International Journal of Mental Health Systems最新文献

Background: Length of stay (LoS) is a critical parameter of inpatient forensic treatment functioning. Inpatient forensic LoS in Czechia varies across hospitals with the number of patients per 100,000 inhabitants and the treatment duration. We aimed to analyse these inter-hospital differences and provide relevant sociodemographic and treatment-related data.

Methods: We collected descriptive parameters from 841 forensic inpatients from 13 hospitals in Czechia, with follow-up data collection after 6 months (N = 800). Data from eight hospitals with > 50 patients (N = 765) were entered into linear regression analyses with subsequent resampling to identify differences in LoS associated with index offence, diagnosis, and treatment type, thereby highlighting interhospital variations.

Results: The cohort comprised predominantly males (mean age, 41.84 years; standard deviation [SD] 3.63) with extended mental health histories; the mean main diagnosis length was 13.2 years (SD 12.18). Most inmates committed violent offences, with psychotic, substance use, or paraphilic disorders predominating. Family contact remained common despite the patients' poor socioeconomic status. The mean LoS was 1,327.58 (SD 1642.41) days. We observed significant differences in LoS among patients from the same diagnostic group. Within the whole system, patients with substance abuse disorders, psychotic disorders, and intellectual disabilities stayed for 760, 1490, and 2441 days, respectively. Violent index offences increased LoS in most hospitals, as did sexual offences, but "other" minor criminal offences (non-violent, non-sexual) were associated with increased LoS only in some hospitals. Sex offender treatment significantly affected LoS in some hospitals, while enrolment into substance use programmes shortened it.

Conclusions: Our study revealed significant inter-hospital variations in LoS associated with index offences, diagnoses, or treatment programs, which could be related to previously unrecognised institutional factors. Regular evaluation of treatment outcomes and implementation of standardised guidelines across the entire system is necessary to balance these differences. The insights provided into inpatient treatment in Czechia can be used to guide policy and practice improvements, enhancing the quality of forensic psychiatric care and ensuring the rights and well-being of the patients. The study addressed the knowledge gap existing in the available literature regarding previously unrecognised factors influencing the LoS at the system "mezzo" level.

Background: Several studies showed strong evidence that the COVID-19 pandemic disrupted mental health service use, with changes in emergency department visits, and psychiatric hospital admissions. It is not clear, however, whether the pandemic caused an increase or decrease in use of services for people with different diagnoses and symptoms.

Methods: We used data from all individuals admitted to psychiatric units in Ontario, Canada (259,620 individuals) from January 1st 2015 to December 31st, 2020 and compared the number of admissions, length of stay, symptoms, and clinical characteristics of this population in 2020 to the average of those who were admitted between 2015 and 2019.

Results: Total number of admissions declined sharply (44%) during the first lockdown period but returned to pre-pandemic levels within about 2 months. This trend, however, was not observed for all types of mental health problems. Admissions for symptoms such as risk of harm to others and addictions were consistently higher after the first wave in May 2020 compared to the same month in the previous 5 years, while symptoms such as social withdrawal, and depression were consistently lower.

Conclusion: Taken together, these results suggest that the impact of the pandemic on the use of mental health services were symptom-specific, which is likely a result of the heterogeneity of mental health problems within this population. This variation in the changes in psychiatry admissions for patients with different clinical profiles should be considered when preparing for future service interruptions.

Background: Perceived need for treatment is a first step along the pathway to effective mental health treatment. Perceived need encompasses a person's recognition that they have a problem and their belief that professional help is needed to manage the problem. These two components could have different predictors.

Methods: Respondents aged 18+ years with 12-month mental disorders from 25 representative household surveys in 21 countries in the World Mental Health Survey Initiative (n = 12,508). All surveys included questions about perceived need; 16 surveys (13 countries) included additional questions about respondents' main reason for perceived need-problem recognition or perceived inability to manage without professional help (n = 9814). Associations of three sets of predictors (disorder, socio-demographics, past treatment) with perceived need and its components were examined using Poisson regression models.

Results: Across the 16 surveys with additional questions, 42.4% of respondents with a 12-month mental disorder reported perceived need for treatment. In separate multivariable models for each predictor set: (1) Most disorder types (except alcohol use disorder, specific phobia), disorder severity, and number of disorders were associated with perceived need and both of its components; (2) Sociodemographic factors tended to differentially predict either problem recognition (females, 30-59 years, disabled/unemployed) or need for professional help (females, homemakers, disabled/unemployed, public insurance); (3) Past treatment factors (type of professional, psychotherapy, helpful or unhelpful treatment) were associated with perceived need and both components, except number of past professionals differentially predicted problem recognition. In a consolidated model: employment and insurance became non-significant; type and number of past professionals seen became more important; helpful past treatment predicted greater need for professional help while unhelpful treatment predicted lower problem recognition. Problem recognition was the more important component in determining perceived need for some groups (e.g., severe disorder, people who consulted non-mental health professionals).

Conclusions: Greater clinical need is a key determinant of perceived need for treatment. Findings suggest a need for strategies to address low perceived need (e.g., in males, older people, alcohol use disorders) and lower endorsement of professional treatment in some groups, and to improve patient's treatment experiences which are important enablers of future help-seeking.

Background: Depression, anxiety, and stress symptoms are common among adolescents; however, studies exploring their relationship with chronotype in European youth populations is scarce. This study aimed to evaluate the association between chronotype status and depression, anxiety, and stress symptoms in adolescents.

Methods: A secondary analysis of the Eating Healthy and Daily Life Activities (EHDLA) cross-sectional study was performed in 703 adolescents (56.3% girls) between 12 and 17 years from the Valle de Ricote, Spain. Chronotype preference was assessed using the Morningness/Eveningness Scale in Children (MESC), while symptoms were evaluated using the Depression, Anxiety, and Stress Scale (DASS-21). A robust generalized linear regression model was used to evaluate the associations between chronotype prefernces and symptoms of depression, anxiety and stress in adolescents.

Results: After adjusting for potential covariates (sex, age, socioeconomic status, body mass index, sleep duration, physical activity, sedentary behavior, and energy intake), the highest probability of having depression, anxiety, and stress was identified in those with an eveningness chronotype preference (depression: 27.4%, 95% confidence interval [CI] 17.5-40.1%; anxiety: 28.5%, 95% CI 18.6-41.0%; stress: 47.6%, 95% CI 34.1-61.5%). Conversely, the lowest probability was observed in adolescents with a morningness chronotype preference (depression: 11.9%, 95% CI 8.3-16.8%; anxiety: 15.4%, 95% CI 11.2-28.9%; stress: 19.5%, 95% CI 14.7-25.5%). Significant differences were found when comparing participants with the eveningness chronotype to those with a morningness or intermediate chronotype preference (p < 0.05 for all comparisons).

Conclusions: Depression, anxiety, and stress symptoms were more likely in adolescents with an eveningness chronotype preference than in those with morningness or intermediate chronotypes. Chronotype preferences should be taken into account for developing interventions that promote better mental health and healthy sleep habits in adolescents.

Background: Evidence suggests the use of a participatory approach for the improvement of TB care, however, there is limited evidence on how integrated depression screening and care could be delivered with TB services. Thus, this study co-designed an integrated care pathway for depression case finding and treatment in TB services, that can be delivered by non-mental health specialists within a low resourced settings.

Methods: We conducted a total of 10 'co-design' workshops with people with TB, carers, tuberculosis and mental health healthcare providers between June and August 2021 in Dhaka, Bangladesh and Peshawar, Pakistan. We adapted the 'Hasso Plattner Institute of Design at Stanford University' for our codesign process. Information gathered during the workshop, through recordings and contemporaneous notes taking, was collated, and analysed to develop the integrated care pathways and materials for impmenting the carepathway.

Results: We co-designed and developed a culturally adaptable care pathway that integrates depression screening into tuberculosis (TB) care, working closely with people affected by TB and healthcare workers in primary, secondary, and tertiary care settings in Bangladesh and Pakistan. We used PHQ-9 only to identify and screen for depression among people with TB in Bangladesh, whereas both PHQ-2 and PHQ-9 were used for depression screening among the Pakistani population. A trained paramedic or laboratory technologist (Bangladesh) and DOTS Facilitator (Pakistan), working within the TB facilities were identified and agreed to deliver the integrated depression screening services.

Conclusion: Stakeholders valued the opportunity to jointly design a care pathway. Iterative and coordinated working with these stakeholders enabled the researchers to understand better, explore and refine the co-design process. This approach assisted in mobilising knowledge about depression and integrating screening for depression within the existing usual TB care pathway, using the lived experience of people with TB and health workers' expertise.

Background: Emotional symptoms have emerged as a major public health concern, affecting the mental and physical well-being of college students worldwide. Negative life events and mental health literacy are commonly recognized as significant predictors of emotional symptoms. However, research on their combined effects remains limited, particularly in longitudinal studies. This study aimed to investigate the interaction between negative life events and mental health literacy in relation to emotional symptoms among college students.

Methods: A longitudinal study was conducted from November 2021 to June 2022 to assess negative life events, mental health literacy, and emotional symptoms among college students. A total of 3,210 students (mean age: 19.49 ± 0.87 years) were selected using a cluster sampling method in Anhui Province, China. Multivariate logistic regression models were employed to evaluate the combined effects of negative life events and mental health literacy on emotional symptoms.

Results: The prevalence of depressive symptoms, anxiety symptoms, and stress symptoms was 15.3%, 19.7%, and 4.2%, respectively. Negative life events were significantly associated with an increased risk of depressive symptoms (RR = 1.568, 95%CI: 1.282-1.918), anxiety symptoms (RR = 1.603, 95%CI: 1.338-1.919), and stress symptoms (RR = 1.717, 95%CI: 1.194-2.470). Additionally, students with inadequate mental health literacy exhibited a higher incidence of depressive symptoms (RR = 1.286, 95%CI: 1.035-1.597) and anxiety symptoms (RR = 1.343, 95%CI: 1.105-1.632) compared to those with adequate mental health literacy. Furthermore, students who experienced high levels of negative life events and had inadequate mental health literacy were at the highest risk of developing depressive symptoms (RR = 2.447, 95%CI: 1.709-3.504) and anxiety symptoms (RR = 2.466, 95%CI: 1.802-3.375).

Conclusion: This study did not confirm a direct correlation between mental health literacy and general psychological health. Moreover, due to contextual differences across societies, the generalizability of these findings should be approached with caution. Nonetheless, the results highlight that negative life events and mental health literacy jointly influence emotional symptoms. These findings underscore the importance of interventions aimed at improving college students' mental health literacy and enhancing their ability to cope with negative life events.

Background: Inpatient mental health care is an integral part of the continuum of mental health care in many countries, though it can be associated with challenges, such as reliance on coercive practices, negative patient experiences, and limited therapeutic options. Given these issues, there is a growing interest in exploring alternative approaches for individuals experiencing a mental health crisis. This research aimed to identify models which offer an alternative to standard inpatient mental health care across all age groups, both nationally and internationally, and to develop a typology for these alternative models.

Methods: A dual literature search and expert consultation research methodology was adopted to identify relevant models. Three typologies of models were developed according to age group and acuity, including: alternatives to standard acute inpatient services for adults; alternatives to longer-stay inpatient services for adults, including rehabilitation and forensic inpatient services; and alternatives to standard inpatient services for children and young people.

Results: We identified an array of service models in each typology, some in community settings, some hospital-based and some working across settings. Models varied greatly in characteristics, extent of implementation and supporting evidence.

Conclusions: Through this mapping exercise, we have developed three novel typologies of alternatives to standard inpatient care. A range of community-based, hospital-based and cross-setting approaches were identified. The identification of services providing inpatient care in a substantially different way to the standard suggests that some improvements could be provided within existing structures. Potential inequities in access to alternatives were identified for certain groups, such as people who are compulsorily detained, younger children, and young people transitioning between children's and adults' services. These typologies can inform future description, evaluation and comparison of different service models. This research also yields some key considerations for the design, development and implementation of alternative mental health service models and service arrays.

Background: Chronic war exposure causes resource shortages, disrupts care for existing health issues, and heavily impacts mental health, increasing the risk of trauma-related psychiatric disorders. Using longitudinal data collected from psychiatric hospitals across Ukraine between January 2022 and May 2024, we aimed to evaluate the functioning and role of these institutions in delivering mental health care during the ongoing war.

Methods: We conducted a second follow-up nationwide longitudinal study of Ukrainian inpatient mental health facilities during the Russian invasion that began in February 2022. Responses were obtained from the heads of 34 inpatient mental health facilities. This paper focuses on 25 facilities that participated in all three consecutive surveys, representing 41% of all psychiatric hospitals in Ukraine. Information on hospitalizations, as well as data on the number, displacement, and injuries of staff as of April 2024, was gathered and compared with findings from previous surveys.

Results: The number of psychiatric hospitalizations increased two years after the onset of the full-scale war in Ukraine compared to both the pre-war period and six months after the invasion began (433.4 in January 2022, 397.5 in April 2022, and 552.0 in April 2024 per month, respectively). The average proportions of hospitalizations attributed to psychological war trauma across the study waves were 12.2% (January 2022), 13.5% (April 2022), and 17.3% (April 2024), with the differences not reaching statistical significance. The average number of psychiatrists, social workers, and junior nurses per facility declined steadily over the study period. As of April 2024, 21.7% of medical workers in the surveyed facilities had been displaced, and 0.5% had sustained injuries.

Conclusions: The number of psychiatric hospitalizations two years into the full-scale war in Ukraine has risen, exceeding both pre-war levels and those recorded six months after the invasion. While hospitalizations related to war trauma have increased, their proportion has remained relatively stable, indicating a sustained demand for trauma-related care.

Background: Data from the World Mental Health (WMH) surveys on the coverage cascade has underscored the importance of perceived need for seeking treatment of mental disorders. However, little research has focused on treatment contact after adjusting for perceived need. We do so here in analysis of WMH data.

Methods: The WMH data considered here come from 25 community surveys implemented between 2001 and 2019 across 21 countries. n = 12,508 of the n = 117,739 respondents in these surveys aged 18 and older met criteria for one or more 12-month DSM-IV anxiety, mood, or substance use disorders assessed across all these surveys. Information was obtained about 12-month treatment of each disorder. The predictors considered were disorder type, socio-demographics, and history of prior treatment.

Results: Twelve-month treatment was obtained for 17.7% of the n = 18,702 12-month person-disorders in the sample, including 34.1% for the 46.5% with perceived need and 3.5% for the 54.5% without perceived need. After adjusting for perceived need, receiving treatment was most strongly associated with disorder characteristics (severity, and highest for major depressive, panic/agoraphobia, and generalized anxiety disorders; lowest for substance use disorders), health insurance, employment status (highest for students, the retired, and the unemployed/disabled), and several aspects of prior treatment. These associations were generally similar in cases with and without perceived need for treatment. 12-month treatment among cases who without perceived need and without history of prior treatment was rare (1.1%).

Conclusions: Findings highlight the critical importance of perceived need for obtaining 12-month treatment in the context of other significant predictors involving complexity and severity of disorders and socio-demographic factors. The importance of prior treatment history was quite striking, as was the finding that absence of both perceived need and prior treatment history were associated with a nearly complete absence of treatment. Policy recommendations emerging from these results include the need to increase health literacy, reduce the stigmatization of mental disorder, enhance access through health insurance, and improve the quality of care given the clear evidence that prior experiences with treatment play an important role in determining the likelihood of again seeking treatment for current problems.