Mental Health Care Centers Research Articles

What if children with psychiatric problems disagree with their clinicians on the need for care? Factors explaining discordance and clinical directions

BackgroundChildren and adolescents in mental healthcare often perceive their care needs and necessary treatment differently from their clinicians. As such discordance between young patients and clinicians may obstruct treatment adherence and compromise treatment outcomes, it is important to understand the factors associated with it. We therefore investigated the factors associated with patient–clinician discordance with regard to care needs in various areas of functioning.MethodsA cross-sectional study involving 244 children/adolescents aged 6–18 participating with their clinicians in treatment at a specialized mental healthcare center. As a previous study conducted by our research group had found the greatest patient–clinician discordance in three CANSAS care needs—“mental health problems,” “information regarding diagnosis and/or treatment,” and “making and/or keeping friends”—we used univariable and multivariable statistics to investigate the factors associated with discordance regarding these three care needs.Resultspatient–clinician discordance on the three CANSAS items was associated with child, parent, and family/social-context factors. Three variables were significant in each of the three final multivariable models: dangerous behavior towards self (child level); severity of psychiatric problems of the parent (parent level); and growing up in a single-parent household (family/social-context level).ConclusionsTo deliver treatment most effectively and to prevent drop-out, it is important during diagnostic assessment and treatment planning to address the patient’s care needs at all three levels: child, parent and family/social context.

Mental Healthcare Policy Reform in Turkey: A Qualitative Study on the Perspectives of User Groups

The mental health policy of Turkey has been undergoing a transformation process since 2006. This change aims to prioritize the establishment of community-based mental health care services and to organize an accessible mental healthcare service network across the country. The main objective is to analyse the politics of mental health policy change in Turkey and to understand the role of user groups in this process by a qualitative analysis of the views of mental health user groups on these transformations. In this context, semi‐structured interviews were conducted with representatives (n = 13) of patient organisations based in Istanbul, Ankara and İzmir. This article reveals that this policy change took the form of the balanced care model, and the introduction of community-based mental health care centers provided to increase the utilization of mental health care services. However, the services in community-based settings were questioned by the respondents due to their purely medical approach to users' recovery processes and this policy change falls short of introducing a holistic perspective to the Turkish mental health care system that would facilitate recovery not only through medical support but also through social support that would empower individuals living with mental health issues.

The effects of national mental health plans on mental health services development in Chile: retrospective interrupted time series analyses of national databases between 1990 and 2017

AimsTo describe changes in mental health services in Chile between 1990 and 2017, and to retrospectively assess the effects of national mental health plans (NMHPs) on mental health services development during this period.MethodsService data (beds in psychiatric hospitals, psychiatric beds in general hospitals, forensic psychiatric beds, beds in protected housing facilities, psychiatric day hospital places, and outpatient mental health care centers) were retrieved from government sources in Chile. Data were reported as rates per 100,000 population. We conducted interrupted time series analyses, using ordinary least-square regressions with Newey-West standard errors, to assess the effects of the 1993 and 2000 NMPHs on mental health services development.ResultsRates of short- and long-stay beds in psychiatric hospitals (per 100,000 population) were reduced from 4.3 to 3.2 and from 19.0 to 2.0 over the entire time span, respectively. The strongest reduction of short- and long-stay beds in psychiatric hospitals was seen between the 1993 and 2000 NMHPs (annual removal of − 0.14 and − 1.03, respectively). We observed increased rates of psychiatric beds in general hospitals from 1.8 to 4.0, beds in protected housing facilities from 0.4 to 10.2, psychiatric day hospital places from 0.4 to 5.0, outpatient mental health care centers from 0.1 to 0.8 and forensic psychiatric beds from 0.3 to 1.1 over the entire time span. The strongest annual increase of rates of psychiatric beds in general hospitals (0.09), beds in protected housing facilities (0.50), psychiatric day hospital places (0.16) and outpatient mental health care centers (0.04) were observed after the 2000 NMHP. Forensic psychiatric beds increased in the year 2007 (0.58) due to the opening of a new facility.ConclusionsThe majority of acute care psychiatric beds in Chile now are based in general hospitals. The strong removal of short- and long-stay beds from psychiatric hospitals after the 1993 NMHP preceded substantial expansion of more modern mental health services in general hospitals and in the community. Only after the 2000 NMHP, the implementation of new mental health services gained momentum. Reiterative policies are needed to readjust mental health services development.

Physical comorbidity among patients attending mental health services at Windhoek Central Hospital, Namibia.

Introductionphysical health problems are common among people with mental illness. Understanding common co-occurring mental and physical conditions can aid health providers to effectively screen individuals and also integrate care for both conditions. The study aimed to determine the prevalence and types of comorbidity among patients attending the outpatient section of the Mental Health Care Centre, Windhoek Central Hospital.Methodsa cross-sectional survey of 385 patients attending the Mental Health Care Centre of Windhoek Central Hospital was carried out using structured questionnaire.Resultsthe study found that 33.8% of participants had comorbid physical and mental conditions. The most common co-occurring physical conditions were from the cardiovascular system (40.8%), infections (30.8%), and neurological conditions (13.0%). Female patients were more likely to have comorbidity compared to their male counterparts (OR=2.8; CI = 1.5-5.0; p=0.001), and the risk of comorbidity increased with age (OR=1.1; CI = 1.0-1.1; p<0.001).Conclusionthe study emphasizes the inseparability of mental and physical health, and the bidirectional association between mental and physical conditions. The high prevalence of somatic disorder points to the need of integration of physical and mental health services. Mental health and somatic services must be adjusted to the fact that most of the people who come to seek help are likely to suffer from more than one illness.

The quality of mental health care-clinic Veldre pilot study results

Background The practice of the assessment of mental health care quality is currently under development in Latvia. Clinic ‘Veldre’ (2012) is one of the only two community – based mental health care centers in Latvia. The quality of clinic ‘Veldre’ has never been assessed. To assess the quality of care for patients with schizophrenia of the ‘Veldre’ clinic’s outpatient department. Methods The retrospective, descriptive, real-life pilot study was performed. Medical chart analysis was performed and the following indicators were assessed in 30 randomly selected schizophrenia outpatients (aged 21–65; 15 male (50%, mean age 45), 15 female (50%, mean age 50): rehospitalization, frequent hospitalization (more than once per year), long-stayers rate (more than 28 days of hospital care), received outpatient care; suicide and mortality rate. Statistical data analysis was performed, correlations were found. Results Results demonstrate weak positive correlations between male gender and (a) rehospitalisation rate (Sperman's rank correlation (rs) −0.27) and (b) long term hospitalisation (Spearmans's rank correlation (rs) 0.27). Conclusions Future research is needed to explore the gender differences in mental health care quality indicators.

Examination of perceptions of schizophrenia patients about community-based mental health care centers and nurses through picture drawing: A qualitative study.

This study aimed to examine the perceptions about community-based mental healthcare centers and nurses who offered services for patients with schizophrenia. This qualitative study was conducted on 15 patients who are diagnosed with schizophrenia and received services in two community-based mental health care centers in Turkey. Three themes emerged regarding the perceptions about nurses, including perceived patient-nurse relationships, perceived personal features of nurses, and feelings about nurses. Five themes appeared concerning the perceptions about the community-based mental health care centers, including participation motivation, perceived care, services for treatment follow-up and adherence, services for social functioning and motivation, and services for rehabilitation and productivity. Patients with schizophrenia had positive perceptions about the nurses and the centers.

An Adjunctive Internet-Based Intervention to Enhance Treatment for Depression in Adults: Randomized Controlled Trial.

BackgroundInternet-based interventions promise to enhance the accessibility of mental health care for a greater number of people and in more remote places. Their effectiveness has been shown for the prevention and treatment of various mental disorders. However, their potential when delivered as add-on to conventional treatment (ie, blended care) is less clear.ObjectiveThe aim of this study is to study the effectiveness of an internet intervention (ASCENSO) implemented in addition to face-to-face treatment as usual (TAU) for depression.MethodsA 2-arm, parallel-group, randomized controlled trial was conducted in an outpatient private mental health care center in Chile. In all, 167 adults, diagnosed with major depressive disorder, without severe comorbidities, and with internet access, were included. Eighty-four participants were assigned to the intervention group and received medical and psychological TAU from the mental health center plus access to the ASCENSO online platform. The control group (n=83) received only TAU. The ASCENSO platform includes psycho-educational information, depressive symptom monitoring and feedback, and managing emergencies based on the principles of cognitive behavioral therapy. Emergency management was mental health provider–assisted. TAU includes access to primary care physicians and psychiatrists, to a brief individual psychotherapy, and to medication when needed. The baseline questionnaires were administered in person, and 6- and 9-months assessments were conducted online. Depression symptoms and quality of life were measured by self-administered questionnaires, and treatment adherence was determined via the Mental Health Center’s internal records. The usage of ASCENSO was assessed by server logs. Reduction on depressive symptomatology was considered as the primary outcome of the intervention and quality of life as a secondary outcome.ResultsOf the 84 participants in the intervention group, 5 participants (6%) never accessed the online platform. Of the remaining 79 participants who accessed ASCENSO, 1 (1%, 1/79) did not answer any of the symptom questionnaire, and most participants (72/79, 91%) answered the monitoring questionnaires irregularly. The ASCENSO intervention implemented in addition to face-to-face care did not improve the outcome of the usual care delivered at the mental health center, either in terms of reduction of depressive symptoms (F2,6087= 0.48; P=.62) or in the improvement of quality of life (EQ-5D-3L: F2,7678=0.24; P=.79 and EQ-VAS: F2,6670= 0.13; P=.88). In contrast, for the primary (F2,850=78.25; P<.001) and secondary outcomes (EQ-5D-3L: F2,1067=37.87; EQ-VAS: F2,4390= 51.69; P<.001) in both groups, there was an improvement from baseline to 6 months (P<.001), but there was no change at 9 months. In addition, no effects on adherence to or use of TAU were found. Finally, the dropout rate for the face-to-face treatment component was 54% (45/84) for the intervention group versus 39% (32/83) for the control group (P=.07).ConclusionsThe fact that the adjunctive access to ASCENSO did not improve outcome could be due to both the rather high effectiveness of TAU and to patients’ limited use of the online platform.Trial RegistrationClinicalTrials.gov NCT03093467; https://clinicaltrials.gov/ct2/show/NCT03093467

The effect of twice-weekly versus once-weekly sessions of either imagery rescripting or eye movement desensitization and reprocessing for adults with PTSD from childhood trauma (IREM-Freq): a study protocol for an international randomized clinical trial

BackgroundTrauma-focused treatments for posttraumatic stress disorder (PTSD) are commonly delivered either once or twice a week. Initial evidence suggests that session frequency affects treatment response, but very few trials have investigated the effect of session frequency. The present study’s aim is to compare treatment outcomes of twice-weekly versus once-weekly sessions of two treatments for PTSD related to childhood trauma, imagery rescripting (ImRs) and eye movement desensitization and reprocessing (EMDR). We hypothesize that both treatments will be more effective when delivered twice than once a week. How session frequency impacts treatment response, whether treatment type moderates the frequency effect, and which treatment type and frequency works best for whom will also be investigated.MethodsThe IREM-Freq trial is an international multicenter randomized clinical trial conducted in mental healthcare centers across Australia, Germany, and the Netherlands. We aim to recruit 220 participants, who will be randomized to one of four conditions: (1) EMDR once a week, (2) EMDR twice a week, (3) ImRs once a week, or (4) ImRs twice a week. Treatment consists of 12 sessions. Data are collected at baseline until one-year follow-up. The primary outcome measure is clinician-rated PTSD symptom severity. Secondary outcome measures include self-reported PTSD symptom severity, complex PTSD symptoms, trauma-related cognitions and emotions, depressive symptoms, dissociation, quality of life, and functioning. Process measures include memory, learning, therapeutic alliance, motivation, reluctance, and avoidance. Additional investigations will focus on predictors of treatment outcome and PTSD severity, change mechanisms of EMDR and ImRs, the role of emotions, cognitions, and memory, the optimization of treatment selection, learned helplessness, perspectives of patients and therapists, the network structure of PTSD symptoms, and sudden treatment gains.DiscussionThis study will extend our knowledge on trauma-focused treatments for PTSD related to childhood trauma and, more specifically, the importance of session frequency. More insight into the optimal session frequency could lead to improved treatment outcomes and less dropout, and in turn, to a reduction of healthcare costs. Moreover, the additional investigations will broaden our understanding of how the treatments work and variables that affect treatment outcome.Trial registrationNetherlands Trial Register NL6965, registered 25/04/2018.

Survey of non-conventional mental health care facilities in C\xf4te d\u2019Ivoire: first stage

BackgroundMental illnesses and disabilities as well as epileptic diseases remain an important public health issue. In Côte d’Ivoire, the provision of psychiatric care and specialised psychosocial facilities is almost non-existent. This study is based on the hypothesis that the care of people suffering from mental illness and epilepsy in Côte d’Ivoire is mainly in the hands of non-conventional mental health care facilities, including so-called ‘Prayer Camps’. These work according to traditional and spiritual principles and are mostly not registered or controlled by the Ivorian authorities.MethodsThis study is the first stage of a multi-stage study. For the first stage, a quantitative method with an exploratory and descriptive aim was chosen. 541 non-conventional mental health care facilities in Côte d’Ivoire were mapped, typologised according to their spiritual orientation and treatment methods, and examined according to some charactersitics. Semi-structured interviews with 435 facility leaders were conducted.ResultsThe article provides a typology of four types of non-conventional mental health care facilities in Côte d’Ivoire including Christian Prayer Camps, Traditional Healing Centres, Phytotherapy Centres, and Roqya Centres. It explores their administrative embedding, the qualification of the facility leaders as well as their willingness, in principle, to cooperate with conventional mental health care centres. A considerable number of non-conventional expressed a desire or acceptance of cooperation with psychiatric organisations.ConclusionsThe next stage of this multi-stage study will be to assess the clinical and legal situation of the patients in these centres. The aim is to interview the patients in order to analyse their perceptions and to capture the concerns of relatives and staff in the centres as well as the human rights situation in a mixed-method study. The long-term objective is to establish future cooperation between conventional psychiatric care providers and suitable non-conventional mental health care facilities and to implement a community mental health care policy in Côte d’Ivoire.

PSYCHOLOGICAL CHARACTERISTICS OF HEALTH-RELATED QUALITY OF LIFE AMONG RETIRED ELITE ATHLETES IN NIGERIA

&lt;p&gt;Retirement from sport is inevitable and unavoidable. It is a major source of threat to the health-related quality of life of retired elite athletes especially among who refute involvement in adequate planning and preparation for life after sports. The purpose of this study was to examine psychological characteristics of health-related quality of life (HRQoL) among retired elite athletes in Oyo State, Nigeria. Two hypotheses were tested. The study employed descriptive survey research design. Purposive sampling technique was used to select one hundred (100) (Male = 63, Female = 37) retired elite athletes. The standardized questionnaires of Athletic Identity Measurement Scale (AIMS), Centre for Epidemiologic Studies-Depression Scale (CES-DS) and the Short-Form 8 (SF-8) Health Survey were used for collection of data from the respondents. The reliability coefficient of the instrument used are 0.86, 0.84 and 0.88 respectively. Data were analysed using descriptive and inferential statistics of frequency counts, percentages and multiple regression. The result of the study showed that, there is significant joint contributions of psychological characteristics on HRQoL (F(2, 97) = 107.581, R = .74, R2 = .686, Adj R2 = .686, p&amp;lt;0.05) with 68.6% of degree of variance. Also, there is significant relative contributions of psychological characteristics [athletic-identity (β = -0.079, t = 0.41, p &amp;lt; .05) and depression (β = -.297, t = -1.521, p&amp;lt;0.05)] on HRQoL. Based on the findings, it was concluded that psychological intervention programme that promotes HRQoL and prepares retired elite athletes for life after sports should be developed and inculcated into the elite athletes’ programme before retirement, while regular visitation to psychological and mental health care centres for optimum advise on health-related wellbeing should carried out by the retired elite athletes. &lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/edu_01/0864/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Barriers to Provision of Spiritual Care in Mental Health Care Centers: A Qualitative Content Analysis

Background: Spiritual care (SC) is an appropriate source for adaptation and coping with disease and life stressors. Although SC contributes to the quality of life and mental health of clients, there are barriers to the provision of such care. Objectives: This study aimed to explore barriers to the provision of SC in mental health care centers from the viewpoints of mental health care provider (MHCP) experts. Methods: This qualitative study was conducted based on conventional content analysis on 19 participants who were selected from different groups of MHCPs. The participants were selected by purposive sampling method from December 2019 to December 2020 in Karaj and Tehran, Iran, by considering the maximum diversity. Data were collected through semi-structured interviews with participants during an average time of 60 min per interview until data saturation. The transcripts of the interviews were analyzed by qualitative content analysis. Results: Barriers to SC were obtained in four categories and 10 subcategories. The categories included “SC concept-related barriers”, “barriers related to MHCPs”, “organizational barriers”, and “barriers related to SC recipients.” Conclusions: This study demonstrated various barriers to the provision of SC to the clients of health care centers that should be removed to promote the level and quality of SC.

An explorative study of factors associated with treatment in specialized mental health care centers among GP patients in Norway

BackgroundEffectiveness and efficiency are part of the quality of care for mental health problems, and treatment should thus be performed at the right level of care. Norwegian guidelines specify which patients should be given priority for treatment in specialized mental health care (SMHC) centers, but there is a lack of agreement on which patients should actually receive SMHC. In this study we wanted to examine what factors (patient and GP characteristics) were related to GP patients who received treatment in SMHC centers.MethodsIn this retrospective cohort study, we looked at 12 months of data from electronic health records from six GP and SMHC centers of hospitals in the catchment area. We included all patients who had been treated at any of the GP centers during the 12-month period (N=18032). We fit a generalized linear mixed model to explore which factors were related to patients receiving treatment in SMHC centers. Further exploration was performed to study the effects of gender and contact frequency.ResultsWe found that 4.6% of all GP patients and 18.4% of the GP patients with a mental health problems were treated in SMHC centers. There were more women than men among the GP-patients (56% vs 44%) and in SMHC centers (55% vs 45%), women with mental health problems were more severely ill than men. However, after adjusting for other factors men were more likely to be treated in SMHC centers (OR: 1.44). Patients with frequent GP contact were more likely to be treated in SMHC centers. The GP characteristics age, gender and specialization did not relate to patients receiving treatment in SMHC centers.ConclusionsMen were more likely to be treated in SMHC centers than women, which may imply that they have different thresholds for entering SMHC centers. GP characteristics were not related to receiving treatment in SMHC centers. More specific knowledge is needed to determine whether men and women currently receive treatment at the lowest possible level of care.

Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the "Memory and Neuropsychiatry Clinic" in Hospital Del Salvador, Chile.

The development of healthcare services for dementia is key to improving access to care and post-diagnostic support for people living with dementia. Memory Units have emerged as a new healthcare service composed of multidisciplinary teams with the goal of improving diagnosis and/or management of dementia patients. The main objective of this study was to describe and evaluate the Reach and Effectiveness of a Memory Unit in a public hospital in Chile, using the RE-AIM model, a multi-component model that allows for the evaluation of the implementation of ongoing healthcare programs. Regarding “R” (Reach): from March 2018 up to June 2019, a total of 510 patients were referred and assessed. Most patients came from primary care (51.9%) and from outpatient services at the Hospital Salvador (39.2%), particularly from the Neurology (63.3%) and Psychiatry (16.0%) departments. We estimated that our Memory Unit assessed 5.39% of all of the dementia patients living in the area of referral. With respect to “E” (Effectiveness): 419 patients are still being followed up at the Memory Unit. Ninety-one patients (18%) were discharged. Of these, 55 (66%) were referred to primary healthcare, 28 (31%) to other outpatient services, 9 (10%) to a specialized mental healthcare center, and 9 (10%) to a daycare center. Due to the short period of time that the Memory Unit has been operating, no other RE-AIM dimensions could be evaluated at this juncture. To our knowledge, this is the first implementation study of a Memory Unit in Latin America, and the first using the RE-AIM model. Although cultural differences worldwide might play a role in the lack of international guidelines, the publication of the experience of the first year of this unit in Chile could inform new countries about this process. Ongoing challenges include continuing to collect data to complement the RE-AIM evaluation and developing a protocol that can be adopted elsewhere in Chile and Latin America. Further studies are needed to assess the benefits of a Memory Unit in comparison to regular care and to develop a model that assures continuity and coordination of care for people with dementia.

ASSESSMENT OF CAREGIVER BURDEN OF MENTALLY ILL PATIENTS: A CROSS SECTIONAL STUDY

One of the main aspects of community care of mentally ill patient is family support. Caregiver Burden is the Physical, Emotional &amp; Financial toll of providing care. A caregiver may go into depression, anxiety, physical burnout or emotional burnout due to stress of giving care to the patient. By assessing the burden and nding out the factors related to high burden we can nd out the coping strategies. This cross-sectional study was planned to assess Caregiver burden of mentally ill patients and also to nd out the factors associated with high caregiver burden among the study subjects. This study was conducted in tertiary mental health care centres of Thiruvananthapuram among 80 primary care givers using Burden Assessment Schedule (BAS) developed by Schizophrenia Research Foundation (SCARF), Chennai and data was analysed to get Proportions and Chi Square. We found that majority of caregivers had high burden and caregiver's relationship with patient is signicantly associated with high burden.

Effectiveness of a digital alcohol moderation intervention as an add-on to depression treatment for young adults: study protocol of a multicentre pragmatic randomized controlled trial

BackgroundDepressive disorders and problematic drinking often co-occur, also among young adults. These co-occurring conditions are associated with various negative health outcomes compared to both conditions alone. Early intervention by addressing alcohol use and depressive symptoms simultaneously in the same treatment might improve both conditions. However, evidence on the (cost-) effectiveness of digital combined depression and alcohol interventions for young adults is currently insufficient. We therefore developed an add-on digital alcohol moderation adherence-focussed guided intervention to complement treatment as usual (TAU) for depressive disorders. The digital intervention is a web-app, including 6 modules based on motivational interviewing and cognitive behavioural therapy. This study aims to evaluate the (cost-)effectiveness of a digital alcohol moderation intervention + TAU compared to TAU on alcohol and depression outcomes among young adults with co-occurring depressive disorders and problematic alcohol use.MethodsOne hundred fifty-six participants, aged 18–35 years, with problematic alcohol use and a diagnosed depressive disorder will participate in a pragmatic multicentre two-arm randomized controlled trial. Problematic alcohol use is operationalised as scoring ≥5 for women and ≥ 8 for men on the Alcohol Use Disorder Identification Test (AUDIT). Participants will be randomized to either the experimental group (digital alcohol intervention + TAU) or control group (TAU only). Participants will be recruited at three Dutch mental health care centres and through social media. Assessments take place at baseline and after 3, 6 and 12 months post-randomization. The primary outcome is treatment response at 6-month follow-up, operationalized as a composite score that combines alcohol use and depression measures and indicates whether treatment has been successful or not. Secondary outcomes are depressive symptoms and alcohol use (i.e. number of weekly standard drinks and AUDIT score). An economic evaluation will be conducted alongside the trial.DiscussionThis study evaluates the (cost-) effectiveness of an add-on digital alcohol moderation intervention for young adults who are in treatment for depressive disorders. If proven effective, the digital intervention could be implemented in mental health care and improve treatment for people with co-occurring depressive disorders and problematic alcohol use.Trial registrationPre-registered on October 29, 2019 in The Netherlands Trial Register (NL8122).

Using an Activity Tracker in Healthcare: Experiences of Healthcare Professionals and Patients.

Despite the increased use of activity trackers, little is known about how they can be used in healthcare settings. This study aimed to support healthcare professionals and patients with embedding an activity tracker in the daily clinical practice of a specialized mental healthcare center and gaining knowledge about the implementation process. An action research design was used to let healthcare professionals and patients learn about how and when they can use an activity tracker. Data collection was performed in the specialized center with audio recordings of conversations during therapy, reflection sessions with the therapists, and semi-structured interviews with the patients. Analyses were performed by directed content analyses. Twenty-eight conversations during therapy, four reflection sessions, and eleven interviews were recorded. Both healthcare professionals and patients were positive about the use of activity trackers and experienced it as an added value. Therapists formulated exclusion criteria for patients, a flowchart on when to use the activity tracker, defined goals, and guidance on how to discuss (the data of) the activity tracker. The action research approach was helpful to allow therapists to learn and reflect with each other and embed the activity trackers into their clinical practice at a specialized mental healthcare center.

Resilient, undercontrolled, and overcontrolled personality types based upon DSM-5 maladaptive personality traits

We explored the clinical relevance of resilient, overcontrolled and undercontrolled personality types based upon DSM-5 maladaptive personality traits. We examined if these prototypes could be differentiated in terms of personality functioning, and internalizing and externalizing pathology. Self-report questionnaires and structured interviews were administered to 192 adult patients referred to a mental health care center specialized in assessment and treatment of personality disorders. Through cluster analysis we identified a resilient type with no elevation on maladaptive trait domains and showing better personality functioning and less pathology than the overcontrolled and undercontrolled types. Furthermore, the overcontrolled type had elevated Negative Affectivity and a higher prevalence of mood disorders, whereas the undercontrolled type had elevations on all maladaptive traits, with the exception of Disinhibition, and higher rates of narcissistic and borderline personality disorders. Given the differences in psychopathology between the types, identifying these types may inform treatment focus. Also, in line with a stepped care model, compared to overcontrollers, resilient types may need less intensive treatment and undercontrollers may need more intensive treatment.

“If you don’t have a word for something, you may doubt whether it’s even real” – how individuals with borderline personality disorder experience change

Objective: This study explored how psychological change was experienced and what treatment-related factors or events were perceived as supporting or hindering their process by individuals with borderline personality disorder. Methods: Eight BPD sufferers attended a 40-session psychoeducational group intervention at a community mental health care center. At intervention end, personal experience of meaningful change was explored in an in-depth interview and data were content-analyzed. Change in BPD symptoms was assessed by the Borderline Personality Disorder Severity Index IV interview. Results: The qualitative content analysis on subjectively perceived meaningful change yielded three core categories: (1) improved ability to observe and understand mental events, (2) decreased disconnection from emotions, emergence of new or adaptive emotional reactions and decrease in maladaptive ones, and (3) a new, more adaptive experience of self and agency. Accordingly, (1) learning and (2) normalizing emerged as the main categories of helpful treatment factors. In turn, treatment-related factors perceived as obstacles were: (1) aggression in the group, and (2) inflexibility. With respect to symptom change, four participants were considered clinically as remitted, and two showed a reliable change. Conclusions: Long-term psychoeducational group therapy seems to enhance mentalization / metacognitive functioning and promote self (or personality) integration in BPD patients.

The Distinguishing Characteristics of Parents Seeking a Mindful Parenting Intervention in Child Mental Health Care

As a clinical intervention, Mindful Parenting has positive effects on parental stress and psychopathology, as well as child psychopathology. However, previous studies have not considered what characterizes parents and families who receive this type of intervention. The current study utilized a quasi-experimental design to determine the characteristics that distinguish parents seeking or referred to a mindful parenting intervention in community child mental health care centers. Two groups of parents were recruited to the study: treatment-seeking parents (n = 89), and a comparison group of parents from a community population (n = 66). All parents completed measures relating to their child’s psychopathology, their own psychopathology, general mindful awareness, and parenting measures of stress, over-reactivity, experiential avoidance and mindful parenting. A cross-sectional comparison confirmed that the treatment-seeking parents reported significantly higher psychopathology in their child (d = 0.91–1.19) and in themselves (d = 0.99–1.21), lower general mindful awareness, and higher parenting stress, over-reactivity, parental experiential avoidance and lower mindful parenting than the community parents. Across all outcomes, group differences in mindful parenting indicated the largest effect (d = 1.77), followed by parenting stress (d = 1.42), general mindfulness (d = 1.34), parental over-reactivity (d = 1.32), and parental experiential avoidance (d = 1.21). Hierarchical binary logistic regression analyses indicated that, next to higher child internalizing problems, lower mindful parenting distinguished treatment-seeking parents from community parents. Those parents seeking or referred to a mindful parenting intervention may benefit most from improvements in the very construct that the intervention targets: cultivating mindful parenting.

Community mental health care in Mexico: a regional perspective from a mid-income country

BackgroundAccess to mental health care is a worldwide public health challenge. In Mexico, an unacceptably high percentage of the population with mental disorders does not receive the necessary treatment, which is mainly due to the lack of access to mental health care. The community mental health care model was created and has been implemented to improve this situation. In order to properly plan and implement this model a precise situational diagnosis of the mental health care network is required, thus this is a first approach to evaluate the community mental health networks in the state of Jalisco.MethodsTwo components from the EvaRedCom–TMS instrument were used including a general description and accessibility of the community mental health care network. A geographic and economic accessibility evaluation was carried out for the different regions of the state ranging from scattered rural to urban communities using information gathered from health institutions, telephone interviews and computer applications.ResultsJalisco’s community mental health network includes a total of 31 centers and 0.64 mental health workers for every 10,000 inhabitants > 15 years of age. The mean transportation cost required to access mental health care was 16.25 USD per visit. The time needed to reach the closest mental health center in 7 of the 13 analyzed regions was more than 30 min and the mean time required to reach a prolonged stay center was 172.7 min with transportation cost (taxi, private and public transport) of 22.3 USD. Some marginalized regions in the state have a mean 114 min required to reach the closest mental health care center and 386 min to reach a prolonged stay center.ConclusionsThis first approach to evaluate the mental health networks in Mexico showed that there are multiple barriers to access its care including an unfavorable number of human resources, long distances, and high costs. The identification of Jalisco’s mental health network deficiencies is the first step towards establishing a properly planned community mental health care model within the country.