Mental Health Treatment Programs Research Articles

Are there differences in the mental health status of adolescents in Puducherry?

The present study assessed the mental health of adolescents in Puducherry, India. This cross-sectional study was conducted on 291 students (121 male and 170 female) in the 14-17year old age group, grades IX and XI. The students were recruited from private, public, co-ed and single sex schools. Along with a Structured Questionnaire, the Mental Health Inventory was administered. We sought to investigate as to whether there would be differences in mental health status of adolescents based on age, class, gender and other demographic variables. There were significant age differences with respect to global mental health, psychological distress, anxiety and loss of behavioural/emotional control. Family type-wise significant differences in global mental health, life satisfaction and loss of behavioural/emotional control were also found. Significant differences were observed with respect to global mental health, psychological well-being, positive effects, psychological distress and depression across socio-economic groups. Number of siblings also accounted for differences in anxiety and emotional ties. However, no significant gender differences were observed across mental health sub-scales. Results suggest the need for promotion of mental health awareness and intervention programs for adolescents, their parents and teachers. There is also a need for advocacy in children and adolescent rights regarding welfare, well-being and protection from violence. The objective is to enhance psychological well-being and reduce psychological distress in students across different social strata.

Risk Factors for Mild Traumatic Brain Injury among US Army Soldiers

The Defense and Veterans Brain Injury Center (2015 DVBIC) reported more than 120,000 mild traumatic brain injury (mTBI) cases since the year 2000 among active duty US Army personnel. Increasing evidence suggests mTBI as a risk factor for development of mental health disorders (MHD) and post-traumatic stress disorder (PTSD). PURPOSE: To determine risk factors for mTBI, PTSD, and MHD and the association of mTBI and non-head injuries with subsequent PTSD and MHD among US Army active duty Soldiers. METHODS: This prospective cohort study utilized the Total Army Injury and Health Outcomes Database (TAIHOD) to analyze soldiers’ (N=1,261,297) medical encounter data between 2002 and 2011. International Classification of Diseases, Ninth Revision [ICD-9] codes were used to identify outcomes of interest: mTBI (CDC surveillance definition for mTBI), PTSD (ICD-9-CM 309.81), and MHD (ICD-9-CM codes to identify depression and anxiety, while excluding the diagnostic code of PTSD [ICD-9-CM 309.81]). Non-head (torso, spine, extremity) injuries were identified by ICD-9-CM codes using the Barell Injury Diagnosis Matrix. RESULTS: From 2002 to 2011 incident mTBI, PTSD, and MHD were found in: 79,505, 71,454, and 285,731 soldiers, respectively. The average injury rate per 1000 soldier years for mTBI, PTSD, and MHD were 17.23, 15.37, and 67.99, respectively. Sustaining a prior (>12 mos.) non-head injury was a significant risk factor for subsequent mTBI (OR 9.82, 95% CI 9.62-10.02). MTBI was associated with increased risk for both subsequent (>12 mos.) PTSD (OR 5.67, 95% CI 5.37-5.98) and MHD (OR 2.99, 95% CI 2.89-3.10). Non-head injury was associated with an increased risk for PTSD (OR 2.15, 95% CI 2.10-2.19) and MHD (OR 2.17, 95% CI 2.15-2.20) to a lesser degree than mTBI. CONCLUSION: Soldiers are at greater risk for developing PTSD and other MHDs for more than a year after an mTBI exposure versus non-head injuries. Identifying populations at risk for mTBI, and those with a previous mTBI exposure, are important consideration for mental health surveillance and intervention programs for both military and civilians. The views, opinions and/or findings contained herein are those of the authors and should not be construed as an official Department of the Army position, or policy.

Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study.

The Korean National Health Insurance, which provides universal coverage for the entire Korean population, is now facing financial instability. Frequent emergency department (ED) users may represent a medically vulnerable population who could benefit from interventions that both improve care and lower costs. To understand the nature of frequent ED users in Korea, we analyzed claims data from a population-based national representative sample. We performed both bivariate and multivariable analyses to investigate the association between patient characteristics and frequent ED use (4+ ED visits in a year) using claims data of a 1% random sample of the Korean population, collected in 2009. Among 156,246 total ED users, 4,835 (3.1%) were frequent ED users. These patients accounted for 14% of 209,326 total ED visits and 17.2% of $76,253,784 total medical expenses generated from all ED visits in the 1% data sample. Frequent ED users tended to be older, male, and of lower socio-economic status compared with occasional ED users (p < 0.001 for each). Moreover, frequent ED users had longer stays in the hospital when admitted, higher probability of undergoing an operative procedure, and increased mortality. Among 8,425 primary diagnoses, alcohol-related complaints and schizophrenia showed the strongest positive correlation with the number of ED visits. Among the frequent ED users, mortality and annual outpatient department visits were significantly lower in the alcohol-related patient subgroup compared with other frequent ED users; furthermore, the rate was even lower than that for non-frequent ED users. Our findings suggest that expanding mental health and alcohol treatment programs may be a reasonable strategy to decrease the dependence of these patients on the ED.

Mental Illness Discrimination in Mental Health Treatment Programs: Intersections of Race, Ethnicity, and Sexual Orientation.

People with mental illnesses (PWMI) who are of color and/or lesbian, gay, or bisexual (LGB) experience mental health disparities, including within mental health treatment programs (MHTPs). Informed by a critical framework with attention to intersectionality and microaggressions, this qualitative study asked 20 PWMI and family members who also are of color and/or LGB whether they had experienced mental illness discrimination in MHTPs, a possible factor in disparities. We also asked participants about aspects of MHTPs that supported recovery. Participants reported that they were ignored/not listened to, not viewed as complex individuals, experienced condescension/lack of respect and violations of privacy or other rights, and were presumed to lack intelligence. In addition, identifying mental illness discrimination was complex due to intersections of identities. Despite these perceptions of discrimination, participants described supportive aspects of MHTPs. Implications for practice and research are offered.

The effects of relocation and level of affectedness on mood and anxiety symptom treatments after the 2011 Christchurch earthquake

In this longitudinal study, we compare the effects of different types of relocation and level of affectedness on the incidence and relapse of mood and anxiety symptom treatments identified by publicly funded care or treatment one year before and one and two years after the ‘2011 Christchurch earthquake’ in New Zealand. Based on a subset of Christchurch residents from differently affected areas of the city identified by area-wide geotechnical land assessments (no to severe land damage) ‘stayers’, ‘within-city movers’, ‘out-of-city movers’ and ‘returners’ were identified to assess the interaction effect of different levels of affectedness and relocation on the incidence and relapse of mood and anxiety symptom treatments over time. Health and sample information were drawn from the New Zealand Ministry of Health's administrative databases allowing us to do a comparison of the pre-/post-disaster treatment status and follow-up on a large study sample.Moving within the city and returning have been identified as general risk factors for receiving care or treatment for mood or anxiety symptoms. In the context of the 2011 Christchurch earthquake, moving within the city showed a protective effect over time, whereas returning was a significant risk factor in the first post-disaster year. Additionally, out-of-city movers from minor, moderately or severely damaged Christchurch's plain areas were identified as especially vulnerable two years post-disaster. Generally, no dose-response relationship between level of affectedness and mood or anxiety symptom treatments was identified, but the finding that similarly affected groups from the city's plain areas and the more affluent Port Hills showed different temporal treatment trends highlights the importance of including socio-economic status in exposure assessment. High-risk groups included females, older adults and those with a pre-existing mental illness. Consequently, mental health intervention programs should target these vulnerable groups, as well as out-of-city movers from affected areas in the long run.

Global mental health and trauma exposure: the current evidence for the relationship between traumatic experiences and spirit possession

BackgroundWe present a literature review on trauma exposure and spirit possession in low- and middle-income countries (LMICs). Despite the World Health Organization's objective of culturally appropriate mental health care in the Mental Health Action Plan 2013–2020, and the recommendations of the Inter-Agency Standing Committee to consider local idioms of distress and to collaborate with local resources, this topic still receives very little attention. Pathological spirit possession is commonly defined as involuntary, uncontrollable, and occurring outside of ritual settings. It is often associated with stigmatization, suffering, and dysfunctional behavior. While spirit possession has been discussed as an idiom of distress in anthropological literature, recent quantitative studies have presented support for a strong relationship between traumatic experiences and pathological possession states.ObjectiveThe aim of this review was to investigate this relationship systematically in LMICs, in view of the debate on how to address the mental health gap in LMICs.MethodsTwenty-one articles, published in peer-reviewed English-language journals between 1994 and 2013, were identified and analyzed with regard to prevalence of possessive trance disorders, patients’ sociodemographic characteristics, and its relation to traumatic experiences.ResultsThe review and analysis of 917 patients with symptoms of possessive trance disorders from 14 LMICs indicated that it is a phenomenon occurring worldwide and with global relevance. This literature review suggests a strong relationship between trauma exposure and spirit possession with high prevalence rates found especially in postwar areas in African countries.ConclusionsMore attention for possessive trance disorders in mental health and psychosocial intervention programs in humanitarian emergency settings as well as in societies in transition in LMICs is needed and justified by the results of this systematic literature review.

The Trauma Risk Management Approach to Post-Traumatic Stress Disorder in the British Military: Masculinity, Biopolitics and Depoliticisation

This paper discusses the political implications of the British military's Trauma Risk Management (TRiM) approach to personnel suffering from combat-related mental debilities such as post-traumatic stress disorder. Drawing on narratives that emerged from qualitative interviews with trained TRiM practitioners and military welfare workers, I tease out some of the assumptions and beliefs about mental health and mental illness that underpin this mental health intervention programme. I explore TRiM as a biopolitical strategy targeted towards the construction of a particular conceptualisation of mental wellness and militarised masculine personhood. As a biopolitical strategy, I argue that TRiM plays an important role in the construction of ideas around mental well-being and mental frailty that best enable the operation of military power in the contemporary British context. I discuss the narrative of transformation in militarised models of masculinity that emerge from discussions of TRiM, and highlight the important political function that this plays in enabling and legitimating militarism. Finally, I draw attention to the ways in which the focus on individual and cultural factors, rather than war as the primary cause of difficulties for servicemen experiencing psychological distress, functions to neutralise the potential trouble that could be instigated for the British military by the bodies of servicemen psychologically damaged by their experiences of conflict.

Race, Education and Positive Perception towards Mental Health Treatments

Gunumuzde isletmelerde orgutsel adalet ve is tatminin saglanmasi onem tasimaktadir. Orgutsel adaletin saglandigi isletmelerde calisanlarin is tatmini, performansi ve dolayisiyla kurumsal performans bundan etkilenmektedir. Bu arastirmanin amaci; orgutsel adalet ve is tatmini arasindaki iliskiyi istatistiksel yontemlerle arastirmaktir. Bu amacla Izmit’te bulunan iki firmanin calisanlari arsindan tesadufi olarak secilen 181 kisiye orgutsel adalet ve is tatmini olcekleri uygulanmistir. Anket sonuclari SPSS 22 programina girilerek degerlendirilmistir. Orgutsel adalet ve is tatmini olcekleri arasindaki iliskiyi arastirmak icin yapilan korelasyon analizi sonucunda orgutsel adalet ve calisanlarin is tatmini arasinda pozitif yonlu anlamli bir iliski tespit edilmistir.

Characteristics of Older Adults With Serious Mental Illness Enrolled in a Publicly Funded In-Home Mental Health Treatment Program

In-home mental health services for older adults will likely become increasingly utilized as the population ages. Little is known about older adults with serious mental illness who receive in-home services through the public mental health system. This study examined the demographic and clinical characteristics of this population. A total of 148 clients were included. Mood disorders were present in 75.7% and schizophrenia spectrum disorders were present in 23.6%. A history of problematic substance use was documented in 47.3% of clients and 31.8% reported suicidal ideation prior to enrollment. A total of 25% of clients utilized psychiatric emergency services during the year prior to enrollment and 15.5% of clients were hospitalized for psychiatric treatment. Older adults who receive in-home mental health services are vulnerable and have complex treatment needs.

Emotional Intelligence of Youth Accessing Residential and Day Treatment Programs: Association with Psychological and Interpersonal Difficulties

Background: Youth with emotional and behavioural problems often experience ongoing mental health challenges placing them at risk for less than optimal attainment of scholastic and occupational goals. Emotional intelligence (EI) has consistently been associated with good mental health (Martins et al.). The purpose for this study was to explore EI in a sample of youth with emotional and behavioural problems severe enough to warrant residential or day treatment. A second purpose was to explore the relationship of EI with psychological and interpersonal difficulties. Methods: Cross-sectional surveys were administered to youth accessing residential and day mental health treatment programs. Results: Thirty youth (mean age 15.30 years, SD1.64; 70% female) reported low Global EI (Total sum 123.00, SD 22.4), and interpersonal problems was strongly correlated with EI. Conclusion: Youth accessing intensive mental health services reported low emotional intelligence and problems with interpersonal relationships. Implications for focusing research and intervention efforts on fostering interpersonal social skills that may improve youths' quality of their relationships and emotional intelligence are discussed.

Dropout prediction in a public mental health intervention for sub-threshold and mild panic disorder

AbstractDropout is a common and serious problem in psychological research and practice. When participants terminate treatment prematurely, this may have methodological and clinical consequences. The aim of this study was to identify predictors of dropout in a sample of patients (N = 217) with sub-threshold and mild panic disorder treated with a public mental health intervention programme based on cognitive-behavioural principles. Three groups of possible baseline predictors were selected from the literature: (1) socio-demographic, (2) personal, and (3) illness-related variables. A total of 51 (23.5%) participants were classified as dropouts. Dropouts were further subdivided into pretreatment dropouts (n = 17) who attended no course sessions at all and regular dropouts (n = 34) who attended 1–5 course sessions. Multivariable logistic regression analyses were used to identify independent predictors of dropout. Few variables were significantly associated with increased odds of dropout and the total explained variance was small. Fewer years of education was the only independent predictor of total dropout and male gender was associated with more pretreatment dropout. No independent predictors were found for regular dropout. It can be concluded that it is difficult to precisely predict dropout risk in patients participating in a public mental health intervention for panic symptoms.

Anxiety Sensitivity in Patients with Alcohol Dependence: A Cross-Sectional Case-Control Study

Anxiety Sensitivity (AS) is a cognitive risk and maintenance factor for anxiety disorders, and it consists of three dimensions: Physical concerns, Cognitive concerns, and Social concerns. No study has investigated the role of AS in individuals with Alcohol-Dependence (A-D), comparing a group of patients with Alcohol-Dependence (A-D) to patients with Anxiety Disorders (AD) and healthy individuals on AS dimensions. Specific dimensions of AS might play a role as cognitive vulnerability and maintenance factors also for A-D-related problems. Examination of AS in patients with A-D might inform clinical practice and public health policy suggesting the integration of treatments specifically targeting AS in A-D patients. The current study aimed to explore the relationship between AS dimensions and A-D. One hundred twenty-five participants, including patients with a diagnosis of A-D (n= 35), patients with a diagnosis of any Anxiety Disorder (AD) (n= 40) and healthy individuals as a control group (CG) (n= 50) completed the ASI-3, STAI-Y and BDI-II. After controlling for anxious traits, A-D patients had stronger Social concerns. Physical and Cognitive concerns appeared, however, significantly more severe among the AD group than the other two groups. Given the strong association between Social concerns and A-D, treatments for A-D patients should also target Social concerns. Study limitations, implications for mental health policy and intervention programs are addressed.

Mental health literacy of resettled Iraqi refugees in Australia: knowledge about posttraumatic stress disorder and beliefs about helpfulness of interventions.

BackgroundResettled refugees are a particularly vulnerable group. They have very high levels of mental health problems, in particular, trauma-related disorders, but very low uptake of mental health care. Evidence suggests that poor “mental health literacy”, namely, poor knowledge and understanding of the nature and treatment of mental health problems is a major factor in low or inappropriate treatment-seeking among individuals with mental health problems. This study used a culturally adapted Mental Health Literacy Survey method to determine knowledge of, and beliefs about, helpfulness of treatment interventions and providers for posttraumatic stress disorder (PTSD) amongst resettled Iraqi refugees.Methods225 resettled Iraqi refugees in Western Sydney attending the Adult Migrant English Program (AMEP), federally funded English language tuition, were surveyed. A vignette of a fictional character meeting diagnostic criteria for PTSD was presented followed by the Mental Health Literacy Survey. PTSD symptomology was measured using the Harvard Trauma Questionnaire part IV (HTQ part IV), with Kessler Psychological Distress Scale (K10) used to measure levels of general psychological distress.ResultsOnly 14.2% of participants labelled the problem as PTSD, with “a problem with fear” being the modal response (41.8%). A total of 84.9% respondents indicated that seeing a psychiatrist would be helpful, followed by reading the Koran or Bible selected by 79.2% of those surveyed. There was some variation in problem recognition and helpfulness of treatment, most notably influenced by the length of resettlement in Australia of the respondents.ConclusionsThese findings have important implications for the design and implementation of mental health promotion and treatment programs for resettled refugees and those who work with them.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0320-x) contains supplementary material, which is available to authorized users.

The importance of an Occupational-based Family Therapy in mental health: a survey study of occupational therapists’ perspectives

A new mental health intervention program – Occupationalbased Family Therapy (OFT), was designed following a survey of 116 occupational therapists in various fields in a health organization in Israel. The survey was used to identify the nature of family interventions used by occupational therapists, the attitudes regarding family involvement in therapy and the new intervention program, OFT. Survey results indicated that mental health occupational therapists have the lowest implementation of family intervention and the highest need and desire for change. In light of the findings the new program OFT in mental health was developed. The OFT was designed to combine systemic family therapy and occupational therapy principles. The program engages the entire family and includes joint family tasks. Application of the OFT is discussed.

The Effect of Maternal Depression on Young Children’s Progress in Treatment

This study examined the effect of maternal depression on the functioning of young, primarily Latino children (birth to 5) in an inner-city mental health treatment program designed for children involved or at risk of involvement with the child welfare system. Children and their mothers were evaluated at entry into the program and at 6-month intervals while in treatment. Maternal depression, child behavior problems, and child development were all measured. At entry into the program, children (n = 194) whose mothers were depressed had higher levels of behavior problems and poorer development. Boys had more problems than girls. A growth curve model of those with more than one measurement point (n = 147) found that although all children improved with treatment, children whose mothers were depressed improved more slowly than children whose mothers were not depressed. Findings support the negative impact of maternal depression on children’s progress in treatment.

Rural-urban differences in mental health, resilience, stigma, and social support among young Australian gay men.

Depression and anxiety are common among young gay men, particularly in comparison with their heterosexual counterparts. Little is known about the mental health and well-being of those living in rural areas, where access to support and opportunities for connecting with other gay men may be relatively limited. We examined differences in the well-being of young rural and urban Australian gay men, including mental health, resilience, stigma-related challenges, and social support. A national online survey was conducted involving 1,034 Australian gay-identified men aged 18-39 years. All analyses adjusted for sociodemographic differences between the rural and urban samples. On average, rural men had significantly lower self-esteem, lower life satisfaction, lower social support, and were significantly more likely to be psychologically distressed, concerned about acceptance from others, and to conceal their sexual orientation compared to urban gay men. While resilience among the rural group was lower, this was no longer significant following sociodemographic adjustment. An examination of psychosocial predictors of psychological distress in the rural sample revealed that lower education and lower tangible support independently predicted greater distress. Young rural Australian gay men appear to be at a considerable disadvantage with regard to mental health and well-being compared with their urban counterparts, and they may need particular attention in mental health prevention and treatment programs.

Children’s reactions to the 2010 Chilean earthquake: The role of trauma exposure, family context, and school-based mental health programming.

Theoretically derived factors (preexisting child characteristics, trauma exposure, caregiver–child relationship, and school-based mental health programming) were examined as potential correlates of distress in children residing in the region closest to the epicenter of the 2010 Chilean earthquake. One year before the earthquake, 2nd-grade students who attended 9 schools that provide government-run mental health intervention programs were assessed via parent and teacher reports for pre-intervention psychosocial difficulties. Between 3–6 months after the earthquake, a preexisting non-trauma focused, school-based intervention was delivered. Approximately 9 months post-earthquake, 117 of these children (randomly selected; mean age 7.59), were interviewed about their experiences during the earthquake and their subsequent psychological responses. Children were exposed to multiple disaster-related traumatic events (M 4.90; SD 1.78); most reported posttraumatic stress (PTS) symptoms and 25.6% met criteria for the Diagnostic and Statistical Manual of Mental Disorders-defined (DSM–IV-TR; APA, 2000) probable PTSD. Female gender and exposure to violent, injurious, or death-related postdisaster traumas were correlated with PTS symptoms. Children’s reports of characteristics of the home environment (conflict with their caregiver, caregiver unavailability to discuss the earthquake) were positively associated with PTS symptoms. Children’s perceptions of caregiver unavailability to discuss the earthquake were associated with higher ongoing earthquake-related worry. Participation in the mental health intervention was associated with significantly lower earthquake-related worry and appeared to protect at-risk youth from elevated PTS symptomatology. Results suggest that participation in school-based mental health programs may be protective for children postdisaster and a negative family environment may be associated with increased postdisaster distress. Implications and potential applications of findings are discussed.

Discrimination, arrest history, and major depressive disorder in the U.S. Black population

Everyday discrimination contributes negatively to depressive symptomatology among Blacks in the US and being arrested could add to this depression. Using data from the National Survey on American Life, the present study determined the association between an arrest history and major depressive disorder (MDD), while accounting for discrimination among African Americans, US-born Afro-Caribbeans and first-generation Black immigrants. Findings from logistic regression analyses adjusted for discrimination suggested an arrest history is associated with 12-month MDD (Adjusted OR=1.47; 95% CI=1.02–2.10) and lifetime MDD (Adjusted OR=1.56 CI=1.17–2.09). Accounting for drug and alcohol dependence attenuated the association between arrest history and 12-month MDD, but not lifetime MDD. The associations between arrest history and both 12-month and lifetime MDD, and discrimination and lifetime MDD varied by ethnic/immigrant group. Specifically, while the association between arrest history and MDD (both 12-month and lifetime) was strongest among US-born Afro-Caribbeans, evidence consistent with the immigrant paradox, the association between discrimination and lifetime MDD was particularly relevant for first-generation Black immigrants, suggesting discrimination may hinder the protection of first-generation status. Mental health prevention and treatment programs should target the stress associated with being arrested and experiencing discrimination among US Blacks.

Profile of children placed in residential psychiatric program: Association with delinquency, involuntary mental health commitment, and reentry into care.

This study examined characteristics and profiles of youth receiving services in 1 of Florida's Medicaid-funded residential mental health treatment programs--State Inpatient Psychiatric Program (SIPP)--between July 1, 2004, and June 30, 2008 (N=1,432). Latent class analysis (LCA) was used to classify youth, and 3 classes were identified: Children With Multiple Needs, Children With No Caregivers, and Abused Children With Substantial Maltreatment History. The results of LCA showed that Children With Multiple Needs experienced the greatest risk for adverse outcomes. Compared with youth in the other 2 classes, these children were more likely to get readmitted to SIPP, more likely to become involved with the juvenile justice system, and more likely to experience involuntary mental health assessments. Implications of the findings are discussed.

The role of common mental and physical disorders in days out of role in the Iraqi general population: Results from the WHO World Mental Health Surveys

In an effort to support mental health policy planning efforts in conjunction with the reconstruction of Iraq, a nationally representative face-to-face household survey was carried out that assessed the prevalence and correlates of common mental disorders in the Iraqi population. A total of 4332 adult (ages 18+) respondents were interviewed (95.2% response rate). The current report presents data on the role impairments (number of days out-of-role in the past 30 days) associated with the nine mental disorders assessed in the survey in comparison to the impairments associated with ten chronic physical disorders also assessed in the survey. These disorders were all assessed with the WHO Composite International Diagnostic Interview. Days out-of-role were assessed with the WHO Disability Assessment Schedule. Both individual-level and societal-level effects of the disorders were estimated. Strongest individual-level predictors were bipolar and drug abuse disorders (176–195 days per year), with mental disorders making up five of the seven strongest predictors. The strongest population-level predictors were headache/migraine and arthritis (22–12% population proportions). Overall population proportions were 57% of days out-of-role due to the chronic physical disorders considered here and 18% for the mental disorders. Despite commonly-occurring mental disorders accounting for more individual-level days out-of-role than the physical disorders, mental disorders are much less likely to receive treatment in Iraq (e.g., due to stigma). These results highlight the need for culturally tailored mental health prevention and treatment programs in Iraq.