De Oliveira, C; Rahioui, H; Smadja, M; Gorsane, M A; Louppe, F
Relationship Scales Questionnaire. During the second phase, which includes individual and group therapy, the aim is to stimulate the capacity of mentalization through different techniques according to the patient's attachment style. These include therapeutic relationship, empathy, affect clarification and elaboration, positive and negative reinforcement. The final phase serves to review the patient's improvement and to prepare him progressively for the end of the therapy which can be experienced as an abandonment. Effectiveness of MBT in treating borderline disorder has been shown in several studies with short and long term benefits. It can be adapted for other personality disorders and specific populations such as adolescents. This article introduces the key concepts and aims of mentalization based treatment. The therapy is briefly described in its different phases and the various techniques are discussed. Clinical trials have shown that MBT is effective in treating borderline disorder in adolescent and adult populations. Despite the effectiveness of this therapy, it is difficult to set up and requires substantial resources. Interpersonal therapy based on attachment provides a therapeutic model focused on problematic areas which can offer an alternative therapy and reduce the fields of investigations. Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.
Bateman, Anthony; Fonagy, Peter
Mentalization is the process by which we implicitly and explicitly interpret the actions of ourselves and others as meaningful based on intentional mental states (e.g., desires, needs, feelings, beliefs, and reasons). This process is disrupted in individuals with comorbid antisocial (ASPD) and borderline personality disorder (BPD), who tend to misinterpret others' motives. Antisocial characteristics stabilize mentalizing by rigidifying relationships within prementalistic ways of functioning. However, loss of flexibility makes the person vulnerable to sudden collapse when the schematic representation is challenged. This exposes feelings of humiliation, which can only be avoided by violence and control of the other person. The common path to violence is via a momentary inhibition of the capacity for mentalization. In this article, the authors outline their current understanding of mentalizing and its relation to antisocial characteristics and violence. This is illustrated by a clinical account of mentalization-based treatment adapted for antisocial personality disorder. Treatment combines group and individual therapy. The focus is on helping patients maintain mentalizing about their own mental states when their personal integrity is challenged. A patient with ASPD does not have mental pain associated with another's state of mind; thus, to generate conflict in ASPD by thinking about the victim will typically be ineffective in inducing behavior change.
Bateman, Anthony; Fonagy, Peter
Mentalization is the process by which we implicitly and explicitly interpret the actions of ourselves and others as meaningful based on intentional mental states (e.g., desires, needs, feelings, beliefs, and reasons). This process is disrupted in individuals with comorbid antisocial (ASPD) and borderline personality disorder (BPD), who tend to misinterpret others' motives. Antisocial characteristics stabilize mentalizing by rigidifying relationships within prementalistic ways of functioning. However, loss of flexibility makes the person vulnerable to sudden collapse when the schematic representation is challenged. This exposes feelings of humiliation, which can only be avoided by violence and control of the other person. The common path to violence is via a momentary inhibition of the capacity for mentalization. In this article, the authors outline their current understanding of mentalizing and its relation to antisocial characteristics and violence. This is illustrated by a clinical account of mentalization-based treatment adapted for antisocial personality disorder. Treatment combines group and individual therapy. The focus is on helping patients maintain mentalizing about their own mental states when their personal integrity is challenged. A patient with ASPD does not have mental pain associated with another's state of mind; thus, to generate conflict in ASPD by thinking about the victim will typically be ineffective in inducing behavior change. 2008 Wiley Periodicals, Inc
Reiter, Melanie; Bock, Astrid; Althoff, Marie-Luise; Taubner, Svenja; Sevecke, Kathrin
Mentalization Based Treatment of an Adolescent Girl with Conduct Disorder This paper will give a short overview on the theoretical concept of mentalization and its specific characteristics in adolescence. A previous study on Mentalization based treatment for adolescents (MBT-A) demonstrated the effectiveness of MBT-A for the treatment of adolescents with symptoms of deliberate self-harm (Rossouw u. Fonagy, 2012). Based on the results of this study Taubner, Gablonski, Sevecke, and Volkert (in preparation) developed a manual for mentalization based treatment for adolescents with conduct disorders (MBT-CD). This manual represents the foundation for a future study on the efficacy of the MBT-A for this specific disorder in young people. The present case report demonstrates the application of specific MBT interventions, as well as the therapeutic course over one year in a 16-year old girl who fulfilled all criteria of a conduct disorder. During the course of treatment, the de-escalating relationship-oriented therapeutic approach can be considered as a great strength of MBT-A, especially for patients with conduct disorders. The clinical picture, as well as the psychological assessment, showed a positive progress over the course of treatment. Despite frequent escalations, forced placements due to acute endangerment of self and others, and a precarious situation with the patient's place of residence towards the end of therapy, MBT-A treatment enabled the patient to continually use the evolved mentalizing capabilities as a resource.
Willoughby, Jay C.; Carubia, Beau A.; Murgolo, Marisa A.; Carter, Debbie R.; Frankel, Karen A.
A recent partnership between the Irving Harris Program in Child Development and Infant Mental Health and the Community Based Psychiatry Program at University of Colorado Hospital joined two different approaches to child mental health treatment: infant mental health and multisystemic therapy (MST). This article illustrates the compatibility of…
Taubner, Svenja; Volkert, Jana; Gablonski, Thorsten-Christian; Rossouw, Trudie
Mentalization-Based Treatment for Adolescents with Borderline Personality Disorder - Concept and Efficacy In recent years, the concept of mentalization has become increasingly important in practice and research. It describes the imaginative ability to understand human behavior in terms of mental states. Mentalization is a central component to understand the etiology and to treat patients with borderline personality disorder (BPD). Both adult and adolescent patients with BPD have limited mentalization abilities, which can be reliably assessed using the Reflective Functioning Scale. Mentalization-Based Treatment (MBT) was originally developed as an integrative approach for the treatment of adult patients with BPD. It is a manualized psychotherapy with psychodynamic roots with the aim to increase mentalizing abilities of patients. Since then, MBT has been further developed for other mental disorders as well as for the treatment of different age groups. One of these developments is MBT for Adolescents (MBT-A). MBT-A includes both individual as well as family sessions and the average duration of therapy is about twelve months. MBT-A can be applied in inpatient and outpatient settings and aims to improve mentalizing abilities in emotionally important relationships and the whole family system. First studies have found evidence for the efficacy of MBT-A. A randomized controlled trial (RCT) is currently being carried out to evaluate the efficacy of MBT-A for adolescents with conduct disorder. However, further evidence for efficacy and further conceptual development is needed.
Hannibal, Niels Jørgensen; Schwantes, Melody
The mentalization based treatment (MBT) model may be a valuable theoretical perspective for music therapists to consider using with clients in need of mental health care, particularly those with borderline personality disorder. This article explores some of the basic principles of MBT and its app...
Full Text Available Abstract Background Early recognition of the signs and symptoms of mental health disorders is important because early intervention is critical to restoring the mental as well as the physical and the social health of an individual. This study sought to investigate patterns of treatment seeking behavior and associated factors for mental illness. Methods A quantitative, institution-based cross sectional study was conducted among 384 psychiatric patients at Jimma University Specialized Hospital (JUSH located in Jimma, Ethiopia from March to April 2010. Data was collected using a pretested WHO encounter format by trained psychiatric nurses. Data was analyzed using SPSS V.16. Result Major depression disorder 186 (48.4%, schizophrenia 55 (14.3% and other psychotic disorders 47 (12.2% were the most common diagnoses given to the respondents. The median duration of symptoms of mental illness before contact to modern mental health service was 52.1 weeks. The main sources of information for the help sought by the patients were found to be family 126 (32.8% and other patients 75 (19.5%. Over a third of the patients 135 (35.2%, came directly to JUSH. Half of the patients sought traditional treatment from either a religious healer 116 (30.2% or an herbalist 77 (20.1% before they came to the hospital. The most common explanations given for the cause of the mental illness were spiritual possession 198 (51.6% and evil eye 61 (15.9%, whereas 73 (19.0% of the respondents said they did not know the cause of mental illnesses. Nearly all of the respondents 379 (98.7% believed that mental illness can be cured with modern treatment. Individuals who presented with abdominal pain and headache were more likely to seek care earlier. Being in the age group 31-40 years had significant statistical association with delayed treatment seeking behavior. Conclusions There is significant delay in modern psychiatric treatment seeking in the majority of the cases. Traditional healers
Brent, Benjamin K; Holt, Daphne J; Keshavan, Matcheri S; Seidman, Larry J; Fonagy, Peter
Disturbances of mentalization have been increasingly associated with the symptoms and functional impairment of people with psychotic disorders. it has been proposed that psychotherapy designed to foster self and other understanding, such as mentalization-based treatment (mBt), may play an important part in facilitating recovery from psychosis. Here, we present an attachment-based understanding of mentalization impairments. We then outline a neuropsychological model that links disruptions of mentalization associated with disturbances in the caregiving environment to the pathophysiology of psychosis in genetically at-risk individuals. this is followed by an illustration of some of the core mBt techniques for the rehabilitation of the capacity to mentalize as applied to the treatment of a patient with a psychotic disorder.
DiMeo, Michelle A.; Moore, G. Kurt; Lichtenstein, Carolyn
Evidence-based treatments (EBTs) are "interventions" that have been proven effective through rigorous research methodologies. Evidence-based practice (EBP), however, refers to a "decision-making process" that integrates the best available research, clinician expertise, and client characteristics. This study examined community mental health service…
Thomsen, Marianne S; Ruocco, Anthony C; Uliaszek, Amanda A
working memory. After 6 months of treatment, patients showed significantly greater increases in sustained attention and perceptual reasoning than controls, with initial deficits in sustained attention among patients resolving after treatment. Improved emotion regulation over the follow-up period...... was associated with increased auditory-verbal working memory capacity, whereas interpersonal functioning improved in parallel with perceptual reasoning. These findings suggest that changes in neurocognitive functioning may track improvements in clinical symptoms in mentalization-based treatment for BPD....
Southam-Gerow, Michael A.; Hourigan, Shannon E.; Allin, Robert B., Jr.
This article describes the application of a university-community partnership model to the problem of adapting evidence-based treatment approaches in a community mental health setting. Background on partnership research is presented, with consideration of methodological and practical issues related to this kind of research. Then, a rationale for…
Snowden, Lonnie R; Wallace, Neal; Cordell, Kate; Graaf, Genevieve
Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services. We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites. Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs. Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities. EPSDT expanded funding increased proportional
McClellan, Sean R.
Objectives. We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California’s Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Methods. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997–2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. Results. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P language-related disparities. Conclusions. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services. PMID:23865663
Snowden, Lonnie R; McClellan, Sean R
We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California's Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997-2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P language-related disparities. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services.
Wakefield, Claire E; McGill, Brittany C; Wilson, Helen L; Patterson, Pandora
Background Online technologies may reduce barriers to evidence-based mental health care, yet they also create numerous ethical challenges. Recently, numerous professional organizations and expert groups have produced best-practice guidelines to assist mental health professionals in delivering online interventions in an ethically and clinically sound manner. However, there has been little critical examination of these international best-practice guidelines regarding appropriate electronic mental health (e-mental health) service delivery via technologies such as videoconferencing (including Skype), particularly for specific, vulnerable populations. Further, the extent to which concordance exists between these guidelines remains unclear. Synthesizing this literature to provide clear guidance to both mental health professionals and researchers is critical to ensure continued progress in the field of e-mental health. Objective This study aims to review all currently available ethical and best-practice guidelines relating to videoconferencing-delivered mental health treatments in order to ascertain the recommendations for which international consensus could be found. Additionally, this review examines the extent to which each set of guidance addresses several key special populations, including children and young people, and populations living with illness. Methods This systematic review examined guidelines using a two-armed search strategy, examining (1) professional organizations’ published guidance; and (2) MEDLINE, PsycINFO, and EMBASE for the past ten years. In order to determine consensus for best-practice, a recommendation was considered "firm" if 50% or more of the reviewed guidelines endorsed it and "tentative" if recommended by fewer guidelines than these. The professional guidelines were also scored by two raters using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) criteria. Results In the study, 19 guidelines were included, yielding 11
Bay, Bjørn; Mortensen, Erik Lykke; Hvidtjørn, Dorte; Kesmodel, Ulrik Schiøler
To assess the mental health of children born after fertility treatment by comparing their risk of mental disorders with that of spontaneously conceived children. Prospective register based cohort study. Nationwide register based information from Danish National Health Registers cross linked by a unique personal identification number assigned to all citizens in Denmark. All children born in Denmark in 1995-2003 with follow-up in 2012 when the children were aged 8-17; 33,139 children were conceived after fertility treatment and 555,828 children were born after spontaneous conception. Absolute risks and hazard ratios for overall and specific mental disorders estimated with adjustment for potential confounding variables. Estimated association between the risk of mental disorders and subtypes of procedures, hormone treatments, gamete types, and cause of infertility. The risk of mental disorders in children born after in vitro fertilisation or intracytoplasmic sperm injection was low, and was no higher than in spontaneously conceived children, except for a borderline significant increased risk of tic disorders (hazard ratio 1.40, 95% confidence interval 1.01 to 1.95; absolute risk 0.3%). In contrast, children born after ovulation induction with or without insemination had low but significantly increased risks of any mental disorder (1.20, 1.11 to 1.31; absolute risk 4.1%), autism spectrum disorders (1.20, 1.05 to 1.37; 1.5%), hyperkinetic disorders (1.23, 1.08 to 1.40; 1.7%), conduct, emotional, or social disorder (1.21, 1.02 to 1.45; 0.8%), and tic disorders (1.51, 1.16 to 1.96; 0.4%). There was no risk systematically related to any specific type of hormone drug treatment. There was a small increase in the incidence of mental disorders in children born after ovulation induction/intrauterine insemination. Children born after in vitro fertilisation/intracytoplasmic sperm injection were found to have overall risk comparable with children conceived spontaneously.
Dorsey, Shannon; Pullmann, Michael D; Kerns, Suzanne E U; Jungbluth, Nathaniel; Meza, Rosemary; Thompson, Kelly; Berliner, Lucy
Supervisors are an underutilized resource for supporting evidence-based treatments (EBTs) in community mental health. Little is known about how EBT-trained supervisors use supervision time. Primary aims were to describe supervision (e.g., modality, frequency), examine functions of individual supervision, and examine factors associated with time allocation to supervision functions. Results from 56 supervisors and 207 clinicians from 25 organizations indicate high prevalence of individual supervision, often alongside group and informal supervision. Individual supervision serves a wide range of functions, with substantial variation at the supervisor-level. Implementation climate was the strongest predictor of time allocation to clinical and EBT-relevant functions.
Roskes, E; Feldman, R
The paper describes initial results of collaboration between a mental health treatment program at a community mental health center in Baltimore and a probation officer of the U.S. federal prison system to serve the mental health needs of offenders on federal probation, parole, supervised release, or conditional release in the community. A forensic psychiatrist in the treatment program and a licensed social worker in the probation office facilitate the close working relationship between the agencies. Treatment services provided or brokered by the community mental health center staff include psychiatric and medical treatment, intensive case management, addictions treatment, urine toxicology screening, psychosocial or residential rehabilitation services, intensive outpatient care, partial hospitalization, and inpatient treatment. Among the 16 offenders referred for treatment during the first 24 months of the collaborative program, 14 were male and 14 were African American. Three of the 16 violated the terms of their release due to noncompliance with stipulated mental health treatment; only one of the three had been successfully engaged in treatment. One patient died, two completed their terms of supervision, and ten remained in treatment at the time of the report. The major strength of this collaboration is the cooperation of the treatment and monitoring agencies with the overall goal of maintaining the offender in the community. Further research is needed to confirm the effectiveness of the clinical model in reducing recidivism and retaining clients.
Kauppi, Kaisa; Välimäki, Maritta; Hätönen, Heli M; Kuosmanen, Lauri M; Warwick-Smith, Katja; Adams, Clive E
Non-compliance is a significant problem among people with serious mental disorders, presenting a challenge for mental health professionals. Prompts such as telephone calls, visits, and a posted referral letter to patients are currently used to encourage patient attendance at clinics and/or compliance with medication. More recently, the use of information and communication technology (ICT)-based prompting methods have increased. Methods include mobile text message (SMS - short message service), e-mail or use of any other electronic device with the stated purpose of encouraging compliance. To investigate the effects of ICT-based prompting to support treatment compliance in people with serious mental illness compared with standard care. We searched the Cochrane Schizophrenia Group's Trials Register (31(st) May 2011 and 9(th) July 2012) which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. Also, we inspected references of all identified studies for further trials and contacted authors of trials for additional information. Relevant randomised controlled trials involving adults with serious mental illness, comparing any ICT-based prompt or combination of prompts by automatic or semi-automatic system compared with standard care. Review authors reliably assessed trial quality and extracted data. We calculated risk ratio (RR) with 95% confidence intervals (CI) using a fixed-effect model. For continuous outcomes, we estimated the mean difference (MD) between groups, again with 95% confidence intervals. A 'Summary of findings' table using GRADE was created, and we assessed included studies for risk of bias. The search identified 35 references, with 25 studies, but we could only include two studies with a total of 358 participants. The studies had a moderate risk of bias, and therefore risk overestimating any positive effects of ICT-based prompting. Both included studies compared semi-automatised ICT-based
Williams, Nathaniel J
Intentions play a central role in numerous empirically supported theories of behavior and behavior change and have been identified as a potentially important antecedent to successful evidence-based treatment (EBT) implementation. Despite this, few measures of mental health clinicians' EBT intentions exist and available measures have not been subject to thorough psychometric evaluation or testing. This paper evaluates the psychometric properties of the evidence-based treatment intentions (EBTI) scale, a new measure of mental health clinicians' intentions to adopt EBTs. The study evaluates the reliability and validity of inferences made with the EBTI using multi-method, multi-informant criterion variables collected over 12 months from a sample of 197 mental health clinicians delivering services in 13 mental health agencies. Structural, predictive, and discriminant validity evidence is assessed. Findings support the EBTI's factor structure (χ (2) = 3.96, df = 5, p = .556) and internal consistency reliability (α = .80). Predictive validity evidence was provided by robust and significant associations between EBTI scores and clinicians' observer-reported attendance at a voluntary EBT workshop at a 1-month follow-up (OR = 1.92, p adoption at a 12-month follow-up (R (2) = .17, p adopt EBTs. Discussion focuses on research and practice applications.
Winchester, Bruce R; Watkins, Sarah C; Brahm, Nancy C; Harrison, Donald L; Miller, Michael J
Depression places a large economic burden on the US health care system. Routine screening has been recognized as a fundamental step in the effective treatment of depression, but should be undertaken only when support systems are available to ensure proper diagnosis, treatment, and follow-up. To estimate differences in prescribing new antidepressants and referral to stress management, psychotherapy, and other mental health (OMH) counseling at physician visits when documented depression screening was and was not performed. Cross-sectional physician visit data for adults from the 2005-2007 National Ambulatory Medical Care Survey were used. The final analytical sample included 55,143 visits, representing a national population estimate of 1,741,080,686 physician visits. Four dependent variables were considered: (1) order for new antidepressant(s), and referral to (2) stress management, (3) psycho therapy, or (4) OMH counseling. Bivariable and multivariable associations between depression screening and each measure of depression follow-up care were evaluated using the design-based F statistic and multivariable logistic regression models. New antidepressant prescribing increased significantly (2.12% of visits without depression screening vs 10.61% with depression screening resulted in a new prescription of an antidepressant). Referral to stress management was the behavioral treatment with the greatest absolute change (3.31% of visits without depression screening vs 33.10% of visits with depression screening resulted in a referral to stress management). After controlling for background sociodemographic characteristics, the adjusted odds ratio of a new antidepressant order remained significantly higher at visits involving depression screening (AOR 5.36; 99.9% CI 2.92-9.82), as did referrals for all behavioral health care services (ie, stress management, psychotherapy, and OMH counseling). At the national level, depression screening was associated with increased new
Rio Navarro, Javier; Cohen, Julien; Rocillo Arechaga, Eva; Zuniga, Edgardo
To establish the prevalence of exposure to physical and sexual violence, mental health symptoms, and medical treatment-seeking behavior among three street-based subpopulation groups in Tegucigalpa, Honduras, and to assess the association between sociodemographic group, mental health indicators, and exposure to violence. An anonymous, cross-sectional survey among randomly selected street-based adolescents, adults, and commercial sex workers (CSWs) was undertaken at the end of 2010 in Tegucigalpa. Médecins Sans Frontières (MSF) mapped places where the study population gathers. Stratified probability samples were drawn for all groups, using two-stage random sampling. Trained MSF staff administered on-site standardized face-to-face questionnaires. Self-reported exposure to severe physical violence in the previous year was 20.9% among street-based adolescents, 28.8% among adults, and 30.6% among CSWs. For the physical violence event self-defined as most severe, 50.0% of the adolescents, 81.4% of the adults, and 70.6% of the CSWs sought medical treatment. Their exposure to severe sexual violence was 8.6%, 28.8%, and 59.2%, respectively. After exposure to the self-defined most severe sexual violence event, 14.3% of adolescents, 31.9% of adults, and 29.1% of CSWs sought treatment. Common mental health and substance abuse symptoms were highly prevalent and strongly associated with exposure to physical (odds ratio 4.5, P < 0.0001) and sexual (odds ratio 3.7, P = 0.0001) violence. Exposure to physical and sexual violence reached extreme levels among street-based subpopulations. Treatment-seeking behavior, particularly after severe sexual violence, was limited. The association of mental health and substance abuse symptoms with exposure to violence could lead to further victimization. Medical and psychological treatments targeting these groups are needed and could help decrease their vulnerability.
Background Severe borderline personality disorder is associated with a very high psychosocial and economic burden. Current treatment guidelines suggest that several manualized treatments, including day hospital Mentalization-Based Treatment (MBT-DH), are effective in these patients. However, only two randomized controlled trials have compared manualized MBT-DH with treatment as usual. Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH, the possible influence of researcher allegiance in one of the trials, and potential problems with the generalization of findings to mental health systems in other countries, this multi-site randomized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherlands. Methods/design The trial is being conducted at two sites in The Netherlands. Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of ≥ 20 on the Borderline Personality Disorder Severity Index were randomly allocated to MBT-DH or treatment as usual. The MBT-DH program consists of a maximum of 18 months’ intensive treatment, followed by a maximum of 18 months of maintenance therapy. Specialist treatment as usual is provided by the City Crisis Service in Amsterdam, a service that specializes in treating patients with personality disorders, offering manualized, non-MBT interventions including family interventions, Linehan training, social skills training, and pharmacotherapy, without a maximum time limit. Patients are assessed at baseline and subsequently every 6 months up to 36 months after the start of treatment. The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index. Secondary outcome measures include parasuicidal behaviour, symptomatic distress, social and interpersonal functioning
Laurenssen, Elisabeth M P; Westra, Dieuwertje; Kikkert, Martijn J; Noom, Marc J; Eeren, Hester V; van Broekhuyzen, Anna J; Peen, Jaap; Luyten, Patrick; Busschbach, Jan J V; Dekker, Jack J M
Severe borderline personality disorder is associated with a very high psychosocial and economic burden. Current treatment guidelines suggest that several manualized treatments, including day hospital Mentalization-Based Treatment (MBT-DH), are effective in these patients. However, only two randomized controlled trials have compared manualized MBT-DH with treatment as usual. Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH, the possible influence of researcher allegiance in one of the trials, and potential problems with the generalization of findings to mental health systems in other countries, this multi-site randomized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherlands. The trial is being conducted at two sites in The Netherlands. Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of ≥ 20 on the Borderline Personality Disorder Severity Index were randomly allocated to MBT-DH or treatment as usual. The MBT-DH program consists of a maximum of 18 months' intensive treatment, followed by a maximum of 18 months of maintenance therapy. Specialist treatment as usual is provided by the City Crisis Service in Amsterdam, a service that specializes in treating patients with personality disorders, offering manualized, non-MBT interventions including family interventions, Linehan training, social skills training, and pharmacotherapy, without a maximum time limit. Patients are assessed at baseline and subsequently every 6 months up to 36 months after the start of treatment. The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index. Secondary outcome measures include parasuicidal behaviour, symptomatic distress, social and interpersonal functioning, personality functioning
Yanos, Philip T.; Roe, David; Lysaker, Paul H.
Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally-led treatment to address this issue. In this article, we discuss our development of a new, group-based approach to the treatment of internalized stigma which we have termed “narrative enhancement and cognitive therapy” (NECT). We describe the treatment approach and offer an illustration of it by way of a case vignette. PMID:21985260
Erbe, Doris; Eichert, Hans-Christoph; Riper, Heleen; Ebert, David Daniel
Many studies have provided evidence for the effectiveness of Internet-based stand-alone interventions for mental disorders. A newer form of intervention combines the strengths of face-to-face (f2f) and Internet approaches (blended interventions). The aim of this review was to provide an overview of (1) the different formats of blended treatments for adults, (2) the stage of treatment in which these are applied, (3) their objective in combining face-to-face and Internet-based approaches, and (4) their effectiveness. Studies on blended concepts were identified through systematic searches in the MEDLINE, PsycINFO, Cochrane, and PubMed databases. Keywords included terms indicating face-to-face interventions ("inpatient," "outpatient," "face-to-face," or "residential treatment"), which were combined with terms indicating Internet treatment ("internet," "online," or "web") and terms indicating mental disorders ("mental health," "depression," "anxiety," or "substance abuse"). We focused on three of the most common mental disorders (depression, anxiety, and substance abuse). We identified 64 publications describing 44 studies, 27 of which were randomized controlled trials (RCTs). Results suggest that, compared with stand-alone face-to-face therapy, blended therapy may save clinician time, lead to lower dropout rates and greater abstinence rates of patients with substance abuse, or help maintain initially achieved changes within psychotherapy in the long-term effects of inpatient therapy. However, there is a lack of comparative outcome studies investigating the superiority of the outcomes of blended treatments in comparison with classic face-to-face or Internet-based treatments, as well as of studies identifying the optimal ratio of face-to-face and Internet sessions. Several studies have shown that, for common mental health disorders, blended interventions are feasible and can be more effective compared with no treatment controls. However, more RCTs on effectiveness and
This article explores some core findings from a qualitative investigation of parents' experiences of their child's treatment in an adolescent mental health service in Sydney, Australia. In particular, the research question was, "How does parents' involvement in the child/adolescent's treatment influence their perception of how they can be helpful in their child's recovery?" The theme of parent hope emerged from the broad qualitative exploration of parent's experience of their involvement in their adolescent's intensive treatment program. A purposive sample of 14 sets of parents participated, being interviewed at admission, discharge, and 6 months following their adolescent's discharge. A continuum of high, moderate, and low levels of hope were evident in this parent sample 6 months after their treatment involvement. The strongly emergent theme was the relationship between parents' hope and agency/self-efficacy. Parents who remained more passive in expecting expert helpers to fix their child experienced reduced hope months after finishing the program. When parents positively changed their interaction with their child, they felt a more sustained hopefulness. These findings generate the hypothesis that if parents are actively involved in changing themselves as part of their child's treatment, they experience increased hope and effectiveness in contributing to their child's recovery.
Findings: therapy compliance, retention in treatment, decrease in somatic symptoms, anxiety, social dysfunction and increase in health was significantly in both combination of psychological intervention method than the Naltroxan group. Mindfulness-based on relapse prevention was more effective than CBT relapse prevention in decreasing of, social dysfunction, relapse prevention, increase of therapy compliance, and health. Results: Mindfulness based relapse prevention was superior to CBT and Naltroxan and considerably increased effectiveness of opioid relapse prevention therapy.
Poser, Charles M., Ed.
A collection of writings by 17 authors, the text includes the following discussions: general principles of diagnosis and management of mental retardation, neurologic evaluation of the infant and child, psychological evaluation, educational information, and treatment of pseudoretardation, communicative disorders, and metabolic and endocrine causes.…
Yanos, Philip T.; Roe, David; Lysaker, Paul H.
Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally-led treatment to address this issue. In this a...
Baker-Ericzén, Mary J.; Jenkins, Melissa M.; Park, Soojin; Garland, Ann F.
Background: Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. Objective: The present study explored the role of prior training in evidence-based treatments (EBTs) on clinicians' assessment and treatment formulations using…
Völlm, Birgit A; Clarke, Martin; Herrando, Vicenç Tort; Seppänen, Allan O; Gosek, Paweł; Heitzman, Janusz; Bulten, Erik
Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Sports psychiatry has developed for the past 3 decades as an emerging field within psychiatry and sports medicine. An International society has been established in 1994 and also national interest groups were implemented, mostly within the national organizations for psychiatry, some also containing the topic of exercise treatment of mental disorders. Where are we now 30 years later? We systematically but also selectively review the medical literature on exercise, sport, psychiatry, mental health and mental disorders and related topics. The number of publications in the field has increased exponentially. Most topics keep remaining on the agenda, e.g., head trauma and concussion, drug abuse and doping, performance enhancement, overtraining, ADHD or eating disorders. Supported by the growing literature, evidence-based recommendations have become available now in many clinical areas. A relatively new phenomenon is muscle dysmorphia, observed in weightlifters, bodybuilders but also in college students and gym users. Further, sports therapy of mental disorders has been studied by more and more high-quality randomized controlled clinical trials. Mostly as a complementary treatment, however, for some disorders already with a 1a evidence level, e.g., depression, dementia or MCI but also post-traumatic stress disorder. Being grown up and accepted nowadays, sports psychiatry still represents a fast-developing field. The reverse side of the coin, sport therapy of mental disorders has received a scientific basis now. Who else than sports psychiatry could advance sport therapy of mental disorders? We need this enthusiasm for sports and psychiatry for our patients with mental disorders and it is time now for a broadening of the scope. Optimized psychiatric prevention and treatment of athletes and ideal sport-related support for individuals with mental disorders should be our main purpose and goal.
Narcissistic personality disorder (NPD) and not otherwise specified personality disorder (borderline and narcissistic) are major mental health problems for men. These pathologies predispose patients to significant relational difficulties which are characterised by intense reactions to perceived threats to the self-esteem and an impaired empathic ability. Understanding these disorders as affect dysregulation stimulated by shame, the author presents how patients in this context are prone to lose their capacity to mentalize. This article describes a specific individual and group mentalization-based treatment and its implementation for treating narcissistic men. Different reflections on the treatment, on empathy, as well as on the adaptation of this treatment for NPD patients are presented and illustrated with clinical vignettes.
Love, Allison R; Okado, Izumi; Orimoto, Trina E; Mueller, Charles W
The present study used exploratory and confirmatory factor analyses to identify underlying latent factors affecting variation in community therapists' endorsement of treatment targets. As part of a statewide practice management program, therapist completed monthly reports of treatment targets (up to 10 per month) for a sample of youth (n = 790) receiving intensive in-home therapy. Nearly 75 % of youth were diagnosed with multiple co-occurring disorders. Five factors emerged: Disinhibition, Societal Rules Evasion, Social Engagement Deficits, Emotional Distress, and Management of Biodevelopmental Outcomes. Using logistic regression, primary diagnosis predicted therapist selection of Disinhibition and Emotional Distress targets. Client age predicted endorsement of Societal Rules Evasion targets. Practice-to-research implications are discussed.
Preyde, Michele; Cameron, Gary; Frensch, Karen; Adams, Gerald
This report stems from a larger study on the outcomes of children and youth who accessed residential treatment or a home-based alternative. In this report an analysis of family descriptive information, the nature of family relationships, and indicators of family functioning for children and youth who have participated in children's mental health…
Caplan, Susan; Cordero, Carolyn
Depression is one of the leading causes of years lived with disability (YLDs) worldwide. Although depression can be successfully treated, 75% of Americans do not receive care. Treatment rates among Latinos immigrants are significantly lower than non-immigrant Latinos and non-Hispanic Whites. Known factors for mental health-care disparities such as poverty, insurance coverage, language barriers, and access to specialty mental health services in Latino neighborhoods do not fully explain the differences in treatment rates. Significant, but poorly understood factors influencing depression treatment among Latinos in the United States are lack of culturally congruent care, low mental health literacy, and stigma. Even though churches are a major source of health information, social and spiritual support for Latinos, the conceptualization of culturally congruent care rarely addresses religious beliefs. Therefore, one strategy to reduce disparities in depression treatment is to partner with churches to address faith-based stigma. Community-based participatory research is recognized as a methodology particularly well suited for creating successful culturally targeted interventions. The purpose of this article is to describe the process of creating a faith-based mental health literacy intervention in the Caribbean Latino community using the principles of community-based participatory research. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Mentalization-based treatment in groups for adolescents with borderline personality disorder (BPD) or subthreshold BPD versus treatment as usual (M-GAB): study protocol for a randomized controlled trial.
Beck, Emma; Bo, Sune; Gondan, Matthias; Poulsen, Stig; Pedersen, Liselotte; Pedersen, Jesper; Simonsen, Erik
Evidence-based outpatient psychotherapeutic programs are first-line treatment of borderline personality disorder (BPD). Early and effective treatment of BPD is crucial to the prevention of its individual, psychosocial, and economic consequences. However, in spite of recent advantages in diagnosing adolescent BPD, there is a lack of cost-effective evidence-based treatment programs for adolescents. Mentalization-based treatment is an evidence-based program for BPD, originally developed for adults. We will investigate whether a specifically designed mentalization-based treatment in groups is an efficacious treatment for adolescents with BPD or subthreshold BPD compared to treatment as usual. The trial is a four-center, two-armed, parallel-group, assessor-blinded randomized clinical superiority trial. One hundred twelve patients aged 14 to 17 referred to Child and Adolescent Psychiatric Clinics in Region Zealand are randomized to 1 year of either mentalization-based treatment in groups or treatment as usual. Patients will be included if they meet at least four DSM-5 criteria for BPD. The primary outcome is self-reported borderline features at discharge. Secondary outcomes will include self-harm, depression, BPD criteria, externalizing and internalizing symptoms, and social functioning, together with parental reports on borderline features, externalizing and internalizing symptoms. Measures of attachment and mentalization will be included as mediational variables. Follow-up assessment will take place at 3 and 12 months after end of treatment. This is the first randomized controlled trial to test the efficacy of a group-based mentalization-based treatment for adolescents with BPD or subthreshold BPD. If the results confirm our hypothesis, this trial will add to the treatment options of cost-effective treatment of adolescent BPD. Clinicaltrials.gov NCT02068326 , February 19, 2014.
Bateman, Anthony; O'Connell, Jennifer; Lorenzini, Nicolas; Gardner, Tessa; Fonagy, Peter
Antisocial personality disorder (ASPD) is an under-researched mental disorder. Systematic reviews and policy documents identify ASPD as a priority area for further treatment research because of the scarcity of available evidence to guide clinicians and policymakers; no intervention has been established as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment which specifically targets the ability to recognise and understand the mental states of oneself and others, an ability shown to be compromised in people with ASPD. The aim of the study discussed in this paper is to investigate whether MBT can be an effective treatment for alleviating symptoms of ASPD. This paper reports on a sub-sample of patients from a randomised controlled trial of individuals recruited for treatment of suicidality, self-harm, and borderline personality disorder. The study investigates whether outpatients with comorbid borderline personality disorder and ASPD receiving MBT were more likely to show improvements in symptoms related to aggression than those offered a structured protocol of similar intensity but excluding MBT components. The study found benefits from MBT for ASPD-associated behaviours in patients with comorbid BPD and ASPD, including the reduction of anger, hostility, paranoia, and frequency of self-harm and suicide attempts, as well as the improvement of negative mood, general psychiatric symptoms, interpersonal problems, and social adjustment. MBT appears to be a potential treatment of consideration for ASPD in terms of relatively high level of acceptability and promising treatment effects. ISRCTN ISRCTN27660668 , Retrospectively registered 21 October 2008.
This paper utilizes the experience of PRIME (Programme for Improving Mental health care) to exemplify how implementation science provides key insights and approaches to closing the treatment gap for mental disorders. The real-world application of strategies described in the implementation science literature, accompanied by use of alternative, rigorous evaluation methods to assess their impact on patient outcomes, can help in closing the mental health treatment gap in disadvantaged populations. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Peters, Roger H; Young, M Scott; Rojas, Elizabeth C; Gorey, Claire M
Over seven million persons in the United States are supervised by the criminal justice system, including many who have co-occurring mental and substance use disorders (CODs). This population is at high risk for recidivism and presents numerous challenges to those working in the justice system. To provide a contemporary review of the existing research and examine key issues and evidence-based treatment and supervision practices related to CODs in the justice system. We reviewed COD research involving offenders that has been conducted over the past 20 years and provide an analysis of key findings. Several empirically supported frameworks are available to guide services for offenders who have CODs, including Integrated Dual Disorders Treatment (IDDT), the Risk-Need-Responsivity (RNR) model, and Cognitive-Behavioral Therapy (CBT). Evidence-based services include integrated assessment that addresses both sets of disorders and the risk for criminal recidivism. Although several evidence-based COD interventions have been implemented at different points in the justice system, there remains a significant gap in services for offenders who have CODs. Existing program models include Crisis Intervention Teams (CIT), day reporting centers, specialized community supervision teams, pre- and post-booking diversion programs, and treatment-based courts (e.g., drug courts, mental health courts, COD dockets). Jail-based COD treatment programs provide stabilization of acute symptoms, medication consultation, and triage to community services, while longer-term prison COD programs feature Modified Therapeutic Communities (MTCs). Despite the availability of multiple evidence-based interventions that have been implemented across diverse justice system settings, these services are not sufficiently used to address the scope of treatment and supervision needs among offenders with CODs.
Suchman, Nancy E.; DeCoste, Cindy L.; McMahon, Thomas J.; Dalton, Rachel; Mayes, Linda C.; Borelli, Jessica
Mothers with histories of alcohol and drug addiction have shown greater difficulty parenting young children than mothers with no history of substance misuse. This study was the second randomized clinical trial testing the efficacy of Mothering from the Inside Out (MIO), a 12-week mentalization-based individual therapy designed to address psychological deficits commonly associated with chronic substance use that also interfere with the capacity to parent young children. Eighty-seven mothers caring for a child between 11 and 60 months of age were randomly assigned to receive 12 sessions of MIO versus 12 sessions of Parent Education (PE)—a psychoeducation active control comparison. Maternal reflective functioning, representations of caregiving, mother-child interaction quality, and child attachment were evaluated at baseline and post-treatment and 3-month follow up. Mother-child interaction quality was assessed again at 12-month follow up. In comparison with PE mothers, MIO mothers demonstrated a higher capacity for reflective functioning and representational coherence at post-treatment and 3-month follow up. At 12-month follow up, compared to PE cohorts, MIO mothers demonstrated greater sensitivity, their children showed greater involvement, and MIO dyads showed greater reciprocity. As addiction severity increased, MIO also appeared to serve as a protective factor for maternal reflective functioning, quality of mother-child interactions, and child attachment status. Results demonstrate the promise of mentalization-based interventions provided concomitant with addiction treatment for mothers and their young children. PMID:28401850
Berg, Lloyd; King, Benjamin; Koenig, Jessica; McRoberts, Roger L
Popular (i.e., nonclassical) musicians have higher rates of mental health disorders and mental health service utilization than the general population. Little is known, however, about how popular musicians perceive mental health interventions in terms of overall satisfaction and therapeutic benefit. An online client satisfaction survey was sent to all musicians and family members who received mental health services through a nonprofit mental health organization in Austin, Texas, between July 2014 and June 2015 (n=628). 260 individuals (41.4%) responded to the survey, of whom 94% (n=244) were musicians. A majority of musician respondents were male (60%) and white (82%). 87% received counseling, 32% received psychiatric medication treatment, and 8% received addiction recovery services. 97% of musicians (205/211) rated their counselor as 'very good' or 'excellent,' 88% (64/79) rated their psychiatric providers as 'very good' or 'excellent,' and 94% (17/19) rated their addiction recovery specialists as 'very good' or 'excellent' (nonsignificant between all categories, p>0.05). 89% of musicians receiving counseling, 84% receiving psychiatric medication treatment, and 95% receiving addiction recovery services agreed or strongly agreed that their symptoms and overall functioning improved as a result of their treatment (nonsignificant between all categories, p>0.05). Popular musicians express strong provider satisfaction and overall benefit when mental health interventions are accessible, affordable, and delivered by professionals familiar with their concerns. More research is needed to understand the unique psychosocial stresses popular musicians face to inform treatment planning for this high-risk, underserved population.
Jeong, Yoo Mi; Veldhuis, Cindy B; Aranda, Frances; Hughes, Tonda L
To examine the unmet needs for mental health and substance use treatment among a diverse sample of sexual minority women (lesbian, bisexual). Sexual minority women are more likely than heterosexual women to report depression and hazardous drinking. However, relatively little is known about sexual minority women's use of mental health or substance use treatment services, particularly about whether use varies by race/ethnicity. Cross-sectional analysis of existing data. Analyses included data from 699 Latina, African American and white sexual minority women interviewed in wave 3 of the 17-year Chicago Health and Life Experiences of Women study. Using logistic regression, we examined the associations among sexual identity, race/ethnicity, use of mental health and substance use treatment, as well as potential unmet need for treatment. Overall, women in the study reported high levels of depression and alcohol dependence, and these varied by sexual identity and race/ethnicity. Use of mental health and substance use treatment also varied by race/ethnicity, as did potential unmet need for both mental health and substance use treatment. Our findings that suggest although use of treatment among sexual minority women is high overall, there is a potentially sizable unmet need for mental health and substance use treatment that varies by race/ethnicity, with Latina women showing the greatest unmet need for treatment. Nurses and other healthcare providers should be aware of the high rates of depression and hazardous drinking among sexual minority women, understand the factors that may increase the risk of these conditions among sexual minority women, the potentially high unmet need for mental health and substance use treatment - perhaps particularly among Latina women and be equipped to provide culturally sensitive care or refer to appropriate treatment services as needed. © 2016 John Wiley & Sons Ltd.
Beck, Emma; Bo, Sune; Gondan, Matthias
Background Evidence-based outpatient psychotherapeutic programs are first-line treatment of borderline personality disorder (BPD). Early and effective treatment of BPD is crucial to the prevention of its individual, psychosocial, and economic consequences. However, in spite of recent advantages...
Bay, Bjørn; Mortensen, Erik Lykke; Hvidtjørn, Dorte
To assess the mental health of children born after fertility treatment by comparing their risk of mental disorders with that of spontaneously conceived children.......To assess the mental health of children born after fertility treatment by comparing their risk of mental disorders with that of spontaneously conceived children....
Suchman, Nancy E; DeCoste, Cindy L; McMahon, Thomas J; Dalton, Rachel; Mayes, Linda C; Borelli, Jessica
Mothers with histories of alcohol and drug addiction have shown greater difficulty parenting young children than mothers with no history of substance misuse. This study was the second randomized clinical trial testing the efficacy of Mothering From the Inside Out (MIO), a 12-week mentalization-based individual therapy designed to address psychological deficits commonly associated with chronic substance use that also interfere with the capacity to parent young children. Eighty-seven mothers caring for a child between 11 and 60 months of age were randomly assigned to receive 12 sessions of MIO versus 12 sessions of parent education (PE), a psychoeducation active control comparison. Maternal reflective functioning, representations of caregiving, mother-child interaction quality, and child attachment were evaluated at baseline and posttreatment and 3-month follow-up. Mother-child interaction quality was assessed again at 12-month follow-up. In comparison with PE mothers, MIO mothers demonstrated a higher capacity for reflective functioning and representational coherence at posttreatment and 3-month follow-up. At 12-month follow-up, compared to PE cohorts, MIO mothers demonstrated greater sensitivity, their children showed greater involvement, and MIO dyads showed greater reciprocity. As addiction severity increased, MIO also appeared to serve as a protective factor for maternal reflective functioning, quality of mother-child interactions, and child attachment status. Results demonstrate the promise of mentalization-based interventions provided concomitant with addiction treatment for mothers and their young children.
Baker-Ericzén, Mary J; Jenkins, Melissa M; Park, Soojin; Garland, Ann F
Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. The present study explored the role of prior training in evidence-based treatments on clinicians' assessment and treatment formulations using case vignettes. Specifically, study aims included using the Naturalistic Decision Making (NDM) cognitive theory to 1) examine potential associations between EBT training and decision-making processes (novice versus expert type), and 2) explore how client and family contextual information affects clinical decision-making. Forty-eight clinicians across two groups (EBT trained=14, Not EBT trained=34) participated. Clinicians were comparable on professional experience, demographics, and discipline. The quasi-experimental design used an analog "think aloud" method where clinicians read case vignettes about a child with disruptive behavior problems and verbalized case conceptualization and treatment planning out-loud. Responses were coded according to NDM theory. MANOVA results were significant for EBT training status such that EBT trained clinicians' displayed cognitive processes more closely aligned with "expert" decision-makers and non-EBT trained clinicians' decision processes were more similar to "novice" decision-makers, following NDM theory. Non-EBT trained clinicians assigned significantly more diagnoses, provided less detailed treatment plans and discussed fewer EBTs. Parent/family contextual information also appeared to influence decision-making. This study offers a preliminary investigation of the possible broader impacts of EBT training and potential associations with development of expert decision-making skills. Targeting clinicians' decision-making may be an important avenue to pursue within dissemination-implementation efforts in mental health practice.
Watts, Sarah E; Andrews, Gavin
Mental disorders are widespread and universal. They are frequently accompanied by considerable harmful consequences for the individual and come at a significant economic cost to a community. Yet while effective evidence based prevention and treatment exists, there are a number of barriers to access, implement and disseminate. Cognitive behavior therapy programs, such as those available at www.thiswayup.com.au are widely available using the Internet in high income countries, such as Australia. With the ubiquitous uptake of Internet users globally, it is suggested that low and middle income countries should consider ways to embrace and scale up these cost effective programs. An explanation of why and some suggestions as to how this can be done are presented. Crown Copyright © 2014. Published by Elsevier B.V. All rights reserved.
Full Text Available Existing studies of mental health interventions in low-resource settings have employed highly structured interventions delivered by non-professionals that typically do not vary by client. Given high comorbidity among mental health problems and implementation challenges with scaling up multiple structured evidence-based treatments (EBTs, a transdiagnostic treatment could provide an additional option for approaching community-based treatment of mental health problems. Our objective was to test such an approach specifically designed for flexible treatments of varying and comorbid disorders among trauma survivors in a low-resource setting.We conducted a single-blinded, wait-list randomized controlled trial of a newly developed transdiagnostic psychotherapy, Common Elements Treatment Approach (CETA, for low-resource settings, compared with wait-list control (WLC. CETA was delivered by lay workers to Burmese survivors of imprisonment, torture, and related traumas, with flexibility based on client presentation. Eligible participants reported trauma exposure and met severity criteria for depression and/or posttraumatic stress (PTS. Participants were randomly assigned to CETA (n = 182 or WLC (n = 165. Outcomes were assessed by interviewers blinded to participant allocation using locally adapted standard measures of depression and PTS (primary outcomes and functional impairment, anxiety symptoms, aggression, and alcohol use (secondary outcomes. Primary analysis was intent-to-treat (n = 347, including 73 participants lost to follow-up. CETA participants experienced significantly greater reductions of baseline symptoms across all outcomes with the exception of alcohol use (alcohol use analysis was confined to problem drinkers. The difference in mean change from pre-intervention to post-intervention between intervention and control groups was -0.49 (95% CI: -0.59, -0.40 for depression, -0.43 (95% CI: -0.51, -0.35 for PTS, -0.42 (95% CI: -0.58, -0.27 for
Carty, Sophie; Thompson, Louise; Berger, Sarah; Jahnke, Katie; Llewellyn, Rebecca
To evaluate the implementation of a regional Books on Prescription (BoP) programme. Seven data collection pathways were used to provide indicators of program implementation, utilisation, acceptability and reach. BoP is seen by prescribers, librarians and consumers as a valuable mental health resource. Key areas for improvement were identified: booklist literacy level and breadth of topic area; confidentiality; program promotion; and prescriber/librarian training. Recommendations are made regarding the improvement of programme acceptability, accessibility and assessment. The establishment of a national BoP scheme would facilitate sustainable and consistent methods for BoP promotion and assessment. The authors hope this evaluation is a step towards actualising this goal. © 2015 Public Health Association of Australia.
... Health Intervention Technology? Join a Study Learn More Technology and the Future of Mental Health Treatment Introduction ... What is NIMH’s Role in Mental Health Intervention Technology? Between FY2009 and FY2015, NIMH awarded 404 grants ...
[Migration biography and culture as determinants of diagnostic and therapeutic processes in mentally ill immigrants. A systematic differentiation based on a qualitative content analysis of treatment courses].
Behrens, Katharina; Calliess, Iris Tatjana
A systematic differentiation of culture- in contrast to migration-related influence factors in diagnostic and therapeutic processes is introduced. "Culture-related" refers to characteristics caused by values, behavior norms and religious attitudes of the ethnic community a person belongs to. "Migration-specific" refers to consequences of moving one's residence from one country to another (e. g., absence of family, trouble with authorities concerning the legal status or ambivalence with respect to returning to the home country). Based on a theoretic background of these determinants, categories for a content analysis were defined and applied to the treatment records of n = 55 first generation immigrants treated in a psychiatric day clinic of an university hospital. The results suggest that migration biography should not only be considered as affecting vulnerability in the genesis of a mental illness, but rather be classified as a factor of at least as much relevance for therapeutic situations as the usually named cultural diversity: summarizing the results of the qualitative content analysis of the entire treatment courses more cases were influenced by migration specific aspects rather than culture specific aspects.
Lemke, Sonne; Boden, Matthew Tyler; Kearney, Lisa K; Krahn, Dean D; Neuman, Matthew J; Schmidt, Eric M; Trafton, Jodie A
We outline the development of a Mental Health Domain to track accessibility and quality of mental health care in the United States Veterans Health Administration (VHA) as part of a broad-based performance measurement system. This domain adds an important element to national performance improvement efforts by targeting regional and facility leadership and providing them a concise yet comprehensive measure to identify facilities facing challenges in their mental health programs. We present the conceptual framework and rationale behind measure selection and development. The Mental Health Domain covers three important aspects of mental health treatment: Population Coverage, Continuity of Care, and Experience of Care. Each component is a composite of existing and newly adapted measures with moderate to high internal consistency; components are statistically independent or moderately related. Development and dissemination of the Mental Health Domain involved a variety of approaches and benefited from close collaboration between local, regional, and national leadership and from coordination with existing quality-improvement initiatives. During the first year of use, facilities varied in the direction and extent of change. These patterns of change were generally consistent with qualitative information, providing support for the validity of the domain and its component measures. Measure maintenance remains an iterative process as the VHA mental health system and potential data resources continue to evolve. Lessons learned may be helpful to the broader mental health-provider community as mental health care consolidates and becomes increasingly integrated within healthcare systems. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Daquin, Jane C; Daigle, Leah E
There is evidence that people with mental disorders are at increased risk of victimisation in prison. It is unclear whether this risk of victimisation varies across types of disorders or symptoms and what role mental health treatment has on victimisation risk in this context. To examine the relationship between specific mental disorders, psychiatric symptoms, and victimisation in prison and the effect of treatment for the disorders on victimisation risk. Using a nationally-representative sample of prisoners, path analyses were conducted to examine the relationship between mental disorder and victimisation. The analyses also examined whether receiving mental health treatment in prison affected any such relationship. Victimisation risk varied with the type of mental disorder or symptoms. Depression, personality disorder, hopelessness, paranoia, and hallucinations were associated with increased victimisation risk. Psychotic illnesses were otherwise negatively associated with victimisation. Receiving mental health treatment in prison was associated with greater risk of victimisation there. Receiving treatment appeared to mediate the relationship between mental disorders, symptoms, and victimisation. The findings suggest that not all inmates with mental disorders are at an increased risk of victimisation. Further, mental health treatment in prison also appears to be a risk factor of victimisation. More research is needed to further elucidate the relationship between mental disorders, treatment, and victimisation. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.
Full Text Available Introduction. This paper deals with medicolegal aspects of the hospital treatment of patients suffering from severe mental disorders and who are prone to violent behavior, dangerous to self and others. Violent acts in this study were defined as deliberate and nonconsensual acts of actual, attempted or threatened harm to a person or persons, and classified into categories of any type of violence, physical violence and nonphysical violence, which is in accordance with approaches used in other risk assessment researches. Outline of Cases. The authors present four cases of mentally ill inpatients whose violent behavior toward self or other persons resulted in self-destruction and physical aggression against other persons. The presented cases involved: 1 selfinjury in a patient with acute organic mental disorder after jumping through a hospital window, 2 suicide by drowning of a patient with acute mental disorder after escaping from intensive care unit, 3 suicide in a depressive patient after escaping from a low-security psychiatry unit, 4 physical violence against body and life of other persons in a patient with chronic mental disorder. Conclusion. The presented cases are considered to be rare in clinical practice and risk of violent behavior and the consequent danger of mentally ill inpatients may be efficiently predicted and prevented with appropriate hospital management based on 1 repeated escalation of violent behavior and 2 protection of the patient and others. Hence, if the physician, in order to prevent harmful consequences, does not apply all the necessary measures, including appropriate diagnostic and therapeutic procedures, as well as treatment in an adequate setting, such act is against the Criminal Law of the Republic of Serbia which sanctions physician's negligence. Also, according to the Law on Obligations of the Republic of Serbia this presents a legal ground for damage claim and the requirement of liability for nonmaterial damage
Chatterjee, Sudipto; Chowdhary, Neerja; Pednekar, Sulochana; Cohen, Alex; Andrew, Gracy; Andrew, Gracy; Araya, Ricardo; Simon, Gregory; King, Michael; Telles, Shirley; Verdeli, Helena; Clougherty, Kathleen; Kirkwood, Betty; Patel, Vikram
Common mental disorders, such as depression and anxiety, pose a major public health burden in developing countries. Although these disorders are thought to be best managed in primary care settings, there is a dearth of evidence about how this can be achieved in low resource settings. The MANAS project is an attempt to integrate an evidence based package of treatments into routine public and private primary care settings in Goa, India. Before initiating the trial, we carried out extensive preparatory work, over a period of 15 months, to examine the feasibility and acceptability of the planned intervention. This paper describes the systematic development and evaluation of the intervention through this preparatory phase. The preparatory stage, which was implemented in three phases, utilized quantitative and qualitative methods to inform our understanding of the potential problems and possible solutions in implementing the trial and led to critical modifications of the original intervention plan. Investing in systematic formative work prior to conducting expensive trials of the effectiveness of complex interventions is a useful exercise which potentially improves the likelihood of a positive result of such trials.
Teh, Lisa B; Hayashi, Kentaro; Latner, Janet; Mueller, Charles W
The Consumer Attitudes towards Evidence Based Services (CAEBS) scale is a 29-item questionnaire designed to assess public views on the role of science in helping to guide mental health treatment. The aim of the current study was to assess the Factor structure the CAEBS in an online sample of adults seeking information about mental health services. The CAEBS was administered to a nationwide sample of participants from websites offering classified advertisements for mental health related study participation (n = 312). An Exploratory Factor Analysis (EFA) suggested four factors based on 26 of the items: Beliefs Regarding Therapists' Practices, Attitudes about Mental Health Policy, Negative Personal-Level Attitudes toward EBPs, and Negative Societal-Level Attitudes towards EBPs. In order to increase consumer empowerment within the mental health-care system and develop policies supporting EBP usage, mental health professionals need to increase communication with the public to address these concerns and leverage positive attitudes. © 2016 Australian College of Mental Health Nurses Inc.
Full Text Available OBJECTIVE: To describe the concept of mentalization, and its application in understanding the development of psychopathology in patients with borderline personality disorder; to give an account of the main features of mentalization-based treatment; to summarise the evidence supporting its effectiveness. DISCUSSION: Mentalization is a predominantly preconscious mental activity that enables the individual to understand him/herself and others in terms of subjective states and mental processes. Psychological trauma in childhood is associated with deficits in mentalization and with the development of borderline personality disorder. Mentalization-based treatment is a psychodynamically-oriented manualized psychotherapy for borderline personality disorder that aims to develop a therapeutic process in which the patient's capacity for mentalization becomes the focus of treatment. Randomized controlled trials have demonstrated the effectiveness of this treatment for patients with borderline personality disorder. CONCLUSIONS: The development of a psychodynamically-oriented therapeutic intervention that specifically targets the deficits involved in the psychopathology of borderline personality disorder is a crucial step in increasing the effectiveness of treatment. Mental health professionals should be adequately prepared to deliver effective interventions to their patients, such as mentalization-based treatment.OBJETIVO: Descrever o conceito de mentalização e sua aplicação no entendimento do desenvolvimento da psicopatologia em pacientes com transtorno de personalidade borderline; descrever as principais características da terapia de mentalização; sumarizar as evidências que demonstram sua efetividade. DISCUSSÃO: Mentalização é uma atividade mental predominantemente pré-consciente que capacita o indivíduo a compreender a si mesmo e aos outros em termos de estados subjetivos e processos mentais. Trauma psicológico na infância está associado
Full Text Available Abstract Background Substance users being admitted to inpatient treatment experience a high level of mental distress. In this study we explored changes in mental distress during treatment. Methods Mental distress, as measured by the HSCL-10, was registered at admission and at discharge among 164 substance users in inpatient treatment in Northern Norway. Predictors of reduction in mental distress were examined utilizing hierarchical regression analysis. Results We found a significant reduction in mental distress in the sample, but the number of patients scoring above cut-off on the HSCL-10 at discharge was still much higher than in the general population. A more severe use of substances as measured by the AUDIT and the DUDIT, and being female, predicted a higher level of mental distress at admission to treatment as well as greater reduction in mental distress during treatment. Holding no education beyond 10 year compulsory school only predicted a reduction in mental distress. Conclusions The toxic and withdrawal effects of substances, level of education as well as gender, contributed to the differences in change in mental distress during treatment. Regression to the mean may in part explain some of the findings.
Thériault, François L; Colman, Ian
Many adults suffering from mental disorders never receive the care they need. The role of family and friends in overcoming mental health treatment barriers is poorly understood. We investigated the association between awareness of lifetime mental health treatment history in one's family or friends, and likelihood of having recently received mental health care for oneself. Using Canadian Community Health Survey 2012-Mental Health data, we defined care seekers as individuals who talked about mental health issues to at least one health professional in the past 12 months. Seekers were matched to non-seekers based on estimated care seeking propensity, and 1933 matched pairs were created. Reported awareness of lifetime treatment history in family and friends was compared between seekers and non-seekers. There were no differences in the distribution of any confounder of interest between seekers and non-seekers. 73% of seekers were aware of treatment history in family or friends, compared to only 56% of non-seekers (RR 1.3; 95% CI 1.2, 1.3). Awareness of treatment history in family members had nearly identical associations with care seeking as awareness of treatment history in friends. We have found a social clustering of mental health care seeking behavior; individuals who were aware of lifetime treatment history in family or friends were more likely to have recently sought care for themselves. These novel results are consistent with a social learning model of care seeking behavior, and could inform efforts to bridge the current mental health treatment gap.
The long-awaited Mental Health Law of China was passed on 26 October 2012 and took effect on 1 May 2013. Being the first national legislation on mental health, it establishes a basic legal framework to regulate mental health practice and recognizes the fundamental rights of persons with mental disorders. This article focuses on the system of involuntary detention and treatment of the mentally ill under the new law, which is expected to prevent the so-called "Being misidentified as mentally disordered" cases in China. A systematic examination of the new system demonstrates that the Mental Health Law of China implicitly holds two problematic assumptions and does not provide adequate protection of the fundamental rights of the involuntary patients. Administrative enactments and further national legislative efforts are needed to remedy these flaws in the new law. Copyright © 2014 Elsevier Ltd. All rights reserved.
Full Text Available A person with moderate mental retardation would, in a western country, be "diagnosed" early on in life. Consequently, such a child is likely to be sent for special education. Given the high level of job requirements, such a person is unlikely to be employed in the open market later in life. Mental retardation is one of the most frequent disabilities in most studies, mental retardation is found in about three percent of the population. Persons even with mild mental retardation have very large difficulties finding employment and are for this reason often deprived of opportunities for suitable and productive income generation this is why most stay poor. But disability does not only cause poverty poverty itself causes disability. This study follows an analysis, based on a review of the Swedish programme for mental retardation during the period 1930-2000. It is concluded that in Sweden a very large proportion of mild and moderate mental retardation has been eliminated though the combination of poverty alleviation with a community-based rehabilitation programme. For these situations a pro-active programme analysing and meeting the needs of the target groups should be useful as a means to achieve poverty alleviation.
Rice, Michael J
This article is the first in a new column focusing on evidence-based practice (EBP) in psychiatric mental health nursing. The EBP movement was strongly influenced by a British epidemiologist, Dr. Cochrane, who advocated care based on randomized clinical controlled trials in the late 1900s. Although the majority of the EBP movement is directed toward developing clinical guidelines, the critical element focuses on the therapeutic relationship and clinical judgment associated with providing care. This column will address a clinical problem, define PICO questions, report knowledge base searches, and present existing evidence. Recommendations will be offered for potential interventions and suggestions for evaluating clinical outcomes. Nurses can no longer view clinical studies as academic exercises discarded on graduation and not applied to the clinical setting. Conscientiously applying what is known about treatments and interventions of ethical, if not legal, value is consistent with the professional definition of care. J Am Psychiatr Nurses Assoc, 2008; 14(2), 107-111. DOI: 10.1177/1078390308315798.
Andrade, L. H.; Alonso, J.; Mneimneh, Z.; Wells, J. E.; Al-Hamzawi, A.; Borges, G.; Bromet, E.; Bruffaerts, R.; de Girolamo, G.; de Graaf, R.; Florescu, S.; Gureje, O.; Hinkov, H. R.; Hu, C.; Huang, Y.; Hwang, I.; Jin, R.; Karam, E. G.; Kovess-Masfety, V.; Levinson, D.; Matschinger, H.; O’Neill, S.; Posada-Villa, J.; Sagar, R.; Sampson, N. A.; Sasu, C.; Stein, D.; Takeshima, T.; Viana, M. C.; Xavier, M.; Kessler, R. C.
Background To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders. Methods Data are from the WHO World Mental Health (WMH) Surveys. Representative household samples were interviewed face-to-face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n= 63,678) and analyzed at different levels of clinical severity. Results Among those with a DSM-IV disorder in the past twelve months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. Desire to handle the problem on one’s own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers both to initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment dropout (39.3%) followed by negative experiences with treatment providers (26.9% of respondents with severe disorders). Conclusions Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide. PMID:23931656
Full Text Available The work of early pioneers like Dorothea Dix was instrumental in the establishment of institutions dedicated especially for the care of the mentally ill. Originally from the United States, she became acquainted with the idea of humane treatment of the mentally ill during her visit to England. After her return to the United States, she conducted a statewide investigation of care for the insane poor in Massachusetts and began to extensively lobby for reforms and establishment of more state-funded institutions for the care of mentally ill. Her efforts led to setting up of several mental health institutions, which became the cornerstone of care of psychiatrically ill, and for training of mental health care providers. Though subsequently, the hegemony of the institutions was challenged, and the era of deinstitutionalization was ushered in, the work of Dorothea Dix is important as it vouched for humane care of patients with mental illnesses.
Bina, Rena; Glasser, Saralee
Attitudes toward seeking mental health treatment are a major predictor of seeking such treatment. Rates of seeking mental health treatment for postpartum depression are low despite contacts with health-care providers and available treatment. This study examined factors associated with four dimensions of attitude toward seeking mental health treatment among Israeli women in the postpartum period. Women (N = 1,059) were recruited (June 2008-February 2009) from a medical center's maternity department within the first two days following delivery and completed a sociodemographic survey and the Attitudes Toward Seeking Professional Psychological Help Scale. Low recognition of need for mental health treatment was associated with having a below average income and no personal and family depression history; low stigma tolerance was associated with being younger, having more children, and defining oneself as ultra-orthodox; low interpersonal openness was associated with having a below average income. Moreover, low confidence in mental health practitioners was associated with being younger and non-ultra-orthodox. Understanding which women are likely to score low on various dimensions of attitude can help target interventions for improving these factors, reducing barriers to receiving mental health treatment among specific groups of women. Research should continue to explore specific attitude dimensions among various populations.
Compulsory treatment of severe mental disorder can seem complicated even to psychiatrists. This article attempts to explain the current legal framework as it applies in common clinical situations in a general medical context.
José Luis Jiménez López
Full Text Available High demand of care and the academic burden of courses of specialization in medicine affect the mental health of medical residents with events ranging from simple emotional discomfort to development of affective disorders in susceptible individuals. The suicide of physicians has produced programs for their attention in some countries. We present the first mental health clinic for residents of a high specialty hospital in Mexico, focused on the prevention of suicide and depression, treatment of mental disorders and mental health promotion. Unlike the reports of other countries, we get participation of more than 95%, we provide appropriate treatment and follow-up to residents with mental disorder, and there has not been a consummate suicide. We assume that the use of different strategies (scrutiny, adapting models of prevention of suicide as a peer and gatekeeper training, informative sessions of mental health promotion and stigma, interventions targeted at individuals and groups with conflicts has been useful against barriers that do not allow doctors to identify the risk of suicide warning signs, seek help for mental disorder, and seek to improve their mental health.
Martin, Michael S; Potter, Beth K; Crocker, Anne G; Wells, George A; Grace, Rebecca M; Colman, Ian
While there is general consensus about the need to increase access to mental health treatment, it is debated whether screening is an effective solution. We examined treatment use by inmates in a prison system that offers universal mental health screening. We conducted an observational study of 7,965 consecutive admissions to Canadian prisons. We described patterns of mental health treatment from admission until first release, death, or March, 2015 (median 14-month follow-up). We explored the association between screening results and time of first treatment contact duration of first treatment episode, and total number of treatment episodes. Forty-three percent of inmates received at least some treatment, although this was often of short duration; 8% received treatment for at least half of their incarceration. Screening results were predictive of initiation of treatment and recurrent episodes, with stronger associations among those who did not report a history prior to incarceration. Half of all inmates with a known mental health need prior to incarceration had at least 1 interruption in care, and only 46% of inmates with a diagnosable mental illness received treatment for more than 10% of their incarceration. Screening results were associated with treatment use during incarceration. However, mental health screening may have diverted resources from the already known highest need cases toward newly identified cases who often received brief treatment suggestive of lower needs. Further work is needed to determine the most cost-effective responses to positive screens, or alternatives to screening that increase uptake of services. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Holmes, Emily A; Blackwell, Simon E; Burnett Heyes, Stephanie; Renner, Fritz; Raes, Filip
Mental imagery is an experience like perception in the absence of a percept. It is a ubiquitous feature of human cognition, yet it has been relatively neglected in the etiology, maintenance, and treatment of depression. Imagery abnormalities in depression include an excess of intrusive negative mental imagery; impoverished positive imagery; bias for observer perspective imagery; and overgeneral memory, in which specific imagery is lacking. We consider the contribution of imagery dysfunctions to depressive psychopathology and implications for cognitive behavioral interventions. Treatment advances capitalizing on the representational format of imagery (as opposed to its content) are reviewed, including imagery rescripting, positive imagery generation, and memory specificity training. Consideration of mental imagery can contribute to clinical assessment and imagery-focused psychological therapeutic techniques and promote investigation of underlying mechanisms for treatment innovation. Research into mental imagery in depression is at an early stage. Work that bridges clinical psychology and neuroscience in the investigation of imagery-related mechanisms is recommended.
Wei, Yifeng; Kutcher, Stan; Szumilas, Magdalena
Adolescence is a critical period for the promotion of mental health and the treatment of mental disorders. Schools are well-positioned to address adolescent mental health. This paper describes a school mental health model, "School-Based Pathway to Care," for Canadian secondary schools that links schools with primary care providers and…
Salerno, John P.
Background: Stigmatizing attitudes toward mental illness and low mental health literacy have been identified as links to social adversity, and barriers to seeking and adhering to treatment among adolescents suffering from mental illness. Prior research has found that it is possible to improve these outcomes using school-based mental health…
This paper discusses interrelations between creativity, mental disorders and their treatment. The psychology of creativity is very important for successful psychopharmacotherapy, but our knowledge about creativity is still insufficient. Even that which is known is not within the armamentarium of most practicing psychiatrists. In the first part of this article creativity and possible associations between creativity, mental health, and well-being are described. The second part deals with the intriguing relationship between creativity and mental disorders. The third part emphasizes the role of creativity in the treatment of mental disorders. This paper ends by underlining the importance of a creativity-enhancing oriented, and personal recovery-focused psychopharmacotherapy in helping psychiatric patients achieve fulfilled and purposeful lives.
McLean, C S; Greer, K; Scott, J; Beck, J C
Support and education groups for the families of the mentally ill have been in existence for at least 20 years. The authors describe a group treatment program established in 1979 for parents of chronically mentally ill individuals living in the community. The goal was to help parents become less overprotective, critical, and hostile so that clients would relapse less frequently and improve their social functioning during their time in the community. The groups provided parents with information and support. Some of the results of the groups include the implementation of new hospital procedures, more effective parenting, and a parent-initiated alliance on behalf of the mentally ill in the locality.
Forensic mental health services exist in a nebulous space at the intersection of two different systems-criminal justice and mental health-and the entanglement of these systems poses intricate problems for psychiatrists. This article discusses the present circumstances of forensic mental health services in Japan, focusing on trends in prison psychiatry. In the traditional Japanese system, offenders with mental disorders were treated within general psychiatry as involuntarily admitted patients, or within the prison system as mentally ill inmates. As a consequence of recent legal reform, however, this situation has radically changed. The Medical Treatment and Supervision Act of 2005 aimed to provide intensive psychiatric treatment to offenders with mental disorders, attaching great importance to their reintegration into society. Under the new system, a person who commits a serious criminal offense in a state of insanity or diminished capacity shall be referred by the public prosecutor to the district court; following a treatment order of the court, the person shall be treated in psychiatric facilities established by the law. While the new system is expected to play a role in the context of specialist forensic psychiatry, its distinction from general psychiatry remains unclear. For example, persons who commit serious crimes, such as assault, in an acute psychotic state are occasionally admitted to general psychiatric hospitals, even if they meet the criteria for a treatment order under the Medical Treatment and Supervision Act. The relationship between prison psychiatry and specialist forensic psychiatry is still more problematic. Compared to the intensive, rehabilitation-oriented care provided under the Medical Treatment and Supervision Act, mental health services in penal institutions have a number of disadvantages, and it is unlikely that mentally ill prisoners have benefited from the recent progress in forensic psychiatry. Statistics show that the number of
This paper examines how an understanding of systematic findings about creative processes involved in art, literature, and science can be applied to the effective treatment of mental illness. These findings and applications are illustrated by particular reference to the work of the poet Sylvia Plath and the treatment of a patient who aspired to become a writer.
Mauritz, M.W.; van de Sande, R.; Goossens, P.J.J.; van Achterberg, T.; Draijer, N.
For patients with comorbid complex posttraumatic stress disorder (PTSD) and psychotic disorder, trauma-focused therapy may be difficult to endure. Phase-based treatment including (a) stabilization, (b) trauma-focused therapy, and (c) integration of personality with recovery of connection appears to
Heywood, Wendy; Lyons, Anthony
People living with HIV (PLHIV) have almost double the risk of depression than the rest of the population, and depression and anxiety among PLHIV have been linked with greater disease progression and other physical health problems. Studies to date, however, have focused almost exclusively on depression or general mental health. Much less research has investigated predictors of anxiety and generalized stress among HIV-positive gay men. This paper reports findings from a national community-based sample of 357 HIV-positive Australians gay men aged 18 years and older. Participants reported elevated rates of depression, anxiety, and generalized stress symptoms. A significant proportion of men with elevated depression and anxiety symptoms were not receiving treatment or had not been diagnosed. Risk factors for elevated mental health concerns included experiences of internalized stigma and discrimination. Anxiety was also associated with lower T-cell CD4 counts. A key protective factor was access to social support. The type of support, in particular emotional support, was found to be more important than the source of support. Our findings suggest that greater emphasis is needed on mental health screening and the provision of emotional support for PLHIV.
Yuxuan Cai, Stefanie; Shuen Sheng Fung, Daniel
Mental health services for youths in Singapore were challenged by accessibility and resource constraints. A community-based mental health program working with schools and other partners was developed to address the population needs. To describe the formation of a community-based mental health program and evaluate the program in terms of its outcome and the satisfaction of the users of this program. Based on needs analyses, a community multidisciplinary team was set up in 15 schools to pilot a new model of care for youths. Implemented progressively over five years, networks of teams were divided into four geographic zones. Each zone had clusters of 10 to 15 schools. These teams worked closely with school counselors. Teams were supported by a psychiatrist and a resident. Interventions were focused on empowering school-based personnel to work with students and families, with the support of the teams. 4,184 students were served of whom 10% were seen by the school counselors and supported by the community team. Only 0.15% required referral to tertiary services. Outcome measured by counselor and teacher ratings showed improvements in the Clinical Global Impression scale and Strengths and Difficulties Questionnaire. These included reductions in conduct problems, emotional problems, hyperactive behaviors and peer problems. Furthermore, prosocial behavior also significantly improved. Preliminary cost effectiveness analyses suggest that community treatments are superior to clinic interventions.
ten Have, M.; de Graaf, R.; van Dorsselaer, S.; Beekman, A.T.F.
Objective: This study examined lifetime treatment contact and delays in treatment seeking, including rates for receipt of helpful treatment, after the onset of specific mental disorders and evaluated factors that predicted treatment seeking and delays in treatment seeking. Methods: Data were from
Eisenberg, Daniel; Downs, Marilyn F; Golberstein, Ezra
Mental illness stigma refers to negative stereotypes and prejudices about people with mental illness, and is a widespread phenomenon with damaging social, psychological, and economic consequences. Despite considerable policy attention, mental illness stigma does not appear to have declined significantly in recent years. Interpersonal contact with persons with mental illness has been identified as a promising approach to reducing mental illness stigma. This study investigates the effect of contact with mental health treatment users on stigma using an observational research design that is free of self-selection bias. The research design is based on the quasi-experiment in which university students are assigned to live together as roommates. Survey data were collected from first-year undergraduates at two large universities in the United States (N = 1605). Multivariable regressions were used to estimate the effect of assignment to a roommate with a history of mental health treatment on a brief measure of stigmatizing attitudes. Contact with a treatment user caused a modest increase in stigma (standardized effect size = 0.15, p = 0.03). This effect was present among students without a prior treatment history of their own, but not among those with a prior history. The findings indicate that naturalistic contact alone does not necessarily yield a reduction in mental illness stigma. This may help explain why stigma has not declined in societies such as the United States even as treatment use has risen substantially. The findings also highlight the importance of isolating the specific components, beyond contact per se, that are necessary to reduce stigma in contact-based interventions. Copyright © 2012 Elsevier Ltd. All rights reserved.
Mattsson, Susanne; Olsson, Erik Martin Gustaf
Background The use of the Internet has the potential to increase access to evidence-based mental health services for a far-reaching population at a low cost. However, low take-up rates in routine care indicate that barriers for implementing Internet-based interventions have not yet been fully identified. Objective The aim of this study was to evaluate the preference for Internet-based psychological interventions as compared to treatment delivered face to face among individuals without past or current use of mental health treatment delivered online. A further aim was to investigate predictors of treatment preference and to complement the quantitative analyses with qualitative data about the perceived advantages and disadvantages of Internet-based interventions. Methods Two convenience samples were used. Sample 1 was recruited in an occupational setting (n=231) and Sample 2 consisted of individuals previously treated for cancer (n=208). Data were collected using a paper-and-pencil survey and analyzed using mixed methods. Results The preference for Internet-based psychological interventions was low in both Sample 1 (6.5%) and Sample 2 (2.6%). Most participants preferred psychological interventions delivered face to face. Use of the Internet to search for and read health-related information was a significant predictor of treatment preference in both Sample 1 (odds ratio [OR] 2.82, 95% CI 1.18-6.75) and Sample 2 (OR 3.52, 95% CI 1.33-9.29). Being born outside of Sweden was a significant predictor of preference for Internet-based interventions, but only in Sample 2 (OR 6.24, 95% CI 1.29-30.16). Similar advantages and disadvantages were mentioned in both samples. Perceived advantages of Internet-based interventions included flexibility regarding time and location, low effort, accessibility, anonymity, credibility, user empowerment, and improved communication between therapist and client. Perceived disadvantages included anonymity, low credibility, impoverished
Connell, Nadine M.
Objectives. We assessed mental health screening and medication continuity in a nationally representative sample of US prisoners. Methods. We obtained data from 18 185 prisoners interviewed in the 2004 Survey of Inmates in State and Federal Correctional Facilities. We conducted survey logistic regressions with Stata version 13. Results. About 26% of the inmates were diagnosed with a mental health condition at some point during their lifetime, and a very small proportion (18%) were taking medication for their condition(s) on admission to prison. In prison, more than 50% of those who were medicated for mental health conditions at admission did not receive pharmacotherapy in prison. Inmates with schizophrenia were most likely to receive pharmacotherapy compared with those presenting with less overt conditions (e.g., depression). This lack of treatment continuity is partially attributable to screening procedures that do not result in treatment by a medical professional in prison. Conclusions. A substantial portion of the prison population is not receiving treatment for mental health conditions. This treatment discontinuity has the potential to affect both recidivism and health care costs on release from prison. PMID:25322306
Jennifer Anne Simmelink
Full Text Available This exploratory study examines the mental health knowledge and training needs of refugee-serving community based organizations in a Midwestern state. A survey was administered to 31 staff members at 27 community based organizations (CBOs to assess the ability of staff to recognize and screen for mental health symptoms that may interfere with successful resettlement. Of the 31 respondents 93.5% (n=29 see refugees with mental health issues and 48.4% (n=15 assess refugees for mental health symptoms – primarily through informal assessment. Mainstream organizations were more likely than ethnic organizations to have received training related to the mental health needs of refugees. Results indicate that while refugee led CBOs recognize mental health symptoms of refugees they may be less likely to assess mental health symptoms and refer for treatment. Policy recommendations for improving CBO services to refugees are offered.
Barry, Colleen L; McGinty, Emma E; Pescosolido, Bernice A; Goldman, Howard H
Public attitudes about drug addiction and mental illness were compared. A Web-based national survey (N=709) was conducted to compare attitudes about stigma, discrimination, treatment effectiveness, and policy support in regard to drug addiction and mental illness. Respondents held significantly more negative views toward persons with drug addiction. More respondents were unwilling to have a person with drug addiction marry into their family or work closely with them. Respondents were more willing to accept discriminatory practices against persons with drug addiction, more skeptical about the effectiveness of treatments, and more likely to oppose policies aimed at helping them. Drug addiction is often treated as a subcategory of mental illness, and insurance plans group them together under the rubric of "behavioral health." Given starkly different public views about drug addiction and mental illness, advocates may need to adopt differing approaches to reducing stigma and advancing public policy.
Resources available for school based mental health services in Enugu urban and head teachers' knowledge of childhood mental health problems. ... PROMOTING ACCESS TO AFRICAN RESEARCH. AFRICAN JOURNALS ONLINE (AJOL) ...
Elkington, Katherine S.; Hackler, Dusty; McKinnon, Karen; Borges, Cristiane; Wright, Eric R.; Wainberg, Milton L.
This research explores the experiences of mental illness stigma in 24 youth (58.3% male, 13-24 years, 75% Latino) in psychiatric outpatient treatment. Using Link and Phelan's (2001) model of stigmatization, we conducted thematic analysis of the interview texts, examining experiences of stigma at individual and structural levels, in addition to the…
Cheng, Tyrone C.; Lo, Celia C.
This research is a secondary data analysis of the impact of adolescents' mental/substance-use disorders and dual diagnosis on their utilization of drug treatment and mental health services. By analyzing the same teenagers who participated in the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study, logistic…
In many countries, there continue to be conflicting opinions and mechanisms regarding the appropriateness of treatment and/or punishment for mentally ill individuals who commit crimes. The general population is concerned with public safety and often finds it difficult to accept the possibility that a mentally ill individual who commits a crime can be hospitalized and eventually discharged, sometimes after a relatively short time. In most countries the options of incarceration and hospitalization are available in concert. In some, incarceration occurs before hospitalization. In others, hospitalization is first, followed by a prison term. An additional option could be "treatment years." The court would determine the number of years of treatment required, according to the crime. This dilemma has no unequivocal solution. The goal is to reach a balance between the right of the patient to treatment and the responsibility of the courts to ensure public safety.
Marques, Luana; Dixon, Louise; Valentine, Sarah E; Borba, Christina P C; Simon, Naomi M; Wiltsey Stirman, Shannon
This study aims to elucidate relations between provider perceptions of aspects of the consolidated framework for implementation research (Damschroder et al., 2009) and provider attitudes toward the implementation of evidence-based treatments (EBTs) in an ethnically diverse community health setting. Guided by directed content analysis, we analyzed 28 semistructured interviews that were conducted with providers during the pre-implementation phase of a larger implementation study for cognitive processing therapy for posttraumatic stress disorder (Resick et al., 2008). Our findings extend the existing literature by also presenting provider-identified client-level factors that contribute to providers' positive and negative attitudes toward EBTs. Provider-identified client-level factors include the following: client motivation to engage in treatment, client openness to EBTs, support networks of family and friends, client use of community and government resources, the connection and relationship with their therapist, client treatment adherence, client immediate needs or crises, low literacy or illiteracy, low levels of education, client cognitive limitations, and misconceptions about therapy. These results highlight the relations between provider perceptions of their clients, provider engagement in EBT training, and subsequent adoption of EBTs. We present suggestions for future implementation research in this area. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Mulder Niels CL
Full Text Available Abstract Background Adults aged 65 and older with severe mental illnesses are a growing segment of the Dutch population. Some of them have a range of serious problems and are also difficult to engage. While assertive community treatment is a common model for treating difficult to engage severe mental illnesses patients, no special form of it is available for the elderly. A special assertive community treatment team for the elderly is developed in Rotterdam, the Netherlands and tested for its effectiveness. Methods We will use a randomized controlled trial design to compare the effects of assertive community treatment for the elderly with those of care as usual. Primary outcome measures will be the number of dropouts, the number of patients engaged in care and patient's psychiatric symptoms, somatic symptoms, and social functioning. Secondary outcome measures are the number of unmet needs, the subjective quality of life and patients' satisfaction. Other secondary outcomes include the number of crisis contacts, rates of voluntary and involuntary admission, and length of stay. Inclusion criteria are aged 65 plus, the presence of a mental disorder, a lack of motivation for treatment and at least four suspected problems with functioning (addiction, somatic problems, daily living activities, housing etc.. If patients meet the inclusion criteria, they will be randomly allocated to either assertive community treatment for the elderly or care as usual. Trained assessors will use mainly observational instruments at the following time points: at baseline, after 9 and 18 months. Discussion This study will help establish whether assertive community treatment for the elderly produces better results than care as usual in elderly people with severe mental illnesses who are difficult to engage. When assertive community treatment for the elderly proves valuable in these respects, it can be tested and implemented more widely, and mechanisms for its effects
Stobbe, Jolanda; Mulder, Niels C L; Roosenschoon, Bert-Jan; Depla, Marja; Kroon, Hans
Adults aged 65 and older with severe mental illnesses are a growing segment of the Dutch population. Some of them have a range of serious problems and are also difficult to engage. While assertive community treatment is a common model for treating difficult to engage severe mental illnesses patients, no special form of it is available for the elderly. A special assertive community treatment team for the elderly is developed in Rotterdam, the Netherlands and tested for its effectiveness. We will use a randomized controlled trial design to compare the effects of assertive community treatment for the elderly with those of care as usual. Primary outcome measures will be the number of dropouts, the number of patients engaged in care and patient's psychiatric symptoms, somatic symptoms, and social functioning. Secondary outcome measures are the number of unmet needs, the subjective quality of life and patients' satisfaction. Other secondary outcomes include the number of crisis contacts, rates of voluntary and involuntary admission, and length of stay. Inclusion criteria are aged 65 plus, the presence of a mental disorder, a lack of motivation for treatment and at least four suspected problems with functioning (addiction, somatic problems, daily living activities, housing etc.). If patients meet the inclusion criteria, they will be randomly allocated to either assertive community treatment for the elderly or care as usual. Trained assessors will use mainly observational instruments at the following time points: at baseline, after 9 and 18 months. This study will help establish whether assertive community treatment for the elderly produces better results than care as usual in elderly people with severe mental illnesses who are difficult to engage. When assertive community treatment for the elderly proves valuable in these respects, it can be tested and implemented more widely, and mechanisms for its effects investigated. The Netherlands National Trial Register NTR1620.
Moriana, Juan Antonio; Gálvez-Lara, Mario; Corpas, Jorge
Most mental health services throughout the world currently regard evidence-based psychological treatments as best practice for the treatment of mental disorders. The aim of this study was to analyze evidence-based treatments drawn from RCTs, reviews, meta-analyses, guides, and lists provided by the National Institute for Health and Care Excellence (NICE), Division 12 (Clinical Psychology) of the American Psychological Association (APA), Cochrane and the Australian Psychological Society (APS) in relation to mental disorders in adults. A total of 135 treatments were analyzed for 23 mental disorders and compared to determine the level of agreement among the organizations. The results indicate that, in most cases, there is little agreement among organizations and that there are several discrepancies within certain disorders. These results require reflection on the meaning attributed to evidence-based practice with regard to psychological treatments. The possible reasons for these differences are discussed. Based on these findings, proposals to unify the criteria that reconcile the realities of clinical practice with a scientific perspective were analyzed. Copyright © 2017 Elsevier Ltd. All rights reserved.
Sessions, Kristen L; Wheeler, Lydia; Shah, Arya; Farrell, Deenah; Agaba, Edwin; Kuule, Yusufu; Merry, Stephen P
Mental illness has been increasingly recognised as a source of morbidity in low- and middle-income countries and significant treatment gaps exist worldwide. Studies have demonstrated the effectiveness of task sharing through community-based treatment models for addressing international mental health issues. This paper aims to evaluate the perceptions of a wide range of mental health stakeholders in a Ugandan community regarding the benefits and barriers to developing a community-based mental health programme. Bwindi Community Hospital (BCH) in south-west Uganda provides services through a team of community health workers to people in the Kanungu District. Thematic analysis of 13 semi-structured interviews and 6 focus group discussions involving 54 community members and 13 mental health stakeholders within the BCH catchment area. Stakeholders perceived benefits to a community-based compared to a hospital-based programme, including improved patient care, lower costs to patients and improved community understanding of mental illness. They also cited barriers including cost, insufficient workforce and a lack of community readiness. Stakeholders express interest in developing community-based mental health programmes, as they feel that it will address mental health needs in the community and improve community awareness of mental illness. However, they also report that cost is a significant barrier to programme development that will have to be addressed prior to being able to successfully establish such programming. Additionally, many community members expressed unique sociocultural beliefs regarding the nature of mental illness and those suffering from a psychiatric disease.
Langeland, Eva; Riise, Trond; Hanestad, Berit R; Nortvedt, Monica W; Kristoffersen, Kjell; Wahl, Astrid K
Although the theory of salutogenesis provides generic understanding of how coping may be created, this theoretical perspective has not been explored sufficiently within research among people suffering from mental health problems. The aim of this study is to investigate the effect of talk-therapy groups based on salutogenic treatment principles on coping with mental health problems. In an experimental design, the participants (residents in the community) were randomly allocated to a coping-enhancing experimental group (n=59) and a control group (n=47) receiving standard care. Coping was measured using the sense of coherence (SOC) questionnaire. Coping improved significantly in the experiment group (+6 points) compared with the control group (-2 points). The manageability component contributed most to this improvement. Talk-therapy groups based on salutogenic treatment principles improve coping among people with mental health problems. Talk-therapy groups based on salutogenic treatment principles may be helpful in increasing coping in the recovery process among people with mental health problems and seem to be applicable to people with various mental health problems.
Lewy, Colleen S; Oliver, Celina M; McFarland, Bentson H
An Internet-based survey sought information about barriers to mental health services for military wives. On the basis of qualitative work, an Internet-based program was created to identify military wives who may have major depressive disorder. Women (N=569, ages 18 to 56) were recruited from 45 states and eight foreign countries. Most participants (78%) reported mild to severe depression. Many (44%) reported unaddressed mental health needs. Barriers included inability to attend daytime appointments (38%), inability to find a counselor who understands the needs of military spouses (35%), inability to find a counselor the participant could trust (29%), concerns about confidentiality (26%), and lack of knowledge about where to get services (25%). The barriers reported differed markedly from those described by distressed women in the general population. Military wives are an underserved population. Knowledge of military culture is essential for civilian mental health providers working with military wives.
Raguz, Nikolett; McDonald, Sheila W; Metcalfe, Amy; O'Quinn, Candace; Tough, Suzanne C
To compare the proportion of women with self-reported depression and anxiety symptoms at four months postpartum between mothers of singletons who conceived spontaneously and mothers who conceived with the aid of fertility treatment. The sample used for this study was drawn from The "All Our Babies Study", a community-based prospective cohort of 1654 pregnant women who received prenatal care in Calgary, Alberta. This analysis included women utilizing fertility treatment and a randomly selected 1:2 comparison group. The data was collected via three questionnaires, two of which were mailed to the participants during pregnancy and one at four months postpartum. Symptoms of depression and anxiety at four months postpartum were measured using the Edinburg Postnatal Depression Scale and the Spielberger State Anxiety Inventory. Secondary outcomes of parenting morale and perceived stress were also evaluated. Descriptive statistics were used to characterize the population. Chi square tests and in cases of small cell sizes, Fisher Exact Tests were used to assess differences in postpartum mental health symptomatology between groups. Seventy-six participants (5.9%) conceived using a form of fertility treatment. At four months postpartum, no significant differences were observed in the proportions reporting excessive depression symptoms (2.6% vs. 5.3%, p = 0.50), anxiety (8.1% vs. 16.9%, p = 0.08) or high perceived stress scores (7.9% vs. 13.3%, p = 0.23). Women who conceived with fertility treatment were less likely to score low on parenting morale compared to women who conceived spontaneously and this was particularly evident in primiparous women (12.5% vs. 33.8%, p = 0.01). There were no group differences in proportions reporting low parenting morale in multiparous women. This study suggests that at four months postpartum, the proportion of women who experience elevated symptoms of depression, anxiety or perceived stress do not differ between mothers who
Jochems, E.C.; van Dam, A.; Duivenvoorden, H.J.; Scheffer, S.C.M.; van der Feltz-Cornelis, C.M.; Mulder, N.L.
The present study assessed motivation for engaging in treatment as rated by clinicians (n = 57) and patients with severe mental illness (SMI, n = 294) using measures based on three different motivation theories. Questionnaires were derived from self-determination theory, the transtheoretical model
Carlsson, Jessica Mariana; Olsen, Dorte Reff; Kastrup, Marianne
to the Rehabilitation and Research Centre for Torture Victims in 2001 to 2002. Data on background, trauma, present social situation, mental symptoms (Hopkins Symptom Checklist-25, Hamilton Depression Scale, Harvard Trauma Questionnaire), and on health-related quality of life (World Health Organization Quality of Life......-Bref) were collected before treatment and after 9 and 23 months. No substantial changes in mental health were observed at the 9-month follow-up, and the minor decrease in some symptoms observed between the 9 and 23 months may reflect regression toward the mean or the natural course of symptoms in this cohort......The aim of this study was to examine long-term changes in symptoms of post-traumatic stress disorder, depression, anxiety, and in health-related quality of life in traumatized refugees 23 months after admission to multidisciplinary treatment. The study group comprised 45 persons admitted...
Jiao, Mingxu; Gu, Jing; Xu, Huifang; Hao, Chun; Lau, Joseph T F; Mo, Phoenix; Liu, Di; Zhao, Yuteng; Zhang, Xiao; Babbitt, Andrew; Hao, Yuantao
A considerable proportion of methadone maintenance treatment (MMT) clients have experienced mental health problems (e.g., depression and anxiety), and poor mental health status is associated with HIV-related risk behaviors and treatment drop-out. Resilience is known to be a protective factor for mental health problems but is not studied among MMT clients in China. This study aimed to explore the relationship between resilience and mental health problems (depression, anxiety and stress) among clients of community-based MMT clinics in China. A total of 208 MMT clients completed the face-to-face interview conducted at 4 of 11 MMT clinics in Guangzhou. The Chinese short version of Depression Anxiety Stress Scale (DASS-21) was used to assess the presence of depressive, anxiety and stress symptoms, and the Connor-Davidson Resilience Scale (CD-RISC) was used to measure resilience. Logistic regression models were fit in data analyses. Of all participants, 12.8%, 19.5% and 8.3% had depression, anxiety and stress, respectively. The mean resilience score was 57.6 (SD = 15.9). In the univariate analyses, resilience was negatively associated with two studied mental health problems (depression and anxiety, OR u = 0.96 and 0.96, p mental health problems of MMT users should consider resilience as an important part in the designing of such interventions.
This article reviews dominant media portrayals of mental illness, the mentally ill and mental health interventions, and examines what social, emotional and treatment-related effects these may have. Studies consistently show that both entertainment and news media provide overwhelmingly dramatic and distorted images of mental illness that emphasise dangerousness, criminality and unpredictability. They also model negative reactions to the mentally ill, including fear, rejection, derision and ridicule. The consequences of negative media images for people who have a mental illness are profound. They impair self-esteem, help-seeking behaviours, medication adherence and overall recovery. Mental health advocates blame the media for promoting stigma and discrimination toward people with a mental illness. However, the media may also be an important ally in challenging public prejudices, initiating public debate, and projecting positive, human interest stories about people who live with mental illness. Media lobbying and press liaison should take on a central role for mental health professionals, not only as a way of speaking out for patients who may not be able to speak out for themselves, but as a means of improving public education and awareness. Also, given the consistency of research findings in this field, it may now be time to shift attention away from further cataloguing of media representations of mental illness to the more challenging prospect of how to use the media to improve the life chances and recovery possibilities for the one in four people living with mental disorders.
Larson, Satu; Chapman, Susan; Spetz, Joanne; Brindis, Claire D.
Background: Children and adolescents exposed to chronic trauma have a greater risk for mental health disorders and school failure. Children and adolescents of minority racial/ethnic groups and those living in poverty are at greater risk of exposure to trauma and less likely to have access to mental health services. School-based health centers…
Pedrelli, Paola; Nyer, Maren; Yeung, Albert; Zulauf, Courtney; Wilens, Timothy
Attending college can be a stressful time for many students. In addition to coping with academic pressure, some students have to deal with the stressful tasks of separation and individuation from their family of origin while some may have to attend to numerous work and family responsibilities. In this context, many college students experience the first onset of mental health and substance use problems or an exacerbation of their symptoms. Given the uniqueness of college students, there is a need to outline critical issues to consider when working with this population. In this commentary, first, the prevalence of psychiatric and substance use problems in college students and the significance of assessing age of onset of current psychopathology are described. Then, the concerning persistent nature of mental health problems among college students and its implications are summarized. Finally, important aspects of treatment to consider when treating college students with mental health problems are outlined, such as the importance of including parents in the treatment, communicating with other providers, and employing of technology to increase adherence. It is concluded that, by becoming familiar with the unique problems characteristic of the developmental stage and environment college students are in, practitioners will be able to better serve them.
Musiat, Peter; Goldstone, Philip; Tarrier, Nicholas
Background E-mental health and m-mental health include the use of technology in the prevention, treatment and aftercare of mental health problems. With the economical pressure on mental health services increasing, e-mental health and m-mental health could bridge treatment gaps, reduce waiting times for patients and deliver interventions at lower costs. However, despite the existence of numerous effective interventions, the transition of computerised interventions into care is slow. The aim of...
Kooistra, L. C.; Ruwaard, J.; Wiersma, J. E.
the costs of mental health care, by reducing treatment duration and/or therapist contact. However, knowledge on blended care for depression is still limited. Objectives: To develop a blended cognitive behavioural treatment (bCBT) for depressed patients in an outpatient specialized mental health care centre...... with depressed patients (n = 9) in specialized mental health care. Patients' clinical profiles were established based on pre-treatment diagnostic information and patient self-reports on clinical measures. Patient treatment adherence rates were explored, together with patient ratings of credibility and expectancy...... the potential to be a valuable treatment option for patients with severe depression in specialized mental health care settings. Further exploration of the effectiveness of our bCBT protocol by means of a randomized controlled trial is warranted. © 2016 The Authors....
Ishikawa, H.; Kawakami, N.; Kessler, R. C.
Background The aim of this study is to estimate the lifetime and 12-month prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV) mental disorders in Japan based on the final data set of the World Mental Health Japan Survey conducted in 2002–2006. Methods Face-to-face household interviews of 4,130 respondents who were randomly selected from Japanese-speaking residents aged 20 years or older were conducted from 2002 to 2006 in 11 community populations in Japan (overall response rate, 56%). The World Mental Health version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured lay administered psychiatric diagnostic interview, was used for diagnostic assessment. Results Lifetime/12-month prevalence of any DSM-IV common mental disorders in Japan was estimated to be 20.3/7.6%. Rank-order of four classes of mental disorders was anxiety disorders (8.1/4.9%), substance disorders (7.4/1.0%), mood disorders (6.5/2.3%), and impulse control disorders (2.0/0.7%). The most common individual disorders were alcohol abuse/dependence (7.3/0.9%), major depressive disorder (6.1/2.2%), specific phobia (3.4/2.3%), and generalized anxiety disorder (2.6/1.3%). While the lifetime prevalence of any mental disorder was greater for males and the middle-aged, the persistence (proportion of 12-month cases among lifetime cases) of any mental disorder was greater for females and younger respondents. Among those with any 12-month disorder, 15.3% were classified as severe, 44.1% moderate, and 40.6% mild. Although a strong association between severity and service use was found, only 21.9% of respondents with any 12-month disorder sought treatment within the last 12 months; only 37.0% of severe cases received medical care. The mental health specialty sector was the most common resource used in Japan. Although the prevalence of mental disorders were quite low, mental disorders were the second
Yank, G R; Barber, J W; Spradlin, W W
Mental health treatment teams are living systems at the group level and comprise key productive subsystems of organizations providing mental health care. Effective treatment teams, like effective organizations, are anticipatory systems that contain subsystems that model and predict future system and environmental conditions and enable responses that increase system viability. A systems analysis of treatment teams highlights their potential instability due to their tendencies to regress toward dysfunctional partial systems and their active maintenance in nonequilibrium steady states with their organizational and external environments. Team subsystems are analyzed from the viewpoints of system processes and also with regard to individuals and their roles. Boundary processes are central to effective team functioning, assure constancy of team membership, and regulate the team's interfaces with its parent agency and with the external environment. Various causes and forms of disturbed information processing within hierarchical organizations are examined, and their effects at the treatment team level are discussed. The conclusion of the discussion focuses on team leadership and how leadership expands upon the concept of the decider subsystem to include role and personal factors to the team's leaders, and functions that are anticipatory and integrative in nature. Effective leaders must set appropriate thresholds for feedback regulation processes, and balance several pairs of seemingly opposing forces, including homeostasis and development, role differentiation and role overlap, and personal accountability and empowerment of others.
Greenberg, Jonathan; Shapero, Benjamin G; Mischoulon, David; Lazar, Sara W
An impaired ability to suppress currently irrelevant mental-sets is a key cognitive deficit in depression. Mindfulness-based cognitive therapy (MBCT) was specifically designed to help depressed individuals avoid getting caught in such irrelevant mental-sets. In the current study, a group assigned to MBCT plus treatment-as-usual (n = 22) exhibited significantly lower depression scores and greater improvements in irrelevant mental-set suppression compared to a wait-list plus treatment-as-usual (n = 18) group. Improvements in mental-set-suppression were associated with improvements in depression scores. Results provide the first evidence that MBCT can improve suppression of irrelevant mental-sets and that such improvements are associated with depressive alleviation.
Almeida de Oliveira, Carlos Francisco; Martins Eulálio, Carlos Evandro; Campelo, Viriato; Dalgalarrondo, Paulo; Dening, Tom
Our aim is to investigate two major tendencies in nineteenth-century Brazilian alienism: mentalism and organicism, by conducting a descriptive study of original Brazilian documents on medical health treatments in the 1830s, 1840s and 1850s. Primary sources of Brazilian alienism were theses, memoirs, official reports, and documents written by clinicians and asylum directors. We analysed early mental treatment in Brazilian lunatic asylums, exploring the relative contributions of two main theoretical orientations: moral treatment (based on Pinel and Esquirol) and 'medical-organicist therapeutic orientation'. Intertextuality was used to assess reports of medical organicist treatment in Brazil. We concluded that contemporaneous textual sources indicate that mid-nineteenth-century alienism in Brazil was predominantly influenced by organicism exported from European countries. Pinel's mentalist view, nevertheless, remained the reference point for clinical issues associated with the doctor-patient relationship. © The Author(s) 2016.
Full Text Available Background: The “treatment gap” (TG for mental disorders refers to the difference that exists between the number of people who need care and those who receive care. The concept is strongly promoted by the World Health Organization and widely used in the context of low- and middle-income countries. Although accepting the many demonstrable benefits that flow from this approach, it is important to critically reflect on the limitations of the concept of the TG and its implications for building capacity for mental health services in Rwanda. Objective: The article highlights concerns that the evidence base for mental health interventions is not globally valid, and problematizes the preponderance of psychiatric approaches in international guidelines for mental health. Specifically, the risk of medicalization of social problems and the limited way in which “community” has been conceptualized in global mental health discourses are addressed. Rather than being used as a method for increasing economic efficiency (i.e., reducing healthcare costs, “community” should be promoted as a means of harnessing collective strengths and resources to help promote mental well-being. This may be particularly beneficial for contexts, like Rwanda, where community life has been disrupted by collective violence, and the resulting social isolation constitutes an important determinant of mental distress. Conclusions: Moving forward there is a need to consider alternative paradigms where individual distress is understood as a symptom of social distress, which extends beyond the more individually oriented TG paradigm. Sociotherapy, an intervention used in Rwanda over the past 10 years, is presented as an example of how communities of support can be built to promote mental health and psychosocial well-being.
Young males, 18 or 19-year-old males; it’s like a soldier (that inhibits treatment- bullpen. They beat each other up, and don’t give seeking...forced me to go to mental health. After seeing a therapist, [they said I] someone wasn’t suicidal , wasn’t homicidal, but [they] told me I...I was given a choice to either stay at the house or go to this Uuvenile delinquency ] group home...Our therapist was good at what she did. That
Weine, Stevan M; Stone, Andrew; Saeed, Aliya; Shanfield, Stephen; Beahrs, John; Gutman, Alisa; Mihajlovic, Aida
New community-based initiatives being developed to address violent extremism in the United States are utilizing mental health services and leadership. This article reviews current approaches to preventing violent extremism, the contribution that mental illness and psychosocial problems can make to violent extremism, and the rationale for integrating mental health strategies into preventing violent extremism. The authors describe a community-based targeted violence prevention model and the potential roles of mental health professionals. This model consists of a multidisciplinary team that assesses at-risk individuals with comprehensive threat and behavioral evaluations, arranges for ongoing support and treatment, conducts follow-up evaluations, and offers outreach, education, and resources for communities. This model would enable mental health professionals in local communities to play key roles in preventing violent extremism through their practice and leadership.
Full Text Available Abstract Background There is no description of outcomes for patients receiving treatment for mental illnesses in humanitarian emergencies. MSF has developed a model for integration of mental health into primary care in a humanitarian emergency setting based on the capacity of community health workers, clinical officers and health counsellors under the supervision of a psychiatrist trainer. Our study aims to describe the characteristics of patients first attending mental health services and their outcomes on functionality after treatment. Methods A total of 114 patients received mental health care and 81 adult patients were evaluated with a simplified functionality assessment instrument at baseline, one month and 3 months after initiation of treatment. Results Most patients were diagnosed with epilepsy (47% and psychosis (31% and had never received treatment. In terms of follow up, 58% came for consultations at 1 month and 48% at 3 months. When comparing disability levels at baseline versus 1 month, mean disability score decreased from 9.1 (95%CI 8.1–10.2 to 7.1 (95%CI 5.9–8.2 p = 0.0001. At 1 month versus 3 months, mean score further decreased to 5.8 (95%CI 4.6–7.0 p Conclusion The findings suggest that there is potential to integrate mental health into primary care in humanitarian emergency contexts. Patients with severe mental illness and epilepsy are in particular need of mental health care. Different strategies for integration of mental health into primary care in humanitarian emergency settings need to be compared in terms of simplicity and feasibility.
Souza, Renato; Yasuda, Silvia; Cristofani, Susanna
There is no description of outcomes for patients receiving treatment for mental illnesses in humanitarian emergencies. MSF has developed a model for integration of mental health into primary care in a humanitarian emergency setting based on the capacity of community health workers, clinical officers and health counsellors under the supervision of a psychiatrist trainer. Our study aims to describe the characteristics of patients first attending mental health services and their outcomes on functionality after treatment. A total of 114 patients received mental health care and 81 adult patients were evaluated with a simplified functionality assessment instrument at baseline, one month and 3 months after initiation of treatment. Most patients were diagnosed with epilepsy (47%) and psychosis (31%) and had never received treatment. In terms of follow up, 58% came for consultations at 1 month and 48% at 3 months. When comparing disability levels at baseline versus 1 month, mean disability score decreased from 9.1 (95%CI 8.1-10.2) to 7.1 (95%CI 5.9-8.2) p = 0.0001. At 1 month versus 3 months, mean score further decreased to 5.8 (95%CI 4.6-7.0) p < 0.0001. The findings suggest that there is potential to integrate mental health into primary care in humanitarian emergency contexts. Patients with severe mental illness and epilepsy are in particular need of mental health care. Different strategies for integration of mental health into primary care in humanitarian emergency settings need to be compared in terms of simplicity and feasibility.
Freeman, D; Reeve, S; Robinson, A; Ehlers, A; Clark, D; Spanlang, B; Slater, M
Mental health problems are inseparable from the environment. With virtual reality (VR), computer-generated interactive environments, individuals can repeatedly experience their problematic situations and be taught, via evidence-based psychological treatments, how to overcome difficulties. VR is moving out of specialist laboratories. Our central aim was to describe the potential of VR in mental health, including a consideration of the first 20 years of applications. A systematic review of empirical studies was conducted. In all, 285 studies were identified, with 86 concerning assessment, 45 theory development, and 154 treatment. The main disorders researched were anxiety (n = 192), schizophrenia (n = 44), substance-related disorders (n = 22) and eating disorders (n = 18). There are pioneering early studies, but the methodological quality of studies was generally low. The gaps in meaningful applications to mental health are extensive. The most established finding is that VR exposure-based treatments can reduce anxiety disorders, but there are numerous research and treatment avenues of promise. VR was found to be a much-misused term, often applied to non-interactive and non-immersive technologies. We conclude that VR has the potential to transform the assessment, understanding and treatment of mental health problems. The treatment possibilities will only be realized if - with the user experience at the heart of design - the best immersive VR technology is combined with targeted translational interventions. The capability of VR to simulate reality could greatly increase access to psychological therapies, while treatment outcomes could be enhanced by the technology's ability to create new realities. VR may merit the level of attention given to neuroimaging.
Maulik, P K; Devarapalli, S; Kallakuri, S; Praveen, D; Jha, V; Patel, A
India has few mental health professionals to treat the large number of people suffering from mental disorders. Rural areas are particularly disadvantaged due to lack of trained health workers. Ways to improve care could be by training village health workers in basic mental health care, and by using innovative methods of service delivery. The ongoing Systematic Medical Appraisal, Referral and Treatment Mental Health Programme will assess the acceptability, feasibility and preliminary effectiveness of a task-shifting mobile-based intervention using mixed methods, in rural Andhra Pradesh, India. The key components of the study are an anti-stigma campaign followed by a mobile-based mental health services intervention. The study will be done across two sites in rural areas, with intervention periods of 1 year and 3 months, respectively. The programme uses a mobile-based clinical decision support tool to be used by non-physician health workers and primary care physicians to screen, diagnose and manage individuals suffering from depression, suicidal risk and emotional stress. The key aim of the study will be to assess any changes in mental health services use among those screened positive following the intervention. A number of other outcomes will also be assessed using mixed methods, specifically focussed on reduction of stigma, increase in mental health awareness and other process indicators. This project addresses a number of objectives as outlined in the Mental Health Action Plan of World Health Organization and India's National Mental Health Programme and Policy. If successful, the next phase will involve design and conduct of a cluster randomised controlled trial.
Burns, T; Knapp, M; Catty, J; Healey, A; Henderson, J; Watt, H; Wright, C
This review investigates the effectiveness of 'home treatment' for mental health problems in terms of hospitalisation and cost-effectiveness. For the purposes of this review, 'home treatment' is defined as a service that enables the patient to be treated outside hospital as far as possible and remain in their usual place of residence. METHODS - SYSTEMATIC LITERATURE SEARCH: 'Home treatment' excluded studies focused on day, residential and foster care. The review was based on Cochrane methodology, but non-randomised studies were included if they compared two services; these were only analysed if they provided evidence of the groups' baseline clinical comparability. METHODS - REVIEW OF ECONOMIC EVALUATIONS: Economic evaluations among the studies found were reviewed against established criteria. METHODS - IDENTIFICATION OF SERVICE COMPONENTS: A three-round Delphi exercise ascertained the degree of consensus among expert psychiatrists concerning the important components of community-based services that enable them to treat patients outside hospital. The identified components were used to construct the follow-up questionnaire. METHODS - FOLLOW-UP OF AUTHORS: As a supplement to the information available in the papers, authors of all the studies were followed up for data on service components, sustainability of programmes and service utilisation. METHODS - DATA ANALYSIS: The outcome measure was mean days in hospital per patient per month over the follow-up period. (1) Comparative analysis - compared experimental to control services. It analysed all studies with available data, divided into 'inpatient-control' and 'community-control' studies, and tested for associations between service components and difference in hospital days. (2) Experimental services analysis - analysed only experimental service data and tested for associations between service components and hospital days. RESULTS - SYSTEMATIC LITERATURE SEARCH: A total of 91 studies were found, conducted over a 30
Larson, S; Chapman, S; Spetz, J; Brindis, CD
Children and adolescents exposed to chronic trauma have a greater risk for mental health disorders and school failure. Children and adolescents of minority racial/ethnic groups and those living in poverty are at greater risk of exposure to trauma and less likely to have access to mental health services. School-based health centers (SBHCs) may be one strategy to decrease health disparities.Empirical studies between 2003 and 2013 of US pediatric populations and of US SBHCs were included if rese...
Vis, Christiaan; Kleiboer, Annet; Prior, Reinhard
Background: Depressive disorder is a major societal challenge. Despite the availability of clinically and cost-effective treatments including Internet interventions, the number of patients receiving treatment is limited. Evidence-based Internet interventions promise wide availability and high...... efficiency of treatments. However, these interventions often do not enter routine mental healthcare delivery at a large scale. The MasterMind project aims to provide insight into the factors that promote or hinder the uptake and implementation of evidence-based Internet interventions by mental healthcare...... practice. Internet-based Cognitive Behaviour Therapy (iCBT) and videoconferencing facilitating collaborative care (ccVC) will be implemented in routine mental healthcare. The services will be offered to 5230 depressed adults in 15 European regions. The current paper describes the evaluation protocol...
Occupational mental health promotion: a prevention agenda based on education and treatment. The American Psychological Association/National Institute for Occupational Safety and Health, Health Promotion Panel, 1990 Work and Well-Being Conference.
PURPOSE OF THE REVIEW. Psychological disorders are one of the 10 leading work-related diseases and injuries in the United States according to the National Institute for Occupational Safety and Health. This article addresses occupational metal health and preventive stress management in the workplace. The individual and organizational costs are briefly considered with concern for reducing the burden of suffering associated with these problems. SEARCH METHOD. As an American Psychological Association interdisciplinary panel, we searched the psychological, medical, public health, and organizational literature. We selected articles relevant to the problem of psychological disorders in the workplace and to enhancing occupational mental health and preventive stress management. IMPORTANT FINDINGS. The panel proposed a national agenda of education and treatment, combined with a program of evaluation research, for addressing these issues. Target populations are identified, and the need for collaboration among a variety of national constituencies is considered. Advancing occupational mental health and promoting skills in preventive stress management is considered in the context of comprehensive health promotion. MAJOR CONCLUSIONS. The panel concluded that there is a pressing need to: 1) set a 'gold' standard concerning the current state of knowledge in the domains of occupational mental health and stress management; 2) identify Diagnostically Related Groups (DRGs) which are stress-related; 3) establish assessment standards for stress and mental health; 4) set guidelines for reasonable interventions; and 5) establish acceptable post-outcome criteria.
Physical and sexual violence, mental health indicators, and treatment seeking among street-based population groups in Tegucigalpa, Honduras Violencia física y sexual, indicadores de salud mental y búsqueda de tratamiento en grupos de población en situación de calle en Tegucigalpa, Honduras
Javier Rio Navarro
Full Text Available OBJECTIVE: To establish the prevalence of exposure to physical and sexual violence, mental health symptoms, and medical treatment-seeking behavior among three street-based subpopulation groups in Tegucigalpa, Honduras, and to assess the association between sociodemographic group, mental health indicators, and exposure to violence. METHODS: An anonymous, cross-sectional survey among randomly selected street-based adolescents, adults, and commercial sex workers (CSWs was undertaken at the end of 2010 in Tegucigalpa. Médecins Sans Frontières (MSF mapped places where the study population gathers. Stratified probability samples were drawn for all groups, using two-stage random sampling. Trained MSF staff administered on-site standardized face-to-face questionnaires. RESULTS: Self-reported exposure to severe physical violence in the previous year was 20.9% among street-based adolescents, 28.8% among adults, and 30.6% among CSWs. For the physical violence event self-defined as most severe, 50.0% of the adolescents, 81.4% of the adults, and 70.6% of the CSWs sought medical treatment. Their exposure to severe sexual violence was 8.6%, 28.8%, and 59.2%, respectively. After exposure to the self-defined most severe sexual violence event, 14.3% of adolescents, 31.9% of adults, and 29.1% of CSWs sought treatment. Common mental health and substance abuse symptoms were highly prevalent and strongly associated with exposure to physical (odds ratio 4.5, P OBJETIVO: Establecer la prevalencia de la exposición a la violencia física y sexual, los síntomas relacionados con la salud mental, y las conductas de búsqueda de tratamiento médico en tres grupos de subpoblaciones en situación de calle en Tegucigalpa, Honduras, y evaluar la asociación entre el grupo sociodemográfico, los indicadores de salud mental y la exposición a la violencia. MÉTODOS: A fines del 2010 en Tegucigalpa se llevó a cabo una encuesta transversal, de carácter anónimo, en
Patel, Vikram; Xiao, Shuiyuan; Chen, Hanhui; Hanna, Fahmy; Jotheeswaran, A T; Luo, Dan; Parikh, Rachana; Sharma, Eesha; Usmani, Shamaila; Yu, Yu; Druss, Benjamin G; Saxena, Shekhar
This Series paper describes the first systematic effort to review the unmet mental health needs of adults in China and India. The evidence shows that contact coverage for the most common mental and substance use disorders is very low. Effective coverage is even lower, even for severe disorders such as psychotic disorders and epilepsy. There are vast variations across the regions of both countries, with the highest treatment gaps in rural regions because of inequities in the distribution of mental health resources, and variable implementation of mental health policies across states and provinces. Human and financial resources for mental health are grossly inadequate with less than 1% of the national health-care budget allocated to mental health in either country. Although China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Improvement of coverage will need to address both supply-side barriers and demand-side barriers related to stigma and varying explanatory models of mental disorders. Sharing tasks with community-based workers in a collaborative stepped-care framework is an approach that is ripe to be scaled up, in particular through integration within national priority health programmes. India and China need to invest in increasing demand for services through active engagement with the community, to strengthen service user leadership and ensure that the content and delivery of mental health programmes are culturally and contextually appropriate. Copyright © 2016 Elsevier Ltd. All rights reserved.
Alexander, Rudolph, Jr.
Notes that, despite changed goals of mental health treatment for inmates, some prison treatment programs still evaluate effects in terms of adjustment indicators. Discusses and critiques proposals in Ohio to use adjustment indicators as outcome measures for new treatment program for mentally ill inmates. Discusses proper outcome measures for…
Barry, Colleen L; McGinty, Emma Elizabeth; Pescosolido, Bernice; Goldman, Howard H.
Objective This study compares current public attitudes about drug addiction with attitudes about mental illness. Methods A web-based national public opinion survey (N=709) was conducted to compare attitudes about stigma, discrimination, treatment effectiveness, and policy support. Results Respondents hold significantly more negative views toward persons with drug addiction compared to those with mental illness. More respondents were unwilling to have a person with drug addiction marry into their family or work closely with them on a job. Respondents were more willing to accept discriminatory practices, more skeptical about the effectiveness of available treatments, and more likely to oppose public policies aimed at helping persons with drug addiction. Conclusions Drug addiction is often treated as a sub-category of mental illness, and health insurance benefits group these conditions together under the rubric of behavioral health. Given starkly different public views about drug addiction and mental illness, advocates may need to adopt differing approaches for advancing stigma reduction and public policy. PMID:25270497
Brown, Larry K; Hadley, Wendy; Donenberg, Geri R; DiClemente, Ralph J; Lescano, Celia; Lang, Delia M; Crosby, Richard; Barker, David; Oster, Danielle
The study examined the efficacy of family-based and adolescent-only HIV prevention programs in decreasing HIV risk and improving parental monitoring and sexual communication among youths in mental health treatment. A randomized controlled trial (RCT) with 721 adolescents (ages 13-18 years) and their caregivers from mental health settings in three U.S. cities were randomly assigned to one of three theory-based, structured group interventions: family-based HIV prevention, adolescent-only HIV prevention, and adolescent-only health promotion. Interventions were delivered during an all-day workshop. Assessments were completed at baseline and three months postintervention. Compared with those in the health intervention, adolescents in the HIV prevention interventions reported fewer unsafe sex acts (adjusted rate ratio=.49, p=.01), greater condom use (adjusted relative change=59%, p=.01), and greater likelihood of avoiding sex (adjusted odds ratio=1.44, p=.05). They also showed improved HIV knowledge (pprevention interventions reduced sexual risk behavior over three months in a large, diverse sample of youths in mental health treatment and that the family-based intervention improved parental monitoring and communication with teens about sex. These interventions show promise.
Lauritzen, Camilla; Reedtz, Charlotte; Martinussen, Monica; vanDoesum, Karin
Children of parents with a mental illness are at risk of developing mental health problems themselves (Beardslee, Versage & Gladstone, 1998; Hosman, van Doesum, & van Santvoort, 2009; Reupert & Maybery, 2007). In order to prevent children of mentally ill parents from developing serious problems, it is therefore beneficial to include a child perspective in the treatment of mentally ill parents by identifying the children of patients, and supporting patients in their parenting role. Norwegia...
Guerrero, Erick G; Padwa, Howard; Lengnick-Hall, Rebecca; Kong, Yinfei; Perrigo, Judith L
Using a random sample of 48 outpatient mental health programs in low-income and racial and ethnic minority communities, this study examined directorial leadership, drug treatment licensure, and implementation of evidence-based protocols and practices to address co-occurring mental health and substance abuse disorders (COD). Understanding of findings was enhanced with focus groups at six clinics. Most programs (81 %) offered COD treatment. Directorial leadership was positively associated with COD treatment (β = 0.253, p = 0.047, 95 % CI 0.003, 0.502) and COD supervision and training (β = 0.358, p = 0.002, 95 % CI 0.142, 0.575). Licensure was negatively associated with COD treatment (β = -0.235, p = 0.041, 95 % CI -0.460, -0.010) and COD supervision and training (β = -0.195, p = 0.049, 95 % CI -0.389, -0.001). Although lack of financial integration may limit the effect of licensing on COD treatment implementation, the response of leaders to regulation, funding, and human resources issues may encourage COD treatment practices. Implications for leadership interventions and policy are discussed in the context of health care reform.
Nagendra P Luitel
Full Text Available There is limited research on the gap between the burden of mental disorders and treatment use in low- and middle-income countries.The aim of this study was to assess the treatment gap among adults with depressive disorder (DD and alcohol use disorder (AUD and to examine possible barriers to initiation and continuation of mental health treatment in Nepal.A three-stage sampling technique was used in the study to select 1,983 adults from 10 Village Development Committees (VDCs of Chitwan district. Presence of DD and AUD were identified with validated versions of the Patient Health Questionnaire (PHQ-9 and Alcohol Use Disorder Identification Test (AUDIT. Barriers to care were assessed with the Barriers to Access to Care Evaluation (BACE.In this sample, 11.2% (N = 228 and 5.0% (N = 96 screened positive for DD and AUD respectively. Among those scoring above clinical cut-off thresholds, few had received treatment from any providers; 8.1% for DD and 5.1% for AUD in the past 12 months, and only 1.8% (DD and 1.3% (AUD sought treatment from primary health care facilities. The major reported barriers to treatment were lacking financial means to afford care, fear of being perceived as "weak" for having mental health problems, fear of being perceived as "crazy" and being too unwell to ask for help. Barriers to care did not differ based on demographic characteristics such as age, sex, marital status, education, or caste/ethnicity.With more than 90% of the respondents with DD or AUD not participating in treatment, it is crucial to identify avenues to promote help seeking and uptake of treatment. Given that demographic characteristics did not influence barriers to care, it may be possible to pursue general population-wide approaches to promoting service use.
Hankerson, Sidney H; Weissman, Myrna M
African Americans underutilize traditional mental health services, compared with white Americans. The authors conducted a systematic review of studies involving church-based health promotion programs for mental disorders among African Americans to assess the feasibility of utilizing such programs to address racial disparities in mental health care. A literature review of MEDLINE, PsycINFO, CINAHL, and ATLA Religion databases was conducted to identify articles published between January 1, 1980, and December 31, 2009. Inclusion criteria were as follows: studies were conducted in a church; the primary objective involved assessment, perceptions and attitudes, education, prevention, group support, or treatment for DSM-IV mental disorders or their correlates; number of participants was reported; qualitative or quantitative data were reported; and African Americans were the target population. Of 1,451 studies identified, only eight met inclusion criteria. Five studies focused on substance-related disorders, six were designed to assess the effects of a specific intervention, and six targeted adults. One study focused on depression and was limited by a small sample size of seven participants. Although church-based health promotion programs have been successful in addressing racial disparities for several chronic medical conditions, the literature on such programs for mental disorders is extremely limited. More intensive research is needed to establish the feasibility and acceptability of utilizing church-based health promotion programs as a possible resource for screening and treatment to improve disparities in mental health care for African Americans.
Ma, Nylanda; Furber, Gareth; Roberts, Rachel; Winefield, Helen
Siblings of children with mental health problems (MHPs) have been found to have higher rates of psychopathology and impaired psychosocial functioning compared to control children. It is not yet known how these siblings are managed within the clinical service context (e.g., are they assessed for mental health problems? Do they receive appropriate psychological treatment?). The following brief report describes a pilot study which aimed to explore (a) the rate of caregiver-identified MHPs in siblings and (b) the proportion of siblings receiving psychiatric or psychosocial treatment or support (i.e., treatment utilisation). Eighty-five caregivers of children receiving treatment at CAMHS were interviewed about the mental health and treatment utilisation of their siblings. The findings revealed a high rate of caregiver-identified MHPs in siblings (34.1%) and a high rate of treatment utilisation (85.7%). The findings suggest that, for the vast majority, when siblings of children with MHPs are identified by their caregivers as having MHPs, they are receiving some kind of support and treatment. Implications for mental health service costs are discussed and recommendations for future research are outlined.
Adkins, Elizabeth C; Zalta, Alyson K; Boley, Randy A; Glover, Angela; Karnik, Niranjan S; Schueller, Stephen M
Homelessness has serious consequences for youth that heighten the need for mental health services; however, these individuals face significant barriers to access. New models of intervention delivery are required to improve the dissemination of mental health interventions that tailor these services to the unique challenges faced by homeless youth. The purpose of this study was to better understand homeless youths' use of technology, mental health experiences and needs, and willingness to engage with technology-supported mental health interventions to help guide the development of future youth-facing technology-supported interventions. Five focus groups were conducted with 24 homeless youth (62.5% female) in an urban shelter. Youth were 18- to 20-years-old with current periods of homelessness ranging from 6 days to 4 years. Transcripts of these focus groups were coded to identify themes. Homeless youth reported using mobile phones frequently for communication, music, and social media. They indicated a lack of trust and a history of poor relationships with mental health providers despite recognizing the need for general support as well as help for specific mental health problems. Although initial feelings toward technology that share information with a provider were mixed, they reported an acceptance of tracking and sharing information under certain circumstances. Based on these results, we provide recommendations for the development of mental health interventions for this population focusing on technology-based treatment options. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Zachrisson, Henrik D; Rödje, Kjetil; Mykletun, Arnstein
Background Only a minority of adolescents reporting symptoms above case-levels on screenings for mental health seeks and receives help from specialist health services. The objective of this study was to a) examine help-seeking for symptoms of anxiety and depression in relation to symptom load dimensionally, b) identify the level of specialization in mental health among service-providers, and c) identify associations between mental health problems and contact with different types of health services. Methods This cross-sectional school-based study (response-rate 88%, n = 11154) is based on Norwegian health surveys among 15 and 16 year olds. Results We found a dose-response association between symptom-load and help seeking. Only 34% of individuals with mental symptom-load above 99th percentile reported help-seeking in the last 12 months. Forty percent of help seekers were in contact with specialists (psychiatrists or psychologists), the remaining were mainly in contact with GPs. Mental health problems increased help seeking to all twelve service providers examined. Conclusion It might not be reasonable to argue that all adolescents with case-level mental health problems are in need of treatment. However, concerning the 99th percentile, claiming treatment need is less controversial. Even in the Norwegian context where mental health services are relatively available and free of charge, help-seeking in individuals with the highest symptom-loads is still low. Most help seekers achieved contact with health care providers, half of them at a non specialized level. Our results suggest that adolescents' recognition of mental health problems or intention to seek help for these are the major "filters" restricting treatment. PMID:16480522
Alvarez, Patricia Elizabeth Sanz de; Rosendo, Ernestina; Alchieri, João Carlos
To present reflections on the type of research conducted on a treatment adherence among users of Public Mental Health System in Brazil and discuss the applicability of the concept of adherence to treatment in this context. Literature review in SciELO, LILACS, Cochrane Library and PubMed / MEDLINE using the Health Sciences Descriptors (DeCS) treatment, adhesion and "mental health" and the specific vocabulary of the Medical Subject Headings (MeSH) "patient compliance/psychologist" y "mental health". They were included for review the complete texts and theses published between 2007-2012 in Portuguese, English and Spanish. 127 articles were recovered, 32 specifically related to mental health. Eight were excluded for duplicates and after reading the remaining 24 articles were selected for this study 10 conducted in the field of Mental Health in Brazil. No investigations have been identified with focus on adherence to psychosocial treatment offered in public mental health. disregard of the mental health legislation and reinforce the asylum model of assistance. Presentar reflexiones sobre el tipo de investigaciones realizadas en Brasil sobre la adhesión al tratamiento de los usuarios del Sistema Público de Salud Mental y discutir la aplicabilidad del concepto de adhesión al tratamiento en dicho contexto. Revisión bibliográfica en las bases SciELO, LILACS, Biblioteca Cochrane y PubMed/MEDLINE utilizando los descriptores de Ciencias de la Salud (DeCS) adhesión, tratamiento y "salud mental" y el vocabulario específico de Medical Subject Headings (MeSH) "patient compliance/psychologist" y "mental health". Se incluyeron los textos completos y las tesis publicadas entre 2007-2012, en portugués, inglés y español. F1eron recuperados 127 artículos, 32 específicamente de la salud mental. Se excluyeron los 8 duplicados y de los 24 restantes fueron seleccionados para el presente trabajo los 10 realizados en Brasil. No se identificaron enfoques sobre la adhesión al
Smolak, A; Gearing, R E; Alonzo, D; Baldwin, S; Harmon, S; McHugh, K
The perceptions and religious beliefs held by family members, mental health and health care professionals, and the community may affect the treatment of individuals with schizophrenia. To better identify and understand the influence of families, professionals and community members on individual's treatment for schizophrenia, this review paper examines: (1) the religious perceptions of families, professionals, and the public towards schizophrenia; (2) religious perceptions of the etiology of schizophrenia; (3) how others perceive religion as a coping mechanism; and (4) how religion influences treatment engagement and help-seeking behaviors. MEDLINE and PsycInfo databases were systematically searched from 1980 to 2010 using the terms schizophrenia, schizoaffective, schizophreniform, psychotic disorder not otherwise specified and religion, religiosity, spirituality, and faith. Forty-three (n = 43) original research studies met the inclusion criteria. This study found that religious beliefs influence the treatment of schizophrenia in the following ways: Religious themes were positively associated with coping, treatment engagement and help-seeking behavior. Evidence of religious underpinnings was found in perceptions of etiology. The findings also indicate that there is often both a preference among family members and caregivers to utilize religious-based professionals and caution toward mental health professionals. Researchers and professionals may find avenues for improving treatment through examining the interaction of religious and schizophrenia at the social support level.
Brown, Larry K.; Hadley, Wendy; Stewart, Angela; Lescano, Celia; Whiteley, Laura; Donenberg, Geri; DiClemente, Ralph
Objective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and…
This book presents an overview of the major types of mental disorders, accompanied by treatment models that are structured, comprehensive, grounded in research, and likely to be effective. Chapter topics are: (1) "Introduction to Effective Treatment Planning"; (2) "Mental Disorders in Infants, Children, and Adolescents"; (3) "Situationally…
Moskos, Michelle A.; Olson, Lenora; Halbern, Sarah R.; Gray, Doug
Forty-nine suicide cases were drawn from an original sample of 151 consecutive youth suicide deaths. We used information from 270 interviews with parents and other survivors to evaluate mental health treatment sought for and by the decedent and barriers to mental health treatment. Participants reported the same primary barriers for the decedent:…
Ketchen Lipson, Sarah; Gaddis, S Michael; Heinze, Justin; Beck, Kathryn; Eisenberg, Daniel
On US college campuses, mental health problems are highly prevalent, appear to be increasing, and are often untreated. Concerns about student mental health are well documented, but little is known about potential variations across the diversity of institutions of higher education. Participants were 43,210 undergraduates at 72 campuses that participated in the Healthy Minds Study from 2007 to 2013. Multivariable logistic regressions focus on associations between institutional characteristics and student mental health and treatment utilization. The following institutional characteristics are associated with worse mental health: doctoral-granting, public, large enrollment, nonresidential, less competitive, and lower graduation rates. Among students with apparent mental health problems, treatment utilization is higher at doctorate-granting institutions, baccalaureate colleges, institutions with small enrollments, and schools with strong residential systems. Although high rates of mental health problems and low treatment utilization are major concerns at all types of institutions of higher education, substantial variation occurs across campuses.
Chisholm, Katharine; Patterson, Paul; Greenfield, Sheila; Turner, Erin; Birchwood, Max
Understanding how adolescents perceive mental illness is important for clinicians wishing to improve engagement, and for the development of educational programmes and health-behaviour directed policies. The current research aimed to develop a preliminary model of how adolescents perceive mental illness and construct their understanding of mental health. Forty-six participants aged 11-18 from six schools in Birmingham, UK, took part in one of 12 group interviews. A thematic analysis highlighted a dual perception of mental illness. Adolescents discussed stereotypes and extreme examples of illness, but also displayed an insightful understanding of mental distress which had developed through participants' own experiences. Participants attempted to reconcile and negotiate these conflicting perceptions by creating distinctions between concepts of 'craziness' and 'normality', and reported experiencing negative emotions relating to both perceptions of illness. The findings suggest that once media stereotypes have been acknowledged, adolescents demonstrate a relatively sophisticated understanding of mental illness, although one which differed at times from the diagnostic medical model of mental illness. Focusing on individual symptoms, prevalence rates and prior contact adolescents have had with individuals with mental illnesses provides a framework to discuss mental health and ill-health with adolescents. John Wiley & Sons Australia, Ltd.
Skarbø, Tove; Rosenvinge, Jan H; Holte, Arne
Many studies report associations between alcohol problems, mental disorder, mental health and suicidal behaviour. Still, more knowledge is needed about possible differential characteristics of these factors in risk groups. This naturalistic and retrospective study included former patients who received emergency treatment in child and adolescent outpatient clinics for their mental health problems. One hundred patients were personally interviewed 5-9 years after treatment referral about alcohol problems and mental disorders. Also, they completed questionnaires about 11 indicators of mental health. At the follow-up, those who had attempted suicide during the follow-up period had more alcohol problems and mental disorders than the non-attempters. However, no association was found between suicide attempt in the follow-up period and the mental health indicators. Among the attempters, a high psychological burden as indicated by mental health disorders and poor mental health were associated with suicide re-attempt (lifetime) and an intention to die.
Fortney, John C; Curran, Geoffrey M; Hunt, Justin B; Lu, Liya; Eisenberg, Daniel; Valenstein, Marcia
A Web-based survey examined treatment seeking among community college students to inform the design of engagement interventions. Veteran and civilian community college students (N=765) were screened for mental disorders and reported perceptions of treatment need, effectiveness, and stigma, as well as service use. Regression analysis identified predictors of pharmacotherapy and psychotherapy use. Of the 511 students who screened positive for a current mental disorder or reported a perceived need for treatment (149 veterans and 362 civilians), 30% reported past-year use of psychotropic medications. Predictors were perceived treatment need (odds ratio [OR]=7.81, p<.001) and the perception that psychotropic medications are effective (OR=3.38, p=.012). Eleven percent of participants reported past-year psychotherapy use, and predictors were a positive screen for posttraumatic stress disorder (OR=2.78, p=.04) and poorer financial status. Modifiable barriers, including perceived need for and effectiveness of treatment, were correlated with pharmacotherapy use and should be targeted by engagement interventions.
Objective: Key Words: Explanatory models; Traditional healers; Mental illness; South AfricaIn many traditional belief systems in Africa, including South Africa, mental health problems may be attributed to the influence of ancestors or to bewitchment. Traditional healers are viewed as having the expertise to address these ...
Eno Louden, Jennifer; Manchak, Sarah M
Mental health treatment adherence is often required for offenders with mental illness supervised on probation and parole. However, research on offenders with mental illness has largely overlooked cultural and ethnic responsivity factors that may affect adherence to treatment. Latinos are a quickly growing subgroup of offenders whose social networks differ in meaningful ways from European Americans' (e.g., size, composition, centrality of family). Social networks are known to relate to both clinical and criminal justice outcomes for offenders with mental illness, and there are features of nonoffender Latinos' social networks that suggest that findings distilled from work with non-Latino offenders may not apply to them. The present study examined the social networks of 86 Latino probationers with serious mental illness to (a) describe the size and composition of these networks and (b) to determine which factors of social networks are related to treatment adherence. The authors found that Latino offenders' social networks are small (∼6 individuals), consisting primarily of family and professionals such as treatment providers and probation officers. Supportive relationships with nonprofessionals and treatment providers was related to lower likelihood of missing treatment appointments, whereas social control and pressure from family and friends to attend treatment was not related to treatment adherence. Findings are discussed within the context of improved practices for community corrections and mental health agencies in working with Latino offenders with mental illness. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Gravenhorst, Franz; Muaremi, Amir; Bardram, Jakob
Mental disorders can have a significant, negative impact on sufferers’ lives, as well as on their friends and family, healthcare systems and other parts of society. Approximately 25 % of all people in Europe and the USA experience a mental disorder at least once in their lifetime. Currently......, monitoring mental disorders relies on subjective clinical self-reporting rating scales, which were developed more than 50 years ago. In this paper, we discuss how mobile phones can support the treatment of mental disorders by (1) implementing human–computer interfaces to support therapy and (2) collecting...... relevant data from patients’ daily lives to monitor the current state and development of their mental disorders. Concerning the first point, we review various systems that utilize mobile phones for the treatment of mental disorders. We also evaluate how their core design features and dimensions can...
Kong, Camillia; Dunn, Michael; Parker, Michael
Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with the genomics revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health.
Bradizza, Clara M.; Maisto, Stephen A.; Vincent, Paula C.; Stasiewicz, Paul R.; Connors, Gerard J.; Mercer, Nicole D.
Few investigators studying alcohol abuse among individuals with a severe mental illness (SMI) have examined predictors of posttreatment alcohol outcomes. In the present study, a multivariate approach based on a theoretical model was used to study the relationship between psychosocial factors and post-treatment-initiation alcohol use. Predictors of…
Tewari, Abha; Kallakuri, Sudha; Devarapalli, Siddhardha; Jha, Vivekanand; Patel, Anushka; Maulik, Pallab K.
Background Availability of basic mental health services is limited in rural areas of India. Health system and individual level factors such as lack of mental health professionals and infrastructure, poor awareness about mental health, stigma related to help seeking, are responsible for poor awareness and use of mental health services. We implemented a mental health services delivery model that leveraged technology and task sharing to facilitate identification and treatment of common mental di...
Ventegodt, Søren; Andersen, Niels Jørgen; Neikrug, Shimshon; Kandel, Isack; Merrick, Joav
We believe that holistic medicine can be used for patient's with mental health disorders. With holistic psychiatry, it is possible to help the mentally ill patient to heal existentially. As in holistic medicine, the methods are love or intense care, winning the trust of the patient, getting permission to give support and holding, and daring to be fully at the patient's service. Our clinical experiences have led us to believe that mental health patient's can heal if only you can make him or he...
Mumbauer, Janyna; Kelchner, Viki
Considering that one in five children has or has had a mental disorder in a given year (National Institute of Mental Health, 2010), the demand for mental health services within the school setting is immense. Bibliotherapy can serve as a preventative and responsive treatment for increasing mental health literacy within the school setting. The…
National Institute of Mental Health (NIMH), 2009
Research shows that half of all lifetime cases of mental illness begin by age 14. Scientists are discovering that changes in the body leading to mental illness may start much earlier, before any symptoms appear. Through greater understanding of when and how fast specific areas of children's brains develop, we are learning more about the early…
Abel, Kristine Fiksdal; Skjærvø, Ingeborg; Ravndal, Edle; Clausen, Thomas; Bramness, Jørgen G
Levels of mental distress are high in patients with substance use disorders (SUD) and investigation of correlates may broaden our understanding of this comorbidity. We investigated self-reported symptoms of mental distress among individuals entering either outpatient opioid maintenance treatment (OMT) or other inpatient SUD treatment and related factors, with a particular focus on perceived self-control. A cross-sectional study including substance users (n = 548; mean age 34 years; 27% women) entering treatment at 21 different treatment-centers across Norway, interviewed between December 2012 and April 2015. Symptoms of mental distress were assessed with Global Symptom Index (GSI) score. Adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) were estimated through multinomial logistic regression. More than half of the participants in both treatment groups reported mental distress (GSI) above clinical cut-off. The use of alcohol and exposure to violence were associated with increased likelihood of high GSI for both patient groups. Also, lower perceived self-control was related to high GSI in both treatment groups. Symptoms of mental distress were equally common among patients entering OMT and those entering other inpatient SUD treatment, even if the patients differed on a number of clinical characteristics. Use of alcohol and exposure to violence were associated with more mental distress in both groups. Perceived self-control also appeared to be important when explaining symptoms of mental distress among these SUD patients.
Full Text Available Abstract Background In clinical practice, sleep disturbance is often regarded as an epiphenomenon of the primary mental disorder. The aim of this study was to test if sleep disturbance, independently of primary mental disorders, is associated with current clinical state and benefit from treatment in a sample representative of public mental health care clinics. Method 2246 patients receiving treatment for mental disorders in eight public mental health care centers in Norway were evaluated in a cross-sectional study using patient and clinician reported measures. Patients reported quality of life, symptom severity, and benefit from treatment. Clinicians reported disorder severity, level of functioning, symptom severity and benefit from treatment. The hypothesis was tested using multiple hierarchical regression analyses. Results Sleep disturbance was, adjusted for age, gender, time in treatment, type of care, and the presence of any primary mental disorder, associated with lower quality of life, higher symptom severity, higher disorder severity, lower levels of functioning, and less benefit from treatment. Conclusion Sleep disturbance ought to be considered a stand-alone therapeutic entity rather than an epiphenomenon of existing diagnoses for patients receiving treatment in mental health care.
Currier, Joseph M; McDermott, Ryon C; McCormick, Wesley H
Record numbers of military veterans are enrolling at colleges/universities across the United States. Although a substantive subset might suffer from mental health problems, the majority of these students might not be amenable to utilizing services. The purpose of this study was to examine the role of treatment-related stigma in intentions to seek professional help among undergraduate student veterans at a university on the U.S. Gulf Coast. Focusing on 251 veterans and a gender-matched comparison group of 251 nonveterans, student veterans endorsed higher probabilities of seeking care from physicians (d = .77) and psychologists or other professionals (d = .67). In addition, nonveteran students had greater self-stigma about seeking help (d = -.27) but veterans had more negative beliefs about treatment efficacy (d = 1.07). When compared with veterans who did not exceed clinical thresholds, those with a probable need for treatment had more stigma (ds = .63). Multivariate analyses also revealed an inverse main effect of self-stigma on intentions to seek help from both professional categories. However, military experience differentially moderated associations between treatment-related beliefs and intentions to seek mental health services. Finally, exploratory analyses identified that student veterans were most likely to engage in therapy/counseling at a Veterans Affairs Medical Center or Clinic, Vet Center, or other noninstitutionally sponsored settings in the community (e.g., private practices, faith-based organizations). Looking ahead, these findings will inform research and the provision of services for addressing the mental health needs of this substantive subpopulation of college students in the United States. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Rastogi, Pramit; Khushalani, Sunil; Dhawan, Swaran; Goga, Joshana; Hemanth, Naveena; Kosi, Razia; Sharma, Rashmi K; Black, Betty S; Jayaram, Geetha; Rao, Vani
Little is known about the presentation of mental health symptoms among South Asians living in the US. To explore mental health symptom presentation in South Asians in the US and to identify facilitators and barriers to treatment. Focus group study. Four focus groups were conducted with 7-8 participants in each group. All participants (N = 29) were clinicians who had been involved in the care of South Asian patients with emotional problems and/or mental illness in the US. Qualitative content analysis. Key themes identified included: generational differences in symptom presentation, stress was the most common symptom for younger South Asians (40 years of age). Substance abuse and verbal/physical/sexual abuse were not uncommon but were often not reported spontaneously. Stigma and denial of mental illness were identified as major barriers to treatment. Facilitators for treatment included use of a medical model and conducting systematic but patient-centered evaluations. South Asians living in the US present with a variety of mental health symptoms ranging from stress associated with acculturation to major mental illnesses. Facilitating the evaluation and treatment of South Asians with mental illness requires sensitivity to cultural issues and use of creative solutions to overcome barriers to treatment. Copyright © 2013 Elsevier B.V. All rights reserved.
Huang, Xuan-Yi; Lin, Mei-Jue; Yang, Tuz-Ching; Hsu, Yuan-Shan
The purposes of this study were to understand the functions of hospital-based home care for people with severe mental illness in Taiwan, and the factors that affect functions of professionals who provide hospital-based home care. Hospital-based home care is a service which provides those people with serious mental illnesses who are in crisis and who are candidates for admission to hospital. Home care has been shown to have several advantages over inpatient treatment. However, there is a lack of knowledge about the functions of hospital-based home care for people with severe mental illness in Taiwan. This qualitative study was based on the grounded theory method of Strauss and Corbin. The study was conducted in six different hospital areas in central Taiwan in 2007-2008. Data were collected using semi-structured face-to-face interviews. Constant comparative analysis continued during the open, axial and selective coding processes until data saturation occurred. Participants were selected by theoretical sampling. When theoretical saturation was achieved, 21 clients with mental illness, 19 carers and 25 professionals were interviewed. Several functions were found when these professionals provided hospital-based home care services for people with severe mental illness in Taiwan, including stabilising the clients illness, supplying emergency care services, improving life-coping abilities, employment and welfare assistance, emotional support for both clients and carers, assistance with future and long-term arrangements and assistance with communication between carers and clients. Hospital-based home care provides several important services for helping clients and their families to live in the community. The recommendations based on the findings of this study can be used as a guide to improve the delivery of hospital-based home care services to community-dwelling clients with severe mental illness and their carers.
Harris, Anthony Wf; Kosic, Tanya; Xu, Jean; Walker, Chris; Gye, William; Redoblado Hodge, Antoinette
Finding work is a top priority for most people; however, this goal remains out of reach for the majority of individuals with a severe mental illness (SMI) who remain on benefits or are unemployed. Supported employment (SE) programs aimed at returning people with a severe mental illness to work are successful; however, they still leave a significant number of people with severe mental illness unemployed. Cognitive deficits are commonly found in SMI and are a powerful predictor of poor outcome. Fortunately, these deficits are amenable to treatment with cognitive remediation therapy (CRT) that significantly improves cognition in SMI. CRT combined with SE significantly increases the likelihood of individuals with severe mental illness obtaining and staying in work. However, the availability of CRT is limited in many settings. The aim of this study was to examine whether Web-based CRT combined with a SE program can improve the rate return to work of people with severe mental illness. A total of 86 people with severe mental illness (mean age 39.6 years; male: n=55) who were unemployed and who had joined a SE program were randomized to either a Web-based CRT program (CogRem) or an Internet-based control condition (WebInfo). Primary outcome measured was hours worked over 6 months post treatment. At 6 months, those participants randomized to CogRem had worked significantly more hours (P=.01) and had earned significantly more money (P=.03) than those participants randomized to the WebInfo control condition. No change was observed in cognition. This study corroborates other work that has found a synergistic effect of combining CRT with a SE program and extends this to the use of Web-based CRT. The lack of any improvement in cognition obscures the mechanism by which an improved wage outcome for participants randomized to the active treatment was achieved. However, the study substantially lowers the barrier to the deployment of CRT with other psychosocial interventions for
Maulik, P. K.; Devarapalli, S.; Kallakuri, S.; Praveen, D.; Jha, V.; Patel, A.
Background. India has few mental health professionals to treat the large number of people suffering from mental disorders. Rural areas are particularly disadvantaged due to lack of trained health workers. Ways to improve care could be by training village health workers in basic mental health care, and by using innovative methods of service delivery. The ongoing Systematic Medical Appraisal, Referral and Treatment Mental Health Programme will assess the acceptability, feasibility and prelimina...
Sullivan, Christopher J.; Sacks, Stanley; McKendrick, Karen; Banks, Steven; Sacks, Joann Y.; Stommel, Joseph
This paper examines outcomes 12 months post-prison release for offenders with co-occurring disorders (n = 185) randomly assigned to either a mental health control treatment (C) or a modified therapeutic community (E). Significant between-group differences were not found for mental health measures, although improvements were observed for each…
Ghaziuddin, M.; And Others
The report describes the successful treatment of trichotillomania (compulsive hair pulling) in a mentally retarded 11-year-old boy with autism and severe mental retardation. Administration of haloperidol resulted in complete cessation of hair pulling which reappeared when the dosage was decreased and ceased again when dosage was reestablished. (DB)
Becker, Kimberly D.; Brandt, Nicole Evangelista; Stephan, Sharon H.; Chorpita, Bruce F.
We examined the measurement of educational outcomes related to children's mental health treatments. A total of 85 papers describing 88 randomized controlled trials that included at least one educational outcome and one mental health outcome were included in these analyses. Forty-five different measures were identified as the primary educational…
Elzakkers, Isis F F M; Danner, Unna N; Hoek, Hans W; van Elburg, Annemarie A
BACKGROUND: Mental capacity to consent to treatment in anorexia nervosa is a neglected area in clinical decision-making. AIMS: To examine clinical and neuropsychological parameters associated with diminished mental capacity in anorexia nervosa. METHOD: An explorative study was conducted in 70 adult
Jochems, Eline C; van Dam, Arno; Duivenvoorden, Hugo J; Scheffer, Sylvia C M; van der Feltz-Cornelis, Christina M; Mulder, Niels L
The present study assessed motivation for engaging in treatment as rated by clinicians (n = 57) and patients with severe mental illness (SMI, n = 294) using measures based on three different motivation theories. Questionnaires were derived from self-determination theory, the transtheoretical model and the integral model of treatment motivation. It was investigated to which extent clinicians of patients with SMI were able to estimate their patient's perspective on motivation for engaging in treatment, to which extent they agreed on the patient's motivation and which factors were associated with estimation and agreement on treatment motivation. It was found that clinicians were poorly to moderately capable of estimating their patient's type of motivation and readiness for change. Further, agreement on the level of motivation between patients and clinicians was moderate. These findings were consistent across diagnostic groups (psychotic and personality disorders). A higher quality therapeutic relationship was generally associated with higher clinician-rated motivation. The patient's ethnicity and socially desirable responding were factors that differentiated between scales of different motivation theories. It is concluded that patients with SMI and their clinicians have different perceptions on the patient's motivation for engaging in psychiatric treatment, regardless of the theoretical framework that is used to measure motivation. The findings imply that a negotiated approach is needed where both perceptions of clinicians and patients on motivation for treatment are considered to ensure effective mental health interventions. Copyright © 2015 John Wiley & Sons, Ltd. Clinicians show poor to moderate capability in estimating how patients perceive their motivation for engaging in treatment, especially so when the patient's motives revolve around feelings of shame and guilt. Clinicians generally give higher motivation ratings for patients where they experience a
Wong, Eunice C; Collins, Rebecca L; Cerully, Jennifer L; Yu, Jennifer W; Seelam, Rachana
Mental illness stigma disproportionately affects help seeking among youth, men, and ethnic minorities. As part of a comprehensive statewide initiative to reduce mental illness stigma and discrimination in California, a broad set of contact-based educational programs were widely disseminated. This study examined whether the effects of contact-based educational programs varied depending on the age, gender, and race-ethnicity of participants. Participants (N = 4122) attended a contact-based educational program that was delivered as part of the statewide initiative to reduce mental illness stigma and discrimination. Self-administered surveys assessing beliefs, attitudes, and intentions toward mental illnesses and treatment were conducted immediately before and after participation in contact-based educational programs. Participant age, gender, and race-ethnicity significantly moderated pre-post changes in mental illness stigma. Although all groups exhibited significant pre-post changes across most of the stigma domains assessed, young adults, females, and Asian and Latino American participants reported larger improvements compared to older adults, males, and Whites, respectively. Findings suggest that contact-based educational programs can achieve immediate reductions in mental illness stigma across a variety of sociodemographic groups and may particularly benefit young adults and racial-ethnic minorities. Further research is needed to assess whether contact-based educational programs can sustain longer-term changes and aid in the reduction of disparities in mental illness stigma and treatment.
Musiat, Peter; Goldstone, Philip; Tarrier, Nicholas
E-mental health and m-mental health include the use of technology in the prevention, treatment and aftercare of mental health problems. With the economical pressure on mental health services increasing, e-mental health and m-mental health could bridge treatment gaps, reduce waiting times for patients and deliver interventions at lower costs. However, despite the existence of numerous effective interventions, the transition of computerised interventions into care is slow. The aim of the present study was to investigate the acceptability of e-mental health and m-mental health in the general population. An advisory group of service users identified dimensions that potentially influence an individual's decision to engage with a particular treatment for mental health problems. A large sample (N = 490) recruited through email, flyers and social media was asked to rate the acceptability of different treatment options for mental health problems on these domains. Results were analysed using repeated measures MANOVA. Participants rated the perceived helpfulness of an intervention, the ability to motivate users, intervention credibility, and immediate access without waiting time as most important dimensions with regard to engaging with a treatment for mental health problems. Participants expected face-to-face therapy to meet their needs on most of these dimensions. Computerised treatments and smartphone applications for mental health were reported to not meet participants' expectations on most domains. However, these interventions scored higher than face-to-face treatments on domains associated with the convenience of access. Overall, participants reported a very low likelihood of using computerised treatments for mental health in the future. Individuals in this study expressed negative views about computerised self-help intervention and low likelihood of use in the future. To improve the implementation and uptake, policy makers need to improve the public perception of such
Lisa C. Kooistra
Discussion: Although no conclusions can be drawn based on the current study, our observations suggest that a blended CBT approach might shorten treatment duration and has the potential to be a valuable treatment option for patients with severe depression in specialized mental health care settings. Further exploration of the effectiveness of our bCBT protocol by means of a randomized controlled trial is warranted.
Hooten, W Michael
Chronic pain and mental health disorders are common in the general population, and epidemiological studies suggest that a bidirectional relationship exists between these 2 conditions. The observations from functional imaging studies suggest that this bidirectional relationship is due in part to shared neural mechanisms. In addition to depression, anxiety, and substance use disorders, individuals with chronic pain are at risk of other mental health problems including suicide and cigarette smoking and many have sustained sexual violence. Within the broader biopsychosocial model of pain, the fear-avoidance model explains how behavioral factors affect the temporal course of chronic pain and provides the framework for an array of efficacious behavioral interventions including cognitive-behavioral therapy, acceptance-based therapies, and multidisciplinary pain rehabilitation. Concomitant pain and mental health disorders often complicate pharmacological management, but several drug classes, including serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and anticonvulsants, have efficacy for both conditions and should be considered first-line treatment agents. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
Mancini, Anthony D; Moser, Lorna L; Whitley, Rob; McHugo, Gregory J; Bond, Gary R; Finnerty, Molly T; Burns, Barbara J
This study identified barriers and facilitators to the high-fidelity implementation of assertive community treatment. As part of a multistate implementation project for evidence-based practices, training and consultation were provided to 13 newly implemented assertive community treatment teams in two states. Model fidelity was assessed at baseline and at six, 12, 18, and 24 months. Key informant interviews, surveys, and monthly on-site visits were used to monitor implementation processes related to barriers and facilitators. Licensing processes of the state mental health authority provided critical structural supports for implementation. These supports included a dedicated Medicaid billing structure, start-up funds, ongoing fidelity monitoring, training in the model, and technical assistance. Higher-fidelity sites had effective administrative and program leadership, low staff turnover, sound personnel practices, and skilled staff, and they allocated sufficient resources in terms of staffing, office space, and cars. Lower-fidelity sites were associated with insufficient resources, prioritization of fiscal concerns in implementation, lack of change culture, poor morale, conflict among staff, and high staff turnover. In cross-state comparisons, the specific nature of fiscal policies, licensing processes, and technical assistance appeared to influence implementation. State mental health authorities can play a critical role in assertive community treatment implementation but should carefully design billing mechanisms, promote technical assistance centers, link program requirements to fidelity models, and limit bureaucratic requirements. Successful implementation at the organizational level requires committed leadership, allocation of sufficient resources, and careful hiring procedures.
Kline, Emily R; Chokran, Cole; Rodenhiser-Hill, Janine; Seidman, Larry J; Woodberry, Kristen A
Many school districts in the United States employ mental health professionals to provide assessment, counselling and crisis interventions within the school setting; however, little is known about actual clinical practices of psychosis screening in schools. The aim of the present study is to examine attitudes and practices regarding psychosis screening among school mental health providers in metropolitan Boston, Massachusetts. School-based mental health clinicians (N = 100) completed an anonymous survey assessing familiarity, screening, and involvement with psychosis and psychosis risk prior to attending trainings on psychosis. Providers reported screening for psychosis less often than other mental health problems and rated themselves as less confident treating psychosis relative to other mental health concerns. Frequency of screening for psychosis was significantly associated with familiarity with psychosis assessment and case management, confidence providing treatment for individuals experiencing psychosis, and the number of students with or at risk for psychosis with whom providers had been involved. Frequency of screening for psychosis was not associated with years of practice, suggesting that both novice and experienced school-based providers may benefit from training on this issue. Community outreach via school-based provider training on assessment and management of psychosis may help to increase providers' understanding of psychosis and increase the practice of verbal or written screening for psychosis and psychosis risk within schools. © 2018 John Wiley & Sons Australia, Ltd.
Raven, D; Jörg, F; Visser, E; Oldehinkel, A J; Schoevers, R A
Timely recognition and treatment of mental disorders with an onset in childhood and adolescence is paramount, as these are characterized by greater severity and longer persistence than disorders with an onset in adulthood. Studies examining time-to-treatment, also referred to as treatment delay, duration of untreated illness or latency to treatment, and defined as the time between disorder onset and initial treatment contact, are sparse and all based on adult samples. The aim of this study was to describe time-to-treatment and its correlates for any health care professional (any care) and secondary mental health care (secondary care), for a broad range of mental disorders, in adolescents. Data from the Dutch community-based cohort study TRacking Adolescents' Individual Lives Survey (TRAILS; N = 2230) were used. The Composite International Diagnostic Interview (CIDI) was administered to assess DSM-IV disorders, the age of onset, and the age of initial treatment contact with any health care professional in 1584 adolescents of 18-20 years old. In total 43% of the adolescents (n = 675) were diagnosed with a lifetime DSM-IV disorder. The age of initial treatment contact with secondary care was based on administrative records from 321 adolescents without a disorder onset before the age of 10. Descriptive statistics, cumulative lifetime probability plots, and Cox regression analyses were used analyze time-to-treatment. The proportion of adolescents who reported lifetime treatment contact with any care varied from 15% for alcohol dependence to 82% for dysthymia. Regarding secondary care, proportions of lifetime treatment contact were lower for mood disorders and higher for substance dependence. Time-to-treatment for any care varied considerably between and within diagnostic classes. The probability of lifetime treatment contact for mood disorders was above 90%, whereas for other mental disorders this was substantially lower. An earlier age of onset predicted a longer, and
Jimenez, Daniel E.; Bartels, Stephen J.; Cardenas, Veronica; Daliwal, Sanam S.; Alegría, Margarita
Background Beliefs concerning the causes of mental illness may help explain why there are significant disparities in the rates of formal mental health service use among racial/ethnic minority elderly as compared with their Caucasian counterparts. This study applies the Cultural Influences on Mental Health framework to identify the relationship between race/ethnicity and differences in: (1) beliefs on the cause of mental illness; (2) preferences for type of treatment; and (3) provider characteristics. Method Analyses were conducted using baseline data collected from participants who completed the Cultural Attitudes toward Healthcare and Mental Illness Questionnaire, developed for the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) study, a multi-site randomized trial for older adults (65+) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1257 non-Latino Whites, 536 African-Americans, 112 Asian-Americans, and 303 Latinos. Results African-Americans, Asian-Americans, and Latinos had differing beliefs regarding the causes of mental illness when compared to Non-Latino Whites. Race/ethnicity was also associated with determining who makes healthcare decisions, treatment preferences, and preferred characteristics of healthcare providers. Conclusions This study highlights the association between race/ethnicity and health beliefs, treatment preferences, healthcare decisions, and consumers' preferred characteristics of healthcare providers. Accommodating the values and preferences of individuals can be helpful in engaging racial/ethnic minority patients in mental health services. PMID:21992942
Jimenez, Daniel E; Bartels, Stephen J; Cardenas, Veronica; Dhaliwal, Sanam S; Alegría, Margarita
Beliefs concerning the causes of mental illness may help to explain why there are significant disparities in the rates of formal mental health service use among racial/ethnic minority elderly as compared with their white counterparts. This study applies the cultural influences on mental health framework to identify the relationship between race/ethnicity and differences in 1) beliefs on the cause of mental illness, 2) preferences for type of treatment, and 3) provider characteristics. Analyses were conducted using baseline data collected from participants who completed the cultural attitudes toward healthcare and mental illness questionnaire, developed for the Primary Care Research in Substance Abuse and Mental Health for the Elderly study, a multisite randomized trial for older adults (65+) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1,257 non-Latino whites, 536 African Americans, 112 Asian Americans, and 303 Latinos. African Americans, Asian Americans, and Latinos had differing beliefs regarding the causes of mental illness when compared with non-Latino whites. Race/ethnicity was also associated with determining who makes healthcare decisions, treatment preferences, and preferred characteristics of healthcare providers. This study highlights the association between race/ethnicity and health beliefs, treatment preferences, healthcare decisions, and consumers' preferred characteristics of healthcare providers. Accommodating the values and preferences of individuals can be helpful in engaging racial/ethnic minority patients in mental health services.
Erdal, Kristi; Singh, Namrita; Tardif, Annette
Internationally, depression is a common psychological disorder whose treatment depends upon its identification by treating professionals as well as patient utilization of mental health care systems; the latter often being hampered by cultural differences between patients and health professionals. The current study used vignettes of depressed patients which varied the culture and/or social circumstances of the patient to assess whether these variables influenced the conceptualization of depression and its treatment. Participants (N=722) included mental health professionals, lay people, immigrants, and refugees in Norway. We found that immigrants and refugees, particularly those of non-western origin, endorsed different types of depression treatments from native Norwegians and mental health professionals, and judged who deserved treatment and who was overreacting based on the patient's culture and social circumstances, while native Norwegians did not. While widely used cross-culturally, vignette methodology is limited in its generalizability to real clinical situations. Acculturation was not evaluated, which may have influenced the results. Findings support the integration of cultural competency ideals not only into treatment, but also into public health promotions of mental health services for lay people. Copyright © 2011 Elsevier B.V. All rights reserved.
Kemmeren, L. L.; van Schaik, D. J F; Riper, H.
is defined as the routine care that subjects receive when they are diagnosed with depression in specialised mental healthcare. Adult patients ≥ 18years old meeting DSM-IV diagnostic criteria for major depressive disorder will be recruited within participating outpatient specialised mental healthcare clinics......, but scientific evidence for the application in routine specialised mental healthcare settings is limited. Also, little is known about the clinical and health-economic benefits of blended treatment, where online interventions are integrated with face-to-face treatment of depression in one treatment protocol....... The primary aim of this study is to investigate the clinical and cost-effectiveness of blended Cognitive Behavioural Therapy (bCBT) for depression, as compared to treatment as usual (TAU) in specialised routine mental healthcare in the Netherlands. This trial is part of the E-COMPARED project which has...
Villatoro, Alice P.; Dixon, Elizabeth; Mays, Vickie M.
The Patient Protection and Affordable Care Act (ACA) is expected to increase access to mental healthcare through provisions aimed at increasing health coverage among the nation's uninsured, including 10.2 million eligible Latino non-elderly adults. The ACA will increase health coverage by expanding Medicaid eligibility to individuals living below 138% of the federal poverty level, subsidizing the purchase of private insurance among individuals not eligible for Medicaid, and requiring employers with 50 or more employees to offer health insurance. An anticipated result of this landmark legislation is improvement in the screening, diagnosis, and treatment of mental disorders in racial/ethnic minorities, particularly for Latinos, who traditionally have had less access to these services. However, these efforts alone may not sufficiently ameliorate mental healthcare disparities for Latinos. Faith-based organizations (FBOs) could play an integral role in the mental healthcare of Latinos by increasing help-seeking, providing religion-based mental health services, and delivering supportive services that address common access barriers among Latinos. Thus, in determining ways to eliminate Latino mental healthcare disparities under the ACA, examining pathways into care through the faith-based sector offers unique opportunities to address some of the cultural barriers confronted by this population. We examine how partnerships between FBOs and primary care patient-centered medical homes (PCMH) may help reduce the gap of unmet mental health needs among Latinos in this era of health reform. We also describe the challenges FBOs and PCMH providers need to overcome in order to be partners in integrated care efforts. PMID:26845492
Eaton, Julian; Agomoh, Ahamefula O
This grass-roots level mental health awareness programme considerably increased use of community-based mental health services in a part of Nigeria where knowledge about treatability of mental illness was limited. The benefits of the programme were sustained for a significant period after the initial awareness programme. In order for attitude changes to be reinforced, similar awareness programmes must be repeated at regular intervals.
Mandryk, R.L.; Birk, M.V.; Lobel, A.M.; Rooij, M.M.J.W. van; Granic, I.; Abeele, V. vanden
The community for research on video games for assessment and intervention for mental health spans multiple disciplines, from cognitive sciences, computer science, and interaction design, to psychology, neurobiology, and medicine. The goal of this workshop is to bring together an international group
Bouis, Stephanie; Reif, Susan; Whetten, Kathryn; Scovil, Janet; Murray, Andrea; Swartz, Marvin
The challenge of providing effective treatment services for the growing population of HIV-positive individuals who are also dually diagnosed with substance use and mental disorders has only recently been recognized as an important public health concern affecting both HIV treatment and prevention. This article describes a treatment model that was…
Marquez, Jorge A; Ramírez García, Jorge I
Family caregivers' views and experiences related to treatment usage processes by their adult relatives with serious and persistent mental illness (SPMI) were empirically examined in a sample of Latino caregivers (n = 17) who were users of services at the National Alliance on Mental Illness (NAMI) in a predominantly Latino- (80%) and Mexican-descent large city in the Southwest United States. We conducted a stability check of qualitative findings with a second sample of Latino caregivers with no exposure to NAMI (n = 15). Overall, the combined sample (N = 32) compared similarly with larger samples of Latino adults and caregivers in quantitative measures of acculturation, familism, caregiver stigma, and depression symptoms. Together, caregivers' stigma and cultural beliefs, such as vergüenza (shame), use of folk healers, and lack of insurance, were major reported barriers to service usage. Family support (and lack of) for treatment also weighed heavily as a facilitator (and a barrier) of service usage, thus highlighting the complexity of family relationship contexts. Substantial portions of caregivers reported that treatment initiation was prompted by psychiatric hospitalization (50%), and that positive experiences with service providers were influential in treatment retention (72%). Given the high levels of family involvement reported among Latino caregivers, the findings underscore the potential role of family caregivers in treatment engagement and retention. Future research is needed that examines family caregivers' role in treatment with models that consider the interplay between cultural background, family level relationships, and service system contexts. PsycINFO Database Record (c) 2013 APA, all rights reserved.
Full Text Available Introduction and goal: Religiosity and spirituality decreasesof the impact of life stress on the tendency to substance use. Everyday addedto the number of people who believe that spirituality is the way to treat neuroses and mental problems. This study aimed to determine the relationship between spiritual health and mental health in patients undergoing to methadone maintenance treatment (MMT dependent on the private and government sector in Sari. Method: This study was cross- sectional study. The target populations of this study were 123 women and men undergoing to methadone maintenance treatment (MMT. The data collected by spiritual and mental health questionnaire and were analyzed using two-sample t-test and spearman correlationin theSPSS (18 software. Findings: The grade average of spiritual health was 43/29 and mental health was 41/26.The results showed that a significant correlation between spiritual health with mental health. The highest correlation was between spiritual healthwith the social function and the lowestcorrelation was with physical problems. There was no significant relationshipbetween of marital status, number of children, sex and spiritual health. Conclusion: According to positive and significant role spiritual health in mental health, so, strengthen the spiritual dimension can to promote mental health and reduce mental disorders and the tendency to addiction.
Saeed, K; Gater, R; Hussain, A; Mubbashar, M
Although native faith healers are found in all parts of Pakistan, where they practice in harmony with the cultural value system, their practice is poorly understood. This study investigated the prevalence, classification and treatment of mental disorders among attenders at faith healers. The work of faith healers with 139 attenders was observed and recorded. The mental status of attenders was assessed using a two-stage design: screening using the General Health Questionnaire followed by diagnostic interview using the Psychiatric Assessment Schedule. The classification used by faith healers is based on the mystic cause of disorders: saya (27%), jinn possession (16%) or churail (14%). Sixty-one percent of attenders were given a research diagnosis of mental disorder: major depressive episode (24%), generalized anxiety disorder (15%) or epilepsy (9%). There was little agreement between the faith healers' classification and DSM-IIIR diagnosis. Faith healers use powerful techniques of suggestion and cultural psychotherapeutic procedures. Faith healers are a major source of care for people with mental health problems in Pakistan, particularly for women and those with little education. Further research should assess methods of collaboration that will permit people with mental health problems to access effective and culturally appropriate treatment.
Albaiti, A.; Liliasari, S.; Sumarna, O.; Martoprawiro, M. A.
Generic science skills (GSS) are required to develop student conception in learning binary system. The aim of this research was to know the improvement of students GSS through the binary system labotoratory activities based on their mental model using hypothetical-deductive learning cycle. It was a mixed methods embedded experimental model research design. This research involved 15 students of a university in Papua, Indonesia. Essay test of 7 items was used to analyze the improvement of students GSS. Each items was designed to interconnect macroscopic, sub-microscopic and symbolic levels. Students worksheet was used to explore students mental model during investigation in laboratory. The increase of students GSS could be seen in their N-Gain of each GSS indicators. The results were then analyzed descriptively. Students mental model and GSS have been improved from this study. They were interconnect macroscopic and symbolic levels to explain binary systems phenomena. Furthermore, they reconstructed their mental model with interconnecting the three levels of representation in Physical Chemistry. It necessary to integrate the Physical Chemistry Laboratory into a Physical Chemistry course for effectiveness and efficiency.
Jochems, Eline C; Mulder, Cornelis L; van Dam, Arno; Duivenvoorden, Hugo J; Scheffer, Sylvia C M; van der Spek, Willem; van der Feltz-Cornelis, Christina M
Treatment disengagement and non-completion poses a major problem for the successful treatment of patients with severe mental illness. Motivation for treatment has long been proposed as a major determinant of treatment engagement, but exact mechanisms remain unclear. This current study serves three purposes: 1) to determine whether a feedback intervention based on the patients' motivation for treatment is effective at improving treatment engagement (TE) of severe mentally ill patients in outpatient psychiatric treatment, 2) to gather insight into motivational processes and possible mechanisms regarding treatment motivation (TM) and TE in this patient population and 3) to determine which of three theories of motivation is most plausible for the dynamics of TM and TE in this population. The Motivation and Treatment Engagement Intervention Trial (MotivaTe-IT) is a multi-center cluster randomized trial investigating the effectiveness of feedback generated by clinicians regarding their patients' treatment motivation upon the patients' TE. The primary outcome is the patients' TE. Secondary outcomes are TM, psychosocial functioning and quality of life. Patients whose clinicians generate monthly motivation feedback (additional to treatment as usual) will be compared to patients who receive treatment as usual. An estimated 350 patients, aged 18 to 65 years, with psychotic disorders and/or severe personality disorders will be recruited from outpatient community mental health care. The randomization will be performed by a computerized randomization program, with an allocation ratio of 1:1 (team vs. team or clinician vs. clinician) and patients, but not clinicians, will be blind to treatment allocation at baseline assessment. Due to the nature of the trial, follow-up assessment can not be blinded. The current study can provide important insights regarding motivational processes and the way in which motivation influences the treatment engagement and clinical outcomes. The
Drukker, M; van Os, J; Sytema, S; Driessen, G; Visser, E; Delespaul, P
Previous work suggests that the Dutch variant of assertive community treatment (ACT), known as Function ACT (FACT), may be effective in increasing symptomatic remission rates when replacing a system of hospital-based care and separate community-based facilities. FACT guidelines propose a different pattern of psychiatric service consumption compared to traditional services, which should result in different costing parameters than care as usual (CAU). South-Limburg FACT patients, identified through the local psychiatric case register, were matched with patients from a non-FACT control region in the North of the Netherlands (NN). Matching was accomplished using propensity scoring including, among others, total and outpatient care consumption. Assessment, as an important ingredient of FACT, was the point of departure of the present analysis. FACT patients, compared to CAU, had five more outpatient contacts after the index date. Cost-effectiveness was difficult to assess. Implementation of FACT results in measurable changes in mental health care use.
Forsman, Anna K; Nordmyr, Johanna; Matosevic, Tihana; Park, A-La; Wahlbeck, Kristian; McDaid, David
This systematic review explored the effectiveness of technology-based interventions in promoting the mental health and wellbeing of people aged 65 and over. Data were collected as part of a wider review commissioned by the National Institute for Health and Care Excellence (NICE) in England on the effectiveness of different actions to promote the mental wellbeing and independence of older people. All studies identified through this review were subject to a detailed critical appraisal of quality, looking at internal and external validity. Twenty-one papers covering evaluations of technological interventions were identified. They examined the psychosocial effects of technologies for education, exposure to, and/or training to use, computers and the internet, telephone/internet communication and computer gaming. Few studies took the form of randomized controlled trials, with little comparability in outcome measures, resulting in an inconsistent evidence base with moderate strength and quality. However, three out of six studies with high or moderate quality ratings (all focused on computer/internet training) reported statistically significant positive effects on psychosocial outcomes, including increased life satisfaction and experienced social support, as well as reduced depression levels among intervention recipients. The review results highlight the need for more methodologically rigorous studies evaluating the effects of technology-based interventions on mental wellbeing. Well-performed technology-based interventions to promote various aspects of mental wellbeing, as identified in this review, can serve as best practice examples in this emerging field. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Hoermann, Simon; McCabe, Kathryn L; Milne, David N; Calvo, Rafael A
Synchronous written conversations (or "chats") are becoming increasingly popular as Web-based mental health interventions. Therefore, it is of utmost importance to evaluate and summarize the quality of these interventions. The aim of this study was to review the current evidence for the feasibility and effectiveness of online one-on-one mental health interventions that use text-based synchronous chat. A systematic search was conducted of the databases relevant to this area of research (Medical Literature Analysis and Retrieval System Online [MEDLINE], PsycINFO, Central, Scopus, EMBASE, Web of Science, IEEE, and ACM). There were no specific selection criteria relating to the participant group. Studies were included if they reported interventions with individual text-based synchronous conversations (ie, chat or text messaging) and a psychological outcome measure. A total of 24 articles were included in this review. Interventions included a wide range of mental health targets (eg, anxiety, distress, depression, eating disorders, and addiction) and intervention design. Overall, compared with the waitlist (WL) condition, studies showed significant and sustained improvements in mental health outcomes following synchronous text-based intervention, and post treatment improvement equivalent but not superior to treatment as usual (TAU) (eg, face-to-face and telephone counseling). Feasibility studies indicate substantial innovation in this area of mental health intervention with studies utilizing trained volunteers and chatbot technologies to deliver interventions. While studies of efficacy show positive post-intervention gains, further research is needed to determine whether time requirements for this mode of intervention are feasible in clinical practice. ©Simon Hoermann, Kathryn L McCabe, David N Milne, Rafael A Calvo. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.07.2017.
Milne, David N
Background Synchronous written conversations (or “chats”) are becoming increasingly popular as Web-based mental health interventions. Therefore, it is of utmost importance to evaluate and summarize the quality of these interventions. Objective The aim of this study was to review the current evidence for the feasibility and effectiveness of online one-on-one mental health interventions that use text-based synchronous chat. Methods A systematic search was conducted of the databases relevant to this area of research (Medical Literature Analysis and Retrieval System Online [MEDLINE], PsycINFO, Central, Scopus, EMBASE, Web of Science, IEEE, and ACM). There were no specific selection criteria relating to the participant group. Studies were included if they reported interventions with individual text-based synchronous conversations (ie, chat or text messaging) and a psychological outcome measure. Results A total of 24 articles were included in this review. Interventions included a wide range of mental health targets (eg, anxiety, distress, depression, eating disorders, and addiction) and intervention design. Overall, compared with the waitlist (WL) condition, studies showed significant and sustained improvements in mental health outcomes following synchronous text-based intervention, and post treatment improvement equivalent but not superior to treatment as usual (TAU) (eg, face-to-face and telephone counseling). Conclusions Feasibility studies indicate substantial innovation in this area of mental health intervention with studies utilizing trained volunteers and chatbot technologies to deliver interventions. While studies of efficacy show positive post-intervention gains, further research is needed to determine whether time requirements for this mode of intervention are feasible in clinical practice. PMID:28784594
Dornan, Julieanne; Kennedy, Miriam; Garland, Jackie; Rutledge, Emer; Kennedy, Harry G
Decision making ability can change with time, depending on mental or physical health. Little is known about the factors that determine this change and the relationship of capacity to time. As a pilot for studies using functional mental capacities as an outcome measure, we sought to quantify this relationship measuring change over time using competence assessment tools, and rating scales for symptoms and global function. We assessed 37 inpatients in a secure psychiatric hospital. All patients met the diagnostic and statistical manual of mental disorders-fourth edition and International classification of diseases, 10th edition criteria for an Axis 1 mental illness, all with psychosis. Patients were interviewed twice a mean of 323 days apart (median 176 days range 17-1221 days). The MacArthur competence assessment tools for consent to treatment (MacCAT-T) and fitness to plead (MacCAT-FP) were used to quantify functional capacity along with the Positive and Negative Syndrome Scale (PANSS) and global assessment of function (GAF) scale. A comparison was also made between those patients prescribed clozapine in comparison to other antipsychotics. The number judged by treating psychiatrists to lack capacity either to make a treatment choice or to plead in court fell from 35 to 8%. Change was greatest for those admitted within the previous 9 months. The measures of capacity improved between time 1 and time 2 for both consent to treatment and fitness to plead. The measures of capacity improved with positive symptoms within the PANSS and with GAF scores. Those with shorter lengths of stay at baseline had the greatest improvements in the MacCAT-FP scores. Effect sizes were medium or large (0.3-0.7+). As expected, patients prescribed clozapine had larger changes in functional mental capacities and larger effect sizes than those prescribed other psychotropics. The results show a strong relationship between the clinicians' assessment of capacity and structured rating scales. We
Thalmayer, Amber Gayle
Self-report scores on personality inventories predict important life outcomes, including health and longevity, marital outcomes, career success, and mental health problems, but the ways they predict mental health treatment have not been widely explored. Psychotherapy is sought for diverse problems, but about half of those who begin therapy drop out, and only about half who complete therapy experience lasting improvements. Several authors have argued that understanding how personality traits relate to treatment could lead to better targeted, more successful services. Here self-report scores on Big Five and Big Six personality dimensions are explored as predictors of therapy presentation, usage, and outcomes in a sample of community clinic clients (N = 306). Participants received evidence-based treatments in the context of individual-, couples-, or family-therapy sessions. One measure of initial functioning and three indicators of outcome were used. All personality trait scores except Openness associated with initial psychological functioning. Higher Conscientiousness scores predicted more sessions attended for family therapy but fewer for couples-therapy clients. Higher Honesty-Propriety and Extraversion scores predicted fewer sessions attended for family-therapy clients. Better termination outcome was predicted by higher Conscientiousness scores for family- and higher Extraversion scores for individual-therapy clients. Higher Honesty-Propriety and Neuroticism scores predicted more improvement in psychological functioning in terms of successive Outcome Questionnaire-45 administrations. Taken together, the results provide some support for the role of personality traits in predicting treatment usage and outcome and for the utility of a 6-factor model in this context. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Full Text Available Melissa Harris Abadi1, Stephen R Shamblen1, Knowlton Johnson1, Kirsten Thompson1, Linda Young1, Matthew Courser1, Jude Vanderhoff1, Thom Browne21Pacific Institute for Research and Evaluation – Louisville Center, Louisville, KY, USA; 2United States Department of State, Bureau of International Narcotics and Law Enforcement, Washington, DC, USAAbstract: Denial of human rights, gender disparities, and living in a war zone can be associated with severe depression and poor social functioning, especially for female drug abusers. This study of Afghan women in drug abuse treatment (DAT centers assesses (a the extent to which these women have experienced human rights violations and mental health problems prior to entering the DAT centers, and (b whether there are specific risk factors for human rights violations among this population. A total of 176 in-person interviews were conducted with female patients admitted to three drug abuse treatment centers in Afghanistan in 2010. Nearly all women (91% reported limitations with social functioning. Further, 41% of the women indicated they had suicide ideation and 27% of the women had attempted suicide at least once 30 days prior to entering the DAT centers due to feelings of sadness or hopelessness. Half of the women (50% experienced at least one human rights violation in the past year prior to entering the DAT centers. Risk factors for human rights violations among this population include marital status, ethnicity, literacy, employment status, entering treatment based on one’s own desire, limited social functioning, and suicide attempts. Conclusions stemming from the results are discussed.Keywords: Afghanistan, women, human rights, mental health, drug abuse treatment
Systematic reviews of randomised clinical trials examining the effects of psychotherapeutic interventions versus "no intervention" for acute major depressive disorder and a randomised trial examining the effects of "third wave" cognitive therapy versus mentalization-based treatment for acute major depressive disorder.
Jakobsen, Janus Christian
Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Cognitive therapy and psychodynamic therapy may be effective treatment options for major depressive disorder, but the effects have only had limited assessment in systematic reviews. The two modern forms of psychotherapy, "third wave" cognitive therapy and mentalization-based treatment, have both gained some ground as treatments of psychiatric disorders. No randomised trial has compared the effects of these two interventions for major depressive disorder. We performed two systematic reviews with meta-analyses and trial sequential analyses using The Cochrane Collaboration methodology examining the effects of cognitive therapy and psycho-dynamic therapy for major depressive disorder. We developed a thorough treatment protocol for a randomised trial with low risks of bias (systematic error) and low risks of random errors ("play of chance") examining the effects of third wave' cognitive therapy versus mentalization-based treatment for major depressive disorder. We conducted a randomised trial according to good clinical practice examining the effects of "third wave" cognitive therapy versus mentalisation-based treatment for major depressive disorder. The first systematic review included five randomised trials examining the effects of psychodynamic therapy versus "no intervention' for major depressive disorder. Altogether the five trials randomised 365 participants who in each trial received similar antidepressants as co-interventions. All trials had high risk of bias. Four trials assessed "interpersonal psychotherapy" and one trial "short psychodynamic supportive psychotherapy". Both of these interventions are different forms of psychodynamic therapy. Meta-analysis showed that psychodynamic therapy significantly reduced depressive symptoms on the Hamilton Depression Rating Scale (HDRS) compared with "no intervention" (mean difference -3.01 (95
Extensive research has shown that children in the United States present with a myriad of mental health concerns, and that those concerns can develop into mental illness if not treated. The consequences of mental illness on students' life both in an out of school is well documented. The need to provide effective treatment to children is also…
Tsan, Jack Y; Stock, Eileen M; Greenawalt, David S; Zeber, John E; Copeland, Laurel A
The purpose of this study was to examine mental health treatment use among Vietnam Veterans with posttraumatic stress disorder and determine whether undergoing major surgery interrupted mental health treatment or increased the risk of psychiatric hospitalization. Using retrospective data from Veterans Health Administration's electronic medical record system, a total of 3320 Vietnam-era surgery patients with preoperative posttraumatic stress disorder were identified and matched 1:4 with non-surgical patients with posttraumatic stress disorder. The receipt of surgery was associated with a decline in overall mental health treatment and posttraumatic stress disorder-specific treatment 1 month following surgery but not during any subsequent month thereafter. Additionally, surgery was not associated with psychiatric admission. © The Author(s) 2014.
Full Text Available The complex multifaceted essence of human as a biological, psychological, social being has attracted the attention of researchers and has caused hot debates during centuries. The deep understanding of the phenomenon of human being, his/her nature and essence is critical for the field of clinical medicine such as psychiatry. Nowadays, diagnosis and treatment of mental disorders are the acute problems. Appropriate methods of diagnosis and treatment in the context of “nature vs nurture” dichotomy cause scientific disputes between experts in the relevant fields. The paper attempts to analyze different approaches to mental disorders, as well as specific and non-specific treatment.
Evans, Elizabeth; Padwa, Howard; Li, Libo; Lin, Veronique; Hser, Yih-Ing
The aim of this study was to determine mental health service utilization patterns among women treated for substance use disorders (SUD) and identify factors associated with patterns of high mental health service use. Data were provided by 4447 women treated for SUD in California during 2000-2002 for whom mental health services utilization records were acquired. A latent class model was fitted to women's high use of services (>6 services/year over 8 years). Multinomial logistic regression was used to identify predisposing, enabling, and need factors associated with utilization patterns. In 8 years after initiating SUD treatment, 50% of women utilized mental health services. High use probability was consistently low for most women (76.9%); for others, however, it decreased immediately following SUD treatment and then increased over time (8.7%), increased immediately following SUD treatment and then decreased (9.3%), or remained consistently high (5.1%). Consistently high services use was negatively associated with marriage (OR 0.60, pwomen with co-occurring mental health disorders at SUD treatment entry did not receive any mental health treatment in the subsequent 8 years. Mental health services utilization patterns among women treated for SUD are heterogeneous and dynamic. Understanding factors related to women's utilization patterns may aid efforts to optimize care and ensure appropriate use of mental health services. Copyright © 2015 Elsevier Inc. All rights reserved.
Ahmad Ali Naji
Conclusion: Some features of mental toughness regardless of the effect of the character can cause mental health that According to the findings, emotional control and self-confidence are more important. It is suggested that these items be taught to improve mental health.
Eustache, Eddy; Gerbasi, Margaret E; Smith Fawzi, Mary C; Fils-Aimé, J Reginald; Severe, Jennifer; Raviola, Giuseppe J; Legha, Rupinder; Darghouth, Sarah; Grelotti, David J; Thérosmé, Tatiana; Pierre, Ermaze L; Affricot, Emmeline; Alcindor, Yoldie; Becker, Anne E
The mental health treatment gap for youth in low- and middle-income countries (LMICs) is substantial; strategies for redress are urgently needed to mitigate the serious health and social consequences of untreated mental illness in youth. To estimate the burden of major depressive episode (MDE) and posttraumatic stress disorder (PTSD) as well as utilization of care among Haitian youth in order to describe the mental health treatment gap in a LMIC setting. We estimated the point prevalence of MDE, PTSD, and subthreshold variants in a school-based sample of youth ( n = 120, ages 18-22 years) using a modified Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID)-based interview and examined treatment utilization among those receiving one of these diagnoses. We assessed additional psychopathology with self-report measures to examine validity of study diagnostic assignments. The combined prevalence of full-syndrome or subthreshold MDE or PTSD was high (36.7%). A large majority of affected individuals (88.6%) had accessed no mental health services in the health sector, and 36.4% had accessed no care of any kind in either the health or folk sectors in the past year. Findings demonstrate a high mental health burden among Haiti's youth and that many youth with MDE and PTSD are not accessing mental health care.
Brijnath, Bianca; Protheroe, Joanne; Mahtani, Kamal Ram; Antoniades, Josefine
Low levels of mental health literacy (MHL) have been identified as an important contributor to the mental health treatment gap. Interventions to improve MHL have used traditional media (eg, community talks, print media) and new platforms (eg, the Internet). Evaluations of interventions using conventional media show improvements in MHL improve community recognition of mental illness as well as knowledge, attitude, and intended behaviors toward people having mental illness. However, the potential of new media, such as the Internet, to enhance MHL has yet to be systematically evaluated. Study aims were twofold: (1) To systematically appraise the efficacy of Web-based interventions in improving MHL. (2) To establish if increases in MHL translated into improvement in individual health seeking and health outcomes as well as reductions in stigma toward people with mental illness. We conducted a systematic search and appraisal of all original research published between 2000 and 2015 that evaluated Web-based interventions to improve MHL. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to report findings. Fourteen studies were included: 10 randomized controlled trials and 4 quasi-experimental studies. Seven studies were conducted in Australia. A variety of Web-based interventions were identified ranging from linear, static websites to highly interactive interventions such as social media games. Some Web-based interventions were specifically designed for people living with mental illness whereas others were applicable to the general population. Interventions were more likely to be successful if they included "active ingredients" such as a structured program, were tailored to specific populations, delivered evidenced-based content, and promoted interactivity and experiential learning. Web-based interventions targeting MHL are more likely to be successful if they include active ingredients. Improvements in MHL see concomitant
Kutcher, Stan; Murphy, Andrea; Gardner, David
The article examines the World Health Organization's Model List of Essential Medicines (EML) and suggests modification for appropriate psychopharmacological treatment of child- and adolescent-onset mental disorders. The EML enlists few of the psychotropic medicines that are useful for the treatment of young people thereby limiting the…
Zivaridelavar, Maryam; Kazemi, Ashraf; Kheirabadi, Gholam Reza
The process of assisted reproductive treatment is a stressful situation in the treatment of infertile couples and it would harm the mental health of women. Fertile women who started infertility treatment due to male factor infertility have reported to experience less stress and depression than other women before the assisted reproductive process but considering the cultural and social factors and also the etiology of the assisted reproductive process, it could affect the metal health of these women. Therefore, this study was conducted to evaluate the mental health of fertile women who undergo assisted reproductive treatment due to male factor infertility. This study was a prospective study on 70 fertile women who underwent assisted reproductive treatment due to male factor infertility. The exclusion criterion was to stop super ovulation induction. To assess mental health, anxiety and depression dimensions of the general health questionnaire were used. Before starting ovulation induction and after oocyte harvesting, the general health questionnaire was filled by women who were under treatment. Data were analyzed using multi-variable linear regression, paired t-test, and Chi-square. The results showed that the mean score of depression and anxiety before ovulation induction and after oocyte harvesting were not significantly different; but the rate of mental health disorder in the depression dimension was significantly decreased after oocytes harvesting (31.7% vs. 39.7%). Also, there was a significant relation between the level of anxiety and depression before ovulation induction and after oocyte harvesting (P reproductive treatment does not affect the mental health in fertile women independently, but these women start assisted reproductive process with high levels of depression and anxiety. Therefore, prior to the assisted reproductive treatment mental health consultation is needed.
de Jong Fransina J
Full Text Available Abstract Background Common mental disorders are the most prevalent of all mental disorders, with the highest burden in terms of work absenteeism and utilization of health care services. Evidence-based treatments are available, but recognition and treatment could be improved, especially in the occupational health setting. The situation in this setting has recently changed in the Netherlands because of new legislation, which has resulted in reduced sickness absence. Severe mental disorder has now become one of the main causes of work absenteeism. Occupational physicians (OPs are expected to take an active role in diagnosis and treatment, and seem to be in need of support for a new approach to handle cases of more complex mental disorders. Psychiatric consultation can be a collaborative care model to achieve this. Methods/design This is a two-armed cluster-randomized clinical trial, with randomization among OPs. Forty OPs in two big companies providing medical care for multiple companies will be randomized to either the intervention group, i.e. psychiatric consultation embedded in a training programme, or the control group, i.e. only training aimed at recognition and providing Care As Usual. 60 patients will be included who have been absent from work for 6–52 weeks and who, after screening and a MINI interview, are diagnosed with depressive disorder, anxiety disorder or somatoform disorder based on DSM-IV criteria. Baseline measurements and follow up measurements (at 3 months and 6 months will be assessed with questionnaires and an interview. The primary outcome measure is level of general functioning according to the SF-20. Secondary measures are severity of the mental disorder according to the PHQ and the SCL-90, quality of life (EQ-D5, measures of Return To Work and cost-effectiveness of the treatment assessed with the TiC-P. Process measures will be adherence to the treatment plan and assessment of the treatment provided by the Psychiatric
Koka, Betty E; Deane, Frank P; Lyons, Geoffrey Cb; Lambert, Gordon
Papua New Guinea is a developing country with limited resources for specialist mental health services. Little is known about the mental health and treatment services of Papua New Guinea. The aim of this study was to clarify the presenting mental health problems encountered by Papua New Guinean health workers and the common treatment approaches used. A total of 203 Papua New Guinean health workers completed a retrospective quantitative survey about their three most recent mental health patients. The survey asked about presenting symptomatology, diagnoses (including culture-bound diagnoses) and treatment approaches. The major presenting mental health problems for males included schizophrenia, substance use disorder, sorcery and spirit possession. Depression was the most common diagnoses for women, followed by sorcery and somatisation. Over 65% of patients were prescribed psychotropic medication, over 50% received some form of psychological intervention and 28% were receiving traditional treatments. Somatic symptoms are common among both male and female Papua New Guineans; however, males may be more likely to present with psychotic symptoms and females with mood-related problems. Schizophrenia and depression are commonly identified with substance use disorder more problematic among males. Culture-specific explanations and treatment are commonly used. © The Author(s) 2013.
Getrich, Christina; Heying, Shirley; Willging, Cathleen; Waitzkin, Howard
Community-based health interventions have emerged as a growing focus for anthropological research. The application of ethnographic approaches in clinical practice settings reveals that community-based interventions must grapple with "noise," or unanticipated factors such as patients' own perceptions of illness and treatment, primary care providers' non-adherence to guidelines-based treatment, the social dynamics of the clinic site itself, and incomplete understanding and acceptance of an intervention by a clinic's staff members. Such noise can influence the implementation and quality of treatment. Thus, identifying clinic-based noise is critical in assessments of fidelity to intervention protocols as well as outcomes of community-based interventions. This paper highlights findings from an evaluation of a mental health intervention focusing on the role of promotoras (briefly trained, non-professional community health workers) as mental health practitioners in two urban New Mexico, USA, community health centers. Our research identified three areas of clinic-based noise: the clinics' physical ability to "absorb" the intervention, the challenges of co-worker instability and interpersonal relationships, and balancing extra workplace demands. The findings demonstrate the value of ethnographic approaches in community-based intervention research.
Anwar-McHenry, Julia; Donovan, Robert John; Nicholas, Amberlee; Kerrigan, Simone; Francas, Stephanie; Phan, Tina
Purpose: Mentally Healthy WA developed and implemented the Mentally Healthy Schools Framework in 2010 in response to demand from schools wanting to promote the community-based Act-Belong-Commit mental health promotion message within a school setting. Schools are an important setting for mental health promotion, therefore, the Framework encourages…
Iglay, Kristy; Santorelli, Melissa L; Hirshfield, Kim M; Williams, Jill M; Rhoads, George G; Lin, Yong; Demissie, Kitaw
This study aimed to compare diagnosis and treatment delays in elderly breast cancer patients with and without pre-existing mental illness. A retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results-Medicare data including 16,636 women 68+ years, who were diagnosed with stage I-IIIa breast cancer in the United States from 2005 to 2007. Mental illness was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes recorded on inpatient and outpatient claims during the 3 years prior to breast cancer diagnosis. Patients were classified as having no mental illness, anxiety, depression, anxiety and depression, or severe mental illness (bipolar disorder, schizophrenia, and other psychotic disorder). Multivariable binomial regression was used to assess the association between mental illness and delays of ≥60 and ≥90 days after adjustment for confounders. Patients with comorbid anxiety and depression had an increased risk for diagnosis delay of ≥90 days from symptom recognition (RR 1.11; 95% CI 1.00, 1.23), and those with severe mental illness had an increased risk for initial treatment delay of ≥60 days from diagnosis (RR 1.36; 95% CI 1.06, 1.74). Patients with any mental illness experienced an increased risk for adjuvant chemotherapy delay of ≥90 days from last operation (RR 1.13; 95% CI 1.01, 1.26) and each category of mental illness, except depression, showed a non-significant trend for this association. Breast cancer patients with mental illness should be closely managed by a cross-functional care team, including a psychiatrist, a primary care physician, and an oncologist, to ensure adequate care is received within an appropriate timeframe.
Gamble, Brandon E.; Lambros, Katina M.
This article provides results from a qualitative study on the efforts of school-based mental health providers (SBMHPs) who serve students in urban, suburban, and ethnically diverse settings to help families access quality mental health services. School-based mental health plays a key role in the provision of direct and indirect intervention…
Hilton, Michael F; Scuffham, Paul A; Vecchio, Nerina; Whiteford, Harvey A
In Australia it has been estimated that mental health symptoms result in a loss of $ AU2.7 billion in employee productivity. To date, however, there has been only one study quantifying employee productivity decrements due to mental disorders when treatment-seeking behaviours are considered. The aim of the current paper was to estimate employee work productivity by mental health symptoms while considering different treatment-seeking behaviours. A total of 60 556 full-time employees responded to the World Health Organization Health and Work Performance Questionnaire. This questionnaire is designed to monitor the work productivity of employees for chronic and acute physical and mental health conditions. Contained within the questionnaire is the Kessler 6, a scale measuring psychological distress along with an evaluation of employee treatment-seeking behaviours for depression, anxiety and any other emotional problems. A univariate analysis of variance was performed for employee productivity using the interaction between Kessler 6 severity categories and treatment-seeking behaviours. A total of 9.6% of employees have moderate psychological distress and a further 4.5% have high psychological distress. Increasing psychological distress from low to moderate then to high levels is associated with increasing productivity decrements (6.4%, 9.4% and 20.9% decrements, respectively) for employees in current treatment. Combining the prevalence of Kessler 6 categories with treatment-seeking behaviours, mean 2009 salaries and number of Australian employees in 2009, it is estimated that psychological distress produces an $ AU5.9 billion reduction in Australian employee productivity per annum. The estimated loss of $ AU5.9 billion in employee productivity due to mental health problems is substantially higher than previous estimates. This finding is especially pertinent given the global economic crisis, when psychological distress among employees is likely to be increasing. Effective
Nakash, Ora; Levav, Itzhak; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Andrade, Laura Helena; Angermeyer, Matthias C.; Bruffaerts, Ronny; Caldas-de-Almeida, Jose Miguel; Florescu, Slivia; de Girolamo, Giovanni; Gureje, Oye; He, Yanling; Hu, Chiyi; de Jonge, Peter; Karam, Elie G.; Kovess-Masfety, Viviane; Medina-Mora, Maria Elena; Moskalewicz, Jacek; Murphy, Sam; Nakamura, Yosikazu; Piazza, Marina; Posada-Villa, Jose; Stein, Dan J.; Taib, Nezar Ismet; Zarkov, Zahari; Kessler, Ronald C.; Scott, Kate M.
Objective To study the comorbidity of common mental disorders (CMDs) and cancer, and the mental health treatment gap among community residents with active cancer, cancer survivors and cancer-free respondents in 13 high- and 11 low-middle income countries. Methods Data were derived from the World Mental Health Surveys (N=66,387; n=357 active cancer, n=1,373 cancer survivors, n=64,657 cancer free respondents). The WHO/Composite International Diagnostic Interview was used in all surveys to estimate CMDs prevalence rates. Respondents were also asked about mental health service utilization in the preceding 12 months. Cancer status was ascertained by self-report of physician’s diagnosis. Results Twelve month prevalence rates of CMDs were higher among active cancer (18.4% SE=2.1) than cancer free respondents (13.3%, SE=0.2) adjusted for socio-demographic confounders and other lifetime chronic conditions (Adjusted Odds Ratio (AOR)=1.44 95% CI 1.05–1.97). CMD rates among cancer survivors (14.6% SE=0.9) compared with cancer-free respondents did not differ significantly (AOR=0.95 95% CI 0.82–1.11). Similar patterns characterized high and low-middle income countries. Of respondents with active cancer who had CMD in the preceding 12 months 59% sought services for mental health problems (SE=5.3). The pattern of service utilization among people with CMDs by cancer status (highest among persons with active cancer, lower among survivors and lowest among cancer-free respondents) was similar in high- (64.0% SE=6.0, 41.2% SE=3.0, 35.6% SE=0.6) and low-middle income countries (46.4% SE=11.0, 22.5% SE=9.1, 17.4% SE=0.7). Conclusions Community respondents with active cancer have relatively higher CMD rates and relatively high treatment gap. Comprehensive cancer care should consider both factors. PMID:23983079
Linden, Michael; Dymke, Tina; Hüttner, Susanne; Schnaubelt, Sabine
The first item of any psychopathological assessment is "general impression". There is some research under the heading of "impression formation" which shows that the outer appearance of a person decides about how a person is perceived by others and how others react. Impression formation is an important factor in social interaction. This is of special importance in mental disorders, which may express themselves in a distorted impression formation. As impression formation is by and large an emotional process, measurement can be done by adjective lists. An example is the bipolar MED rating scale. Such lists can be used in therapy to help patients and therapists to understand the problem and initiate modifications. A special group intervention in occupational therapy is described. Results suggest that impression formation is quite objective, that self- and observer judgments coincide and that therapy can help to adopt a less irritating outer appearance. © Georg Thieme Verlag KG Stuttgart · New York.
Merrill, Brett M; Warren, Jared S; Garcia, Darren J; Hardy, Sam A
The purpose of this study was to examine the relationship between youth motivation and psychotherapy outcomes in routine community mental health settings. One hundred fifty youth, ages 12-17, from three community mental health clinics completed the Youth Outcome Questionnaire and Treatment Support Measure at frequent intervals over the course of treatment. Increases in motivation followed a curvilinear trajectory. On average, youth motivation significantly increased over the course of therapy according to both self- and parent reports (p motivation over the course of therapy was negatively associated with the slope for mental health symptoms (p motivation did not predict overall change or the rate of change in symptoms. However, there was significant individual variability in patterns of youth motivation. Our findings demonstrate that youth show increases in motivation over the course of therapy with most gains occurring in the first few sessions. Because increases in motivation over the course of therapy were related to decreases in mental health symptoms, further research is needed to examine how treatment interventions or other factors such as parent motivation may moderate this relationship. Additional research examining the likely complex relationship between initial youth motivation and treatment outcomes in community mental health settings is needed.
Buckley, Gary I; Malouff, John M
In this study, the authors evaluated the effectiveness of a video, developed for this study and using principles of cognitive learning theory, to produce positive attitudinal change toward mental health treatment. The participants were 35 men and 45 women who were randomly assigned to watch either an experimental video, which included 3 positive 1st-person accounts of psychotherapy or a control video that focused on the psychological construct of self. Pre-intervention, post-intervention, and 2-week follow-up levels of attitude toward mental health treatment were measured using the Attitude Toward Seeking Professional Help Scale (E. H. Fischer & J. L. Turner, 1970). The experimental video group showed a significantly greater increase in positive attitude than did the control group. These results support the effectiveness of using the vicarious reinforcement elements of cognitive learning theory as a basis for changing attitudes toward mental health treatment.
Dawson, S L; Dash, S R; Jacka, F N
The departure from traditional lifestyles and the rising disease burden of mental disorders are increasing global health concerns. Changes in diet around the world mean that populations are now increasingly reliant on highly processed, poor quality foods, which have been linked to increased risk for mental disorder. Conversely, a nutrient-rich diet is understood to be protective of mental health, and researchers are now aiming to understand the biological underpinnings of this relationship. The gut microbiota has been proposed as a key mediator of this link, given its association with both diet and mental health. Importantly, several critical "windows of opportunity" for prevention and intervention have been identified, particularly early life and adolescence; these are periods of rapid development and transition that provide a foundation for future health. Strategies that promote overall diet quality, high in fiber and nutrients, have been linked to increased microbial diversity and gut health. Improving diet quality and subsequent gut health may have benefits for individuals' mental health, as well as the mental health of future generations. Here we discuss specific, targeted dietary and gut focused strategies for the prevention and treatment of mental disorder. © 2016 Elsevier Inc. All rights reserved.
Coughtrey, Anna E.; Shafran, Roz; Lee, Michelle; Rachman, Stanley
The recommended treatment for obsessive-compulsive disorder (OCD) is cognitive behavior therapy (CBT) incorporating exposure and response prevention (ERP), which is effective for approximately 50% of patients. However, there has been little advance in treatment outcomes since the introduction of ERP in 1979. It has been suggested that some…
Prochaska, Judith J; Fromont, Sebastien C; Wa, Christina; Matlow, Ryan; Ramo, Danielle E; Hall, Sharon M
Youth with psychiatric disorders are at increased risk of tobacco use. Outpatient mental health settings have received little investigation for delivering tobacco treatment. This study obtained formative data to guide development of a tobacco cessation program for transitional age youth with co-occurring psychiatric disorders with a focus on outpatient mental health settings. Applying qualitative methods, we analyzed transcripts from interviews with 14 mental health clients (aged 16-23) and 8 mental health providers. The youth identified internal (nicotine addiction and mood), social, parental, and media influences to their use of tobacco. Providers' viewed youth tobacco use as a normative developmental process, closely tied to management of psychiatric symptoms, supported by parents, and of lower priority relative to youth alcohol and illicit drug use. Youth and providers believed that clinicians can do more to address tobacco use in practice and emphasized nonjudgmental support and nondirective approaches. Top recommended quitting strategies, however, differed notably for the youth (cold turkey, support from friends, physical activity, hobbies) and providers (cessation pharmacotherapy, cessation groups, treatment referrals). Mental health providers' greater prioritization of other substances and view of youth smoking as developmentally normative and a coping strategy for psychopathology are likely contributing to the general lack of attention to tobacco use currently. Integrating care within mental health settings would serve to reach youth in an arena where clinical rapport is already established, and study findings suggest receptivity for system improvements. Of consideration, however, is the apparent disconnect between provider and youth recommended strategies for supporting cessation.
Ally, Yaseen; Laher, Sumaya
The important role that religious beliefs may have on perceptions of mental illness cannot be ignored. Many religions including Islam advocate witchcraft and spirit possession--all of which are thought to influence the behaviour of a person so as to resemble that of a mentally ill individual. Thus this research explored Muslim Faith Healers perceptions of mental and spiritual illness in terms of their understanding of the distinctions between the two, the aetiologies and the treatments thereof. Six Muslim Healers in the Johannesburg community were interviewed and thematic content analysis was used to analyse the data. From the results it is clear that the faith healers were aware of the distinction between mental and spiritual illnesses. It was also apparent that Islam has a clear taxonomy that distinguishes illness and the causes thereof. Treatments are then advised accordingly. Thus this paper argues that the predominant Western view of the aetiology and understanding of mental illness needs to acknowledge the various culturally inclined taxonomies of mental illness so as to better understand and aid clients.
Zivaridelavar, Maryam; Kazemi, Ashraf; Kheirabadi, Gholam Reza
Introduction: The process of assisted reproductive treatment is a stressful situation in the treatment of infertile couples and it would harm the mental health of women. Fertile women who started infertility treatment due to male factor infertility have reported to experience less stress and depression than other women before the assisted reproductive process but considering the cultural and social factors and also the etiology of the assisted reproductive process, it could affect the metal h...
Wetterlin, Felicia M; Mar, Marissa Y; Neilson, Erika K; Werker, Gregory R; Krausz, Michael
Due to the high prevalence of psychological disorders and the lack of access to care among Canadian youth, the development of accessible services is increasingly important. eMental Health is an expanding field that may help to meet this need through the provision of mental health care using technology. The primary goals of the study are to explore youth experiences with traditional and online mental health resources, and to investigate youth expectations for mental health websites. A Web-based survey containing quantitative and qualitative questions was delivered to youth aged 17-24 years. Participants were surveyed to evaluate their use of mental health resources as well as their preferences for various components of a potential mental health website. A total of 521 surveys were completed. Most participants (61.6%, 321/521) indicated that they had used the Internet to seek information or help for feelings they were experiencing. If they were going through a difficult time, 82.9% (432/521) of participants were either "somewhat likely" or "very likely" to use an information-based website and 76.8% (400/521) reported that they were either "somewhat unlikely" or "very unlikely" to visit social media websites for information or help-seeking purposes during this time. Most (87.7%, 458/521) participants rated their online privacy as very important. Descriptions of interventions and treatments was the most highly rated feature to have in a mental health-related website, with 91.9% (479/521) of participants regarding it as "important" or "very important". When presented a select list of existing Canadian mental health-related websites, most participants had not accessed any of the sites. Of the few who had, the Canadian Mental Health Association website was the most accessed website (5.8%, 30/521). Other mental health-related websites were accessed by only 10.9% of the participants (57/521). The findings suggest that despite interest in these tools, current eMental Health
Dauber, Hanna; Braun, Barbara; Pfeiffer-Gerschel, Tim; Kraus, Ludwig; Pogarell, Oliver
Aim of this study was to investigate the current health care situation for patients with co-occurring mental disorders in addiction treatment. Therefore, data from the German Substance Abuse Treatment System ( N = 194,406) was analysed with regard to the prevalence of comorbid mental disorders, treatment characteristics and outcomes of patients with comorbid psychiatric diagnosis. In outpatient setting, the prevalence of comorbid diagnoses was considerably lower (4.6%) than in inpatient setting (50.7%), but mood and anxiety disorders were the most prevalent additional diagnoses in both settings. In the treatment of patients with these comorbid disorders, we found higher rates of complementary internal and external (psychiatric) treatment, more co-operations and referrals after treatment, and positive treatment process outcomes. Findings indicate that the knowledge of an additional diagnosis influences the health care provision of affected patients and can therefore be seen as the essential precondition for providing adequate and comprehensive treatment. This highlights the importance of a sufficient consideration and diagnostic assessment of mental disorders in addiction treatment to further improve the health care situation of comorbid patients.
Loreto, Aline Rodrigues; Carvalho, Carlos Felipe Cavalcanti; Frallonardo, Fernanda Piotto; Ismael, Flavia; Andrade, Arthur Guerra de; Castaldelli-Maia, João Maurício
The aim of this study was to investigate smoking treatment effectiveness and retention in a population with and without mental disorders (MD). Participants received cognitive behavioral therapy (CBT) plus nicotine patch alone or in combination with other medications (i.e., gum, bupropion, or nortriptyline) for smoking cessation treatment in a Brazilian Psychosocial Care Center unit (CAPS), taking into account sociodemographics and smoking profile covariates. The study involved comparison of treatment success (seven-day point prevalence abstinence at the end of the treatment) and retention (presence of the individual in all of the four medical consultations and six group sessions) in two subsamples of patients with MD (n = 267) and without MD (n = 397) who were included in a six-week treatment provided by a CAPS from 2007 to 2013. The treatment protocol comprised group CBT and pharmacotherapy (nicotine patches, nicotine gums, and bupropion and nortriptyline available, prescribed by psychiatrists). Within patients with MD, CBT plus nicotine patch plus bupropion (aOR = 2.00, 95% CI [1.14, 3.50], p = .015) and CBT plus nicotine patch plus gum (aOR = 2.10, 95% CI [1.04, 4.23], p = .036) were associated with treatment success. Within patients without MD, female gender (aOR = 0.60, 95% CI [0.37, 0.95], p = .031) and lower Heaviness of Smoking Index score (aOR = 0.80, 95% CI [0.65, 0.99], p = .048) were associated with treatment success. No variable was associated with dropout or retention within patients with or without MD. Our findings support the use of CBT plus nicotine patch plus bupropion as well as CBT plus nicotine patch plus gum in samples with high rates of medical, psychiatric, and addiction disorders. These findings support those of previous studies in the general population. Pharmacological treatment associated with group CBT based on cognitive-behavioral concepts and combined with ongoing MD treatment seems to be the best option for smoking cessation
Abadi, Melissa Harris; Shamblen, Stephen R; Johnson, Knowlton; Thompson, Kirsten; Young, Linda; Courser, Matthew; Vanderhoff, Jude; Browne, Thom
Denial of human rights, gender disparities, and living in a war zone can be associated with severe depression and poor social functioning, especially for female drug abusers. This study of Afghan women in drug abuse treatment (DAT) centers assesses (a) the extent to which these women have experienced human rights violations and mental health problems prior to entering the DAT centers, and (b) whether there are specific risk factors for human rights violations among this population. A total of 176 in-person interviews were conducted with female patients admitted to three drug abuse treatment centers in Afghanistan in 2010. Nearly all women (91%) reported limitations with social functioning. Further, 41% of the women indicated they had suicide ideation and 27% of the women had attempted suicide at least once 30 days prior to entering the DAT centers due to feelings of sadness or hopelessness. Half of the women (50%) experienced at least one human rights violation in the past year prior to entering the DAT centers. Risk factors for human rights violations among this population include marital status, ethnicity, literacy, employment status, entering treatment based on one's own desire, limited social functioning, and suicide attempts. Conclusions stemming from the results are discussed.
Gálvez-Lara, Mario; Corpas, Jorge; Moreno, Eliana; Venceslá, José F; Sánchez-Raya, Araceli; Moriana, Juan A
In recent decades, the evidence on psychological treatments for children and adolescents has increased considerably. Several organizations have proposed different criteria to evaluate the evidence of psychological treatment in this age group. The aim of this study was to analyze evidence-based treatments drawn from RCTs, reviews, meta-analyses, guides and lists provided by four leading international organizations. The institutions reviewed were the National Institute for Health and Care Excellence, the Society of Clinical Child and Adolescent Psychology (Division 53) of the American Psychological Association, Cochrane Collaboration and the Australian Psychological Society in relation to mental disorders in children and adolescents. A total of 137 treatments were analyzed for 17 mental disorders and compared to determine the level of agreement among the organizations. The results indicate that, in most cases, there is little agreement among organizations and that there are several discrepancies within certain disorders. These results require reflection on the meaning attributed to evidence-based treatments with regard to psychological treatments in children and adolescents. The possible reasons for these differences could be explained by a combination of different issues: the procedures or committees may be biased, different studies were reviewed, different criteria are used by the organizations or the reviews of existing evidence were conducted in different time periods.
Xu, Junfang; Wang, Jian; Liu, Ruiyun; Xing, Jinshui; Su, Lei; Yu, Fenghua; Lu, Mingshan
Mental health is increasingly becoming a huge public health issue in China. Yet for various cultural, healthcare system, and social economic reasons, people with mental health need have long been under-served in China. In order to inform the current on-going health care reform, empirical evidences on the economic burden of mental illnesses in China are urgently needed to contribute to health policy makers' understanding of the potential benefits to society from allocating more resources to preventing and treating mental illness. However, the cost of mental illnesses and particularly its trend in China remains largely unknown. To investigate the trend of health care resource utilization among inpatients with mental illnesses in China, and to analyze what are the factors influencing the inpatient costs. Our study sample included 15,721 patients, both adults and children, who were hospitalized over an eight-year period (2005-2012) in Shandong Center for Mental Health (SCMH), the only provincial psychiatric hospital in Shandong province, China. Data were extracted from the Health Information System (HIS) at SCMH, with detailed and itemized cost data on all inpatient expenses incurred during hospitalization. The identification of the patients was based on the ICD-10 diagnoses recorded in the HIS. Descriptive analysis was done to analyze the trend of hospitalization cost and length of stay during the study period. Multivariate stepwise regression analysis was conducted to assess the factors that influence hospitalization cost. Among the inpatients in our sample, the most common mental disorders were schizophrenia, schizotypal and delusional disorders. The disease which had the highest per capita hospital expense was behavioral and emotional disorders with onset usually occurring in childhood and adolescence (RMB 8,828.4; US$ 1,419.4, as compared to the average reported household annual income of US$ 2,095.3 in China). The average annual growth rate of per capita
Systematic reviews of randomised clinical trials examining the effects of psychotherapeutic interventions versus "no intervention" for acute major depressive disorder and a randomised trial examining the effects of "third wave" cognitive therapy versus mentalization-based treatment for acute major
Jakobsen, Janus Christian
systematic reviews with meta-analyses and trial sequential analyses using The Cochrane Collaboration methodology examining the effects of cognitive therapy and psycho-dynamic therapy for major depressive disorder. We developed a thorough treatment protocol for a randomised trial with low risks of bias...... therapy versus mentalisation-based treatment for major depressive disorder. The first systematic review included five randomised trials examining the effects of psychodynamic therapy versus "no intervention' for major depressive disorder. Altogether the five trials randomised 365 participants who in each...... this result. The second systematic review included 12 randomised trials examining the effects of cognitive therapy versus "no intervention" for major depressive disorder. Altogether a total of 669 participants were randomised. All trials had high risk of bias. Meta-analysis showed that cognitive therapy...
Full Text Available In Islamic teaching, the communication with God and remembering Him is considered a factor for mental unlocking and transcendence, which causes much psychological and health effects; religious and Islamic teachings particularly affect people's health. The present study was conducted with the aim to determine effect of Islamic-based spiritual therapy on mental health and self-esteem in addicts. This is an experimental pretest-posttest study with trial and control groups. This is an experimental pretest-posttest study with trial and control groups. Study population consisted of addicts from a methadone-therapy addiction treatment center. The sample size initially included 90 randomly selected addicts from the mentioned center, of whom 40 were chosen from those that scored the lowest in self-esteem questionnaire and highest in mental health questionnaire, and were then randomly divided into trial and control groups. The trial group received nine 2-hour sessions of spiritual therapy, but the control group received no intervention. Data were collected using the goldberg's general health questionnaire-28 and coopersmith's self-esteem inventory, and analyzed using covariance analysis. The results obtained confirmed effectiveness of spiritual therapy with emphasis on Islamic teachings in improving self-esteem and mental health of addicts.
Van Dorn, R A; Grimm, K J; Desmarais, S L; Tueller, S J; Johnson, K L; Swartz, M S
The public health, public safety and clinical implications of violent events among adults with mental illness are significant; however, the causes and consequences of violence and victimization among adults with mental illness are complex and not well understood, which limits the effectiveness of clinical interventions and risk management strategies. This study examined interrelationships between violence, victimization, psychiatric symptoms, substance use, homelessness and in-patient treatment over time. Available data were integrated from four longitudinal studies of adults with mental illness. Assessments took place at baseline, and at 1, 3, 6, 9, 12, 15, 18, 24, 30 and 36 months, depending on the parent studies' protocol. Data were analysed with the autoregressive cross-lag model. Violence and victimization were leading indicators of each other and affective symptoms were a leading indicator of both. Drug and alcohol use were leading indicators of violence and victimization, respectively. All psychiatric symptom clusters - affective, positive, negative, disorganized cognitive processing - increased the likelihood of experiencing at least one subsequent symptom cluster. Sensitivity analyses identified few group-based differences in the magnitude of effects in this heterogeneous sample. Violent events demonstrated unique and shared indicators and consequences over time. Findings indicate mechanisms for reducing violent events, including trauma-informed therapy, targeting internalizing and externalizing affective symptoms with cognitive-behavioral and psychopharmacological interventions, and integrating substance use and psychiatric care. Finally, mental illness and violence and victimization research should move beyond demonstrating concomitant relationships and instead focus on lagged effects with improved spatio-temporal contiguity.
Leppänen, V; Hakko, H; Sintonen, H; Lindeman, S
The implementation of effective psychotherapies in community mental health care is challenging. This study aimed to create a well-structured and easily applicable treatment model for patients with severe borderline personality disorder (BPD). We integrated a schema therapy based psycho-educational group into an available individual therapy. Two groups were formed: (1) community treatment by experts (CTBE) patients (n = 24) receiving new treatment and (2) treatment as usual (TAU) patients (n = 47). Changes in symptoms were measured by Borderline Personality Disorder Severity Index-IV interview and quality of life by the 15D health-related quality of life questionnaire. After 1 year the CTBE patients showed a significant reduction in a wider range of BPD symptoms and better quality of life than TAU patients. The results of this study are encouraging. A well-structured treatment model was successfully implemented into community mental health care with improved patient adherence to treatment and superior treatment outcomes compared to TAU patients.
Janse van Rensburg, A B; Jassat, W
This is the second of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). Objectives for the review were to provide realistic estimates of cost for unit activities and to establish a quality assurance cycle that may facilitate cost centre management. The study described and used activity-based costing (ABC) as an approach to analyse the recurrent cost of acute in-patient care for the financial year 2007-08. Fixed (e.g. goods and services, staff salaries) and variable recurrent costs (including laboratory' 'pharmacy') were calculated. Cost per day, per user and per diagnostic group was calculated. While the unit accounted for 4.6% of the hospital's total clinical activity (patient days), the cost of R8.12 million incurred represented only 2.4% of the total hospital expenditure (R341.36 million). Fixed costs constituted 90% of the total cost. For the total number of 520 users that stayed on average 15.4 days, the average cost was R1,023.00 per day and R15748.00 per user. Users with schizophrenia accounted for the most (35%) of the cost, while the care of users with dementia was the most expensive (R23,360.68 per user). Costing of the application of World Health Organization norms for acute care staffing for the unit, projected an average increase of 103% in recurrent costs (R5.1 million), with the bulk (a 267% increase) for nursing. In the absence of other guidelines, aligning clinical activity with the proportion of the hospital's total budget may be an approach to determine what amount should be afforded to acute mental health in-patient care activities in a general regional hospital such as HJH. Despite the potential benefits of ABC, its continued application will require time, infrastructure and staff investment to establish the capacity to maintain routine annual cost analyses for different cost centres.
Biringer, Eva; Davidson, Larry; Sundfør, Bengt; Ruud, Torleif; Borg, Marit
Focus on service users' needs, coping and empowerment, user involvement, and comprehensiveness are supposed to be key elements of the Community Mental Health Centres in Norway. Taking a user-oriented approach means acknowledging the individual's own expectations, aims and hopes. However, studies that have investigated service users' expectations of treatment and support at Community Mental Health Centres are hard to find. The aim of the study was therefore to explore service users' expectations at the start of treatment at a Community Mental Health Centre. Within a collaborative framework, taking a hermeneutic-phenomenological approach, ten service users participated in in-depth interviews about their expectations, hopes and aims for treatment and recovery. The participants sought help due to various mental health issues that had interfered with their lives and created disability and suffering. A data-driven stepwise approach in line with thematic analysis was used. The study was approved by the Norwegian Social Science Data Services. The following four main themes representing participants' expectations at the start of treatment were elicited: hope for recovery, developing understanding, finding tools for coping and receiving counselling and practical assistance. Participants' expectations about treatment were tightly interwoven with their personal aims and hopes for their future life, and expectations were often related to practical and financial problems, the solution of which being deemed necessary to gain a safe basis for recovery in the long run. The transferability of the results may be limited by the small number of participants. The study emphasises how important it is that service users' personal aims and expectations guide the collaborative treatment process. In addition to providing treatment aimed at improving symptoms, Community Mental Health Centres should take a more comprehensive approach than today by providing more support with family issues
Research demonstrates that addressing mental health issues in children can yield both increased academic performance and better social-emotional skills. In the past, school-based mental health services for students have been implemented inconsistently and usually in combination with community partners. When school mental health interventions are…
Bains, Ranbir Mangat; Diallo, Ana F.
Mental health issues affect 20-25% of children and adolescents, of which few receive services. School-based health centers (SBHCs) provide access to mental health services to children and adolescents within their schools. A systematic review of literature was undertaken to review evidence on the effectiveness of delivery of mental health services…
Bay, Bjørn; Mortensen, Erik Lykke; Kesmodel, Ulrik Schiøler
conceived children was not increased, except for a borderline significantly increased risk of tic disorders (HR 1.4 (1.0-1.9)). In contrast, children born after ovulation induction with or without insemination had significantly increased risks of any mental disorder (HR 1.2 (1.1-1.3)), autism spectrum...... used in the treatments. Limitations, reason for caution The study did not include information on parental psychiatric history and since it is well known that mental disorders run in families, this could explain our findings if children conceived after OI/IUI were born by parents with a higher......Abstract Study question We compared the risk of mental disorders in childhood and adolescence between children born after fertility treatments with in vitro fertilization (IVF), intra cytoplasmic sperm injection (ICSI) or ovulation induction (OI) with or without insemination (IUI) and children born...
Thaís Bento Lima-Silva
Full Text Available Abstract There is scant research evidence regarding training effects among elderly with limited educational experience. Research indicating an association between metamemory and memory performance is based on samples of older adults with at least 12 years of education. Objectives: To test the efficacy of a cognitive training program based on the creation of mental images and changes in specific aspects of metamemory in individuals with 3 to 15 years of education (M=8.38, SD=4.24. Methods: 37 older adults participated in five training sessions (Training Group (TG and 32 control subjects completed only pre and post test assessments (Control Group (CG including the Mini Mental Status Examination (MMSE, the Geriatric Depression Scale (GDS, the Brief Cognitive Screening Battery (BCSB (naming and memorization of 10 pictures, animal category verbal fluency test, the Clock Drawing Test (CDT, the Story subtest from the Rivermead Behavioural Memory Test (RBMT, the Memory Complaint Questionnaire (MAC-Q, and the Picture and Story domains from the Memory Self-Efficacy Questionnaire (MSEQ. Results: The TG showed significant improvement between pre and post tests on the delayed recall of the 10 pictures and in self-efficacy for the memorization of stories. These same changes were not found in the CG . Conclusions: Five-session cognitive training may lead to significant improvements in episodic memory and memory self-efficacy, an aspect of metamemory, in individuals with an average of 8 years of education.
Full Text Available Mental health and behavioural problems are common among students commencing university. University life can be stressful and problems often exacerbate during their course of study, while others develop disorders for the first time. The WHO World Mental Health Surveys International College Student Project aims to conduct longitudinal research to examine and monitor student mental health and wellbeing. The Ulster University Student Wellbeing study, which commenced in September 2015 in Northern Ireland (NI, was conducted as part of this initiative (wave 1, n = 739, using the WMH-CIDI to examine psychopathology. Baseline prevalence rates of lifetime and 12-month mental health and substance disorders, ADHD and suicidality were high, with more than half of new undergraduate students reporting any lifetime disorder. Co-morbidity was common with 19.1% of students experiencing three or more disorders. Logistic regression models revealed that females, those over 21, non-heterosexual students, and those from a lower SES background were more likely to have a range of mental health and behavioural problems. Overall, 10% of new entry students received treatment for emotional problems in the previous year. However, 22.3% of students with problems said they would not seek help. The study provides important information for universities, policy makers and practice, on mental health and wellbeing in young people generally but particularly for students commencing university. The findings will assist in the development and implementation of protection and prevention strategies in the university setting and beyond.
McLafferty, Margaret; Lapsley, Coral R; Ennis, Edel; Armour, Cherie; Murphy, Sam; Bunting, Brendan P; Bjourson, Anthony J; Murray, Elaine K; O'Neill, Siobhan M
Mental health and behavioural problems are common among students commencing university. University life can be stressful and problems often exacerbate during their course of study, while others develop disorders for the first time. The WHO World Mental Health Surveys International College Student Project aims to conduct longitudinal research to examine and monitor student mental health and wellbeing. The Ulster University Student Wellbeing study, which commenced in September 2015 in Northern Ireland (NI), was conducted as part of this initiative (wave 1, n = 739), using the WMH-CIDI to examine psychopathology. Baseline prevalence rates of lifetime and 12-month mental health and substance disorders, ADHD and suicidality were high, with more than half of new undergraduate students reporting any lifetime disorder. Co-morbidity was common with 19.1% of students experiencing three or more disorders. Logistic regression models revealed that females, those over 21, non-heterosexual students, and those from a lower SES background were more likely to have a range of mental health and behavioural problems. Overall, 10% of new entry students received treatment for emotional problems in the previous year. However, 22.3% of students with problems said they would not seek help. The study provides important information for universities, policy makers and practice, on mental health and wellbeing in young people generally but particularly for students commencing university. The findings will assist in the development and implementation of protection and prevention strategies in the university setting and beyond.
McLafferty, Margaret; Lapsley, Coral R.; Ennis, Edel; Armour, Cherie; Murphy, Sam; Bunting, Brendan P.; Bjourson, Anthony J.; O'Neill, Siobhan M.
Mental health and behavioural problems are common among students commencing university. University life can be stressful and problems often exacerbate during their course of study, while others develop disorders for the first time. The WHO World Mental Health Surveys International College Student Project aims to conduct longitudinal research to examine and monitor student mental health and wellbeing. The Ulster University Student Wellbeing study, which commenced in September 2015 in Northern Ireland (NI), was conducted as part of this initiative (wave 1, n = 739), using the WMH-CIDI to examine psychopathology. Baseline prevalence rates of lifetime and 12-month mental health and substance disorders, ADHD and suicidality were high, with more than half of new undergraduate students reporting any lifetime disorder. Co-morbidity was common with 19.1% of students experiencing three or more disorders. Logistic regression models revealed that females, those over 21, non-heterosexual students, and those from a lower SES background were more likely to have a range of mental health and behavioural problems. Overall, 10% of new entry students received treatment for emotional problems in the previous year. However, 22.3% of students with problems said they would not seek help. The study provides important information for universities, policy makers and practice, on mental health and wellbeing in young people generally but particularly for students commencing university. The findings will assist in the development and implementation of protection and prevention strategies in the university setting and beyond. PMID:29236727
Tucker, Anita R.; Javorski, Steve; Tracy, Julie; Beale, Bobbi
Background: There is an increasing need to identify effective mental health treatment practices for children and adolescents in community-based settings, due to current mixed findings of existing interventions. This study looked at adventure therapy (AT) as a viable option to meet this need. Objective: Using a sample of 1,135 youth from a…
Tol, W.A.; Komproe, I.H.; Jordans, M.J.D.; Ndayisaba, A.; Ntamatumba, P.; Sipsma, H.; Smallegange, E.S.; Macy, R.D.; de Jong, J.T.V.M.
Background: Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder, depression, and anxiety (treatment aim); and improving
Tol, Wietse A.; Komproe, Ivan H.; Jordans, Mark J D; Ndayisaba, Aline; Ntamutumba, Prudence; Sipsma, Heather; Smallegange, Eva S.; Macy, Robert D.; de Jong, Joop T V M; Komproe, J
Background: Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder, depression, and anxiety (treatment aim); and improving
Levit, Katharine R; Stranges, Elizabeth; Coffey, Rosanna M; Kassed, Cheryl; Mark, Tami L; Buck, Jeffrey A; Vandivort-Warren, Rita
Goals were to describe funding for specialty behavioral health providers in 1986 and 2005 and examine how the recession, parity law, and Affordable Care Act (ACA) may affect future funding. Numerous public data sets and actuarial methods were used to estimate spending for services from specialty behavioral health providers (general hospital specialty units; specialty hospitals; psychiatrists; other behavioral health professionals; and specialty mental health and substance abuse treatment centers). Between 1986 and 2005, hospitals-which had received the largest share of behavioral health spending-declined in importance, and spending shares trended away from specialty hospitals that were largely funded by state and local governments. Hospitals' share of funding from private insurance decreased from 25% in 1986 to 12% in 2005, and the Medicaid share increased from 11% to 23%. Office-based specialty providers continued to be largely dependent on private insurance and out-of-pocket payments, with psychiatrists receiving increased Medicaid funding. Specialty centers received increased funding shares from Medicaid (from 11% to 29%), and shares from other state and local government sources fell (from 64% to 46%). With ACA's full implementation, spending on behavioral health will likely increase under private insurance and Medicaid. Parity in private plans will also push a larger share of payments for office-based professionals from out-of-pocket payments to private insurance. As ACA provides insurance for formerly uninsured individuals, funding by state behavioral health authorities of center-based treatment will likely refocus on recovery and support services. Federal Medicaid rules will increase in importance as more people needing behavioral health treatment become covered.
Theurer, Gregory; Lovell, David
An intensive case management treatment program for mentally ill offenders (MIOs) is outlined, and subsequent recidivism of participants is evaluated. Features of the program and its development are discussed. Sixty-four (64) participants released from state prison between 1998 and 2003 were matched with a group of MIOs released earlier on eight…
Andrei M. Beliaev
Full Text Available Introduction: In modern medicine professional relationship between the clinician and the patient is patient-centered. Patients become actively involved in the treatment decision making process and are encouraged to express their health-related preferences. Some patients may, however, refuse a favorable risk/benefit ratio treatment. This manuscript presents three cases of refusal of treatment by mentally competent surgical patients and discusses differences in their management. Conclusion: To achieve the best medical outcome for patients who possess the Actual Understanding test of mental competence clinicians use the deliberate model of medical professional relationship. For patients demonstrating the Understanding test of mental competence and wishing to utilize their health-related preferences physicians are obliged to deploy the interpretive model of doctor-patient relationship. In mentally competent patients with an illness-induced acute psychological regression the interpretive model of doctor-patient relationship as an initial strategy and cognitive behavior therapy can be useful in modifying treatment rejecting behavior and improving medical outcome.
Osofsky, Joy; Wieder, Serena; Noroña, Carmen Rosa; Lowell, Darcy; Worthy, D'Lisa Ramsey
Infant and early childhood mental health interventions and treatment take place in many different settings including clinics serving adults and children, primary care centers, pediatric clinics, private practice offices, homes, early intervention offices, and child care centers. In addition, the types of evaluations and services offered in these…
Kutschera, P. C.; Caputi, Marie A.; Pelayo, Jose Maria G., III
Virtually no formal treatment protocol exists for the health/mental health care of biracial Filipino Amerasians in the Philippines. Today this large group comprises a mostly socioeconomically at risk diaspora. A recent 3-year study found depression, elevated anxiety, joblessness, social isolation, substance and alcohol abuse, and housing…
E.C. Jochems (Eline)
textabstractThe main aim of the current thesis was to empirically test and compare three current theoretical models of motivation for treatment in the context of outpatient psychiatric care for patients with severe mental illness (SMI). In a literature review (Chapter 2), we argued that
de Haan, A.M.; Boon, A.E.; de Jong, J.T.V.M.; Hoeve, M.; Vermeiren, R.R.J.M.
A large proportion (28% up to 75%) of the treatments in youth mental health care results in premature termination (dropout). It is important to gain knowledge of the determinants of dropout because it can have very severe consequences. The aim of our meta-analytic review was to provide an overview
L.M. van Ravesteyn (Leontien); M.P. Lambregtse-van den Berg (Mijke); W.J.G. Hoogendijk (Witte); A.M. Kamperman (Astrid)
textabstractBackground For women suffering from an antepartum mental disorder (AMD), there is lack of evidencebased treatment algorithms due to the complicated risk-benefit analysis for both mother and unborn child. We aimed to provide a comprehensive overview of pharmacological and
Albino J Oliveira-Maia; Albino J Oliveira-Maia; Albino J Oliveira-Maia; Albino J Oliveira-Maia; Carina Mendonça; Marta Camacho; Maria João Pessoa; Joaquim Gago; Joaquim Gago
Within clinical psychiatry, recovery from severe mental illness has classically been defined according to symptoms and function (service-based recovery). However, service-users have argued that recovery should be defined as the process of overcoming mental illness, regaining self-control and establishing a meaningful life (customer-based recovery). Here we aimed to compare customer-based and service-based recovery and clarify their differential relationship with other constructs, namely needs...
Oliveira-Maia, Albino J.; Mendon?a, Carina; Pessoa, Maria J.; Camacho, Marta; Gago, Joaquim
Within clinical psychiatry, recovery from severe mental illness (SMI) has classically been defined according to symptoms and function (service-based recovery). However, service-users have argued that recovery should be defined as the process of overcoming mental illness, regaining self-control and establishing a meaningful life (customer-based recovery). Here, we aimed to compare customer-based and service-based recovery and clarify their differential relationship with other constructs, namel...
MacEwan, Joanna P; Seabury, Seth; Aigbogun, Myrlene Sanon; Kamat, Siddhesh; van Eijndhoven, Emma; Francois, Clement; Henderson, Crystal; Citrome, Leslie
The objectives of this study were to assess the level of private and public investment in research and development of treatments for schizophrenia and other mental disorders compared to other diseases in order to present data on the economic burden and pharmaceutical innovation by disease area, and to compare the level of investment relative to burden across different diseases. The levels of investment and pharmaceutical innovation relative to burden across different diseases were assessed. Disease burden and prevalence for mental disorders (schizophrenia, bipolar disorder, and major depressive disorder); cancer; rheumatoid arthritis; chronic obstructive pulmonary disorder; diabetes; cardiovascular disease; and neurological disorders (dementia and epilepsy) were estimated from literature sources. Pharmaceutical treatment innovation was measured by the total number of drug launches and the number of drugs launched categorized by innovativeness. Research and development expenditures were estimated using published information on annual public and domestic private research and development expenditures by disease area. Lastly, investment relative to disease burden was measured among the set of disease classes for which all three measures were available: schizophrenia, bipolar disorder, major depressive disorder, cancer, rheumatoid arthritis, chronic obstructive pulmonary disease, diabetes, cardiovascular disease, and neurology (dementia and epilepsy combined). The level of investment and pharmaceutical innovation in mental disorders was comparatively low, especially relative to the burden of disease. For mental disorders, investment was $3.1 per $1,000 burden invested in research and development for schizophrenia, $1.8 for major depressive disorder, and $0.4 for bipolar disorder relative to cancer ($75.5), chronic obstructive pulmonary disease ($9.4), diabetes ($7.6), cardiovascular disease ($6.3), or rheumatoid arthritis ($5.3). Pharmaceutical innovation was also low
Gourlay, D; Lun, K C; Liya, G
This paper describes recent research that proposes virtual reality techniques as a therapy for patients with cognitive and psychological problems. Specifically this applies to victims of conditions such as traumatic brain injury, Alzheimers and Parkinsons. Additionally virtual reality therapy offers an alternative to current desensitization techniques for the treatment of phobias Some important issues are examined including means of user interaction, skills transfer to the real world, and side-effects of virtual reality exposure.
Full Text Available In my discussion about the early treatment, I am going to point out three important matters:1. Open public health serviceThe deliveries are made at hospitals and the health service is the first to detect and treat children who are disturbed in their development. It also supervisor pregnancies. Upon the delivery, the screening test is used to analyze the risk delivery. At the beginning, the treatment is individual.2. Group (5-8 children in regular kindergartenThe transition of the child from the clinical treatment to the kindergarten is the result of an agreement between the team of experts both from the health institutes and pedagogical field of activity working in this way also when the child is in the nursery.The group of 5-8 handicapped children is now under the supervision of a nursery teacher having been to obtain special pedagogical education.3. Seminars of parentsThe state unity of associations providing for handicapped, in cooperation with local associations, organizes seminars lasting several days for parents and children.The purpose of the seminars is first of all helping parents in solving their emotional problems and also informing them on numerous issues appearing in connection with their child and themselves.
Full Text Available About 40 years ago, the mental health services providing strategies have been dramatically changed worldwide. As well as, it is considered as a new revolution in mental health and named as community-based mental health movement. Moreover, mental health centers in Iran have been established in order to make a change in urban community-based mental health (CMHC. The first CMHC was founded in Tehran 16th district in 2010. In Yazd, it was established in 2010. In this article, the steps for establishment of the first CMHC were described.
Kang-Yi, Christina D.; Mandell, David S.; Hadley, Trevor
Background: This study examined the impact of school-based mental health programs on children's school outcomes and the utilization of acute mental health services. Methods: The study sample included 468 Medicaid-enrolled children aged 6 to 17 years who were enrolled 1 of 2 school-based mental health programs (SBMHs) in a metropolitan area…
Milfort, Roline; Bond, Gary R; McGurk, Susan R; Drake, Robert E
This study examined barriers to employment among Social Security Disability Insurance (SSDI) beneficiaries who received comprehensive vocational and mental health services but were not successful in returning to work. This study examined barriers to employment among 430 SSDI beneficiaries with mental disorders who received evidence-based vocational and mental health services for two years but worked less than one month or not at all. Comprehensive care teams, which included employment specialists, made consensus judgments for each participant, identifying the top three barriers to employment from a checklist of 14 common barriers. Teams most frequently identified three barriers to employment: poorly controlled symptoms of mental illness (55%), nonengagement in supported employment (44%), and poorly controlled general medical problems (33%). Other factors were identified much less frequently. Some SSDI beneficiaries, despite having access to comprehensive services, continued to experience psychiatric impairments, difficulty engaging in vocational services, and general medical problems that limited their success in employment.
Margaret J. Penning
Full Text Available There is a well-established link between marital status and mental health, but previous research has produced mixed results about the reasons for this relationship. Some studies propose that marriage provides protection from stressors and increases personal coping abilities (the causation perspective, whereas other studies argue that marriage markets “weed out” individuals predisposed to illness (the selection perspective. This article addresses the causation-versus-selection debate by examining the effect of marital status on duration of treatment for mental illness. The empirical analysis uses longitudinal data and GEE models to estimate group-level differences in duration of treatment. The results suggest that marriage does not appear to confer a health advantage in terms of duration of treatment. However, the study demonstrates that the never-married experience longer treatment time than the married, divorced, and widowed.
Full Text Available There is a well-established link between marital status and mental health, but previous research has produced mixed results about the reasons for this relationship. Some studies propose that marriage provides protection from stressors and increases personal coping abilities (the causation perspective, whereas other studies argue that marriage markets “weed out” individuals predisposed to illness (the selection perspective. This article addresses the causation-versus-selection debate by examining the effect of marital status on duration of treatment for mental illness. The empirical analysis uses longitudinal data and GEE models to estimate group-level differences in duration of treatment. The results suggest that marriage does not appear to confer a health advantage in terms of duration of treatment. However, the study demonstrates that the never-married experience longer treatment time than the married, divorced, and widowed.
Shields, Laura; Chauhan, Ajay; Bakre, Ravindra; Hamlai, Milesh; Lynch, Durwin; Bunders, Joske
Despite the knowledge that people with mental illness often seek care from multiple healing systems, there is limited collaboration between these systems. Greater collaboration with existing community resources could narrow the treatment gap and reduce fragmentation by encouraging more integrated care. This paper explores the origins, use, and outcomes of a collaborative programme between faith-based and allopathic mental health practitioners in India. We conducted 16 interviews with key stakeholders and examined demographic and clinical characteristics of the user population. Consistent with previous research, we found that collaboration is challenging and requires trust, rapport-building, and open dialogue. The collaboration reached a sizeable population, was reviewed favourably by key stakeholders-particularly on health improvement and livelihood restoration-and perhaps most importantly, views the client holistically, allowing for both belief systems to play a shared role in care and recovery. Results support the idea that, despite differing practices, collaboration between faith-based and allopathic mental health practitioners can be achieved and can benefit clients with otherwise limited access to mental health care. © The Author(s) 2016.
Shi, Zhenrong; MacBeth, Angus
Presenting with common mental health difficulties, particularly depression and anxiety, there is also preliminary evidence that mindfulness-based interventions (MBIs) including mindfulness-based cognitive therapy (MBCT), mindfulness-based stress reduction (MBSR) and integrated mindfulness yoga practices may also be effective in reducing common mental health difficulties during pregnancy. We systematically reviewed and synthesized the current literature on the effectiveness of MBIs in reducing severity of perinatal anxiety and depression. Databases including PubMed, Cochrane Library, IndMED and PsychoInfo were searched for relevant studies. Manual searches were conducted in relevant articles and Google Scholar. Seventeen cohorts representing 18 studies were included. Pre-post effect sizes were reported for both treatment and control groups. Seven randomized controlled trials (RCTs), two non-randomized controlled trials and nine treatment evaluations were included. Maternal participation in an MBI was associated with reductions in perinatal anxiety of moderate to large magnitude. Results for the effect of MBIs on depression were less consistent, with pre-post treatment reductions of moderate magnitude, but no significant differences in depression scores when MBI was compared with a control group. There was some evidence that MBIs were associated with increased mindfulness. Risk of bias in studies was variable. Our review offers preliminary evidence for the effectiveness of MBIs in reducing perinatal anxiety, with more equivocal findings with regard to perinatal depressive symptoms. Further methodologically rigorous evaluation using RCTs and longer follow-up periods are recommended.
Toot, Sandeep; Devine, Mike; Orrell, Martin
To assess the effectiveness of crisis resolution/home treatment services for older people with mental health problems. A systematic review was conducted to report on the effectiveness of crisis resolution/home treatment teams (CRHTTs) for older people with mental health problems. As part of the review, we also carried out a scoping exercise to assess the typologies of older people's CRHTTs in practice, and to review these in the context of policy and research findings. The literature contains Grade C evidence, according to the Oxford Centre of Evidence Based Medicine (CEBM) guidelines, that CRHTTs are effective in reducing numbers of admissions to hospitals. Outcomes such as length of hospital stay and maintenance of community residence were reviewed but evidence was inadequate for drawing conclusions. The scoping exercise defined three types of home treatment service model: generic home treatment teams; specialist older adults home treatment teams; and intermediate care services. These home treatment teams seemed to be effectively managing crises and reducing admissions. This review has shown a lack of evidence for the efficacy of crisis resolution/home treatment teams in supporting older people with mental health problems to remain at home. There is clearly a need for a randomised controlled trial to establish the efficacy of crisis resolution/home treatment services for older people with mental health problems, as well as a more focussed assessment of the different home treatment service models which have developed in the UK. Copyright © 2011 John Wiley & Sons, Ltd.
This article focuses on the measure of involuntary treatment of mental patients in the community, not only with regard to human rights and more specifically those of persons with mental disorders, but also with regard to ethics and deontology in mental healthcare delivery service. In this light, the important role of informed consent in psychiatry with regard to the psychiatric act is examined. Informed consent of mental patients in treatment when they are in need of voluntary or involuntary hospitalization is further examined, while emphasis is being put on the case of involuntary treatment. The Convention for Human Rights and Biomedicine (Convention of Οviedo), the European Convention of Human Rights, other documents of International Organizations (UN) and specialized national legislation (A. 2071/1992, Chapter vi, Greek law) constitute basic reference and interpretation points. The examination of consent and the demarcation of the exceptions are important issues that need to be approached. More particularly, our interest lies with the article 7 of the Convention for Human Rights and Biomedicine, which specifically refers to the protection of person who suffers from a mental disorder. The opinion that informed consent in psychiatric treatment and involuntary treatment are concepts and processes which are distinct but not always mutually exclusive is enhanced. In any case, involuntary treatment causes major dilemmas as far as informed consent in the psychiatric act is concerned, as it raises issues that affect the autonomy of the person. Today, however, there are many factors which influence public politics towards the adoption of the measure of involuntary treatment within the community. How is it that this paradoxical link is legitimized and justified: involuntary treatment and community? The enactment of the above mentioned measure in many European and North American countries has created new paths in the practice of contemporary psychiatry. Nonetheless, it
Mishkin, Arie; Cohen-Hadad, Gerard; Lang, Michal; Kofler, Esther; Vardi, Yoel; Schrira, Samuel; Heresco-Levy, Uriel
The role of the sick funds in the delivery of mental health outpatient services is expected to increase in Israel in the near future. Consequently there is an urgent need for assessing relevant parameters of the patient populations and treatment patterns presently characterizing sick fund's mental health delivery frameworks. During a random census month all patients who referred to Kupat Holim Meuhedet mental health services in Jerusalem district completed structured questionnaires including demographic, medical and mental health history data, and the Symptom Checklist 90 (SCL-90). The professionals who performed the screening assessments filled in a structured questionnaire referring to clinical status parameters, diagnosis and treatment decisions. Eighty-three new referrals were screened during the period studied, out of which 54 (65%) were absorbed within the treatment framework of the sick fund. Women patients were twice as numerous as men. The sample was heterogeneous in terms of demographic characteristics and included relatively high rates of recent physical injury and medical hospitalization. Only approximately 10% of the patients had been referred by their family doctor and only approximately 3% had psychotic disorders. The symptom profile reported was characterized by mild to moderate severity and the most common DSM-IV diagnoses made were depressive, anxiety adjustment and personality disorders. About 50% of the sample was recommended individual psychotherapy and though not mutually exclusive approximately 40% psychotropic medication. Relatively small sample size and catchment area. Before generalization of the findings, larger scale studies are warranted. This pilot study offers a rigorous examination of the content of care of a small sick fund mental health delivery system. Our findings may be instrumental in the development of new services and adaptations to changes in mental health policies.
Elie G Karam
Full Text Available There are no published data on national lifetime prevalence and treatment of mental disorders in the Arab region. Furthermore, the effect of war on first onset of disorders has not been addressed previously on a national level, especially in the Arab region. Thus, the current study aims at investigating the lifetime prevalence, treatment, age of onset of mental disorders, and their relationship to war in Lebanon.The Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation study was carried out on a nationally representative sample of the Lebanese population (n = 2,857 adults. Respondents were interviewed using the fully structured WHO Composite International Diagnostic Interview 3.0. Lifetime prevalence of any Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV disorder was 25.8%. Anxiety (16.7% and mood (12.6% were more common than impulse control (4.4% and substance (2.2% disorders. Only a minority of people with any mental disorder ever received professional treatment, with substantial delays (6 to 28 y between the onset of disorders and onset of treatment. War exposure increased the risk of first onset of anxiety (odds ratio [OR] 5.92, 95% confidence interval [CI] 2.5-14.1, mood (OR 3.32, 95% CI 2.0-5.6, and impulse control disorders (OR 12.72, 95% CI 4.5-35.7.About one-fourth of the sample (25.8% met criteria for at least one of the DSM-IV disorders at some point in their lives. There is a substantial unmet need for early identification and treatment. Exposure to war events increases the odds of first onset of mental disorders.
Rosenbaum, Simon; Tiedemann, Anne; Stanton, Robert; Parker, Alexandra; Waterreus, Anna; Curtis, Jackie; Ward, Philip B
Physical activity (PA) and exercise is increasingly being recognised as an efficacious component of treatment for various mental disorders. The association between PA and cardiometabolic disease is well established, as is the strong link between mental illness, sedentary behaviour and poor cardiometabolic health. Examples of successful integration of clinical PA programs within mental health treatment facilities are increasing. The aim of this review was to summarise the evidence regarding PA and mental illness, and to present examples of clinical exercise programs within Australian mental health facilities. A narrative synthesis of systematic reviews and clinical trials was conducted. Evidence supporting the inclusion of PA programs as an adjunct to treatment for various conditions was presented; including depression, schizophrenia, anxiety disorders, post-traumatic stress disorder and substance abuse. In light of the available evidence, the inclusion of clinical PA programs within mental health treatment, facilitated by dedicated clinicians (exercise physiologists / physiotherapists) was justified. PA is a feasible, effective and acceptable adjunct to usual care for a variety of mental disorders. There is a clear need for greater investment in initiatives aiming to increase PA among people experiencing mental illness, given the benefits to both mental and physical health outcomes. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Vujcic, Maja; Tomicevic-Dubljevic, Jelena; Grbic, Mihailo; Lecic-Tosevski, Dusica; Vukovic, Olivera; Toskovic, Oliver
The general disproportion of urban development and the socio-economical crisis in Serbia, followed by a number of acute and chronic stressors, as well as years of accumulated trauma, prevented the parallel physical, mental and social adaptation of society as a whole. These trends certainly affected the quality of mental health and well-being, particularly on the vulnerable urban population, increasing the absolute number of people with depression, stress and psychosomatic disorders. This study was pioneering in Serbia and was conducted in collaboration with the Faculty of Forestry, the Institute of Mental Health and the Botanical Garden in Belgrade, in order to understand how spending time and performing horticulture therapy in specially designed urban green environments can improve mental health. The participants were psychiatric patients (n=30), users of the day hospital of the Institute who were randomly selected for the study, and the control group, assessed for depression, anxiety and stress before and after the intervention, using a DASS21 scale. During the intervention period the study group stayed in the Botanical garden and participated in a special programme of horticulture therapy. In order to exclude any possible "special treatment'' or ''placebo effect", the control group was included in occupational art therapy while it continued to receive conventional therapy. The test results indicated that nature based therapy had a positive influence on the mental health and well-being of the participants. Furthermore, the difference in the test results of the subscale stress before and after the intervention for the study group was F1.28 = 5.442 and pmental health. Copyright © 2017 Elsevier Inc. All rights reserved.
Pennay, Amy; McNair, Ruth; Hughes, Tonda L; Leonard, William; Brown, Rhonda; Lubman, Dan I
Lesbian, bisexual and queer (LBQ) women experience substantial unmet alcohol and mental health treatment needs. This paper explores the way in which sexual identity shapes experience, and needs, in relation to alcohol and mental health treatment, and presents key messages for improving treatment. Twenty-five in-depth interviews were undertaken with same-sex attracted Australian women, aged 19-71. Interview transcripts were analysed thematically. Key messages offered by participants focused on language, disclosure and practitioner training. Variation in sexual identity did not alter treatment expectations or needs; however, we noted an important difference with respect to identity salience, with high LBQ identity salience linked with preference for disclosure and acknowledgement of sexual identity in treatment interactions, and low identity salience linked with a preference not to disclose and for sexual identity not to require acknowledgement in treatment. Treatment providers may find it useful to gather information about the centrality of sexual identity to LBQ women as a means of overcoming treatment barriers related to heteronormative conventions and discrimination, language and disclosure. Implications for public health: Treatment providers should adopt more inclusive language, seek information about identity salience and the importance of sexual identity to the current treatment, and regularly pursue LBQ-related professional development upskilling. © 2017 The Authors.
The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Project: Development and Testing of Electronic Decision Support System and Formative Research to Understand Perceptions about Mental Health in Rural India.
Maulik, Pallab K; Tewari, Abha; Devarapalli, Siddhardha; Kallakuri, Sudha; Patel, Anushka
Common mental disorders (CMD) such as depression, suicidal risk and emotional/medically unexplained complaints affect a large number of people in India, but few receive appropriate care. Key reasons for this include few trained mental health professionals and stigma associated with mental health. A potential approach to address poor access to care is by training village healthcare workers in providing basic mental health care, and harnessing India's vast mobile network to support such workers using mobile-based applications. We propose an intervention to implement such an approach that incorporates the use of mobile-based electronic decision support systems (EDSS) to provide mental health services for CMD, combined with a community-based anti-stigma campaign. This will be implemented and evaluated across 42 villages in Andhra Pradesh, a south Indian state. This paper discusses the development and testing of the EDSS, and the formative research that informed the anti-stigma campaign. The development of the EDSS used an iterative process that was validated against clinical diagnosis. A mixed methods approach tested the user acceptability of the EDSS. Focus group discussions and in-depth interviews provided community-level perceptions about mental health. This study involved 3 villages and one primary health centre. The EDSS application was found to be acceptable, but some modifications were needed. The community lacked adequate knowledge about CMD and its treatment and there was stigma associated with mental illness. Faith and traditional healers were considered to be important mental health service providers. A number of barriers and facilitators were identified in implementing the intervention analysed in a framework using Andersen's behavioural model of health services use. The findings assisted with refining the intervention prior to large-scale implementation and evaluation.
The Systematic Medical Appraisal, Referral and Treatment (SMART Mental Health Project: Development and Testing of Electronic Decision Support System and Formative Research to Understand Perceptions about Mental Health in Rural India.
Pallab K Maulik
Full Text Available Common mental disorders (CMD such as depression, suicidal risk and emotional/medically unexplained complaints affect a large number of people in India, but few receive appropriate care. Key reasons for this include few trained mental health professionals and stigma associated with mental health. A potential approach to address poor access to care is by training village healthcare workers in providing basic mental health care, and harnessing India's vast mobile network to support such workers using mobile-based applications. We propose an intervention to implement such an approach that incorporates the use of mobile-based electronic decision support systems (EDSS to provide mental health services for CMD, combined with a community-based anti-stigma campaign. This will be implemented and evaluated across 42 villages in Andhra Pradesh, a south Indian state. This paper discusses the development and testing of the EDSS, and the formative research that informed the anti-stigma campaign.The development of the EDSS used an iterative process that was validated against clinical diagnosis. A mixed methods approach tested the user acceptability of the EDSS. Focus group discussions and in-depth interviews provided community-level perceptions about mental health. This study involved 3 villages and one primary health centre.The EDSS application was found to be acceptable, but some modifications were needed. The community lacked adequate knowledge about CMD and its treatment and there was stigma associated with mental illness. Faith and traditional healers were considered to be important mental health service providers.A number of barriers and facilitators were identified in implementing the intervention analysed in a framework using Andersen's behavioural model of health services use.The findings assisted with refining the intervention prior to large-scale implementation and evaluation.
Green, Stuart A; Honeybourne, Emmi; Chalkley, Sylvia R; Poots, Alan J; Woodcock, Thomas; Price, Geraint; Bell, Derek; Green, John
This study aims to identify patient and treatment factors that affect clinical outcomes of community psychological therapy through the development of a predictive model using historic data from 2 services in London. In addition, the study aims to assess the completeness of data collection, explore how treatment outcomes are discriminated using current criteria for classifying recovery, and assess the feasibility and need for undertaking a future larger population analysis. Observational, retrospective discriminant analysis. 2 London community mental health services that provide psychological therapies for common mental disorders including anxiety and depression. A total of 7388 patients attended the services between February 2009 and May 2012, of which 4393 (59%) completed therapy, or there was an agreement to end therapy, and were included in the study. Different combinations of the clinical outcome scores for anxiety Generalised Anxiety Disorder-7 and depression Patient Health Questionnaire-9 were used to construct different treatment outcomes. The predictive models were able to assign a positive or negative clinical outcome to each patient based on 5 independent pre-treatment variables, with an accuracy of 69.4% and 79.3%, respectively: initial severity of anxiety and depression, ethnicity, deprivation and gender. The number of sessions attended/missed were also important factors identified in recovery. Predicting whether patients are likely to have a positive outcome following treatment at entry might allow suitable modification of scheduled treatment, possibly resulting in improvements in outcomes. The model also highlights factors not only associated with poorer outcomes but inextricably linked to prevalence of common mental disorders, emphasising the importance of social determinants not only in poor health but also poor recovery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
Maulik, Pallab K; Kallakuri, Sudha; Devarapalli, Siddhardha
Background: There are large gaps in the delivery of mental health care in low- and middle-income countries such as India, and the problems are even more acute in rural settings due to lack of resources, remoteness, and lack of infrastructure, amongst other factors. The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health Project was conceived as a mental health services delivery model using technology-based solutions for rural India. This paper reports on the operational strategies used to facilitate the implementation of the intervention. Method: Key components of the SMART Mental Health Project included delivering an anti-stigma campaign, training of primary health workers in screening, diagnosing and managing stress, depression and increased suicide risk and task sharing of responsibilities in delivering care; and using mobile technology based electronic decision support systems to support delivery of algorithm based care for such disorders. The intervention was conducted in 42 villages across two sites in the state of Andhra Pradesh in south India. A pre-post mixed methods evaluation was done, and in this paper operational challenges are reported. Results: Both quantitative and qualitative results from the evaluation from one site covering about 5000 adults showed that the intervention was feasible and acceptable, and initial results indicated that it was beneficial in increasing access to mental health care and reducing depression and anxiety symptoms. A number of strategies were initiated in response to operational challenges to ensure smoother conduct of the project and facilitated the project to be delivered as envisaged. Conclusions: The operational strategies initiated for this project were successful in ensuring the delivery of the intervention. Those, coupled with other more systematic processes have informed the researchers to understand key processes that need to be in place to develop a more robust study, that could eventually be
Mental health problems often go undiagnosed or unaddressed until a crisis or extreme event brings the problem to the forefront. Youth are particularly at risk for lack of identification and treatment in regard to mental health issues. This article describes an advanced nursing practice mental health initiative for at-risk teenage girls based on Hildegard Peplau's nursing theory, group process, and healing through holistic health approaches. A support group, RICHES, was developed with focus on core components of relationships, identity, communication, health, esteem, and support. The acronym RICHES was chosen as the name of the support group. Selected themes and issues addressed in this school-based support group are illustrated in case vignettes. Through a collaborative approach with the community and school, this practice initiative presents a unique healing process that extends knowledge in the realm of intervention with at-risk teenage girls. Further research is needed on the efficacy of support groups to modify risk factors and to address goals for primary prevention in at-risk teenage girls. © The Author(s) 2014.
Yan, Shengyuan; Tran, Cong Chi; Wei, Yingying; Habiyaremye, Jean Luc
Developing an early warning model to predict the driver's mental workload (MWL) is critical and helpful, especially for new or less experienced drivers. The present study aims to investigate the correlation between new drivers' MWL and their work performance, regarding the number of errors. Additionally, the group method of data handling is used to establish the driver's MWL predictive model based on subjective rating (NASA task load index [NASA-TLX]) and six physiological indices. The results indicate that the NASA-TLX and the number of errors are positively correlated, and the predictive model shows the validity of the proposed model with an R 2 value of 0.745. The proposed model is expected to provide a reference value for the new drivers of their MWL by providing the physiological indices, and the driving lesson plans can be proposed to sustain an appropriate MWL as well as improve the driver's work performance.
Jochems Eline C
Full Text Available Abstract Background Treatment disengagement and non-completion poses a major problem for the successful treatment of patients with severe mental illness. Motivation for treatment has long been proposed as a major determinant of treatment engagement, but exact mechanisms remain unclear. This current study serves three purposes: 1 to determine whether a feedback intervention based on the patients’ motivation for treatment is effective at improving treatment engagement (TE of severe mentally ill patients in outpatient psychiatric treatment, 2 to gather insight into motivational processes and possible mechanisms regarding treatment motivation (TM and TE in this patient population and 3 to determine which of three theories of motivation is most plausible for the dynamics of TM and TE in this population. Methods/design The Motivation and Treatment Engagement Intervention Trial (MotivaTe-IT is a multi-center cluster randomized trial investigating the effectiveness of feedback generated by clinicians regarding their patients’ treatment motivation upon the patients’ TE. The primary outcome is the patients’ TE. Secondary outcomes are TM, psychosocial functioning and quality of life. Patients whose clinicians generate monthly motivation feedback (additional to treatment as usual will be compared to patients who receive treatment as usual. An estimated 350 patients, aged 18 to 65 years, with psychotic disorders and/or severe personality disorders will be recruited from outpatient community mental health care. The randomization will be performed by a computerized randomization program, with an allocation ratio of 1:1 (team vs. team or clinician vs. clinician and patients, but not clinicians, will be blind to treatment allocation at baseline assessment. Due to the nature of the trial, follow-up assessment can not be blinded. Discussion The current study can provide important insights regarding motivational processes and the way in which motivation
Background Treatment disengagement and non-completion poses a major problem for the successful treatment of patients with severe mental illness. Motivation for treatment has long been proposed as a major determinant of treatment engagement, but exact mechanisms remain unclear. This current study serves three purposes: 1) to determine whether a feedback intervention based on the patients’ motivation for treatment is effective at improving treatment engagement (TE) of severe mentally ill patients in outpatient psychiatric treatment, 2) to gather insight into motivational processes and possible mechanisms regarding treatment motivation (TM) and TE in this patient population and 3) to determine which of three theories of motivation is most plausible for the dynamics of TM and TE in this population. Methods/design The Motivation and Treatment Engagement Intervention Trial (MotivaTe-IT) is a multi-center cluster randomized trial investigating the effectiveness of feedback generated by clinicians regarding their patients’ treatment motivation upon the patients’ TE. The primary outcome is the patients’ TE. Secondary outcomes are TM, psychosocial functioning and quality of life. Patients whose clinicians generate monthly motivation feedback (additional to treatment as usual) will be compared to patients who receive treatment as usual. An estimated 350 patients, aged 18 to 65 years, with psychotic disorders and/or severe personality disorders will be recruited from outpatient community mental health care. The randomization will be performed by a computerized randomization program, with an allocation ratio of 1:1 (team vs. team or clinician vs. clinician) and patients, but not clinicians, will be blind to treatment allocation at baseline assessment. Due to the nature of the trial, follow-up assessment can not be blinded. Discussion The current study can provide important insights regarding motivational processes and the way in which motivation influences the treatment
Boden, Matthew Tyler
To examine prevalence, functioning and treatment associated with all DSM-5 12-month mood, anxiety, eating and substance use disorders among people with diabetes in data obtained from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Through multistage stratified randomized sampling a sample representative of the United States civilian population was obtained. Prevalence of diabetes (Type 1 and 2), DSM-5 disorders, physical and mental functioning, and treatment utilization were assessed via telephone interview. Analyses of weighted data (N=36,138) included calculation of descriptive statistics, and chi-square, logistic and linear regression analyses. Participants with (vs. without) diabetes (9.3% of weighted sample) had a significantly: (a) higher prevalence of any anxiety disorder and posttraumatic stress disorder (with and without adjustment for sociodemographic characteristics), and any mood disorder, major depressive disorder and specific phobia (with adjustment), (b) lower prevalence of any substance use disorder and alcohol and tobacco use disorders (with and without adjustment), and cannabis use disorder (without adjustment). Among participants with diabetes, mental disorder prevalence was consistently associated with sex and age, and to a lesser frequency, race/ethnicity. Lower levels of physical and mental functioning were found among participants with diabetes and a comorbid mental disorder. A minority of participants with diabetes and a comorbid mental disorder received treatment for mood and anxiety disorders, and few received treatment for eating and substance use disorders. Multiple types of mood, anxiety, eating and substance use disorders are prevalent, problematic, and often untreated among people with diabetes. Published by Elsevier Inc.
Aggarwal, Neil Krishan; Pieh, Matthew C; Dixon, Lisa; Guarnaccia, Peter; Alegría, Margarita; Lewis-Fernández, Roberto
To describe studies on clinician communication and the engagement of racial/ethnic minority patients in mental health treatment. Authors conducted electronic searches of published and grey literature databases from inception to November 2014, forward citation analyses, and backward bibliographic sampling of included articles. Included studies reported original data on clinician communication strategies to improve minority treatment engagement, defined as initiating, participating, and continuing services. Twenty-three studies met inclusion criteria. Low treatment initiation and high treatment discontinuation were related to patient views that the mental health system did not address their understandings of illness, care or stigma. Treatment participation was based more on clinician language use, communication style, and discussions of patient-clinician differences. Clinicians may improve treatment initiation and continuation by incorporating patient views of illness into treatment and targeting stigma. Clinicians may improve treatment participation by using simple language, tailoring communication to patient preferences, discussing differences, and demonstrating positive affect. Lack of knowledge about the mental health system and somatic symptoms may delay treatment initiation. Discussions of clinician backgrounds, power, and communication style may improve treatment participation. Treatment continuation may improve if clinicians tailor communication and treatment plans congruent with patient expectations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Gostin, Lawrence O
Despite countless promises for a better life by national commissions, governments and the international community, there has evolved a vicious cycle of neglect, abandonment, indignity, cruel and inhuman treatment, and punishment of persons with mental illness. This shameful history of benign, and sometimes malignant, neglect of persons with mental illness is well understood, with the deep stigma and unredressed discrimination, the deplorable living conditions, and the physical and social barriers preventing their integration and full participation in society. The maltreatment of this vulnerable population has been reinforced by the hurtful stereotypes of incompetency and dangerousness. The belief that persons with mental illness are uniformly dangerous is an equally harmful myth. It provides policy makers with an ostensible justification to exercise control over persons with mental illness, even if they have not committed a violent offence. However, research demonstrates that the class of persons with most mental illnesses is no more dangerous than other populations, and that the vast majority of violence is committed by persons without mental illness. This article will show how this vulnerable population has been unconscionably treated. First, the gross violations of human rights that have occurred, and continue to occur, in 'old' psychiatric institutions will be examined. The deinstitutionalization movement, however, resulted in new places of confinement for this population, such as jails, prisons and homeless shelters. The second part of this paper will explore the new realities of criminal confinement of persons with mental illness. As we will see, incarceration of this vulnerable population in the criminal justice system has caused enormous suffering. If Dostoyevsky was correct that the 'degree of civilization... can be judged by entering its prisons', then by that measure, we are a deeply uncivilized society.
Zhuo, Yue; Bradizza, Clara M; Maisto, Stephen A
The interrelationships between severe mental illness, substance use, and aggression are of longstanding importance with implications for community treatment programs, treatment research and public policy. Through the analysis of longitudinal data collected from 278 patients over a 6-month period following admission to an outpatient dual diagnosis treatment program, this study examined the association between dual diagnosis treatment attendance and subsequent aggression among individuals diagnosed with both a severe mental illness and a substance use disorder. We also tested substance use and psychiatric symptoms as mediators of this treatment-aggression relationship. The results of structural equation modeling analyses indicated that dual diagnosis treatment was associated with lower levels of subsequent aggression. Mediational analyses indicated that greater treatment involvement was associated with reduced substance use, which was associated with lower levels of aggression; thus, substance use was found to mediate the relationship between dual diagnosis treatment and aggression. Surprisingly, severity of psychiatric symptoms did not predict later aggression. These findings suggest that targeting substance use reduction in treatment may have the additional benefit of reducing the risk of later aggression among dual diagnosis patients. Copyright © 2014 Elsevier Inc. All rights reserved.
Zinzow, Heidi M; Britt, Thomas W; Pury, Cynthia L S; Jennings, Kristen; Cheung, Janelle H; Raymond, Mary Anne
Despite significant mental health needs among sexual assault (SA) victims in the military, little is known about treatment-seeking patterns or factors associated with service use. This study examined service use behavior, barriers, and facilitators of mental health treatment-seeking in an active duty sample of 927 U.S. Army soldiers with mental health problems. SA victims (n = 113) did not differ from non-victims on barriers or facilitators after adjusting for demographic and mental health variables, with stigma rated as the largest barrier. Most SA victims (87.6%) had sought informal support and 59.3% had sought formal treatment. One third of treatment-seekers had dropped out of treatment. Multivariate logistic regression analyses identified several correlates of treatment-seeking among SA victims: Black race (OR = 7.57), SA during the military (OR = 4.34), positive treatment beliefs (OR = 2.22), social support for treatment (OR = 2.14), self-reliance (OR = 0.47), and stigma towards treatment seekers (OR = 0.43). Mental health symptoms were not associated with treatment seeking. Findings suggested that treatment-facilitating interventions should focus on improving recognition of mental health symptoms, altering perceptions related to self-reliance, and reducing stigma. Interventions should also enlist support for treatment-seeking from unit members, leaders, and significant others. © 2015 International Society for Traumatic Stress Studies.
Coles, Meredith E; Coleman, Shannon L
Anxiety disorders represent the single largest mental health problem in the United States [Greenberg et al., 1999. J Clin Psychiatry 60:427-435; Rice and Miller, 1998. Br J Psychiatry 173:4-9]. However most individuals with anxiety disorders never seek treatment [Henderson et al., 2002. Can J Psychiatry 47:819-824; Mojtabai et al., 2002. Arch Gen Psychiatry 59:77-84; Roness et al., 2005. Acta Psychiatr Scand 111:51-58]. Deficits in the ability to recognize anxiety disorders and beliefs about them, (i.e., "mental health literacy") may contribute to low levels of help seeking. Survey data assessing mental health literacy for multiple anxiety disorders and for depression were collected from 284 undergraduate students enrolled in psychology courses at a public university in the United States. Specifically, respondents were presented with vignettes portraying individuals experiencing various forms of mental illness and were asked to label the disorder, its cause and whether or not they would recommend treatment. Findings showed that social phobia and obsessive compulsive disorder (OCD) were associated with recognition rates that were generally high and similar to depression (approximately 80%). In contrast, less than half of the respondents labeled panic disorder or generalized anxiety disorder (GAD) correctly. Symptoms of OCD were attributed to mental illness by approximately 50% of respondents, but such attributions were rare for the other anxiety disorders studied (anxiety disorders and according to perceptions of the causes of symptoms. Given that the current sample was well-educated young adults, mental health literacy of the general public may be even lower.
Leontien M van Ravesteyn
Full Text Available For women suffering from an antepartum mental disorder (AMD, there is lack of evidence-based treatment algorithms due to the complicated risk-benefit analysis for both mother and unborn child. We aimed to provide a comprehensive overview of pharmacological and non-pharmacological interventions to treat AMD and performed a meta-analysis of the estimated treatment effect on the psychiatric symptoms during pregnancy.MedLine, PsycINFO and Embase databases were searched by two independent reviewers for clinical trials with a control condition on treatment of women with AMD, i.e. major depressive (MDD, anxiety, psychotic, eating, somatoform and personality disorders. We inventoried the effect of the treatment, i.e. decrease of psychiatric symptoms at the end of the treatment or postpartum. We adhered to the PRISMA-protocol.Twenty-nine trials were found involving 2779 patients. Trials studied patients with depressive disorders (k = 28, and anxiety disorders (k = 1. No pharmacological trials were detected. A form of psychotherapy, like Cognitive Behavioural Therapy (g = -0.61; 95%CI:-0.73 to -0.49, I2 = 0%; k = 7 or Interpersonal Psychotherapy (g = -0.67; 95%CI:-1.27 to -0.07; I2 = 79%; k = 4, holds robust benefit for pregnant women with MDD. Body-oriented interventions (g = -0.43; 95%CI:-0.61 to -0.25; I2 = 17%; k = 7 and acupuncture (g = -0.43; 95%CI:-0.80 to -0.06; I2 = 0%; k = 2 showed medium sized reduction of depressive symptoms. Bright light therapy (g = -0.59; 95%CI:-1.25 to 0.06; I2 = 0%; k = 2, and food supplements (g = -0.51; 95%CI:-1.02 to 0.01; I2 = 20%; k = 3 did not show significant treatment effects. One study was found on Integrative Collaborative Care.This meta-analysis found a robust moderate treatment effect of CBT for MDD during pregnancy, and to a lesser extent for IPT. As an alternative, positive results were found for body-oriented interventions and acupuncture. No evidence was found for bright light therapy and food supplements
Jacobsson, L; Merdasa, F
This article describes the traditional concepts and treatment of mental disorders in the Oromo areas in western Ethiopia before the revolution in 1974. There are three traditional cultural influences operating: traditional Oromo thinking, the Coptic church and the Islamic culture. One important element in traditional Oromo thinking is that each person is believed to possess an ayana, which is a special divine agent that can descend upon people, but also means a person's character and personality. In the traditional Oromo society, the Kallu is the religious leader who, through an ecstatic ritual technique, can investigate the causes of the disorder and advise what to do. Mental disorders are generally explained as resulting from disturbances in the relationship between people and divinity. The second important cultural element in western Ethiopia is the orthodox Coptic church, which usually looks upon mental disorders as possession by evil spirits, which are thus treated by specially gifted priests and monks by praying and giving holy water or eventually exhortation. According to Islamic teaching in the area, mental disorders are caused by evil spirits sent by God to punish the unfaithful people. Some Muslim sheiks treat mental cases with prayers, but herbal remedies are also used. There is a great intermingling of these different cultural and religious elements and people attend different healers and religious leaders more depending on the reputation of the person than on cultural and religious affiliation.
Ruud, Torleif; Flage, Karin Blix; Kolbjørnsrud, Ole-Bjørn; Haugen, Gunnar Brox; Sørlie, Tore
Since 1999, a national two-year multidisciplinary onsite training program has been in operation in Norway. The program trains frontline workforce personnel who provide community treatment to people with severe mental illness. A national network of mental health workers, consumers, caregivers, and others providing or supporting psychosocial treatment and rehabilitation for people with severe mental illness has organized local onsite part-time training programs in collaboration with community mental health centers (CMHCs), municipalities, and primary care providers. CMHC and primary care staff are trained together to increase collaboration. Nationwide dissemination has continued, with new local programs established every year. Evaluations have shown that the program is successful.
Brimblecombe, Nicola; Knapp, Martin; Murguia, Silvia; Mbeah-Bankas, Henrietta; Crane, Steve; Harris, Abi; Evans-Lacko, Sara; Ardino, Vittoria; Iemmi, Valentina; King, Derek
This study aims to evaluate the outcomes and economic case for a UK innovative youth-specific mental health service for 16-25 year olds. A pre-, during- and post-treatment comparative design for 20 young people at high risk of developing psychosis who received 2 years' treatment with the service, using outcomes that concurred with the service aims: changes in mental health, employment rates and service use. Forty-five percent of those at risk and with symptoms of serious mental illness commencing treatment were not receiving mental health services at baseline. Compared with service use prior to treatment at the youth-specific service, hospital admissions, Accident and Emergency, and criminal justice system use appear to decrease over the 2 years of treatment and the year after treatment, with potential cost differences of £473 000. Mental health improved or stayed the same, compared with baseline. Employment rates improved, although the sample size for this is very small. Potential cost differences associated with service users moving into employment over the 2 years are £148 000. The estimated cost over 2 years of providing the youth-specific mental health service to these young people was £106 000. Given the extensive long-term negative consequences and high costs of untreated mental illness in the 16-25 age group and the documented problems young people have in receiving appropriate services, this youth-specific, age-appropriate service model appears to be successful, with improved outcomes and cost differences in the short-term, and with encouraging implications for the longer term. © 2015 Wiley Publishing Asia Pty Ltd.
Doll, Beth; Nastasi, Bonnie K.; Cornell, Laura; Song, Samuel Y.
School-based mental health services are those delivered by school-employed and community-employed providers in school buildings. With the implementation of provisions of the Patient Protection and Affordable Care Act (2010) that funds school-based health centers, school-based mental health services could become more broadly available in…
Gibin, Gustavo Bizarria; Ferreira, Luiz Henrique
The current legislation determines that the chemist must have a solid comprehension about chemical concepts. Literature presents the concept of mental model, which is determinant to the learning of phenomena and concepts. This paper presents some mental models that students of the Chemistry course at UFSCar have about chemical concepts. A lot of incoherence was observed in student's mental models, which is an evidence that there are problems in the learning of chemistry education.
Srebnik, Debra; Sugar, Andrea; Coblentz, Patrick; McDonell, Michael G; Angelo, Frank; Lowe, Jessica M; Ries, Richard K; Roll, John
Emerging evidence supports the effectiveness of contingency management (CM) for addictions treatment among individuals with co-occurring serious mental illness (SMI). Addiction treatment for people with SMI generally occurs within community mental health centers (CMHCs) and it is not known whether CM is acceptable within this context. Client views regarding CM are also unknown. This study is the first to describe CM acceptability among CMHC clinicians, and the first to explore client views. Clinician-level predictors of CM acceptability are also examined. This study examined views about CM among 80 clinicians and 29 clients within a CMHC within the context of a concurrent CM study. Three-quarters of clinicians reported they would use CM if funding were available. Clinicians and clients affirmed that incentives enhance abstinence motivation. Clinician CM acceptability was related to greater years of experience, and identifying as an addictions or co-occurring disorders counselor, more than a mental health clinician. The findings provide preliminary evidence that CMHC clinicians, serving clients with addictions and complicating SMI, and client participants in CM, view CM as motivating and a positive tool to facilitate recovery. As an evidence-based intervention, CM warrants further efforts toward funding and dissemination in CMHCs. Copyright © American Academy of Addiction Psychiatry.
Josef I. Ruzek
Full Text Available Internet-facilitated interventions may offer numerous advantages in reaching the large numbers of military service men and women exposed to traumatic events. The Internet is now a primary source of health-related information for consumers and research has shown the effectiveness of web-based interventions in addressing a range of mental health problems.Clinicians can learn how to bring Internet education and intervention into routine care, to help clients better understand mental health issues and learn skills for self-management of problems.The Afterdeployment.org (AD Internet site can be used by health care professionals serving U.S. military personnel returning from Iraq and Afghanistan, and their families. The site currently addresses 18 key domains of functioning, including post-traumatic stress, sleep, anger, alcohol and drugs, and military sexual trauma. It provides an extensive amount of client and family education that is suitable for immediate use by clients and providers, as well as the kinds of interactive workshop content and self-assessment tools that have been shown to be helpful in other treatment contexts. AD can be utilized in clinical practice in a variety of ways: as an adjunct to treatment for PTSD, to supplement existing treatments for a range of post-deployment problems, or as the primary focus of treatment for a client.AD represents a kind of service that is likely to become increasingly available in coming years and that is important for mental health providers to actively explore as a tool for extending their reach, improving their efficiency, and improving quality of care.For the abstract or full text in other languages, please see Supplementary files under Reading Tools online.
Full Text Available Xuelu Liu,1 Xueming Lou,1 Xianliang Cheng,2 Yong Meng1 1Department of Cardiology, 2Department of Endocrinology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China Background: Metoprolol treatment is well established for chronic heart failure (CHF patients, but the central nervous system side effects are often a potential drawback.Objective: To investigate the impact of metoprolol treatment on change in mental status of CHF patients with clinical psychological disorders (such as depression, anxiety, and burnout syndrome.Methods: From February 2013 to April 2016, CHF patients with clinical mental disorders received metoprolol (23.75 or 47.5 mg, qd PO, dose escalated with 23.75 mg each time until target heart rate [HR] <70 bpm was achieved at the Second Affiliated Hospital of Kunming Medical University. Mental status was assessed by means of the Hospital Anxiety and Depression Scale (HADS and the Copenhagen Burnout Inventory (CBI scale. The primary outcome assessed was change in mental status of patients post-metoprolol treatment and the association with reduction in HR achieved by metoprolol.Results: A total of 154 patients (median age: 66.39 years; males: n=101 were divided into eight groups on the basis of their mental status. HR decreased significantly from baseline values in all the groups to <70 bpm in the 12th month, P≤0.0001. The HADS depression and CBI scores significantly increased from baseline throughout the study frame (P≤0.0001 for all groups, but a significant decrease in the HADS anxiety score was observed in patients with anxiety (P≤0.0001 for all groups. Regression analysis revealed no significant correlation in any of the groups between the HR reduction and the change in the HADS/CBI scores, except for a change in the CBI scores of CHF patients with depression (P=0.01, which was HR dependent.Conclusion: Metoprolol treatment worsens the depressive and high burnout
Ghahramanlou-Holloway, Marjan; LaCroix, Jessica M; Koss, Kari; Perera, Kanchana U; Rowan, Anderson; VanSickle, Marcus R; Novak, Laura A; Trieu, Theresa H
Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines ( N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines ( N = 40) was matched to a non-treatment-seeking sample of Marines ( N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls ( p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed.
Climie, Emma A.
Given the increasing identification of children with emotional/behavioral disorders (EBD), it is imperative that innovative ways of addressing these concerns are explored. Fewer than half of students identified with mental illness receive treatment, leaving a significant proportion of students to cope with mental illness without support. One…
Campbell, Amy T; Aulisio, Mark P
To answer the questions of whether psychiatric patients should ever be allowed to refuse life-sustaining treatment in favor of comfort care for a condition that is caused by a psychiatric disorder, and if so, under what conditions. Case discussion and normative ethical and legal analysis. We argue that psychiatric patients should sometimes be allowed to refuse life-sustaining treatment in favor of comfort care for a condition that is caused by that psychiatric disorder and articulate the core considerations that should be taken into account when such a case arises. We also suggest that unwillingness among many, especially mental health professionals, to consider seriously both of these questions risks perpetuating stigmatization of persons with psychiatric disorders, i.e., that the "mentally" ill should not be allowed to make significant decisions for themselves-a-a stigmatization that can result in persons with mental disorders both being prevented from exercising autonomous choice even when they are capable of it, and being denied good comfort care at the end of life--care which would be offered to patients with similarly life-threatening conditions that were not deemed to be the result of "mental" illness. Copyright © 2012 Wiley Periodicals, Inc.
Gfroerer, Joe; Kuramoto, S. Janet; Ali, Mir; Woodward, Albert M.; Teich, Judith
Objectives. We designed this study to examine differences in receipt of mental health treatment between low-income uninsured nonelderly adults with serious mental illness (SMI) who were eligible for Medicaid under the Affordable Care Act (ACA) and their existing Medicaid counterparts. Assessing these differences might estimate the impact of the Medicaid expansion efforts under the ACA on receipt of mental health treatment among uninsured nonelderly adults with SMI. Methods. We examined data from 2000 persons aged 18 to 64 years who participated in the 2008 to 2013 National Survey on Drug Use and Health, had income below 138% of the federal poverty level, met SMI criteria, and either were uninsured (n = 1000) or had Medicaid-only coverage (n = 1000). We defined SMI according to the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act. We used descriptive analyses and logistic regression modeling. Results. In the 28 states currently expanding Medicaid, the model-adjusted prevalence (MAP) of receiving mental health treatment among Medicaid-only enrollees with SMI (MAP = 71.3%; 95% confidence interval [CI] = 65.74%, 76.29%) was 30.1% greater than their uninsured counterparts (MAP = 54.8%; 95% CI = 48.16%, 61.33%). In the United States, the MAP of receiving mental health treatment among Medicaid-only enrollees with SMI (MAP = 70.4%; 95% CI = 65.67%, 74.70%) was 35.9% higher than their uninsured counterparts (MAP = 51.8%; 95% CI = 46.98%, 56.65%). Conclusions. Estimated increases in receipt of mental health treatment because of enrolling in Medicaid among low-income uninsured adults with SMI might help inform planning and implementation efforts for the Medicaid expansion under the ACA. PMID:25790424
Research has estimated that the percentage of children and adolescents experiencing significant mental health difficulties is as high as 20% of all youth, and that only one-fourth of these students receive therapeutic services outside of school. Given this gap between the need and availability of mental health services, schools often become the…
Fertility treatment has been associated with obstetrical and perinatal complications. It is, however, uncertain whether fertility treatment or parental subfertility is associated with long-term development of the children. We aimed to assess the growth and mental health of children and adolescents conceived after fertility treatment compared to spontaneously conceived controls. First, we evaluated all previous studies comparing neurodevelopmental outcomes between children conceived after fertility treatment and spontaneous conceived controls. The systematic review clarified methodological limitations in the existing literature on the long-term development of children conceived after medical assisted reproduction. Although several studies had been published, large, well-controlled studies with long-term follow-up and thorough statistical adjustments were still few. Second, we evaluated the children's mental health by assessing the risk of mental disorders. We studied a population of 555,828 children conceived after spontaneous conception and 33,139 children conceived after fertility treatment with follow-up in 2012 when the children were 8-17 years old. The absolute risk and hazard ratio of overall and specific mental disorders were estimated while adjusting for potential confounding variables. Further, we estimated the association between subtypes of procedures, hormonal treatment, gamete types and cause of infertility on the one hand and the risk of mental disorders on the other. Children conceived after ovulation induction had a low, but significantly increased risks of autism spectrum disorders, hyperkinetic disorders, conduct, emotional, or social disorders, and tic disorders. Children conceived after IVF or ICSI showed no increased risk, except for a small risk of tic disorders. There was no risk systematically related to any specific type of hormone drug treatment. Thus, the increased risks may rely on residual confounding such as unknown parental factors
Hsieh, Ming-Hong; Wu, Hui-Ching; Chou, Frank Huang-Chih; Molodynski, Andrew
The purpose of this study was to investigate East-West cultural attitudes of mental healthcare professionals (MHPs) towards Involuntary Treatment Orders (ITOs) among Taiwan, England, Wales, and New Zealand. Data on Taiwanese MHPs' views of ITO regime were collected from the National Psychiatric Disease Mandatory Assessment and Community Care Review Committee (N = 176). A national survey instrument was designed to assess the level of support for ITOs among senior clinicians and to determine their views on the importance of various factors in decision-making, the mechanisms through which coercion may work, impediments to its use, and its perceived impact on patients and therapeutic relationships. A descriptive analysis was carried out with data presented as appropriate for the distribution and a t-test was used to detect any differences by respondents. Risk reduction was ranked the most important factor in use of ITOs and reasons for discharging an order. Female respondents had higher approval ratings, with 85 % of agreeing that ITOs were of benefit to the therapeutic relationship, assured long-term stability, and increased medication compliance. The results suggest that clinicians decide the use of ITOs largely based on the risk management, both in terms of starting and ending an order. However, the use of ITOs vary which reflected in the practice. Given this variation in the use of enabling legislation, multidisciplinary input in decision-making is an essential safety mechanism.
Sherrill, Joel T
This commentary underscores the importance and potential of the research approaches and intervention strategies described in the JCCAP special issue on the Science of Adaptive Treatment Strategies in Child and Adolescent Mental Health for addressing the widely observed heterogeneity in response to even our most promising research-informed interventions. First, the commentary briefly summarizes the advantages of these approaches and highlights how these programs of research are responsive to widely agreed-upon calls for more personalized, prescriptive interventions. Next, the commentary briefly discusses key common challenges and gaps in our knowledge that might be addressed to advance the development, testing, and implementation of adaptive intervention strategies. For example, research to identify robust moderators that might serve as potential tailoring variables for initial assignment and sequencing of interventions, efforts to operationalize surrogate endpoints for early identification of individuals who are unlikely to respond to first-line interventions, and research that helps define what constitutes an adequate exposure (i.e., dose) or response threshold (e.g., response that suggests the need to intensify, switch, or augment interventions) would inform decision rules for adaptive algorithms. The commentary concludes with a discussion of potential strategies and current initiatives that might ultimately help facilitate research on more targeted, prescriptive approaches to intervening, including efforts to encourage investigators to use common data elements, to share and integrate data across trials, and to employ a more mechanism-based approach to intervention development and testing.
Butler, Jeremy R; Hyler, Steven E
This article examines the portrayals and myths of child and adolescent psychiatry relevant to the current practitioner. Although behavioral and emotional problems abound onscreen, the formal diagnosis of youth mental illness is uneven and rare. Common myths of brainwashing, incarceration, parent blame, parent supplantation, violence, and evil are explored, with current commercial examples of each. The impact of these portrayals on young patients, peers, parents, and the public at large are examined through the prevalence of different stereotypes across different genres more likely viewed by different ages. Positive and negative depictions of illness and treatment are identified for education and awareness, and the authors provide advice for using Hollywood films successfully as a helpful intervention in the mental health treatment of children and adolescents.
Lehr, D; Kunzler, A; Helmreich, I; Behrendt, D; Chmitorz, A; Lieb, K
Resilience is associated with a positive and resource-oriented perspective. Therefore, it seems especially attractive for health promotion and prevention. In recent years, interventions to foster resilience have been increasingly developed, which train resilience factors and are mainly conducted in a face to face group format. The question is raised what potential internet-based interventions (i-interventions) that train resilience factors have for health promotion and prevention. Based on a narrative overview, the possibilities for i‑interventions that train resilience factors for health promotion and prevention are investigated and the state of research is described. The effects of the i‑interventions presented here, which aim at fostering resilience, on measures of mental health and well-being are heterogeneous and vary between low to high effects. Stronger evidence for the efficacy of these measures exists for more general i‑interventions that also train resilience factors but are conceptualized for the prevention of specific disorders, such as depression or for stress reduction. Given the heterogeneous nature of intervention contents, theoretical foundations and therapeutic methods used, the heterogeneity of the evidence is discussed. In addition, perspectives for the further development of resource-oriented resilience interventions are outlined.
People diagnosed with borderline personality disorder (BPD) are highly prevalent in acute mental health wards, with staff nurses identifying a challenge in working with people who can be significantly distressed. This has contributed to a negative stereotype verging on stigmatization. Mentalization-based therapy (MBT) is a psychological therapy which has been shown to be of benefit to people with a diagnosis of BPD, yet it has been utilized and evaluated only in partial hospitalization and outpatient settings. Despite this, most people diagnosed with BPD will continue to be treated in generic inpatient settings such as acute mental health. Mentalization-based therapy skills training (MBT-S) is a new and cost-effective 2-day workshop aiming to provide generalist practitioners with MBT skills for use in generic settings. This study aimed to capture staff perceptions of the impact of MBT-S on their practice when working with people with a diagnosis of BPD in acute mental health. Through two focus groups, this study assessed the perceptions of nine staff nurses. An interpretive phenomenological approach was utilized in data analysis. Participants found the approach easy to grasp, improving of consistency between staff and flexible in its use in planned or 'off the cuff' discussions. MBT-S promoted empathy and humane responses to self-harm, impacted on participants ability to tolerate risk and went some way to turning the negative perception of BPD through changing the notion of patients as 'deliberately difficult'. Staff felt empowered and more confident in working with people with a diagnosis of BPD. The positive implication for practice was the ease in which the approach was adopted and participants perception of MBT-S as an empowering skill set which also contributed to attitudinal change. In acute mental health environments, which may not have the resources to provide long-term structured treatments to patients, MBT-S could be viewed as ideal as participants
Bains, Ranbir M.; Cusson, Regina; White-Frese, Jesse; Walsh, Stephen
Background: We summarize utilization patterns for mental health services in school-based health centers. Methods: Administrative data on school-based health center visits in New Haven, Connecticut were examined for the 2007-2009 school years. Relative frequencies of mental health visits by age were calculated as a percentage of all visits and were…
Hays, Krystal; Aranda, Maria P.
Faith-based interventions have emerged culturally sensitive way to address mental health issues among African Americans. This systematic review explores the scope and efficacy of faith-based mental health intervention outcomes among African Americans. Extracted data included the study population, setting, study design, intervention, adaptations,…
Andersen, Anders Johan W; Svensson, Tommy
Internet-based mental health services increase rapidly. However, national surveys are incomplete and the consequences for such services are poorly discussed. This study describes characteristics of 60 Internet-based mental health services in Norway and Sweden and discusses their social consequences. More than half of the services were offered by voluntary organisations and targeted towards young people. Professionals answered service users' questions in 60% of the services. Eight major themes were identified. These characteristics may indicate a shift in the delivery of mental health services in both countries, and imply changes in the understanding of mental health.
Bains, Ranbir M; Cusson, Regina; White-Frese, Jesse; Walsh, Stephen
We summarize utilization patterns for mental health services in school-based health centers. Administrative data on school-based health center visits in New Haven, Connecticut were examined for the 2007-2009 school years. Relative frequencies of mental health visits by age were calculated as a percentage of all visits and were stratified by sex, ethnicity/race, and insurance status. Mental health visits accounted for the highest proportion of visits (31.8%). The proportion of mental health visits was highest at 8 years (42.8%) and at 13 years (39.0%). The proportion of mental health visits among boys (38.4%) was higher than among girls (26.7%). Hispanic students had a lower proportion of mental health visits than black students (23.5% vs 35.8%) in all but 2 age groups. Students in the white/other ethnicity category had higher proportions of mental health visits than Hispanic and black students between ages 12 and 15. Students with no health insurance (22.5%) had lower proportions of mental health visits than students covered by Medicaid (34.3%) or private insurance (33.9%). The percentage of mental health visits by students with private insurance was highest (37.2%-49%) in the 13-15 age range. Usage patterns for mental health issues show pronounced, nonrandom variation relative to age and other demographic characteristics especially with 8-year-old boys. © 2017, American School Health Association.
The aim of this paper is to inform mental health professionals about Activity-based funding (ABF) and the implications for data collection and clinical practice, in particular for consultation-liaison (CL) psychiatry. Activity-based funding may provide an opportunity for mental health services to be more equitably resourced, but much needs to be done to demonstrate that the funding model works in mental health. It is important to ensure that data collected is meaningful and accurate and reflects the diverse roles of mental health clinicians, including in CL. Inpatient and community services should be integrated in the model, as well as safeguards against potential abuse. Clinicians, in partnership with initiatives such as the Australian Mental Health Outcomes and Classification Network, are best placed to guide the development of an ABF system for mental health which appropriately recognises the complexity and variability between patients in different settings. © The Royal Australian and New Zealand College of Psychiatrists 2014.
The present study was designed to examine the relationship between self-stigma and quality of life over a one year time period for 71 people with mental illness who were receiving compulsory community mental health treatment. It was hypothesized that, over time, self-stigma would have the direct effect of eroding quality of life among people with…
Bateman, Anthony W; Fonagy, Peter
The treatment of borderline personality disorder (BPD) remains controversial. The authors have developed an evidence-based treatment program rooted in attachment theory that integrates research on constitutional factors with environmental influences. BPD is conceived of as a disorder in the self-structure brought about through environmentally induced distortion of psychological functioning, which decouples key mental processes necessary for interpersonal and social function. The primary mental function involved is mentalization, which is enfeebled by an absence of contingent and marked mirroring during development. Treatment strategies target mentalization in order to foster the development of stable internal representations, to aid the formation of a coherent sense of self, and to enable to borderline patient to form more secure relationships in which motivations of self and other are better understood. Destabilization of the self leads to emotional volatility, so treatment also needs to focus on identification and appropriate expression of affect. This article describes some of the techniques used to enhance mentalization within the context of group and individual psychotherapy. Targeting of current symptomatology and behavior is insufficient. Therapists need to retain their own ability to mentalize, maintain mental closeness, focus on current mental states, and avoid excessive use of conflict interpretation and metaphor while paying careful attention to the use of transference and countertransference.
Sawamura, Jitsuki; Morishita, Shigeru; Ishigooka, Jun
We previously presented a group theoretical model that describes psychiatric patient states or clinical data in a graded vector-like format based on modulo groups. Meanwhile, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, the current version), is frequently used for diagnosis in daily psychiatric treatments and biological research. The diagnostic criteria of DSM-5 contain simple binominal items relating to the presence or absence of specific symptoms. In spite of its simple form, the practical structure of the DSM-5 system is not sufficiently systemized for data to be treated in a more rationally sophisticated way. To view the disease states in terms of symmetry in the manner of abstract algebra is considered important for the future systematization of clinical medicine. We provide a simple idea for the practical treatment of the psychiatric diagnosis/score of DSM-5 using depressive symptoms in line with our previously proposed method. An expression is given employing modulo-2 and -7 arithmetic (in particular, additive group theory) for Criterion A of a 'major depressive episode' that must be met for the diagnosis of 'major depressive disorder' in DSM-5. For this purpose, the novel concept of an imaginary value 0 that can be recognized as an explicit 0 or implicit 0 was introduced to compose the model. The zeros allow the incorporation or deletion of an item between any other symptoms if they are ordered appropriately. Optionally, a vector-like expression can be used to rate/select only specific items when modifying the criterion/scale. Simple examples are illustrated concretely. Further development of the proposed method for the criteria/scale of a disease is expected to raise the level of formalism of clinical medicine to that of other fields of natural science.
Gold, Paul B; Meisler, Neil; Santos, Alberto B; Carnemolla, Mark A; Williams, Olivia H; Keleher, Jennie
Urban-based randomized clinical trials of integrated supported employment (SE) and mental health services in the United States on average have doubled the employment rates of adults with severe mental illness (SMI) compared to traditional vocational rehabilitation. However, studies have not yet explored if the service integrative functions of SE will be effective in coordinating rural-based services that are limited, loosely linked, and geographically dispersed. In addition, SE's ability to replicate the work outcomes of urban programs in rural economies with scarce and less diverse job opportunities remains unknown. In a rural South Carolina county, we designed and implemented a program blending Assertive Community Treatment (ACT) with an SE model, Individual Placement and Support (IPS). The ACT-IPS program operated with ACT and IPS subteams that tightly integrated vocational with mental health services within each self-contained team. In a 24-month randomized clinical trial, we compared ACT-IPS to a traditional program providing parallel vocational and mental health services on competitive work outcomes for adults with SMI (N = 143; 69% schizophrenia, 77% African American). More ACT-IPS participants held competitive jobs (64 versus 26%; p < .001, effect size [ES] = 0.38) and earned more income (median [Mdn] = $549, interquartile range [IQR] = $0–$5,145, versus Mdn = $0, IQR = $0–$40; p < .001, ES = 0.70) than comparison participants. The competitive work outcomes of this rural ACT-IPS program closely resemble those of urban SE programs. However, achieving economic self-sufficiently and developing careers probably require increasing access to higher education and jobs imparting marketable technical skills. PMID:16177278
Mandryk, Regan Lee; Birk, Max Valentin
Designers of digital interventions for mental health often leverage interactions from games because the intrinsic motivation that results from game-based interventions may increase participation and translate into improved treatment efficacy. However, there are outstanding questions about the suitability (eg, are desktop or mobile interventions more appropriate?) and intervention potential (eg, do people with depression activate enough to play?) of games for mental health. In this paper, we aimed to describe the presently unknown relationship between gaming activity and indicators of well-being so that designers make informed choices when designing game-based interventions for mental health. We gathered validated scales of well-being (Beck's Depression Inventory [BDI-II], Patient Health Questionnaire [PHQ-9], trait anxiety [TA], and basic psychological needs satisfaction [BPNS]), play importance (control over game behavior: control; gamer identity: identity), and play behavior (play frequency, platform preferences, and genre preferences) in a Web-based survey (N=491). The majority of our participants played games a few times a week (45.3%, 222/490) or daily (34.3%, 168/490). In terms of depression, play frequency was associated with PHQ-9 (P=.003); PHQ-9 scores were higher for those who played daily than for those who played a few times a week or less. Similarly, for BDI-II (P=.01), scores were higher for those who played daily than for those who played once a week or less. Genre preferences were not associated with PHQ-9 (P=.32) or BDI-II (P=.68); however, platform preference (ie, mobile, desktop, or console) was associated with PHQ-9 (P=.04); desktop-only players had higher PHQ-9 scores than those who used all platforms. Platform preference was not associated with BDI-II (P=.18). In terms of anxiety, TA was not associated with frequency (P=.23), platform preference (P=.07), or genre preference (P=.99). In terms of needs satisfaction, BPNS was not associated with
Albino J Oliveira-Maia
Full Text Available Within clinical psychiatry, recovery from severe mental illness has classically been defined according to symptoms and function (service-based recovery. However, service-users have argued that recovery should be defined as the process of overcoming mental illness, regaining self-control and establishing a meaningful life (customer-based recovery. Here we aimed to compare customer-based and service-based recovery and clarify their differential relationship with other constructs, namely needs and quality of life. The study was conducted in 101 patients suffering from severe mental illness, recruited from a rural community mental health setting in Portugal. Customer-based recovery and function-related service-based recovery were assessed respectively using a shortened version of the Mental Health Recovery Measure (MHRM-20 and the Global Assessment of Functioning score. The Camberwell Assessment of Need scale was used to objectively assess needs, while subjective quality of life was measured with the TL-30s scale. Using multiple linear regression models, we found that the Global Assessment of Functioning score was incrementally predictive of the MHRM-20 score, when added to a model including only clinical and demographic factors, and that this model was further incremented by the score for quality of life. However, in an alternate model using the Global Assessment of Functioning score as the dependent variable, while the MHRM-20 score contributed significantly to the model when added to clinical and demographic factors, the model was not incremented by the score for quality of life. These results suggest that, while a more global concept of recovery from severe mental illness may be assessed using measures for service-based and customer-based recovery, the latter, namely the MHRM-20, also provides information about subjective well-being. Pending confirmation of these findings in other populations, this instrument could thus be useful for
Aarons, Gregory A.; Sawitzky, Angelina C.
Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for ...
Evans-Lacko, S; Aguilar-Gaxiola, S; Al-Hamzawi, A; Alonso, J; Benjet, C; Bruffaerts, R; Chiu, W T; Florescu, S; de Girolamo, G; Gureje, O; Haro, J M; He, Y; Hu, C; Karam, E G; Kawakami, N; Lee, S; Lund, C; Kovess-Masfety, V; Levinson, D; Navarro-Mateu, F; Pennell, B E; Sampson, N A; Scott, K M; Tachimori, H; Ten Have, M; Viana, M C; Williams, D R; Wojtyniak, B J; Zarkov, Z; Kessler, R C; Chatterji, S; Thornicroft, G
The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data. Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI). Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes). The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.
Cañete-Nicolás, Carlos; Hernández-Viadel, Miguel; Bellido-Rodríguez, Carmen; Lera-Calatayud, Guillem; Asensio-Pascual, Pedro; Pérez-Prieto, Juan F; Calabuig-Crespo, Roman; Leal-Cercós, Carmen
Involuntary Outpatient Treatment (IOT) expects to improve treatment compliance and, therefore, prevent the impairment of patients with severe mental illness, as well as the risk for them and others. Besides IOT introduction defenders and opponent's states, scientific literature offers contradictory results. Legislative changes have been taken in the vast majority of our neighbouring countries in order to regulate IOT application. There is no legal regulation in Spain; however, OIT application is possible in certain Spanish cities. This article reviews IOT in Spain and surrounding countries.
Timpano, Francesca; Pirrotta, Fabio; Bonanno, Lilla; Marino, Silvia; Marra, Angela; Bramanti, Placido; Lanzafame, Pietro
Neuropsychological testing is a prime criterion of good practice to document cognitive deficits in a rapidly aging population. Telecommunication technologies may overcome limitations related to test administration. We compared performance of the Italian videoconference-based version of the Mini Mental State Examination (VMMSE) with performance of the standard MMSE administered face-to-face (F2F), to validate the Italian version of the 28-item VMMSE. To validate the Italian version of the VMMSE, we compared its performance with standard F2F. The sample (n=342) was administered three VMMSEs within 6 weeks after F2F testing. We identified the optimal cutoff through the receiver operating characteristic curve, as well as the VMMSE consistency through inter- and intrarater reliability (Inter/RR and Intra/RR) analysis. We found high levels of sensitivity and specificity for the optimal VMMSE cutoff identification and an accuracy of 0.96 (95% confidence interval 0.94-0.98). Intra/RR and inter/RR were highly significant. This study demonstrates that VMMSE is a valid instrument in clinical and research screening and monitoring of subjects affected by cognitive disorders. This study shows a significant correlation between videoconference assessment and the F2F one, providing an important impetus to expand studies and the knowledge about the usefulness of tele-assistance services. Our findings have important implications for both longitudinal assistance and clinical care of demented patients.
Haliko, Shannon; Downs, Julie; Mohan, Deepika; Arnold, Robert; Barnato, Amber E
Variation in the intensity of acute care treatment at the end of life is influenced more strongly by hospital and provider characteristics than patient preferences. We sought to describe physicians' mental models (i.e., thought processes) when encountering a simulated critically and terminally ill older patient, and to compare those models based on whether their treatment plan was patient preference-concordant or preference-discordant. Seventy-three hospital-based physicians from 3 academic medical centers engaged in a simulated patient encounter and completed a mental model interview while watching the video recording of their encounter. We used an "expert" model to code the interviews. We then used Kruskal-Wallis tests to compare the weighted mental model themes of physicians who provided preference-concordant treatment with those who provided preference-discordant treatment. Sixty-six (90%) physicians provided preference-concordant treatment and 7 (10%) provided preference-discordant treatment (i.e., they intubated the patient). Physicians who intubated the patient were more likely to emphasize the reversible and emergent nature of the patient situation (z = -2.111, P = 0.035), their own comfort (z = -2.764, P = 0.006), and rarely focused on explicit patient preferences (z = 2.380, P = 0.017). Post-decisional interviewing with audio/video prompting may induce hindsight bias. The expert model has not yet been validated and may not be exhaustive. The small sample size limits generalizability and power. Hospital-based physicians providing preference-discordant used a different mental model for decision making for a critically and terminally ill simulated case. These differences may offer targets for future interventions to promote preference-concordant care for seriously ill patients.
Välimäki, Maritta; Hätönen, Heli M; Lahti, Mari E; Kurki, Marjo; Hottinen, Anja; Metsäranta, Kiki; Riihimäki, Tanja; Adams, Clive E
Virtual reality (VR) is computerised real-time technology, which can be used an alternative assessment and treatment tool in the mental health field. Virtual reality may take different forms to simulate real-life activities and support treatment. To investigate the effects of virtual reality to support treatment compliance in people with serious mental illness. We searched the Cochrane Schizophrenia Group Trials Register (most recent, 17th September 2013) and relevant reference lists. All relevant randomised studies comparing virtual reality with standard care for those with serious mental illnesses. We defined virtual reality as a computerised real-time technology using graphics, sound and other sensory input, which creates the interactive computer-mediated world as a therapeutic tool. All review authors independently selected studies and extracted data. For homogeneous dichotomous data the risk difference (RD) and the 95% confidence intervals (CI) were calculated on an intention-to-treat basis. For continuous data, we calculated mean differences (MD). We assessed risk of bias and created a 'Summary of findings' table using the GRADE approach. We identified three short-term trials (total of 156 participants, duration five to 12 weeks). Outcomes were prone to at least a moderate risk of overestimating positive effects. We found that virtual reality had little effects regarding compliance (3 RCTs, n = 156, RD loss to follow-up 0.02 CI -0.08 to 0.12, low quality evidence), cognitive functioning (1 RCT, n = 27, MD average score on Cognistat 4.67 CI -1.76 to 11.10, low quality evidence), social skills (1 RCT, n = 64, MD average score on social problem solving SPSI-R (Social Problem Solving Inventory - Revised) -2.30 CI -8.13 to 3.53, low quality evidence), or acceptability of intervention (2 RCTs, n = 92, RD 0.05 CI -0.09 to 0.19, low quality evidence). There were no data reported on mental state, insight, behaviour, quality of life, costs, service utilisation, or
Hansotte, Elinor; Payne, Shirley I; Babich, Suzanne M
Left undiagnosed and/or untreated, the short-and long-term sequelae of postpartum depression may negatively impact both mother and child. In Western countries, access to mental health care is influenced by socioeconomic factors. The objective of this systematic literature review is to compile factors that hinder and improve access to postpartum depression treatment in low-income women after a positive screen for postpartum depression. The key question of focus is: what are the characteristics associated with access to mental health treatment for low-income women with a positive postpartum depression screen in Western countries? A PRISMA-based systematic literature review was conducted of studies published in English before February 2016 that looked at treatment for postpartum depression in low-income women who had been identified with the condition. PubMed and EBSCO databases were searched using MESH and key terms and found 100 articles that met the selection criteria. After review by two independent researchers, 18 studies with 17 unique populations were included in the literature review. Two independent abstractors searched the included articles for themes surrounding impediments and advantages for low-income women identified with postpartum depression in obtaining mental health treatment. Characteristics of successful mental health treatment included studies that employed the use of a home visitor and those that separated outcomes for women with previous mental health treatment. Themes that emerged as treatment obstacles included cultural barriers, physical barriers, systemic health care barriers, and social barriers. This review will help to better inform screening and treatment priorities for those in the medical field who may encounter women experiencing postpartum depression and are not aware of the various barriers to care specific to low-income women. This review will also help policymakers identify specific obstacles that are not addressed in postpartum
Peterson, Emma; Busch, Susan
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 changed the landscape of mental health and substance use disorder coverage in the United States. The MHPAEA's comprehensiveness compared with past parity laws, including its extension of parity to plan management strategies, the so-called nonquantitative treatment limitations (NQTL), led to significant improvements in mental health care coverage. In this article, we review the history of this landmark legislation and its recent expansions to new populations, describe past research on the effects of this and other mental health/substance use disorder parity laws, and describe some directions for future research, including NQTL compliance issues, effects of parity on individuals with severe mental illness, and measurement of benefits other than mental health care use.
Mojtabai, Ramin; Chen, Lian-Yu; Kaufmann, Christopher N; Crum, Rosa M
Barriers to both mental health and substance use disorder treatments have rarely been examined among individuals with comorbid mental health and substance use disorders. In a sample of 393 adults with 12-month major depressive episodes and substance use disorders, we compared perceived barriers to these two types of treatments. Data were drawn from the 2005-2011 U.S. National Surveys on Drug Use and Health. Overall, the same individuals experienced different barriers to mental health treatment versus substance use disorder treatment. Concerns about negative views of the community, effects on job, and inconvenience of services were more commonly reported as reasons for not receiving substance use disorder treatment. Not affording the cost of care was the most common barrier to both types of treatments, but more commonly reported as a barrier to mental health treatment. Improved financial access through the Affordable Care Act and parity legislation and integration of mental health and substance use disorder services may help to reduce treatment barriers among individuals with comorbid mental health and substance disorders. © 2013.
Reavley, Nicola J; Morgan, Amy J; Jorm, Anthony F
The aim of the study was to assess the factors predicting experiences of avoidance, discrimination and positive treatment in people with mental health problems. In 2014, telephone interviews were carried out with 5220 Australians aged 18+, 1381 of whom reported a mental health problem or scored highly on a symptom screening questionnaire. Questions covered experiences of avoidance, discrimination and positive treatment by friends, spouse, other family, workplace, educational institution and others in the community; as well as disclosure of mental health problems. Avoidance, discrimination and positive treatment scores were calculated by counting the number of domains in which each occurred. Predictors of avoidance, discrimination and positive treatment were modelled with negative binomial regression analyses. After adjusting for the effects of other predictors in multivariate analyses, symptom severity and a diagnosis of 'any other disorder' (most commonly psychotic disorders or eating disorders) predicted experiences of both avoidance and discrimination but not positive treatment. Disclosing a mental health problem in more settings was also associated with higher rates of avoidance and discrimination, but also with positive treatment. Disclosure of mental health problems to others may increases experiences of discrimination, but may also increase experiences of positive treatment. These findings can help to inform decision making by people with mental health problems about disclosure, particularly in the case of more severe or low-prevalence disorders.
Choi, Sam; Adams, Susie M; MacMaster, Samuel A; Seiters, John
A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. The purpose of this study is to identify factors during the initial phase of treatment which predict retention in private residential treatment for individuals with co-occurring substance use and mental health disorders. The participants were 1,317 individuals with co-occurring substance abuse and mental health disorders receiving treatment at three residential treatment centers located in Memphis, TN, Malibu, CA, and Palm Springs, CA. Bivariate analysis and logistic regression were utilized to identify factors that predict treatment retention at 30 days. The findings indicate a variety of factors including age, gender, types of drug, Addiction Severity Index Medical and Psychiatric scores, and readiness to change. These identified factors could be incorporated into pretreatment assessments, so that programs can initiate preventive measures to decrease attrition and improve treatment outcomes.
Gevers, Aník; Dartnall, Elizabeth
In this short communication, we assert that mental health has a crucial role in the primary prevention of sexual and gender-based violence (SGBV). However, we found that most research and practice to date has focused on the role of mental health post-violence, and SGBV primary prevention is relying on public health models that do not explicitly include mental health. Yet, key concepts, processes, and competencies in the mental health field appear essential to successful SGBV primary prevention. For example, empathy, self-esteem, compassion, emotional regulation and resilience, stress management, relationship building, and challenging problematic social norms are crucial. Furthermore, competencies such as rapport building, group processing, emotional nurturing, modelling, and the prevention of vicarious trauma among staff are important for the successful implementation of SGBV primary prevention programmes. SGBV primary prevention work would benefit from increased collaboration with mental health professionals and integration of key mental health concepts, processes, and skills in SGBV research.
Full Text Available In this short communication, we assert that mental health has a crucial role in the primary prevention of sexual and gender-based violence (SGBV. However, we found that most research and practice to date has focused on the role of mental health post-violence, and SGBV primary prevention is relying on public health models that do not explicitly include mental health. Yet, key concepts, processes, and competencies in the mental health field appear essential to successful SGBV primary prevention. For example, empathy, self-esteem, compassion, emotional regulation and resilience, stress management, relationship building, and challenging problematic social norms are crucial. Furthermore, competencies such as rapport building, group processing, emotional nurturing, modelling, and the prevention of vicarious trauma among staff are important for the successful implementation of SGBV primary prevention programmes. SGBV primary prevention work would benefit from increased collaboration with mental health professionals and integration of key mental health concepts, processes, and skills in SGBV research.
Full Text Available BackgroundTreatment of offenders in forensic mental health is complex. Often, these in- or outpatients have low treatment motivation, suffer from multiple disorders, and have poor literacy skills. eHealth may be able to improve treatment outcomes because of its potential to increase motivation and engagement, and it can overcome the predominant one-size-fits-all approach by being tailored to individual patients.ObjectiveTo examine its potential, this systematic review studies the way that eHealth has been used and studied in forensic mental health and identifies accompanying advantages and disadvantages for both patients and treatment, including effectiveness.MethodsA systematic search in Scopus, PsycINFO, and Web of Science was performed up until December 2017. Studies were included if they focused on technological interventions to improve the treatment of forensic psychiatric patients.ResultsThe search resulted in 50 studies in which eHealth was used for treatment purposes. Multiple types of studies and technologies were identified, such as virtual reality, web-based interventions, and videoconferencing. The results confirmed the benefits of technology, for example, the acquisition of unique information about offenders, effectiveness, and tailoring to specific characteristics, but indicated that these are not fully taken advantage of.DiscussionTo overcome the barriers and obtain the benefits, eHealth has to have a good fit with patients and the forensic psychiatric context. It has to be seamlessly integrated in existing care and should not be added as an isolated element. To bridge the gap between the current situation and eHealth’s potential, further research on development, implementation, and evaluation should be conducted.
Kip, Hanneke; Bouman, Yvonne H A; Kelders, Saskia M; van Gemert-Pijnen, Lisette J E W C
Treatment of offenders in forensic mental health is complex. Often, these in- or outpatients have low treatment motivation, suffer from multiple disorders, and have poor literacy skills. eHealth may be able to improve treatment outcomes because of its potential to increase motivation and engagement, and it can overcome the predominant one-size-fits-all approach by being tailored to individual patients. To examine its potential, this systematic review studies the way that eHealth has been used and studied in forensic mental health and identifies accompanying advantages and disadvantages for both patients and treatment, including effectiveness. A systematic search in Scopus, PsycINFO, and Web of Science was performed up until December 2017. Studies were included if they focused on technological interventions to improve the treatment of forensic psychiatric patients. The search resulted in 50 studies in which eHealth was used for treatment purposes. Multiple types of studies and technologies were identified, such as virtual reality, web-based interventions, and videoconferencing. The results confirmed the benefits of technology, for example, the acquisition of unique information about offenders, effectiveness, and tailoring to specific characteristics, but indicated that these are not fully taken advantage of. To overcome the barriers and obtain the benefits, eHealth has to have a good fit with patients and the forensic psychiatric context. It has to be seamlessly integrated in existing care and should not be added as an isolated element. To bridge the gap between the current situation and eHealth's potential, further research on development, implementation, and evaluation should be conducted.
Siskind, Dan; Harris, Meredith; Diminic, Sandra; Carstensen, Georgia; Robinson, Gail; Whiteford, Harvey
A key step in informing mental health resource allocation is to identify the predictors of service utilisation and costs. This project aims to identify the predictors of mental health-related acute service utilisation and treatment costs in the year following an acute public psychiatric hospital admission. A dataset containing administrative and routinely measured outcome data for 1 year before and after an acute psychiatric admission for 1757 public mental health patients was analysed. Multivariate regression models were developed to identify patient- and treatment-related predictors of four measures of service utilisation or cost: (a) duration of index admission; and, in the year after discharge from the index admission (b) acute psychiatric inpatient bed-days; (c) emergency department (ED) presentations; and (d) total acute mental health service costs. Split-sample cross-validation was used. A diagnosis of psychosis, problems with living conditions and prior acute psychiatric inpatient bed-days predicted a longer duration of index admission, while prior ED presentations and self-harm predicted a shorter duration. A greater number of acute psychiatric inpatient bed-days in the year post-discharge were predicted by psychosis diagnosis, problems with living conditions and prior acute psychiatric inpatient admissions. The number of future ED presentations was predicted by past ED presentations. For total acute care costs, diagnosis of psychosis was the strongest predictor. Illness acuity and prior acute psychiatric inpatient admission also predicted higher costs, while self-harm predicted lower costs. The development of effective models for predicting acute mental health treatment costs using existing administrative data is an essential step towards a workable activity-based funding model for mental health. Future studies would benefit from the inclusion of a wider range of variables, including ethnicity, clinical complexity, cognition, mental health legal status
Drapalski, Amy; Bennett, Melanie; Bellack, Alan
Gender differences in patterns and consequences of substance use, treatment-seeking, and motivation to change were examined in two samples of people with serious mental illness (SMI) and comorbid substance use disorders (SUDs): a community sample not currently seeking substance abuse treatment (N = 175) and a treatment-seeking sample (N = 137). In both groups, women and men demonstrated more similarities in the pattern and severity of their substance use than differences. However, treatment-seeking women showed greater readiness to change their substance use. Mental health problems and traumatic experiences may prompt people with SMI and SUD to enter substance abuse treatment, regardless of gender.
Heyman, R E; Wojda, A K; Eddy, J M; Haydt, N C; Geiger, J F; Slep, A M Smith
Over 1 in 5 dental patients report moderate to severe dental fear. Although the efficacy of cognitive-behavioral treatment (CBT) for dental fear has been examined in over 20 randomized controlled trials-with 2 meta-analyses finding strong average effect sizes ( d > 1)-CBT has received almost no dissemination beyond the specialty clinics that tested it. The challenge, then, is not how to treat dental fear but how to disseminate and implement such an evidence-based treatment in a way that recognizes the rewards and barriers in the US health care system. This mixed-method study investigated the potential of disseminating CBT through care from a mental health provider from within the dental home, a practice known as evidence-based collaborative care (EBCC). Two preadoption studies were conducted with practicing dentists drawn from a self-organized Practice-Based Research Network in the New York City metropolitan area. The first comprised 3 focus groups ( N = 17), and the second involved the administration of a survey ( N = 46). Focus group participants agreed that CBT for dental fear is worthy of consideration but identified several concerns regarding its appeal, feasibility, and application in community dental practices. Survey participants indicated endorsement of factors promoting the use of EBCC as a mechanism for CBT dissemination, with no factors receiving less than 50% support. Taken together, these findings indicate that EBCC may be a useful framework through which an evidence-based treatment for dental fear treatment can be delivered.
Kotter, Roxana; Kräplin, Anja; Pittig, Andre; Bühringer, Gerhard
Systematic and quantitative reviews on the effects of land-based self-exclusion are scarce. Therefore, the current review aimed to provide a comprehensive summary of (1) the demographic characteristics of land-based self-excluders and changes after exclusion, including (2) gambling behavior, (3) gambling problems, (4) mental symptoms, and (5) mental health. A systematic database and literature search was performed following PRISMA guidelines. Nineteen naturalistic studies met the eligibility criteria. The quality of all included records was rated via adaption of the Newcastle-Ottawa Scale. Results from higher-quality records were more heavily weighted. Self-excluders were predominantly men in their early or middle forties. Changes after exclusion revealed wide ranges in the rates of abstinence (13-81%), rates of gambling reduction (29-92%), and rates of exclusion breaches (8-59%). The records consistently demonstrated significant changes in pathological gambling from before exclusion (61-95%) to after exclusion (13-26%). Up to 73% of self-excluders exhibited symptoms of anxiety, depression, and substance use disorders at program enrollment. Several aspects of mental health improved after exclusion, e.g., quality of life. Problem and pathological gambling are most prevalent in young men, but self-exclusion was most prominent in middle-aged men. The magnitude of effects widely differed between studies despite overall benefits of self-exclusion, and many individuals continued gambling after exclusion. This shortcoming could be minimized using improved access controls and the extension of exclusion to other gambling segments. High rates of pathological gambling and other mental disorders in self-excluders highlight the need for improved early detection and treatment accessibility.
Evans, Steven W; Randy Koch, J; Brady, Christine; Meszaros, Peggy; Sadler, Joanna
Youth with learning and behavioral problems are at elevated risk for substance use during adolescence. Although evidence-based substance use prevention and screening practices are described in the literature, the extent with which these are provided to these youth is unclear. Mental health professionals in schools and community mental health centers are in an ideal position to conduct substance use screening and prevention practices since they have frequent contact with this high risk group. In order to determine whether these mental health professionals were using evidence based substance use screening and prevention programs with these youth, we analyzed 345 completed surveys from mental health professionals in schools and community clinics throughout a mid-Atlantic state. Results indicated that a large portion of the respondents were unfamiliar with evidence based practices and they were infrequently used. Implications for the division of labor at schools and community mental health centers are discussed in relation to time allotment and priority for these procedures.
Cláudia Ribeiro Franulovic Campos
Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: University students are generally at the typical age of onset of mental disorders that may affect their academic performance. We aimed to characterize the university students attended by psychiatrists at the students’ mental health service (SAPPE and to compare their academic performance with that of non-patient students. DESIGN AND SETTING: Cross-sectional study based on review of medical files and survey of academic data at a Brazilian public university. METHODS: Files of 1,237 students attended by psychiatrists at SAPPE from 2004 to 2011 were reviewed. Their academic performance coefficient (APC and status as of July 2015 were compared to those of a control group of 2,579 non-patient students matched by gender, course and year of enrolment. RESULTS: 37% of the patients had had psychiatric treatment and 4.5% had made suicide attempts before being attended at SAPPE. Depression (39.1% and anxiety disorders/phobias (33.2% were the most frequent diagnoses. Severe mental disorders such as psychotic disorders (3.7% and bipolar disorder (1.9% were less frequent. Compared with non-patients, the mean APC among the undergraduate patients was slightly lower (0.63; standard deviation, SD: 0.26; versus 0.64; SD: 0.28; P = 0.025, but their course completion rates were higher and course abandonment rates were lower. Regarding postgraduate students, patients and non-patients had similar completion rates, but patients had greater incidence of discharge for poor performance and lower dropout rates. CONCLUSION: Despite the inclusion of socially vulnerable people with severe mental disorders, the group of patients had similar academic performance, and in some aspects better, than, that of non-patients.
Campos, Cláudia Ribeiro Franulovic; Oliveira, Maria Lilian Coelho; Mello, Tânia Maron Vichi Freire de; Dantas, Clarissa de Rosalmeida
University students are generally at the typical age of onset of mental disorders that may affect their academic performance. We aimed to characterize the university students attended by psychiatrists at the students' mental health service (SAPPE) and to compare their academic performance with that of non-patient students. Cross-sectional study based on review of medical files and survey of academic data at a Brazilian public university. Files of 1,237 students attended by psychiatrists at SAPPE from 2004 to 2011 were reviewed. Their academic performance coefficient (APC) and status as of July 2015 were compared to those of a control group of 2,579 non-patient students matched by gender, course and year of enrolment. 37% of the patients had had psychiatric treatment and 4.5% had made suicide attempts before being attended at SAPPE. Depression (39.1%) and anxiety disorders/phobias (33.2%) were the most frequent diagnoses. Severe mental disorders such as psychotic disorders (3.7%) and bipolar disorder (1.9%) were less frequent. Compared with non-patients, the mean APC among the undergraduate patients was slightly lower (0.63; standard deviation, SD: 0.26; versus 0.64; SD: 0.28; P = 0.025), but their course completion rates were higher and course abandonment rates were lower. Regarding postgraduate students, patients and non-patients had similar completion rates, but patients had greater incidence of discharge for poor performance and lower dropout rates. Despite the inclusion of socially vulnerable people with severe mental disorders, the group of patients had similar academic performance, and in some aspects better, than, that of non-patients.
Ramchand, Rajeev; Griffin, Beth Ann; Harris, Katherine M.; McCaffrey, Daniel F.; Morral, Andrew R.
This study examined suicide ideation, attempts, and subsequent mental health service among a sample of 948 youth from substance abuse treatment facilities across the U.S. Youth were surveyed at intake and every three months for a one year period. Thirty percent of youth reported ideating in at least one interview and 12% reported attempting suicide; almost half reported receiving outpatient mental health treatment at least once and close to one-third reported being on prescription drugs for a...
Barbosa-Branco, Anadergh; Bultmann, Ute; Steenstra, Ivan
This study aims to determine the prevalence and duration of sickness benefit claims due to mental disorders and their association with economic activity, sex, age, work-relatedness and income replacement using a population-based study of sickness benefit claims (> 15 days) due to mental disorders in
Habacha, Hamdi; Moreau, David; Jarraya, Mohamed; Lejeune-Poutrain, Laure; Molinaro, Corinne
The effect of stimuli size on the mental rotation of abstract objects has been extensively investigated, yet its effect on the mental rotation of bodily stimuli remains largely unexplored. Depending on the experimental design, mentally rotating bodily stimuli can elicit object-based transformations, relying mainly on visual processes, or egocentric transformations, which typically involve embodied motor processes. The present study included two mental body rotation tasks requiring either a same-different or a laterality judgment, designed to elicit object-based or egocentric transformations, respectively. Our findings revealed shorter response times for large-sized stimuli than for small-sized stimuli only for greater angular disparities, suggesting that the more unfamiliar the orientations of the bodily stimuli, the more stimuli size affected mental processing. Importantly, when comparing size transformation times, results revealed different patterns of size transformation times as a function of angular disparity between object-based and egocentric transformations. This indicates that mental size transformation and mental rotation proceed differently depending on the mental rotation strategy used. These findings are discussed with respect to the different spatial manipulations involved during object-based and egocentric transformations.
O'Reilly, Aileen; Barry, James; Neary, Marie-Louise; Lane, Sabrina; O'Keeffe, Lynsey
The use of peer education has been well documented within the discipline of health promotion, but not within the youth mental health domain. This paper describes an evaluation of an innovative schools-based peer education training programme that involved preparing young people to deliver a mental health workshop to their peers. Participants…
Blackman, Kate F.; Powers, Joelle D.; Edwards, Jeffrey D.; Wegmann, Kate M.; Lechner, Ethan; Swick, Danielle C.
Mental health needs among children in the United States have significant consequences for children and their families, as well as the schools that serve them. This qualitative study evaluated the second year of an innovative school-based mental health project that created a multi-system partnership between an urban school district, a public mental…
Johnson, Tristan E.; Lee, Youngmin
In an effort to better understand learning teams, this study examines the effects of shared mental models on team and individual performance. The results indicate that each team's shared mental model changed significantly over the time that subjects participated in team-based learning activities. The results also showed that the shared mental…
Hemelrijk, E.; van Ballegooijen, W.; Donker, T.; van Straten, A.; Kerkhof, A.J.F.M.
Background: Common mental disorders have been found to be related to suicidal ideation and behavior. Research in the field of web-based interventions for common mental disorders, however, usually excludes participants with a suicidal risk, although a large proportion of participants might suffer
Simonsen, Sebastian; Juul, Sophie; Kongerslev, Mickey
The Mentalization-Based Treatment Adherence and Quality Scale (MBT-AQS) is a 17-item measure of treatment adherence and quality of individual mentalization-based therapy (MBT). Until now, reliability research on the scale has primarily been conducted by highly experienced raters from the Norwegian...... MBT therapists in a clinical setting following a brief one-day training course. The overall reliabilities for six raters were good for adherence (.67) and for quality (.62). Thus, the MBT-AQS was found to be an appropriate MBT adherence rating instrument with clinical and educational utility outside...... MBT Quality Lab who were part of its development. Hence, it can be questioned whether only experts in research settings can achieve satisfying levels of reliability on the scale. In this study, we investigated whether a satisfying level of reliability on the MBT-AQS could be obtained by experienced...
Jonathan K Burns
Full Text Available Background. Low- and middle-income countries carry the major burden of mental disorders, yet owing to a significant lack of resources, they experience a ‘treatment gap’ in the range of 75 - 85%. Methods. Epidemiological data on mental disorders in South Africa, national census data and locally developed models for establishing treatment needs were used to calculate expected annual acute admissions and inpatient care, as well as expected annual ambulatory visits in KwaZulu-Natal (KZN Province, South Africa. These were compared with actual acute admission and inpatient care rates as well as actual ambulatory visits to mental health services in the province, derived from the District Health Information Systems. These comparisons allowed an estimation of the treatment gap for mental disorders in the province. Results. Approximately 956 000 adults were estimated to live with mental disorders in KZN. Only 19.8% (10 620 of expected admissions (53 623 took place during the one-year reporting period; while the total number of acute inpatient days accounted for 26.1% of the expected number. Average length of stay (ALOS for acute admissions was longer (21 days than the expected ALOS (16 days. At the recommended level of 30% coverage, ambulatory visits to mental health facilities accounted for 21% of the expected visits during the one-year period. Conclusion. In keeping with previous estimates, these results provide evidence that the ‘treatment gap’ for acute inpatient and ambulatory mental healthcare in KZN is ~80%. This rate is similar to the estimated mental health resource gap in the province, suggesting that gross inadequacies in mental health service provision translate directly into major unmet needs for those living with mental disorders.
Full Text Available Background and Aims: The cost-of-treatment studies can help to make informed decisions while planning health-care services. This study is aimed to assess direct costs of outpatient treatment of four common chronic severe mental illnesses in a tertiary care hospital in South India. Methods: The patients with ICD-10 diagnoses of schizophrenia, unspecified nonorganic psychosis, bipolar disorder, and recurrent depression were recruited by purposive sampling from a government teaching hospital in South India. The total cost-of-treatment to the patient and the hospital was computed for each disorder as a percentage of the per-capita income of an individual patient. Results: The study comprised a total of 140 patients. The average monthly total cost-of-treatment was Indian Rupees (INR 770 (95% confidence interval of 725 to 815, or approximately US$ 12.8. The monthly total cost-of-treatment was INR 720 for schizophrenia, INR 750 for unspecified nonorganic psychosis, INR 830 for bipolar disorder, and INR 790 for recurrent depression, with no significant differences between groups. On an average, 22.8% of total cost-of-treatment was borne by the patient, and the rest by the hospital. The patients spent a median of 12% of their per-capita income on treatment related to direct costs. Conclusions: Despite substantial government subsidies, patients do incur some expenses in treatment of chronic psychiatric illnesses. The attempts to reduce treatment and travel costs can facilitate psychiatric care to larger number of individuals.
Kozlowski, B W
ABSTRACT Many forms of vitamin supplementation have been proposed for the treatment of behavioral and cognitive disorders in children with mental retardation. Except for nutrient deficiencies and selected inborn errors of metabolism, the efficacy of these treatments has not been established. Therapeutic supplementation with vitamin B(6) in Down syndrome and folie acid in fragile X syndrome was attempted following the identification of apparent biochemical aberrations involving the nutrients. Double-blind controlled trials have revealed no evidence that B(6) treatment was effective in Down syndrome. Very limited evidence, only among prepubertal subjects, suggested that behaviors improved with folie acid treatment in fragile X syndrome. There is less clarity of the scientific rationales for various combinations of vitamins (or vitamins and minerals) that have been promoted according to the concept of orthomolecular medicine. Well-designed controlled studies, with data presented in conformity with generally accepted scientific standards, have not supported the efficacy of megadose supplementation with 1) multivitamins in cognitive disabilities or attention deficit disorders, or 2) multivitamins and minerals in Down syndrome or other forms of mental retardation. Insufficient data are available to support claims made for vitamin B(6) and magnesium supplementation in autism. Research in the larger field of nutrient-behavior research has reinforced the need for studies to be more rigorously designed and to draw on the expertise of multiple disciplines. Evidence of toxic effects of nutrients continues to accrue, reinforcing the fact that megadoses should not be used indiscriminately or without physician monitoring. For children with mental retardation generally, assuring that established nutritional needs are met warrants primary consideration.
Edlund, Mark J; Booth, Brenda M; Han, Xiaotong
Only a fraction of individuals with alcohol use disorders (AUDs) receive any AUD treatment during a given year. If a substantial proportion of individuals with unmet need for AUD treatment are receiving mental health treatment, accessibility of AUD treatment could potentially be improved by implementing strategies to ensure that individuals receiving mental health care are referred to the AUD sector or by increasing rates of AUD treatment in individuals receiving mental health treatment. We assessed patterns and predictors of mental health treatment and AUD treatment among individuals with 12-month AUDs, using secondary data analyses from two national surveys, the National Survey on Drug Use and Health (NSDUH; n = 4,545 individuals with AUDs) and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 3,327 individuals with AUDs). In both NSDUH and NESARC, 8% of individuals with AUDs reported past-year AUD treatment. Among individuals with AUDs, mental health treatment was more common than AUD treatment, with 20% of NSDUH respondents and 11% of NESARC respondents reporting receiving mental health treatment. Greater mental health morbidity increased the odds of mental health treatment, and AUD severity increased the odds of AUD treatment. Mental health morbidity also increased the odds of AUD treatment, mainly by increasing the odds of receiving the category of both AUD and mental health treatment. Because individuals with AUDs are more likely to receive mental health treatment than AUD treatment, a key opportunity to improve the overall accessibility of treatment for AUDs may be to focus on improving AUD treatment among individuals receiving mental health treatment.
Decision making ability can change with time, depending on mental or physical health. Little is known about the factors that determine this change and the relationship of capacity to time. As a pilot for studies using functional mental capacities as an outcome measure, we sought to quantify this relationship measuring change over time using competence assessment tools, and rating scales for symptoms and global function.
Valenza, Gaetano; Lanatà, Antonio; Paradiso, Rita; Scilingo, Enzo Pasquale
Mental disorders, characterized by impaired emotional and mood balance, are common in the West. Recent surveys have found that millions of people (age 18?65) have experienced some kind of mental disorder, such as psychotic disorder, major depression, bipolar disorder, panic disorder, social phobia, and somatoform disorder . Specifically, in 2010, 164.8 million people in Europe were affected by such illnesses .
Lawrence, P; Fulbrook, P; Somerset, S; Schulz, P
WHAT IS KNOWN ON THE SUBJECT?: Despite differences between samples, some literature reviews have suggested that MI is effective in enhancing treatment attendance for individuals with mental health issues. Little is known regarding the effects of MI as a pre-treatment on individuals who are not seeking treatment for mental health issues. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This systematic review of the literature and meta-analysis demonstrates that MI is most beneficial for individuals who are not seeking mental health treatment. MI represents an opportunity for health promotion when patients are unmotivated but may otherwise be amenable to an intervention. MI is effective as a pre-treatment intervention to motivate individuals to attend further post-MI treatment and counselling. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: MI is a process and a useful tool for clinicians in all therapeutic interactions, to motivate their patients to seek further assistance for mental heath issues. Health promotion and encouragement to attend further treatment sessions can be facilitated through telephone contact. Introduction The stages of change model suggests that individuals seeking treatment are in the "preparation" or the "action" stage of change, which is the desired outcome of successful Motivational Interviewing (MI) interventions. MI is known to enhance treatment attendance among individuals with mental health problems. Aim This study examined the published research on MI as a pre-treatment to enhance attendance among individuals treatment-seeking and non-treatment-seeking for mental health issues. Methods Fourteen randomized controlled trials were identified, and MI efficacy was examined dichotomously: attendance or non-attendance for post-MI therapy. Subgroup analysis investigated treatment-seeking and non-treatment-seeking groups. Results Despite wide variations in sample sizes, blinding and monitoring, intervention fidelity was absent in the majority of published
Mahmoudi, Babak; Erfanian, Abbas
Mental imagination is the essential part of the most EEG-based communication systems. Thus, the quality of mental rehearsal, the degree of imagined effort, and mind controllability should have a major effect on the performance of electro-encephalogram (EEG) based brain-computer interface (BCI). It is now well established that mental practice using motor imagery improves motor skills. The effects of mental practice on motor skill learning are the result of practice on central motor programming. According to this view, it seems logical that mental practice should modify the neuronal activity in the primary sensorimotor areas and consequently change the performance of EEG-based BCI. For developing a practical BCI system, recognizing the resting state with eyes opened and the imagined voluntary movement is important. For this purpose, the mind should be able to focus on a single goal for a period of time, without deviation to another context. In this work, we are going to examine the role of mental practice and concentration skills on the EEG control during imaginative hand movements. The results show that the mental practice and concentration can generally improve the classification accuracy of the EEG patterns. It is found that mental training has a significant effect on the classification accuracy over the primary motor cortex and frontal area.
Wang, Zhenjie; Du, Wei; Pang, Lihua; Zhang, Lei; Chen, Gong; Zheng, Xiaoying
In the study described herein, we investigated and explored the association between wealth inequality and the risk of mental disability in the Chinese population. We used nationally represented, population-based data from the second China National Sample Survey on Disability, conducted in 2006. A total of 1,724,398 study subjects between the ages of 15 and 64, including 10,095 subjects with mental disability only, were used for the analysis. Wealth status was estimated by a wealth index that was derived from a principal component analysis of 10 household assets and four other variables related to wealth. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for mental disability for each category, with the lowest quintile category as the referent. Confounding variables under consideration were age, gender, residence area, marital status, ethnicity, education, current employment status, household size, house type, homeownership and living arrangement. The distribution of various types and severities of mental disability differed significantly by wealth index category in the present population. Wealth index category had a positive association with mild mental disability (p for trend wealth index category had a significant, inverse association with mental disability when all severities of mental disability were taken into consideration. This study’s results suggest that wealth is a significant factor in the distribution of mental disability and it might have different influences on various types and severities of mental disability. PMID:26492258
Sattler, Frank A; Franke, Gabriele H; Christiansen, Hanna
International studies have revealed that gay and bisexual men present more mental health problems than the general male population. Furthermore, there is evidence that minority stress predicts mental health problems in gay and bisexual men. The aim of the present study is to provide initial data on mental health differences in Germany and to analyze the effect of minority stress. Mental health data on n = 1903 German gay and bisexual men and n = 958 men from a population-based sample were assessed using a shortened version of the SCL-90-S. The mental health of the two samples was compared. Furthermore, a linear regression was conducted for the gay and bisexual sample: mental health was used as the criterion and minority stressors as predictors. As compared to our population sample, gay and bisexual men demonstrated more mental health problems with a moderate effect size. In the regression, minority stress predicted mental health problems in the gay and bisexual sample. We observed pronounced mental health differences between gay and bisexual men versus the population sample. These differences could be at least partly due to the minority stress gay and bisexual men face. Research should focus on how to reduce and cope with minority stress.
Azarnoosh, Mahdi; Motie Nasrabadi, Ali; Mohammadi, Mohammad Reza; Firoozabadi, Mohammad
Highlights: Mental fatigue indices’ variation discussed during simple long-term attentive task. Symbolic dynamics of reaction time and EEG signal determine mental state variation. Nonlinear quantifiers such as entropy can display chaotic behaviors of the brain. Frontal and central lobes of the brain are effective in attention investigations. Mental fatigue causes a reduction in the complexity of the brain’s activity. Abstract: To investigate nonlinear analysis of attention physiological indices this study used a simple repetitive attentive task in four consecutive trials that resulted in mental fatigue. Traditional performance indices, such as reaction time, error responses, and EEG signals, were simultaneously recorded to evaluate differences between the trials. Performance indices analysis demonstrated that a selected task leads to mental fatigue. In addition, the study aimed to find a method to determine mental fatigue based on nonlinear analysis of EEG signals. Symbolic dynamics was selected as a qualitative method used to extract some quantitative qualifiers such as entropy. This method was executed on the reaction time of responses, and EEG signals to distinguish mental states. The results revealed that nonlinear analysis of reaction time, and EEG signals of the frontal and central lobes of the brain could differentiate between attention, and occurrence of mental fatigue in trials. In addition, the trend of entropy variation displayed a reduction in the complexity of mental activity as fatigue occurred.
Shi, Zhenrong; MacBeth, Angus
Presenting with common mental health difficulties, particularly depression and anxiety, there is also preliminary evidence that mindfulness-based interventions (MBIs) including mindfulness-based cognitive therapy (MBCT), mindfulness-based stress reduction (MBSR) and integrated mindfulness yoga practices may also be effective in reducing common mental health difficulties during pregnancy. We systematically reviewed and synthesized the current literature on the effectiveness of MBIs in reducing...
Reavley, Nicola J; Jorm, Anthony F
Stigma and discrimination are central concerns for people with mental health problems. The aim of the study was to carry out a national survey in order to assess experiences of avoidance, discrimination and positive treatment in people with mental health problems. In 2014, telephone interviews were carried out with 5220 Australians aged 18+, 1381 of whom reported a mental health problem or scored highly on a symptom screening questionnaire. Questions covered experiences of avoidance, discrimination and positive treatment by friends, spouse, other family, workplace, educational institution and others in the community. In most domains, respondents reported more positive treatment experiences than avoidance or discrimination. Friends and family were more likely to avoid the person than to discriminate. The results can provide input into the design of anti-discrimination interventions and further empower people with mental health problems as they advocate for change in the area of discrimination. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Woodhead, Charlotte; Ashworth, Mark; Broadbent, Matthew; Callard, Felicity; Hotopf, Matthew; Schofield, Peter; Soncul, Murat; Stewart, Robert J; Henderson, Max J
Suboptimal treatment of cardiovascular diseases (CVD) among patients with severe mental illness (SMI) may contribute to physical health disparities. To identify SMI characteristics associated with meeting CVD treatment and prevention guidelines. Population-based electronic health record database linkage between primary care and the sole provider of secondary mental health care services in south east London, UK. Cardiovascular disease prevalence, risk factor recording, and Quality and Outcomes Framework (QOF) clinical target achievement were compared among 4056 primary care patients with SMI whose records were linked to secondary healthcare records and 270 669 patients without SMI who were not known to secondary care psychiatric services, using multivariate logistic regression modelling. Data available from secondary care records were then used to identify SMI characteristics associated with QOF clinical target achievement. Patients with SMI and with coronary heart disease and heart failure experienced reduced prescribing of beta blockers and angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACEI/ARB). A diagnosis of schizophrenia, being identified with any indicator of risk or illness severity, and being prescribed with depot injectable antipsychotic medication was associated with the lowest likelihood of prescribing. Linking primary and secondary care data allows the identification of patients with SMI most at risk of undertreatment for physical health problems. © British Journal of General Practice 2016.
Watkins, Katherine E; Smith, Brad; Akincigil, Ayse; Sorbero, Melony E; Paddock, Susan; Woodroffe, Abigail; Huang, Cecilia; Crystal, Stephen; Pincus, Harold Alan
The quality of mental health care provided by the U.S. Department of Veterans Affairs (VA) was compared with care provided to a comparable population treated in the private sector. Two cohorts of individuals with mental disorders (schizophrenia, bipolar disorder, posttraumatic stress disorder, major depression, and substance use disorders) were created with VA administrative data (N=836,519) and MarketScan data (N=545,484). The authors computed VA and MarketScan national means for seven process-based quality measures related to medication evaluation and management and estimated national-level performance by age and gender. In every case, VA performance was superior to that of the private sector by more than 30%. Compared with individuals in private plans, veterans with schizophrenia or major depression were more than twice as likely to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treatment. Findings demonstrate the significant advantages that accrue from an organized, nationwide system of care. The much higher performance of the VA has important clinical and policy implications.
Langer, David A; Jensen-Doss, Amanda
The shared decision-making (SDM) model is one in which providers and consumers of health care come together as collaborators in determining the course of care. The model is especially relevant to youth mental health care, when planning a treatment frequently entails coordinating both youth and parent perspectives, preferences, and goals. The present article first provides the historical context of the SDM model and the rationale for increasing our field's use of SDM when planning psychosocial treatments for youth and families. Having established the potential utility of SDM, the article then discusses how to apply the SDM model to treatment planning for youth psychotherapy, proposing a set of steps consistent with the model and considerations when conducting SDM with youth and families.
Maria Ines Quintana
Full Text Available OBJECTIVE: Estimate the prevalence of psychotropic drugs use in the city of Rio de Janeiro, Brazil, and establish its relationship with the presence of mental disorders. METHODS: A probabilistic sample of non-institutionalized individuals, from the general population of Rio de Janeiro (n = 1208;turn out:81%, 15 years or older, who were interviewed using the Composite International Diagnostic Interview 2.1 (depression, anxiety-phobia, OCD\\PTSD, alcoholism sections, and asked about their psychotropic use during a 12 and one-month period before the interview. Data were collected between June/2007-February/2008.The prevalence was estimated with a confidence interval of 95%. The associations between psychotropics use and mental disorders were analyzed through a logistic regression model (Odds Ration - OR. RESULTS: The one-month prevalence of psychotropic drug use was 6.55%, 3.19% for men and 9.13% for women. Antidepressants were the most frequently used drug (2.78%, followed by anorectics (1.65%, tranquilizers (1.61% and mood stabilizers (1.23%. General practitioners issued the highest number of prescriptions (46.3%, followed by psychiatrists (29.3%; 86.6% of the psychotropic drugs used were paid for by the patient himself. Individuals with increased likelihood of using psychotropic drugs were those that had received a psychiatric diagnosis during a one-month period before the study (OR:3.93, females (OR:1.82, separated/divorced (OR:2.23, of increased age (OR:1.03, with higher income (OR:2.96, and family history of mental disorder (OR:2.59; only 16% of the individuals with a current DSM IV diagnosis were using a psychotropic drug; 17% among individuals with a depression-related diagnosis and 8% with Phobic Anxiety Disorders-related diagnosis used psychotropics. CONCLUSION: Approximately 84% of individuals displaying some mental disorder did not use psychotropic drugs, which indicates an important gap between demand and access to treatment. A
Furiak Nicolas M
Full Text Available Abstract Background Adherence to antipsychotics for schizophrenia is associated with favorable clinical outcomes. This study compared annual mental-health service utilization by recent medication adherence levels for patients treated for schizophrenia, and assessed whether adherence levels change from pre- to post-psychiatric hospitalization. Methods We analyzed data from a large prospective, non-interventional study of patients treated for schizophrenia in the United States, conducted between 7/1997 and 9/2003. Detailed mental-health resource utilization was systematically abstracted from medical records and augmented with patients' self report. Medication possession ratio (MPR with any antipsychotic in the 6 months prior to enrollment was used to categorize patients as: adherent (MPR ≥ 80%, N = 1758, partially adherent (MPR ≥ 60% Results Adherent patients had a lower rate of psychiatric hospitalization compared with partially adherent and non-adherent patients (p Conclusion Adherence is associated with lower utilization of acute care services and greater engagement in outpatient mental-health treatment. Adherence is a potentially dynamic phenomenon, which may improve, at least temporarily, following patients' psychiatric hospitalizations.
Edel, Marc-Andreas; Raaff, Vanessa; Dimaggio, Giancarlo; Buchheim, Anna; Brüne, Martin
Borderline personality disorder (BPD) is characterized by emotional instability, interpersonal dysfunction, and other features that typically develop before a background of insecure attachment and traumatic experiences. Dialectical behaviour therapy (DBT) has proven highly effective in reducing self-harm and improving emotion regulation, whereby problems concerning social cognition, which are also characteristic of BPD, may need additional approaches such as mentalization-based treatment (MBT). Here, we examined, in a pilot study, the effectiveness of MBT given adjunct to DBT, compared to DBT alone, in an inpatient sample with BPD, whereby mentalization was measured using a novel cartoon-based task. Both treatments were highly effective in reducing symptom severity. The combination of DBT and MBT was superior in reducing fearful attachment and in improving affective mentalizing. Mentalization-based treatment in combination with DBT may improve certain aspects of social cognitive skills and attachment security, as compared to DBT alone, although the exact mechanisms that led to these changes need to be studied further. Clinical implications Dialectical behaviour therapy (DBT) can usefully be combined with mentalization-based treatment (MBT). The combination of DBT and MBT reduces self-harm more than DBT alone. DBT plus MBT may lead to a reduction in fearful attachment and improvement of affective mentalizing. Short-term combinations of evidence-based borderline treatments may enrich psychiatric inpatient care. Therefore, such approaches deserve further research. Limitations The treatment condition was therapeutically more intense than the control condition. The study lacked a follow-up assessment. The impact of comorbid conditions on treatment response was not taken into account. Adherence to the manualized approach was not measured. © 2016 The British Psychological Society.
Gum, Amber M; Iser, Lindsay; King-Kallimanis, Bellinda L; Petkus, Andrew; DeMuth, Anne; Schonfeld, Lawrence
Aims of the study were to describe behavioral health treatment utilization patterns of community-dwelling older adults with depressive symptoms over a six-month period and to identify factors associated with treatment use, guided by a theoretical model emphasizing the dynamic nature of treatment use patterns over time and social context. A total of 144 participants ≥65 years old with depressive symptoms completed an in-person baseline interview and six monthly telephone follow-up interviews. Outcomes at each follow-up included the use of antidepressants or counseling. Covariates included personal and social context variables. Approximately half of the participants (N=70, 48%) received no formal treatment (antidepressant prescription or counseling). Treatment use or nonuse did not change for most participants. More participants with severe symptoms received antidepressants (25%-37%) than did those with milder symptoms (10%-14%), although more participants in the latter group started (milder, 62%,versus severe, 49%) and stopped (milder, 77%, versus severe, 26%) antidepressant treatment at least once. Fewer individuals received counseling overall, with no clear patterns by symptom severity. In multivariate longitudinal analyses, treatment use at follow-up was independently associated with younger age, current major depressive episode, baseline use of antidepressant, intention to begin a new treatment at baseline, and receipt of advice to seek treatment. Over a six-month period, most older adults with depressive symptoms in this study continued their use or nonuse of mental health treatment. Demographic, need, attitudinal, and social variables were related to treatment use over time. Addressing intentions and providing advice may facilitate treatment seeking.
de Haan, Anna M; Boon, Albert E; de Jong, Joop T V M; Vermeiren, Robert R J M
A large proportion of treatments in youth mental health care are prematurely terminated by the patient. Treatment dropout can have severe consequences. Since ethnic minority youth are treated less often for mental disorders than other youth, it is important to analyse their risk for dropout and to determine if there are ethnicity-specific determinants. This review aimed to provide an overview of the findings from empirical studies on child and adolescent therapy dropout by ethnic minority and to determine if there were ethnicity-specific dropout determinants. An extensive literature search was performed to locate relevant journal articles. Identified articles were inspected for relevant references and these articles were then included in the meta-analysis. A total of 27 studies were accepted for analysis. The results showed that ethnic minority patients have a higher risk of treatment dropout than ethnic majority patients and that dropout rates are ethnically specific. Several differences in dropout predictors among the ethnic groups were found. In spite of diverse results, review limitations, and the lack of several key variables in the available research, some clinical recommendations are made. The review indicates that to prevent dropout, therapists should pay attention to variables such as ethnic background, therapist-patient ethnic match, and the quality of the therapeutic relationship.
Buckingham, Elizabeth; Schrage, Ezra; Cournos, Francine
People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services. PMID:23401785
Full Text Available Background: Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes. Objective: To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS disorders and the cost-effectiveness of treatment interventions. Design: Narrative overview methodology. Results and conclusions: Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1 accurate and thorough assessment of the health burdens of MNS disorders, 2 design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3 information on the use and costs of traditional medicines, and 4 cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context.
Jack, Helen; Wagner, Ryan G.; Petersen, Inge; Thom, Rita; Newton, Charles R.; Stein, Alan; Kahn, Kathleen; Tollman, Stephen; Hofman, Karen J.
Background Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes. Objective To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS) disorders and the cost-effectiveness of treatment interventions. Design Narrative overview methodology. Results and conclusions Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1) accurate and thorough assessment of the health burdens of MNS disorders, 2) design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3) information on the use and costs of traditional medicines, and 4) cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context. PMID:24848654
Full Text Available People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services.
Baandrup, Lone; Østrup Rasmussen, Jesper; Klokker, Louise
BACKGROUND AND AIM: The Danish Health and Medicines Authority assembled a group of experts to develop a national clinical guideline for patients with schizophrenia and complex mental health needs. Within this context, ten explicit review questions were formulated, covering several identified key...... therapy for persistent positive and/or negative symptoms, and the combination of cognitive behavioural therapy and motivational interviewing for cannabis and/or central stimulant abuse. SSRI or SNRI add-on treatment for persistent negative symptoms should be used only cautiously. Where no evidence...
BACKGROUND: Khat (Catha edulis) contains a psychoactive substance, cathinone, which produces central nervous system stimulation analogous to amphetamine. It is believed that ... Using cut-off point 7 out of 20 on the Self Reporting Questionnaire-20, 25.8% of the study population was found to have mental distress.
Costa, Rosalia; Colizzi, Marco
Cross-sex hormonal treatment represents a main aspect of gender dysphoria health care pathway. However, it is still debated whether this intervention translates into a better mental well-being for the individual and which mechanisms may underlie this association. Although sex reassignment surgery has been the subject of extensive investigation, few studies have specifically focused on hormonal treatment in recent years. Here, we systematically review all studies examining the effect of cross-sex hormonal treatment on mental health and well-being in gender dysphoria. Research tends to support the evidence that hormone therapy reduces symptoms of anxiety and dissociation, lowering perceived and social distress and improving quality of life and self-esteem in both male-to-female and female-to-male individuals. Instead, compared to female-to-male individuals, hormone-treated male-to-female individuals seem to benefit more in terms of a reduction in their body uneasiness and personality-related psychopathology and an amelioration of their emotional functioning. Less consistent findings support an association between hormonal treatment and other mental health-related dimensions. In particular, depression, global psychopathology, and psychosocial functioning difficulties appear to reduce only in some studies, while others do not suggest any improvement in these domains. Results from longitudinal studies support more consistently the association between hormonal treatment and improved mental health. On the contrary, a number of cross-sectional studies do not support this evidence. This review provides possible biological explanation vs psychological explanation (direct effect vs indirect effect) for the hormonal treatment-induced better mental well-being. In conclusion, this review indicates that gender dysphoria-related mental distress may benefit from hormonal treatment intervention, suggesting a transient reaction to the nonsatisfaction connected to the incongruent body
Costa, Rosalia; Colizzi, Marco
Cross-sex hormonal treatment represents a main aspect of gender dysphoria health care pathway. However, it is still debated whether this intervention translates into a better mental well-being for the individual and which mechanisms may underlie this association. Although sex reassignment surgery has been the subject of extensive investigation, few studies have specifically focused on hormonal treatment in recent years. Here, we systematically review all studies examining the effect of cross-sex hormonal treatment on mental health and well-being in gender dysphoria. Research tends to support the evidence that hormone therapy reduces symptoms of anxiety and dissociation, lowering perceived and social distress and improving quality of life and self-esteem in both male-to-female and female-to-male individuals. Instead, compared to female-to-male individuals, hormone-treated male-to-female individuals seem to benefit more in terms of a reduction in their body uneasiness and personality-related psychopathology and an amelioration of their emotional functioning. Less consistent findings support an association between hormonal treatment and other mental health-related dimensions. In particular, depression, global psychopathology, and psychosocial functioning difficulties appear to reduce only in some studies, while others do not suggest any improvement in these domains. Results from longitudinal studies support more consistently the association between hormonal treatment and improved mental health. On the contrary, a number of cross-sectional studies do not support this evidence. This review provides possible biological explanation vs psychological explanation (direct effect vs indirect effect) for the hormonal treatment-induced better mental well-being. In conclusion, this review indicates that gender dysphoria-related mental distress may benefit from hormonal treatment intervention, suggesting a transient reaction to the nonsatisfaction connected to the incongruent body
Mardon, Austin; Nichol, Kenneth; Mardon, Catherine; Mardon, Austin
It is well known in the history of terrestrial naval expeditions that members of long expeditions could and did suffered from serious mental illnesses. Depression and even psychosis could inflict crew members, and in serious cases this sometimes resulted in violence directed towards others or themselves. There was little that the medical practitioners of the time could do to alleviate these illnesses. Modern psychiatry operates within a paradigm of the normalcy of the modern western standard of living. When we place humans outside these normal experiences, we place them in vulnerable positions. For the foreseeable future, spaceflight will continue to result in extremely physically, mentally and spiritually arduous expeditions. As we start our journey towards Mars and beyond, the time humans will be in the isolation of space, and subjected to these extraordinary stresses, will increase. The recent incident where an American astronaut had a mental collapse and was criminally charged is indicative of this real possibility. One solution could be to have more pre-screening but this only goes so far, especially when the rigorous training and the actual mission might cause psychological problems that were never present before hand. Eastern and Western philosophies and religious systems can provide a framework to draw upon to strengthen the mental and spiritual psyche of the astronauts on a long duration expedition. Meditative techniques and prayer techniques, if within the belief system of the astronaut, might serve to prevent or ameliorate the severity of a mental collapse should it occur during a space mission. Many of the American astronauts that went to the Moon reported having intense emotional and spiritual reactions based on the intensity of their experiences. For several of these men, the courses of their lives were changed. What astronauts will face by going back to the Moon and further a field to Mars, will be dangerous and extremely mentally taxing. At the
Preyde, Michele; Watkins, Hanna; Ashbourne, Graham; Lazure, Kelly; Carter, Jeff; Penney, Randy; White, Sara; Frensch, Karen; Cameron, Gary
The outcomes of youth accessing residential treatment or intensive home-based treatment are varied. Understanding youth's perceptions of their well-being may inform service. The purpose of this report was to explore perceptions of youth's mental health, life satisfaction, and outlook for the future. Youth reported ongoing struggles with mental…
Hossain, Mohammad Shahadat; Afif Monrat, Ahmed; Hasan, Mamun
to ignorance, incompleteness, and randomness. So, a belief rule-based expert system (BRBES) has been designed and developed with the capability of handling the uncertainties mentioned. Evidential reasoning works as the inference engine and the belief rule base as the knowledge representation schema......Mental disorder is a change of mental or behavioral pattern that causes sufferings and impairs the ability to function in ordinary life. In psychopathology, the assessment methods of mental disorder contain various types of uncertainties associated with signs and symptoms. This study identifies...
Gone, Joseph P
The calls for evidence-based practice (EBP) and cultural competence (CC) represent two increasingly influential mandates within the mental health professions. Advocates of EBP seek to standardize clinical practice by ensuring that only treatment techniques that have demonstrated therapeutic outcomes under scientifically controlled conditions would be adopted and promoted in mental health services. Advocates of CC seek to diversify clinical practice by ensuring that treatment approaches are designed and refined for a multicultural clientele that reflects a wide variety of psychological orientations and life experiences. As these two powerful mandates collide, the fundamental challenge becomes how to accommodate substantive cultural divergences in psychosocial experience using narrowly prescriptive clinical practices and approaches, without trivializing either professional knowledge or cultural difference. In this Introduction to a special issue of Transcultural Psychiatry, the virtue of an interdisciplinary conversation between and among anthropologists, psychologists, psychiatrists, and social work researchers in addressing these tensions is extolled. © The Author(s) 2015.
Barfar, Eshagh; Sharifi, Vandad; Amini, Homayoun; Mottaghipour, Yasaman; Yunesian, Masud; Tehranidoost, Mehdi; Sobhebidari, Payam; Rashidian, Arash
There have been claims that community mental health principles leads to the maintenance of better health and functioning in patients and can be more economical for patients with severe and chronic mental disorders. Economic evaluation studies have been used to assess the cost-effectiveness of national health programs, or to propose efficient strategies for health care delivery. The current study is intended to test the cost-effectiveness of an Aftercare Service when compared with Treatment-As-Usual for patients with severe mental disorders in Iran. This study was a parallel group randomized controlled trial. A total of 160 post-discharge eligible patients were randomized into two equal patient groups, Aftercare Service (that includes either Home Visiting Care, or Telephone Follow-up for outpatient treatment) vs Treatment-As-Usual, using stratified balanced block randomization method. All patients were followed for 12 months after discharge. The perspective of the present study was the societal perspective. The outcome measures were the rate of readmission at the hospitals after discharge, psychotic symptoms, manic symptoms, depressive symptoms, illness severity, global functioning, quality of life, and patients' satisfaction with the services. The costs included the intervention costs and the patient and family costs in the evaluation period. There was no significant difference in effectiveness measures between the two groups. The Aftercare Service arm was about 66,000 US$ cheaper than Treatment-As-Usual arm. The average total cost per patient in the Treatment-As-Usual group was about 4651 USD, while it was reduced to 3823 US$ in the Aftercare Service group; equivalent to a cost reduction of about 800 USD per patient per year. Given that there was no significant difference in effectiveness measures between the two groups (slightly in favor of the intervention), the Aftercare Service was cost-effective. The most important limitation of the study was the relatively
Fazel, Mina; Garcia, Jo; Stein, Alan
Access to needed mental health services can be particularly difficult for newly arrived refugee and asylum-seeking adolescents, although many attend school. This study examined young refugees' impressions and experience of mental health services integrated within the school system. Semi-structured interviews were conducted with 40 adolescent refugees discharged by three school-based mental health services across the United Kingdom. Two-thirds preferred to be seen at school. Rumination and worry about insecurity in the asylum process had a negative impact particularly on the adolescents' social functioning and ability to focus at school. The important role played by teachers in supporting and mediating contact with mental health services was valued by those interviewed. The study confirms that schools offer an important location for mental health services for adolescent refugees and provide an important portal for integration of services. © The Author(s) 2016.
Patel, Vikram; Kirkwood, Betty R; Pednekar, Sulochana; Weiss, Helen; Mabey, David
The determinants of common mental disorders in women have not been described in longitudinal studies from a low-income country. Population-based cohort study of 2494 women aged 18 to 50 years, in India. The Revised Clinical Interview Schedule was used for the detection of common mental disorders. There were 39 incident cases of common mental disorder in 2166 participants eligible for analysis (12-month rate 1.8%, 95% CI 1.3-2.4%). The following baseline factors were independently associated with the risk for common mental disorder: poverty (low income and having difficulty making ends meet); being married as compared with being single; use of tobacco; experiencing abnormal vaginal discharge; reporting a chronic physical illness; and having higher psychological symptom scores at baseline. Programmes to reduce the burden of common mental disorder in women should target poorer women, women with chronic physical illness and who have gynaecological symptoms, and women who use tobacco.
Punamäki, Raija-Leena; Tiitinen, Aila; Lindblom, Jallu; Unkila-Kallio, Leila; Flykt, Marjo; Vänskä, Mervi; Poikkeus, Piia; Tulppala, Maija
Do children born after assisted reproductive techniques (ART; IVF/ICSI) display more mental health issues or social and cognitive developmental problems at 7-8 years than naturally conceived (NC) controls, and does child gender play a role? ART children do not differ with regard to mental health or social and cognitive developmental problems when compared with controls, but some gender-specific differences do exist. Systematic reviews have not found any evidence of delays in neurocognitive or sensorimotor development in ART children. However findings on the effect of the type of ART treatment (IVF versus ICSI) on the offspring's physical and mental development have not been uniform. Knowledge of the role of child gender in ART research is scarce. This prospective follow-up study compares mental health and social and cognitive developmental problems between 7-8-year-old ART and NC children, controlling for the father's age, length of the parents' partnership, mother's parity, child's gestational age, and the need of neonatal intensive care unit (NICU). Further, within the ART group, we analysed whether the treatment type (IVF versus ICSI) and the child's gender are associated with the mental health and developmental outcomes. In this study, 255 singleton ART children (IVF and ICSI) were compared with 278 NC children on parent-reported internalizing and externalizing symptoms, and social (social skills and peer relations) and cognitive development (executive functioning, perception, memory, and language). Within the ART group, 164 IVF and 76 ICSI children were compared on the same outcomes. Statistics included analyses of covariates (ANCOVA) with group main effects, group and gender interaction effects, and Bonferroni post hoc tests. ART and NC children did not differ generally in terms of their internalizing and externalizing symptoms or in the number of social and cognitive developmental problems (Group main effects, P > 0.05), but gender-specific group differences
Bakker, David; Kazantzis, Nikolaos; Rickwood, Debra; Rickard, Nikki
Background The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp de...
Purpose – The purpose of this paper is to scrutinise two ostensibly disparate approaches to school-based mental health promotion and offer a conceptual foundation for considering possible synergies between them. Design/methodology/approach – The paper examines current conceptualisations of child and youth mental health and explores how these inform school-based prevention and intervention approaches. The dominance of discrete, “expert-driven” psychosocial programmes as well as the...
Simonsen, Sebastian; Lau, Marianne Engelbrecht
We present data on approximately 200 patients treated for personality disorder at Stolpegaard Psychotherapeutic Centre in Denmark. The personality disorder clinic offers mentalization based treatment primarily delivered in groups. Patients have either been assigned to a standardized, time...... restricted treatment package or have been treated in the regional treatment program where duration is longer and individual psychotherapy is delivered in addition to group therapy. Data on symptom severity and interpersonal problems have been collected pre and post treatment. We discuss the implications...
Harper, Erin; Kruger, Ann Cale; Hamilton, Chela; Meyers, Joel; Truscott, Stephen D.; Varjas, Kris
School-based mental health practitioners are positioned to address low-income urban African American girls' mental health needs through culturally responsive services. Despite the importance of culturally reflective practice, it is understudied. We asked school-based mental health practitioners (N = 7) to reflect on barriers and facilitators to…
Fernandez, A; Howse, E; Rubio-Valera, M; Thorncraft, K; Noone, J; Luu, X; Veness, B; Leech, M; Llewellyn, G; Salvador-Carulla, L
Universities are dynamic environments. But university life presents challenges that may affect the mental health of its community. Higher education institutions provide opportunities to promote public health. Our objective is to summarise the current evidence on strategies to promote mental health at the university, following a setting-based model. We conducted a systematic literature review following standard methods. Published literature that evaluated structural and organizations strategies to promote mental health at the university was selected. 19 papers were included. The majority of the studies were targeting the students, with only four aiming to promote employees' mental health. The most promising strategies to promote mental wellbeing included changes in the way students are taught and assessed. On the other hand, social marketing strategies had not impact on mental health. There is inconclusive evidence related to the effectiveness of policies to promote mental health. Universities should invest in creating supportive physical, social and academic environments that promote student and staff mental wellbeing. However, the current body of evidence is scarce and more research is needed to recommend what are the best strategies.
Wang, Zhenjie; Du, Wei; Pang, Lihua; Zhang, Lei; Chen, Gong; Zheng, Xiaoying
In the study described herein, we investigated and explored the association between wealth inequality and the risk of mental disability in the Chinese population. We used nationally represented, population-based data from the second China National Sample Survey on Disability, conducted in 2006. A total of 1,724,398 study subjects between the ages of 15 and 64, including 10,095 subjects with mental disability only, were used for the analysis. Wealth status was estimated by a wealth index that was derived from a principal component analysis of 10 household assets and four other variables related to wealth. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for mental disability for each category, with the lowest quintile category as the referent. Confounding variables under consideration were age, gender, residence area, marital status, ethnicity, education, current employment status, household size, house type, homeownership and living arrangement. The distribution of various types and severities of mental disability differed significantly by wealth index category in the present population. Wealth index category had a positive association with mild mental disability (p for trend disability (p for trend disability when all severities of mental disability were taken into consideration. This study's results suggest that wealth is a significant factor in the distribution of mental disability and it might have different influences on various types and severities of mental disability.
van der Watt, A S J; van de Water, T; Nortje, G; Oladeji, B D; Seedat, S; Gureje, O
This work complements a quantitative review by Nortje et al. (Lancet Psychiatry 3(2):154-170, 2016) by exploring the qualitative literature in regard to the perceived effectiveness of traditional and faith healing of mental disorders. Qualitative studies focusing specifically on traditional and/or faith healing practices for mental illness were retrieved from eight databases. Data were extracted into basic coding sheets to facilitate the assessment of the quality of eligible papers using the COREQ. Sixteen articles met the inclusion criteria. Despite methodological limitations, there was evidence from the papers that stakeholders perceived traditional and/or faith healing to be effective in treating mental illness, especially when used in combination with biomedical treatment. Patients will continue to seek treatment from traditional and/or faith healers for mental illness if they perceive it to be effective regardless of alternative biomedical evidence. This provides opportunities for collaboration to address resource scarcity in low to middle income countries.
Gottlieb, Peter; Gabrielsen, Gorm; Kørner, Alex; Stølan, Liv Os
By including §69 into the Danish Penal Code, it has since 1975 been possible to use psychiatric measures as legal sanctions for even non-psychotic offenders-if the measure is believed to be preventive of future crime. To be able to decide on the applicability of treatment measures as sanctions in criminal cases, the court will request a psychiatric report. They may furthermore ask a medical expert consultation board, the Danish Medico-Legal Council, for an opinion on the mental status of the defendant. To describe a sample of offenders falling under §69 and the use of the section in sentencing offenders to treatment instead of punishment. All 298 opinions given by the Medico-Legal Council between April 1, 2005 and December 31, 2007 of defendants definitely or possibly falling under §69 of the Danish Penal Code were rated together with the psychiatric assessment reports and the final verdicts on socio-demographic, health and criminal items, and the data were computerized. The sample was characterized by severe criminality and mental disorder. Forty-six percent (138/298) were sentenced by the court to a psychiatric measure instead of punishment. The results document that §69 of the Danish Penal Code is used as intended by the law.
Gaddis, S Michael; Ramirez, Daniel; Hernandez, Erik L
Scholars suggest that public mental health stigma operates at a meso-level and is associated with severity of symptoms, disclosure, self-esteem, and treatment-seeking behavior. However, the operationalization of public stigma nearly always comes from an individual-level generalization of what others believe. Using data from over 60,000 students on 75 U.S. college and university campuses between 2009 and 2015, we contextualize public stigma by creating a school-level measure of students' individual-level endorsed mental health treatment stigma. We present multilevel logistic regression models for 21 different dependent variables. We find that even after controlling for individual-level stigma scores, school-level stigma is negatively associated with self-reports of suicidal ideation and self-injury, although not associated with screens for depression or anxiety. Moreover, school-level stigma is negatively associated with medication use, counseling and therapy visits, and to a lesser degree, informal support. We suggest that future research should continue to examine the contextual environment of public stigma, while policymakers may be able to implement changes to significantly reduce stigma at this level. Copyright © 2017 Elsevier Ltd. All rights reserved.
Degenhardt, Louisa; Glantz, Meyer; Evans‐Lacko, Sara; Sadikova, Ekaterina; Sampson, Nancy; Thornicroft, Graham; Aguilar‐Gaxiola, Sergio; Al‐Hamzawi, Ali; Alonso, Jordi; Helena Andrade, Laura; Bruffaerts, Ronny; Bunting, Brendan; Bromet, Evelyn J.; Miguel Caldas de Almeida, José; de Girolamo, Giovanni; Florescu, Silvia; Gureje, Oye; Maria Haro, Josep; Huang, Yueqin; Karam, Aimee; Karam, Elie G.; Kiejna, Andrzej; Lee, Sing; Lepine, Jean‐Pierre; Levinson, Daphna; Elena Medina‐Mora, Maria; Nakamura, Yosikazu; Navarro‐Mateu, Fernando; Pennell, Beth‐Ellen; Posada‐Villa, José; Scott, Kate; Stein, Dan J.; ten Have, Margreet; Torres, Yolanda; Zarkov, Zahari; Chatterji, Somnath; Kessler, Ronald C.; Adamowski, Tomasz; Aguilar‐Gaxiola, Sergio; Al‐Hamzawi, Ali; Al‐Kaisy, Mohammad; Alonso, Jordi; Altwaijri, Yasmin; Andrade, Laura Helena; Atwoli, Lukoye; Auerbach, Randy P.; Axinn, William G.; Benjet, Corina; Borges, Guilherme; Bromet, Evelyn J.; Bruffaerts, Ronny; Bunting, Brendan; Caldas de Almeida, José Miguel; Cardoso, Graça; Chardoul, Stephanie; Chatterji, Somnath; Filho, Alexandre Chiavegatto; Cia, Alfredo H.; Cuijpers, Pim; Degenhardt, Louisa; de Girolamo, Giovanni; de Graaf, Ron; de Jonge, Peter; Ebert, David D.; Evans‐Lacko, Sara; Fayyad, John; Florescu, Silvia; Galea, Sandro; Germine, Laura; Ghimire, Dirgha J.; Gilman, Stephen E.; Glantz, Meyer D.; Gluzman, Semyon; Gureje, Oye; Haro, Josep Maria; Harris, Meredith G.; He, Yanling; Hinkov, Hristo; Hu, Chi‐Yi; Huang, Yueqin; Karam, Aimee Nasser; Karam, Elie G.; Kawakami, Norito; Kessler, Ronald C.; Kiejna, Andrzej; Koenen, Karestan C.; Kovess‐Masfety, Viviane; Lara, Carmen; Lee, Sing; Lepine, Jean‐Pierre; Levav, Itzhak; Levinson, Daphna; Liu, Zhaorui; Martins, Silvia S.; McGrath, John J.; McLaughlin, Katie A.; Medina‐Mora, Maria Elena; Mneimneh, Zeina; Moskalewicz, Jacek; Navarro‐Mateu, Fernando; Nock, Matthew K.; O'Neill, Siobhan; Ormel, Johan; Pennell, Beth‐Ellen; Piazza, Marina; Piotrowski, Patryk; Posada‐Villa, José; Ruscio, Ayelet M.; Scott, Kate M.; Slade, Tim; Smoller, Jordan W.; Stagnaro, Juan Carlos; Stein, Dan J.; Street, Amy E.; Tachimori, Hisateru; ten Have, Margreet; Thornicroft, Graham; Torres, Yolanda; Vilagut, Gemma; Viana, Maria Carmen; Wells, Elisabeth; Williams, David R.; Williams, Michelle A.; Wojtyniak, Bogdan; Zaslavsky, Alan M.
Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross‐nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12‐month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality (“minimally adequate treatment”). Among the 70,880 participants, 2.6% met 12‐month criteria for substance use disorders; the prevalence was higher in upper‐middle income (3.3%) than in high‐income (2.6%) and low/lower‐middle income (2.0%) countries. Overall, 39.1% of those with 12‐month substance use disorders recognized a treatment need; this recognition was more common in high‐income (43.1%) than in upper‐middle (35.6%) and low/lower‐middle income (31.5%) countries. Among those who recognized treatment need, 61.3% made at least one visit to a service provider, and 29.5% of the latter received minimally adequate treatment exposure (35.3% in high, 20.3% in upper‐middle, and 8.6% in low/lower‐middle income countries). Overall, only 7.1% of those with past‐year substance use disorders received minimally adequate treatment: 10.3% in high income, 4.3% in upper‐middle income and 1.0% in low/lower‐middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate
Fries, Brant E; Schmorrow, Angela; Lang, Sylvia W; Margolis, Philip M; Heany, Julia; Brown, Greg P; Barbaree, Howard E; Hirdes, John P
This study reports on a representative sample of prisoners in Michigan correctional facilities to determine the prevalence of psychiatric illness and the delivery of mental health (MH) services. Mental health assessments were conducted with 618 incarcerated subjects using the interRAI Correctional Facilities (interRAI CF). Subjects were randomly sampled based on four strata: males in the general population, males in administrative segregation, males in special units, and females. The interRAI CF assessments were merged with secondary data provided by the Michigan Department of Corrections (MDOC) containing information on MH diagnoses or services that the subjects were receiving within the facilities, demographics, and sentencing. Study results show that 20.1% of men and 24.8% of women in Michigan prisons have a substantial level of MH symptoms and that 16.5% and 28.9%, respectively, are receiving MH services. However, when compared with Michigan Department of Corrections MH care records, 65.0% of prisoners who are experiencing symptoms of mental illness are not currently receiving any psychiatric services. The mis-match between symptoms and service delivery suggests the need for improved procedures for identifying and measuring psychiatric symptoms within Michigan correctional facilities to ensure that appropriate individuals receive needed care. It is recommended that a standardized assessment process be implemented and conducted at regular intervals for targeting and improving psychiatric care in the prison system. Copyright © 2013 Elsevier Ltd. All rights reserved.
Kristen L. Sessions
Results: Stakeholders perceived benefits to a community-based compared to a hospital-based programme, including improved patient care, lower costs to patients and improved community understanding of mental illness. They also cited barriers including cost, insufficient workforce and a lack of community readiness.Conclusions: Stakeholders express interest in developing community-based mental health programmes, as they feel that it will address mental health needs in the community and improve community awareness of mental illness. However, they also report that cost is a significant barrier to programme development that will have to be addressed prior to being able to successfully establish such programming. Additionally, many community members expressed unique sociocultural beliefs regarding the nature of mental illness and those suffering from a psychiatric disease.
Hoare, Erin; Fuller-Tyszkiewicz, Matthew; Skouteris, Helen; Millar, Lynne; Nichols, Melanie; Allender, Steven
This paper aimed to systematically evaluate the mental health and well-being outcomes observed in previous community-based obesity prevention interventions in adolescent populations. Systematic review of literature from database inception to October 2014. Articles were sourced from CINAHL, Global Health, Health Source: Nursing and Academic Edition, MEDLINE, PsycARTICLES and PsycINFO, all of which were accessed through EBSCOhost. The Cochrane Database was also searched to identify all eligible articles. PRISMA guidelines were followed and search terms and search strategy ensured all possible studies were identified for review. Intervention studies were eligible for inclusion if they were: focused on overweight or obesity prevention, community-based, targeted adolescents (aged 10-19 years), reported a mental health or well-being measure, and included a comparison or control group. Studies that focused on specific adolescent groups or were treatment interventions were excluded from review. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. Primary outcomes were measures of mental health and well-being, including diagnostic and symptomatic measures. Secondary outcomes included adiposity or weight-related measures. Seven studies met the inclusion criteria; one reported anxiety/depressive outcomes, two reported on self-perception well-being measures such as self-esteem and self-efficacy, and four studies reported outcomes of quality of life. Positive mental health outcomes demonstrated that following obesity prevention, interventions included a decrease in anxiety and improved health-related quality of life. Quality of evidence was graded as very low. Although positive outcomes for mental health and well-being do exist, controlled evaluations of community-based obesity prevention interventions have not often included mental health measures (n=7). It is recommended that future interventions
Hoare, Erin; Fuller-Tyszkiewicz, Matthew; Skouteris, Helen; Millar, Lynne; Nichols, Melanie; Allender, Steven
Objectives This paper aimed to systematically evaluate the mental health and well-being outcomes observed in previous community-based obesity prevention interventions in adolescent populations. Setting Systematic review of literature from database inception to October 2014. Articles were sourced from CINAHL, Global Health, Health Source: Nursing and Academic Edition, MEDLINE, PsycARTICLES and PsycINFO, all of which were accessed through EBSCOhost. The Cochrane Database was also searched to identify all eligible articles. PRISMA guidelines were followed and search terms and search strategy ensured all possible studies were identified for review. Participants Intervention studies were eligible for inclusion if they were: focused on overweight or obesity prevention, community-based, targeted adolescents (aged 10–19 years), reported a mental health or well-being measure, and included a comparison or control group. Studies that focused on specific adolescent groups or were treatment interventions were excluded from review. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. Primary and secondary outcome measures Primary outcomes were measures of mental health and well-being, including diagnostic and symptomatic measures. Secondary outcomes included adiposity or weight-related measures. Results Seven studies met the inclusion criteria; one reported anxiety/depressive outcomes, two reported on self-perception well-being measures such as self-esteem and self-efficacy, and four studies reported outcomes of quality of life. Positive mental health outcomes demonstrated that following obesity prevention, interventions included a decrease in anxiety and improved health-related quality of life. Quality of evidence was graded as very low. Conclusions Although positive outcomes for mental health and well-being do exist, controlled evaluations of community-based obesity prevention interventions have
Miller, Christopher J; McInnes, D Keith; Stolzmann, Kelly; Bauer, Mark S
There is great interest in leveraging technology, including cell phones and computers, to improve healthcare. A range of e-health applications pertaining to mental health such as messaging for prescription refill or mobile device videoconferencing are becoming more available, but little is known about the mental health patient's interest in using these newer applications. We mailed a survey to 300 patients seen in the general mental health clinic of a local Veterans Affairs Medical Center. Survey questions focused on interest in use of cell phones, tablets, and other computers in patients' interactions with the healthcare system. A total of 74 patients, primarily treated for depression, post-traumatic stress disorder, or anxiety disorders, returned completed surveys. Nearly all reported having a cell phone (72/74, 97%), but fewer than half reported having a smartphone (35/74, 47%). Overall, a substantial majority (64/74, 86%) had access to an Internet-capable device (smartphone or computer, including tablets). Respondents appeared to prefer computers to cell phones for some health-related communications, but did not express differential interest for other tasks (such as receiving appointment reminders). Interest in use was higher among younger veterans. Most veterans with a mental health diagnosis have access to technology (including cell phones and computers) and are interested in using that technology for some types of healthcare-related communications. While there is capacity to utilize information technology for healthcare purposes in this population, interests vary widely, and a substantial minority does not have access to relevant devices. Although interest in using computers for health-related communication was higher than interest in using cell phones, single-platform technology-based interventions may nonetheless exclude crucial segments of the population.
Full Text Available Introduction: In the United States emergency medical services (EMS protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management. Results: Protocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64% suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39% give specific parameters. Half the agencies (52% recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24% recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42% advise supplemental oxygen as needed; only seven (21% give specific parameters. In terms of considering various etiologies of AMS, 25 (76% give instructions to consider trauma, 20 (61% to consider stroke, and 18 (55% to consider seizure. Twenty-three (70% of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol. Conclusion: Protocols
Horton, Gail; Diaz, Naelys; McIlveen, John; Weiner, Michael; Mullaney, Donald
The purpose of this study was to explore the prevalence rates of co-occurring mental health problems among 70 flight attendants in substance abuse treatment. Results indicated that flight attendants in treatment were more likely to experience alcohol dependency than drug dependency. A high proportion of participants reported clinical levels of…
Lindley, Steven; Cacciapaglia, Holly; Noronha, Delilah; Carlson, Eve; Schatzberg, Alan
Identifying factors that influence mental health outcomes in veterans can aid in the redesign of programs to maximize the likelihood of early resolution of problems. To that end, we examined demographic and clinical process data from 2,684 veterans who scored positive on a mental health screen. We investigated this data set for patterns and possible predictors of mental health referral acceptance and attendance. The majority of patients had not received mental health treatment within the last two years (76%). Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) were more likely to accept a mental health referral for depression but were equally likely to attend a mental health visit as other era veterans. Decreased acceptance was associated with provider type and contact method, clinic location, depression only, and specific age ranges (65-74). Among those who accepted a referral, decreased attendance was associated with clinic location, depression only, and retirement. No variables predicted OEF/OIF acceptance/attendance. In conclusion, our findings illustrate the importance of close, continual monitoring of clinical process data to help reveal targets for improving mental health care for veterans. © 2010 Association for Research in Nervous and Mental Disease.
Kirsch, Daniel J; Pinder-Amaker, Stephanie L; Morse, Charles; Ellison, Marsha L; Doerfler, Leonard A; Riba, Michelle B
College students' need for mental health care has increased dramatically, leaving campus counseling and mental health centers struggling to meet the demand. This has led to the investigation and development of extra-center, population-based interventions. Student-to-student support programs are but one example. Students themselves are a plentiful, often-untapped resource that extends the reach of mental health services on campus. Student-to-student programs capitalize on students' natural inclination to assist their peers. A brief review of the prevalence and effects of mental disorders in the college population is provided, followed by a broad overview of the range of peer-to-peer programs that can be available on college campuses. Two innovative programs are highlighted: (1) a hospital- and community-based program, the College Mental Health Program (CMHP) at McLean Hospital, and 2) the Student Support Network (SSN) at Worcester Polytechnic Institute. The subsequent section reviews the literature on peer-to-peer programs for students with serious and persistent mental illness for which there is a small but generally positive body of research. This lack of an empirical basis in college mental health leads the authors to argue for development of broad practice-research networks.
Haili, Hasnawati; Maknun, Johar; Siahaan, Parsaoran
Physics is a lessons that related to students' daily experience. Therefore, before the students studying in class formally, actually they have already have a visualization and prior knowledge about natural phenomenon and could wide it themselves. The learning process in class should be aimed to detect, process, construct, and use students' mental model. So, students' mental model agree with and builds in the right concept. The previous study held in MAN 1 Muna informs that in learning process the teacher did not pay attention students' mental model. As a consequence, the learning process has not tried to build students' mental modelling ability (MMA). The purpose of this study is to describe the improvement of students' MMA as a effect of problem solving based learning model with multiple representations approach. This study is pre experimental design with one group pre post. It is conducted in XI IPA MAN 1 Muna 2016/2017. Data collection uses problem solving test concept the kinetic theory of gasses and interview to get students' MMA. The result of this study is clarification students' MMA which is categorized in 3 category; High Mental Modelling Ability (H-MMA) for 7Mental Modelling Ability (M-MMA) for 3Mental Modelling Ability (L-MMA) for 0 ≤ x ≤ 3 score. The result shows that problem solving based learning model with multiple representations approach can be an alternative to be applied in improving students' MMA.
Fisher, Jacqueline Horan; Lichvar, Emily; Hogue, Aaron; Dauber, Sarah
This study examines clinical and family predictors of perceived need for treatment and engagement in mental health treatment services among community-referred racial/ethnic minority adolescents and their primary caregivers. Findings indicated that the majority of families perceived a need for treatment, but that perceived need was not associated with treatment engagement. Family factors (i.e., low cohesion and high conflict within the family) predicted perceived need for treatment among adolescents, whereas clinical factors (i.e., adolescent internalizing and externalizing symptomatology) predicted caregiver perceived need for adolescent treatment. Neither clinical nor family factors predicted treatment engagement.
Perlman Christopher M
Full Text Available Abstract Background Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs using the Resident Assessment Instrument - Mental Health (RAI-MH, a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally. Methods Retrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry. Results Subscales from the RAI-MH, the Depression Severity Index (DSI and Cognitive Performance Scale (CPS, were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance
Full Text Available Introduction: Long-term benzodiazepine (BZD treatment in patients with mental disorders is widespread in clinical practice, and this is also the case of patients with schizophrenia, although the evidence is weak and BZD prescription is discouraged by guidelines and medical authorities. Data on BZD prescription are usually derived from national or regional databases whereas information on the use of BZD by patients with schizophrenia and related psychoses in general population-based samples is limited. Materials and Methods: Information for 77 patients with psychotic disorders who were regularly attending follow-up appointments with the multidisciplinary Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia, Northwest Greece, during 1-year period (2015 was obtained from our database. Results: From the total of 77 engaged patients, 30 (39% were regularly prescribed BZDs in the long term, as part of their treatment regimen. Prescribed BZDs were mostly diazepam and lorazepam, in 43.3% of cases each. The mean daily dose of these compounds was 13 mg and 3.77 mg, respectively. Statistical analysis showed a correlation of long-term BZD use with the history of alcohol/substance abuse. Most patients were receiving BZD continuously for several years, and the mean dose was steady within this interval. Conclusions: A large proportion of patients with psychotic disorders were regularly prescribed BZD in long term. It appears that when BZDs are prescribed for some period in the course of a psychotic disorder, their use commonly exceeds the recommended interval and then becomes a regular part of the chronic treatment regimen. Future research should address the factors that may be related to the long-term BZD use by patients with psychotic disorders. Interventions for the reduction of regular BZD prescription should target the primary care setting and all those who treat first episode patients.
Wolff, Nancy; Frueh, B Christopher; Shi, Jing; Schumann, Brooke E
An open trial design was used to examine the implementation and effectiveness of a cognitive-behavioral intervention (Seeking Safety) for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) for incarcerated women with Axis I mental disorders who self-referred for specialty trauma treatment. The study sample was female inmates aged 18 and old who were primarily minority, had experienced childhood-based trauma, committed violent crimes, had a serious mental illness, and resided in maximum, medium, and minimum compounds of a women's prison. A total of 74 women completed the group intervention, with the average attending 23 of the 28 sessions (82%). Implementation feasibility was demonstrated by the ability to recruit, screen, assign, and retain participation. Effectiveness was supported by changes pre-post intervention on the PTSD Checklist (ES=0.56) and Global Severity Index (ES=0.47). Of the 19 completers with PCL scores of 50 or higher pre-intervention, 16 (84%) had scores below 50, the "cut score" consistent with or supportive of a PTSD diagnosis. Three-quarters or more of participants reported that Seeking Safety was helpful in each of the following areas: overall, for traumatic stress symptoms, for substance use, to focus on safety, and to learn safe coping skills. Future directions include the need for larger scale randomized controlled trials in medium or maximum security prisons and fidelity evaluations of non-research dissemination efforts. Published by Elsevier Ltd.
Bhaumik, Sabyasachi; Gangadharan, Satheesh; Hiremath, Avinash; Russell, Paul Swamidhas Sudhakar
Psychological treatments are widely used for the management of mental health and behavioural problems in people with intellectual disabilities. The evidence base, including the cost-effectiveness of such interventions, is limited. This editorial explores the current evidence base and analyses its strengths and limitations. The editorial also highlights current problems in conducting randomised controlled trials in this area and suggests a way forward.
Mond, J. M.; Marks, P.; Hay, P. J.; Rodgers, B.; Kelly, C.; Owen, C.; Paxton, S. J.
This research examined the "mental health literacy" of adolescents concerning eating-disordered behavior. A vignette describing a fictional 16-year old female meeting diagnostic criteria for bulimia nervosa was presented to 522 female high school students, followed by a series of questions concerning treatment of and treatment-seeking…
Callaghan, Sascha; Ryan, Christopher J
To analyse, and explain to Australasian psychiatrists, recent proposed changes to the terms of coercive treatment for mental illness in Tasmania and Victoria and to place the proposals in the context of a broader human rights framework that is likely to impact the future shape of mental health legislation more generally. The Australian law reform proposals are reviewed against the requirements of numerous human rights instruments, including the recently ratified United Nations Convention on the Rights of Persons with Disabilities. Ethical and legal arguments are made to support the proposed changes and to introduce others, taking into account academic commentary on mental health law and recent empirical work on the ability to usefully categorise patients by their likelihood of harm to self and others. The Victorian and Tasmanian draft mental health bills propose a new basis for compulsory psychiatric treatment in Australasia. If they become law, coercive psychiatric treatment could only be applied to patients who lack decision-making capacity. The Tasmanian draft bill also sets a new benchmark for timely independent review of compulsory treatment. However both jurisdictions propose to retain an 'additional harm' test which must be satisfied before patients may be treated without consent. This differs from non-psychiatric cases, where if patients are unable to consent to medical treatment for themselves, they will be entitled to receive coercive treatment if it is in their best interests. The proposed changes under the Tasmanian and Victorian draft mental health bills will ensure that, in line with local and international human rights obligations, only patients who lack decision-making capacity may be coercively treated for mental illness. However the continuing 'additional harm' criteria may breach human rights obligations by imposing a discriminatory threshold for care on patients who are unable to consent to treatment for themselves. This could be avoided by
Breslau, Joshua; Cefalu, Matthew; Wong, Eunice C; Burnam, M Audrey; Hunter, Gerald P; Florez, Karen R; Collins, Rebecca L
To resolve contradictory evidence regarding racial/ethnic differences in perceived need for mental health treatment in the USA using a large and diverse epidemiologic sample. Samples from 6 years of a repeated cross-sectional survey of the US civilian non-institutionalized population were combined (N = 232,723). Perceived need was compared across three non-Hispanic groups (whites, blacks and Asian-Americans) and two Hispanic groups (English interviewees and Spanish interviewees). Logistic regression models were used to test for variation across groups in the relationship between severity of mental illness and perceived need for treatment. Adjusting statistically for demographic and socioeconomic characteristics and for severity of mental illness, perceived need was less common in all racial/ethnic minority groups compared to whites. The prevalence difference (relative to whites) was smallest among Hispanics interviewed in English, -5.8% (95% CI -6.5, -5.2%), and largest among Hispanics interviewed in Spanish, -11.2% (95% CI -12.4, -10.0%). Perceived need was significantly less common among all minority racial/ethnic groups at each level of severity. In particular, among those with serious mental illness, the largest prevalence differences (relative to whites) were among Asian-Americans, -23.3% (95% CI -34.9, -11.7%) and Hispanics interviewed in Spanish, 32.6% (95% CI -48.0, -17.2%). This study resolves the contradiction in empirical evidence regarding the existence of racial/ethnic differences in perception of need for mental health treatment; differences exist across the range of severity of mental illness and among those with no mental illness. These differences should be taken into account in an effort to reduce mental health-care disparities.
Breslau, Joshua; Cefalu, Matthew; Wong, Eunice C.; Burnam, M. Audrey; Hunter, Gerald P.; Florez, Karen R.; Collins, Rebecca L.
Purpose To resolve contradictory evidence regarding racial/ethnic differences in perceived need for mental health treatment in the USA using a large and diverse epidemiologic sample. Methods Samples from 6 years of a repeated cross-sectional survey of the US civilian non-institutionalized population were combined (N = 232,723). Perceived need was compared across three non-Hispanic groups (whites, blacks and Asian-Americans) and two Hispanic groups (English interviewees and Spanish interviewees). Logistic regression models were used to test for variation across groups in the relationship between severity of mental illness and perceived need for treatment. Results Adjusting statistically for demographic and socioeconomic characteristics and for severity of mental illness, perceived need was less common in all racial/ethnic minority groups compared to whites. The prevalence difference (relative to whites) was smallest among Hispanics interviewed in English, −5.8% (95% CI −6.5, −5.2%), and largest among Hispanics interviewed in Spanish, - 11.2% (95% CI −12.4, −10.0%). Perceived need was significantly less common among all minority racial/ethnic groups at each level of severity. In particular, among those with serious mental illness, the largest prevalence differences (relative to whites) were among Asian-Americans, −23.3% (95% CI −34.9, −11.7%) and Hispanics interviewed in Spanish, 32.6% (95% CI −48.0, −17.2%). Conclusions This study resolves the contradiction in empirical evidence regarding the existence of racial/ethnic differences in perception of need for mental health treatment; differences exist across the range of severity of mental illness and among those with no mental illness. These differences should be taken into account in an effort to reduce mental health-care disparities. PMID:28550518
Zhang, Melvyn W B; Ho, Roger C M; Mcintyre, Roger S
Over the past decade, there have been massive advances in technology. These advances in technology have significantly transformed various aspects of healthcare. The advent of E-health and its influence on healthcare practice also implies that there is a paradigm shift in the way healthcare professionals work. Conventionally, healthcare professionals would have to refer to books and journals for updates in treatment algorithms, but with the advent of technology, they could access this information via the web or via various smartphone applications on the go. In the field of Psychiatry, one of the commonest mental health disorder to date, with significant morbidity and mortality is that of Major depressive disorder. Routinely, clinicians and healthcare professionals are advised to refer to standard guidelines in guiding them with regards to their treatment options. Given the high prevalence of conditions like Major Depressive Disorder, it is thus of importance that whatever guidelines that clinicians and healthcare professionals refer to are constantly kept up to date, so that patients could benefit from latest evidence based therapy and treatment. A review of the current literature highlights that whilst there are a multitude of smartphone applications designed for mental health care, previous systematic review has highlighted a paucity of evidence based applications. More importantly, current literature with regards to provision of treatment information to healthcare professionals and patients are limited to web-based interventions. It is the aim of this technical note to highlight a methodology to which the authors have conceptualized in the implementation of an evidence based mental health guideline applications, known as the `Wiki Guidelines' smartphone application. The authors hope to illustrate the algorithms behind the development of the application, and how it could be easily updated by the guidelines working group.
Rezaei, Sajjad; Asgari, Karim; Yousefzadeh, Shahrokh; Moosavi, Heshmat-Allah; Kazemnejad, Ehsan
Neurosurgical treatment and the severity of head injury (HI) can have remarkable effect on patients' neuropsychiatric outcomes. This research aimed to study the effect of these factors on cognitive functioning, general health and incidence of mental disorders in patients with a traumatic brain injury (TBI). In this descriptive, longitudinal study, 206 TBI patients entered the study by consecutive sampling; they were then compared according to neurosurgery status and severity of their HI. Both groups underwent neurosurgical and psychological examinations. The mini mental state examination (MMSE) and general health questionnaire-28 items (GHQ-28) were administered to the study participants. At follow-up, four months later, the groups underwent a structured clinical interview by a psychiatrist based on the diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) diagnostic criteria regarding the presence of mental disorders. Analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) were performed and adjusted for the effect of confounding variables (age, gender, Glasgow outcome scale (GOS) , and level of education). The severity of HI had the most significant effect for the following variables; cognitive functioning and physical symptoms (P < 0.05). The effect of the neurosurgical treatment factor was not significant; however, the interaction effect of the two variables on social dysfunction, and total score of the GHQ-28 questionnaire appeared to be significant (P < 0.05). Fisher's exact test indicated that after a four month follow-up period, no significant differences were seen between the two groups (with or without neurosurgery) in the incidence of mental disorders, while χ(2) Test showed that having a more severe HI is significantly correlated with the incidence of mental disorders (P < 0.01). The implications of this study should be discussed with an emphasis on negative, effective factors on the cognitive
Sands, Natisha; Elsom, Stephen; Keppich-Arnold, Sandra; Henderson, Kathryn; King, Peter; Bourke-Finn, Karen; Brunning, Debra
Telephone-based mental health triage services are frontline health-care providers that operate 24/7 to facilitate access to psychiatric assessment and intervention for people requiring assistance with a mental health problem. The mental health triage clinical role is complex, and the populations triage serves are typically high risk; yet to date, no evidence-based methods have been available to assess clinician competence to practice telephone-based mental health triage. The present study reports the findings of a study that investigated the validity and usability of the Mental Health Triage Competency Assessment Tool, an evidence-based, interactive computer programme designed to assist clinicians in developing and assessing competence to practice telephone-based mental health triage. © 2015 Australian College of Mental Health Nurses Inc.
I propose an "Interaction Model of Mental Disability (IMMD)". Several models based on ICIDH are being proposed and tested around the world focusing on different aspects of disability. Though ICIDH is an inclusive model in health services, social security, insurance, education, and so on, the remarkable point of IMMD is to visualize the mutual relation of mental disability (impairment, disability and handicap) and other factors (environmental factors, personal factors). IMMD is a practical reh...
Oliveira-Maia, Albino J; Mendonça, Carina; Pessoa, Maria J; Camacho, Marta; Gago, Joaquim
Within clinical psychiatry, recovery from severe mental illness (SMI) has classically been defined according to symptoms and function (service-based recovery). However, service-users have argued that recovery should be defined as the process of overcoming mental illness, regaining self-control and establishing a meaningful life (customer-based recovery). Here, we aimed to compare customer-based and service-based recovery and clarify their differential relationship with other constructs, namely needs and quality of life. The study was conducted in 101 patients suffering from SMI, recruited from a rural community mental health setting in Portugal. Customer-based recovery and function-related service-based recovery were assessed, respectively, using a shortened version of the Mental Health Recovery Measure (MHRM-20) and the Global Assessment of Functioning score. The Camberwell Assessment of Need scale was used to objectively assess needs, while subjective quality of life was measured with the TL-30s scale. Using multiple linear regression models, we found that the Global Assessment of Functioning score was incrementally predictive of the MHRM-20 score, when added to a model including only clinical and demographic factors, and that this model was further incremented by the score for quality of life. However, in an alternate model using the Global Assessment of Functioning score as the dependent variable, while the MHRM-20 score contributed significantly to the model when added to clinical and demographic factors, the model was not incremented by the score for quality of life. These results suggest that, while a more global concept of recovery from SMI may be assessed using measures for service-based and customer-based recovery, the latter, namely the MHRM-20, also provides information about subjective well-being. Pending confirmation of these findings in other populations, this instrument could thus be useful for comprehensive assessment of recovery and subjective
Smith, Eric G; Austin, Karen L; Kim, Hyungjin Myra; Eisen, Susan V; Kilbourne, Amy M; Miller, Donald R; Zivin, Kara; Hannemann, Claire; Sauer, Brian C; Valenstein, Marcia
BackgroundThe mood stabilisers lithium and valproate might plausibly have differing associations with mortality because of differing effects on mental health and various physiological indicators.AimsTo assess associations between lithium, valproate and non-suicide mortality.MethodIntention-to-treat, propensity score-matched cohort study.ResultsLithium was associated with significantly reduced non-suicide mortality in the intent-to-treat cohort over 0-90 days (hazard ratio (HR) = 0.67, 95% CI 0.51-0.87) but not longer. In secondary analyses, a sizeable reduction in mortality was observed during active treatment with lithium across all time periods studied (for example 365-day HR = 0.62, 95% CI 0.45-0.84), but significantly increased risks were observed among patients discontinuing lithium by 180 days (HR = 1.54, 95% CI 1.01-2.37).ConclusionsPatients initiating lithium had lower non-suicide mortality over 0-90 days than patients initiating valproate and consistently lower non-suicide mortality among patients maintaining treatment, but elevated risk among patients discontinuing treatment by 180 days. Although residual confounding or selection effects cannot be excluded, this study suggests potential benefits to enhancing lithium treatment persistence and the monitoring of patients discontinuing lithium. There is a need for further research. © The Royal College of Psychiatrists 2015.
Ben-Porath, Denise D.; Peterson, Gregory A.; Smee, Jacqueline
This article describes an effort to implement and examine dialectical behavior therapy's (DBT) effectiveness in a community mental health setting. Modifications made to address unique aspects of community mental health settings are described. Barriers encountered in implementation of DBT treatment in community mental health settings, such as staff…
Bagroy, Shrey; Kumaraguru, Ponnurangam; De Choudhury, Munmun
Psychological distress in the form of depression, anxiety and other mental health challenges among college students is a growing health concern. Dearth of accurate, continuous, and multi-campus data on mental well-being presents significant challenges to intervention and mitigation efforts in college campuses. We examine the potential of social media as a new “barometer” for quantifying the mental well-being of college populations. Utilizing student-contributed data in Reddit communities of over 100 universities, we first build and evaluate a transfer learning based classification approach that can detect mental health expressions with 97% accuracy. Thereafter, we propose a robust campus-specific Mental Well-being Index: MWI. We find that MWI is able to reveal meaningful temporal patterns of mental well-being in campuses, and to assess how their expressions relate to university attributes like size, academic prestige, and student demographics. We discuss the implications of our work for improving counselor efforts, and in the design of tools that can enable better assessment of the mental health climate of college campuses. PMID:28840202
Bagroy, Shrey; Kumaraguru, Ponnurangam; De Choudhury, Munmun
Psychological distress in the form of depression, anxiety and other mental health challenges among college students is a growing health concern. Dearth of accurate, continuous, and multi-campus data on mental well-being presents significant challenges to intervention and mitigation efforts in college campuses. We examine the potential of social media as a new "barometer" for quantifying the mental well-being of college populations. Utilizing student-contributed data in Reddit communities of over 100 universities, we first build and evaluate a transfer learning based classification approach that can detect mental health expressions with 97% accuracy. Thereafter, we propose a robust campus-specific Mental Well-being Index: MWI. We find that MWI is able to reveal meaningful temporal patterns of mental well-being in campuses, and to assess how their expressions relate to university attributes like size, academic prestige, and student demographics. We discuss the implications of our work for improving counselor efforts, and in the design of tools that can enable better assessment of the mental health climate of college campuses.
Patel, Rashmi; Shetty, Hitesh; Jackson, Richard; Broadbent, Matthew; Stewart, Robert; Boydell, Jane; McGuire, Philip; Taylor, Matthew
Bipolar disorder is a significant cause of morbidity and mortality. Although existing treatments are effective, there is often a substantial delay before diagnosis and treatment initiation. We sought to investigate factors associated with the delay before diagnosis of bipolar disorder and the onset of treatment in secondary mental healthcare. Retrospective cohort study using anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust (SLaM) Biomedical Research Centre (BRC) Case Register on 1364 adults diagnosed with bipolar disorder between 2007 and 2012. The following predictor variables were analysed in a multivariable Cox regression analysis: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder. The outcomes were time to recorded diagnosis from first presentation to specialist mental health services (the diagnostic delay), and time to the start of appropriate therapy (treatment delay). The median diagnostic delay was 62 days (interquartile range: 17-243) and median treatment delay was 31 days (4-122). Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18-3.06) and treatment delay (4.40, 3.63-5.62). Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33-0.41) and substance misuse disorders (0.44, 0.31-0.61). Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay. Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder after initiation of specialist mental healthcare, particularly those who have prior diagnoses of alcohol and substance misuse disorders. These findings highlight a need for further study on strategies to better identify underlying symptoms and offer appropriate treatment sooner
Full Text Available Bipolar disorder is a significant cause of morbidity and mortality. Although existing treatments are effective, there is often a substantial delay before diagnosis and treatment initiation. We sought to investigate factors associated with the delay before diagnosis of bipolar disorder and the onset of treatment in secondary mental healthcare.Retrospective cohort study using anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust (SLaM Biomedical Research Centre (BRC Case Register on 1364 adults diagnosed with bipolar disorder between 2007 and 2012. The following predictor variables were analysed in a multivariable Cox regression analysis: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder. The outcomes were time to recorded diagnosis from first presentation to specialist mental health services (the diagnostic delay, and time to the start of appropriate therapy (treatment delay.The median diagnostic delay was 62 days (interquartile range: 17-243 and median treatment delay was 31 days (4-122. Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18-3.06 and treatment delay (4.40, 3.63-5.62. Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33-0.41 and substance misuse disorders (0.44, 0.31-0.61. Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay.Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder after initiation of specialist mental healthcare, particularly those who have prior diagnoses of alcohol and substance misuse disorders. These findings highlight a need for further study on strategies to better identify underlying symptoms and offer appropriate treatment
Friedrich, Bettina; Mason, Oliver John
information and often the aims of the interventions are vague or not stated at all. Due to the heterogeneity of the studies and relative scarcity of evaluation projects on football interventions for people with mental health problems, the authors could not conduct an in-depth systematic review. Furthermore, the information on methods was often unsatisfying and despite efforts to get more detailed input from the authors of cited papers, those gaps could not always be filled. Instead of coming up with a crystal-clear summary of whether and how football interventions work for everybody, topics were identified that need to be addressed in the planning of interventions, in evaluation studies, in implementation efforts and in the theoretical discourse. This paper constitutes a helpful overview for everybody who is interested in the theoretical background of football interventions for people with mental health problems, for people who are planning to develop respective interventions, for researchers who engage in evaluation projects that look into the effectiveness of football interventions (or similar exercise interventions) as well as for the people who are interested in how football interventions can be implemented. This paper is likely to make a contribution to the advancement of alternative exercise interventions that aim at improving mental, physical and social health in people with mental health problems. This paper will help putting the topic of football interventions (and similar, alternative exercise interventions) further up on the public health agenda by providing an overview of the empirical evidence at hand and by specifying advantages of the approach as well as pointing out actions that need to be taken to make football a recognised, evidence based and viable option for adjunct mental health treatment that is attractive to potential participants as well as funders as well as to the potential participants. There is no comprehensive summary to date that provides a
Kuipers, G.S.; den Hollanders, S.; van der Ark, L.A.; Bekker, M.H.J.
Purpose To investigate whether recovery from an eating disorder is related to pre-treatment attachment and mentalization and/or to improvement of attachment and mentalization during treatment. Method For a sample of 38 anorexia nervosa (AN) and bulimia nervosa (BN) patients receiving treatment the
Kuipers, G. S.; den Hollander, S.; van der Ark, L.A.; Bekker, M.H.J.
Purpose To investigate whether recovery from an eating disorder is related to pre-treatment attachment and mentalization and/or to improvement of attachment and mentalization during treatment. Method For a sample of 38 anorexia nervosa (AN) and bulimia nervosa (BN) patients receiving treatment the
Cook, Mekeila C; Barnert, Elizabeth; Ijadi-Maghsoodi, Roya; Ports, Kayleen; Bath, Eraka
The study sought to: 1) describe the mental health and substance use profiles among participants of a specialty trafficking court program (the Succeed Though Achievement and Resilience Court); 2) describe youths' mental health and substance use treatment prior to participating in the program; and 3) examine whether abuse influences report of mental health problems and/or substance use. Retrospective case review of court files was performed on commercially sexually exploited youth who volunteered to participate in the court from 2012 to 2014 (N = 184). All participants were female. Mental health problems and report of substance use was high among this population. Substance use differed at statistically significant levels between youth with a documented abuse history compared to those with no abuse history. Substance use also differed by report of mental health problems. Unexpected findings included the high rate of hospitalization for mental health problems and relatively low substance use treatment prior to STAR Court participation. Opportunities for improvement in critical points of contact to identify commercially sexually exploited youth and address their health needs are discussed.
Wolpert, Miranda; Humphrey, Neil; Deighton, Jessica; Patalay, Praveetha; Fugard, Andrew J. B.; Fonagy, Peter; Belsky, Jay; Vostanis, Panos
We report on a randomized controlled trial of Targeted Mental Health in Schools (TaMHS), which is a nationally mandated school-based mental health program in England. TaMHS aimed to improve mental health for students with, or at risk of, behavioral and emotional difficulties by providing evidence-informed interventions relating to closer working…
McLone, Suzanne G; Kouvelis, Antigone; Mason, Maryann; Sheehan, Karen
Suicide is the third-leading cause of death among Illinois residents aged 15 to 24 years. The Illinois Violent Death Reporting System (IVDRS) was developed to help prevent these deaths by providing timely, complete data. Understanding the circumstances surrounding suicide for those aged 15 to 24 years who are not receiving mental health treatment can help others: (1) recognize signs of potential crisis and (2) connect them to mental health treatment. The IVDRS data were collected from five Illinois counties-Cook, DuPage, Kane, McHenry, and Peoria-from 2005 to 2010. All cases with the manner suicide, aged 15 to 24 years, were extracted for analysis. Data were described using frequencies and percentages, and statistical differences between groups were determined using χ analysis. There were a total of 386 suicides in those aged 15 to 24 years in IVDRS from 2005 to 2010. Most 15- to 19-year-olds (67%) and 20- to 24-year-olds (78%) were not receiving mental health treatment at the time of death. Among those not receiving mental health treatment, 22% and 13% of those aged 15 to 19 and 20 to 24 years, respectively, had disclosed their intent to commit suicide to another. One third were identified as being depressed or in a depressed mood (not necessarily a clinical diagnosis) in both age groups. One quarter in both age groups experienced a crisis (current, acute precipitating, or forthcoming event) within 2 weeks of their suicides. The majority of adolescents and young adults were not in mental health treatment at the time death. Among those not in mental health treatment at the time of death, the 15- to 19-year-olds were more likely to share their suicidal intentions than the 20- to 24-year-olds. Epidemiological study, level IV.
Mays Vickie M
Full Text Available Abstract Background Prior research has shown a higher prevalence of substance use and mental disorders among sexual minorities, however, the influence of sexual orientation on treatment seeking has not been widely studied. We use a model of help-seeking for vulnerable populations to investigate factors related to treatment for alcohol or drug use disorders and mental health disorders, focusing on the contributions of gender, sexual orientation, and need. Methods Survey data were obtained from a population-based probability sample of California residents that oversampled for sexual minorities. Logistic regression was used to model the enabling, predisposing, and need-related factors associated with past-year mental health or substance abuse treatment utilization among adults aged 18–64 (N = 2,074. Results Compared with individuals without a diagnosed disorder, those with any disorder were more likely to receive treatment. After controlling for both presence of disorder and other factors, lesbians and bisexual women were most likely to receive treatment and heterosexual men were the least likely. Moreover, a considerable proportion of sexual orientation minorities without any diagnosable disorder, particularly lesbians and bisexual women, also reported receiving treatment. Conclusion The study highlights the need to better understand the factors beyond meeting diagnostic criteria that underlie treatment utilization among sexual minorities. Future research should also aim to ascertain the effects of treatment provided to sexual minorities with and without diagnosable disorders, including the possibility that the provision of such treatment may reduce the likelihood of their progression to greater severity of distress, disorders, or impairments in functioning.
Isobel, Sophie; Meehan, Felicity; Pretty, Danielle
There has been limited examination of the use of relationship based structured parenting programs that focus on emotional interactions in the parent-child dyad in families where a parent has a mental illness. There is also a lack of awareness of the practicalities of providing such interventions within adult mental health services. This study explores the process and outcomes of a nurse led emotional awareness based parenting program for adult clients of a mental health service. Participants demonstrated a significant reduction in difficult parenting moments and associated stress and distress as well as promising improvements in overall distress and emotional awareness. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.
Mental health legislation (MHL) is required to ensure a regulatory framework for mental health services and other providers of treatment and care, and to ensure that the public and people with a mental illness are afforded protection from the often-devastating consequences of mental illness. To provide an overview of evidence on the significance of MHL for successful primary care for mental health and community mental health servicesMethod: A qualitative review of the literature on the significance of MHL for successful primary care for mental health and community mental health services was conducted. In many countries, especially in those who have no MHL, people do not have access to basic mental health care and treatment they require. One of the major aims of MHL is that all people with mental disorders should be provided with treatment based on the integration of mental health care services into the primary healthcare (PHC). In addition, MHL plays a crucial role in community integration of persons with mental disorders, the provision of care of high quality, the improvement of access to care at community level. Community-based mental health care further improves access to mental healthcare within the city, to have better health and mental health outcomes, and better quality of life, increase acceptability, reduce associated social stigma and human rights abuse, prevent chronicity and physical health comorbidity will likely to be detected early and managed. Mental health legislation plays a crucial role in community integration of persons with mental disorders, integration of mental health at primary health care, the provision of care of high quality and the improvement of access to care at community level. It is vital and essential to have MHL for every country.
Tan, Xi; Marshall, Vincent D.; Balkrishnan, Rajesh; Patel, Isha; Chang, Jongwha; Erickson, Steven R.
Psychotropic medications are a common treatment for mental illness in people with developmental disabilities. Medication adherence is a critical determinant of the effectiveness of psychotropic drugs, but psychotropic medication adherence research specific to this population remains limited. This retrospective study analyzed Marketscan®…
Full Text Available This article reviews the intersection between adolescent pregnancy and mental health. The research involving mental health risks for adolescent pregnancy and for parents who are teenagers are discussed. Depression and conduct disorder have emerged with the most attention. Research-based treatment of these disorders in adolescents is presented.
Shelby, Sarah R; Labott, Susan; Stout, Rebecca A
Although bariatric surgery has become a recognized treatment for obesity, its utility among patients with severe psychiatric disorders has not been extensively studied. A few studies have reported similar weight loss outcomes in these patients, but psychiatric status after bariatric surgery has been studied only minimally, and it is unknown if exacerbation of the mental illness affects weight loss. The aim of this study was to shed greater light on the issue of serious mental illness and bariatric surgery. Specifically, do patients with a diagnosis of schizophrenia, bipolar I, and bipolar II have poorer weight loss outcomes postbariatric surgery than the general bariatric surgery population? Also, do patients with these diagnoses experience an exacerbation of psychiatric symptoms after bariatric surgery, and if so, is the exacerbation of these disorders linked to poorer weight loss results? Midwest university medical center. A medical record review of approximately 1500 bariatric patients in a Midwest university medical center was conducted to identify those patients with diagnoses of schizophrenia, bipolar I, and bipolar II. Information was gathered on bariatric surgery outcomes and changes in psychiatric status postsurgery. Eighteen patients were identified as undergoing bariatric surgery and having a diagnosis of schizophrenia, bipolar I, or bipolar II. Weight loss in this group was significant and comparable to expected outcomes of absolute weight lost, changes in body mass index, and percentage excess weight loss for patients in the typical bariatric population. Postsurgery psychiatric status was known on 10 patients. All 10 patients experienced some exacerbation of psychiatric problems yet weight loss outcomes were still as expected. Bariatric surgery is a viable obesity treatment option for patients with schizophrenia, bipolar I, and bipolar II disorders. Symptom exacerbations occurred postsurgery, although it is not clear if these were due to the surgery or
M R Sumathi
Full Text Available According to World Health Organization, 10-20% of children and adolescents all over the world are experiencing mental disorders. Correct diagnosis of mental disorders at an early stage improves the quality of life of children and avoids complicated problems. Various expert systems using artificial intelligence techniques have been developed for diagnosing mental disorders like Schizophrenia, Depression, Dementia, etc. This study focuses on predicting basic mental health problems of children, like Attention problem, Anxiety problem, Developmental delay, Attention Deficit Hyperactivity Disorder (ADHD, Pervasive Developmental Disorder(PDD, etc. using the machine learning techniques, Bayesian Networks and Fuzzy clustering. The focus of the article is on learning the Bayesian network structure using a novel Fuzzy Clustering Based Bayesian network structure learning framework. The performance of the proposed framework was compared with the other existing algorithms and the experimental results have shown that the proposed framework performs better than the earlier algorithms.
Full Text Available Abstract Background Improvements in treatment have resulted in an increasing number of cancer survivors potentially being able to return to work after medical treatment. In this paper we focus on the considerations regarding return to work (RTW of breast cancer absentees in the Belgian context and how these considerations are related to reactions from their social environment. Methods A qualitative study was performed to understand the RTW considerations of Belgian breast cancer absentees who had undergone breast cancer surgery in 2006. Twenty-two participants (mean age 46 were included and interviewed between May 2008 and August 2009 in their personal environment. An in-depth analysis (Grounded Theory took place using the Qualitative Analysis Guide of Leuven (Quagol. Results Before the actual RTW, breast cancer employees try to build an image of the future resumption of work based on medical grounds and their knowledge of the workplace. Four matters are considered prior to RTW: (i women want to leave the sick role and wish to keep their job; (ii they consider whether working is worth the effort; (iii they reflect on their capability; and (iv they have doubts about being accepted in the workplace after returning. These inner thoughts are both product and input for the interaction with the social environment. The whole process is coloured by uncertainty and vulnerability. Conclusion Our study demonstrated that mental preparation for RTW is not a linear process of improvement. It shows a detailed picture of four types of considerations made by breast cancer survivors before they actually resume work. Vulnerability appears to be an overarching theme during mental preparation. As the social environment plays an important role, people from that environment must become more aware of their influence on decreasing or increasing a woman’s vulnerability while preparing for RTW.
Baxter, Joanne; Kokaua, Jesse; Wells, J Elisabeth; McGee, Magnus A; Oakley Browne, Mark A
To compare ethnic groups for the 12 month prevalence of mental disorders and 12 month treatment contact in Te Rau Hinengaro: The New Zealand Mental Health Survey. Te Rau Hinengaro: The New Zealand Mental Health Survey, undertaken in 2003 and 2004, was a nationally representative face-to-face household survey of 12,992 New Zealand adults aged 16 years and over, including Māori (n = 2595), Pacific people (n = 2236) and a composite Other ethnic group (predominantly European) (n = 8161). Ethnicity was measured using the 2001 census ethnicity question. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0) was used to measure disorder. The overall response rate was 73.3%. The 12 month prevalence of any mental disorder was highest in Māori (29.5%; 26.6, 32.4), followed by Pacific people (24.4%; 21.2, 27.6) and Others (19.3%; 18.0, 20.6). Adjustment for age, sex, education and household income reduced differences: Māori (23.9%; 21.3, 26.4), Pacific (19.2%; 16.4, 22.1) and Other (20.3%; 18.9, 21.6). A similar pattern was seen for serious disorder and most individual disorders or disorder groups. After adjustment, Māori were most different from Pacific people and Others for substance use disorder. Both Māori and Pacific people had a higher prevalence of bipolar disorder than Others. Pacific people had the lowest prevalence of major depressive disorder. Among those with disorder, the proportion with a visit for mental health problems to any service was highest among Others (41.1%; 38.1, 44.1), with Māori (32.5%; 28.3, 36.7) intermediate and Pacific (25.4%, 19.4, 31.4) lowest. Adjustment did not alter ethnic differences in service contact. Māori, and to a lesser extent Pacific people, have a higher prevalence of 12 month mental disorders than Others. Differences are reduced after adjusting for sociodemographic correlates. Relative to need
Dressing, Harald; Salize, Hans Joachim; Gordon, Harvey
There is only limited research on the various legal regulations governing assessment, placement and treatment of mentally ill offenders in European Union member states (EU-member states). To provide a structured description and cross-boundary comparison of legal frameworks regulating diversion and treatment of mentally disordered offenders in EU-member states before the extension in May 2004. A special focus is on the concept of criminal responsibility. Information on legislation and practice concerning the assessment, placement and treatment of mentally ill offenders was gathered by means of a detailed, structured questionnaire which was filled in by national experts. The legal regulations relevant for forensic psychiatry in EU-member states are outlined. Definitions of mental disorders given within these acts are introduced and compared with ICD-10 diagnoses. Finally the application of the concept of criminal responsibility by the law and in routine practice is presented. Legal frameworks for the processing and placement of mentally disordered offenders varied markedly across EU-member states. Since May 2004 the European Union has expanded to 25 member states and in January 2007 it will reach 27. With increasing mobility across Europe, the need for increasing trans-national co-operation is becoming apparent in which great variation in legal tradition pertains.
Chong, Bun San; Gohil, Kajal; Pawar, Ravikiran; Makdissi, Jimmy
The objective of the present study was to evaluate the anatomical relationship between mental foramen (MF), including the incidence of the anterior loop of the inferior alveolar nerve (AL), and roots of mandibular teeth in relation to risk of nerve injury with endodontic treatment. Cone-beam computed tomography (CBCT) images, which included teeth either side of the MF, were randomly selected. The anonymised CBCT images were reconstructed and examined in coronal, axial and sagittal planes, using three-dimensional viewing software, to determine the relationship and distance between MF and adjacent mandibular teeth. The actual distance between the root apex and MF was calculated mathematically using Pythagoras' theorem. If present, the incidence of an AL in the axial plane was also recorded. The root apex of the mandibular second premolar (70 %), followed by the first premolar (18 %) and then the first molar (12 %), was the closest to the MF. Ninety-six percent of root apices evaluated were >3 mm from the MF. An AL was present in 88 % of the cases. With regards to endodontic treatment, the risk of nerve injury in the vicinity of the MF would appear to be low. However, the high incidence of the AL highlights the need for clinicians to be aware and careful of this important anatomical feature. The risk of injury to the MN with endodontic treatment would appear to be low, but given the high incidence, it is important to be aware and be careful of the AL.
Miller, Rachel; Mason, Susan E
The concept of open-ended groups is expanded to include an open-door model (OEOD) wherein members with severe mental illnesses, including schizophrenia disorders and bi-polar, can join, leave, and re-enter groups as their life circumstances dictate their availability and willingness for treatment. This model is grounded on the work of Schopler and Galinsky's (1984/2006) and Galinsky and Schopler's (1989) theses on the value and processes of open-ended groups and includes perspectives on mutual aid and group development. Groupwork with the OEOD format is illustrated with examples taken from a group of 79 participants diagnosed with first-episode schizophrenia/schizoaffective disorders, 40 of who had co-occurring substance abuse. Of the 79 participants in the OEOD group program, 70 (89%) remained in treatment for the maximum of 3 years. The over-all value of group treatment for this population is reviewed along with the small number of available publications on open-ended and open-door-type groups.
Esposito-Smythers, Christianne; Hadley, Wendy; Curby, Timothy W; Brown, Larry K
Adolescents with mental health conditions represent a high-risk group for substance use, deliberate self-harm (DSH), and risky sexual behavior. Mental health treatment does not uniformly decrease these risks. Effective prevention efforts are needed to offset the developmental trajectory from mental health problems to these behaviors. This study tested an adjunctive cognitive-behavioral family-based alcohol, DSH, and HIV prevention program (ASH-P) for adolescents in mental healthcare. A two group randomized design was used to compare ASH-P to an assessment only control (AO-C). Participants included 81 adolescents and a parent. Assessments were completed at pre-intervention as well as 1, 6, and 12-months post-enrollment, and included measures of family-based mechanisms and high-risk behaviors. ASH-P relative to AO-C was associated with greater improvements in most family process variables (perceptions of communication and parental disapproval of alcohol use and sexual behavior) as well as less DSH and greater refusal of sex to avoid a sexually transmitted infection. It also had a moderate (but non-significant) effect on odds of binge drinking. No differences were found in suicidal ideation, alcohol use, or sexual intercourse. ASH-P showed initial promise in preventing multiple high-risk behaviors. Further testing of prevention protocols that target multiple high-risk behaviors in clinical samples is warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.
Full Text Available New treatment approaches are needed for patients with severe and composite mental disorders who appear resistant to conventional treatments. Such treatment resistant patients often have diagnoses of psychotic or bipolar disorders or severe personality disorders and comorbid conditions. Here we evaluate Basal Exposure Therapy (BET, a novel ward-integrated psychotherapeutic approach for these patients. Central to BET is the conceptualization of undifferentiated existential fear as basic to the patients’ problem, exposure to this fear, and the therapeutic platform Complementary External Regulation (CER which integrates and governs the totality of interventions throughout the treatment process. BET is administered at a locked-door ward with six patient beds and 13.5 full time employees, including a psychiatrist and two psychologists. Thirty-eight patients who had completed BET were included, all but two being female, mean age 29.9 years. Fourteen patients had a diagnosis of schizophrenia or schizoaffective disorder (F20/25, eight had bipolar disorder or recurrent depressive disorder (F31/33, eight had diagnoses in the F40-49 domain (anxiety, stress, dissociation, five were diagnosed with emotionally unstable personality disorder (F60.3, and three patients had other diagnoses. Twenty of the patients (53% had more than one ICD-10 diagnosis. Average treatment time in BET was 13 months, ranging from 2 to 72 months. Time-series data show significant improvements in symptoms and functioning from enrolment to discharge, with effect sizes at 0.76 for the Dissociation Experience Scale, 0.93 for the Brief Symptom Inventory, 1.47 for the Avoidance and Action Questionnaire, and 1.42 and 1.56, respectively for the functioning and symptom subscales of the Global Assessment of Functioning Scale. In addition, the patients used significantly less antiepileptic, antipsychotic, anxiolytic and antidepressant medications at discharge than at treatment enrolment
Guzmán, Javier; Kessler, Ronald C; Squicciarini, Ana Maria; George, Myriam; Baer, Lee; Canenguez, Katia M; Abel, Madelaine R; McCarthy, Alyssa; Jellinek, Michael S; Murphy, J Michael
Skills for Life (SFL) is the largest school-based mental health program in the world, screening and providing services to more than 1,000,000 students in Chile over the past decade. This is the first external evaluation of the program. Of the 8,372 primary schools in Chile in 2010 that received public funding, one-fifth (1,637) elected to participate in SFL. Each year, all first- and third-grade students in these schools are screened with validated teacher- and parent-completed measures of psychosocial functioning (the Teacher Observation of Classroom Adaptation-Re-Revised [TOCA-RR] and the Pediatric Symptom Checklist-Chile [PSC-CL]). Students identified as being at risk on the TOCA-RR in first grade are referred to a standardized 10-session preventive intervention in second grade. This article explores the relationships between workshop participation and changes in TOCA-RR and PSC-CL scores, attendance, and promotion from third to fourth grades. In all, 16.4% of students were identified as being at-risk on the TOCA-RR. Statistically significant relationships were found between the number of workshop sessions attended and improvements in behavioral and academic outcomes after controlling for nonrandom selection into exposure and loss to follow-up. Effect sizes for the difference between attending most (7-10) versus fewer (0-6) sessions ranged from 0.08 to 0.16 standard deviations. This study provides empirical evidence that a large-scale mental health intervention early in schooling is significantly associated with improved behavioral and academic outcomes. Future research is needed to implement more rigorous experimental evaluation of the program, to examine longer-term effects, and to investigate possible predictors of heterogeneity of treatment response. Copyright © 2015 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
McMeel, Lorri S.; Leathers, Sonya J.; Strand, Tonya C.
This article reviews existing measures related to evidence-based practices with children and self-efficacy and describes the development and psychometric properties of the Evidence-Based Mental Health Practices With Children Efficacy Scale. This scale was developed to assess students' and clinicians' self-efficacy in their abilities to use…
Nicole M Fett
Morphea is a rare fibrosing disorder of the skin. Evidence-based treatment strategies in morphea are lacking. This review summarizes the available data on morphea treatment and provides therapeutic strategies based on morphea subtypes. The Cochrane Library, Medline and Embase from inception until May of 2011 were searched using the key words "morphea" and "morphea treatment." Reference lists of the resultant articles, as well as relevant reviews, were also searched. This review focuses on ran...
Full Text Available Rosalia Costa,1 Marco Colizzi2 1Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, Tavistock Centre, 2Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK Abstract: Cross-sex hormonal treatment represents a main aspect of gender dysphoria health care pathway. However, it is still debated whether this intervention translates into a better mental well-being for the individual and which mechanisms may underlie this association. Although sex reassignment surgery has been the subject of extensive investigation, few studies have specifically focused on hormonal treatment in recent years. Here, we systematically review all studies examining the effect of cross-sex hormonal treatment on mental health and well-being in gender dysphoria. Research tends to support the evidence that hormone therapy reduces symptoms of anxiety and dissociation, lowering perceived and social distress and improving quality of life and self-esteem in both male-to-female and female-to-male individuals. Instead, compared to female-to-male individuals, hormone-treated male-to-female individuals seem to benefit more in terms of a reduction in their body uneasiness and personality-related psychopathology and an amelioration of their emotional functioning. Less consistent findings support an association between hormonal treatment and other mental health-related dimensions. In particular, depression, global psychopathology, and psychosocial functioning difficulties appear to reduce only in some studies, while others do not suggest any improvement in these domains. Results from longitudinal studies support more consistently the association between hormonal treatment and improved mental health. On the contrary, a number of cross-sectional studies do not support this evidence. This review provides possible biological explanation vs psychological explanation (direct effect vs indirect effect
Kearns, Michelle; Muldoon, Orla T; Msetfi, Rachel M; Surgenor, Paul W G
The stigma surrounding mental ill-health is an important issue that affects likelihood of diagnosis and uptake of services, as those affected may work to avoid exposure, judgment, or any perceived loss in status associated with their mental ill-health. In this study, we drew upon social identity theory to examine how social group membership might influence the stigma surrounding mental ill-health. Participants from two urban centers in Ireland (N = 626) completed a survey measuring stigma of mental health, perceived social support as well as identification with two different social groups (community and religion). Mediation analysis showed that subjective identification with religious and community groups led to greater perceived social support and consequently lower perceived stigma of mental ill-health. Furthermore, findings indicated that high identification with more than one social group can lead to enhanced social resources, and that identification with a religious group was associated with greater community identification. This study thus extends the evidence base of group identification by demonstrating its relationship with stigma of mental ill-health, while also reinforcing how multiple identities can interact to enhance social resources crucial for well-being. © Society for Community Research and Action 2017.
Vähäniemi, Anu; Warwick-Smith, Katja; Hätönen, Heli; Välimäki, Maritta
High-quality mental health care requires written strategies to set a vision for the future, yet, there is limited systematic information available on the monitoring and evaluation of such strategies. The aim of this nationwide study is to evaluate local mental health strategies in community-based mental health services provided by municipalities. Mental health strategy documents were gathered through an online search and an e-mail survey of the local authorities of all Finnish mainland municipalities (n = 320). Out of 320 municipalities, documents for 129 municipalities (63 documents) were included in the study. The documents obtained (n = 63) were evaluated against the World Health Organization checklist for mental health strategies and policies. Evaluation of the process, operations and content of the documents, against 31 indicators in the checklist. Out of 320 Finnish municipalities, 40% (n = 129) had a mental health strategy document available and 33% (n = 104) had a document that was either in preparation or being updated. In these documents, priorities, targets and activities were clearly described. Nearly all (99%) of the documents suggested a commitment to preventative work, and 89% mentioned a dedication to developing community-based care. The key shortfalls identified were the lack of consideration of human rights (0%), the limited consideration of research (5%) and the lack of financial planning (28%) to successfully execute the plans. Of the documents obtained, 60% covered both mental health and substance abuse issues. This study contributes to the limited evidence base on health care strategy evaluations. Further research is needed to understand the potential impact of policy analysis. © The Author(s) 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: email@example.com
Ahuja, Ravish; Jyoti, Bhuvan; Shewale, Vinod; Shetty, Shridhar; Subudhi, Santosh Kumar; Kaur, Manpreet
Behavioral management of patients forms one of the foremost components of pediatric dental treatment. Some children readily cooperate with dental treatment, while others require general anesthesia as a part of treatment protocol for carrying out various dental procedures. Hence, we evaluated the pediatric patients with and without mental retardation, who underwent dental treatment under general anesthesia. The present study analyzed the record of 480 pediatric patients reporting in the department of pedodontics from 2008 to 2014. Analysis of the records of the patients who underwent dental treatment under general anesthesia was done and all the patients were divided into two study groups depending upon their mental level. For the purpose of evaluation, the patients were also grouped according to their age; 4 to 7 years, 8 to 12 years, and 13 to 18 years. Measurement of decayed, missing, and filled teeth and scores for both deciduous and permanent dentition was done before and after the commencement of the dental treatment. Chi-square test and independent t-test were used for evaluating the level of significance. While comparing the patients in the two groups, maximum number of patients is present in the age group of 13 to 18 years. While comparing the indices' score between the two study groups in various age intervals, no statistically significant results were obtained. Restorative treatment and dental extractions were the most common dental treatments that were seen at a higher frequency in the intellectual disability study group. In patients with mental retardation, a higher frequency of restorative treatment and extractions occurs as compared to healthy subjects of similar age group. Therefore, they require special attention regarding maintenance of their oral health. Special attention should be given for maintaining the oral health of patients with special health care needs as compared to their physically and mentally normal counterparts.
Porsdam Mann, Sebastian; Bradley, Valerie J; Sahakian, Barbara J
The incidence of human rights violations in mental health care across nations has been described as a "global emergency" and an "unresolved global crisis." The relationship between mental health and human rights is complex and bidirectional. Human rights violations can negatively impact mental health. Conversely, respecting human rights can improve mental health. This article reviews cases where an explicitly human rights-based approach was used in mental health care settings. Although the included studies did not exhibit a high level of methodological rigor, the qualitative information obtained was considered useful and informative for future studies. All studies reviewed suggest that human-rights based approaches can lead to clinical improvements at relatively low costs. Human rights-based approaches should be utilized for legal and moral reasons, since human rights are fundamental pillars of justice and civilization. The fact that such approaches can contribute to positive therapeutic outcomes and, potentially, cost savings, is additional reason for their implementation. However, the small sample size and lack of controlled, quantitative measures limit the strength of conclusions drawn from included studies. More objective, high quality research is needed to ascertain the true extent of benefits to service users and providers.
Mayberry, Lindsay Satterwhite; Heflinger, Craig Anne
Family involvement in the planning and execution of mental health treatment has been shown to positively influence child outcomes; however, there is wide variability in the levels of involvement by families. The current study investigated the influence of child, family caregiver, service system, and community factors on the level of family…
Facon, Bruno; Sahiri, Safia; Riviere, Vinca
The aim of the present study was to demonstrate the efficacy of combining two operant learning procedures--shaping and fading--for treating selective mutism. The participant was a 12-year-old boy with mental retardation presenting a severe long-term selective mutism. The treatment was aimed at increasing the loudness of his vocalizations in an…
Gonzalez, Jodi M.; Alegria, Margarita; Prihoda, Thomas J.
This article investigates attitudes toward seeking mental health treatment in a national epidemiological sample. Young adults reported the most negative attitudes, as compared to older adults. Males reported more negative attitudes, as compared to females, a consistent finding in young adults. The gender difference was not consistent in Latinos…
Full Text Available Sleep problems are common in people with serious mental illness, and impact negatively on functioning and wellbeing. To understand the development of sleep problems, their maintenance, and their treatment, an in depth understanding of patient perspectives is crucial. A systematic literature review was conducted using Medline, AMED, PsychInfo, Embase and CINAHL. Qualitative and quantitative studies were included if they explored or measured patient perspectives on sleep, sleep problems or sleep treatments in people with serious mental illness. Of the 2,067 hits, only 22 met review inclusion criteria, and high quality evidence was sparse. The limited findings suggested sleep was seen as highly interlinked with mental health. Evaluations of treatments varied, however perceived efficacy and personalisation of treatments were valued. Some evidence suggested patient priorities and conceptualisations regarding sleep may diverge from those of validated screening tools developed in general population and sleep medicine samples. More rigorous research is needed to support adaptation and development of interventions and outcome measures for use in specialist mental health settings. Qualitative studies exploring the experience of sleep disturbance in particular diagnostic groups and contexts are urgently required, as are patient perspectives on sleep interventions.
Britt, Thomas W; Wright, Kathleen M; Moore, Dewayne
The present research examined positive and negative leadership behaviors as predictors of stigma and practical barriers to mental health treatment. Soldiers completed measures of noncommissioned officer (NCO) and officer leadership, stigma, and practical barriers to getting mental health treatment at 2, 3, and 4 months following a 15-month deployment to Afghanistan. The results revealed that positive and negative NCO and officer leader behaviors were predictive of overall stigma and barriers to care (collapsed across the three time periods), with only NCO positive and negative behaviors being uniquely predictive of stigma when included in the same model with officer behaviors. In addition, negative and positive NCO leader behaviors were predictive of stigma within participants over the course of the three month time period, and positive NCO leader behaviors were inversely related to practical barriers to mental health treatment within participants across the same time period. The results are discussed in terms of how different leader behaviors may be linked to different factors influencing a soldier's decision to seek mental health treatment.
Seponski, Desiree M; Lewis, Denise C; Megginson, Maegan C
Mental health issues are significant contributors to the global burden of disease with the highest incidence in resource poor countries; 90% of those in need of mental health treatment reside in low resource countries but receive only 10% of the world's resources. Cambodia, the eighth least developed country in the world, serves as one example of the need to address mental health concerns in low-income, resource poor countries. The current study utilises responsive evaluation methodology to explore how poverty-stricken Cambodian clients, therapists and supervisors experience Western models of therapy as culturally responsive to their unique needs. Quantitative and qualitative data were triangulated across multiple stakeholders using numerous methods including a focus group, interviews, surveys, case illustrations and live supervision observation and analysed using constant comparative analysis. Emerging findings suggest that poverty, material needs, therapy location and financial situations greatly impact the daily lives and mental health conditions of Cambodians and hinder clients' therapeutic progress. The local community needs and context of poverty greatly hinder clients' therapeutic progress in therapy treatment and when therapy does not directly address the culture of poverty, clients did not experience therapy as valuable despite some temporary decreases in mental health symptoms.
Ramsey, Alex T; Montgomery, Katherine
Despite concerns around the use of technology-based interventions, they are increasingly being employed by social workers as a direct practice methodology to address the mental health needs of vulnerable clients. Researchers have highlighted the importance of using innovative technologies within social work practice, yet little has been done to summarize the evidence and collectively assess findings. In this systematic review, we describe accounts of technology-based mental health interventions delivered by social workers over the past 10 years. Results highlight the impacts of these tools and summarize advantages and disadvantages to utilizing technologies as a method for delivering or facilitating interventions.
Fernandez, Fabrice; Lézé, Samuel
Morality is one of the most important elements of social actions, specifically in medical settings. Unfortunately, in social science, morality is often undertheorized and can lead to moralism. The aim of the paper is to test the "moral economy theory" which highlights the link between some local moral evaluations and a political context. We focus on "treatment" as therapeutic tool and as moral regulation of patients in a French remand centre. On the basis of an ethnography of forms of care for prisoners (2009-2010), and semi-directed interviews with working mental health professionals (n = 10), we analyse their engagement and their moral expectations of the prisoners under their care. Firstly, we show how prisoners are selected and then converted into patients deserving of attention (expectations of honesty, sincerity and compliance). Secondly, we show how these patients are divided into three main intervention categories, in which the treatment is both therapeutic and moral (expectations of responsibility, recognition of guilt, and self-esteem). Finally, we discuss these moral criteria within a new moral economy of vulnerability. Copyright © 2011 Elsevier Ltd. All rights reserved.
There is a high prevalence of mental disorders in the community population of older adults, especially in medical treatment facilities. Therefore, clinicians who treat geriatric patients cannot neglect the psychiatric vulnerability of the elderly population. The fragility of psychological functioning of the elderly is caused not only by psychological contributors, such as various kinds of experiences of loss, but also by biological factors such as decreases in neurotransmitters and in the number of neurons. Another point geriatric clinicians should pay attention to is the powerful mind-body connection in the elderly. Recent psychoneuroimmunological research demonstrates that depression or other types of emotional stress damages the immune system, which can induce some physical diseases. This is especially true for the elderly, who have weakened cell-mediated immune function and are more susceptible to influence by the damaged immune function caused by such psychiatric dysfunction. Also, depression in the elderly can often lead to malnutrition or dehydration, which can induce various kinds of physical illness. On the other hand, physical illness in the elderly can induce depression, because of the psychological vulnerability of the elderly. Due to the strong mind-body connection in the elderly, the availability of psychiatric care is essential. When providing psychiatric care for the elderly, the clinician should attend to all symptoms, not minimizing the importance of biological treatment, while also trying to support the elderly patients psychologically through acceptance of their need for interdependency and respect for their narcissism.
Harris, Marc Ashley
Mental ill health accounts for 13 per cent of total global disease burden with predictions that depression alone will be the leading cause of disease burden globally by 2030. Poor mental health is consistently associated with deprivation, low income, unemployment, poor education, poorer physical health and increased health-risk behaviour. A plethora of research has examined the relationship between physical activity and mental wellbeing; however, the influence of community-wide gamification-based physical activity interventions on mental wellbeing, to the authors' knowledge, is yet to be explored. In view of this paucity of attention, the current study examined the relationship between physical activity and mental wellbeing pre/post a community-wide, gamification-based intervention. The findings revealed that increases in mental wellbeing were significantly greater for the least active prior to the intervention, and a strong, positive correlation between increase in physical activity and increase in mental wellbeing was observed.
Marc Ashley Harris
Full Text Available Mental ill health accounts for 13 per cent of total global disease burden with predictions that depression alone will be the leading cause of disease burden globally by 2030. Poor mental health is consistently associated with deprivation, low income, unemployment, poor education, poorer physical health and increased health-risk behaviour. A plethora of research has examined the relationship between physical activity and mental wellbeing; however, the influence of community-wide gamification-based physical activity interventions on mental wellbeing, to the authors’ knowledge, is yet to be explored. In view of this paucity of attention, the current study examined the relationship between physical activity and mental wellbeing pre/post a community-wide, gamification-based intervention. The findings revealed that increases in mental wellbeing were significantly greater for the least active prior to the intervention, and a strong, positive correlation between increase in physical activity and increase in mental wellbeing was observed.
Ahola, Kirsi; Virtanen, Marianna; Honkonen, Teija; Isometsä, Erkki; Aromaa, Arpo; Lönnqvist, Jouko
Work disability due to common mental disorders has increased in Western countries during the past decade. The contribution of depressive, anxiety, and alcohol use disorders to all disability pensions at the population level is not known. Epidemiological health data from the Finnish Health 2000 Study, gathered in 2000-2001, was linked to the national register on disability pensions granted due to the ICD-10 diagnoses up to December 2007. Mental health at baseline was assessed using the Composite International Diagnostic Interview (CIDI). Sociodemographic, clinical, and work-related factors, health behaviors, and treatment setting were used as covariates in the logistic regression analyses among the 3164 participants aged 30-58 years. Anxiety, depressive, and comorbid common mental disorders predicted disability pension when adjusted for sex and age. In the fully adjusted multivariate model, comorbid common mental disorders, as well as physical illnesses, age over 45 years, short education, high job strain, and previous long-term sickness absence predicted disability pension. The study population included persons aged 30 or over. Sub groups according to mental disorders were quite small which may have diminished statistical power in some sub groups. Baseline predictors were measured only once and the length of exposure could not be determined. The systems regarding financial compensation to employees differ between countries. Comorbid mental disorders pose a high risk for disability pension. Other independent predictors of work disability include socio-demographic, clinical, work-related, and treatment factors, but not health behavior. More attention should be paid to work-related factors in order to prevent chronic work disability. Copyright © 2011 Elsevier B.V. All rights reserved.