SSM. Mental health最新文献

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.

Background

Worldwide, approximately 64 million people are living with serious mental illnesses (SMI), such as schizophrenia and bipolar disorder. Because community perceptions and attitudes can impact help-seeking and the course of illness, understanding and incorporating these perspectives, and addressing misconceptions and harmful attitudes, is a critical component of comprehensive mental health support. These concepts are deeply rooted in local culture and belief systems, yet research to provide local understanding is often lacking, particularly in low- and middle-income countries.

Objective

The aim of this study was to assess relative caregivers' and other key community members’ perceptions and attitudes towards people with SMI in Cambodia.

Methods

A brief survey that included open-ended assessment of mental health knowledge and beliefs was interviewer-administered to 115 relative caregivers of people with SMI. Additionally, 20 community members considered knowledgeable about mental health (e.g., traditional healers, local authorities, family caregivers) participated in semi-structured qualitative interviews that explored perceptions and attitudes toward SMI in Cambodia.

Results

Participants included 56 men and 79 women. While respondents were able to identify signs and symptoms of SMI, the most commonly perceived causes were spiritual (e.g., spells, ghosts); family crisis (e.g., domestic violence); and physical health problems. Both respondent groups showed empathy for people with SMI (e.g., pity) but also reported feelings of fear and shame (e.g., perceived tendency toward violence and not wanting to live with such a person).

Conclusion

Both caregivers likely to seek help and respected local figures likely to be involved in initial help-seeking efforts demonstrated limited understanding of SMI as a medical disorder suitable for management within the formal healthcare system. Commonly reported misperceptions are likely to lead to delayed access to care and poorer treatment within the community. Strengthening mental health knowledge among caregivers and key community leaders may hold promise for improving peer support and community referral pathways.

The calls to eliminate restrictive practices (e.g., seclusion and physical restraint) from mental health care services have been gaining momentum over time and have been one of the many issues at the forefront of international mental health care systems. Whilst it is known that restrictive practices are often harmful and traumatic for the mental health service user, there is a lack of synthesis of the factors that are influencing restrictive practices’ ultimate reduction and elimination from the perspective of mental health service users and practitioners. The aim of this research was to conduct a qualitative evidence synthesis of the literature regarding the perceptions and experiences of mental health service users and practitioners about restrictive practices in mental health care services. A systematic search and inclusion strategy identified 44 relevant articles for review. Inductive thematic synthesis resulted in five themes across the articles: (1) Meaning and emotional experience, (2) Re-traumatisation and dehumanisation, (3) Professional competencies and varying experiences, (4) Balancing safety versus care, and (5) Alternatives to restrictive practices. Discussion of these themes highlighted the many layered and often uncomfortable nature of restrictive practices which can pervade mental health facilities across the world.

Post-rape research and support often focuses on external stigma, yet many rape survivors experience appreciable shame, self-blame and internalized-stigma. Despite a growing literature describing the impact of these feelings on survivors' emotional wellbeing, there has been little research on this in South Africa, where an average of 40,000 rape cases are reported annually. To strengthen our understanding of female rape survivors' experiences and perceptions of shame, self-blame and internalized-stigma, we undertook qualitative research with 16 survivors in eThekwini, South Africa. They participated in 2–3 in-depth and life history interviews, that sought to enable them to express how they made meaning of post-rape internalized-stigma, shame and self-blame, and how these may have influenced their psychological reactions to rape. The paper describes the women's experiences and reactions to the rape and reflects on how their descriptions contribute to theoretical perspectives on shame, self-blame and internalized-stigma. The women expressed feelings of shame, self-blame, and internalized-stigma, describing these as distinct, yet inter-connected. These feelings were a reaction to views expressed by family, community members and service providers, their relationship to the perpetrator, the extent of gossip about the incident and gender norms and rape myths. Furthermore, while the stigma was felt at an individual level, it was driven by external stigma enacted at interpersonal and structural/community levels. Women who had experienced more than one rape, explained this through the internally-stigmatizing notion of being ‘rape-able’. This study addresses a significant knowledge gap which could improve contextually appropriate post-rape care services and interventions in South Africa, particularly psychological support for survivors. Finally, while rape survivors should be supported to address their own shame, self-blame and internalized-stigma, external stigma needs to be addressed at interpersonal and structural levels.

Rising rates of youth anxiety, depression, and suicide mean that pediatricians are increasingly likely to encounter children struggling with their mental health in their clinical practices. Despite pediatric professional organizations encouraging pediatricians to contribute more to mental healthcare and suicide prevention, research on the role of pediatricians and whether families consider them a resource is limited. Drawing on original survey (N = 1230) and interview data (N = 102), we investigate how families conceptualize and involve pediatricians in their children’s mental healthcare, including during suicidal crises. Our survey data show that while families considered mental health professionals the ideal point of contact, pediatricians were a close second, confirming that families view pediatricians as a mental health resource. Parent interviews clarify that parents most often turn to pediatricians for medication and referrals to other mental health professionals or because mental health professionals were inaccessible. We also examine how pediatricians helped (by connecting families promptly to appropriate care) or hurt (by stigmatizing suicide or by providing interventions associated with harm) during a child’s suicidal crisis. We conclude by emphasizing the importance of proper suicide prevention training for pediatricians, as well as suggesting directions for future research.