Provision Of Mental Health Services Research Articles

Mental health attendances in Australia during the COVID-19 pandemic: A telehealth success story?

IntroductionThe COVID-19 pandemic has significantly impacted the delivery of mental health services globally. Within Australia, the COVID-19 pandemic and subsequent containment measures have led to reduced face-to-face attendances. To maintain access to mental health consultations, new telehealth services were introduced by the Australian Government in late March 2020.ObjectivesWe aimed to quantify the impact of the COVID-19 pandemic on patterns of mental health attendances in Australia using an interrupted time series model.MethodsTo characterise patterns of mental health service utilisation, monthly mental health attendances between January 2016 and June 2020 were extracted from the Medicare database, stratified by clinician type: general practitioner (GP), psychiatrist, and allied health. We used triple exponential smoothing to model attendances between January 2017 and December 2019. Observed and predicted attendances between January and June 2020 were compared with 95% confidence (p<0.05).Results Our models showed decreased mental health attendances in March and April, consistent with all healthcare services during this time. While uptake of telehealth was significant, it only partially covered the reduction in mental health attendances.Conclusions Our modelling highlights the significant impacts of the COVID-19 pandemic on mental health services in Australia, with telehealth only partially compensating for the reduction in face-to-face attendances. These results suggest that telehealth services may not be suitable for all individuals (e.g. those without reliable internet access). Given that telehealth will likely remain a feature of mental health service provision, outreach and face-to-face services should be considered for vulnerable groupsDisclosureNo significant relationships.

Internet and psychosocial interventions: What is the evidence?

Abstract BodyDigital mental health, before, during and after the COVID-19 pandemic Over the last two decades the digital landscape of mental health care research and service innovation has gained momentum. This period is characterized by many successes’ stories but brilliant failures as well. Today, e-mental health is like a two-headed Janus. One side of his face illustrates the birth of innovative technologies that entered mental health service provision. In parallel, the evidence-base for the application of these new technologies, such as internet-based treatments for depression, has been established with effect sizes comparable to those of face-to-face treatments. The other side of his face shows, however, that eMental-health has not yet lived up to its’ full potential as its actual delivery, evaluation and implementation in routine care has proven to be a much longer and bumpier road than expected. The question addressed in this presentation will be ‘what does the future hold’? Acknowledging that futures are difficult to predict Heleen Riper nevertheless provides insights into how we may overcome some of these bumps by combining the best of two worlds, i.e. blending digital and face-to-face components into one integrated treatment approach. She will illustrate these new developments by virtue of the results of the H2020 European Comparative Effectiveness Study for Major Depression and current experiences with especially videoconferencing during the Covid-19 pandemic.DisclosureNo significant relationships.

RELATIONSHIP BETWEEN DURATION OF UNTREATED PSYCHOSIS AND COGNITIVE FUNCTIONS USING MODIFIED SCORS (SCHIZOPHRENIA COGNITION RATING SCALE) IN SCHIZOPHRENIA PATIENTS IN SAIFUL ANWAR GENERAL HOSPITAL

Mental health is a significant health problem in the world, including Indonesia. Lack of understanding and concern for the community, limitations and unequal distribution of mental health service provider also contribute to obstacles to increase public understanding and concern for mental health. This problem will give an impact on the difficulty of patients in accessing care and treatment. The emergence of the phenomenon of Duration of Untreated Psychosis (DUP) or untreated psychosis in society contributes to the worsening of the disease course of schizophrenic patients. One of the main clinical manifestations seen in schizophrenic patients is a decline in cognitive function. SCoRS is present as an easy and effective instrument in quantitatively measuring cognitive function. In the study used a modified SCoRS instrument that was more adapted to Indonesian’s culture. This study was conducted to determine the relationship between the duration of untreated psychosis and cognitive function using modified SCoRS, especially in schizophrenic patients at Saiful Anwar General Hospital. The research method used observational analytic with cross-sectional approach. Selection of research subjects based on inclusion and exclusion criteria. Then do the appropriate history taking and psychiatric examination. Correlation analysis using Spearman to determine the relationship of variable duration of psychosis without therapy and cognitive function assessed using SCoRS modification (p <0.05). The results prove that there is a significant relationship between the variable duration of therapy without therapy and cognitive function variables assessed using SCoRS modification with a weak correlation level (correlation coefficient 0.340).

RELATIONSHIP BETWEEN DURATION OF UNTREATED PSYCHOSIS AND COGNITIVE FUNCTIONS USING MODIFIED SCORS (SCHIZOPHRENIA COGNITION RATING SCALE) IN SCHIZOPHRENIA PATIENTS IN SAIFUL ANWAR GENERAL HOSPITAL

Mental health is a significant health problem in the world, including Indonesia. Lack of understanding and concern for the community, limitations and unequal distribution of mental health service provider also contribute to obstacles to increase public understanding and concern for mental health. This problem will give an impact on the difficulty of patients in accessing care and treatment. The emergence of the phenomenon of Duration of Untreated Psychosis (DUP) or untreated psychosis in society contributes to the worsening of the disease course of schizophrenic patients. One of the main clinical manifestations seen in schizophrenic patients is a decline in cognitive function. SCoRS is present as an easy and effective instrument in quantitatively measuring cognitive function. In the study used a modified SCoRS instrument that was more adapted to Indonesian’s culture. This study was conducted to determine the relationship between the duration of untreated psychosis and cognitive function using modified SCoRS, especially in schizophrenic patients at Saiful Anwar General Hospital. The research method used observational analytic with cross-sectional approach. Selection of research subjects based on inclusion and exclusion criteria. Then do the appropriate history taking and psychiatric examination. Correlation analysis using Spearman to determine the relationship of variable duration of psychosis without therapy and cognitive function assessed using SCoRS modification (p <0.05). The results prove that there is a significant relationship between the variable duration of therapy without therapy and cognitive function variables assessed using SCoRS modification with a weak correlation level (correlation coefficient 0.340).

Protocol for a quasi-experimental, 950 county study examining implementation outcomes and mechanisms of Stepping Up, a national policy effort to improve mental health and substance use services for justice-involved individuals

BackgroundThe criminal justice system is the largest provider of mental health services in the USA. Many jurisdictions are interested in reducing the use of the justice system for mental health problems. The national Stepping Up Initiative helps agencies within counties work together more effectively to reduce the number of individuals with mental illness in jails and to improve access to mental health services in the community. This study will compare Stepping Up counties to matched comparison counties over time to (1) examine the effectiveness of Stepping Up and (2) test hypothesized implementation mechanisms to inform multi-agency implementation efforts more broadly.MethodsThe study will survey 950 counties at baseline, 18 months, and 36 months in a quasi-experimental design comparing implementation mechanisms and outcomes between 475 Stepping Up counties and 475 matched comparison counties. Surveys will be sent to up to four respondents per county including administrators of jail, probation, community mental health services, and community substance use treatment services (3800 total respondents). We will examine whether Stepping Up counties show faster improvements in implementation outcomes (number of justice-involved clients receiving behavioral health services, number of behavioral health evidence-based practices and policies [EBPPs] available to justice-involved individuals, and resources for behavioral health EBPP for justice-involved individuals) than do matched comparison counties. We will also evaluate whether engagement of hypothesized mechanisms explains differences in implementation outcomes. Implementation target mechanisms include (1) use of and capacity for performance monitoring, (2) use and functioning of interagency teams, (3) common goals and mission across agencies, and (4) system integration (i.e., building an integrated system of care rather than adding one program or training). Finally, we will characterize implementation processes and critical incidents using survey responses and qualitative interviews.DiscussionThere are few rigorous, prospective studies examining implementation mechanisms and their relationship with behavioral health implementation outcomes in justice and associated community behavioral health settings. There is also limited understanding of implementation mechanisms that occur across systems with multiple goals. This study will describe implementation outcomes of Stepping Up and will elucidate target mechanisms that are effective in multi-goal, multi-agency systems.

Exploration of the views of healthcare professionals working in a mental health trust in England on pharmacists as future approved clinicians: early findings

Abstract Introduction The 2007 amendment to the Mental Health Act (MHA) 1983 enabled various non-medical professionals to now qualify as approved clinicians (ACs); these included social workers, mental health and learning disability nurses, clinical psychologists and occupational therapists. [1–2] As ACs, these professionals can take on roles of clinical leadership whilst assuming responsibility for patients under the Act. Although mental health pharmacists have recognised specialist clinical roles and regularly work alongside these professionals in caring for patients, they are not presently permitted to practise as ACs. Aim This study sets out to investigate the views of healthcare professionals working in a mental health trust in England on this hitherto unexplored group of the mental health workforce as potential ACs. Methods Upon obtaining ethics approval, pharmacists, ACs and other experienced mental health professionals working in one mental health trust in England were approached via internal trust email to take part in a digitally audio recorded semi-structured interview to explore their views on pharmacists as potential ACs in future. A thematic analysis is being performed on the entire set of transcripts and an additional sentiment analysis will be applied to specific parts of the dataset. Results A total of 11 interviews were completed with 6 pharmacists, 4 medical ACs and 1 ‘other’ mental health professional thus far, with recruitment ongoing. Emerging themes included wide recognition among participants of highly valued key skills of pharmacists within mental health services provision, for instance their ability to access and appraise specialist literature as well as their analytical skills to apply expert knowledge to real-life cases. Participants identified unique challenges to pharmacists potentially becoming ACs in future, namely the traditional organisational structures whereby pharmacists are line managed and clinically supervised from within a pharmacy department which sits external to the clinical teams they typically work in, and the lack of pharmacists being fully embedded in interdisciplinary teams. Conclusion Since this is the first study of its kind to be conducted on a small cohort of participants working within one mental health trust in England, this qualitative study will likely highlight the need for further research to be carried out on the topic, such as data collection in several other NHS trusts as well as recruiting participants from the working group and other stakeholders involved in the most recent amendment of the Act. Whilst data collection and analysis are ongoing, initial findings help shed light on potential barriers and also possible solutions to these, as well as other opportunities for pharmacists wishing to assume higher leadership roles within mental health services in England.

The COVID PIVOT - Re-orienting Child and Youth Mental Health Care in the Light of Pandemic Restrictions.

The COVID pandemic required significant changes in the provision of youth mental health services during the period of lockdown/stay at home orders. Things which were identified as changing significantly during this period included: service via telehealth; working from home, split teams (to reduce infection risk), and social (physical) distancing. An online survey of clinicians was conducted involving both closed and open ended questions. Service staff identified significant benefits from the changes to the way services were delivered as well as some impediments and challenges. Advantages in the new way of working revolved around the flexibility of the virtual service, with appointments online enabling families to more easily overcome issues of transport, work commitments, childcare and disruption to routines and timing. The online platforms also enabled some family members to participate who otherwise might not have been able to come to appointments in person. Disadvantages included where there were issues with availability and access to appropriate technology or private spaces, or when the young person was very young, very unwell, unstable, isolated or at higher risk. This study suggests that telehealth and flexible working arrangements have become an essential new element in the clinicians’ toolkit to be offered either alone or as a supplement to in person interventions.

Implications for mental health workforce strategy, professional training and supervision of more widespread adoption of the multi-professional Responsible Clinician role: Results of a qualitative inquiry

Within mental health legislation in England and Wales the Responsible Clinician for specific patients should be the Approved Clinician with the most appropriate expertise to meet their primary assessment and treatment needs. The study aimed to explore nurse and psychologist perspectives on becoming a Responsible Clinician in the context of their limited uptake of the role and calls for an increase in advanced practice roles within mental health. It comprised a qualitative inquiry in the form of a thematic analysis of 12 semi-structured interviews. Four sub-themes emerged under the theme of ‘becoming a Responsible Clinician’. They were: (i) the Responsible Clinician amongst other roles; (ii) developing in the role; (iii) working with psychiatrist colleagues; and (iv) organisational context. Responsible Clinicians were juggling the role with other senior clinical responsibilities, often without a coherent programme of ongoing educational development or organisational support structures. If mental health service provider organisations adopt this extended role more widely then role-specific support and supervision arrangements should be in place as part of a coherent workforce strategy. This is particularly important given the legal and ethical responsibilities of the Responsible Clinician.

Care at Doorsteps for Persons with Severe Mental Illnesses as a Part of District Mental Health Program (DMHP): A Qualitative Needs Assessment and Psychosocial Framework.

Care at Doorstep (CAD) is a home care service that includes medical and social care by skilled professionals. The purpose of this paper is to explore the need for CAD among users of the district mental health programme (DMHP) in Ramanagaram, Karnataka, India who have severe mental illness. The design of this study was descriptive where a qualitative inductive methodology was adopted. Data was collected from interviews of 20 caregivers and 7 mental health service providers linked to the DMHP. Socio demographic information was collected from participants and a semi-structured interview guides were used to explore needs and challenges in delivering care at home by the professionals. The themes that emerged from the manually transcribed and coded data were categorized as needs and challenges and used for developing a CAD model.

Readiness to deliver person\u2010focused care in a fragile situation: the case of Mental Health Services in Lebanon

BackgroundEvidence suggests wide variability in the provision of mental healthcare across countries. Countries experiencing fragility related risks suffer from a high burden of mental-ill health and additionally have limited capacity to scale up mental health services given financial and human resource shortages. Integration of mental health services into routine primary care is one potential strategy for enhancing service availability, however little is known about the experiences of currently active health care providers involved in mental health and psychosocial support service (MHPSS) provision at primary care level. This study aims to determine how healthcare providers offering MHPSS services at primary care levels in Lebanon perceive mental health and the health system’s ability to address the rising mental ill-health burden with a view to identify opportunities for strengthening MHPSS service implementation geared towards integrated person focused care model.MethodsA qualitative study design was adopted including 15 semi-structured interviews and 2 participatory group model-building workshops with health care providers (HCPs) involved in mental healthcare delivery at primary care level. Participants were recruited from two contrasting fragility contexts (Beirut and Beqaa). During workshops, causal loop diagrams depicting shared understandings of factors leading to stress and mental ill health, associated health seeking behaviors, and challenges and barriers within the health system were elicited. This research is part of a larger study focused on understanding the dynamics shaping mental health perceptions and health seeking behaviours among community members residing in Lebanon.ResultsFindings are organized around a causal loop diagram depicting three central dynamics as described by workshop participants. First, participants linked financial constraints at household levels and the inability to secure one’s livelihood with contextual socio-political stressors, principally referring to integration challenges between host communities and Syrian refugees. In a second dynamic, participants linked exposure to war, conflict and displacement to the occurrence of traumatic events and high levels of distress as well as tense family and community relations. Finally, participants described a third dynamic linking cultural norms and patriarchal systems to exposure to violence and intergenerational trauma among Lebanon’s populations. When describing help-seeking pathways, participants noted the strong influence of social stigma within both the community and among health professionals; the latter was noted to negatively affect patient-provider relationships. Participants additionally spoke of difficulties in the delivery of mental health services and linked this to the design of the health system itself, noting the current system being geared towards patient centered care, which focuses on the patient’s experiences with a disease only, rather than person focused care where providers and patients acknowledge broader structural and social influences on health and work together to reach appropriate decisions for tackling health and other social needs. Barriers to delivery of person focused care include the lack of coherent mental health information systems, limited human capacity to deliver MHPSS services among primary health care staff and inadequate service integration and coordination among the many providers of mental health services in our study contexts. Critically however, provider accounts demonstrate readiness and willingness of health professionals to engage with integrated person focused care models of care.ConclusionsMental ill health is a major public health problem with implications for individual health and wellbeing; in a fragile context such as Lebanon, the burden of mental ill health is expected to rise and this presents substantive challenges for the existing health system. Concrete multi-sectoral efforts and investments are required to (1) reduce stigma and improve public perceptions surrounding mental ill health and associated needs for care seeking and (2) promote the implementation of integrated person focused care for addressing mental health.

Predictors of the length of stay of psychiatric inpatients: protocol for a systematic review and meta-analysis

BackgroundLength of stay (LOS) for inpatient psychiatric services is an important factor with serious drawbacks when it is extended more than needed. Impacts on economy, social functioning, and stigma can hamper improvement and affect the patients’ experiences on future mental healthcare. Predictions of which patients have a higher chance for prolonged LOS have been extensively researched. Previous systematic reviews found consistent predictors of both longer and shorter LOS. However, they do not provide an estimate from the pooled effect sizes. Furthermore, to our knowledge, there is no meta-analysis on the influence of these factors. The primary objective of this study will be to provide point estimates on the effect sizes of all studied predictors of the LOS of psychiatric inpatients.MethodsWe will conduct a systematic search in PubMed, MEDLINE, EMBASE, and PsycINFO for observational studies evaluating the effect size of independent factors on the length of stay of psychiatric inpatients. Prospective and retrospective cohorts that assess the influence of predictors through the reporting of standardized regression coefficients will be included. We will provide a qualitative synthesis of the findings from each study and perform a meta-analysis from pooled regression coefficients that were adjusted for other variables or confounders in order to obtain a point estimate and confidence interval for all factors extracted from the included studies.DiscussionThe results from this study may provide more accurate predictions for mental health institutions, psychiatrists, mental health service providers, patients, and families on the prognosis regarding the length of stay for needed inpatient care. This information may be used to anticipate individuals with a higher chance for prolonged hospitalization to plan the necessary interventions for these specific situations. Considering both the benefits and disadvantages of longer and shorter stays, the pooled estimates for independent factors may be used by mental healthcare providers and patients for informed decision-making. The results from this study will also update results presented in previous studies and identify the strengths and limitations from the current available evidence.Systematic review registrationPROSPERO ID CRD42020172840

Utilizing passive sensing data to provide personalized psychological care in low-resource settings.

Background: With the growing ubiquity of smartphones and wearable devices, there is an increased potential of collecting passive sensing data in mobile health. Passive data such as physical activity, Global Positioning System (GPS), interpersonal proximity, and audio recordingscan provide valuable insight into the lives of individuals. In mental health, these insights can illuminate behavioral patterns, creating exciting opportunities for mental health service providers and their clients to support pattern recognition and problem identification outside of formal sessions. In the Sensing Technologies for Maternal Depression Treatment in Low Resource Settings (StandStrong) project, our aim was to build an mHealth application to facilitate the delivery of psychological treatments by lay counselors caring for adolescent mothers with depression in Nepal. Methods: This paper describes the development of the StandStrong platform comprising the StandStrong Counselor application, and a cloud-based processing system, which can incorporate any tool that generates passive sensing data. We developed the StandStrong Counselor application that visualized passively collected GPS, proximity, and activity data. In the app, GPS data displays as heat maps, proximity data as charts showing the mother and child together or apart, and mothers' activities as activity charts. Lay counselors can use the StandStrong application during counseling sessions to discuss mothers' behavioral patterns and clinical progress over the course of a five-week counseling intervention. Achievement Awards based on collected data can also be automatically generated and sent to mothers. Additionally, messages can be sent from counselors to mother's personal phones through the StandStrong platform. Discussion: The StandStrong platform has the potential to improve the quality and effectiveness of psychological services delivered by non-specialists in diverse global settings.

Funding Diversity: A Case Study of A State-initiated, Funding-driven Program to Diversify Mental Health Service Provision in Minnesota

ABSTRACT Human service organizations are reconfiguring to address diversifying populations and widening inequality. However, institutional change is challenging to implement and fund; resource scarcity and stakeholder buy-in are barriers. In this case study, we analyze a funding-driven, state-initiated program that supports mental health professionals who are people of color in order to decrease health disparities. Analyses of interviews and documents depict how the program struggled with high turnover and uninspired, halfhearted messaging, but was nevertheless well loved. Findings illustrate how the ‘pitch’ and leadership matter in programming for institutional change and its contested nature, a contestation that funding alone cannot temper.

COVID-19 pandemic: demographic and clinical correlates of disturbed sleep among 6,041 Canadians

Objectives Psychological burdens of the COVID-19 pandemic are likely to impact sleep negatively. We investigate prevalence and correlates of disturbed sleep among subscribers to Text4Hope a daily supportive text message program launched in Alberta to support residents to deal with stress, anxiety, and depression. Methods A survey link was sent to Text4Hope subscribers to assess demographic and clinical variables, including disturbed sleep, stress, anxiety, and depression using the third question on the Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale, Generalised Anxiety Disorder 7-item scale, and PHQ-9, respectively. Data were analysed using univariate and logistic regression analyses. Results Overall, 6041 out of 32,805 Text4Hope subscribers completed the survey (18.4% response rate). Prevalence of disturbed sleep was 77.8%. Subscribers aged 41–60 years were twice as likely to present with sleep disturbance compared to individuals ≤25 years (OR 1.89, 95% CI: 1.27–2.81). Individuals with moderate/high anxiety and stress symptoms and those with passive death wish/suicidal ideation had higher probability for sleep disturbance [(OR 4.05, 95% CI: 3.33–4.93), (OR 2.42, 95% CI: 1.99–2.94), and (OR 2.39, 95% CI: 1.69–3.38)], respectively. Conclusion As the pandemic continues, more Canadians are likely to develop sleep problems, an important consideration for planning mental health services. KEY POINTS This is the first study to examine the prevalence rates and demographic and clinical correlates of disturbed sleep in a large sample (n = 6041) of Canadians during the COVID-19 pandemic. Prevalence of disturbed sleep was high at 77.8%. Individuals aged 41–60 years were twice as likely to present with sleep disturbance compared to individuals ≤25 years (OR 1.89, 95% CI: 1.27–2.81). Individuals with moderate/high anxiety symptoms, moderate/high stress symptoms, and suicidal ideation/thoughts of self-harm had higher likelihood of developing sleep disturbance, compared to individuals lacking these symptoms [(OR 4.05, 95% CI: 3.33–4.93) and (OR 2.42, 95% CI: 1.98–2.94)], respectively. As the pandemic continues, with fear of multiple waves, more Canadians are likely to develop sleep problems, an important consideration for planning the provision of mental health services.

Utilizing passive sensing data to provide personalized psychological care in low-resource settings

Background: With the growing ubiquity of smartphones and wearable devices, there is an increased potential of collecting passive sensing data in mobile health. Passive data such as physical activity, Global Positioning System (GPS), interpersonal proximity, and audio recordings can provide valuable insight into the lives of individuals. In mental health, these insights can illuminate behavioral patterns, creating exciting opportunities for mental health service providers and their clients to support pattern recognition and problem identification outside of formal sessions. In the Sensing Technologies for Maternal Depression Treatment in Low Resource Settings (StandStrong) project, our aim was to build an mHealth application to facilitate the delivery of psychological treatments by lay counselors caring for adolescent mothers with depression in Nepal. Methods: This paper describes the development of the StandStrong platform comprising the StandStrong Counselor application, and a cloud-based processing system, which can incorporate any tool that generates passive sensing data. We developed the StandStrong Counselor application that visualized passively collected GPS, proximity, and activity data. In the app, GPS data displays as heat maps, proximity data as charts showing the mother and child together or apart, and mothers’ activities as activity charts. Lay counselors can use the StandStrong application during counseling sessions to discuss mothers’ behavioral patterns and clinical progress over the course of a five-week counseling intervention. Achievement Awards based on collected data can also be automatically generated and sent to mothers. Additionally, messages can be sent from counselors to mother’s personal phones through the StandStrong platform. Discussion: The StandStrong platform has the potential to improve the quality and effectiveness of psychological services delivered by non-specialists in diverse global settings.

Behavioural responses and anxiety symptoms during the coronavirus disease 2019 (COVID-19) pandemic in Japan: A large scale cross-sectional study

BackgroundThis study explored the behavioural responses and anxiety symptoms of the general adult population in Japan during the ongoing coronavirus disease 2019 (COVID-19) outbreak. MethodsA web-based cross-sectional survey was conducted between 12th and May 13, 2020. Quota sampling was used to attain equal gender and age distributions representative of the Japanese population. ResultsA total of 4127 complete responses were analysed. Higher educational level (B = 0.045, p = 0.002) and household income (B = 0.04, p = 0.009) were associated with a higher increase in preventive measures when comparing before and after the state of emergency was declared. The highest reported social anxiety was a feeling of fear (65.6%), followed by embarrassment (43.8%), keeping infection a secret (41.3%), avoidance (41.3%), and stigma (25.5%). A total of 86.1% of the respondents reported moderate to severe anxiety. The partial least square-based structural equation modelling (PLS-SEM) revealed that being female has the greatest effect (B = 0.246, p < 0.0001) on higher current preventive measures, followed by social anxiety (B = 0.119; p = 0.001) and State-Trait Anxiety Inventory scores (B = 0.153; p < 0.001). Perceived susceptibility (B = 0.033, p = 0.020), knowing someone who have been diagnosed with COVID-19 (B = 0.097, p < 0.001), higher income (B = 0.079, p < 0.001) and educational level (B = 0.045; p = 0.004) all had a small but significant effect on influencing levels of preventive measures. ConclusionsA moderate level of preventive practices found in this study indicates the need to encourage behavioural change to limit the spread of the coronavirus. The provision of mental health services is warranted as anxiety symptoms are prevalent.

Early Warning Signs of a Mental Health Tsunami: A Coordinated Response to Gather Initial Data Insights From Multiple Digital Services Providers.

Introduction: The immediate impact of coronavirus 2019 (COVID-19) on morbidity and mortality has raised the need for accurate and real-time data monitoring and communication. The aim of this study is to document the initial observations from multiple digital services providers during the COVID-19 crisis, especially those related to mental health and well-being.Methods: We used email and social media to announce an urgent call for support. Digital mental health services providers (N = 46), financial services providers (N = 4), and other relevant digital data source providers (N = 3) responded with quantitative and/or qualitative data insights. People with lived experience of distress, as service users/consumers, and carers are included as co-authors.Results: This study provides proof-of-concept of the viability for researchers and private companies to work collaboratively toward a common good. Digital services providers reported a diverse range of mental health concerns. A recurring observation is that demand for digital mental health support has risen, and that the nature of this demand has also changed since COVID-19, with an apparent increased presentation of anxiety and loneliness.Conclusion: Following this study, we will continue to work with providers in more in-depth ways to capture follow-up insights at regular time points. We will also onboard new providers to address data representativeness. Looking ahead, we anticipate the need for a rigorous process to interpret insights from an even wider variety of sources in order to monitor and respond to mental health needs.

Prevalence and associated factors of DSM-5 insomnia disorder in the general population of Qatar

BackgroundEpidemiological studies of insomnia in the Middle East remain scarce. The present study aimed to estimate the prevalence of insomnia and explore its associations in the general population of Qatar. With almost 100 nationalities, Qatar is one of the most culturally diverse, richest, and fastest developing countries in the Arabian Peninsula.MethodsA probability sample of community-dwelling adults were surveyed in February of 2019. A total of 1611 respondents completed face-to-face interviews in Arabic or English. Logistic regression modeled associations with insomnia, our dependent variable, as defined by a score of ≤16 on the eight-item Sleep Condition Indicator or according to criteria for insomnia in the Diagnostic & Statistical Manual of Mental Disorders, fifth edition or DSM-5.ResultsApproximately, 5.5% of the sample screened positive for insomnia and the 30-day prevalence of those who met all the DSM-5 criteria for insomnia disorder was 3.0%. In addition, 2.0% of the sample screened positive for depression and 3.4% for anxiety in the past 2 weeks. Multivariable analysis showed the following were significantly associated with insomnia: Arab ethnicity, young age, unemployment, being married, having less than high school education, fair or poor health, anxiety, and depression.ConclusionsInsomnia prevalence was in the lower range of previously reported DSM-defined estimates from developed Western countries. Our findings highlight the need for raising awareness and improving sleep hygiene in potential risk groups such as younger adults and those of Arab ethnicity, in addition to incorporating insomnia screening in the provision of mental health services.

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to Improve Collaboration in School Mental Health: Protocol for a Mixed Methods Hybrid Effectiveness-Implementation Study.

BackgroundPublic schools in the United States are the main providers of mental health services to children but are often ill equipped to provide quality mental health care, especially in low-income urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), have the potential to improve treatment implementation and collaboration within schools.ObjectiveThe objective of this study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools.MethodsStudy participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Thereafter, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. The primary outcome measures include the feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of interprofessional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at three time points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services.ResultsRecruitment for the study has begun. Goals for aim 1 are expected to be completed in Spring 2021.ConclusionsThis study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate can ready both mental health and school systems for implementation of evidence-based mental health practices.Trial RegistrationClinicalTrials.gov NCT04440228; https://clinicaltrials.gov/ct2/show/NCT04440228International Registered Report Identifier (IRRID)DERR1-10.2196/26567

Antenatal Depression and Associated Factors among Pregnant Women Attending Antenatal Care Service in Kochi Health Center, Jimma Town, Ethiopia.

Background Antenatal depression has immense public health importance, as it can adversely affect both the mother and child health. The problem contributes to the disease burden in both developed and developing countries. Despite this, it is less investigated and not getting the necessary attention in the study setting. Objective The aim of the study was to assess the prevalence of antenatal depression and associated factors among women attending antenatal care (ANC) service in Kochi Health Center, Jimma town, southwest Ethiopia, 2019. Method Institutional based cross-sectional survey was conducted on 314 pregnant women attending Kochi Health Center from February 15 to April 15, 2019. A systematic random sampling technique was used to include the study participants. Antenatal depression was assessed using the Patient Health Questionnaire (PHQ-9) tool. Data was collected through face-to-face interviews using a pretested and structured questionnaire. Descriptive statistics was done to summarize the dependent and independent variables. Moreover, the chi-square test analysis was done to determine the association between the outcome and explanatory variables. Results A total of 314 pregnant women participated in the study, making a response rate of 96.7%. The study has revealed a total of 52 (16.6%) of the respondent had antenatal depression. A chi-square test of independence analysis showed a significant association between antenatal depression and marital status, family history of depression, pregnancy planning, history of abortion, social support, and intimate partner violence (P < 0.00001). Conclusion The study has shown that the prevalence of antenatal depression was high and associated with multiple psychosocial, clinical, and obstetric factors. Therefore, screening pregnant women for depression and the provision of necessary mental health services is recommended to mitigate the adverse health outcome of the problem.