SSM. Mental health最新文献

Though mental distress poses a large and growing threat to population health, our understanding of how its social distribution has changed over time and what these changes imply for mental health equity is limited. To address this, we use data from the Behavioral Risk Factor Surveillance System to non-parametrically describe how age-standardized prevalence of frequent mental distress (FMD) and social inequities in FMD have changed in the United States between 1993 and 2019 for intersectional social groups defined by ethnicity, race, sex, educational attainment, and household poverty status. We find that age-standardized FMD prevalence has increased for almost all social groups, that health inequities between more and less privileged groups have mostly widened in absolute terms but narrowed relatively, and that relying solely on common group FMD summaries masks substantial heterogeneity across intersectional subgroups. Our findings show an urgent need to address the sociopolitical determinants of mental distress, prioritizing policies which would address the growing inequitable burden experienced by those less privileged.

We critically examine how biological narratives of mental illness mediate relations between personal experiences and socio-structural conditions of distress in crisis contexts. Using three case studies of contemporary crises in Russia, the Republic of Cameroon, and Bangladesh, we showcase the ways in which biological meanings of mental illness carry political and structural significance as authorities employ “biologization” for political ends. In Russia, biologization is strategically useful to authorities seeking to control a populace, as chronic “conditions” can be “treated” indefinitely. In Cameroon, state psychiatrists in Yaoundé incentivize patient citizenship through biological frameworks of illness and intervention. In Bangladesh, the embodied presence of Rohingya refugees is a medium by which they can engage politically; therapeutic intervention becomes a site of political consensus in which Rohingya enact a “fictive biological citizenship.” Biologization of mental illness forms a basis for reinforcing or challenging the power of the state and the meaning of citizenship in distinct ways across these three contexts, highlighting the importance of attending to its political implications as it is invoked in frameworks of diagnosis, explanation, prognosis, and treatment in global contexts of ostensible crisis.

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”.