SSM. Mental health最新文献

Background

The Arab Region accounts for most of the world's refugees. Despite being dispersed across the globe, most of these refugees are internally displaced within the region. A growing body of research argues that Western biomedical frameworks for conceptualizing, diagnosing, and treating trauma may not be suitable for non-Western and trauma caused by political violence inflicted on entire populations over time. The cultural and socio/political contexts of trauma are increasingly recognized as key to understanding trauma-related distress. Arab trauma research has emerged in the past 30 years. Nevertheless, the results are not systematically consolidated.

Aim

This review aims to identify and map knowledge production in the Arab Region that is challenging Western notions of trauma experienced by Arab refugees in the region and attempts to explore the contours of a more culturally congruent conceptualization of trauma.

Method

Following the PRISMA extension for scoping reviews (PRISMA-ScR), we conducted a scoping review. Peer-reviewed, empirical literature from 1990 to 2023 was searched in eight English and three Arabic databases.

Results and implications

Out of 2654 articles only ten were included. Included publications explored two main areas: conceptualization of trauma in Arab samples and addressing the subject of traumatization. The articles highlighted the limitations of using the PTSD model to diagnose and treat Arab refugees' traumatic stress and the importance of contextual, structural, and cultural factors in distress conceptualization. The articles provide research, clinical, and policy implications addressing adoption of social justice frameworks, development of contextually relevant trauma models, clinical investigations and assessment of symptoms and idioms.

The initial year after parental death is a critical period for grief and coping. Despite its significance for declines in and recovery of adult mental health, this initial period is not sufficiently captured in existing research following changes across annual or even broader intervals. This paper assesses the impact of the first and second parent’s death on adult mental health on more fine-grained monthly timescales. Using data from up to 12 waves of the German Socio-Economic Panel Study (GSOEP) and fixed-effects models with yearly and monthly impact functions, the analysis yielded two main findings. First, mental health declines were much deeper when measured on a monthly scale. The magnitude of drops recorded within the first two months following parental death approximately doubled those measured at an annual scale. Second, recovery occurred much faster when recorded on a monthly timescale and was evident already a few months after the loss of a parent. Overall, this study suggests that reaction and adaptation to parental death are stronger and faster than previously documented. The study additionally identified variations in mental health responses. Those who lost their first parent had worse mental health a year after the event compared to those who lost their second parent. The most significant decline in mental health, around 10 points, occurred among daughters one to two months after their mother's death. When the mother died first, the impact was more severe on mental health, especially among younger daughters and sons.

Implementation science and human-centered design (HCD) offer useful frameworks and methods for considering and designing for individuals' needs and preferences when implementing new interventions or technologies in global health. When used in tandem, the two approaches may blend creative and partnered research methods with a focus on the factors necessary to design, implement, and sustain interventions. However, research is needed that describes the process of blending these two approaches and explores the experiences of community partners. This study builds from a stepped-wedge cluster-randomized trial in Western Kenya, wherein teachers and community health volunteers have been trained to provide trauma-focused cognitive behavioral therapy (TF-CBT). Mobile phones emerged as a tool to supervise lay counselors from afar; however, their use was characterized by unique challenges. Informed by human-centered design and implementation science, we first engaged lay counselors (n = 24) and supervisors (n = 3) in individual semi-structured interviews then hosted an in-person participatory workshop to “co-design” solutions to optimize the use of mobile phone supervision. Lay counselors participated in focus group discussions regarding their experiences in the workshop. Focus group transcripts were analyzed using thematic analysis. We describe our approach as well as focus group discussion results. Counselors felt the workshop was a valuable experience to learn new strategies from their colleagues, and they enjoyed the “collaborative spirit” that emerged as they worked together. Counselors felt that varying small and large group discussions fostered participation by creating opportunities for more people to engage and share their thoughts. Counselors suggested the approach be improved by providing more tangible materials (e.g., hand-outs) and more closely following a schedule of activities. It is important to also center stakeholders’ experiences as partners in the research process. Though counselors largely expressed positive sentiments, they also shared valuable suggestions for how to improve participatory research practices in the future.

Depression is a major global health concern especially among mothers of young children in low- and middle-income countries (LMICs). While various risk and protective factors have been well-established, the role of fathers in potentially mitigating maternal depression remains understudied. This study aimed to investigate the association between father involvement and maternal depressive symptoms in rural Western Kenya. We used cross-sectional baseline data collected in February–March 2023 from a cluster-randomized controlled trial evaluating the effectiveness of a community-based parenting program for improving early childhood development. Primary caregivers with children 0–18 months of age were enrolled into the trial across 51 villages in Nyamira and Vihiga counties. We analyzed data from 413 mothers who were in a relationship with a male partner (i.e., father of the young child). Maternal depressive symptoms were measured using the CESD-10. Father involvement was reported using a multidimensional measure of men's engagement in childcare activities, household chores, early learning activities, and affection towards their child. We used multilevel regression models to estimate the adjusted associations between father involvement (overall score and by specific domains) and maternal depressive symptoms. We also conducted exploratory subgroup analyses to assess whether this association differed by child age. Overall, greater father involvement was associated with fewer maternal depressive symptoms. Specifically, fathers' engagement in household chores and childcare activities had the strongest protective associations. Exploratory subgroup analyses revealed larger associations for mothers with younger children under 6 months. Our findings suggest that father involvement is a protective factor for maternal mental health. Engaging fathers in early childhood interventions and encouraging men's involvement in caregiving activities may potentially benefit maternal well-being.

Introduction

United States emergency departments (ED) visit rates for nonfatal self-harm increased by 42% from 2001 to 2016. Previous suicide mortality research has provided conflicting evidence on the use of suicide-related Internet searches as a surveillance tool for self-harm and suicidal ideation. However, few have used rigorous approaches to account for autocorrelation at the aggregate level, and none have focused on Internet searches related to suicide prevention.

Methods and results

Over a 9-year study period (2007–2015), suicidality-related search data were extracted using the Google Health Application Programming Interface (API) for Arizona and California – states, chosen for their differing age distributions and rigorous ED injury coding policies. We examined several combined suicide prevention-related search queries. Using autoregressive integration moving average (ARIMA) models and a Box-Jenkins approach, we assessed whether increased prevention-related Internet searches related to suicidality are predictive of lower subsequent ED visits related to suicidal ideation with or without self-harm injury. In both states, greater prevention-related queries were associated with lower ED visits approximately four to six weeks later.

Conclusions

Our results indicate that Internet-based search volumes related to suicide prevention may have the potential to monitor suicidality and online suicide prevention resources offer meaningful opportunities for mental health support.

A zero-risk paradigm currently dominates the organization and delivery of mental health care within inpatient settings, giving rise to a proliferation of risk management strategies that are ineffective and produce harms. Drawing on Foucault's confinement and grounded in a comprehensive analysis of the extant literature, we identify three central processes that constitute this paradigm, including: risk is situated within the patient; eliminating risk is a foundational aim; and mental health professionals lead decision-making. Responding to the zero-risk paradigm, this paper proposes a novel safety paradigm comprised of four intersecting components, undertaken collectively by mental health professionals to guide practice: i) holding risk, ii) building capacity, iii) prioritizing relationships, and iv) re-envisioning environments. Foundationally underlying these commitments is direct action toward reducing coercive practices and structures, such as chemical and physical restraints, seclusion, and door locking. Mental health professionals are encouraged to challenge the zero-risk paradigm and its resultant risk management approaches, and embrace a safety paradigm to meaningfully re-orient care toward enhancing patients' safety and well-being during and following hospitalization.

Introduction

Experience-based co-design (EBCD) is a structured methodology of conducting healthcare quality improvement bringing together people with lived experience of a condition, families or carers, and healthcare service providers. EBCD has been applied to mental health and substance use (MHSU) settings. This scoping review aimed to: (a) synthesize the literature on the application of EBCD in the MHSU service sector; and (b) map out key adaptations made to the EBCD process, as well as the perceived impacts of the process and considerations unique to the MHSU sphere.

Methods

A scoping review methodology was applied. Systematic searches for articles describing EBCD projects in MHSU were conducted across six bibliographic databases for literature published between 2013 and 2023, together with gray literature searches and reviews of reference lists. Records were screened for relevance, resulting in 24 included articles. Data were extracted in a spreadsheet and using qualitative data analysis software. Results are reported descriptively and in table format.

Results

EBCD is being conducted in the MHSU sector in a limited number of high-income, English-speaking countries, applied to both quality improvement and new intervention development. Extensive methodology adaptations are described, with some steps frequently removed from the process or modified. A number of positive impacts of EBCD are described, highlighting the development of service adaptations or new services, as well as positive interpersonal impacts among stakeholders.

Conclusions

EBCD is a valuable approach to collaboratively co-designing quality improvement initiatives with users of MHSU services, families or carers, and service providers, although it is also applied to new intervention development. Those implementing EBCD should carefully consider the way planned adaptations may affect the information gathered, the implementation experience, and the co-designed solutions. It is important to apply trauma-informed practices to EBCD and follow recommendations for authentic engagement, to promote genuine participation in co-designing solutions.

The term severe mental illness (SMI) is often used in academic work, primary care practice, and policy, acknowledging the health disparities experienced by, and need for improved support for, this population. However, here we draw from the varied experiences of our authorship team to reflect on some problematic operationalisations of the term SMI and its usage, specifically in policy, primary care practice, and academic discourses in England and the UK. Benefits of the SMI label in accessing specialised services are evident but, in this commentary, we start a discussion on its necessity and unintended consequences for wider health support. We focus on physical health support specifically. We hope that this commentary encourages dialogue among practitioners, researchers, stakeholders and commissioners concerning wider uses of the term SMI.

Globally, there has been a substantial increase in the number of men being diagnosed with anxiety disorders. Despite this, men's mental health research often focusses on uncovering why men don't, rather than why they do, seek help. Within this context, men's help-seeking pathways for anxiety are poorly understood. This study mapped the help-seeking pathways of 419 Australian-based men for anxiety. Respondents 16 to 77 years-old (M = 40.92 years, SD = 15.36) reported multiple instances of help-seeking (n = 321, 77%) elaborating on their drivers for help-seeking via an open-text qualitative survey. Thematic analysis of men's responses was used to generate three themes, first detailing common tipping points of men's anxiety (namely relationship issues and work stress), and second, the reclusive causes and consequences of men's anxiety (burdensome symptoms and unmet expectations). These two themes converged into a third theme of help-seeking where defeatist (i.e., resigned abandonment self-management strategies) or defiant (proactive motivation in reaction to new events) motivations propelled men into either assisted or solitary help-seeking pathways. The current study findings afford important insights about the drivers that lead men to seek help for anxiety across the life course. Interventions targeting men's help-seeking for anxiety should accentuate the potential benefits of community-based mental health treatment within the context of men's social connectedness. Such interventions would also benefit from leveraging positive masculine ideals including strength, emotional-control and competition which can be both a barrier to, and driver for, help-seeking in the context of men's anxiety.