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Stolper H, van der Vegt M, van Doesum K, Steketee M. The Integrated Family Approach in Mental Health Care Services: A Study of Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:640. [PMID: 38791854 PMCID: PMC11121543 DOI: 10.3390/ijerph21050640] [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: 03/07/2024] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Parental mental disorders in families are frequently accompanied with other problems. These include family life, the development of children, and the social and economic environment. Mental health services often focus treatments on the individual being referred, with little attention to parenting, the family, child development, and environmental factors. This is despite the fact that there is substantial evidence to suggest that the children of these parents are at increased risk of developing a mental disorder throughout the course of their lives. Young children are particularly vulnerable to environmental influences given the level of dependency in this stage of development. OBJECTIVE The main objective of this study was to identify whether there were a complexity of problems and risks in a clinical sample of patients and their young children (0-6) in mental health care, and, if so, whether this complexity was reflected in the integrated treatment given. METHODS The data were collected for 26 risk factors, based on the literature, and then subdivided into the parental, child, family, and environmental domains. The data were obtained from the electronic case files of 100 patients at an adult mental health service and the corresponding 100 electronic case files of their infants at a child mental health service. RESULTS The findings evidenced a notable accumulation of risk factors within families, with a mean number of 8.43 (SD 3.2) risk factors. Almost all of the families had at least four risk factors, more than half of them had between six and ten risk factors, and a quarter of them had between eleven and sixteen risk factors. Furthermore, two-thirds of the families had at least one risk factor in each of the four domains. More than half of the families received support from at least two organizations in addition to the involvement of adult and child mental health services, which is also an indication of the presence of cumulative problems. CONCLUSION This study of a clinical sample shows clearly that the mental disorder among most of the patients, who were all parents of young children, was only one of the problems they had to deal with. The cumulation of risk factors-especially in the family domain-increased the risk of the intergenerational transmission of mental disorders. To prevent these parents and their young children being caught up in this intergenerational cycle, a broad assessment is needed. In addition, malleable risk factors should be addressed in treatment and in close collaboration with other services.
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Affiliation(s)
- Hanna Stolper
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam (EUR), 3062 PA Rotterdam, The Netherlands;
- Jeugd ggz Dimencegroep, 8017 CA Zwolle, The Netherlands;
| | | | - Karin van Doesum
- Department of Clinical Psychology, Radboud University Nijmegen, 6525 XZ Nijmegen, The Netherlands;
- Impluz Dimencegroep, 7411 GT Deventer, The Netherlands
| | - Majone Steketee
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam (EUR), 3062 PA Rotterdam, The Netherlands;
- Verwey-Jonker Instituut, 3522 KE Utrecht, The Netherlands
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Campbell C, Dodd J, Francetic I. Outcomes for university students following emergency care presentation for deliberate self-harm: a retrospective observational study of emergency departments in England for 2017/2018. BMJ Open 2024; 14:e078672. [PMID: 38320836 PMCID: PMC10860022 DOI: 10.1136/bmjopen-2023-078672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES Identify university-aged students and contrast their healthcare provision and outcomes with other patients in the same age group attending emergency departments for deliberate self-harm. DESIGN Retrospective cross-sectional observational study. SETTING Patients visiting 129 public hospital emergency departments across England between April 2017 and March 2018. PARTICIPANTS 14 074 patients aged 18-23 visiting emergency departments for conditions linked to deliberate self-harm, 1016 of which were identified as university-aged students. OUTCOME MEASURES We study various outcomes across the entire patient pathway in the emergency department: waiting time to initial assessment on arrival at the emergency department, count of investigations delivered, discharge destination (patients refusing treatment or leave before being seen, referred to another provider or admitted to inpatient care, discharged with no follow-up) and unplanned follow-up visit within 7 days. RESULTS We find a statistically significant difference of 0.262 (-0.491 to -0.0327) less investigations delivered to students compared with non-students (about 8% compared with the baseline number of investigations for non-students). Stratified analyses reveal that this difference is concentrated among students visiting the emergency department outside of regular working hours (-0.485 (-0.850 to -0.120)) and students visiting for repeated deliberate self-harm episodes (-0.881 (-1.510 to -0.252)). Unplanned reattendance within 7 days is lower among students visiting emergency departments during out of hours (-0.0306 (-0.0576 to -0.00363)), while students arriving by ambulance are less likely to be referred to another provider (-0.0708 (-0.140 to -0.00182)) compared with non-students. CONCLUSIONS We find evidence of less-intense investigations being delivered to patients aged 18-23 identified as students compared with non-students visiting emergency departments after an episode of deliberate self-harm. Given the high risk of suicide attempts after episodes of deliberate self-harm among students, our findings may highlight the need for more focused interventions on this group of patients.
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Affiliation(s)
- Catherine Campbell
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Joe Dodd
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Igor Francetic
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
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Huang L, Kern ML, Oades LG. Chinese international students’ conceptualizations of wellbeing: A prototype analysis. Front Psychol 2022; 13:939576. [PMID: 36092054 PMCID: PMC9450937 DOI: 10.3389/fpsyg.2022.939576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Wellbeing can mean different things to different people, even in the same culture with the same language. People living at the intersection of two languages and cultures, such as Chinese students studying in an English-speaking nation, not only speak a different language than their host country, but also may have different conceptualizations of wellbeing itself. This study investigated Chinese international students’ (aged 18–39, N = 123) conceptualizations of wellbeing using a modified prototype analysis, which provided insights on people’s underlying structure of the construct as revealed through language. Chinese international students’ conceptualizations of wellbeing were prototypically structured; key components of wellbeing included positive relationships, security, positivity/optimism, physical health, and self-strength. The findings broaden the understanding of layperson wellbeing conceptualizations, provide insights into the wellbeing related concepts and language that are most used by international Chinese students, and inform strategies that tertiary education institutions might adopt to effectively support Chinese international students’ wellbeing.
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Yue JL, Li N, Que JY, Hu SF, Xiong NN, Deng JH, Ma N, Sun SW, Chi R, Shi J, Sun HQ. Workforce situation of the Chinese mental health care system: results from a cross-sectional study. BMC Psychiatry 2022; 22:562. [PMID: 35996107 PMCID: PMC9394058 DOI: 10.1186/s12888-022-04204-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/05/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND High-quality mental health services can improve outcomes for people with mental health problems and abate the burden of mental disorders. We sought to identify the challenges the country's mental health system currently faces and the human resource situation related to psychological services and to provide recommendations on how the mental health workforce situation could be addressed in China. METHODS This study used a cross-sectional survey design. A web-based questionnaire approach and a convenience sampling method were adopted. It was carried out from September 2020 to January 2021 in China, and we finally included 3824 participants in the analysis. Descriptive statistical analysis of the characteristics of the study sample was performed. The risk factors for competence in psychological counseling/psychotherapy were assessed using multiple linear regression analysis. RESULTS Workforce related to psychotherapy is scarce in China, especially in Western China and community mental health sectors. Psychiatrists (39.1%) and nurses (38.9%) were the main service providers of psychotherapy in psychiatric hospitals, and clinical psychologists (6.9%) and counsellors (5.0%) were seriously scarce in mental health care sectors. A total of 74.2% of respondents had no systematic psychological training, and 68.4 and 69.2% of them had no self-experience and professional supervision, respectively. Compared with clinical psychologists and counselors, psychiatrists and nurses had less training. Systematic psychological training (β = - 0.88), self-experience (β = - 0.59) and professional supervision (β = - 1.26) significantly influenced psychotherapy capacity (P<0.001). CONCLUSIONS Sustained effort will be required to provide a high-quality, equitably distributed psychotherapy workforce in China, despite challenges for community mental health sectors and western China being likely to continue for some time. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits.
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Affiliation(s)
- Jing-Li Yue
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Na Li
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Jian-Yu Que
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Si-Fan Hu
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Na-Na Xiong
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Jia-Hui Deng
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Ning Ma
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Si-Wei Sun
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Rui Chi
- grid.11135.370000 0001 2256 9319Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191 China
| | - Jie Shi
- grid.11135.370000 0001 2256 9319National Institute on Drug Dependence, Peking University, Beijing, China
| | - Hong-Qiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191, China.
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Sierk A, Travers E, Economides M, Loe BS, Sun L, Bolton H. A New Digital Assessment of Mental Health and Well-being in the Workplace: Development and Validation of the Unmind Index. JMIR Ment Health 2022; 9:e34103. [PMID: 35037895 PMCID: PMC8804960 DOI: 10.2196/34103] [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] [Received: 10/08/2021] [Accepted: 11/21/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Unmind is a workplace, digital, mental health platform with tools to help users track, maintain, and improve their mental health and well-being (MHWB). Psychological measurement plays a key role on this platform, providing users with insights on their current MHWB, the ability to track it over time, and personalized recommendations, while providing employers with aggregate information about the MHWB of their workforce. OBJECTIVE Due to the limitations of existing measures for this purpose, we aimed to develop and validate a novel well-being index for digital use, to capture symptoms of common mental health problems and key aspects of positive well-being. METHODS In Study 1A, questionnaire items were generated by clinicians and screened for face validity. In Study 1B, these items were presented to a large sample (n=1104) of UK adults, and exploratory factor analysis was used to reduce the item pool and identify coherent subscales. In Study 2, the final measure was presented to a new nationally representative UK sample (n=976), along with a battery of existing measures, with 238 participants retaking the Umind Index after 1 week. The factor structure and measurement invariance of the Unmind Index was evaluated using confirmatory factor analysis, convergent and discriminant validity by estimating correlations with existing measures, and reliability by examining internal consistency and test-retest intraclass correlations. RESULTS Studies 1A and 1B yielded a 26-item measure with 7 subscales: Calmness, Connection, Coping, Happiness, Health, Fulfilment, and Sleep. Study 2 showed that the Unmind Index is fitted well by a second-order factor structure, where the 7 subscales all load onto an overall MHWB factor, and established measurement invariance by age and gender. Subscale and total scores correlate well with existing mental health measures and generally diverge from personality measures. Reliability was good or excellent across all subscales. CONCLUSIONS The Unmind Index is a robust measure of MHWB that can help to identify target areas for intervention in nonclinical users of a mental health app. We argue that there is value in measuring mental ill health and mental well-being together, rather than treating them as separate constructs.
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Affiliation(s)
| | | | | | - Bao Sheng Loe
- The Psychometrics Centre, Judge Business School, University of Cambridge, Cambridge, United Kingdom
| | - Luning Sun
- The Psychometrics Centre, Judge Business School, University of Cambridge, Cambridge, United Kingdom
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Fernald DH, Zittleman L, Gilchrist EC, Brou LI, Brou LI, Niebauer L, Ledonne C, Sutter C, Felzien M, Westfall JM, Green LA. UPSTREAM! Together evaluation results from community efforts to prevent mental, emotional, and behavioral health problems. EVALUATION AND PROGRAM PLANNING 2021; 89:102000. [PMID: 34555734 DOI: 10.1016/j.evalprogplan.2021.102000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/08/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
Mental, emotional, and behavioral (MEB) health problems are prevalent globally. Despite effective programs that can prevent MEB problems and promote mental health, there has not been widespread adoption. UPSTREAM! Together was a planning project in three Colorado communities. Communities partnered with academic and policy entities to 1) translate evidence about MEB problem prevention into locally-relevant messages and materials and 2) develop long-term plans for broad implementation of interventions to prevent high-priority MEB problems. Community members recognized the need to talk about MEB problems to prevent them. The UPSTREAM! communities localized messages designed to start conversations and sustain attention on preventing MEB problems. The communities understood that prevention takes sustained community attention and advocacy, knowing that important outcomes may be years away. Long-term implementation plans aimed to strengthen families and enhance social connections among youth. Despite community readiness and capacity to implement evidence-based programs, there were few funding opportunities, delaying program implementation and revealing gaps between funding policies and community readiness. This community-engaged experience suggests an achievable approach, acceptable to communities, and worthy of further development and testing. Policies that cultivate and support local expertise may help to increase wider community adoption of evidence-based programs that promote mental health among youth.
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Affiliation(s)
- Douglas H Fernald
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Linda Zittleman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Emma C Gilchrist
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States; Eugene S. Farley, Jr. Health Policy Center, Aurora, CO, United States
| | - Lina I Brou
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Lina I Brou
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Linda Niebauer
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States; Eugene S. Farley, Jr. Health Policy Center, Aurora, CO, United States
| | - Charlotte Ledonne
- San Luis Valley Area Health Education Center, Alamosa, CO, United States
| | - Christin Sutter
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States; High Plains Research Network Community Advisory Council, Sterling, CO, United States
| | - Maret Felzien
- High Plains Research Network Community Advisory Council, Sterling, CO, United States
| | - John M Westfall
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States; Eugene S. Farley, Jr. Health Policy Center, Aurora, CO, United States
| | - Larry A Green
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States; Eugene S. Farley, Jr. Health Policy Center, Aurora, CO, United States
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Leach MJ, Gillam M, Gonzalez-Chica DA, Walsh S, Muyambi K, Jones M. Health care need and health disparities: Findings from the Regional South Australia Health (RESONATE) survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:905-917. [PMID: 32767700 DOI: 10.1111/hsc.13124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 05/05/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
Regional South Australia has some of the highest rates of psychological distress, chronic disease and multimorbidity of any Australian State or Territory. Yet, the healthcare needs of this population are still not completely understood. To better understand the healthcare needs of regional South Australians, we invited adults living in the region to complete the 44-item consumer utilisation, expectations and experiences of healthcare instrument (CONVERSATIONS), online or in hard-copy. The survey was conducted between April 2017 and March 2018. A multi-modal recruitment campaign was utilised to promote the survey. We examined associations between study outcomes and remoteness area, and drew comparisons between our findings and other surveys reporting pertinent outcomes in the urban SA population. The questionnaire was completed by 3,926 adults (52.5% females; 37.6% aged 60 + years). Among the 264 distinct health conditions reported by participants, the most prevalent were hypertension (31.6%), depression (25.7%), anxiety (23.5%) and hypercholesterolaemia (22.9%). The lifetime prevalence of these conditions among participants exceeded rates reported in urban SA. The largest regional-urban health disparities were observed for eczema/dermatitis, skin cancer, other cancer types and cataracts, where prevalence rates were 2075%, 400%, 373% and 324% higher, respectively, than that reported in urban SA. Participants also reported higher levels of multimorbidity (37.7% higher) relative to urban South Australians. By contrast, participants appeared to be exposed to fewer lifestyle risk behaviours (e.g. smoking, alcohol, inadequate fruit or vegetable intake) than their urban counterparts. In summary, there was a high level of healthcare need, and considerable health disparity among participants when compared with urban settings (particularly for skin and eye conditions). These findings highlight the need for a more targeted approach to delivering health services and health promotion activities in regional areas.
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Affiliation(s)
- Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, NSW, Australia
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | | | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Kuda Muyambi
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
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Hentges RF, Krug CMW, Shaw DS, Wilson MN, Dishion TJ, Lemery-Chalfant K. The long-term indirect effect of the early Family Check-Up intervention on adolescent internalizing and externalizing symptoms via inhibitory control. Dev Psychopathol 2020; 32:1544-1554. [PMID: 31896379 PMCID: PMC7332376 DOI: 10.1017/s0954579419001482] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study examined the long-term effects of a randomized controlled trial of the Family Check-Up (FCU) intervention initiated at age 2 on inhibitory control in middle childhood and adolescent internalizing and externalizing problems. We hypothesized that the FCU would promote higher inhibitory control in middle childhood relative to the control group, which in turn would be associated with lower internalizing and externalizing symptomology at age 14. Participants were 731 families, with half (n = 367) of the families assigned to the FCU intervention. Using an intent-to-treat design, results indicate that the FCU intervention was indirectly associated with both lower internalizing and externalizing symptoms at age 14 via its effect on increased inhibitory control in middle childhood (i.e., ages 8.5-10.5). Findings highlight the potential for interventions initiated in toddlerhood to have long-term impacts on self-regulation processes, which can further reduce the risk for behavioral and emotional difficulties in adolescence.
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Affiliation(s)
- Rochelle F. Hentges
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Daniel S. Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melvin N. Wilson
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
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Garcia-Rizo C, Bitanihirwe BKY. Implications of early life stress on fetal metabolic programming of schizophrenia: A focus on epiphenomena underlying morbidity and early mortality. Prog Neuropsychopharmacol Biol Psychiatry 2020; 101:109910. [PMID: 32142745 DOI: 10.1016/j.pnpbp.2020.109910] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/16/2020] [Accepted: 03/03/2020] [Indexed: 12/19/2022]
Abstract
The fetal origin of adult disease hypothesis postulates that a stressful in utero environment can have deleterious consequences on fetal programming, potentially leading to chronic disease in later life. Factors known to impact fetal programming include the timing, intensity, duration and nature of the external stressor during pregnancy. As such, dynamic modulation of fetal programming is heavily involved in shaping health throughout the life course, possibly by influencing metabolic parameters including insulin action, hypothalamic-pituitary-adrenal activity and immune function. The ability of prenatal insults to program adult disease is likely to occur as a result of reduced functional capacity in key organs-a "thrifty" phenotype-where more resources are re-allocated to preserve critical organs such as the brain. Notably, it has been postulated that the manifestation of neuropsychiatric disorders in individuals priorly exposed to prenatal stress may arise from the interaction between hereditary factors and the intrauterine environment, which together precipitate disease onset by disrupting the trajectory of normal brain development. In this review we discuss the evidence linking prenatal programming to neuropsychiatric disorders, mainly schizophrenia, via a "Thrifty psychiatric phenotype" concept. We start by outlining the conception of the thrifty psychiatric phenotype. Next, we discuss the convergence of potential mechanistic pathways through which prenatal insults may trigger epigenetic changes that contribute to the increased morbidity and early mortality observed in neuropsychiatric disorders. Finally, we touch on the public health importance of fetal programming for these disorders. We conclude by providing a brief outlook on the future of this evolving field of research.
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Affiliation(s)
- Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Institute of Biomedical Research Agusti Pi iSunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain.
| | - Byron K Y Bitanihirwe
- Centre for Global Health, Trinity College Dublin, Dublin, Ireland; Department of Psychology, Trinity College Dublin, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
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Asmundson GJ, Blackstock C, Bourque MC, Brimacombe G, Crawford A, Deacon SH, McMullen K, McGrath PJ, Mushquash C, Stewart SH, Stinson J, Taylor S, Campbell-Yeo M. Easing the disruption of COVID-19: supporting the mental health of the people of Canada—October 2020—an RSC Policy Briefing. Facets (Ott) 2020. [DOI: 10.1139/facets-2020-0082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic has had a significant impact on the mental health of the people of Canada. Most have found it challenging to cope with social distancing, isolation, anxiety about infection, financial security and the future, and balancing demands of work and home life. For some, especially those who have had to face pre-existing challenges such as structural racism, poverty, and discrimination and those with prior mental health problems, the pandemic has been a major impact. The Policy Briefing Report focuses on the current situation, how the COVID-19 pandemic has exacerbated significant long-standing weaknesses in the mental health system and makes specific recommendations to meet these challenges to improve the well-being of the people of Canada. The COVID-19 pandemic has had a detrimental effect on mental health of people in Canada but the impact has been variable, impacting those facing pre-existing structural inequities hardest. Those living in poverty, and in some socially stratified groups facing greater economic and social disadvantage, such as some racialized and some Indigenous groups and those with preexisting mental health problems, have suffered the most. Some occupational groups have been more exposed to the virus and to psychological stress with the pandemic. The mental health care system was already overextended and under resourced. The pandemic has exacerbated the problems. The care system responded by a massive move to virtual care. The future challenge is for Canada to strengthen our knowledge base in mental health, to learn from the pandemic, and to provide all in Canada the support they need to fully participate in and contribute to Canada’s recovery from the pandemic.
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Affiliation(s)
| | - Cindy Blackstock
- First Nations Child and Family Caring Society of Canada, Ottawa, ON, Canada
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Marie Claire Bourque
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Glenn Brimacombe
- Policy and Public Affairs, Canadian Psychological Association, Ottawa, ON, Canada
| | - Allison Crawford
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - S. Hélène Deacon
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Ken McMullen
- Emergency Services, The City of Red Deer, Red Deer, AB, Canada
| | - Patrick J. McGrath
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Chair of the Working Group, Halifax, NS, Canada
| | - Christopher Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
- Dilico Anishinabek Family Care, Thunder Bay, ON, Canada
| | - Sherry H. Stewart
- Departments of Psychiatry and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Jennifer Stinson
- Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Steven Taylor
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University and IWK Health, Halifax, NS, Canada
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Macneil C, Foster F, Nicoll A, Monfries R, Coulson L, Osman H, Grainger M, Cotton S. Effectiveness of a professional development training program in increasing knowledge of mental health clinicians specializing in early psychosis. Early Interv Psychiatry 2019; 13:1003-1010. [PMID: 30666776 DOI: 10.1111/eip.12785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/08/2018] [Accepted: 12/26/2018] [Indexed: 11/27/2022]
Abstract
AIM For early psychosis services to be effective, it is essential to have staff that are trained in evidence-based interventions in this area. In this paper, we report on research undertaken by The Early Psychosis Prevention and Intervention Centre's Statewide Services (ESW) team. The focus was on assessing knowledge acquisition in early psychosis clinicians that had attended ESW's specialist training. METHODS Between October 2012 and October 2017, data were collected from a large cohort of clinicians that had attended 46 ESW workshops covering topics identified in international guidelines as key components of early psychosis service provision. Participants were asked to complete between 3 and 11 pre- and post-workshop short answer and/or multiple choice questions that related to learning outcomes for the workshop. The percentage of correct responses before and after the workshop was compared for each participant, with a cumulative measure taken to provide information regarding knowledge acquisition across each workshop. RESULTS Participant compliance was high (89.7%) with 962 completed questionnaires being collected from 1073 attendees across the workshops. Results showed that the ESW training led to a statistically significant increase in clinician knowledge from pre-training scores of 47.2% correct, to 83.5% correct answers at the conclusion of training (pre M = 47.2%, SD = 28.8; post M = 83.5%, SD = 23.7; t[890] = -35.66, P < 0.001). CONCLUSIONS Training that utilized adult learning principles had a strong focus on evidence-based interventions, and used clinical examples to embed core principles, led to a statistically significant increase in early intervention clinician knowledge.
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Affiliation(s)
- Craig Macneil
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia.,Early Psychosis Prevention and Intervention Centre, Orygen Youth Health, Parkville, Victoria, Australia
| | - Frances Foster
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia
| | - Amanda Nicoll
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia
| | - Richard Monfries
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia
| | - Lucas Coulson
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia.,Early Psychosis Prevention and Intervention Centre, Orygen Youth Health, Parkville, Victoria, Australia
| | - Helen Osman
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia
| | - Michelle Grainger
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia.,Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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MacKenzie A, Tomblin Murphy G, Audas R. A dynamic, multi-professional, needs-based simulation model to inform human resources for health planning. HUMAN RESOURCES FOR HEALTH 2019; 17:42. [PMID: 31196188 PMCID: PMC6567915 DOI: 10.1186/s12960-019-0376-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/12/2019] [Indexed: 05/31/2023]
Abstract
BACKGROUND As population health needs become more complex, addressing those needs increasingly requires the knowledge, skills, and judgment of multiple types of human resources for health (HRH) working interdependently. A growing emphasis on team-delivered health care is evident in several jurisdictions, including those in Canada. However, the most commonly used HRH planning models across Canada and other countries lack the capacity to plan for more than one type of HRH in an integrated manner. The purpose of this paper is to present a dynamic, multi-professional, needs-based simulation model to inform HRH planning and demonstrate the importance of two of its parameters-division of work and clinical focus-which have received comparatively little attention in HRH research to date. METHODS The model estimates HRH requirements by combining features of two previously published needs-based approaches to HRH planning-a dynamic approach designed to plan for a single type of HRH at a time and a multi-professional approach designed to compare HRH supply with requirements at a single point in time. The supplies of different types of HRH are estimated using a stock-and-flow approach. RESULTS The model makes explicit two planning parameters-the division of work across different types of HRH, and the degree of clinical focus among individual types of HRH-which have previously received little attention in the HRH literature. Examples of the impacts of these parameters on HRH planning scenarios are provided to illustrate how failure to account for them may over- or under-estimate the size of any gaps between the supply of and requirements for HRH. CONCLUSION This paper presents a dynamic, multi-professional, needs-based simulation model which can be used to inform HRH planning in different contexts. To facilitate its application by readers, this includes the definition of each parameter and specification of the mathematical relationships between them.
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Affiliation(s)
- Adrian MacKenzie
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
- WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
| | - Gail Tomblin Murphy
- WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, Halifax, Canada
- Nova Scotia Health Authority, Halifax, Canada
| | - Rick Audas
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Carlson K, Kieran K. Narratives of neonatal abstinence syndrome. Arch Psychiatr Nurs 2019; 33:275-283. [PMID: 31227080 DOI: 10.1016/j.apnu.2019.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Kelly Carlson
- McLean Hospital, Belmont, MA, United States of America.
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Segal L, Guy S, Leach M, Groves A, Turnbull C, Furber G. A needs-based workforce model to deliver tertiary-level community mental health care for distressed infants, children, and adolescents in South Australia: a mixed-methods study. LANCET PUBLIC HEALTH 2019; 3:e296-e303. [PMID: 29884435 DOI: 10.1016/s2468-2667(18)30075-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND High-quality mental health services for infants, children, adolescents, and their families can improve outcomes for children exposed to early trauma. We sought to estimate the workforce needed to deliver tertiary-level community mental health care to all infants, children, adolescents, and their families in need using a generalisable model, applied to South Australia (SA). METHODS Workforce estimates were determined using a workforce planning model. Clinical need was established using data from the Longitudinal Study of Australian Children and the Young Minds Matter survey. Care requirements were derived by workshopping clinical pathways with multiprofessional panels, testing derived estimates through an online survey of clinicians. FINDINGS Prevalence of tertiary-level need, defined by severity and exposure to childhood adversities, was estimated at 5-8% across infancy and childhood, and 16% in mid-adolescence. The derived care pathway entailed reception, triage, and follow-up (mean 3 h per patient), core clinical management (mean 27 h per patient per year), psychiatric oversight (mean 4 h per patient per year), specialised clinical role (mean 12 h per patient per year), and socioeconomic support (mean 12 h per patient per year). The modelled clinical full-time equivalent was 947 people and budget was AU$126 million, more than five times the current service level. INTERPRETATION Our novel needs-based workforce model produced actionable estimates of the community workforce needed to address tertiary-level mental health needs in infants, children, adolescents, and their families in SA. A considerable expansion in the skilled workforce is needed to support young people facing current distress and associated family-based adversities. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits. FUNDING National Health and Medical Research Council (Australia), Department of Health SA.
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Affiliation(s)
- Leonie Segal
- Health Economics and Social Policy Group, University of South Australia, Adelaide, SA, Australia.
| | | | - Matthew Leach
- Department of Rural Health, University of South Australia, Adelaide, SA, Australia
| | - Aaron Groves
- Office of the Chief Psychiatrist, Tasmanian Department of Health and Human Services, Hobart, TAS, Australia
| | | | - Gareth Furber
- Health Counselling and Disability Services, Flinders University, Adelaide, SA, Australia
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15
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Kowalenko NM, Culjak G. Workforce planning for children and young people's mental health care. LANCET PUBLIC HEALTH 2018; 3:e266-e267. [DOI: 10.1016/s2468-2667(18)30100-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 10/14/2022]
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Leach MJ, Jones M, Gillam M, May E. Regional South Australia Health (RESONATE) survey: study protocol. BMJ Open 2018; 8:e019784. [PMID: 29654014 PMCID: PMC5905783 DOI: 10.1136/bmjopen-2017-019784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/02/2018] [Accepted: 02/26/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Access to quality healthcare services is considered a moral right. However, for people living in regional locations, timely access to the services that they need may not always be possible because of structural and attitudinal barriers. This suggests that people living in regional areas may have unmet healthcare needs. The aim of this research will be to examine the healthcare needs, expectations and experiences of regional South Australians. METHODS AND ANALYSIS The Regional South Australia Health (RESONATE) survey is a cross-sectional study of adult health consumers living in any private or non-private dwelling, in any regional, rural, remote or very remote area of South Australia and with an understanding of written English. Data will be collected using a 45-item, multidimensional, self-administered instrument, designed to measure healthcare need, barriers to healthcare access and health service utilisation, attitudes, experiences and satisfaction. The instrument has demonstrated acceptable psychometric properties, including good content validity and internal reliability, good test-retest reliability and a high level of acceptability. The survey will be administered online and in hard-copy, with at least 1832 survey participants to be recruited over a 12-month period, using a comprehensive, multimodal recruitment campaign. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Human Research Ethics Committee of the University of South Australia. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, broadcast media, print media, the internet and various community/stakeholder engagement activities.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Esther May
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Segal L, Guy S, Furber G. What is the current level of mental health service delivery and expenditure on infants, children, adolescents, and young people in Australia? Aust N Z J Psychiatry 2018; 52:163-172. [PMID: 28709383 DOI: 10.1177/0004867417717796] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The study aim was to estimate the current level of ambulatory mental health service delivery to young people aged 0-24 years in Australia and associated government expenditure. Recognising the importance of the early years for the development of mental illness and socioeconomic outcomes, we were particularly interested in service access by infants and young children. METHODS We extracted information from government administrative datasets on the number of people who received mental health services, number of services and expenditure through the health sector for 2014-2015. Results are primarily reported by age groups 0-4, 5-11, 12-17 and 18-24 years. RESULTS Less than 1% of 0- to 4-year-olds received a mental health service in any one service setting, whereas nearly 11% of 18- to 24-year-olds received a mental health service through the Medicare Benefits Schedule Better Access programme alone. Many more services were delivered to 12- to 24-year-olds (>4 million) than to 0- to 11-year-olds (552,000). Medicare Benefits Schedule Better Access delivers services to more children and youth than do state/territory community mental health services, although the latter provide more services per client. In 2013-2014, Australian Government expenditure on ambulatory mental health services for 0- to 24-year-olds was AUD428 million, similar to the AUD491 million spent by state/territory governments. CONCLUSION The study provides a benchmark for data-driven service planning to ensure that the mental health needs of infants, children and young people are met. Our results indicate that the youngest age group are underserviced relative to need, even noting infants and children may receive services for behavioural/mental health issues from providers not captured in our study (such as paediatricians). The developmental origins of mental illness underlies the urgency of adequate provision by governments of perinatal, infant and child mental health services to avoid loss of life potential and reduce the pressures on the justice, child protection and welfare systems.
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Affiliation(s)
- Leonie Segal
- Health Economics and Social Policy Group, Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
| | - Sophie Guy
- Health Economics and Social Policy Group, Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
| | - Gareth Furber
- Health Economics and Social Policy Group, Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
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Twizeyemariya A, Guy S, Furber G, Segal L. Risks for Mental Illness in Indigenous Australian Children: A Descriptive Study Demonstrating High Levels of Vulnerability. Milbank Q 2018; 95:319-357. [PMID: 28589608 PMCID: PMC5461394 DOI: 10.1111/1468-0009.12263] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Sophie Guy
- School of Health Sciences, University of South Australia
| | - Gareth Furber
- School of Health Sciences, University of South Australia
| | - Leonie Segal
- School of Health Sciences, University of South Australia
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Furber G, Leach M, Guy S, Segal L. Developing a broad categorisation scheme to describe risk factors for mental illness, for use in prevention policy and planning. Aust N Z J Psychiatry 2017; 51:230-240. [PMID: 27117756 DOI: 10.1177/0004867416642844] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The prevention of mental illness involves identifying and modifying those characteristics and exposures of an individual that threaten their mental health - commonly referred to as risk factors. Existing categorisations of risk factors for mental illness are either limited in their scope or oversimplified in their description. As part of a large mental health workforce and service planning project, we set out to develop a more detailed and comprehensive categorisation scheme to describe risk factors for mental illness. METHODS We conducted a rapid review of MEDLINE and Google Scholar for meta-analytic studies that examined the characteristics and exposures that typify the population with mental illness in order to identify and categorise potential risk factors. RESULTS The search uncovered 1628 relevant studies, from which 10 primary and 23 secondary categories of risk factors were identified, ranging from genetic and biomedical to psychological and sociocultural. The review revealed interesting distortions in the focus of the literature, with the majority of studies focused on a few disorders (schizophrenia, depression and neurodegenerative disorders) and genetic, psychological and physiological risks. In contrast, environmental (e.g. media exposure) and occupational (e.g. employee health) were under-represented. CONCLUSION The categorisation scheme developed in this paper is a step towards a more detailed taxonomy of risk factors for mental illness; this will be most useful in guiding clinicians, researchers and policy-makers in driving the prevention agenda forward.
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Affiliation(s)
- Gareth Furber
- 1 Health Economics and Social Policy Group, Centre for Population Health Research, University of South Australia, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Matthew Leach
- 2 School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia
| | - Sophie Guy
- 1 Health Economics and Social Policy Group, Centre for Population Health Research, University of South Australia, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Leonie Segal
- 1 Health Economics and Social Policy Group, Centre for Population Health Research, University of South Australia, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, SA, Australia
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Guy S, Furber G, Leach M, Segal L. How many children in Australia are at risk of adult mental illness? Aust N Z J Psychiatry 2016; 50:1146-1160. [PMID: 27009274 DOI: 10.1177/0004867416640098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the prevalence of children in the Australian population with risk factors for adult mental illness. METHOD Key risk factors and risk domains were identified from a 2013 review of longitudinal studies on child and adolescent determinants of adult mental illness. Data items were identified from the Longitudinal Study of Australian Children that map onto the risk domains and were used to estimate the prevalence of these key individual risk factors and the magnitude of multiple risk in children aged 3 months to 13 years. RESULTS Even by infancy, risk factors for adult mental illness are highly prevalent, with 51.7% of infants having multiple risks. In 10 infants, 1 was born to mothers who consumed daily alcohol and 1 in 8 to mothers who smoked cigarettes daily during pregnancy. Also, 10.5% of infants were in families where the parents had separated, which increased to 18% in 10-11 year-olds. Psychological problems in the clinical range (based on the Strengths and Difficulties Questionnaire total problems score) ranged from 7.8% to 9.7% across the 4-13 years age range. Risks from negative parenting behaviours were highly prevalent across age groups. Two-thirds of children aged 12-13 years had parents who displayed low warmth or exhibited high hostility/anger. Across childhood, one in seven children are in families exposed to 3+ major life stressors. By age 8-9 years, more than 18% of children are exposed to ⩾5 risk factors. CONCLUSIONS We find that modifiable risk factors for adult mental illness occur at the earliest stage in the life course and at greater prevalence than is commonly recognised. Considerable capacity will be required in child and adolescent mental health services and complementary family support programmes if risk factors for adult mental illness that are already apparent in infancy and childhood are to be addressed.
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Affiliation(s)
- Sophie Guy
- Health Economics and Social Policy Group, Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
| | - Gareth Furber
- Health Economics and Social Policy Group, Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
| | - Matthew Leach
- School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia
| | - Leonie Segal
- Health Economics and Social Policy Group, Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
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