Preventive Mental Health Care Research Articles

Особенности раннего постсуицидального периода у лиц с психическими расстройствами после повторных суицидальных попыток

Study Objective: To study characteristics of the early post-suicidal period after suicide attempts in patients with mental disorders. Study Design: This was a retrospective clinical study. Materials and Methods: The study looked at the characteristics of the early post-suicidal period after suicide attempts in a group of 260 subjects with mental disorders (schizophrenia-spectrum disorders, organic, affective, neurotic, addictive, or personality disorders, or intellectual disability). The mean age of patients who attempted suicide was 43.5 ± 17.7 years. The numbers of men and women were almost equal: 134 (51.5%) and 126 (48.5%), respectively (p>0.05). The mean duration of hospitalization was 42.7 ± 43.2 bed-days. The study methods included clinical examinations, psychopathological assessments, psychometrics, and statistical-mathematical methods. Study Results: The authors identified the following main types of early post-suicidal period: the critical type (n = 73, 28.1%) and denial of a suicide attempt (n = 55, 21.2%) were the most common and the analytical type (n = 23, 8.8%) was the least common. The study determined that 77 (29.6%) psychiatric inpatients with a history of attempting suicide made another attempt. The most common methods of attempted suicide in this group of patients included poisoning with medications (n = 41, 53.2%) and self-cutting (n = 26, 33.8%), and 40.3% were under the influence of alcohol at the time of the repeat suicide attempt. Among the patients who made a repeat suicide attempt, manipulative and suicide-fixated types of post-suicidal period were observed significantly more often. Patients with mental disorders who made repeat suicide attempts showed poor social adjustment in their professional life and overall attitude toward life. Conclusion: The characteristics of the post-suicidal period identified in patients with mental disorders who have made a repeat suicide attempt should be taken into consideration when planning and providing secondary preventive mental healthcare services. Further investigation of these characteristics in various groups of patients, combined with a search for predictive factors for repeat suicide attempts, as well as evaluation of the effectiveness of previously provided preventive mental health care, will make it possible to better tailor these services and reduce the overall risk of suicidal behavior in people with mental disorders. Keywords: suicide, repeat suicide attempt, type of post-suicidal period, mental disorder, social adjustment.

Settling Ulysses: An Adapted Research Agenda for Refugee Mental Health.

Refugees and asylum seekers arriving in Europe during the 2015/2016 wave of migration have been exposed to war conditions in their country of origin, survived a dangerous journey, and often struggled with negative reception in transit and host countries. The mental health consequence of such forced migration experiences is named the Ulysses syndrome. Policies regarding the right to residency can play an important role in reducing mental health symptoms. We propose that facilitating a sense of belonging should be seen as one important preventive mental healthcare intervention. A refugee mental health agenda needs to take into account the interplay between refugees’ and asylum seekers’ mental health, feeling of belonging, and access to healthcare. We urge for policies to restore individuals’ dignity, and recognize the right for homecoming to parallel the mythology of Ulysses.

Designing behavioral self-regulation application for preventive personal mental healthcare.

Most of computerized cognitive behavioral therapy targeted restoration and few have targeted primary prevention. The purpose of this study is to obtain the knowledge for further development on preventive mental healthcare application. We developed a personal mental healthcare application which aimed to give users the chance to manage their mental health by self-monitoring and regulating their behavior. Through the 30-day field trial, the results showed improvement of mood score through conducting of suggested action, and the depressive mood of the participants was significantly decreased after the trial. The possibility of application and further problem was confirmed.

Direct Mental Health Spending Topped $200 Billion in 2013

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessDirect Mental Health Spending Topped $200 Billion in 2013Nick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:1 Jul 2016https://doi.org/10.1176/appi.pn.2016.6b18AbstractA comprehensive assessment of spending from 1996 to 2013 reveals that mental illness far exceeds other chronic conditions including heart disease and cancer, driven strongly by increases in the cost of depression and anxiety care.While it is no secret that mental illness places a huge economic burden on the United States, a new analysis of national medical spending trends between 1996 and 2013 provides a stark picture of the impact of psychiatric problems compared with other medical conditions. The study, published online May 18 in Health Affairs, found that mental disorders accounted for an estimated $201 billion in direct health care costs in 2013, representing nearly one-tenth of all medical spending that year. Heart conditions and trauma, which came in second and third, accounted for $147 billion and $143 billion, respectively. In 1996, mental disorders were second costliest at $79 billion, trailing heart conditions, which accounted for $105 billion in spending.Of the $200 billion in costs, more than 40 percent came from outside the general civilian population, a group that includes nursing community residents, psychiatric hospital inpatients, prisoners, and active-duty military; no other medical category had such a large chunk of spending derived from this category of institutionalized civilians and active military. Charles Roehrig, Ph.D., the founding director of the Center for Sustainable Health Spending at Altarum Institute in Michigan and author of the spending analysis, noted that other estimates of medical spending, such as the Medical Expenditure Panel Survey (MEPS) conducted by the Agency for Healthcare Research and Quality (AHRQ), do not include this subpopulation and their financial impact.However, the driving force of these costs might surprise some. “People might naturally think that the increased spending is due to the rise of Alzheimer’s and other dementia cases as our population ages,” Roehrig told Psychiatric News. “But that was not the case.”He pointed out that spending on dementia care rose only an average of 4 percent annually in the analysis period (1996 to 2013)—slightly below the 4.3 percent annual growth of the United States gross domestic product (GDP) in that same period. Rather, spending for depression and anxiety, which grew at over 7 percent annually from 1996 to 2013, was responsible for much of the increase. The future, though, could be a different story. “In 2013, only the oldest baby boomers had become eligible for Medicare, which means an influx of people ready to enter into the category of institutionalized civilians is looming,” Roehrig said. “And as of yet no one has reached the threshold of curing diseases of the very elderly, so there is an urgent need to think proactively about managing costs.”APA President Maria A. Oquendo, M.D., agreed with this assessment. “The fact that more than 40 percent is spent on populations in prisons, nursing homes, and other institutional settings demonstrates the need to invest more in preventive mental health care,” she told Psychiatric News.As an example, she noted that spending for heart conditions increased by only 2 percent annually from 1996 to 2013, which the study attributed in part to increased prevention measures, such as a reduction in smoking and more awareness and treatment of risk factors like high blood pressure and high cholesterol.“However, while noninstitutional mental health care is significantly less expensive, this study should not be misread to mean we need to invest less in outpatient settings,” Oquendo added. “The reality is that we need to spend wisely on all fronts.” Roehrig noted that these spending estimates do not account for all medically related costs; there was insufficient data for three categories of expenses (durable medical equipment, nondurable medical products, and other personal health care) totaling around $274 billion to allocate them among the various medical conditions and thus were not included in the analysis.The study was funded by the Department of Commerce, Bureau of Economic Analysis. ■An abstract of “Mental Disorders Top the List of the Most Costly Conditions in the United States: $201 Billion” can be accessed here. ISSUES NewArchived

A Vision for Preventative Mental Healthcare

The importance of preventative medicine has been firmly established for decades, most notably in addressing risk factors for cardiovascular disease. However, in the field of mental healthcare, the prevention agenda has received insufficient attention. One of the principal reasons for this, besides the global funding deficit for mental health (WHO, 2011), is that mental disorders have complex etiology. Within this biopsychosocial framework, understanding of both the molecular biology of neuropsychiatric disorders and deep-rooted economic and social risk factors (e.g. poverty, unemployment, and abuse) remains limited. Presently, few evidence-based interventions are scalable at the population level

Deployment-related mental health support: comparative analysis of NATO and allied ISAF partners

BackgroundFor years there has been a tremendous gap in our understanding of the mental health effects of deployment and the efforts by military forces at trying to minimize or mitigate these. Many military forces have recently systematized the mental support that is provided to support operational deployments. However, the rationale for doing so and the consequential allocation of resources are felt to vary considerably across North Atlantic Treaty Organisation (NATO) International Security Assistance (ISAF) partners. This review aims to compare the organization and practice of mental support by five partnering countries in the recent deployment in Afghanistan in order to identify and compare the key methods and structures for delivering mental health support, describe bottlenecks and illustrate new developments.MethodInformation was collected through document analysis and semi-structured interviews with key military mental healthcare stakeholders. The review resulted from close collaboration between key military mental healthcare professionals within the Australian Defense Forces (ADF), Canadian Armed Forces (CAF), United Kingdom Armed Forces (UK), Netherlands Armed Forces (NLD), and the United States Army (US). Key stakeholders were interviewed about the mental health support provided during a serviceperson's military career. The main items discussed were training, prevention, early identification, intervention, and aftercare in the field of mental health.ResultsAll forces reported that much attention was paid to mental health during the individual's military career, including deployment. In doing so there was much overlap between the rationale and applied methods. The main method of providing support was through training and education. The educative focus was to strengthen the mental resilience of individual soldiers while providing a range of mental healthcare services. All forces had abandoned standard psychological debriefing after critical incidents. Instead, by default, mental healthcare professionals acted to support the leader and peer led “after action” reviews. All countries provided professional mental support close to the front line, aimed at early detection and early return to normal activities within the unit. All countries deployed a mental health support team that consisted of a range of mental health staff including psychiatrists, psychologists, social workers, mental health nurses, and chaplains. There was no overall consensus in the allocation of mental health disciplines in theatre. All countries (except the US) provided troops with a third location decompression (TLD) stop after deployment, which aimed to recognize what the deployed units had been through and to prepare them for transition home. The US conducted in-garrison ‘decompression’, or ‘reintegration training’ in the US, with a similiar focus to TLD. All had a reasonably comparable infrastructure in the field of mental healthcare. Shared bottlenecks across countries included perceived stigma and barriers to care around mental health problems as well as the need for improving the awareness and recognition of mental health problems among service members. among service personnel as well as the need for improving the awareness and recognition of symptoms as being indicative of a mental health problems among servicemembers.ConclusionThis analysis demonstrated that in all five partners state-of-the-art preventative mental healthcare was included in the last deployment in Afghanistan, including a positive approach towards strengthening the mental resilience, a focus on self-regulatory skills and self-empowerment, and several initiatives that were well-integrated in a military context. These initiatives were partly/completely implemented by the military/colleagues/supervisors and applicable during several phases of the deployment cycle. Important new developments in operational mental health support are recognition of the role of social leadership and enhancement of operational peer support. This requires awareness of mental problems that will contribute to reduction of the barriers to care in case of problems. Finally, comparing mental health support services across countries can contribute to optimal preparation for the challenges of military deployment.

Possible Risk Factors for Acute Stress Disorder and Post-Traumatic Stress Disorder After an Industrial Explosion.

There have been deaths and injuries after an explosion which happened in an industrial region in Ankara in February 2011. The aim of this study was to determine the prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD), and to determine the variables which can be the risk factors for PTSD. In this study, we included a total of 197 subjects who were present at the factory building and at the four offices nearby when the disaster occurred. All the participants were assessed one month after the explosion and 157 of them were reassessed six months after the explosion. Socio-demographic information forms were given and the Clinician-Administered PTSD Scale (CAPS) was administered to the participants one month after the explosion. Psychiatric assessments were done using the structured clinical interview for DSM-IV axis-I disorders (SCID-I). The CAPS was re-applied six month after the disaster. At the first-month assessments, ASD was detected in 37.1% of participants and PTSD in 13.7%, whereas PTSD was observed in 16.6% of subjects at the sixth month of the accident. According to the first month data, having any psychiatric disorder before the incident, physical injury, acquaintances among the dead and the injured people, being involved in the incident and seeing dead people were detected as the risk factors for PTSD. At the sixth month assessment, physical injury, acquaintances among the dead and the injured, being involved in the incident were seen as risk factors for PTSD. ASD and PTSD can be seen after an explosion. Having a previous psychiatric disorder and being directly affected by trauma and being injured are the risk factors for PTSD. This study implies that preventive mental health care services should include the management of current psychiatric condition and employee safety issues.

Missed opportunities for mental and behavioral health care

In an urban comprehensive healthcare system (Cambridge Health Alliance, Cambridge, Massachusetts), investigators performed a longitudinal study of children and adolescents who received behavioral and mental health screening in order to assess adherence to returning for subsequent preventive care visits. For those non-adherent patients, the authors sought to determine why they were “lost” from their medical home or whether they were actually seen in another medical home setting (ie, acute care visit) or system venue (ie, emergency department). In fact, 85% of 461 non-adherent children and adolescents subsequently returned for acute care or delayed preventive care or emergency care in the same medical system. Since mental health/behavioral health risk characteristics were one predictor of non-adherence with scheduled preventive health visits, it behooves pediatricians not to miss opportunities during unscheduled visits to re-connect with patients and continue preventive mental health care. This approach has worked toward keeping a vulnerable population for delayed immunizations up-to-date. Article page 666▶ Mental and Behavioral Health Screening at Preventive Visits: Opportunities for Follow-Up of Patients Who are Nonadherent with the Next Preventive VisitThe Journal of PediatricsVol. 158Issue 4PreviewTo determine the type of subsequent care received by children nonadherent with their next preventive visit and whether behavioral factors predict use of emergency or acute care in this population. Full-Text PDF

Perceived parenting style, depression and anxiety levels in a Turkish late-adolescent population

The socio-economic status of family has an effect on the mental health. Individuals from “low-S.E.S” families are more prone to depression and anxiety disorders. This study observes the relation between perceived parenting style and depressive moods in Turkish adolescents from 3 different S.E.S levels. A total of 150 subjects representing 3 different S.E.S levels were given the “My Memories of Upbringing”, Children Depression Inventory, and State-Trait Anxiety Inventory tests. Results indicate that school guidance and psychological counseling services should develop policies addressing parents for giving insight about their parenting style which in turn might result in preventive mental healthcare.

Communicating evidence-based mental health care to service users

There is a significant gap between evidence-based mental health care and patients, their family members and carers. To inform preventative mental health care among existing and potential service users, this review identifies effective methods for communicating evidence. A systematic review located 14 publications that met search criteria. Several methods can effect behavioural and/or intermediary change among existing and/or potential service users: namely, mass media; health warning labels; policy change; community interventions; school-based programs; parent programs; and psychoeducation. Robust evidence, however, is lacking. Although effective approaches are likely to be founded on several factors, the review concludes with a discussion of a research agenda, and appropriate methodologies that could strengthen the knowledge base that guides the communication of evidence-based mental health care to service users. This agenda has important implications for practitioners, policymakers, and researchers, which are also discussed.

P02-93 Psychosocial conditions and suicidal behavior in pregnat teenagers: A case-control study in Brazil

Aim:To compare the psychosocial profile and suicidal behavior of 110 pregnant teenagers (PT) with 110 non-pregnant teenagers (NPT).Method:Subjects were matched by age and residential district. A structured interview and psychometric scales were used. Uni-and multivariate logistic regression were performed.Results:Prevalence in the PT and the NPT groups were: attempted suicide (20.0% vs 6.3%); depression (26.3% vs 13.6%); anxiety (43.6% vs 28.0%). Univariate analysis revealed the following significant associations with pregnancy: relocation in the previous 3 years (odds ratio (OR) = 6); years of schooling ≤7 (OR = 3.4); dropping out of school (OR = 5.2); death of a parent during childhood (OR = 2.9); use of alcohol/drugs in the family (OR = 2.5); previous attempted suicide (OR = 3.6); suicide by a relative (OR = 2.1); threats of physical/sexual abuse (OR = 3.5); depression (OR = 2.2); low level of social support (OR = 4.2), psychosocial difficulties (OR = 4.4); prior use of marijuana (OR = 4.8); weekly intake of alcohol over the previous 12 months (OR = 4.2). Multivariate analysis identified the following associations: relocation (OR = 6.4); prior use of tobacco (OR = 2.9); dropping out of school (OR = 2.3); suicide by a social acquaintance (OR = 2.5).Conclusion:The PT case group exhibited a psychosocial profile whose characteristics clearly differentiate this group from the NPT control group. Preventive mental health care is needed to help pregnant teenagers because their behavioral pattern exposes them to high risk for suicide.

Psychosocial conditions and suicidal behavior in pregnant teenagers

To compare the psychosocial profile and suicidal behavior of 110 pregnant teenagers (PT) with 110 non-pregnant teenagers (NPT). Subjects were matched by age and residential district. The research instruments used were a structured clinical interview and a self-reporting questionnaire based on psychometric scales whose answers were subjected to univariate and multivariate logistic regression. Prevalence in the PT and the NPT groups were found to be as follows: attempted suicide (20.0 vs. 6.3%); depression (26.3 vs. 13.6%); anxiety (43.6 vs. 28.0%). Univariate analysis revealed the following significant associations with pregnancy: relocation in the previous 3 years (odds ratio (OR) = 6); years of schooling < or =7 (OR = 3.4); repeating a year in school (OR = 2.4); dropping out of school (OR = 5.2); death of a parent during childhood (OR = 2.9); use of alcohol/drugs in the family (OR = 2.5); previous attempted suicide (OR = 3.6); suicide by a relative (OR = 2.1); threats of physical/sexual abuse (OR = 3.5); depression (OR = 2.2); low level of social support (OR = 4.2); traumatic events (OR = 5.1) and psychosocial difficulties (OR = 4.4); prior use of tobacco and marijuana (OR = 4.0 and 4.8 respectively); weekly intake of alcohol over the previous 12 months (OR = 4.2). Multivariate analysis identified the following associations: relocation (OR = 6.4); prior use of tobacco (OR = 2.9); dropping out of school for a period in excess of 6 months (OR = 2.3); suicide by a social acquaintance (OR = 2.5). The PT case group exhibited a psychosocial profile whose characteristics clearly differentiate this group from the NPT control group. Preventive mental health care is needed to help PT because their behavioral pattern exposes them to high risk for suicide.

Innovations in Preventive Mental Health Care Services for Adolescents

Purpose This descriptive study examined programs designed to provide mental health-related preventive services to at-risk adolescents. Methods Qualitative interviews were conducted with state and local program directors and key personnel in public health and mental health departments and academic researchers who have initiated preventive services. Results States and local communities offer varied mental health-related preventive services for high-risk adolescents in diverse settings. Services include public education, screening, early intervention for adolescents, and educational programs for primary care providers. Funding mechanisms include state general funds, foundation grants, and Medicaid and the State Children's Health Insurance Program dollars. Evaluation is essential to maintain services and to persuade funders and other stakeholders to sustain these efforts. Conclusions State and local prevention-related mental health programs have been implemented with limited funding, but significant local advocacy and community support. More extensive evaluation and cost effectiveness studies may encourage policymakers to expand services. Further data are necessary to determine how prevention-related mental health programs can best serve vulnerable youth.

Anger in the Combat Zone

A U.S. Army Reserve Combat Stress Control prevention team was dispatched to Afghanistan in support of Operation Enduring Freedom to provide preventative mental health care to a U.S. Army airborne division and Special Operations forces. The team's mission was to ensure mental health readiness of units in the area of operations. In Bagram, Afghanistan, the Combat Stress Control team identified anger as a very prevalent emotion in the combat zone. Anger management interventions with individual and group counseling were implemented to help soldiers cope with anger. Of 7,000 military personnel stationed there during the team's rotation, there was not one completed suicide or homicide. This article describes how the 113th Medical Company identified, treated, and controlled anger at Bagram Airbase, Afghanistan, between June 20, 2002, and December 20, 2002, with anger management interventions. This article does not address the psychophysiological features of anger.

Preventative mental health care: accessing the target population.

Preventative approaches to mental illness are becoming a focus of clinical and research settings. To date, however, few clinical programs have been established with this primary aim. This descriptive paper summarises patterns of referral to one service providing clinical care for young people known to be at high risk of developing a psychotic illness. A 20-month survey of referrals to the service revealed that most patients had a prolonged and circuitous route to assessment. Additionally, a lengthy time period elapsed between the onset of symptoms and initiation of help seeking. Information arising from this survey may influence the development of strategies to improve access to this service and others aimed at the prevention of psychosis. Further, this information may affect the development of generalised preventative mental health services for young people.

Mental Health Care: The Singapore Context

This article describes the remedial and preventive mental health care available in Singapore, with special emphasis on how world-views and other social-cultural factors influence the diagnosis and psychosocial treatment of the mentally ill. Certain behavioural concepts typical of the local population and significant in help-seeking therapy, especially in the area of family counselling and support, are included in the discussion on in-patient and community care. Effective delivery and usage of services are shown to be dependent on the ability to blend professional knowledge with the world-views and cultural expectations of the service-user.

Tertiary prevention in mental health care: effects of group meetings for family caregivers.

Several series of discussion groups were conducted for people caring for relatives who suffer from chronic schizophrenia. Groups aimed to provide information from both experts and fellow caregivers about the illness and about coping techniques, and to foster emotional support within the peer group. Owing to the small number of subjects, statistical power was inadequate to test effects quantitatively; however, the responses of the family caregivers to structured follow-up questions indicated many gains from group attendance. Attendance and participation rates were high once subjects were engaged; positive outcomes were reported by the carers, and they actively sought feedback of their dissatisfactions with mental health services to the relevant decision-makers. The results are relevant both in the area of preventive mental health care for carers, and in promoting collaboration between carers and professionals.

Making it work: preventive mental health care for disadvantaged preschoolers.

Combining education and mental health services in a preschool setting for disadvantaged children can produce significant benefits for these children and their parents. At a time of fiscal constraints, partnerships between the education and mental health sectors can amplify both systems' achievements in a time-efficient manner. Such partnerships recognize and use each profession's expertise to create a more balanced, efficient, and realistic approach to serving children. This article looks at the technical, interpersonal, theoretical, and philosophical aspects of developing mental health-education partnerships in community preschool programs for disadvantaged children and their families. Issues to be addressed in establishing such partnerships include the referral process and tracking of client status, roles and job definition, communication, mutual respect, space and territory issues, and confidentiality. Family outreach, the parent-therapist partnership, professional boundaries, and benefits of partnership are also discussed.