Transitioning to community-based mental healthcare: reform experiences of five countries

Mental Health of Adolescents Exposed to the War in Ukraine

Importance

With exposure to traumatic events and reduced access to mental health care, adolescents of Ukraine during the Russian invasion since February 2022 are at high risk of psychiatric conditions. However, the actual mental health burden of the war has scarcely been documented.

Objective

To investigate the prevalence of a positive screen for psychiatric conditions among adolescents amidst the ongoing war in Ukraine as well as their associations with war exposure.

Design, Setting, and Participants

This cross-sectional study reports the results from the first wave of the Adolescents of Ukraine During the Russian Invasion cohort, the largest cohort study on Ukrainian adolescents' mental health during the Russian invasion since 2022. Using self-reported questionnaires, the national-level prevalence of a positive screen for various psychiatric conditions was estimated among adolescents aged 15 years or older attending secondary school in Ukraine in person or online (including those residing abroad but attending Ukrainian secondary school online) and the prevalence among Ukrainian adolescents living abroad due to the war.

Exposure

Self-reported exposure to war.

Main Outcomes and Measures

A positive screen for psychiatric conditions. The association between self-reported war exposure and a positive screen for each of the psychiatric conditions was also evaluated.

Results

A total of 8096 Ukrainian adolescents (4988 [61.6%] female) living in Ukraine or abroad were included in the analyses. Based on national-level estimates, 49.6% of the adolescents were directly exposed to war, 32.0% screened positive for moderate or severe depression, 17.9% for moderate or severe anxiety, 35.0% for clinically relevant psychological trauma, 29.5% for eating disorders, and 20.5% for medium risk or higher of substance use disorder. The burden of psychiatric symptoms was similarly large among Ukrainian adolescents living abroad. Adolescents exposed to war were more likely to screen positive for depression (prevalence ratio [PR], 1.39; 95% CI, 1.29-1.50), anxiety (PR, 1.62; 95% CI, 1.45-1.81), clinically relevant psychological trauma (PR, 1.41; 95% CI, 1.32-1.50), eating disorders (PR, 1.21; 95% CI, 1.12-1.32), and substance use disorder (PR, 1.11; 95% CI, 0.98-1.25).

Conclusions and Relevance

The findings of this study suggest that the mental health burden of Ukrainian adolescents amidst the Russian invasion of Ukraine is substantial. Mental health care efforts to alleviate the mental health burden of Ukrainian adolescents are needed.

Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study

OBJECTIVE

To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations.

METHOD

This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed.

RESULTS

Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58).

CONCLUSION

Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Helping intentions toward suicidal people among young adults: Patterns, transitions, and influencing factors

BACKGROUND

Public involvement is an essential element of effective suicide prevention. However, few studies have investigated laypeople's intentions and behaviors in supporting suicidal people, especially within Chinese contexts. This study was conducted among young adults in Hong Kong to identify categories of helping intentions toward suicidal people, and to understand whether, and why, youth transitioned over time between helping intention categories.

METHODS

A total of 807 Hong Kong young adults (18-35 years) participated in this two-wave study across 2018 (W1) and 2019 (W2). Latent class analyses were conducted to identify categories of helping intentions toward suicidal people. A latent transition analysis was applied to explore the stability of the categories over time, and the factors that influenced stability.

RESULTS

Three categories were identified in both waves: 1) dedicated helpers (W1: 28.38 %, W2: 28.50 %), 2) willing helpers (W1: 30.24 %, W2: 33.83 %), and 3) inconsistent helpers (W1: 41.39 %, W2: 37.67 %). 73.48 % of the young adults stayed in the same category across two years. Gender, and attitudes toward suicide victims were related to category membership and transitions between categories.

LIMITATIONS

Measurement of helping intentions may not be thorough. Further studies are required to examine whether the findings can be generalized to the other population.

CONCLUSIONS

Effective community engagement is essential for suicide prevention. Young adults in Hong Kong exhibited different helping intentions toward suicidal people, that were moderately stable over a two-year period. Understanding how and why young adults behave differently toward suicidal people is important when planning effective suicide prevention programs.

OUTPATIENT SERVICES FOR PEOPLE WITH MENTAL DISORDERS IN THE KYRGYZ REPUBLIC: WHAT’S NEXT?

Outpatient care for patients with mental disorders in the Kyrgyz Republic remains underdeveloped. This is largely due to the political instability and refusal of the government to prioritize the mental health services in terms of funding. Psychiatric treatment is still provided by the major state hospitals, and community-based and psychosocial services are almost entirely absent. This article describes attempts of the mental health to survive, and Herculean efforts to provide outpatient care for people with mental disorders. Efforts of several fruitfully working NGOs are insufficient to satisfy the need. There is a gradual and irreversible movement toward the development of the private sector in the field of mental health, including private psychiatric hospitals and private psychotherapy services. However, without a more articulated and proactive position of the state on the issues of mental health system, and without the initiatives to provide better legislative grounds for outpatient services, the outpatient care might remain chaotic for longer.

The Quality of Care Provided by Outpatient Mental Health Services in Georgia

Georgia has recently made a commendable effort to reform mental health care. The Concept on Mental Health Care adopted by the Government and the two strategic plans for 20142020 and 20212031, which aimed to develop comprehensive evidence-based, culturally appropriate, and human rights-oriented mental health care, have promoted the deinstitutionalization and development of community mental health services. Since 2018, new standards of care for mental health ambulatories and mobile teams have been imposed and implemented in the state programme and funded accordingly. The study aimed to investigate the quality of care in community mental health services. As a result, we monitored the mental health ambulatories in all major cities and regional centres of the country (in total, 16 ambulatories) and the mobile teams which had at least two years of experience (in total, 14 mobile teams). The data analyses showed that the new standards for ambulatories and mobile teams increased access to and coverage of mental health care across the country. However, further effort is still needed to achieve comprehensive treatment by mental health care services.