Mental Health Priorities Research Articles

Psychiatry and Politics: Can They Mix?

Psychiatry and Politics: Can They Mix?

Mental health interventions and priorities for research for adult survivors of torture and systematic violence: a review of the literature

This research describes the development and findings of a literature review and analysis meant to inform the international torture and trauma treatment community. The review focuses on interventions that have been used among populations affected by torture, based on a review of journals indexed in commonly used search engines. Work on the review began in September 2008 and continued to be updated until March 2014. In total, 88 studies of interventions for torture victims were identified. Studies ranged from randomized controlled trials utilizing evidence-based treatments to case studies employing non-structured, supportive therapies. Based on the results of the analysis, we have included recommendations for interventions that demonstrate effectiveness in treating survivors of torture and other systematic violence who suffer from PTSD, depression and anxiety. Priorities for mental health research for survivors of torture and other systematic violence are also recommended.

Aligning an undergraduate psychological medicine subject with the mental health needs of the local region

BackgroundThe James Cook University (JCU) medical school recently revised its Year 2 human development and behaviour module to be more relevant and practical for students, and more aligned with the mental health priorities of the local region (north Queensland). This study reports medical students’ level of preparedness conferred by the re-designed ‘Psychological Medicine and Human Development’ (PMHD) subject for their later 4-week, rural clinical placement in Year 2.MethodsNon-randomized, controlled ‘naturalistic’ study with pre- and post-intervention surveys. The patient mental health experiences of Year 2 students who went on clinical placement after undertaking the PMHD subject were compared to those who went on placement before undertaking PMHD.ResultsA total of 209 JCU Year 2 medical students completed surveys from a possible 217 (response rate = 96%). Compared to students whom had not taken PMHD before going on placement, students going on placement after undertaking PMHD were significantly more likely to report: feeling comfortable discussing mental health issues with patients (p = 0.001); being prepared for mental health discussions with patients (p < 0.001); having an actual mental health discussion with a patient (p < 0.001); and, volunteering an opinion on the appropriateness of their supervising doctor’s response (p < 0.001). Students reported subject content involving information and classroom instruction on assessing and interviewing patients for mental illness to be of most use.ConclusionsProviding medical students with psychological medicine information on locally prevalent mental health conditions plus practical classroom experiences in conducting mental state exams better prepares them for interacting with patients experiencing psychological distress. This novel methodology – aligning formal teaching in a subject with an evaluation utilizing a proximate student placement to provide useful feedback on the curriculum content and assess the relevance of the material taught – could be used to revise other content areas of a medical course to be more locally relevant and practically focused, and then to evaluate the success of this revision.

Maternal mental health priorities, help-seeking behaviors, and resources in post-conflict settings: a qualitative study in eastern Uganda

BackgroundLimited knowledge exists to inform the selection and introduction of locally relevant, feasible, and effective mental health interventions in diverse socio-cultural contexts and health systems. We examined stakeholders’ perspectives on mental health-related priorities, help-seeking behaviors, and existing resources to guide the development of a maternal mental health component for integration into non-specialized care in Soroti, eastern Uganda.MethodsWe employed rapid ethnographic methods (free listing and ranking; semi-structured interviews; key informant interviews and pile sorting) with community health workers (n = 24), primary health workers (n = 26), perinatal women (n = 24), traditional and religious healers (n = 10), and mental health specialists (n = 9). Interviews were conducted by trained Ateso-speaking interviewers. Two independent teams conducted analyses of interview transcripts following an inductive and thematic approach. Smith’s Salience Index was used for analysis of free listing data.ResultsWhen asked about common reasons for visiting health clinics, the most salient responses were malaria, general postnatal care, and husbands being absent. Amongst the free listed items that were identified as mental health problems, the three highest ranked concerns were adeka na aomisio (sickness of thoughts); ipum (epilepsy), and emalaria (malaria). The terms epilepsy and malaria were used in ways that reflected both biomedical and cultural concepts of distress. Sickness of thoughts appeared to overlap substantially with major depression as described in international classification, and was perceived to be caused by unsupportive husbands, intimate partner violence, chronic poverty, and physical illnesses. Reported help-seeking for sickness of thoughts included turning to family and community members for support and consultation, followed by traditional or religious healers and health centers if the problem persisted.ConclusionOur findings add to existing literature that describes ‘thinking too much’ idioms as cultural concepts of distress with roots in social adversity. In addition to making feasible and effective treatment available, our findings indicate the importance of prevention strategies that address the social determinants of psychological distress for perinatal women in post-conflict low-resource contexts.

Occupational health status of electronics manufacturing female employees in China

Electronics industry is a typical labor-intensive industry in China. There are a lot of female workers and various occupational hazard factors in the workplace. This article reviewed the characteristics of employment of women in electronics industry, occupational hazards of exposure, protective measures, occupational disease situation, influence of reproductive health and mental health, and occupational health management. Electronics female emplyees have the priority in reproductive health and mental health. Besides, this group has poor protective measures, occupational health management and policy should be taken to enhance the level of women health in electronics industry.

The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis

SummaryBackgroundSleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations.MethodsWe did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251.FindingsBetween March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohen's d=1·11; p<0·0001), paranoia (−2·22, −2·98 to −1·45, Cohen's d=0·19; p<0·0001), and hallucinations (−1·58, −1·98 to −1·18, Cohen's d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported.InterpretationTo our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision.FundingWellcome Trust.

Personality disorder: A mental health priority area

Personality disorders have received limited recognition as a public health priority, despite the publication of treatment guidelines and reviews showing effective treatments are available. Inclusive approaches to understanding and servicing personality disorder are required that integrate different service providers. This viewpoint paper identifies pertinent issues surrounding early intervention, treatment needs, consumer and carer experiences, and the need for accurate and representative data collection in personality disorder as starting points in mental health care reform.

Mental health education in occupational therapy professional preparation programs: Alignment between clinician priorities and coverage in university curricula.

Occupational therapy programs must prepare graduates for work in mental health. However, this area of practice is complex and rapidly changing. This study explored the alignment between educational priorities identified by occupational therapists practising in mental health and level of coverage of these topics in occupational therapy programs in Australia and New Zealand. Surveys were distributed to heads of all occupational therapy programs across Australia and New Zealand. The survey included educational priorities identified by occupational therapists in mental health from a previous study. Respondents were requested to identify the level of coverage given to each of these priorities within their curriculum. These data were analysed to determine a ranking of educational topics in terms of level of coverage in university programs. Responses were received for 19 programs from 16 universities. Thirty-four topics were given 'High-level coverage' in university programs, and these were compared against the 29 topics classified as 'Essential priorities' by clinicians. Twenty topics were included in both the 'Essential priorities' and 'High-level coverage' categories. Topics considered to be 'Essential priorities' by clinicians which were not given 'High-level coverage' in university programs included the following: mental health fieldwork experiences; risk assessment and management; professional self-care resilience and sensory approaches. While there appears to be overall good alignment between mental health curricula and prioritiesidentified by practising occupational therapists, thereare some discrepancies. These discrepancies are described and establish a strong foundation for further discussion between clinicians, academics and university administration to support curriculum review and revision.

Evaluating Depressive Symptomatology, Maternal Loneliness, and Maternal Self-Esteem in Mothers Who Attend a New Moms Peer Support Group

Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Mental Health, Presented at the 38th National NAPNAP Conference on Pediatric Health Care, March 17, 2017, Denver, CO. The purpose of this project was to compare depressive symptomatology, loneliness, and self-esteem between mothers who did and mothers who did not attend an existing peer support group in a large urban pediatric office between 8- and 12-weeks postpartum. Postpartum depression is the most common form of morbidity after delivery with an estimated prevalence of 13% (O'Hara & Swain, 1996). The etiology of postpartum depression remains unclear, with identified risk factors including: life stress, child-care stress, marital conflict, low maternal self-esteem, and lack of social support (Dennis, 2003). Research shows that a lack of social support is a significant predictor of postpartum depression (Dennis, 2014), and mothers with a higher perceived level of loneliness are more likely to experience depressive symptomatology postpartum (Nielsen Forman, Videbech, Hedegaard, Dalby Salvig, & Secher, 2000). Do women who attend New Mom's Coffee (NMC), a peer support group for mothers offered by a pediatric clinic, experience lower rates of depressive symptomatology, less loneliness, and higher levels of self-esteem than mothers who do not attend the group? A quasi-experimental project was conducted at a large outpatient practice in western Pennsylvania using a non-randomized two-group post-test comparison design. The sample included mothers who attended NMC (n=21) and mothers with children in the practice that did not attend NMC (n=12). The project was approved by the physician-owner of the practice and the Human Research Protection Office at the university determined that the study qualified for expedited IRB review. Mothers who agreed to participate in the intervention group were asked to attend NMC at least once a week from 8- through 12-weeks postpartum. Participants completed demographic data 8-weeks postpartum, and the Edinburgh Postnatal Depression Scale, UCLA Loneliness Scale, and Rosenberg Self-Esteem Scale at 8- and 12-weeks postpartum. A chi-square analysis evaluated differences between intervention and comparison groups for each of these instruments from 8- to 12 weeks. Student t-tests were used to compare the differences in scores of each scale between groups. Groups were comparable in age, education, ethnicity, marital status and household income. There was a decrease in the EPDS scores in both groups with a greater decrease in the intervention group than the comparison group: 27.6% and 9.8% respectively (P=0.653). There was a statistically significant decrease in the loneliness score of the intervention group (6.4%) in contrast with an 11.7% increase in the comparison group (P=0.033). The difference in the self-esteem score was statistically significant with a 4.4% increase in the intervention group and a 3.2% decrease in the comparison group (P=0.045). NMC offers peer support for new mothers. The partnership between the pediatricians' office and NMC enables the care provider to screen first time mothers for postpartum depression and educate them about the potential benefits of attending NMC. This project may contribute to adoption of this disease prevention strategy to prevent postpartum depression through use of peer support groups in the outpatient pediatric setting.

A suicide research agenda for people from immigrant and refugee backgrounds

ABSTRACTThe aim of this study was to establish mental health and suicide research priorities for people from immigrant and refugee background in Australia. This article focuses on the data relevant to the development of the suicide research agenda. This study was conducted using Delphi consensus method with two rounds of online questionnaires. A total of 138 and 86 participants, respectively, completed the first and second rounds of survey. Participants were policy makers, service providers, academics, service users, and carer advocates in Australia with expertise in mental health and/or suicide among people from immigrant and refugee backgrounds. Of the total 268 research questions included in the questionnaires, 70 questions about suicide were ranked as essential by over 50% respondents (i.e., the set level of consensus). In particular, research questions regarded as the greatest priority related to access and engagement with suicide prevention services, suicide protective and risk factors compared to populations not from immigrant and refugee backgrounds, and culturally appropriate assessment of suicide risk.

Building system capacity for the integration of mental health at the level of primary care in Tunisia: a study protocol in global mental health

BackgroundIn low- and middle-income countries (LMICs), addressing the high prevalence of mental disorders is a challenge given the limited number and unequal distribution of specialists, as well as scarce resources allocated to mental health. The Mental Health Gap Action Programme (mhGAP) and its accompanying Intervention Guide (IG), developed by the World Health Organization (WHO), aim to address this challenge by training non-specialists such as general practitioners (GPs) in mental health care. This trial aims to implement and evaluate an adapted version of the mhGAP-IG (version 1.0) offered to GPs in 2 governorates of Tunisia (i.e., Tunis and Sousse), in order to uncover important information regarding implementation process and study design before country-wide implementation and evaluation.Methods/DesignFirst, a systematic review will be conducted to explore types and effectiveness of mental health training programs offered to GPs around the world, with a specific focus on programs implemented and evaluated in LMICs. Second, a cluster randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the implemented training based on the mhGAP-IG (version 1.0). Third, multiple case study design will be used to explore how contextual factors impact the successful implementation of the training and desired outcomes.DiscussionIn Tunisia, an important need exists to further develop proximity health services and to address the growing mental health treatment gap. One solution is to train GPs in the detection, treatment, and management of mental health problems, given their strategic role in the healthcare system. This trial thus aims to implement and evaluate an adapted version of a training based on the mhGAP-IG (version 1.0) in Tunis and Sousse before country-wide implementation and evaluation. Several contributions are envisioned: adding to the growing evidence on the mhGAP and its accompanying guide, especially in French-speaking nations; building research capacity in Tunisia and more generally in LMICs by employing rigorous designs; evaluating an adapted version of the mhGAP-IG (version 1.0) on a sample of GPs; generating important information regarding implementation process and study design before country-wide implementation; and complimenting the trial results with implementation analysis, a priority in global mental health.

Calibrating well-being, quality of life and common mental disorder items: psychometric epidemiology in public mental health research.

BackgroundThe assessment of ‘general health and well-being’ in public mental health research stimulates debates around relative merits of questionnaire instruments and their items. Little evidence regarding alignment or differential advantages of instruments or items has appeared to date.AimsPopulation-based psychometric study of items employed in public mental health narratives.MethodMultidimensional item response theory was applied to General Health Questionnaire (GHQ-12), Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and EQ-5D items (Health Survey for England, 2010–2012; n = 19 290).ResultsA bifactor model provided the best account of the data and showed that the GHQ-12 and WEMWBS items assess mainly the same construct. Only one item of the EQ-5D showed relevant overlap with this dimension (anxiety/depression). Findings were corroborated by comparisons with alternative models and cross-validation analyses.ConclusionsThe consequences of this lack of differentiation (GHQ-12 v. WEMWBS) for mental health and well-being narratives deserves discussion to enrich debates on priorities in public mental health and its assessment.

Time for a global commission on mental health institutions

Time for a global commission on mental health institutions

Vulnerable children a 'mental health priority', say MPs.

LOOKED AFTER children should be made a priority in having their mental health assessed by specialists, say MPs.

Trust and the Dilemmas of Suicide Risk Assessment in Non-government Mental Health Services

ABSTRACTReducing suicide rates is a national mental health priority as over 2,200 people die from suicide each year in Australia. Increasingly, nongovernment organisations (NGOs) provide services to people experiencing severe and persistent mental illnesses—a significant cohort at risk of suicide. While clinical services are generally seen as the arbiters of risk, little is known of how suicide risk assessments are undertaken in NGOs. This article reports the findings of a survey-based pilot study of 44 frontline workers in mental health-focused NGOs in Tasmania, Australia, with the aim of sketching a preliminary picture of this under-studied terrain. We identified the assessment practices utilised by workers, and the challenges and dilemmas they experienced in navigating issues of trust in suicide risk assessment in contexts where they often felt vulnerable and under-prepared. We argue that these early findings demonstrate the need for organisations to foster cultures of trust to facilitate both the activities of relationship building between practitioners and clients, and those of monitoring risk.

Defining Research Priorities for Nutrition and Mental Health: Insights from Dietetics Practice.

In 2014, a national initiative aimed at defining a research agenda for nutrition and mental health among diverse stakeholders was completed and included insights from more than 300 registered dietitians. This study explores the data from dietitians based on their years of practice, mental health experiences, and community of practice in relationship to identified mental health and nutrition research priorities. Analysis of numerical data (n = 299) and content analysis of open-ended responses (n = 269) revealed that respondents desired research for specific mental health conditions (MHCs), emotional eating, food addiction, populations with special needs, and people encountering major life transitions (e.g., recovery from abuse, refugees). Findings from the quantitative and textual data suggested that dietitians want research aimed at addressing the concerns of those in the community, fostering consumer nutrition knowledge and skill acquisition, and developing services that will impact quality of life. Subgroup analysis indicated that dietitians: (i) in early years of practice want information about specific MHCs; (ii) living in smaller towns and rural areas want data about the cost benefits of dietetics practice in mental health; and (iii) who also had additional stakeholder roles (e.g., service provider) selected priorities that address gaps in mental health services. This study highlights opportunities to tailor nutrition and mental health research that advance dietetics practice.

Perceived health concerns among sexual minority women in Mumbai, India: an exploratory qualitative study

The experiences of sexual minority women (i.e., women who do not identify as ‘heterosexual’) in India have largely been absent in scientific literature. In partnership with India’s oldest and largest sexual and gender minority-advocacy organisation, the Humsafar Trust, our study used community-based participatory research principles to explore the lived experiences and health concerns of sexual minority women in Mumbai. Study methodologies included interviews with key informants, a focus group comprised of six women, and an additional 12 in-person interviews with sexual minority women to identify important physical, mental, social and other health priorities from these women’s perspectives. Thematic data are organised within the framework offered by the social ecological model, including individual, interpersonal, micro and macro levels. Findings from this study are important in providing the groundwork for future research and intervention involving sexual minority women in India, a dramatically underserved population.

Key influences in the design and implementation of mental health information systems in Ghana and South Africa.

Strengthening of mental health information systems (MHIS) is essential to monitor and evaluate mental health services in low and middle-income countries. While research exists assessing wider health management information systems, there is limited published evidence exploring the design and implementation of MHIS in these settings. This paper aims to identify and assess the key factors affecting the design and implementation of MHIS, as perceived by the key stakeholders in Ghana and South Africa. We report findings from the Mental Health and Poverty Project, a 5-year research programme implemented within four African countries. The MHIS strengthening in South Africa and Ghana included two related components: intervention and research. The intervention component aimed to strengthen MHIS in the two countries, and the research component aimed to document interventions in each country, including the key influences. Data were collected using semi structured interviews with key stakeholders and reviews of key documents and secondary data from the improved MHIS. We analyzed the qualitative data using a framework approach. Key components of the MHIS intervention involved the introduction of a redesigned patient registration form, entry into computers for analysis every 2 months by clinical managerial staff, and utilization of data in hospital management meetings in three psychiatric hospitals in Ghana; and the introduction of a new set of mental health indicators and related forms and tally sheets at primary care clinics and district hospitals in five districts in the KwaZulu-Natal and Northern Cape provinces in South Africa. Overall, the key stakeholders perceived the MHIS strengthening as an effective intervention in both countries with an enhanced set of indicators in South Africa and introduction of a computerized system in Ghana. Influences on the design and implementation of MHIS interventions in Ghana and South Africa relate to resources, working approaches (including degree of consultations during the design stage and communication during implementation stage) and the low priority of mental health. Although the influencing factors represent similar categories, more influences were identified on MHIS implementation, compared with the design stage. Different influences appear to be related within, and across, the MHIS design and implementation and may reinforce or negate each other thus leading to the multiplier or minimization effects. The wider context, similar to other studies, is important in ensuring the success of such interventions. Future MHIS strengthening interventions can consider three policy implications which emerged from our analysis and experience: enhancing consultations during the intervention design, better consideration of implementation challenges during design, and better recognition of relations between different influences.

Mental Health Priorities: Stigma Elimination and Community Advocacy in College Settings

Low rates of psychological help-seeking among college students have been attributed to a lack of awareness about on-campus resources and to mental illness stigma. One mental health advocacy organization, Active Minds, collaborates with its university-recognized student-run on-campus chapters to promote service use and psychological healthy activities. This study quantitatively evaluated 15 mental health priorities. Surveyed participants ( N = 46) represented Active Minds national office staff and on-campus chapter leaders. Factor analysis revealed 3 overarching priorities: illness awareness, community improvement, and stigma change. University leaders should consider collaborating with student-energized efforts to destigmatize and improve help-seeking behavior among college students.

Preparing the Field for Feasibility Testing of a Parenting Intervention for War-Affected Mothers in Northern Uganda.

In this article, we discuss the successful implementation of an adapted evidence-based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long-term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance-use disorders. The processes described here cover a 4-year period culminating in the implementation of the nine-session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.