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König D, Gleiss A, Vyssoki B, Harrer C, Trojer A, Groemer M, Weber S, Glahn A, Sommer L, Listabarth S, Wippel A. Suicide risk after discharge from in-patient psychiatric care: A 15-year retrospective cohort study of individual patient data. J Affect Disord 2024; 354:416-423. [PMID: 38479514 DOI: 10.1016/j.jad.2024.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/05/2024] [Accepted: 03/09/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Suicide rates are known to be increased in patients after discharge from in-patient psychiatric treatment. However, evidence on risk factors for suicide within this patient group are contradictory. Thus, this study aims to investigate suicide after discharge from a sizeable psychiatric care facility to determine associated risk factors. METHODS Data on individual patient level from a 15-year single-centre cohort were linked to data from the national death registry and cumulative incidence rates were calculated applying competing risk models. Independent variables included the patients' sex, age at admission, diagnosis, and length of admission. For each of these factors, subdistribution hazards ratios were calculated using a Fine-Gray model. RESULTS In our sample of 18,425 discharges, when using patients with the diagnosis of substance-use-disorders as a comparator, a significant increase in hazard of post-discharge suicide for male sex (SHR = 1.67;p = 0.037) as well as the discharge diagnoses of affective disorders (SHR = 3.56;p = 0.017) and neurotic stress and somatoform disorders (SHR = 3.73;p = 0.024) were found. Interestingly, the hazard of suicide significantly decreased in more recent discharges (SHR = 0.93;p = 0.006). No statistically significant association of the length of admission with the suicide risk was found (SHR = 0.98;p = 0.834). LIMITATIONS Suicides may have been mis-identified as natural death in the national death register. CONCLUSION Male sex and distinct diagnoses were associated with an increased risk for suicide after discharge from a psychiatric care institution. The markedly increased suicide risk within this patient collective highlights the need for the development of tools to assess suicidal behaviour in this group of patients reliably.
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Affiliation(s)
- Daniel König
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Institute of Clinical Biometrics, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Benjamin Vyssoki
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christine Harrer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Armin Trojer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Magdalena Groemer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Sabine Weber
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Glahn
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical University of Hannover, Hannover, Germany
| | - Lea Sommer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Listabarth
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Wippel
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
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Javadizadeh E, Oudshoorn A, Letts L, Barbic S, Shanoff C, Marshall CA. Participatory Research with Persons who Experience Mental Illness in Occupational Therapy: A Scoping Review. Can J Occup Ther 2024; 91:203-221. [PMID: 38240309 PMCID: PMC11088223 DOI: 10.1177/00084174231212760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Background. Persons who experience mental illness also face stigma and discrimination that frequently lead to a loss of ability to exercise autonomy and agency in their lives. Purpose. The range and breadth of literature exploring participatory research with persons living with mental illness are unknown in occupational therapy and occupation science. We initiated this study to fill this gap in the existing occupational therapy and occupational science literature. Method. Using the method of Arksey and O'Malley, we have conducted a scoping review to identify the range and breadth of literature. A qualitative content analysis was performed. Findings. A total of 34 articles were included in the narrative synthesis. The content analysis led to three related themes from the included studies: (1) coming together; (2) unique potential of participatory research; and (3) challenges in conducting participatory research. Conclusions. This review highlights that participatory research is well suited to research conducted with persons living with mental illness to support meaningful engagement and minimize stigma throughout the research process. This review can guide future participatory research and practice in occupational therapy and occupational science with persons living with mental illness.
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Affiliation(s)
- Elham Javadizadeh
- Elham Javadizadeh, Health & Rehabilitation Sciences, Elborn College, University of Western Ontario, London, Ontario, Canada.
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Lawn S, Shelby-James T, Manger S, Byrne L, Fuss B, Isaac V, Kaambwa B, Ullah S, Rattray M, Gye B, Kaine C, Phegan C, Harris G, Worley P. Evaluation of lived experience Peer Support intervention for mental health service consumers in Primary Care (PS-PC): study protocol for a stepped-wedge cluster randomised controlled trial. Trials 2024; 25:319. [PMID: 38745299 DOI: 10.1186/s13063-024-08165-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The demand for mental health services in Australia is substantial and has grown beyond the capacity of the current workforce. As a result, it is currently difficult for many to access secondary healthcare providers. Within the secondary healthcare sector, however, peer workers who have lived experience of managing mental health conditions have been increasingly employed to intentionally use their journey of recovery in supporting others living with mental health conditions and their communities. Currently, the presence of peer workers in primary care has been limited, despite the potential benefits of providing supports in conjunction with GPs and secondary healthcare providers. METHODS This stepped-wedge cluster randomised controlled trial (RCT) aims to evaluate a lived experience peer support intervention for accessing mental health care in primary care (PS-PC). Four medical practices across Australia will be randomly allocated to switch from control to intervention, until all practices are delivering the PS-PC intervention. The study will enrol 66 patients at each practice (total sample size of 264). Over a period of 3-4 months, 12 h of practical and emotional support provided by lived experience peer workers will be available to participants. Scale-based questionnaires will inform intervention efficacy in terms of mental health outcomes (e.g., self-efficacy) and other health outcomes (e.g., healthcare-related costs) over four time points. Other perspectives will be explored through scales completed by approximately 150 family members or carers (carer burden) and 16 peer workers (self-efficacy) pre- and post-intervention, and 20 medical practice staff members (attitudes toward peer workers) at the end of each study site's involvement in the intervention. Interviews (n = 60) and six focus groups held toward the end of each study site's involvement will further explore the views of participants, family members or carers, peer workers, and practice staff to better understand the efficacy and acceptability of the intervention. DISCUSSION This mixed-methods, multi-centre, stepped-wedge controlled study will be the first to evaluate the implementation of peer workers in the primary care mental health care sector. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001189617. Registered on 17 November 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386715.
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Affiliation(s)
- Sharon Lawn
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
- Lived Experience Australia, PO Box 96, 5048, Brighton, Australia
| | - Tania Shelby-James
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Sam Manger
- Lifestyle Medicine, James Cook University, James Cook University LPO, 150 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - Louise Byrne
- School of Management, RMIT, GPO Box 2476, Melbourne, VIC, 3001, Australia
| | - Belinda Fuss
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Vivian Isaac
- Faculty of Science and Health, Charles Sturt University, Albury, NSW, 2640, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Megan Rattray
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Bill Gye
- Community Mental Health Australia, PO Box 668, Rozelle, NSW, 2039, Australia
| | - Christine Kaine
- Lived Experience Australia, PO Box 96, 5048, Brighton, Australia
| | - Caroline Phegan
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Geoff Harris
- Mental Health Coalition of South Australia, Suite 2/195 North Terrace, Adelaide, SA, 5000, Australia
| | - Paul Worley
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Henry BF, Gray J. Access to Psychiatric and Education Services During Incarceration in the United States. Psychiatr Serv 2024:appips20230335. [PMID: 38693834 DOI: 10.1176/appi.ps.20230335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Individuals with psychiatric disorders are incarcerated at disproportionately high rates and often have low educational attainment. Access to psychiatric and education services within prisons has been described as inadequate, but recent data are lacking. The authors sought to assess the association of psychiatric disorders with both educational attainment before incarceration and access to psychiatric and education services during incarceration. METHODS Data were from the 2016 Survey of Prison Inmates, a national survey of adults incarcerated in U.S. state and federal prisons (N=24,848). Multinomial regression was used to identify associations of educational attainment before incarceration with psychiatric disorders and sociodemographic factors. Multivariable logistic regression models were used to assess associations of psychiatric disorders with access to psychiatric and education services during incarceration and with sociodemographic factors. RESULTS Before incarceration, 57.3% of survey respondents had less than a high school diploma. Across four education and psychiatric services, only 8.4%-44.8% of respondents reported participating in these services during incarceration, despite 57.3% reporting a psychiatric or learning disorder. Psychiatric disorders were associated with lower educational attainment before incarceration and lower access to education services during incarceration. Psychiatric disorders were associated with higher odds of access to psychiatric services during incarceration. Men had lower educational attainment before incarceration and lower odds of accessing psychiatric and education services during incarceration. CONCLUSIONS Incarcerated people had a high need for psychiatric and education services. Individuals with psychiatric disorders had lower odds of participating in education services during incarceration, highlighting the need for policies and services that increase participation.
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Affiliation(s)
- Brandy F Henry
- Department of Educational Psychology, Counseling, and Special Education, College of Education (Henry, Gray), and Consortium on Substance Use and Addiction, Social Science Research Institute (Henry), Pennsylvania State University, University Park
| | - Joy Gray
- Department of Educational Psychology, Counseling, and Special Education, College of Education (Henry, Gray), and Consortium on Substance Use and Addiction, Social Science Research Institute (Henry), Pennsylvania State University, University Park
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Karim S, Cai B, Merchant AT, Wilcox S, Zhao X, Alston K, Liu J. Antenatal depressive symptoms and adverse birth outcomes in healthy start participants: The modifying role of utilization of mental health services. Midwifery 2024; 132:103985. [PMID: 38581969 DOI: 10.1016/j.midw.2024.103985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE We examined the association between antenatal depressive symptoms and adverse birth outcomes in Midland Healthy Start (MHS) participants and determined whether receiving mental health services reduced the odds of adverse outcomes among those with elevated antenatal depressive symptoms. METHOD Data from a retrospective cohort of participants (N = 1,733) served by the MHS in South Carolina (2010-2019) were linked with their birth certificates. A score of ≥16 on the Center for Epidemiologic Studies Depression Scale was defined as elevated antenatal depressive symptoms. Services provided by MHS were categorized into: (1) receiving mental health services, (2) receiving other services, and (3) not receiving any services. Adverse birth outcomes included preterm birth, low birth weight, and small for gestational age. RESULTS Around 31 % had elevated antenatal depressive symptoms. The prevalences of preterm birth, low birthweight, and small for gestational age were 9.5 %, 9.1 %, and 14.6 %, respectively. No significant associations were observed between elevated depressive symptoms and adverse outcomes. Among women with elevated antenatal depressive symptoms, the odds for small for gestational age were lower in those who received mental health services (AOR 0.33, 95 % CI 0.15-0.72) or other services (AOR 0.34, 95 % CI 0.16-0.74) compared to those who did not receive any services. The odds for low birth weight (AOR 0.34, 95 % CI 0.13-0.93) were also lower in those who received mental health services. CONCLUSIONS Receiving screening and referral services for antenatal depression reduced the risks of having small for gestational age or low birth weight babies among MHS participants.
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Affiliation(s)
- Sabrina Karim
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, Columbia, SC, 29208, USA
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, Columbia, SC, 29208, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, Columbia, SC, 29208, USA
| | - Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC 29208, USA
| | - Xingpei Zhao
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, Columbia, SC, 29208, USA
| | | | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, Columbia, SC, 29208, USA.
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Broersen M, Creemers DHM, Frieswijk N, Vermulst AA, Kroon H. Effects of Youth Flexible Assertive Community Treatment: outcomes of an 18-month observational study. Soc Psychiatry Psychiatr Epidemiol 2024; 59:745-758. [PMID: 37280465 PMCID: PMC11087363 DOI: 10.1007/s00127-023-02508-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE This Multicenter Youth Flexible ACT Study examined the effect of Youth Flexible Assertive Community Treatment on symptomatic, social, and personal recovery outcomes of adolescents dealing with multifaceted psychiatric and social care needs who do not readily engage in regular office-based mental health services. METHODS Newly admitted clients (n = 199) aged 12-24 years from 16 Youth Flexible ACT teams participated in this observational prospective cohort study. Client and practitioner questionnaires were administered every 6 months, up to 18 months. Latent growth curve analyses were conducted to examine changes in symptomatic, social, and personal recovery outcomes throughout Flexible ACT. RESULTS Our analyses of client-reported outcomes showed a decrease in overall psychosocial difficulties, depressive symptoms, and subclinical psychosis symptoms. Moreover, outcomes showed improved social interaction with peers, quality of life, and feelings of empowerment and fewer contacts with the police/legal system. In addition, analyses of clinician-reported outcomes showed a decrease in problems related to family life, peer relationships, school/work attendance, emotional symptoms, and attentional problems. Problems related to personal finance, school and work status, substance misuse, disruptive and aggressive behavior, self-injury, and self-care and independence remained unchanged. CONCLUSION Our results showed that clients participating in Youth Flexible ACT improved in symptomatic, social, and personal recovery outcomes over 18 months. With its integrated approach and personalized care, this service delivery model is promising for adolescents unable to engage successfully in regular (office based) mental health support services.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, The Netherlands.
- Tranzo-Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
| | | | | | | | - Hans Kroon
- Tranzo-Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
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Marchi M, Venturi G, Visentini C, Pinelli M, Priebe S, Galeazzi GM. The therapeutic relationship in community mental health services: a systematic review of the literature. Soc Psychiatry Psychiatr Epidemiol 2024; 59:731-743. [PMID: 37875610 DOI: 10.1007/s00127-023-02581-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE This systematic review aimed to investigate the therapeutic relationship (TR) between mental health professionals (MHPs) and their patients in community mental health services (CMHS). METHODS PubMed (Medline), PsycINFO, CINAHL, CENTRAL, and Web of Science were searched for studies that assessed TR in CMHS using quantitative measures developed specifically for this setting (i.e., Helping Alliance Scale [HAS] and the Scale to Assess the Therapeutic Relationship [STAR]). Studies were included if they considered adult patients with a psychiatric disorder and/or any MHP working in CMHS. Meta-analysis and narrative synthesis assessed the association between patients' and MHPs' ratings and identified predictors of TR. RESULTS Of 1934 studies, 15 were included in the review, including 3004 patients. A total of 1127 patients and 963 MHPs were considered in the meta-analysis. The heterogeneity of the studies was high, and there was no significant difference between the patients' and MHPs' TR ratings in the random-effects model (standardized mean difference [SMD]: - 0.39 [95% CI: - 1.03; 0.24]). In the multivariable meta-regression, only duration of illness was significantly associated with TR ratings (unstandardized regression coefficient [B]: 0.388 [95% CI: 0.217; 0.558]). A recovery-oriented service, shared decision-making, and the recognition of patient needs contributed to more positive TR ratings. CONCLUSION Patients and MHPs converged in their TR ratings, although patients gave lower ratings. Routine assessment of TR in CMHS can inform reflective practice and service development, as TR can be assessed easily and early in the treatment process. Future research should focus on developing and testing interventions to improve TR in CMHS.
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Affiliation(s)
- Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy
| | - Giulia Venturi
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy
| | - Chiara Visentini
- Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Margherita Pinelli
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy
| | | | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy.
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Hayes D, Camacho EM, Ronaldson A, Stepanian K, McPhilbin M, Elliott RA, Repper J, Bishop S, Stergiopoulos V, Brophy L, Giles K, Trickett S, Lawrence S, Winship G, Meddings S, Bakolis I, Henderson C, Slade M. Evidence-based Recovery Colleges: developing a typology based on organisational characteristics, fidelity and funding. Soc Psychiatry Psychiatr Epidemiol 2024; 59:759-768. [PMID: 36905435 PMCID: PMC10007645 DOI: 10.1007/s00127-023-02452-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE Recovery Colleges (RCs) have been implemented across England with wide variation in organisational characteristics. The purpose of this study is to describe RCs across England in terms of organisational and student characteristics, fidelity and annual spending, to generate a RC typology based on characteristics and to explore the relationship between characteristics and fidelity. METHODS All RC in England meeting criteria on recovery orientation, coproduction and adult learning were included. Managers completed a survey capturing characteristics, fidelity and budget. Hierarchical cluster analysis was conducted to identify common groupings and generate an RC typology. RESULTS Participants comprised 63 (72%) of 88 RC in England. Fidelity scores were high (median 11, IQR 9-13). Both NHS and strengths-focussed RCs were associated with higher fidelity. The median annual budget was £200,000 (IQR £127,000-£300,000) per RC. The median cost per student was £518 (IQR £275-£840), cost per course designed was £5,556 (IQR £3,000-£9,416) and per course run was £1,510 (IQR £682-£3,030). The total annual budget across England for RCs is an estimated £17.6 m including £13.4 m from NHS budgets, with 11,000 courses delivered to 45,500 students. CONCLUSION Although the majority of RCs had high levels of fidelity, there were sufficiently pronounced differences in other key characteristics to generate a typology of RCs. This typology might prove important for understanding student outcomes and how they are achieved and for commissioning decisions. Staffing and co-producing new courses are key drivers of spending. The estimated budget for RCs was less than 1% of NHS mental health spending.
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Affiliation(s)
- Daniel Hayes
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB, UK.
| | - Elizabeth M Camacho
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Amy Ronaldson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Katy Stepanian
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Merly McPhilbin
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
| | - Rachel A Elliott
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Julie Repper
- ImROC, Nottinghamshire Healthcare NHS Foundation Trust, Duncan Macmillan House, Porchester Road, Mapperley, Nottingham, NG3 6AA, UK
| | - Simon Bishop
- Nottingham University Business School, Nottingham, NG8 1BB, UK
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
| | - Lisa Brophy
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Kirsty Giles
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Sarah Trickett
- RECOLLECT Lived Experience Advisory Panel, Nottingham, UK
| | | | - Gary Winship
- School of Education, University of Nottingham, Nottingham, NG2 5BY, UK
| | - Sara Meddings
- ImROC, Nottinghamshire Healthcare NHS Foundation Trust, Duncan Macmillan House, Porchester Road, Mapperley, Nottingham, NG3 6AA, UK
| | - Ioannis Bakolis
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, UK
- Nord University, Postboks 474, 7801, Namsos, Norway
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Engels A, Stein J, Riedel-Heller SG, König HH, Konnopka C. Temporal and spatial changes in the provision of mental health care during the COVID-19 pandemic in Germany: a claims-based cohort study on patients with severe mental disorders. Soc Psychiatry Psychiatr Epidemiol 2024; 59:789-797. [PMID: 37831078 PMCID: PMC11087346 DOI: 10.1007/s00127-023-02571-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Major lockdowns were imposed in Germany from March until May 2020 and from December 2020 until May 2021. We studied the influence of these lockdowns, the strain on intensive care units and the strictness of COVID-19-related containment strategies on the utilization of mental health care among patients with severe mental disorders. METHODS We used health insurance claims data to identify n = 736,972 patients with severe mental disorders shortly before the pandemic and n = 735,816 patients a year earlier. We applied entropy balancing to adjust for baseline differences by district. For a 12-month follow-up, we modeled monthly changes in utilization through meta-analytic models using both the COVID-19 stringency index and intensive care unit cases per 100,000 inhabitants as predictors. Our outcomes were changes in psychiatric hospital days and time treated by outpatient psychiatrists. RESULTS Psychiatric hospital days declined by at least 7.7% in all calender month during the pandemic. Peak reduction rates were observed in April (- 27.9%), May (- 22.3%) 2020 and January 2021 (- 18.3%). Utilization changes were associated with the stringency index and the second lockdown. Time treated by psychiatrists was shorter in April (- 16.2%) and May (- 11.5%) 2020 and in January 2021 (- 10.5%), which was partially offset by higher utilization in June and September 2020. These utilization changes were associated with the stringency index and the strain on intensive care units during both lockdowns. CONCLUSION Hospitals did not maintain the level of utilization during the pandemic, while outpatient psychiatrists adapted more quickly, presumably due to digital and telemedical care.
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Affiliation(s)
- Alexander Engels
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246, Hamburg, Germany
| | - Janine Stein
- Institute for Social Medicine, Occupational Medicine and Public Health, University Medical Center Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute for Social Medicine, Occupational Medicine and Public Health, University Medical Center Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246, Hamburg, Germany
| | - Claudia Konnopka
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246, Hamburg, Germany.
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Bonfine N, Barrenger SL, Munetz MR. Approaching Jail Diversion and Prevention of Criminal Legal System Involvement Simultaneously. Psychiatr Serv 2024; 75:489-491. [PMID: 38050441 DOI: 10.1176/appi.ps.20230218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Despite prolific jail diversion initiatives, people with serious mental illness continue to be overrepresented in the criminal legal system. This continued overrepresentation has led to recent calls to address social determinants of health and criminal risk factors rather than to allocate new resources to diverting people from the criminal legal system. This shift toward prevention by addressing social factors that influence health and criminal legal outcomes should occur alongside a continued focus on diversion to understand what works and for whom. An effective, well-funded, and comprehensive community-based mental health services system could serve as the ultimate intercept for preventing criminal legal system involvement.
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Affiliation(s)
- Natalie Bonfine
- Department of Psychiatry, Northeast Ohio Medical University, Rootstown
| | | | - Mark R Munetz
- Department of Psychiatry, Northeast Ohio Medical University, Rootstown
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Lynch L, Moorhead A, Long M, Hawthorne-Steele I. "If you don't actually care for somebody, how can you help them?": Exploring Young People's Core Needs in Mental Healthcare-Directions for Improving Service Provision. Community Ment Health J 2024; 60:796-812. [PMID: 38430285 PMCID: PMC11001725 DOI: 10.1007/s10597-024-01237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/10/2024] [Indexed: 03/03/2024]
Abstract
Youth suicide and mental health are important issues of global concern that require timely and evidence-based interventions to increase quality of life and prevent deaths. Findings report that young people have lower mental health help-seeking rates, and there is a lack of qualitative research examining why. The aim of this research study was to further understanding on young people's core needs in mental healthcare based on actual experiences (PLE) of help-seeking with providers of mental health services. Constructivist Grounded Theory methods (Charmaz, 2014) informed this study design, and in-depth interviews and a focus group were conducted with 18 young people. The findings were presented across four sub-categories, which together describe the common factors, that are regarded as essential in youth mental healthcare provision. These include: 1. The services; 2. The helper; 3. The interventions, and 4. The impact of development. Critical discussion into young people's needs in mental healthcare was provided including the key service factors, approach and rapport with helpers, types of intervention and alignment with typical developmental capacity. This article provides guidance on how to improve, design, or reform service provision, and can be a useful resource for policy makers, service providers and practitioners. This study concluded that youth participation in the co-design of service provision is important as it can reduce health disparities and ensure that services provide relevant, respectful and suitable care that reflects the way in which young people experience mental health problems as well as the ways in which they want to be helped.
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Affiliation(s)
- Louise Lynch
- School of Communication and Media, Faculty of Arts, Humanities and Social Sciences, Ulster University, York Street, Belfast, Co. Antrim, BT15 1ED, Northern Ireland.
| | - Anne Moorhead
- School of Communication and Media, Institute for Nursing and Health Research, Ulster University, York Street, Belfast, Co. Antrim, BT15 1ED, Northern Ireland
| | - Maggie Long
- School of Communication and Media, Centre for Communication and Media Research, Faculty of Arts, Humanities and Social Science, Ulster University, York Street, Belfast, Co. Antrim, BT15 1ED, Northern Ireland
| | - Isobel Hawthorne-Steele
- School of Applied Social and Policy Sciences, Faculty of Arts, Humanities and Social Sciences, Ulster University, York Street, Belfast, Co. Antrim, BT15 1ED, Northern Ireland
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Scanlon F, Morgan RD, Aceves D. Implementing a Treatment for People with Serious Mental Illness in Jail: A Mixed-Methods Study of Stakeholder Perspectives on Feasibility and Acceptability. Adm Policy Ment Health 2024:10.1007/s10488-024-01380-4. [PMID: 38662179 DOI: 10.1007/s10488-024-01380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
People with mental illness are over-represented in the U.S. criminal legal system. Jail presents an optimal opportunity to provide needed mental health care as the entry point to corrections. However, there is a lack of programming available in jails, which may be partly due to limited understanding of how to successfully implement interventions in this complex setting. We implemented a nine-session psychotherapeutic intervention for people with serious mental illness in a county jail. As part of a larger implementation-effectiveness hybrid study, we gathered mixed-methods data from stakeholders (treatment recipients and jail administrators) on the feasibility and acceptability of the intervention's implementation. In focus group discussions and qualitative interviews, treatment recipients (n = 29) provided qualitative and quantitative data on their perceptions of the implementation's feasibility and acceptability. Jail administrators (n = 6) completed two quantitative self-report measures on their perceptions of the treatment's feasibility and acceptability. Qualitative analyses were conducted by two coders using inductive thematic template analysis; seven global themes relating to treatment recipients' perceptions of the assets and hindrances to feasibility and acceptability were developed and are presented with supporting quotations. Quantitatively, all treatment recipients endorsed the intervention's feasibility (100%), and nearly all (97%) endorsed its acceptability. On both self-report measures, jail administrators' mean scores fell above a-priori thresholds indicating feasibility and acceptability. We found qualitative and quantitative support for the use of this intervention in jail from both sets of stakeholders. These results have implications for clinical service and policy in jail, where service providers struggle to meet the considerable demand for mental health services.
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Nogueira-Leite D, Marques-Cruz M, Cruz-Correia R. Individuals' attitudes toward digital mental health apps and implications for adoption in Portugal: web-based survey. BMC Med Inform Decis Mak 2024; 24:99. [PMID: 38637866 PMCID: PMC11025147 DOI: 10.1186/s12911-024-02488-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The literature is consensual regarding the academic community exhibiting higher levels of mental disorder prevalence than the general population. The potential of digital mental health apps for improving access to resources to cope with these issues is ample. However, studies have yet to be performed in Portugal on individuals' attitudes and perceptions toward digital mental health applications or their preferences and decision drivers on obtaining mental health care, self-assessment, or treatment. OBJECTIVE This study aims to understand the determinants of digital mental health applications use in the Portuguese academic community of Porto, along with potential adoption barriers and enablers. METHODS A cross-sectional, web-based survey was delivered via dynamic email to the University of Porto's academic community. Data collection occurred between September 20 and October 20, 2022. We used structural equation modeling to build three models, replicating a peer-reviewed and published study and producing a newly full mediation model shaped by the collected data. We tested the relationships between use of digital mental health apps and perceived stress, perceived need to seek help for mental health, perceived stigma, past use of mental health services, privacy concerns, and social influence. RESULTS Of the 539 participants, 169 (31.4%) reported having used digital mental health apps. Perceived stress and a latent variable, comprising perceptions of mental health problems and coping strategies, were positively associated with mental health app use, while privacy concerns regarding one's information being accessible to others were negatively associated. Perceived stigma, need to seek help, and close relationships did not have a statistically significant direct effect. CONCLUSIONS These findings can inform product and policy development of new, better-targeted digital mental health app interventions, with implications for researchers and academia, industry, and policymakers. Our study concludes that, to maximize adherence to these apps, they should have low to no financial charges, demonstrate evidence of their helpfulness and focus on the timely delivery of care. We also conclude that to foster digital mental health app use, there is a need to improve mental health literacy, namely regarding self-awareness of one's conditions, acceptable stress levels, and overall behavior towards mental health. TRIAL REGISTRATION RR2-10.2196/41040.
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Affiliation(s)
- Diogo Nogueira-Leite
- Health Data Science Ph.D. Program, Faculty of Medicine of the University of Porto, Porto, Portugal.
- Department of Community Medicine, Health Information and Decision-Making, Faculty of Medicine of the University of Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal.
- Nova School of Business and Economics Health Economics & Management Knowledge Center, New University of Lisbon, Lisbon, Portugal.
| | - Manuel Marques-Cruz
- Health Data Science Ph.D. Program, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Community Medicine, Health Information and Decision-Making, Faculty of Medicine of the University of Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal
- Nova School of Business and Economics Health Economics & Management Knowledge Center, New University of Lisbon, Lisbon, Portugal
| | - Ricardo Cruz-Correia
- Department of Community Medicine, Health Information and Decision-Making, Faculty of Medicine of the University of Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal
- Center for Health Technology and Services Research, Porto, Portugal
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14
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Soori BIP, Regmi K, Pappas Y. Factors Influencing the Integration of Traditional Medicine and Mainstream Medicine in Mental Health Services in West Africa: A Systematic Review Using Narrative Synthesis. Community Ment Health J 2024:10.1007/s10597-024-01263-w. [PMID: 38619699 DOI: 10.1007/s10597-024-01263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/27/2024] [Indexed: 04/16/2024]
Abstract
This study explored the enablers and obstacles to the integration of traditional medicine and mainstream medicine in mental health services in West Africa. This study is a systematic review conducted in accordance with the relevant parts of the Preferred Reporting Items for Systematic reviews and Meta-analyses. Keywords searches were done in databases, and other reference lists were also searched. The Rainbow model of integrated care and a thematic analysis framework were used to account for the factors influencing the integration of traditional medicine and mainstream medicine in mental health services in West Africa. A total of 12 studies met the eligibility criteria after the evaluation of 6413 articles from databases and reference lists. The themes of: policy and implementation; different conceptualisation of mental health/referrals; trust issues, and education and training, were enablers or obstacles of integration depending on how they worked to facilitate or hinder integration. There was an indication of little integration of TM and MM at the macro, meso and micro levels in mental health services in West Africa. Though the study does cover all the West African states evenly, it is recommended that policy-makers and stakeholders interested in integration should ensure integration activities, especially policies, cut across all the levels of the rainbow model of integrated care and are planned and aligned at the macro, meso and micro levels instead of using ad hoc measures, informal initiatives or placing TM services in MM mental health services, which do not amount to integration.
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Affiliation(s)
- Batuuroh I P Soori
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK.
| | - Krishna Regmi
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK
| | - Yannis Pappas
- Faculty of Health and Social Sciences, Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK
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15
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Whitehead R, Hopkins L, Dight S, Kennard M, McGrath B. Adolescent Violence in the Home Among Youth Presenting to an Early Psychosis Service: An Exploration of Contributing Factors. Community Ment Health J 2024:10.1007/s10597-024-01268-5. [PMID: 38607463 DOI: 10.1007/s10597-024-01268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 03/14/2024] [Indexed: 04/13/2024]
Abstract
Adolescent violence in the home is a growing public health issue and remains under reported and under-researched. The focus of the present research is to investigate factors that may contribute to adolescent violence in the home, among acohort of young people with co-occurring early psychosis. Data relates to 50 young people (16 females, 33 males, 1 nonbinary) aged from 16-25 who were clients at a youth early psychosis service in Melbourne, Australia. Results from a discriminant function analysis revealed the two major contributing factors to whether someone used violence in the home, were whether a young person had a coexisting neurodevelopmental or intellectual disability and whether they used violence outside the home. The findings provide preliminary evidence that engaging in violence outside the home and the presence of a neurodevelopmental or intellectual disability may make it more likely for young people with early psychosis to use violence in the home.
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Affiliation(s)
- Richard Whitehead
- Alfred Health Child and Youth Mental Health Service, Melbourne, Australia.
- School of Psychology, Deakin University, Melbourne, Australia.
| | - Liza Hopkins
- Alfred Health Child and Youth Mental Health Service, Melbourne, Australia
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Eapen V, Gerstl B, Ahinkorah BO, John JR, Hawker P, Nguyen TP, Brice F, Winata T, Bowden M. Evidence-based brief interventions targeting acute mental health presentations for children and adolescents: systematic review. BJPsych Open 2024; 10:e78. [PMID: 38602192 PMCID: PMC11060074 DOI: 10.1192/bjo.2024.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Brief intervention services provide rapid, mobile and flexible short-term delivery of interventions to resolve mental health crises. These interventions may provide an alternative pathway to the emergency department or in-patient psychiatric services for children and young people (CYP), presenting with an acute mental health condition. AIMS To synthesise evidence on the effectiveness of brief interventions in improving mental health outcomes for CYP (0-17 years) presenting with an acute mental health condition. METHOD A systematic literature search was conducted, and the studies' methodological quality was assessed. Five databases were searched for peer-reviewed articles between January 2000 and September 2022. RESULTS We synthesised 30 articles on the effectiveness of brief interventions in the form of (a) crisis intervention, (b) integrated services, (c) group therapies, (d) individualised therapy, (e) parent-child dyadic therapy, (f) general services, (g) pharmacotherapy, (h) assessment services, (i) safety and risk planning and (j) in-hospital treatment, to improve outcomes for CYP with an acute mental health condition. Among included studies, one study was rated as providing a high level of evidence based on the National Health and Medical Research Council levels of evidence hierarchy scale, which was a crisis intervention showing a reduction in length of stay and return emergency department visits. Other studies, of moderate-quality evidence, described multimodal brief interventions that suggested beneficial effects. CONCLUSIONS This review provides evidence to substantiate the benefits of brief interventions, in different settings, to reduce the burden of in-patient hospital and readmission rates to the emergency department.
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Affiliation(s)
- Valsamma Eapen
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; and Discipline of Psychiatry and Mental Health, University of New South Wales, Australia
| | - Brigitte Gerstl
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; and Discipline of Psychiatry and Mental Health, University of New South Wales, Australia
| | - Bright Opoku Ahinkorah
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, Australia; and School of Public Health, University of Technology Sydney, Australia
| | - James Rufus John
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; and Discipline of Psychiatry and Mental Health, University of New South Wales, Australia
| | - Patrick Hawker
- Discipline of Psychiatry and Mental Health, University of New South Wales, Australia
| | - Thomas P. Nguyen
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, Australia; and Mental Health Team, School of Medicine, Western Sydney University, Australia
| | - Febe Brice
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia
| | - Teresa Winata
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, Australia; and Infant, Child and Adolescent Mental Health Service (ICAMHS), South Western Sydney Local Health District, Australia
| | - Michael Bowden
- Child and Youth Mental Health, New South Wales Ministry of Health, Australia; Sydney Medical School, University of Sydney, Australia; and Department of Psychological Medicine, Sydney Children's Hospitals Network, Australia
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17
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Allsopp K, Varese F, French P, Young E, White H, Chung P, Davey J, Hassan AA, Wright SA, Barrett A, Bhutani G, McGuirk K, Shields G, Huntley F, Jordan J, Rowlandson A, Sarsam M, Ten Cate H, Walker H, Watson R, Willbourn J, Hind D. A service mapping exercise of four health and social care staff mental health and wellbeing services, Resilience Hubs, to describe health service provision and interventions. BMC Health Serv Res 2024; 24:430. [PMID: 38575960 PMCID: PMC10996192 DOI: 10.1186/s12913-024-10835-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND NHS England funded 40 Mental Health and Wellbeing Hubs to support health and social care staff affected by the COVID-19 pandemic. We aimed to document variations in how national guidance was adapted to the local contexts of four Hubs in the North of England. METHODS We used a modified version of Price's (2019) service mapping methodology. Service level data were used to inform the analysis. A mapping template was adapted from a range of tools, including the European Service Mapping Schedule, and reviewed by Hub leads. Key data included service model; staffing; and interventions. Data were collected between March 2021 - March 2022 by site research assistants. Findings were accuracy-checked by Hub leads, and a logic model developed to theorise how the Hubs may effect change. RESULTS Hub goals and service models closely reflected guidance; offering: proactive outreach; team-based support; clinical assessment; onward referral, and rapid access to mental health support (in-house and external). Implementation reflected a service context of a client group with high mental health need, and high waiting times at external mental health services. Hubs were predominantly staffed by experienced clinicians, to manage these mental health presentations and organisational working. Formulation-based psychological assessment and the provision of direct therapy were not core functions of the NHS England model, however all Hubs incorporated these adaptations into their service models in response to local contexts, such as extensive waiting lists within external services, and/or client presentations falling between gaps in existing service provision. Finally, a standalone clinical records system was seen as important to reassure Hub users of confidentiality. Other more nuanced variation depended on localised contexts. CONCLUSION This study provides a map for setting up services, emphasising early understandings of how new services will integrate within existing systems. Local and regional contexts led to variation in service configuration. Whilst additional Hub functions are supported by available literature, further research is needed to determine whether these functions should comprise essential components of staff wellbeing services moving forward. Future research should also determine the comparative effectiveness of service components, and the limits of permissible variation. STUDY REGISTRATION researchregistry6303.
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Affiliation(s)
- Kate Allsopp
- Complex Trauma & Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, 3rd Floor Rawnsley Building, Hathersage Road, Manchester, UK.
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK.
| | - Filippo Varese
- Complex Trauma & Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, 3rd Floor Rawnsley Building, Hathersage Road, Manchester, UK
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK
| | - Paul French
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Brooks Building, Bonsall Street, Manchester, UK
- Pennine Care NHS Foundation Trust, Trust Headquarters, 225 Old Street, Ashton-Under-Lyne, Greater Manchester, UK
| | - Ellie Young
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Trust Headquarters, 225 Old Street, Ashton-Under-Lyne, Greater Manchester, UK
| | - Hannah White
- Complex Trauma & Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, 3rd Floor Rawnsley Building, Hathersage Road, Manchester, UK
| | - Priscilla Chung
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Sceptre Point, Sceptre Way, Walton Summit, Preston, UK
| | - Jessica Davey
- Humber and North Yorkshire Resilience Hub, Tees Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Edward Pease Way, Darlington, UK
| | - Alysha A Hassan
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, UK
| | - Sally-Anne Wright
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Sceptre Point, Sceptre Way, Walton Summit, Preston, UK
| | - Alan Barrett
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Trust Headquarters, 225 Old Street, Ashton-Under-Lyne, Greater Manchester, UK
- School of Health Science, University of Salford, Mary Seacole Building, Frederick Road Campus, Broad St, Salford, UK
| | - Gita Bhutani
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Sceptre Point, Sceptre Way, Walton Summit, Preston, UK
| | - Katherine McGuirk
- Greater Manchester Health and Social Care Partnership, 4th Floor, 3 Piccadilly Place, Manchester, UK
| | - Gemma Shields
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK
| | - Fay Huntley
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, UK
- Doctorate of Clinical Psychology, School of Health in Social Science, Old Medical School, University of Edinburgh, Teviot Place, Room 2.2, Doorway 6, Edinburgh, UK
| | - Joanne Jordan
- Humber and North Yorkshire Resilience Hub, Tees Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Edward Pease Way, Darlington, UK
| | - Aleix Rowlandson
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK
| | - May Sarsam
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, UK
| | - Hein Ten Cate
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Sceptre Point, Sceptre Way, Walton Summit, Preston, UK
| | - Holly Walker
- Humber and North Yorkshire Resilience Hub, Tees Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Edward Pease Way, Darlington, UK
| | - Ruth Watson
- Greater Manchester Mental Health NHS Foundation Trust, Trust Headquarters, Bury New Road, Prestwich, Manchester, M25 3BL, UK
| | - Jenni Willbourn
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Trust Headquarters, 225 Old Street, Ashton-Under-Lyne, Greater Manchester, UK
| | - Daniel Hind
- School of Health and Related Research, The Innovation Centre, University of Sheffield, 217 Portobello, Sheffield, UK
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Sun M, Zhou H, Li Y, Wang J, Yang W, Gong Y, Xu J, Zhang J, Yang X, Bueber M, Phillips MR, Zhou L. Professional characteristics, numbers, distribution and training of China's mental health workforce from 2000 to 2020: a scoping review. Lancet Reg Health West Pac 2024; 45:100992. [PMID: 38699293 PMCID: PMC11064725 DOI: 10.1016/j.lanwpc.2023.100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/25/2023] [Accepted: 12/05/2023] [Indexed: 05/05/2024]
Abstract
Over the last 20 years, the numbers, types, distribution, and qualifications of mental health professionals in China have changed dramatically. However, there has been no systematic attempt to collect information about this transformation in the human resources available to provide mental health services-information that needs to be regularly updated to improve the country's coordination of these services. This scoping review compiles current details about China's mental health workforce and identifies critical gaps in available research and reporting. We reviewed all relevant studies and reports published between 1 January 2000 and 30 June 2021 in two English-language and four Chinese-language databases, the website of China's National Health Commission, and national and provincial health services yearbooks. In addition to summarising data from government yearbooks, we integrated relevant results from 82 peer-reviewed publications and two government reports. From 2000 to 2020, the number of psychiatrists in the country increased by 139%, and the number of psychiatric nurses increased by 340%. However, the much higher ratio of mental health professionals per 100,000 population and the better quality of training of mental health professionals in urban, eastern provinces compared to rural, western provinces has not changed. Progress has been made in standardising the training of psychiatrists, but there are no standardised training programs for psychiatric nurses, clinical psychologists, or psychiatric social workers. Future research needs to address several issues that limit the effectiveness of policies aimed at increasing the size, quality and equitable distribution of China's mental health workforce: 1) limited data available about the numbers and characteristics of professionals who provide mental health services, 2) absence of nationally standardised training programs for non-psychiatric medical professionals and non-medical personnel who provide essential monitoring and supportive care to persons with mental illnesses, and 3) failure to scientifically assess the outcomes of currently available training programs.
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Affiliation(s)
- Meng Sun
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongling Zhou
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yue Li
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiali Wang
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenjuan Yang
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yi Gong
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiahuan Xu
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiawen Zhang
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinhu Yang
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Marlys Bueber
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Michael R. Phillips
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Departments of Psychiatry and Epidemiology, Columbia University, New York, NY, USA
| | - Liang Zhou
- Department of Social Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
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Karolaakso T, Autio R, Suontausta P, Leppänen H, Rissanen P, Näppilä T, Tuomisto MT, Pirkola S. Mental health service diversity and work disability: associations of mental health service system characteristics and mood disorder disability pensioning in Finland. Soc Psychiatry Psychiatr Epidemiol 2024; 59:631-642. [PMID: 37117785 PMCID: PMC10960744 DOI: 10.1007/s00127-023-02481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE Public mental health services (MHS) are crucial in preventing psychiatric disability pensions (DP). We studied the associations between mood disorder DP risk and the characteristics of Finnish municipalities' MHS provision using the ESMS-R mapping tool and Finnish population registers, based on first-time granted mood disorder DPs between 2010 and 2015. METHODS The final data set included 13,783 first-time mood disorder DP recipients and 1088 mental health service units in 104 municipalities. We focused on five different MHS types: all MHS, outpatient care provision, local services without and with gatekeeping, and centralized services. Three factors for each MHS type were studied: service resources, richness, and diversity index. Negative binomial regression models were used in the analysis. RESULTS In all the municipalities, higher service richness and diversity regarding all MHS, outpatient care and local services with gatekeeping were associated with a lower DP risk. In urban municipalities, service richness was mainly associated with lower DP risk, and in semi-urban municipalities service diversity and resources were primarily associated with lower DP risk in outpatient care and local services with gatekeeping. In rural municipalities, DP risk indicated no association with MHS factors. CONCLUSION The organization and structure of MHS play a role in psychiatric disability pensioning. MHS richness and diversity are associated with lower mood disorder DP in specific societal contexts indicating their role as quality indicators for regional MHS. The diversity of service provision should be accounted for in MHS planning to offer services matching population needs.
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Affiliation(s)
- Tino Karolaakso
- Faculty of Social Sciences (Psychology), Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
- Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Reija Autio
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Petra Suontausta
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Helena Leppänen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Päivi Rissanen
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Turkka Näppilä
- Tampere University Library, Tampere University, Tampere, Finland
| | - Martti T Tuomisto
- Faculty of Social Sciences (Psychology), Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
| | - Sami Pirkola
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
- Department of Adult Psychiatry, Tampere University Hospital, Tampere, Finland
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20
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Lee K, Hough K. Racial Disparity of Mental Health Service Utilization Among Low-Income Head Start Eligible Parents. J Racial Ethn Health Disparities 2024; 11:611-620. [PMID: 36959391 DOI: 10.1007/s40615-023-01545-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/25/2023]
Abstract
Based on the Head Start Impact Study, 1706 parents who had mild, moderate, and severe depressive symptoms were selected to examine the following questions: (1) Are there racial disparities in mental health service utilization among low-income parents? (2) Does Head Start have an impact on mental health service utilization across white, African American, and Hispanic parents? The present research found that, compared to white parents, African American and Hispanic parents are significantly less likely to utilize mental health services. Head Start impact was found for white parents but not for African American and Hispanic parents. Furthermore, parents who spoke a language other than English had higher household risk factors, and reside in rural areas are less likely to utilize mental health services. Mental health providers should deliver patient-centered services that consider cultural and linguistic competency as well as the personal life context of their patients to remove any barriers to accessing mental health services.
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Affiliation(s)
- Kyunghee Lee
- School of Social Work, Michigan State University, 226 Baker Hall, East Lansing, MI, 48824, USA.
| | - Kerri Hough
- School of Social Work, Michigan State University, 226 Baker Hall, East Lansing, MI, 48824, USA
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21
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Minshall D, Tracy DK, Tarn M, Greenberg N. Mental health at work: societal, economic and health imperatives align; it's time to act. Br J Psychiatry 2024; 224:115-116. [PMID: 38470301 DOI: 10.1192/bjp.2024.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
The enormous impact of mental illness on work and productivity is a global challenge, with immense costs to wider society. Now is the time for action, with new international guidelines and an emergent consensus on occupational mental healthcare. Alongside governments, organisations and employers, psychiatrists have a leading role to play.
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Affiliation(s)
- Darren Minshall
- UK Defence Medical Services, Department of Community Mental Health, HM Naval Base Devonport, Plymouth, UK
| | - Derek K Tracy
- West London NHS Trust, London, UK; and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Tarn
- Occupational Psychiatry, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Neil Greenberg
- Department of Psychological Medicine, King's College London, London, UK
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22
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Agudelo-Hernández F, Toro GIS, Plata-Casas LI. Human rights and support groups to improve quality of life, self-care and disability in epilepsy: [Rights and support groups for epilepsy]. Seizure 2024; 117:229-234. [PMID: 38507937 DOI: 10.1016/j.seizure.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND People with epilepsy have multiple barriers to recovering their quality of life. The objective of the present study was to determine the impact of a community group intervention focused on the components of mutual aid and human rights, to improve the quality of life in people with epilepsy. METHODS Prospective quasi-experimental study, incorporating pre- and post-intervention evaluations. There were 102 people who underwent an intervention focused on the central components of mutual aid groups (Active agency, Coping strategies, Emotion recognition and management, Problem solving, Supportive interaction, Identity construction, Trust, and Social networks) and in the QualityRights strategy. As evaluation instruments, scales were used to determine quality of life (QOLIE-10), treatment adherence (Morisky Test), self-care behaviors, perception of disability and quality in the provision of health services. RESULTS Correlations were shown between the variables proposed for quality of life. The intervention showed an improvement in all variables and a moderate to large effect in the self-care domain. There was a significant effect size in the self-care and quality of life variables with the intervention. Pharmacological adherence showed a moderate effect size in young people, adults and older adults. Regarding the perception of disability, the effect size was found only in adults. The pharmacological adherence variable also had a moderate effect size. This does specify the age groups, but not in the general sample. CONCLUSION Seizure-free time constitutes a fundamental element in recovery. However, psychosocial conditions constitute key elements to achieve a better quality of life in people with epilepsy.
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23
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Williams R, Ostinelli EG, Agorinya J, Minichino A, De Crescenzo F, Maughan D, Puntis S, Cliffe C, Kurtulmus A, Lennox BR, Cipriani A. Comparing interventions for early psychosis: a systematic review and component network meta-analysis. EClinicalMedicine 2024; 70:102537. [PMID: 38516103 PMCID: PMC10955207 DOI: 10.1016/j.eclinm.2024.102537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Background 'Early Intervention in Psychosis' (EIP) services have been associated with improved outcomes for early psychosis. However, these services are heterogeneous and many provide different components of treatment. The impact of this variation on the sustained treatment effects is unknown. Methods We performed a systematic review and component network meta-analysis (cNMA) of randomised controlled trials (RCTs) that compared specialised intervention services for early psychosis. We searched CENTRAL (published and unpublished), EMBASE, MEDLINE, CINAHL, PsycINFO and Web of Science from inception to February 2023. Primary outcomes were negative and positive psychotic symptoms at 3-month and 1-year follow-up and treatment dropouts. Secondary outcomes were depressive symptoms and social functioning at 1-year follow-up. We registered a protocol for our study in PROSPERO (CRD42017057420). Findings We identified 37 RCTs including 4599 participants. Participants' mean age was 25.8 years (SD 6.0) and 64.0% were men. We found evidence that psychological interventions (this component grouped all psychological treatment intended to treat, or ameliorate the consequences of, psychotic symptoms) are beneficial for reducing negative symptoms (iSMD -0.24, 95% CI -0.44 to -0.05, p = 0.014) at 3-month follow-up and may be associated with clinically relevant benefits in improving social functioning scores at 1-year follow-up (iSMD -0.52, 95% CI -1.05 to 0.01, p = 0.052). The addition of case management has a beneficial effect on reducing negative symptoms (iSMD -1.17, 95% CI -2.24 to -0.11, p = 0.030) and positive symptoms (iSMD -1.05, 95% CI -2.02 to -0.08, p = 0.033) at 1-year follow-up. Pharmacotherapy was present in all trial arms, meaning it was not possible to examine the specific effects of this component. Interpretation Our findings suggest psychological interventions and case management in addition to pharmacotherapy as the core components of services for early psychosis to achieve sustained clinical benefits. Our conclusions are limited by the small number of studies and sparsely connected networks. Funding National Institute for Health and Care Research.
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Affiliation(s)
- Ryan Williams
- Department of Brain Sciences, Imperial College London, London, UK
- South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Edoardo G. Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | | | - Amedeo Minichino
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Franco De Crescenzo
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Daniel Maughan
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Stephen Puntis
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Charlotte Cliffe
- Biomedical Research Centre, Kings College London, London, UK
- Surrey and Borders Partnership NHS Foundation Trust, UK
| | - Ayse Kurtulmus
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Department of Psychiatry, Istanbul Medeniyet University, Istanbul, Turkey
| | - Belinda R. Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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24
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Zarzar TR, Rosen DL, Ashkin EA. Supporting People With Serious Mental Illness After Prison Release: The FIT Wellness Model. Psychiatr Serv 2024; 75:395. [PMID: 38204367 DOI: 10.1176/appi.ps.20230513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Affiliation(s)
- Theodore R Zarzar
- Departments of Psychiatry (Zarzar), Medicine (Rosen), and Family Medicine (Ashkin), University of North Carolina School of Medicine, Chapel Hill
| | - David L Rosen
- Departments of Psychiatry (Zarzar), Medicine (Rosen), and Family Medicine (Ashkin), University of North Carolina School of Medicine, Chapel Hill
| | - Evan A Ashkin
- Departments of Psychiatry (Zarzar), Medicine (Rosen), and Family Medicine (Ashkin), University of North Carolina School of Medicine, Chapel Hill
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25
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Misiak B, Frydecka D. Psychotic-like experiences predict the perceived intent to seek treatment: A network perspective. Schizophr Res 2024; 266:100-106. [PMID: 38387252 DOI: 10.1016/j.schres.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/17/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024]
Abstract
We aimed to investigate as to whether psychotic-like experiences (PLEs) predict the perceived intent to seek treatment. Our secondary aim was to explore which PLEs predict the perceived need to seek treatment using a network analysis. The study was based on a community sample of individuals with a negative history of psychiatric treatment. At baseline, they completed questionnaires recording the presence of PLEs, depressive, and anxiety symptoms. After 6-7 months, they were reassessed with respect to the perceived intent to seek treatment. A total of 1100 individuals were assessed at baseline (aged 27.1 ± 5.1 years, 48.6 % males). The follow-up assessment was completed by 581 individuals (52.8 %). Higher baseline levels of PLEs were associated with a greater intent to seek treatment at the follow-up before (Beta = 0.289, p < 0.001) and after adjustment for sociodemographic characteristics, depressive and anxiety symptoms (Beta = 0.128, p = 0.004). A network analysis demonstrated that the intent to seek treatment was connected to five nodes of PLEs including "déjà vu experiences" (weight = 0.046), "problems in differentiating reality and imagination" (weight = 0.103), "a lack of control over own ideas or thoughts" (weight = 0.077), "being distracted by distant sounds" (weight = 0.105), and "paranoid thoughts" (weight = 0.145). Findings from the present study indicate that PLEs might contribute to help-seeking behaviors regardless of co-occurring depressive and anxiety symptoms. However, specific PLEs may differ with respect to their effects on the perceived intent to seek treatment.
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
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26
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Sultana T. Intersectional Effect of Gender, Race, and Socioeconomic Status in Mental Health Service Utilization: Evidence from the Canadian Community Health Survey 2015-2016. Community Ment Health J 2024; 60:589-599. [PMID: 38041771 DOI: 10.1007/s10597-023-01213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/15/2023] [Indexed: 12/03/2023]
Abstract
This study examined the intersectional effects of gender, race, and socioeconomic status (SES) on mental health service utilization (MHSU) employing the intersectionality framework. Data was extracted from Canadian Community Health Survey 2015-2016 with a total of 85,619 sample. Covariate adjusted prevalence ratio (aPR) and the predicted probability of MHSU from intersectional analyses were estimated using Poisson regression with robust variance. The prevalence of MHSU was 15.04% overall, 19.61% among women, 10.27% among men, 21.56% among white women and 11.12% among white men. The study observed overall significant intersectional effect of SES by gender and race on MHSU. For instance, white men with the lowest income were more likely to have MHSU compared to their counterparts. Similarly, the predicted probability of MHSU decreased with the increase of SES that varied by gender and race. Two-way and three-way interactions also confirmed statistical significance (p-interaction < 0.05) of intersectional effect of gender, race, and SES. The observed socioeconomic differences in MHSU across gender and racial groups can be explained by intersectionality.
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Affiliation(s)
- Toufica Sultana
- General Education Cell, Eastern University, Dhaka, Bangladesh.
- South Asian Institute for Social Transformation (SAIST), Dhaka, Bangladesh.
- Department of Sociology, University of Saskatchewan, Saskatoon, Canada.
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27
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Barber J, Childs AW, Resnick S, Connors EH. Leveraging Measurement-Based Care to Reduce Mental Health Treatment Disparities for Populations of Color. Adm Policy Ment Health 2024:10.1007/s10488-024-01364-4. [PMID: 38489017 DOI: 10.1007/s10488-024-01364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 03/17/2024]
Abstract
Disparities in mental health treatment have consistently been documented for clients of color as compared to White clients. Most mental health care disparities literature focuses on access to care at the point of initial engagement to treatment, resulting in a dearth of viable solutions being explored to retain clients in care once they begin. Measurement-based care (MBC) is a person-centered practice that has been shown to improve the therapeutic relationship, make treatment more personalized, and empower the client to have an active role in their care. Problems with therapeutic alliance and treatment relevance are associated with early termination for communities of color in mental health services. However, MBC has not been explored as a clinical practice to address therapeutic alliance and continual engagement for people of color seeking mental health care. This Point of View describes several MBC features that may be able to impact current sources of disparity in mental health treatment quality and provides a rationale for each. Our hope is that the field of MBC and progress feedback will more explicitly consider the potential of MBC practices to promote equity and parity in mental health services of color and will start to explore these associations empirically. We also discuss whether MBC should be culturally adapted to optimize its relevance and effectiveness for communities of color and other groups experiencing marginalization. We propose that MBC has promise to promote equitable mental health service quality and outcomes for communities of color.
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Affiliation(s)
- Jessica Barber
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Department of Veterans Affairs, Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT, USA.
| | - Amber W Childs
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Sandra Resnick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs, Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT, USA
| | - Elizabeth H Connors
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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28
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Alzubaidi H, Saidawi W, Goldstone L, Saddik B, Abduelkarem AR, Abu-Gharbieh E, Alzoubi KH, Samorinha C. A roadmap beyond dispensing for educating and training community pharmacists on key mental health competencies: A mixed-methods national study. Res Social Adm Pharm 2024:S1551-7411(24)00087-1. [PMID: 38503576 DOI: 10.1016/j.sapharm.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Including pharmacists in collaborative mental healthcare models has yielded positive results. Establishing processes to enhance pharmacists' mental health care capabilities is crucial for addressing the increasing burden and improving access to mental health services. OBJECTIVES This study evaluated community pharmacists' mental health competencies and analyzed associated factors using a rigorous international framework. Additionally, it sought to identify pharmacists' training needs and support requirements as the first stop in creating a roadmap for enhancing mental healthcare through community pharmacies. METHODS A large-scale national study employing a mixed-methods approach was conducted with community pharmacists in United Arab Emirates. Semi-structured individual interviews and a cross-sectional survey were conducted. Pharmacists' core competencies were assessed using the Core Mental Health Competencies Framework for all Pharmacy Professionals. Generalized linear models were utilized to identify predictors of pharmacists' competency levels. Thematic analysis was used to analyze qualitative data. RESULTS In total 650 community pharmacists completed the survey (93.7% response rate). Eight pharmacists participated in semi-structured interviews. Nearly two-thirds (63.7%) received general communication skills training, while training in motivational interviewing (44.7%), shared decision-making (37.2%), and mental illness stereotyping/stigma (23.9%) were less common. Pharmacists reported lower perceived competence in their relationship with multidisciplinary teams (M = 3.02, SD = 0.89), stigma recognition (M = 3.02, SD = 1.04), and identifying mental health crises and aiding in the person's safety (M = 3.01, SD = 1.05). Poor communication skills (p < 0.001) and working in pharmacies that do not stock psychotropic medications (p = 0.023) were associated with lower perceived competence. Qualitative analysis identified training needs in various domains, including attitudes, values, and beliefs about mental health; relationships with multidisciplinary teams; communication skills; pharmaceutical knowledge; and personal and service development. CONCLUSIONS Mental health-related training is needed for community pharmacists. Addressing these needs through an intentional roadmap approach will enable pharmacists to better engage with patients with mental illness and increase access to care.
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Affiliation(s)
- Hamzah Alzubaidi
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, University City Road, University City, PO Box, 27272, Sharjah, United Arab Emirates; Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates, University City, PO Box, 27272, Sharjah, United Arab Emirates; School of Medicine, Deakin Rural Health, Deakin University Faculty of Health, Warrnambool, Victoria 3216, Australia.
| | - Ward Saidawi
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates, University City, PO Box, 27272, Sharjah, United Arab Emirates.
| | - Lisa Goldstone
- USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, United States.
| | - Basema Saddik
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates, University City, PO Box, 27272, Sharjah, United Arab Emirates; Department of Family and Community Medicine & Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates; School of Population Health, Faculty of Medicine and Health, UNSW Australia, Australia.
| | - Abduelmula R Abduelkarem
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, University City Road, University City, PO Box, 27272, Sharjah, United Arab Emirates; Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates, University City, PO Box, 27272, Sharjah, United Arab Emirates.
| | - Eman Abu-Gharbieh
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates, University City, PO Box, 27272, Sharjah, United Arab Emirates; Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, University City Road, University City, PO Box, 27272, Sharjah, United Arab Emirates; Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates, University City, PO Box, 27272, Sharjah, United Arab Emirates.
| | - Catarina Samorinha
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates, University City, PO Box, 27272, Sharjah, United Arab Emirates.
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29
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Pierotti L, Cooper J, James C, Cassels K, Gara E, Denholm R, Wood R. Can computer simulation support strategic service planning? Modelling a large integrated mental health system on recovery from COVID-19. Int J Ment Health Syst 2024; 18:12. [PMID: 38448987 PMCID: PMC10918932 DOI: 10.1186/s13033-024-00623-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND COVID-19 has had a significant impact on people's mental health and mental health services. During the first year of the pandemic, existing demand was not fully met while new demand was generated, resulting in large numbers of people requiring support. To support mental health services to recover without being overwhelmed, it was important to know where services will experience increased pressure, and what strategies could be implemented to mitigate this. METHODS We implemented a computer simulation model of patient flow through an integrated mental health service in Southwest England covering General Practice (GP), community-based 'talking therapies' (IAPT), acute hospital care, and specialist care settings. The model was calibrated on data from 1 April 2019 to 1 April 2021. Model parameters included patient demand, service-level length of stay, and probabilities of transitioning to other care settings. We used the model to compare 'do nothing' (baseline) scenarios to 'what if' (mitigation) scenarios, including increasing capacity and reducing length of stay, for two future demand trajectories from 1 April 2021 onwards. RESULTS The results from the simulation model suggest that, without mitigation, the impact of COVID-19 will be an increase in pressure on GP and specialist community based services by 50% and 50-100% respectively. Simulating the impact of possible mitigation strategies, results show that increasing capacity in lower-acuity services, such as GP, causes a shift in demand to other parts of the mental health system while decreasing length of stay in higher acuity services is insufficient to mitigate the impact of increased demand. CONCLUSION In capturing the interrelation of patient flow related dynamics between various mental health care settings, we demonstrate the value of computer simulation for assessing the impact of interventions on system flow.
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Affiliation(s)
- Livia Pierotti
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK.
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
| | - Jennifer Cooper
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Charlotte James
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
- Bristol, North Somerset and South Gloucestershire Integrated Care Board, UK National Health Service, Bristol, UK
| | - Kenah Cassels
- Bristol, North Somerset and South Gloucestershire Integrated Care Board, UK National Health Service, Bristol, UK
| | - Emma Gara
- Bristol, North Somerset and South Gloucestershire Integrated Care Board, UK National Health Service, Bristol, UK
| | - Rachel Denholm
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
- HDR UK Southwest, Bristol, UK
| | - Richard Wood
- Bristol, North Somerset and South Gloucestershire Integrated Care Board, UK National Health Service, Bristol, UK
- HDR UK Southwest, Bristol, UK
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30
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Ragnhildstveit A, Tuteja N, Seli P, Smart L, Uzun N, Bass LC, Miranda AC, Ford TJ, Neufeld SAS. Transitions from child and adolescent to adult mental health services for eating disorders: an in-depth systematic review and development of a transition framework. J Eat Disord 2024; 12:36. [PMID: 38454528 PMCID: PMC10921655 DOI: 10.1186/s40337-024-00984-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Eating disorders (EDs) peak in mid-to-late adolescence and often persist into adulthood. Given their early onset and chronicity, many patients transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) for ongoing, speciality ED care. This transition typically occurs at 18 years of age, when important biological, psychosocial, and vocational changes take place. Thus, smooth and effective transitions are paramount for ensuring service continuity, as well as reducing the risk of ED relapse and premature death. Here, we synthesized evidence on transitions from CAMHS to AMHS for young people with EDs, aiming to inform future research, clinical practice, and healthcare policy. METHODS A systematic review of the literature was conducted. This adhered to PRISMA guidelines. PubMed, Embase, and Scopus electronic databases were queried from inception to December 3, 2023. Leveraging the PICOS framework, study eligibility was evaluated in the qualitative synthesis. Data regarding methodology, analytic approach, and associated outcomes were then extracted. The quality of evidence was examined using critical appraisal tools. Finally, concept mapping was applied to organize findings into a transition framework. RESULTS The search returned 76 articles. Of these, 14 were included in the final review. Articles were grouped into 'qualitative' (n = 10), 'cross-sectional' (n = 2), and 'longitudinal cohort' (n = 2) studies based on research design. Overall, ED transitions were complex, multifaceted, and challenging for patients, caregivers, and providers alike. This resulted from an interplay of temporal- (e.g., timing of ED onset and transition), stakeholder- (e.g., patient ambivalence towards recovery) and systemic- (e.g., differences between services) related factors. Most studies were of moderate-to-high quality. Findings informed the development of five transition strategies designed to facilitate effective transfers across ED care: Timely talks, Readiness, Inclusion, Preparation, and Synergy (TRIPS). CONCLUSIONS Transitions from CAMHS to AMHS appear problematic for young people with EDs and other involved stakeholders. The field stands to benefit from TRIPS, an actionable, evidence-based framework that aims to alleviate challenges of transitioning and subsequently improve ED trajectories. As a logical next step, future work should empirically test the TRIPS framework, exploring its predictive utility and clinical value.
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Affiliation(s)
| | - Nandita Tuteja
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Paul Seli
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Leo Smart
- Neuroscience Program, Bates College, Lewiston, ME, USA
| | - Naz Uzun
- Department of Psychology, University of Manchester, Manchester, England, UK
| | - Lisa C Bass
- Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alyssa C Miranda
- Consciousness and Transformative Studies, National University, San Diego, CA, USA
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge, England, UK
| | - Sharon A S Neufeld
- Department of Psychiatry, University of Cambridge, Cambridge, England, UK
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Harris MG, Kazdin AE, Munthali RJ, Vigo DV, Stein DJ, Viana MC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade LH, Bunting B, Chardoul S, Gureje O, Hu C, Hwang I, Karam EG, Navarro-Mateu F, Nishi D, Orozco R, Sampson NA, Scott KM, Vladescu C, Wojtyniak B, Xavier M, Zarkov Z, Kessler RC. Factors associated with satisfaction and perceived helpfulness of mental healthcare: a World Mental Health Surveys report. Int J Ment Health Syst 2024; 18:11. [PMID: 38429785 PMCID: PMC10908125 DOI: 10.1186/s13033-024-00629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Mental health service providers are increasingly interested in patient perspectives. We examined rates and predictors of patient-reported satisfaction and perceived helpfulness in a cross-national general population survey of adults with 12-month DSM-IV disorders who saw a provider for help with their mental health. METHODS Data were obtained from epidemiological surveys in the World Mental Health Survey Initiative. Respondents were asked about satisfaction with treatments received from up to 11 different types of providers (very satisfied, satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, very dissatisfied) and helpfulness of the provider (a lot, some, a little, not at all). We modelled predictors of satisfaction and helpfulness using a dataset of patient-provider observations (n = 5,248). RESULTS Most treatment was provided by general medical providers (37.4%), psychiatrists (18.4%) and psychologists (12.7%). Most patients were satisfied or very satisfied (65.9-87.5%, across provider) and helped a lot or some (64.4-90.3%). Spiritual advisors and healers were most often rated satisfactory and helpful. Social workers in human services settings were rated lowest on both dimensions. Patients also reported comparatively low satisfaction with general medical doctors and psychiatrists/psychologists and found general medical doctors less helpful than other providers. Men and students reported lower levels of satisfaction than women and nonstudents. Respondents with high education reported higher satisfaction and helpfulness than those with lower education. Type of mental disorder was unrelated to satisfaction but in some cases (depression, bipolar spectrum disorder, social phobia) was associated with low perceived helpfulness. Insurance was unrelated to either satisfaction or perceived helpfulness but in some cases was associated with elevated perceived helpfulness for a given level of satisfaction. CONCLUSIONS Satisfaction with and perceived helpfulness of treatment varied as a function of type of provider, service setting, mental status, and socio-demographic variables. Invariably, caution is needed in combining data from multiple countries where there are cultural and service delivery variations. Even so, our findings underscore the utility of patient perspectives in treatment evaluation and may also be relevant in efforts to match patients to treatments.
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Affiliation(s)
- Meredith G Harris
- School of Public Health, The University of Queensland, c/o QCMHR, Locked Bag 500, Archerfield, QLD, 4108, Australia.
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wolston Park Rd, Wacol, QLD, 4076, Australia.
| | - Alan E Kazdin
- Department of Psychology, Yale University, 2 Hillhouse Avenue- 208205, New Haven, CT, 06520, USA
| | - Richard J Munthali
- Department of Psychiatry, University of British Columbia, UBC Hospital - Detwiller Pavilion, Room 2813, 2255 Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, V6T 2A1, Canada
| | - Daniel V Vigo
- Department of Psychiatry, University of British Columbia, UBC Hospital - Detwiller Pavilion, Room 2813, 2255 Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, V6T 2A1, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Dan J Stein
- Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Rondebosch, Cape Town, ZA, 7925, South Africa
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Espirito Santo - ES, Rua Dr. Euríco de Águiar, 888/705, Vitoria, Espirito Santo - ES, 2905-600, Brazil
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, 2921 Stockton Blvd., Suite 1408, Sacramento, CA, 95817, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, P.O.Box 88, Al-Diwaniyah, Al-Qadisiyah, Iraq
| | - Jordi Alonso
- IMIM-Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
- Pompeu Fabra University (UPF), Plaça de la Mercè, 10-12, Barcelona, 08002, Spain
| | - Laura Helena Andrade
- University of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica - LIM 23, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, CEP 05403-010, Brazil
| | - Brendan Bunting
- School of Psychology, Ulster University, College Avenue, Londonderry, BT48 7JL, UK
| | - Stephanie Chardoul
- Survey Research Center, Institute for Social Research, University of Michigan, 330 Packard, Room G358, Ann Arbor, MI, 48104, USA
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, PMB, 5116, Nigeria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, 518020, China
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Elie G Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Ashrafieh, 166378, Lebanon
- Faculty of Medicine, Balamand University, Rond Point Saloumeh, Sin el Fil, Beirut, Lebanon
| | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigacion y Formación en Salud Mental, Servicio Murciano de Salud, Murcia Health Service, C/ Lorca, nº 58. -El Palmar, Murcia, 30120, Spain
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, El Palmar, Murcia, 30120, Spain
- Centro de Investigación Biomédica en Red en Epidemíologia y Salud Pública, El Palmar, Murcia, 30120, Spain
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ricardo Orozco
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Calz. Mexico-Xochimilco 101, San Lorenzo Huipulco, Ciudad de México, 14370, Mexico
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand
| | - Cristian Vladescu
- National Institute for Health Services Management, 31 Vaselor Str, Bucharest, 21253, Romania
- University Titu Maiorescu, Dâmbovnicului no. 22, Bucharest, Romania
| | - Bogdan Wojtyniak
- National Institute of Public Health, National Research Institute, 24 Chocimska St, Warsaw, 00-791, Poland
| | - Miguel Xavier
- Faculdade Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, Lisbon, 1169-056, Portugal
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, 15, Acad. Ivan Geshov Blvd, Sofia, 1431, Bulgaria
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
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Bauer A, Gregoire A, Tinelli M, Knapp M. Costs and benefits of scaling psychosocial interventions during the perinatal period in England: A simulation modelling study. Int J Nurs Stud 2024; 154:104733. [PMID: 38493516 DOI: 10.1016/j.ijnurstu.2024.104733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Globally, guidance recommends the integration of mental health into maternal and child healthcare to address common maternal mental health problems during the perinatal period. However, implementing this in the real-world requires substantial resource allocations. OBJECTIVE The aim of this study was to estimate the likely costs and consequences linked to scaling the delivery of treatment (in the form of psychosocial interventions) during the perinatal period. DESIGN Simulation modelling. SETTING(S) England. METHODS Costs and consequences were modelled for three scenarios of assumed provision of services, whereby one referred to the projected provision under current government plans, with no additional scaling up of treatment. The other two scenarios referred to additional scaling of treatment: in one scenario, this referred to the provision of treatment by midwives and health visitors trained in the routine enquiry about mental health and delivery of psychosocial interventions; in the other scenario this referred to an expanded provision by primary mental health services. For each scenario and in yearly intervals (covering a ten-year period, 2015 to 2024), unit cots and outcomes were assigned to the activities women were assumed to receive (routine enquiry, assessment, treatment, care coordination). All costs were in 2020 pounds sterling. Data sources for the modelling included: published findings from randomised controlled trials; national unit cost source; national statistics; and expert consultation. RESULTS If the projected treatment gap was to be addressed, an estimated additional 111,154 (50,031) women would be accessing treatment in 2015 (2024). Estimated total costs (including cost offsets) in the scenario of projected provision under current government plans would be £73.5 million in 2015 and £95.2 million in 2024, whilst quality-adjusted life years gained would be 901 and 928 respectively. Addressing the treatment gap through provision by trained midwives and health visitors could mean additional costs of £7.3 million in 2015 but lower costs of £18.4 million in 2024. The additional quality-adjusted life years gained are estimated at 2096 in 2015 and 1418 in 2024. A scenario in which the treatment gap would be met by primary mental health services was likely to be more costly and delivered less health gains. CONCLUSIONS Findings from this modelling study suggest that scaling the integration of mental health care into routinely delivered care for women during the perinatal period might be economically viable. REGISTRATION N/A. TWEETABLE ABSTRACT Integrating mental health into maternal and child healthcare might generate economic benefits new study by @a_annettemaria and @knappem @CPEC_LSE finds #increasing access to treatment for women with perinatal mental health problems.
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Affiliation(s)
- Annette Bauer
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, United Kingdom.
| | | | - Michela Tinelli
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, United Kingdom. https://twitter.com/CPEC_LSE
| | - Martin Knapp
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, United Kingdom. https://twitter.com/knappem
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Green HD, Pescosolido BA. Social pathways to care: how community-based network ties shape the health care response of individuals with mental health problems. Soc Psychiatry Psychiatr Epidemiol 2024; 59:431-442. [PMID: 37072564 PMCID: PMC10113125 DOI: 10.1007/s00127-023-02476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/30/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Mental health research has powerfully documented inequities related to characteristics, such as ethnicity and gender. Yet how and where disparities like unmet need occur have been more elusive. Drawing from a now modest body of research that deployed the Network Episode Model (NEM), we examine how individuals create patterns of response to mental health problems, influenced by the culture and resources embedded in their social networks. METHODS The Person-to-Person Health Interview Study (P2P; N ~ 2,700, 2018-2021) provides representative, community-based, NEM-tailored data. Both descriptive, latent class and multinomial regression analyses mark mental health care-seeking patterns, including individuals consulted and activities used, as well as the influence of the structure and cultural content of social networks. RESULTS Latent class analysis detected five pathways with good fit statistics. The Networked General Care Path (37.0%) and The Kin General Care Path (14.5%) differ only in whether friends are activated in using the general care sector. The Networked Multi-Sector Care Path (32.5%) and The Saturated Path (12.6%) involve family, friends, and both general and specialty care with only the latter expanding consultation to coworkers and clergy. The Null Path (3.3%), or no contacts, is not used as perceived problem severity increases. Network size and strength are associated with the more complex pathways that activate ties, respectively. Trust in doctors is associated with pathways that include specialty providers but not others at work or church. Race, age, and rural residence have specific pathway effects, while gender has no significant impact. CONCLUSIONS Social networks propel individuals with mental health problems into action. Tie strength and trust produce care responses that are fuller and more targeted. Considering the nature of homophily, results also suggest that majority status and college education are clearly implicated in networked pathways. Overall, findings support community-targeted rather than individually based efforts to increase service use.
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Affiliation(s)
- Harold D Green
- Department of Applied Health Science, School of Public Health and the Irsay Institute, Indiana University, Bloomington, IN, USA.
| | - Bernice A Pescosolido
- Department of Sociology, College of Arts & Sciences and the Irsay Institute, Indiana University, Bloomington, IN, USA
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Halladay J, Georgiades K, MacKillop J, Lipman E, Pires P, Duncan L. Identifying patterns of substance use and mental health concerns among adolescents in an outpatient mental health program using latent profile analysis. Eur Child Adolesc Psychiatry 2024; 33:739-747. [PMID: 36947251 PMCID: PMC10031175 DOI: 10.1007/s00787-023-02188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
Though mental health and substance use concerns often co-occur, few studies have characterized patterns of co-occurrence among adolescents in clinical settings. The current investigation identifies and characterizes these patterns among adolescents presenting to an outpatient mental health service in Ontario, Canada. Data come from cross-sectional standardized patient intake assessments from 916 adolescents attending an outpatient mental health program (January 2019-March 2021). Latent profile analysis identified patterns of substance use (alcohol, cannabis, (e-) cigarettes) and emotional and behavioral disorder symptoms. Sociodemographic and clinical correlates of these patterns were examined using multinomial regression. Three profiles were identified including: 1) low substance use and lower frequency and/or severity (relative to other patients in the sample) emotional and behavioral disorder symptoms (26.2%), 2) low substance use with higher emotional and behavioral disorder symptoms (48.2%), and 3) high in both (25.6%). Profiles differed in sociodemographic and clinical indicators related to age, gender, trauma, harm to self, harm to others, and service use. Experiences of trauma, suicide attempts, and thoughts of hurting others increased the odds of adolescents being in the profile high in both substance use and symptoms compared to other profiles. These findings further document the high rates of substance use in adolescents in mental health treatment and the profiles generally map onto three out of four quadrants in the adapted four-quadrant model of concurrent disorders, indicating the importance of assessing and addressing substance use in these settings.
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Affiliation(s)
- Jillian Halladay
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia.
- The Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5Th St, Hamilton, ON, L8N 3K7, Canada.
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - James MacKillop
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- The Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5Th St, Hamilton, ON, L8N 3K7, Canada
| | - Ellen Lipman
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Paulo Pires
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Laura Duncan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
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Harnett JE, Leach MJ, Karzon R, McIntyre E. Mental Health Literacy and Education of Complementary Medicine Practitioners: A Cross-Sectional Study. Adm Policy Ment Health 2024; 51:217-225. [PMID: 38236455 PMCID: PMC10850010 DOI: 10.1007/s10488-023-01339-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
An estimated 42% of Australians who consult complementary medicine (CM) practitioners have a mental health diagnosis. Preparedness of CM practitioners in managing such diagnoses is currently unknown. A cross-sectional survey of 257 CM practitioners who reported caring for people with a mental health diagnosis. Practitioners' mental health literacy, educational needs, and confidence in the assessment, management, and treatment of mental health-including suicide risk-were analysed. Most (59.1%) participants had no formal qualifications in mental health and 44.3% indicated they had not completed any training in psychological therapies. Only 20% were trained in mindfulness-based techniques or goal setting. Over 50% reported their undergraduate qualification contained insufficient mental health content to prepare them for clinical practice. Over one-half had attended continuing professional education on mental health. Practitioners reported greater confidence in assessing, managing, and treating mental wellbeing over complex mental health disorders and suicide risk. These findings uncovered a deficit in the CM practitioner's surveyed mental health education. As these CM practitioners are a primary point of contact for patients with mental health diagnoses, there is a critical need to expedite skills development in this workforce to support the delivery of safe and effective primary mental health care.
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Affiliation(s)
- Joanna E Harnett
- Faculty of Medicine and Health School of Pharmacy, The University of Sydney, Building A15, Science Rd, Camperdown, NSW, 2006, Australia.
| | - Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Rifle Range Rd, Lismore, NSW, 2054, Australia
| | - Randa Karzon
- Endeavour College of Natural Health, Fortitude Valley, QLD, 4006, Australia
| | - Erica McIntyre
- Institute for Sustainable Futures, University of Technology Sydney, Sydney, NSW, Australia
- Research Institute for Innovative Solutions for Wellbeing and Health, Faculty of Health, University of Technology Sydney, Box 123, Broadway, NSW, 2007, Australia
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Deahl M. General psychiatry, still in no-man's land after all these years. Br J Psychiatry 2024; 224:86-88. [PMID: 38018821 DOI: 10.1192/bjp.2023.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Mental health services have changed beyond recognition in my 38-year career. In this editorial I reflect on those changes and highlight the issues that undermine patient care and damage staff morale. In particular, modern mental health services have undermined the therapeutic relationship, the bedrock underpinning all psychiatric treatment.
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Affiliation(s)
- Martin Deahl
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Isaacs AN, Mitchell EKL. Mental health integrated care models in primary care and factors that contribute to their effective implementation: a scoping review. Int J Ment Health Syst 2024; 18:5. [PMID: 38331913 PMCID: PMC10854062 DOI: 10.1186/s13033-024-00625-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND In the state of Victoria, Australia, the 111-day lockdown due to the COVID-19 pandemic exacerbated the population's prevailing state of poor mental health. Of the 87% of Australians who visit their GP annually, 71% of health problems they discussed related to psychological issues. This review had two objectives: (1) To describe models of mental health integrated care within primary care settings that demonstrated improved mental health outcomes that were transferable to Australian settings, and (2) To outline the factors that contributed to the effective implementation of these models into routine practice. METHODS A scoping review was undertaken to synthesise the evidence in order to inform practice, policymaking, and research. Data were obtained from PubMed, CINAHL and APA PsycINFO. RESULTS Key elements of effective mental health integrated care models in primary care are: Co-location of mental health and substance abuse services in the primary care setting, presence of licensed mental health clinicians, a case management approach to patient care, ongoing depression monitoring for up to 24 months and other miscellaneous elements. Key factors that contributed to the effective implementation of mental health integrated care in routine practice are the willingness to accept and promote system change, integrated physical and mental clinical records, the presence of a care manager, adequate staff training, a healthy organisational culture, regular supervision and support, a standardised workflow plan and care pathways that included clear role boundaries and the use of outcome measures. The need to develop sustainable funding mechanisms has also been emphasized. CONCLUSION Integrated mental health care models typically have a co-located mental health clinician who works closely with the GP and the rest of the primary care team. Implementing mental health integrated care models in Australia requires a 'whole of system' change. Lessons learned from the Mental Health Nurse Incentive Program could form the foundation on which this model is implemented in Australia.
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Affiliation(s)
- Anton N Isaacs
- Monash University School of Rural Health, Sargeant Street, PO Box 723, Warragul, VIC, 3820, Australia.
| | - Eleanor K L Mitchell
- Monash University School of Rural Health, Corner of Victoria Street & Day Street, PO Box 1497, Bairnsdale, VIC, 3875, Australia
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Morar T, Breedt JE, Mdaka N, Maaroganye K, Robertson L. Is mental health in South Africa moving forward? BJPsych Int 2024; 21:1-3. [PMID: 38304409 PMCID: PMC10803769 DOI: 10.1192/bji.2023.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/23/2023] [Indexed: 02/03/2024] Open
Abstract
A landmark South African Mental Health Conference took place in April 2023, marking the first national collaborative conference between government and mental health professionals. The theme was Join the Movement, and a 'whole of society' approach was emphasised, imploring various sectors to collaborate in relieving the country's burden of mental illness. Challenges in mental health were raised and possible solutions presented. This article discusses the conference, aspects of psychiatric care in South Africa, South Africa's health system issues and the importance of moving forward measurably.
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Affiliation(s)
- Tejil Morar
- Psychiatrist, Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jozef Erasmus Breedt
- Psychiatric Registrar, Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nokuthula Mdaka
- Psychiatrist, Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kagisho Maaroganye
- Psychiatrist, Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lesley Robertson
- Psychiatrist, Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hurtado SLB, Gardona N, de Almeida IM, Querol MAP. Change Laboratory intervention for promoting learning about causes and prevention of workplace aggressions in a mental health facility. Nurse Educ Pract 2024; 75:103878. [PMID: 38277801 DOI: 10.1016/j.nepr.2024.103878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/13/2023] [Accepted: 01/01/2024] [Indexed: 01/28/2024]
Abstract
AIM To assess a Change Laboratory (CL) intervention concerning the promotion of learning about the causes and prevention of workplace aggression in a Healthcare Service for Drug and Alcohol Users. BACKGROUND It is estimated that one fourth of all healthcare professionals worldwide have already experienced some kind of workplace violence. In mental health facilities, aggressions have multiple origins, including moments when physical restraint is applied or situations when the patients' demands are not met. This problem is aggravated in facilities known for their practice of imposing disciplinary measures. Several studies have shown the need to reduce disciplinary means, as well as the importance of health service teams and user participation in designing strategies to prevent aggression. DESIGN This study employed a qualitative approach with an exploratory and descriptive design. An intervention was conducted in a Healthcare Service for Drug and Alcohol Users, in Brazil. The COREQ guidelines were followed for reporting. METHODS This study is a qualitative analysis of nine sessions of a CL, which was conducted in 2022 with 12 healthcare professionals, mainly women from the nursing staff. RESULTS These workers identified the main causes of aggression after a historical and empirical analysis of the nature of the work performed and the contradictions inherent within it. They also recognized the need for cooperative teams prepared to recognize potentially aggressive situations beforehand. CONCLUSIONS This article brings practical contributions by showing a detailed analysis of how the CL intervention method, using the principle of Transformative Agency Double Stimulation, promotes a sequence of learning actions. The method helped participants to systematically understand the causes of the situations that give rise to workplace violence, examining the goal of the activity as something socially and historically constructed. Likewise, this method helped the professionals to collectively build the key components of a potential prevention program against aggression in the workplace.
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Affiliation(s)
| | - Nataly Gardona
- Botucatu School of Medicine, São Paulo State University, Brazil
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Reich H, Niermann HCM, Voss C, Venz J, Pieper L, Beesdo-Baum K. Sociodemographic, psychological, and clinical characteristics associated with health service (non-)use for mental disorders in adolescents and young adults from the general population. Eur Child Adolesc Psychiatry 2024; 33:391-400. [PMID: 36807526 PMCID: PMC10869368 DOI: 10.1007/s00787-023-02146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/19/2023] [Indexed: 02/21/2023]
Abstract
Most adolescents and young adults who experience psychological distress do not seek professional help. This study aims to enhance the understanding of sociodemographic, psychological, and clinical characteristics associated with the underuse of health services by adolescents and young adults with mental disorders. Data from a cross-sectional, epidemiological study with a population-based sample (N = 1180 participants, 14-21 years old) were used. Participants completed a fully standardized, computer-assisted diagnostic interview (DIA-X-5/D-CIDI) administered by trained clinical interviewers to assess lifetime mental disorders according to DSM-5 as well as lifetime health service use for mental health problems, and completed self-report questionnaires to assess various psychological variables (e.g., stigma). Predictors of health service use were examined using univariate and multiple logistic regression analyses, data were weighted for age and sex to improve representativeness Of n = 597 participants with any lifetime mental disorder, 32.4% [95% CI 28.4; 36.7] had ever used any health services because of a mental health, psychosomatic, or substance use problem. Even less had received psychotherapeutic or pharmacological treatment (Cognitive Behavioral Therapy: 12.1% [9.5; 15.2]; other psychotherapy: 10.7% [8.4; 13.7]; medication: 5.4% [3.7; 7.8]). High education was associated with less health service use (low/ middle/ other vs. high education: 53.8% vs. 26.9%; OR = 0.26, p < .001). In the multiple regression model, stigma toward mental disorders was the single psychological variable associated with a reduced likelihood of using health services (OR = 0.69 [0.52; 0.90], p < .01). These findings draw attention to the treatment gap for mental disorders during adolescence and highlight related factors to be addressed in public health contexts.
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Affiliation(s)
- H Reich
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Depression Research Centre of the German Depression Foundation, Department for Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Heinrich-Hoffmann-Str. 10, Frankfurt am Main, 60528, Frankfurt, Germany
| | - H C M Niermann
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - C Voss
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - J Venz
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - L Pieper
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - K Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
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Nazari A, Garmaroudi G, Foroushani AR, Askari A. Psychometric assessment of the Persian adaptation of the attitudes toward seeking professional psychological help scale-short form. BMC Psychiatry 2024; 24:75. [PMID: 38279091 PMCID: PMC10811866 DOI: 10.1186/s12888-023-05388-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/20/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND AND PURPOSE Mental health disorders are a growing concern worldwide, with a significant impact on public health. Understanding attitudes toward seeking professional psychological help is essential in addressing these issues. In the Iranian context, there is a need for a reliable tool to measure these attitudes. This study aims to assess the validity and reliability of the Persian Adaptation of the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF). MATERIALS AND METHODS A cross-sectional study was conducted in May 2023, utilizing a convenience sampling method with 1050 participants aged 10 to 65 years in Iran.The ATSPPH-SF questionnaire, consisting of 10 items and 2 subscales, was employed. The questionnaire underwent translation and cultural adaptation, and its validity was assessed through qualitative face and content validities. Confirmatory factor analysis (CFA) was used to evaluate construct validity. Reliability was assessed using McDonald's omega coefficient and Cronbach's alpha coefficient. Data collection was conducted through an online survey. RESULTS The CFA results indicated a two-factor structure for the ATSPPH-SF, with one factor representing openness to seeking treatment for emotional problems and the other factor reflecting the value and need for seeking treatment. The model demonstrated acceptable fit indices. Both McDonald's omega coefficient and Cronbach's alpha coefficient suggested good internal consistency for the scale. The mean total score for the ATSPPH-SF was 21.37 (SD = 5.52), indicating the reliability and validity of the scale for the Iranian population. CONCLUSION This study confirms the suitability of the short-form ATSPPH-SF with 10 items and 2 subscales as a valid and reliable tool for assessing attitudes toward seeking professional psychological help in the Iranian population. With no prior appropriate instrument available, this scale fills a crucial gap. It can be employed to measure attitudes among various demographic groups, aiding in the design of targeted interventions to enhance mental health literacy and reduce the stigma associated with seeking professional psychological help in Iran.
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Affiliation(s)
- Abouzar Nazari
- Department of Health Education and Promotion, Faculty of Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Garmaroudi
- Department of Health Education and Promotion, School of Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Askari
- Department of Psychology, Faculty of Psychology and Educational Sciences, Shahid Beheshti University, Tehran, Iran
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Blom S, Lindh F, Lundin A, Burström B, Hensing G, Löve J. How gender and low mental health literacy are related to unmet need for mental healthcare: a cross-sectional population-based study in Sweden. Arch Public Health 2024; 82:12. [PMID: 38273389 PMCID: PMC10809616 DOI: 10.1186/s13690-023-01228-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/08/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Men are more likely to have unmet need for mental healthcare than women. However, an under-investigated aspect of the gender difference is the role of mental health literacy. This study investigated how combinations of gender and mental health literacy were related to two indicators of unmet need: not perceiving a need for mental healthcare despite poor mental health, and refraining from seeking mental healthcare. METHODS This cross-sectional study was based on a questionnaire sent to a general population sample, aged 16-84 years, in Stockholm County, Sweden, in 2019. Of the 1863 respondents (38%), 1563 were included (≥18 years). The sample was stratified into four groups, men and women with low or high mental health literacy, using the third quartile of the Mental Health Knowledge Schedule. The likelihood of not perceiving a need for mental healthcare and refraining from seeking mental healthcare, at any time in life, were investigated by calculating odds ratios with 95% confidence intervals. RESULTS Men with low mental health literacy were most likely to not perceive a need for mental healthcare, also when adjusting for age, education, and poor mental health (OR 5.3, 95% CI 3.6-7.7), and to refrain from seeking mental healthcare, also when adjusting for age and education (OR 3.3, 95% CI 1.7-6.4), followed by men with high mental health literacy (OR 1.9, 95% CI 1.5-2.4, and OR 1.5, 95% CI 1.0-2.2) and women with low mental health literacy (OR 1.9, 95% CI 1.2-2.9, and OR 2.1, 95% CI 1.1-3.9). Women with high mental health literacy were least likely (reference group). CONCLUSION The results show differences in the likelihood of unmet need for mental healthcare based on combinations of gender and mental health literacy level, with men having low mental health literacy being most at risk, and women with high mental health literacy being least at risk. This challenges generalisations of a gender difference in unmet need by showing heterogeneity among men and women based on mental health literacy. Men with low mental health literacy may be particularly in need of targeted interventions to reduce potential individual and societal consequences of their unmet need.
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Affiliation(s)
- Sara Blom
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden.
| | - Frida Lindh
- Centre for Epidemiology and Community Medicine, Region Stockholm, Solnavägen 1E, 104 31, Stockholm, Sweden
| | - Andreas Lundin
- Centre for Epidemiology and Community Medicine, Region Stockholm, Solnavägen 1E, 104 31, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden
| | - Jesper Löve
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden
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Zhang L, Hou XY, Liu Y. Measuring Mental Health Service Accessibility for Indigenous Populations: a Systematic Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01899-6. [PMID: 38270837 DOI: 10.1007/s40615-023-01899-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024]
Abstract
Indigenous populations have experienced inequality of accessing mental health services compared with their non-Indigenous counterparts, although the way of measuring mental health service accessibility for Indigenous populations is unclear. This systematic review examines measures of mental health service accessibility for Indigenous people, including the diversity of mental health services that are available to them and the barriers to accessing mental healthcare. Using a systematic search procedure, we identified 27 studies that explored Indigenous populations' mental health service access. Our review shows that 18 studies used interview-based methods to explore how Indigenous people use mental health services, and only nine studies used quantitative methods to measure the uptake of mental health services. While advanced methods for quantifying geographical access to healthcare services are widely available, these methods have not been applied in the current literature to explore the potential access to mental health services by Indigenous populations. This is partially due to limited understanding of how Indigenous populations seek mental healthcare, barriers that prevent Indigenous people from accessing diverse types of mental health services, and scarcity of data that are available to researchers. Future research could focus on developing methods to support spatially explicit measuring of accessibility to mental health services for Indigenous populations.
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Affiliation(s)
- Lihong Zhang
- School of the Environment, The University of Queensland, Brisbane, Queensland, Australia
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Yan Liu
- School of the Environment, The University of Queensland, Brisbane, Queensland, Australia.
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Pryjmachuk S, Kirk S, Fraser C, Evans N, Lane R, Crooks J, McGowan R, Naughton G, Neill L, Camacho E, Bower P, Bee P, McDougall T. A collaboratively produced model of service design for children and young people with common mental health problems. BMC Health Serv Res 2024; 24:133. [PMID: 38268003 PMCID: PMC10809440 DOI: 10.1186/s12913-024-10562-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Little is known about the effectiveness of, and implementation complexities associated with, service delivery models for children and young people (CYP) experiencing 'common' mental health problems such as anxiety, depression, behavioural difficulties and self-harm. This paper outlines how a model for high-quality service design for this population group was developed by identifying available services, their effectiveness, cost-effectiveness and acceptability, and the barriers and enablers to access. METHODS Sequential, mixed-methods design, combining evidence syntheses (scoping and integrative reviews of the international literature) with primary research (a collective case study in England and Wales). Data from these two elements were collaboratively synthesised in a subsequent model-building phase. RESULTS The scoping review yielded a service model typology. The integrative review found effectiveness evidence only for four models: collaborative care (the only service model to also have cost-effectiveness evidence), outreach approaches, brief intervention services and an organisational framework called 'Availability, Responsiveness and Continuity'. No service model seemed more acceptable than others. Three case study themes were identified: pathways to support; service engagement; and learning and understanding. The model-building phase identified rapid access, learning self-care skills, individualised support, clear information, compassionate and competent staff and aftercare planning as core characteristics of high-quality services. These characteristics were underpinned by four organisational qualities: values that respect confidentiality; engagement and involvement; collaborative relationships; and a learning culture. CONCLUSIONS A consistent organisational evidence-base for service design and delivery in CYP's mental health spanning many years appears to have had little impact on service provision in England and Wales. Rather than impose - often inflexible and untested - specific local or national models or frameworks, those commissioning, designing and delivering mental health services for CYP should (re)focus on already known, fundamental components necessary for high-quality services. These fundamental components have been integrated into a collaboratively produced general model of service design for CYP with common mental health problems. While this general model is primarily focused on British service provision, it is broad enough to have utility for international audiences.
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Affiliation(s)
- Steven Pryjmachuk
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
- Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| | - Susan Kirk
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Claire Fraser
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Nicola Evans
- School of Healthcare Studies, Cardiff University, Cardiff, UK
| | - Rhiannon Lane
- School of Healthcare Studies, Cardiff University, Cardiff, UK
| | | | | | | | | | | | - Peter Bower
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Penny Bee
- School of Health Sciences, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Tim McDougall
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
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Anderson KK, Rodrigues R, Le B, Mamun M, Archie S, Edwards J, Elton-Marshall T, Gilliland J, Myran DT, Palaniyappan L, Perlman CM, Seabrook JA, Murray RM, Shariff SZ. Impact of non-medical cannabis legalization with market restrictions on health service use and incident cases of psychotic disorder in Ontario, Canada. Int J Drug Policy 2024; 123:104285. [PMID: 38071933 DOI: 10.1016/j.drugpo.2023.104285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/01/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Cannabis is a risk factor in the onset and persistence of psychotic disorders. There is concern that non-medical cannabis legalization in Canada may have population-level impacts on psychotic disorders. We sought to examine changes in health service use and incident cases of psychotic disorder following cannabis legalization, during a period of tight restrictions on retail stores and product types. METHODS We conducted a cross-sectional interrupted time-series analysis using linked population-based health administrative data from Ontario (Canada) from January 2014 to March 2020. We identified psychosis-related outpatient visits, emergency department visits, hospitalizations, and inpatient length of stay, as well as incident cases of psychotic disorders, among people aged 14 to 60 years. RESULTS We did not find evidence of increases in health service use or incident cases of psychotic disorders over the short-term (17 month) period following cannabis legalization. However, we found clear increasing trends in health service use and incident cases of substance-induced psychotic disorders over the entire observation window (2014-2020). CONCLUSION Our findings suggest that the initial period of tight market restriction following legalization of non-medical cannabis was not associated with an increase in health service use or frequency of psychotic disorders. A longer post-legalization observation period, which includes expansion of the commercial cannabis market, is needed to fully understand the population-level impacts of non-medical cannabis legalization; thus, it would be premature to conclude that the legalization of non-medical cannabis did not lead to increases in health service use and incident cases of psychotic disorder.
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Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London ON Canada; ICES Western, London ON Canada; Lawson Health Research Institute, London Health Sciences Centre, London ON Canada.
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada
| | | | - Maliha Mamun
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON Canada
| | - Jordan Edwards
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton ON Canada
| | - Tara Elton-Marshall
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa ON Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto ON Canada; Dalla Lana School of Public Health, University of Toronto, Toronto ON Canada
| | - Jason Gilliland
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Department of Geography and Environment, Western University, London ON Canada
| | - Daniel Thomas Myran
- Department of Family Medicine, University of Ottawa, Ottawa ON Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa ON Canada; ICES uOttawa, Ottawa Hospital Research Institute, Ottawa ON Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal ON Canada
| | | | - Jamie A Seabrook
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London ON Canada; School of Food and Nutritional Sciences, Brescia University College, London ON Canada
| | - Robin M Murray
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - Salimah Z Shariff
- Arthur Labatt Family School of Nursing, Western University, London ON Canada; ICES Western, London ON Canada; Lawson Health Research Institute, London Health Sciences Centre, London ON Canada
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Babajani F, Salari N, Hosseinian-Far A, Abdoli N, Mosafer H, Heidarian P, Mohammadi M. Prevalence of suicide attempts across the African continent: A systematic review and meta-analysis. Asian J Psychiatr 2024; 91:103878. [PMID: 38142521 DOI: 10.1016/j.ajp.2023.103878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Over 700,000 people worldwide lose their lives through suicide every year. The prevalence of suicide has increased, especially in low- and middle-income countries such as many African countries. For every fatal suicidal attempt, there are approximately 20 other non-fatal suicide attempts within the population. The purpose of this study is to investigate the prevalence of attempts of suicides in the African continent through a systematic review and meta-analysis. METHODS To identify relevant sources, the PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar repositories and databases were systematically searched without a lower time limit and until July 2023. The heterogeneity of the studies was checked with the I2 index, and accordingly random effects model was adopted to perform the analysis. Data analysis was conducted within the Comprehensive Meta-Analysis software (v.2). RESULTS In the review of 48 studies with a sample size of 244,701 people, the prevalence of suicide attempts in Africa was found to be 9.9% (95%CI: 8.5%-11.6%). With the increase in the year of study, the prevalence of suicide attempt in the African continent increases. Also, with the increase in the sample size, the prevalence of suicide attempts in Africa decreases. The suicide attempt prevalence among African men and woman slightly differed with 7.6% and 8.2%, respectively. CONCLUSION Suicide attempt is an important public health concern in Africa. The findings of this study are important not only for African health policy making, but also to contribute to the accuracy of global estimates with respect to suicide attempts.
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Affiliation(s)
- Fateme Babajani
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
| | - Nasrin Abdoli
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hadis Mosafer
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pegah Heidarian
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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Soronen K. Acting as a Mental Health Expert by Experience and Its Impact on Social Identity. Community Ment Health J 2024; 60:179-190. [PMID: 37976006 PMCID: PMC10799801 DOI: 10.1007/s10597-023-01207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
This study was conducted to examine the construction of social identity among mental health experts by experience working in Finnish municipal mental healthcare services. The construction of social identity is approached as an ongoing lifelong process that is significantly affected by lived experiences with mental health problems and recovery from them. The research data consist of focus group discussions, and the analysis is based on a thematic design that is initially material-driven. As a result, four categories are formed to describe the effect of acting as an expert by experience on social identity and the importance of the issue. Experts by experience have to consider profound questions about their identity and future in their new life situation. The individual meanings of acting as an expert by experience are considered particularly important. The support provided by group members builds confidence in one's chances of success and thereby supports the development of social identity. Social identities of experts by experience are partially built in encounters with professionals representing the mental health care system. This creates opportunities for new roles for those who act as experts by experience.
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Affiliation(s)
- Kari Soronen
- Faculty of Social Sciences, University of Lapland, Rovaniemi, Finland.
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Myhre MØ, Walby FA, Bramness JG, Mehlum L. Trajectories of Service Contact before Suicide in People with Substance Use Disorders-A National Register Study. Arch Suicide Res 2024; 28:200-215. [PMID: 36472383 DOI: 10.1080/13811118.2022.2151959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to identify trajectories of service use during the last year before suicide death and the characteristics associated with the trajectories in patients with substance use disorders. METHODS This study used a national registry data linkage, which included all patients with substance use disorders who died by suicide in Norway between 2010 and 2018. In- and outpatient contacts with mental health or substance use services during the last year before suicide death was analyzed by week using Sequence State Analysis and cluster analysis to identify trajectories. Logistic regression was used to measure the association between the characteristics and the trajectories. RESULTS We identified four trajectories of service contact. A brief contact trajectory (n = 366) with a low proportion of weeks in contact (M weeks = 8.3), associated with less psychosis or bipolar disorder (aOR = 0.13 (0.08-0.22)) and higher age. A regular contact trajectory (n = 160), with a higher proportion of contact (M weeks = 47.9), associated with psychosis or bipolar disorder (aOR = 3.66 (2.10-6.47)) and depressive or anxiety disorder (aOR = 3.11 (1.93-5.13)). An intermittent contact trajectory (n = 195) with most contacts with outpatient substance use disorder services (M weeks = 9.7). A continuous contact trajectory (n = 109) with a high proportion of inpatient contact (M weeks = 44.5), strongly associated with psychosis or bipolar disorder (aOR = 6.08 (3.26-11.80)). CONCLUSION Longitudinal descriptions of service use reveal different trajectories that are important to consider when developing policies or interventions to reduce the risk of suicide death in patients with substance use disorders.
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Solerdelcoll M, Ilzarbe D, Fortea A, Morer A, Lazaro L, Sugranyes G, Baeza I. Psychopathology and mental health service use among youth in foster care admitted to a psychiatric inpatient unit: a 4-year retrospective controlled study. Eur Child Adolesc Psychiatry 2024; 33:39-50. [PMID: 36542199 PMCID: PMC9768764 DOI: 10.1007/s00787-022-02104-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 10/24/2022] [Indexed: 12/24/2022]
Abstract
Youth in foster care (FC) are at increased risk of poor psychosocial outcomes. The aim of this study was to assess psychopathology and mental health service use among youth living in FC who require psychiatric hospitalisation. All individuals admitted to our Children and Adolescent Inpatient Psychiatry Unit between 2014 and 2017 who were in FC were systematically reviewed. The control group was defined as all youth living with their immediate family and hospitalised in our unit throughout 2016. We identified 89 patients placed in FC and 247 controls. Socio-demographic and clinical data were retrospectively collected from computerised charts. A survival analysis of emergency department visits and readmission to the hospital was conducted. Compared to controls, the FC group presented significantly higher rates of conduct disorder (78.7% vs 14.6%; p < 0.001) and substance use disorder (49.4% vs 27.5%; p < 0.001), mainly cannabis use (34.8% vs 16.6%; p < 0.001); higher rates of comorbidity (96.6% vs 55.9%; p < 0.001) and mean number of comorbid diagnoses (3.3 ± 1.1 vs 2.3 ± 0.5; p < 0.001). The FC group had a higher number of emergency room visits before and after admission than controls. FC youth were also 2.77 times more likely to visit the emergency department after discharge, and in a shorter time period, than controls (p = 0.004). Disruptive behaviours, substance use disorder, and comorbid psychopathology were all more prevalent among FC youth than controls. Specific strategies are needed to optimize community mental health resources and address the increased use of emergency services by these youth before and after hospitalisation.
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Affiliation(s)
- Mireia Solerdelcoll
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 16 De Crespingy Park, London, SE5 8AF, UK.
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain.
- Department of Medicine, University of Barcelona, Barcelona, Spain.
| | - Daniel Ilzarbe
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Adriana Fortea
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Astrid Morer
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Luisa Lazaro
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
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Selinheimo S, Gluschkoff K, Kausto J, Turunen J, Väänänen A. Sociodemographic Factors as Predictors of the Duration of Long-term Psychotherapy: Evidence from a Finnish Nationwide Register Study. Adm Policy Ment Health 2024; 51:35-46. [PMID: 37828416 PMCID: PMC10791957 DOI: 10.1007/s10488-023-01305-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE The role of sociodemographic factors in determining psychotherapy duration has been largely unexplored despite their known association with treatment use. We examined the association between sociodemographic factors and rehabilitative psychotherapy treatment duration, as well as any changes in duration over time. METHOD We used three register-based nationally representative cohorts. Participants included employed Finnish individuals (n = 5572, 77% women, mean age = 37) who started psychotherapy treatment in 2011, 2013 or 2016 and were followed until 2019. We used negative binomial regression to examine the association between sociodemographic factors (age, gender, education, occupational status, income, geographical area of residence, and onset year of treatment) with treatment duration. RESULTS The mean treatment duration was 27 months (with a standard deviation of 12 months). Several sociodemographic factors were associated with treatment duration. Gender and education were found to have the largest impact on treatment duration, with females having a longer duration (IRR 1.08, 95% CI 1.04-1.11) and those with low education having a shorter duration (IRR 0.91, 95% CI 0.85-0.97), resulting in a difference of 2-3 months. Treatment duration also increased in later years, which suggests potentially increasing differences in treatment implementation. At largest, the combined effect of all factors corresponded to a 10-month difference in treatment duration. CONCLUSIONS The duration of long-term psychotherapy varied across the sociodemographic groups and increased in all studied groups in the 2010s.
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Affiliation(s)
| | - Kia Gluschkoff
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Johanna Kausto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jarno Turunen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki, Finland
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