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Karran EL, Grant AR, Lee H, Kamper SJ, Williams CM, Wiles LK, Shala R, Poddar CV, Astill T, Moseley GL. Do health education initiatives assist socioeconomically disadvantaged populations? A systematic review and meta-analyses. BMC Public Health 2023; 23:453. [PMID: 36890466 PMCID: PMC9996883 DOI: 10.1186/s12889-023-15329-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: 10/27/2022] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Health education interventions are considered critical for the prevention and management of conditions of public health concern. Although the burden of these conditions is often greatest in socio-economically disadvantaged populations, the effectiveness of interventions that target these groups is unknown. We aimed to identify and synthesize evidence of the effectiveness of health-related educational interventions in adult disadvantaged populations. METHODS We pre-registered the study on Open Science Framework https://osf.io/ek5yg/ . We searched Medline, Embase, Emcare, and the Cochrane Register from inception to 5/04/2022 to identify studies evaluating the effectiveness of health-related educational interventions delivered to adults in socio-economically disadvantaged populations. Our primary outcome was health related behaviour and our secondary outcome was a relevant biomarker. Two reviewers screened studies, extracted data and evaluated risk of bias. Our synthesis strategy involved random-effects meta-analyses and vote-counting. RESULTS We identified 8618 unique records, 96 met our criteria for inclusion - involving more than 57,000 participants from 22 countries. All studies had high or unclear risk of bias. For our primary outcome of behaviour, meta-analyses found a standardised mean effect of education on physical activity of 0.05 (95% confidence interval (CI) = -0.09-0.19), (5 studies, n = 1330) and on cancer screening of 0.29 (95% CI = 0.05-0.52), (5 studies, n = 2388). Considerable statistical heterogeneity was present. Sixty-seven of 81 studies with behavioural outcomes had point estimates favouring the intervention (83% (95% CI = 73%-90%), p < 0.001); 21 of 28 studies with biomarker outcomes showed benefit (75% (95%CI = 56%-88%), p = 0.002). When effectiveness was determined based on conclusions in the included studies, 47% of interventions were effective on behavioural outcomes, and 27% on biomarkers. CONCLUSIONS Evidence does not demonstrate consistent, positive impacts of educational interventions on health behaviours or biomarkers in socio-economically disadvantaged populations. Continued investment in targeted approaches, coinciding with development of greater understanding of factors determining successful implementation and evaluation, are important to reduce inequalities in health.
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Affiliation(s)
- E L Karran
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
| | - A R Grant
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - H Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal, Sciences, University of Oxford, Oxford, UK.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - S J Kamper
- School of Health Sciences, University of Sydney, Sydney, NSW, Australia.,Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - C M Williams
- University of Newcastle, Sydney, NSW, Australia.,Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - L K Wiles
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - R Shala
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.,Department of Physiotherapy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - C V Poddar
- Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - T Astill
- Western Sydney University, Sydney, NSW, Australia
| | - G L Moseley
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
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2
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Keller EM, Owens GP. Understanding help-seeking in rural counties: A serial mediation analysis. J Clin Psychol 2021; 78:857-876. [PMID: 34614200 DOI: 10.1002/jclp.23260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Rural areas in the Southern United States are characterized by certain cultural values that may delay or prevent mental health service utilization. The present study examined a four-stage chain of serial mediation where higher levels of general self-reliance would be related to greater levels of public stigma, which would in turn be related to higher levels of self-stigma, followed by greater self-reliance about managing mental health problems, and finally, more negative attitudes toward seeking help from psychologists. METHOD Community members who lived in rural counties in the Southern United States (N = 783) completed measures of these constructs online. RESULTS Mediation analyses supported a direct association between general self-reliance and attitudes toward help-seeking that was explained in serial by higher levels of public stigma, self-stigma, and mental health self-reliance. CONCLUSIONS Clinical implications for rural practitioners are suggested including instilling policy changes, increasing provider visibility, and addressing barriers in therapy.
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Affiliation(s)
- Emily M Keller
- University of Tennessee, Department of the Psychology, Knoxville, Tennessee, USA
| | - Gina P Owens
- University of Tennessee, Department of the Psychology, Knoxville, Tennessee, USA
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3
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Fischer EP, Curran GM, Fortney JC, McSweeney JC, Williams DK, Williams JS. Impact of Attitudes and Rurality on Veterans' Use of Veterans Health Administration Mental Health Services. Psychiatr Serv 2021; 72:521-529. [PMID: 33691490 PMCID: PMC8638372 DOI: 10.1176/appi.ps.201900275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Veterans, especially those residing in rural areas, continue to underutilize mental health care. This longitudinal study assessed attitudes relevant to seeking mental health care services from the Veterans Health Administration (VHA) over 12 months, adjusting for residence. METHODS A questionnaire addressing attitudes, sociodemographic factors, residence, place identity, perceived health status and needs, and structural barriers was administered by telephone to 752 veterans with previous VHA service use. Service use data were obtained from a VHA database. RESULTS In adjusted models, four attitudes were significantly associated with underuse of VHA mental health care (no use vs. any use; no use vs. nonsustained use vs. sustained use). Higher levels of mistrust of others (adjusted odds ratio [AOR]=1.06, p=0.046), emotional stoicism (AOR=1.08, p=0.003), belief in the self-resolving nature of mental health problems (AOR=1.91, p=0.015), and belief in the efficacy of religious counseling for such problems (AOR=1.09, p=0.022) were associated with no subsequent service use versus any use. Place identity (suburban), older age, and greater need were associated with greater odds of VHA use. For the comparison of no use versus sustained use, women had lower odds of no use (AOR=0.49, p<0.001); similarly, women had lower odds of nonsustained use versus sustained use (AOR=0.45, p<0.001). CONCLUSIONS The association of potentially modifiable attitudes with underuse of VHA mental health services suggests that attitudes offer useful targets for efforts to increase mental health care use. That these attitudes were influential regardless of residence suggests that programs addressing attitudinal barriers can be broadly targeted.
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Affiliation(s)
- Ellen P Fischer
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney)
| | - Geoffrey M Curran
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney)
| | - John C Fortney
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney)
| | - Jean C McSweeney
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney)
| | - D Keith Williams
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney)
| | - J Silas Williams
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock (Fischer, Curran, J. S. Williams); Department of Psychiatry, College of Medicine (Fischer), Department of Pharmacy Practice, College of Pharmacy (Curran), Department of Nursing Science, College of Nursing (McSweeney), and Department of Biostatistics (D. K. Williams), University of Arkansas for Medical Sciences, Little Rock; Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, University of Washington School of Medicine, Seattle (Fortney)
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Snell-Rood C, Feltner F, Schoenberg N. What Role Can Community Health Workers Play in Connecting Rural Women with Depression to the "De Facto" Mental Health Care System? Community Ment Health J 2019; 55:63-73. [PMID: 29299719 DOI: 10.1007/s10597-017-0221-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/26/2017] [Indexed: 01/18/2023]
Abstract
The prevalence of depression among rural women is nearly twice the national average, yet limited mental health services and extensive social barriers restrict access to needed treatment. We conducted key informant interviews with community health workers (CHWs) and diverse health care professionals who provide care to Appalachian women with depression to better understand the potential roles that CHWs may play to improve women's treatment engagement. In the gap created by service disparities and social barriers, CHWs can offer a substantial contribution through improving recognition of depression; deepening rural women's engagement within existing services; and offering sustained, culturally appropriate support.
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Affiliation(s)
- Claire Snell-Rood
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, 207H University Hall #7360, Berkeley, CA, 94720, USA.
| | | | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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5
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Abstract
Purpose We examined openly shared substance-related tweets to estimate prevalent sentiment around substance use and identify popular substance use activities. Additionally, we investigated associations between substance-related tweets and business characteristics and demographics at the zip code level. Methods A total of 79,848,992 tweets were collected from 48 states in the continental United States from April 2015-March 2016 through the Twitter API, of which 688,757 were identified as being related to substance use. We implemented a machine learning algorithm (maximum entropy text classifier) to estimate sentiment score for each tweet. Zip code level summaries of substance use tweets were created and merged with the 2013 Zip Code Business Patterns and 2010 US Census Data. Results Quality control analyses with a random subset of tweets yielded excellent agreement rates between computer generated and manually generated labels: 97%, 88%, 86%, 75% for underage engagement in substance use, alcohol, drug, and smoking tweets, respectively. Overall, 34.1% of all substance-related tweets were classified as happy. Alcohol was the most frequently tweeted substance, followed by marijuana. Regression results suggested more convenience stores in a zip code were associated with higher percentages of tweets about alcohol. Larger zip code population size and higher percentages of African Americans and Hispanics were associated with fewer tweets about substance use and underage engagement. Zip code economic disadvantage was associated with fewer alcohol tweets but more drug tweets. Conclusions The patterns in substance use mentions on Twitter differ by zip code economic and demographic characteristics. Online discussions have great potential to glorify and normalize risky behaviors. Health promotion and underage substance prevention efforts may include interactive social media campaigns to counter the social modeling of risky behaviors.
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6
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Fischer EP, McSweeney JC, Wright P, Cheney A, Curran GM, Henderson K, Fortney JC. Overcoming Barriers to Sustained Engagement in Mental Health Care: Perspectives of Rural Veterans and Providers. J Rural Health 2016; 32:429-438. [DOI: 10.1111/jrh.12203] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/27/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Ellen P. Fischer
- Center for Mental Healthcare & Outcomes Research; Central Arkansas Veterans Healthcare System; North Little Rock Arkansas
- Department of Psychiatry, College of Medicine; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Jean C. McSweeney
- College of Nursing; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Patricia Wright
- College of Nursing; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Ann Cheney
- Department of Social Medicine & Population Health, University of California; Riverside School of Medicine; Riverside California
| | - Geoffrey M. Curran
- Center for Mental Healthcare & Outcomes Research; Central Arkansas Veterans Healthcare System; North Little Rock Arkansas
- Department of Psychiatry, College of Medicine; University of Arkansas for Medical Sciences; Little Rock Arkansas
- Department of Pharmacy Practice, College of Pharmacy; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Kathy Henderson
- Center for Mental Healthcare & Outcomes Research; Central Arkansas Veterans Healthcare System; North Little Rock Arkansas
| | - John C. Fortney
- Center of Innovation for Veteran-Centered and Value-Driven Care; VA Puget Sound Health Care System; Seattle Washington
- Department of Psychiatry; University of Washington School of Medicine; Seattle Washington
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7
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Snell-Rood C, Hauenstein E, Leukefeld C, Feltner F, Marcum A, Schoenberg N. Mental health treatment seeking patterns and preferences of Appalachian women with depression. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2016; 87:233-241. [PMID: 27322157 DOI: 10.1037/ort0000193] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This qualitative study explored social-cultural factors that shape treatment seeking behaviors among depressed rural, low-income women in Appalachia-a region with high rates of depression and a shortage of mental health services. Recent research shows that increasingly rural women are receiving some form of treatment and identifying their symptoms as depression. Using purposive sampling, investigators recruited 28 depressed low-income women living in Appalachian Kentucky and conducted semistructured interviews on participants' perceptions of depression and treatment seeking. Even in this sample of women with diverse treatment behaviors (half reported current treatment), participants expressed ambivalence about treatment and its potential to promote recovery. Participants stressed that poor treatment quality-not merely access-limited their engagement in treatment and at times reinforced their depression. While women acknowledged the stigma of depression, they indicated that their resistance to seek help for their depression was influenced by the expectation of women's self-reliance in the rural setting and the gendered taboo against negative thinking. Ambivalence and stigma led women to try to cope independently, resulting in further isolation. This study's findings reiterate the need for improved quality and increased availability of depression treatment in rural areas. In addition, culturally appropriate depression interventions must acknowledge rural cultural values of self-reliance and barriers to obtaining social support that lead many women to endure depression in isolation. (PsycINFO Database Record
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Affiliation(s)
- Claire Snell-Rood
- Department of Behavioral Science, University of Kentucky College of Medicine
| | | | - Carl Leukefeld
- Department of Behavioral Science, University of Kentucky College of Medicine
| | | | - Amber Marcum
- Department of Psychology, University of Kentucky
| | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky College of Medicine
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8
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Cheng TC, Lo CC. Domestic Violence and Treatment Seeking: A Longitudinal Study of Low-Income Women and Mental Health/Substance Abuse Care. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2014; 44:735-59. [DOI: 10.2190/hs.44.4.d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A study with 591 low-income women examined domestic violence's role in treatment seeking for mental health or substance abuse problems. (The women resided in one of two California counties.) Following Aday's behavioral model of health services utilization, the secondary data analysis considered the women's need, enabling, and predisposing factors. Generalized estimating equations analyzed the women's longitudinal records of treatment seeking. Results showed that those in the sample who were likely to seek treatment had experienced three or more controlling behaviors and only one abusive behavior. Multivariate data analysis showed treatment-seeking women were likely to be white and older; responsible for few dependent children; not graduates of high school; employed; not participating in Medicaid; diagnosed; and perceiving a need for treatment. The implications of these results for services and policies are discussed.
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9
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Lutfiyya MN, Bianco JA, Quinlan SK, Hall C, Waring SC. Mental health and mental health care in rural America: the hope of redesigned primary care. Dis Mon 2012; 58:629-38. [PMID: 23062679 DOI: 10.1016/j.disamonth.2012.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rhew IC, David Hawkins J, Oesterle S. Drug use and risk among youth in different rural contexts. Health Place 2011; 17:775-83. [PMID: 21414831 DOI: 10.1016/j.healthplace.2011.02.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 01/26/2011] [Accepted: 02/06/2011] [Indexed: 10/18/2022]
Abstract
This study compared levels of drug use and risk and protective factors among 18,767 adolescent youths from communities of less than 50,000 in population living either on farms, in the country but not on farms, or in towns. Current alcohol use, smokeless tobacco use, inhalant use, and other illicit drug use were more prevalent among high school-aged youths living on farms than among those living in towns. Prevalence of drug use did not significantly vary across youths living in different residential contexts among middle school youths. While risk and protective factors showed associations of similar magnitude with drug use across residential location, high school students living on farms were exposed to greater numbers of risk factors across multiple domains than were students living in towns. The findings suggest that outreach to farm-dwelling youths may be particularly important for interventions seeking to prevent adolescent drug use in rural settings.
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Affiliation(s)
- Isaac C Rhew
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Avenue NE #401, Seattle, WA 98115, USA.
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Hilton MF, Scheurer RW, Sheridan J, Cleary CM, Whiteford HA. Employee psychological distress and treated prevalence by indices of rurality. Aust N Z J Public Health 2010; 34:458-65. [DOI: 10.1111/j.1753-6405.2010.00590.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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Gabriel A, Violato C. The development and psychometric assessment of an instrument to measure attitudes towards depression and its treatments in patients suffering from non-psychotic depression. J Affect Disord 2010; 124:241-9. [PMID: 19944465 DOI: 10.1016/j.jad.2009.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 10/29/2009] [Accepted: 11/12/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop and psychometrically assess an instrument to measure patients' attitudes towards depression, to its treatments, and aspects of professional help in patients suffering from depression. METHOD A 27 item Likert type instrument was developed and written based on an evidence from a literature review and in consultation with experts in depression. Psychiatrists (n=12) participated in a validation process of the instrument before it was administered to outpatients (n=63) suffering from non-psychotic depression. RESULTS Internal consistency reliability for the instrument was 0.79 (Cronbach's alpha) and there was 88% overall agreement between experts about the relevance of the instruments' items to test patients' attitudes to depression and its treatments, providing evidence for content validity. Factor analysis resulted in five cohesive and theoretically meaningful factors: 1) Acceptance of treatment, 2) Perceived stigma and shame, 3) Negative attitude towards antidepressants, 4) Self stigma, and 5) Preference for psychotherapy. CONCLUSION The developed instrument is a reliable, valid and empirical measure to assess attitudes towards depression and its treatments. Future research should be designed to replicate and extend the present findings with larger and more heterogeneous samples.
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Affiliation(s)
- Adel Gabriel
- University of Calgary and Calgary Health region, 2000 Pegasus Road NE, Calgary, Canada T2E 8K7.
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Glisson C, Schoenwald SK, Hemmelgarn A, Green P, Dukes D, Armstrong KS, Chapman JE. Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. J Consult Clin Psychol 2010; 78:537-50. [PMID: 20658810 PMCID: PMC3951378 DOI: 10.1037/a0019160] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A randomized trial assessed the effectiveness of a 2-level strategy for implementing evidence-based mental health treatments for delinquent youth. METHOD A 2 x 2 design encompassing 14 rural Appalachian counties included 2 factors: (a) the random assignment of delinquent youth within each county to a multisystemic therapy (MST) program or usual services and (b) the random assignment of counties to the ARC (for availability, responsiveness, and continuity) organizational intervention for implementing effective community-based mental health services. The design created 4 treatment conditions (MST plus ARC, MST only, ARC only, control). Outcome measures for 615 youth who were 69% male, 91% Caucasian, and aged 9-17 years included the Child Behavior Checklist and out-of-home placements. RESULTS A multilevel, mixed-effects, regression analysis of 6-month treatment outcomes found that youth total problem behavior in the MST plus ARC condition was at a nonclinical level and significantly lower than in other conditions. Total problem behavior was equivalent and at nonclinical levels in all conditions by the 18-month follow-up, but youth in the MST plus ARC condition entered out-of-home placements at a significantly lower rate (16%) than youth in the control condition (34%). CONCLUSIONS Two-level strategies that combine an organizational intervention such as ARC and an evidence-based treatment such as MST are promising approaches to implementing effective community-based mental health services. More research is needed to understand how such strategies can be used effectively in a variety of organizational contexts and with other types of evidence-based treatments.
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Affiliation(s)
- Charles Glisson
- Children's Mental Health Services Research Center, University of Tennessee, Knoxville, TN 37996-3332, USA.
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Heise B. Healthcare system use by risky alcohol drinkers: A secondary data analysis. ACTA ACUST UNITED AC 2010; 22:256-63. [DOI: 10.1111/j.1745-7599.2010.00500.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cully JA, Jameson JP, Phillips LL, Kunik ME, Fortney JC. Use of Psychotherapy by Rural and Urban Veterans. J Rural Health 2010; 26:225-33. [DOI: 10.1111/j.1748-0361.2010.00294.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Price SK, Proctor EK. A Rural Perspective on Perinatal Depression: Prevalence, Correlates, and Implications for Help-Seeking Among Low-Income Women. J Rural Health 2009; 25:158-66. [DOI: 10.1111/j.1748-0361.2009.00212.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Siskind D, Wiley-Exley E. Comparison of Assertive Community Treatment Programs in Urban Massachusetts and Rural North Carolina. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2009; 36:236-46. [DOI: 10.1007/s10488-009-0208-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 01/30/2009] [Indexed: 10/21/2022]
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Abstract
This editorial provides an overview of how far access to mental health care is limited by perceptions of stigma and anticipated discrimination. Globally over 70% of young people and adults with mental illness receive no treatment from healthcare staff. The rates of non-treatment are far higher in low income countries. Evidence from some descriptive studies and epidemiological surveys suggest that potent factors increasing the likelihood of treatment avoidance, or long delays before presenting for care include: (i) lack of knowledge about the features and treatability of mental illnesses; (ii) ignorance about how to access assessment and treatment; (iii) prejudice against people who have mental illness, and (iv) expectations of discrimination against people who have a diagnosis of mental illness. The associations between low rates of help seeking, and stigma and discrimination are as yet poorly understood and require more careful characterisation and analysis, providing the platform for more effective action to ensure that a greater proportion of people with mental illness are effectively treated in future.
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Chamberlain P, Brown CH, Saldana L, Reid J, Wang W, Marsenich L, Sosna T, Padgett C, Bouwman G. Engaging and recruiting counties in an experiment on implementing evidence-based practice in California. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2008; 35:250-60. [PMID: 18302015 PMCID: PMC2562896 DOI: 10.1007/s10488-008-0167-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 02/07/2008] [Indexed: 11/24/2022]
Abstract
There is a growing consensus that implementation of evidence-based intervention and treatment models holds promise to improve the quality of services in child public service systems such as mental health, juvenile justice, and child welfare. Recent policy initiatives to integrate such research-based services into public service systems have created pressure to expand knowledge about implementation methods. Experimental strategies are needed to test multi-level models of implementation in real world contexts. In this article, the initial phase of a randomized trial that tests two methods of implementing Multidimensional Treatment Foster Care (an evidence-based intervention that crosses child public service systems) in 40 non-early adopting California counties is described. Results are presented that support the feasibility of using a randomized design to rigorously test contrasting implementation models and engaging system leaders to participate in the trial.
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Affiliation(s)
- Patricia Chamberlain
- Center for Research to Practice, 392 E. 3rd Avenue, Eugene, OR 97401, USA, e-mail: ;
| | | | - Lisa Saldana
- Center for Research to Practice, 392 E. 3rd Avenue, Eugene, OR 97401, USA, e-mail: ;
| | - John Reid
- Center for Research to Practice, 392 E. 3rd Avenue, Eugene, OR 97401, USA, e-mail: ;
| | - Wei Wang
- University of South Florida, Tampa, FL, USA
| | | | - Todd Sosna
- California Institute for Mental Health, Sacramento, CA, USA
| | - Courtenay Padgett
- Center for Research to Practice, 392 E. 3rd Avenue, Eugene, OR 97401, USA, e-mail: ;
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Davey MP, Watson MF. Engaging African Americans in Therapy: Integrating a Public Policy and Family Therapy Perspective. CONTEMPORARY FAMILY THERAPY 2007. [DOI: 10.1007/s10591-007-9053-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Probst JC, Laditka SB, Moore CG, Harun N, Powell MP. Race and Ethnicity Differences in Reporting of Depressive Symptoms. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2007; 34:519-29. [PMID: 17849182 DOI: 10.1007/s10488-007-0136-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Accepted: 08/10/2007] [Indexed: 12/22/2022]
Abstract
Our study explored race and ethnicity differences in reporting of symptoms to physicians and other practitioners among respondents to the 1999 National Health Interview Survey who screened positive for depression. Respondents were asked if they had told a doctor or another practitioner (nurse, social worker, psychologist, clergy, other) about their problems. Whites and Hispanics were significantly more likely to communicate with a physician or other practitioner than were African Americans, even with personal characteristics held constant. Practitioners should actively elicit descriptions of feelings and mood, especially with African Americans, and be prepared to treat or refer patients appropriately.
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Affiliation(s)
- Janice C Probst
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, USA.
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Jameson JP, Blank MB. The role of clinical psychology in rural mental health services: Defining problems and developing solutions. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1468-2850.2007.00089.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Elder M. A reason for optimism in rural mental health care: Emerging solutions and models of service delivery. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2007. [DOI: 10.1111/j.1468-2850.2007.00090.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jackson H, Judd F, Komiti A, Fraser C, Murray G, Robins G, Pattison P, Wearing A. Mental health problems in rural contexts: What are the barriers to seeking help from professional providers? AUSTRALIAN PSYCHOLOGIST 2007. [DOI: 10.1080/00050060701299532] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Henry Jackson
- Department of Psychology, School of Behavioural Science, University of Melbourne
| | - Fiona Judd
- Bendigo Health and School of Psychology, Psychiatry and Psychological Medicine, Monash University
| | - Angela Komiti
- Bendigo Health and School of Psychology, Psychiatry and Psychological Medicine, Monash University
| | - Caitlin Fraser
- Bendigo Health and School of Psychology, Psychiatry and Psychological Medicine, Monash University
| | - Greg Murray
- Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Garry Robins
- Department of Psychology, School of Behavioural Science, University of Melbourne
| | - Philippa Pattison
- Department of Psychology, School of Behavioural Science, University of Melbourne
| | - Alex Wearing
- Department of Psychology, School of Behavioural Science, University of Melbourne
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Abstract
Early psychosis (EP), in which the terms first-episode psychosis or first-break psychosis are also considered, is an area of developing research intensity. Although it is apparent that considerable progress has been made in establishing best practice criteria and protocols for EP in general, the particular issues pertaining to rural areas have not received the same attention. The purpose of the present study was to conduct a systematic review of the literature of early psychosis programmes, initiatives and research in rural areas in order to help establish the best available evidence. The authors conducted a systematic search of major electronic databases, based on the NHMRC hierarchy of evidence, an established scale, for identified early psychosis cross-referenced with multiple rural terms, between the years 1995 and 2005. A total of 637 articles met the initial search criteria; 206 were identified as having primary significance; three dealt specifically with rural areas. There is a paucity of research findings or published literature concerning the specific needs or characteristics of early psychosis practice or service delivery in rural areas. A number of inferences and suggestions for further research, investigations and policy directions are put forward for consideration.
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Affiliation(s)
- Mark Welch
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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Sakamoto S, Tanaka E, Neichi K, Sato K, Ono Y. Sociopsychological factors relating to suicide prevention in a Japanese rural community: coping behaviors and attitudes toward depression and suicidal ideation. Psychiatry Clin Neurosci 2006; 60:676-86. [PMID: 17109701 DOI: 10.1111/j.1440-1819.2006.01582.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In response to the rise in suicide in Japan since 1998, some suicide prevention measures in local communities have been put into action. However, in the previous suicide prevention measures, sociopsychological factors were not fully taken into consideration. In the present study, the authors surveyed sociopsychological factors relating to suicide and depression (i.e. people's coping behavior and thoughts about depression and suicidal ideation, and their attitudes toward suicide and psychiatric treatment), and their differences in gender and generations. The present study was conducted in a rural area of Japan (Town A), where the suicide rate is much higher than the national average. The authors randomly selected 10% of the residents (i.e. 532 people) aged between 40 and 79 years on the basis of resident registration. Health promotion volunteers in Town A visited these 532 people individually, distributed questionnaires, and asked them to anonymously answer the questionnaire within 4 weeks. Data from 450 residents (193 men, 257 women) were analyzed in the present study. Although there were few gender differences, some significant differences were found between the younger (40-59 years) and older (60-79 years) residents. Generally, the younger were more pessimistic about their mental health than the elderly. It was also noteworthy that about 10% of the people thought that it was natural for them to have suicidal ideation, and about 18% reported that they had experienced suicidal ideation. Some suggestions were given to provide more effective suicide prevention measures.
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Affiliation(s)
- Shinji Sakamoto
- Department of Psychology, College of Humanities and Sciences, Nihon University, Tokyo, Japan.
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Komiti A, Judd F, Jackson H. The influence of stigma and attitudes on seeking help from a GP for mental health problems: a rural context. Soc Psychiatry Psychiatr Epidemiol 2006; 41:738-45. [PMID: 16819564 DOI: 10.1007/s00127-006-0089-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lack of mental health specialists in rural and remote communities suggest that rural communities depend more on general practitioners (GPs) for mental health care. Residents of rural communities are less likely than urban residents to seek help from their GPs for mental health issues. The aim of the current study was to examine whether attitudinal factors including perceived stigma, influenced rural residents seeking help from GPs. METHOD Help-seeking for psychological issues was retrospectively reported by 300 community residents in rural north-west Victoria. Current distress levels, functional disability, and current or lifetime syndromal disorder were recorded. Attitudes towards seeking professional psychological help, perceptions of stigma about mental illness, and belief in helpfulness of GPs, were also measured. RESULTS Having a positive attitude towards seeking professional help, and believing that a GP would be helpful, were significant predictors of ever having sought help from a GP for mental health problems. Other independent predictors of help-seeking included having a mood, anxiety or substance use disorder, higher distress levels, and greater functional disability due to physical problems. CONCLUSIONS Seeking help from a GP for psychological problems was predicted by having a positive attitude towards seeking professional psychological help as well as believing a GP would be helpful in treating psychological problems. Illness variables were also strong predictors of help-seeking behaviour. Contrary to expectations, perceived stigma did not influence help-seeking. The findings of this study highlight the important role of GPs in the treatment of mental health problems in the rural community.
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Affiliation(s)
- Angela Komiti
- Centre for Rural Mental Health, Monash University School of Psychology, Psychiatry and Psychological Medicine and Bendigo Health Care Group, P.O. Box 126, Bendigo, VIC, 3552, Australia.
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Tsao JCI, Dobalian A, Wiens BA, Gylys JA, Evans GD. Posttraumatic stress disorder in rural primary care: improving care for mental health following bioterrorism. J Rural Health 2006; 22:78-82. [PMID: 16441340 DOI: 10.1111/j.1748-0361.2006.00006.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Recent bioterrorism attacks have highlighted the critical need for health care organizations to prepare for future threats. Yet, relatively little attention has been paid to the mental health needs of rural communities in the wake of such events. A critical aspect of bioterrorism is emphasis on generating fear and uncertainty, thereby contributing to increased needs for mental health care, particularly for posttraumatic stress disorder, which has been estimated to occur in 28% of terrorism survivors. PURPOSE Prior experience with natural disasters suggests that first responders typically focus on immediate medical trauma or injury, leaving rural communities to struggle with the burden of unmet mental health needs both in the immediate aftermath and over the longer term. The purpose of the present article is to draw attention to the greater need to educate rural primary care providers who will be the frontline providers of mental health services following bioterrorism, given the limited availability of tertiary mental health care in rural communities. METHODS We reviewed the literature related to bioterrorism events and mental health with an emphasis on rural communities. FINDINGS AND CONCLUSIONS Public health agencies should work with rural primary care providers and mental health professionals to develop educational interventions focused on posttraumatic stress disorder and other mental disorders, as well as algorithms for assessment, referral, and treatment of post-event psychological disorders and somatic complaints to ensure the availability, continuity, and delivery of quality mental health care for rural residents following bioterrorism and other public health emergencies.
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Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.
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Glisson C, Schoenwald SK. The ARC organizational and community intervention strategy for implementing evidence-based children's mental health treatments. ACTA ACUST UNITED AC 2006; 7:243-59. [PMID: 16320107 DOI: 10.1007/s11020-005-7456-1] [Citation(s) in RCA: 260] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper reviews the implications of organizational and community intervention research for the implementation of effective mental health treatments in usual community practice settings. The paper describes an organizational and community intervention model named ARC for Availability, Responsiveness and Continuity, that was designed to support the improvement of social and mental health services for children. The ARC model incorporates intervention components from organizational development, interorganizational domain development, the diffusion of innovation, and technology transfer that target social, strategic, and technological factors in effective children's services. This paper also describes a current NIMH-funded study that is using the ARC intervention model to support the implementation of an evidence-based treatment, Multisystemic Therapy (MST), for delinquent youth in extremely rural, impoverished communities in the Appalachian Mountains of East Tennessee.
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Affiliation(s)
- Charles Glisson
- Children's Mental Health Services Research Center, University of Tennessee, Knoxville, Tennessee 37996-3332, USA.
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Fraser CE, Smith KB, Judd F, Humphreys JS, Fragar LJ, Henderson A. Farming and mental health problems and mental illness. Int J Soc Psychiatry 2005; 51:340-9. [PMID: 16400909 DOI: 10.1177/0020764005060844] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Farmers experience one of the highest rates of suicide of any industry and there is growing evidence that those involved in farming are at higher risk of developing mental health problems. This article provides an overview of the literature examining mental health issues experienced by farming populations in the United Kingdom, Europe, Australia, Canada and the United States and identifies areas for further research. METHOD A literature review (Medline, Science Direct, Ingenta, Proquest and PsychINFO) was carried out using the words 'farmers', 'agriculture', 'depression', 'mental health', 'mental illness', 'stress', and 'suicide', as well as a review of relevant papers and publications known to the authors. (Papers not written in English and those published prior to 1985 were excluded.) RESULTS Fifty-two papers were identified with the majority focusing on stress and coping styles in farmers (24). A number of studies also focused on neuropsychological functioning and agricultural chemical use (7), depression (7), suicide (9), general mental health (4) and injury and mental health (1). This body of research studied male farmers, female farmers, farm workers, farming families, and young people living on farms. Research to date indicates that farmers, farm workers and their respective families face an array of stressors related to the physical environment, structure of farming families and the economic difficulties and uncertainties associated with farming which may be detrimental to their mental health. CONCLUSION Whilst suicide rates in some groups of farmers are higher than the general population, conclusive data do not exist to indicate whether farmers and farming families experience higher rates of mental health problems compared with the non-farming community. It is clear, however, that farming is associated with a unique set of characteristics that is potentially hazardous to mental health and requires further research.
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Affiliation(s)
- C E Fraser
- Centre for Rural Mental Health, Bendigo Health Care Group, Victoria, Australia
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31
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Sakamoto S, Tanaka E, Neichi K, Ono Y. Where is help sought for depression or suicidal ideation in an elderly population living in a rural area of Japan? Psychiatry Clin Neurosci 2004; 58:522-30. [PMID: 15482584 DOI: 10.1111/j.1440-1819.2004.01295.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although suicide is increasingly becoming a social problem in Japan, especially among the elderly, little early intervention or suicide prevention is done. A project was begun which, since 1999, has aimed to detect depression at an early stage as a suicide prevention measure in a model area of Town A, which had a high suicide rate. In order to promote early intervention and prevention in a community, it is important to know where residents seek help if they become depressed or have suicidal ideation. Therefore, in the present study, help-seeking behavior using case vignettes was investigated. Data from 230 residents (82 men, 148 women) in the model area of Town A, aged 65 or over, were analyzed in the present study. If participants were unable to answer by themselves due to physical condition, public health nurses read out each item and wrote in their answers. The relationship between help-seeking behavior and demographic variables, psychosocial variables, depressive symptoms and so forth, were examined. The results show that participation in mental health workshops facilitated consultation with specialists (e.g. primary care doctors and nurses). The expected effects of psychoeducation on the general public and specialists were considered.
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32
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Kirchner JE, Cody M, Thrush CR, Sullivan G, Rapp CG. Identifying factors critical to implementation of integrated mental health services in rural VA community-based outpatient clinics. J Behav Health Serv Res 2004; 31:13-25. [PMID: 14722477 DOI: 10.1007/bf02287335] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to gain a better understanding of the critical components associated with implementing integrated mental health care services in rural VA community-based outpatient clinics (CBOCs). In-person semi-structured interviews were conducted with 20 health care providers and staff within a year after placing a trained advanced practice nurse (APN) to provide mental health/substance abuse (MH/SA) care at 2 rural CBOCs in the southeastern United States. Four raters independently evaluated interview transcripts and conducted content analysis to summarize the interview results. The results indicate that key contextual factors related to leadership, staff attitudes and beliefs, and unique organizational factors of the clinic and the community can affect the success of such clinical innovations. In addition to providing descriptive information about the attitudes, beliefs, and experiences of CBOC personnel regarding implementation of integrated MH/SA services using APNs, the study findings suggest several domains that could be explored in future studies of integrated mental health service delivery to rural veterans through primary care.
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Affiliation(s)
- JoAnn E Kirchner
- VA South Central MIRECC, Central Arkansas Veterans Healthcare System (152/NLR), 2200 Ft Roots Dr, North Little Rock, AR 72114, USA.
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Identifying Factors Critical to Implementation of Integrated Mental Health Services in Rural VA Community-Based Outpatient Clinics. J Behav Health Serv Res 2004. [DOI: 10.1097/00075484-200401000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Despite the widespread notion of the bucolic life in the country, major depressive disorder (MDD) is common among impoverished women in the rural South. Women with MDD seldom get treated because of the paucity of treatment available, the inability to pay for services because of no insurance, and the distance they must travel to reach care. Even if treatment was available, impoverished rural Southern women are unlikely to seek services because of cultural and social prohibitions. These include incongruence between the biomedical model of MDD and sociocultural explanations for its causes and manifestations, stigma, and traditional viewpoints of women that keep them isolated and invisible. Innovative treatment strategies must be devised for these women that are based on local views of MDD and its treatment, and people and monetary resources available in poor rural economies. Needed research with this population include ethnographic studies to gain understanding of the cultural factors associated with MDD and its treatment and evaluation of outreach, and other novel paradigms of rural service delivery including the use of nonprofessional personnel. Although the problems of treatment and research with this population are daunting, there is an opportunity for imagination, innovation, and creativity in devising local solutions to local problems.
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Affiliation(s)
- Emily J Hauenstein
- University of Virginia School of Nursing, Charlottesville, VA 22908-0782, USA.
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35
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Rost K, Fortney J, Fischer E, Smith J. Use, quality, and outcomes of care for mental health: the rural perspective. Med Care Res Rev 2002; 59:231-65; discussion 266-71. [PMID: 12205828 DOI: 10.1177/1077558702059003001] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review synthesizes empirical research in rural mental health services to identify current research priorities to improve the mental health of rural Americans. Using a conceptual framework of the multiple determinants of use, quality, and outcomes, the authors address (1) how key constructs are operationalized, (2) their theoretical influence on the care process, (3) reported differences for nonmetropolitan and metropolitan individuals or within nonmetropolitan individuals, (4) salient issues rural advocates have raised, and (5) key research questions. While the authors recognize that rurality is a useful political umbrella to organize advocacy efforts, they propose that investigators no longer employ any of the multiple definitions of the term in the literature as even intrarural comparisons have not provided compelling evidence about the underlying causes of observed outcomes differences. Until these underlying causes have been identified, it is difficult to determine which components of the nonmetropolitan service system need to be improved.
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Fox JC, Blank M, Rovnyak VG, Barnett RY. Barriers to help seeking for mental disorders in a rural impoverished population. Community Ment Health J 2001; 37:421-36. [PMID: 11419519 DOI: 10.1023/a:1017580013197] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined barriers to seeking mental health care reported by individuals in a rural impoverished population, by screening 646 randomly selected adults for depression, anxiety, and alcohol abuse. Respondents who screened positive were randomly assigned to one of three groups: (1) no intervention, (2) an educational intervention alone, or (3) the educational intervention in the presence of a significant other. Those who screened positive for disorders cited barriers to care at significantly higher rates than respondents who screened negative. Respondents who received the educational intervention endorsed several barriers at significantly lower rates in the follow-up telephone call (subsequent to the intervention) than in the original interview (prior to the intervention). Virtually all respondents in a subsample of 142 subjects (99.3%) said they would seek mental health care if they thought mental health services would help them.
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Affiliation(s)
- J C Fox
- Southeastern Rural Mental Health Research Center, University of Virginia, Charlottesville 22908-0393, USA.
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37
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Johnson MR, Gold PB, Siemion L, Magruder KM, Frueh BC, Santos AB. Panic disorder in primary care: patients' attributions of illness causes and willingness to accept psychiatric treatment. Int J Psychiatry Med 2001; 30:367-84. [PMID: 11308039 DOI: 10.2190/txnb-v7vu-7h32-c7yt] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study assessed the causes that primary care patients with panic disorder (PD) attribute to their panic symptoms, and their acceptance of various psychiatric treatment options. METHODS In a cross-sectional assessment of 306 patients treated at two primary care clinics, 42 met criteria for DSM-IV PD in the past year. The authors classified these 42 PD-positive patients to one of two groups: those receiving both primary and specialty mental health care (PC+MH; n = 19) and those receiving only primary care (PC-only; n = 23). Patients rated the probability of four possible causes of their panic symptoms, and level of acceptability of three psychiatric and two medical treatments for PD. To place primary care patients' ratings into a broader context, a third contrast group of PD-positive patients, recruited from clinical trials of investigational PD pharmacotherapies (n = 31), also rated causes and treatment acceptability. RESULTS Participants of the three treatment groups attributed psychiatric causes for their panic symptoms in approximately the same proportion (78 percent to 90 percent; p = ns). PC-only participants attributed medical causes for panic symptoms more frequently than PC+MH and PD Clinical Trials participants (48 percent vs. 5 percent and 32 percent; p = .01). Remarkably, the great majority of patients across all groups expressed willingness to see psychiatrists (84 percent to 94 percent) and psychotherapists (95 percent to 100 percent), and to take psychotropic medications (87 percent to 100 percent). CONCLUSIONS In this study most patients attributed a psychiatric cause for panic symptoms and communicated strong acceptance of psychiatric treatment. Thus, we recommend that primary care clinicians more assertively inform their patients of PD diagnoses and recommend psychiatric treatments with less fear about stigmatizing and alienating them.
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Affiliation(s)
- M R Johnson
- Medical University of South Carolina, Charleston, USA
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