Whether and how people reach care.
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1651 to 1675 of 2,047Integrating peer-provided services: a quasi-experimental study of recovery orientation, confidence, and empowerment.
Objective: Peer-provided mental health services have become increasingly prominent in recent years, despite a lack of evidence of beneficial impact. The study presented here compared the effectiveness of the Vet-to-Vet program, a peer education and support program, and standard care without peer support on measures of recovery orientation, confidence, and empowerment.
Methods: Participants were recruited in two consecutive cohorts between 2002 and 2006, one before the implementation of the Vet-to-Vet program in June 2002 (cohort 1; N=78) and one after (cohort 2; N=218). Follow-up interviews were conducted at one, three, and nine months. There were few baseline differences between the cohorts. Intention-to-treat analyses compared cohorts on changes over time on measures of recovery orientation, confidence, and empowerment. A third cohort (cohort 2-V) was constructed that consisted of the …
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[Psychopathologies encountered on the island of Mayotte between 1998 and 2004].
Before 2001, psychiatric care on the island of Mayotte was ensured by missionaries from the Reunion Island. A mental health system has since been gradually installed, although the culture in Mayotte, mixing practicing Muslim women and traditional animists, still leaves a broad place for traditional healers. This paper presents a retrospective study of 1212 psychiatric case reports, aimed at indexing the various psychopathologies according to the CIM 10, on the island of Mayotte between 1998 and 2004. The files, before and after the opening of the mental health centre, were compared with those of the psychiatric diagnoses of the Comorians. The results show an evolution in the chronic pathologies treated in the Comorians: delirious disorders, and the organic, major, mental disorders in the first psychiatric files have given way to depressive episodes and somatoform disorders. Nevertheless,…
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Belfer ML (2008)MEDLINE-indexed journal, not yet read by usJournal of child psychology and psychiatry, and allied disciplines424 citations Child and adolescent mental disorders: the magnitude of the problem across the globe.
Objective: Describe objectively the global gaps in policy, data gathering capacity, and resources to develop and implement services to support child mental health.
Methods: Report on the World health Organization (WHO) child and adolescent mental health resources Atlas project. The Atlas project utilized key informants and was supplemented by studies that focused on policy. This report also draws on current epidemiological studies to provide a context for understanding the magnitude of the clinical problem.
Results: Current global epidemiological data consistently reports that up to 20% of children and adolescents suffer from a disabling mental illness; that suicide is the third leading cause of death among adolescents; and that up to 50% of all adult mental disorders have their onset in adolescence. While epidemiological data appears relatively uniform globally, the same is not true for…
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Mental health of patients from different cultures in Germany.
Background: Empirical studies on migration and mental health of migrants are still rare. In Germany they are often characterised by low sample sizes and are limited to certain diseases and geographical areas (old federal states). The comparability of their results is limited. Nonetheless, the assessment of migrants' health is necessary for adequate medical and psychosocial care for this target group.
Aim: To provide data on mental health of migrants from Poland and from Vietnam in Germany.
Methods: We have assessed a random sample of migrants from Poland (n=140) and from Vietnam (n=88) using the Giessen Subjective Complaints List - 24 (GSCL-24) and the Hospital Anxiety and Depression Scale (HADS). Additionally we asked migrants about their knowledge of health care institutions in case of psychosocial problems, their demands and the existing barriers to health care utilisation.
Results: M…
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Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war.
Context: To promote early identification of mental health problems among combat veterans, the Department of Defense initiated population-wide screening at 2 time points, immediately on return from deployment and 3 to 6 months later. A previous article focusing only on the initial screening is likely to have underestimated the mental health burden.
Objective: To measure the mental health needs among soldiers returning from Iraq and the association of screening with mental health care utilization.
Design, setting, and participants: Population-based, longitudinal descriptive study of the initial large cohort of 88 235 US soldiers returning from Iraq who completed both a Post-Deployment Health Assessment (PDHA) and a Post-Deployment Health Re-Assessment (PDHRA) with a median of 6 months between the 2 assessments.
Main outcome measures: Screening positive for posttraumatic stress disorder (PT…
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Developmental trajectories of depressive symptoms from early childhood to late adolescence: gender differences and adult outcome.
Background: Limited information is available on gender differences and young-adult poor outcome in children and adolescents following distinct developmental trajectories of depressive symptoms.
Methods: Parent information on depressive symptoms of 4- to 18-year-olds from an ongoing Dutch community-based longitudinal multiple-cohort study (N = 2,076) was used to estimate trajectories from semi-parametric mixture models. The identified trajectories were used to predict depressive problems, general mental health problems, referral to mental health care, and educational attainment in young adulthood.
Results: In both genders six distinct developmental trajectories were identified. Gender differences existed not only in level, but also in shape and timing of onset of depressive problems. Only in girls was a chronic trajectory of early childhood-onset depression identified. In both boys and gi…
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Caring as a resilient practice in mental health nursing.
This paper will develop a discussion about caring as a modern mental health nurse. We argue that the demands of mental health nursing today extend beyond the more traditional skills of care and caring. We believe that in order to meet mental health needs in the 21st century that caring should be extended to encompass the additional expertise of emotional intelligence and resilience. Emotional intelligence, resilience, and resilient behaviours have the potential to assist individuals to transcend negative experiences and transform these experiences into positive self-enhancing ones. This has implications for improved consumer outcomes through role-modelling and educational processes, but also may hold implications in supporting a strong workforce in mental health.
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Developing strategies to integrate peer providers into the staff of mental health agencies.
This study informs new strategies that promote integration of peer providers into the staff of social service agencies. Executive directors, human resource managers, supervisors and co-workers at 27 agencies in New York City were interviewed in-depth. Focus groups with peers were conducted. Consistent with previous research, respondents identified attitudes toward recovery, role conflict and confusion, lack of policies and practices around confidentiality, poorly defined job structure and lack of support as problems that undermined integration. Emerging from the data are strategies related to human resource policies and practices and workgroup relationships and operations that can improve employment of peer staff.
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Socio-demographic differences in acculturation and mental health for a sample of 2nd generation/early immigrant Arab Americans.
This study examined socio-demographic differences in acculturation patterns among early immigrant and second-generation Arab Americans, using data from 120 participants who completed a Web-based study. Although sex, age, education, and income did not significantly relate to the acculturation process, respondents who were female and those who were married reported greater Arab ethnic identity and religiosity. Striking differences were found based on religious affiliation. Christian patterns of acculturation and mental health were consistent with acculturation theory. For Muslims, however, integration was not associated with better mental health, and religiosity was predictive of better family functioning and less depression. The results of this study suggest unique acculturation patterns for Christian and Muslim subgroups that can better inform future research and mental health service.
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The development of core competencies for the practice of marriage and family therapy.
In response to a series of national policy reports regarding what has been termed the "quality chasm" in health and mental health care in the United States, in January 2003, the American Association for Marriage and Family Therapy convened a task force to develop core competencies (CC) for the practice of marriage and family therapy (MFT). The task force also was responding to a call for outcome-based education and for the need to answer questions about what marriage and family therapists do. Development of the CC moves the field of MFT into a leading-edge position in mental health. This article describes the development of the CC, outcomes of the development process for the competencies, and recommendations for their continued development and implementation.
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Factors associated with mental health service need and utilization among unaccompanied refugee adolescents.
This study is the first to address the need for mental health Care (MHC) and the patterns of utilization of MHC services among Unaccompanied Refugee Minors (URM). Information concerning the well being, mental health need, and utilization of services of URM was collected from three informants, the minors themselves (n = 920), their legal guardians (n = 557), and their teachers (n = 496). The well-being, need and utilization of MHC services of URM was compared with those of a representative Dutch adolescent sample (n = 1059). The findings of this study indicated that URM that report a mental health care need (57.8%) also report higher levels of emotional distress than Dutch adolescents who report a similar need for MHC (8.2%). In addition, guardians and teachers detect emotional distress and mental health care needs in only a small percentage (30%) of URM. The referral of URM to mental hea…
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Brassington J, Krawitz R (2006)MEDLINE-indexed journal, not yet read by usAustralasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists16 citations Australasian dialectical behaviour therapy pilot outcome study: effectiveness, utility and feasibility.
Objectives: This paper aims to describe the outcome of 10 patients treated in a New Zealand pilot study of dialectical behaviour therapy (DBT) for people with borderline personality disorder (BPD), and to ascertain the clinical utility and feasibility of implementing DBT into a standard New Zealand public mental health service.
Method: Patients had a clinical and an International Personality Disorder Examination diagnosis of BPD and received 6 months of standard DBT treatment. Rating scales used were the Millon Clinical Muliaxial Inventory, 3rd edition (MCMI-III) and the Symptom Checklist 90-Revised (SCL-90-R), which were completed pre treatment and post treatment. Pre-post treatment data were completed on inpatient resource usage. Qualitative patient interviews were conducted post treatment.
Results: There were statistically significant improvements in functioning on 10 of the 24 MCMI-I…
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Characteristics and needs of asylum seekers and refugees in contact with London community mental health teams: a descriptive investigation.
Background: Asylum seekers and refugees may have substantial needs for mental health care, to which both pre-migration and post-migration traumas are likely to contribute. However, there is a paucity of data available to guide appropriate service development.
Aims: To ascertain numbers and describe the characteristics and needs of asylum seekers and refugees in contact with London Community Mental Health Teams (CMHTs).
Method: Data were obtained from staff and clinical records regarding socio-demographic and clinical characteristics and service use. Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) and Health of the Nation Outcome Scales (HoNOS) were completed.
Results: A total of 104 (11%) of the CMHT population were asylum seekers or refugees. Co-morbidity was frequent, and psychiatrists reported significant diagnostic uncertainty for 30%. The most common diagnoses were d…
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Fernández A, Haro JM, Codony M, Vilagut G, Martínez-Alonso M, Autonell J, Salvador-Carulla L, Ayuso-Mateos JL, Fullana MA, Alonso J (2006)MEDLINE-indexed journal, not yet read by usJournal of affective disorders52 citations Treatment adequacy of anxiety and depressive disorders: primary versus specialised care in Spain.
Background: Literature suggests that a high proportion of the population with mental disorders remains either untreated or poorly treated. This study aimed to describe the adequacy of treatment for Anxiety and Depressive disorders in Spain, how this differs between providers (primary versus specialised care) and which factors are associated with appropriate care.
Method: Data were derived from the Spanish sample (N=5473) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross sectional study in a representative sample of adults. The subsample analyzed was composed by the 133 subjects with a mental disorder in the year prior to the interview who received treatment. Treatment adequacy was evaluated in two different ways: (1) considering definitions of minimally adequate treatment evidence based guidelines and criteria used in other epidemiological studies; (2) consi…
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Satisfaction with treatment among patients with depressive and bipolar disorders.
Background: Patients' satisfaction with care may be an important factor in relation to adherence to treatment and continued psychiatric care. Few studies have focused on satisfaction in patients with depressive and bipolar disorders.
Method: A comprehensive multidimensional questionnaire scale, the Verona Service Satisfaction Scale-Affective, was mailed to a large population of patients with depressive or bipolar disorders representative of outpatients treated at their first contact to hospital settings in Denmark.
Results: Among the 1,005 recipients, 49.9% responded to the letter. Overall, patients were satisfied with the help provided, but satisfaction with the professionals' contact to relatives was low. Younger patients (age below 40 years) were consistently more dissatisfied with care especially with the efficacy of treatment, professionals' skills and behaviour and the information …
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Hunt IM, Kapur N, Robinson J, Shaw J, Flynn S, Bailey H, Meehan J, Bickley H, Burns J, Appleby L, Parsons R (2006)MEDLINE-indexed journal, not yet read by usThe British journal of psychiatry : the journal of mental science77 citations Suicide within 12 months of mental health service contact in different age and diagnostic groups: National clinical survey.
Background: Suicide prevention is a health service priority but the most effective approaches to prevention may differ between different patient groups.
Aims: To describe social and clinical characteristics in cases of suicide from different age and diagnostic groups.
Method: A national clinical survey of a 4-year (1996-2000) sample of cases of suicide in England and Wales where there had been recent (<1 year) contact with mental health services (n=4859).
Results: Deaths of young patients were characterised by jumping from a height or in front of a vehicle, schizophrenia, personality disorder, unemployment and substance misuse. In older patients, drowning, depression, living alone, physical illness, recent bereavement and suicide pacts were more common. People with schizophrenia were often in-patients and died by violent means. About a third of people with depressive disorder died within…
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Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan.
Context: The US military has conducted population-level screening for mental health problems among all service members returning from deployment to Afghanistan, Iraq, and other locations. To date, no systematic analysis of this program has been conducted, and studies have not assessed the impact of these deployments on mental health care utilization after deployment.
Objectives: To determine the relationship between combat deployment and mental health care use during the first year after return and to assess the lessons learned from the postdeployment mental health screening effort, particularly the correlation between the screening results, actual use of mental health services, and attrition from military service.
Design, setting, and participants: Population-based descriptive study of all Army soldiers and Marines who completed the routine postdeployment health assessment between May 1…
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Galanter M (2006)MEDLINE-indexed journal, not yet read by usPsychiatric services (Washington, D.C.)10 citations Innovations: alcohol & drug abuse: spirituality in Alcoholics Anonymous: a valuable adjunct to psychiatric services.
Alcoholics Anonymous (AA) is described as a spiritual fellowship by many of its members, but its spiritual orientation needs to be better understood by clinicians and researchers. Spirituality is a latent construct, one that is inferred from multiple component dimensions, such as social psychology, neurophysiology, and treatment outcome research. Mechanisms related to its role in promotion of recovery in AA are discussed from the perspective of these findings, along with related options for professionally grounded treatment, such as Twelve-Step Facilitation. This discussion illustrates the importance of further research on AA and spirituality and of employing them in the provision of psychiatric services.
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The nature and impact of conflict within service coordination teams for children and adolescents with serious emotional and behavioral challenges.
While both theory and empirical research regarding work team performance suggests that conflict can play an important role in determining productivity and other outcomes, the impact of conflict on the effectiveness of service coordination teams is not well understood. In this study, the team records and charts of 189 young people maintained by service coordinators in a system of care initiative were analyzed to identify the number of intra-team conflicts, the participants involved in each conflict, the theme of each conflict and their relationship with the likelihood that young people were successful in meeting their treatment goals. Findings indicate that interpersonal concerns and concerns about team member follow-through were the most frequent types of conflict. More important, our analyses suggest that more frequent conflicts significantly increased the likelihood that a child and fa…
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The Trichotillomania Impact Project (TIP): exploring phenomenology, functional impairment, and treatment utilization.
Background: Trichotillomania (TTM) occurs in 0.6% to 3.4% of adults. Questions remain about phenomenological features of the disorder, its impact on functioning, and treatment utilization. The current study (i.e., The Trichotillomania Impact Project) was designed to provide initial information regarding these issues.
Method: An Internet-based survey was completed by 1697 individuals who self-reported symptoms consistent with a diagnosis of TTM (DSM-IV-TR). The survey assessed phenomenological experiences; social, occupational, academic, and psychological impact; as well as treatment-seeking experiences. The survey link operated from April 2005 through May 2005.
Results: Survey results suggest considerable variability in TTM phenomenology. Individuals with more severe TTM symptoms endorsed more frequent phenomenological experiences of physical or mental anxiety prior to pulling and relief…
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Peer support among adults with serious mental illness: a report from the field.
Peer support is based on the belief that people who have faced, endured, and overcome adversity can offer useful support, encouragement, hope, and perhaps mentorship to others facing similar situations. While this belief is well accepted for many conditions, such as addiction, trauma, or cancer, stigma and stereotypes about mental illness have impeded attempts on the part of people in recovery to offer such supports within the mental health system. Beginning in the early 1990s with programs that deployed people with mental illness to provide conventional services such as case management, opportunities for the provision and receipt of peer support within the mental health system have proliferated rapidly across the country as part of the emerging recovery movement. This article defines peer support as a form of mental health care and reviews data from 4 randomized controlled trials, which…
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Psychiatric disorders and mental health service use among caregivers of advanced cancer patients.
Purpose: Despite research demonstrating the psychological burden of caregiving for advanced cancer patients, limited information exists on the prevalence of psychiatric disorders and mental health service use among these informal caregivers.
Methods: Two hundred informal caregivers of advanced cancer patients were interviewed and administered the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition and an assessment of mental health service use.
Results: Thirteen percent of caregivers met criteria for a psychiatric disorder; 25% accessed treatment for mental health concerns since the patient's cancer diagnosis. The frequencies of current psychiatric disorders were as follows: panic disorder, 8.0% (95% CI, 4.6% to 12.7%), major depressive disorder, 4.5% (95% CI, 2.1% to 8.4%), post-traumatic stress disorder, 4.0% (95% CI, 1.7% to 7.7%),…
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The course of mental health after miscarriage and induced abortion: a longitudinal, five-year follow-up study.
Background: Miscarriage and induced abortion are life events that can potentially cause mental distress. The objective of this study was to determine whether there are differences in the patterns of normalization of mental health scores after these two pregnancy termination events.
Methods: Forty women who experienced miscarriages and 80 women who underwent abortions at the main hospital of Buskerud County in Norway were interviewed. All subjects completed the following questionnaires 10 days (T1), six months (T2), two years (T3) and five years (T4) after the pregnancy termination: Impact of Event Scale (IES), Quality of Life, Hospital Anxiety and Depression Scale (HADS), and another addressing their feelings about the pregnancy termination. Differential changes in mean scores were determined by analysis of covariance (ANCOVA) and inter-group differences were assessed by ordinary least s…
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School-based mental health programming for children with inattentive and disruptive behavior problems: first-year treatment outcome.
This article examines the effectiveness of an evidence-based behavioral treatment package for children with inattentive and disruptive behavior problems when delivered in the context of a school-based mental health program. Child symptomatology and functioning are assessed in a treatment group (n = 30) and a waitlist control group (n = 12) across multiple time points (fall, winter, and spring). Treatment includes a daily report card procedure, year-long teacher consultation, and parenting sessions. According to the parent report, treated children show marked reductions in hyperactive and impulsive, oppositional or defiant and aggressive behavior, and marked improvement in peer relationships. Teachers observe treatment-related group differences in inattention, academic functioning, and the student-teacher relationship. Feasibility and acceptability data have implications for transporting …
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Mental health research in primary care: mandates from a community advisory board.
Purpose: We wanted to obtain the viewpoints of a community advisory board in training junior minority faculty members and graduate students for community-based participatory research (CBPR) on mental health in primary care.
Methods: During training institutes, members of a community advisory board presented plenary sessions on research collaboration with communities. The program director edited the transcribed recordings of the presentations for style but not for content. Advisory board members collaborated in revising the transcripts and summarizing themes.
Results: Board members expressed several key themes. Research must take into account traditional healing practices and prior exploitative research. Historical trauma impedes collaborations, which require conflict resolution and departure from traditional definitions of normalcy. Researchers should include communities in formulating r…
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