Global Mental Health最新文献

In this study, we examined the patterns of subjective well-being (SWB) measures among pregnant women and quantified the extent to which pregnancy intendedness is associated with low SWB measures during pregnancy. We analyzed data from the 2021 Nigeria Multiple Indicator Cluster Survey comprising 3,491 pregnant women. The associations between pregnancy intention and low SWB measures (unhappiness, low life satisfaction [LS] and diminished optimism) were determined by fitting series of multilevel logistic regression models with random intercepts. Among pregnant women in our sample 20%, 37.5% and 9.6%, reported being unhappy, experiencing low LS and having diminished optimism, respectively. However, we found no significant association between pregnancy intention and being unhappy (mistimed: adjusted odds ratio [aOR] = 1.19, 95% CI = 0.88-1.60; unwanted: aOR = 1.16, 95% CI = 0.71-1.91), experiencing low LS (mistimed: aOR = 1.07, 95% CI = 0.83-1.37; unwanted: aOR = 1.06, 95% CI = 0.69-1.65) and having diminished optimism (mistimed: aOR = 1.22, 95% CI = 0.82-1.82; unwanted: aOR = 1.07, 95% CI = 0.56-2.04). Findings from the study suggest that pregnant women in Nigeria who reported having either a mistimed or unwanted pregnancy were just as likely to report being unhappy, experience low LS and have diminished optimism as women whose pregnancy was intended.

Background: High rates of intimate partner violence (IPV) and mental disorders are present in Mozambique where there is a significant treatment gap. We aimed to report Mozambican community stakeholder perspectives of implementing couple-based interpersonal psychotherapy (IPT-C) in preparation for a pilot trial in Nampula City.

Methods: We conducted 11 focus group discussions (6-8 people per group) and seven in-depth interviews with key informants in mental health or gender-based violence (n = 85) using purposive sampling. We used grounded theory methods to conduct an inductive coding and then deductively applied the consolidated framework for implementation research (CFIR).

Results: For the outer setting, local attitudes that stigmatize mental health conditions and norm IPV as well as an inefficient legal system were barriers. Stakeholders expressed high acceptability of IPT-C, although a lack of resources was a structural challenge for the inner setting. Adaptation of the approach to screen for and address potential mediators of IPV was important for adopting a multisectoral response to implementation and planning. Delivering IPT-C in the community and in collaboration with community stakeholders was preferable.

Conclusion: Stakeholders recommended multilevel involvement and inclusion of community-based programming. Task shifting and use of technology can help address these resource demands.

Perinatal depression is associated with adverse maternal, newborn and child health outcomes. Treatment gaps and sociocultural factors contribute to its disproportionate burden in low- and middle-income countries (LMICs). Task-sharing approaches, such as peer counseling, have been developed to improve access to mental health services. We conducted a scoping review to map the current literature on peer counseling for perinatal women experiencing depression in LMICs. We searched CINAHL, MEDLINE, APA PsycINFO, Global Health and EMBASE for literature with no date limits. We included 73 records in our analysis, with most being systematic reviews and meta-analyses, randomized controlled trials and qualitative studies. Most studies were conducted in India and Pakistan and published from 2020 onward. The Thinking Healthy Program (THP) and its Peer-Delivered (THPP) adaptation were the most common interventions. Studies suggested effectiveness, feasibility, acceptability and transferability of peer counseling, particularly within the THPP, for perinatal depression. Studies indicated that local women, as peers and lay counselors, are preferred and effective implementation agents. Gaps in the evidence include those relating to understanding perinatal depression (e.g., contextual understandings of the etiology, comorbidity and heterogeneity and social conditions of psychosocial distress including long-term impacts on relationships and children's development) and understanding and improving implementation. Further research on the adaptation, scaling up and integration of peer-delivered approaches with other approaches to improve impact are needed. There are also gaps in understanding the perspectives and experiences of peer counselors. Evidence gaps may stem from an emphasis on conventional public health approaches and measures derived from Western psychiatry, such as randomized controlled trials. There is relatively little research or implementation that prioritizes peer counselors in terms of understanding their perspectives and experiences (e.g., of professionalization), despite them being central to peer-delivered models. Task sharing has the potential to both empower peer counselors through mental health benefits and professional opportunities but also render peer counselors susceptible to vicarious exposure to traumatic stories and difficult situations amid limitations in available support. Better understanding counselors' and perinatal women's experiences can help decolonize the evidence base and improve implementation.

Enhancing resilience is one way to prevent future mental illnesses and encourage recovery in the face of adversity. To develop and test the acceptability and feasibility (A&F) of a combined family and individual resilience intervention in two rural/semi-rural low-income settings in India and Kenya. We developed a five-session intervention including Life Skills Education (LSE) and a model of family resiliency. Among adolescents aged 14-16 years and their families in India and Kenya, we collected socio-demographics and audio records of delivery and undertook a process evaluation. Due to COVID-19, we developed a hybrid intervention. The facilitators and participants preferred the in-person model. India: Of 17 families, 10 fully completed the intervention. They identified three critical components: 1) story-telling, 2) cooperation and working together and 3) expressing feelings. Kenya: All 15 families completed the intervention. Critical elements were 1) seeing social value in learning to make good decisions, 2) promoting an optimistic view of life, 3) hearing stories that resonated with their situation and 4) enhancing family performance through knowledge-building. We mapped the active ingredients, showing fidelity and acceptability. The intervention showed promising A&F parameters. Flexibility and local adaptation were important for delivery.

Feb. 19, 2024.

Background: Mental health (MH) system in Serbia still relies heavily on the medical model with very restricted availability of community-based support. The aim of this study was to provide insight into the everyday experiences and unmet needs of psychiatric users suffering from schizophrenia spectrum disorders in Serbia who are also users of community MH services.

Method: We recruited the participants (N = 11; 9 males; aged 26-65, M = 48.5), long-term psychiatric users (11-57 years, M = 29.4) diagnosed with a schizophrenia spectrum disorder, from a community MH centre. We conducted in-depth semi-structured interviews with them, which we analysed relying on the principles of thematic analysis.

Results: Three broad themes relevant to participants' well-being and quality of life were identified: leading a meaningful and fulfilled life; the importance of continuity of socialisation and support; and maintaining control and a sense of agency. Community MH services have markedly figured in facilitating all three dimensions.

Conclusions: Findings suggest that providing continuous services that address the users' need to engage in activities that give them meaning and purpose, provide socialisation and peer support, and promote their autonomy and agency can play a vital role in advancing the process of recovery and well-being of long-term psychiatric users.

Our systematic review aims to synthesise the evidence on interventions targeting improvement in patient adherence to psychological treatments for common mental disorders. A search was conducted on six electronic databases using search terms under the following concepts: common mental disorders, adherence, psychological treatments and controlled trial study design. Due to the heterogeneity in intervention content and outcomes evaluated in the included studies, a narrative synthesis was conducted. Risk of bias was assessed using the Cochrane Risk of Bias Version 2 tool for randomised controlled trials and the Cochrane ROBINS-I tool for non-randomised controlled trials. The search yielded 23 distinct studies with a total sample size of 2,779 participants. All studies were conducted in high-income or upper-middle-income countries. Interventions to improve patient adherence to psychological treatments included reminders and between-session engagement (e.g., text messages), motivational interviewing, therapy orientation (e.g., expectation-setting) and overcoming structural barriers (e.g., case management). Interventions from 18 out of 23 studies were successful in improving at least one primary adherence outcome of interest (e.g., session attendance). Some studies also reported an improvement in secondary outcomes - six studies reported an improvement in at least one clinical outcome (e.g., depression), and three studies reported improvements in at least one measure of well-being or disability (e.g., days spent in in-patient treatment). By incorporating these interventions into psychological treatment services, therapists can better engage with and support their patients, potentially leading to improved mental health outcomes and overall well-being.

Caribbean health research has overwhelmingly employed measures developed elsewhere and rarely includes evaluation of psychometric properties. Established measures are important for research and practice. Particularly, measures of stress and coping are needed. Stressors experienced by Caribbean people are multifactorial, as emerging climate threats interact with existing complex and vulnerable socioeconomic environments. In the early COVID-19 pandemic, our team developed an online survey to assess the well-being of health professions students across university campuses in four Caribbean countries. This survey included the Perceived Stress Scale, 10-item version (PSS-10) and the Brief Resilient Coping Scale (BRCS). The participants were 1,519 health professions students (1,144 females, 372 males). We evaluated the psychometric qualities of the measures, including internal consistency, concurrent validity by correlating both measures, and configural invariance using confirmatory factor analysis (CFA). Both scales had good internal consistency, with omega values of 0.91 for the PSS-10 and 0.81 for the BRCS. CFA suggested a two-factor structure of the PSS-10 and unidimensional structure of the BRCS. These findings support further use of these measures in Caribbean populations. However, the sampling strategy limits generalizability. Further research evaluating these and other measures in the Caribbean is desirable.

Objective: This systematic review aimed to review therapeutic patient education (TPE) programmes in managing psychiatric disorders, considering the diversity in delivering agents, intervention formats, targeted skills, and therapeutic outcomes.

Methods: Comprehensive database searches, including Web of Science, PubMed, and COCHRANE, were conducted from September 2019 to January 2023, yielding 514 unique records, with 33 making it through rigorous evaluation for full-text review. Eleven studies met the inclusion criteria, focusing on various psychiatric disorders such as depression, bipolar disorder, psychosis, and multiple serious mental illnesses. A total of 38 studies were included from our previous review to supplement the current database search.

Results: TPE programmes exhibited diversity in delivering agents and intervention formats, with a notable presence of multidisciplinary teams and various professionals. The interventions prioritized coping strategies and disease management techniques, though the extent varied based on the disorder. Effectiveness was heterogeneous across studies; some interventions showed significant benefits in areas such as symptom management, coping, and functional improvement, while others reported no significant outcomes.

Conclusion: The findings underscore the potential of TPE in psychiatric care, revealing its multifaceted nature and varied impact. TPE not only addresses deficits but also leverages patients' existing strengths and capabilities. Despite the reported benefits, a portion of the interventions lacked statistical significance, indicating the necessity for continuous refinement and evaluation.

Hypertension and depression are increasingly common noncommunicable diseases in Ghana and worldwide, yet both are poorly controlled. We sought to understand how healthcare workers in rural Ghana conceptualize the interaction between hypertension and depression, and how care for these two conditions might best be integrated. We conducted a qualitative descriptive study involving in-depth interviews with 34 healthcare workers in the Kassena-Nankana districts of the Upper East Region of Ghana. We used conventional content analysis to systematically review interview transcripts, code the data content and analyze codes for salient themes. Respondents detailed three discrete conceptual models. Most emphasized depression as causing hypertension: through both emotional distress and unhealthy behavior. Others posited a bidirectional relationship, where cardiovascular morbidity worsened mood, or described a single set of underlying causes for both conditions. Nearly all proposed health interventions targeted their favored root cause of these disorders. In this representative rural Ghanaian community, healthcare workers widely agreed that cardiovascular disease and mental illness are physiologically linked and warrant an integrated care response, but held diverse views regarding precisely how and why. There was widespread support for a single primary care intervention to treat both conditions through counseling and medication.