SSM. Mental health最新文献

In South Africa, substance use, violence, and HIV risk disproportionately affect young poor Black women. Few studies have explicitly measured the co-occurrence of these health risks or the impact on mental health and wellbeing for this population. To this aim, we use a person-centred approach to explore the clustering of health risks among young Black women from urban informal settlements in Durban, South Africa, enrolled in an intervention trial. Latent class analysis identified three health risk subgroups with increasing levels of health risk co-occurrence: while all three subgroups had high rates of emotional/economic intimate partner violence, they differed in their levels of the other health risks, with one (“lower-risk”) subgroup defined by experiencing violence against women (VAW), another by the co-occurrence of VAW with problematic alcohol use (i.e. “mid-risk”), and the last (“high-risk”) subgroup by the co-occurrence of VAW, problematic alcohol use and sexual risk behaviour. Descriptive analyses showed that lower education and food insecurity were associated with greater health risk co-occurrence and that this in turn was associated with increased chances of depression and suicidal ideation. Between subgroup differences persisted over time - after two years, the chances of experiencing violence, problematic alcohol use, transactional sex and depression remained elevated for the women who initially experienced more health risks. Persistent yet differing levels of risk suggest the need for urgent structural interventions that address these health risks synergistically while taking account of individual differing primary and secondary prevention needs. Our analyses highlight that social epidemics such as poverty, racism and gender inequality play into the production of poor health outcomes, including poor mental health. These are the underlying structural issues that need to be addressed in order to protect women’s health and reduce harm.

Geographic resettlement induces acculturative stress in refugees. In response, they utilize social support to deal with acculturative stress and to adapt to the host community. In this study we sought to understand how North Korean refugees (NKRs) utilize social support to reduce acculturative stress. We conducted semi-structured interviews with 30 NKRs in South Korea and 20 South Koreans (SKs) who were friends or acquaintances of NKRs. Purposive and snowballing sampling strategies were used to recruit participants at two sites. Following a Grounded Theory approach, we analyzed the data using initial coding, focused coding, and constant comparison. We found that NKR participants coped with loneliness by exchanging emotional support with other NKRs who share their lived experiences and by building solidarity with them. NKRs described expanding their social networks to include SKs in order to assimilate into their communities. Many SKs tried to develop family-like relationships with NKRs. While SKs were important resources for informational or instrumental support early on, their roles were sometimes replaced by other NKRs as social ties among NKRs were strengthened. All NKRs who reported that they strategically approached SKs to learn about South Korean culture had held full-time jobs and appeared to be better adjusted to South Korea. Appraisal support was the least reported type of social support, but some NKRs tried to deal with social discrimination through positive appraisal. To reduce acculturative stress, NKRs sought varied types of social support from different kinds of social network members. Findings highlight the need to diversify and strengthen social support for NKRs, thereby fostering coping strategies and reducing acculturative stress.

There is limited evidence on the economic burden of chronic diseases with co-occurring depression and alcohol use disorder (AUD) for people in low-and middle-income countries. We describe patient costs related to the utilisation of services and identify factors associated with the economic burden of co-occurring depression and AUD for people with HIV and/or diabetes using government health services in South Africa. We used baseline data from participants enrolled in a cluster randomised controlled trial (RCT). The sample (N = 1340) comprised participants classified as having risk of depression but not AUD (n = 689), risk of AUD but not of depression (n = 221); or risk of depression and AUD (n = 430). We measured total patient costs (direct patient costs (out-of-pocket payments (OOPP) plus indirect patient costs), and catastrophic costs. We applied a conceptual framework to guide multiple linear and logistic regression analyses examining factors associated with economic burden. Mean monthly total costs per patient and the percentage of these total costs attributable to OOPP were (US$9.78 [56.13%]; US$5.98 [24.58%]; US$7.16 [34.07%]) for the depression, AUD, and AUD and depression groups respectively. The depression group reported significantly more visits to private healthcare providers, higher OOPP and higher prevalence of catastrophe than other groups. OOPP were positively associated with urban location and higher educational attainment. Total patient costs were positively associated with urban location, HIV and diabetes comorbidity, and being employed. Higher utilisation was associated with greater odds of income loss. Results indicate a concerning economic burden in people with a chronic disease and co-occurring depression or AUD and suggest that cost and time may present barriers to accessing care. Given that psychological treatments for mental health conditions are largely unavailable in government health services, improving access to care for the most vulnerable may require coordination of financial risk protection mechanisms alongside scale-up of effective first-line psychological treatments.

People with serious mental health conditions face social exclusion and have poorer social outcomes compared to the general population in several areas of life. Social exclusion also negatively impacts mental health. Promising models of support to improve social outcomes for people with serious mental health conditions have been described in the literature and proliferate in practice, but typologies of support are not clearly established and a robust evidence base for effective approaches is lacking in many areas. We conducted a scoping review of relevant literature and consulted with experts in the field to identify models to improve social circumstances across eight life domains, with the aim of developing a conceptual framework to distinguish the main broad approaches to improving the social circumstances of people with serious mental health conditions. We also sought to explore which approaches have been used in models within each life domain. This work was conducted in collaboration with a group of expert stakeholders, including people with lived experience of accessing mental health services. We developed a conceptual framework which distinguishes sources and types of support, allowing description of complex interventions to improve the social circumstances of people with serious mental health problems, and providing a framework to guide future service development and evaluation.

While incarceration has proven detrimental to mental well-being, it remains unknown if community supervision is better for mental well-being than incarceration. Our objective was to explore the individual- and community-level relationships between community supervision and mental well-being and to examine inequities by race. We conducted 20 in-depth interviews with individuals on community supervision (e.g., probation, parole) in North Carolina and conducted thematic analysis separately by race. For many, criminal legal involvement began at a young age, often due to substance use for White individuals or over-policing for Black participants. The themes were: (1) “It’s a Thursday. Move on.”: surviving over the life course in the context of the criminal legal system; (2) “Merry go round of death”: the criminal legal system as a trap; (3) “I love you, but I have to love you from over here”: social support as a double-edged sword while on community supervision; and (4) " [Probation] ain’t nothing but a rope to hang yourself”: mental health issues created and exacerbated by criminal legal involvement. Individuals’ experiences on community supervision were often dehumanizing and difficult, preventing them from achieving well-being. This system must be redesigned to meet individual and community needs.

Purpose

Despite affecting up to 20% of women and being the leading cause of preventable deaths during the perinatal and postpartum period, maternal mental health conditions are chronically understudied. This study is the first to identify spatial patterns in perinatal mental health conditions, and relate these patterns to place-based social and environmental factors that drive cluster development.

Methods

We performed spatial clustering analysis of emergency department (ED) visits for perinatal mood and anxiety disorders (PMAD), severe mental illness (SMI), and maternal mental disorders of pregnancy (MDP) using the Poisson model in SatScan from 2016 to 2019 in North Carolina. Logistic regression was used to examine the association between patient and community-level factors and high-risk clusters.

Results

The most significant spatial clustering for all three outcomes was concentrated in smaller urban areas in the western, central piedmont, and coastal plains regions of the state, with odds ratios greater than 3 for some cluster locations. Individual factors (e.g., age, race, ethnicity) and contextual factors (e.g., racial and socioeconomic segregation, urbanity) were associated with high risk clusters.

Conclusions

Results provide important contextual and spatial information concerning at-risk populations with a high burden of maternal mental health disorders and can better inform targeted locations for the expansion of maternal mental health services.

This paper explores the relationship between historical research and the field of global mental health. It identifies a gap in the current literature, and argues that an in-depth historical approach is critical for understanding and overcoming current challenges and controversies in global mental health. The authors propose that a thick historical analysis has the capacity to broaden and diversify the discussion about the core concepts in global mental health (such as illness, suffering, care or culture), and to nuance our understanding of the field’s development and impact in specific political and social contexts. The paper analyzes how a systematic historical approach is crucial for understanding colonial and post-colonial power relations embedded in the field of global mental health, and encourages researchers and practitioners to view history as a source of imagination, and of alternative ideas and initiatives in mental health that go beyond existing psychiatric frames of representations, and towards truly radical and egalitarian projects and relations. This exercise in alternative historical imagination does not need to interfere with nor disrupt the urgency of mental health practice today; on the contrary, it is meant to improve the effectiveness of interventions. It can provide practitioners with a new and enriched language to resolve long-standing clinical dilemmas (e.g. related to patient adherence or limited success of certain cultural adaptations), which could not be properly addressed previously

Background

The COVID-19 pandemic disproportionately impacted Black Americans. Rates of hospitalization, mortality, and morbidity increased and racial inequities in unemployment, job benefits, and working conditions widened. This study identifies specific factors associated with the well-being of Black adults in the U.S. workforce one year into the pandemic.

Methods

Data came from the 2021 National Health Interview Survey (N = 1,984). Ordinary least squares regressions were computed to identify correlates of psychological distress and life satisfaction among Black adults in the workforce two weeks prior to the survey.

Results

Black workers experienced significant distress. Life satisfaction was particularly low among those who provided direct medical care. Having a job with paid sick leave was consistently associated with lower psychological distress. Low household food security was associated with higher psychological distress and with lower life satisfaction. Social support was positively associated with well-being.

Conclusion

These findings have important implications for health in Black communities and for recruiting and retaining Black workers in the health care system. Supporting Black physicians matters for their mental health amidst growing rates of suicide in this population. As policymakers continue to develop and legislate policies to promote recovery from the social, economic, and health consequences of the pandemic, attention to how these policies will support all Black workers is critical.

As the number of psychiatric hospitals are on the rise in China, this article examines how the psychiatric discourse as articulated by hospital staff interacts with local cultural understandings of madness/mental illness, as well as how such interactions impact patients and families’ reception of psychiatry. Data comes from 16 months of fieldwork in a psychiatric hospital in South China. We show that psychiatric professionals at the hospital attempted to establish their professional authority by discrediting other cultural epistemologies embraced by patients or families, such as religious and traditional Chinese medical understandings. Despite the quick effect of psychopharmaceuticals to control symptoms, the psychiatric perspective ultimately fell short in addressing the social and moral struggles faced by patients, such as patriarchy and gender-based violence. Moreover, as psychiatric professionals unreflexively used certain problematic local concepts to convey a biomedical and even genetically-determined account of mental illness to patients and families, they risked entrenching the stigma of mental illness and disempowering their clients. To improve the quality of mental healthcare, to make clients feel culturally safe and respected in clinical encounters, psychiatric professionals in China should develop a more holistic approach that takes into account the biological, psychological, and sociocultural aspects of mental illness, that recognizes the diverse sources of help clients may rely on. They should also develop a critical awareness of the language they use and of the power dynamics in which they and their clients are situated.