Severe Mental Health Conditions Research Articles

Eating Disorders: A Historical Perspective and Analysis of Current Treatment Approaches

Eating disorders are severe mental health conditions that are associated with a high level of illness and death. These disorders, which include anorexia nervosa, bulimia nervosa, and binge eating disorder, have complex causes that involve a combination of genetic, psychological, and sociocultural factors. The treatment for eating disorders focuses on restoring weight and establishing healthy eating habits, while also addressing underlying issues related to emotional regulation and distorted thoughts. Over time, the approach to treating eating disorders has evolved, with changes in both psychiatry and clinical psychology. In the past, these disorders were often seen as unexplainable forms of hysteria and were treated with rest cures and confinement in asylums. The introduction of psychoanalysis, behaviorism, and pharmacology brought about an expansion in the range of therapeutic options available, although their effectiveness remained limited. Progress was made through the establishment of specialized inpatient programs and the implementation of standardized treatment protocols, leading to improved outcomes. Presently, evidence-based protocols incorporate psychological therapy, nutrition rehabilitation, and medical monitoring that are tailored to meet the individual needs of patients. Among the various treatment approaches, family-based treatment has shown the strongest empirical support for young individuals, while enhanced cognitive behavioral therapy has proven effective for adults. Despite the significant advancements made, eating disorder interventions still face challenges such as high relapse rates, indicating the need for further evolution in intervention strategies to enhance prevention and accessibility. This paper aims to examine the historical development of eating disorder treatments while providing a critical analysis of the current gold standard interventions. The discussion will address the persisting challenges in reducing eating disorder morbidity and mortality by exploring innovative therapeutic targets, modalities, and methods of dissemination.

COVID-19 experience of people with severe mental health conditions and families in South Africa.

People with severe mental health conditions, such as schizophrenia, and their family caregivers are underserved in low- and middle-income countries where structured psychosocial support in the community is often lacking. This can present challenges to recovery and for coping with additional strains, such as a pandemic. This study explored the experiences and coping strategies of people with lived experience of a severe mental health condition, and family caregivers, in South Africa during the initial stages of the coronavirus disease 2019 (COVID-19) pandemic. This qualitative study was conducted in the Nelson Mandela Bay District, Eastern Cape, South Africa, in the most restrictive period of the COVID-19 lockdown. Telephonic qualitative interviews were conducted with people with lived experience (n = 14) and caregivers (n = 15). Audio recordings were transcribed and translated to English from isiXhosa. Thematic analysis was conducted with NVivo 12. Participants described negative impacts including increased material hardship, intensified social isolation and heightened anxiety, particularly among caregivers who had multiple caregiving responsibilities. Coping strategies included finding ways to not only get support from others but also give support, engaging in productive activities and taking care of physical health. The main limitation was inclusion only of people with access to a telephone. Support needs for people with severe mental health conditions and their families should include opportunities for social interaction and sharing coping strategies as well as bolstering financial security. These findings indicate that current support for this vulnerable group is inadequate, and resource allocation for implementation of additional community-based, recovery-focused services for families must be prioritised.

Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries.

Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.

Fear and depression among health care professionals: a cross-sectional study during COVID-19 pandemic in Bangladesh

Background: COVID-19 pandemic is a public health emergency of international concern that can result in severe mental health conditions like depression and fear in health-care professionals (HCPs). Methods: A cross-sectional study was conducted, where 834 HCPs were self-recruited via social media. Multiple linear regression analyses were performed to identify predicting factors. Results: Approximately one-third of the total participants were depressed (27.3%) and those with depressive symptoms had significant fear of COVID-19. Significant risk factors for depressive symptoms were being female, being married, having no children, having high risk elderly persons at home, being afraid of death due to COVID-19 and having comorbid diseases. Fear of death due to COVID-19 was the most common significant contributing factor the scales for depression model, β=0.397, for fear of COVID-19 model and β=0.478 respectively. Quality of PPE played a vital role for depression as majority of HCPs. About 65.3% of HCPs who were restless while examining a patient with flu symptoms and majority of HCPs who felt insecure about their family members. Conclusions: Most of the HCPs faced several challenges during COVID-19 and psychological impacts of frontline HCPs were associated with interventions and rehabilitations to improve the mental health.

Mental health care in Guyana's jails before and after Independence

AbstractThis article considers the intersecting geographical, social, medical and political frameworks necessary to construct an understanding of mental health in Guyanese prisons, historically and in the present day. Taking an interdisciplinary approach to integrate archives, modern records and interviews, it looks first at colonial and independent state management of mental health impacts with respect to sentencing, incarceration and rehabilitation. It moves on to reflect on recent efforts to provide co‐ordinated policies and practices at national level to tackle more effectively moderate to severe mental health conditions. Here it shows that, as in the colonial period, prisoners and prison officials are typically neglected. Overall, our appreciation of the importance of what we term the coloniality of incarceration and public health enables us to deepen an understanding of the development and ongoing significance of approaches to mental ill health in the modern state, following Guyana's independence from colonial rule in 1966.

Facilitators for increasing dental attendance of people from vulnerable groups: a rapid review of evidence relevant to the UK

AbstractObjective To rapidly review facilitators of access for vulnerable groups and to evaluate their effectiveness.Methods Data sources: MEDLINE via Ovid. Publications in English from 2000. Data selection: Research involving ‘vulnerable groups' relevant to UK health systems, with a primary outcome of increasing attendance. Data extraction: One author extracted and tabulated data. These were audited by a second author. Data synthesis: A narrative synthesis was produced.Results Data from 31 studies were available for ten vulnerable groups: people with learning, physical or sensory disabilities (n = 8); people experiencing homelessness (n = 6); prisoners (n = 4); asylum-seekers and refugees (n = 3); people living in socioeconomically deprived areas (n = 3); people with severe mental health conditions (n = 2); vulnerable children (n = 2); dependent older people (n = 1); Gypsy, Roma or Traveller groups (n = 1); and people with drug dependency (n = 1). Many facilitators involved organisational reform and more integration of health, social and other services. Other facilitators included: modification of premises; team development and skill-mix use; and awareness of needs and flexible services to meet them. Few studies evaluated effectiveness.Conclusion Although facilitators for access for vulnerable groups have been proposed, there is little evidence to support or refute their effectiveness. Efforts are needed to promote access for vulnerable groups in the UK with evaluation plans embedded.

Psychotropic medication use pre and post-diagnosis of cluster B personality disorder: a Quebec’s health services register cohort

BackgroundCluster B personality disorders (PDs) are considered some of the most severe mental health conditions. Scarce evidence exists about the real-world utilization of psychotropics for cluster B PD individuals.ObjectiveWe aimed to uncover trends and patterns of psychotropic medication use among individuals diagnosed with cluster B PD in the year before and after their diagnosis and to identify factors associated with medication use in a large cohort of individuals newly diagnosed with cluster B PDs.MethodsWe conducted a population-based observational study using Quebec’s health services register. We identified Quebec residents aged ≥14 years and insured with the provincial drug plan with a first diagnosis of cluster B PD recorded between April 1, 2002, and March 31, 2019. Cluster B PD was defined with ICD-9/10 diagnostic codes. We retrieved all claims for the main psychotropic medication classes: antipsychotics, antidepressants, anxiolytics, mood stabilizers, and attention-deficit/hyperactivity disorder (ADHD) medications. We calculated the proportion of individuals exposed to these medication classes and analyzed trends over the years using robust Poisson regression models, adjusting for potential confounders. We used robust Poisson regression to identify factors associated with medication class use.ResultsWe identified 87,778 new cases of cluster B PD, with a mean age of 44.5 years; 57.5% were women. Most frequent psychiatric comorbidities in the five years before cluster B PD diagnosis were depression (50.9%), anxiety (49.7%), and psychotic disorders (37.5%). Most individuals (71.0%) received at least one psychotropic during the year before cluster B PD diagnosis, and 78.5% received at least one of these medications in the subsequent year. The proportion of users increased after the diagnosis for antidepressants (51.6–54.7%), antipsychotics (35.9–45.2%), mood stabilizers (14.8–17.0%), and ADHD medications (5.1–5.9%), and remained relatively stable for anxiolytics (41.4–41.7%). Trends over time showed statistically significant increased use of antipsychotics and ADHD medications, decreased use of anxiolytics and mood stabilizers, and a stable use of antidepressants.ConclusionPsychotropic medication use is highly prevalent among cluster B PD individuals. We observed an increase in medication use in the months following the diagnosis, particularly for antipsychotics, antidepressants, and mood stabilizers.

Diagnosing borderline personality disorder: Reports and recommendations from people with lived experience.

Borderline personality disorder (BPD) is a severe mental health condition marked by impairments in self and interpersonal functioning. Stigma from health staff may often result in a reluctance to diagnose, impacting recovery trajectories. Qualitative interviews were conducted with participants (N = 15; M Age = 36.4 years, SD = 7.5; 93.3% female) with lived experience of BPD exploring topics of illness onset, insight, experience of diagnosis and treatment. Qualitative responses were analysed within a co-design framework with a member of the research team who identifies as having a lived experience of BPD. On average, participant symptoms emerged at 12.1years of age (SD = 6.6years, range 1.5-27), but diagnoses of BPD were delayed until 30.2years (SD = 7.8years, range 18-44) resulting in a 'diagnosis gap' of 18.1years (SD = 9.6years, range 3-30). Participant explanations for BPD emergence varied from biological, psychological and social factors. Benefits of diagnosis (e.g., fostering insight, aiding treatment planning and reducing isolation) were contrasted with challenges (e.g., stigma and treatment unavailability). Delay in diagnosis was common, and no participants reported receiving a diagnosis of BPD during their adolescence yet 85% felt they would have benefited from a diagnosis in adolescence. Only a quarter (27%) felt highly supported in the diagnostic process. An ideal four-step diagnosis procedure was outlined based on recommendations from participants with a lived experience; this involved the following: (1) explain the process, (2) assess thoroughly, (3) explore how the features are active in everyday life and (4) link diagnosis to evidence-based treatment planning.

Predictors of positive outcomes from 'Early Intervention in Psychosis': protocol for a national retrospective cohort study.

Psychotic disorders are severe and prevalent mental health conditions associated with long-term disability, reduced quality of life, and substantial economic costs. Early Intervention in Psychosis (EIP) services aim to provide timely and comprehensive treatment for psychotic disorders, and EIP service input is associated with improved outcomes. However, there is limited understanding of the specific components of EIP care that contribute to these improvements. There is significant nationwide variability in the commissioning and delivery of EIP, with individuals receiving different packages of components from different services. In this study, we seek to explore associations between EIP components and clinically significant outcomes, in order to understand the mechanisms underlying improved psychosis care. This national retrospective cohort study will utilize data from the 2019 National Clinical Audit of Psychosis (NCAP), examining the care received by 10,560 individuals treated by EIP services in England. Exposure data from the NCAP, capturing the components of care delivered by EIP services, will be linked with outcome data from routine NHS Digital datasets over a three-year follow-up period. This will be the first study to use this method to examine this population in England. The primary outcomes will be surrogate measures of relapse of psychosis (hospital admission and referral to community-based crisis intervention services). Secondary outcomes include duration of admissions, emergency hospital attendances, episodes of detention under the Mental Health Act, and all-cause mortality. We will use multilevel regression to examine associations between exposures and outcome events. We will handle missing data using appropriate imputation techniques. This study aims to provide valuable insights into the long-term effects of variations in EIP service delivery. The study involves a large, diverse cohort including individuals treated by every EIP service in England. While there are limitations inherent in the observational nature of the study, any associations identified will be of great relevance to clinicians, researchers, and policymakers seeking to optimize EIP care. The results will enable more targeted treatment planning, resource allocation, and potential innovations in EIP care, ultimately leading to improved prognoses for people experiencing psychosis.

COVID-19 restrictions: impact on obesity in people with severe mental health conditions

Background: Whilst the COVID-19 pandemic’s negative impacts on the general population’s mental health have become apparent to both experts and laymen alike; the effects on adults with severe mental illness (SMI), and particularly the impacts on their nutritional and physical health, have been overlooked. Accordingly, this commentary will discuss and raise awareness of the impact on weight management and dietary intake foradults with SMI.
 Methods: This commentary article was borne out of discussions between academics, clinicians, and an expert by experience as part of wider survey research exploring supporting adults with severe mental illness to manage their weight.
 Results and discussion: This commentary discusses the impact of the COVID-19 pandemic on inpatients with severe mental illness, but also reflects on wider infrastructure and systemic issues that highlight difficulties faced by service users to manage both their weight and mental illness. For instance, socioeconomicimpacts contribute to poverty and food insecurity which affects access to dietary quantity and nutritional quality. Distancing and restriction measures affect community-based service users’ access to both physical and mental healthcare and may precipitate relapse of mental health difficulties. Additionally, iatrogenic and psychologically driven weight gain coupled with disruption of regular weight monitoring may lead toincreasing diabesity rates.
 Conclusion: Obesity is a multifaceted issue with a cause and effect that is complex, particularly for those with severe mental illness who may face particular barriers to receiving both physical and mental health support, which can impact on their weight management.

Persons with severe mental health conditions should be included as a key population in HIV programmes - a case study of South Africa.

Persons with severe mental health conditions should be included as a key population in HIV programmes - a case study of South Africa.

Indicadores de severidad clínica en la comorbilidad de trastorno bipolar y trastorno límite de personalidad: una revisión sistemática

IntroductionBipolar disorder (BD) is a severe chronic mental health condition with significant morbidity and mortality. It is characterized by affective episodes of mania and depression, as well as mixed states. Borderline personality disorder (BPD) is characterized by emotional instability and a pattern of impulsive behavior associated with suicidality. Both diagnoses can be comorbid and present high dysfunction and severity. MethodsThe aim of this study was to describe the differential characteristics in terms of clinical severity, present in samples of patients with BD–BPD comorbidity versus samples of patients with only one of these diagnoses. A systematic review of the literature of cross-sectional, case–control and cohort studies was carried out in which samples of BD or BPD patients were compared with samples of BD–BPD comorbidity, published in English and Spanish, and that considered a population between 18 and 65 years old. Those studies that considered samples of patients with other comorbidities were excluded. ResultsA total of 12 studies were included, which included a total of 4246 patients of both sexes. The comorbidity of BD and BPD presented higher suicidality, depressive episodes and mania/hypomania, aggressiveness, anger and hostility, hospitalizations, worse functioning and greater severity of symptoms compared to those with a single diagnosis, especially BD. ConclusionsThe comorbidity of BD and BPD presents evidence of a greater impact on the clinical course compared to those who do not present this condition.

Exploring biomedical and traditional care pathways for people with psychosis in Karachi, Pakistan.

Psychosis is known to have an adverse impact on an individual's quality of life, social and occupational functioning. A lack of treatment options for psychotic disorders such as schizophrenia contributes to adverse outcomes for individuals. A significant proportion of people with psychosis consult both formal and traditional routes of care. This warrants a need to explore perceptions around treatment options provided by diverse care providers, as the identification of avenues for support can improve psychiatric, alternative treatment and social outcomes. Focus groups discussions (FGDs) and in-depth interviews (IDIs) were used. Interactive Research and Development (IRD) research staff conducted 20 IDIs and 2 FGDs to obtain information about the perspectives, treatment pathways and experiences of individuals with psychosis, their caregivers, and service providers. Questions for clinician care providers and faith healers revolved around perceptions of psychosis, service users' background, subject knowledge and treatment, feedback and referral mechanisms, and promotion of services. A thematic analysis was used to analyze the interviews and coding was conducted on NVivo. The results were categorized into five themes: perception of psychosis, experience of seeking/receiving care, assessment and diagnosis methods, promotion of services, and living with psychosis. Across service providers and patients, there was a wide variety of causes attributed to psychosis, and an overall lack of awareness regarding severe mental health conditions from both formal and informal care-providers. Biomedical treatment received mixed reviews, while some reported it as beneficial, the limited number of institutes and clinicians to cater for patients, stigma within society and care providers, the burden of caregiving, and misinformation from faith healers were all significant barriers to treatment. The results highlight the use of traditional healing practices for psychosis in Pakistan, which, coupled with inadequate referral mechanisms, present an opportunity to bridge the treatment gap between clinical and traditional healing practices through integration of treatment within community structures and systems. Better awareness of psychosis and its treatment methods, alongside interventions that reduce stigma could help facilitate help-seeking behavior and reduce the burden of caregiving.

Community Rehabilitation in the Recovery of People with Mental Disabilities in Cianjur Regency, West Java Province

Mental health is an important issue that cannot be ignored.  The impact of poor quality of life, such as disability, neglect, inhumane treatment, not only on the sufferer, but also on the family, makes mental health issues need serious attention.  Based on concern to make social rehabilitation for mental health disorders widely developed in Indonesian society, this study aim find out how community rehabilitation methods are used to recover people with mental disabilities in West Java.  This study uses a qualitative approach with descriptive method. there are nine informants, including institutional administrators, people with mental disabilities who have recovered, and social service employees.  Collecting data with in-depth interviews, observations, FGDs and study documentation.  Qualitative data analysis with interactive techniques.  The results of this study indicate that the methods used in social rehabilitation for people with mental disabilities are varied, namely using a medical approach in the form of drugs, and a religious and cultural approach, with reading the yellow book prayer, special rituals, and special treatment.  The success of the recovery was recognized by each institution, as well as by the people with mental disabilities who recovered.  The results also show that recovery does not mean returning to health, 100% normal, but recovering to be able to communicate with others, be independent and participate in family and community activities.  The results also show that recovery varies, influenced by various factors.  When viewed from the results of this study, the most important is the healing method used.  The failure of recovery was also found, the cause was due to severe mental health conditions, inappropriate healing methods, and the lack of family support.
 Keywords: Mental Health, People with Disabilities, Social Rehabilitation, Community-Based Rehabilitation

Readmission and associated clinical factors among individuals admitted with bipolar affective disorder at a psychiatry facility in Uganda

BackgroundBipolar affective disorder (BAD) is a common severe mental health condition with a relapsing course that may include periods of hospital re-admissions. With recurrent relapses and admissions, the course, prognosis, and patient’s overall quality of life can be affected negatively. This study aims to explore the rates and clinical factors associated with re-admission among individuals with BAD.MethodThis study used data from a retrospective chart review of all records of patients with BAD admitted in 2018 and followed up their hospital records for four years till 2021 at a large psychiatric unit in Uganda. Cox regression analysis was used to determine the clinical characteristics associated with readmission among patients diagnosed with BAD.ResultsA total of 206 patients living with BAD were admitted in 2018 and followed up for four years. The average number of months to readmission was 9.4 (standard deviation = 8.6). The incidence of readmission was 23.8% (n = 49/206). Of those readmitted during the study period, 46.9% (n = 23/49) and 28.6% (n = 14/49) individuals were readmitted twice and three times or more, respectively. The readmission rate in the first 12 months following discharge was 69.4% (n = 34/49) at first readmission, 78.3% (n = 18/23) at second readmission, and 87.5% (n = 12/14) at third or more times. For the next 12 months, the readmission rate was 22.5% (n = 11/49) for the first, 21.7% (n = 5/23) for the second, and 7.1% (n = 1/14) for more than two readmissions. Between 25 and 36 months, the readmission rate was 4.1% (n = 2/49) for the first readmission and 7.1% (n = 1/14) for the third or more times. Between 37 and 48 months, the readmission rate was 4.1% (n = 2/49) for those readmitted the first time. Patients who presented with poor appetite and undressed in public before admission were at increased risk of being readmitted with time. However, the following symptoms/clinical presentations, were protective against having a readmission with time, increased number of days with symptoms before admission, mood lability, and high energy levels.ConclusionThe incidence of readmission among individuals living with BAD is high, and readmission was associated with patients’ symptoms presentation on previous admission. Future studies looking at BAD using a prospective design, standardized scales, and robust explanatory model are warranted to understand causal factors for hospital re-admission and inform management strategies.

Suicidal behavior among inpatients with severe mental conditions in a public mental health hospital in Uganda

BackgroundSuicidal behaviors are prevalent among inpatients with severe mental conditions and may result in many dying by suicide. Few studies have focused on the burden of suicidal behaviors among these inpatients in low-income settings, despite suicide being consistently higher in lower-income countries such as Uganda. This study, therefore, provides the prevalence and associated factors of suicidal behaviors and suicide attempts among inpatients with severe mental conditions in Uganda.MethodThis was a retrospective chart review of all individuals admitted with severe mental conditions to a large psychiatry inpatient unit in Uganda for four years (2018–2021). Two separate logistic regressions were conducted to determine the factors associated with suicidal behaviors or suicidal attempts among the admitted individuals.ResultsThe prevalence of suicidal behavior and suicidal attempts among 3104 (mean age = 33, Standard deviation [SD] = 14.0; 56% were males) were 6.12% and 3.45%, respectively. Having a diagnosis of depression increased the likelihood of both suicidal behaviors (adjusted odds ratio [aOR]: 5.36; 95% confidence interval [CI]: 2.14–13.37; p =0.001) and attempts (aOR: 10.73; 95% CI: 3.44–33.50; p < 0.001). However, a diagnosis of substance-related disorder increased the likelihood of having attempted suicide (aOR: 4.14; 95% CI: 1.21–14.15; p = 0.023). The likelihood of having suicidal behavior decreased as one increased in age (aOR: 0.97; 95% CI: 0.94–0.99; p = 0.006) and increased among individuals reporting stress from financial constraints (aOR: 2.26; 95% CI: 1.05–4.86; p = 0.036).ConclusionSuicidal behaviors are common among inpatients managed for severe mental health conditions in Uganda, especially those with substance use and depressive disorders. In addition, financial stressors are a main predictor in this low-income country. Therefore, regular screening for suicide behaviors is warranted, especially among individuals with depression, and substance use, among those who are young, and among those reporting financial constraints/stress.

Use of high cost care among Veterans with comorbid mental illness and Alzheimer's Disease and related dementias.

Alzheimer's Disease and Other Related Dementias (AD/ADRD) leads to frequent emergency department (ED) and inpatient use. Mental health symptoms among persons with AD/ADRD increases cognitive and functional disabilities and could contribute to these high rates of intensive health care use. The objective of this paper is to assess the relationship of mental illness on 12-month patterns in hospitalization and ED use among Veterans aged 65 and over with a new AD/ADRD diagnosis. We used an existing dataset of administrative electronic health record data of Veterans with AD/ADRD from the US Veterans Health Administration linked with Medicare claims data from 2011-2015. We use multivariable logistic regression to examine the association between no pre-existing mental illness, pre-existing mental illness (e.g., major depressive disorder, generalized anxiety disorder, or post-traumatic stress disorder), and pre-existing severe mental illness-or SMI-(e.g., bipolar disorder, major depressive disorder with psychosis, or schizophrenia) and 12- month ED and hospitalization use and readmissions among Veterans who had an initial hospitalization visit. We estimated predicted probabilities, differential effect, and associated 95% confidence intervals. In our sample, 1.4% had SMI and 11% had non-SMI mental illness. The unadjusted percentage with inpatient and ED use was higher among Veterans with SMI (34% and 26%, respectively) and Veterans with non-SMI mental illness (20%, 16%) compared with Veterans without pre-existing mental illness (12%, 9%). Compared to individuals with no pre-existing mental illness, having a pre-existing mental illness (1.27 percentage points, 95% CI: 0.76, 1.78) and a pre-existing SMI (7.17 percentage points, 95% CI: 5.66, 8.69) were both associated with an increased likelihood of ED use. The same pattern was observed for any inpatient use (mental illness 2.18, 95% CI: 1.59, 2.77; SMI 9.91, 95% CI: 8.21, 11.61). Only pre-existing SMI was associated higher hospitalization readmission. Pre-existing mental illness increases use of high cost, intensive health care and this association is higher of more severe mental health conditions. We also show that pre-existing mental illness exerts a unique influence, above and beyond other comorbidities, such as diabetes, on ED and inpatient visits. More needs to be done to increase recognition of the unique risks of this combination of health conditions and encourage strategies to address them. Developing, testing, and implementing comprehensive strategies that address the intersection of ADRD and mental illness is promising approach that requires more focused attention.

Schizophrenia and Sexual Behaviour

Schizophrenia is a chronic and severe mental health condition characterized by a range of symptoms, including hallucinations, delusions, disorganized thinking, and speech difficulties. Sexual behaviour in individuals with schizophrenia can be affected by a combination of factors, including the symptoms of the condition, medication side effects, social factors, and personal beliefs and values. Research suggests that individuals with schizophrenia are more likely to have issues with intimacy, experience difficulties with sexual functioning, and engage in risky sexual behaviour. Treatment strategies for these issues may include addressing the underlying causes of sexual dysfunction, developing appropriate communication skills, and providing support to promote healthy sexual relationships. Overall, understanding the complex relationship between schizophrenia and sexual behaviour is important for promoting the overall wellbeing of individuals living with this condition.

Afet Sonrası Travmalarda Psikolojik Yaklaşım

Natural disasters are one of the biggest problems of humanity in recent years. Although earthquakes are the most common events in these disasters, they are also responsible for the majority of casualties. Disasters also affect socioeconomic, health and psychological areas by affecting societies in different dimensions. Due to the psychological traumas experienced by individuals after disasters, their lives are greatly affected. If the necessary psychological support is not provided, individuals may face more severe mental health conditions. The inadequacy of social awareness on this issue and the need arising from the unavoidable psychological consequences of the disaster reveal the necessity of specialization in this field and social support. In this article, disaster psychology will be discussed in general terms and what can be done about it will be emphasized. Keywords: Disaster psychology, psychological approach, trauma

Children of parents with different severities of mental health conditions have higher risk of somatic morbidity: a Danish nationwide register-based cohort study

BackgroundChildren with the most severe parental mental health conditions have an elevated risk of numerous adversities including somatic morbidity. However, there is no knowledge concerning physical health in most children affected by parental mental health conditions. Therefore, the aim was to examine the association between different severities of parental mental health conditions and somatic morbidity in children of different age-groups and further explore the combinations of maternal and paternal mental health conditions on child somatic morbidity.MethodsIn this register-based cohort study, we included all children born in Denmark between 2000–2016 and linked parents. Parental mental health conditions were categorised into four severity groups (no, minor, moderate, and severe). Somatic morbidity in offspring was categorised into broad disease categories corresponding to the International Classification of Diseases. We estimated the risk ratio (RR) using Poisson regression, of the first registered diagnosis in different age-groups.ResultsOf the around 1 million children in the study > 14.5% were exposed to minor parental mental health conditions and < 2.3% were exposed to severe parental mental health conditions. Overall, the analyses revealed a higher risk of morbidity in exposed children across all disease categories. The strongest association was observed for digestive diseases in children aged < 1 year exposed to severe parental mental health conditions (RR: 1.87 (95% CI: 1.74–2.00). Generally, the risk of somatic morbidity increased the more severe the parental mental health conditions. Both paternal and especially maternal mental health conditions were associated with a higher risk of somatic morbidity. The associations were strongest if both parents had a mental health condition.ConclusionChildren with different severities of parental mental health conditions experience a higher risk of somatic morbidity. Although children with severe parental mental health conditions had the highest risk, children with minor parental mental health conditions should not be neglected as more children are exposed. Children with both parents having a mental health condition were the most vulnerable to somatic morbidity and maternal mental health conditions were more strongly associated with somatic morbidity than paternal. More support and awareness of families with parental mental health conditions is highly needed.