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Lee YJ, Palmer J, Cline AC, Lee H. Factors Influencing the Health Care Utilization Among People With Depression and/or Anxiety Symptoms. J Am Psychiatr Nurses Assoc 2023:10783903231197655. [PMID: 37724452 PMCID: PMC10988633 DOI: 10.1177/10783903231197655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND This analysis aimed to examine the factors predictive of service utilization among patients with anxiety and/or depression. Quick and appropriate treatment for anxiety and depression can reduce disease burden and improve social functioning. Currently, less than half of the population with comorbid anxiety and depression receives the recommended treatment. AIMS This analysis aims to identify factors predictive of utilizing mental health treatment for those with anxiety and/or depression by analyzing intrinsic, patient-centered factors. METHOD This study is a cross-sectional cohort analysis using National Health Interview Survey (NHIS) 2019 data. The sample size is 7,156 adults aged 18 to 64 with family incomes ≤100% of the federal poverty level. We used multivariate logistic regression analysis to identify factors predictive of care utilization in this population. Variables of interest include scores on Patient Health Questionnaire-8 (PHQ-8) and Generalized Anxiety Disorder-7 (GAD-7), service utilization, level of social functioning, having a usual source for care, and previous mental health care utilization. Additional covariates were age, gender, race, country of origin, education, marital status, and insurance coverage. RESULTS Twenty-one percent of respondents reported using mental health services. Factors predictive of care utilization were older age, female gender, limited social functioning, having a usual source of care, and insurance coverage. CONCLUSION There are significant barriers to receiving quick and appropriate care for anxiety and/or depression. Strategies should focus on reducing barriers for young adults, men, and the uninsured/underinsured. Strategies for integrating mental health services into primary care could increase the percentage of people with anxiety and/or depression who receive services.
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Affiliation(s)
- Young Ji Lee
- Young Ji Lee, PhD, MSN, RN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Josh Palmer
- Joshua Palmer, DNP, PMHNP-BC, RN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Alice Curtis Cline
- Alice Curtis Cline, MSN, CNM. PhD, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Heeyoung Lee
- Heeyoung Lee, PhD, PMHNP-BC, FAAN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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2
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de Beurs E, Jadnanansing R, Etwaroo K, Blankers M, Bipat R, Peen J, Dekker J. Norms and T-scores for screeners of alcohol use, depression and anxiety in the population of Suriname. Front Psychiatry 2023; 14:1088696. [PMID: 37181892 PMCID: PMC10172675 DOI: 10.3389/fpsyt.2023.1088696] [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: 02/01/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Background There is a considerable gap between care provision and the demand for care for common mental disorders in low-and-middle-income countries. Screening for these disorders, e.g., in primary care, will help to close this gap. However, appropriate norms and threshold values for screeners of common mental disorders are lacking. Methods In a survey study, we gathered data on frequently used screeners for alcohol use disorders, (AUDIT), depression, (CES-D), and anxiety disorders (GAD-7, ACQ, and BSQ) in a representative sample from Suriname, a non-Latin American Caribbean country. A stratified sampling method was used by random selection of 2,863 respondents from 5 rural and 12 urban resorts. We established descriptive statistics of all scale scores and investigated unidimensionality. Furthermore, we compared scores by gender, age-group, and education level with t-test and Mann-Whitney U tests, using a significance level of p < 0.05. Results Norms and crosswalk tables were established for the conversion of raw scores into a common metric: T-scores. Furthermore, recommended cut-off values on the T-score metric for severity levels were compared with international cut-off values for raw scores on these screeners. Discussion The appropriateness of these cut-offs and the value of converting raw scores into T-scores are discussed. Cut-off values help with screening and early detection of those who are likely to have a common mental health disorder and may require treatment. Conversion of raw scores to a common metric in this study facilitates the interpretation of questionnaire results for clinicians and can improve health care provision through measurement-based care.
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Affiliation(s)
- Edwin de Beurs
- Department of Clinical Psychology, Leiden Universiteit, Leiden, Netherlands
- Research department, Arkin Mental Health Care, Amsterdam, Netherlands
- *Correspondence: Edwin de Beurs,
| | - Raj Jadnanansing
- Department of Psysiology, Anton de Kom University, Tammenga, Suriname
| | - Kajal Etwaroo
- Department of Psysiology, Anton de Kom University, Tammenga, Suriname
| | - Matthijs Blankers
- Research department, Arkin Mental Health Care, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
- Trimbos Institute, Utrecht, Netherlands
| | - Robbert Bipat
- Department of Psysiology, Anton de Kom University, Tammenga, Suriname
| | - Jaap Peen
- Research department, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Jack Dekker
- Research department, Arkin Mental Health Care, Amsterdam, Netherlands
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
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3
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Pipe A, Ravindran N, Paric A, Patterson B, Van Ameringen M, Ravindran AV. Treatments for child and adolescent attention deficit hyperactivity disorder in low and middle-income countries: A narrative review. Asian J Psychiatr 2022; 76:103232. [PMID: 35987096 DOI: 10.1016/j.ajp.2022.103232] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects approximately 2-7 % of children globally and is associated with a myriad of difficulties that have long-term consequences. Most children and adolescents live in low- and middle-income countries (LMICs), but there are few reports and no consolidation of findings on ADHD treatment outcomes in this population. We conducted a review of ADHD treatment literature for children and adolescents living in LMICs. METHODS Studies were identified using databases (PsychoINFO, Pubmed, MEDLINER, EMBASE, Global Health, Academic Search Complete, Google Scholar). The initial search produced 139 articles. These were filtered for language, title, abstract, and full-text keyword identification to yield a final 20 articles to be included in this review. RESULTS Reports on outcomes of both psychological and pharmacological treatment were relatively sparse, particularly the former, which mostly referred to parent training and multimodal programs in pre-school children. Most evidence exists for the benefit of methylphenidate-IR with a few reports on other agents, including clonidine, atomoxetine, and lisdexamfetamine. Methylphenidate is the most common agent to treat ADHD in youth in LMICs. Younger age, combined subtype, and comorbid oppositional defiant disorder were associated with poorer treatment outcome. CONCLUSION Access to treatment for ADHD is overall limited in LMICs and varied among individual countries. Pharmacological treatments were generally more available than psychological interventions. Several barriers including stigma, cost, and lack of resources were reported to impact treatment acceptance. More research in LMICs is needed to improve and expand mental health services in these regions.
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Affiliation(s)
- Amy Pipe
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario N6A 5C1, Canada.
| | - Nisha Ravindran
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J 1H4 Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8 Canada.
| | - Angela Paric
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J 1H4 Canada.
| | - Beth Patterson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Ontario, L8N 3K7 Canada; MacAnxiety Research Centre, McMaster University, 1057 Main Street West, Hamilton, Ontario, L8S 1B8 Canada.
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Ontario, L8N 3K7 Canada.
| | - Arun V Ravindran
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J 1H4 Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8 Canada.
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4
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Gladstone TRG, Ugueto AM, Muleta M, Meshesha TM, Ambaafris GG, Patwa MC, Zhong C, Buchholz KR. Development and Pilot Test of a Group Cognitive Behavioral Intervention for Women Recovering From Fistula Repair Surgery in Ethiopia. Front Public Health 2022; 10:862351. [PMID: 35734763 PMCID: PMC9207711 DOI: 10.3389/fpubh.2022.862351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Obstetric fistula is a serious complication that affects thousands of women in low-income countries. Women who suffer from obstetric fistulae are at risk of developing mental health problems, but to date most interventions have focused on repairing the physical consequences of fistulae through surgery. The goal of the current study is to develop an evidence-based intervention targeting symptoms of depression, anxiety, and trauma in women recovering from fistula repair surgery. First, hospital staff and patients awaiting surgery at a fistula hospital in Ethiopia participated in qualitative interviews to provide information on the mental health needs of women with fistulae, how the hospital tends to these women's psychological needs, and the training needs of staff members. Data from these interviews were used to develop the COFFEE intervention (CBT with Obstetric Fistula for Education and Empowerment). COFFEE is a modular, group intervention that teaches psycho-education, behavioral activation, relaxation, problem solving, cognitive restructuring, and includes a trauma narrative. Patients then participated in an open trial of the COFFEE intervention at the University of Gondar Hospital. Five separate groups were conducted with 24 women who were enrolled post-fistula repair surgery. Women completed pre-treatment self-report questionnaires, participated in group sessions conducted by nurses (with 8 sessions delivered across 10–14 days), and were assessed post-treatment and at 3-month follow-up. Results indicate a significant reduction on depression and anxiety symptoms scores across the three time points [F(2, 40) = 68.45, p < 0.001 partial η2 = 0.774]. Additionally, there was a significant decrease in traumatic stress scores from baseline to post-treatment [F(1.10, 21.98) = 100.51, p < 0.001 partial η2 = 0.834]. Feedback forms completed by nurses and patients suggest the intervention was well-received. Results of this open-trial suggest the COFFEE intervention is feasible, acceptable, and clinically beneficial to treat symptoms of depression, anxiety, and traumatic stress in women post-fistula repair surgery in a hospital setting.
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Affiliation(s)
- Tracy R. G. Gladstone
- Wellesley Centers for Women, Wellesley College, Wellesley, MA, United States
- *Correspondence: Tracy R. G. Gladstone
| | - Ana M. Ugueto
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Tsega M. Meshesha
- MIT Center for Biomedical Innovation, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Genet G. Ambaafris
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mariya C. Patwa
- School of Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Cordelia Zhong
- Wellesley Centers for Women, Wellesley College, Wellesley, MA, United States
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5
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Slatina Murga S, Janković S, Muhić M, Sikira H, Burn E, Priebe S, Džubur Kulenović A. Effectiveness of a structured intervention to make routine clinical meetings therapeutically effective (DIALOG+) for patients with depressive and anxiety disorders in Bosnia and Herzegovina: A cluster randomised controlled trial. PSYCHIATRY RESEARCH COMMUNICATIONS 2021; 1:None. [PMID: 35028649 PMCID: PMC8721954 DOI: 10.1016/j.psycom.2021.100010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022]
Abstract
Background DIALOG+ is a patient-centred, solution-focused intervention, which aims to make routine patient-clinician meetings therapeutically effective. Existing evidence suggests that it is effective for patients with psychotic disorders in high-income countries. We tested the effectiveness of DIALOG + for patients with depressive and anxiety disorders in Bosnia and Herzegovina, a middle-income country. Methods We conducted a parallel-group, cluster randomised controlled trial of DIALOG+ in an outpatient clinic in Sarajevo. Patients inclusion criteria were: 18 years and older, a diagnosis of depressive or anxiety disorders, and low quality of life. Clinicians and their patients were randomly allocated to either the DIALOG + intervention or routine care in a 1:1 ratio. The primary outcome, quality of life, and secondary outcomes, psychiatric symptoms and objective social outcomes, were measured at 6- and 12-months by blinded assessors. Results Fifteen clinicians and 72 patients were randomised. Loss to follow-up was 12% at 6-months and 19% at 12-months. Quality of life did not significantly differ between intervention and control group after six months, but patients receiving DIALOG + had significantly better quality of life after 12 months, with a medium effect size (Cohen's d = 0.632, p = 0.007). General symptoms as well as specifically anxiety and depression symptoms were significantly lower after six and 12 months, and the objective social situation showed a statistical trend after 12 months, all in favour of the intervention group. No adverse events were reported. Limitations Delivery of the intervention was variable and COVID-19 affected 12-month follow-up assessments in both groups. Conclusion The findings suggest DIALOG + could be an effective treatment option for improving quality of life and reducing psychiatric symptoms in patients with depressive and anxiety disorders in a low-resource setting. As DIALOG+ is used within routine clinical meeting, no additional staff or resources are required for implementation. DIALOG+ utilises existing patient resources, is not difficult to implement and is inexpensive. Eighty patients met our inclusion criteria and 72 agreed to participate and completed a baseline assessment. At 12 months, the intervention group showed a significantly better quality of life. Patients in the intervention group had significantly lower levels of symptoms time with medium to large effect sizes. The objective social situation did not differ significantly between the two groups after six months. The objective social situation showed a statistical trend towards a more positive outcome in the intervention group. Findings suggest DIALOG + could be an effective treatment for improving quality of life and reducing psychiatric symptoms.
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Affiliation(s)
- S Slatina Murga
- Department of Psychiatry, Clinical Centre University of Sarajevo, Bosnia and Herzegovina
| | - S Janković
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - M Muhić
- Department of Psychiatry, Clinical Centre University of Sarajevo, Bosnia and Herzegovina
| | - H Sikira
- Department of Psychiatry, Clinical Centre University of Sarajevo, Bosnia and Herzegovina
| | - E Burn
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, United Kingdom
| | - S Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, United Kingdom
| | - A Džubur Kulenović
- Department of Psychiatry, Clinical Centre University of Sarajevo, Bosnia and Herzegovina
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6
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Connolly SM, Vanchu-Orosco M, Warner J, Seidi PA, Edwards J, Boath E, Irgens AC. Mental health interventions by lay counsellors: a systematic review and meta-analysis. Bull World Health Organ 2021; 99:572-582. [PMID: 34354312 PMCID: PMC8319860 DOI: 10.2471/blt.20.269050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate the effectiveness of community-based mental health interventions by professionally trained, lay counsellors in low- and middle-income countries. Methods We searched PubMed®, Cochrane Central Register of Controlled Trials, PROSPERO and EBSCO databases and professional section publications of the United States National Center for PTSD for randomized controlled trials of mental health interventions by professionally trained, lay counsellors in low- and middle-income countries published between 2000 and 2019. Studies of interventions by professional mental health workers, medical professionals or community health workers were excluded because there are shortages of these personnel in the study countries. Additional data were obtained from study authors. The primary outcomes were measures of post-traumatic stress disorder, depression, anxiety and alcohol use. To estimate effect size, we used a random-effects meta-analysis model. Findings We identified 1072 studies, of which 19 (involving 20 trials and 5612 participants in total) met the inclusion criteria. Hedges' g for the aggregate effect size of the interventions by professionally trained, lay counsellors compared with mostly either no intervention or usual care was -0.616 (95% confidence interval: -0.866 to -0.366). This result indicates a significant, medium-sized effect. There was no evidence of publication bias or any other form of bias across the studies and there were no extreme outliers among the study results. Conclusion The use of professionally trained, lay counsellors to provide mental health interventions in low- and middle-income countries was associated with significant improvements in mental health symptoms across a range of settings.
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Affiliation(s)
- Suzanne M Connolly
- 70 Payne Place, Suite 6, Sedona, AZ 86446, United States of America (USA)
| | | | - Jan Warner
- Department of Social Work Services, Veterans Affairs Medical Center, Cleveland, USA
| | | | - Jenny Edwards
- School of Leadership Studies, Fielding Graduate University, Santa Barbara, USA
| | - Elisabeth Boath
- Department of Social Work and Social Welfare, Staffordshire University, Stoke-on-Trent, England
| | - A C Irgens
- Department of Psychiatry, Sørlandet Hospital, Arendal, Norway
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7
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Ryan GK, Bauer A, Endale T, Qureshi O, Doukani A, Cerga-Pashoja A, Brar SK, Eaton J, Bass JK. Lay-delivered talk therapies for adults affected by humanitarian crises in low- and middle-income countries. Confl Health 2021; 15:30. [PMID: 33892755 PMCID: PMC8062937 DOI: 10.1186/s13031-021-00363-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Published by the World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR) in 2015, the mental health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG) recommends brief versions of structured psychological interventions for people experiencing symptoms of common mental disorders (CMDs). mhGAP-HIG acknowledges a growing body of evidence suggesting these interventions can be delivered by lay workers to people affected by humanitarian crises in low- and middle-income countries (LMICs). However, there has not yet been a systematic review and synthesis of this evidence. This paper reports the results of a systematic review of qualitative, quantitative, and mixed-methods studies assessing the implementation and/or effectiveness of talk therapies for CMDs when provided by lay workers in LMICs to adults who have survived or are currently living in humanitarian situations. METHODS Seven electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library, and ClinicalTrials.gov . We also hand-searched the contents pages of three academic journals, reference lists of 30 systematic reviews, and online resource directories of two mental health networks. A preliminary list of included studies was circulated to topical experts for review, and all included studies were backward and forward searched. All titles, abstracts, and full-texts were independently double-screened. Quality appraisal and data extraction were carried out by a single reviewer and checked by a second reviewer, using standardised tools. Any disagreements were discussed and referred to a third reviewer as needed. RESULTS We identified 23 unique studies and carried out a narrative synthesis of patient and implementation outcome data. Every evaluation of the effectiveness of lay-delivered talk therapies for adults affected by humanitarian crises in LMICs showed some treatment effect for at least one CMD, and often multiple CMDs. Implementation research generally found these interventions to be acceptable, appropriate and feasible to implement, with good fidelity to manualised therapies. CONCLUSION Although results are promising, particularly for individually-delivered talk therapies based on cognitive behavioural therapy techniques, there is a high degree of heterogeneity in this literature. We make several recommendations on how to improve the quality and generalisability of research on this topic, to facilitate further evidence synthesis. TRIAL REGISTRATION PROSPERO registration number: CRD42017058287 .
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Affiliation(s)
- Grace K Ryan
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. .,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK.
| | - Andreas Bauer
- Department of Psychology, University of Bath, Bath, UK
| | - Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College of Columbia University, New York City, New York, USA
| | - Onaiza Qureshi
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK
| | - Asmae Doukani
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK
| | - Arlinda Cerga-Pashoja
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK.,Global Health Training, Public Health England, London, UK
| | - Savvy K Brar
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York City, New York, USA
| | - Julian Eaton
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK.,Mental Health, CBM Global, Laudenbach, Germany
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA.,Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
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8
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Cole CL, Waterman S, Hunter ECM, Bell V, Greenberg N, Rubin GJ, Beck A. Effectiveness of small group cognitive behavioural therapy for anxiety and depression in Ebola treatment centre staff in Sierra Leone. Int Rev Psychiatry 2021; 33:189-197. [PMID: 32301358 DOI: 10.1080/09540261.2020.1750800] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Following the 2014 Ebola outbreak, South London and Maudsley NHS Foundation Trust (SLAM) were commissioned to provide a 'culturally appropriate, effective and sustainable' intervention to address the psychological needs of the Sierra Leonean Ebola Treatment Centre (ETC) staff. The study evaluated the effectiveness of group Cognitive Behavioural Therapy (CBT) developed to treat anxiety, depression and functional impairment amongst a sample of former ETC staff in Sierra Leone. Group comparisons explored whether the effect of the intervention differed dependent on the facilitators that delivered it, as well as whether it differed between former staff of high- and low-risk ETC roles. A sample of 253 former ETC staff attended the group CBT intervention comprised of eight sessions over six weeks. Outcome measures were administered upon entry and within two weeks after the intervention. At post-intervention, anxiety, depression and functional impairment significantly reduced. Reading ability (RA) was introduced as a covariate having impacted the outcomes. The intervention effect differed by facilitators delivering the sessions but not by ETC role risk. The implications of these results are discussed. Group CBT is a promising psychological intervention for treating the anxiety, depression and functional impairment of former ETC staff in Sierra Leone. Furthermore, as part of a stepped-care approach, it may provide a model for psychological support for staff that have worked on the frontline during future epidemics.
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Affiliation(s)
- Charles L Cole
- South London and Maudsley NHS Foundation Trust, London, UK.,Division of Psychiatry, University College London, London, UK
| | | | | | - Vaughan Bell
- South London and Maudsley NHS Foundation Trust, London, UK.,Division of Psychiatry, University College London, London, UK
| | - Neil Greenberg
- Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - G James Rubin
- Kings College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Alison Beck
- South London and Maudsley NHS Foundation Trust, London, UK
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9
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Lepping P, Whittington R, Sambhi R, Lane S, Poole R, Leucht S, Cuijpers P, McCabe R, Waheed W. Clinical relevance of findings in trials of CBT for depression. Eur Psychiatry 2020; 45:207-211. [DOI: 10.1016/j.eurpsy.2017.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/08/2017] [Indexed: 12/15/2022] Open
Abstract
AbstractCognitive behavioural therapy (CBT) is beneficial in depression. Symptom scores can be translated into Clinical Global Impression (CGI) scale scores to indicate clinical relevance. We aimed to assess the clinical relevance of findings of randomised controlled trials (RCTs) of CBT in depression. We identified RCTs of CBT that used the Hamilton Rating Scale for Depression (HAMD). HAMD scores were translated into Clinical Global Impression – Change scale (CGI-I) scores to measure clinical relevance. One hundred and seventy datasets from 82 studies were included. The mean percentage HAMD change for treatment arms was 53.66%, and 29.81% for control arms, a statistically significant difference. Combined active therapies showed the biggest improvement on CGI-I score, followed by CBT alone. All active treatments had better than expected HAMD percentage reduction and CGI-I scores. CBT has a clinically relevant effect in depression, with a notional CGI-I score of 2.2, indicating a significant clinical response. The non-specific or placebo effect of being in a psychotherapy trial was a 29% reduction of HAMD.
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10
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O'Donnell ML, Lau W, Fredrickson J, Gibson K, Bryant RA, Bisson J, Burke S, Busuttil W, Coghlan A, Creamer M, Gray D, Greenberg N, McDermott B, McFarlane AC, Monson CM, Phelps A, Ruzek JI, Schnurr PP, Ugsang J, Watson P, Whitton S, Williams R, Cowlishaw S, Forbes D. An Open Label Pilot Study of a Brief Psychosocial Intervention for Disaster and Trauma Survivors. Front Psychiatry 2020; 11:483. [PMID: 32670099 PMCID: PMC7332836 DOI: 10.3389/fpsyt.2020.00483] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/12/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In the aftermath of disaster, a large proportion of people will develop psychosocial difficulties that impair recovery, but for which presentations do not meet threshold criteria for disorder. Although these adjustment problems can cause high distress and impairment, and often have a trajectory towards mental health disorder, few evidence-based interventions are available to facilitate recovery. OBJECTIVE This paper describes the development and pilot testing of an internationally developed, brief, and scalable psychosocial intervention that targets distress and poor adjustment following disaster and trauma. METHOD The Skills fOr Life Adjustment and Resilience (SOLAR) program was developed by an international collaboration of trauma and disaster mental health experts through an iterative expert consensus process. The resulting five session, skills-based intervention, deliverable by community-based or frontline health or disaster workers with little or no formal mental health training (known as coaches), was piloted with 15 Australian bushfire survivors using a pre-post with follow up, mixed-methods design study. RESULTS Findings from this pilot demonstrated that the SOLAR program was safe and feasible for non-mental health frontline workers (coaches) to deliver locally after two days of training. Participants' attendance rates and feedback about the program indicated that the program was acceptable. Pre-post quantitative analysis demonstrated reductions in psychological distress, posttraumatic stress symptoms, and impairment. CONCLUSIONS This study provides preliminary evidence that the delivery of the SOLAR program after disaster by trained, frontline workers with little or no mental health experience is feasible, acceptable, safe, and beneficial in reducing psychological symptoms and impairment among disaster survivors. Randomized controlled trials of the SOLAR program are required to advance evidence of its efficacy.
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Affiliation(s)
- Meaghan Louise O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Winnie Lau
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Julia Fredrickson
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Kari Gibson
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Richard Allan Bryant
- School of Psychology, University of New South Wales, UNSW Sydney, Kensington, NSW, Australia
| | - Jonathan Bisson
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, United Kingdom
| | - Susie Burke
- Australian Psychological Society, Melbourne, VIC, Australia
| | - Walter Busuttil
- Department of Psychiatry, Combat Stress, UK, Leatherhead, United Kingdom
| | | | - Mark Creamer
- Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Debbie Gray
- Mental Health Promotion and Illness Prevention, Addiction Mental Health - Alberta Health Services, Calgary, AB, Canada
| | - Neil Greenberg
- Academic Department of Military Mental Health, King's College London, London, United Kingdom
| | - Brett McDermott
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Alexander C McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia
| | - Candice M Monson
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Andrea Phelps
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
| | - Josef I Ruzek
- National Center for PTSD, Dissemination and Training Division, US Department of Veterans Affairs, Palto Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, CA, United States
| | - Paula P Schnurr
- National Center for PTSD, Executive Division, US Department of Veterans Affairs, White River Junction, VT, United States.,Department of Psychiatry, Geisel School of Medicine, Dartmouth, Hanover, NH, United States
| | | | - Patricia Watson
- National Center for PTSD, Dissemination and Training Division, US Department of Veterans Affairs, Palto Alto, CA, United States
| | - Shona Whitton
- Australian Red Cross, North Melbourne, VIC, Australia
| | - Richard Williams
- Welsh Institute for Health and Social Care, University of South Wales, Wales, United Kingdom
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia.,Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, The University of Melbourne, Carlton, VIC, Australia.,Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
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Yatham S, Sivathasan S, Yoon R, da Silva TL, Ravindran AV. Depression, anxiety, and post-traumatic stress disorder among youth in low and middle income countries: A review of prevalence and treatment interventions. Asian J Psychiatr 2018; 38:78-91. [PMID: 29117922 DOI: 10.1016/j.ajp.2017.10.029] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Low and middle income countries (LMICs) not only have the majority of the world's population but also the largest proportion of youth. Poverty, civil conflict and environmental stressors tend to be endemic in these countries and contribute to significant psychiatric morbidity, including depression, anxiety and post-traumatic stress disorder (PTSD). However, mental health data from LMICs is scarce, particularly data on youth. Evaluation of such information is crucial for planning services and reducing the burden of disability. This paper reviews the published data on the prevalence and randomized trials of interventions for depression, anxiety and PTSD in youth in LMICs. METHODS PubMed and Google Scholar were searched for articles published in English up to January 2017, using the keywords: Low/middle income country, depression, anxiety, post-traumatic stress disorder, child, youth, adolescent, prevalence, treatment, intervention, and outcomes. RESULTS The few prevalence studies in LMICs reported rates of up to 28% for significant symptoms of depression or anxiety among youth, and up to 87% for symptoms of PTSD among youth exposed to traumatic experienences, though these rates varied widely depending on several factors, including the assessments tools used. Most rigorous interventions employed some form or variation of CBT, with mixed results. Studies using other forms of psychosocial interventions appear to be heterogeneous and less rigorous. CONCLUSIONS The mental health burden due to depression and anxiety disorders in youth is substantial in LMICs, with high needs but inadequate services. Youth specific services for early detection and cost-effective interventions are needed.
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Affiliation(s)
- Swetha Yatham
- University of British Columbia, Canada (Currently St. George's Medical School, University of London, United Kingdom)
| | | | - Rosalia Yoon
- University of Toronto and Centre for Addiction and Mental Health, Canada
| | - Tricia L da Silva
- University of Toronto and Centre for Addiction and Mental Health, Canada
| | - Arun V Ravindran
- University of Toronto and Centre for Addiction and Mental Health, Canada.
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12
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Wainberg ML, Helpman L, Duarte CS, Vermund SH, Mootz JJ, Gouveia L, Oquendo MA, McKinnon K, Cournos F. Curtailing the communicability of psychiatric disorders. Lancet Psychiatry 2018; 5:940-944. [PMID: 30316807 PMCID: PMC6433373 DOI: 10.1016/s2215-0366(18)30342-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/12/2018] [Accepted: 08/24/2018] [Indexed: 12/14/2022]
Abstract
Although psychiatric disorders are classified as non-communicable diseases, we believe this classification is too rigid and limiting. We present evidence of the communicability of psychiatric disorders through three major pathways: infectious and ecological, familial, and sociocultural communicability. Successful strategies developed to control the spread of communicable infectious diseases are relevant to curtailing the communicability of psychiatric disorders, thereby reducing their burden. Current interventions and policies that conceptualise psychiatric illnesses as non-communicable mostly focus on the individual. By applying strategies from infectious disease and chronic illness prevention models within a socioecological framework, we posit a broad communicable chronic disease psychiatric illness control plan for effectively treating the patient with the psychiatric disorder (host) as early as possible, providing benefits to their family and the community, and preventing transmission to others.
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Affiliation(s)
- Milton L Wainberg
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - Liat Helpman
- Psychiatric Research Unit, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Cristiane S Duarte
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - Jennifer J Mootz
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Lidia Gouveia
- Department of Mental Health, Mozambique Ministry of Health, Avenida Eduardo Mondlane, Maputo, Mozambique
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Karen McKinnon
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Francine Cournos
- Mailman School of Public Health, Columbia University, New York, NY, USA
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13
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Bouras N, Ikkos G, Craig T. From Community to Meta-Community Mental Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E806. [PMID: 29677100 PMCID: PMC5923848 DOI: 10.3390/ijerph15040806] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/24/2022]
Abstract
Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work. Others receive little or no service at all. In today’s complex landscape of increasingly specialised services for people with mental health problems, the number of possible interfaces between services is increasing. Together with existing uneven financing systems and a context of constant change, these interfaces are challenging us to develop effective care pathways adjusted to the needs of service users and their carers. This discussion paper reviews the developments in community mental health care over the recent years and puts forward the concept of “Meta-Community Mental Health Care”. “Meta-Community Mental Health Care” embraces pluralism in understanding and treating psychiatric disorders, acknowledges the complexities of community provision, and reflects the realities and needs of the current era of care.
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Affiliation(s)
- Nick Bouras
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, P.O. Box 27, London SE5 8AF, UK.
| | - George Ikkos
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA4 7LP, UK.
| | - Thomas Craig
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, P.O. Box 27, London SE5 8AF, UK.
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14
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Abstract
We aimed to determine the prevalence and determinants of depression using mobile based mental health Global Action Programme Intervention guide (mhGAP-IG) in remote health care settings where most priority mental health problems are managed by non-mental health specialists and evaluate the feasibility of the application. Adult patients were recruited from four rural public health facilities in Kenya using systematic random sampling and screened for depression. There were no missing items since the application prevented saving of data unless all the items were answered. The prevalence of depression was 25% with suicidal behavior being the most significant comorbid problem. Older age, personal and a family history of a mental disorder were significantly correlated with depression. Exploring the use of health-related mobile applications in identification of priority mental health problems is useful notably in low-resource settings; and also forms a basis for prevention of mental disorders and intervention at acute stages.
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15
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Singla DR, Kohrt BA, Murray LK, Anand A, Chorpita BF, Patel V. Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries. Annu Rev Clin Psychol 2017; 13:149-181. [PMID: 28482687 PMCID: PMC5506549 DOI: 10.1146/annurev-clinpsy-032816-045217] [Citation(s) in RCA: 374] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Common mental disorders, including depression, anxiety, and posttraumatic stress, are leading causes of disability worldwide. Treatment for these disorders is limited in low- and middle-income countries. This systematic review synthesizes the implementation processes and examines the effectiveness of psychological treatments for common mental disorders in adults delivered by nonspecialist providers in low- and middle-income countries. In total, 27 trials met the eligibility criteria; most treatments targeted depression or posttraumatic stress. Treatments were commonly delivered by community health workers or peers in primary care or community settings; they usually were delivered with fewer than 10 sessions over 2-3 months in an individual, face-to-face format. Treatments included common elements, such as nonspecific engagement and specific domains of behavioral, interpersonal, emotional, and cognitive elements. The pooled effect size was 0.49 (95% confidence interval = 0.36-0.62), favoring intervention conditions. Our review demonstrates that psychological treatments-comprising a parsimonious set of common elements and delivered by a low-cost, widely available human resource-have moderate to strong effects in reducing the burden of common mental disorders.
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Affiliation(s)
- Daisy R Singla
- Sinai Health Network, Toronto, Ontario, Canada M5G 1X5
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada M5T 1R8;
| | - Brandon A Kohrt
- Duke Global Health Institute, Department of Psychiatry, Duke University, Durham, North Carolina 27710;
| | - Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205;
| | | | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, California 90095;
| | - Vikram Patel
- Sangath, Goa, India 403501;
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02115;
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon India 122022
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16
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Burgess RA. Policy, power, stigma and silence: Exploring the complexities of a primary mental health care model in a rural South African setting. Transcult Psychiatry 2016; 53:719-742. [PMID: 28317469 DOI: 10.1177/1363461516679056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Movement for Global Mental Health's (MGMH) efforts to scale up the availability of mental health services have been moderately successful. Investigations in resource-poor countries like South Africa have pointed to the value of an integrated primary mental health care model and multidisciplinary collaboration to support mental health needs in underserved and underresourced communities. However, there remains a need to explore how these policies play out within the daily realities of communities marked by varied environmental and relational complexities. Arguably, the lived realities of mental health policy and service delivery processes are best viewed through ethnographic approaches, which remain underutilised in the field of global mental health. This paper reports on findings from a case study of mental health services for HIV-affected women in a rural South African setting, which employed a motivated ethnography in order to explore the realities of the primary mental health care model and related policies in South Africa. Findings highlighted the influence of three key symbolic (intangible) factors that impact on the efficacy of the primary mental health care model: power dynamics, which shaped relationships within multidisciplinary teams; stigma, which limited the efficacy of task-shifting strategies; and the silencing of women's narratives of distress within services. The resultant gap between policy ideals and the reality of practice is discussed. The paper concludes with recommendations for building on existing successes in the delivery of primary mental health care in South Africa.
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Affiliation(s)
- Rochelle Ann Burgess
- London Metropolitan University; University of Kwa-Zulu Natal; London School of Economics
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17
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Abstract
BACKGROUND Global mental health is a relatively new field that has focused on disparities in mental health services across different settings, and on innovative ways to provide feasible, acceptable, and effective services in poorly-resourced settings. Neuroethics, too, is a relatively new field, lying at the intersection of bioethics and neuroscience; it has studied the implications of neuroscientific findings for age-old questions in philosophy, as well as questions about the ethics of novel neuroscientific methods and interventions. DISCUSSION In this essay, we address a number of issues that lie at the intersection of these two fields: an emphasis on a naturalist and empirical position, a concern with both disease and wellness, the importance of human rights in neuropsychiatric care, and the value of social inclusion and patient empowerment. SUMMARY These different disciplines share a number of perspectives, and future dialogue between the two should be encouraged.
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Affiliation(s)
- Dan J Stein
- />Department of Psychiatry & MRC Unit on Anxiety & Stress Disorders, University of Cape Town, Groote Schuur Hospital, Rondebosch, Cape Town, 7700 South Africa
| | - James Giordano
- />Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics and Department of Neurology, Georgetown University Medical Center, Washington, DC USA
- />Human Science Center, Ludwig-Maximilians Universität, Professor-Huber-Platz 2, 80539 München, Germany
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18
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Taylor SJC, Pinnock H, Epiphaniou E, Pearce G, Parke HL, Schwappach A, Purushotham N, Jacob S, Griffiths CJ, Greenhalgh T, Sheikh A. A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02530] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Stephanie JC Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Centre for Population Health Science, University of Edinburgh, Edinburgh, UK
| | - Eleni Epiphaniou
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Gemma Pearce
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Hannah L Parke
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Anna Schwappach
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Neetha Purushotham
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Sadhana Jacob
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Chris J Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Trisha Greenhalgh
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Aziz Sheikh
- Centre for Population Health Science, University of Edinburgh, Edinburgh, UK
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Blay SL, Fillenbaum GG, da Silva PFR, Peluso ET. Use of psychotherapy in a representative adult community sample in São Paulo, Brazil. J Nerv Ment Dis 2014; 202:688-94. [PMID: 25118139 PMCID: PMC4149600 DOI: 10.1097/nmd.0000000000000181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little is known about the use of psychotherapy to treat common mental disorders in a major city in a middle-income country. Our data come from in-home interviews with a stratified random sample of 2000 community residents aged 18 to 65 years in the city of São Paulo, Brazil. The information obtained included sociodemographic characteristics; psychotropic drugs; mental status; and lifetime, previous 12 months, and current use of psychotherapy. Logistic regression was used to examine determinants of use of psychotherapy. Of the sample, 22.7% met General Health Questionnaire-12 criteria for common mental disorders. Lifetime, previous 12 months, and current use of psychotherapy were reported by 14.6%, 4.6%, and 2.3% of the sample, respectively. Users typically were women, were more educated, had higher income, were not married, were unemployed, and had common mental disorders. Further analysis found that 47% (with higher education and income) paid out-of-pocket, and 53% used psychotropic medication. Psychotherapy does not seem to be the preferred treatment of common mental disorders.
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Affiliation(s)
- Sergio L Blay
- *Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina-UNIFESP), São Paulo, Brazil; †Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC; and ‡University Bandeirantes, São Paulo, Brazil
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20
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Watt MH, Wilson SM, Joseph M, Masenga G, MacFarlane JC, Oneko O, Sikkema KJ. Religious coping among women with obstetric fistula in Tanzania. Glob Public Health 2014; 9:516-27. [PMID: 24735435 DOI: 10.1080/17441692.2014.903988] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Religion is an important aspect of Tanzanian culture, and is often used to cope with adversity and distress. This study aimed to examine religious coping among women with obstetric fistulae. Fifty-four women receiving fistula repair at a Tanzanian hospital completed a structured survey. The Brief RCOPE assessed positive and negative religious coping strategies. Analyses included associations between negative religious coping and key variables (demographics, religiosity, depression, social support and stigma). Forty-five women also completed individual in-depth interviews where religion was discussed. Although participants utilised positive religious coping strategies more frequently than negative strategies (p < .001), 76% reported at least one form of negative religious coping. In univariate analysis, negative religious coping was associated with stigma, depression and low social support. In multivariate analysis, only depression remained significant, explaining 42% of the variance in coping. Qualitative data confirmed reliance upon religion to deal with fistula-related distress, and suggested that negative forms of religious coping may be an expression of depressive symptoms. Results suggest that negative religious coping could reflect cognitive distortions and negative emotionality, characteristic of depression. Religious leaders should be engaged to recognise signs of depression and provide appropriate pastoral/spiritual counselling and general psychosocial support for this population.
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Affiliation(s)
- Melissa H Watt
- a Duke Global Health Institute, Duke University , Durham , NC , USA
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21
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Abstract
INTRODUCTION Husband working abroad may have not only favorable outcomes for wives and other family members but also adverse consequences, including psychological problems. Present study intended to look into psychiatric morbidity profiles of the Nepalese female psychiatric patients and the stressors related with their husband working abroad. MATERIALS AND METHODS This is a hospital-based descriptive study with convenient sampling method. Hundred consecutive female psychiatric patients, with the particular stressor, coming into the contact of the investigating team were enrolled within the study period of 12 months. The psychiatric morbidities/diagnoses were sorted out according to the International classification of disease and infirmity, 10(th) edition (ICD-10) criteria. RESULTS Average age of the enrolled cases was 29 years. Nearly half of the women were illiterate or barely literate. Some other stressors, besides the one of husband working abroad were found to precipitate the illness in about 60%, main being relational and health problems. Common presenting complaints were mood, anxiety, and physical symptoms. Almost 30% of the subjects had some mental illness in their past too and similar proportion had in their blood relatives. About one-third admitted to use substances, mainly alcohol and cigarettes. The common psychiatric diagnoses were mood, anxiety, neurotic, and stress-related disorders. Nearly 10% had presented for suicide attempt. CONCLUSIONS The status of husband working abroad may have adverse consequences in mental health of women. Mood affect, anxiety, and stress-related disorders are common psychiatric illness among them.
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Affiliation(s)
- Dhana Ratna Shakya
- Department of Psychiatry, Bishweshwar Prasad Koirala Institute of Health Sciences, Dharan, Nepal
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22
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Ünlü Ince B, Cuijpers P, van 't Hof E, van Ballegooijen W, Christensen H, Riper H. Internet-based, culturally sensitive, problem-solving therapy for Turkish migrants with depression: randomized controlled trial. J Med Internet Res 2013; 15:e227. [PMID: 24121307 PMCID: PMC3849840 DOI: 10.2196/jmir.2853] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/30/2013] [Accepted: 09/09/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Turkish migrants living in the Netherlands have a high prevalence of depressive disorders, but experience considerable obstacles to accessing professional help. Providing easily accessible Internet treatments may help to overcome these barriers. OBJECTIVE The aim of this study was to evaluate the effectiveness of a culturally sensitive, guided, self-help, problem-solving intervention through the Internet for reducing depressive symptoms in Turkish migrants. METHODS A two-armed randomized controlled trial was conducted. The primary outcome measure was the severity of depressive symptoms; secondary outcome measures were somatic symptoms, anxiety, quality of life, and satisfaction with the treatment. Participants were assessed online at baseline, posttest (6 weeks after baseline), and 4 months after baseline. Posttest results were analyzed on the intention-to-treat sample. Missing values were estimated by means of multiple imputation. Differences in clinical outcome between groups were analyzed with a t test. Cohen's d was used to determine the between-groups effect size at posttreatment and follow-up. RESULTS Turkish adults (N=96) with depressive symptoms were randomized to the experimental group (n=49) or to a waitlist control group (n=47). High attrition rates were found among the 96 participants of which 42% (40/96) did not complete the posttest (6 weeks) and 62% (59/96) participants did not complete the follow-up assessment at 4 months. No significant difference between the experimental group and the control group was found for depression at posttest. Recovery occurred significantly more often in the experimental group (33%, 16/49) than in the control group (9%, 4/47) at posttest (P=.02). Because of the high attrition rate, a completers-only analysis was conducted at follow-up. The experimental group showed significant improvement in depression compared to the control group both at posttest (P=.01) and follow-up (P=.01). CONCLUSIONS The results of this study did not show a significant effect on the reduction of depressive symptoms. However, the effect size at posttest was high, which might be an indicator of the possible effectiveness of the intervention when assessed in a larger sample and robust trial. Future research should replicate our study with adequately powered samples. TRIAL REGISTRATION Dutch Trial Register: NTR2303. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2303 (Archived by WebCite at http://www.webcitation.org/6IOxNgoDu).
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Affiliation(s)
- Burçin Ünlü Ince
- Department of Clinical Psychology, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, Netherlands.
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Clarke K, King M, Prost A. Psychosocial interventions for perinatal common mental disorders delivered by providers who are not mental health specialists in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med 2013; 10:e1001541. [PMID: 24204215 PMCID: PMC3812075 DOI: 10.1371/journal.pmed.1001541] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 09/11/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Perinatal common mental disorders (PCMDs) are a major cause of disability among women. Psychosocial interventions are one approach to reduce the burden of PCMDs. Working with care providers who are not mental health specialists, in the community or in antenatal health care facilities, can expand access to these interventions in low-resource settings. We assessed effects of such interventions compared to usual perinatal care, as well as effects of interventions based on intervention type, delivery method, and timing. METHODS AND FINDINGS We conducted a systematic review, meta-analysis, and meta-regression. We searched databases including Embase and the Global Health Library (up to 7 July 2013) for randomized and non-randomized trials of psychosocial interventions delivered by non-specialist mental health care providers in community settings and antenatal health care facilities in low- and middle-income countries. We pooled outcomes from ten trials for 18,738 participants. Interventions led to an overall reduction in PCMDs compared to usual care when using continuous data for PCMD symptomatology (effect size [ES] -0.34; 95% CI -0.53, -0.16) but not binary categorizations for presence or absence of PCMDs (OR 0.62, 95% CI 0.35, 1.080 [corrected]. We found a significantly larger ES for psychological interventions (three studies; ES -0.46; 95% CI -0.58, -0.33) than for health promotion interventions (seven studies; ES -0.15; 95% CI -0.27, -0.02). Both individual (five studies; ES -0.18; 95% CI -0.34, -0.01) and group (three studies; ES -0.48; 95% CI -0.85, -0.11) interventions were effective compared to usual care, though delivery method was not associated with ES (meta-regression β coefficient -0.11; 95% CI -0.36, 0.14). Combined group and individual interventions (based on two studies) had no benefit compared to usual care, nor did interventions restricted to pregnancy (three studies). Intervention timing was not associated with ES (β 0.16; 95% CI -0.16, 0.49). The small number of trials and heterogeneity of interventions limit our findings. CONCLUSIONS Psychosocial interventions delivered by non-specialists are beneficial for PCMDs, especially psychological interventions. Research is needed on interventions in low-income countries, treatment versus preventive approaches, and cost-effectiveness. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Kelly Clarke
- UCL Institute for Global Health, University College London, London, United Kingdom
- * E-mail:
| | - Michael King
- Mental Health Sciences Unit, University College London, London, United Kingdom
| | - Audrey Prost
- UCL Institute for Global Health, University College London, London, United Kingdom
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Aboud FE, Singla DR. Challenges to changing health behaviours in developing countries: a critical overview. Soc Sci Med 2012; 75:589-94. [PMID: 22633158 DOI: 10.1016/j.socscimed.2012.04.009] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 04/25/2012] [Indexed: 11/26/2022]
Abstract
This overview of recent research on health behaviour change in developing countries shows progress as well as pitfalls. In order to provide guidance to health and social scientists seeking to change common practices that contribute to illness and death, there needs to be a common approach to developing interventions and evaluating their outcomes. Strategies forming the basis of interventions and programs to change behaviour need to focus on three sources: theories of behaviour change, evidence for the success and failure of past attempts, and an in-depth understanding of one's audience. Common pitfalls are a lack of attention to the wisdom of theories that address strategies of change at the individual, interpersonal, and community levels. Instead, programs are often developed solely from a logic model, formative qualitative research, or a case-control study of determinants. These are relevant, but limited in scope. Also limited is the focus solely on one's specific behaviour; regardless of whether the practice concerns feeding children or seeking skilled birth attendants or using a latrine, commonalities among behaviours allow generalizability. What we aim for is a set of guidelines for best practices in interventions and programs, as well as a metric to assess whether the program includes these practices. Some fields have approached closer to this goal than others. This special issue of behaviour change interventions in developing countries adds to our understanding of where we are now and what we need to do to realize more gains in the future.
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