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Implementation, sustainability, and impact of Common Elements Treatment Approach in Ugandan healthcare facilities 共同要素治疗方法在乌干达保健设施中的实施、可持续性和影响
IF 2.6 Q1 PSYCHIATRY Pub Date : 2025-12-01 DOI: 10.1016/j.ssmmh.2025.100569
Amanda P. Miller , Gertrude Nakigozi , Emma Menya , Caleb Figge , Hafsa Lukwata , William Byansi , Stephen Mugamba , Doreen Tuhebwe , Laura Murray , Fred Nalugoda , Stephen Watya , George William Ddaaki , Alex Daama , Robert Bulamba , James Nkale , Emma Kyasanku , Godfrey Kigozi , Grace Kigozi , Susan M. Kiene
The health and social consequences of untreated mental health disorders and heavy alcohol use are substantial, particularly in settings with high HIV-prevalence. Transdiagnostic approaches may offer a more efficient public health response, particularly where behavioral health services are limited. The present study explored the implementation of Common Elements Treatment Approach (CETA), a transdiagnostic intervention, in Western Uganda, from the perspectives of multilevel stakeholders. One-on-one in-depth interviews with multilevel stakeholders involved in the rollout of CETA in Uganda were conducted (n = 20) including Ministry of Health officials (n = 2), CETA trainers (n = 2), clinic managers (n = 5), and frontline providers (n = 11) involved in the rollout of CETA. Data were thematically analyzed and organized using the Consolidated Framework for Implementation Research (CFIR 2.0). Key themes that emerged, organized by CFIR 2.0 domain and construct, included the acceptability and perceived need for CETA (and its perceived advantages over existing behavioral health services), the importance of expanding CETA beyond healthcare facilities into communities (through a task-shifting approach that leverages community health workers) to reduce provider fatigue and eliminate transportation related barriers to patient retention, and the necessity of building in-country capacity to support long-term sustainability and the train-the-trainer apprenticeship model. This qualitative implementation assessment provides suggestions for optimization of CETA delivery for this context in future implementation. Rigorous testing of CETA is needed to examine both implementation and effectiveness outcomes in Uganda.
未经治疗的精神疾患和酗酒会造成严重的健康和社会后果,特别是在艾滋病毒高流行的环境中。跨诊断方法可能提供更有效的公共卫生反应,特别是在行为卫生服务有限的地方。本研究从多层次利益相关者的角度探讨了共同要素治疗方法(CETA)在乌干达西部的实施,这是一种跨诊断干预。对参与乌干达CETA推广的多层次利益相关者进行了一对一的深入访谈(n = 20),包括卫生部官员(n = 2)、CETA培训师(n = 2)、诊所管理人员(n = 5)和参与CETA推广的一线提供者(n = 11)。使用实施研究统一框架(CFIR 2.0)对数据进行主题分析和组织。由CFIR 2.0领域和结构组织的关键主题包括对CETA的可接受性和感知需求(及其对现有行为健康服务的感知优势),将CETA从医疗设施扩展到社区的重要性(通过利用社区卫生工作者的任务转移方法),以减少提供者疲劳并消除与患者保留相关的交通障碍,以及建设国内能力以支持长期可持续性和培训师培训模式的必要性。这种定性的实施评估为在未来的实施中优化CETA的交付提供了建议。需要对CETA进行严格测试,以审查乌干达的执行情况和有效性结果。
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引用次数: 0
Transforming mental health care in Kenya: The critical role of routine outcomes monitoring in specialized services 肯尼亚精神卫生保健的变革:常规结果监测在专业服务中的关键作用
IF 2.6 Q1 PSYCHIATRY Pub Date : 2025-12-01 DOI: 10.1016/j.ssmmh.2025.100570
Clara Paz , Anne A. Obondo , Ian Kanyanya , Caleb Othieno , Manasi Kumar
This short communication advocates for the strategic implementation of Routine Outcome Monitoring (ROM) systems within Kenya's specialized mental health institutions, especially teaching and referral hospitals. The proposed shift aims to transform these institutions into learning health systems, dynamic structures that systematically capture and utilize data from everyday clinical practice to drive continuous improvement in care quality, accountability, and population mental health outcomes. Kenya's mental health system, while advancing in policy and infrastructure, still faces a critical gap in routine, data-driven practices that support outcome-based care. ROM offers a practical and scalable solution to bridge this divide.
We emphasize that this transition requires more than technological adoption. It demands a systemic reorientation: establishing digital standards for outcome tracking, allocating protected time for data reflection, strengthening referral pathways, and aligning local practices with national health indicators. These changes can help institutions become national exemplars, where evidence from clinical encounters informs policy, enhances training, and fosters research capacity.
ROM is framed not as a technical add-on but as a transformative tool capable of reshaping how care is delivered, evaluated, and improved over time. It can anchor Kenya's mental health care in real-time learning, ensuring that services adapt responsively to the needs of patients and communities. With political will, stakeholder collaboration, and thoughtful implementation, Kenya has the opportunity to lead among LMICs in establishing a mental health system that is evidence-informed, equitable, and sustainable.
这种简短的沟通倡导在肯尼亚的专业精神卫生机构,特别是教学和转诊医院内战略性地实施常规结果监测(ROM)系统。拟议的转变旨在将这些机构转变为学习型卫生系统,即系统地捕获和利用来自日常临床实践的数据的动态结构,以推动护理质量、问责制和人口心理健康结果的持续改进。肯尼亚的精神卫生系统虽然在政策和基础设施方面取得了进展,但在支持基于结果的护理的常规、数据驱动的实践方面仍面临重大差距。ROM提供了一种实用且可扩展的解决方案来弥合这一鸿沟。我们强调,这一过渡需要的不仅仅是采用技术。它要求进行系统的重新定位:为结果跟踪建立数字标准,为数据反思分配受保护的时间,加强转诊途径,并使地方做法与国家卫生指标保持一致。这些变化可以帮助机构成为国家典范,从临床经验中获得的证据为政策提供信息,加强培训,并促进研究能力。ROM不是作为一种技术附加,而是作为一种变革性工具,能够随着时间的推移重塑护理的交付、评估和改进方式。它可以将肯尼亚的精神卫生保健固定在实时学习中,确保服务能够响应患者和社区的需求。有了政治意愿、利益攸关方合作和周到的实施,肯尼亚有机会在中低收入国家中率先建立循证、公平和可持续的精神卫生系统。
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引用次数: 0
From Trauma to Resilience to Peace? Charting resilient and pluralistic paths forward in post-civil war Sri Lanka 从创伤到复原再到和平?为内战后的斯里兰卡规划了富有弹性和多元化的前进道路
IF 2.6 Q1 PSYCHIATRY Pub Date : 2025-12-01 DOI: 10.1016/j.ssmmh.2025.100509
Eranda Jayawickreme, Nuwan Jayawickreme
This introductory editorial for the special issue, “From Trauma to Resilience to Peace? Charting Paths Forward in Post-Civil-War Sri Lanka,” synthesizes six distinct contributions to map the island's psychosocial landscape in the sixteen years since the end of the civil war. Quantitative and qualitative examinations demonstrates that wartime violence, chronic economic stressors, and political volatility continue to impact mental health, while maternal narratives highlight the trans-generational impact of the war. Yet these investigations also reveal some hopeful possibilities for promoting resilience using tools such as spiritual coping, social-capital buffers, and practitioner ingenuity. New directions include targeted clinical care and social-protection policies combined with transitional-justice safeguards and community-based pluralism initiatives. Together, these articles make the case that sustainable peace must be both psychosocial and political, anchoring mental health recovery in both material security and engaged inter-ethnic and inter-religious coexistence.
这篇特刊的导论社论题为“从创伤到恢复到和平?”《绘制内战后斯里兰卡的前进道路》综合了六个不同的贡献,描绘了内战结束后16年里这个岛屿的社会心理景观。定量和定性检查表明,战时暴力、长期经济压力和政治动荡继续影响心理健康,而母亲的叙述则强调了战争的跨代影响。然而,这些调查也揭示了利用精神应对、社会资本缓冲和实践者的独创性等工具来提高弹性的一些有希望的可能性。新的方向包括有针对性的临床护理和社会保护政策,结合过渡司法保障措施和基于社区的多元化倡议。这些条款共同说明,可持续和平必须既是社会心理和平,也是政治和平,将精神健康康复置于物质安全之中,并促进种族间和宗教间共存。
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引用次数: 0
Between compassion and control: nursing ethos, professional responsibilities, limited resources, and the use of psychotropic drugs in dementia care 在同情和控制之间:护理精神,专业责任,有限的资源,以及痴呆症护理中精神药物的使用
IF 2.6 Q1 PSYCHIATRY Pub Date : 2025-11-29 DOI: 10.1016/j.ssmmh.2025.100568
Niklas Petersen
The widespread use of psychotropic medication in long-term care, especially antipsychotics for managing dementia-related behaviours, is controversial due to serious side effects, significant risks, and increased mortality rates. While prescribing authority lies with physicians, nurses often demand treatment and administer as-needed medications at their discretion. This study discusses the ongoing reliance on antipsychotics within the context of structural tensions between person-centred nursing values, multiple professional responsibilities, and resource constraints in long-term care facilities. Drawing on in-depth qualitative interviews with 15 nurses across seven German nursing homes, the study reveals diverse ways in which nursing staff navigate the use of psychotropic medication in dementia care. While nurses' self-descriptions and explicit ethos are framed in humanistic terms – addressing individual needs, promoting health and preserving functional capacities of those in need of care – they also feel responsible for protecting other residents and maintaining organisational stability in the care facilities. While some nurses still try to uphold their person-centred care ethos, seek to resist the rationing of care, and strongly oppose excessive sedation, others set aside their compassionate nursing values in everyday care and rationalise psychotropic medication for managing dementia-related behaviours as a matter of organisational necessity. Moving beyond individualised explanations for the overuse of psychotropic drugs, this study discusses the practices of pharmacological behaviour control as part of a pharmaceuticalisation of dementia care and as emblematic of the broader social-political governance of ageing and dementia.
在长期护理中广泛使用精神药物,特别是用于控制痴呆症相关行为的抗精神病药物,由于严重的副作用、重大风险和死亡率增加而引起争议。虽然处方权属于医生,但护士经常要求治疗,并根据需要酌情给药。本研究讨论了长期护理机构在以人为本的护理价值观、多重专业责任和资源限制之间的结构性紧张关系背景下对抗精神病药物的持续依赖。通过对7家德国养老院的15名护士进行深入的定性访谈,该研究揭示了护理人员在痴呆症护理中使用精神药物的多种方式。虽然护士的自我描述和明确的精神是以人文主义的方式构建的——解决个人需求,促进健康和保持需要护理的人的功能能力——但她们也感到有责任保护其他居民和维持护理机构的组织稳定。虽然一些护士仍然试图坚持以人为本的护理精神,试图抵制护理配给,并强烈反对过度镇静,但其他人在日常护理中搁置了他们富有同情心的护理价值观,并将精神药物合理化,以管理与痴呆症相关的行为,作为组织必要性的问题。除了对过度使用精神药物的个体化解释之外,本研究还讨论了药理学行为控制的实践,作为痴呆症护理药物化的一部分,并作为老龄化和痴呆症的更广泛的社会政治治理的象征。
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引用次数: 0
Access to somatic healthcare for people with lived experience of mental health conditions in Austria: A trialogic participatory action research study 在奥地利,有精神健康状况生活经历的人获得躯体保健:一项试验参与性行动研究
IF 2.6 Q1 PSYCHIATRY Pub Date : 2025-11-19 DOI: 10.1016/j.ssmmh.2025.100566
Tobias Fragner , Christopher Tupy , Lisa Kainzbauer , Lisa Lehner , Magdalena Eitenberger , Joy Ladurner , Igor Grabovac
People with lived experience of mental health conditions (PWLE) encounter significant obstacles when accessing somatic healthcare services, contributing to higher morbidity and reduced life expectancy compared to the general population. This research sought to identify the barriers and facilitators that PWLE face in accessing and using somatic healthcare in Austria, with the goal of co-creating strategies to address current challenges. Employing a participatory action research approach from the conceptualization and grant-writing stages and reflecting the principles of “mental health trialogue,” this study involved a steering committee composed of a person with lived experience, a family member of PWLE, and a healthcare professional. Based on World Café methodology, two co-creation workshops fostered open dialogue and collaboration among participants representing these three perspectives. Data were gathered through participant observation and systematic collection of workshop contributions, which were thematically analyzed. A total of 52 participants, with 27 in the first and 25 in the second workshop, contributed to the study. Six overarching themes were derived: (1) Awareness among healthcare professionals; (2) Accessibility and health facility design; (3) Structural diversity of services; (4) Lack of care coordination; (5) Bureaucracy and material support; and (6) Societal awareness. Findings underscore the need for systemic changes to address diagnostic overshadowing in somatic healthcare services, particularly through the design of more inclusive services and the expansion of networking between and within PWLE and their caregivers. Aiming to achieve health equity, this study provides specific policy and practice pathways to counter diagnostic overshadowing and ensure PWLEs’ somatic health needs are adequately addressed.
有精神健康状况生活经历的人在获得躯体保健服务时遇到重大障碍,与一般人群相比,这导致了更高的发病率和更短的预期寿命。这项研究旨在确定奥地利残疾人在获得和使用身体保健方面面临的障碍和促进因素,目的是共同制定战略,以应对当前的挑战。本研究采用参与式行动研究方法,从概念和拨款撰写阶段开始,并反映了“精神健康三方对话”的原则,涉及一个指导委员会,该委员会由一位有生活经验的人、一位残疾人家庭成员和一位医疗保健专业人员组成。基于世界咖啡馆的方法,两个共同创作研讨会促进了代表这三个观点的参与者之间的公开对话和合作。通过参与观察和系统收集讲习班贡献来收集数据,并对其进行主题分析。共有52名参与者参与了这项研究,其中27人参加了第一次研讨会,25人参加了第二次研讨会。得出了六个总体主题:(1)卫生保健专业人员的意识;(2)无障碍和卫生设施设计;(3)服务业结构多样性;(4)缺乏护理协调;(5)官僚主义和物质支持;(6)社会意识。研究结果强调需要进行系统性改革,以解决躯体保健服务中诊断的阴影问题,特别是通过设计更具包容性的服务和扩大残疾人及其护理人员之间和内部的网络。为了实现健康公平,本研究提供了具体的政策和实践途径,以对抗诊断阴影,并确保残疾人的身体健康需求得到充分解决。
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引用次数: 0
Adverse migration experiences, border community stress, and the mental health of asylum-seeking women in transit at the Mexico-U.S. border 在墨西哥-美国过境的寻求庇护妇女的不利移民经历、边境社区压力和心理健康。边境
IF 2.6 Q1 PSYCHIATRY Pub Date : 2025-11-19 DOI: 10.1016/j.ssmmh.2025.100567
Shira M. Goldenberg , Kayla Saadeh , Kaylee Ramage , Eileen Pitpitan , Steffanie Strathdee , Monica Álvarez Aguilar , Nicole Elizabeth Ramos , Gudelia Rangel , Ietza Bojorquez
We evaluated the association between adverse migration experiences, border community stress, and mental health symptoms in a community-recruited sample of asylum-seeking women. As part of a mixed-methods, community-academic partnership, we analyzed cross-sectional questionnaires conducted with asylum-seeking women at the Tijuana-San Diego border (N = 151) between Feb–July 2024. Symptoms of anxiety (56.6 %), moderate-to-severe depression (45.9 %), and post-traumatic stress (52 %) were common, with 70.1 % experiencing symptoms of at least one of these. Most (82.1 %) faced adverse experiences during migration journey and high levels of current border community stress. When we examined the relationship between each type of adverse migration experience and mental health symptoms, lack of safe shelter during migration was marginally associated with experiencing current generalized anxiety symptoms, whereas other types of adverse experiences had positive, but null, associations. Higher border community stress was associated with experiencing generalized anxiety, depression, and PTSD symptoms. Asylum-seeking women at the Mexico-U.S. border face significant mental health risks during migration and while waiting to enter the U.S. Structural and multilevel interventions to mitigate these are needed, including changes to asylum deterrence policies and scale-up of humanitarian services.
我们在社区招募的寻求庇护妇女样本中评估了不良移民经历、边境社区压力和心理健康症状之间的关系。作为混合方法的一部分,我们分析了2024年2月至7月期间在蒂华纳-圣地亚哥边境(N = 151)对寻求庇护的妇女进行的横断面问卷调查。焦虑(56.6%)、中度至重度抑郁(45.9%)和创伤后应激(52%)的症状很常见,其中70.1%至少有其中一种症状。大多数人(82.1%)在移民过程中面临不利经历,目前边境社区压力很大。当我们检查每种类型的不良迁移经历与心理健康症状之间的关系时,迁移期间缺乏安全庇护所与当前的广泛性焦虑症状有轻微关联,而其他类型的不良经历有积极的关联,但没有关联。较高的边境社区压力与经历广泛性焦虑、抑郁和创伤后应激障碍症状有关。在美墨边境口岸寻求庇护的妇女。边境人员在移民期间和等待进入美国期间面临严重的心理健康风险,需要采取结构性和多层次的干预措施来减轻这些风险,包括改变庇护威慑政策和扩大人道主义服务。
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引用次数: 0
Mealtime practices in the treatment of restrictive eating disorders: an ethnographic study of Norwegian youth psychiatric units 进餐时间的做法在治疗限制性饮食失调:挪威青年精神病学单位的人种学研究
IF 2.6 Q1 PSYCHIATRY Pub Date : 2025-11-07 DOI: 10.1016/j.ssmmh.2025.100564
Tone Jørgensen , Trine Brinkmann , Ann-Karina E. Henriksen , Esben S.B. Olesen
Youths with restrictive eating disorders can be admitted to voluntary and involuntary treatment in acute psychiatric units for children and adolescents when their need for help is urgent or there is an emergency situation related to their vital functions. Providing sufficient nutrition for these patients is a key focus in treatment plans, making meal planning and calorie intake an essential part of the treatment. This article examines mealtime practices in the treatment of restrictive eating disorders at child and adolescent psychiatric acute hospitals in Norway. The analysis shows a complex interplay between treatment and coercion, where coercion underpins and ultimately ensures treatment compliance. The study contributes to the limited literature on coercion in inpatient child and adolescent psychiatry, and findings call for critical reflection to advance new ways of enforcing nutritional intake for patients with eating disorders admitted to involuntary treatment.
The analysis is based on ethnographic fieldwork conducted across three acute units in Norway. Drawing on Goffman's perspectives on frame analysis and his dramaturgical approach to social interaction, we examine how the establishment of frames in eating situations produces different meanings for this treatment activity. In our analysis, we demonstrate how three different frames (a biomedical therapeutic frame, a coercion frame, and a mealtime frame) constitute and regulate interactional behaviour in eating situations, and how participants negotiate these frames. It is argued that treatment and coercion are entangled in the routine treatment activity of meals, which makes coercion omnipresent in the treatment of restrictive eating disorders.
患有限制性饮食失调症的青少年可以在儿童和青少年急症精神科接受自愿和非自愿治疗,如果他们需要紧急帮助,或者遇到与他们的重要功能有关的紧急情况。为这些患者提供足够的营养是治疗计划的重点,使饮食计划和卡路里摄入成为治疗的重要组成部分。这篇文章检查了在挪威儿童和青少年精神病急性医院治疗限制性饮食失调的用餐时间做法。分析显示了治疗和强制之间复杂的相互作用,其中强制支持并最终确保治疗依从性。这项研究对住院儿童和青少年精神病学强制治疗的有限文献有所贡献,研究结果呼吁进行批判性反思,以推进对接受非自愿治疗的饮食失调患者强制营养摄入的新方法。该分析是基于在挪威的三个急性单位进行的人种学田野调查。借鉴戈夫曼对框架分析的观点和他对社会互动的戏剧方法,我们研究了在进食情境中框架的建立如何为这种治疗活动产生不同的意义。在我们的分析中,我们展示了三种不同的框架(生物医学治疗框架,强制框架和用餐时间框架)如何构成和调节饮食情境中的互动行为,以及参与者如何协商这些框架。有人认为,治疗和强迫在日常饮食治疗活动中纠缠在一起,这使得强迫在限制性饮食失调的治疗中无处不在。
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引用次数: 0
Rethinking water insecurity's relationship to mental health: Evidence from Iran indicates positive emotions also matter 重新思考水不安全与心理健康的关系:来自伊朗的证据表明,积极情绪也很重要
IF 2.6 Q1 PSYCHIATRY Pub Date : 2025-11-07 DOI: 10.1016/j.ssmmh.2025.100563
Seyed Ahmad Mir Mohamad Tabar , Alexandra Brewis , Mahmod Teimouri , Maryam Sohrabi
This study examines how water-related emotions explain differences in mental health outcomes associated with household water insecurity, based on randomized sampling of 685 households in 2024 in a severely water-stressed region of Iran. This extends current water insecurity research by empirically testing both negative and positive emotional mediators of mental health outcomes. In response to recent calls for better means to capture water-related emotional valences we first develop and validate a novel adaptation of the PANAS scale. Using structural equation modeling, we then are able to confirm that negative water-related emotions (such as anger and shame) mediate the relationship between household water insecurity and mental health, with stronger negative emotional responses linked to heightened depression/anxiety. However, positive water-related emotions (such as gratitude and hope) also independently predict better mental health. This suggests a novel dual-pathway model. Contrary to expectations, gender does not significantly moderate these relationships, likely due to context-specific gender roles through which men and women share household water management responsibilities. Overall, our findings emphasize the need for more nuanced models that link the lived experience of water insecurity with emotion and mental health, including consideration of the potential role of positive emotions.
本研究基于2024年伊朗严重缺水地区685户家庭的随机抽样,探讨了与水有关的情绪如何解释与家庭用水不安全相关的心理健康结果差异。通过实证测试心理健康结果的消极和积极情绪中介,扩展了当前的水不安全研究。为了响应最近对更好地捕捉与水有关的情感效价的呼吁,我们首先开发并验证了一种新的PANAS量表。利用结构方程模型,我们能够证实与水有关的负面情绪(如愤怒和羞耻)介导了家庭用水不安全和心理健康之间的关系,更强烈的负面情绪反应与加剧的抑郁/焦虑有关。然而,与水有关的积极情绪(如感激和希望)也独立预示着更好的心理健康。这提示了一种新的双途径模型。与预期相反,性别并没有显著调节这些关系,这可能是由于男性和女性分担家庭用水管理责任的特定背景下的性别角色。总的来说,我们的研究结果强调需要更细致入微的模型,将水不安全的生活经历与情绪和心理健康联系起来,包括考虑积极情绪的潜在作用。
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引用次数: 0
The costs, outcomes and returns on investment of a package of intersectoral interventions for mental, neurological, and substance-use disorders, and intellectual disabilities in South Africa 南非精神、神经和物质使用障碍以及智力残疾一揽子部门间干预措施的成本、结果和投资回报
IF 2.6 Q1 PSYCHIATRY Pub Date : 2025-11-07 DOI: 10.1016/j.ssmmh.2025.100560
Donela Besada , Sumaiyah Docrat , Barbara Barrett , Crick Lund
South Africa faces a significant burden from mental, neurological, and substance-use (MNS) conditions, with a substantial treatment gap that hampers the country's progress toward universal health coverage (UHC). Despite National Health Insurance (NHI) reforms, equity in access, affordability and preparedness remain concerns. The South African Mental Health Investment Case (MHIC) was commissioned to evaluate the costs and benefits of implementing mental health interventions over a 15-year period to inform national planning and budgeting. The analysis incorporated a comprehensive stakeholder consultation process including a Delphi study for expert consensus and uses the WHO Inter-UN OneHealth Tool and Excel-based modelling to estimate health and economic benefits.
The MHIC estimates substantial economic and social returns, particularly for interventions targeting common mental health conditions, with benefit to cost ratios of 4.0 and 3.6 to 1 for adult and childhood depression, 4.7 to 1 for perinatal depression and 1.5 and 0.6 to 1 for adult and childhood anxiety, respectively. The total investment needed represents approximately 11.6 % of the current health budget and aligns with recommended international norms for mental health funding. The cost of inaction is significant, unaddressed MNS conditions could cost South Africa 4 % of its GDP annually. The MHIC highlights the value of early prevention programs, including school-based interventions and targeted psychosocial support, which could avert prevalent cases and enhance productivity. By reallocating resources towards primary and community-based care, the MHIC advocates for an efficient and sustainable approach aligned with South Africa's UHC goals, emphasizing the critical need for intersectoral collaboration.
南非面临着精神、神经和药物使用(MNS)疾病带来的沉重负担,巨大的治疗缺口阻碍了该国在实现全民健康覆盖(UHC)方面取得进展。尽管进行了国民健康保险改革,但在获取、负担能力和准备方面的公平性仍然令人担忧。委托南非精神卫生投资案例(MHIC)评估在15年期间实施精神卫生干预措施的成本和收益,为国家规划和预算编制提供信息。该分析纳入了一个全面的利益攸关方协商进程,包括征求专家共识的德尔菲研究,并使用世卫组织联合国间“一个健康”工具和基于excel的建模来估计健康和经济效益。MHIC估计,这将带来巨大的经济和社会回报,特别是针对常见心理健康状况的干预措施,对成人和儿童抑郁症的效益成本比分别为4.0和3.6比1,对围产期抑郁症的效益成本比为4.7比1,对成人和儿童焦虑症的效益成本比分别为1.5和0.6比1。所需的总投资约占当前卫生预算的11.6%,并符合建议的精神卫生供资国际规范。不作为的代价是巨大的,未解决的MNS条件可能使南非每年损失其国内生产总值的4%。MHIC强调了早期预防规划的价值,包括以学校为基础的干预措施和有针对性的社会心理支持,这可以避免流行病例并提高生产力。通过将资源重新分配给初级保健和基于社区的保健,卫生保健委员会倡导采取符合南非全民健康覆盖目标的有效和可持续的方法,强调部门间合作的迫切需要。
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引用次数: 0
Within and between person effects of structural stigma, support, and concealment on internalized stigma: A 7-year longitudinal study in a sample of same-sex couples 结构性耻辱感、支持和隐藏对内化耻辱感的影响:一项针对同性伴侣样本的7年纵向研究
IF 2.6 Q1 PSYCHIATRY Pub Date : 2025-11-07 DOI: 10.1016/j.ssmmh.2025.100558
Josh Nguyen , Timothy J. Cronin , Sophie Marsland , Joel R. Anderson , Christopher A. Pepping

Background

Sexual minority individuals continue to experience significantly higher levels of mental ill health than heterosexual people due to ongoing exposure to sexual minority stressors. Internalized sexual stigma is a key driver of negative mental health outcomes among sexual minority individuals and couples, yet few longitudinal studies have examined how internalized stigma changes over time and its antecedents. This study examined (1) the seven-year trajectory of internalized stigma, and (2) the effect of structural discrimination, friend and family support for relationship, and concealment on changes in internalized stigma at both within-person and between-person levels.

Methods

We used linear mixed effects models in a sample of 660 sexual minority adults (n = 330 same-sex couples; Mage = 39.5 years, SD = 10.8) who were assessed annually over seven years.

Results

Results showed that internalized stigma remained stable over time. There were significant between-person effects of structural stigma, friend support, and concealment on internalized stigma over time, suggesting that those who, on average, report greater structural stigma and concealment, and lower support from friends, tend to report higher internalized stigma over time. There were significant within-person effects of concealment on internalized stigma at the same timepoint, indicating that when individuals conceal their sexual identity more than usual, they are also more likely to report higher internalized stigma. There was no lagged within-person association between concealment and internalized stigma. There were no within-person effects of friend or family support on internalized stigma at the same or following timepoint.

Conclusions

These findings highlight the importance of examining individual, social and structural drivers of internalized stigma over time. This research has important implications for developing effective interventions to reduce minority stress and improve mental health among sexual minority individuals.
背景:由于持续暴露于性少数群体的压力源,性少数群体的心理健康状况明显高于异性恋者。内化的性耻辱感是性少数个体和夫妻负面心理健康结果的关键驱动因素,但很少有纵向研究调查内化的耻辱感是如何随时间变化的及其前因后果。本研究考察了(1)内化耻辱感的7年发展轨迹;(2)结构性歧视、朋友和家庭对关系的支持以及隐瞒对内化耻辱感在人内和人间水平变化的影响。方法采用线性混合效应模型对660名性少数成年人(n = 330对同性伴侣;Mage = 39.5年,SD = 10.8)进行了为期7年的年度评估。结果内化病耻感随时间的推移保持稳定。随着时间的推移,结构性耻辱感、朋友支持和隐蔽性对内化耻辱感有显著的人际效应,这表明那些平均而言,结构性耻辱感和隐蔽性较高,朋友支持较低的人,随着时间的推移,往往会报告较高的内化耻辱感。在同一时间点,隐藏性取向对内化污名有显著的人内效应,这表明当个体比平时更多地隐藏自己的性取向时,他们也更有可能报告更高的内化污名。在隐藏和内化耻辱之间没有滞后的人际关系。在同一或随后的时间点上,朋友或家庭支持对内化耻辱没有个人影响。这些发现强调了随着时间的推移,检查内化耻辱的个人、社会和结构驱动因素的重要性。本研究对制定有效的干预措施以减轻性少数群体压力和改善性少数群体的心理健康具有重要意义。
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引用次数: 0
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SSM. Mental health
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