Gaps In Mental Health Care Research Articles

A Community Assessment of Psychological Distress in Pacific Islanders Across San Francisco Bay Area Churches During the COVID-19 Pandemic.

The COVID-19 pandemic has exacerbated health and social disparities among US Pacific Islanders (PI). Historically, PIs have experienced a high burden of mental illness yet have underutilized mental health services. These already large treatment gaps in mental health care among PIs may worsen during the COVID-19 pandemic. In the face of pre-existing challenges, little is known about the impacts of the COVID-19 pandemic on mental health outcomes among PIs. A community-based, cross-sectional survey was administered to members of 13 PI churches across the San Francisco Bay Area. We assessed the burden of psychological distress among PIs and its associations with demographic, sociocultural, and health factors. Among 439 PI respondents, nearly half reported moderate or severe psychological distress. Only about one-tenth took prescription medication for mental health and less than half utilized a mental health provider in the past year. Most trusted PI churches to provide health and social services. Respondents reporting moderate or severe psychological distress were less likely to utilize a mental health provider in the past year and more likely to feel marginalized, excluded, isolated, or alienated from society "most of the time" or "always." Psychological distress was also associated with "fair" or "poor" health status, female gender, older adults, low trust in PI churches to provide health and social services, and concern over household finances. Partnerships with faith-based and community-based organizations are essential to address unmet mental health needs and promote support-seeking behaviors among PIs during this ongoing pandemic and beyond.

Canadian news media coverage of suicide during the COVID-19 pandemic.

The COVID-19 pandemic led to concerns about increases in suicidal behaviour. Research indicates that certain types of media coverage of suicide may help reduce suicidality (the Papageno effect), while other types may increase suicidality (the Werther effect). This study aimed to examine the tone and content of Canadian news articles about suicide during the first year of the pandemic. Articles about suicide from Canadian news sources were collected and coded for adherence to responsible reporting of suicide guidelines. Articles which directly discussed suicidal behaviour in the COVID-19 context were identified and compared to other suicide articles in the same period. Lastly, a thematic analysis was conducted on the sub-sample of articles discussing suicide in the COVID-19 context. The sub-set of articles about suicide in the COVID-19 context (n = 103) contained significantly more putatively helpful content compared to non-COVID-19 articles (n = 457), such as including help information (56.3% Vs 23.6%), quoting an expert (68.0% Vs 16.8%) and educating about suicide (73.8% Vs 24.9%). This lower adherence among non-COVID-19 articles is concerning as they comprised over 80% of the sample. On the plus side, fewer than 10% of all articles provided monocausal, glamourized or sensational accounts of suicide. Qualitative analysis revealed the following three themes: (i) describing the epidemiology of suicidal behaviour; (ii) discussing self and communal care; and (iii) bringing attention to gaps in mental health care. Media articles about suicide during the first year of the pandemic showed partial adherence to responsible reporting of suicide guidelines, with room for improvement.

Actualizing community–academic partnerships in research: a case study on rural perinatal peer support

Background Within the field of patient and public involvement in health service research, there is a growing movement towards not only involving patients in research but engaging them as co-producers of knowledge. We explore such a co-productive research relationship in a case study on rural perinatal mental health, with the aim of collaboratively developing knowledge based on both the relevant lived experience of a community partner, and the systemic knowledge of academic researchers.Methods Data was gathered through a community forum and subsequent interviews with social service program administrators from rural British Columbia, Canada. Interviews were analyzed separately by the community partner and academic researchers using principles of thematic analysis. Both the community partner and academic researchers were involved from project genesis to data collection, analysis, interpretation, and manuscript writing.ResultsCommon themes identified by the academic and community researchers included needs for peer support, barriers to peer support, and gaps in mental health care. Divergently, the academic researcher focused on systems-level challenges while the community partner emphasized the impact of power dynamics within health systems. Researchers generated five methodological values propositions from the process of co-production, including (a) mutual respect for all viewpoints, (b) a rejection of assumed hierarchy, (c) commitments to truth speaking, (d) attention to process, and (e) equivalence of contribution.ConclusionsCo-production highlights the value of lived experience in health research, sets it in conversation with scientific inquiry, and moves away from hierarchies of assumed knowledge often embedded in traditional health care research. Incorporating both academic researcher and community partner writing into our paper reflects a commitment to maintaining the integrity and authenticity of lived experience, an affirmation of its equal validity as a source of knowledge, and a rejection of qualifying patient voices. The exploration of this co-production research relationship lays groundwork for future research teams considering collaborative methodology. We suggest co-productive research as a means of addressing the epistemic injustice that arises in health care research from the privileging of certain forms of knowledge, and the exclusion of others, namely that derived from patient experience.

A systematic review of evidence-based interventions for child and adolescent mental health problems in low- and middle-income countries

BackgroundTreatments for mental health problems in childhood and adolescence have advanced in the last 15 years. Despite advances in research, most of the evidence on effective interventions comes from high-income countries, while evidence is scarce in low- and middle-income countries (LMICs), where 90% of world's children and adolescents live. The aim of this review was to identify evidence-based interventions tested in LMICs to treat or prevent child and adolescent mental health problems. MethodsWe conducted a systematic review of seven major electronic databases, from January 2007 to July 2019. We included randomised or non-randomised clinical trials that evaluated interventions for children or adolescents aged 6 to 18 years living in LMICs and who had, or were at risk of developing, one or more mental health problems. Results were grouped according to the studied conditions. Due to the heterogeneity of conditions, interventions and outcomes, we performed a narrative synthesis. The review was registered at PROSPERO under the number CRD42019129376. FindingsOf 127,466 references found through our search strategy, 107 studies were included in narrative synthesis after the eligibility verification processes. Nineteen different conditions and nine types of interventions were addressed by studies included in the review. Over 1/3 of studied interventions were superior to comparators, with psychoeducation and psychotherapy having the highest proportion of positive results. One-third of studies were classified as presenting low risk of bias. InterpretationThis review shows that different interventions have been effective in LMICs and have the potential to close the mental health care gap among children and adolescents in low-resource settings.

Digitally filling the access gap in mental health care: An investigation of the association between rurality and online engagement with validated self-report screens across the United States

Mental health disorders are highly prevalent, yet few persons receive access to treatment; this is compounded in rural areas where mental health services are limited. The proliferation of online mental health screening tools are considered a key strategy to increase identification, diagnosis, and treatment of mental illness. However, research on real-world effectiveness, especially in hard to reach rural communities, is limited. Accordingly, the current work seeks to test the hypothesis that online screening use is greater in rural communities with limited mental health resources. The study utilized a national, online, population-based cohort consisting of Microsoft Bing search engine users across 18 months in the United States (representing approximately one-third of all internet searches), in conjunction with user-matched data of completed online mental health screens for anxiety, bipolar, depression, and psychosis (N = 4354) through Mental Health America, a leading non-profit mental health organization in the United States. Rank regression modeling was leveraged to characterize U.S. county-level screen completion rates as a function of rurality, health-care availability, and sociodemographic variables. County-level rurality and mental health care availability alone explained 42% of the variance in MHA screen completion rate (R2 = 0.42, p < 5.0 × 10−6). The results suggested that online screening was more prominent in underserved rural communities, therefore presenting as important tools with which to bridge mental health-care gaps in rural, resource-deficient areas.

Scalability of a task-sharing psychological intervention for refugees: A qualitative study in the Netherlands

Mental health systems across the world struggle to meet the needs of present and future populations. People affected by war and forced displacement, such as refugees, have especially high unmet psychological needs. Shifting tasks from mental health specialists to less specialised providers is increasingly opted as an innovative solution to overcome the mental health care gap. Yet little is known about how task-sharing interventions for refugees can be implemented on a larger scale and integrated in existing systems. In this article, we use a system innovation perspective to examine the factors influencing the potential for scaling up a task-sharing psychological intervention for refugees called ‘Problem Management Plus’ (PM+) in the Netherlands. Semi-structured interviews were conducted with individuals (n=42) knowledgeable about PM+ and the Dutch mental health system for refugees. Findings suggest that the feasibility of wider implementation largely depends on whether barriers like stigma, attrition, fragmentation, competition, legal, and financial challenges can be overcome. Formalising the roles of new non-specialist workers will be important, including developing structures for their accreditation and supervision. There are various possibilities for institutional anchoring of the innovation: in asylum centres, formal health care, and communities. The integration scenarios identified in this study need to be tested, evaluated, refined, and reported in future implementation research.

A Comprehensive Review on the Effects of Humor in Patients With Depression.

Depression is a leading cause of disability worldwide and a major contributor to the overall global burden of disease. Although there are known, effective treatments for depression, people in low- and middle-income areas experience multiple barriers which limit their ability to receive adequate treatment. Some known barriers to effective care include a lack of resources, lack of trained healthcare providers, and social stigma associated with mental disorders and this creates gaps in mental health care and the need for more treatment modalities and adjuvant therapies to address these gaps. This review article was conducted using the scale for the assessment of non-systematic review articles (SANRA). We searched three databases; EMBASE, PubMed (MEDLINE), and Google Scholar using specified search terms. We had a total of nine articles with sample sizes ranging from 37 to 1551, and the age of participants ranged from 23 to 93 years. Articles were diverse in race and geographical locations. The articles were derived from cross-sectional studies, randomized studies, and experimental studies, and they focused on the relationship between humor and depression, and the reduced risk of depression in the study population. The articles identified different aspects of the relationship between humor and depression. The willingness of patients with depression to recognize or participate in humor could be defective resulting in abnormal social interactions such as withdrawal. However, there was some significant influence of humor or its styles on patients with depression either mitigating depressive symptoms or having no impact at all.

How is mental health care provided through community pharmacies? A quest for improvement

Background:Mental disease burden is increasing globally, and a substantial shortage of mental health professionals remains. Community pharmacists can improve population mental health outcomes to bridge the mental health care gap. However, there is a paucity of data on community pharmacists’ provision of mental health care.Objective:To assess community pharmacist-delivered care to people with mental illness in the United Arab Emirates (UAE), focusing on dispensing and counseling practices, pharmacists’ confidence and comfort in providing care, and attitudes and beliefs towards mental illness.Methods:This was a mixed-methods study with an exploratory, sequential design. Semi-structured interviews explored community pharmacists’ practices, challenges and strategies to improve care. Data were analyzed thematically, and the results guided questionnaire development. The questionnaire was also informed by the Framework of Core Mental Health Competencies for All Pharmacy Professionals and other relevant literature and administered to community pharmacists in four out of seven emirates. Logistic regression was used to identify the predictors of pharmacist practices.Results:In the interviews, community pharmacists described adopting a precautionary attitude and perceived their role as a dispensing one. They reported challenges such as emotional discomfort and lack of training but highlighted the need for a different approach to patients with mental illness. In total, 252 pharmacists completed the questionnaire, and 74% reported performing at least five counseling practices. Logistic regression showed that pharmacists who performed a higher number of practices (≥5) were younger, received continuing education on mental health care in the last two years, and had higher confidence levels.Conclusion:UAE community pharmacists performed basic dispensing practices and reported discomfort during encounters with patients with mental illness. Training on patient-centered communication skills and psychiatric therapeutics is needed to improve pharmacist-delivered services, alongside increased collaboration with other providers and services.

Mental Health and Information Reporting Assistant: technological innovation including low- and middle-income countries - an update

Introduction According to the World Health Organization, addressing the mental health care gap for adolescents, especially in low-resource contexts, is a priority. Evidence-based assessment is crucial for selecting treatment strategies and for quality management.ObjectivesTo develop a digital platform for evidence-based assessments and implement it in different low-resource settings.MethodsThe project operates according to the principles of digital development (https://digitalprinciples.org/), including designing with the user, user testing, understanding the ecosystem, resusing software and being open source, think about sustainability and addressing privacy and security.ResultsDifferent implementation contexts (in Tanzania, Kosovo and Chile) will be presented.The learned lessons will be presented to the audience.ConclusionsMHIRA is a promising tool that helps bridge the gap regarding adolescent mental health in low-resource settings. Challenges include the clinicans attitude towards evidence based assessment, sustainability of the project and integration with the existing information technology eco-system and regulations.DisclosureNo significant relationships.

Perspectives on addressing bipolar disorder in the obstetric setting

ObjectivePerinatal Psychiatry Access Programs have emerged to help obstetric professionals meet the needs of perinatal individuals with mental health conditions, including bipolar disorder (BD). We elucidate obstetric professionals' perspectives on barriers and facilitators to managing BD in perinatal patients, and how Access Programs may affect these processes. MethodsWe conducted three focus groups with obstetric professionals, two with- and one without-exposure to an Access Program, the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. Focus groups discussed experiences, barriers, facilitators, and solutions to caring for perinatal individuals with BD. Qualitative data were coded and analyzed by two independent coders; emergent themes were examined across exposure groups. ResultsThirty-one obstetric professionals (7 without-exposure, 24 with-exposure) participated. Identified themes included: (1) gaps in perinatal BD education; (2) challenges in patient assessment; (3) MCPAP for Moms as a facilitator for addressing BD; and (4) importance of continued outreach and destigmaization to increase care collaboration. ConclusionsBarriers to obstetric professionals accessing adequate mental healthcare for their patients with BD abound. With psychiatric supports in place, it is possible to build obstetric professionals' capacity to address BD. Perinatal Psychiatry Access Programs can facilitate obstetric professionals bridging these gaps in mental health care.

Review: Impact of urgent youth outpatient mental health care on patient and health system outcomes - a scoping review.

Young people often face barriers to psychiatric care and are increasingly seeking crisis services for mental health issues through the emergency department (ED). Urgent psychiatric care models provide youth in crisis with rapid access to time-limited mental health care on an outpatient basis. This scoping review aims to evaluate the impact of such urgent psychiatric services for youth aged 13-25 on patient and health system outcomes. We conducted a literature search on PubMed, EMBASE, MEDLINE, PsycINFO, and the Cochrane Database of Systematic Reviews for studies published from inception to November 20, 2020. We included studies that described outpatient psychiatric services designed for youth aged 13 to 25, took place in a clinical setting, and offered any combination of assessment, treatment, and referral. We excluded studies describing suicide intervention programmes. Our search yielded six studies, four of which were descriptive studies and two of which were randomized controlled trials. Most studies found that access to urgent psychiatric care for youth was associated with reduced ED volumes, fewer health system costs, and fewer hospitalizations. None of the studies presented evidence that urgent psychiatric services are associated with improved patient symptomatology or functioning. The results of this scoping review highlight the scarcity of robust evidence evaluating the effectiveness of urgent care for youth mental health. Further experimental studies and a set of standardized quality measures for evaluating these services are needed to bridge this critical gap in mental health care for youth in crisis.

India’s path towards better mental health in a pandemic

COVID-19 has wide-ranging effects on population health including mental health, particularly in low-and-middle-income countries (LMICs). Outbreak and interventions such as quarantine and isolation against it have contributed to psychosocial adversities. We aimed to review the state of India’s mental healthcare planning, identify the gaps in the health systems and policies, and present cost-effective and scalable solutions. Necessary background information was triangulated through an iterative literature review of the policy, preprint, and peer-reviewed research literature. We focused on the following themes-a) health system capacity, policy, and law for India, b) psychological impact of COVID-19 outbreak in India, c) psychological impact of interventions against COVID-19, and d) best practices across countries for mental health management during the pandemic. We used qualitative synthesis to identify health systems and policy gaps to generate short- and long-term solutions supported by high-grade evidence for effectiveness, cost-effectiveness, and adaptation feasibility in India. The Indian health system has several shortcomings in its mental health care that became pronounced during the current COVID-19 pandemic. To overcome these, long-term goals should include increased public financing, increased human resources production, integration of health emergency and mental health policies and legislation. Immediate needs could be met by scale-up of task-shifting initiatives and telepsychiatry services in rural regions. In the ongoing pandemic, employing school-based psychosocial interventions, public awareness campaigning, subverting misinformation through broadcast legislations, and stigma reduction for general mental illnesses are pertinent. These solutions can help bridge the gaps in mental health care in India.

Psychische Belastung von Geflüchteten in vorläufigen Unterkünften des Rhein-Neckar-Kreises/Baden-Württemberg

Due to pre-, peri-, and post-migration stress factors, the prevalence of mental illnesses among refugees is higher than in the average population. To survey the prevalence of symptoms of posttraumatic stress disorder, depression and anxiety disorder among refugees who have been living in Germany for a longer period of time in a low threshold manner, a study with short questionnaires in temporary accommodations in the Rhine-Neckar region was conducted. To determine the prevalence of psychological stress symptoms, all adult refugees in 7 temporary accommodations in the Rhine-Neckar region were approached. If they agreed to participate and spoke one of the 7 available languages, psychological stress was assessed using PC-PTSD-5 and PHQ-4 (n=106). On average, the participants experienced 3.18 (SD 2.48) traumatic events. 47.2% showed symptoms of posttraumatic stress disorder, 37.7% of depression and 29.2% of anxiety disorder. Neither gender nor age was significantly related to certain traumatic events or the diagnoses mentioned. This study shows a high prevalence of traumatization and psychological distress among refugees that have been living in Germany for several months or years. However, both the identification of affected persons and mental health care is associated with numerous challenges. Even after a longer stay in Germany, the prevalence of psychological distress is significantly higher in both genders and across all age groups compared to the general population. There is a great need to identify mentally ill refugees systematically and to close existing gaps in mental health care.

Perspectives of university health care students on mental health stigma in Nigeria: Qualitative analysis.

Mental illness is a significant public health burden in low- and middle-income countries. A wide treatment gap in mental health care exists within the Nigerian health care system and this gap is worsened by the presence of stigma associated with mental illness, which leads to delay in treatment or acts as a barrier to any care. In this study, our aim was to understand the factors that underlie mental illness stigma in order to inform the design of effective stigma-reducing interventions among health care students in Nigeria. We conducted four focus groups among university health care students in March 2019 in Nigeria. The students included nursing, pharmacy, and medical trainees from a university teaching hospital. We used an inductive-driven thematic analysis to identify codes and themes related to mental health stigma and conceptualization of mental health within the study group. Among the 40 participants, we identified how specific interpretations of religious and spiritual beliefs may be associated with stigmatizing behaviors such as social distancing and discrimination. Conceptualization of mental illness as a communicable disease and the attribution of mental illness to a moral failing contributed to stigma mechanisms. Overall, eight themes associated with mental health stigma and mental health-related concepts were found: spirituality, discrimination and devaluation, conceptualization of mental health, attribution theories, methods to reduce stigma, shortage of resources, violence and dangerousness, and maltreatment. We found that the co-existence of spiritual beliefs and biomedical and psychological models of mental health is a key factor to consider in the design of effective stigma-reducing interventions among university health students in Nigeria.

Developing a statewide network of coaches to support youth access to evidence-based practices.

Although youth face many barriers in accessing effective mental health care, schools are one setting where they can more easily receive treatment. Research shows that training and supports are needed for school mental health professionals to provide effective care. Coaching, which involves in vivo support for school mental health professionals, is one helpful strategy. We describe the process of recruiting and training community clinicians to become coaches. The Transforming Research into Action to Improve the Lives of Students (TRAILS) program successfully recruited and trained a network of 86 community clinicians to become coaches. Clinicians attended two day-long trainings and participated in 12 weeks of personalized consultation. Clients to whom these clinicians provided CBT showed significant symptom improvement. Clinicians also reported that they increased their knowledge and use of core CBT strategies, including psychoeducation, exposure, and behavioral activation. Community mental health professionals who are trained as coaches can address gaps in access to care for youth. We demonstrate one strategy for strengthening and leveraging clinicians' knowledge of CBT to support the school-based implementation of CBT.

Lessons Learned: Providing Supportive Accountability in an Online Anxiety Intervention

Technology-delivered interventions have the potential to help address the treatment gap in mental health care but are plagued by high attrition. Adding coaching, or minimal contact with a nonspecialist provider, may encourage engagement and decrease dropout, while remaining scalable. Coaching has been studied in interventions for various mental health conditions but has not yet been tested with anxious samples. This study describes the development of and reactions to a low-intensity coaching protocol administered to N = 282 anxious adults identified as high risk to drop out of a web-based cognitive bias modification for interpretation intervention. Undergraduate research assistants were trained as coaches and communicated with participants via phone calls and synchronous text messaging. About half of the sample never responded to coaches’ attempts to schedule an initial phone call or did not answer the call, though about 30% completed the full intervention with their coach. Some anxious adults may choose technology-delivered interventions specifically for their lack of human contact and may fear talking to strangers on the phone; future recommendations include taking a more intensive user-centered design approach to creating and implementing a coaching protocol, allowing coaching support to be optional, and providing users with more information about how and why the intervention works.

Mental health care delivery in poor settings through trained female community health workers: A five-year intervention program in Somaliland

Background: The situation of mental health globally is alarming particularly in developing countries. In Somaliland/Somalia, every third person may be suffering from some sort of mental illness according to the World Health Organization. Major barriers to improve mental health include stigma and lack of skilled human resources. Objectives: The aim was to explore the feasibility of organizing integrated community-based mental, epilepsy and mother and child health services delivered by trained female community health workers (FCHWs) in three urban sites (Borama, Baki and Dila) in the Awdal Region, Somaliland. Methods: After selection of the 3 project sites and recruitment and training of project staff, a baseline survey was carried out. First, the sites were properly mapped based on existing geographical administrative sectors and sub-sectors of the sites. Then a representative sample of 2,722 households was randomly selected from all the 3 sites. The female head of each of those households were then interviewed using a questionnaire containing 22 questions on the target groups. The questionnaire responses were coded, and data analysed using Statistical software program, SPSS. After the baseline survey, the FCHWs were deployed in the sites assigning a specified area to each female worker. The FCHWs worked 6 hours per day 6 days per week and were required to visit 6 families each day including follow-ups. Their activities included identification of patients with severe mental illness (SMI) or with epilepsy, counselling, distribution of medications, follow-up of patients already on medication, referral, stigma reduction and documentation of their daily activities in logbooks. Results: The baseline study showed that 12% of the households were taking care of at least one person with SMI each, while 7% had one person with epilepsy each. Of the patients with SMI, 18% were on chains. During the project period (2015-2019), the number of people with SMI or with epilepsy who benefited from the project was 2.225 and 738 respectively and their families empowered through increased mental health awareness. Among the patients with SMI, 237 were on chains before intervention and 85% of them were successfully released from their shackles. Conclusions: This project has shown that deployment of trained and supported FCHWs can be used to reduce the mental health care gap in Somaliland. It is suggested as a model project which could, hopefully, be replicated and tested in other similar settings.

The current state of mental healthcare in Bangladesh: part 2 - setting priorities.

This is the second of a two-part profile on mental healthcare in Bangladesh. It describes the state of mental health research in the country and presents a set of priorities for addressing improvements to the fundamental gaps in mental healthcare highlighted in part 1. Focus on building infrastructure for public mental health facilities, training skilled mental health professionals, adequate distribution of financial resources and addressing stigma are all priorities that will contribute to significantly improving mental healthcare in Bangladesh.

The voice of mental health practice in Australia: a mixed‐method cross‐sectional study of gaps and areas of need

ObjectivesTo examine the perceptions of health professionals regarding the gaps in mental health service provision in Australia and their need for assistance in managing patients with mental illness. MethodA total of 570 health professionals participated in an anonymous online survey in January 2018 that assessed: i) health professionals’ current levels of need for assistance in the management of patients with mental health conditions; and ii) perceived gaps in the mental health care system, and how these can be addressed. Data were analysed using a mixed‐methods approach. ResultsOf those surveyed, 71.2% of health professionals and 77.3% of general practitioners reported that they required assistance in managing their patients with at least one stage of care for at least one type of mental disorder. Qualitative analyses revealed eight major themes in health professionals’ perceptions of gaps in mental health service provision, including affordability and accessibility, the problems with crisis‐driven care and the ‘missing middle’. ConclusionOverall, the results of this study provide a concerning insight into the substantial gaps in mental health care within the Australian system. Implications for public healthThe results of this study add weight to ongoing calls for reform of and increased investment in the Australian mental health care system.

Benzodiazepine Misuse: An Epidemic Within a Pandemic.

Coronavirus disease 2019 (COVID-19) had deleterious effects on patients with mental health problems and several studies have shown a spike in the rates of depression, insomnia, and post-traumatic stress disorder. Anxiety and insomnia rates have also increased among both the general public and health care professionals. Benzodiazepines are some of the most commonly used drugs in the treatment of anxiety and insomnia. However, benzodiazepines are also misused, abused alone, or abused in combination with other drugs. Lockdowns and social distancing have also had negative consequences on patients with mental health problems. We assessed the extent of benzodiazepine use during the pandemic and interpreted its effects in the future. We conducted a literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and eight articles reviewed specifically reported worrying fluctuations in benzodiazepine use during the pandemic. We observed varied trends in the usage of benzodiazepines in various parts of the world. Some studies showed an increase in the consumption of benzodiazepine while others demonstrated a decrease in the prescription refills of benzodiazepine, which may be a result of gaps in mental health care. At this time, we can conclude that the current trend with benzodiazepine use is fluctuating and mental health professionals must continue to exercise caution before prescribing benzodiazepines. Future research is also warranted to be aware of the changing patterns and to avoid misuse and/or abuse at an epidemic level.