Burden Of Mental Health Conditions Research Articles

Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment

The proportion of mental disorders and burden causally attributable to childhood maltreatment is unknown. To determine the contribution of child maltreatment to mental health conditions in Australia, accounting for genetic and environmental confounding. This meta-analysis involved an epidemiological assessment accounting for genetic and environmental confounding between maltreatment and mental health and 3 cross-sectional national surveys: the Australian Child Maltreatment Study (ACMS) 2023, National Study of Mental Health and Well-being 2020-2022, and Australian Burden of Disease Study 2023. Causal estimates were derived on the association between childhood maltreatment and mental health conditions from a meta-analysis of quasi-experimental studies. This was combined with the prevalence of maltreatment from the ACMS to calculate the population attributable fraction (PAF). The PAF was applied to the number and burden of mental health conditions in Australia, sourced from 2 population-based, nationally representative surveys of Australians aged 16 to 85 years, to generate the number and associated burden of mental disorders attributable to child maltreatment. Physical abuse, sexual abuse, emotional abuse, or neglect prior to age 18 years. Proportion and number of cases, years of life lost, years lived with disability, and disability-adjusted life-years of mental health conditions (anxiety, depression, harmful alcohol and drug use, self-harm, and suicide attempt) attributable to childhood maltreatment. Meta-analytic estimates were generated from 34 studies and 54 646 participants and applied to prevalence estimates of childhood maltreatment generated from 8503 Australians. Childhood maltreatment accounted for a substantial proportion of mental health conditions, ranging from 21% (95% CI, 13%-28%) for depression to 41% (95% CI, 27%-54%) of suicide attempts. More than 1.8 million cases of depressive, anxiety, and substance use disorders could be prevented if childhood maltreatment was eradicated. Maltreatment accounted for 66 143 years of life lost (95% CI, 43 313-87 314), primarily through suicide, and 184 636 disability-adjusted life-years (95% CI, 109 321-252 887). This study provides the first estimates of the causal contribution of child maltreatment to mental health in Australia. Results highlight the urgency of preventing child maltreatment to reduce the population prevalence and burden of mental disorders.

THE BURGEONING BURDEN OF PERINATAL MENTAL HEALTH IN LOWER MIDDLE-INCOME COUNTRIES

THE BURGEONING BURDEN OF PERINATAL MENTAL HEALTH IN LOWER MIDDLE-INCOME COUNTRIES

The EMPOWER Occupational e-Mental Health Intervention Implementation Checklist to Foster e-Mental Health Interventions in the Workplace: Development Study.

Occupational e-mental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions. The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions. Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing "elements that positively affect implementation" and 17 barriers presented as statements addressing "concerns toward implementation." If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from "very difficult to implement" to "very easy to implement." In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholders' responses to the open survey's questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews. In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees. Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist.

Democratizing access to psychological therapies: Innovations and the role of psychologists.

Psychological therapies are highly effective interventions for a range of mental health conditions and often preferred by many patients over medication. Unfortunately, most people who could benefit from these therapies do not receive them. This is true even in the United States, which enjoys relatively high numbers of mental health professionals. The lack of access is further compounded by structural inequities, such as income, geography, and race. The low and inequitable access to one of the most effective interventions for mental health conditions is, arguably, one of the most significant barriers to addressing the growing burden of mental health conditions globally. There are several reasons which might contribute to this inequity, notably the historical reliance on complex treatment protocols designed in settings which serve a nonrepresentative group of persons with mental health problems and, consequently, an emphasis on specialist providers and in-person protocols. These factors lead to long and expensive training, variable quality of delivery, and enhanced costs and challenges to patient engagement. In contrast to medication, the lack of a commercial incentive to promote psychological therapies means that there are no market forces which fuel their scaling up. Given there will never be enough psychologists to serve the large unmet and growing mental health needs in the population, we consider stepped and collaborative models that leverage the range of expertise offered by diverse providers, to offer a pathway to scale up a person-centered approach for psychological treatments. In this article, we highlight three innovations that address some barriers and the potential roles of clinical psychologists to broaden the reach of psychological therapies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effect of COVID-19 Pandemic on the Mental Health of Healthcare Workers

Background: The novel coronavirus 2019, or COVID-19, has gripped all corners of the world and has created a crisis that significantly affected people's mental health around the globe, including healthcare workers (HCWs). Purpose: This study aimed to bring the results to the attention of healthcare systems' policymakers and managers so as to fully recognize the severity of the situation and set the groundwork for appropriate interventions to address the condition of HCWs. Methods: This systematic review searched PubMed, Google, Google Scholar, and Scopus for literature relevant to mental health conditions among healthcare workers during this pandemic. This review includes the searches from March to October 2020. Results: The main findings were symptoms of anxiety, depression, stress, psychological trauma, insomnia and sleep problems, burnout and fatigue, and distress. Most studies suggest that social and family support, hygiene measures, and physical activity are safeguards for mental health and are among the recommended protective interventions for promoting mental health. Limitations: The researcher has reservations about the findings' generalizability as the samples may not represent the population. Conclusion: This review highlights the existing burden of mental health conditions reported by HCWs during the COVID-19 pandemic. It revealed consistent reports of stress, anxiety, and depressive symptoms resulting from COVID-19. Implications: Longitudinal data will be helpful through surveys of representative samples of the general population. More relevant and recent data in Asian countries could inform understanding of challenges concerning COVID-19 and the impacts on healthcare workers' mental health and well-being, particularly those in the Philippines.

Children and Young Adults With Inflammatory Bowel Disease Have an Increased Incidence and Risk of Developing Mental Health Conditions: A UK Population-Based Cohort Study.

The burden of mental health conditions in children and young adults with inflammatory bowel disease remains unclear. We assessed this using a primary care database in the United Kingdom. A retrospective, observational study compared children and young adults with incident inflammatory bowel disease 5 to 25 years of age (2010-2020) against population control subjects. Outcomes comprised incident depression, anxiety disorder, eating disorders, body image disorders, attention-deficit disorders, behavioral disorders, adjustment disorders, acute stress disorder, schizophrenia, bipolar disorder, posttraumatic stress disorder, self-harm, parasuicide (including suicide), and sleep disturbance. The any mental health condition category comprised any of these conditions. A total of 3898 young patients with incident inflammatory bowel disease were matched to 15 571 control subjects. Inflammatory bowel disease patients were significantly more likely to develop new posttraumatic stress disorder (adjusted hazard ratio [aHR], 2.47; 95% confidence interval [CI], 1.23-4.94), eating disorders (aHR, 1.85; 95% CI, 1.05-3.26), self-harm (aHR, 1.49; 95% CI, 1.00-2.21), sleep disturbance (aHR, 1.40; 95% CI, 1.15-1.71), depression (aHR, 1.34; 95% CI, 1.16- 1.56), anxiety (aHR, 1.25; 95% CI, 1.06-1.48), and any mental health condition (aHR, 1.28; 95% CI, 1.12-1.46). Male inflammatory bowel disease patients aged 12 to 17 years, and patients with Crohn's disease appear to have the highest risk for developing new mental health conditions. Young inflammatory bowel disease patients have a significantly higher incidence and risk of new mental health conditions. Mental health remains a critically overlooked aspect of inflammatory bowel disease patient management. Further research into identifying optimal monitoring tools and support for these patients is required to improve patient care. The study protocol was specified and registered a priori.ClinicalTrials.gov study identifier: NCT05206734.

Cross-country analysis of national mental health investment case studies in sub-Saharan Africa and Central, South and South-East Asia.

Despite the increasing interest in and political commitment to mental health service development in many regions of the world, there remains a very low level of financial commitment and corresponding investment. Assessment of the projected costs and benefits of scaling up the delivery of effective mental health interventions can help to promote, inform and guide greater investment in public mental health. A series of national mental health investment case studies were carried out (in Bangladesh, Kenya, Nepal, Philippines, Uganda, Uzbekistan and Zimbabwe), using standardized guidance developed by WHO and UNDP and implemented by a multi-disciplinary team. Intervention costs and the monetized value of improved health and production were computed in national currency units and, for comparison, US dollars. Benefit-cost ratios were derived. Across seven countries, the economic burden of mental health conditions was estimated at between 0.5%-1.0% of Gross Domestic Product. Delivery of an evidence-based package of mental health interventions was estimated to cost US$ 0.40-2.40 per capita per year, depending on the country and its scale-up period. For most conditions and country contexts there was a return of >1 for each dollar or unit of local currency invested (range: 0.0-10.6 to 1) when productivity gains alone are included, and >2 (range: 0.4-30.3 to 1) when the intrinsic economic value of health is also considered. There was considerable variation in benefit-cost ratios between intervention areas, with population-based preventive measures and treatment of common mental, neurological and conditions showing the most attractive returns when all assessed benefits are taken into account. Performing a mental health investment case can provide national-level decision makers with new and contextualized information on the outlays and returns that can be expected from renewed local efforts to enhance access to quality mental health services. Economic evidence from seven low- and middle-income countries indicates that the economic burden of mental health conditions is high, the investment costs are low and the potential returns are substantial.

BH02 Online psychological support for patients with alopecia areata: an evaluation of available online psychological support material based on the National Centre for Complementary and Integrated Health guidelines

Abstract Alopecia areata is an autoimmune disorder causing nonscarring hair loss that is associated with significant psychological comorbidity (Macbeth AE, Holmes S, Harries M et al. The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care. Br J Dermatol 2022; 187:73–81). In addition to seeking psychological support from medical professionals, patients will often turn to online resources. In this study, we evaluated the range and quality of the online psychological support material available for patients with alopecia areata. A Google search was undertaken using private browsing on 5 June 2022, with several search terms: ‘alopecia areata online support group UK’, ‘alopecia support’ and ‘alopecia areata psychology’. The National Centre for Complementary and Integrated Health (NCCIH) guidelines for the evaluation of online resources were used. These guidelines assess information source and accuracy, funding, peer review status, linking policies and contemporaneity. Our search generated a total of 154 000 results. Advertisements, scientific articles, educational resources and duplicates were excluded, with nine resources included in the final analysis. Of the nine resources reviewed, three were specific for patients with alopecia areata, with the remaining resources focused on other types of hair loss. Six were authored or reviewed by dermatologists and seven had a documented peer review process of their content. One resource had no clear authorship and three had no clear peer review process. Nine of the resources were charity funded and one was a National Health Service resource. Four had been updated in the last 3 years and a further two within 5 years. All resources had clearly documented security and linking policies. All resources acknowledged the psychological impact of hair loss and eight had links to support groups or discussion forums. Only five had psychological support and advice on their website, with others only referring to the psychological burden and then signposting patients on to other sources for support. Only three of the resources referred to therapies such as cognitive behavioural therapy. The prevalence of mental health comorbidity in alopecia areata is high compared to the general population (Macbeth et al.). Our preliminary study has shown that the online psychological support available is lacking. With patients increasingly turning to the Internet for support and health information, there is an opportunity and need for development in this area.

Young people's data governance preferences for their mental health data: MindKind Study findings from India, South Africa, and the United Kingdom.

Mobile devices offer a scalable opportunity to collect longitudinal data that facilitate advances in mental health treatment to address the burden of mental health conditions in young people. Sharing these data with the research community is critical to gaining maximal value from rich data of this nature. However, the highly personal nature of the data necessitates understanding the conditions under which young people are willing to share them. To answer this question, we developed the MindKind Study, a multinational, mixed methods study that solicits young people's preferences for how their data are governed and quantifies potential participants' willingness to join under different conditions. We employed a community-based participatory approach, involving young people as stakeholders and co-researchers. At sites in India, South Africa, and the UK, we enrolled 3575 participants ages 16-24 in the mobile app-mediated quantitative study and 143 participants in the public deliberation-based qualitative study. We found that while youth participants have strong preferences for data governance, these preferences did not translate into (un)willingness to join the smartphone-based study. Participants grappled with the risks and benefits of participation as well as their desire that the "right people" access their data. Throughout the study, we recognized young people's commitment to finding solutions and co-producing research architectures to allow for more open sharing of mental health data to accelerate and derive maximal benefit from research.

Codesign of a digital health tool for suicide prevention: protocol for a scoping review

IntroductionThe role of digital health in providing psychological treatment and support for the prevention of suicide is well documented. Particular emphasis has been placed on digital health technologies during the...

OP28 Children and young adults with inflammatory bowel disease have an increased incidence and risk of developing mental health conditions: a UK population-based cohort study

Abstract Background While it is widely recognised that inflammatory bowel disease (IBD) is associated with depression and anxiety, the burden of mental health conditions in children and young adults with IBD remains unclear. This study assessed this burden using UK population-based data. Methods A retrospective observational study was performed using a large UK primary care dataset (Optimum Patient Care Research Database). Children and young adults aged 5–25 years diagnosed with IBD between 2010 and 2020 were propensity score matched with up to four population controls. The association between IBD and incident depression, anxiety disorder (AD), eating disorders, body image disorders, attention-deficit disorders, behavioural disorders, adjustment disorders, acute stress disorder, schizophrenia, bipolar disorder, post-traumatic stress disorder (PTSD), self-harm, parasuicide (including suicide), sleep disturbance and ‘any mental health condition’ (a composite consisting of all these mental health conditions) was investigated. Absolute risk was derived using Kaplan-Meier analysis. Relative risk of all outcomes up to 10-years in the IBD cohort versus controls was estimated using adjusted Cox proportional hazards models controlling for age, sex, socioeconomic status, ethnicity, and other conditions (asthma, atopic dermatitis, allergic rhinitis, thyroid disease, epilepsy, diabetes mellitus, cancer, juvenile idiopathic arthritis, systemic lupus erythematosus, ankylosing spondylitis, and psoriatic arthritis). Results 3,898 young patients with incident IBD were matched to 15,571 controls. IBD patients were significantly more likely to develop PTSD (adjusted Hazard Ratio [aHR] 2.47, 95% CI 1.23-4.94), eating disorders (aHR 1.85, 95% CI 1.05-3.26), self-harm (aHR 1.49, 95% CI 1.00-2.21), sleep disturbance (aHR 1.40, 95% CI 1.15-1.71), depression (aHR 1.34, 95% CI 1.16- 1.56), AD (aHR 1.25, 95% CI 1.06-1.48), and ‘any mental health condition’ (aHR 1.28, 95% CI 1.12-1.46) (Figure 1). In subgroup analysis, male sex, and IBD patients aged 12 to 17 appear to have the greatest additional risk for developing mental health conditions (Figure 2) and Crohn’s disease had a higher risk than ulcerative colitis (aHR 1.32, 95% CI 1.10-1.58 and aHR 1.19, 95% CI 0.95-1.49 respectively). Conclusion Young IBD patients have a significantly higher incidence and risk of new mental health conditions. Mental health remains a critically overlooked aspect of IBD patient management. Further research into identifying optimal monitoring tools and support for these patients is required to improve patient care.

The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care.

BackgroundAlopecia areata (AA) is a common cause of nonscarring hair loss that can have a profound psychological impact.ObjectivesTo assess the co‐occurrence of depression and anxiety in adults with AA compared with the general population, and to evaluate the mental health treatment burden and impact on time off work and unemployment.MethodsIn total, 5435 people with newly diagnosed AA in UK primary care were identified from the Oxford Royal College of General Practitioners Research and Surveillance Centre network database, and matched to 21 740 controls. In cases and controls, we compared the prevalence and incidence of depressive episodes, recurrent depressive disorder and anxiety disorder, rates of time off work and unemployment, and, in those with pre‐existing mental health conditions, rates of mental health‐related prescribing and referral rates. This observational was registered with ClinicalTrials.gov (NCT04239521).ResultsDepression and anxiety were more prevalent in people diagnosed with AA than in controls (P < 0·001). People with AA were also more likely to subsequently develop new‐onset depression and anxiety: adjusted hazard ratio (aHR) for recurrent depressive disorder 1·38 [95% confidence interval (CI) 1·13–1·69], depressive episodes aHR 1·30 (95% CI 1·04–1·62) and anxiety disorder aHR 1·33 (95% CI 1·09–1·63); to be issued time off work certificates (aHR 1·56, 95% CI 1·43–1·71); and to be recorded as unemployed (aHR 1·82, 95% CI 1·33–2·49). Higher rates of antidepressant prescribing were also seen in people with AA.ConclusionsPeople with AA have higher rates of depression and anxiety than those without AA. This impacts deleteriously on mental health treatment burden, time off work and unemployment. Evidence‐based mental health treatment programmes are needed for people with AA.

The Legality and Ethical Issues of Certifying Laypersons as Mental Health Counselors in India.

The burden of mental health conditions and consequent disability impacts are felt most in low- and middle-income settings. These settings are constrained by the limited availability of resources to provide even essential aspects of mental health care (MHC). Task shifting and sharing interventions have shown promise in delivering community-based MHC across such low-resource settings. Some counseling tasks such as friendship bench interventions have been successfully shifted to laypersons. However, ethical and legal concerns regarding laypersons' incorporation in MHC delivery systems have not been examined. To examine the ethical and legal concerns surrounding the certification of laypersons as community-based mental health counselors. We undertook an academic review of various legislations pertinent to MHC service delivery and the certification of allied health care professionals to inform on acceptable and tenable strategies toward incorporating such a task-shifted intervention. Scaling up the training of human resources to address access problems can be the first step in addressing the MHC access and treatment gaps. The certification of laypersons as community-based mental health counselors, although legally tenuous, can be pioneered by tertiary-level MHC institutions. This certification has sound ethical justification and is a progressive step toward realizing universal mental health coverage.

Mental health training needs of physicians in Bangladesh: Views from stakeholders

Bangladesh is a lower-middle-income country with a high burden of mental health conditions and inadequate health systems. Prior research in similar settings has found that training physicians in mental health literacy can contribute to reducing the mental health treatment gap and strengthening the mental health care pathway. This study explores the need for mental health training for physicians by gathering stakeholders’ perspectives and proposes recommendations for designing a mental training program in the context of Bangladesh.Key informant interviews were conducted among psychiatrists (n ​= ​9), and mental health entrepreneurs (n ​= ​7); one focus group discussion was conducted with psychologists (n ​= ​8); and one-on-one interviews were held with physician (n ​= ​17). Due to the COVID-19 restrictions, all interviews were conducted online, recorded and transcribed. Transcriptions were analyzed thematically, utilizing both an inductive and deductive approach.The data analysis from forty-one stakeholders generated three major themes and eight subthemes. Stakeholders perceived that the inadequate mental health system and low mental health awareness among physicians significantly contribute to the mental health treatment gaps. Stakeholders emphasized the need to include mental health training for physicians to increase skills related to identification and management of mental health conditions. Stakeholders suggested some basic components for the training content, feasible modalities to deliver the training, and implementation challenges. Recommendations included utilizing online training, ensuring interesting and practical content, and incorporating certification systems. At a systems level, stakeholders recommended including a mental health curriculum in undergraduate medical education, capacity building of other healthcare workers and increasing awareness at the policy level.There is clear agreement among stakeholders that implementing mental health training for physicians will promote universal health coverage and reduce the mental health treatment gap in Bangladesh. These findings can support creation of policies to strengthen the care pathway in countries with limited resources.

What social determinants outside paid work are related to development of mental health during life? An integrative review of results from the Northern Swedish Cohort

BackgroundDespite global increase in burden of mental health conditions, longitudinal studies on factors related to development of mental health are scarce. Particularly integrated understanding of how factors at each level of ecological system interact to influence mental health of individuals during their life is missing. Both work and outside work (life beyond work) spheres are two important areas in human life which can have independent effects on mental health of individuals. In this integrative review, we aimed to synthesis findings about social determinants outside paid work that are related to development of mental health during life in a 27-year prospective Swedish Cohort study by using Bronfenbrenner’s Ecological Systems Theory.MethodsThe material for this paper consists of all mental health related papers within Northern Swedish Cohort. Papers related to outside paid work exposures of life circumstances were selected. An integrative review was conducted on 27 papers and deductive qualitative content analysis in relation to Bronfenbrenner ecological framework was performed to identify the main themes.ResultsThe results of this review showed that class structures and gender order at macro-level permeated into all other levels and finally became embodied in the individuals as symptoms of mental health during life. At the “exo-level” neighbourhood disadvantage was related to mental ill-health of individuals. The importance of parental interaction with other settings, like school, for mental health of individuals was highlighted at “meso-level”. At “micro-level” poor social relationships; social and material adversities and inequality in gender relations during adult life were related to mental ill-health.ConclusionWe found mental health of individuals to be related to both unique and common factors manifesting at different socio-ecological levels. Social structures at the macro-level namely class structures and gender order permeate all other levels and eventually become embodied in the individuals as symptoms of mental health during life. Interventions addressing gender and class related inequalities might be of importance for improving mental health of individuals during their life.

Hormone therapy in transgender adults – guidelines in practice for pathologists

Transgender (trans) people include people with a binary (i.e., male or female) and non-binary identity and are one of the most marginalised groups in our community with a high burden of mental health conditions and suicidality. Due to discrimination, many fear healthcare settings. Acceptance, understanding and gender-affirming care can significantly improve distress and allay fear which is important even within pathology departments. Whilst phlebotomists will need to abide by policies for patient identification, an individual’s preferred name and pronoun should be used in interactions. Legal sex as registered with Medicare may not reflect sex-assigned at birth or inform on use of feminising or masculinising hormone therapy which impacts upon sex-specific reference ranges (i.e., haemoglobin, eGFR). There are also impacts in anatomical pathology reporting such as in providing histology of reproductive organs which may not align with gender markers. In the ideal setting, information including legal name, preferred name, sex-assigned at birth, gender identity and use of feminising or masculinising hormone therapy should be available to allow phlebotomists, pathologists and treating clinicians to provide gender-affirming care and clinically-relevant reports. Moreover, reporting of dual male and female sex-specific reference ranges may be useful for people who have recently commenced gender-affirming hormone therapy or in those using non-standard hormone regimens (i.e., low dose testosterone). Implementation of these changes presents a myriad of information system challenges but also an opportunity to ensure the highest standards of care for the Australian trans community.

Role of Dignity in Mental Healthcare: Impact on Ageism and Human Rights of Older Persons

The global demographic shift toward an aging population is predicted to result in a significant burden of mental health conditions and psychosocial disability. There has been a greater awareness of ageism and its toxic effects creating a paradigm shift to include a human right, ethical, and social justice-based approach to augment the biomedical model of mental healthcare. The concept of dignity lies at the heart of human rights and must be a central concept integrated into public health and mental healthcare. Dignity denotes the self-respect and worthiness of an individual as well as social consideration of his/her identity. Dignity in older persons is multi-dimensional and includes several factors such as privacy, independence, inclusion, autonomy, etc. There are several determinants such as frailty, dependence, sensory, cognitive impairment and socioeconomic vulnerabilities, which tend to compromise dignity in the elderly and hence their fundamental rights. One such construct is that of ageism which comprises stereotypes, prejudice and discrimination based on age. Ageism and related forms of stigma impair dignified healthcare in older persons and deprive them of their rights. Mental health professionals are uniquely positioned to incorporate the strategies to promote dignity in their clinical care and research as well as advocate for related social/health policies based on a human rights approach. These intersections are discussed in this paper in light of the United Nations Convention on Rights of the Older Persons.

Mental Health Consequences for Healthcare Workers During the COVID-19 Pandemic: A Scoping Review to Draw Lessons for LMICs.

Background: The COVID-19 pandemic has had a significant impact on the mental health of healthcare workers (HCWs) particularly in low and middle-income countries (LMICs). This scoping review provides a summary of current evidence on the mental health consequences of COVID on HCWs.Methods: A scoping review was conducted searching PubMed and Embase for articles relevant to mental health conditions among HCWs during COVID-19. Relevant articles were screened and extracted to summarize key outcomes and findings.Results: A total of fifty-one studies were included in this review. Depressive symptoms, anxiety symptoms, psychological trauma, insomnia and sleep quality, workplace burnout and fatigue, and distress were the main outcomes reviewed. Most studies found a high number of symptoms endorsed for depression, anxiety, and other conditions. We found differences in symptoms by sex, age, and HCW role, with female, younger-aged, frontline workers, and non-physician workers being affected more than other subgroups.Conclusion: This review highlights the existing burden of mental health conditions reported by HCWs during COVID-19. It also demonstrates emerging disparities among affected HCW subgroups. This scoping review emphasizes the importance of generating high quality evidence and developing informed interventions for HCW mental health with a focus on LMICs.

Incremental burden of mental health conditions in adult patients with focal seizures

IntroductionClinical research has consistently established mental health conditions (MHCs) as frequent comorbidities of epilepsy. However, the extent of economic burden of comorbid MHC in patients with focal seizures has not been systematically investigated. This retrospective cohort analysis of health plan claims compared healthcare use and costs among adult patients with focal seizures with and without comorbid MHC. MethodsWe utilized the Inovalon Medical Outcomes Research for Effectiveness and Economics (MORE2) Registry, longitudinal data from over 150 commercial, Medicare Advantage, and managed Medicaid health plans for the analysis, and identified a cohort of patients with focal (partial-onset) seizure with relevant ICD9/10 diagnosis codes with and without MHC. Mental health conditions were defined as diagnoses for anxiety, bipolar condition/mania, attention-deficit conduct condition, major depression, schizophrenia, and other psychotic conditions, and patients without MHC were propensity score-matched to patients with preexisting MHC on baseline patient characteristics. The assessment examined a series of outcomes, including 1) direct healthcare resource utilization and 2) total provider reimbursement. ResultsPatients with preexisting MHC were more likely to receive adjunctive epilepsy therapy as well as broad-spectrum antiepileptic drugs/antiseizure medications (ASMs). Additionally, patients with focal seizures and MHC were significantly more likely to utilize high-cost healthcare services. The presence of MHC was associated with approximately 50% greater utilization of emergency department (ED), physician, and inpatient services. Consequently, healthcare expenditures were significantly higher among patients with MHC ($17,596 vs. $10,857; 62% higher, p < 0.001), with the trend consistent across all care settings. ConclusionsThis analysis illustrates the health service utilization and cost implications of MHC among patients with focal seizures. The data suggest that patients with MHC have a greater overall clinical burden, which may be associated with higher healthcare resource use and expenditures. Because of the potential burden and costs associated with MHC, neurologists should consider screening patients with focal seizures for mental health disorders to identify and initiate treatment for comorbid mental health disorders.

Mental health services utilization after Mariana dam burst

Abstract Background The global burden of mental health conditions is increasing, especially in middle- and low-income countries and frequently the quality of mental health services is lower than the quality of services for other conditions. Disasters may increase this burden through their direct impact or due to secondary stressors, such as the preclusion of access to essential services. The aim of this study is to assess the impact of Mariana dam burst (Brazil) in November 2015, in the utilization of public mental health services by the population that experienced an interruption of water supply after the event. Methods We used data from DATASUS, the database of the Brazilian public health system, analyzing data from 34 months before to 36 months after the event. We defined as affected the population living in the municipalities of Minas Gerais state that had an interruption of water supply after the event and the rest of the state population as the comparison group. We designed an Interrupted time-series analysis to evaluate both immediate and gradual changes in use of mental health services after the accident. Results The affected population included 381,749 inhabitants and the comparison group 20,487,352 inhabitants. The monthly rate of mental health visits in the affected population in the beginning of the series was 296 (CI 182 to 409, p &amp;lt; 0.001) per 100.000 person-month. Comparing the groups after the event, we observed a non-statistically significant higher increase in the rate of visits immediately after the event of 115.96 (CI -30.00 to 261.92, p = 0.118) and a significant increase in the monthly rate of visits (change in slope) of 15.55 (CI 8.19 to 22.92, p &amp;lt; 0.001) in the affected group. Discussion The results suggest that the event translated in a long-term increase in mental health services utilization. We believe that this study presents an innovative methodology on the assessment of mental health services after disasters and that it could be adapted to other contexts. Key messages Indirect impacts of disasters may be associated with long-term changes in the utilization of mental health services. Interrupted time series using routine data are useful tools for the assessment of health services utilization following disasters.