which they stated supported their autonomy, dignity, and safety. They emphasized the staff's willingness to build relationships, thus demonstrating true commitment to the guests. Guests highlighted the value of daytime access to the shelter, as it granted them autonomy over their time, reduced their substance use, and helped them build relationships with staff and other guests. The co-directors and staff designed the shelter quickly and without US models for reference; they turned to international literature, local harm reduction health care providers, and women living in encampments for guidance on the shelter policies. The staff were passionate and committed to the health and stability of the guests. Most staff found value in the low-threshold model, though some were challenged by it, believing it enabled drug use and did not require the guests to "get better." CONCLUSIONS This evaluation indicates the value of low-threshold, harm reduction shelters as alternatives to traditional models. While these shelters do not mitigate the need for overarching housing reform, they are important measures to meet the needs of women experiencing unsheltered homelessness who face intersectional oppression.
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Affiliation(s)
- Corinne A Beaugard
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA, 02215, USA.
- , 801 Massachusetts Avenue, Crosstown Building 4th Floor, Suite 400, Boston, MA, 02180, USA.
| | - Fay Khudairi
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
| | - Oluwatoyin Yesufu
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
| | - Andrea Farina
- St. Francis House, 39 Boylston St, Boston, MA, 02116, USA
| | - Jordana Laks
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
- Chobanian and Avedisian School of Medicine, Department of Internal Medicine, Boston University, 801 Massachusetts Ave 6th Floor, Boston, MA, 02119, USA
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Su KY, Feldman BJ, Feldman CT, Saluja S, Coulourides Kogan AM, Cousineau MR. Behavioral Health Care Delivery Through Street Medicine Programs in California. Community Ment Health J 2024; 60:283-291. [PMID: 37526807 PMCID: PMC10822007 DOI: 10.1007/s10597-023-01169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
Mental health and substance use disorders are prevalent among people experiencing homelessness. Street Medicine can reach unhoused people who face barriers to accessing healthcare in more traditional medical settings including shelter-based clinics. However, there is little guidance on best practices for mental health and substance use treatment through Street Medicine. The aim of the study was to describe behavioral health care through Street Medicine by analyzing data from the California Street Medicine Landscape survey and follow-up qualitative interviews. Most street medicine programs utilize non-psychiatrists to diagnose and treat mental health and substance use disorders, though the capacity to provide the level of care needed varies. There is a lack of street-based psychiatric clinicians and programs have difficulty making referrals to mental health and addiction services. This report shows that Street Medicine could serve as a strategy to expand access to behavioral health care for the unhoused.
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Affiliation(s)
- Kimberly Y Su
- Keck School of Medicine of USC, Los Angeles, CA, USA.
| | | | | | - Sonali Saluja
- Keck School of Medicine of USC, Los Angeles, CA, USA
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Namata C, Hatzidimitriadou E. Strategies for improving access to primary care services for homeless immigrants in England: a Delphi study. Prim Health Care Res Dev 2023; 24:e70. [PMID: 38093561 PMCID: PMC10790723 DOI: 10.1017/s1463423623000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/22/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
AIM The aim of the study was to identify the most prioritized strategies in improving access to primary care services (PCS) for homeless immigrants. BACKGROUND The issue of improving access to PCS for homeless immigrants is a complex and multifaceted one, and yet there is limited research on the strategies aimed at improving these services. Hence, the need for more studies that directly engage homeless immigrants and service providers in understanding their barriers to accessing PCS and their preferences for improving access to these services. METHODS The study used a two round Delphi method to elicit the views of stakeholders. The Delphi process utilized a web-based questionnaire. The stakeholders included healthcare providers and voluntary sector providers. The first round had a total of 58 items belonging to 14 categories. The second round comprised a total of 25 items belonging to 12 categories which were preselected based on participants' ranking of their importance in the first round. Participants were required to rank the relative importance of all the items on a 5-point Likert scale. Data were analysed using the STATA-15 software package. FINDINGS A total of 12 stakeholders participated in both rounds of the Delphi survey. The top three strategies encompassed fighting against discrimination and prejudice, improving and promoting mental health services, and empowering homeless immigrants. These evidence-based strategies hold the potential to support the implementation of healthcare interventions aimed at improving access to PCS and healthcare outcomes for homeless immigrants. However, it is crucial to conduct further research that includes homeless immigrants in the Delphi study to gain insights into the strategies that are most important to them in enhancing access to PCS, as they are the primary target users. Such research will contribute to the development of comprehensive and effective interventions tailored to the specific needs of homeless.
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Affiliation(s)
- Carol Namata
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, England
| | - Eleni Hatzidimitriadou
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, England
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Marshall CA, Phillips B, Holmes J, Todd E, Hill R, Panter G, Easton C, Landry T, Collins S, Greening T, O’Brien A, Jastak M, Ridge R, Goldszmidt R, Shanoff C, Laliberte Rudman D, Carlsson A, Aryobi S, Szlapinski J, Carrillo-Beck R, Pacheco N, Perez S, Oudshoorn A. "I can't remember the last time I was comfortable about being home": lived experience perspectives on thriving following homelessness. Int J Qual Stud Health Well-being 2023; 18:2176979. [PMID: 36803094 PMCID: PMC9946331 DOI: 10.1080/17482631.2023.2176979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
PURPOSE Strategies for preventing and ending homelessness are frequently measured by their effectiveness on indices of tenancy sustainment. To shift this narrative, we conducted research to identify what is needed to "thrive" following homelessness from the perspectives of persons with lived experience in Ontario, Canada. METHODS Conducted in the context of a community-based participatory research study aimed at informing the development of intervention strategies, we interviewed 46 persons living with mental illness and/or substance use disorder [n = 25 (54.3%) unhoused; n = 21 (45.7%) housed following homelessness] using qualitative interviews. A subsample of 14 participants agreed to engage in photovoice interviews. We analysed these data abductively using thematic analysis informed by health equity and social justice. RESULTS Participants described experiences of "living in a state of lack" following homelessness. This essence was expressed through four themes: 1) housing as part one of the journey to home; 2) finding and keeping "my people"; 3) meaningful activity as critical for thriving following homelessness; and 4) struggling to access mental health supports in the context of challenging circumstances. CONCLUSIONS Individuals struggle to thrive following homelessness in the context of insufficient resources. There is a need to build on existing interventions to address outcomes beyond tenancy sustainment.
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Affiliation(s)
- Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada,CONTACT Carrie Anne Marshall Assistant Professor Western University, Occupational Therapy Director, Social Justice in Mental Health Research Lab – www.sjmhlab.com Faculty of Health Sciences Elborn College, Room 2533 1201 Western Rd., London, ON, Canada N6H 1H1 Tel: 519 661-2111 Ext. 88956
| | - Brooke Phillips
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Julia Holmes
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Eric Todd
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | | | - George Panter
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Corinna Easton
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | | | - Sarah Collins
- Salvation Army London Centre of Hope, London, Canada
| | | | | | - Marlo Jastak
- Addiction and Mental Health Services Kingston, Frontenac, Lennox & Addington (KFLA), Kingston, Canada
| | | | - Rebecca Goldszmidt
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Chelsea Shanoff
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | | | | | - Suliman Aryobi
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Jessica Szlapinski
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Rozelen Carrillo-Beck
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Nicole Pacheco
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Shauna Perez
- Addiction and Mental Health Services Kingston, Frontenac, Lennox & Addington (KFLA), Kingston, Canada
| | - Abe Oudshoorn
- School of Nursing, Western University, London, Canada
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Neves Horácio A, Bento A, Gama Marques J. Personality and attachment in the homeless: A systematic review. Int J Soc Psychiatry 2023; 69:1312-1326. [PMID: 36951386 PMCID: PMC10523821 DOI: 10.1177/00207640231161201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Homeless people present high rates of psychopathology, including personality disorders. Given the link between personality disorders and attachment, and the potential importance of these two traits for understanding homeless populations. AIMS Our aim was to review all studies focusing on attachment and on the full assessment of personality disorders in the homeless. METHOD Overall, 213 studies were screened through title and abstract. Of these, 63 articles were chosen for full-text assessment. RESULTS A total of 14 articles met eligibility criteria and were included in the present review. Six studies evaluated personality disorders and eight studies assessed attachment in the homeless. In general, reports suggested that personality disorders are highly common in the homeless, with frequencies ranging between 64% and 79% for any personality disorder. The most common personality diagnoses were paranoid (14%-74%), borderline (6%-62%), avoidant (14%-63%), and antisocial (4%-57%) personality disorders. Attachment reports differed in the methods used and presented diverse results and correlates. Even so, insecure types of attachment dominated in the homeless, accounting for 62% to 100% of the samples. CONCLUSIONS The high prevalence of personality disorders and insecure types of attachment in the homeless may impact intervention strategies for these people. The available literature evaluating attachment and the full assessment of personality disorders in the homeless is scarce, which supports the need for more research on these two topics.
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Affiliation(s)
- Andreia Neves Horácio
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - António Bento
- Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
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Natividad M, Seeman MV, Paolini JP, Balagué A, Román E, Bagué N, Izquierdo E, Salvador M, Vallet A, Pérez A, Monreal JA, González-Rodríguez A. Monitoring the Effectiveness of Treatment in Women with Schizophrenia: New Specialized Cooperative Approaches. Brain Sci 2023; 13:1238. [PMID: 37759839 PMCID: PMC10526759 DOI: 10.3390/brainsci13091238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Women with schizophrenia have specific health needs that differ from those of men and that change through successive life stages. We aimed to review the biopsychosocial literature on schizophrenia that addresses clinically important questions related to the treatment of women, including somatic morbi-mortality, hyperprolactinemia, comorbid substance use disorders, social risk factors, and medication effectiveness/safety. Data search terms were as follows: (Morbidity AND mortality) OR hyperprolactinemia OR ("substance use disorders" OR addictions) OR ("social risk factors") OR ("drug safety" OR prescription) AND women AND schizophrenia. A secondary aim was to describe a method of monitoring and interdisciplinary staff strategies. Schizophrenia patients show an increased risk of premature death from cardiovascular/respiratory disease and cancer compared to the general population. The literature suggests that close liaisons with primary care and the introduction of physical exercise groups reduce comorbidity. Various strategies for lowering prolactin levels diminish the negative long-term effects of hyperprolactinemia. Abstinence programs reduce the risk of victimization and trauma in women. Stigma associated with women who have serious psychiatric illness is often linked to reproductive functions. The safety and effectiveness of antipsychotic drug choice and dose differ between men and women and change over a woman's life cycle. Monitoring needs to be multidisciplinary, knowledgeable, and regular.
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Affiliation(s)
- Mentxu Natividad
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Mary V. Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5P 3L6, Canada;
| | - Jennipher Paola Paolini
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Ariadna Balagué
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Eloïsa Román
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Noelia Bagué
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Eduard Izquierdo
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Mireia Salvador
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Anna Vallet
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - Anabel Pérez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
| | - José A. Monreal
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
- Institut de Neurociències, Universitat Autònoma de Barcelona (UAB), 08221 Terrassa, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, Fundació Docència i Recerca Mutua Terrassa, University of Barcelona, 08221 Terrassa, Spain; (M.N.); (J.P.P.); (E.R.); (N.B.); (E.I.); (M.S.); (A.V.); (A.P.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
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12
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Yohannes K, Berhane Y, Bradby H, Herzig van Wees S, Målqvist M. Contradictions hindering the provision of mental healthcare and psychosocial services to women experiencing homelessness in Addis Ababa, Ethiopia: service providers' and programme coordinators' experiences and perspectives. BMC Health Serv Res 2023; 23:821. [PMID: 37528372 PMCID: PMC10391936 DOI: 10.1186/s12913-023-09810-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Mental health conditions are among the health issues associated with homelessness, and providing mental healthcare to people experiencing homelessness is challenging. Despite the pressing issue of homelessness in Addis Ababa, Ethiopia, there is scant research on how service providers address women's mental health and psychosocial needs. Therefore, we explored service providers' and programme coordinators' perceptions and experiences regarding mental healthcare and psychosocial services delivery to women experiencing street homelessness in the city. METHODS We conducted a descriptive qualitative study with selected healthcare and social support providers and programme coordinators. The study involved 34 participants from governmental and non-governmental organisations in Addis Ababa, Ethiopia. Data were analysed using an inductive thematic approach. RESULTS Four themes were derived from the analysis. The first of these was "divergent intentions and actions". While service providers and programme coordinators showed empathy and compassion, they also objectified and blamed people for their own homelessness. They also expressed opposing views on mental health stigma and compassion for these people. The second theme addressed "problem-solution incompatibility", which focused on the daily challenges of women experiencing homelessness and the types of services participants prioritised. Service providers and programme coordinators proposed non-comprehensive support despite the situation's complexity. The participants did not emphasise the significance of gender-sensitive and trauma-informed care for women experiencing street homelessness in the third theme, "the lack of gendered and trauma-informed care despite an acknowledgement that women face unique challenges". The fourth theme, "mismatched resources," indicated structural and systemic barriers to providing services to homeless women. CONCLUSIONS Conflicting attitudes and practices exist at the individual, organisational, and systemic levels, making it challenging to provide mental healthcare and psychosocial services to women experiencing homelessness. An integrated, gender-sensitive, and trauma-informed approach is necessary to assist women experiencing homelessness.
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Affiliation(s)
- Kalkidan Yohannes
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden.
- Department of Women's and Children's Health, WoMHeR- Women's Mental Health during the Reproductive Lifespan, Uppsala University, Uppsala, Sweden.
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- International Child Health and Nutrition- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Sibylle Herzig van Wees
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Mats Målqvist
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden
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13
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Mugambwa KA, Lutchmun W, Gach J, Bader C, Froeschl G. Mental health of people with limited access to health services: a retrospective study of patients attending a humanitarian clinic network in Germany in 2021. BMC Psychiatry 2023; 23:270. [PMID: 37076828 PMCID: PMC10114436 DOI: 10.1186/s12888-023-04727-7] [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: 09/29/2022] [Accepted: 03/29/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Germany has a statutory health insurance system. However, a substantial part of the population still suffers from limited access to regular health services. While humanitarian organizations are partially filling this gap, people with limited access show a high prevalence of mental disorders. This study investigates the prevalence, and social determinants of mental disorders in patients attending the clinics of a humanitarian health network in three major cities in Germany, as well as perceived barriers to healthcare access in this population. METHODS We performed a descriptive, retrospective study of individuals attending the outpatient clinics of the humanitarian organization Ärzte der Welt, in Berlin, Hamburg and Munich, in 2021. Medico-administrative data was collected using a digital questionnaire at first presentation to the clinics. We report the prevalence of both perceived altered mental health and diagnosed mental disorders, as well as the perceived barriers to healthcare access in this population. We performed a logistic regression analysis to identify the socio-demographic factors associated with mental disorders. RESULTS Our study population consisted of 1,071 first presenters to the clinics in 2021. The median age at presentation was 32 years and 57.2% of the population were male. 81.8% experienced a form of homelessness, 40% originated from non-EU countries and only 12.4% had regular statutory health insurance. 101 (9.4%) patients had a diagnosed mental disorder. In addition, 128 (11.9%) patients reported feeling depressed, 99 (9.2%) reported a lack of interest in daily activities, and 134 (12.5%) lacked emotional support in situations of need on most days. The most reported barrier to accessing health services was high health expenses, reported by 61.3% of patients.In the bivariate logistic regression analysis age, insurance status and region of origin were significantly associated with mental disorders. In the multivariable analysis, only age groups 20-39 and 40-59 years remained significant. CONCLUSIONS People with limited access to regular health services have a high need for mental health services. As a chronic condition, this is even more difficult to manage outside of regular services, where humanitarian clinics are only filling the gap in serving basic health needs.
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Affiliation(s)
- Kashung Annie Mugambwa
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.
- Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Wandini Lutchmun
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Janina Gach
- Ärzte der Welt Deutschland e.V, Munich, Germany
| | | | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany
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14
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Subica AM, Sampaga DS, Ortiz-Misiaszek J, Martin TKK, Okamoto SK. The Mental Health, Substance Use, Physical Health, and Mental Health Treatment Need of Community Individuals Experiencing Homelessness in Hawai'i. Community Ment Health J 2023; 59:1021-1026. [PMID: 36892628 PMCID: PMC9995740 DOI: 10.1007/s10597-022-01076-9] [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: 09/10/2022] [Accepted: 12/13/2022] [Indexed: 03/10/2023]
Abstract
Limited research has examined the mental health of individuals experiencing homelessness in Hawai'i, which bears the nation's second highest homelessness rate. Mental health, substance use, treatment need, and health data were collected from 162 unhoused individuals in Hawai'i County by visiting community locations where they congregate (e.g., beaches, vacant buildings). 77% of participants were Native Hawaiian/Pacific Islander (NH/PI) with participants demonstrating severe rates of mental and substance use disorders including 57% experiencing major depressive disorder (MDD), 56% experiencing generalized anxiety disorder (GAD), and 64%, 74%, and 12% experiencing alcohol, methamphetamine, and opioid use disorders, respectively-heightening overdose risk. Treatment need was high (62%) but health was poor (85% reporting fair/poor health), with MDD and GAD predicting reduced general health (p < 0.05). Study findings indicate Hawai'i unhoused individuals are disproportionately Indigenous NH/PI, enduring striking mental and physical health disparities that may be reduced by increasing access/utilization of community mental health programs/services.
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Affiliation(s)
- Andrew M Subica
- Department of Social Medicine, Population, and Public Health, University of California, Riverside School of Medicine, 900 University Ave, 92521, Riverside, CA, USA.
| | | | | | - Tammy K K Martin
- School of Social Work, Hawai'i Pacific University, Honolulu, HI, USA
| | - Scott K Okamoto
- Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, Honolulu, HI, USA
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15
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Schiffler T, Kapan A, Gansterer A, Pass T, Lehner L, Gil-Salmeron A, McDermott DT, Grabovac I. Characteristics and Effectiveness of Co-Designed Mental Health Interventions in Primary Care for People Experiencing Homelessness: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:892. [PMID: 36613214 PMCID: PMC9820061 DOI: 10.3390/ijerph20010892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023]
Abstract
People experiencing homelessness (PEH) face a disproportionately high prevalence of adverse mental health outcomes compared with the non-homeless population and are known to utilize primary healthcare services less frequently while seeking help in emergency care facilities. Given that primary health services are more efficient and cost-saving, services with a focus on mental health that are co-designed with the participation of users can tackle this problem. Hence, we aimed to synthesize the current evidence of such interventions to assess and summarize the characteristics and effectiveness of co-designed primary mental healthcare services geared towards adult PEH. Out of a total of 10,428 identified records, four articles were found to be eligible to be included in this review. Our findings show that co-designed interventions positively impacted PEH's mental health and housing situation or reduced hospital and emergency department admissions and increased primary care utilization. Therefore, co-designed mental health interventions appear a promising way of providing PEH with continued access to primary mental healthcare. However, as co-designed mental health interventions for PEH can improve overall mental health, quality of life, housing, and acute service utilization, more research is needed.
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Affiliation(s)
- Tobias Schiffler
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Ali Kapan
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Alina Gansterer
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Thomas Pass
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Lisa Lehner
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
- Department of Science & Technology Studies, Cornell University, 303 Morrill Hall, Ithaca, NY 14853, USA
| | - Alejandro Gil-Salmeron
- International Foundation for Integrated Care, Wolfson College, Linton Rd., Oxford OX2 6UD, UK
| | - Daragh T. McDermott
- NTU Psychology, School of Social Sciences, Nottingham Trent University, Nottingham NG1 4FQ, UK
| | - Igor Grabovac
- Center for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
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16
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Abstract
BACKGROUND Our goal was to identify the demographic profile of the people living homeless with mental illness in Lisboa, Portugal, and their relationship with the national healthcare system. We also tried to understand which factors contribute to the number and duration of psychiatric admissions among these homeless people. METHODS We used a cross-sectional design, collecting data for 4 years among homeless people, in Lisboa, Portugal, that were referred as possible psychiatric patients to Centro Hospitalar Psiquiátrico de Lisboa (CHPL). In total, we collected data from 500 homeless people, then cross-checked these people in our CHPL hospital electronic database and obtained 467 patient matches. RESULTS The most common psychiatric diagnosis in our sample was drug abuse (34%), followed by alcohol abuse (33%), personality disorder (24%), and acute stress reaction (23%). Sixty-two percent of our patients had multiple diagnoses, a subgroup with longer follow-ups, more psychiatric hospitalizations, and longer psychiatric hospitalizations. The prevalence of psychotic disorders was high: organic psychosis (17%), schizophrenia (15%), psychosis not otherwise specified (14%), and schizoaffective disorder (11%), that combined altogether were present in more than half (57%) of our homeless patients. CONCLUSION The people living homeless with multiple diagnoses have higher mental health needs and worse determinants of general health. An ongoing effort is needed to identify and address this subgroup of homeless people with mental illness to improve their treatment and outcomes.
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17
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Marshall CA, Phillips B, Holmes J, Todd E, Hill R, Panter G, Easton C, Landry T, Collins S, Greening T, O'Brien A, Jastak M, Ridge R, Goldszmidt R, Shanoff C, Laliberte Rudman D, Carlsson A, Aryobi S, Perez S, Oudshoorn A. 'We stick people in a house and say okay, you're housed. The problem is solved': A qualitative study of service provider and organisational leader perspectives on thriving following homelessness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6018-e6029. [PMID: 36128972 DOI: 10.1111/hsc.14035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/27/2022] [Accepted: 09/12/2022] [Indexed: 06/15/2023]
Abstract
Research aimed at identifying and evaluating approaches to homelessness has predominately focused on strategies for supporting tenancy sustainment. Fewer studies focus on strategies for enabling thriving following homelessness, and the perspectives of service providers and organisational leaders (SPOL) on this topic are rare. We conducted this study in the context of a community-based participatory research project in two cities in Ontario, Canada. This research was aimed at identifying the strengths and challenges of existing supports in enabling thriving following homelessness, followed by co-designing a novel intervention alongside persons with lived experience of homelessness (PWLEH) and SPOL. The current study presents the findings of interviews conducted in 2020-2021 with SPOL in organisations serving PWLEH. We interviewed 60 individuals including service providers (n = 38; 63.3%) and organisational leaders (n = 22; 36.7%) using semi-structured qualitative interviews. Interviews were conducted and recorded on Zoom to align with physical distancing protocols associated with the COVID-19 pandemic. Recordings were transcribed verbatim and analysed abductively informed by the lenses of social justice and health equity. The essence of our findings is represented by a quote from a research participant: 'We stick people in a house and say okay, you're housed. The problem is solved'. This essence was expressed through five themes: (1) stuck in a system that prevents thriving, (2) substance use as an important coping strategy that prevents tenancy sustainment and thriving, (3) the critical importance of targeting community integration following homelessness, (4) incorporating peer expertise as imperative and (5) people need to be afforded options in selecting housing and services following homelessness. Our findings indicate that SPOL envision possibilities of thriving following homelessness yet are embedded within a system that often prevents them from supporting individuals who are leaving homelessness to do so. Research, practice and policy implications are discussed.
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Affiliation(s)
- Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Brooke Phillips
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Julia Holmes
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Eric Todd
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - River Hill
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - George Panter
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Corinna Easton
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Terry Landry
- Providence Care Hospital, Kingston, Ontario, Canada
| | - Sarah Collins
- Salvation Army London Centre of Hope, London, Ontario, Canada
| | | | - Ashley O'Brien
- HIV and Aids Regional Services, Kingston, Ontario, Canada
| | - Marlo Jastak
- Addiction and Mental Health Services Kingston, Frontenac, Lennox & Addington (KFLA), Kingston, Ontario, Canada
| | | | - Rebecca Goldszmidt
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Chelsea Shanoff
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | | | | | - Suliman Aryobi
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Shauna Perez
- Addiction and Mental Health Services Kingston, Frontenac, Lennox & Addington (KFLA), Kingston, Ontario, Canada
| | - Abe Oudshoorn
- School of Nursing, Western University, London, Ontario, Canada
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18
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Marshall CA, Boland L, Westover LA, Goldszmidt R, Bengall J, Aryobi S, Isard R, Easton C, Gewurtz R. Effectiveness of employment-based interventions for persons experiencing homelessness: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2142-2169. [PMID: 35748222 DOI: 10.1111/hsc.13892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/26/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Employment is frequently desired by persons who experience homelessness yet is often elusive. Little is known about the range and effectiveness of employment-based interventions evaluated in existing literature on key psychosocial outcomes including employment participation, mental well-being, housing tenure, community integration and substance use. To identify and synthesise existing studies, we conducted a systematic review of effectiveness using the methodology proposed by the Joanna Briggs Institute (JBI) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Following the removal of duplicates, we screened 13,398 titles and abstracts, and reviewed 79 studies at the full-text review stage using two independent raters. A total of 16 studies met criteria for inclusion in a narrative synthesis and were subjected to critical appraisal. The majority of studies were conducted in the US (n = 14; 87.5%) with other studies published in Canada (n = 1; 6.3%) and Australia (n = 1; 6.3%). Interventions evaluated in existing studies included combined substance use and vocational skills interventions (n = 7; 43.8%), supported employment (n = 6; 37.5%), and integrated supports including an employment component (n = 3; 18.8%). The effectiveness of these interventions on employment, mental well-being, housing tenure, community integration, and substance use is presented. Findings suggest that research evaluating employment interventions for persons who experience homelessness is in an early stage of development. Researchers and practitioners may consider collaborating with persons with lived experiences of homelessness and practitioners in co-designing and modifying existing approaches to target key outcomes more effectively. Policymakers may consider allocating resources to such initiatives to further the development of practice and research aimed at supporting persons who experience homelessness to secure and sustain employment during and following homelessness.
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Affiliation(s)
- Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Leonie Boland
- Faculty of Health and Human Sciences, Occupational Therapy, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Lee Ann Westover
- Teacher's College, Columbia University, New York City, New York, USA
| | - Rebecca Goldszmidt
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Jordana Bengall
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Suliman Aryobi
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Roxanne Isard
- Disciplinary Coordinator for the Faculty of Information & Media Studies & the Faculty of Education, Allyn & Betty Taylor Library, Western University, London, Ontario, Canada
| | - Corinna Easton
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Rebecca Gewurtz
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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19
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Hossain MM, Nesa F, Das J, Aggad R, Tasnim S, Bairwa M, Ma P, Ramirez G. Global burden of mental health problems among children and adolescents during COVID-19 pandemic: An umbrella review. Psychiatry Res 2022; 317:114814. [PMID: 36055064 PMCID: PMC9420079 DOI: 10.1016/j.psychres.2022.114814] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/30/2022]
Abstract
Mental health problems among children and adolescents are increasingly reported amidst the coronavirus disease (COVID-19) pandemic. In this umbrella review, we aimed to synthesize global evidence on the epidemiologic burden and correlates of child and adolescent mental health (CAMH) problems during this pandemic from existing systematic reviews and meta-analyses. Adopting the Joanna Briggs Institute (JBI) methodology, we evaluated 422 citations and identified 17 eligible reviews with medium to high methodological quality. Most of the reviews reported a high prevalence of anxiety, depression, sleep disorders, suicidal behavior, stress-related disorders, attention-deficit/hyperactivity disorder, and other mental health problems. Also, factors associated with CAMH such as age, gender, place of residence, educational attainment, household income, sedentary lifestyle, social media and internet use, comorbidities, family relationships, parents' psychosocial conditions, COVID-19 related experiences, closure of schools, online learning, and social support were reported across reviews. As most studies were cross-sectional and used nonrepresentative samples, future research on representative samples adopting longitudinal and intervention designs is needed. Lastly, multipronged psychosocial care services, policies, and programs are needed to alleviate the burden of CAMH problems during and after this pandemic.
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Affiliation(s)
- M. Mahbub Hossain
- Department of Decision and Information Sciences, C.T. Bauer College of Business, University of Houston, Houston, TX 77204, USA,Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX 77204, USA,Corresponding author at: Department of Decision and Information Sciences, C.T. Bauer College of Business, University of Houston, Houston, TX 77204, USA
| | - Fazilatun Nesa
- Research Initiative for Health Equity, Khulna, Bangladesh
| | - Jyoti Das
- Research Initiative for Health Equity, Khulna, Bangladesh
| | - Roaa Aggad
- School of Public Health, Texas A&M University, College Station, TX 77840, USA
| | - Samia Tasnim
- School of Public Health, Texas A&M University, College Station, TX 77840, USA
| | - Mohan Bairwa
- All Indian Institute of Medical Sciences, New Delhi, India
| | - Ping Ma
- School of Public Health, Texas A&M University, College Station, TX 77840, USA
| | - Gilbert Ramirez
- Robert Stempel College of Public Health and Social Work, Florida International University, FL 33174, USA
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20
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Wiens K, Rosella LC, Kurdyak P, Chen S, Aubry T, Stergiopoulos V, Hwang SW. Determinants of Hospital Use and Physician Services Among Adults With a History of Homelessness. Health Serv Insights 2022; 15:11786329221127150. [PMID: 36325379 PMCID: PMC9618755 DOI: 10.1177/11786329221127150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
Background: People experiencing homelessness have diverse patterns of healthcare use. This study examined the distribution and determinants of healthcare encounters among adults with a history of homelessness. Methods: Administrative healthcare records were linked with survey data for a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness. Binary and count models were used to identify factors associated with hospital admissions, emergency department visits and physician visits for comparison across the 2 cohorts. Results: During the 1-year follow-up period, a higher proportion of people in the cohort with a mental illness used any inpatient (27% vs 14%), emergency (63% vs 53%), or physician services (90% vs 76%) compared to the general homeless cohort. People from racialized groups were less likely use nearly all health services, most notably physician services. Other factors, such as reporting of a regular source of care, poor perceived general health, and diagnosed chronic conditions were associated with higher use of all health services except psychiatric inpatient care Conclusion: When implementing interventions for patients with the greatest health needs, we must consider the unique factors that contribute to higher healthcare use, as well as the barriers to healthcare access.
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Affiliation(s)
- Kathryn Wiens
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Kathryn Wiens, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada.
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Tim Aubry
- School of Psychology & Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
| | | | - Stephen W Hwang
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada
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21
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Chikwava F, O’Donnell M, Ferrante A, Pakpahan E, Cordier R. Patterns of homelessness and housing instability and the relationship with mental health disorders among young people transitioning from out-of-home care: Retrospective cohort study using linked administrative data. PLoS One 2022; 17:e0274196. [PMID: 36054257 PMCID: PMC9439254 DOI: 10.1371/journal.pone.0274196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives The study examined the relationship between mental health, homelessness and housing instability among young people aged 15–18 years old who transitioned from out-of-home in 2013 to 2014 in the state of Victoria, Australia with follow-up to 2018. We determined the various mental health disorders and other predictors that were associated with different levels of homelessness risk, including identifying the impact of dual diagnosis of mental health and substance use disorder on homelessness. Methodology Using retrospective de-identified linked administrative data from various government departments we identified various dimensions of homelessness which were mapped from the European Topology of Homelessness (ETHOS) framework and associated mental health variables which were determined from the WHO ICD-10 codes. We used ordered logistic regression and Poisson regression analysis to estimate the impact of homelessness and housing instability respectively. Results A total homelessness prevalence of 60% was determined in the care-leaving population. After adjustment, high risk of homelessness was associated with dual diagnosis of mental health and substance use disorder, intentional self-harm, anxiety, psychotic disorders, assault and maltreatment, history of involvement with the justice system, substance use prior to leaving care, residential and home-based OHC placement and a history of staying in public housing. Conclusions There is clearly a need for policy makers and service providers to work together to find effective housing pathways and integrated health services for this heterogeneous group of vulnerable young people with complex health and social needs. Future research should determine longitudinally the bidirectional relationship between mental health disorders and homelessness.
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Affiliation(s)
- Fadzai Chikwava
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Melissa O’Donnell
- Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Anna Ferrante
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Eduwin Pakpahan
- Department of Mathematics, Physics & Electrical Engineering, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Reinie Cordier
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Sarma KM, Carthy SL, Cox KM. Mental disorder, psychological problems and terrorist behaviour: A systematic review and meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1268. [PMID: 36913225 PMCID: PMC9364674 DOI: 10.1002/cl2.1268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Background The link between mental health difficulties and terrorist behaviour has been the subject of debate for the last 50 years. Studies that report prevalence rates of mental health difficulties in terrorist samples or compare rates for those involved and not involved in terrorism, can inform this debate and the work of those responsible for countering violent extremism. Objectives To synthesise the prevalence rates of mental health difficulties in terrorist samples (Objective 1-Prevalence) and prevalence of mental health disorders pre-dating involvement in terrorism (Objective 2-Temporality). The review also synthesises the extent to which mental health difficulties are associated with terrorist involvement compared to non-terrorist samples (Objective 3-Risk Factor). Search Methods Searches were conducted between April and June 2022, capturing research until December 2021. We contacted expert networks, hand-searched specialist journals, harvested records from published reviews, and examined references lists for included papers to identify additional studies. Selection Criteria Studies needed to empirically examine mental health difficulties and terrorism. To be included under Objective 1 (Prevalence) and Objective 2 (Temporality), studies had to adopt cross-sectional, cohort, or case-control design and report prevalence rates of mental health difficulties in terrorist samples, with studies under Objective 2 also needing to report prevalence of difficulties before detection or involvement in terrorism. For Objective 3 (Risk Factor) studies where there was variability in terrorist behaviour (involved vs. not involved) were included. Data Collection and Analysis Captured records were screened in DisillterSR by two authors. Risk of bias was assessed using Joanna Briggs Institute checklists, and random-effects meta-analysis conducted in Comprehensive Meta-Analysis software. Results Fifty-six papers reporting on 73 different terrorist samples (i.e., studies) (n = 13,648) were identified. All were eligible for Objective 1. Of the 73 studies, 10 were eligible for Objective 2 (Temporality) and nine were eligible for Objective 3 (Risk Factor). For Objective 1, the life-time prevalence rate of diagnosed mental disorder in terrorist samples (k = 18) was 17.4% [95% confidence interval (CI) = 11.1%-26.3%]. When collapsing all studies reporting psychological problems, disorder, and suspected disorder into one meta-analyses (k = 37), the pooled prevalence rate was 25.5% (95% CI = 20.2%-31.6%). When isolating studies reporting data for any mental health difficulty that emerged before either engagement in terrorism or detection for terrorist offences (Objective 2: Temporality), the life-time prevalence rate was 27.8% (95% CI = 20.9%-35.9%). For Objective 3 (Risk Factor), it was not appropriate to calculate a pooled effect size due the differences in comparison samples. Odds ratios for these studies ranged from 0.68 (95% CI = 0.38-1.22) to 3.13 (95% CI = 1.87-5.23). All studies were assessed as having high-risk of bias which, in part, reflects challenges conducting terrorism research. Author's Conclusions This review does not support the assertion that terrorist samples are characterised by higher rates of mental health difficulties than would be expected in the general population. Findings have implications for future research in terms of design and reporting. There are also implications for practice with regards the inclusion of mental health difficulties as indicators of risk.
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Affiliation(s)
- Kiran M. Sarma
- School of PsychologyNational University of Ireland Galway (University of Galway)GalwayIreland
| | - Sarah L. Carthy
- School of PsychologyNational University of Ireland Galway (University of Galway)GalwayIreland
- Institute of Security and Global AffairsLeiden UniversityLeidenThe Netherlands
| | - Katie M. Cox
- School of PsychologyNational University of Ireland Galway (University of Galway)GalwayIreland
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Methodological approaches for assessing certainty of the evidence in umbrella reviews: A scoping review. PLoS One 2022; 17:e0269009. [PMID: 35675337 PMCID: PMC9176806 DOI: 10.1371/journal.pone.0269009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 05/12/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction The number of umbrella reviews (URs) that compiled systematic reviews and meta-analysis (SR-MAs) has increased dramatically over recent years. No formal guidance for assessing the certainty of evidence in URs of meta-analyses exists nowadays. URs of non-interventional studies help establish evidence linking exposure to certain health outcomes in a population. This study aims to identify and describe the methodological approaches for assessing the certainty of the evidence in published URs of non-interventions. Methods We searched from 3 databases including PubMed, Embase, and The Cochrane Library from May 2010 to September 2021. We included URs that included SR-MAs of studies with non-interventions. Two independent reviewers screened and extracted data. We compared URs characteristics stratified by publication year, journal ranking, journal impact factor using Chi-square test. Results Ninety-nine URs have been included. Most were SR-MAs of observational studies evaluating association of non-modifiable risk factors with some outcomes. Only half (56.6%) of the included URs assessed the certainty of the evidence. The most frequently used criteria is credibility assessment (80.4%), followed by GRADE approach (14.3%). URs published in journals with higher journal impact factor assessed certainty of evidence than URs published in lower impact group (77.1 versus 37.2% respectively, p < 0.05). However, criteria for credibility assessment used in four of the seven URs that were published in top ranking journals were slightly varied. Conclusions Half of URs of MAs of non-interventional studies have assessed the certainty of the evidence, in which criteria for credibility assessment was the commonly used method. Guidance and standards are required to ensure the methodological rigor and consistency of certainty of evidence assessment for URs.
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Sarma KM, Carthy SL, Cox KM. PROTOCOL: Mental disorder, psychological problems and terrorist behaviour: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1249. [PMID: 36911352 PMCID: PMC9186052 DOI: 10.1002/cl2.1249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/26/2022] [Indexed: 05/08/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows: the first objective of the review (Objective 1-Prevalence) is to present a synthesis of the reported prevalence rates of mental health difficulties in terrorist samples. Where sufficient data is available, the synthesis will be sensitive to the heterogeneity of the terrorism phenomenon by exploring the rates of mental health difficulties for different forms of terrorism and for different terrorist roles (e.g., bombing, logistics, finance, etc.). The second objective (Objective 2-Temporality) will synthesise the extent to which mental health difficulties pre-date involvement in terrorism within prevalence studies. Finally, the third objective (Objective 3-Risk) aims to further establish temporality by examining the extent to which the presence of mental disorder is associated with terrorist involvement by comparing terrorist and non-terrorist samples.
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Affiliation(s)
- Kiran M. Sarma
- School of PsychologyNational University of Ireland Galway (University of Galway)GalwayIreland
| | - Sarah L. Carthy
- School of PsychologyNational University of Ireland Galway (University of Galway)GalwayIreland
| | - Katie M. Cox
- School of PsychologyNational University of Ireland Galway (University of Galway)GalwayIreland
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Hossain MM, Saha N, Rodela TT, Tasnim S, Nuzhath T, Roy TJ, Burdine JN, Ahmed HU, McKyer ELJ, Basu BK, Ma P. Global research on syndemics: a meta-knowledge analysis (2001-2020). F1000Res 2022; 11:253. [PMID: 36936050 PMCID: PMC10015119 DOI: 10.12688/f1000research.74190.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Syndemics or synergies of cooccurring epidemics are widely studied across health and social sciences in recent years. METHODS We conducted a meta-knowledge analysis of articles published between 2001 to 2020 in this growing field of academic scholarship. RESULTS We found a total of 830 articles authored by 3025 authors, mostly from high-income countries. Publications on syndemics are gradually increasing since 2003, with rapid development in 2013. Each article was cited more than 15 times on average, and most (n = 604) articles were original studies. Syndemics research focused on several areas, including HIV/AIDS, substance abuse, mental health, gender minority stressors, racism, violence, chronic physical and mental disorders, food insecurity, social determinants of health, and coronavirus disease 2019. Moreover, biopsychosocial interactions between multiple health problems were studied across medical, anthropological, public health, and other disciplines of science. CONCLUSIONS The limited yet rapidly evolving literature on syndemics informs transdisciplinary interests to understand complex coexisting health challenges in the context of systematic exclusion and structural violence in vulnerable populations. The findings also suggest applications of syndemic theory to evaluate clinical and public health problems, examine the socioecological dynamics of factors influencing health and wellbeing, and use the insights to alleviate health inequities in the intersections of synergistic epidemics and persistent contextual challenges for population health.
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Affiliation(s)
- Md Mahbub Hossain
- EviSyn Health, Khulna, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | - Nobonita Saha
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | - Tahmina Tasnim Rodela
- Department of Economics, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Samia Tasnim
- EviSyn Health, Khulna, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | - Tasmiah Nuzhath
- EviSyn Health, Khulna, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | - Tamal Joyti Roy
- Institute of Information and Communication Technology, Khulna, Bangladesh
| | - James N. Burdine
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | | | - E. Lisako J. McKyer
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | | | - Ping Ma
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
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Hossain MM, Saha N, Rodela TT, Tasnim S, Nuzhath T, Roy TJ, Burdine JN, Ahmed HU, McKyer ELJ, Basu BK, Ma P. Global research on syndemics: a meta-knowledge analysis (2001-2020). F1000Res 2022; 11:253. [PMID: 36936050 PMCID: PMC10015119 DOI: 10.12688/f1000research.74190.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Syndemics or synergies of cooccurring epidemics are widely studied across health and social sciences in recent years. METHODS We conducted a meta-knowledge analysis of articles published between 2001 to 2020 in this growing field of academic scholarship. RESULTS We found a total of 830 articles authored by 3025 authors, mostly from high-income countries. Publications on syndemics are gradually increasing since 2003, with rapid development in 2013. Each article was cited more than 15 times on average, and most (n = 604) articles were original studies. Syndemics research focused on several areas, including HIV/AIDS, substance abuse, mental health, gender minority stressors, racism, violence, chronic physical and mental disorders, food insecurity, social determinants of health, and coronavirus disease 2019. Moreover, biopsychosocial interactions between multiple health problems were studied across medical, anthropological, public health, and other disciplines of science. CONCLUSIONS The limited yet rapidly evolving literature on syndemics informs transdisciplinary interests to understand complex coexisting health challenges in the context of systematic exclusion and structural violence in vulnerable populations. The findings also suggest applications of syndemic theory to evaluate clinical and public health problems, examine the socioecological dynamics of factors influencing health and wellbeing, and use the insights to alleviate health inequities in the intersections of synergistic epidemics and persistent contextual challenges for population health.
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Affiliation(s)
- Md Mahbub Hossain
- EviSyn Health, Khulna, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | - Nobonita Saha
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | - Tahmina Tasnim Rodela
- Department of Economics, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Samia Tasnim
- EviSyn Health, Khulna, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | - Tasmiah Nuzhath
- EviSyn Health, Khulna, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | - Tamal Joyti Roy
- Institute of Information and Communication Technology, Khulna, Bangladesh
| | - James N. Burdine
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | | | - E. Lisako J. McKyer
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
| | | | - Ping Ma
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, College Stataion, Texas, 77840, USA
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Scarlett H, Davisse-Paturet C, Longchamps C, Aarbaoui TE, Allaire C, Colleville AC, Convence-Arulthas M, Crouzet L, Ducarroz S, Melchior M. Depression during the COVID-19 pandemic amongst residents of homeless shelters in France. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 6:100243. [PMID: 34632442 PMCID: PMC8487751 DOI: 10.1016/j.jadr.2021.100243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/14/2021] [Accepted: 09/24/2021] [Indexed: 12/28/2022] Open
Abstract
Background Accumulating evidence suggests that the COVID-19 pandemic has negatively affected global mental health and well-being. However, the impact amongst homeless persons has not been fully evaluated. The ECHO study reports factors associated with depression amongst the homeless population living in shelters in France during the spring of 2020. Methods Interview data were collected from 527 participants living in temporary and/or emergency accommodation following France's first lockdown (02/05/20 – 07/06/20), in the metropolitan regions of Paris (74%), Lyon (19%) and Strasbourg (7%). Interviews were conducted in French, English, or with interpreters (33% of participants, ∼20 languages). Presence of depression was ascertained using the Patient Health Questionnaire (PHQ-9). Results Amongst ECHO study participants, 30% had symptoms of moderate to severe depression (PHQ-9 ≥ 10). Multivariate analysis revealed depression to be associated with being female (aOR: 2.15; CI: 1.26–3.69), single (aOR: 1.60; CI: 1.01–2.52), chronically ill (aOR: 2.32; CI: 1.43: 3.78), facing food insecurity (aOR: 2.12; CI: 1.40–3.22) and participants’ region of origin. Persons born African and Eastern Mediterranean regions showed higher levels of depression (30–33% of participants) than those migrating from other European countries (14%). Reduced rates of depression were observed amongst participants aged 30–49 (aOR: 0.60; CI: 0.38–0.95) and over 50 (aOR: 0.28; CI: 0.13–0.64), compared to 18–29-year-olds. Limitations These data are cross-sectional, only providing information on a given moment in time. Conclusions Our results indicate high levels of depression amongst homeless persons during the COVID-19 pandemic. Predicted future instability and economic repercussions could particularly impact the mental health of this vulnerable group.
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Affiliation(s)
- Honor Scarlett
- Équipe de Recherche en Épidémiologie Sociale, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP,Sorbonne Université, INSERM, Paris F75012, France
| | - Camille Davisse-Paturet
- Équipe de Recherche en Épidémiologie Sociale, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP,Sorbonne Université, INSERM, Paris F75012, France
| | - Cécile Longchamps
- Équipe de Recherche en Épidémiologie Sociale, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP,Sorbonne Université, INSERM, Paris F75012, France
| | - Tarik El Aarbaoui
- Équipe de Recherche en Épidémiologie Sociale, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP,Sorbonne Université, INSERM, Paris F75012, France
| | - Cécile Allaire
- French National Public Health Agency, Santé Publique France, Saint-Maurice F94415, France
| | - Anne-Claire Colleville
- French National Public Health Agency, Santé Publique France, Saint-Maurice F94415, France
| | - Mary Convence-Arulthas
- Équipe de Recherche en Épidémiologie Sociale, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP,Sorbonne Université, INSERM, Paris F75012, France
| | - Lisa Crouzet
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, France
| | - Simon Ducarroz
- Équipe de Recherche en Épidémiologie Sociale, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP,Sorbonne Université, INSERM, Paris F75012, France.,Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, France
| | - Maria Melchior
- Équipe de Recherche en Épidémiologie Sociale, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP,Sorbonne Université, INSERM, Paris F75012, France.,CNRS, Institut Convergences Migration, Aubervilliers, France
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Tyrrell G, Lee C, Eurich D. Is there a need for pneumococcal vaccination programs for the homeless to prevent invasive pneumococcal disease? Expert Rev Vaccines 2021; 20:1113-1121. [PMID: 34365882 DOI: 10.1080/14760584.2021.1966301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Homeless are a vulnerable segment of society at risk for infections. Invasive pneumococcal disease (IPD) infections are increasingly identified in homeless as a major contributor of morbidity and mortality. Very few countries have recommended pneumococcal vaccination programs for the homeless. AREAS COVERED A literature review of IPD in the homeless from 1980 to 2020 in PubMed and Scopus using terms, 'homeless,' and 'homelessness,' and after 'chronic' or 'transitory' homeless was conducted. Gray literature from the CDC, WHO and major governmental agencies/organizations were included. Terms for IPD eligible for inclusion in the database search included 'pneumococcal disease,' 'invasive pneumococcal disease,' 'Streptococcus pneumoniae.' This included outbreaks of pneumococcal disease in the homeless, clinical characteristics associated with pneumococcal disease in the homeless, pneumococcal vaccines and vaccination recommendations for the homeless. EXPERT OPINION Homeless populations are at increased risk for IPD in comparison to the general population. This is due to clinical conditions experienced by the homeless including alcoholism and cigarette smoking. In addition, a collection of specific pneumococcal serotypes are associated with IPD in this group. Pneumococcal vaccine programs aimed at this population would likely decrease the incidence of IPD for this group and contribute to better overall health for the homeless.
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Affiliation(s)
- Gregory Tyrrell
- Provincial Laboratory For Public Health, Alberta Precision Laboratories And Division Of Diagnostic And Applied Microbiology, Department Of Laboratory Medicine And Pathology, University Of Alberta, Edmonton, Canada
| | - Cerina Lee
- School Of Public Health, University Of Alberta, Edmonton, Canada
| | - Dean Eurich
- School Of Public Health, University Of Alberta, Edmonton, Canada
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Ramos GG, West AE, Begay C, Telles VM, D'Isabella J, Antony V, Soto C. Substance use disorder and homelessness among American Indians and Alaska Natives in California. J Ethn Subst Abuse 2021; 22:350-371. [PMID: 34339341 DOI: 10.1080/15332640.2021.1952125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
American Indian and Alaska Native (AIAN) communities have higher rates of substance use than other racial and ethnic groups. Substance use disorder (SUD) is tied to the increased risk of experiencing homelessness. National policies have also led to the disproportionate rates of homelessness among AIAN communities. However, specific experiences related to the occurrence of SUD and homelessness among AIAN in California, as well as seeking and accessing SUD treatment, are not well understood. This study explored potential SUD risk and resilience factors for AIANs experiencing homelessness and their experiences when seeking services for SUD. Nineteen interviews were conducted in northern, central, and southern California. Thematic analysis was used for these data. The five primary codes were: (1) risk factors for SUD, (2) resilience related to SUD service seeking, (3) services available, (4) barriers accessing services, and (5) services needed. Based on the results, themes for risk were trauma, mental health, and community conditions. Themes for resilience were identified at individual and community levels and included personal motivation and community support and inclusiveness. Themes for services available were limited knowledge about service types and services' location. The themes for barriers accessing services were identified at internal and external levels, and included lack of readiness and transportation challenges, respectively. Themes for services needed included continuum of care, integrated care, and culturally sensitive services. Findings highlight the importance of addressing the potential risk factors and service needs of AIANs experiencing homelessness to provide comprehensive and culturally sensitive services to reduce substance use.
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Affiliation(s)
- G G Ramos
- University of Southern California, Los Angeles, CA, USA
| | - A E West
- University of Southern California, Los Angeles, CA, USA
| | - C Begay
- University of Southern California, Los Angeles, CA, USA
| | - V M Telles
- University of Southern California, Los Angeles, CA, USA
| | - J D'Isabella
- University of Southern California, Los Angeles, CA, USA
| | - V Antony
- University of Southern California, Los Angeles, CA, USA
| | - C Soto
- University of Southern California, Los Angeles, CA, USA
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30
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Gutwinski S, Schreiter S, Deutscher K, Fazel S. The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis. PLoS Med 2021; 18:e1003750. [PMID: 34424908 PMCID: PMC8423293 DOI: 10.1371/journal.pmed.1003750] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/07/2021] [Accepted: 08/02/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Homelessness continues to be a pressing public health concern in many countries, and mental disorders in homeless persons contribute to their high rates of morbidity and mortality. Many primary studies have estimated prevalence rates for mental disorders in homeless individuals. We conducted a systematic review and meta-analysis of studies on the prevalence of any mental disorder and major psychiatric diagnoses in clearly defined homeless populations in any high-income country. METHODS AND FINDINGS We systematically searched for observational studies that estimated prevalence rates of mental disorders in samples of homeless individuals, using Medline, Embase, PsycInfo, and Google Scholar. We updated a previous systematic review and meta-analysis conducted in 2007, and searched until 1 April 2021. Studies were included if they sampled exclusively homeless persons, diagnosed mental disorders by standardized criteria using validated methods, provided point or up to 12-month prevalence rates, and were conducted in high-income countries. We identified 39 publications with a total of 8,049 participants. Study quality was assessed using the JBI critical appraisal tool for prevalence studies and a risk of bias tool. Random effects meta-analyses of prevalence rates were conducted, and heterogeneity was assessed by meta-regression analyses. The mean prevalence of any current mental disorder was estimated at 76.2% (95% CI 64.0% to 86.6%). The most common diagnostic categories were alcohol use disorders, at 36.7% (95% CI 27.7% to 46.2%), and drug use disorders, at 21.7% (95% CI 13.1% to 31.7%), followed by schizophrenia spectrum disorders (12.4% [95% CI 9.5% to 15.7%]) and major depression (12.6% [95% CI 8.0% to 18.2%]). We found substantial heterogeneity in prevalence rates between studies, which was partially explained by sampling method, study location, and the sex distribution of participants. Limitations included lack of information on certain subpopulations (e.g., women and immigrants) and unmet healthcare needs. CONCLUSIONS Public health and policy interventions to improve the health of homeless persons should consider the pattern and extent of psychiatric morbidity. Our findings suggest that the burden of psychiatric morbidity in homeless persons is substantial, and should lead to regular reviews of how healthcare services assess, treat, and follow up homeless people. The high burden of substance use disorders and schizophrenia spectrum disorders need particular attention in service development. This systematic review and meta-analysis has been registered with PROSPERO (CRD42018085216). TRIAL REGISTRATION PROSPERO CRD42018085216.
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Affiliation(s)
- Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefanie Schreiter
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Biomedical Innovation Academy, Berlin Institute of Health, Berlin, Germany
| | - Karl Deutscher
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Sultana A, Tasnim S, Sharma R, Pawar P, Bhattcharya S, Hossain MM. Psychosocial Challenges in Palliative Care: Bridging the Gaps Using Digital Health. Indian J Palliat Care 2021; 27:442-447. [PMID: 34898939 PMCID: PMC8655652 DOI: 10.25259/ijpc_381_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022] Open
Abstract
Psychosocial health is a major palliative care concern globally. Patients and caregivers engaged in palliative care may experience deteriorated mental and social health conditions. Global evidence informs a high burden of depression, anxiety, psychological distress and other mental health problems among the palliative care populations. Those challenges aggravate the preexisting palliative care issues, such as lack of access and suboptimal quality of care. Palliative caregiving, both in the institutional and community settings, should be strengthened, incorporating psychosocial support for the patients and their caregivers. The recent advancements in digital health technologies have shown promising impacts in facilitating health communication, decision-making and delivering psychosocial interventions using digital devices and platforms. Adopting evidence-based interventions can help the users to access mental health resources and communicate with each other to promote shared decision-making and management of health problems. Health-care organisations and systems may explore opportunities to advance psychosocial care using digital technologies. Leveraging advanced technologies in palliative caregiving may require multifaceted research exploring potential barriers and opportunities at the user, institutional and systems levels. Nonetheless, palliative care policies and health systems measures should be strengthened to develop and implement digital support systems that may improve psychosocial health and overall palliative care outcome.
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Affiliation(s)
- Abida Sultana
- Department of Mental Health, EviSyn Health, Khulna, Bangladesh
| | - Samia Tasnim
- Department of Health Promotion and Community Health Sciences, Texas A&M University, Texas, United States
| | - Rachit Sharma
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, United States
| | - Priyanka Pawar
- Department of Programs, GRID Council, Delhi-NCR, Delhi, India
| | - Sudip Bhattcharya
- Department of Community Medicine, Himalayan Institute of Medical Sciences, Dehradun, India
| | - Md Mahbub Hossain
- Department of Health Promotion and Community Health Sciences, Texas A&M University, Texas, United States
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Schreiter S, Speerforck S, Schomerus G, Gutwinski S. Homelessness: care for the most vulnerable - a narrative review of risk factors, health needs, stigma, and intervention strategies. Curr Opin Psychiatry 2021; 34:400-404. [PMID: 33993170 DOI: 10.1097/yco.0000000000000715] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW To summarize the most recent literature on risk factors of homelessness, mental, and somatic health needs, healthcare use, stigma as well as intervention strategies for people experiencing homelessness. RECENT FINDINGS Studies identified adverse life events as well as mental health problems like drug use or suicidality as significant predictors of becoming homeless. Prevalence rates of mental disorders, especially substance use disorders, psychotic disorders, and depression are high. Barriers of healthcare use are financial resources and insurance status as well as experiences of discrimination. Aspects of trust and safety as well as age and gender were identified of high importance in the design of interventions. Strategies of permanent supportive housing like Housing First have shown a stable positive effect on housing stability, but not mental health outcomes. Peer support, forms of intensive case management, and harm reduction strategies are the most promising approaches to address these further needs. SUMMARY Exploration into the relationship of homelessness and mental health as well as adequate intervention strategies is far from being conclusive. Especially, the development of effective interventions addressing issues of trauma, stigma and discrimination, community integration, and mental health needs is still in its infancy.
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Affiliation(s)
- Stefanie Schreiter
- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany
| | - Sven Speerforck
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Psychiatrie, Leipzig, Germany
| | - Georg Schomerus
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Psychiatrie, Leipzig, Germany
| | - Stefan Gutwinski
- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
- Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany
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Hossain MM, Rahman M, Trisha NF, Tasnim S, Nuzhath T, Hasan NT, Clark H, Das A, McKyer ELJ, Ahmed HU, Ma P. Prevalence of anxiety and depression in South Asia during COVID-19: A systematic review and meta-analysis. Heliyon 2021; 7:e06677. [PMID: 33898819 PMCID: PMC8056240 DOI: 10.1016/j.heliyon.2021.e06677] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has impacted biopsychosocial health and wellbeing globally. Pre-pandemic studies suggest a high prevalence of common mental disorders, including anxiety and depression in South Asian countries, which may aggravate during this pandemic. This systematic meta-analytic review was conducted to estimate the pooled prevalence of anxiety and depression in South Asian countries during the COVID-19 pandemic. METHOD We systematically searched for cross-sectional studies on eight major bibliographic databases and additional sources up to October 12, 2020, that reported the prevalence of anxiety or depression in any of the eight South Asian countries. A random-effects model was used to calculate the pooled proportion of anxiety and depression. RESULTS A total of 35 studies representing 41,402 participants were included in this review. The pooled prevalence of anxiety in 31 studies with a pooled sample of 28,877 was 41.3% (95% confidence interval [CI]: 34.7-48.1, I 2 = 99.18%). Moreover, the pooled prevalence of depression was 34.1% (95% CI: 28.9-39.4, I 2 = 99%) among 37,437 participants in 28 studies. Among the South Asian countries, India had a higher number of studies, whereas Bangladesh and Pakistan had a higher pooled prevalence of anxiety and depression. No studies were identified from Afghanistan, Bhutan, and Maldives. Studies in this review had high heterogeneity, high publication bias confirmed by Egger's test, and varying prevalence rates across sub-groups. CONCLUSION South Asian countries have high prevalence rates of anxiety and depression, suggesting a heavy psychosocial burden during this pandemic. Clinical and public mental health interventions should be prioritized alongside improving the social determinants of mental health in these countries. Lastly, a low number of studies with high heterogeneity requires further research exploring the psychosocial epidemiology during COVID-19, which may inform better mental health policymaking and practice in South Asia.
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Affiliation(s)
- Md Mahbub Hossain
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Mariya Rahman
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Nusrat Fahmida Trisha
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Samia Tasnim
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Tasmiah Nuzhath
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Nishat Tasnim Hasan
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Heather Clark
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Arindam Das
- The IIHMR University, Jaipur, Rajasthan 302029, India
| | - E. Lisako J. McKyer
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
| | - Helal Uddin Ahmed
- National Institute of Mental Health (NIMH), Sher-E-Bangla Nagar, Dhaka 1207, Bangladesh
| | - Ping Ma
- School of Public Health, Texas A&M University, College Station, TX 77843, United States
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Smartt C, Ketema K, Frissa S, Tekola B, Birhane R, Eshetu T, Selamu M, Prince M, Fekadu A, Hanlon C. Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study. BMC Public Health 2021; 21:568. [PMID: 33752638 PMCID: PMC7986271 DOI: 10.1186/s12889-021-10629-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Little is known about the pathways followed into and out of homelessness among people with experience of severe mental illness (SMI) living in rural, low-income country settings. Understanding these pathways is essential for the development of effective interventions to address homelessness and promote recovery. The aim of this study was to explore pathways into and out of homelessness in people with SMI in rural Ethiopia. Methods In-depth interviews were conducted with 15 people with SMI who had experienced homelessness and 11 caregivers. Study participants were identified through their participation in the PRIME project, which implemented a multi-component district level plan to improve access to mental health care in primary care in Sodo district, Ethiopia. People enrolled in PRIME who were diagnosed with SMI (schizophrenia, schizoaffective disorder or bipolar disorder) and who had reported experiencing homelessness at recruitment formed the sampling frame for this qualitative study. We used OpenCode 4.0 and Microsoft Excel for data management. Thematic analysis was conducted using an inductive approach. Results Study participants reported different patterns of homelessness, with some having experienced chronic and others an intermittent course. Periods of homelessness occurred when family resources were overwhelmed or not meeting the needs of the person with SMI. The most important pathways into homelessness were reported to result from family conflict and the worsening of mental ill health, interplaying with substance use in many cases. Participants also mentioned escape and/or wanting a change in environment, financial problems, and discrimination from the community as contributing to them leaving the home. Pathways out of homelessness included contact with (mental and physical) health care as a catalyst to the mobilization of other supports, family and community intervention, and self-initiated return. Conclusions Homelessness in people with SMI in this rural setting reflected complex health and social needs that were not matched by adequate care and support. Our study findings indicate that interventions to prevent and tackle homelessness in this and similar settings ought to focus on increasing family support, and ensuring access to acceptable and suitable housing, mental health care and social support. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10629-8.
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Affiliation(s)
- Caroline Smartt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | | | - Souci Frissa
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | - Bethlehem Tekola
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | - Rahel Birhane
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia
| | - Tigist Eshetu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia
| | - Medhin Selamu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia
| | - Martin Prince
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | - Abebaw Fekadu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia.,Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Charlotte Hanlon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK. .,King's College London, King's Global Health Institute, London, UK. .,Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia. .,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia.
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Sultana A, Tasnim S, Hossain MM, Bhattacharya S, Purohit N. Digital screen time during the COVID-19 pandemic: a public health concern. F1000Res 2021. [DOI: 10.12688/f1000research.50880.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Due to the restrictions imposed to contain the coronavirus disease 2019 (COVID-19) pandemic, different population groups have adapted to varying screen time levels, which may have profound implications on their physical and mental wellbeing. Several empirical studies included in this review reported a sudden upward change in screen time across different population groups. A higher number of people with increased screen time compared to their pre-pandemic state and prolonged duration of total screen time substantiates such assertions. The available evidence suggests that screen time is associated with obesity, hypertension, type 2 diabetes, myopia, depression, sleep disorders, and several non-communicable diseases. This elevated burden of diseases is more prevalent among individuals who have sedentary lifestyles and other unhealthy behaviors that are likely to increase during quarantine or isolation due to COVID-19. Hence, it is critical to assess the adverse health outcomes that may appear as long-term consequences of such behavior. Researchers and practitioners need to revisit the available guidelines and incorporate evidence-based interventions for preventing unhealthy screen time among the affected individuals. Such interventions may address harmful behaviors associated with screen time and promote active lifestyles that may improve health across populations during and after this pandemic.
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Rodriguez-Moreno S, Farchione TJ, Roca P, Marín C, Guillén AI, Panadero S. Initial Effectiveness Evaluation of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders for Homeless Women. Behav Modif 2020; 46:506-528. [PMID: 33345583 DOI: 10.1177/0145445520982562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to evaluate the effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders adapted for homeless women (UPHW). Eighty-one homeless women participated in this single-blinded quasi-experimental clinical trial, involving up to 12 sessions of group treatment, and 3-and 6-month follow-ups. The participants received either immediate treatment with the UPHW (n = 46) or delayed treatment, following a 12-week wait-list control period (WLC; n = 35). Primary outcomes included depression and anxiety. Secondary measures comprised positive and negative affect, psychological well-being, health perception, and social support. The UPHW resulted in significant improvement on measures of anxiety, depression and negative affect. Improvements in anxiety and depression were maintained over a 3-month follow-up period, but not at 6-month. The reliability of the clinical changes showed significant differences between UPHW and WLC for depression. Moreover, the inter-session assessment in the UPHW group showed a linear trend reduction for depression and anxiety scores along the 12 sessions. The clinical implications on the UPHW in social settings are also discussed.
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Hossain MM. Alice in Wonderland syndrome (AIWS): a research overview. AIMS Neurosci 2020; 7:389-400. [PMID: 33263077 PMCID: PMC7701374 DOI: 10.3934/neuroscience.2020024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Alice in Wonderland syndrome (AIWS) is a rare neuropsychiatric condition characterized by distorted visual perceptions, body schema, and experience of time. A global overview of research on AIWS can inform future developments and clinical practice in this field. This bibliometric study aimed to analyze the characteristics of the global research landscape on AIWS. METHODS Bibliometric data on AIWS related publications published until 2019 were retrieved from the Web of Science database. The data were analyzed using statistical and scientometric tools to evaluate the publication trends, key research domains, top contributing journals, institutions, and countries associated with AIWS-related research. RESULTS A total of 125 published items were analyzed with a mean of 3 authors and 8.15 citations per document. Most articles were published after 2008, in medical journals focused on neuropsychiatric sciences, and most institutions affiliated with AIWS research were based on high-income countries. Major research domains associated with AIWS included visual disturbances, body image, migraine, infections, risk factors, and other clinical correlates. Several overarching domains were identified; however, clinical research on diagnosis, treatment, and prognosis of AIWS is relatively limited. CONCLUSION The current research landscape informs a developing trend in AIWS research in selected regions and specialties. Future research should emphasize multidisciplinary and translational investigations on clinical and epidemiological areas through global collaborations that may advance the knowledge and practice on AIWS.
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Affiliation(s)
- Md Mahbub Hossain
- Nature Study Society of Bangladesh, Khulna 09000, Bangladesh
- EviSyn Health, Khulna 09000, Bangladesh
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX 77843, USA
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Ahuja NJ, Nguyen A, Winter SJ, Freeman M, Shi R, Rodriguez Espinosa P, Heaney CA. Well-Being without a Roof: Examining Well-Being among Unhoused Individuals Using Mixed Methods and Propensity Score Matching. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197228. [PMID: 33023231 PMCID: PMC7579497 DOI: 10.3390/ijerph17197228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022]
Abstract
The morbidity and mortality experiences of people who are unhoused have been well-described, but much less is known about the overall well-being of these individuals. In this mixed methods study, housed and unhoused participants completed a multi-faceted 10 domain measure of well-being (the Stanford WELL Survey), and a subset of unhoused participants shared their experiences during qualitative interviews. Using propensity score matching, unhoused participants (n = 51) were matched at a ratio of 1:5 with housed participants (n = 255). The mean overall well-being score of the unhoused participants was significantly lower than that of the matched housed participants (B = −5.022, p = 0.013). Additionally, the two groups differed on some of the constituent domains of well-being, with unhoused participants reporting statistically significantly lower mean scores on social connectedness (B = −1.086, p = 0.000), lifestyle and daily practices (B = −1.219, p = 0.000), stress and resilience (B = −0.493, p = 0.023), experience of emotions (B = −0.632, p = 0.009), physical health (B = −0.944, p = 0.0001), and finances (B = −3.099, p = 0.000). The unhoused participants had a statistically significantly higher mean score for spirituality and religiosity (B = 2.401, p = 0.000) than their matched housed counterparts. The qualitative interviews further highlighted spirituality and religion as a coping mechanism for the unhoused. The results of this study highlight both unexpected strengths exhibited by the unhoused individuals and areas of challenge.
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Affiliation(s)
- Naina J Ahuja
- Stanford Prevention Research Center, Stanford School of Medicine, Stanford University, Palo Alto, CA 94304, USA; (N.J.A.); (A.N.); (S.J.W.); (M.F.); (R.S.); (P.R.E.)
| | - Allison Nguyen
- Stanford Prevention Research Center, Stanford School of Medicine, Stanford University, Palo Alto, CA 94304, USA; (N.J.A.); (A.N.); (S.J.W.); (M.F.); (R.S.); (P.R.E.)
| | - Sandra J Winter
- Stanford Prevention Research Center, Stanford School of Medicine, Stanford University, Palo Alto, CA 94304, USA; (N.J.A.); (A.N.); (S.J.W.); (M.F.); (R.S.); (P.R.E.)
| | - Mark Freeman
- Stanford Prevention Research Center, Stanford School of Medicine, Stanford University, Palo Alto, CA 94304, USA; (N.J.A.); (A.N.); (S.J.W.); (M.F.); (R.S.); (P.R.E.)
| | - Robert Shi
- Stanford Prevention Research Center, Stanford School of Medicine, Stanford University, Palo Alto, CA 94304, USA; (N.J.A.); (A.N.); (S.J.W.); (M.F.); (R.S.); (P.R.E.)
| | - Patricia Rodriguez Espinosa
- Stanford Prevention Research Center, Stanford School of Medicine, Stanford University, Palo Alto, CA 94304, USA; (N.J.A.); (A.N.); (S.J.W.); (M.F.); (R.S.); (P.R.E.)
| | - Catherine A Heaney
- Stanford Prevention Research Center, Stanford School of Medicine, Stanford University, Palo Alto, CA 94304, USA; (N.J.A.); (A.N.); (S.J.W.); (M.F.); (R.S.); (P.R.E.)
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
- Correspondence:
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Hossain MM, Sultana A, Purohit N. Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence. Epidemiol Health 2020; 42:e2020038. [PMID: 32512661 PMCID: PMC7644933 DOI: 10.4178/epih.e2020038] [Citation(s) in RCA: 289] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/02/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Transmission of infectious diseases is often prevented by quarantine and isolation of the populations at risk. These approaches restrict the mobility, social interactions, and daily activities of the affected individuals. In recent coronavirus disease 2019 (COVID-19) pandemic, quarantine and isolation are being adopted in many contexts, which necessitates an evaluation of global evidence on how such measures impact the mental health outcomes among populations. This umbrella review aimed to synthesize the available evidence on mental health outcomes of quarantine and isolation for preventing infectious diseases. METHODS We searched nine major databases and additional sources and included articles if they were systematically conducted reviews, published as peer-reviewed journal articles, and reported mental health outcomes of quarantine or isolation in any population. RESULTS Among 1,364 citations, only eight reviews met our criteria. Most of the primary studies in those reviews were conducted in high-income nations and in hospital settings. These articles reported a high burden of mental health problems among patients, informal caregivers, and healthcare providers who experienced quarantine or isolation. Prevalent mental health problems among the affected individuals include depression, anxiety, mood disorders, psychological distress, posttraumatic stress disorder, insomnia, fear, stigmatization, low self-esteem, lack of self-control, and other adverse mental health outcomes. CONCLUSIONS This umbrella review found severe mental health problems among individuals and populations who have undergone quarantine and isolation in different contexts. This evidence necessitates multipronged interventions including policy measures for strengthening mental health services globally and promoting psychosocial wellbeing among high-risk populations.
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Affiliation(s)
- Md Mahbub Hossain
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, USA
- Nature Study Society of Bangladesh, Khulna, Bangladesh
| | - Abida Sultana
- Nature Study Society of Bangladesh, Khulna, Bangladesh
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