Identification Of Mental Health Problems Research Articles

A qualitative study on the adaptation of community programmes for the promotion of early detection and health-seeking of perinatal depression in Nepal

BackgroundDespite the high burden of perinatal depression in Nepal, the detection rate is low. Community-based strategies such as sensitization programmes and the Community Informant Detection Tool (CIDT) have been found to be effective in raising awareness and thus promoting the identification of mental health problems. This study aims to adapt these community strategies for perinatal depression in the Nepalese context.MethodsWe followed a four-step process to adapt the existing community sensitization program manual and CIDT. Step 1 included in-depth interviews with women identified with perinatal depression (n=36), and focus group discussions were conducted with health workers trained in community mental health (n=13), female community health volunteers (FCHVs), cadre of Nepal government for the prevention and promotion of community maternal and child health (n=16), and psychosocial counsellors (n=5). We explored idioms and understanding of depression, perceived causes, and possible intervention. Step 2 included draft preparation based on the qualitative study. Step 3 included a one-day workshop with the psychosocial counsellors (n=2) and health workers (n=12) to assess the understandability and comprehensiveness of the draft and to refine the content. A review of the CIDT and community sensitization program manual by a psychiatrist was performed in Step 4.ResultsThe first step led to the content development for the CIDT and community sensitization manual. Multiple stakeholders and experts reviewed and refined the content from the second to fourth steps. Idioms of depression and commonly cited risk factors were incorporated in the CIDT. Additionally, myths of perinatal depression and the importance of the role of family were added to the community sensitization manual.ConclusionBoth the CIDT and community sensitization manual are grounded in the local context and are simple, clear, and easy to understand.

Improving English Teaching Strategies From the Perspective of College Students' Mental Health

Implementing mental health education (MHE) in schools is vital for students' psychological well-being. Subject infiltration integrates psychological factors into subject learning, promoting healthy development. However, English learning can introduce issues like self-confidence and language anxiety. Early identification of mental health problems (MHP) is crucial. This study, rooted in humanistic psychology and constructivism, explores affective factors, strategies, teaching, and English listening. The algorithm, based on the DeepPsy model, shows promise, identifying 75% of students with MHP. This research aids universities in offering timely support to high-risk students, minimizing long-term harm. The algorithm contributes to a healthier learning environment by enhancing English teaching and addressing mental health issues early.

Mental health screening in pediatric lower limb deficiency population.

Youth with lower limb deficiency (LLD) may be at increased risk for mental health difficulties. However, guidelines around psychosocial screening are not well established. To describe the implementation and results of a mental health screening process in a multidisciplinary prosthetics clinic. Survey. Outpatient specialty care clinic located within a children's hospital. All patients ages 0-18 years with LLD seen at a monthly multidisciplinary prosthetics clinic between September 2019 and January 2023 (n = 75). Not applicable. Quality of life was measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric proxy survey. Psychological functioning was measured using the Strengths and Difficulties Questionnaire (SDQ). Descriptive statistics were used to determine the proportion of patients who endorsed clinically significant concerns. Of the 75 clinic visits during the study time frame, the psychosocial screeners were completed at 38 (51%). A total of 25 unique patients completed the screeners; 12 patients completed the screener more than once. The most commonly endorsed concerns on the PROMIS were issues with physical mobility (65%) and upper extremity function (40%). The SDQ revealed that a majority (62.5%) of the screened patients had an overall score above the clinical cutoff, indicating psychosocial distress in more than one area. The most commonly reported mental health concern was peer problems (62.5%). Post hoc analysis of repeat screenings indicated that most problems identified during the first screening persisted at follow-up screenings. Clinically significant psychological concerns were common among the sample, indicating the need to address this aspect of patients' well-being. Preliminary data on repeat screenings suggest that clinically significant concerns may not self-resolve. Routine psychosocial screening is critical for early identification of mental health problems and timely referral to evidence-based psychological interventions.

Adaptation of an existing intervention to improve mental health literacy in educators

Abstract Mental health problems are increasingly prevalent among adolescents. Improving mental health literacy (MHL) within the school context has been identified as a useful prevention strategy. Recently, interventions have been developed aimed to improve the MHL of educators, who have a key role in identifying signals of mental health problems and promoting help-seeking in adolescents. To implement such existing interventions in another context and assess their effectiveness, it is necessary to first adapt them in a systematic way. Therefore, we systematically adapted an existing intervention targeting MHL of secondary school educators in the Netherlands following the Intervention Mapping (IM) Adapt principles. We followed the six-step procedure of IM Adapt in an iterative process. As part of that, we 1) performed a needs assessment with adolescents and educators, 2) identified a suitable existing intervention (i.e., ‘LEARN': a suitable existing English-language intervention that aligned with the formulated goals and determinants (mentalhealthliteracy.org)), 3) consulted mental health and educational experts for adaptation planning, and 4) translated, shortened, and adapted it to fit the needs of the Dutch context. This resulted in a 6-module digital online training that upholds the fidelity of the original intervention. Finally, we made plans for 5) further implementation and 6) (preliminary) evaluation of the intervention to improve Dutch secondary school educators’ MHL. Following the principles of IM Adapt, we systematically adapted an existing comprehensive MHL training for Dutch secondary school educators, which has the potential to promote mental health help-seeking of adolescents in schools and support early identification of mental health problems and illness. Future research is needed to evaluate its feasibility and effectiveness. Key messages • For implementation of existing interventions in another context and assess their effectiveness, it is necessary to first adapt them in a systematic way. • We systematically adapted an existing MHL training for Dutch secondary school educators, which has the potential to promote mental health help-seeking of adolescents in schools.

The acceptability of the Fire and Rescue Service working with primary care to improve identification of mental health problems in older adults. A mixed-method qualitative study.

Mental ill-health in older adults (aged 60 years and over) is often underdiagnosed and undertreated. Older adults are less likely to access mental health services owing to perceived stigma and fear of being a burden. Non-traditional providers of health care, such as the Fire and Rescue Services (FRS), provide a possible solution to facilitate early detection of problems and help-seeking among older adults, especially in the context of pressured statutory services. To examine whether and how FRS Home Fire Safety Visits (HFSV) could be optimised to include detection and signposting for mental health problems - particularly anxiety and depression - in older adults. This mixed-method qualitative study took place in the West Midlands, UK in 2022. This study involved focus groups (n = 24) and interviews with FRS staff (n = 4) to develop an in-depth contextual understanding of he acceptability and feasibility of expanding HFSV to include identification of anxiety and depression. FRS staff were open to expanding their HFSVs to include mental health, provided they had sufficient training and support from partner agencies in primary and social care settings to accept referrals for service users presenting with symptoms of anxiety and/or depression. The positive reputation of FRS staff and engagement with older adults suggests that HFSV could support the detection of anxiety and depression in older adults, and appropriate signposting to other services including primary care.

Perspective of Teachers on the Mental Health of Students: A Mental Health Literacy Survey

Improving mental health literacy in teachers can help in early identification of mental health problems in children and adolescents and facilitate help-seeking behaviour. Objective: A mental health literacy survey was undertaken in a school located in Bijnor district, Uttar Pradesh to assess baseline knowledge and beliefs about mental health issues in teachers. Method: A questionnaire based on Mental Health Literacy and Capacity Survey For Educators was administered in 39 teachers in an English medium school in Bijnor, Uttar Pradesh. Results: Impulse control difficulties, family and stress related issues, anger issues and bullying were the most common problems that teachers faced with the students in three months preceding the survey. The four commonest measures teachers used to deal with the problems included meeting with the parents (82%), talking with the students to understand the problem and offering support (75%), changing their style of interaction with the student (75%) and reaching out to the administration of the school for support (33%). Increased training opportunities and promotion of collaborative problem solving techniques were some of the measures suggested by teachers to improve mental health literacy. Additional measures such as encouraging students’ to participate in extracurricular activities were suggested to support the mental health needs of the students better. Conclusion: Mental health literacy evaluation in teachers and structured programmes to improve mental health literacy can help teachers in supporting the mental health needs of students.

Self-Identification of Mental Health Problems Among Young Adults Experiencing Homelessness.

Young adults experiencing homelessness (YAEH) have high rates of mental health problems but low rates of mental health service use. This study examined identification of mental health problems among YAEH in seven U.S. cities and its relationship to service use.YAEH that screened positive for depression, psychological distress, or Post Traumatic Stress (n = 892) were asked whether they felt they had a mental health problem. One-third identified as having a mental health problem (35%), with 22% endorsing not sure. Multinomial logistic regression models found that older age, cisgender female or gender-expansive (compared to cisgender male), and LGBQ sexual orientation, were positively associated with self-identification and Hispanic race/ethnicity (compared to White) was negatively associated. Self-identification of a mental health problem was positively associated with use of therapy, medications, and reporting unmet needs. Interventions should target understanding mental health, through psychoeducation that reduces stigma, or should reframe conversations around wellness, reducing the need to self-identify.

[Ukrainians Refugees: how to address their health needs in times of migration crisis?]

February 2022: Russia attacks Ukraine. Anticipating the wave of refugees generated by this war, the Geneva University Hospitals create a Ukraine Task Force. In this context, the Programme Santé Migrants (PSM), a reference consultation for refugees, realises that it will not be able to cope with the number of those coming from Ukraine in addition to the others, and creates a parallel structure: the PSM bis. The article describes how it was set up and the challenges that were faced, in particular: express training of staff in ambulatory medicine in a context of migratory crisis, focus on early identification of mental health problems and their management. This experience highlights the importance of a coordinated, interdisciplinary, and culturally adapted approach to responding to a crisis situation.

PEGASE Program: Identification of babies in the child protection system at risk of developmental delays or disorders and the implementation of a ‘supra‐optimal’ care pathway

AbstractThe importance of the first three years of life for children's development and the consequences for their general health in adulthood have been widely documented in the international literature, including the benefits of early identification and intervention programs. Additionally, convergent research has highlighted wide‐ranging negative trajectories attributable to both the short and long‐term consequences of abuse and neglect and their neurobiological impact on health and development. However, formal identification processes and the use of standardised screening tools in child protection remain relatively rare despite the potential societal impact of child maltreatment in terms of public and economic health. Moreover, delays between the initial identification of mental health problems and health and developmental disorders, and the introduction of appropriate interventions persist. Abused and neglected infants risk an exacerbation of the consequences of early maltreatment due to insufficient access to prompt assessment and treatment, including appropriate responses to their health needs.The aim of this article is to present the PEGASE program, an innovative French program for very young children in care, which is modelled on the care of premature babies. By setting up an early care pathway, it aims to ensure adequate medical follow‐up – both somatic and psychiatric – through standardised examination and tailored interventions in order to limit the adverse health and developmental consequences of abuse. The presentation of the PEGASE program is supplemented by a case study.

Suicides and Suicidal Ideation During the Perinatal Period: Clinical and Demographic Data

Suicide is the second-leading cause of death for women in the postpartum period. Psychiatric disorders are common in pregnancy, affecting 15-29% of pregnant women, whereas clinical depression affects 10%-15% of them. Women during pregnancy and the postpartum period are particularly vulnerable to suicidal ideation. The prevalence of suicidal ideation ranges from 5% to 14% worldwide, while the rate of suicide during pregnancy and the postpartum period lies between two to three per 100,000 for countries like the UK and the USA. The main risk factor for suicidal ideation in the perinatal period is depression. Other mental illnesses, like schizophrenia, anxiety, bipolar and adjustment disorder, consist of risk factors too. Some of the high-risk social characteristics for suicide thoughts are younger age, unpartnered status and well-being with their marriage, high parity, non-Caucasian race, no health insurance, poor social support, unplanned pregnancy, low-income origin country, unemployment, low educational level and smoking. Obstetrics complications like severe vaginal laceration, low weight infants and admission in the neonatal intensive care unit, perinatal fetal mortality and prior abortions consist of risk factors. Physical, psychological or sexual intimate partner violence, sexual trauma and history of physical or sexual abuse in the army, physical or sexual abuse during childhood, all contribute to suicidal thought. Knowledge of the psychiatric history from the time of enrolment in maternity units, better identification of mental health problems via psychometric screening tools, as well as the use of proper referral and medication, should be the routine in health care services.

Factors associated with pregnancy-related anxiety among pregnant women attending antenatal care follow-up at Bedelle general hospital and Metu Karl comprehensive specialized hospital, Southwest Ethiopia.

Pregnancy-related anxiety (PRA) is an anxiety related to the pregnancy, involving labor and delivery, the well-being of the fetus/infant and the mother, the availability of quality of healthcare resources, and the capacity to parent. There is scarcity of study conducted on magnitude of Pregnancy-related anxiety and its associated factors among pregnant women in Ethiopia. The main objective of this research was to assess factors associated with Pregnancy-related anxiety among pregnant women attending ANC follow-up at Bedelle general and Metu Karl comprehensive specialized hospitals, Southwest Ethiopia. A hospital-based cross-sectional study design was used among pregnant women attending ANC follow-up. Data were collected from 406 sampled pregnant women who were selected through a systematic random sampling technique. Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R2) was used to measure the outcome variable. The collected data were analyzed using Statistical Package for Social Sciences (SPSS) version 26. Logistic regression analyses were done to identify factors associated with Pregnancy-related anxiety and significance level set at p < 0.05. The overall prevalence of PRA in this study was 32.7%. Unwanted pregnancy AOR = 2.77, 95% CI [1.71, 4.54], high perceived stress AOR = 2.39, 95% CI [1.54, 3.62], young age AOR = 2.14, 95% CI [1.49, 2.83], depression AOR = 2.09, 95% CI [1.39, 2.89], low income AOR = 2.01, 95% CI [1.29, 3.14], and poor social support AOR = 1.79, 95% CI [1.14, 3.37] were significantly associated with Pregnancy-related anxiety. The findings of this study showed that the prevalence of Pregnancy-related anxiety was high in the study area and positively associated with young age, low income, poor social support, high perceived stress, depression, and unwanted pregnancy. This finding suggests that clinicians should integrate screening for Pregnancy-related anxiety into clinical standards, more efforts should be made in the future to reduce the anxiety among pregnant women who had an unwanted pregnancy, young women, and poor social support. Also, it is good to encourage the pregnant mother to enhance their social connectedness by creating a self-help group, and increasing early identification of mental health problems throughout their daily ANC follow-up.

Mental Health Interventions among Adolescents in India: A Scoping Review.

Early adolescence is the period of the emergence of most mental disorders contributing significantly to the mental health burden globally, including India. The major challenges in India are early identification of mental health problems, treatment gap, lack of professionals, and interventions that address the same. Our review aimed to assess the effectiveness of mental health interventions among adolescents in India. We systematically searched PubMed, PsycINFO, and Cochrane databases and used cross-referencing to review the interventions published from 2010 to 2020. Eleven interventions were included in this review; nine were school-based, one community, and one digital. Most of the school-based programs used a life skills curriculum. Additionally, coping skills and resilience curricula showed improvement in depressive symptoms, cognitive abilities, academic stress, problem-solving, and overall mental well-being. The multi-component whole-school intervention was quite promising and helped in improving the overall school climate and various other mental health outcomes. Hence, school-based programs should be implemented as an entry point for screening mental health problems. However, there is a need for a more comprehensive mental health program in the country for adolescents. Additionally, there is a need to address the gap by conducting more interventions for early and out-of-school adolescents.

The role of the teacher in identifying (non-Western) children in need for psychosocial care

Abstract Background The prevalence of mental health problems in Europe is higher among children with a non-Western than a Western background. Nevertheless, non-Western children use less psychosocial care. A possible explanation is the differences in parents' perceived need for care. Non-Western parents generally have a lower perceived need, which calls for other significant adults in the children's life to identify this need. This study investigates whether teachers could fulfil a role in identifying mental problems, especially in non-Western children, to improve the access to care. Methods The study sample of 9-year-old children was retrieved from the Generation R Study (N = 3,084), a population-based cohort of children born in Rotterdam, the Netherlands. Teacher- and mother-reported problems were measured at 6 years via questionnaires. Psychosocial care use was mother-reported at the research centre at 9 years (8.1% used care). Results Our findings showed that, among children who used care, elevated problem levels at 6 years were reported for 10% by mothers and teachers, for 16% by mothers only and for 22% by teachers only. Hierarchical logistic regressions showed that having teacher-reported problems was associated with psychosocial care use (OR:3.06, p&amp;lt;.05), also after adjusting for mother-reported problems (OR:2.83, p&amp;lt;.05). Ethnic background did not moderate this association. Nonetheless, non-Western children did use significantly less care than Western children (OR:.58, p&amp;lt;.05), irrespective of their problem level. Conclusions The association between teacher-reported problems and psychosocial care use suggests that teachers can play a role in identifying mental problems in children, in addition to parents. The role of the teacher might be particularly important for non-Western children in Western countries as their parents report on average a lower need for care, irrespective of the actual need. This calls for prevention strategies that focus on the teacher's unique position. Key messages Teachers have an important role in the identification of mental health problems and access to psychosocial care for children. The signalling function of teachers is extra important for children with a non-Western migrant background as this group uses less care, irrespective of their problem level.

Screening for Mental Health Problems in Epidemics: Is It Justifiable?

Given the overwhelming mental health consequences of infectious epidemics, timely identification and treatment of people with mental health problems is essential. In this narrative review, screening instruments and procedures for identification of mental health problems at the time of epidemic crises are reviewed and the results are discussed in the context of our experience in the recent COVID-19 epidemic in Iran. Forty studies were retrieved from searches in several databases which used screening procedures for identification of mental health conditions during infectious epidemics. Studies were performed on three groups of health care workers, at-risk general population, and patients with confirmed/ suspected infection, using a wide range of instruments. Most have used screening instruments for the purpose of prevalence estimation and only 5 have included it as a health intervention while none has investigated its effectiveness. The evidence base for screening at the time of epidemics is weak. If it is used to identify the needs and enhance help seeking, the screening instruments should have adequate psychometric properties; moreover, their integration in the available services is strongly recommended. Original studies are needed to investigate the usefulness of mental health screening programs in crises such as the COVID-19 epidemic.

Innovative mental health policies, plans and interventions: How to manage consequences of economic crisis?

Abstract BodyAvailable evidence shows that countries may shield their population’s exposure and vulnerability to mental health risks during and after an economic recession by strengthening their policies and reorienting their budgets. Populations’ mental health protection during economic crises can only be achieved by the policies of different sectors. Social protection, social programmes and social safety nets proved to be fundamental buffers against inequalities in mental health. Several actions have proven to be effective in this area, including measures to improve social protection, reduce income inequalities, and mitigate the impacts of unemployment. To address the negative consequences of unemployment, active labour market programmes, including special programmes for unemployed young people and families, programmes to promote the employment of people with disabilities, and debt relief programmes should be implemented. The response of the health system is critical. During and after economic recessions, it is fundamental to ensure the responsiveness and effectiveness of the mental health system. To attain this goal, mental health services that are closer to the populations and that facilitate the early identification of mental health problems and the implementation of integrated interventions should be strengthened. The latter is a crucial approach to tackle the mental health problems that more often worsen in periods of economic instability, such as depression, suicidal behaviour and heavy drinking. A special attention should also be dedicated to strengthening the network of community-based mental health services, promoting the integration of mental health in primary care, and enhancing the coordination between mental health services and social care.DisclosureNo significant relationships.

The potential of using hair cortisol to measure chronic stress in occupational healthcare; a scoping review.

ObjectivesWorkplace‐based selective prevention of mental health problems currently relies on subjective evaluation of stress complaints. Hair cortisol captures chronic stress responses and could be a promising biomarker for the early identification of mental health problems. The objective was to provide an overview of the state‐of‐the‐art knowledge on the practical value of hair cortisol in the occupational setting.MethodsWe performed a scoping review of cross‐sectional and longitudinal studies in PubMed, Embase, and PsycINFO up to November 2019 assessing the relations of hair cortisol with work‐related stressors, perceived stress, and mental health outcomes in healthy workers.ResultsWe found five longitudinal studies, of which two observed an increase in work‐related stressors to be associated with higher hair cortisol, one found a relation with lower hair cortisol and one did not find a relationship. Findings of cross‐sectional studies were also mixed. The one available longitudinal study regarding mental health showed that hair cortisol was not related to depressive symptoms.ConclusionsHair cortisol measurement within occupational health research is still in its early stage and more longitudinal studies are urgently needed to clarify its relationship with work‐related stressors and perceived stress before hair cortisol can be used to identify workers at risk for mental health problems.

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

The lack of continuity of health care for women after the postpartum visit can be especially problematic for women with perinatal depression (depression during pregnancy and up to 1 year postpartum). Many women have the onset of depression in the third trimester or postpartum, and 23%–46% of women with postpartum depression (PPD) continue to have symptoms for 1–2 years after follow-up (Vliegen et al., 2014Vliegen N. Casalin S. Luyten P. The course of postpartum depression: A review of longitudinal studies.Harvard Review of Psychiatry. 2014; 22: 1-22Crossref PubMed Scopus (136) Google Scholar). In addition, rates of maternal suicide peak at 6–9 months postpartum (Mangla et al., 2019Mangla K. Hoffman M.C. Trumpff C. O’Grady S. Monk C. Maternal self-harm deaths: An unrecognized and preventable outcome.American Journal of Obstetrics & Gynecology. 2019; 221: 295-303Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar; Metz et al., 2016Metz T.D. Rovner P. Hoffman M.C. Allshouse A.A. Beckwith K.M. Binswanger I.A. Maternal deaths from suicide and overdose in Colorado, 2004–2012.Obstetrics and Gynecology. 2016; 128: 1233Crossref PubMed Scopus (95) Google Scholar). Lack of health care continuity in the critical postpartum period, therefore, can have negative implications for maternal and child health. Ten percent to 20% of women experience perinatal depression, but only 4% of women with perinatal depression are treated to remission (Cox et al., 2016Cox E.Q. Sowa N.A. Meltzer-Brody S.E. Gaynes B.N. The perinatal depression treatment cascade: baby steps toward improving outcomes.Journal of Clinical Psychiatry. 2016; 77: 1189-1200Crossref PubMed Scopus (109) Google Scholar). Black and Latina women are less likely to initiate postpartum mental health care, and less likely than White women to receive follow-up treatment or continued care (Kozhimannil et al., 2011Kozhimannil K.B. Trinacty C.M. Busch A.B. Huskamp H.A. Adams A.S. Racial and ethnic disparities in postpartum depression care among low-income women.Psychiatric Services. 2011; 62: 619-625Crossref PubMed Scopus (112) Google Scholar). Integrating mental health treatments into obstetric settings can improve access during pregnancy (Byatt et al., 2019Byatt N. Xu W. Levin L.L. Moore Simas T.A. Perinatal depression care pathway for obstetric settings.International Review of Psychiatry. 2019; 31: 210-228Crossref PubMed Scopus (19) Google Scholar), but it is challenging to ensure continuity of mental health care after delivery. Women often experience interruptions in health care after delivery, and the interruptions in care can be especially challenging for women with low incomes. In states without Medicaid expansion, pregnancy coverage often ends on the last day of the month in which the 60-day postpartum period ends. In states that have opted into Medicaid expansion, women can enroll in standard Medicaid, Marketplace coverage, or employer-sponsored coverage when pregnancy coverage ends, but these options often do not offer the enhanced benefits available under pregnancy Medicaid (Johnson et al., 2020Johnson K. Rosenbaum S. Handley M. The next steps to advance maternal and child health in Medicaid: Filling gaps in postpartum coverage and newborn enrollment.Health Affairs. 2020; (Available:)www.healthaffairs.org/do/10.1377/hblog20191230.967912/full/Date accessed: August 12, 2020Google Scholar). Women insured by Medicaid have high rates of drop in care in the postpartum period, with only 60% of women attending their 6-week postpartum check (Weir et al., 2011Weir S. Posner H.E. Zhang J. Willis G. Baxter J.D. Clark R.E. Predictors of prenatal and postpartum care adequacy in a Medicaid managed care population.Women's Health Issues. 2011; 21: 277-285Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar). Even fewer women have continuity of care beyond the 6-week postpartum visit (Kozhimannil and Fontaine, 2013Kozhimannil K.B. Fontaine P. Care from family physicians reported by pregnant women in the United States.Annals of Family Medicine. 2013; 11: 350-354Crossref PubMed Scopus (23) Google Scholar). This commentary discusses the implications of the postpartum care transition for mental health care and makes recommendations for future research and policy changes. Pregnancy is traditionally viewed as an “episode” of care, and many women do not receive obstetric care after the routine postpartum visit that occurs 6–8 weeks after delivery. Episodic pregnancy care can be at odds with the nature of depression, which is a chronic and recurring disorder. Inadequate care transitions can result in missed identification of mental health problems or lack of continuity of mental health care that was initiated in the prenatal setting (Katon et al., 2017Katon J.G. Lewis L. Hercinovic S. McNab A. Fortney J. Rose S.M. Improving perinatal mental health care for women veterans: Description of a quality improvement program.Maternal and Child Health Journal. 2017; : 1-8Google Scholar). This issue might be more easily addressed in family medicine settings or Federally Qualified Health Centers, where patients often continue to seek care for themselves and their children after delivery. Approximately one-third of pregnant women report receiving care from a family medicine physician at some time during their pregnancy, although it is unclear whether women consulted family physicians for general primary care, prenatal care, or other health services (Kozhimannil and Fontaine, 2013Kozhimannil K.B. Fontaine P. Care from family physicians reported by pregnant women in the United States.Annals of Family Medicine. 2013; 11: 350-354Crossref PubMed Scopus (23) Google Scholar). Women who receive prenatal care in obstetric settings may find themselves “homeless” with respect to medical and mental health care after their 6-week visit with their prenatal provider. We list here potential ways to support uninterrupted treatment for perinatal depression, especially in the context of integrated care models. Integrated mental health treatments such as the perinatal collaborative care model (CoCM) can improve depression treatment access and outcomes (Grote et al., 2015Grote N.K. Katon W.J. Russo J.E. Lohr M.J. Curran M. Galvin E. Carson K. Collaborative care for perinatal depression in socioeconomically disadvantaged women: A randomized trial.Depression and Anxiety. 2015; 32: 821-834Crossref PubMed Scopus (74) Google Scholar). In the perinatal CoCM, a psychiatric consultant reviews the care of a panel of patients with a care manager (CM) and makes treatment recommendations based on the CM assessment. These recommendations are communicated to the obstetric clinicians who are primarily responsible for mental health care. Only women with complex psychiatric conditions are seen in person by the psychiatrist, thus ensuring access to higher level services for those who need it most. The CM is in the obstetric clinic, and collects and tracks data, such as depression symptom measures, in a registry. CMs serve as the patient's primary contact for mental health needs, monitoring outcomes, following up between visits, providing evidence-based psychotherapy, and collaborating with the primary care or prenatal provider. Perinatal CoCM can improve access to high-quality mental health care, is effective in improving depressive symptoms, is cost effective, is acceptable to patients, and is reimbursed by a number of payors (American Psychiatric Association, 2019American Psychiatric AssociationGetting paid in the collaborative care model.2019www.psychiatry.org/psychiatrists/practice/professional-interests/integrated-care/get-paidDate accessed: August 12, 2020Google Scholar; Bhat et al., 2018Bhat A. Reed S. Mao J. Vredevoogd M. Russo J. Unger J. Unützer J. Delivering perinatal depression care in a rural obstetric setting: A mixed methods study of feasibility, acceptability and effectiveness.Journal of Psychosomatic Obstetrics and Gynecology. 2018; 39: 273-280Crossref PubMed Scopus (9) Google Scholar). When compared with other populations, the perinatal period presents several features supportive of CoCM implementation. Frequent follow-up in the perinatal period (with 10–15 visits during pregnancy and 1–2 visits postpartum for “low-risk” pregnancies) provides an ideal framework for repeated administration of validated depression symptom measures such as the Patient Health Questionnaire-9 (Kroenke et al., 2001Kroenke K. Spitzer R.L. Williams J.B.W. The PHQ-9: Validity of a brief depression severity measure.Journal of General Internal Medicine. 2001; 16: 606-613Crossref PubMed Scopus (19891) Google Scholar) or the Edinburgh Postnatal Depression Scale (Cox et al., 1987Cox J.L. Holden J.M. Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale.British Journal of Psychiatry. 1987; 150: 782-786Crossref PubMed Scopus (8337) Google Scholar). Regular measurement of symptoms is a cornerstone of the perinatal CoCM and serves two functions: repeat screening to detect incident cases of depression, and measurement of symptoms in established cases of depression to track symptom trajectories and provide stepped care treatment recommendations. One example of a perinatal CoCM program is COMPASS at Northwestern University (Compass Program, 2019Compass ProgramNorthwestern.2019www.nm.org/conditions-and-care-areas/womens-health/obgyn/obstetrics/postnatal-care/compassDate accessed: August 12, 2020Google Scholar). All pregnant and postpartum women are eligible for CoCM and all enrolled women are followed for 1 year after delivery. This system is designed to achieve stabilization during pregnancy and 1 year postpartum, with plans for referral to ongoing care after that point for women with ongoing mental health needs. The team based CoCM approach with CM outreach and follow-up decreases the burden on the prenatal provider and ensures that the short duration of prenatal and postpartum visits is not a barrier to delivering mental health treatment. Data from the COMPASS program (E. Miller, personal communication, 22 January 2020) show that of 1,553 women referred to COMPASS over 1 year, 761 (49%) were referred postpartum. Of women referred postpartum, 266 (35%) were referred after 8 weeks postpartum and 84 (11%) were referred after 12 weeks postpartum. Therefore, extending care through 1 year postpartum has expanded access to more women. Many obstetric clinicians consider themselves to be primary care providers (PCPs), and women consider their obstetric clinicians their PCPs as well (Melville et al., 2014Melville J.L. Reed S.D. Russo J. Croicu C.A. Ludman E. LaRocco-Cockburn A. Katon W. Improving care for depression in obstetrics and gynecology: A randomized controlled trial.Obstetrics and Gynecology. 2014; 123: 1237-1246Crossref PubMed Scopus (70) Google Scholar). Yet, not all obstetric clinicians have the same treatment philosophy or approach and may not manage depression after the immediate postpartum period, and this necessitates a postpartum care transition. Although there should ideally be a warm hand off to a PCP (a primary care practice with integrated mental health would be ideal) at the 6-week postpartum visit, fewer than 33% of women nationally transition to a PCP within the year after childbirth (Bennett et al., 2014Bennett W.L. Chang H.-Y. Levine D.M. Wang L. Neale D. Werner E.F. Clark J.M. Utilization of primary and obstetric care after medically complicated pregnancies: An analysis of medical claims data.Journal of General Internal Medicine. 2014; 29: 636-645Crossref PubMed Scopus (96) Google Scholar). The Committee Opinion from the American Colleges of Obstetricians and Gynecologists and the Association of Women's Health, Obstetric and Neonatal Nurses recommends that anticipatory guidance for the postpartum period begin during pregnancy, with the patient and their obstetric clinician identifying the transition plan for health care in the postpartum period. It also reinforces the importance of the “fourth trimester” and the concept of ongoing postpartum care rather than a one-time visit (American College of Obstetricians and Gynecologists Committee on Obstetric Practice, 2016American College of Obstetricians and Gynecologists Committee on Obstetric PracticeCommittee opinion no. 666: Optimizing postpartum care.Obstetrics and Gynecology. 2016; 127: e187Crossref PubMed Scopus (67) Google Scholar). Supporting the identification of a PCP early in pregnancy for all pregnant patients will decrease the risk of postpartum gaps in care. Conversations by obstetric clinicians with patients regarding postpartum transition of care to a PCP, providing written information to the patient, and assisting patients in finding a PCP can increase the rates of postpartum transition to a PCP (Matthews, 2016Matthews C.J. A systems intervention for the transition of postpartum women to primary care.2016https://www.congress.gov/bill/116th-congress/house-bill/4996?q=%7B%22search%22%3A%5B%22H.R.4996%22%5D%7D&s=1&r=1Date accessed: August 12, 2020Google Scholar). It is well-documented that women have higher rates of attending their child's well-child visit than of attending their own postpartum visit, and this is especially true for women insured by Medicaid (Van Berckelaer et al., 2011Van Berckelaer A.C. Mitra N. Pati S. Predictors of well child care adherence over time in a cohort of urban Medicaid-eligible infants.BMC Pediatrics. 2011; 11: 36Crossref PubMed Scopus (17) Google Scholar; Weir et al., 2011Weir S. Posner H.E. Zhang J. Willis G. Baxter J.D. Clark R.E. Predictors of prenatal and postpartum care adequacy in a Medicaid managed care population.Women's Health Issues. 2011; 21: 277-285Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar). The American Academy of Pediatrics recommends that pediatricians screen for maternal PPD at the 1-, 2-, 4-, and 6-month well-child visit (Earls, 2010Earls M.F. Committee on Psychosocial Aspects of Child and Family Health American Academy of PediatricsIncorporating recognition and management of perinatal and postpartum depression into pediatric practice.Pediatrics. 2010; 126: 1032-1039Crossref PubMed Scopus (324) Google Scholar). Approaches to a positive PPD screen in pediatric settings vary, and include clinical decision support algorithms and local resource and referral lists (Waldrop et al., 2018Waldrop J. Ledford A. Perry L.C. Beeber L.S. Developing a postpartum depression screening and referral procedure in pediatric primary care.Journal of Pediatric Health Care. 2018; 32: e67-e73Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar), care management based on risk profiles and responsiveness (Olin et al., 2017Olin S.-c. S. McCord M. Stein R.E. Kerker B.D. Weiss D. Hoagwood K.E. Horwitz S.M. Beyond screening: A stepped care pathway for managing postpartum depression in pediatric settings.Journal of Women's Health. 2017; 26: 966-975Crossref PubMed Scopus (17) Google Scholar), and embedded adult psychiatrists or co-located care (Young et al., 2019Young C.A. Burnett H. Ballinger A. Castro G. Steinberg S. Nau M. Beck A.L. Embedded maternal mental health care in a pediatric primary care clinic: A qualitative exploration of mothers’ experiences.Academic Pediatrics. 2019; 19: 934-941Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar). Given the health care utilization patterns of new parents, with up to 7 well-child visits in the first year of life (Kerker et al., 2016Kerker B.D. Storfer-Isser A. Stein R.E. Garner A. Szilagyi M. O'Connor K.G. Horwitz S.M. Identifying maternal depression in pediatric primary care: Changes over a decade.Journal of Developmental and Behavioral Pediatrics. 2016; 37: 113Crossref PubMed Scopus (29) Google Scholar), pediatric offices have the ability to help address postpartum gaps in mental health treatment for parents. Many women with a low incomes who are at higher risk for perinatal mental health problems receive home visiting services. Some home visiting services utilize protocols to screen for and refer women for mental health problems (Ammerman et al., 2010Ammerman R.T. Putnam F.W. Bosse N.R. Teeters A.R. Van Ginkel J.B. Maternal depression in home visitation: A systematic review.Aggression and Violent Behavior. 2010; 15: 191-200Crossref PubMed Scopus (103) Google Scholar) or provide integrated mental health treatment (Ammerman et al., 2014Ammerman R.T. Putnam F.W. Teeters A.R. Van Ginkel J.B. Moving beyond depression: A collaborative approach to treating depressed mothers in home visiting programs.Zero to Three. 2014; 34: 20-27Google Scholar). Maternity support services or enhanced prenatal care programs funded by state Medicaid programs can also improve access to mental health treatments (Kroll-Desrosiers et al., 2015Kroll-Desrosiers A.R. Crawford S.L. Moore Simas T.A. Rosen A.K. Mattocks K.M. Improving pregnancy outcomes through maternity care coordination: A systematic review.Womens Health Issues. 2015; 26: 87-99Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar). However, physicians and prenatal providers may not be aware of these additional services, leading to reduced utilization of the enhanced services, or a lack of coordination between clinical and community-based services (Raffo et al., 2014Raffo J.E. Gary M. Forde G.K. Meghea C.I. Roman L.A. Physician awareness of enhanced prenatal services for Medicaid-insured pregnant women.Journal of Public Health Management and Practice. 2014; 20: 236-239Crossref PubMed Scopus (2) Google Scholar). Prenatal providers can help bridge the postpartum gap by coordinating care with home visiting programs, exchanging treatment plans and symptom measures with the patient's consent. Payment for prenatal care is often in the form of bundled payments, a single, fixed payment for a group of services provided to treat a condition during a defined episode of care. However, most prenatal bundles apply only to low-risk pregnancies and do not provide for the added services that mental health care requires. Given the high prevalence of perinatal depression, there is an urgent need to incentivize provision of mental health care and provide structured guidance for obstetric practices on how to bill for the mental health screening and treatment services that they provide. Obstetric practices using bundled payments for maternity care could bill CoCM codes separately and in addition to the bundled payment. (CoCM codes are reimbursed by Medicaid in several states [American Psychiatric Association, 2019American Psychiatric AssociationGetting paid in the collaborative care model.2019www.psychiatry.org/psychiatrists/practice/professional-interests/integrated-care/get-paidDate accessed: August 12, 2020Google Scholar]). Additional obstetric visits for depression management in the postpartum period can also be billed as added on evaluation and management encounters. Many state Medicaid programs reimburse caregiver depression screening during well child visits (Center for Medicaid and CHIP Services, 2016Center for Medicaid and CHIP ServicesMay 11Maternal depression screening and treatment: A critical role for Medicaid in the care of mothers and children.www.medicaid.gov/federal-policy-guidance/downloads/cib051116.pdfDate: 2016Date accessed: August 12, 2020Google Scholar); however, no data are available on reimbursement strategies for PPD treatment programs in pediatric settings (Olin et al., 2015Olin S.S. Kerker B. Stein R.E. Weiss D. Whitmyre E.D. Hoagwood K. Horwitz S.M. Can postpartum depression be managed in pediatric primary care?.Journal of Women's Health. 2016; 25: 381-390Crossref PubMed Scopus (21) Google Scholar). Ensuring high-quality and uninterrupted treatment for perinatal mental health disorders will require concerted efforts from multiple stakeholders—prenatal, primary care, pediatric, public health and allied health providers, payors, and policymakers. Both the CoCM and patient-centered medical homes are grounded in the chronic care model (Wagner et al., 1996Wagner E.H. Austin B.T. Von Korff M. Organizing care for patients with chronic illness.Milbank Quarterly. 1996; : 511-544Crossref PubMed Scopus (2101) Google Scholar) and include principles of coordination and comprehensiveness of care, continuity, access, using evidence-based treatments, and quality improvement methods (Unützer et al., 2013Unützer J. Harbin H. Schoenbaum M. Druss B. The collaborative care model: An approach for integrating physical and mental health care in Medicaid health homes. Health Home, Information Resource Center, 2013: 1-13http://www.chcs.org/media/HH_IRC_Collaborative_Care_Model__052113_2.pdfDate accessed: August 12, 2020Google Scholar). If applied to perinatal mental health treatments, these principles could help to decrease maternal morbidity and mortality, and increase patient and provider satisfaction. The support that a patient-centered medical home can provide for people with mental health conditions has been described for general adult (Starfield and Shi, 2004Starfield B. Shi L. The medical home, access to care, and insurance: A review of evidence.Pediatrics. 2004; 113: 1493-1498PubMed Google Scholar) and pediatric populations (Asarnow et al., 2017Asarnow J.R. Kolko D.J. Miranda J. Kazak A.E. The pediatric patient-centered medical home: Innovative models for improving behavioral health.American Psychologist. 2017; 72: 13Crossref PubMed Scopus (65) Google Scholar); this could be used as a template for patient centered maternity care, which includes attention to mental health. Evaluations of pregnancy centered medical home pilot programs have shown improved pregnancy outcomes (Berrien et al., 2015Berrien K. Ollendorff A. Menard M.K. Pregnancy medical home care pathways improve quality of perinatal care and birth outcomes.North Carolina Medical Journal. 2015; 76: 263-266Crossref PubMed Scopus (7) Google Scholar), but these programs do not yet define how mental and behavioral health fits into this model. The management of perinatal psychiatric conditions requires a multidisciplinary approach involving members from various care teams that may include obstetric clinicians, maternal fetal medicine clinicians, psychiatry, social work, nursing, and pediatrics, to name just a few. We have highlighted the need for a more integrated system of care between obstetrics and pediatrics, and Medicaid enhanced prenatal services and prenatal clinical care (Raffo et al., 2014Raffo J.E. Gary M. Forde G.K. Meghea C.I. Roman L.A. Physician awareness of enhanced prenatal services for Medicaid-insured pregnant women.Journal of Public Health Management and Practice. 2014; 20: 236-239Crossref PubMed Scopus (2) Google Scholar). Early experiences from perinatal CoCM programs such as COMPASS demonstrate that extending the duration of the postpartum period beyond the traditionally defined 6 weeks can expand mental health treatment access to more women in need. Careful documentation of time and resources invested, billing procedures adopted, patient outcomes, and patient and provider satisfaction will be imperative in making the case for wider implementation of this approach. However, this integrated mental health approach may not be possible in all settings. In these cases, we recommend close collaboration and care coordination with other health care and community-based providers who support women in the postpartum period, such as pediatric providers and home visiting nurses. In all cases, discussions about establishing or continuing primary care in the postpartum period must begin during pregnancy, and the 6-week postpartum visit must be used to link women to ongoing primary care. As we recognize the importance of maternal mental health for maternal and child outcomes and we reconceptualize how long the postpartum period lasts, there may also be a need to restructure how we reimburse perinatal health care services. One option could include having these high-risk pregnancies (related to mental health) take the form of a “layered bundle,” which would cover the additional care needed. Examples of this extra care include additional visits related to mental health care and extending postpartum care services up to 6–12 months postpartum. Quality metrics added on could include depression screening rates and linkage to mental health resources. Another important policy change would be expanding pregnancy insurance coverage to one year postpartum. Recently, California implemented the Provisional Postpartum Care Extension program (Provisional Postpartum Care Extension, 2020Provisional Postpartum Care Extension. 2020https://www.congress.gov/bill/116th-congress/house-bill/4996?q=%7B%22search%22%3A%5B%22H.R.4996%22%5D%7D&s=1&r=1Date accessed: August 12, 2020Google Scholar) extending MediCal coverage to 1 year postpartum for individuals with maternal mental health conditions. The pending bill Helping MOMS Act of 2019 (“H.R. 4996, 2019H.R. 4996Helping MOMS Act of 2019.2019https://www.congress.gov/bill/116th-congress/house-bill/4996?q=%7B%22search%22%3A%5B%22H.R.4996%22%5D%7D&s=1&r=1Date accessed: August 12, 2020Google Scholar”) would also allow states to provide one year of postpartum coverage. Policy changes such as these can help to decrease racial–ethnic disparities in insurance disruptions experienced by Hispanic, Black, and indigenous women who are disproportionally enrolled in pregnancy Medicaid and experience higher rates of loss of insurance in the postpartum period (Daw et al., 2020Daw J.R. Kolenic G.E. Dalton V.K. Zivin K. Winkelman T. Kozhimannil K.B. Admon L.K. Racial and ethnic disparities in perinatal insurance coverage.Obstetrics and Gynecology. 2020; 135: 917Crossref PubMed Scopus (19) Google Scholar). Redesigning the way prenatal and postpartum care is provided is a complex undertaking, and ensuring continuity of high-quality mental health care in the postpartum period can be difficult, but it is time to find a medical home for women with perinatal depression. This will mean disrupting workflows and innovating on payment mechanisms in the short term, but it is a small price to pay for the health of women and our future generations. Amritha Bhat, MD, MPH, is Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Washington. Her areas of expertise include perinatal psychiatry and collaborative care. Her research involves developing integrated mental health care models that include attention to the parent-infant dyad. Emily S. Miller, MD, MPH, is Assistant Professor, Departments of Obstetrics and Gynecology and Psychiatry and Behavioral Sciences, Northwestern University. She has expertise in health services to optimize perinatal mental health care, with a specific focus on implementation of perinatal collaborative care. Amelia Wendt, MD, is a third-year resident in the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. She is a member of the Perinatal Psychiatry pathway, actively involved in interdisciplinary resident education, and presented nationally on perinatal behavioral health topics. Anna Ratzliff, MD, PhD, is a Professor, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. She is the director of the residency training program and co director of the AIMS center. Her expertise is in collaborative care and interprofessional education.

Adolescent mental health: analysis using YP-CORE test in School health services in Croatia

Abstract Issue Adolescent mental health problems are a leading health problem in this population and remain unrecognized for a long time. The aim of this study was to examine the mental health problems with YP-CORE test as a part of regular school health periodic examination of first-year secondary school students (ages 15-16). Description of Problem Study included 392 first-year Zagreb secondary school students (74.5% girls) academic year 2019/2020. Data were collected by YP-CORE test ten questions about feeling over the last week. The students provided informed consent, and testing was done during regular periodic examinations. Data were analyzed using descriptive statistics. Results At risk of mental health problems were 7.5% of girls (22/292) and 2.0% of boys. Nine girls (3.1%) had a low overall score, ≤ 19 points, which would mean little risk but had a positive answer to the question 'I've thought of hurting myself'. Ten girls (3.3%) had a score of ≥ 20, which meant an increased risk and a particularly positive answer was the 'I've thought of hurting myself' question. Three girls (1%) had a score of ≥ 20, which meant an increased risk with no additional risk of auto-aggression. The results in the boys are completely different. Two students, 2% (2/100) had a total score of ≥ 17, which meant an increased risk and a particularly positive answer was the 'I've thought of hurting myself' question. All recognized risk students are immediately involved in the counseling of the School and University Medicine Counseling Services provided by every secondary school in Croatia. Lessons The results of the study showed that mental health problems have 6.1% secondary school students with gender differences, girls 7.5%, boys 2%. School health service developed a protocol for students at increased risk. The first step is school medicine specialist interview with the student, then with the parents and the student, and second step including school staff and other professionals. Key messages Early identification of mental health problems, timely intervention and continuous monitoring of mental health among secondary school students in Croatia. Counseling service for students should be available within the school health service, implementing preventative measures and working closely with other services and professionals.

[Parents' and Childcare Teachers' Agreement on Mental Health Problems, Psychosocial Ressources and Need for Action].

Parents' and Childcare Teachers' Agreement on Mental Health Problems, Psychosocial Ressources and Need for Action Young Children with mental health problems rarely receive professional help. Recognising a problem is one key factor for mental health care utilisation in kindergarten age. In this study psychosocial problems and ressources of 255 children (age 3,0-6,6 years) were assessed by parents and childcare teachers with the instrument "Verhaltensskalen für das Kindergartenalter" (VSK, Koglin u. Petermann, 2016). Subjective need for action was also measured. Teachers announced a need for action in 19.8 % of the children, while parents did so for 17.3 % of the children, but they agreed only for 18.9 % of these children. So agreement on need for action was low (κ = .16). Agreement was also low for psychosocial problems (Median ICC = .32), and very low with respect to the borderline/clinical range (κ = .13). No agreement was found for psychosocial ressources. Results underline the importance for Early Education and Care professionals to cooperate with institutions like social-pediatric centers to avoid blind spots in the identification of mental health problems in preschool age.

Mental Health Literacy, Help-Seeking Behaviour and Wellbeing in Young People: Implications for Practice

Research indicates that individuals who have high levels of mental health literacy engage in help-seeking for mental health issues more in comparison to those with low mental health literacy. It is therefore important to ensure that young people are able to identify signs of psychological distress and identify appropriate supports and resources when necessary. Preliminary research has identified gender differences in help-seeking and identification of mental health problems. This study aimed to investigate the relationship between mental health literacy, help-seeking intentions and wellbeing in senior high school students. The sample consisted of 22 females and 10 male students, ranging from 16–18 years. Findings indicated a positive correlation between wellbeing and general help-seeking, as well as wellbeing and help-seeking for suicidal ideation. Gender differences were identified for aspects of mental health literacy and help-seeking intentions. Results of this research have implications for practitioners in fostering positive outcomes and developing targeted interventions towards improving mental health literacy and help-seeking behaviour in the future.