International Journal of Mental Health Systems最新文献

Background: Little is known about uptake of mental healthcare services by homeless people and even less is known about those living in precarious housing. The "WohnLos" study determined the prevalence of non-secure housing (defined as homelessness or precarious housing) among inpatients of two groups of public mental health hospitals in the state of North Rhine-Westphalia (NRW), Germany.

Methods: We conducted a questionnaire survey in the two hospital groups, which provide in- and out-patient mental healthcare for a population of about ten million people. Clinical staff filled in a questionnaire for every inpatient on two record dates in 2020 and 2021. The questionnaire included sociodemographic variables, clinical variables, information on psychiatric care, and information on the individual housing situation.

Results: Fifteen of the twenty hospitals participated in the study and provided information on 4252 inpatients (return rate per hospital on average 59%). The prevalence of non-secure housing was on average 16.5% of all cases (7.9% homeless (houseless or roofless) and 8.6% precarious housing (insecure or inadequate)). The prevalence of non-secure housing was highly variable between the hospitals. The highest rates were found in hospitals located in large cities in the Rhineland and the lowest rates in the Ruhr industrial area. Among the patients with non-secure housing, the sociodemographic and clinical characteristics were similar in the subgroups of patients living in homelessness and patients living in precarious housing. Diagnoses of schizophrenia and substance use disorders, younger age, male gender, unemployment and migration background were important factors associated with non-secure housing. Social support was an important protective factor.

Conclusions: We identified implementable features of services for mental health inpatients with housing needs, like discharge management initiating psychosocial support from families and professional social services, the implementation of services bridging the gap between inpatient and outpatient settings, and the networking with housing-oriented post-discharge services like housing first and residential care facilities. Our study draws special attention to mentally ill patients living in precarious housing conditions, who constitute half of all mental healthcare inpatients with housing needs in our study, and who have similar psychosocial burden and housing needs as homeless patients.

Background: The sub-Saharan African Regional Partnership for mental health and capacity building (SHARP) study was a clinic-randomized trial of two implementation strategies for integrating depression screening and treatment into non-communicable diseases' (NCD) clinics in Malawi between 2019 and 2022. We report on the barriers to implementing depression care integration at SHARP study sites and potential solutions.

Methods: N = 39 in-depth interviews with participants from all ten sites were conducted, recorded, transcribed, coded in NVivo 12 and analyzed by qualitative experts. We used thematic analysis to identify implementation challenges and potential solutions. The Consolidated Framework for Implementation Research helped to develop guides and organize the results.

Results: Outer setting barriers included high workload (due to high patient volume, increased paperwork, shortage of staff), the effects of coronavirus disease 2019 (COVID-19) pandemic, staff turnover and negative provider attitudes. Limited clinic space arose as an inner setting barrier. Workload can be overcome by increasing the number of NCD personnel, decentralizing the depression/NCD services and integrating mental health and NCD documents (implementation process). The COVID-19 pandemic presented unique challenges including fear of interpersonal contact and changes in scheduling staff that were difficult to overcome in the short term. To deal with the effects of staff turnover, participants identified the need for continuous depression training to new providers. Lobbying for more rooms from leadership can address concerns of limited space. To reduce negative provider attitudes, participants urged facility leadership to make themselves available for consultations and mentorship and to provide continuous learning opportunities such as refresher trainings.

Conclusion: The experience in the SHARP study highlights the need for a culture of continuous learning and adaptation in healthcare settings, enabling the development of strategies to overcome evolving challenges. Planning for the integration of mental health and NCD care should extend beyond immediate challenges and consider long-term goals and sustainability.

Trial registration: This study reports part of the findings from the endpoint evaluation of the SHARP clinical trial that is registered at ClinicalTrials.gov, NCT03711786 first posted 20,181,018.

Background: Most women living with HIV in low- and middle-income countries remain undiagnosed and untreated for depression. Even though depression has an adverse effect on treatment outcome and disease progression, less attention is given. The progression of depression is influenced by coping mechanism. The aim of this study was to identify the coping strategies used by depressed women living with HIV in Gondar town health facilities, north west, Ethiopia.

Methods: Health institution based cross-sectional study was conducted in Gondar town health facilities, in north-western Ethiopia. All women living with HIV (n = 1043) were screened for depression symptoms using the validated Patient Health Questionnaire, 9 item version (PHQ-9). Those who scored ten or more, "moderate depression among women living with HIV," (n = 435) were included in this study. The BRIEF Coping with Problem Experienced (COPE-28) scale was used to assess coping strategies. Construct validity of the brief COPE was evaluated using confirmatory factor analysis with AMOS 23 software. Linear regression model was fitted and beta coefficients were used to interpret the significant factors for coping strategies at p- values < 0.05 with 95% confidence interval.

Results: Dysfunctional coping strategy was more widely practiced than emotional focused or problem focused coping strategies. From the emotional coping strategy, spiritual believes and praying coping were the most frequently used coping strategies in the study group. Time taken to initiate antiretroviral therapy (ART) less than 5 years and the increment of viral load were significantly associated with dysfunctional coping strategy. Having 1-2 children and fear of COVID-19 were the significant factors for problem focused coping strategy. An increment in emotion focused coping was associated with food insecurity. Social support and distance from health institutions 5 km or more were found to have a positive association with problem and emotion-focused coping strategies. Conversely, time taken to initiate antiretroviral therapy (ART) 5 years and more negatively correlated with both problem and emotion-focused coping mechanisms.

Conclusion: The study revealed that all coping strategies were utilized by depressed women living with HIV (WLWHIV). Strengthening spiritual coping styles proved beneficial in reducing depression among these individuals. It is recommended that depressed WLWHIV practice problem and emotion-focused coping strategies. Additionally, social support enhances both problem and emotion-focused coping approaches. Factors contributing to dysfunctional coping included having started ART less than five years ago and high viral load levels. Therefore, providing holistic support for depressed WLWHIV is essential to improve their mental health.

Background: High unmet need for treatment of mental disorders exists throughout the world. An understanding of barriers to treatment is needed to develop effective programs to address this problem.

Methods: Data on barriers were obtained from face-to-face interviews in 22 community surveys across 19 countries (n = 102,812 respondents aged ≥ 18 years, 57.7% female, median age [interquartile range]: 43 [31-57] years; 68.5% weighted average response rate) in the World Mental Health (WMH) surveys. We focus on the n = 5,136 respondents with 12-month DSM-IV anxiety, mood, or substance use disorders with perceived need for treatment. The n = 2,444 such respondents who did not receive treatment were asked about barriers to receiving treatment, whereas the n = 926 respondents who received treatment with a delay were asked about barriers leading to delays. Consistent with previous research, we distinguished five broad classes of barriers: low perceived disorder severity, two types of barriers in the domain of predisposing factors (beliefs/attitudes about treatment ineffectiveness and stigma) and two types in the domain of enabling factors (financial and nonfinancial). Baseline predictors of receiving treatment found in a prior report (i.e., comparing the n = 2,692 respondents who received treatment with the n = 2,444 who did not) were examined as predictors of barriers, while barriers were examined as mediators of associations between these predictors and treatment.

Results: Most respondents reported multiple barriers. Barriers among respondents who did not receive treatment included low perceived severity (52.9%), perceived treatment ineffectiveness (44.8%), nonfinancial (40.2%) and financial (32.9%) barriers in the domain of enabling factors, and stigma (20.6%). Barriers causing delays in treatment had a similar rank-order but were reported by higher proportions of respondents (X²₁ = 3.8-199.8, p = 0.050- < 0.001). Barriers were predicted by low education, disorder type, age, employment status, and financial obstacles. Predictors varied as a function of barrier type.

Conclusions: A wide range of barriers to treatment exist among people with mental disorders even after a need for treatment is acknowledged. Most such individuals have multiple barriers. These results have important implications for the design of programs to decrease unmet need for treatment of mental disorders.

Health personnel lack a common standard for assessing lethality of suicide attempts. This may lead to inconsistent assessments and unclear reports about suicide attempts. We argue that the Risk-Rescue Rating Scale (RRRS) may help in resolving this problem. It is a measure based on observable indications of the medical danger of a suicide attempt and of the patient's efforts to avoid or achieve rescue. The instrument is a clinician-rated supplement to self-reports and can be administered in a few minutes and learned in a single brief teaching session. We adapted the RRRS for contemporary use in a Norwegian acute adolescent mental health service clinic. We developed a training program for clinicians, a user manual, and a series of five video-based role-played interview cases for reliability testing. In this study, we recruited 28 clinicians with professional backgrounds typical of Norwegian mental health personnel. They rated five role-played video interviews using the RRRS and the well-established interview instrument the Suicide Intent Scale (SIS) and obtained 140 sets of scores. We estimated the interrater reliability (intraclass correlation coefficient [ICC]) to be .93 for the RRRS and .94 for the SIS, both excellent levels. Correlation was .80 between the RRRS and SIS items that were similar to the RRRS and .53 for SIS items measuring other topics, indicating good concurrent and discriminant validity. Adopting a common standard for communicating about suicide attempts can improve clinical practice, and the RRRS may prove to be a reliable and practical candidate for this task.

Introduction: Group Interpersonal Therapy (IPT), an evidence-based treatment of depression recommended by the WHO mhGAP Intervention Guide, was implemented through a task-shifting approach in Senegal, as a treatment for depressed people living with HIV (PLWH). Since a description of the resources used and the implementation costs incurred is necessary to inform policymakers better, this study aimed to estimate the costs associated with its implementation.

Methods: Intervention costs were analyzed using an "ingredients-based costing approach" from the provider's perspective. We identified and described the start-up and implementation costs for the initial phase and a projection over 5 years (implementation at capacity). We estimated total annual costs and cost per beneficiary. We conducted a scenario analysis to highlight some cost uncertainties and their impacts.

Results: The total annual costs were estimated at $4064 for the initial phase and $8161 for the implementation at capacity. The training was the main cost driver representing approximately 60% of the total annual costs. The cost per beneficiary receiving group IPT was estimated at $65 for the implementation at capacity. The scenario analysis also illustrated the importance of parameters like the screening strategy, training activities, and allocation to cover transport costs mobilized by participants.

Conclusion: This cost analysis highlighted the costs and cost allocations required to implement group IPT in Senegal to treat depression in PLWH. This preliminary work should enable policymakers to identify the optimal resources to be mobilized to implement and ensure the sustainability of this therapy in HIV at a country-level program.

Background: Digital interventions (DIs) have emerged as promising tools for promoting mental health in the workplace. However, evidence on if, how, and under what circumstances they affect positive outcomes requires elucidation. This systematic realist review aimed to synthesize current knowledge on contexts, mechanisms, and outcomes of workplace DIs to enhance mental health at work.

Methods: The review integrates elements of both systematic and realist review methodologies. Forty-four workplace mental health DIs studies were gathered through a systematic electronic search using PsycNet, Scopus, Web of Science, and PubPsych.

Results: Results showed that demographics, previous mental health, and personal skills were the main individual context factors influencing the success of DIs. Key mechanisms were DIs usage, frequency, adherence, and relevance of content triggering positive perceptual shifts. Results showed improvements in psychological resources, wellbeing, and affect. Reduced ill-health symptoms were also evidenced. Five propositions were developed on the contexts and mechanisms under which digital interventions yield positive outcomes for mental health at work.

Conclusions: This study highlights several areas where future research can expand our understanding of DIs in the workplace by examining interactions between mechanisms and cultural aspects influencing implementation.

Background: Despite the significant burden of alcohol use disorders (AUD), there is a large treatment gap, especially in settings and populations affected by armed conflict. A key barrier to care is the lack of contextually relevant interventions and adequately skilled human resources to deliver them. This paper describes the systematic development of the CHANGE intervention, a potentially scalable psychological intervention for people with co-existing AUD and psychological distress in conflict-affected populations, delivered by non-specialist workers (NSWs).

Methods: CHANGE was developed in sequential steps: (1) identifying potential treatment strategies through a meta-review and Delphi survey with international experts; (2) in-depth interviews (IDIs) with key stakeholders from the study settings in Uganda and Ukraine; and (3) three consultative workshops with international experts and experts from Uganda and Ukraine to develop a theoretical framework for the intervention informed by outputs of the Delphi and IDIs.

Results: In the Delphi survey, experts reached agreement on the acceptability, feasibility and potential effectiveness of the following components: identify high-risk situations, problem solving skills, assessment, handling drinking urges, communication skills, pros and cons of drinking, and identifying high-risk situations. From the IDIs we identified (a) causal attributions for using alcohol e.g., psychosocial stressors; (b) cultural norms related to alcohol consumption such as patriarchal stereotypes; and (c) coping strategies to deal with drinking problems such as distraction. The CHANGE intervention developed through the consultative workshops can be delivered in three sequential phases focussed on assessment, feedback, and information (Phase 1); providing the client with need-based skills for dealing with high-risk situations related to alcohol use (Phase 2), and relapse prevention and management (Phase 3).

Conclusions: CHANGE is a contextually relevant and potentially scalable treatment for co-existing AUD and psychological distress to be delivered by NSWs to conflict-affected populations. Effectiveness and cost-effectiveness of CHANGE will be tested in Uganda and Ukraine.