International Journal of Mental Health Systems最新文献

Background: Caring for individuals with mental illness is stressful, with challenges like stigma, unequal responsibilities, and patient behavior. These stressors impact caregivers' mental health and treatment outcomes, yet little is known about coping strategies in Ethiopia. Therefore, this mixed-methods study assessed the coping strategies, lived experiences, and determinants for coping among family caregivers of patients with mental illness in northwest Ethiopia.

Methods: A convergent parallel mixed-methods study was conducted between June and July 2024. A total of 592 caregivers were selected using systematic random sampling. Data were collected through face-to-face interviews. Coping strategies were assessed using the 28-item Brief-COPE tool, while qualitative data were collected via tape-recorded in-depth interviews. Quantitative data were analyzed with SPSS AMOS Version 23 software using structural equation modeling, and qualitative data were analyzed with inductive thematic analysis using NVivo-15.

Results: The mean adaptive and maladaptive coping scores were 34.65 (SD = 7.70) and 21.10 (SD = 5.00), respectively. Lower adaptive coping was significantly associated with being a farmer (β = -0.21), female sex (β = -0.10), older age (β = -0.07), longer illness duration (β = -0.10), and a higher number of patient hospital admissions (β = -0.07). Experiences of physical abuse and repeated hospitalizations also indirectly reduced adaptive coping. In contrast, perceived stigma showed a small but positive association with adaptive coping. Higher maladaptive coping was strongly predicted by caregiving burden (β = 0.39) and psychological distress (β = 0.13), with additional indirect effects from comorbid illnesses and abuse experiences. Social support demonstrated a protective effect by indirectly reducing maladaptive coping. Overall, family caregivers experienced substantial emotional, financial, and social challenges, underscoring the need for interventions that reduce caregiver burden, enhance social support, and address psychological distress.

Conclusion: Family caregivers exhibited lower coping strategies compared with the general population, highlighting their vulnerability. The findings indicate that caregiving burden and psychological distress play a central role in maladaptive coping, while social support serves as a protective factor. These results emphasize the need for comprehensive caregiver-focused interventions and the integration of caregiver support into mental health policies to promote adaptive coping and sustainable caregiving.

Background: Understanding help-seeking behaviors of young people with mental health concerns is crucial for developing responsive mental health services and policies. This study aimed to explore the help-seeking journeys of Colombian youth, the formal and informal services they reached out to when faced with psychological distress and the order in which these services were consulted. Additionally, it examined the differences between pathways of actual service users and those modeled by fictional characters.

Methods: This study employed a mixed-methods design to explore help-seeking behaviors among Colombian youth (ages 10-19) facing mental health concerns, with a focus on service usage, sequence of access, and differences between actual (Clinical Sample, CLS) and perceived pathways (Community Sample, COS). The methodology combined semi-structured interviews, visual journey mapping, and social network analysis (SNA) to capture both qualitative and quantitative dimensions.

Results: 30 young people (53% female, median age = 16, IQR = 3) participated in interviews, of which 19 disclosed past service usage (CLS) and 11 narrated hypothetical scenarios (COS). The findings revealed the absence of a 'typical' care seeking pathway. A trend, however, was observed of prioritizing informal services, such as friends and family, as an initial step in help-seeking behavior. CLS participants reported longer and more complex service pathways, averaging 14.7 services, often involving specialists such as psychiatrists and other medical specializations, with third-party involvement (e.g., parents, educators) in initiating contact. Hypothetical journeys were shorter, with a median of 8 services, always initiated by the characters, and mostly resolved within community settings, with educators and psychologists as key sources of support. In both groups, the primary objective of help-seeking was symptom reduction; however, actual service users took two times longer (Mdn = 120, IQR = 700) to seek helpfrom the onset of symptoms than those projected on fictional characters (Mdn = 60 days, IQR = 90).

Conclusions: The study demonstrates the importance of informal support systems regardless of youth's past service usage and help-seeking experience. It also reveals discrepancies between how help-seeking is perceived and experienced showing an underestimation of the complexity involved in finding mental health support which could potentially explain delays in help initiation and difficulties in navigating support resources.

People living in rural and remote areas face many barriers when trying to access mental health services. These barriers include a lack of resources, not enough services, difficulty finding and keeping staff, long distances, cultural differences, and low awareness of mental health issues. This scoping review followed the PRISMA-ScR framework and searched seven major databases: PubMed, EMBASE, The Cochrane Library, Scopus, PsycINFO, Web of Science, and CINAHL Complete. Studies were included if they used qualitative, cross-sectional, or cohort designs and followed JBI guidelines. A total of 30 studies from 11 countries were reviewed. Barriers were grouped into four levels: system/policy, social/community, family, and individual, which are based on the Socio-ecological Resilience Framework. At the system and policy level, common problems were insufficient resources, complex systems, technology challenges, privacy concerns, poor service quality, staff shortages, and high costs. The challenges at the social and community level included distance, cultural differences, stigma, low awareness, and environmental pressures. Family-level barriers were weak family or peer support, stigma within families, and poor education. Individual barriers included low quality of life, poor understanding of mental illness, and negative attitudes toward mental health services. Although the review only covered studies from 2007 to 2024 and did not include all populations, it offers important information. A socio-ecological resilience approach may help improve mental health services in rural and remote areas.

Background: Treatments for mental disorders vary widely in type and quality, with many patients failing to receive treatments that meet even minimally adequate standards. We use data from the World Mental Health (WMH) surveys to investigate this variation by examining the prevalence and correlates of minimally adequate treatment (MAT) among patients receiving treatment for common mental disorders.

Methods: Data comes from 25 WMH cross-sectional surveys implemented in 21 countries (n = 1,838 respondents with n = 3,538 12-month treated disorders). MAT was defined according to widely used criteria: pharmacotherapy (≥ 1 month of medication with ≥ four visits to a healthcare provider) or counseling (≥ eight sessions with any provider). Multivariable regression analyses were used to examine associations of socio-demographic, disorder-related, and treatment-related factors with MAT.

Results: Approximately two-thirds (66.2%) of treated cases met MAT criteria. There was limited variation in MAT prevalence across disorder types, number of disorders, or years since disorder onset, but MAT prevalence was positively associated with increased disorder severity. Socio-demographic differences were nonsignificant. Relatively substantial differences in MAT prevalence were found by treatment sector (highest MAT prevalence among patients treated by mental health specialists and those treated by multiple provider types). Further analysis showed that these associations were explained by differences in premature discontinuation, completion of a full course of treatment that did not qualify as MAT, and still being in treatment at the time of interview that did not yet qualify as MAT. Low perceived disorder severity unrelated to more objective measures of severity was a central factor in accounting for premature discontinuation.

Conclusions: While approximately two-thirds of treated cases meet MAT criteria, significant gaps remain involving both premature discontinuation and cases where respondents reported completing a 'full recommended course of treatment' that did not involve enough visits or medication duration to meet the MAT standards. Expanding access to mental health specialty providers and increasing patient education about disorder severity would be useful in increasing the proportion of treated cases that receive MAT. Future research should focus on validating MAT definitions against clinical outcomes, standardizing assessment frameworks, and exploring provider- and system-level determinants of treatment adequacy.

Objective: Given the importance of economic considerations for the uptake of interventions into psychiatric policy and practice, this systematic review appraises existing economic evaluations of interventions that aim to reduce aggression and restrictive interventions in inpatient mental health settings.

Methods: Eight economic and scientific databases, along with targeted Google Scholar searches, were surveyed for gray and peer-reviewed literature from 01/2000 to 08/2025. Selection criteria included: (1) quantitative studies in peer-reviewed journals or grey literature, (2) a broad range of economic evaluation methods (costs, cost analysis, cost-effectiveness, and cost-benefit), (3) non-geriatric adults and emerging adults (≥ 15 years old) in (4) psychiatric inpatient settings, and (5) non-pharmacological interventions targeting aggression, violence and/or restrictive interventions (e.g., seclusion, restraints, forced medication). Narrative synthesis is presented with a quality appraisal using the CHEERS reporting checklist 2022.

Results: Twenty studies were selected, with the majority conducted in acute wards. Eleven studies reported only the cost of interventions, prominently featuring the cost of restrictive interventions, sensory modulation, and staff training. Moreover, twelve studies reported savings, eight of which allowed cost-analyses. Two interventions yielded clinical benefits and net savings. Assessment of reporting quality revealed few sensitivity analyses to model uncertainty, heterogeneity or distributional effects.

Conclusions: While this review intended to guide organizations in selecting interventions, the current state of evidence can provide some evidence on the cost-benefit of a handful of interventions and re-affirms the costliness of restrictive interventions. Future pre-post studies may benefit from methods featured in this review to estimate the cost of professional time and partner with organizations to access internal financial data. There remains a need for purposeful cost-effectiveness analyses and for demonstrated long-term clinical benefits to inform interventions for aggression management.

Background: Traditional and faith healers (TFHs) play a prominent role in the care of people with severe mental health conditions (MHCs) in many countries. Consequently, there have been calls for closer collaboration between TFHs and mental health care practitioners. This scoping review aimed to map the literature on the experiences of, and perspectives on, traditional and faith healing for people with severe MHCs in Ethiopia.

Methods: The review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. Pubmed, Embase, CINAHL, Scopus, Web of Science, and PsycINFO databases were searched from the earliest available records to May 2024. Online student MSc/PhD theses and catalogued Ethiopian publications up to 2015 were also searched. Studies were included if they were in English and of any study design using primary data collection. Narrative synthesis was chosen for data synthesis.

Results: Of the 3,824 records identified, 31 were included. There were 17 qualitative, 12 quantitative, and two mixed methods studies, conducted in most regions in Ethiopia but with more focus on urban than rural settings. Findings were synthesised under the following themes: perceived causes of MHCs; pathways to care and help-seeking preferences; identification and intervention methods used by TFHs; experience of treatment, satisfaction with care, gaps, and barriers; and collaboration between TFHs and mental health practitioners. People with severe MHCs commonly accessed TFHs first and alongside biomedical care. A substantial range of healers was identified but they were not accessible or acceptable to all communities equally. TFH interventions were diverse and some of their practices were reported to be harmful. However, there were few in-depth studies of TFH care processes. Furthermore, there was little evidence about the experience of care from the perspective of people with severe MHCs. Efforts toward collaboration emphasised the need to develop relationships within which differences could be negotiated.

Conclusion: Although much is known about the place of TFHs within care pathways for people with MHCs in Ethiopia, there are evidence gaps in relation to the perspectives of people with MHCs and rich contextual understanding of healing processes, both of which are needed for meaningful collaboration to occur.

Since the Russian invasion in February 2022, millions of Ukrainians have been exposed to war-related trauma, with projections indicating hundreds of thousands of individuals will develop debilitating trauma/stressor-related disorders. Ukraine faces a critical shortage of mental health professionals trained in evidence-based care (EBC) for post-traumatic stress disorder (PTSD), and even fewer with expertise in implementation research. This study examined changes in clinicians' confidence in implementing evidence-based trauma care and conducting implementation research following a comprehensive training program. Forty-one Ukrainian mental health professionals attended a five-day training workshop in Lviv, Ukraine, covering evidence-based PTSD treatments and implementation research frameworks. Participants completed pre- and post-training surveys that assessed their confidence levels and perceived barriers. Data was analyzed using Wilcoxon signed-ranks tests, multiple regression, and thematic analysis. Participants demonstrated significant increases in confidence in both implementing evidence-based trauma care and conducting implementation research. Training efficacy was independent of professional background and years of experience. Thematic analysis identified key barriers to implementing EBC and in conducting implementation research. Findings highlight the need for continued effort to address the identified barriers to adapting EBC in a Ukrainian context. This training model may serve as a foundation for developing a sustainable mental health workforce capable of addressing the severe trauma burden in Ukraine.

Background: Australia's mental health system needs to expand rapidly to meet the growing demand for care by young Australians. Participatory systems modelling (PSM) has emerged as a valuable method for guiding strategic decision-making in mental health policy.

Methods: This paper evaluates the participatory methods and approaches utilised in a series of PSM workshops focused on the development of a youth mental health decision-support tool for the Brisbane South region, Queensland. Baseline and two follow-up timepoints of semi-structured interviews were conducted with a range of local stakeholders, including mental health professionals, service managers, commissioning organisations, and young people with lived experience.

Results: Participants emphasised the need for diversity of stakeholder representation in workshops, but acknowledged the challenge of recruiting young stakeholders and culturally diverse stakeholders. Clear communication and education around the decision-support tool, as well as the utilisation of flexible methods for obtaining stakeholder input, both served to empower stakeholders in their contributions to the workshops and strengthen stakeholder engagement and knowledge sharing.

Conclusions: The adoption of more adaptive and flexible workshop activities, and a move away from more structured systems modelling workshop 'scripts', is required to engage diverse participants within the youth mental health space. Results suggest knowledge sharing and stakeholder engagement is an active process that is developed along the course of the workshops, enabled by education and clear communication, empowering participants to meaningfully contribute. Future PSM workshops should continue to develop additional activities and more targeted engagement with youth stakeholders to enhance their contributions.

Background: PhotoVoice is a participatory approach that uses photography to offer a useful platform for sharing the stories of people with mental health conditions whose voices are often marginalized. This study aimed to explore the experiences of people with lived experiences and caregivers in constructing brief recovery narratives presented at training sessions that highlight their experiences before, during, and after mental health treatment.

Method: A participatory photovoice study was carried out with 16 participants from the Sodo district, Ethiopia. The participants were people with lived experiences (n = 8) and caregivers (n = 8) selected via purposive sampling. Field notes, photographs and testimonies arising from the PhotoVoice sessions were analysed together with in-depth interviews with participants. The data were analysed via narratives used during photovoice sessions and thematic analysis.

Results: The PhotoVoice training experience was mostly positively received and brought to light a variety of perceived benefits through providing an inclusive understanding of mental health and related misconceptions and by addressing stigma and discrimination-related myths in the community. Furthermore, the participants reported the benefit of being engaged in productive activities that improved their communication and relationships with other people. The photographs revealed the stigmatized experiences of participants seeking alternative treatment solutions and challenges in accessing and gaining awareness of mental health. Stress and fear of public speaking and negative feedback from their family and community were the main barriers to participation in the photoVoice sessions.

Conclusions: This study shows that PhotoVoice training has important value in eliciting insights from participants' lived experiences. The findings indicate that this approach is important for the empowerment of people with lived experiences and their family members and for coping with the stigma and discrimination they encounter. Stakeholders working in mental health can use and adapt this participatory technique to empower service users and family members and reduce the impacts of stigma associated with mental illnesses.

Background: Minder is a mental health and substance use mobile application found to have a small but significant effects in a recent randomized trial. Poor engagement has been identified as a common threat to the effectiveness of digital mental health tools that is not accounted for in intention-to-treat analyses. The objective of this study is to conduct a prespecified secondary analyses to identify factors associated with engagement and examine the impact of engagement on trial outcomes.

Methods: 1489 students were randomized to either the intervention (n = 743) or waitlist control (n = 746). Primary outcomes were changes in anxiety (General Anxiety Disorder 7 (GAD-7)), depression (Patient Health Questionnaire 9 (PHQ-9)), and alcohol consumption (US Alcohol Use Disorders Identification Test-Consumption Scale (USAUDIT-CS)) at 30-days. Secondary outcomes included frequency of substance use and mental wellbeing (Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWS)). A Complier Average Causal Effect (CACE) analysis was conducted using 3 separate criteria reflecting differing engagement levels: (1) a binary measure: use of any app component, (2) a continuous measure: number of unique days of app use, and (3) an ordinal measure: number of components accessed within the app.

Results: 80.4% of participants used at least one app feature. Statistically significant differences were observed in app utilization across gender, ethnicity, having a history of depression or anxiety, higher baseline PHQ-9, higher SWEMWS, and poor/fair overall self-assessed mental and physical health. Any use of Minder was associated with significantly lower scores on the GAD-7 (adjusted group mean difference = - 1.09, 95% CI - 1.60 to - 0.57; P < .01) and PHQ-9 (adjusted group mean difference = - 0.84, 95% CI - 1.41 to - 0.27; P < .01) with increasing number of unique utilization days or components accessed associated with increased reductions. Any use of Minder was associated with significantly higher scores on the SWEMWS (adjusted group mean difference = 0.93, 95% CI 0.46 to 1.39; P < .01) and lower frequency of cannabis use (adjusted group mean difference = - 0.15, 95% CI - 0.23 to - 0.06; P < .01) with increased app utilization associated with larger improvements.

Conclusions: The CACE analysis identified significant dose-response relationships indicating that increased use of the Minder app leads to larger effects that can reach levels of clinical significance.

Trial registration: ClinicalTrials.gov NCT05606601 (November 3, 2022); https://clinicaltrials.gov/ct2/show/NCT05606601 .