Treatment Of Common Mental Disorders Research Articles

The effect of mental health training on the knowledge of common mental disorders among medical officers in primary health centres in rural Karnataka.

Background:Deficits in knowledge regarding identification and treatment of common mental disorders (CMD) and stigmatizing attitudes towards CMDs exist among primary care physicians in India.Objectives:We aimed to assess the gain in knowledge of CMDs among primary health centre (PHC) doctors, after they underwent training in the identification and treatment of CMDs, and to assess the relationship between the gain in knowledge and demographic variables. We also assessed attitudes towards depression among PHC doctors who underwent training.Methods:We assessed knowledge of CMDs among 38 PHC doctors before and after training using a multiple-choice questionnaire (MCQ). The training session included didactic teaching and case-based discussions.Results:The post-test mean score was significantly higher compared to the pre-test mean score (P < 0.0001), indicative of a significant mean gain in knowledge of CMDs among PHC doctors following training. Significant improvements were noted on the questions assessing identification of CMDs, knowledge of depressive symptoms and identification of panic attacks, post-training (all P < 0.05). Participants with lower pre-test scores had greater improvements in knowledge post-training. Around half of the PHC doctors endorsed negative attitudes towards depression.Conclusions:We demonstrated the efficacy of a training programme for PHC doctors in improving their knowledge of CMDs. Stigmatizing attitudes towards depression were present among around half the PHC doctors even after the training. This has implications for the strategy of integrating mental healthcare into primary care, with the overall goal of reducing the treatment gap for CMDs.

The impact of mental health support for the chronically ill on hospital utilisation: Evidence from the UK

Individuals with common mental disorders (CMDs) such as depression and anxiety frequently have co-occurring long-term physical health conditions (LTCs) and this co-occurrence is associated with higher hospital utilisation. Psychological treatment for CMDs may reduce healthcare utilisation through better management of the LTC, but there is little previous research. We examined the impact of psychological treatment delivered under the nationwide Improving Access to Psychological Therapies (IAPT) programme in England on hospital utilisation 12-months after the end of IAPT treatment. We examined three types of hospital utilisation: Inpatient treatment, Outpatient treatment and Emergency Room attendance. We examined individuals with Chronic Obstructive Pulmonary Disease (COPD) (n = 816), Diabetes (n = 2813) or Cardiovascular Disease (CVD) (n = 4115) who received psychological treatment between April 2014 and March 2016. IAPT episode data was linked to hospital utilisation data which went up to March 2017. Changes in the probability of hospital utilisation were compared to a matched control sample for each LTC. Individuals in the control sample received IAPT treatment between April 2017 and March 2018. Compared to the control sample, the treated sample had significant reductions in the probability of all three types of hospital utilisation, for all three LTCs 12-months after the end of IAPT treatment. Reductions in utilisation of Emergency Room, Outpatient and non-elective Inpatient treatment were also observed immediately following the end of psychological treatment, and 6-months after, for individuals with diabetes and CVD, compared to the matched sample. These findings suggest that psychological interventions for CMDs delivered to individuals with co-occurring long-term chronic conditions may reduce the probability of utilisation of hospital services. Our results support the roll-out of psychological treatment aimed at individuals who have co-occurring CMDs and long-term chronic conditions.

Stratified Care vs Stepped Care for Depression

Depression is a major cause of disability worldwide. Although empirically supported treatments are available, there is scarce evidence on how to effectively personalize psychological treatment selection. To compare the clinical effectiveness and cost-effectiveness of 2 treatment selection strategies: stepped care and stratified care. This multisite, cluster randomized clinical trial recruited participants from the English National Health Service from July 5, 2018, to February 1, 2019. Thirty clinicians working across 4 psychological therapy services were randomly assigned to provide stratified (n = 15) or stepped (n = 15) care. In stepped care, patients sequentially access low-intensity guided self-help followed by high-intensity psychotherapy. In stratified care, patients are matched with either low- or high-intensity treatments at initial assessment. Data were analyzed from May 18, 2020, to October 13, 2021, using intention-to-treat principles. All clinicians used the same interview schedule to conduct initial assessments with patients seeking psychological treatment for common mental disorders, but those in the stratified care group received a personalized treatment recommendation for each patient generated by a machine learning algorithm. Eligible patients received either stratified or stepped care (ie, treatment as usual). The preregistered outcome was posttreatment reliable and clinically significant improvement (RCSI) of depression symptoms (measured using the 9-item Patient Health Questionnaire). The RCSI outcome was compared between groups using logistic regression adjusted for baseline severity. Cost-effectiveness analyses compared incremental costs and health outcomes of the 2 treatment pathways. A total of 951 patients were included (618 women among 950 with data available [65.1%]; mean [SD] age, 38.27 [14.53] years). The proportion of cases of RCSI was significantly higher in the stratified care arm compared with the stepped care arm (264 of 505 [52.3%] vs 134 of 297 [45.1%]; odds ratio, 1.40 [95% CI, 1.04-1.87]; P = .03). Stratified care was associated with a higher mean additional cost per patient (£104.5 [95% CI, £67.5-£141.6] [$139.83 (95% CI, $90.32-$189.48)]; P < .001) because more patients accessed high-intensity treatments (332 of 583 [56.9%] vs 107 of 368 [29.1%]; χ2 = 70.51; P < .001), but this additional cost resulted in an approximately 7% increase in the probability of RCSI. In this cluster randomized clinical trial of adults with common mental disorders, stratified care was efficacious and cost-effective for the treatment of depression symptoms compared with stepped care. Stratified care can improve depression treatment outcomes at a modest additional cost. isrctn.org Identifier: ISRCTN11106183.

Scaling up psychological treatments: Lessons learned from global mental health.

Evidence-based psychological treatments are among the most effective interventions in medicine and are recommended as the first line of treatment to address the significant burden of depression, anxiety, and stress-related disorders worldwide. Despite this evidence, these treatments remain inaccessible for the great majority of the world's population. Global Mental Health (GMH) is an evolving discipline of research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide. Equity is a driving principle, and this recognizes that inequalities exist within all nations and between nations. At the heart of this equity, there is the need for person-centered care. This essay discusses how GMH has sought to address a range of barriers to scale up the delivery of psychological treatments for common mental disorders. While the initial focus of the field has been to address access to quality care in low- and middle-income countries, this article also draws attention to how similar strategies are being implemented at scale in some high-income countries, with appropriate modifications to suit the context. In considering some of these evidence-based, contextually driven strategies, psychological communities have potential to address the growing burden of depression and anxiety worldwide. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Socioeconomic Deprivation and Dropout from Contemporary Psychological Intervention for Common Mental Disorders: A Systematic Review

Dropout during psychological intervention is a significant problem. Previous evidence for associations with socioeconomic deprivation is mixed. This study aimed to review the evidence for associations between deprivation and dropout from contemporary adult psychological interventions for common mental disorders (CMDs). Systematic review, narrative synthesis and random effects meta-analysis of peer-reviewed English language journal articles published June 2010–June 2020 was conducted. Data sources included medline, PsycInfo, databases indexed by web of science, ProQuest social science database and sociology collection, and the Cochrane Library, supplemented by forward and backward citation searching. Five studies were eligible for inclusion (mean N = 170, 68% female, 60% White Caucasian, 32% dropout rate, predominantly cognitive behaviour therapy/cognitive processing therapy). Narrative synthesis indicated an overall non-significant effect of deprivation on dropout. Meta-analytic significance of controlled (k = 3) and uncontrolled (k = 4) effects depended on the measure of deprivation included for those studies using more than one measure (controlled OR 1.21–1.32, p = 0.019–0.172, uncontrolled OR 1.28–1.76, p = 0.024–0.423). The low number of included studies meant sub-group comparisons were limited, despite some tentative indications of potential differential effects. A comparator set of excluded studies showed similar uncertainty. There was limited evidence that did not overall suggest a clear significant effect of deprivation on dropout from contemporary individual CMD interventions. However, more contemporary research is needed, as effects may vary according to clinical and methodological factors, and for dropout versus non-initiation.

Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS): performance in a clinical sample in relation to PHQ-9 and GAD-7

PurposeThis study assesses the construct validity and sensitivity to change of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) as an outcome measure in the treatment of common mental disorders (CMD) in primary care settings.Methods127 participants attending up to 5 sessions of therapy for CMD in primary care self-rated the SWEMWBS, the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) scales. SWEMWBS’s construct validity and sensitivity to change was evaluated against the PHQ-9 and GAD-7 across multiple time points in two ways: correlation coefficients were calculated between the measures at each time point; and sensitivity to change over time was assessed using repeated measures ANOVA.ResultsScore distributions on SWEMWBS, but not PHQ-9 and GAD-7, met criteria for normality. At baseline, 92.9% (118/127) of participants scored above clinical threshold on either PHQ-9 or GAD-7. Correlations between SWEMWBS and PHQ-9 scores were calculated at each respective time point and ranged from 0.601 to 0.793. Correlations between SWEMWBS and GAD-7 scores were calculated similarly and ranged from 0.630 to 0.743. Significant improvements were seen on all three scales over time. Changes in PHQ-9 and GAD-7 were curvilinear with greatest improvement between sessions 1 and 2. Change in SWEMWBS was linear over the five sessions.ConclusionsThis exploratory study suggests that SWEMWBS is acceptable as a CMD outcome measure in primary care settings, both in terms of construct validity and sensitivity to change. Given patient preference for positively over negatively framed measures and statistical advantages of measures which are normally distributed, SWEMWBS could be used as an alternative to PHQ-9 and GAD-7 in monitoring and evaluating CMD treatment.

Reporting Cultural Adaptation in Psychological Trials - The RECAPT criteria.

There is a lack of empirical evidence on the level of cultural adaptation required for psychological interventions developed in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies to be effective for the treatment of common mental disorders among culturally and ethnically diverse groups. This lack of evidence is partly due to insufficient documentation of cultural adaptation in psychological trials. Standardised documentation is needed in order to enhance empirical and meta-analytic evidence. A "Task force for cultural adaptation of mental health interventions for refugees" was established to harmonise and document the cultural adaptation process across several randomised controlled trials testing psychological interventions for mental health among refugee populations in Germany. Based on the collected experiences, a sub-group of the task force developed the reporting criteria presented in this paper. Thereafter, an online survey with international experts in cultural adaptation of psychological interventions was conducted, including two rounds of feedback. The consolidation process resulted in eleven reporting criteria to guide and document the process of cultural adaptation of psychological interventions in clinical trials. A template for documenting this process is provided. The eleven criteria are structured along A) Set-up; B) Formative research methods; C) Intervention adaptation; D) Measuring outcomes and implementation. Reporting on cultural adaptation more consistently in future psychological trials will hopefully improve the quality of evidence and contribute to examining the effect of cultural adaptation on treatment efficacy, feasibility, and acceptability.

Economic threshold analysis of delivering a task-sharing treatment for common mental disorders at scale: the Friendship Bench, Zimbabwe

BackgroundTask-sharing treatment approaches offer a pragmatic approach to treating common mental disorders in low-income and middle-income countries (LMICs). The Friendship Bench (FB), developed in Zimbabwe with increasing adoption in other...

Is alcohol use associated with psychological treatment attendance and clinical outcomes?

To investigate associations between alcohol use, psychological treatment attendance, and clinical outcomes. We analysed electronic health records for N = 7,986 patients accessing psychological treatment for common mental disorders. Data were collected for pre-treatment alcohol use (average units per week) and severity of dependence (SDS), number of therapy contacts attended, pre- and post-treatment anxiety (GAD-7), and depression (PHQ-9) symptom severity. Hierarchical regression was used to examine associations between alcohol use/dependence and post-treatment symptom severity controlling for intake severity and relevant confounders. After controlling for confounders, alcohol use had significant nonlinear associations with pre-treatment depression severity (R2 = .54, p < .01, cubic trend), and post-treatment anxiety (R2 = .23, p < .01, quadratic trend). Alcohol use was not significantly associated with intake anxiety, post-treatment depression or treatment duration. SDS was not significantly associated with depression severity, alcohol severity, or total contacts after controlling for confounders. Alcohol users are just as likely to engage in and benefit from evidence-based psychological treatments for depression in primary care. A nonlinear association between alcohol use and anxiety treatment outcomes indicates that light-to-moderate drinkers have some shared characteristic that favours treatment response. Depression and anxiety problems often co-occur with alcohol use and dependence. Conventional wisdom in the field suggests that heavy alcohol users may not engage well or benefit from psychological therapies for depression and anxiety. We found no empirical support for the above assumptions in a large clinical sample. Alcohol consumption was not significantly associated with treatment attendance or depression treatment outcomes. A nonlinear association between alcohol use and anxiety outcomes suggests that moderate drinkers may have some shared characteristic that favours treatment response.

Designing Lifestyle Interventions for Common Mental Disorders: What Can We Learn from Diabetes Prevention Programs?

Lifestyle factors including diet, sleep, physical activity, and substance use cessation, are recognised as treatment targets for common mental disorders (CMDs). As the field of lifestyle-based mental health care evolves towards effectiveness trials and real-world translation, it is timely to consider how such innovations can be integrated into clinical practice. This paper discusses the utility and scale-up of lifestyle interventions for CMDs and draws on diabetes prevention literature to identify enablers and barriers to translation efforts. We discuss the extent to which lifestyle interventions aimed at managing CMDs and preventing diabetes share commonalities (program content, theoretical underpinnings, program structures, interventionists, frameworks promoting fidelity, quality, sustainability). Specific considerations when utilising these programs for mental health include personalising content with respect to symptoms and trajectories of depression and anxiety, medication regimen and genetic risk profile. As this field moves from efficacy to effectiveness and implementation, it is important to ensure issues in implementation science, including “voltage drop”, “program drift”, logistics, funding, and resourcing, are in line with evidence-based models that are effective in research settings. Ongoing considerations includes who is best placed to deliver this care and the need for models to support implementation including long-term financing, workforce training, supervision, stakeholder and organisational support.

Mobile-based interventions for common mental disorders in youth: a systematic evaluation of pediatric health apps

BackgroundThe access to empirically-supported treatments for common mental disorders in children and adolescents is often limited. Mental health apps might extend service supplies, as they are deemed to be cost-efficient, scalable and appealing for youth. However, little is known about the quality of available apps. Therefore, we aimed to systematically evaluate current mobile-based interventions for pediatric anxiety, depression and posttraumatic stress disorder (PTSD).MethodsSystematic searches were conducted in Google Play Store and Apple App Store to identify relevant apps. To be eligible for inclusion, apps needed to be: (1) designed to target either anxiety, depression or PTSD in youth (0–18 years); (2) developed for children, adolescents or caregivers; (3) provided in English or German; (4) operative after download. The quality of eligible apps was assessed with two standardized rating systems (i.e., Mobile App Rating Scale (MARS) and ENLIGHT) independently by two reviewers.ResultsOverall, the searches revealed 3806 apps, with 15 mental health apps (0.39%) fulfilling our inclusion criteria. The mean overall scores suggested a moderate app quality (MARS: M = 3.59, SD = 0.50; ENLIGHT: M = 3.22, SD = 0.73). Moreover, only one app was evaluated in an RCT. The correlation of both rating scales was high (r = .936; p < .001), whereas no significant correlations were found between rating scales and user ratings (p > .05).ConclusionsOur results point to a rather poor overall app quality, and indicate an absence of scientific-driven development and lack of methodologically sound evaluation of apps. Thus, future high-quality research is required, both in terms of theoretically informed intervention development and assessment of mental health apps in RCTs. Furthermore, institutionalized best-practices that provide central information on different aspects of apps (e.g., effectiveness, safety, and data security) for patients, caregivers, stakeholders and mental health professionals are urgently needed.

Using a theory of change to develop an integrated intervention for depression, diabetes and hypertension in Zimbabwe: lessons from the Friendship Bench project

BackgroundNon-communicable diseases (NCDs) are projected to become the leading cause of disability and mortality in sub-Saharan Africa by 2030; a vast treatment gap exists. There is a dearth of knowledge on developing evidence-based interventions that address comorbid NCDs using a task-shifting approach. The Friendship Bench, a brief psychological intervention for common mental disorders delivered by trained community grandmothers, is a promising intervention for comorbid NCDs. Although task-shifting appears to be a rational approach, evidence suggests that it may bring about tension between existing professionals from whom tasks are shifted. A Theory of Change approach is an effective way of managing the unintended tension by bringing together different stakeholders involved to build consensus on how to task shift appropriately to the parties involved. We aimed to use a theory of change approach to formulating a road map on how to successfully integrate diabetes and hypertension care into the existing Friendship Bench in order to come up with an integrated care package for depression, hypertension and diabetes aimed at strengthening NCD care in primary health care systems in Zimbabwe.MethodA theory of change workshop with 18 stakeholders from diverse backgrounds was carried out in February 2020. Participants included grandmothers working on the Friendship Bench project (n = 4), policymakers from the ministry of health (n = 2), people with lived experience for the three NCDs (n = 4), health care workers (n = 2), and traditional healers (n = 2).Findings from earlier work (situational analysis, desk review, FGDs and clinic-based surveys) on the three NCDs were shared before starting the ToC. A facilitator with previous experience running ToCs led the workshop and facilitated the co-production of the ToC map. Through an iterative process, consensus between the 18 stakeholders was reached, and a causal pathway leading to developing a framework for an intervention was formulated.ResultsThe ToC singled out the need to use expert clients (people with lived experience) to promote a patient-centred care approach that would leverage the existing Friendship Bench approach. In the face of COVID-19, the stakeholders further endorsed the use of existing digital platforms, notably WhatsApp, as an alternative way to reach out to clients and provide support. Leveraging existing community support groups as an entry point for people in need of NCD care was highlighted as a win-win by all stakeholders. A final framework for an NCD care package supported by Friendship Bench was presented to policymakers and accepted to be piloted in five geographical areas.ConclusionsThe ToC can be used to build consensus on how best to use using an existing intervention for common mental disorders to integrate care for diabetes and hypertension. There is a need to evaluate this new intervention through an adequately powered study.

Acceptability of a digital return-to-work intervention for common mental disorders: a qualitative study on service user perspectives

BackgroundThere is an evident discrepancy between need and provision of evidence-based return-to-work (RTW) interventions in existing mental health services. Online dissemination of evidence-based interventions is presumed to reduce this gap. However, there is almost no knowledge available on perceived acceptability of digital RTW interventions among service users, which are factors that might influence the development and implementation of future interventions. The aim of this study was to develop knowledge of service user acceptability of mWorks, a proposed digital RTW solution.MethodsParticipants (n = 18) with experience of common mental disorder and sick leave were recruited with a purposive snowball sampling method. Semi-structured interviews (n = 12) and one focus group interview (n = 6) were conducted. A deductive thematic analysis was performed according to the Theoretical Framework of Acceptability.ResultsDigital RTW interventions were perceived as acceptable and aligned with participant value. Participants expressed positive attitudes toward having access to support, regardless of time and place. A certain ambiguity between a decline in social interactions and opportunities to RTW in a safe space was reported. Participants were confident in their ability to use digital RTW solutions, but reported the need to reduce stressful elements of using smartphones. Overly demanding digital solutions, i.e. ones requiring high cognitive effort, were described as burdensome.ConclusionsFor digital RTW solutions to be acceptable, they need to complement traditional services by providing accessible and person-centred support throughout the RTW process. They should be designed to reduce the need for cognitive effort. Future research should explore how to balance user autonomy with other support components in digital interventions.

Employees Receiving Inpatient Treatment for Common Mental Disorders in Germany: Factors Associated with Time to First and Full Return to Work

Purpose In Germany, return to work (RTW) after inpatient treatment for common mental disorders (CMDs) is a complex process at the intersection of the mental healthcare system and the workplace. This study examined (1) the time to first and full RTW and (2) associated factors among employees receiving inpatient treatment for CMDs. Methods In this prospective cohort study, employees receiving inpatient psychiatric or medical rehabilitation treatment for CMDs were interviewed by phone during their last week before discharge. Follow-up interviews were conducted after 6, 12, and 18 months. Health-, personal, and work-related factors were used from baseline measurement. Parametric survival analysis was conducted to identify factors associated with time to first and full RTW. Results A total of N = 269 participants who stayed at a psychiatric clinic or a medical rehabilitation facility were included. Almost all participants (n = 252, 94%) from both treatment settings reported a first RTW and a full RTW. The time to first and full RTW was shortest among participants from medical rehabilitation (both median 6 days) and longer among participants from psychiatric treatment (median 17 days to first RTW and 73 days to full RTW). While only health-related and personal factors were associated with time to first RTW, leadership quality and needed individual RTW support were associated with time to full RTW. Conclusions More attention to work accommodation needs for RTW in clinical practice and coordinated actions towards RTW in collaboration with key RTW stakeholders in the workplace may support a timely RTW.Clinical Registration Number DRKS00010903, retrospectively registered.

Mental Health Applications for Primary and Secondary Prevention of Common Mental Disorders: Attitudes of German Employees.

Background: Web-based and mobile mental health applications for the prevention and treatment of common mental disorders (CMDs) are on the rise. Under certain circumstances they have proved to be effective for a range of conditions (e.g., depression).Objective: There is not sufficient evidence regarding the benefits and barriers especially for mobile phone apps and for programs in the field of primary prevention. Studies on the acceptance of potential users of mental health apps yielded mixed outcomes. In a large survey we investigated the attitudes of employees toward mental health apps and various traditional mental health services. Our main research question in this contribution focuses on the acceptance of apps compared to other measures and the moderating influence of individual characteristics.Methods: The standardized survey was completed by members of an online access panel with different job types. A set of 33 self-developed items, including three questions on e-health, captured the perceived relevance of prevention at the (A) occupational, (B) individual, and (C) societal level. On the basis of an exploratory factor analysis, mean scores for mapping seven (sub-)dimensions were constructed and compared using the Wilcoxon test. The influence of potential predictors was analyzed in linear regression models.Results: The data of 610 respondents were analyzed (response rate 75%). Support from mental health applications was rated significantly less important compared to all other dimensions at the levels (A) to (C). Respondents were more likely to use mental health apps if they felt literate with electronic devices, perceived a high relevance of work-related demands as causal factors for CMDs, stated they would be ashamed of having a CMD, and would be willing to begin psychotherapy if recommended.Discussion and Conclusions: The results confirm the critical attitudes of potential mental health app users found in other studies. Since users with a negative attitude toward e-health might have a higher risk for dropout and non-adherence as well as lower intervention effects, well-designed educational strategies should be carried out beforehand.

Conducting research on building psychosocial support for Syrian refugee families in a humanitarian emergency

BackgroundThis case study describes research, which is located in Turkey, where more than 750,000 Syrian refugees reside autonomously in Istanbul. The research developed and pilot tested a novel model for helping urban refugee families with limited to no access to evidence-based mental health services, by delivering a transdiagnostic family intervention for common mental disorders in health and non-health sector settings using a task-sharing approach. This case study addresses the following question: What challenges were encountered in developing and piloting a low intensity trans-diagnostic family support intervention in a humanitarian emergency setting?DiscussionThe rapidly growing scale of humanitarian crises requires new response capabilities geared towards addressing populations with prolonged high vulnerability to mental health consequences and limited to no access to mental health, health, and social resources.The research team faced multiple challenges in conducting this research in a humanitarian emergency setting including: 1) Non-existent or weak partnerships geared towards mental health research in a humanitarian emergency; 2) Lack of familiarity with task-sharing; 3).Insufficient language and cultural competency; 3) Fit with families’ values and demands; 4) Hardships of urban refugees. Through the research process, the research team learned lessons concerning: 1) building a coalition of academic and humanitarian organization partners; 2) investing in the research capacity building of local researchers and partners; 3) working in a community-collaborative and multi-disciplinary approach.ConclusionConducting research in humanitarian emergency settings calls for innovative collaborative and multidisciplinary approaches to understanding and addressing many sociocultural, contextual, practical and scientific challenge.

Transdiagnostic internet cbt for mixed anxiety and depressive: Results from a feasibility study in primary care

IntroductionIn response to the treatment gap for anxiety and depressive disorders, psychological treatments with innovative modalities and high implementation potential are essential. Internet CBT (iCBT) is a cost/effective approach that could improve access to a low-intensity evidence-based CBT intervention.ObjectivesTo assess the feasibility and acceptability of the French adaptation of the physician-prescribed six-lesson This Way Up transdiagnostic iCBT program for mixed anxiety and depressive disorders developed in Australia.MethodsFeasibility study with pre- post-intervention evaluations, including an embedded qualitative study in Family Medicine Groups (Quebec, Canada). Inclusion criteria comprise a family physician diagnosis of Major Depression, Panic Disorder, Agoraphobia, Social Anxiety Disorder or Generalized Anxiety Disorder. Primary self-reported outcomes: PHQ-9 (depression) and GAD-7 (anxiety); secondary measures include diagnostic-specific scales and health service utilisation.ResultsFamily physicians (N=21) from five Family Medicine Groups prescribed iCBT to 45 patients (30 women, 15 men; mean age = 39.7), 31 initiated the program. To date, 20 patients completed 5 or 6 lessons, nine completed between 2 and 4. Intervention and post-treatment assessments are ongoing, results forthcoming. Results of semi-structured interviews with patients (N=15) and family physicians (ongoing) on iCBT acceptability indicate it is beneficial, practical and easy to use. Program adherence requires patient readiness and determination and could be fostered by motivational support from clinicians.ConclusionsResults support this French iCBT program’s scaling-up potential to contribute to reducing the gap in evidence-based treatments for common mental disorders. Its implementation in primary care could improve the effectiveness, efficiency and equity to a rapidly accessible treatment.

TRANSTORNOS MENTAIS COMUNS EM ESTUDANTES DE ODONTOLOGIA: REVISÃO DE LITERATURA

Objetivo: Analisar estudos que avaliaram Transtornos Mentais Comuns (TMC) em estudantes de Odontologia através de uma revisão integrativa da literatura, descrevendo características desse transtorno e sua prevalência nessa população. Métodos: foi realizada uma busca e seleção de artigos científicos que abordassem o tema em estudantes de odontologia. Para isso, no período de junho e julho de 2020 foi realizada uma busca nas bases de dados eletrônicas Scielo e PubMed, além de busca ativa em referências. Os descritores utilizados foram “transtorno mental” (mental disorders) e “estudantes de odontologia” (dental students), associados pelo operador boleano AND. Resultados: Foram avaliados 14 artigos, publicados de 2011 a 2019, somando um total de 6.136 indivíduos. A prevalência de TMC em estudantes de Odontologia variou entre 30 e 45%, sendo a prevalência de estresse variando de 54 a 79%, ansiedade 50 a 65% e depressão 12 a 62%. Considerações finais: A análise dos estudos demonstra a importância de se estabelecer formas de avaliação precoce, de diagnóstico e tratamento de transtorno mental comum na população de estudantes de odontologia, sendo relevante a adoção de estratégias de prevenção e promoção de saúde mental por parte de políticas públicas e privadas.

Common mental disorders among seasonal migrant farmworkers in Northwest Ethiopia

BackgroundSeasonal migrant farmworkers in Ethiopia are a vulnerable segment of the population facing numerous threats to their mental health. This research aimed to determine the magnitude of common mental disorders (CMDs) and its associated factors among seasonal migrant farmworkers in the northwest of Ethiopia.MethodsA cross-sectional study was conducted. A total of 950 seasonal migrant farmworkers were selected randomly. CMDs were assessed using the self-reporting questionnaire (SRQ-20) and a structured questionnaire was employed to collect the associated characteristics of socio-demographic data. Data were analyzed using descriptive statistics, bivariate, and multivariable binary logistic regression. The adjusted odds ratio (AOR) with a 95% confidence level was used to declare a statistically significant association with CMDs.ResultsThe prevalence of CMDs was found to be 23.05% (219/950; 95% CI 20.47–25.84) among seasonal migrant farmworkers. The prevalence of psychological stress was 74.53% (708/950; 95% CI 71.65–77.20). Having a daily income below USD 5 (AOR = 1.53, 95% CI: 1.10–2.15), moderate perceived stress (AOR = 3.18, 95% CI: 1.18, 5.36), severe perceived stress (AOR = 16.15, 95% CI: 8.96, 29.11), and heat-related illness (AOR = 1.60, 95% CI: 1.11, 2.30) were associated with a higher likelihood of experiencing CMD. On the other hand, those seasonal migrant farmworkers who migrated for the first time (AOR = 0.38, 95% CI: 0.23–0.65) and those who received health related information (AOR = 0.60, 95% CI: 0.42, 0.85) were less likely to have CMDs.ConclusionIn this study, CMDs were found to be prevalent among seasonal migrant farmworkers. These findings highlight the importance of systematic development of community-based mental health services in combination with rural primary health care centers and an integrated approach to the health care of farmworkers such as screening, early identification, and treatment of CMDs of seasonal migrant farmworkers.

Banbury Forum Consensus Statement on the Path Forward for Digital Mental Health Treatment.

A major obstacle to mental health treatment for many Americans is accessibility: the United States faces a shortage of mental health providers, resulting in federally designated shortage areas. Although digital mental health treatments (DMHTs) are effective interventions for common mental disorders, they have not been widely adopted by the U.S. health care system. National and international expert stakeholders representing health care organizations, insurance companies and payers, employers, patients, researchers, policy makers, health economists, and DMHT companies and the investment community attended two Banbury Forum meetings. The Banbury Forum reviewed the evidence for DMHTs, identified the challenges to successful and sustainable implementation, investigated the factors that contributed to more successful implementation internationally, and developed the following recommendations: guided DMHTs should be offered to all patients experiencing common mental disorders, DMHT products and services should be reimbursable to support integration into the U.S. health care landscape, and an evidence standards framework should be developed to support decision makers in evaluating DMHTs.