SSM. Mental health最新文献

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.

Water insecurity and other social-ecological factors may be associated with depression in low and middle-income contexts (LMICs). This is understudied among urban refugee youth in LMICs, who experience multiple forms of marginalization. We conducted a cross-sectional survey with a peer-driven sample of urban refugee youth aged 16–24 in Kampala, Uganda. We explored: the prevalence of depression (moderate, moderately severe); associations between social-ecological (structural, community, interpersonal, intrapersonal) factors and depression; and associations between an Index of Vulnerability (IoV) comprised of social-ecological stressors and depression. Among n = 335 participants (mean age: 20.8 years, standard deviation: 3.1), in multivariable analyses, longer time in Uganda, water insecurity, lower social support, parenthood, and recent intimate partner violence were associated with moderate depression; and longer time in Uganda, water insecurity, and lower social support were associated with moderately severe depression. IoV scores were associated with moderate depression among men and women, and moderately severe depression among women. The IoV scores accounted for more variance in moderate/moderately severe depression among women than any single indicator; among men, water insecurity was most strongly associated with moderate depression. Future research can explore strategies to address water insecurity and other social-ecological stressors to promote health and wellbeing with urban refugee youth.

Bipolar disorder has risen in prominence in recent years, arguably in part through its association with various celebrities and positive related attributes such as creativity. The category itself has also widened with increasing numbers seeking out the diagnosis. Drawing upon observations of a psychoeducation programme for bipolar disorder and semi-structured interviews with those diagnosed, this paper considers the role of diagnostic prestige and essentialism in shaping identificatory practices surrounding bipolar disorder. The data suggests that bipolar comes to fulfil a meaningful explanatory role for participants, providing an important sense of group belonging and identity.This tendency to positively relate to bipolar in order to promote social cohesion and positive self-understandings is linked to the practice of ‘strategic essentialism’ (Spivak, 1990; Voronka, 2017), whereby category homogeneity is emphasised. The benefits associated with the diagnosis arguably encourage boundary making and homogenisation in order to prevent category dilution and loss of meaning. As such, while essentialism can be helpful in maintaining group cohesion, it is also associated with diagnostic possessiveness, whereby individuals undermine the diagnostic claims of others, creating divisions between those with and without the diagnosis.

Background

Gun violence is a global public health concern that has significant implications for mental health. This systematic review aims to synthesize the existing literature on the mental health consequences of interpersonal gun violence.

Methods

A comprehensive search was conducted across PubMed, PsycInfo, and Web of Science databases to identify relevant studies published up to December 15, 2023. Studies were included if they documented the mental health impact of interpersonal gun violence. The data extraction process included information on study design, population characteristics, exposure to gun violence, mental health indicators, and measurement instruments.

Results

A total of 58 studies were included in the review. The studies varied in design, population, and mental health indicators assessed. We found that exposure to interpersonal gun violence was significantly associated with increased reports of post-traumatic stress disorder, depressive symptoms, and substance use. We also found that interpersonal gun violence exposure was associated with increased disruptive behaviors and the likelihood of gun carrying especially among adolescents. Further, those closer to the interpersonal gun violence consistently reported more adverse mental health consequences than persons less centrally involved. The review also highlighted limitations in the current literature, including a narrow focus on certain mental health indicators and a paucity of studies from countries other than the US.

Conclusion

The consequences of interpersonal gun violence extend beyond immediate physical injury to include enduring mental health impacts. This review also highlights the need for further research to better understand the impact of gun violence on mental health.

Epidemiological studies conducted in high-income countries have shown that immigrant mothers and their children suffer from an augmented morbidity and mortality, including with regard to their mental health. Drawing on the “niche sociality” concept (Manning et al., 2023) as an analytic tool, our paper aims to analyze the postpartum experience of immigrant mothers in Switzerland as well as the circumstances to which these mothers connect their experience and often their distress. This qualitative study included semidirected interviews with immigrant mothers (n=20) and with the health and social care professionals who cared for them (n=26) as well as ethnographic observations. We conducted a thematic analysis and triangulated the data produced with mothers themselves and professionals. Immigrant mothers shared mixed feelings regarding their experience. They often lived their maternity while experiencing a gendered loneliness. As members of transnational families, they dearly missed their relatives living abroad. Their position as new mothers and as immigrant persons comprised complex sociomaterial ordeals related to their (un)employment, housing, and sociality. Drawing from their practice in the community, professionals' narratives completed mothers'. Professionals critiqued the unequal access to quality health care as well as the petty measures that interfered with mothers' and infants’ safety that were taken by street-level bureaucrats (Lipsky, 2010 (1980)). Reflexive and engaging, mothers shared sensible and nuanced narratives about their experience and initiatives to rebuild their niche sociality.