SSM. Mental health最新文献

Intro

Suicide is a public health concern globally. While suicide ideation and suicide attempts are strong risk factors for fatal suicide, most people with suicidal thoughts do not proceed to making a suicide attempt, and most people who have survived a suicide attempt do not eventually die by suicide. Researchers have established theories that describe an ideation-to-action framework, distinguishing suicide attempts from suicide ideation. Understanding this distinction is vital for developing and implementing effective suicide prevention strategies. It highlights the importance of early identification and intervention, and the need for ongoing mental health support and resources for individuals at risk of suicide.

Methods

Sixteen participants with suicide ideation were interviewed to explore what protected against death by suicide despite different levels of suicidal thoughts.

Results

Three recurrent themes were identified from interviewees’ stories: 1) suicidal thoughts as a space; 2) fear and concerns; and 3) coping strategies.

Conclusion

We found synchronicity between our findings and common clinical intervention strategies that highlight protective factors in promoting mental health and saving lives from at-risk groups.

The following study was conducted in order to assess convergent construct validity and internal consistency of a Khmer-language adaptation of the Psychache Scale, a 13-item self-report instrument used to assess subjective experiences of psychological pain. The Psychache Scale (PAS) was translated into Khmer and back-translated to verify accurate meaning. The Khmer translation was corrected to address cultural and linguistic nuances for the Cambodian population and piloted among 121 students and recent graduates. The final Khmer version of the PAS showed high internal consistency (Cronbach's alpha = 0.928). Results also showed that scores on the Psychache Scale were strongly associated with related concepts of depression (r² = 0.545, p = 0.000), anxiety (r² = 0.438, p = 0.000), stress (r² = 0.459, p = 0.000), and Baksbat, a Cambodian-specific cultural concept of distress (r² = 0.549, p = 0.000). Contrary to a priori hypotheses, the Psychache Scale was also negatively and statistically significantly associated with age (Kruskal-Wallis χ2 = 20.561, df = 4, p = 0.000) and was negatively statistically significantly related to education level (Kruskal-Wallis χ2 = 13.053, df = 2 p = 0.001). Given these results, the Psychache Scale shows potential clinical utility in the Cambodian context, though future research may consider how psychological pain differs according to age and education levels.

Health risks from water quality pose a major threat to billions of people globally. Most microbial contaminants have short subclinical periods, compared to chemical contaminants that can take years to manifest, which can translate to less attention in the policy sphere. Complex water quality issues in Bangladesh, including arsenic contamination, offer an ideal case study to highlight the wide-ranging health and social impacts of perceived and invisible contaminants. This paper presents a cross-sectional study where two tools are explored for understanding the less visible health impacts of water contamination: (1) measuring subclinical disease via nail arsenic measurements (n = 899) to better ascertain chronic exposure; and (2) understanding the relationship between water quality and psychosocial distress (n = 876), for men and women across three sites with varying water quality issues. Applying generalised linear regression models, subclinical arsenic showed strong positive correlation with water arsenic, while the relationship between severity of psychosocial distress and water arsenic was modified by perceived risk from arsenic. Subclinical disease was much more prevalent than what current exposure through drinking water would indicate, with 65.3% of participants having nail arsenic levels above the 1 μg/g cut-off for unexposed individuals (spanning across sites with average water arsenic as low as 2.51 μg/L and as high as 379 μg/L). Further demonstrating the breadth of unseen outcomes of water contamination, uncertainty was the most commonly expressed component of distress, followed by worry, fear, suffering, and lack of choice. The presence of psychosocial distress underscores how experiences of contaminated water go beyond physiological illnesses, while the use of subclinical biomarkers can shift the understanding of disease and provide a useful way of leveraging policy change by pinpointing exactly where and by whom intervention is needed.

Background

Referral processes in Child and Adolescent Mental Health Services (CAMHS) have been reported as stressful and inadequate by young people and parents/carers, who struggle during waiting periods for the referral outcome decision. The Covid19 pandemic was an unprecedented time of distress for young people, parents/carers, and healthcare staff, with increased mental health challenges and stretched staff having to adapt modes of care, thus exacerbating difficulties for CAMHS.

Aim

This qualitative study aimed to capture the unique lived experiences of young people, parents/carers, and CAMHS staff during the referral process in the peak of the Covid19 pandemic.

Methods

As part of the STADIA trial, between 2020 and 2022, 109 semi-structured interviews across 8 NHS sites were conducted with young people (aged 16–17), parents/carers, and NHS staff including clinicians, commissioners, managers, and researchers embedded in clinical services. Interviews were analysed using thematic analysis.

Results

Three themes were elicited to express young people, staff, and parents/carer experiences of the referral process, CAMHS, and the impact of Covid19: 1) referral as a starting point; 2) changes to methods of appointment delivery and their effect on CAMHS experience; and 3) experiences and evaluation of services.

Conclusion

Although CAMHS was seen as the pinnacle of mental health support, there was dissatisfaction with waiting times, limited communication, unclear referral processes, and limited clinical capacity and resources for young people, parent/carers, and staff. Covid19 forced CAMHS into adapting to a hybrid model of care, increasing accessibility for young people, parents/carers and staff and highlighting areas for improvement. Secure and consistent support and increases in staff resources are essential to address challenges with CAMHS delivery and improve the experiences of young people, parent/carers, and staff.

Background

Mental-health-related stigma prevents youth from seeking help for mental health problems. Limited studies in low- and middle-income countries assess the effect of arts-based education in reducing such stigma among youth, thereby leaving a gap in evidence-based, age- and culturally-appropriate interventions.

Objective

To evaluate the impact, feasibility, and acceptability of CREATORS, an arts-based educational program on reducing mental-health-related stigma among youth in India.

Methods

We conducted a mixed-methods, pre-post control group study among college-going adolescents in Hyderabad, India. At baseline and post-intervention (after six weeks), we examined differences in intended behavior towards people with mental health problems.

Results

Our study involved 432 participants across three study groups: participants creating art on the theme of mental-health-related stigma over six weeks (n = 123), a student audience viewing 2-h arts show by participants (n = 244), and a control group (n = 65). Between baseline and post-test, participants creating art showed significantly lower stigma towards people with mental health problems compared to members of the control group (coefficient = 1.55, 95%CI 0.06–3.04, p = 0.041). Participants found the intervention useful and enjoyable (>95%; n = 773 across six weeks). Participants identified that collaborative creation of art made the subject of mental health interesting and relatable.

Conclusions

Participating in an arts-based educational program was associated with significantly lower mental-health-related stigma among youth compared to a control group in the short term. High acceptability of the program demonstrates the utility of arts-based education to address mental-health-related stigma. With community partners and artists as facilitators, our program may support mental health specialists in mental health promotion.

In the United States, there exists a large disparity in the diagnosis of schizophrenia between Black and White individuals. Some of the symptoms associated with schizophrenia, such as agitation, delusions, and non-compliance, were previously linked to a now-discontinued condition known as “Protest Psychosis.” This proposed subtype of schizophrenia diagnosis emerged during the 1950s and 1960s in response to racial tensions during the Civil Rights movement and preceded an increase in schizophrenia diagnosis among Black populations, potentially leading to racial disparities in this psychiatric condition that continue to permeate the modern context.

In May 2020, the police killing of George Floyd sparked widespread protests through the Black Lives Matter Movement. Given the historical precedence of “protest psychosis” in response to the Civil Rights Movement, we examined disparities in Emergency Department (ED) visits diagnosed as schizophrenia/psychosis immediately following the police killing of George Floyd in May 2020. We used monthly data on ED visits from January 2016 to December 2020 across 5 University of California health systems. We used ARIMA (Autoregressive Integrated Moving Average) time-series analysis to derive the residual values of ED visits diagnosed as schizophrenia/psychosis among Black persons and examined whether these residuals increased selectively among Black persons in June 2020. Results from time-series analyses indicate 34 additional ED visits above expected levels diagnosed as schizophrenia/psychosis among Black persons in June 2020 (p < 0.05), amounting to a 25% increase in these visits among Black persons. These results indicate a perpetuation of historical trends and cohere with expectations from the legacy of “Protest Psychosis”.

Food insecurity is a major threat to global public health and sustainable development. As of 2022, 2.4 billion people worldwide experienced moderate to severe food insecurity. The occurrence and severity of food insecurity can depend greatly on power and social hierarchies, with women and girls often being less food secure than men and boys even within the same household. Moreover, social roles, such as the socialization of a mother to feed her children, impact food insecurity and its consequences. This study aims to uncover the relationships between food insecurity and mental health for women in the Chitwan Valley of Nepal. Utilizing longitudinal data from the Chitwan Valley Family Study, we connect food security data from 2015 with mental health data collected from 2016 to 2018. We find that women have a higher prevalence of major depressive disorder, generalized anxiety disorder, and panic attacks than men, especially if they are experiencing food insecurity. Among women, we find that those who have recently experienced severe food insecurity have a significantly higher likelihood of meeting diagnostic criteria for generalized anxiety disorder and panic attacks than food-secure women. However, women's food insecurity is not significantly correlated with major depressive disorder. Moreover, we find that food insecurity is likely to co-occur with women's agricultural and wage work. These findings suggest a need for gender-attentive policy and programs accounting for both causes and consequences of food insecurity.

Background

Postpartum depression (PPD) is a common experience among mothers worldwide. Family members, especially husbands, can play an integral role in supporting and helping mothers recover from PPD. However, husbands are typically not included in interventions to address postpartum depression among women. This study explored husbands’ perspectives on engaging in a counseling intervention augmented with a digital health component for the treatment of PPD.

Methods

A convergent mixed methods design was used to evaluate husbands’ attitudes and involvement in a counseling and digital intervention for mothers in a semi-urban region of Nepal.

Thematic analysis of semi-structured interviews was used to derive emergent themes. A joint display examined differences in themes for husbands whose wives experienced a significant decline in PPD symptoms as measured by the Patient Health Questionnaire-9 pre and post intervention, as compared to husbands of women whose symptoms stayed the same or worsened.

Results

Thirteen husbands were interviewed. Three primary themes emerged: the impact of gender norms and attitudes on engagement in the intervention, involvement and support in the intervention, and suggestions for future interventions for PPD. Among wives who experienced a reduction in depression symptoms, their husbands were more likely to endorse gender-equitable norms and attitudes and the husbands provided emotional support, as well as participating in household chores and childcare.

Conclusion

When husbands are living in the same household, providing support and being involved in their wives’ PPD treatment can help them recover. Husbands describe time at home and work as barriers to being able to help their wives. PPD interventions that involve husbands might need to educate husbands about how they can provide emotional support to their partner.

Residing in poverty-impacted Ugandan communities and raising children with disruptive behavior disorders (DBDs) is associated with above heightened parenting stress. An evidence-based intervention designed to help parents tailor their parenting style to effectively manage children with DBDs was implemented in Uganda between 2017 and 2023. At the end of the intervention, caregivers displayed lower levels of parenting stress than controls, however the mechanisms by which stress reduction occurred is unknown. We investigated whether the intervention's effect on parenting stress was mediated by parenting practices, family cohesion, or mental health.

Mediation was assessed using Mitchell and Maxwell's cross-lagged auto-regressive approach. Each mediation model regressed the outcome parenting stress score at each time point onto intervention group assignment (0 = Control; 1 = Multiple Family Group (MFG) intervention) and parenting stress score at the preceding time point. Each mediator was investigated one at a time and regressed onto intervention group assignment and the mediator score at the preceding time point. Parenting stress score was also regressed onto the preceding time point mediator score. The residuals for mediators and parenting stress were allowed to correlate at each time point. We included regression pathways from each covariate to the mediators and outcomes at subsequent waves and were included in the model as random variables.

The findings show that the intervention had a significant direct effect on parenting stress at 16 weeks post intervention initiation and was partially mediated by parenting practices, caregiver mental health, and parenting stress at 8 weeks, but we found no evidence it was mediated by family cohesion, supporting two of our hypotheses.

Equipping caregivers with parenting skills and strategies to improve mental health can go a long way in reducing overall parenting stress among caregivers with DBDs. Our findings could be leveraged to enhance stress reduction among caregivers of children with DBDs in the long-term.