Mental Health Response Research Articles

The Effect of Memory Training on Cognitive Function: A Systematic Review

Memory is related to the processes that allow us to record, store and then retrieve experiences and information. Memory as an information processor is analogized by psychologists and neurologists as a computer. The recording process, called encoding, is the process of obtaining information conveyed to the system by translating it into neural code which is processed in the brain.The goal of the research titled is to systematically evaluate and synthesize existing studies to determine the impact of memory training interventions on various aspects of cognitive function. This includes assessing how memory training may enhance skills such as attention, processing speed, working memory, and overall cognitive performance. By identifying patterns, strengths, and limitations in the current literature, the study aims to provide insights into the effectiveness of memory training programs and guide future research and practical applications in cognitive enhancement.Method: Articles used in systematic reviews are typically sourced from various academic databases such as PubMed, PsycINFO, Scopus, and Google Scholar. These include studies published in peer-reviewed journals. The keywords used for searching may include phrases like "memory training," "cognitive function," "cognitive enhancement," "working memory," and other related terms. This combination of keywords helps filter relevant articles. For instance, in this review, there might be 150 articles identified through the initial search. After a selection process based on inclusion and exclusion criteria, approximately 30 articles are chosen for further analysis. The articles included in the systematic review are examined systematically, following the PRISMA 2020 guidelines: Study Identification,Study Selection,Data Extraction,Analysis and Synthesis Analyzing the results from the selected studies and compiling conclusions based on the available evidence.Results: The findings from these five literature studies cumulatively imply that activities involving the Al-Quran, such as listening, reading, or memorizing, have a positive impact on various aspects of physical and mental health, cognitive function, and brain responses. The implications of these results may stimulate further research in the field of cognitive interventions, as well as provide a more in-depth look at the role of memorization in the development of cognitive abilities at critical developmental stages.Conclusion: From the five studies reviewed, it can be concluded that memory training interventions, especially in the context of memorizing the Qur'an, contribute positively to the improvement of cognitive function in various age groups, including children, adolescents, adults, and the elderly. The implications of these findings give impetus to further research in the field of cognitive intervention, focusing on memorization strategies, as well as providing deeper insight into the role of memorization in the development of cognitive abilities at critical stages of life.

The Unique Impacts of COVID-19 on Low-Income and Diverse Canadian Women's Mental Health Profiles: A Latent Transition Analysis.

There is evidence of an overall decline in women's mental health, particularly those with young children, in the wake of the COVID-19 pandemic. However, research has also found heterogeneity in women's mental health responses. This longitudinal study sampled low-income women with young children by recruiting from the government's child care financial subsidy waitlist. To examine heterogeneity in women's mental health responses to COVID-19, a latent transition analysis was employed to identify profiles of anxiety, depression, and stress among 289 low-income mothers. Using these identified profiles, we examined the transitional patterns between profiles before and during COVID-19 and the sociodemographic and familial factors related to these profiles. A three-profile solution was identified prior to COVID-19 and a four-profile solution during COVID-19, with some profiles exhibiting qualitatively different defining characteristics. Latent transition analyses found diverse patterns of mental health changes after the onset of COVID-19. Mothers with better mental health prior to COVID-19 tended to have the most stable mental health during COVID-19. In contrast, mothers who were highly stressed prior to COVID-19 were equally likely to improve or decline after the onset of the pandemic. In addition, the relationships between race, parenting practices, child temperament, and child mental health were significantly related to mothers' mental health profiles. These findings describe mothers' experiences and areas where policymakers and practitioners can tailor support to low-income women with young children.

Improving mental health response in earthquake-prone regions: recommendations following the recent earthquake in Türkiye

We are members of Students’ Education, Empowerment and Development in Mental Health, a group of medical students and psychiatrists from around the globe under the Psychiatry, Medicine and Primary Care Section of the World Psychiatric Association. In this article, we put forward recommendations to help improve the mental health response in disaster-prone regions such as Türkiye. We recommend a three-step multi-tiered mental health response system that could significantly help to address the immediate, short-term and long-term mental health needs of communities directly affected by a disaster. The recommendation draws from the relevant literature and, most importantly, from our lived experiences of living in earthquake-prone countries.

Instructors’ challenges facilitating mental health first aid training with law enforcement

ABSTRACT Following highly publicized incidents of police responses to individuals with a mental illness, policing executives attempt to placate public outcry by mandating mental health training. However, police training curriculums are not well-evaluated, especially pertaining to implementation challenges that may arise. Using interviews with certified Mental Health First Aid instructors (n = 18), this study explores challenges experienced when implementing and facilitating the training with law enforcement officers (LEOs). Thematic analysis identified four themes: 1) In general, LEOs are a difficult group to train; 2) LEOs and their agencies often have different expectations for training compared to other populations; 3) instructors must be knowledgeable surrounding LEO-specific state and local policies surrounding mental health responses; and 4) instructors lacking credibility with the LEO audience may find facilitating the training to be more challenging. Findings highlight the importance of carefully selecting both instructors and training participants when implementing mental health training.

Maintaining Mental Health: Mindfulness Techniques for Clinicians

Urologists suffer from one of the highest rates of burnout, with negative effects for both physicians and patients. We share simple mindfulness-based strategies as invaluable tools for improving mental health, regulating physical and emotional responses to stressors, and strengthening resilience.

The relationship between menstrual cycle pattern and post-traumatic stress in women following the 2023 earthquake in Turkey.

In the aftermath of natural disasters, understanding the intricate links between mental health and physiological responses, such as menstrual cycle patterns, becomes crucial. This study explores the relationship between post-traumatic stress and menstrual irregularities among women of reproductive age residing in regions affected by the 2023 earthquake in Turkey. 309 women of reproductive age living in 11 provinces affected by the earthquake centered in Kahramanmaraş on February 6, 2023 and declared as disaster areas constituted the study sample. Data were collected online using Google forms nine months after the earthquake. The collected data were obtained using the Participant Information Form, Impact of Events Scale and Post-traumatic Stress Disorder-Short Form. In the data analysis, descriptive statistics such as count, percentage, median, minimum, and maximum were used, along with statistical tests including the Mann-Whitney U test, chi-squared test, multiple logistic regression analysis, and ROC analysis. In the study, an increase in menstrual irregularities among women was observed following the earthquake (%14.3 to %44.8, p<.001). Risk factors for menstrual irregularities included post-traumatic stress symptoms, comorbid chronic diseases, and smoking. The prevalence of PTSD was found to be 22.7% and this was associated with women with menstrual irregularities. Setting the cut-off score of the IES-R scale at 45.50 resulted in higher sensitivity for detecting irregular menstrual cycles. Women's menstrual cycles are affected after an earthquake. Therefore, post-earthquake mental health recovery programs should specifically address the protection of women's physical and mental health. This comprehensive approach can reduce the effects of earthquake-induced stress and trauma.

Exposure to climate events and mental health: Risk and protective factors from the California Health Interview Survey

There is increasing awareness of the effects of climate change on mental health, but more work on understanding risk and protective factors is needed. The 2021 California Health Interview Survey included new questions about exposure to extreme weather events and mental health responses. This study aims to identify how individual factors and neighborhood social cohesion are associated with negative mental health effects of exposure to extreme weather events. In this cross-sectional, representative study, we used data from the 2021 California Health Interview Survey to analyze the association between respondent characteristics and self-report of negative mental health effects following exposure to extreme weather events. Univariate and multivariate logistic regression models were used, adjusting for individual-level sociodemographics and measures of neighborhood social cohesion. We found that 53% of the sample reported being affected by climate events (n = 12,955), and of these, 22.8% (n = 2,955) reported a negative impact on their mental health. Respondents who were younger, White, female, college-educated, or living in a rural area were more likely to report adverse mental health effects of climate events for themselves or household members. Individuals who had experienced property damage were much more likely to report negative mental health effects due to climate events [property damage adjusted OR 3.73, 95% CI 2.82–3.76]. This study identifies subgroups that may have higher vulnerability to the mental health effects of climate change events. Future research is needed to develop targeted prevention and outreach interventions to these subgroups to build individual- and community-level resilience.

Stress beliefs moderate the impact of COVID-19 related work stress on depressive, anxiety and distress symptoms in health care workers.

Health care workers are at increased risk for mental health issues due to high psychological and physical job demands. According to a recent study, stress beliefs (i.e., believing stress to be detrimental to one's health) might influence physicians' mental health in response to a naturalistic stressor (COVID-19 hospital working conditions). Due to a small sample size and high alpha error inflation, the suggested association needs to be interpreted with caution. The current study aims to replicate those findings in a larger sample. A cross-sectional survey among N=418 (64.1% female; Median age=30-39years) physicians and nurses of a large German medical centre was conducted during the COVID-19 pandemic (May/June 2021). Perception of pandemic related increase of work stress was assessed via self-report. Stress beliefs were assessed with the Beliefs About Stress Scale, and mental health symptoms were assessed with the 21-item Depression Anxiety Stress Scale. Stress beliefs moderated the association between increased work stress and mental health symptoms. Increased work stress was associated with increased depressive, anxiety and distress symptoms only in health care workers with medium (simple slope=2.22, p<.001; simple slope=1.27, p<.001; simple slope=3.19, p<.001) and high (simple slope=3.13; p<.001; simple slope=1.66, p<.05; simple slope=4.33, p<.001) negative stress beliefs. Among health care workers with low negative stress beliefs increased work stress was not associated with increased depressive, anxiety and distress symptoms. This confirms negative stress beliefs as variable of interest in research on the impact of stress on mental health in health care workers.

Spatial patterns of Mental Health Act apprehensions in Toronto, Canada, 2014-2022.

This research examines the temporal rates and spatial patterns of police-involved Mental Health Act (MHA) apprehensions in Toronto, Canada, from 2014 to 2022. Building from the work of Toronto Police Services (TPS), the goal of this research is to deepen our understanding of MHA apprehensions and provide insights which may be used to guide local mental health reform efforts. Using data collected by TPS, an exploratory, descriptive analysis of spatial patterns of MHA apprehension events between 2014 and 2022 at the neighbourhood level was conducted. To identify high-rate clusters, we used a discrete Poisson model in SaTScan, with a circular moving window. Primary and secondary clusters with a relative risk of 1.5 or greater are reported. From 2014 to 2022, 93,932 MHA apprehensions occurred in Toronto. Apprehension rates were found to vary substantially between neighbourhoods, with approximately 91% of Toronto's 140 neighbourhoods experiencing a net positive increase in rates during the study period after adjusting for population growth. Repeated spatial cluster analysis for each year revealed a range of 4 to 7 clusters annually, with the downtown core consistently emerging as an area of elevated risk (RR range 1.58-1.99). Rising MHA apprehensions within Toronto highlight the pressing need to confront the city's intensifying mental health needs. These findings offer valuable insights into the patterns and nature of police-involved MHA apprehensions, outline reproducible analysis methods that can be used by others, and support targeted evaluation, expansion, and implementation of downstream initiatives to improve mental health responses.

Mental health preparedness and response to epidemics focusing on COVID-19 pandemic: a qualitative study in Iran

BackgroundDuring epidemics, the number of individuals whose mental health is affected is greater than those affected by the infection itself. This is because psychological factors have a direct relationship with the primary causes of the disease and mortality worldwide. Therefore, an increasing investment in research and strategic actions for mental health is essential globally, given the prevalence of infectious diseases.The aim of this study was to elucidate and describe the strategies for mental health preparedness and response during epidemics, with a focus on the COVID-19 pandemic in Iran.MethodsA qualitative study was conducted in Iran from 2022 to 2023. Purposeful Sampling was employed, continuing until data saturation was achieved. Data collection involved semi-structured interviews and observational notes with 20 managers and experts possessing expertise, experience, and knowledge in mental health. Ultimately, the participants' opinions, based on their experiences, were analyzed using the qualitative content analysis method with a conventional approach, resulting in the categorization of data into codes, subcategories, and categories.ResultsThe study revealed participants' opinions and experiences, categorized into two overarching categories: Preparedness, Policy-Making, and Planning Strategies (with four subcategories), and Response Strategies (comprising thirteen subcategories).ConclusionThe opinions and experiences of managers and experts in this study revealed that an appropriate mental health response during pandemics requires preparedness before the occurrence of such crises and the implementation of suitable response strategies after the occurrence. Managers, policymakers, and decision-makers in this field should pay attention to the solutions derived from the experiences of such crises to respond more preparedly in the future.

Resilience during lockdown: a longitudinal study investigating changes in behaviour and attitudes among older females during COVID-19 lockdown in the UK

In order to slow the spread of COVID-19, on March 23, 2020, a strict lockdown was implemented in the UK. This was followed by alternating periods of less restrictive lockdowns until most public health restrictions were lifted in the summer of 2021. While these measures were necessary, they significantly affected people’s daily activities, lifestyles, and mental well-being.This paper presents a longitudinal research study that focused on females aged 55 + in the UK, aiming to understand how COVID-19 and the subsequent 15-month period of lockdowns affected their lifestyles and emotions. The study collected data through online surveys, where respondents reported the frequency and mode of access to activities, and their positive and negative emotional experiences during distinct study phases that encompassed both lockdown and less strict periods.In contrast to previous studies highlighting vulnerabilities for females and the elderly during lockdowns, this research found that the studied group maintained an overall positive outlook throughout the study period and successfully adapted to the lockdowns by increasing their engagement in certain activities, in particular, activities like ‘getting active’. In addition, our findings indicate rapid adaptive behaviour change towards many online activities, such as cultural activities. However, the study also revealed negative emotions and a decrease in some activities during the second lockdown in 2020 and the subsequent lockdowns in 2021, underscoring the challenges inherent in prolonged periods of confinement. In addition, the study found negative affect associated with some activities, including working and studying from home.The findings provide valuable insights into how females aged over 55 coped with stressful circumstances, which can inform the development of resilient and mental health-conscious public health policies and responses in preparation for future pandemics or other hazards.

‘I was having an anxiety attack and they pepper sprayed me': police apprehension in mental health contexts in Australia

ABSTRACT Police attendance in mental health contexts is often traumatic for the person in crisis, their family and first responders. Existing literature on police involvement in mental health responses tends to focus on police perspectives. Scholarship exploring lived experience perspectives is limited, yet is crucial for informing programmes, policies and reforms. We present findings from one of the first projects co-produced with people with lived experiences of being apprehended by police under mental health legislation. Interviews were conducted with twenty participants who had experience(s) of police apprehension across Australia. Findings highlight the social disadvantage experienced by participants prior to being apprehended and that use of force (such as tasering, pepper spraying and restraining in locked police vans) was common and over-used. Our study identified that police apprehension has lasting and wide-ranging impacts, leading to loss of employment, trauma, property damage, negative self-perceptions, discrimination, and fear of future police responses. Some participants were also apprehended by police while experiencing family violence and were misidentified as perpetrators. We argue police use of force mirrors the use of force within mental health services, with participants not experiencing a clear separation between police and mental health responses. The article shares participants’ ideas for change, including response models based on human rights, police non-attendance and peer-led initiatives. Our findings suggest the need for investment in alternatives to police responses and further research involving lived experience perspectives to inform out understanding of mental health crisis responses.

WHO framework on meaningful engagement: A transformational approach to integrate lived experience in the noncommunicable disease and mental health agenda.

As the global public health community continues to reflect and recover from the COVID-19 pandemic, noncommunicable diseases (NCDs), and mental health and neurological conditions remains one of the largest unmet gaps in progress towards meeting the Sustainable Development Goals (SDG). People living with these health conditions, particularly among those most marginalized, acutely understand the impact of these failures in global action and investment. Integrating lived experience into the NCD and mental health response can act as an accelerator for action. Through a participatory process to co-create the WHO Framework on Meaningful Engagement on NCDs, and Mental Health and Neurological Conditions, we conducted a mixed methods and semi-structured approach, including informal consultations, focus groups, in-depth interviews, online surveys, and a short film series, that captured the perspectives of 700 individuals from 111 countries, including 386 individuals with lived experience. Working alongside lived experience communities and other relevant stakeholders, we have established and co-created a set of principles, enablers and actions for operationalizing meaningful engagement, related to dignity and respect, power and equity, inclusivity and intersectionality, commitment and transparency, and institutionalization and contextualization. People with lived experience have a right to be equitably included in all levels of policy-setting, design and implementation of programs, and to have a central role in reforming and reorienting the structures and systems intended to address the complex multifactorial challenges that they face. WHO is committed to leveraging its role in global health to further operationalize meaningful engagement within WHO and its Member States.

Types of COVID-19 Disaster Work and Psychological Responses in National Guard Service Members.

The National Guard (NG) served as a critical component of the U.S. response to the coronavirus disease 2019 pandemic. Understanding the impact of types of pandemic-related disaster work on mental health responses can aid in sustaining NG service members' health and preparation for subsequent activations and future pandemics. We surveyed 1,363 NG unit (NGU) service members (88% Army; 80% enlisted; 32% 30 to 39 years old; 84% male) following activation in response to the pandemic. Surveys were administered between August and December 2020, which was approximately 2 to 3 months post-activation. Surveys assessed overall activation stress, participation in different types of disaster work, probable post-traumatic stress disorder (PTSD), anxiety and depression, and anger. A disaster work stress scale assessed different types of disaster work during activation and associated stress levels. For each individual, we calculated an overall work task stress (WTS) scaled score, with a maximum score of 100. Logistic regression analyses were conducted to examine the relationship of high-stress disaster work tasks to post-activation PTSD, anxiety and depression, and anger, adjusting for socio-demographic and service-related variables. The study was approved by the Institutional Review Board of the Uniformed Services University (USU) in Bethesda, MD. Among NGU service members, 12.7% (n = 172) described their activation as very/extremely stressful. The work tasks with the highest scaled scores were as follows: (1) Patient transportation (WTS scaled score = 100); (2) working with the dead (WTS = 82.2); and (3) working with families of coronavirus disease 2019 patients (WTS = 72.7). For each individual's work tasks, we identified the work task associated with the highest WTS score. The top one-third of WTS scores were classified as the high-stress group. Approximately 9% of participants (n = 111) had probable PTSD, 6.7% (n = 85) had clinically significant anxiety and depression, and 12.3% (n = 156) had high anger. Multivariable logistic regression analyses, adjusting for covariates, found that NGU service members exposed to the highest level of disaster WTS were more likely to report PTSD (odds ratio [OR] = 1.48 [95% confidence interval [CI] = 1.13-1.94], χ2 = 7.98), anxiety and depression (OR = 1.91 [95% CI = 1.17-3.13]; χ2 = 6.67), and anger (OR = 1.63 [95% CI = 1.13-2.37]; χ2 = 6.66) post-activation. Identifying work tasks associated with high levels of stress can help detect individuals at risk for adverse mental health responses post-exposure. Distinguishing features of high-stress work conditions can be generalized to other types of work conditions and disaster response and are important targets for planning and preventive efforts.

Three distinct patterns of mental health response following accidents in mountain sports: a follow-up study of individuals treated at a tertiary trauma center

The restorative effect of physical activity in alpine environments on mental and physical health is well recognized. However, a risk of accidents and post-accident mental health problems is inherent to every sport. We aimed to characterize mental health in individuals following mountain sport accidents requiring professional medical management. Adult victims of mountain sport accidents treated at the hospital of the Medical University of Innsbruck (Austria) between 2018 and 2020 completed a cross-sectional survey at least 6 months following the admission (median 44 months, n = 307). Symptoms of post-traumatic stress disorder (PTSD, PCL-5), anxiety, depression, and somatization (PHQ), resilience (RS-13), sense of coherence (SOC-9L), post-traumatic growth (PTGI), and quality of life (EUROHIS-QOL), as well as sociodemographic and clinical information, were obtained from an online survey and extracted from electronic health records. Mental health outcome patterns were investigated by semi-supervised medoid clustering and modeled by machine learning. Symptoms of PTSD were observed in 19% of participants. Three comparably sized subsets of participants were identified: a (1) neutral, (2) post-traumatic growth, and (3) post-traumatic stress cluster. The post-traumatic stress cluster was characterized by high prevalence of symptoms of mental disorders, low resilience, low sense of coherence, and low quality of life as well as by younger age, the highest frequency of pre-existing mental disorders, and persisting physical health consequences of the accident. Individuals in this cluster self-reported a need for psychological or psychiatric support following the accident and more cautious behavior during mountain sports since the accident. Reliability of machine learning-based prediction of the cluster assignment based on 40 variables available during acute medical treatment of accident victims was limited. A subset of individuals show symptoms of mental health disorders including symptoms of PTSD when assessed at least 6 months after mountain sport accident. Since early identification of these vulnerable patients remains challenging, psychoeducational measures for all patients and low-threshold access to mental health support are key for a successful interdisciplinary management of victims of mountain sport accidents.

Maternal Mental Health Responses to COVID-19 Shocks and Uncertainty in Rural Pakistan

In this paper, we investigate the association between a battery of mental health measures and experienced morbidity and mortality due to COVID-19, worry about disease risk, experienced economic shocks, and economic uncertainty about the future. We find that an environment of heightened economic uncertainty might impact mental health above and beyond the effects of realized shocks. A 1 standard deviation increase in economic uncertainty is associated with a 0.223 standard deviation decrease in mental health. This association is strongest among women who were depressed at baseline. We also find that current uncertainty is associated with future economic shocks.

SCOPING REVIEW OF PSYCHOLOGICAL RESEARCH AND PUBLICATIONS RELATED TO THE EFFECTS OF THE COVID-19 PANDEMIC AND THE MEASURES TAKEN

Publications of 21 scientific studies from the field of psychology and psychiatry related to the effects that the spread of COVID-19 has on mental health and the measures taken by mental health professionals to control the negative consequences on the psyche of people are presented. In this regard, the aim of the article is to present a summary of the main subjects in scientific research in the field of mental health. The article differentiates five main problem areas in relation to people's mental health and emotional response to COVID-19: in terms of age; gender differences; personality characteristics; professional activity and behaviour; telepsychiatry and telepsychology. The analysis of the publications shows that the effects can be divided into two categories: short-term and long-term, and in both categories the effects can be positive and negative; the authors emphasize the phenomenology of subjective experiences. Most researchers draw the following conclusions: the COVID-19 pandemic has provoked high levels of stress, mental instability, PTSD, depression, cognitive and neurological disorders; vulnerable groups (elderly people, young people, health professionals, people with mental health problems before the pandemic, homeless people and refugees) have more mental health problems during the pandemic and are slower to recover. Another important conclusion from the 21 studies studied is that it is necessary to formulate recommendations to improve people's mental health, to involve mental health professionals in the development of comprehensive public health policies and to support health care workforce as well as to improve public health prevention strategies, especially during health crises.

Revealing the source: How awareness alters perceptions of AI and human-generated mental health responses

In mental health care, the integration of artificial intelligence (AI) into internet interventions could significantly improve scalability and accessibility, provided that AI is perceived as being as effective as human professionals. This longitudinal study investigates the comparative perceptions of ChatGPT and human mental health support professionals across three dimensions: authenticity, professionalism, and practicality. Initially, 140 participants evaluated responses from both sources without knowing their origin, revealing that AI-generated responses were rated significantly higher across all dimensions. Six months later, the same cohort (n = 111) reassessed these messages with the source of each response disclosed, aiming to understand the impact of source transparency on perceptions and trust towards AI. The results indicate a shift in perception towards human responses, only in terms of authenticity (Cohen's d = 0.45) and reveal a significant correlation between trust in AI and its practicality rating (r = 0.25), but not with authenticity or professionalism. A comparative analysis between blind and informed evaluations revealed a significant shift in favour of human response ratings (Cohen's d = 0.42–0.57), while AI response ratings experienced minimal variation. These findings highlight the nuanced acceptance and role of AI in mental health support, emphasizing that the disclosure of the response source significantly shapes perceptions and trust in AI-generated assistance.

The Effects of the COVID-19 Pandemic on Healthcare Providers' Mental Health: Experiences at Kenyatta National Hospital, Kenya.

In 2020, healthcare providers were expected to provide care to individuals with coronavirus disease 2019 (COVID-19), putting them at risk of acquiring COVID-19. The possibility of acquiring poorly understood infectious diseases while providing care may have an impact on the mental health of providers. We conducted a study to explore the effects of COVID-19 on the mental health of healthcare providers. Between April and August 2021, we conducted in-depth interviews with 60 healthcare providers in the infectious disease unit (IDU) and other units of the hospital (non-IDU). The healthcare providers completed an online self-administered survey form with demographic data (age, sex, average income, and known contact with a COVID-19 patient). We used semi-structured interview guides to understand the healthcare providers' lived experiences of stress, anxiety, depression, and their associated factors. We transcribed the interviews verbatim and coded and analyzed the transcripts to derive thematic concepts related to mental health experiences. The healthcare providers had a median age of 37 years [IQR 20.0-58.0], and 56.7% were female, 30.0% nurses, 18.3% medical doctors, and 11.7% laboratory technologists. The healthcare providers reported increased stress during the pandemic, attributed to the high demand for patient care, changes in social life, and fear of COVID-19 infection. They also reported experiences of anxiety and depression as a result of limited knowledge at the beginning of the pandemic and the perception that "COVID-19 resulted in death". Testing positive for COVID-19, high exposure to COVID-19 risks, and the death of patients and colleagues reportedly affected the healthcare providers' mental health. Additionally, the healthcare providers reported mental health support through debriefing meetings, peer-to-peer support, and psychological counseling, with privacy and confidentiality concerns. Healthcare providers faced mental health issues such as stress and anxiety while taking care of COVID-19 patients. An effective mental health response requires institutional practices that address context-specific challenges such as privacy and confidentiality.

Roles and Dynamics within Community Mental Health Systems During the COVID-19 Pandemic: A Qualitative Systematic Review and Meta-Ethnography

ABSTRACT Globally, COVID-19 had an immense impact on mental health systems, but research on how community mental health (CMH) systems and services contributed to the pandemic mental health response is limited. We conducted a systematic review and meta-ethnography to understand the roles of CMH services, determinants of the quality of CMH care, and dynamics within CMH systems during COVID-19. We searched and screened across five databases and appraised study quality using the CASP tool, which yielded 27 qualitative studies. Our meta-ethnographic process used Noblit and Hare’s approach for synthesizing findings and applying interpretive analysis to original research. This identified several key themes. Firstly, CMH systems played the valuable pandemic role of safety nets and networks for the broader mental health ecosystem, while CMH service providers offered a continuous relationship of trust to service users amidst pandemic disruptions. Secondly, we found that the determinants of quality CMH care during COVID-19 included resourcing and capacity, connections across service providers, customized care options, ease of access, and human connection. Finally, we observed that power dynamics across the CMH landscape disproportionately excluded marginalized groups from mainstream CMH systems and services. Our findings suggest that while the pandemic role of CMH was clear, effectiveness was driven by the efforts of individual service providers to meet demand and service users’ needs. To reprise its pandemic role in the future, a concerted effort is needed to make CMH systems a valuable part of countries’ disaster mental health response and to invest in quality care, particularly for marginalized groups.