Mental Health Research Project Research Articles

Design of a Remote Multiparametric Tool to Assess Mental Well-Being and Distress in Young People (mHealth Methods in Mental Health Research Project): Protocol for an Observational Study.

Mental health conditions have become a substantial cause of disability worldwide, resulting in economic burden and strain on the public health system. Incorporating cognitive and physiological biomarkers using noninvasive sensors combined with self-reported questionnaires can provide a more accurate characterization of the individual's well-being. Biomarkers such as heart rate variability or those extracted from the electrodermal activity signal are commonly considered as indices of autonomic nervous system functioning, providing objective indicators of stress response. A model combining a set of these biomarkers can constitute a comprehensive tool to remotely assess mental well-being and distress. This study aims to design and validate a remote multiparametric tool, including physiological and cognitive variables, to objectively assess mental well-being and distress. This ongoing observational study pursues to enroll 60 young participants (aged 18-34 years) in 3 groups, including participants with high mental well-being, participants with mild to moderate psychological distress, and participants diagnosed with depression or anxiety disorder. The inclusion and exclusion criteria are being evaluated through a web-based questionnaire, and for those with a mental health condition, the criteria are identified by psychologists. The assessment consists of collecting mental health self-reported measures and physiological data during a baseline state, the Stroop Color and Word Test as a stress-inducing stage, and a final recovery period. Several variables related to heart rate variability, pulse arrival time, breathing, electrodermal activity, and peripheral temperature are collected using medical and wearable devices. A second assessment is carried out after 1 month. The assessment tool will be developed using self-reported questionnaires assessing well-being (short version of Warwick-Edinburgh Mental Well-being Scale), anxiety (Generalized Anxiety Disorder-7), and depression (Patient Health Questionnaire-9) as the reference. We will perform correlation and principal component analysis to reduce the number of variables, followed by the calculation of multiple regression models. Test-retest reliability, known-group validity, and predictive validity will be assessed. Participant recruitment is being carried out on a university campus and in mental health services. Recruitment commenced in October 2022 and is expected to be completed by June 2024. As of July 2023, we have recruited 41 participants. Most participants correspond to the group with mild to moderate psychological distress (n=20, 49%), followed by the high mental well-being group (n=13, 32%) and those diagnosed with a mental health condition (n=8, 20%). Data preprocessing is currently ongoing, and publication of the first results is expected by September 2024. This study will establish an initial framework for a comprehensive mental health assessment tool, taking measurements from sophisticated devices, with the goal of progressing toward a remotely accessible and objectively measured approach that maintains an acceptable level of accuracy in clinical practice and epidemiological studies. OSF Registries N3GCH; https://doi.org/10.17605/OSF.IO/N3GCH. DERR1-10.2196/51298.

Reasons for non-participation of children and adolescents in a large-scale school-based mental health project.

Non-participation in mental health studies is an under-explored but very important topic. Investigating reasons for non-participation holds promise for the planning of future study designs and recruitment strategies. This study aimed at investigating reasons for children and adolescents (C&A) not participating in a school-based mental health research project. Data collection took place within the school-based recruitment of a large-scale multi-site project ("ProHEAD-Promoting Help-seeking using E-technology for Adolescents") in Germany. Participants were N = 534 C&A aged ≥ 12 years attending secondary schools. The present cross-sectional study analyzed anonymous survey data of C&A who themselves or whose parents, respectively, did not provide written consent to participate in the mental health research project. The questionnaire consisted of 14 items covering potential reasons for non-participation, and four free text fields. Besides descriptive statistics, free text field answers were analyzed using qualitative content analysis. Students indicated an average of M = 2.94 (SD = 1.75) reasons for their non-participation in the project. In the descriptive analysis of indicated items, the three most frequently reported reasons for non-participation included students reporting to not be concerned by the topic "mental health" (n = 290, 54.3%), not having returned the consent form to the teacher (n = 175, 32.8%), and not having time for participation (n = 149, 27.9%). In the qualitative content analysis, the most frequently assigned categories were organizational reasons (n = 216, 57.1%), general disinterest in study participation (n = 139, 36.8%), and personal attitudes toward the topic "mental health" (n = 84, 22.2%), such as not being concerned with the topic "mental health" (n = 23, 6.1%) or being too concerned with the topic "mental health" (n = 16, 4.2%). The study provides unique insights into reasons for C&A and their caregivers not participating in a large federally funded mental health research project. The results suggest that in order to increase participation rates, stigma should be reduced, parents as well as teachers should be involved where possible, and the use of incentives might be helpful. The study highlights the importance of assessing reasons for non-participation, especially in online intervention studies on mental health.

The three-factor structure of the Autism-Spectrum Quotient Japanese version in pregnant women.

There is a rising interest in perinatal mental health studies, and proper psychometric tools to assess autistic traits among this population in Japan are vital. This study aimed to clarify the optimal factor structure of the AQ as part of a perinatal mental health research project. We used the Japanese version of the AQ (AQ-J) to measure autistic-like traits in pregnant women. Participants were 4,287 Japanese women who were pregnant or who had given birth within the last month. We performed exploratory factor analysis (EFA) using the first sample group (n = 2,154) to obtain factor structures for the final item selections. We performed confirmatory factor analysis (CFA) using the second sample group (n = 2,133) to obtain a model with good fit, then compared the model to all previously proposed models to determine the best-fitting model. The EFA analysis identified a model consisting of 25 items distributed across three factors. Cronbach's alpha for the total 25-item AQ-J, 9-item "Social interaction" factor, 11-item "Non-verbal communication" factor, and 5-item "Restricted interest" factor was 0.829, 0.829, 0.755, and 0.576, respectively. McDonald's omega and its 95% confidence interval were 0.826 (0.821-0.836), 0.835 (0.821-0.837), 0.755 (0.744-0.766), and 0.603 (0.556-0.596), respectively. CFA confirmed that the three-factor structure had an acceptable fit (goodness of fit index: 0.900, comparative fit index: 0.860, root mean square error of approximation: 0.066). These findings indicated that the three-factor model was better than the 13 existing models. The findings are discussed in relation to the adequacy of the AQ-J for assessing autistic traits in perinatal women. We recommend the use of this 25-item, three-factor AQ-J model for this population owing to its superiority to all previous models.

"Ngany Kamam, I Speak Truly": First-Person Accounts of Aboriginal Youth Voices in Mental Health Service Reform.

Aboriginal young people are experts in their own experience and are best placed to identify the solutions to their mental health and wellbeing needs. Given that Aboriginal young people experience high rates of mental health concerns and are less likely than non-Indigenous young people to access mental health services, co-design and evaluation of appropriate mental health care is a priority. Increasing Aboriginal young people's participation in mental health service reform is key to ensuring services are culturally secure, relevant and accessible. This paper presents first-person accounts from three Aboriginal young people who worked alongside their Elders and in a positive and constructive partnership with mainstream mental health services on a three-year participatory action research project in Perth, Western Australia, in Whadjuk Nyoongar boodja (Country). The young people recount their experiences as participants and co-researchers on a systems change mental health research project and share their views on the importance of privileging Aboriginal youth voices. Their accounts highlight that Aboriginal young people's participation and leadership must be understood through a decolonising lens and that working in genuine partnership with the community is key to increasing their contact and engagement with mental health care and improving mental health and wellbeing outcomes.

Experiences of patients advising on mental health research: qualitative study in South-East European countries

Background Although patient and carer involvement in research is well-developed in many countries, this area has been largely overlooked in South-East European countries. Aims To explore experiences of patients participating in newly set up lived experience advisory panels (LEAPs) within a European Commission funded, large-scale, multi-country mental health research project that focused on improving treatment of individuals with psychosis. Method Twenty-one mental health patients were individually interviewed across five countries: Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia. Topic guides covered the experience of participating in LEAPs and their sustainability. Data were analysed by framework analysis. Results Seven themes were identified about participating in LEAPs: predominantly positive evaluation, high levels of participant motivation, therapeutic benefits for participants, few challenges, various future perspectives, positive appraisal of the research project and mixed reflections on mental healthcare. Overall, patients’ experiences were positive and enabled them to feel empowered. Patients expressed interest in remaining involved in advisory panels. Additionally, they felt that they could potentially contribute to the work of non-government organisations. Conclusions This study is among the few studies exploring patient participation in research projects, and the first such study conducted in South-East European countries. Patients are highly motivated for this engagement, which has the potential to empower them to take on new social roles. Significant efforts at the national level are needed in each country, to make patient involvement in research standard practice.

Improving mental health and psychosocial wellbeing in humanitarian settings: reflections on research funded through R2HC

Major knowledge gaps remain concerning the most effective ways to address mental health and psychosocial needs of populations affected by humanitarian crises. The Research for Health in Humanitarian Crisis (R2HC) program aims to strengthen humanitarian health practice and policy through research. As a significant portion of R2HC’s research has focused on mental health and psychosocial support interventions, the program has been interested in strengthening a community of practice in this field. Following a meeting between grantees, we set out to provide an overview of the R2HC portfolio, and draw lessons learned. In this paper, we discuss the mental health and psychosocial support-focused research projects funded by R2HC; review the implications of initial findings from this research portfolio; and highlight four remaining knowledge gaps in this field. Between 2014 and 2019, R2HC funded 18 academic-practitioner partnerships focused on mental health and psychosocial support, comprising 38% of the overall portfolio (18 of 48 projects) at a value of approximately 7.2 million GBP. All projects have focused on evaluating the impact of interventions. In line with consensus-based recommendations to consider a wide range of mental health and psychosocial needs in humanitarian settings, research projects have evaluated diverse interventions. Findings so far have both challenged and confirmed widely-held assumptions about the effectiveness of mental health and psychosocial interventions in humanitarian settings. They point to the importance of building effective, sustained, and diverse partnerships between scholars, humanitarian practitioners, and funders, to ensure long-term program improvements and appropriate evidence-informed decision making. Further research needs to fill knowledge gaps regarding how to: scale-up interventions that have been found to be effective (e.g., questions related to integration across sectors, adaptation of interventions across different contexts, and optimal care systems); address neglected mental health conditions and populations (e.g., elderly, people with disabilities, sexual minorities, people with severe, pre-existing mental disorders); build on available local resources and supports (e.g., how to build on traditional, religious healing and community-wide social support practices); and ensure equity, quality, fidelity, and sustainability for interventions in real-world contexts (e.g., answering questions about how interventions from controlled studies can be transferred to more representative humanitarian contexts).

PhotoVoice: An Ideal Methodology for Use within Recovery-Oriented Mental Health Research

At the heart of recovery-orientated mental health care and the Patient and Public Involvement (PPI) movement, is the inclusion of experts by experience as collaborators on mental health research projects. However, embedding Public and Patient Involvement (PPI) can be challenging in academic institutions that have long-standing researcher-as-expert structures in place. PhotoVoice is a collaborative, participant-centric community-based methodology that has potential to overcome some of the challenges encountered within Public and Patient Involvement (PPI). This discursive paper describes what PhotoVoice is, why it was developed, it’s application in research and its alignment to recovery principles. Thereby arguing that PhotoVoice is an ideal methodology for use within recovery-orientated research.

Shared Decision Making in a Youth Mental Health Service Design and Research Project: Insights From the Pan-Canadian ACCESS Open Minds Network.

Shared decision making (SDM) is the process by which health care providers and patients collaborate to make health care decisions. This collaboration leads to informed decision making and improved outcomes. However, research on SDM specific to the field of youth mental health is scarce. ACCESS Open Minds (ACCESS OM) is a youth mental health research and evaluation project that implemented and evaluated SDM practices within its various activities and operations. The ACCESS OM network spans a diversity of youth mental health settings across Canada, and includes various stakeholders such as youth, family members and carers, clinicians, researchers, and policy makers. The project values all types of knowledge (specifically, experiential, cultural, clinical, and scientific knowledge) as necessary to lead to better health research, care delivery, and outcomes for patients and their communities. Similarly, it acknowledges the lived experience of patients and, family and carers as expertise. Through the integration of SDM practices, ACCESS OM has formulated valuable insights that can be applied to other health problems and settings. This paper, written by youth and family council members, operational staff, and researchers from the project, will share challenges and solutions that arose in the integration of SDM practices within ACCESS OM’s knowledge translation strategy, governance structures, clinical contexts, and capacity-building initiatives.Video abstract Shared Decision Making in a Youth Mental Health Service Design and Research Project: Insights From the Pan-Canadian ACCESS Open Minds Network (MP4  234838 kb)Electronic supplementary materialThe online version of this article (10.1007/s40271-020-00444-5) contains supplementary material, which is available to authorized users.

Pharmaceutical industry, academia and people with experience of mental illness as partners in research: a need for ethical guidance

Background: Several social and policy developments have led to research partnerships in mental health research, which depart from traditional research models. One form of such partnerships is among research institutions, industry (pharmaceutical and biotech) and people with lived experience of mental illness (RIPs). There are several benefits but also ethical challenges in RIPs. An ethics-based approach to anticipating and addressing such ethical issues in mental health research is lacking. Given the expansion of RIPs in treatment development for mental health illness, guidance to support ethical and trustworthy collaborative mental health research projects is essential. Methods: To develop a moral framework for evaluating the ethics of RIPs, we systematically searched PubMed for peer-reviewed literature discussing good practices in research partnerships. Searches were also conducted in websites of known organizations supporting patient engagement with industry in mental health research and in the references of short-listed articles. Following application of exclusion criteria, remaining articles were critically examined and summarised to synthesise principles for ethically acceptable RIPs and inform clear guidance and practices. Results: Critical analysis and synthesis of the short-listed articles highlighted the need for two sets of principles to guide ethical RIPs: principles for (a) RIPs as a trustworthy enterprise (e.g. public accountability, transparency) and (b) fair RIPs (e.g. effective governance, respect). We discuss the application of these principles in problem-solving strategies that can support best practice in establishing fair and successful mental health research partnerships among research institutions, industry and people with lived experience of mental illness. Conclusions: Ethical guidance is needed to prevent and address challenges in RIPs and to promote the scientific and social benefits of these new research partnership models in mental health research. We show how the proposed moral framework can guide research partners in designing, sustaining and assessing ethical and trustworthy collaborative mental health research projects.

Addressing Inequities in Indigenous Mental Health and Wellbeing through Transformative and Decolonising Research and Practice

Aim: This paper discusses the current mental health and social and emotional wellbeing in Indigenous Australian mental health and wellbeing, the gaps in research, the need for transformative and decolonising research and practice, and the opportunities and recommendations to address existing mental health inequities. Method: This paper reviews key mental health and social and wellbeing policy documents and frameworks, and examines relevant literature documenting current decolonising strategies to improve programs, services and practice. It also draws on the key findings of the Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP) and Transforming Indigenous Mental Health and Wellbeing research projects. In addition this work builds on the substantial work of the national Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) which outlines a range of solutions to reduce the causes, prevalence, and impact of Indigenous suicide by identifying, translating, and promoting the adoption of evidenced based best practice in Indigenous specific suicide prevention activities. Discussion and Conclusion: This paper details the challenges as well as the promise and potential of engaging in transformative and decolonising research and practice to address the existing health service inequities. Acknowledging and addressing these health inequities is an urgent and critical task given the current COVID-19 pandemic and potential for further increasing the adverse mental health and wellbeing gap for Indigenous Australians.

Young people and an NHS participation worker reflect on their involvement in a creative, collaborative mental health research project

Most UK child and adolescent mental health services (CAMHS) support young people up to the age of 17/18, at which point they are discharged, or transition to an adult service. This transition is often difficult for young people, as they also face the complex physical and psychosocial changes of adolescence. Transition from CAMHS is often poorly managed, with negative outcomes for young people. Improved preparation may improve both outcomes and experience. We worked with 17 young people and staff from three NHS mental health foundation trusts to co-produce the CAMHS Transition Preparation Programme (TPP), deliverable in routine NHS settings. We took a creative, participatory approach to maximize young people's involvement in the research. Young people steered the direction of the work, and were involved in decision-making and dissemination both nationally and within their trusts. In this commentary, two young participant–researchers and one NHS staff member describe the project from their perspectives.

Integrated health and Social Care Project – Mental Health

Project Title: Integrated Care Models in Mental Health Research Project: Self assessment of an Integrated NHS Trust; National Perspective Challenges and Opportunities survey; & Small Scale Front Line Practitioners' Research Projects.Mersey Care NHS Trust has been successful in becoming an NHS North West Education Integrated Care Demonstrator site. The project considered the effectiveness of social care values, principles, role, functions, and delivery within an integrated Mental Health setting by engaging the workforce, partners, commissioners and service user/carers. The aim of the project was to elicit a considered, informed and collective value judgement from participants (here service users, carers, social workers, other professionals and managers) on the effectiveness of mental health social work in an integrated setting.The project ran between April to November 2015 and aimed to capture confidence in the role of mental health social work interventions, thinking and approaches in integrated settings, including understanding and working with social networks and communities.The project objectives included strengthening the evaluation which has already been started in the Trust, from an objective viewpoint and to explore and build an evidence base for integrated working which is then to be disseminated across other integrated mental health services. Also considered was the effectiveness of social care values, principles and delivery within an integrated mental health setting by engaging the workforce, partners, third sector, commissioners and service users.The Project has three research project activities:Research Activity One: Evaluating Mersey Care NHS Trust’s Mental Health Social Work Integrated Support & Development programme1. To complete a review of the literature in relation to mental health social work in integrated settings in the context of development and training needs2. Review and compare local policies, standards and social work workforce developments with the current literature in relation to mental health social work in integrated settings3. Compare the views of practitioners and people who access services with what is found in the literature to evaluate the effectiveness of Mersey Care’s modelFive deliberative sessions were held; three with professionals and two service users and carers. Each group was provided with a summary of what had been found in the literature review about what constitutes ‘good’ mental health social work in integrated setting which was.Research Activity 2: Small Scale Frontline Research ProjectsIn additional to the main body of the learning, the project also supported a number of small scale practitioner research projects. Seven studies were undertaken to provide contemporary evidence based and practitioners led. Topics included: Parity between physical & mental health; safeguarding adults/children; multidisciplinary working with asylum seekers; and whole system approach to trauma informed care.Research Activity 3: National Survey What Makes Integration Sustainable In Mental HealthThe aim of this strand of the project was to explore why integration within mental health services between health and social care has been sustained in certain mental health trusts whilst in others integration has not.The learning from each of the three research activities formed the basis of a portfolio containing reports and recommendations that provided a detailed understanding of best practice in relation to integrated working in mental health. The process provided learning that was able to identify good practice in the existing models of integration in the context of current policies and identify gaps and develop strategies for strengthening the integration model in Mental Health.Community Care Magazine has already published an article about the project findings and their significant relevance to professional and organisational development and practice. Link below:http://www.communitycare.co.uk/2016/02/05/care-act-increasing-tensions-nhs-trusts-social-worker-integration/Mersey Care is now a pilot site to test out a number of products developed by the Department of Health and the College of Social Work. Details below:Three resources were released together in February 2016- ‘Social work for better mental health’ The Strategic Statement- ‘How are we doing?’ An organisational and workforce self-assessment resource for implementation of the College role categories- ‘Making the difference’: A framework for direct service user and carer feedback and collaboration to promote high quality social work in mental healthFinally the project findings will support the government national integration policy including the Healthy Liverpool Scheme which is an excellent programme bringing clinical commissioners, providers and the Local Authority to work hard together to rebalance the healthcare system in Liverpool with greater focus on prevention, proactive care in community settings and integrated delivery across providers, with patients actively involved in their care (Panorama documentary, NHS - The Perfect Storm, July 2015).

The 2013 Canadian Forces Mental Health Survey: Background and Methods.

The 2013 Canadian Forces Mental Health Survey (CFMHS) collected detailed information on mental health problems, their impacts, occupational and nonoccupational determinants of mental health, and the use of mental health services from a random sample of 8200 serving personnel. The objective of this article is to provide a firm scientific foundation for understanding and interpreting the CFMHS findings. This narrative review first provides a snapshot of the Canadian Armed Forces (CAF), focusing on 2 key determinants of mental health: the deployment of more than 40,000 personnel in support of the mission in Afghanistan and the extensive renewal of the CAF mental health system. The findings of recent population-based CAF mental health research are reviewed, with a focus on findings from the very similar mental health survey done in 2002. Finally, key aspects of the methods of the 2013 CFMHS are presented. The findings of 20 peer-reviewed publications using the 2002 mental health survey data are reviewed, along with those of 25 publications from other major CAF mental health research projects executed over the past decade. More than a decade of population-based mental health research in the CAF has provided a detailed picture of its mental health and use of mental health services. This knowledge base and the homology of the 2013 survey with the 2002 CAF survey and general population surveys in 2002 and 2012 will provide an unusual opportunity to use the CFMHS to situate mental health in the CAF in a historical and societal perspective.

What Affects Family Physicians’ Participation in Research: Outcomes from a Depression Self-Care Study

Background: To describe factors associated with family physicians (FPs) recruitment and participation in a mental health research project. Methods: 400 FPs were randomly approached for a feasibility study of telephone-supported self-care for depression in adults with chronic physical diseases. FP participation included (1) completing questionnaires at study enrolment and termination to identify personal characteristics, attitudes to patient self-care, and aspects of study implementation; and (2) encouraging patient self-completion of screening forms on depression and comorbid chronic disease in order to assess study eligibility. Outcome measures were the number of FPs who adhered to these tasks, as well as the number of eligible patients recruited from each practice. Chi square and Fisher’s Exact Tests permitted comparison of binary or categorical values, while the Kruskal-Wallis non-parametric test was used for continuous scales. Results: Of the 400 FPs randomly selected, 29.8% (119/400) were not reachable by telephone; 42.8% (171/400) were assessed as not meeting eligibility criteria; and 59 (53.6%) of the remaining 110 met eligibility criteria, consented, and participated. Predominant reasons for participation were past experience with research projects, interest in the specific topic of mental health care, enthusiasm about self-care, and sense of collegiality. 86.4% (51/59) completed the study entry questionnaire, and 62.7% (37/59) the end of study questionnaire. 66.1% (39/59) submitted at least one positive screening form (range 1-43), with such participation occurring more often amongst FPs in solo practice or with previous research experience. Conclusion: Recruiting FPs to participate in mental health research and adhere to protocols is challenging and time intensive. To optimize such involvement researchers may need to employ creative strategies unique to study sites, idiosyncrasies of the doctors, and the nature of the topic undergoing study.

Mental health research in the Syrian humanitarian crisis.

In areas of armed conflicts, efforts to provide mental health services for refugees and internally displaced populations (IDPs) generally lack measures of effectiveness, and the gap between research and practice is significant (1). The Syrian Crisis has been described by the United Nations High Commissioner for Refugees (UNHCR) as “the great tragedy of this century” (2). The UNHCR reports at least 24 agencies currently providing mental health and psychological support to Syrian refugees (3). The actual interventions provided vary considerably among the agencies, which complicates the implementation of academic research and mental health services in humanitarian settings (4). This is further challenged by the limited academic publications on the matters of Syrian refugees’ mental health beyond basic needs assessment (3, 5–7). In an effort to standardize mental health interventions in humanitarian settings, the Inter-Agency Standing Committee (IASC) had published standardized guidelines for provision of mental health services, but had not addressed the role of academic research (8). Creating a research agenda for mental health in the less-resourceful settings has been emphasized (9). However, there are barriers to establish academic research in emergency humanitarian settings. Those barriers have been identified before (8), and we will mention few examples here in relevance to the Syrian scenario. The research conducted in conflict settings is often designed and executed by “foreign” institutions outside the area of the conflict or disaster (8), and the Syrian Crisis is no exception (5, 6, 10). This is likely to affect the efficacy and sustainability of interventions. Incorporating local institutions and humanitarian workers in designing and conducting the research would likely foster a sense of ownership in the locals and ensure sustainability. For instance, thousands of educated Syrian youth have sought refuge in the neighboring countries since the beginning of the conflict (11). Incorporating this educated population as research assistants and cultural brokers in mental health research projects would enhance ownership, sustainability, and efficacy of such projects. Another obstacle for academic research is reaching the non-refugee; i.e., displaced populations. The internally displaced living within the battlefields inside Syria, is an example (10). Additionally, mental health research in refugee camps across the borders requires availability of basic needs such as shelter, food, water, and basic medical services which are not always secured, or stable (12), and can interrupt research efforts. Hence, initiating needs assessment, intervention implementation, and effectiveness studies in the relatively more stable areas such as Turkey (13) can allow for manageable pilot research projects. In the future, those studies can be replicated and tested in less stable areas. In a recent study (currently in press and detailed elsewhere), one of us (Hussam Jefee-Bahloul) and colleagues surveyed a sample of Syrian refugees in a busy refugee primary care clinic in Kilis Turkey (6). The assessment used a standardized and validated tool that can reflect psychological stress. In brief, a significant number of refugees (41%) met the cut off criteria for needing further psychological assessment; however, less than a half had a perceived need to see a mental health specialist, and less so was open to mental health services provided via technology (telepsychiatry). The example of telepsychiatry here is relevant to the topic of this article as it represents an example of mental health innovative interventions that require testing in humanitarian settings. Conducting a sufficient basic needs assessment in a very busy primary care refugee clinic had mandated administration of a simple, time-efficient, and non-threatening questionnaire rather than standard psychological stress test batteries. Recruitment process was received with mixed reactions by the refugees; either desperation to seek help or suspiciousness of the foreign workers (even though our data collection was done by an Arabic speaking Arab-American medical student). Also, subjects of the study were hesitant to cooperate given the stigma surrounding mental illness in the Syrian culture. Nevertheless, this kind of needs assessment studies can be replicated and used as cornerstones for interventions effectiveness studies in the unstable conflict areas of Syria. Here thereafter, a philosophical gap lies between the academic “perfectionistic” views on research and the “practical” perspectives of humanitarian workers (e.g., the focus of humanitarian workers on immediate short-term-outcomes rather than long-term-outcomes) (8). This gap is justified by the emergency context of these situations. Refugees fleeing conflict areas may exhibit acute symptoms of psychological stress that require immediate attention by the humanitarian workers. The application of academic research in these acute settings may not guarantee immediate effective remedies for people under duress. Humanitarian workers may also have concerns that application of research designs will interrupt the flow of humanitarian work. This can explain the hesitance to incorporate research in conflict settings. On the other hand, the expansion of this gap will prevent field-based humanitarian interventions from catching up with evidence-based medicine. Hence, the need to bridge this gap and address these valid concerns has never been more imperative. Incorporating thoughtfully designed interventions and standardized outcome measurements into the routine humanitarian protocols and training manuals may help solve this problem. It is worth mentioning that some academic projects had successfully incorporated academic research into humanitarian settings in the past (14–19) and more is hoped to be accomplished on mental health of those affected by the Syrian Crisis. Finally, the schism between the academic and the humanitarian platforms and audiences adds to the observed gap. The academic literature and the humanitarian platforms rarely merge. Some academic journals have designated certain issues to humanitarian causes (4), however, this does not guarantee delivery of this information to the target audience, i.e., humanitarian organizations, workers, and policy makers. Unifying the academic and humanitarian platforms, can allow audiences from both fields to interact, share experience, and collaborate on much needed mental health research in areas of conflict.

Patient and Public Involvement in the Coproduction of Knowledge

Patient and public involvement in health research is increasingly well established internationally, but the impacts of involvement on the research process are hard to evaluate. We describe a process of qualitative data analysis in a mental health research project with a high level of mental health service user and carer involvement, and reflect critically on how we produced our findings. Team members not from research backgrounds sometimes challenged academic conventions, leading to complex findings that would otherwise have been missing. An essential component of how we coproduced knowledge involved retaining methodological flexibility so that nonconventional research voices in the team could situate and critique what was conventionally known. Deliberate and transparent reflection on how "who we are" informed the knowledge we produced was integral to our inquiry. We conclude that reflecting on knowledge (co)production is a useful tool for evaluating the impact of patient and public involvement on health research.

An Exploration of the Effect of Community Engagement in Research on Perceived Outcomes of Partnered Mental Health Services Projects().

Mental health research projects address sensitive issues for vulnerable populations and are implemented in complex environments. Community-Based Participatory Research approaches are recommended for health research on vulnerable populations, but little is known about how variation in participation affects outcomes of partnered research projects. We developed a conceptual model demonstrating the impact of community engagement in research on outcomes of partnered projects. We collected data on key constructs from community and academic leaders of 21 sampled partnered research projects in two cycles of an NIMH research center. We conducted empirical analyses to test the model. Our findings suggest that community engagement in research is positively associated with perceived professional development, as well as political and community impact.

Service user involvement in mental health research: a user's perspective

SummaryThis article focuses on service user involvement in supporting and undertaking mental health research. It is written from the author's perspective as a service user with bipolar disorder who has built on previous experience as an academic researcher in business and management studies by active involvement in a number of mental health research projects in a service user capacity. The article highlights contrasting approaches taken by different projects in how they involve service users and provides learning points based on the author's and other service users' experiences.

Mental health research, ethics and multiculturalism

In this paper we examine ethical issues relevant to conducting mental health research with refugees and immigrant communities that have cultural orientations and social organisation that are substantially different to those of the broader Australian community, and we relate these issues to NH&MRC Guidelines. We describe the development and conduct of a mental health research project carried out recently in Melbourne with the Somali community, focusing on ethical principles involved, and relating these to the NH&MRC National Statement on Ethical Conduct in Research Involving Humans, and the NH&MRC document Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research. The experience of conducting mental health research with the Somali community highlights the fact that the principles of inclusion and benefit enunciated in the NH&MRC document Values and Ethics are particularly pertinent when conducting research with refugees and immigrant communities that are culturally distant to those of the broader Australian community. These principles inform issues of research design and consent, as well as guiding respectful engagement with the participating community and communication of the research findings.

Mental Health Research in General Practice

To explore problems in carrying out a mental health research project in the general practice setting. Open-ended interviews were conducted with general practice stakeholders, focusing on impediments to the conduct of mental health research in general practice and possible means for improving the participation of general practitioners in such research. Participants in the consultations were members of five divisions of general practice, senior staff within an academic department of general practice, four general practitioners and a research group engaged with general practice research. The discussions were recorded in detailed interview notes, and key issues and themes emerging from consultations were derived by the researchers. Three main themes summarized most of the issues reported through the consultations, including structural issues (e.g. disruption of practice, time limitations and lack of remuneration), process issues (e.g. researcher-general practice communication, researcher-imposed issues and need for partnerships) and content issues (e.g. study design, study procedures and methods). The consultations revealed similar findings to previously published reports concerning general practice research, with an emphasis on the need for partnerships between researchers and general practice organizations in the conduct of such research.