Whether and how people reach care.
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1051 to 1075 of 2,047Chandra A, Minkovitz CS (2006)MEDLINE-indexed journal, not yet read by usThe Journal of adolescent health : official publication of the Society for Adolescent Medicine184 citations Stigma starts early: gender differences in teen willingness to use mental health services.
Purpose: To explore gender differences and the role of stigma in teen willingness to use mental health services.
Methods: Self-administered, written questionnaires were conducted with 274 eighth graders in a suburban community in a mid-Atlantic state. Teens reported on social support for emotional concerns, mental health experience and knowledge, and stigma and barriers associated with mental health service use. Data analysis included chi-square statistics and analysis of variance (ANOVA) to examine associations between gender and independent variables of interest. Logistic regression analyses assessed the relationship of gender, stigma, and willingness to use mental health services, adjusting for race and receipt of mental health services.
Results: More girls than boys turned to a friend for help for an emotional concern, whereas more boys turned to a family member first. Boys had less …
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Coping, fostering resilience, and driving care innovation for autistic people and their families during the COVID-19 pandemic and beyond.
The new coronavirus disease (COVID-19) pandemic is changing how society operates. Environmental changes, disrupted routines, and reduced access to services and social networks will have a unique impact on autistic individuals and their families and will contribute to significant deterioration in some. Access to support is crucial to address vulnerability factors, guide adjustments in home environments, and apply mitigation strategies to improve coping. The current crisis highlights that our regular care systems are not sufficient to meet the needs of the autism communities. In many parts of the world, people have shifted to online school and increased use of remote delivery of healthcare and autism supports. Access to these services needs to be increased to mitigate the negative impact of COVID-19 and future epidemics/pandemics. The rapid expansion in the use of telehealth platforms can …
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Understanding Men's Engagement and Disengagement When Seeking Support for Mental Health.
Men are less likely to utilize health care services compared with women. When it comes to mental health, men have been reported to hold more reluctant attitudes toward engaging with mental health services. Current studies have predominantly been quantitative and focused on understanding effective strategies to promote men's engagement and why men may avoid help-seeking or may not seek help early; few studies exist of men's disengagement from services. Much of this research has been undertaken from the services' perspective. The study reported here attempts to gain better insight into the reasons men give for their disengagement from mental health services and what men say will reengage them back into the system. This research was a secondary analysis of data collected by a national survey conducted by Lived Experience Australia (LEA). Responses of 73 male consumers were gathered and anal…
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Lawn S, Waddell E, Rikkers W, Roberts L, Beks T, Lawrence D, Rioseco P, Sharp T, Wadham B, Daraganova G, Van Hooff M (2022)MEDLINE-indexed journal, not yet read by usHealth & social care in the community4 citations Families' experiences of supporting Australian veterans and emergency service first responders (ESFRs) to seek help for mental health problems.
The objective of this phenomenological study was to describe families' experiences of supporting veterans and emergency service first responders (ESFRs) (known also as public safety personnel) to seek help for a mental health problem. In-depth semi-structured open-ended interviews were undertaken with 25 family members of Australian veterans and ESFRs. Fourteen participants were family members of police officers. Data were analysed thematically. Participants described a long and difficult journey of supporting the person's help-seeking across six themes. Traumatic exposures, bullying in the workplace and lack of organisational support experienced by veterans/ESFRs caused significant family distress. Families played a vital role in help-seeking but were largely ignored by veteran/ESFR organisations. The research provides a rich understanding of distress and moral injury that is experience…
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Gender differences in barriers to mental healthcare for UK military veterans: a preliminary investigation.
Introduction: Limited UK research focuses on female military veterans' gender-related experiences and issues when accessing civilian mental healthcare support. This study sought to illuminate a preliminary understanding of any gender differences in barriers that may discourage them accessing mental healthcare support.
Methods: A total of 100 participants completed an open online survey of UK triservice veterans who identified as having experienced postmilitary mental health problems. They completed a 30-item Barriers to Access to Care Evaluation scale and were asked to elaborate using free-text questions. Resulting quantitative data were analysed for gender-related differences, while the qualitative text was thematically explored.
Results: While stigma, previous poor experience of mental healthcare and a lack of trust in civilian providers were found to act as barriers to postmilitary su…
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Mental health service use among migrant and Swedish-born children and youth: a register-based cohort study of 472,129 individuals in Stockholm.
Purpose: Migrant children underutilize mental health services (MHS), but differences according to age, reason for migration, type of problem, and time have not been thoroughly analyzed. We aimed to explore utilization of MHS among migrant children and youth and to study if the hypothesized lower utilization could be explained by fewer neurodevelopmental assessments.
Methods: A cohort of the population aged 0-24 years in Stockholm, comprising 472,129 individuals were followed for maximum 10 years, between January 1, 2006 and December 31, 2015. We categorized individuals as accompanied refugee migrants, unaccompanied refugee migrants and non-refugee migrants, or Swedish-born. We used survival and logistic analyses to estimate rates of utilization of MHS.
Results: Migrant children and youth utilized less MHS than the majority population, with hazard ratios ranging from 0.62 (95% CI: 0.57; 0…
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Understanding differences in mental health service use by men: an intersectional analysis of routine data.
Purpose: Rates of help-seeking for common mental health problems are lower for men, but less is known about patterns of engagement once they are in contact with services. Previous research has been limited in its ability to understand the intersection between service user characteristics and engagement. This study compared analytic approaches to investigate intersectional associations between sociodemographic and socioeconomic indicators and use of psychological treatment services by men.
Method: Data from 9,904 male service users attending two psychological treatment services in London were analysed. The association between ethnicity, sexual orientation, religious affiliation and employment status of service users and service use outcomes was explored using multinomial logistic regression and latent class analysis (LCA).
Results: Being from a minoritised ethnic background, of Muslim fai…
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Hellström L, Beckman L (2021)MEDLINE-indexed journal, not yet read by usInternational journal of environmental research and public health34 citations Life Challenges and Barriers to Help Seeking: Adolescents' and Young Adults' Voices of Mental Health.
Listening to the voices of adolescents and young adults regarding their lived experiences could be a way to identify important skills and abilities for adaptive and positive behaviour that will enable youth to deal effectively with the demands and challenges of everyday life. Hence, the aim with the current study is to explore the experiences and understandings of the life situation among adolescents and young adults of today, by making their voices heard in regards to mental health and help-seeking behaviour. A total of 6 group interviews were conducted with 22 adolescents and young adults (13 girls and 9 boys) ages 17-25 (M = 18.6 years). Data analysis was conducted using qualitative content analysis and resulted in two categories and five subcategories. The first category, Life challenges, included views on the sources of mental health, how to manage different types of relationships, …
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Alvarez-Jimenez M, Rice S, D'Alfonso S, Leicester S, Bendall S, Pryor I, Russon P, McEnery C, Santesteban-Echarri O, Da Costa G, Gilbertson T, Valentine L, Solves L, Ratheesh A, McGorry PD, Gleeson J (2020)MEDLINE-indexed journal, not yet read by usJournal of medical Internet research74 citations A Novel Multimodal Digital Service (Moderated Online Social Therapy+) for Help-Seeking Young People Experiencing Mental Ill-Health: Pilot Evaluation Within a National Youth E-Mental Health Service.
Background: Mental ill-health is the leading cause of disability worldwide. Moreover, 75% of mental health conditions emerge between the ages of 12 and 25 years. Unfortunately, due to lack of resources and limited engagement with services, a majority of young people affected by mental ill-health do not access evidence-based support. To address this gap, our team has developed a multimodal, scalable digital mental health service (Enhanced Moderated Online Social Therapy [MOST+]) merging real-time, clinician-delivered web chat counseling; interactive user-directed online therapy; expert and peer moderation; and peer-to-peer social networking.
Objective: The primary aim of this study is to ascertain the feasibility, acceptability, and safety of MOST+. The secondary aims are to assess pre-post changes in clinical, psychosocial, and well-being outcomes and to explore the correlations between …
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Barriers to Mental Health Help-Seeking Amongst Refugee Men.
Rates of help-seeking for mental health problems are low amongst refugee communities, despite the high prevalence of PTSD reported amongst these individuals. Research suggests that the key barriers to seeking help for psychological problems include structural barriers (e.g., unstable housing), cultural barriers (e.g., mental health stigma), and barriers specific to refugees and asylum seekers (e.g., visa status). This study examined the effect of structural, cultural and refugee specific barriers on the relationship between PTSD symptom severity and intentions to seek help from professional, social, and community sources. Data was collected from 103 male refugees and asylum seekers with an Arabic-, Farsi-, or Tamil-speaking background. Participants completed measures indexing demographics, trauma exposure, PTSD symptoms, mental health stigma, and help-seeking intentions. Path analyses in…
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Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study.
Background: The Mental Health eClinic (MHeC) aims to deliver best-practice clinical services to young people experiencing mental health problems by making clinical care accessible, affordable, and available to young people whenever and wherever they need it most. The original MHeC consists of home page with a visible triage system for those requiring urgent help; a online physical and mental health self-report assessment; a results dashboard; a booking and videoconferencing system; and the generation of a personalized well-being plan. Populations who do not speak English and reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers; have weaker social support networks; and have higher rates of psychological distress. This scenario is acquiring significant relevan…
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Psychiatric stigma and discrimination in South Africa: perspectives from key stakeholders.
Background: Stigma and discrimination against people with mental illness remain barriers to help seeking and full recovery for people in need of mental health services. Yet there is scarce research investigating the experiences of psychiatric stigma on mental health service users in low- and middle-income countries (LMICs). The aim of this study was therefore to explore the experiences of psychiatric stigma by service users in order to inform interventions to reduce such stigma and discrimination in one LMIC, namely South Africa.
Methods: Participants comprised a total of 77 adults aged above 18 years, made up of service providers including professional nurses (10), lay counsellors (20), auxiliary social workers (2); and service users (45).
Results: Psychiatric stigma was found to be perpetuated by family members, friends, employers, community members and health care providers. Causes of…
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Experiences of families who help young rural men with emergent mental health problems in a rural community in New South Wales, Australia.
A qualitative study was conducted in rural New South Wales, Australia, to understand the barriers to help-seeking among young rural men with emergent mental health problems. Participants who had real life experiences of these problems within their families were interviewed. Themes emerged from the data which explained some barriers to early intervention. Despite these barriers, families had developed skills in helping and in providing early mental health help to their sons. The findings of this study showed that a substantial burden on the emotional and social integrity of the family, combined with diminished psychological well-being, caused some parents to question how long they could cope before they reached 'the end of their strings'. This downward spiralling trajectory of mental health and well-being for both the young men and their families has implications for clinical practice. Cu…
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Wainberg ML, Lovero KL, Duarte CS, Fiks Salem A, Mello M, Bezuidenhout C, Mootz J, Feliciano P, Suleman A, Fortunato Dos Santos P, Weissman MM, Cournos F, Marques AH, Fumo W, Mabunda D, Alves-Bradford JE, Mello M, Mari JJ, Ngwepe P, Cidav Z, Mocumbi AO, Medina-Marino A, Wall M, Gouveia L, Oquendo MA (2021)MEDLINE-indexed journal, not yet read by usPsychiatric services (Washington, D.C.)25 citations Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence-Based Practices (PRIDE) in Mozambique.
Background: Mental health conditions impose a major burden worldwide, especially in low- and middle-income countries (LMICs), where health specialists are scarce. A challenge to closing LMICs' mental health treatment gap is determining the most cost-effective task-shifting pathway for delivering mental health services using evidence-based interventions (EBIs). This article discusses the protocol for the first study implementing comprehensive mental health services in LMICs.
Methods: In partnership with the Mozambican Ministry of Health, this cluster-randomized, hybrid implementation effectiveness type-2 trial will evaluate implementation, patient, and service outcomes of three task-shifting delivery pathways in 20 Mozambican districts (population 4.7 million). In pathway 1 (usual care), community health workers (CHWs) and primary care providers (PCPs) refer patients to district-level men…
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Psychotherapy in a resource-constrained setting: Understanding context for adapting and integrating a brief psychological intervention into primary care.
Low- and middle-income countries have few mental health professionals, and efforts to increase access to treatment are a global priority. A key gap is the lack of integration of psychotherapy interventions as a part of accessible evidence-based care. Current recommendations suggest that the integration of mental health treatments, including psychotherapy, into existing primary care pathways may serve as a means to address this disparity. Understanding the cultural and contextual factors that affect this process is a critical step in identifying necessary adaptations. The aim of this qualitative study was to identify contextual factors associated with integrating psychotherapy in primary care in a predominantly rural district in south-central Ethiopia. Purposive sampling was used to recruit 48 mental health service users, caregivers, health care providers, and community leaders. Semistruc…
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Longitudinal assessment of an anti-stigma campaign related to common mental disorders in rural India.
Background: Stigma related to mental health and lack of trained mental health professionals is a major cause for an increased treatment gap, particularly in rural India. The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health project delivered a complex intervention involving task sharing, an anti-stigma campaign and use of technology-based, decision-support tools to empower primary care workers to identify and manage depression, anxiety, stress and suicide risk. AimsThe aim of this article is to report changes in stigma perceptions over three time points in the rural communities where the anti-stigma campaign was conducted.
Method: A multimedia-based anti-stigma campaign was conducted over a 3-month period in the West Godavari district of Andhra Pradesh, India. Following that, the primary care-based mental health service was delivered for 1 year. The anti-stigma c…
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Disclosure and understanding of cancer diagnosis and prognosis for people with intellectual disabilities: findings from an ethnographic study.
Purpose: Growing numbers of people with intellectual disabilities are diagnosed with a life-limiting illness such as cancer. Little is known about disclosure of diagnosis and prognosis to this group. The study aim was to explore how much people with intellectual disabilities who have cancer understand about their diagnosis and prognosis, and to explore how much they are told about their cancer.
Method: 13 people with intellectual disabilities and cancer took part in a 3-year ethnographic study. Data collection consisted mostly of participant observation. Participants were visited regularly for a median of 7 months.
Results: Eleven participants were told that they had cancer, but most were not helped to understand the implications of this diagnosis or their prognosis. Decisions around disclosure, as well as the task of truth-telling, rested mostly with relatives and paid carers. Those wit…
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Navigating diagnoses: understanding mind-body relations, mental health, and stigma in Nepal.
Anthropologists and psychiatrists traditionally have used the salience of a mind-body dichotomy to distinguish Western from non-Western ethnopsychologies. However, despite claims of mind-body holism in non-Western cultures, mind-body divisions are prominent in non-Western groups. In this article, we discuss three issues: the ethnopsychology of mind-body dichotomies in Nepal, the relationship between mind-body dichotomies and the hierarchy of resort in a medical pluralistic context, and, finally, the role of mind-body dichotomies in public health interventions (biomedical and psychosocial) aimed toward decreasing the stigmatization of mental illness. We assert that, by understanding mind-body relations in non-Western settings, their implications, and ways in which to reconstitute these relations in a less stigmatizing manner, medical anthropologists and mental health workers can contribut…
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Sultan AS (2007)case reportMEDLINE-indexed journal, not yet read by usPatient education and counseling3 citations Medicine in the 21st century: the situation in a rural Iraqi community.
Objective: To describe the health beliefs and practice in a rural Iraqi community.
Methods: Personal observations and practice; narratives of colleagues.
Results: Rural Iraqi society has remained unchanged in beliefs and practices in many ways since the Babylonian and Sumerian eras over four millennia ago. Like other rural societies, it has a culture that includes values, beliefs, customs, communication style, and behaviors. Those beliefs often invoke supernatural agents such as evil, jinni, witchcraft and the results of sin, bad luck and envy. Primitive and current religious beliefs join with the effects of poverty and illiteracy. These rural people view health and disease quite differently from the views of their physicians and these cultural beliefs and practices confound current patient-clinician communication. Although physicians view the medical encounter as the main tool of diagno…
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Digital technology can revolutionize mental health services delivery: The COVID-19 crisis as a catalyst for change.
The unprecedented COVID-19 crisis presents an imperative for mental health care systems to make digital mental health interventions a routine part of care. Already because of COVID-19, many therapists have rapidly moved to using telehealth in place of in-person contact. In response to this shift, Waller and colleagues compiled a series of expert recommendations to help clinicians pivot to delivering teletherapy to address eating disorders during COVID-19. However, numerous barriers still impede widespread adoption and implementation of digital interventions. In this commentary, we aim to extend the recommendations for clinicians offered by Waller and colleagues by presenting a roadmap of the systems- and policy-level requirements that are needed. We advocate for addressing barriers associated with training, licensing, safety, privacy, payment, and evaluation, as these factors have greatl…
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What should be done to support the mental health of healthcare staff treating COVID-19 patients?
There is an urgent need to provide evidence-based well-being and mental health support for front-line clinical staff managing the COVID-19 pandemic who are at risk of moral injury and mental illness. We describe the evidence base for a tiered model of care, and practical steps on its implementation.
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Coghill DR (2017)editorial or commentMEDLINE-indexed journal, not yet read by usEpidemiology and psychiatric sciences30 citations Organisation of services for managing ADHD.
There is considerable variation in practice, both between and with different countries in the management of attention deficit hyperactivity disorder (ADHD). Whilst there is no one optimal model of service organisation there are general principles of care that can be introduced to reduce this variability. There are frequent debates and discussions about which professional group is best placed to manage ADHD at different points in the life cycle. Who delivers care is however less important than ensuring that training schemes provide adequate exposure, training and experience to both the core and non-core skills required to provide a comprehensive package of care. Most evidence-based guidelines recommend a multi-modal, multi-professional and multi-agency approach. Many also promote the use of both stepped care and shared care approaches for the management of ADHD. As most of those with ADHD…
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Starcevic V (2013)editorial or commentMEDLINE-indexed journal, not yet read by usThe British journal of psychiatry : the journal of mental science27 citations Hypochondriasis and health anxiety: conceptual challenges.
The relationship between hypochondriasis and health anxiety is examined by considering a DSM-5 proposal to replace the current heterogeneous concept of hypochondriasis with two disorders. The key issues are to ascertain whether these conditions are relatively distinct and whether they adequately represent the full range of clinical manifestations encompassed by hypochondriasis.
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Impact of early postmigration health and quality of life on later health and service use among Syrian refugees in Norway: a prospective cohort study.
Background: Previous studies indicate initial health improvements following resettlement for refugees, but the long-term trajectories remain unclear. This study explores health outcomes and healthcare use among Syrian refugees in Norway, focusing on the impact of early health and quality of life (QOL) on future outcomes.
Methods: This prospective cohort study used data from the Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway and Integration for Health projects. Baseline factors, self-rated health (SRH) and QOL, were collected 1 year after arrival. Health outcomes and healthcare use were assessed at 1 and 4 years (2019-2023) post-resettlement. Changes over time were analysed with generalized estimating equations, and associations with baseline factors were assessed using generalized linear models, presenting relative risks (RR) with 95% confidence i…
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"All I Know Is That We Failed": The Experiences of Human Service Workers Supporting the Health of Unaccompanied Minors.
Unaccompanied children (UC) in the United States represent a vulnerable migrant population because they are under age 18, traveling without a parent or guardian, and apprehended by the United States Border Patrol after a dangerous journey. Many have experienced various forms of trauma prior to and while migrating, so the weeks (and, in some cases, months) they are in government-contracted programs and shelters are a critical opportunity to assess their health and mental health needs and to intervene as needed. This article examines how staff members working at government-contracted agencies address UC health and mental needs. Drawing from 65 in-depth interviews with human service workers at these agencies, the authors identify how staff navigate and influence UC access to care. The findings reveal how frontline staff shape UC access to medical, dental, and mental health services, often i…
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