Untreated Mental Health Problems Research Articles

Individuals with currently untreated mental illness: causal beliefs and readiness to seek help.

Many people with mental illness do not seek professional help. Beliefs about the causes of their current health problem seem relevant for initiating treatment. Our aim was to find out to what extent the perceived causes of current untreated mental health problems determine whether a person considers herself/himself as having a mental illness, perceives need for professional help and plans to seek help in the near future. In a cross-sectional study, we examined 207 untreated persons with a depressive syndrome, all fulfilling criteria for a current mental illness as confirmed with a structured diagnostic interview (Mini International Neuropsychiatric Interview). The sample was recruited in the community using adverts, flyers and social media. We elicited causal explanations for the present problem, depression literacy, self-identification as having a mental illness, perceived need for professional help, help-seeking intentions, severity of depressive symptoms (Patient Health Questionnaire - Depression), and whether respondents had previously sought mental healthcare. Most participants fulfilled diagnostic criteria for a mood disorder (n = 181, 87.4%) and/or neurotic, stress-related and somatoform disorders (n = 120, 58.0%) according to the ICD-10. N = 94 (45.4%) participants had never received mental health treatment previously. Exploratory factor analysis of a list of 25 different causal explanations resulted in five factors: biomedical causes, person-related causes, childhood trauma, current stress and unhealthy behaviour. Attributing the present problem to biomedical causes, person-related causes, childhood trauma and stress were all associated with stronger self-identification as having a mental illness. In persons who had never received mental health treatment previously, attribution to biomedical causes was related to greater perceived need and stronger help-seeking intentions. In those with treatment experience, lower attribution to person-related causes and stress were related to greater perceived need for professional help. While several causal explanations are associated with self-identification as having a mental illness, only biomedical attributions seem to be related to increase perceived need and help-seeking intentions, especially in individuals with no treatment experiences. Longitudinal studies investigating causal beliefs and help-seeking are needed to find out how causal attributions guide help-seeking behaviour. From this study it seems possible that portraying professional mental health treatment as not being restricted to biomedical problems would contribute to closing the treatment gap for mental disorders.

Access to Mental Health Care Services for the Orphan and Vulnerable Children in Addis Ababa Ethiopia

A lot of children in the world suffer from untreated mental health problems. The global burdens of mental illness are high but promoting compressive care services are neglected in most countries. The objective of this review journal was to discover access and barriers to mental health care services for the orphan and vulnerable children in Addis Ababa, Ethiopia. The systematic review was used to collect and analyze a relevant information from Global Health, PubMed, Google Scholar, Clinical Social Work Abstracts, Summon, WHO, PsychInfo Ethiopian Universities, and NIH data sources. Many research journals published after 2001 were identified and analyzed based on meeting inclusion and exclusion criteria as well as quality standards. The barriers associated to finance, logistic, stigma and traditional beliefs, and perceptions towards mental health problems and treatment. Children mental health care services are poorly understood, not adequately addressed, not assessment based, and incomprehensive rather it is based on traditional practices.

The Stigma of Mental Illness as a Barrier to Self Labeling as Having a Mental Illness.

The aim of this study was to investigate whether personal stigma decreases self-identification as having a mental illness in individuals with untreated mental health problems. We interviewed 207 persons with a currently untreated mental health problem as confirmed by a structured diagnostic interview. Measures included symptom appraisal, self-identification as having a mental illness (SELFI), self-labeling (open-ended question on the nature of their problem) stigma-related variables (explicit and implicit), as well as sociodemographics, current symptom severity, and previous treatment. Support for discrimination and implicit stigmatizing attitude were both associated with lower likelihood of self-identification. More social distance and support for discrimination were associated with less self-labeling. Previous treatment was the strongest predictor of symptom appraisal, SELFI, and self-labeling. Destigmatizing mental illness could increase awareness of personal mental health problems, potentially leading to lower rates of untreated mental illness.

Mental Health Care Service and Mental Problems among Orphan and Vulnerable Children in Addis Ababa Ethiopia

AbstractA lot of children in the world suffer from untreated mental health problems. The global burdens of childhood mental disorders are increasing but mental health care services are neglected in most countries. The objective of this critical analysis was to realize the access to mental health service and mental problems among orphan and vulnerable children in Addis Ababa, Ethiopia. To achieve the purpose of the analysis, the method was based on the critical analysis of the recent research literature from Pub-Med, Global Health, Google Scholar, Ethiopian Universities, Psych-Info, and WHO data sources. Thirty-six journals published after 2001 were identified and critically analyzed based on scientific inclusion and exclusion criteria as well as analyzed in a systematic manner. The orphan and vulnerable children face a prospect of a persistent effort for physically continued existence, for fundamental needs, education, love and affection, and protection against exploitation violence and bias. The problem of meeting these desires of the children corresponds to a major new challenge that requires an in-depth research, future interventions, and policy plans in tackling the problem. In light of the problem in Ethiopia, researches regarding the mental health care services of the orphan and vulnerable children in Addis Ababa are extremely inadequate.

Associations between causal attributions and personal stigmatizing attitudes in untreated persons with current mental health problems

Past research has shown that among the general public, certain causal explanations like biomedical causes are associated with stronger desire for social distance from persons with mental illness. Aim of this study was to find out how different causal attributions of persons with untreated mental health problems regarding their own complaints are associated with stigmatizing attitudes, anticipated self-stigma when seeking help and perceived stigma-stress. Altogether, 207 untreated persons with a current depressive syndrome were interviewed. Biomedical causes, but also belief in childhood trauma or unhealthy behavior as a cause of the problem, were associated with stronger personal stigma and with more stigma-stress. Similarities and differences to findings among the general population and implications for future research are discussed.

Scope, Scale, and Dose of the World's Largest School-Based Mental Health Programs.

Untreated mental health problems are among the most disabling, persistent, and costly health conditions. Because they often begin in childhood and continue into adulthood, there has been growing interest in preventive mental health programs for children. In recent years, several such programs have been implemented at regional, state, or national scale, and although many experimental studies have documented positive outcomes of individual programs, this article represents the first attempt to systematically compare the largest programs in terms of scope, scale, and dose. The school-based mental health programs discussed in this review appear to have reached more than 27 million children over the last decade, and many of these programs have collected systematic outcomes data. The role that such programs can play in low- and middle-income countries (LMICs) is a secondary focus of this article. Until recently, wide-scaled, preventive, mental health interventions for children have been studied almost exclusively in high-income countries even though around 80% of the global population of children reside in LMICs. Since a number of programs are now operating on a large scale in LMICs, it has become possible to consider child mental health programs from a more global perspective. With both the increasing diversity of countries represented and the growing scale of programs, data sets of increasing quality and size are opening up new opportunities to assess the degree to which preventive interventions for child mental health, delivered at scale, can play a role in improving health and other life outcomes.

Treated versus untreated mental health problems in adolescents: A six-year comparison of emotional and behavioral problem trajectories

IntroductionMultidisciplinary guidelines in adolescent mental health care are based on RCTs, while treatment efficacy can be different from effectiveness seen in ‘the real world’. Studies in the real world conducted so far suggest that treatment has a negligible effect on follow-up symptomatology. However, these studies did not incorporate the pre-treatment trajectory of symptoms nor investigated a dose-response relationship.ObjectivesTo test whether future treatment users and non-users differed in emotional and behavioural problem scores, whether specialist mental health treatment (SMHT) was effective in reducing problem levels while controlling for pre-treatment trajectory, and to seek evidence of a dose-response relationship.MethodsSix-year follow up data were used from the Tracking Adolescents’ Individual Lives Survey (TRAILS). We identified adolescents with a clinical level of problem behaviour on the Child Behaviour Checklist or Youth Self Report and first SMHT between the ages 13 and 16. Adolescents with a clinical level of problem behaviour but without SMHT use served as control group. A psychiatric case register provided data on number of treatment contacts. Using regression analysis, we predicted the effect of treatment on post-treatment problem scores.ResultsTreated adolescents more often had a (severe) diagnosis than untreated adolescents. Pre-treatment trajectories barely differed between treated and untreated adolescents. Treatment predicted an increase in follow-up problem scores, regardless of the number of sessions.ConclusionThe quasi-experimental design calls for modest conclusions. We might however need to take a closer look at real-world service delivery, and invest in developing treatments that can achieve sustainable benefits.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Addressing the mental health needs of looked after children in foster care: the experiences of foster carers

Introduction Despite well-documented vulnerabilities to mental health problems among the increasing population of looked after children, there continues to be poor uptake and utilization of Child and Adolescent Mental Health Services (CAMHS). Aim To elicit views of foster carers regarding the mental health needs of children and adolescents in their care and their experiences of accessing mental health services. Methods A grounded theory approach and semistructured interviews with ten foster carers. Results The experience of being a foster carer was the core category, with three major themes: (1) foster carers' psychological understanding of challenging behaviour; (2) barriers to accessing CAMHS; (3) the importance of support. Discussion A key finding of this research is that barriers to accessing CAMHS were not experienced at the point of referral, but once within the mental health system. The foster carers demonstrated a proactive approach to accessing services but expressed a need for more support structures related directly to the viability of the placement. Implications for practice Mental health nurses have a pivotal role in providing a more responsive and needs-led service for this population; professional support to foster carers to include facilitating peer support; and clinical interventions for the looked after children.

Mental Health Problems among Slum Children – A Preliminary Survey

Slum children are at risk for serious mental health problems because of their economic and social environments. Little is known about their mental health. This cross sectional study was carried out to know the extent of mental health problems among slum-dweller children in Dhaka city, Bangladesh. One hundred and twenty students of four different primary schools were selected. In the first stage of the study, socio-demographic data as well as information about mental health problems were collected through socio-demographic questionnaire and validated Bengali version of Rutter B2 scale respectively, from the teachers of the schools. In the second stage, all the students were assessed again personally by the both authors with the help of Diagnostic and Statistical Manual of Mental Disorders- fourth edition (DSM-IV). High prevalence of mental health problems was found among slum children (70.8%). Emotional, conduct and undifferentiated disorders were detected in 14.17%, 45.83% and 10.83%, respectively. Conduct disorder was 3.23 times more prevalent in the children than was emotional disorder. It was more prevalent in boys than in girls (57.90% vs 34.90%). Significant relationships were found among gender and emotional disorder (p < 0.030), father’s employment status and undifferentiated disorder (p < 0.010), substance abuse by father and child’s emotional disorder(p <0.050) and also, gender and conduct disorder (p < 0.001). High prevalence of mental health problems among slum children is alarming. Unrecognized and consecutively untreated mental health problems during childhood may have life-long impact.

Recovering from a stroke: A narrative review on post-stroke anxiety treatment and management

Recovering from a stroke: A narrative review on post-stroke anxiety treatment and management

Barriers and facilitators for mental healthcare in pediatric lupus and mixed connective tissue disease: a qualitative study of youth and parent perspectives

BackgroundUntreated mental health problems may result in poor outcomes for youth with systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD). We investigated perceptions, barriers and facilitators for mental healthcare of these youth.MethodsWe conducted 32 semi-structured interviews with 16 outpatient youth with SLE/MCTD, ages 11–22 years, and their parents. We used purposive sampling to deliberately obtain the experiences of youth screened during a previous study for depression and anxiety with the Patient Health Questionnaire 9 and the Screen for Childhood Anxiety and Related Disorders, respectively. We recruited 6 youth with previous positive screens and 10 with negative screens. We assessed interim mental health history, and qualitatively examined perceptions, barriers and facilitators for mental healthcare.ResultsYouth with a mental health history increased from 6 (38 %) at initial screening to 9 (56 %) at interview (mean follow-up = 2.1 years). Youth receiving mental health treatment increased from 33 to 67 %. Youth and parents identified rheumatologists as primary physicians and found mental health screening in rheumatology acceptable. Barriers to mental healthcare included: stigma; fear; uncertainty about getting help; parental emotional burden; minimization by doctors; and limited mental healthcare access. Facilitators included: strong clinician relationships; clinician initiative, sincerity and normalization in discussing mental health; and increased patient/family awareness of mental health issues in SLE/MCTD.ConclusionYouth with SLE/MCTD and their parents perceive pediatric rheumatologists as a preferred source for mental health screening, guidance and referral. Interventions addressing barriers and enhancing facilitators may improve mental healthcare for youth with SLE/MCTD.

Student driven mental health promotion in an Australian university setting

The purpose of this study was to investigate university students׳ perceptions of mental health problems, through an exploration of proposed health promotion interventions. An action research approach was undertaken to inform the health promotion interventions of the MindWise study. A qualitative thematic analysis of focus group data was undertaken. Three themes were abstracted from the data: the importance of (i) harm minimisation messaging, (ii) emphasising early intervention and acknowledging the impact of untreated mental health problems, (iii) addressing stigma and concerns about confidentiality. Student involvement is a cost-effective way to increase the acceptability of health promotion initiatives by other students.

Child, Adolescent and Young Adult Suicides: A Comparison Based on the Queensland Suicide Registry

Objective: The incidence of suicides increases rapidly up to the age of 20 years. Despite major developmental changes, only a limited number of studies has compared characteristics of child, adolescent and young adult suicides. The aim of the current study was to compare demographic, psychosocial and psychiatric characteristics of suicides in three youngest age groups - 10-14 years, 15-19 years and 20-24 years - in Queensland, Australia, between 2002 and 2011. Methods: The Queensland Suicide Register (QSR) contains information from a variety of sources, including: police report of death to a Coroner, post-mortem autopsy report, toxicology report and Coroner’s findings. Annual suicide rates were calculated by gender and age group. Odds Ratios (OR) with 95% confidence intervals (95% CI), Chi2 test are presented. Results: Between 2002 and 2011, there were 850 youth suicides recorded in the QSR - 43 aged 10-14 years, 295 aged 15-19 years and 512 aged 20-24 years. The proportion of males increased with age (51.2%, 69.5% and 76.6%). However, the proportion of Indigenous people decreased significantly with age (45.2%, 18.1% and 14.5%). Hanging was the most frequent suicide method for all age groups and for both genders, decreasing significantly with age for both genders. Prevalence of a diagnosed psychiatric disorder, substance use and psychiatric treatment increased with age. Evidence of untreated mental health problems was reported without significant differences between age groups. Similarly, there were no significant differences in history of previous suicide attempts and communication of suicide intent. Suicide in social group and attention to suicide in media, family conflict, school/ work-related problems and childhood trauma decreased significantly with age while relationship problems increased. Conclusion: Suicides in early adolescence were characterised by higher prevalence of family conflicts, schoolrelated problems and suicides in social groups. Suicides in young adults had significantly higher prevalence of psychiatric disorders and were much more impacted by relationship problems. The characteristics of suicides in late adolescents fell in between the other age groups.

Does Patient Race/Ethnicity Influence Physician Decision-Making for Diagnosis and Treatment of Childhood Disruptive Behavior Problems?

Race/ethnic disparities in utilization of children's mental health care have been well documented and are particularly concerning given the long-term risks of untreated mental health problems (Institute of Medicine, 2003; Kessler et al. Am J Psychiatry 152:10026-1032, 1995). Research investigating the higher rates of unmet need among race/ethnic minority youths has focused primarily on policy, fiscal, and individual child or family factors that can influence service access and use. Alternatively, this study examines provider behavior as a potential influence on race/ethnic disparities in mental health care. The goal of the study was to examine whether patient (family) race/ethnicity influences physician diagnostic and treatment decision-making for childhood disruptive behavior problems. The study utilized an internet-based video vignette with corresponding survey of 371 randomly selected physicians from across the USA representing specialties likely to treat these patients (pediatricians, family physicians, general and child psychiatrists). Participants viewed a video vignette in which only race/ethnicity of the mother randomly varied (non-Hispanic White, Hispanic, and African American) and then responded to questions about diagnosis and recommended treatments. Physicians assigned diagnoses such as oppositional defiant disorder (48 %) and attention deficit disorder (63 %) to the child, but there were no differences in diagnosis based on race/ethnicity. The majority of respondents recommended psychosocial treatment (98 %) and/or psychoactive medication treatment (60 %), but there were no significant differences based on race/ethnicity. Thus, in this study using mock patient stimuli and controlling for other factors, such as insurance coverage, we did not find major differences in physician diagnostic or treatment decision-making based on patient race/ethnicity.

Help-Seeking Behaviors of Men for Mental Health and the Impact of Diverse Cultural Backgrounds

A growing research body suggests that men are less likely than women to seek help from professional counselors for mental health problems and stressful life events (Komiya, Good, & Sherrod, 2000). Untreated mental health problems can have a significant impact on the health and development of the client as well as the client’s family members. Various factors such as help-seeking attitudes influence men’s help-seeking behaviors in regard to mental health services. Males demonstrate less positive attitudes toward seeking help in order to avoid talking about stressful events and painful feelings because of masculine norms and stigma. Help-seeking attitudes, masculine norms, and stigma are reviewed for their associations with men’s opposition to seeking help when psychological problems occur. The author of this paper presents further literature about males from diverse cultural backgrounds to emphasize the particular factors that impact men’s reduced willingness to seek counseling.

Addressing Parental Mental Health Within Interventions for Children

Untreated parent mental health problems have deleterious effects upon the family, yet caregivers are unlikely to receive services for their emotional health. We conducted a review of treatments and services for children and adolescents that also offered services to parents. Child treatment and service studies were included in the present study if they analyzed parent symptoms or diagnoses over time, and the intervention contained a parent component. Of 200 studies reviewed, 20 contained a component for the parent and assessed the parent's emotional health at multiple time points. Depression and anxiety were the most commonly studied parental mental health problem; most parent components consisted of behavioral strategies in service of the child's psychological health. Major shifts in health care policy affecting mental health services provide an opportunity to create integrated and coordinated health and behavioral health systems. Attention must be given to ensure that the workforce of providers, the administrative structures, and the reimbursement strategies are strengthened and connected to serve the needs of parents/caregivers and children in order to enhance family outcomes.

NIMH Fosters ‘Practice-Ready’ Solutions to Integrating Primary, MH Care

Research at the interface of mental health and primary care should focus on generating knowledge that decision makers need and incorporating practice-based evidence.

HIV-infected mental health patients: characteristics and comparison with HIV-infected patients from the general population and non-infected mental health patients

ObjectivesHIV-infected patients are at increased risk of developing mental health symptoms, which negatively influence the treatment of the HIV-infection. Mental health problems in HIV-infected patients may affect public health. Psychopathology, including depression and substance abuse, can increase hazardous sexual behaviour and, with it, the chance of spreading HIV. Therefore, it is important to develop an optimal treatment plan for HIV-infected patients with mental health problems. The majority of HIV-infected patients in the Netherlands (almost 60%) are homosexual men.The main objectives of this study were to describe the clinical and demographic characteristics of patients with HIV who seek treatment for their mental health symptoms in the Netherlands. Secondly, we tested whether HIV infected and non-infected homosexual patients with a lifetime depressive disorder differed on several mental health symptoms.MethodsWe compared a cohort of 196 patients who visited the outpatient clinic for HIV and Mental Health with HIV-infected patients in the general population in Amsterdam (ATHENA-study) and with non-HIV infected mental health patients (NESDA-study). DSM-IV diagnoses were determined, and several self-report questionnaires were used to assess mental health symptoms.ResultsDepressive disorders were the most commonly occurring diagnoses in the cohort and frequent drug use was common. HIV-infected homosexual men with a depressive disorder showed no difference in depressive symptoms or sleep disturbance, compared with non-infected depressive men. However, HIV-positive patients did express more symptoms like fear, anger and guilt. Although they showed significantly more suicidal ideation, suicide attempts were not more prevalent among HIV-infected patients. Finally, the HIV-infected depressive patients displayed a considerably higher level of drug use than the HIV-negative group.ConclusionHabitual drug use is a risk factor for spreading HIV. It is also more often diagnosed in HIV-infected homosexual men with a lifetime depression or dysthymic disorder than in the non-infected population. Untreated mental health problems, such as depressive symptoms and use of drugs can have serious repercussions. Therefore, general practitioners and internists should be trained to recognize mental health problems in HIV-infected patients.

Understanding the Behavioral Determinants of Mental Health Service Use by Urban, Under-Resourced Black Youth: Adolescent and Caregiver Perspectives.

Black adolescents with mental health problems are less likely than non-Black adolescents with mental health problems to receive treatment, primarily for non-financial reasons including negative perceptions of services and providers, and self-stigma associated with experiencing mental health problems. To better understand these obstacles, 16 adolescents and 11 caregivers, recruited from two K-8th grade elementary-middle schools, participated in four focus groups guided by the unified theory of behavior to explore mental health help-seeking behaviors and perceptions of mental health services. In the focus groups, caregivers acknowledged more positive attitudes about seeking mental health services than adolescents, but both expected the experience of actually doing so to be negative. Adolescents and caregivers also acknowledged social norms that inhibit their mental health help-seeking. Therefore, we conclude that interventions targeting expectancies and social norms might increase the connection of urban, under-resourced Black adolescents and their families to mental health services, and be particularly important given the long-term consequences of untreated mental health problems for this group.

Attitudes and Beliefs About Treatment Among College Students With Untreated Mental Health Problems

This study estimated attitudes and beliefs about treatment in a national sample of college students with untreated mental health problems. A retrospective analysis of the 2007 and 2009 Healthy Minds Study, an online survey of college students in the United States, was conducted. The random sample included 13,105 survey participants from 26 institutions. Students with untreated depression, anxiety, or suicidal ideation (N=2,350) were classified by attitudes about treatment (stigma), beliefs about effectiveness of treatment, and perceived need for treatment. A majority (65%) of untreated students reported low stigma and positive beliefs about treatment effectiveness, including 42% who perceived a need for help and 23% who did not. For a large proportion of young people with untreated mental illness, attitudes and knowledge about mental illness may no longer be among the main barriers to help seeking. Research and practice need to consider new approaches for understanding and influencing help-seeking behavior.