Training In Mental Health Care Research Articles

Closing the gap in access to child mental health care: provider feedback from the Wisconsin Child Psychiatry Consultation Program

BackgroundMental illnesses are common among children and negatively impact wellbeing during childhood as well as later in life. However, many children with these conditions are not able to access needed mental health care. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) was created to reduce gaps in access to care by providing primary care providers with referral resources, access to behavioral health consultations, and training on mental health topics.ObjectivesThe purpose of this study was 1) to assess the effectiveness of the WI CPCP in Milwaukee County, providing specific insights into provider’s ability to care for child mental health, and 2) identify challenges Milwaukee PCPs faced in providing mental health care to child patients and contextualize these challenges in a conceptual framework of access to health care.MethodsA cross-sectional mixed-methods secondary data analysis was conducted using data collected from online baseline and nine-month follow-up surveys completed by providers participating in the program practicing in Milwaukee County from 2014 to 2022. Provider confidence and skill in providing mental health care was analyzed quantitatively using Two-sample Wilcoxon rank-sum (Mann–Whitney) tests (baseline vs. follow-up survey responses) and descriptive statistics (follow-up survey only). Provider challenges to providing mental health care were analyzed qualitatively using a thematic analysis research approach.ResultsResults from quantitative analyses showed that provider confidence and skill in treating childhood anxiety and depression improved from baseline to follow-up. Results from qualitative analyses were categorized by factors within and beyond the scope of WI CPCP. Within the scope of WI CPCP, providers reported a lack of knowledge of referral options and a lack of training in mental health care as well as a lack of knowledge in assessing and treating mental disorders. Still, many barriers to mental healthcare access persist that are beyond the scope of WI CPCP, such as long wait times and a lack of insurance coverage.ConclusionsThis study supports the effectiveness of the program to improve access to care for children. However, there is a need for additional solutions such as better reimbursement for mental health professionals and expanded insurance coverage.

PEMBENTUKAN DAN PELATIHAN KADEK SAJIKU (SEHAT JIWAKU) SEBAGAI UPAYA MEWUJUDUKAN DESA SIAGA SIEHAT JIWA MASYARAKAT TELUK TOMINI

The Mental Health Alert Village (DSSJ) is a community-based mental health program service model formed from the alert village's development. A form of community empowerment through a community-based mental health service approach, namely the formation and training of mental health cadres. Cadres play a role in identifying risk groups through data collection, early detection, providing health education, motivating patients and families and conducting program outreach to the community. This Thematic KKN service aims to empower the community by forming and training serving (healthy my soul) cadres. The methods include training, lectures, questions and answers, discussions and practice. This program is in collaboration with the Tabongo Village Government, Dulupi. Implementation of activities at the preparation stage emphasizes the preparation of teams and partners through joint coordination meetings regarding the need for implementing actions. This activity was part of my mental health care training (SAJIKU). Community participation in training for enthusiastic cadres was targeted at 80% of those invited to attend; in reality, 100% followed. There was an increase ine-ISSN : 2715-9558 p-ISSN : 2716-0912 Volume 6 Issue 153Jurnal Pengabdian Kepada Masyarakat Ungu (ABDI KE UNGU)knowledge from pre and post-scores; the average pre-test score was 50 to 82 for the average post-test score. Cadres are expected to continue to practice learning about mental health by continuing to carry out mental health care activities and providing education to the community.

Designing a Novel Digitally Delivered Antiracism Intervention for Mental Health Clinicians: Exploratory Analysis of Acceptability.

There is a great need for evidence-based antiracism interventions targeting mental health clinicians to help mitigate mental health disparities in racially and ethnically minoritized groups. This study provides an exploratory analysis of mental health clinicians' perspectives on the acceptability of a web-based antiracism intervention. Mental health clinicians were recruited from a single academic medical center through outreach emails. Data were collected through individual 30-minute semistructured remote video interviews with participants, then recorded, transcribed, and analyzed using content analysis. A total of 12 mental health clinicians completed the study; 10 out of 12 (83%) were female candidates. Over half (7/12, 58%) of the respondents desired more robust antiracism training in mental health care. Regarding the web-based antiracism intervention, (8/12, 67%) enjoyed the digitally delivered demo module, (7/12, 58%) of respondents suggested web-based content would be further enhanced with the addition of in-person or online group components. Our results suggest a strong need for additional antiracist training for mental health clinicians. Overall, participants responded favorably to novel web-based delivery methods for an antiracism intervention. These findings provide important support for future development and pilot testing of a large-scale digitally enhanced antiracist curriculum targeting mental health clinicians.

Assessing the need for pre-mental health competencies in undergraduate education: insights from graduate faculty surveys.

Despite the value of clinical competencies for masters- and doctoral-level practitioners as well as the tremendous variability in preparedness for graduate school and at graduation from graduate school, there are no competency standards for students pursuing mental healthcare careers prior to graduate study. This study aimed to identify potential pre-mental health competency standards for undergraduates pursuing mental healthcare careers. Faculty at masters and doctoral programs in a range of mental healthcare fields were asked to rate their expectations of entry-level competence and the perceived entry-level competence of their first-year, bachelor-level graduate students on 42 sub-competencies derived from the APA's Competency Benchmarks in Professional Psychology. Faculty of both masters (N = 320) and doctoral (N = 220) programs reported high expectations of first-year graduate students for 11 competency categories (professional values/attitudes; relationships; management-administration; interdisciplinary systems; individual/cultural diversity; advocacy; scientific knowledge and methods; reflective practice, self-assessment, and self-care; ethical standards and policy; supervision, and research/evaluation) and 25 sub-competencies. Faculty in masters programs rated students as not meeting their expectations in 28 sub-competencies, while faculty in doctoral programs rated students as not meeting their expectations in 17 sub-competencies. Faculty recommended internships as well as improvement in writing, counseling skills, professional behavior, diversity, equity, and inclusion, cultural competence and humility, research methods, reading research, connecting research to practice, and education about the different mental healthcare professions. Our findings suggest that students would benefit from intentional training in multiple pre-mental health competency areas at the undergraduate level to facilitate graduate-level training in mental healthcare and to better prepare our future clinicians.

FC12: Ageism and mental health stigma: key barriers to accessing mental health services among Peruvian older adults

Objective:To explore barriers towards mental health services for older adults with symptoms of depression and/or anxiety in a low-resource community in Lima, Peru. We explored these barriers from the perspective of older adults and health providers.Methods:We conducted an interview-based qualitative study. The first set of interviews was carried out between October 2018 and February 2019, and the second, between January 2022 and September 2022. In the first sample, we interviewed 38 older adults ≥60 years with symptoms of depression (Patient Health Questionnaire-9 ≥ 10), anxiety (Beck Anxiety Inventory ≥ 16), or those who had previous experience using formal mental health care irrespective of current symptoms. In the second sample, we included 20 health providers (8 psychologists, 2 general practitioners, 2 nurses, 4 psychiatrists, 4 social workers). We used an inductive thematic data analysis.Results:We identified two main barriers: stigma towards mental health conditions and care, and ageism. Stigma and ageism interacted with each other and exacerbated other barriers to mental health services. Stigma led to negative labels for people with mental health conditions and shame among older adults to disclose their feelings to health providers. Looking at the health system, health care facilities were described as not being age friendly. Additionally, aside from psychologists and psychiatrists, most providers mentioned little previous training in mental health care, but even less about the nuances of treating mental health challenges in old age. Among older adults, other important barriers were the accumulated mistrust towards health professionals and lack of knowledge about existing services and how they work. Importantly, older adults mentioned competing priorities, for example, not having time to seek care because they needed to work to obtain food. Other barriers included hidden costs incurred for transportation to health centers or to obtain medications. For older adults with diminished physical mobility, lack of accompaniment to attend health appointments was another important barrier.Conclusions:Community-based mental health interventions towards older adults need to address ageism and mental health stigma to improve access to care. Furthermore, training for health providers must be improved and expanded to prioritize older adult mental health care.

Attitudes of nursing students towards mental health and the influence of social desirability: a cross-sectional study

PurposeIdentifying negative attitudes toward mental illness among students on nursing undergraduate degrees can help to design teaching strategies able to reduce the stigma attached to this condition. This study aims to assess attitudes toward mental health and intentions regarding future behavior in university nursing students initiating their training in the treatment of mental health problems (MHPs).Design/methodology/approachA descriptive, observational and cross-sectional study was designed. A sample of 162 nursing students completed scales to assess their attitudes toward mental health, stigma, predicted behavior and social desirability. Simple and a multiple linear regression was performed adjusted for the social desirability scale result.FindingsNursing students with previous experience of MHPs presented positive attitudes and behavioral intentions toward mental illness. Those who had no such experience before their training in mental health nursing presented certain stigmatizing attitudes. Attitudes toward MHPs may be affected by stigma and also by social desirability bias. The training in mental health care given to nursing students should aim to reduce its influence to help them carry out their future duties efficiently and compassionately.Originality/valueThis study demonstrates the relevance of university teaching plans, which should place special emphasis on promoting knowledge and developing skills and attitudes in nursing students undergoing training in mental health care to ensure optimal levels of performance in their future careers.

Mental Health Prevention and Promotion-A Narrative Review.

Extant literature has established the effectiveness of various mental health promotion and prevention strategies, including novel interventions. However, comprehensive literature encompassing all these aspects and challenges and opportunities in implementing such interventions in different settings is still lacking. Therefore, in the current review, we aimed to synthesize existing literature on various mental health promotion and prevention interventions and their effectiveness. Additionally, we intend to highlight various novel approaches to mental health care and their implications across different resource settings and provide future directions. The review highlights the (1) concept of preventive psychiatry, including various mental health promotions and prevention approaches, (2) current level of evidence of various mental health preventive interventions, including the novel interventions, and (3) challenges and opportunities in implementing concepts of preventive psychiatry and related interventions across the settings. Although preventive psychiatry is a well-known concept, it is a poorly utilized public health strategy to address the population's mental health needs. It has wide-ranging implications for the wellbeing of society and individuals, including those suffering from chronic medical problems. The researchers and policymakers are increasingly realizing the potential of preventive psychiatry; however, its implementation is poor in low-resource settings. Utilizing novel interventions, such as mobile-and-internet-based interventions and blended and stepped-care models of care can address the vast mental health need of the population. Additionally, it provides mental health services in a less-stigmatizing and easily accessible, and flexible manner. Furthermore, employing decision support systems/algorithms for patient management and personalized care and utilizing the digital platform for the non-specialists' training in mental health care are valuable additions to the existing mental health support system. However, more research concerning this is required worldwide, especially in the low-and-middle-income countries.

BPSS Award

BPSS Award

Art and psychiatry in the 21st century: here's to more messy - and magical - entanglements.

In a volatile world, during a time of multiple crises and amid a projected upsurge in mental illnesses as an aftermath of the COVID-19 pandemic, now is a critical time to consider how art and psychiatry can entangle with each other. Submissions like that of Lily Aston can create new spaces for conversation, reflection and constructive collisions. This can help disrupt and extend the state of psychiatry, management of psychiatric services, and education and training in mental healthcare, and advance how we understand other bodies and minds around us, and how knowledge can be created.

Psychiatric referrals in general practice

IntroductionOver half of patients with mental disorders are seen by primary care physicians. However, as for patients with somatic problems, referral to psychiatrists seems to be sometimes necessary.ObjectivesThe present study aimed to identify reasons and difficulties perceived by general practitioners (GP) in mental health referrals.MethodsA cross-sectional web-based survey was conducted between August 22 and September 23, 2020, so that 47 responses of GP were included.ResultsThe mean age of respondents was 37.3 years. Their seniority as doctors was 8 years on average. Among them, only 17% attended a post-university psychiatric training. The participants reported that they refer on average 32.5% of patients with mental disorders to psychiatrist: 85.1% to psychiatric hospital, 40.4% to liberal psychiatrists and 21.3% to clinical psychologists. Regarding the reasons for referral to mental healthcare structures, 70.2% of doctors justified their doing so by their insufficient training in mental healthcare; 66% by a need for hospitalization, 57.4% by the presence of delusions, while in 27.7 % of cases, the transfer was carried out at the request of the patient or his family. The difficulties mentioned by GP were patient refusal to consult a psychiatrist (70.2%) and difficulties related to the management delay (44.7%).ConclusionsPatient and health system factors, as well as physicians experience seem to have important influences on mental health referral. Open communication and ease of consultation with psychiatrists can make the care of patients with mental health problems even more rewarding to the primary care physician.

Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) through non-specialist providers and telemedicine: a study protocol for a non-inferiority randomized controlled trial

BackgroundDepression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Yet, as few as 20% of these women are treated with frontline interventions such as evidence-based psychological treatments. Major barriers to uptake are the limited number of specialized mental health treatment providers in most settings, and problems with accessing in-person care, such as childcare or transportation. Task sharing of treatment to non-specialist providers with delivery on telemedicine platforms could address such barriers. However, the equivalence of these strategies to specialist and in-person models remains unproven.MethodsThis study protocol outlines the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) randomized trial. SUMMIT is a pragmatic, non-inferiority test of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a brief, behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms. Specialists (psychologists, psychiatrists, and social workers with ≥ 5 years of therapy experience) and non-specialists (nurses and midwives with no formal training in mental health care) were trained in the BA protocol, with the latter supervised by a BA expert during treatment delivery. Consenting pregnant and postpartum women with Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10 (N = 1368) will be randomized to one of four arms (telemedicine specialist, telemedicine non-specialist, in-person specialist, in-person non-specialist), stratified by pregnancy status (antenatal/postnatal) and study site. The primary outcome is participant-reported depressive symptoms (EPDS) at 3 months post-randomization. Secondary outcomes are maternal symptoms of anxiety and trauma symptoms, perceived social support, activation levels and quality of life at 3-, 6-, and 12-month post-randomization, and depressive symptoms at 6- and 12-month post-randomization. Primary analyses are per-protocol and intent-to-treat. The study has successfully continued despite the COVID-19 pandemic, with needed adaptations, including temporary suspension of the in-person arms and ongoing randomization to telemedicine arms.DiscussionThe SUMMIT trial is expected to generate evidence on the non-inferiority of BA delivered by a non-specialist provider compared to specialist and telemedicine compared to in-person. If confirmed, results could pave the way to a dramatic increase in access to treatment for perinatal depression and anxiety.Trial registrationClinicalTrials.gov NCT 04153864. Registered on November 6, 2019.

Неожиданные пересечения: культурно-историческая психология в городском центре психического здоровья?

This paper will reflect on the influence of Vygotsky and Luria in my work as an occupational therapist in the community mental health setting of an ‘Activity Centre’ in the National Health Service, between 1991 and 2001. The paper will discuss a limited study, referencing Vygotsky during that period, with the benefit of hindsight and subsequent developments in the field of cultural-historical psychology. The origi¬nal study raised the questions of what evidence could be found to support the application of Vygotsky’s Zone of Proximal Development (ZPD) with a mixed group of adults in a community setting, and how this process of learning might be assessed and evaluated. At the time, these questions were informed by litera¬ture sources no later than 1998, and learning theory was often absent from professional training in mental healthcare. However, I will propose that some models of practice in mental health — particularly those founded in psycho-analytic group therapy and occupational therapy — could be enhanced by a deeper un-derstanding of Vygotsky’s ZPD, Luria’s model of field research, and the discussion of some less established connections in psychoanalytic praxis.

Factors that facilitate recognition and management of domestic violence by primary care physicians in a Chinese context\xa0-\xa0a mixed methods study in Hong Kong

BackgroundDomestic violence is common in the community. Many of its victims present to primary care physicians (PCPs) but are not being recognized and managed. The barriers, with specific reference to a Chinese cultural context, were investigated earlier. This paper explored the factors which facilitated the process of recognizing and managing suspected cases of domestic violence by PCPs in Hong Kong.MethodsFour focus group interviews were conducted to explore in-depth the experiences of PCPs in recognition, management and referral of domestic violence cases from which facilitators were identified. The relevant themes were then investigated in a questionnaire survey with 504 PCPs working in public and private sectors.ResultsThe focus group participants emphasized mood symptoms as useful indicators for probable abuse and continuity of care was important to unmask issues of domestic violence. The top facilitators perceived by the respondents of the survey included: a trusting doctor-patient relationship (99.8%), good communication skills (99.0%), patients’ unexplained bruises (96.3%), medical history (94.6%), and mood symptoms (94.4%). Further, the survey found that PCPs with longer years of practice, a medical degree obtained from Western countries, and postgraduate training in family counselling or psychological medicine perceived more facilitators in managing domestic violence.ConclusionsWithout a local screening policy and training protocol to manage domestic violence, PCPs regarded their skills in mental healthcare and good relationships with patients as the key facilitators. While training in mental health care helps PCPs manage domestic violence, a specific protocol emphasizing medical-social collaboration is anticipated to facilitate them to take a more proactive and effective stance from screening to management.

Barriers Remain: Perceptions and Uses of Comics by Mental Health and Social Care Library Users

This article is part of a larger study investigating the perceived value of using comics as an information resource in the teaching and training of mental health and social care professionals in a higher education setting.We surveyed 108 library users at the Tavistock and Portman NHS Foundation Trust, which specialises in mental health and social care and is a centre for both treatment and training. The study showed that most participants believed that comics have a potential role to play in mental health care training, and that challenges remain in getting comics perceived in ways that are not limited by existing prejudices or socio-cultural assumptions.Amongst other findings, the study found no significant association between the age or gender of participants and their attitudes to comics in an academic context. Participants considered that the most useful application of comics within the mental health and social care domain was their potential use in medical or therapeutic settings with young people. Even when our sample was not dominated by participants who reported reading comics regularly, the study showed that recent experience of reading comics seems to positively influence how comfortable participants feel about using comics for teaching or learning.Publisher’s Note: This article was originally published with an incorrect peer review statement, which said that this article was an internally reviewed editorial. This has now been amended to reflect the fact that this is a piece of research that underwent double blind peer review by two external reviewers.

Perceived Stigma Towards Psychiatric Illnesses in Mental Health Trainees: A Cross-Sectional Study

Psychiatric disorders have always been seen as character disturbances and hence have always bore higher stigma than many other physical illnesses. In most of the cases the stigma is seen as negative stereotype arising out of poor awareness about the condition. In that case the stigma should reduce with the increase in the awareness about the condition. The current study focused upon exploring the stigma towards psychiatric disorders in the mental health trainees. A sample of 50 students of various mental health care training programs; clinical psychology, psychiatry, psychiatric social work and psychiatric nursing, were evaluated for their perceived stigma of psychiatric disorders using three versions of a tool developed to compare self-stigma, family-stigma, and social-stigma. Our results show that participants experienced significantly different levels of stigma for these levels (F (1.65, 81.26) = 56.64, p < 0.0001, ηp2 = 0.536), with highest level of stigma perceived in relation to self (M = 42.8, SE = 1.53) which was significantly more than both family (M = 30.78, SE = 1.19) and society (M = 29.76, SE = 1.24) conditions. The findings were same irrespective of the specialization i.e. clinical psychology, psychiatry etc. within mental health training programs. Further analysis about the group comparison among the mental health trainees suggested that psychiatric nursing group perceived significantly higher level of overall stigma than any other group of specialization. The findings indicate that better understanding of psychiatric condition alone might not eliminate the stigma attached to it.

Le rôle du médecin généraliste dans la prise en charge des pathologies psychiatriques

AimPsychiatric disorders represent a huge burden of disease worldwide. Significant gaps in their diagnosis and treatment remain. In Morocco, an observed shortage of psychiatrists would logically call for their collaboration with family physicians. Our objectives were to analyse perceptions of general practitioners’ capacity to manage psychiatric disorders, to study the difficulties encountered in their management of these pathologies, and to assess their degree of collaboration with existing mental health structures. MethodsA cross-sectional nationwide survey of family physicians practicing in urban and rural areas in the private and public sectors in the Kingdom of Morocco was organised. Carried out over a period of 10 months (April 2016 to January 2017), the study was based on an anonymised self-administered questionnaire comprising 23 items. Were excluded from the sample: physicians who had tested the questionnaire prior to its distribution, medical students, family physicians employed in administrative services, resident doctors in university hospitals, and questionnaires with incomplete answers. ResultsAll in all, five hundred and four questionnaires were distributed, with a participation rate of 79.8%, while 57.9% of the respondents were men. Their seniority as doctors ranged from 1 year to 60 years with average duration of 19.5±11 years. An overwhelming majority of the doctors had obtained their doctorates in Morocco, while 8.4% had been trained abroad. The majority of the doctors surveyed worked in private practice in urban areas (53.1%), and most of them (81.9%) agreed that the management of psychiatric disorders is a public health priority. The participating physicians stated that they received an average of five patients per day suffering from mental disorders, representing 17.3% of their medical consultations. According to their perceptions, the most frequent psychiatric pathologies were depression, somatoform disorders and sleep disturbances, which were cited by 92.9%, 78.8% and 78.5% of them respectively. Regarding the diagnosis of psychiatric pathologies, 60.2% of the doctors considered bipolar disorder as a difficult pathology to diagnose, followed by schizophrenia, autism and dementia, while the pathologies reported as the most difficult to treat were addictive behaviours, schizophrenia, bipolar disorder, autism and dementia. Physicians felt a need for training, primarily pertaining to anxiety disorders, schizophrenia and bipolar disorders (49.5%, 35% and 33.7%, respectively). Nearly a quarter of the respondents (22.4%) mentioned a need for training in management of all psychiatric illnesses. Regarding the reasons for their referral of patients to mental health care structures, 65.4% of the physicians justified their doing so by a need for hospitalisation, while in 43.7% of cases, the transfer was carried out at the request of the patient or his family. The difficulties mentioned by the respondents were firstly a lack of adapted means of care (77.5%), followed by their insufficient training in mental healthcare (52.4%) and absence of collaboration with mental health professionals (52.4%). ConclusionFor the majority of the physicians surveyed, psychiatry represented a public health priority, and their prioritising provides a probable explanation for their positive perception of their role in the management of mental disorders. However, we went on to observe that a number of difficulties constituted obstacles to their role in management of mental disorders and induced them to refer their patients to psychiatrists. Our analysis highlighted the impact of continuing education on physicians’ attitudes and the interest of collaboration between practitioners. Efforts in university teaching and continuous education should be encouraged in view of enabling family physicians to more effectively cope with the demands of daily practice and meet the expectations of the overall population.

Factors associated with the evolution of attitudes towards mental illness in a cohort of nursing students

WHAT IS KNOWN ON THE SUBJECT?: People with mental health difficulties have poorer physical health than the general population. The stigmatizing attitude of health professionals impacts the quality of care for these people. There is a broad background on the effectiveness of activities based on theoretical training, clinical practices or social contact to improve nursing students' attitudes towards people with mental health difficulties. There is an important need to assess whether the benefits identified in the short term are maintained in the longer term. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The positive evolution of attitudes towards mental illness does not last over time. Some students' attitude towards people with a mental health difficulty worsened in the final stage of their training after completing clinical practices. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is necessary for tutors incorporate an understanding of stigma throughout the degree training and to discuss with the students the emotional aspects experienced during the performance of clinical practices. The design of any anti-stigma intervention must include the factor of "time". ABSTRACT: Introduction The stigma of health professionals is a contributing factor to morbi-mortality among people with mental health difficulties. There is a lack of research on long-term outcomes in nursing students. Objective To identify factors associated with the evolution of stigmatizing attitudes towards mental illness in a cohort of students trained in mental health. Method A prospective observational study of the impact of training in mental health care. Age, gender, stigma, level of previous familiarity with mental illness, self-education by Internet, academic performance and the place where practicums are conducted were evaluated on three occasions over 15months. Results Academic performance, online consultation and the size or origin of the theoretical group were indicators of better attitudes. The positive evolution of attitudes does not last over time. Discussion Instability over time could be explained by students' experience in the practicum, although the time itself has been identified as a determining factor. Practical implications Further studies should be promoted in academia to assess the content of mental health training and its influence on the evolution of the stigmatizing attitude. It is also necessary to address stigma in small groups, where students with better academic results lead anti-stigma activities.

災害時「こころのケア・トレーニング・マニュアル」構築に関する一提案

災害時「こころのケア・トレーニング・マニュアル」構築に関する一提案

Opportunities and obstacles to screening for perinatal depression among women in Zimbabwe: A narrative review of literature.

BackgroundThe perinatal period provides an opportune time for health care providers to screen for and proffer interventions for women suffering from depression. However, routine screening for depression is not done in primary care settings in Zimbabwe.AimThis narrative review discusses opportunities and obstacles surrounding screening for perinatal depression in primary care settings in Zimbabwe, with a view to stress the importance of routine screening to policy-makers.MethodsBoth electronic and manual searches were done on PubMed, PubMed Central, African Journals Online, Google Scholar and the University of Zimbabwe Institutional Repository (UZIR) using the following key terms: ‘women and antenatal depression’, ‘prenatal depression’, ‘postnatal depression’, ‘postpartum depression’, ‘depressive disorder’, or ‘common mental disorder’ and ‘screening and Zimbabwe’.ResultsAlthough opportunities for depression screening are possible because of the high antenatal and postnatal service coverage, the potential for universal screening is fraught with human and financial resource constraints, lack of training in mental health care among primary health care providers and lack of locally validated screening tools for depression.ConclusionThere is a need to channel resources into the training of midwives and other primary health care providers on mental health issues affecting women perinatally.

Body and mind: retention in antiretroviral treatment care is improved by mental health training of care providers in Ethiopia

BackgroundEthiopia has achieved a high coverage of antiretroviral treatment (ART), but maintaining lifelong care is still a great challenge. Mental illnesses often co-exist with HIV/AIDS and may compromise the retention on ART. In order to improve prolonged retention in ART care, basic training in mental health care was introduced for ART providers, but this hasn’t been evaluated yet. The aim of this study was to examine if this training has improved patient retention in care.MethodA retrospective cohort study was employed to compare attrition from ART between clients attended by care provider trained with basic mental health service (exposed) and those in the standard ART follow-up care (unexposed) in public health facilities. A routine patient follow-up electronic database enrolled for ART between 2005 and 2017 was abstracted for the study. The Kaplan-Meier plot was used to compare the attrition rates between the two groups. The log-rank test was used to assess differences in the groups. The Cox proportional hazards regression model was used to determine predictors of attrition. We used estimated effect size of hazard ratios (HR) with 95% confidence intervals (CI).ResultDuring the 12 years of observation, 8009 study participants under ART were followed for 33,498 person-years. The incidence of attrition was 6.5 per 100 person-years and 21% higher in the unexposed group (HR 1.21; 95% CI 1.1, 1.3), and retention in care was significantly higher in the mental health exposed group throughout the study period. WHO clinical staging III/IV, tuberculosis coinfection, the male gender, and poor functional status were independent risk factors for attrition.ConclusionWe found that clients in the group exposed to mental health care training tended to have better retention in ART care with some variation according to gender, WHO Clinical stage and functional status. Training of ART providers in mental health may be considered in order to strengthen ART retention in low resource settings.