Assessment Instrument-Mental Health Research Articles

Risk factors of developing psychological problems among frontline healthcare professionals working in the COVID-19 pandemic era: a meta-analysis

BackgroundThis study sought to evaluate the risk factors behind developing psychological problems as per specific mental health assessment instruments. This study focuses specifically on frontline healthcare professionals of the COVID-19 pandemic era, and evaluated the psychological assessment of frontline healthcare professionals.MethodsStudies reporting on the psychological assessment of frontline healthcare professionals were retrieved from the PubMed, Embase, Web of Science, Ovid, EBSCO, and Cochrane Library databases. The recommended method was used to assess the risk of bias of the included studies. The random-effects method was applied when significant heterogeneity was observed.ResultsThe combined results from the 20 included articles indicated that frontline healthcare professionals had a higher risk of developing anxiety in comparison with non-frontline healthcare workers, with similar levels of depression scoring were observed. Healthcare providers aged > 40 years had a lower probability of developing anxiety and seemed to experience minimal depression. Conversely, frontline workers had a higher incidence of anxiety than that of depression. Being single (not in a relationship) could influence the PHQ-9 scores instead of those concerning the GAD-7. The gender gap was not proven to be significantly wide between healthcare professionals with or without anxiety; however, being male was proven to be positively correlated with depression.ConclusionIn general, the risk factors for susceptibility to psychological problems among frontline healthcare professionals during the COVID-19 pandemic concerned those of a lower age, being single, being male, and being engage in frontline healthcare work.

Anxiety and depression in pregnant women who have experienced a previous perinatal loss: a case-cohort study from Scandinavia

BackgroundPerinatal loss can have long-lasting adverse effects on a woman’s psychosocial health, including during subsequent pregnancies. However, maternal mental health status after perinatal loss during subsequent pregnancy is understudied with very little data available for Scandinavian populations.AimsThe primary aim of the study was to explore the association between previous perinatal loss and anxiety/depression symptoms of expectant mothers during the subsequent pregnancy. The secondary aim of this study was to explore possible determinants of maternal mental health during the subsequent pregnancy, independent of previous perinatal loss.MethodThis case-cohort study is based on primary data from Scandinavian Successive Small-for-Gestational Age Births Study (SGA Study) in Norway and Sweden. The total case-cohort sample in the current study includes 1458 women. Cases include 401 women who had reported a previous perinatal loss (spontaneous abortion, stillbirth, or neonatal death) and who responded to two mental health assessment instruments, the State-Trait Anxiety Inventory (STAI), and the Centre for Epidemiological Studies Depression (CES-D) scale. Multiple linear regression models were used to assess the association between previous perinatal loss and maternal mental health in subsequent pregnancy.ResultsScandinavian pregnant women with previous perinatal loss reported higher symptoms for both anxiety and depression during their subsequent pregnancy compared to mothers in the same cohort reported no previous perinatal loss. Multiple linear regression analyses showed a positive association between previous perinatal loss and per unit increase in both total anxiety score (β: 1.22, 95% CI: 0.49–1.95) and total depression score (β: 0.90, 95% CI: 0.06–1.74). We identified several factors associated with maternal mental health during pregnancy independent of perinatal loss, including unintended pregnancy despite 97% of our population being married/cohabitating.ConclusionWomen who have experienced previous perinatal loss face a significantly higher risk of anxiety and depression symptoms in their subsequent pregnancy.

Sex Differences in Determinants of Suicide Risk Preceding Psychiatric Admission: An Electronic Medical Record Study.

BackgroundIndividuals requiring inpatient psychiatric care represent a group at higher risk of progressing toward suicide attempt. Using electronic medical record (EMR) data collected from psychiatric inpatient admissions, the objective of this study was to identify sex differences in risk factors for suicide plans and/or attempts within the 30 days preceding hospital admission.MethodsResident Assessment Instrument for Mental Health (RAI-MH) intake data were obtained for patients admitted to a Canadian tertiary-care hospital deemed a “threat or danger to self” during a 10-year period (2008–2018). Data was extracted for individuals categorized into three groups: non-suicidal (N = 568), presence of suicide plan (N = 178), and presence of suspected suicide attempt (N = 124) in the 30 days prior to hospital admission. Multivariate logistic regression models were used to examine determinants of suicide risk.ResultsAcross all models, diagnosis of depression was the strongest predictor of suicide plan and/or attempt (OR = 5.54, 95% CI = 3.71–8.27, p < 0.001). Comparing clinical symptoms between suicidal and non-suicidal groups at the time of admission, the largest effect sizes were found for hopelessness (p < 0.001, η2 = 0.11), and guilt or shame (p < 0.001, η2 = 0.09). Female sex was identified as a significant factor for elevated suicidal risk (OR = 1.56, 95% CI = 1.01–2.21, p = 0.01), thus we stratified the regression model by sex to identify specific risk factors for suicide plan and/or attempt for males and females. Among males, having no confidant (OR = 2.13, 95% CI = 1.19–3.80, p = 0.01), presence of recent stressors (OR = 1.95, 95% CI = 1.16–3.29, p = 0.01), and participation in social activities (OR = 1.67, 95% CI = 1.02–2.71, p = 0.04) were important predictors, while among females, younger age (OR = 0.96, 95% CI = 0.94–0.97, p < 0.001) increased odds of suicide plan and/or attempt.ConclusionEMR-derived findings highlight different psychosocial and clinical determinants for males and females associated with suicide plan or attempt prior to psychiatric admission. Identifying precipitating factors that elevate imminent suicide risk may inform suicide prevention efforts for psychiatric inpatients.

Translating, contextually adapting, and pilot testing of psychosocial and mental health assessment instruments for Congolese refugees in Rwanda and Uganda

BackgroundForcibly displaced people are at elevated risk of experiencing circumstances that can adversely impact on mental health. Culturally and contextually relevant tools to assess their mental health and psychosocial needs are essential to inform the development of appropriate interventions and investigate the effectiveness of such interventions.MethodsWe conducted two related studies: (1) to translate and contextually adapt the Patient Health Questionnaire (PHQ-9), a measure of depressive symptomatology, along with assessment instruments measuring levels of daily stress (Checklist for Daily & Environmental Stressors; CDES), social capital (Shortened and Adapted Social Capital Assessment Tool; SASCAT) and perceived social support (Multidimensional Scale of Perceived Social Support; MSPSS) for use with Congolese refugees; (2) to conduct pilot testing of the assessment instruments (including cognitive interviewing about participants’ views of completing them) and a validation of the adapted PHQ-9 using a ‘known group’ approach by recruiting Congolese refugees from refugee settings in Rwanda (n = 100) and Uganda (n = 100).ResultsStudy 1 resulted in the translation and adaptation of the assessment instruments. No substantive adaptations were made to the SASCAT or MSPSS, while notable linguistic and contextual adaptations were made in both sites to the CDES and the PHQ-9. The cognitive interviewing conducted in Study 2 indicated that the adapted assessment instruments were generally well received by members of the refugee communities. Participants recruited on the basis that local informants adjudged them to have high levels of depressive symptoms had significantly higher PHQ-9 scores (M = 11.02; SD = 5.84) compared to those in the group adjudged to have low levels of depressive symptoms (M = 5.66; SD = 5.04). In both sites, the adapted versions of the PHQ-9 demonstrated concurrent validity via significant positive correlations with levels of daily stressors. Each of the four adapted assessment instruments demonstrated at least adequate levels of internal consistency in both sites.ConclusionsThe adapted versions of the PHQ-9, CDES, SASCAT and MSPSS are appropriate for use amongst Congolese refugees in Rwanda and Uganda. We recommend further application of the approaches used in the current studies for contextually adapting other assessment instruments in humanitarian settings.

The interRAI Child and Youth Suite of Mental Health Assessment Instruments: An Integrated Approach to Mental Health Service Delivery.

Various biological, social, psychological, and environmental factors impact children and youth living with mental health problems across their lifespan. To meet the wide-ranging challenges of mental illness, service system integration is needed to improve efficiencies and reduce fragmentation. Unfortunately, the mental health system has been plagued by the lack of coordination across services. There is a general consensus that mental health service delivery must ensure a child or youth’s needs are addressed in a collaborative, coordinated, and seamless manner. A key element to successful integration is the development of a comprehensive standardized screening and assessment system. Numerous assessments have been developed to assess child mental health and functioning, but they typically have a very narrow focus with limited use and utility. Not only does this reduce the ability to take a life course perspective to mental health, but this uncoordinated approach also results in redundancies in information collected, additional resources, and increased assessor burden for children, youth, and their families. The interRAI child and youth mental health assessment suite was developed in response to the need for an integrated mental health system for young persons. This suite includes screening and assessment instruments for in-patient and community settings, emergency departments, educational settings, and youth justice custodial facilities. The instruments form a mental health information system intentionally designed to work in an integrated fashion beginning in infancy, and incorporate key applications such as care planning, outcome measurement, resource allocation, and quality improvement. The design of these assessment tools and their psychometric properties are reviewed. Data is then presented using examples related to interpersonal trauma, illustrating the use and utility of the integrated suite, along with the various applications of these assessment systems.

Mental Health Risk and Associated Factors in the Aftermath of the 2015 Earthquake in Nepal: A Systematic Literature Review

Background: In 2015, Nepal was struck by two massive earthquakes with magnitudes over the 7.0 Richter Scale, imposing short- and long-term mental health risks. This review aims to: (a) evaluate mental health risk among the earthquake survivors; and, (b) identify factors that influence it. Methods: The following databases: Scopus and PubMed were searched to identify studies published from 2015 to July 2020 on the mental health risk among the Nepali populations. Inclusion criteria were: (a) primary research related to mental health after the 2015 earthquakes in Nepal, (b) English language articles, (c) access to full-text literature, and (d) studies conducted on the general population of Nepal. Exclusion criteria were: (a) newspaper articles or other forms of popular media, (b) grey records and reviews or, (c) studies carried out among patients in a clinical setting. Key features and risk of bias factors were extracted from each study to obtain necessary characteristics for further analysis of results. Results: The initial search produced 134 articles, however, a total, 14 studies fulfilled the inclusion criteria and were explored for this review. Ten of these articles were obtained from established databases, and four additional studies were obtained from other sources. Findings indicate that post-traumatic stress was mostly present among earthquake survivors with rates varying from 4.9% to 51%. Mental health risks for children and adolescent were mostly high with rates greater than 23% across studies. However, the adult prevalence rate for mental health risk was lower than that of children and adolescents, with most rates across studies lower than 20%. Socio-demographic factors (such as gender and age) and methodological heterogeneities such as variations in study design and mental health tools used to assess rates were associated factors that potentially influenced the findings. Conclusion: Mental health risks are present among earthquake survivors in Nepal. Various factors have been identified as potential mental health risk rate influencers including sex, with females presenting as the higher at-risk group for mental health relative to males. Methodological issues such as a wide range of mental health assessment instruments employed across studies can potentially impact rates.

ICCareD: The Development of an Algorithm to Identify Factors Associated With Distress Among Caregivers of Children and Youth Referred for Mental Health Services.

Caregiver well-being plays an important role in children's development and a number of factors have been found to impact distress levels among caregivers of children and youth referred for mental health services. Further, caregiver distress impacts youth psychopathology, its acuity as well as related mental health interventions. The purpose of this study was to develop and validate an algorithm for identifying caregivers who are at greatest risk of experiencing caregiver distress. This algorithm was derived from, and will be embedded in, existing comprehensive interRAI child and youth instruments. Ontario data based on the interRAI Child and Youth Mental Health assessment instruments (ChYMH and ChYMH-DD) were analyzed to identify predictors of distress among caregivers of children and youth ages 4–18 years. Starting with proactive aggression, the algorithm uses 40 assessment items to assign one of 30 nodes that are grouped into five levels of risk. The interRAI ChYMH Caregiver Distress (iCCareD) algorithm was validated using longitudinal data from mental health agencies across Ontario and was found to be a good predictor among this sample with a c-statistic of 0.71 for predicting new or ongoing caregiver distress and 65% for both sensitivity and specificity using algorithm values of 3 or greater. This algorithm provides an evidence-based decision-support tool embedded within a comprehensive assessment tool that may be used by clinicians to inform their selection of supports and services for families.

An Examination of the Performance of the interRAI Risk of Harm to Others Clinical Assessment Protocol (RHO CAP) in Inpatient Mental Health Settings.

We study violence risk prediction at St. Joseph's Healthcare Hamilton. Data from January 2016 to December 2017 have been anonymized and collected, for a total of 870 episodes of inpatient aggressions perpetrated by 337 patients. We examine the predictive performance of a clinical indicator embedded in a mandatory assessment tool for psychiatric facilities in Ontario, the Resident Assessment Instrument for Mental Health (RAI-MH): the Risk of Harm to Others Clinical Assessment Protocol (RHO CAP). The RHO CAP's performance is studied among two groups of patients. Moreover, an analysis of the most important risk factors associated with harmful incidents is presented. The RHO CAP has demonstrated a better performance in discriminating which patients were more at risk to commit some type of aggression than at identifying the risk of harm among those who will commit aggression.

NHU CẦU TÀI LIỆU “CÔNG TÁC XÃ HỘI TRONG BỆNH VIỆN” CỦA NGƯỜI LÀM CÔNG TÁC XÃ HỘI TRONG BỆNH VIỆN TẠI VIỆT NAM

The material “Hospital Social Work” is essential in the process of professionalization of social work in Vietnam today. This study aimed to describe the demands for the material “Hospital Social Work” among social workers and health workers in hospital in Vietnam. On that basis, we recommended the content of this material. The study was conducted on 175 participants including 103 social workers and 72 health workers from seven hospitals at central levels. Our study showed that health workers had a higher demand for the content of “Basic information about hospital social work” (p = 0.018), while social workers had a higher demand for the content of “Intervention methods of hospital social work” (p = 0.004); “Social work skills in hospitals” (p = 0.028); “Mental health assessment instruments” (p = 0.007) and “Social work process in hospital” (p = 0.005). The study also made recommendations to the Ministry of Health and schools of social work in Vietnam to compile this material effectively and in accordance with reality.

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care.

The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.

Factors Associated With Opiate Use Among Psychiatric Inpatients: A Population-Based Study of Hospital Admissions in Ontario, Canada.

Background:Use of opiates, including synthetic opioids, is associated with a number of negative consequences, including increased risk of opioid use disorders and other mental health conditions. However, studies are limited in examining patterns of opiate use among persons in inpatient psychiatry, particularly those that consider the relationship between pain and opiate use.Objective:This study examined the prevalence in the prior 12 months to admission and patterns of opiate use and pain in a population-based study of persons admitted to inpatient psychiatry in Ontario, Canada.Methods:We conducted retrospective cross-sectional study of 165 434 persons admitted to inpatient psychiatry between January 1, 2006 and December 31, 2017. Using data from the Resident Assessment Instrument for Mental Health, we examined prevalence and factors associated with opiate use in the prior 12 months by a number of patient characteristics, including demographics, mental and physical health status, concurrent substance use, pain severity and frequency, and health region of residence.Results:The prevalence of opiate use within 12 months of admission was 7.5%, between 17% and 22% among those experiencing daily pain, and 27% among persons with a primary substance use disorder. Multivariable analyses revealed strong associations among demographic and clinical variables with opiate use (c = 0.91), including being of younger age, use of other substances, greater frequency and severity of pain, and health region of residence.Conclusion:The strong relationship between pain and opiate use in this population, and the regional variation in this pattern, supports the need for integrated care for mental illness and substance use, and therapeutic approaches to pain management that reduce risks of problems associated with substance use for persons with mental health conditions.

Closer to the Truth: Admission to Multiple Psychiatric Facilities and an Inaccurate History of Hospitalization Are Strongly Associated with Inpatient Suicide.

To investigate clinical associations within Canadian psychiatric inpatient suicides. We conducted a case-control study comparing 98 patients who died by suicide while in hospital and 196 similarly admitted living inpatient controls. All were admitted to an Ontario psychiatric bed between 2008 and 2015 inclusive and had data collected at admission using the Resident Assessment Instrument for Mental Health (RAI-MH). The data were analyzed with bivariate tests and logistic regression modeling. The strongest associations with inpatient suicide were prior admission to any Ontario psychiatric bed within the previous 30 days (odds ratio [OR] = 6.13), self-harm assessed at prior admission to a psychiatric hospital other than the hospital of suicide (OR = 6.07), and prior admission to a psychiatric hospital other than the hospital of suicide in the previous year (OR = 5.38). A multivariate model using risk factors assessed at admission had an area under the curve (AUC) of 0.77. The model improved to (AUC) 0.81 using a retrospective search of all Ontario admissions to more accurately detect prior admissions. The risk model was optimized to (AUC) 0.83 when the model also included a "discrepancy" variable to denote records in which admission assessment data and retrospective search data did not agree regarding past month admissions. In addition to the well-known risks of suicide associated with previous suicide attempts and depressive conditions, our data suggest a particular risk of inpatient suicide associated with inpatient care in more than one hospital, particularly when the treating clinicians were unaware of recent previous admissions.

Predictors of Electroconvulsive Therapy Use in a Large Inpatient Psychiatry Population.

There is limited research on reliable and clinically useful predictors of electroconvulsive therapy (ECT) use. We aimed to examine factors that predict ECT use in an inpatient psychiatric population. Retrospective analysis of provincial database for inpatient psychiatry. This study is a retrospective analysis of a provincial database for inpatient psychiatry. The study includes all psychiatric inpatients 18 years or older in Ontario, Canada, assessed with the Resident Assessment Instrument for Mental Health (RAI-MH) within the first 3 days of admission between 2009 and 2014 (n = 153,023). The RAI-MH is a validated assessment tool which includes a breadth of information on symptoms, self-harm, functioning, social support, comorbid medical diagnoses, and risk appraisal. Multivariable analyses were performed using SAS. One hundred forty-five thousand seven hundred (95.2%) of patients admitted had no history of ECT treatment and were not scheduled to receive ECT. A total of 7323 (or 4.8% of the patient population) had either a history of ECT use or were scheduled to receive ECT. Overall rate of ECT use was highest in patients with a provisional diagnosis of mood disorder (7.2%) compared with schizophrenia/other psychotic disorder (3.1%) or substance-related disorder (1.7%). Women were more likely to receive ECT compared with men (overall rates of ECT use 6.2% and 3.4%, respectively). Overall rate of ECT use increased significantly with increasing age. Number of prior hospitalizations was also a strong predictor of ECT use. Conversely, patients with elevated Risk of Harm to Others, schizophrenia, or a substance use disorder were all significantly less likely to receive ECT. All variables examined were statistically significant (P < 0.0001). Higher Severity of Self Harm Scores predicted past use, but not scheduled use of ECT. This is the largest study to date on predictors of ECT use. Utilization of RAI-MH is a novel and clinically useful method for evaluating predictors of ECT use. Predictors of ECT use within an inpatient population include: presence of a mood disorder, female sex, older age, low risk of harm to others, number of lifetime hospitalizations, lack of substance use disorder, and inability to care for self.

Expert Consensus to Examine the Cross-Cultural Utility of Substance Use and Mental Health Assessment Instruments for Use with Indigenous Clients

Evaluation of minority-culture specific treatment centres for substance use and mental health is challenging. The challenge is compounded by a paucity of validated instruments for assessing substance use and mental ill health. In the field of Australian Indigenous alcohol and other drug service provision there are few guidelines to determine which instruments should be targets for validation for use with Indigenous clients. As such, reliable, validated, evaluable data on the client population is limited, posing multifaceted concerns for clinicians and service providers as well as evaluators. The aim of this study was to pilot the use of a participatory expert consensus approach to evaluate, rate and select suitable majority-culture substance use and mental health assessment instruments for use with their clients. Eight practitioners of an Indigenous-specific substance misuse residential treatment centre participated. The findings reinforce the value of consensus approaches for stakeholder engagement and to provide a sense of ownership of the results. In this setting, consensus on the implementation of an agreed set of Indigenous-specific and non-Indigenous specific instruments improved the ownership of the instruments by clinicians allowing for the use of valid and/or reliable instruments that also had good face validity. This makes it more probable that reliable client wellbeing data will be collected. This is crucial to program evaluation at a later point in time. This study was a novel approach to generating evidence to inform practice in the absence of normative practice guidelines.

The use of a brief mental health screener to enhance the ability of police officers to identify persons with serious mental disorders

Police agencies in Canada and elsewhere have received much criticism over how they respond to persons with serious mental disorders. The adequacy of training provided to police officers on mental health issues and in particular on recognizing indicators of serious mental disorders has been a major concern. This paper describes the process that led to the development of a new brief mental health screener (interRAI Brief Mental Health Screener, BMHS) designed to assist police officers to better identify persons with serious mental disorders. The interRAI BMHS was developed in collaboration with interRAI, an international, not-for-profit consortium of researchers. The government of Ontario had previously partnered with interRAI to develop and implement the Resident Assessment Instrument for Mental Health (RAI-MH), the assessment system mandated for use on all persons admitted into inpatient psychiatric care in the province. Core items on the interRAI BMHS were obtained through analysis (N=41,019) of RAI-MH data together with input from representatives from health care, police services, and patient groups. Two police services in southwestern Ontario completed forms (N=235) on persons thought to have a mental disorder. Patient records were later accessed to determine patient disposition. The use of summary and inferential statistics revealed that the variables significantly associated with being taken to hospital by police included performing a self-injurious act in the past 30days, and others being concerned over the person's risk for self-injury. Variables significantly associated with being admitted included abnormal thought process, delusions, and hallucinations. The results of the study indicate that the 14-variable algorithm used to construct the interRAI BMHS is a good predictor of who was most likely to be taken to hospital by police officers and who was most likely to be admitted. The instrument is an effective means of capturing and standardizing police officer observations enabling them to provide more and better quality information to emergency department (ED) staff. Teaching police officers to use the form constitutes enhanced training on major indicators of serious mental disorders. Further, given that items on the interRAI BMHS are written in the language of the health system, language acts as common currency between police officers and ED staff laying the foundation for a more collaborative approach between the systems.

Using the RAI-MH to support shared decision-making in mental healthcare.

Persons with mental illness often struggle to meaningfully participate in decisions about their services. This study engaged persons with mental illness to understand how health information could empower them. Participants reported wanting information on diagnoses, medications, symptoms, and strengths as well as clinician notes and rationale. The Resident Assessment Instrument for Mental Health contains this information and is mandated in in-patient psychiatry. Its findings could be summarized and shared with individuals to promote and facilitate shared decision-making.

Use of unconventional therapies by primary care patients – Religious resources vs. complementary or alternative medicine services

The study examines the difference in characteristics between primary care patients who turn to "religious resources for medical purposes" (RRMP) and those who turn to "complementary or alternative medicine" (CAM) services to cope with a physical or mental health problem. Data were collected from eight primary care clinics in Israel and included 905 Jewish patients aged 25-75. A self-report questionnaire with a battery of validated mental health assessment instruments and two questionnaires regarding use of unconventional therapies (RRMP and CAM services) were administered to the participants. The association of various variables with type of 'service use' was examined through logistic regression analysis. Primary care patients suffering from emotional problems have a propensity to utilize unconventional therapies in addition to conventional medical treatment. However, differences exist between patients who turn to RRMP and to CAM. The risk factors for turning to RRMP are North African, Middle Eastern or Israeli origin, low SES, religious observance, and high use of primary care clinics. For using CAM services the risk factor is high SES. In the present study, a quarter of primary care patients also use additional resources for their medical problems. While all segments of the population use unconventional resources, our study reveals that two types of unconventional therapies - RRMP and CAM - tend to be used by two different population sectors. It is noteworthy that those suffering from mental health problems are more likely to utilize unconventional resources.

Strategies for assessing mental health in Haiti: Local instrument development and transcultural translation

The lack of culturally appropriate mental health assessment instruments is a major barrier to screening and evaluating efficacy of interventions. Simple translation of questionnaires produces misleading and inaccurate conclusions. Multiple alternate approaches have been proposed, and this study compared two approaches tested in rural Haiti. First, an established transcultural translation process was used to develop Haitian Kreyòl versions of the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). This entailed focus group discussions evaluating comprehensibility, acceptability, relevance, and completeness. Second, qualitative data collection was employed to develop new instruments: the Kreyòl Distress Idioms (KDI) and Kreyòl Function Assessment (KFA) scales. For the BDI and BAI, some items were found to be nonequivalent due to lack of specificity, interpersonal interpretation, or conceptual nonequivalence. For all screening tools, items were adjusted if they were difficult to endorse or severely stigmatizing, represented somatic experiences of physical illness, or were difficult to understand. After the qualitative development phases, the BDI and BAI were piloted with 31 and 27 adults, respectively, and achieved good reliability. Without these efforts to develop appropriate tools, attempts at screening would have captured a combination of atypical suffering, everyday phenomena, and potential psychotic symptoms. Ultimately, a combination of transculturally adapted and locally developed instruments appropriately identified those in need of care through accounting for locally salient symptoms of distress and their negative sequelae.

Childhood abuse and cannabis use among adolescents with mental health needs in Ontario, Canada

Objective: The purpose of this study was to examine the association between childhood abuse (emotional, physical and sexual abuse) and cannabis use among adolescents with mental health needs. Methods: Data on 3681 adolescent in-patients, 12–18 years old, were obtained from the Resident Assessment Instrument for Mental Health (RAI-MH). Using logistic regression, we estimated the odds of using cannabis by adolescents who experienced childhood abuse after controlling for age, gender, Aboriginal origin, problems with addiction, history of criminal justice involvement and symptoms of depression and mania. Results: There were 1844 adolescents, representing 50.1%, who reported using cannabis within the last 12 months. Controlling for demographic and patient characteristics, we found that cannabis use in the past year was strongly associated with childhood sexual and physical abuse. Compared to non-abused females, females who experienced sexual and physical abuse were more likely to have used cannabis. For males, the experience of physical abuse was marginally associated with cannabis use. Conclusion: The current data demonstrate the strong association between childhood sexual and physical abuse and cannabis use with a particularly strong association for females. Efforts aimed at treating cannabis use in adolescents who present with mental health needs should also consider their abuse histories.

Prescription Medication Misuse Among Adolescents With Severe Mental Health Problems in Ontario, Canada

The purpose of this study was to examine the prevalence of prescription medication misuse among adolescents with severe mental health problems in Ontario, Canada, and to explore some of the factors that influence the misuse of prescription medication. Data were obtained from the Resident Assessment Instrument for Mental Health. A total of 2,677 adolescents between the ages of 12 and 18 years who were admitted into adult mental health beds were analyzed. Logistic regression was used in estimating the likelihood of misusing prescription medication. Overall, 17% of adolescent inpatients misused prescription medication. In the multivariate model, the following were found to be associated with misuse: being female, having multiple psychiatric admissions, education, threat or danger to self, problem with addiction, history of emotional abuse, use of alcohol, past year use of opiates and cannabis, as well as symptoms of depression. Misuse of prescription medication was less likely to occur among adolescents with a diagnosis of schizophrenia and adolescents who were admitted as a result of posing a threat or danger to others. Implications of the findings are discussed with suggestions for future research.