Management Of Mental Health Problems Research Articles

Health care professionals’ perspectives on physical activity within the Ugandan mental health care system

BackgroundMental health care systems in Africa are faced with a high burden of mental disorders. There is need to explore evidence-based, scalable interventions to compliment the “traditional” health care system. Physical activity (PA) can augment the effectiveness of existing programs. However, little is known about the perspectives of health care professionals on PA. Understanding this is key to implementation. MethodsThis was a qualitative exploratory study based on 13 key informant interviews among experienced health care professionals working at Butabika National Referral and Teaching Hospital, Uganda. Data was analyzed through content thematic analysis. ResultsParticipants reported PA benefits were: improved individual competences and engagement, social reintegration and reduced family and community burden. Self-stigma, lack of community support, lack of infrastructure and equipment, lack of monitoring capacity, human resource challenges and a focus solely on pharmacotherapy were among the most reported barriers to application of PA in management of mental health problems. ConclusionDespite the high level of understanding of PA among health care professionals, PA promotion largely depends on implementation of strategies to deal with community and health systems barriers. Although patients need to be empowered to deal with their individual barriers, greater support and action is needed by policy makers. Public health programs should support PA through community engagement and social re-integration programs. The government should promote a holistic mental health care perspective and provide adequate infrastructural and human resources to support PA in the existing primary and mental health care systems.

Care of Women with Obesity in Pregnancy

Care of Women with Obesity in Pregnancy

Profiles of traditional healers and their healing practices in the Eastern Cape province of South Africa

BackgroundDespite the widespread use of traditional healers in the management of mental health problems among South Africans, there is a knowledge gap in their practices that needs to be narrowed in order to develop a more collaborative and integrated mental health system. There is a need to better understand traditional practices from the perspective of the healers themselves and how these align with Western approaches.AimWe specifically explored the journey towards becoming a traditional healer, the types of interventions and key practices in the management of mental disorders, and the extent to which traditional healers collaborate with conventional medical practitioners.MethodsThis mixed-methods study involved 77 traditional healers who practice in the Eastern Cape province of South Africa. We administered semi-structured interviews to gather data on healer training, experiences and practices. The Patient Health Questionnaire (PHQ-9) was used to screen for depression. All interviews were conducted in isiXhosa at participants’ homes.ResultsMost of the healers were female (80.5%) and only half (49%) had a traditional healing certificate. Healer training typically consisted of six key steps and was mostly facilitated by a non-family member or trainer, as directed by the ancestors. Most healers treated physical illnesses (86%) and called on their ancestors to assist with diagnoses (90%). Only 40% of healers treated mental illnesses. While some healers revealed tensions in working with Western practitioners, the majority were open to collaboration (71%).ConclusionTraditional healers may have an important role to play in the development of culturally-relevant mental health care in South Africa. This study contributes to a greater understanding of what it means to be a traditional healer, and the types of treatment provided. The findings emphasise that conventional mental health practitioners need to make equal effort to collaborate, especially if we are to provide culturally-relevant mental health care in traditional South African settings.

Elderly Mental Health in Developing Countries

Geriatric Psychiatry deals with specific issues and challenges that arise in the assessment and management of mental health problems in elderly. As a specialty it has not received much attention in developing countries until recently. Elderly will soon be major consumers of mental health care in developing countries. Common psycho-social issues among the elderly and their impact on the mental health in the developing regions of the world and the complex interplay between physical health and mental health in the elderly are described. Dementia and depression are described in some detail focussing on relevant research to highlight the challenges in developing countries. Potential solutions to address the challenges of elderly mental health in developing countries are discussed.

Elderly Mental Health in Developing Countries

Geriatric Psychiatry deals with specific issues and challenges that arise in the assessment and management of mental health problems in elderly. As a specialty it has not received much attention in developing countries until recently. Elderly will soon be major consumers of mental health care in developing countries. Common psycho-social issues among the elderly and their impact on the mental health in the developing regions of the world and the complex interplay between physical health and mental health in the elderly are described. Dementia and depression are described in some detail focussing on relevant research to highlight the challenges in developing countries. Potential solutions to address the challenges of elderly mental health in developing countries are discussed.

Managing information gaps on caregivers of psychotic patients in primary health settings of Yogyakarta, Indonesia.

Background: Information gaps hinder the management of psychotic patients. Incorporating mental health services into primary care might solve the problem. Health workers can be trained to provide psycho-education for caregivers of psychotic patients.Methods: This study was a two stage experimental study. In the first stage, 43 health workers were trained to provide a psycho-education for caregivers of psychotic patients. Next, 10 health workers were selected to provide the psycho-education. Participants were family caregivers of psychotic patients (n = 113) randomly assigned to control and intervention groups. Pre- and post-tests were conducted to assess the results. Statistical analyses were conducted using paired t tests and analysis of covariance (ANCOVA).Results: The intervention group scored higher for Knowledge of Psychosis at post-test. Both groups showed significant increase of knowledge (paired t tests: P<0.001; P<0.001; respectively) and the increases were not significantly different between the groups (ANCOVA: P=0.057).Conclusion: Psycho-education was applicable in primary care settings. Training primary care health workers is a feasible method to address information gaps in the management of mental health problems.

Threatened miscarriage and depressive and anxiety symptoms among women and partners in early pregnancy

BackgroundAntenatal depression has been associated with poor maternal and fetal outcomes, and threatened miscarriage is often seen clinically to impact adversely on maternal wellbeing, notwithstanding the limited research evidence. Our study aims to examine the link between threatened miscarriage and antenatal depression and anxiety in an Asian obstetric population. MethodsWe recruited 121 women and 68 partners facing threatened miscarriage, and 241 women and 180 partners experiencing uncomplicated pregnancies from a tertiary maternity hospital in Singapore. All participants completed a Patient Information Questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). ResultsThe proportion of women with major depressive and anxiety symptomatology was significantly higher among women facing threatened miscarriage compared to those with stable pregnancies (depressive: 33.1% vs. 17.0%, p = 0.008; anxiety: 48.8% vs. 23.7%, p < 0.0001). Amongst their partners, there was a non-significant trend towards a similar finding (depressive: 10.3% vs. 7.2%, p = 0.439; anxiety: 23.5% vs. 18.9%, p = 0.478). Threatened miscarriage remained significantly associated with major depressive symptomatology after adjusting for potential confounders among women (OR 2.70; 95% CI 1.55, 4.71; p < 0.0001) but not among their partners (OR 1.47; 95% CI 0.56, 3.87; p = 0.430). LimitationsThis study is limited by its cross-sectional design and relatively small sample size for male partners. ConclusionAntenatal depressive and anxiety symptomatology affects one in four women in their first trimester, with even higher prevalence among women facing threatened miscarriage. Targeted depression and anxiety screening that includes women facing threatened miscarriages may facilitate early and efficient detection and management of mental health problems among pregnant women.

How do people with long-term mental health problems negotiate relationships with network members at times of crisis?

BackgroundSocial network processes impact on the genesis and management of mental health problems. There is currently less understanding of the way people negotiate networked relationships in times of crisis compared to how they manage at other times.ObjectiveThis paper explores the patterns and nature of personal network involvement at times of crises and how these may differ from day‐to‐day networks of recovery and maintenance.MethodSemi‐structured interviews with 25 participants with a diagnosis of long‐term mental health (MH) problems drawn from recovery settings in the south of England. Interviews centred on personal network mapping of members and resources providing support. The mapping interviews explored the work of network members and changes in times of crisis. Interviews were recorded, transcribed and analysed using a framework analysis.ResultsThree key themes were identified: the fluidity of network relationality between crisis and recovery; isolation as a means of crises management; leaning towards peer support. Personal network input retreated at times of crisis often as result of “ejection” from the network by participants who used self‐isolation as a personal management strategy in an attempt to deal with crises. Peer support is considered useful during a crisis, whilst the role of services was viewed with some ambiguity.ConclusionsSocial networks membership, and type and depth of involvement, is subject to change between times of crisis and everyday support. This has implications for managing mental health in terms of engaging with network support differently in times of crises versus recovery and everyday living.

Building system capacity for the integration of mental health at the level of primary care in Tunisia: a study protocol in global mental health

BackgroundIn low- and middle-income countries (LMICs), addressing the high prevalence of mental disorders is a challenge given the limited number and unequal distribution of specialists, as well as scarce resources allocated to mental health. The Mental Health Gap Action Programme (mhGAP) and its accompanying Intervention Guide (IG), developed by the World Health Organization (WHO), aim to address this challenge by training non-specialists such as general practitioners (GPs) in mental health care. This trial aims to implement and evaluate an adapted version of the mhGAP-IG (version 1.0) offered to GPs in 2 governorates of Tunisia (i.e., Tunis and Sousse), in order to uncover important information regarding implementation process and study design before country-wide implementation and evaluation.Methods/DesignFirst, a systematic review will be conducted to explore types and effectiveness of mental health training programs offered to GPs around the world, with a specific focus on programs implemented and evaluated in LMICs. Second, a cluster randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the implemented training based on the mhGAP-IG (version 1.0). Third, multiple case study design will be used to explore how contextual factors impact the successful implementation of the training and desired outcomes.DiscussionIn Tunisia, an important need exists to further develop proximity health services and to address the growing mental health treatment gap. One solution is to train GPs in the detection, treatment, and management of mental health problems, given their strategic role in the healthcare system. This trial thus aims to implement and evaluate an adapted version of a training based on the mhGAP-IG (version 1.0) in Tunis and Sousse before country-wide implementation and evaluation. Several contributions are envisioned: adding to the growing evidence on the mhGAP and its accompanying guide, especially in French-speaking nations; building research capacity in Tunisia and more generally in LMICs by employing rigorous designs; evaluating an adapted version of the mhGAP-IG (version 1.0) on a sample of GPs; generating important information regarding implementation process and study design before country-wide implementation; and complimenting the trial results with implementation analysis, a priority in global mental health.

Adolescent deliberate self-poisoning in South-East Melbourne.

To describe the characteristics of adolescents presenting with deliberate self-poisoning (DSP) to a large Australian healthcare network. This is a retrospective chart review of 12-17 year olds presenting to three Monash Health EDs with self-poisoning from January 2012 to December 2014. There were 35 207 adolescent presentations in the study period. A total of 721 cases were for DSP (2%), and 501 (1.4%) presented with recreational or accidental self-poisoning. The most common DSP toxicants were paracetamol (28%), non-steroidal anti-inflammatory agents (15%) and serotonin reuptake inhibitors (10%). Of the DSP presentations, 96% were impulsive events; 23% of patients (n = 129) presented on multiple occasions, and 67% of all DSP cases had a past psychiatric history, particularly depression (57%). Disposition for DSP patients included 60% discharged home, 6% short stay unit, 19% medical admission, 13% psychiatric admission and 2% intensive care unit admission. There were no mortalities. Adolescent DSP presentations frequently involved impulsive ingestion of over-the-counter medications, suggesting less access to prescription medications. Additionally, pre-existing mental health history and re-presentation were common. Initiatives to prevent DSP might include an increased focus on the early identification and management of mental health problems in adolescents in the community.

Health-related quality of life and depression among medical sales representatives in Pakistan.

Pharmaceutical companies have been known to pose stress and mental harassment on medical sales representatives (MSRs) in-order to increase pharmaceutical sales. This cross sectional descriptive study, conducted during November and December 2014 in the Lahore and Bahawalpur districts of Punjab, Pakistan, evaluates the Health-Related Quality of Life (HRQoL) and extent of depression among MSRs in Pakistan. The significant predictors of HRQoL and depression among the MSRs were also determined. Using a convenience sampling technique, all consenting MSRs (N = 318) of pharmaceutical companies were asked to self-complete the Short Form-36 (SF-36v2) Health Survey and Stanford Personal Health Questionnaire (PHQ-8). The standard scoring scheme for the SF36v2 and PHQ-8 questionnaires was used. The PHQ-8 scores showed that 16.4 % (n = 52) and 2.5 % of respondents were suffering from major depression and severe major depression, respectively. Being depressed and having difficulty in achieving sales targets were the factors independently associated with lower physical health. Similarly, depression, insufficient time for the family and monthly income less than 36,000 Pakistan Rupees were significant predictors of lower mental health. The factors associated with depression included insufficient time for the family and unsatisfactory behavior of the managers. Compromised mental health and the prevalence of depression among the MSRs suggest pharmaceutical companies need to devise health management strategies and interventions to ensure effective prevention and management of mental health problems among Pakistani MSRs.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-2716-1) contains supplementary material, which is available to authorized users.

HUBUNGAN TINGKAT PENDIDIKAN DAN TINGKAT PENGETAHUAN TENTANG KESEHATAN JIWA DENGAN SIKAP MASYARAKAT TERHADAP PASIEN GANGGUAN JIWA DI RW XX DESA DUWET KIDUL, BATURETNO, WONOGIRI

Introduction: management of mental health problems require complex handling.This of course must involve all parties. Mental patients who have recovered willbe returned to the family and society. This requires the readiness of families andcommunities. During this time in the community or family is still found theresponse and understanding is not correct to mental patients, but their role iscrucial to the recovery of patients with mental disorders.Purpose of the study: To determine the relationship between the level ofeducation and level of knowledge about mental health and community attitudestowards mental patients in RW XX Duwet Kidul Baturetno, Wonogiri .Subjects: were people in RW XX Duwet Kidul, Baturetno, Wonogiri aged adults(18-60 years ) some 108 people taken at random by the table KrecjieThis research method is correlation study involving the three variables, the firstvariable is the level of education, the second variable is the level of knowledgeand the third variable is the attitude of society, with logistic regression statisticaltest.Results: of the study obtained Nagelkerke R Square value of 0.279.Conclusion The study each variable is jointly influence public attitudes againstmental patients was 27.9%, while the remaining 72.1% is influenced by othervariables attitude.Keywords: Education Level, Level of Knowledge, Attitudes Society

Examining whether offspring psychopathology influences illness course in mothers with recurrent depression using a high-risk longitudinal sample.

Depression is known to be influenced by psychosocial stressors. For mothers with recurrent depressive illness, the presence of psychopathology in their children may have important effects on their own mental health. Although the impact of maternal depression on child mental health is well-established, no study to date, as far as we are aware, has examined the extent to which offspring psychopathology influences the course of depression in mothers with a history of recurrent depressive illness, what types of child psychopathology impact maternal mental health, or whether risks vary by child gender. Aims were to (a) Use a longitudinal design to examine whether adolescent psychopathology (depression, disruptive behavior disorder; DBD) predicts recurrence of a depressive episode and depression symptom course in women with a history of recurrent depression; and (b) To test if observed effects vary by child gender. 299 mothers with recurrent major depressive disorder and their adolescent offspring were assessed on 2 occasions, 29 months apart. Maternal depression and offspring psychopathology were assessed using semistructured interview measures. Cross-generational links across time were assessed using structural equation modeling. Analyses were adjusted for past severity of maternal depression. Offspring depression symptoms but not DBD symptoms at baseline predicted future episode recurrence in mothers. Depression symptoms in daughters (β = .16, p = .039) but not sons (β = −.07, p = .461), predicted an increase in maternal depression symptoms across time. Psychopathology in daughters is associated with long-term depressive symptoms in women (mothers) with a history of recurrent depression. Findings highlight the importance of careful assessment and management of mental health problems in adolescents for more effective management of maternal depression. This study suggests that offspring symptoms of depression may be important for the recurrence of maternal depression episodes. Girls’ symptoms of depression may be a particularly important psychosocial stressor for the development of depressive symptoms in mothers with a history of recurrent depression.

A review of research and nursing management of mental health problems in pregnancy and motherhood

A review of research and nursing management of mental health problems in pregnancy and motherhood

The primary care physician/psychiatrist joint consultation: A paradigm shift in caring for patients with mental health problems?

ObjectiveThirty to forty percent of patients seen in primary care medicine suffer from mental health problems, but primary care physicians (PCPs) often feel unprepared to deal with their patients' mental health problems. Joint consultations conducted with a liaison psychiatrist can help. The purpose of this study was to evaluate the experience of joint consultations in a primary care service in Geneva, Switzerland. MethodsWe retrospectively analyzed reports of psychiatric evaluations conducted between October 2010 and August 2012 (n=182), in the Primary Care Service of the Geneva University Hospitals. We also carried out 4 focus groups with 23 physicians-in-training to explore their experiences and perceptions of the joint consultations. ResultsSeventy two percent of the evaluations resulted in a psychiatric diagnosis. Psychiatric follow-up was not considered necessary in 61% of cases. Focus groups revealed that prior to experiencing joint consultations, PCPs considered mental health problems to be the domain of psychiatrists and outside their own area of competence. Joint consultations helped to demystify the role of psychiatrists, reduce their anxiety and increase PCPs’ confidence in dealing with patients’ mental health problems. ConclusionJoint consultations enabled PCPs to shift away from a dichotomous view of somatic versus mental health problems and their management, and towards a more integrated view. Implications for practiceJoint consultations provide a useful strategy for training primary care physicians in the management of mental health problems. Integrated management of somatic and mental health problems can lead to a better understanding of the patient and improve the therapeutic relationship.

Introduction to longitudinal data analysis in psychiatric research.

SummaryThe onset, course, and management of mental health problems typically occur over relatively long periods of time, so a substantial proportion of psychiatric research – particularly the research that can provide clear answers about the complex interaction of biological, psychological, and social factors – requires multiple assessments of individuals and the environments in which they live over time. However, many psychiatric researchers use incorrect statistical methods to analyze this type of longitudinal data, a problem that can result in unrecognized bias in analytic results and, thus, incorrect conclusions. This paper provides an introduction to the topic of longitudinal data analysis. It discusses the different dataset structures used in the analysis of longitudinal data, the classification and management of missing data, and methods of adjusting for intra-individual correlation when developing multivariate regression models using longitudinal data.

Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy.

BackgroundAlthough practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs’ barriers were evaluated.MethodsOPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs’ experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training.ResultsThe training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p < .05) were found in knowledge, self-efficacy, motivation to use the guideline and its applicability to individual patients. After the training, OPs did not perceive any barriers related to knowledge and self-efficacy. Perceived adherence increased from 48.8% to 96.8% (p < .01).ConclusionsThe results imply that an implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs’ knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0364-8) contains supplementary material, which is available to authorized users.

English

ABTRACT Many persons suffering psychotic illnesses, such as schizophrenia, are largely untreated in low income countries. In these settings, most persons with severe mental illness live with their families. Thus, families play a particular critical role in determining whether a person with a psychotic illness will receive treatment and what the quality of treatment. Psychoeducation has proven to be extremely effective in helping families develop the knowledge and skills which is necessary to help their family members. Indonesia has a national policy to integrate the management of mental health problems into the primary health care system. However, in practice, such care does not implemented effectively. A preliminary study in primary health centers in two districts of Bantul and Gunung Kidul regency, Yogyakarta province, showed that there was very little or there is not any training for health care workers on diagnosis and treatment of psychotic disorder. This study was conducted to evaluate the effectiveness of the training program for health workers in three primary health centers in Yogyakarta, Indonesia, to provide psychoeducation to family caregivers for persons with psychotic disorder. A quasi-experimental study with the approach of one group pre and posttest design was performed in this study. Fortythree health workers in 3 primary health centers in Bantul and Gunung Kidul, Yogyakarta were trained every week for a month to provide psychoeducation to family caregivers who live with psychotic disorder patient. Result showed that the baseline score of knowledge of schizophrenia among health workers in 3 primary health centers in Bantul and Gunung Kidul before training were not significantly different (p=0.162). After the psychoeducation training program there were significantly different (p=0.003) of the score of knowledge of schizophrenia among health workers in 3 primary health care centers compared with before training. For conclusion, the training program to provide psychoeducation to family care providers of persons with psychotic disorder for primary health workers was effective to increase their knowledge of schizophrenia.

Knowledge and experience of ED Triage nurses in management of patients with mental health needs: The Triage Model of Lazio (TML)

Background In recent years, Emergency Departments (ED) have reported a growing number of patients with mental health (MH) related presentations: often this condition is not recognized or not properly treated. Triage nurses are pivotal to the early detection and management of MH problems. The rapid assessment of MH presentations at triage requires skill, knowledge, experience and confidence. One of the more complex aspects of triage is suicide risk assessment. This study provides an overview of the …

Effectiveness and Acceptability of Group Psychoeducation for the Management of Mental Health Problems in Survivors of Child Sexual Abuse (CSA)

There has been limited published research on the effectiveness of manualized psychoeducational approaches for the mental health and behavioral problems of child sexual abuse (CSA) survivors. The present study aims to add to the evidence base for the effectiveness and acceptability of such interventions. A total of 37 enrolled into a brief psychoeducation program (i.e., 10 sessions) aiming to help stabilize mental health and behavioral outcomes (e.g., self-harm), while on the waiting list for mental health services. Participants completed a set of self-rated measures at baseline, pre-intervention, post-intervention and 3-month follow-up. Although there was no change over time with regard to general distress, traumatic symptomatology, depression, anxiety, self-esteem, and life satisfaction, completers were less likely to report self-harm and presented with decreased rates of smoking, alcohol and substance misuse, and involvement in illegal and antisocial behaviors at post-treatment and follow-up. Qualitative data also suggested that overall the program is well tolerated by participants, despite the high attrition rate (43%). Although further research is required to establish the efficacy of this intervention, preliminary results indicate that the new intervention may be useful for stabilizing behavioral problems at post-treatment and follow-up. Strategies to improve attrition rates in future research and clinical practice are discussed.