Social interventions targeted at people with severe mental illness (SMI) often include volunteers. Volunteers’ perspectives are important for these interventions to work. This article investigates the experiences of volunteer families who befriend a person with SMI.
Qualitative interviews with members of volunteer families.
The families were motivated by helping a vulnerable person and by engaging in a rewarding relationship. However, the families often doubted their personal judgement and relied on mental health workers to act as safety net.
The volunteer involvement is meaningful but also challenging. The families value professional support.
Unemployment is closely associated with depressive symptoms. We conducted analysis to find whether the job loss increased the risk of depressive symptoms according to job status, occupation and tenure.
Data were collected from Korean Welfare Panel Study (KOWEPS) from 2007 to 2013. To measure the increase in depressive score, we selected respondents who answered for at least 2 years of continuous waves. We performed a longitudinal analysis by generalized estimating equation (GEE) method with a total of 19,399 cases. Among them, 608 cases (3.1%) experienced job loss.
There was a significant rise in depressive score after job loss (β = 1.34, p = .000). In subgroup analysis, precarious and low-tenure workers are considerably more depressed after job loss (precarious: β = 1.98, p < .0001, low-tenure workers: β = 1.31, p = .001). Both white and blue collar workers showed a rise in depressive score significantly (white collar: β = 1.16, p = .031; blue: β = 2.03, p = .001).
The results showed that precarious and low-tenure workers were relatively vulnerable in mental health after experiencing job loss with low and negative expectation for re-employment. It implies that supports for encouraging work skill and financial supports during the unemployment period should be needed.
Epigenetics refers to the study of heritable changes in gene expression not involving changes in DNA sequence and is presently an active area of research in biology and medicine. There is increasing evidence that epigenetics is involved in the pathogenesis of psychiatric disorders.
Several studies conducted to date have suggested that psychosocial factors act by modifying epigenetic mechanisms of gene expression in the brain in the pathogenesis of psychiatric disorders. Such studies have been conducted both on brain tissues and also using peripheral tissues as substitutes for brain tissues. This article reviews such studies.
Epigenetic mechanisms of gene expression in the brain appear to link one individual with another in the context of social psychiatry. Epigenetics appears to be of major importance to the field of social psychiatry.
The number of internal migrant children in China has reached 35.8 million by the end of 2010. Previous studies revealed inconsistent findings regarding the mental health status of rural-to-urban migrant adolescents, as well as the impact of peer, teacher and parental support on the mental health of Chinese adolescent migrants.
Using a comparative approach, this study attempted to compare the mental health status between migrant and urban-born adolescents and to clarify the specific roles of different sources of social support in the mental health of migrant and urban adolescents.
A cross-sectional survey using a cluster convenience sampling strategy was performed in Beijing, China. A structured questionnaire was filled out by 368 rural-to-urban migrant adolescents and 325 urban-born adolescents.
A significant difference was found only for positive affect (PA) but not for negative affect (NA) between the two groups, favouring the urban-born adolescents. Social support from all the three sources were all predictive of PA among rural-to-urban migrant adolescents, while only peer support contributed to PA among urban-born adolescents. Unexpectedly, teachers’ support contributed to an increase in NA among urban-born adolescents.
The findings contribute to understanding of the mental health status of migrant adolescents in China and the differential impact of the various sources of social support on migrant and urban-born adolescents. Also the findings may inform the development of mental health services and programmes that can potentially benefit a large number of internal migrant adolescents in China.
Suicide is a major worldwide public health issue. Various studies showed that individual attitudes toward suicide change in a region with high suicide rate. Attitudes are one of the components of a global and complex system: social representations (SRs).
In France, the Brittany region has an abnormally high death rate due to suicides. Our research focuses on the SRs of suicide in this region. The hypothesis underlying this project is that suicide SRs are different between an area with a high suicide rate and a region less affected by suicide.
A comparative study between the Brittany and Alsace regions, with the latter showing a statistically much lower suicide rate. The persons polled responded to a three-word free-association task around the question ‘For you, suicide is ...?’ An analysis of word frequency and evocation rank was then carried out.
In confirmation of our hypothesis, SRs were different between Brittany and the control region.
The study’s results open new avenues of research, specific to Brittany, in terms of the collective or individual effects of suicides, in terms of psycho-pathological conditions – essentially on depression, and in terms of training, on the stereotypes associated with suicide.
Voice hearing experiences, or auditory verbal hallucinations, occur in healthy individuals as well as in individuals who need clinical care, but news media depict voice hearing primarily as a symptom of mental illness, particularly schizophrenia.
This article explores whether, and how, public perception of an exaggerated association between voice hearing and mental illness might influence individuals’ need for clinical care.
A narrative literature review was conducted, using relevant peer-reviewed research published in the English language.
Stigma may prevent disclosure of voice hearing experiences. Non-disclosure can prevent access to sources of normalizing information and lead to isolation, loss of social support and distress. Internalization of stigma and concomitantly decreased self-esteem could potentially affect features of voices such as perceived voice power, controllability, negativity and frequency, as well as distress. Increased distress may result in a decrease in functioning and increased need for clinical care.
The literature reviewed suggests that stigma has the potential to increase need for care through many interrelated pathways. However, the ability to draw definitive conclusions was constrained by the designs of the studies reviewed. Further research is needed to confirm the findings of this review.
Many patients suffering from psychosis are nonadherent to their medications. Nonadherence can range from treatment refusal to irregular use or partial change in daily medication doses.
To investigate whether symptom dimensions, post-discharge care plans and being involved with faith healer affect the adherence to treatment in patients with schizophrenia.
A total of 121 patients with schizophrenia were examined 6 weeks post-discharge from the inpatient unit and assessed for full, partial or nonadherence to medication.
There was a significant association between family involvement and partial adherence and between community team involvement post-discharge and full adherence to medications. Psycho-education was a predictor for adherence to medications, persecutory delusions and lack of insight predicted partial adherence, while being involved with faith healers predicted nonadherence.
Adherence to medications and socio-demographic variables are independent. This study demonstrated that nonadherence or partial adherence to medications is associated with lack of insight and persecutory delusions. Psycho-education could improve the adherence to medication compliances.
The goal of treatment in mental illness has evolved from a symptom-based approach to a personal recovery–based approach. The aim of this study was to evaluate the predictors of personal recovery among patients with bipolar disorder.
A total of 185 patients with bipolar disorder, currently in remission, were evaluated on Recovery Assessment Scale (RAS), Internalized Stigma of Mental Illness Scale (ISMIS), Brief Religious coping scale (RCOPE), Duke University Religiosity Index (DUREL), Religiousness Measures Scale, Hamilton depression rating scale (HDRS), Young Mania rating scale (YMRS) and Global Assessment of Functioning (GAF) scale.
The mean age of the sample was 40.5 (standard deviation (SD), 11.26) years. Majority of the participants were male, married, working, Hindu by religion and belonged to extended/joint families of urban background. In the regression analysis, RAS scores were predicted significantly by discrimination experience, stereotype endorsement and alienation domains of ISMIS, level of functioning as assessed by GAF, residual depressive symptoms as assessed by HDRS and occupational status. The level of variance explained for total RAS score and various RAS domains ranged from 36.2% to 46.9%.
This study suggests that personal recovery among patients with bipolar disorder is affected by stigma, level of functioning, residual depressive symptoms and employment status of patients with bipolar disorder.
Despite its efficacy and safety, electroconvulsive therapy (ECT) is underutilized, in part due to stigma associated with the treatment.
The aim of this study was to test the hypothesis that experiencing ECT has an impact on associated stigma, as measured by patient and family knowledge of and attitudes toward ECT.
A comprehensive literature search was conducted using MEDLINE, EMBASE and PsycINFO. Studies with cross-sectional and/or longitudinal designs were identified. Studies were further categorized into subcategories based on participant type (patients or patient family members) and outcome domain (knowledge or attitudes). Effect size (Cohen’s d) was calculated for each study and then integrated into each subcategory (participant type by outcome domain) using a random effect model.
Eight studies were identified as being eligible for analysis. Two studies were cross-sectional, five were longitudinal and one incorporated both designs. Analysis of the longitudinal studies indicated that experiencing ECT both increased knowledge of and improved attitudes toward ECT in patients; in family members of patients, analysis showed significant positive change in knowledge of ECT, but no significant change in attitudes toward ECT.
Experience with ECT may have a positive impact on knowledge of and attitudes toward ECT. However, the quality of evidence of included studies was low; further research is required in order to clarify the relationship and to identify information of use to individuals considering ECT as a treatment option.
User participation is advocated on the basis that consumers know their own needs better than anyone else. Photovoice is a participatory research method that empowers the grass-root population to give voice on concerned issues for eliciting social change.
This study explores the experience and impact of user participation in mental health services (MHS) in Hong Kong through photovoice. It also examines the effects of this method in studying user participation.
In this qualitative inquiry, authors, two peer researchers and three participants were involved in the various stages of research design, data collection and data analysis. Participants took photos showing their perception and experiences of being involved in different MHS systems. They shared their narratives through these images and reflected on the participatory experience of photovoice.
User participation was experienced as a gradual process of assuming control that involved personal responsibility, connection with peers, collaboration with staff, redefinition of boundaries and social inclusion. Meaningful participation gave rise to a sense of contribution, interpersonal connection and self-worth and transformed one’s identity. Participants enjoyed the mutual interaction and derived benefit from the photovoice process. Issues such as consent and confidentiality arose in implementation.
Participation entails partnership among service users, providers and peers. Photovoice opens up new space for unfolding expert knowledge. Further application of this participatory approach with the local community is suggested in order to develop person-centered care.
To examine, for the first time in Vietnam, whether urbanity of respondents among other socio-demographic factors affects the public perception of stigma attached to persons with mental illness in Hanoi.
A general population-based survey was carried out in 2013 in the greater Hanoi area. The perception of stigma attached to people with mental illness was elicited using Link’s perceived discrimination and devaluation scale (PDDS) carried out in Vietnamese language. The survey sample (n = 806) was stratified for gender, urban/rural location, age, household size and marital status, in accordance with the 2013 Vietnamese census.
Comparing the total score of the PDDS and its single items, we found less perceived stigma and discrimination among the rural population of Hanoi and in respondents who reported religious attainment to either Buddhism or Christianity. Logistic regression analyses found no significant influences of gender, age, household size or marital status regarding the perceived stigma toward persons with mental illness.
Less negative perception of stigma attached to persons with mental illness that was observed among the rural population in the Hanoi area may be interpreted in the light of possibly more demanding living conditions in modern urban Vietnam with less opportunities for mentally ill patients and points toward a dynamic interaction with rapidly changing living conditions in Asian megacities.
Duration of untreated psychosis (DUP) has been considered as a poor prognostic factor for psychotic disorder. Several studies have been investigating different predictors of DUP in Western countries, while in Egypt only a few studies have examined various predictors of DUP.
To study DUP in Egyptian patients with psychotic disorders and to investigate how certain illnesses, patient, socio-cultural risk factors and help-seeking behaviour are correlated with prolonged DUP.
The sample included 100 patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) diagnosis of psychotic disorder were selected and interviewed to assess DUP. They were interviewed using the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scale.
Mean (±standard deviation (SD)) of DUP was found to be 36.93(±45.27) months. DUP was correlated with various sociodemographic and clinical variables. Following log transformation of DUP, correlation with PANSS scores was done and revealed highly significant statistical relation of DUP to PANSS negative and PANSS positive scores. In linear regression analysis, it was found that age of patients, the age of onset, residence, being illiterate, the insidious mode of onset, negative family history of psychiatric disorder and the severity of illness as indicated by PANSS are among DUP predictors.
Longer DUP results from multiple patient- and illness-related factors. This has many implications in targeting early intervention with specific consideration to cultural factors.
Self-management of bipolar disorder (BD) is challenging for many individuals.
Interviews were used to assess perceived barriers to disease self-management among 21 high-risk patients with BD. Content analysis, with an emphasis on dominant themes, was used to analyze the data.
Three major domains of barriers emerged: individual barriers (psychological, knowledge, behavioral and physical health); family/community-level barriers (lack of support and resources); and provider/healthcare system (inadequate communication and access to care).
Care approaches providing social and peer support, optimizing communication with providers and integrating medical and psychiatric care may improve self-management of BD in this vulnerable population.
T. S. Eliot’s The Waste Land and A. Ginsberg’s Howl are two landmark poems of the 20th century which have a unique way of dealing with emotional suffering.
(a) To explore the interplay between emotional suffering, conflicting relationships and societal perceptions; (b) to show the therapeutic effect of the writing process; (c) to analyse the portrayal of ‘madness’; and (d) to discuss, in contemporary psychiatric terms, the ‘solutions’ offered by the poets.
Qualitative research with a narrative, hermeneutic approach.
Against the background of wartime/genocide and postwar disillusionment, close relationships are projected onto societal perceptions. Concepts of (self-)control, compassion, empowerment and self-efficacy are offered as solutions to overcome feelings of despair.
In a time of perceived societal and environmental crises, both poems help us understand people’s fears and how to counteract them. Besides biological approaches, the narrative approach to the suffering human being has not lost its significance.
Gatekeeper training for community facilitators, to identify and respond to those at risk of suicide, forms an important part of multi-level community-based suicide prevention programmes.
This study examined the effects of gatekeeper training on attitudes, knowledge and confidence of police officers in dealing with persons at risk of suicide.
A total of 828 police officers across three European regions participated in a 4-hour training programme which addressed the epidemiology of depression and suicidal behaviour, symptoms of depression, warning signs and risk factors associated with suicidal behaviour, motivating help-seeking behaviour, dealing with acute suicidal crisis and informing bereaved relatives. Participants completed internationally validated questionnaires assessing stigmatising attitudes, knowledge about depression and confidence in dealing with suicidal persons pre- and post-training.
There were significant differences among countries in terms of previous exposure to suicidal persons and extent of previous training. Post-training evaluation demonstrated significant improvements in stigmatising attitudes, knowledge and confidence in all three countries.
The consistently positive effects of gatekeeper training of police officers across different regions support inclusion of this type of training as a fundamental part of multi-level community-based suicide prevention programmes and roll-out, nationally and internationally.
Knowledge about subjective perceptions and explanatory models has the potential to inform clinical evaluation and lead to development of patient-friendly treatment models in medically unexplained physical symptoms (MUPS).
To collect qualitative data about explanatory models in MUPS.
A cross-sectional observational study was done among patients with MUPS presenting over a 2-year period to a specialty psychosomatic clinic. The Short Explanatory Model of Illness interview was used to gather qualitative data about explanatory models which were subsequently recoded using standard manuals.
A total of 123 subjects were evaluated. The nature of symptoms was most commonly reported as ‘non-specific’ (n = 102, 82.9%) but of moderate to severe intensity (n = 87, 73.8%). Getting cured or showing improvement was the most common expectation from treatment (n = 58, 47.9%). Moderate to severe impact of symptoms was reported on work output (n = 100, 84%), emotional life (n = 85, 71.4%) and physical mobility (n = 59, 49.1%). A considerable proportion was either dissatisfied (n = 61, 50%) or frankly unhappy (n = 38, 31.4%) with treatment received.
There is a need to re-calibrate the clinical approach to people with MUPS to enhance treatment satisfaction. Our findings could assist in evolving culturally sensitive conceptualizations of illness and in developing patient-centred models for therapy in MUPS patients.
We examined the long-term effects of parental divorce timing on depression using longitudinal data from the Korean Welfare Panel Study.
Depression symptoms were measured using the 11 items of Center for Epidemiologic Scale for Depression (CES-D-11), and we categorized parental divorce timing into ‘early childhood’, ‘adolescent’ and ‘none’.
Although participants who experienced parental divorce during adolescence exhibited a significantly higher CES-D-11 score (p = .0468), ‘early childhood’ participants displayed the most increased CES-D-11 score compared to the control group (p = .0007). Conversely, among participants who were unsatisfied with their marriage, those who experienced parental divorce in early childhood showed lower CES-D-11 scores, while ‘adolescent period’ participants exhibited significantly higher CES-D-11 scores (p = .0131).
We concluded that timing of parental divorce exerts substantial yet varied effects on long-term depression symptoms and future marriage satisfaction.
In Japan, psychiatrists have noted two different types of depression, traditional/melancholic depression and ‘modern-type’ depression (MTD). Although both the modern and the traditional types of depression overlap in regard to symptoms, these are two distinct syndromes, which can lead to confusion for Japanese people.
This study aims to examine impressions of two types of depression using vignettes and clarify the differences in perceptions of the two types.
The participants, 206 Japanese undergraduates, were presented with two vignettes, one describing a patient with traditional-type depression and the other describing a patient with MTD, and then were asked to answer questions regarding their perceptions of the patient. In order to control covariates (i.e. perceived severity and dysfunction of depression), analyses of covariance with repeated measures were administered.
People generally had more negative perceptions of the patient with MTD. For example, when the protagonist was the patient with MTD, people were more likely to avoid and less motivated to support the patient. Large differences were also found in causal attribution to internal and controllable causes.
Negative impressions of the patient with MTD may be partly explained by causal attribution to internal and controllable factors.
Available occupational therapy assessment scales focus on specific areas of functioning. There is a need for comprehensive evaluation of diverse aspects of functioning in people with mental illness.
To develop a comprehensive assessment scale to evaluate diverse aspects of functioning among people with mental illness and to assess its validity and reliability.
Available instruments, which evaluate diverse aspects of functioning in people with mental illness, were retrieved. Relevant items, which evaluate specific functions, were selected by a committee of mental health experts and combined to form a comprehensive instrument. Face and content validity and feasibility were assessed and the new instrument was piloted among 60 patients with mental illness. The final version of the instrument was employed in 151 consecutive clients, between 18 and 60 years of age, who were also assessed using Global Assessment of Functioning (GAF), Occupational Therapy Task Observation Scale (OTTOS), Social Functioning Questionnaire (SFQ), Rosenberg Self Esteem Scale (RSES) and Pai and Kapur Family Burden Interview Schedule (FBIS) by two therapists. The inter-rater reliability and test–retest reliability of the new instrument (Vellore Occupational Therapy Evaluation Scale (VOTES)) were also evaluated.
The new scale had good internal consistency (Cronbach’s alpha = .817), inter-rater reliability .928 (.877–.958) and test–retest reliability .928 (.868–.961). The correlation between the general behaviour domain (Pearson’s Correlation Coefficient [PCC] = –.763, p = .000), task behaviour (PCC = –.829, p = .000), social skills (PCC = –.351, p = .000), intrapersonal skills (PCC = –.208, p = .010), instrumental activities of daily living (IADL) (PCC = –.329, p = .038) and leisure activities (PCC = –.433, p = .005) scores of VOTES with the corresponding domains in the scales used for comparison was statistically significant. The correlation between the total score of VOTES and the total scores of OTTOS, SFQ and RSES was also statistically significant suggesting convergent validity. The correlation between the total score of VOTES with the total score of FBI is not statistically significant, implying good divergent validity.
VOTES seems to be a promising tool to assess overall functioning of people with mental illness.
Suicidal ideation is understudied among men who have sex with men (MSM) across Sub-Saharan Africa.
This study aimed to explore social capital and sexual behavior stigma associated with suicidal ideation among MSM in the West African nations of The Gambia, Burkina Faso and Togo.
Participants were recruited using respondent-driven sampling and snowball sampling across multiple cities (n = 1555) from July 2011 to August 2013. During a single study visit, participants completed a survey. Logistic regression models were used to assess bivariate and multivariable associations with suicidal ideation.
The prevalence of lifetime suicidal ideation was 13% overall and ranged 6%–17% across study sites. After adjusting for potential confounders, MSM who reported stigma as a result of having sex with men were more likely to report suicidal ideation. Physical and sexual violence was strongly associated with suicidal ideation, including being physically harmed (adjusted odds ratio (aOR) = 2.94, 95% confidence interval (CI) = 1.91, 4.52), tortured (aOR = 3.86, 95% CI = 2.17, 6.86) and raped (aOR = 3.07, 95% CI = 2.05, 4.60). In contrast, increasing social participation with the broader community was associated with decreased report of suicidal ideation (aOR = 0.91, 95% CI = 0.85, 0.99).
Sexual behavior stigma should be addressed to improve mental health among MSM in Western Sub-Saharan Africa.
Relabeling has been proposed as a strategy to reduce the stigma associated with mental illnesses. Previous studies have shown that changing the names of psychiatry clinics has led to reduced feelings of being stigmatized among patients. In Taiwan, terms other than ‘psychiatry’ (in Chinese, jīng shén kē) are more commonly used in the names of psychiatry clinics. The term ‘psychosomatic clinics’ is widely used instead.
This study investigated the characteristics of psychiatry clinic names in order to better understand the role of clinic names in primary care settings.
Relevant data were extracted from an open database maintained by the government of Taiwan. These data included the names of community psychiatry clinics and hospital-based psychiatry clinics, population size and the degree of urbanization in the area served by each clinic.
At the time of this study, there were 254 community psychiatry clinics and 190 hospital-based psychiatry clinics in Taiwan. Only 18.9% of the community clinic names included the term ‘psychiatry’. Additionally, 14.6% of community clinic names and 28.4% of hospital-based clinic names included the term ‘psychosomatics’. The regions in which clinics without ‘psychiatry’ in their names were located had significantly larger populations and higher levels of urbanization than the regions in which clinics with ‘psychiatry’ in their names were located.
A low prevalence of the term ‘psychiatry’ in community psychiatry clinic names was found in Taiwan. The stigma associated with psychiatry and other socio-cultural factors are hypothesized to explain this phenomenon.
Given increasing numbers of compulsory admissions, it is important to assess patient risk profiles and identify factors that are appropriate for intervention.
A sample of 116 patients who were compulsorily admitted was studied. Socio-demographic and clinical characteristics were recorded. Patients were interviewed twice using the Verona Service Satisfaction Scale and the Birchwood Insight Scale. Changes in insight and satisfaction during 2 years were linked to the incidence of involuntary re-admissions in the next three follow-up years.
A higher mean score for patient satisfaction was found (mean=3.77, standard deviation (SD)=0.56; p<=.001) in the second interview than in the baseline interview (mean=3.26, SD=0.65). There was also an improvement in insight (in the second interview: mean=7.22, SD=2.86 and in the baseline interview: mean=6.34, SD=3.18; p=.027). There was an inverse correlation between increasing satisfaction (in years 1–2) and the incidence of involuntary admission in years 3–5 (odds ratio (OR)=0.445, 95% confidence interval (CI)=0.252–0.793; p=.006). This association proved to be dependent on a history of involuntary admission.
Increasing patient satisfaction in the first 2 years was associated with a lower risk of compulsory re-admission in the subsequent follow-up period, but this association proved to be dependent on a history of involuntary admissions in these first two follow-up years. Increase in insight during the same period did not show any effect whatsoever.
There are no studies researching the relationship between house-poor persons and mental health. Therefore, this study aimed to investigate the relationship between house-poor status and depressive symptoms.
To examine the relationship between the house-poor and depressive symptoms according to household income.
Data from the Korean Welfare Panel Study were used. House-poor were defined as people having possession with over 10% house-related interest in disposable income. About 7,565 participants over the age of 19 years were followed up from 2011 to 2013. The generalized estimating equations were used for analysis.
Individuals with more house-related debt showed increasingly higher depression scores (possession with under 5% related debt to disposable income β = 0.2024, p = .1544; under 10% β = 0.7030, p = .0008; over 10% β = 1.3207, p < .0001). Individuals possessing houses with over 10% ratio of house-related debts to disposable income had higher depression scores than individuals without house ownership (no possession β = 0.8927, p < .0001).
Individuals without houses and individuals owning houses with higher percentages of house-related interests showed higher levels of depressive symptoms. Therefore, this study affirmed that the importance of considering the most vulnerable groups in addressing the mental health of individual.
The mental health ‘treatment gap’ is at its widest in low-resource countries where the vast majority of its people have no access to mental health services and where developing effective models of primary mental health care that can expand from research pilot sites to large-scale population-based services is a major research and practice imperative.
The Mental Health in Zomba initiative builds upon an earlier pilot project to establish and sustain a district-wide scale-up of a village-based health workers’ mental health task-sharing intervention in Southern Malawi across a population of more than 600,000 people.
The article describes the development, implementation and structured evaluation of the impact of this task-sharing initiative.
Results from an examination of the care for 240 consecutive attendees show how the village-based workers recognised and responded to the needs of people experiencing both common and severe mental health problems and how they facilitated 850 mental health promotion events to more than 40,000 people within their communities.
A new and essential district-wide tier of mental health service was established at the crucial intersection between health centre and the community. Within the socio-cultural context of rural Malawi with its diverse explanatory models for psychological distress, the approach of the village-based health worker was found to be both credible and practical in meeting the needs of the population and therefore responding to both the ‘supply’ and ‘demand’ elements of the mental health treatment gap.
Support from one’s family has been reported to have a positive effect on depression severity. Hence, family dinnertimes, when whole family can gather together, can be effective to depression by providing support from family.
We investigate the association between the dinner companion and depression, and the differences in this association by gender, living arrangement and household composition.
We used the Korea National Health and Nutrition Examination Survey 2014 data. A total of 4,181 individuals were included. We classified participants by their dinner companions as follows: dinner with family, dinner with others and eating alone. Depression was measured by using the 9-item Patient Health Questionnaire. Logistic regression analysis was used to investigate the association.
Those who ate dinner alone (odds ratio (OR): 1.53, 95% confidence interval (CI): 1.04–2.25) had higher depression rate compared to those who had dinner with family. The subgroup analysis indicated that men, those who live with others and those living in a second-generation household who ate dinner alone had greater odds of having depressive symptoms.
Those who usually eat dinner alone have greater odds of developing depression compared to those who have dinner with their family. As such, family dinnertimes may help to alleviate depressive moods.
To describe the perceived experiences of stigma and discrimination among people living with severe and persistent mental illness in assertive community treatment (ACT teams) settings in New South Wales (NSW), Australia.
The Discrimination and Stigma Scale (DISC) was used in this cross-sectional study with people living with severe and persistent mental illness. The DISC is a reliable and valid, quantitative and qualitative instrument used to explore and measure levels of negative, anticipated and positive discrimination. Relevant clinical history and socio-demographic information were also collected.
A total of 50 clients participated, with 40 (80%) reporting experienced negative discrimination in at least one life area. Negative discrimination was most commonly experienced in being avoided or shunned (n=25, 50%), by neighbours (n=24, 48%) and family (n=23, 46%). Anticipated discrimination was common, with half of participants (n=25, 50%) feeling the need to conceal their mental health diagnosis.
Discrimination was highly prevalent in everyday aspects of life. While healthcare professionals often tend to increase perceived stigma and discrimination, this was only experienced in interactions with general health professionals, while interactions with ACT team members decreased perceived stigma and increased positive discrimination. This indicates that healthcare professionals potentially have a significant role in reducing stigma and discrimination in mental health and that such an effect may be optimised in an ACT team setting.
There is some evidence that, in contrast to depressed women, depressed men tend to report alternative symptoms that are not listed as standard diagnostic criteria. This may possibly lead to an under- or misdiagnosis of depression in men.
This study aims to clarify whether depressed men and women report different symptoms.
This study used data from the 2007 Australian National Survey of Mental Health and Wellbeing that was collected using the World Health Organization’s Composite International Diagnostic Interview. Participants with a diagnosis of a depressive disorder with 12-month symptoms (n = 663) were identified and included in this study. Differential item functioning (DIF) was used to test whether depressed men and women endorse different features associated with their condition.
Gender-related DIF was present for three symptoms associated with depression. Depressed women were more likely to report ‘appetite/weight disturbance’, whereas depressed men were more likely to report ‘alcohol misuse’ and ‘substance misuse’.
While the results may reflect a greater risk of co-occurring alcohol and substance misuse in men, inclusion of these features in assessments may improve the detection of depression in men, especially if standard depressive symptoms are under-reported.
There has been increasing evidence that childhood traumas are related to reduced health-related quality of life, neurobiological changes and long-term adverse effects, such as an increase in the likelihood of psychiatric disorders in adulthoods. The aim of this study was to investigate the relationships between childhood traumas and type D personality.
In total, 187 university students (64 males and 123 females; mean age = 21.69 ± 2.00) were included in the study. All participants were evaluated using the Type D Personality Scale (DS-14), Childhood Trauma Questionnaire (CTQ-28) and Beck Depression Inventory (BDI). The participants were divided into the two groups according to the presence of type D personality. Then, statistical analyses were performed.
The frequency of type D personality in participants was 43.3% (n = 81). The emotional neglect, physical neglect, emotional abuse component of the CTQ-28, total CTQ-28 scores and BDI scores were higher in the group with type D personality than in the group without type D personality (p < .001, p = .003, p = .001, p < .001 and p < .001, respectively). There were significantly positive correlations between the type D personality scores and BDI scores, emotional neglect, physical neglect, emotional abuse and childhood trauma total scores (p < .05, for all). Linear regression analyses showed that the significant and independent predictors of the score of DS-14 were total score of CTQ-28 and BDI score.
Childhood trauma may be associated with type D personality, and there is predictive value of the childhood trauma on the scores of type D personality.
The civil war, lasting from 1983 to 2009, and the tsunami that struck Southeastern Asia in 2004 were major stressors that changed the demographic landscape of the northern province of Sri Lanka. The composition of families changed dramatically, with an increase in female-headed households, largely due to casualties. The conservation of resources (COR) model was applied in this study to examine relationships between risk and resiliency factors among women heading households, including women widowed by war or disaster.
This study represents an investigation of the association between predictive risk and resiliency factors (i.e. war damage and loss, social support, economic status, religious participation and discrimination) and outcomes representing well-being (depressive symptoms, family adjustment and a rating of physical health).
Data from 514 women heading households living in the Kilinochchi district of Sri Lanka were collected through face-to-face interviews in 2013, and associations among the data were estimated using path analysis.
Results suggest that resiliency factors that are representative of greater resources generally predicted lower levels of distress and vice versa.
Further study informing intervention development with women heading households in Sri Lanka is warranted to better understand which individual, family and community resources are most important to mobilize for sustainable recovery efforts to be successful in the decades following war and natural disaster.
Due to the economic recession, several people in Europe became unemployed. This situation may risk their mental health.
This study explored parents’ perceptions about their unemployment’s effects in daily life during the recession.
A total of 59 unemployed parents (40.7% fathers and 59.3% mothers), ageing 44.4 years (±6.2), answer a question on how the unemployment affected their family lives. Thematic analysis was used to analyse data.
The findings suggest that unemployment is a source of adult and youth mental distress and of economic hardship and changes in family relations.
Support to unemployed individuals and their families could benefit from these insights when granting the needed financial and socioemotional assistance.
Our study explores perceptions of the caregiver support for mental health service users (MHSUs) in a low- to middle-income country setting.
We conducted in-depth individual interviews with 16 MHSUs and their treatment partners/caregivers from a treatment partner and text-message intervention study.
Treatment partners/caregivers felt obligated to care for MHSUs, but had a limited understanding of mental illness. They found supporting adherence to treatment difficult due to a number of factors including violence, food insecurity and substance abuse.
Socioeconomic and environmental factors affecting the lives of MHSUs have impact on caregiver relationships with MHSUs in their care.
The aim of this study was to investigate Hong Kong nationals’ ability to recognize 13 different mental disorders and to examine whether there may be a relationship between their mental health literacy (MHL) and their tendency to describe/explain symptoms of mental disorders in physical terms.
A total of 299 participants took part in this study and the vignettes depict post-traumatic stress disorder, depression, obsessive–compulsive disorder (OCD), dependent personality disorder, schizotypal personality disorder, generalized anxiety disorder, agoraphobia, bipolar disorder, social phobia, panic disorder, narcissistic personality disorder, schizophrenia and antisocial personality disorder.
Overall, OCD was the best identified and the personality disorders were the worst. A significant negative correlation was found between participants’ MHL and the rate of offering a ‘physical’ rather than a ‘psychological’ explanation. Some mental disorders were better recognized than others such as OCD (40.1%) and depression (36.3%). However, the majority of the other disorders were very poorly recognized and labelled with the rest having ‘correct response’ rates of lower than 15%. Over half of the mental disorders had ‘correct’ response rates of lower than 5%.
In accordance with many other studies in the area, this study found Asian participants poor at recognizing mental disorders. This is probably due to the fact that mental illnesses of all kinds remain a taboo topic.
Despite further recent research into the consequences associated with human sex trafficking, scant evidence associated with the mental health outcomes among victims of sex trafficking remains, including within Nepal where trafficking continues to be a growing problem.
To investigate the prevalence and explanatory factors of depression, anxiety and post-traumatic stress disorder (PTSD) symptoms among female survivors being housed and supported by two non-governmental organisations (NGOs) in Nepal.
A total of 66 female sex trafficking survivors being housed by two NGOs were purposively sampled. Anxiety and depression symptomatology were measured using the Hopkins Symptoms Checklist–25 instrument and PTSD symptomatology was measured using the PTSD Checklist–Civilian Version.
In all, 87%, 85.5% and 29.7% of the sample scored above anxiety, depression and PTSD thresholds, respectively. HIV-positive status and length of workday during trafficking period significantly associated with at least one outcome measure.
The results contribute further evidence of how damaging sex trafficking can be to victims, particularly in terms of being at risk of clinical depression and/or anxiety. Continued efforts to prevent trafficking from occurring as well as effective, timely intervention for survivors are needed.
Despite links between early relational experiences and psychopathology, data regarding childhood emotional neglect among Canadian mental health services users are scarce.
To explore the absence of emotional support experiences reported by Canadian psychiatric outpatients, and to examine the relationship between childhood emotional support and borderline personality disorder (BPD) features.
A survey regarding childhood emotional support was completed by consecutively admitted adult outpatients, along with self-report assessments of symptom distress and BPD features.
A substantial proportion of outpatients reported absent emotional support experiences. After controlling for the effects of age and symptom distress, childhood emotional support was found to be significantly negatively associated with BPD features.
The findings add further support to the need for clinical attention to the early relational experiences of mental health service users.
Since 2008, Greece has entered a long period of economic crisis with adverse effects on various aspects of daily life. In this frame, it is quite important to examine the suicide trends in Greece.
Our analysis covered the period 1992–2012. 2012 was the last year for which official suicide data were available. The inclusion of data for pre-crisis period enabled us to assess trends in suicide preceding the economic crisis, starting in 2008. Trends in sex- and age-adjusted standardized suicide rates (SSR) were analyzed using joinpoint regression.
Total SSR presented statistically significant annual decrease of 0.89% (95% confidence interval (CI): –1.7, –0.1) during the period 1992–2008. After 2009, the trend in total SSR increased statistically significant annual increase (12.48%; 95% CI: 0.3%, 26.1%). SSR in males presented an initial period of modest annual decrease (–0.84%; 95% CI: –1.6%, –0.1%), during the period 1992–2008. After 2009, an annual increase by 9.25% (95% CI: 2.7%, 16.3%) was revealed. No change in female SSR trend was observed during the studied period.
According to the results of this study, there is clear evidence of an increase in the overall SSR and male SSR in Greece during the period of the current financial crisis.
The aim of this study was to examine changes in the distribution of causes of death and mortality rates among psychiatric patients visiting a psychiatric emergency room (PER), to determine clinically useful predictors for avoiding premature mortality among these patients and to discuss possible interventions.
The study was designed as a historical prospective record linkage study of patients with at least one visit to a Danish PER in 1995–2007. Five consecutive 3-year cohorts of individuals aged 20 to <80 years were identified. Data from the Danish Civil Registration System were linked to the Cause of Death Register and the Central Psychiatric Research Register, and logistic predictor analyses for premature death were performed.
The standardised mortality ratio (SMR) of all visitors compared to the general Danish population was approximately 5. Overall, patients with drug and/or alcohol use disorder experienced at least a twofold increase in SMR compared to patients without substance use disorder. In the case of patients with schizophrenia and a concurrent substance use disorder, the SMR increased considerably. During the period, substance use disorder was the strongest predictor of premature death among visitors to a PER (odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.5, 2.2).
Persons visiting the PER had an increased SMR and substance use disorders were the strongest predictor of premature death within 3 years. However, death caused by substance use disorder is preventable, and PERs are ideal points of early intervention. Systematic screening for substance use disorder at the PER and/or crisis intervention teams may be effective intervention strategies.
This study used attitude statement and vignette methodology to examine a mixed British sample’s belies about the causes and consequences of depression.
To test whether the group would recognise both vignettes with having depression and that the favoured cure would be Psychotherapy/Talking Cure.
In all, 320 adults completed a two-part questionnaire. In the first part, they were given two vignettes describing a 30-year-old female and a 45-year-old male both with depression. They were asked what they thought (if anything) was wrong with the person and how they could best be helped. In the second part, they completed two questionnaires, one which lists 47 possible causes and the other 48 possible treatments for depression.
Most participants ‘diagnosed’ depression for the two vignettes although they chose very different terms and offered a variety of ‘cures’, including medication and counselling. The questionnaires about cause and cure factored into seven interpretable factors which were logically correlated. A series of regressions showed that sex, age, media interest, political beliefs, experience with depression and other mental illnesses as well as having known of others diagnosed with depression predicted different beliefs about the causes and cures of depression.
People have a detailed and multidimensional view of the causes and cures for depression which is systematically related to each other.
There is a dearth of instruments to assess schizophrenia persons’ Family Emotional Climate (FEC).
This study aims to explore the relation between family members’ personality traits and FEC.
We invited a convenience sample of 50 both gender family members who were accompanying the person with schizophrenia for out-patient department (OPD) consultation to provide data on a socio-demographic proforma and the researcher prepared ‘Emotional climate assessment questionnaire – caregivers’ version’ (ECAQ-C) as well as the Eysenck personality questionnaire.
Caregivers’ extroversion traits (r = .427, p = .002) were positively correlated and neuroticism traits were negatively correlated (r = –.330, p = .019) with their positive perception of FEC. There was a higher perception of positive FEC (mean scores = 65.5 ± 10.5) while caregivers seemed to perceive less negative FEC (mean scores = 36.5 ± 10.2). Caregivers with education above 11th std perceived less (2 = 8.6, p = .013) of negative FEC.
The findings highlight that caregivers’ personality traits seem to influence the FEC. While caregivers’ perception of FEC is positive in this study, those in the higher education group seem to have a better perception of FEC indicating that education also may influence FEC.
Mental health services (MHS) use is a complex behaviour that does not only concern individuals with current mental disorder. To date, few studies have examined age-related contextualisation of MHS use. Reasons for seeking help may vary according to development stages in adulthood.
This study aimed to determine which predisposing, enabling and need factors, using Andersen’s model, were associated with MHS use according to adult development stages among individuals with or without current psychiatric diagnosis.
Three age groups were examined: 18- to 29-year-olds (n = 775), 30- to 49-year-olds (n = 1,560) and 50- to 64-year-olds (n = 960). Data were obtained from the Montreal Longitudinal Catchment Area Study. Bivariate and multivariate logistic regression analyses were conducted for each age group separately to determine which predisposing, enabling and need factors were associated with MHS use in the past 12 months.
For 18- to 29-year-olds, one enabling factor (Internet search) and two need factors (presence of major depressive disorder and number of stressful events) were positively associated with MHS use. For 30- to 49-year-olds, one predisposing factor (family history of mental disorder), four enabling factors (not currently working or in school, perceiving neighbourhood disorder, social cohesion and Internet searching) and one need factor (major depressive disorder) correlated with help seeking. For 50- to 64-year-olds, two predisposing factors (family history of mental disorder and higher self-perceived stigma), two enabling factors (low satisfaction in personal relationship and Internet searching) and one need factor (alcohol dependence) were associated with MHS use.
Factors associated with MHS use differ according to adult development stages. Programmes and policies should be based on age-related contextualisation to increase MHS use.
Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety disorders. We aimed to investigate the relationship between EE and demographic and clinical characteristics of patients with panic disorder (PD), to determine whether there is a difference between PD, major depressive disorder (MDD) patients and healthy controls (HC) in terms of EE and to investigate the effect of EE on quality of life (QOL) in patients with PD.
Our study involved a total of 150 participants (50 patients in each group). All participants were given the Level of Expressed Emotion (LEE) scale and the short-form health survey (SF)-36 . Furthermore, the EE scale was completed by the participant’s key relatives.
EE was associated with some sociodemographic and clinical variables in patients with PD. There was no significant difference between PD and MDD and between PD and HC in terms of the LEE and the EE and their subscale scores. It was also demonstrated that EE had no effect on the QOL in patients with PD.
EE was not different in PD compared to MDD and HC. Additionally, EE was not related to QOL in PD.
Cardiovascular diseases are the most common causes of premature death in patients with schizophrenia. We aimed at reducing cardiovascular risk factors in non-selected outpatients with schizophrenia using methods proven effective in short-term trials. Furthermore, we examined whether any baseline characteristics were associated with positive outcomes.
All outpatients treated for schizophrenia at two Danish hospitals were included in this 1-year follow-up study. The patients were offered health interventions both individually and in groups. Weight, waist circumference, blood glucose, serum lipids, and information on smoking and alcohol were obtained.
On average, small significant increases in body mass index (BMI) and waist circumferences were observed while small non-significant improvements in other cardiovascular risk factors were seen. Patients with high baseline BMI and patients with duration of treated illness beyond 2 years had significantly better intervention outcomes.
Our results show that it was difficult to improve physical health in a group of non-selected patients with schizophrenia as part of routine care. The patients were not easily motivated to participate in the interventions, and it was difficult to monitor the recommended metabolic risk measures in the patient group. Future research should focus on simple strategies in health promotion that can be integrated into routine care.
In China, since the rural labor, leaving their children in the hometown to other caregivers is a trend that has been increasing, and the impact of parental absence on the well-being of left-behind children is increasingly drawing attention in the Chinese society. However, there is a lack of study on the potential impacts of being left behind on later psychosocial outcomes in adolescence and associated protective factors.
This study was conducted on a large sample of Chinese college students to test the moderating effect of resilience between left-behind experience and mental health problems.
The Connor–Davidson Resilience Scale and Symptom Checklist as well as a self-reported questionnaire about left-behind experience designed by the authors were adopted for a survey with 2,968 Chinese college students as respondents.
Totally, 1,063 students (35.8%) had 1 year or more left-behind experience. Compared to those who had no left-behind experience, the students who had left-behind experience were rated lower on resilience score and higher on mental health problem score. Mental health problems had a negative correlation with resilience. Regression analysis showed that resilience moderated left-behind experience and mental health problems.
Individuals with left-behind experience are more vulnerable to mental health problems. Promoting resilience may be helpful for prevention of mental health problems in college students with left-behind experience.
To evaluate the impact of psychoeducational intervention on the levels of burden, of self-esteem and quality of life in caregivers of patients diagnosed with Bipolar Disorders.
In this randomized clinical trial, changes in degree of burden, levels of self-esteem and quality of life were evaluated. Caregivers could participate in the group of psychoeducation (six sessions) or usual treatment (without psychoeducation following a manual).
There were no significant differences regarding levels of objective burden between groups. Both groups presented improvement in subjective burden scores throughout the interventions. Objective burden scores showed significant reduction in the usual treatment group (p = .003) and a trend toward decrease in the psychoeducational intervention (p = .081). There are no differences regarding improvement in perceived self-esteem and quality of life when comparing means between the groups with and without intervention.
A six-session caregiver psychoeducational intervention on bipolar disorder did not bring benefits to caregiver’s health. A longer longitudinal follow-up study would be crucial to see whether there were differences in degree of burden, perceived self-esteem and quality of life over time in caregivers.
The evolution of Recovery-oriented mental health services in Western nations across the globe has given rise to a growth in community-based psychosocial support services, to assist in meeting the diverse needs of consumers. This article reports findings of research that explored the perceptions of community workers who are employed by non-profit organisations and deliver psychosocial support services to support delivery of Recovery-oriented clinical mental health services.
The focus of the research reported in this article includes the benefits and challenges encountered by the community workers when working with clinicians.
The research was undertaken as part of a single-case embedded study, which evaluated the implementation of Recovery-oriented approaches to the delivery of clinical mental health services in a major urban centre located in south-eastern Australia.
Generally, community workers employed by the non-profit organisations perceived the implementation of Recovery-oriented clinical mental health services to be a positive step forward for consumers. Challenges to the delivery of Recovery-oriented services included issues arising from the many different understandings of what it means to experience mental health Recovery, the quality of communication between the community workers and clinicians and the clinicians’ lack of understanding of the role of non-profit organisations and community workers.
The article concludes with recommendations to address the challenges involved, with a view to improving the partnerships between community workers and clinicians, and the Recovery journey of people with serious mental illness.
The attitudes of psychiatric hospital personnel are critically related to the quality of mental health care, but few studies have investigated this issue.
This study is aimed at an exploration of the attitudes of psychiatric hospital personnel toward people with mental illness and at an examination of the associated factors.
A self-report questionnaire, the Mental Illness Attitude Scale (MIAS), was used to collect data from psychiatric hospital personnel in Taiwan (n = 290). The MIAS included 46 items and 4 dimensions: acceptance, rehabilitation and prognosis, social distance and recommendations for interventions.
Rehabilitation and prognosis had the highest item average scores (4.03) and social distance had the lowest item average scores (3.22). Stigmatization and the number of different types of contacted clients were two significantly associated attitude factors.
Psychiatric hospital personnel in Taiwan tend to have positive attitudes toward people with mental illness in general situations but hold less positive attitudes in terms of community integration-related issues and intimate relationships. More evidence-based community services should be conducted to decrease personnel concerns about the successful community integration of those who are mentally ill. Future studies can investigate the concept and impact of stigmatization more deeply.
The Great Recession has caused worldwide tangible costs in terms of cuts in employment and income, which have been widely recognised also as major social determinants of mental health. Italy has not been spared from the financial crisis with severe societal and mental health consequences. In addition, a strong earthquake hit the province of Modena, Italy, in 2012, that is, amid the crisis.
In this study, we explored and investigated the possible additional impact of concurrent events such as economic crisis and a natural disaster.
Our analysis elaborated data from two local surveys, ICESmo2 (2006) and ICESmo3 (2012), and a national survey carried out in 2013 by the Italian National Institute of Statistics (Istituto Nazionale di Statistica (ISTAT)). A regression model was adopted to distinguish the effect of the crisis and the earthquake.
Our analysis confirmed the negative effect of the economic crisis on psychological wellbeing, but within the province of Modena such an effect resulted as even stronger compared with the rest of Italy, particularly within those areas struck by the earthquake.
Being hit by a combination of two major negative events might have a significantly increased negative effect on psychological health. The higher repercussion observed is not only attributable to the occurrence of a natural disaster but can be reasonably related to the additional effect of unemployment on psychological dimensions.
The most prevalent psychiatric disorders are mood, anxiety and somatoform (MAS) disorders which show high mutual comorbidity, childhood trauma and elevated risk of suicidality. So far, no studies have compared suicide risk in a secondary care population with comorbid MAS disorders. This gap was taken as starting point for the study.
In comparing suicidal and non-suicidal MAS patients, the following was examined: suicide risk in the three disorder groups, socio-demographic and clinical characteristics, occurrence of childhood trauma types and contribution of childhood trauma to suicidality.
This cross-sectional study compared suicidal (n = 316) versus non-suicidal comorbid MAS outpatients (n = 929) by means of the Mini-International Neuropsychiatric Interview Plus (MINI-Plus), Brief Symptom Inventory (BSI), Short Form Health Survey 36 (SF-36), Dimensional Assessment of Personality Pathology–Short Form (DAPP-SF) and Childhood Trauma Questionnaire (CTQ).
Compared to non-suicidal MAS patients, suicidal MAS patients mostly had mood disorders (single/comorbid), multiple diagnoses, worse functioning, more personality pathology (self-harm) and more childhood neglect and abuse.
Especially (comorbid) depressed patients are at risk for suicide, and routine screening and monitoring of childhood trauma and suicidality in them are recommended, along with the timely deployment of appropriate trauma-focused psychotherapy.
Several guidelines consider psychosocial treatments an essential component of clinical management of bipolar disorders in addition to drug therapy. However, to what extent such interventions are available in everyday practice to the average patient attending mental health services is not known.
This study aims to investigate access of people with bipolar disorders to psychosocial treatments in a community-based care system.
Information on care delivery and service utilization were retrieved from the psychiatric database of Lombardy, Italy, covering a population of 9,743,000, for all adults who had at least one contact in 2009 with psychiatric services. Rates of patients with a diagnosis of bipolar disorder who had access to individual psychotherapy, couple/family therapy, group psychotherapy and family interventions were calculated and compared to patients with schizophrenia and depression.
A total of 8,899 subjects with bipolar disorder had been in contact with psychiatric services, corresponding to a treated annual prevalence rate of 1.1. More than 80% of patients were treated in community settings. Rates of patients receiving structured psychosocial treatments ranged from 0.7% for couple/family therapy to 6.1% for individual psychotherapy. No differences with patients with schizophrenia and depression were found. Patients with schizophrenia received more interventions labeled as rehabilitation.
Few people with bipolar disorders had access to psychosocial treatments. Even in a well-developed system of community care, offer of psychosocial interventions for bipolar disorders is inadequate. This issue should be a target for future research on dissemination and implementation strategies.
Traumatic events experienced by parents who have survived genocide influence mental health among their offspring. This study aims at exploring how the communication of traumatic events between Khmer Rouge survivors and their offspring was perceived by both generations.
Qualitative interviews were performed with six Khmer Rouge survivors and with six young people representing the second generation and were analysed using a content analysis approach.
Parents felt that informing their children was important to instill gratitude for living a better life and to empower them. Among children, this was met with empathy but sometimes also disbelief and at times they blamed their parents for being too submissive.
The study discloses the complexity, pros and cons of intergenerational sharing of trauma.
To determine the perception of the term schizophrenia among university students.
This cross-sectional study was performed in April 2015 with students from Canik Basarı University (Samsun/Turkey). A patient history was first established. We then investigated to what extent students agreed with 10 statements based on that patient history. Three separate questionnaire forms (versions A, B and C), differing only in terms of the diagnosis in the patient in the history, were prepared. The three diagnoses were ‘Schizophrenia’ (version A), ‘A psychiatric disease by the name of Bleuler’s syndrome’ (version B) and ‘Brain tumor’ (version C). The questionnaires were administered in a class environment. In all, 771 students participated.
Statistically significant differences between the forms were determined in only two statements (‘A.’s disease will represent a problem in A.’s future career’ and ‘A. will in all probability have problems with the law in the future’). While no difference was determined between versions A and B at two-way comparisons, a statistically significant difference was observed between versions A and B and version C.
No difference was determined between students’ attitudes toward a diagnosis of ‘schizophrenia’ and one of ‘a psychiatric disease known as Bleuler’s syndrome’. The focus in preventing stigmatization of schizophrenia should not concentrate on a name change alone. Changing the name schizophrenia may be of no use unless public ignorance and fear of psychiatric diseases can also be overcome.
Recovery was previously regarded as a somewhat unattainable goal, and the subjective experience was de-emphasised. Lately, the person and his or her experiences are emphasised.
Seven participants were interviewed regarding their experience of recovery from first-episode psychosis in schizophrenia. Data were analysed using interpretative phenomenological analysis (IPA).
Support and having to care for another are possibly the greatest contributors to their recovery. Spirituality plays an important role. Stigma, found to be ingrained and pervasive, could be a barrier to recovery. The rediscovery by the participants of their abilities (re)introduced a sense of agency.
The narrative in the process of recovery is crucial.
The purpose is to explore the consequences of war and its impact on mental health with attention to the Mediterranean area.
Narrative review of consequences of war on mental health and on the mental health of the communities in the current crises in the Mediterranean region.
A series of outbreaks of war are still raging in the Mediterranean region and producing horrible effects with a considerable number of refugees with unsatisfied needs. Studies relating to conflicts of the past suggest that the mental health consequences of these wars may affect future generations for many years. While violations of human rights are not new, what is new are attacks on medical institutions perceived to be traditionally Western.
The scientific community has to fight violence through mediation of conflicts. The idea that science can improve lives is a concept that is found in the history of all Mediterranean cultures. The Greek and Roman medical tradition was saved thanks to doctors of the Arab courts when Christian fundamentalism fought science in the Middle Ages. Health institutions are the product of the great Islamic medical tradition as well as Western culture.
The prevalence of trauma-related problems among refugees and asylum seekers is extremely high due to adverse experiences associated with forced migration. Although the literature presents a considerable number of guidelines and theoretical frameworks for working with traumatized refugees and asylum seekers, the efficacy, feasibility and applicability of these interventions have little empirical evidence.
The purpose of this article is to critically review the literature to provide a rationale for developing culturally sensitive, evidence-based interventions for refugees and asylum seekers.
A literature review integrating research findings on interventions designed especially for traumatized asylum seekers and refugees was conducted. Retained studies had to use some quantitative measurements of post-traumatic stress and to have pre- and post-measurements to evaluate the efficacy of the intervention. Studies included in this review cover a wide variety of interventions, including trauma-focused interventions, group therapy, multidisciplinary interventions and pharmacological treatments.
The majority of studies with traumatized refugees and asylum seekers reported positive outcomes of the intervention in reducing trauma-related symptoms. There is evidence to support the suitability of cognitive-behavioral therapy (CBT) and narrative exposure therapy (NET) in certain populations of refugees. Other intervention studies are limited by methodological considerations, such as lack of randomization, absence of control group and small samples.
This review has again highlighted the shortage of guiding frameworks available to investigators and clinicians who are interested in tailoring interventions to work with refugees and asylum seekers. Theoretical, ethical and methodological considerations for future research are discussed.
Hikikomori, a form of social withdrawal first reported in Japan, may exist globally but cross-national studies of cases of hikikomori are lacking.
To identify individuals with hikikomori in multiple countries and describe features of the condition.
Participants were recruited from sites in India, Japan, Korea and the United States. Hikikomori was defined as a 6-month or longer period of spending almost all time at home and avoiding social situations and social relationships, associated with significant distress/impairment. Additional measures included the University of California, Los Angeles (UCLA) Loneliness Scale, Lubben Social Network Scale (LSNS-6), Sheehan Disability Scale (SDS) and modified Cornell Treatment Preferences Index.
A total of 36 participants with hikikomori were identified, with cases detected in all four countries. These individuals had high levels of loneliness (UCLA Loneliness Scale M = 55.4, SD = 10.5), limited social networks (LSNS-6 M = 9.7, SD = 5.5) and moderate functional impairment (SDS M = 16.5, SD = 7.9). Of them 28 (78%) desired treatment for their social withdrawal, with a significantly higher preference for psychotherapy over pharmacotherapy, in-person over telepsychiatry treatment and mental health specialists over primary care providers. Across countries, participants with hikikomori had similar generally treatment preferences and psychosocial features.
Hikikomori exists cross-nationally and can be assessed with a standardized assessment tool. Individuals with hikikomori have substantial psychosocial impairment and disability, and some may desire treatment.
Despite widespread acceptance of the principle that patients should be informed about their diagnosis, many clinicians are reluctant to provide a diagnosis of schizophrenia. This study examines family caregivers’ experiences of the communication of a schizophrenia diagnosis and related information.
A generic qualitative methodological approach was used. In all, 13 family caregivers were recruited in regional New South Wales, Australia. Semi-structured interviews were used to explore their experiences and perceptions of discussing the diagnosis, prognosis and treatment of schizophrenia with mental health professionals. Interviews were recorded, transcribed, codes generated and thematic analysis undertaken.
Family caregivers described long and difficult pathways to being given a diagnosis, haphazard means of finding out the diagnosis, high unmet needs for information, exclusion from the medical care process and problematic communication and general interactions with mental health clinicians. Caregivers were unanimous about the importance of receiving a timely diagnosis, for them and their relative with schizophrenia.
Family caregivers are an integral part of the mental health-care system, and they should be included early in discussions of diagnosis and treatment of a person with schizophrenia. Their perspectives on communicating a diagnosis of schizophrenia provide important information for communication skills training of psychiatrists and other mental health professionals.
Non-suicidal self-injurious behaviour (NSSI) is a growing concern among youth and rarely reaches the attention of mental health and medical services.
The study explored the occurrence, methods, characteristics and reported reasons for NSSI among a sample of college students in India.
A total of 470 participants from undergraduate and postgraduate colleges completed the Functional Assessment of Self Mutilation (FASM) questionnaire.
Results indicated that 31.2% of the participants reported NSSI in the past year, with the mean age of onset being 15.9 years. Moderate/severe forms of NSSI were reported by 19.8% of the sample. The most common method was self-hitting (15.2%) followed by cutting or carving skin (13.2%). A majority of self-injurers endorsed multiple methods of NSSI, and there were no significant gender differences in NSSI rates. The NSSI was performed both to regulate internal emotional states (automatic reinforcement) and to influence others in the environment (social reinforcement).The most commonly endorsed reasons for NSSI were ‘to feel relaxed’ and ‘to get control of the situation’, while the least frequently endorsed reasons were ‘to make others angry’ and ‘to avoid college, work, or other activities’.
The findings underscore the need to increase the awareness and understanding of NSSIs and to plan targeted interventions among college youth.
More mental health services are adopting the recovery paradigm. This study adds to prior research by (a) using measures of stages of recovery and elements of recovery that were designed and validated in a non-Western, Chinese culture and (b) testing which demographic factors predict advanced recovery and whether placing importance on certain elements predicts advanced recovery.
We examined recovery and factors associated with recovery among 75 Hong Kong adults who were diagnosed with schizophrenia and assessed to be in clinical remission. Data were collected on socio-demographic factors, recovery stages and elements associated with recovery. Logistic regression analysis was used to identify variables that could best predict stages of recovery. Receiver operating characteristic curves were used to detect the classification accuracy of the model (i.e. rates of correct classification of stages of recovery).
Logistic regression results indicated that stages of recovery could be distinguished with reasonable accuracy for Stage 3 (‘living with disability’, classification accuracy = 75.45%) and Stage 4 (‘living beyond disability’, classification accuracy = 75.50%). However, there was no sufficient information to predict Combined Stages 1 and 2 (‘overwhelmed by disability’ and ‘struggling with disability’). It was found that having a meaningful role and age were the most important differentiators of recovery stage.
Preliminary findings suggest that adopting salient life roles personally is important to recovery and that this component should be incorporated into mental health services.
The characterization of auditory verbal hallucinations (AVH) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), diverges from recent research literature, which demonstrates the occurrence of AVH in individuals who are psychologically healthy. This discrepancy raises the question of how the public perceives AVH. Public perceptions are important because they could potentially affect how individuals with AVH interpret these experiences and how people view voice hearers.
Because media portrayals can provide a window into how phenomena are viewed by the public, an archival study of newspaper articles was carried out to examine depictions of AVH.
A sample of 181 newspaper articles originating in the United States was analyzed using a content analysis approach.
The majority of articles examined contained no suggestion that AVH are possible in psychologically healthy individuals. Most articles suggested that AVH were a symptom of mental illness, and many suggested that AVH were associated with criminal behavior, violence and suicidality.
The news media examined tended to present a misleading and largely pathologizing view of AVH. More research is needed to shed light on how, and to what extent, public perceptions may influence those who experience AVH.
Interferential care differs from the current community-based care programs in that it targets a larger, heterogeneous group and combines brokerage and full service elements in a multi-organizational care team. The team provides all the services itself, but with the aim to prepare clients within a few months for referral to regular (ambulant) healthcare services. The aim of this study was to assess the effectiveness of interferential care.
In a multisite, pretest–posttest design, 523 patients of three interferential care teams were followed. Quality of life, problem severity, problems with referral and engagement were assessed at baseline, at referral and again after 6 months. Analyses were performed using linear mixed modeling.
Interferential care showed moderate to strong effects on quality of life and problem severity. These effects persisted (quality of life) or further improved (problem severity) until follow-up 6 months after referral to regular services. There were also small effects on both engagement and problems with referral.
Interferential care offers significant improvements in quality of life and problem severity in persons who have severe problems on several life areas and who are currently not reached by healthcare services. It is a promising community-based care program for healthcare systems in which regular care already contains many elements of home-based practice.
Up to 50% of patients with schizophrenia are non-adherent with antipsychotic medication.
To establish the efficacy of adherence therapy (AT) compared to treatment as usual (TAU) in improving clinical outcomes in patients with schizophrenia following an acute exacerbation of illness.
A parallel-group, single-blind, randomised controlled trial. Fieldwork was conducted in Thailand. Patients received eight weekly sessions of AT in addition to TAU. The primary outcome was improvement in psychopathology (measured using the Positive and Negative Syndrome Scale (PANSS)) at 26-week follow-up. Secondary outcomes included patient attitudes towards medication, global functioning and side-effects.
In total, 70 inpatients with schizophrenia were recruited to the trial. At 26-week follow-up, PANSS total scores improved in the AT compared to the TAU group by a mean of –3.94 points (effect size = 0.24). The number needed to treat (NNT) was 5. There was no significant effect on patients’ attitudes towards treatment, functioning or medication side-effects. No treatment-related adverse effects were reported.
AT improves psychopathology in Asian patients with schizophrenia following an acute exacerbation of illness.
Background: Most disadvantaged women are exposed to risk factors for depression, but not all necessarily have an identical risk for this mental health problem. A better prediction of which low socioeconomic status (SES) women are most at risk for depressive symptoms can help target preventive interventions at high-risk subgroups most in need of support.
Aims: Exploring which demographic, socioeconomic and psychological risk factors are associated with self-reported depressive symptoms in a sample of low-SES women and whether the number of risk factors might expose them to an accumulated risk.
Methods: Between April 2005 and November 2007, 519 disadvantaged women from urban neighbourhoods in Maastricht, a southern Dutch city, participated in a cross-sectional survey on stress and depressive symptoms.
Results: Lower education levels, no current employment and lower net monthly family incomes were socioeconomic risk factors associated with higher scores for depressive symptoms. The psychological risk factor ‘perceived stress’ had the highest explained variance and was most strongly associated with depressive symptoms. Women exposed to multiple risk factors across domains had a cumulated risk for depressive symptomatology.
Conclusion: Low-SES women who seem most eligible for targeted preventive action are those with cumulative risks. Depression prevention strategies for this population may benefit from focusing on perceived stress since this is an important modifiable risk factor.
The etiology of mental illness has been attributed to many different causes by people of various cultural backgrounds, including supernatural beliefs. This in turn affects the help-seeking behavior. Aim of this study was to explore the supernatural belief and pathways of care in patients with obsessive compulsive disorder (OCD) attending a tertiary care hospital located in north India.
In all, 89 consecutive patients diagnosed with OCD (according to the International Classification of Diseases–10th Revision (ICD-10)) and ≥ 15 years of age were evaluated for their supernatural belief and help seeking.
More than half of the patients (54%) believed in supernatural causes and 57.3% attributed their illness to supernatural causes. In addition to supernatural causes, many patients also attributed their illness to stress (household/work-related stress) or chemical imbalance in the body and or mind. About two-thirds of the patients (n = 58; 65.2%) first contacted a psychiatrist for their symptoms of OCD. Those who first contacted faith healers believed in one of the supernatural causations.
Patients with OCD hold multiple beliefs regarding the etiology and treatment of mental illness which can affect their pathways to care.
In the 1950s, researchers showed an association between low socio-economic status (SES) and psychosis. Two competing theories social causation and social drift were proposed to explain the findings. In the intervening years, contrasting evidence emerged as some studies showed no association between SES and schizophrenia. At present, the nature of the relationship is still unclear; currently, there are no reviews in the literature examining the association between social class at birth and psychosis.
To search the literature to clarify the relationship between social class at birth, measured by paternal occupation at birth, and the risk of adult-onset psychosis.
A systematic search of the literature using a combination of keywords in Group 1 together with the keywords in Group 2 was performed in October 2012 in the following online databases: (a) MEDLINE (1946–2012), (b) PubMed, (c) Embase (1980–2012), (d) PsycINFO (1806–2012) and (e) Web of Science (1899–2012). Reference lists were also hand searched. The search provided 3,240 studies; following screening of the titles and abstracts by inclusion and exclusion criteria and quality assessment of the full text, 14 studies were identified to be appropriate for the review. The keywords used for the search were as follows: Group 1 – social class, social status, socioeconomic, socio-economic, SES; Group 2 – psychosis, psychoses, schizophrenia.
Seven studies showed an association between low SES and psychosis. Four studies showed no association, and three studies showed an association with high SES.
There is not enough evidence to support the association between social class and psychosis. While some findings showed an association between low social class and psychosis, there were a number of conflicting studies showing no association or a link with higher social class. Interestingly, the results followed a temporal pattern, as all the studies conducted after 2001 supported an association between low SES at birth and psychosis. Four of the six studies employed a prospective design with large sample populations, indicating the need for further investigation.
A recent migration trend from Korea is transnational family arrangement where mothers migrate with children to English-speaking countries, while the fathers stay in the home country. Mothers in these families may experience more challenges than other family members because they have to adjust to a new country, new parenting role and family separation. But little is known about their mental health.
This article scopes the evidences in the literature on impact of transnational family arrangement and migration on the mental health of Korean transnational mothers.
A comprehensive search was undertaken in 16 databases and 17 studies were identified.
The evidence on the mental health of Korean transnational mothers was analyzed into two themes: (1) challenges and life difficulties, (2) psychological and emotional states. In relation to the life difficulties such as role changes, adaptation in the host country and lack of social support, the mothers reported anxiety, depression, increased psychological distress and feeling of isolation. Positive perceptions such as sense of empowerment and increased self-confidence were also reported.
The evidence suggests that there may be a potential for vulnerability to mental health problems in Korean transnational mothers. More research is needed to assess their mental health and to identify the risk factors.
Incarceration and homelessness are closely related yet studied rarely. This article aimed to study the incarcerated homeless and identify specific vulnerabilities, which rendered them different from the nonincarcerated homeless. It also aimed to describe the homeless population and its significant involvement with the criminal justice and enforcement system.
Data were derived from the British Columbia Health of the Homeless Study (BCHOHS), carried out in three cities in British Columbia, Canada: the large urban center Vancouver (n = 250), Victoria (n = 150) and Prince George (n = 100). Measures included socio-demographic information, the Maudsley Addiction Profile (MAP), the Childhood Trauma Questionnaire (CTQ) and the Mini International Neuropsychiatric Interview (MINI) Plus.
Incarcerated homeless were more often male (66.6%), were in foster care (56.4%) and had greater substance use especially of crack cocaine (69.6%) and crystal methamphetamine (78.7%). They also had greater scores on emotional and sexual abuse domains of CTQ, indicating greater abuse. A higher prevalence of depression (57%) and psychotic disorders (55.3%) was also observed. Risk factors identified which had a positive predictor value were male gender (p < .001; odds ratio (OR) = 2.8; 95% confidence interval (CI): 1.7–4.4), a diagnosis of depression (p = .02; 95% CI: 1.1–4.4) and severe emotional neglect (p = .02; 95% CI: 1.1–3.2) in the childhood.
Homeless individuals may be traumatized at an early age, put into foster care, rendered homeless, initiated into substance use and re-traumatized on repeated occasions in adult life, rendering them vulnerable to incarceration and mental illness.
Introduction: Depression is the most frequently seen mental disease in the pregnancy period. The first trimester of pregnancy is important in terms of its effects on both the fetus and on the mother. This study has researched the prevalence of depression in women in the first trimester of their pregnancies in Erzurum, which is a large province in the Eastern region of Turkey.
Method: The study participants were 463 pregnant women who were in the first trimester of their pregnancy. Screening was primarily carried out using the Edinburgh Postnatal Depression Scale (EPDS), and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV)–Clinical Version (SCID-I) was applied to those participants with a score of 12 points and higher. To assess the risk factors, a sociodemographic data form was completed by the authors.
Results: The total depressive disorder rate was 16.8% in women in the first trimester of their pregnancies (12.3% major depressive disorder, 1.5% double depression, 2.6% minor depressive disorder and 0.4% dysthymia). A history of mental disease, mental disease suffered during a previous pregnancy, exposure to violence in the present pregnancy, an unplanned pregnancy and spouse’s unemployment were predictors for depressive disorders.
Conclusion: It is important to identify the risk groups for the early recognition of depression in pregnancy. Developing depression screening programs can be useful for early diagnosis and therapy.
Background: People with a low material living standard experience more psychological distress than those with a high living standard, but previous studies suggest the size of this difference is modest.
Aim: To measure the association between living standard and psychological distress using a multidimensional measure of living standard, the Economic Living Standard Index (ELSI).
Methods: Adults aged 25–64 years (n = 8,465) were selected from a New Zealand community survey. Logistic regression models were used to compare household income and ELSI scores as risk factors for high psychological distress, defined as a K10 score of 12 or over.
Results: In the population, the prevalence of high psychological distress was 5.8%. The prevalence of high distress increased steeply with decreasing living standard. In the most deprived decile according to ELSI score, 24.3% had high distress, compared to 0.8% in the least deprived decile. For household income, high distress was present in 15.9% of people in the lowest decile and 2.2% of the highest decile. In fully adjusted models, ELSI score remained significantly associated with high distress but household income was not.
Conclusion: The mental health disparity between those at opposite ends of the social spectrum is very large. Comprehensive measures such as the ELSI give a more accurate estimate of this disparity than household income.
Background: Leverage is a particular type of treatment pressure that is used within community mental health services to increase patients’ adherence to treatment. Because leverage involves practitioners making proposals that attempt to influence patients’ behaviours and choices, the use of leverage raises ethical issues.
Aim: To provide guidance that can assist practitioners in making judgements about whether it is ethically acceptable to use leverage in a particular clinical context.
Method: Methods of ethical analysis.
Results: Four ethical duties relevant to making such judgements are outlined. These four duties are (1) benefitting the individual patient, (2) benefitting other individuals, (3) treating patients fairly and (4) respecting patients’ autonomy. The practical requirements that follow from each of these duties are considered in detail. It is argued that practitioners should determine whether the use of leverage will mean that care is provided in ways that are consistent with the requirements of these four duties, regardless of whether the patient accepts or rejects the terms of the proposal made.
Conclusion: Particular attention must be paid to determine how the requirements of the four duties should be applied in each specific treatment scenario, and in making careful judgements when these duties pull in opposing directions.
Background: As the suicide rate in Japan has remained high since 1998, various suicide prevention measures have been implemented in Japanese local communities.
Aims: To report our findings on the effect of a psychoeducational video as a suicide prevention measure in a Japanese rural town.
Methods: Questionnaires were randomly mailed to 2,000 residents aged between 30 and 79 years. Within 4 weeks, volunteers in the town visited the residents individually and collected the questionnaires. The variables reported in this study are demographics, awareness of suicide prevention measures available in the town, whether the residents watched the video, help-seeking from advisers regarding suicidal ideation and financial problems and attitudes towards suicide.
Results: We analysed data collected from 1,118 people who reported their demographics (i.e. sex, age, and job) and whether they had watched the video. By conducting a series of logistic regression and multiple regression analyses and controlling for demographic variables, we found that watching the video had substantial psychoeducational effects.
Conclusion: Despite conducting a cross-sectional study, our new suicide prevention measures were considered effective for psychoeducation. However, further studies using a longitudinal design are needed.
Background: In 2008, the Swiss Civil Code was amended. From 1 January 2013, each Swiss canton may propose specific provisions for involuntary outpatient treatment (community treatment orders (CTOs)) for individuals with mental disorders.
Aim: This review catalogues the legal provisions of the various Swiss cantons for CTOs and outlines the differences between them. It sets this in the context of variations in clinical provisions between the cantons.
Methods: Databases were searched to obtain relevant publications about CTOs in Switzerland. The Swiss Medical Association, Swiss Federal Statistical Office, Swiss Health Observatory and all the 26 Cantonal medical officers were contacted to complete the information. Conférence des cantons en matière de protection des mineurs et des adultes (COPMA), the authority which monitors guardianship legislation, and Pro Mente Sana, a patients’ right association, were also approached.
Results: Three articles about CTOs in Switzerland were identified. Psychiatric provisions vary considerably between cantons and only a few could provide complete or even partial figures for rates of compulsion in previous years. Prior to 2013, only 6 of the 20 cantons, for which information was returned, had any provision for CTOs. Now, every canton has some form of legal basis but the level of detail is often limited. In eight cantons, the powers of the measure are not specified (for example, use of medication). In 12 cantons, the maximum duration of the CTO is not specified. German speaking cantons and rural cantons are more likely to specify the details of CTOs.
Conclusion: Highly variable Swiss provision for CTOs is being introduced despite the absence of convincing international evidence for their effectiveness or good quality data on current coercive practice. Careful monitoring and assessment of these new cantonal provisions are essential.
Background: Not much is known about factors that contribute to resilience among women facing intimate partner violence (IPV), particularly from countries where patriarchy predominates. This qualitative study aimed to gather the perspectives of Indian women self-identified as resilient in the face of IPV and tried to understand the strategies and resources that helped them to maintain or regain resilience.
Materials: Data were collected from 16 consenting women who reported IPV and whose husbands were being treated for alcohol problems at a psychiatric centre in Bangalore, India. A semi-structured guided interview format that aimed at understanding factors that enabled them to feel resilient despite IPV in their challenging circumstances was used to gather narratives from the participants.
Discussion: Six themes were identified using QSR NVivo software. They were as follows: the support of women, men and family; personal attributes; dignity and work; being strong for the children; and faith in God. Among these women, supportive social networks, personal attributes and aspirations were major clusters contributing to resilience.
Conclusion: Attention to these factors may provide an important, strengths-based perspective for interventions to enhance women’s resilience when facing IPV.
Background: Several countries have prescribed standard guidelines for media professionals on suicide reporting. However, the implementation of these guidelines has been varied. Suicide rates in South Asia are one of the highest in the world, and it is known that media guidelines for suicide reporting are not followed adequately. However, there are no published reports available from this region.
Aim: This study aimed at assessing newspaper reports of suicide for quality of reporting based on standard reporting guidelines and to study differences between English and vernacular (Kannada) newspapers in Bangalore, South India.
Methods: A total of 341 newspaper reports of suicide from 550 newspapers (3 English and 3 Kannada) over 3 months were systematically assessed for compliance with reporting guidelines. Each report was evaluated on 2 domains and 36 parameters. Data were analyzed for frequency of inappropriate reporting and patterns compared between vernacular and English newspapers.
Results: In all, 87% of the reports were those of completed suicide. Non-compliant reporting – method of suicide was reported in 89% and 32% of reports were in prominent pages of the newspaper, 95% mentioned gender, 90% reported the name, 80% reported age and suicide location, 75% reported life events related to suicide, 70% reported occupation, 69% had headline explicity on suicide and 61% reported monocausality. Only 16% reported mental disorder related to suicide, and less than 3% included information on suicide prevention and helplines. Vernacular papers showed significantly better compliance in 16 of the 20 areas. However, protective characteristics were better reported in English newspapers.
Conclusion: Majority of reports on suicides in newspapers from Bangalore did not comply with standard guidelines of reporting. There is a strong need to evolve local guidelines and mechanisms for ensuring responsible reporting which have important implications in prevention of suicide.
Background: Papua New Guinea is a developing country with limited resources for specialist mental health services. Little is known about the mental health and treatment services of Papua New Guinea.
Aim: The aim of this study was to clarify the presenting mental health problems encountered by Papua New Guinean health workers and the common treatment approaches used.
Methods: A total of 203 Papua New Guinean health workers completed a retrospective quantitative survey about their three most recent mental health patients. The survey asked about presenting symptomatology, diagnoses (including culture-bound diagnoses) and treatment approaches.
Results: The major presenting mental health problems for males included schizophrenia, substance use disorder, sorcery and spirit possession. Depression was the most common diagnoses for women, followed by sorcery and somatisation. Over 65% of patients were prescribed psychotropic medication, over 50% received some form of psychological intervention and 28% were receiving traditional treatments.
Conclusions: Somatic symptoms are common among both male and female Papua New Guineans; however, males may be more likely to present with psychotic symptoms and females with mood-related problems. Schizophrenia and depression are commonly identified with substance use disorder more problematic among males. Culture-specific explanations and treatment are commonly used.
Background: Stigma toward people with bipolar disorder (BD) is pervasive and can have many negative repercussions. Common approaches to stigma reduction include education and intergroup contact. From this perspective, the Collaborative RESearch Team to study psychosocial issues in Bipolar Disorder (CREST.BD) and Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to develop an intervention to combat stigma. The result is a personal narrative intervention that combines contact, education and drama to educate audiences and dispel the myths that drive stigma.
Aim: This study reports on the impact of the CREST.BD-CANMAT stigma-reduction intervention in filmed format.
Methods: A sample of 137 participants was recruited to view the film, including health-care service providers, university students in a health-care-related course, people with BD and their friends and family members and the general public. Participants were evaluated for stigmatizing attitudes and the desire for social distance before and after the intervention and 1 month later.
Results: For health-care service providers, the intervention was associated with statistically significant improvements in several categories of stigmatizing attitudes, with maintenance 1 month later. The impact was more modest for the other subsamples. Students demonstrated progressive, significant improvements in the desire for (less) social distance. Some improvements were observed among members of the BD community and the general public, but these were limited and eroded over time.
Conclusion: This study demonstrated that a filmed dramatic intervention based on the lived experience of BD has statistically significant, sustainable stigma-reduction impacts for health-care service providers and more limited impacts for other target groups. This intervention can be considered an effective tool for use in stigma-reduction campaigns specifically targeting members of the health-care sector. Results are discussed in the context of multi-component stigma-reduction campaigns and the potential needs of target groups.
Background: Several studies have revealed positive associations between religiosity, health and happiness. However, the vast majority of these studies were carried out on native English-speaking participants.
Aims: The objective of this study was to estimate the relations between religiosity, health and happiness among a sample (N = 372) of Qatari adolescents (Mage = 15.2).
Method: The students responded to five self-rating scales to assess religiosity, mental health, physical health, happiness and satisfaction with life.
Results: Boys obtained a higher mean score on mental health than did their female counterparts. All the correlations between the rating scales were significant and positive. Principal component analysis disclosed one component and labelled ‘Religiosity, health and happiness’ in both sexes. The multiple stepwise regression indicated that the predictors of religiosity were the self-ratings of satisfaction with life and happiness in boys, whereas the predictors among girls were satisfaction with life and physical health.
Conclusions: On the basis of the responses of the present sample, it was concluded that those who consider themselves as religious were more happy, satisfied with their life and healthy.
Background: Stigmatisation is a source of chronic stress and a major barrier to recovery for people with mental illnesses. The internalisation of stigma can have a negative impact on an individual’s social relations and lead to feelings of loneliness and depression.
Aim: This research is aimed at testing the hypothesis that the internalised stigma of mental illness contributes to the intensification of depressive symptoms indirectly, through its impact on feelings of loneliness.
Methods: A total of 110 individuals with diagnoses of psychotic disorders (International Classification of Diseases–10th Revision (ICD-10): F20–F29) were assessed with measures of internalised stigma, loneliness, depression, positive and negative symptoms and global functioning. The ordinary least squares regression was used for data analysis.
Results: After adding loneliness to the regression model, the initially significant impact of internalised stigma on depressive symptoms disappeared. As expected, loneliness proved to be a full mediator in the relationship between stigma and depression.
Conclusion: The study findings provide useful insights into the mechanisms of the harmful effects of stigma on people with mental illness. Internalised stigma and loneliness should be considered important targets for interventions aiming to promote recovery.
Background: Germany provides a wide range of highly developed mental health care to its citizens. The aim of this study was to identify factors influencing the voluntariness of admissions to psychiatric hospitals. Especially the impact of demographic factors of the region, characteristics of the psychiatric hospitals and characteristics of the psychosocial services was analyzed.
Method: A retrospective analysis of hospital admission registers from 13 German adult psychiatric hospitals in 2009 was conducted. Public data on the regional psychiatric accommodation and demographic situation were added. Hospitals were dichotomously divided according to their index of involuntary admissions. Group comparisons were performed between the clinics with low and high involuntary admission indices. Analysis was conducted with clinical, psychiatric provision and demographic data related to inpatients in the Landschaftsverbands Westfalen-Lippe (LWL)-PsychiatryNetwork.
Results: Especially the range of services provided by the social-psychiatric services in the region such as number of supervised patients and home visits had an influence on the proportion of involuntary admissions to a psychiatric hospital. Some demographic characteristics of the region such as discretionary income showed further influence. Contrary to our expectations, the characteristics of the individual hospital seem to have no influence on the admission rate.
Conclusion: Social-psychiatric services show a preventive impact on involuntary acute psychiatry interventions. Sociodemographic factors and patient variables play a role with regard to the number of involuntary hospitalizations, whereas characteristics of hospitals seemed to play no role.
Background: Previous research suggests that mental health literacy regarding the personality disorders is low, with few disorders being recognised.
Aims: The current study aimed to examine the effect of a background in psychology as a predictor of knowledge of the personality disorders.
Methods: An opportunistic sample of 165 participants (mean age = 30.12 years, standard deviation (SD) = 15.27 years) took part in the study. Participants were instructed to read 10 personality disorder vignettes and other ‘filler’ items and rate each person in terms of how happy, successful at work and good at personal relationships they are, as well as whether they have a psychological problem.
Results: Results showed, as predicted, that those with a background in psychology were more accurate at labelling disorders. In addition, laypeople’s mental health literacy was good for identifying the presence of personality disorders, but was considerably poorer when naming them.
Conclusion: Recognising that people may have a disorder and having a ‘correct’ or recognised label are not the same thing.
Background: Schizophrenia is a severe mental disorder with substantial socioeconomic burden associated with poorer psychosocial functioning during the course of illness. In schizophrenia patients, multiple factors play a role in occupational functioning.
Aim: It was aimed to investigate the relationship between different working conditions and quality of life and self-esteem on patients with schizophrenia in Turkey.
Methods: A total of 100 patients diagnosed as schizophrenic were divided into three groups: competitive working, supported working and unemployed.
Results: The groups did not differ significantly with regard to psychotic symptoms, self-esteem and illness history. Working was associated with higher scores on quality of life subscales especially in supported working group, whereas unemployed patients had more depressive symptoms and autonomic drug side effects.
Conclusion: Structured working programs which may improve social life of patients with schizophrenia in many aspects is warranted in Turkey.
Background: With the rapid development of economy, depression disorder is not only a public health issue but also a socioeconomic problem and attracting more and more attention in China.
Aims: The target of this study is to examine the prevalence of depression and the related risk factors in the Dibao population in northwestern China.
Method: A cross-sectional analysis in a random sample survey conducted in three northwestern Chinese cities in 2007. The data from 4459 respondents with completed Center for Epidemiological Studies–Depression (CES-D) scales were evaluated to explore the key risk factors for depression. Using depression as a binary variable according to the cutoff of the CES-D score and then as a continuous variable, multiple logistic and line regression analysis were performed to compare the odds ratio and the weight of different risk factors for depression.
Results: The prevalence of depression in non-Dibao population was 34.7% but that in the Dibao population was 50.0% (p < .001). After adjusting for important confounders, Dibao population had an odds ratio (OR) of 1.38 (95% confidence interval (CI): 1.16–1.63) to have possible depression compared to those non-Dibao people. Furthermore, depression was associated with a higher OR of indebtedness (OR: 1.59, 95% CI: 1.31–1.93), and a small amount of debt would increase the possibility of depression for Dibao people (OR: 1.69, 95% CI: 1.28–2.23). In addition, gender, body mass index (BMI), tobacco use and social network were also important risk factors for depression in the Dibao population. Using depression as a continuous variable, being a member of the Dibao population and being indebted will add 2.06 and 1.83 to the CES-D score, respectively, compared with the non-Dibao population and not being indebted. A comparison of the odds ratios of depression between the Dibao and the non-Dibao population showed that factors such as gender, BMI, tobacco use, social network and indebtedness were statistically significant in the Dibao population but were not statistically significant in the non-Dibao population. Additionally, having a savings account was statistically significant in the non-Dibao population but not in the Dibao population.
Conclusions: It was not surprising, as proved by other studies, that gender, obesity and social network were risk factors associated with depression in the Dibao population. Our findings indicated that a small amount of indebtedness was also closely related to depression in the Dibao population.
Background: Recent decades have witnessed some integration of mental health care and religious resources.
Aim: We measured primary care physicians’ (PCPs) and psychiatrists’ knowledge of religious mental health-care providers, and their willingness to refer there.
Methods: A national survey of PCPs and psychiatrists was conducted, using vignettes of depressed and anxious patients. Vignettes included Christian or Jewish patients, who regularly or rarely attended services. We asked whether physicians knew of local religious mental health providers, and whether they would refer patients there.
Results: In all, 896/1427 PCPs and 312/487 psychiatrists responded. Half of PCPs (34.1%–44.1%) and psychiatrists (51.4%–56.3%) knew Christian providers; fewer PCPs (8.5%–9.9%) and psychiatrists (15.8%–19.6%) knew Jewish providers. Predictors included the following: patients were Christian (odds ratio (OR) = 2.2–2.9 for PCPs, 2.3–2.4 for psychiatrists), respondents were Christian (OR = 2.1–9.3 for PCPs) and respondents frequently attend services (OR = 3.5–7.0 for PCPs). Two-thirds of PCPs (63.3%–64%) and psychiatrists (48.8%–52.6%) would refer to religious providers. Predictors included the following: patients regularly attend services OR = 1.2 for PCPs, 1.6 for Psychiatrists, depression vignette only), respondents were Christian (OR = 2.8–18.1 for PCPs, 2.3–9.2 for psychiatrists) and respondents frequently attend services (OR = 5.1–6.3 for PCPs).
Conclusion: Many physicians would refer patients to religious mental health providers. However, less religious PCPs are less knowledgeable about local religious providers.
Objective: To screen 212 women for depression symptoms during pregnancy and postpartum in Serbia.
Methods: Questionnaires that covered key demographic and obstetric information and Edinburgh Postnatal Depression Scale (EPDS) were administered at the third trimester of pregnancy and at 8 weeks postpartum.
Results: In all, 21% of the sample was screened as depression positive during pregnancy. Subsequently, efforts were made to follow up 195 women through postpartum. Of the 195 women, 11% were screened positive during postpartum. Risk factors were low education level, low satisfaction with financial situation, high-risk pregnancy and depression during pregnancy. Logistic regression with backward elimination showed that women who had high-risk pregnancy have threefold increased risk of postpartum depression, and women who had antenatal depressive symptoms have 10-fold increased risk of postpartum depression.
Conclusion: In countries where screening tool for depression is not applied routinely in obstetrics settings, clinicians should be aware of risk factors, frequency and level of depressive symptoms during pregnancy and postpartum.
Background: Evaluation of mental health services based on patients’ needs assessments has never taken place in Greece, although it is a crucial factor for the efficient use of their limited resources.
Aim: To examine the inter-rater and test–retest reliability and the concurrent/convergent validity of the Greek research version of the Camberwell Assessment of Need–Research (CAN-R).
Method: A total of 53 schizophrenic patient–staff pairs were interviewed twice to test the inter-rater and test–retest reliability of the Greek version of the CAN-R. The World Health Organization Quality of Life–Brief Form (WHOQOL-BREF) and World Health Organization Disability Assessment Schedule–2.0 (WHODAS-2.0) were administered to the patients to examine concurrent validity.
Results: The inter-rater and test–retest reliability of patient and staff interviews for the 22 individual items and the eight summary scores of the instrument’s four sections were good to excellent. Significant correlations emerged between CAN scores and the WHOQOL-BREF and WHODAS-2.0 domains for both patient and staff ratings, indicating good concurrent validity.
Conclusion: Our results suggest that the Greek version of the CAN-R is a reliable instrument for assessing mental health patients’ needs. Moreover, it is the first CAN-R validity study with satisfactory results using WHOQOL-BREF and WHODAS-2.0 as criterion variables.
Background: Public beliefs about appropriate treatment impact, help-seeking and treatment adherence.
Aim: To determine the recommendations of the Sardinian public for the treatment of depression.
Methods: In 2012, a population-based survey was conducted by phone in Sardinia (N = 1,200). In the context of a fully structured interview, respondents were presented with a vignette depicting a case of depression. Subsequently, they were asked about their treatment recommendations. The results are contrasted with findings from a similar survey which had been conducted in Vienna 3 years before.
Results: In Sardinia as in Vienna, psychotherapy was the uncontested favorite, while antidepressant medication was recommended by relatively few respondents. In Sardinia, there were also no marked differences between urban and rural areas with regard to these two treatments. However, between Sardinia and Vienna, as well as within Sardinia, great differences were found with regard to autogenic training and ‘alternative’ methods like homeopathic medicines and acupuncture.
Conclusion: Cross-cultural comparisons may help better understand treatment preferences of the public. In Sardinia, as in Vienna, there seems to be a need for improving the public’s knowledge about the appropriate treatment of depression.
Objective: Our purpose was to assess stigma toward schizophrenia in a representative sample of the Brazilian general population.
Methods: The sample consisted of 1015 individuals interviewed by telephone. A vignette describing someone with schizophrenia was read, and four stigma aspects regarding this hypothetical individual were assessed: stereotypes, restrictions, perceived prejudice and social distance. Latent profile analysis searched for stigma profiles among the sample. Multinomial logistic regression was used to find correlates of each class.
Results: Four stigma profiles were found; ‘no stigma’ individuals (n = 251) mostly displayed positive opinions. ‘Labelers’ (n = 222) scored high on social distance; they more often had familial contact with mental illness and more often labeled the vignette’s disorder as schizophrenia. ‘Discriminators’, the group with the majority of individuals (n = 302), showed high levels of stigmatizing beliefs in all dimensions; discriminators were significantly older. ‘Unobtrusive stigma’ individuals (n = 240) seemed to demonstrate uncertainty or low commitment since they mostly answered items with the middle/impartial option.
Conclusion: Some findings from the international literature were replicated; however, familial contact increased stigma, possibly denoting a locally modulated determinant. Hereby, our study also adds important cross-cultural data by showing that stigma toward schizophrenia is high in a Latin-American setting. We highlight the importance of analyzing the general population as a heterogeneous group, aiming to better elaborate anti-stigma campaigns.
Background: Contrasting social status of ethnic groups differentially impacts the use of psychiatric services, including in Israel, despite its universal health system. However, relevant studies are limited.
Aims: To examine ethnic differences in mental health treatment gap and in access to specialized care.
Methods: Data were gathered from two sources. Study I included Mizrahi (Jews of North African/Asian origin, socially disadvantaged, n = 136) and Ashkenazi (Jews of European American origin, socially advantaged, n = 69) who were diagnosed with common mental disorders in the preceding 12 months in the Israeli component of the World Mental Health Survey. Study II included Mizrahi (n = 133) and Ashkenazi (n = 96) service users entering ambulatory mental health care.
Results: Study I showed that the treatment gap was larger among Mizrahi compared with Ashkenazi respondents (28% standard error (SE) = 4.1 and 45% SE = 6.2, respectively, sought services) following adjustment for sociodemographic confounders (adjusted odds ratio (AOR) = 2.28, 95% confidence interval (CI) = 1.1–4.8). Study II showed that the access to specialized care lagged over a year among 40% of service users of both ethnic groups. No significant ethnic differences emerged in variables related to delay in accessing care.
Conclusions: Treatment gap was larger among ethnically disadvantaged compared with the advantaged group. However, once in treatment, service users of both ethnic groups report similar barriers to care.
Background: The Japanese term hikikomori means literally ‘to be confined’. Social withdrawal can be present in severe psychiatric disorders; however, in Japan, hikikomori is a defined nosologic entity. There have been only a few reported cases in occidental culture.
Material: We present a case report of a Spanish man with prolonged social withdrawal lasting for 4 years.
Discussion: This is a case of prolonged social withdrawal not bound to culture, as well as the second case of hikikomori reported in Spain. We propose prolonged social withdrawal disorder as a disorder not linked to culture, in contrast to hikikomori.
Conclusion: Further documentation of this disorder is still needed to encompass all cases reported in Japan and around the world.
Background: There are major gaps in knowledge about beliefs, stigma and discrimination in Uganda, including the relationship between different cultural beliefs and stigmatising responses, how stigma and beliefs result in discrimination and the impact of social factors such as gender, poverty and ethnic conflict.
Aim: This exploratory study aims to understand beliefs, stigma and discrimination associated with mental health in Uganda in more depth from the perspectives of different stakeholders.
Methods: Focus groups and interviews were undertaken with mental health activists, policymakers, practitioners, non-governmental and human rights organisations, journalists and academics.
Results: Stigma was reported by individuals, families, communities and institutions, including health services. The study also found stigmatising beliefs linked to traditional, religious and medical explanatory frameworks, high levels of ‘associated stigma’, common mental health problems rarely medicalised and discrimination linked to poverty, gender and conflict.
Conclusions: The findings suggest the need to address stigma in their cultural and social context, alongside other human rights initiatives.
Background and aims: There is a dearth of data on the predictors of insight in schizophrenia. This study attempted to assess the predictors of insight in a cohort of first-episode schizophrenia followed up over 5 years.
Methods: Patients diagnosed to have Diagnostic and statistical manual of mental disorders (4th ed.; DSM-IV) schizophrenia (n = 131) were assessed prospectively for insight, psychopathology and explanatory models of illness over a 5-year period using standard instruments. Multiple linear regression and generalized estimating equations (GEE) were employed to assess predictors of insight.
Results: We could follow up 95 (72.5%) patients, 5 years after recruitment. A total of 65 of these patients interviewed at 60 months (68.4%) achieved remission. Cross-sectional evaluations suggest a relationship between insight, psychosis rating and explanatory models of illness with good insight and medical models associated with good outcome. However, baseline and early illness data do not predict insight scores at 5 years. Serial longitudinal assessment of insight is negatively associated with Brief Psychiatric Rating Scale (BPRS) scores and positively associated with the number of nonmedical explanatory models of illness held by patients.
Conclusion: These findings argue that insight and explanatory models of illness are secondary to psychopathology, course and outcome. They are dependent on the trajectory of the person’s illness, are not independent of the condition and call for multifaceted understanding of the issues.
Background: Homelessness, a worldwide psychosocial phenomenon, is now also prevalent in Greece, mainly in Athens area.
Methods: The possible psychiatric morbidity related to help-seeking and the underlying factors were explored in a sample of 254 homeless people from Greater Athens area, using the Mini International Neuropsychiatric Interview (M.I.N.I.).
Results: The sample was predominantly male (74%) with mean age of 51 years, being in their majority homeless for over 25 months, 34.3% of them living in rough sleeping places. Overall, 56.7% of the sample met the criteria for a current Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV) psychiatric disorder with 20.8% comorbidity. Only 36.2% of the identified psychiatric cases had any recent psychiatric care, while 44.4% were taking non-prescribed medication and 20.2% have been hospitalized in the last year. On the contrary, 70% of alcohol- and drug-dependent persons have been treated in a psychiatric agency, while 60.0% of them participated in rehabilitation program the last year. Logistic regression analysis revealed that being older, more educated with longer duration of homelessness, recognizing the suffering from a psychiatric problem as well as being diagnosed as ‘psychotic’ increased the likelihood to seek help.
Conclusions: The vast majority of the homeless mentally ill persons were lacking any current psychiatric care. The planning of a mental health–care delivery parallel to the existing social welfare system is needed to serve the unmet mental health needs of this population.
Background: Engaging in social interaction has, for people with psychiatric disabilities, been shown to enhance well-being and the experience of meaning and to generally prevent the worsening of mental illness.
Aim: The aim of the study was to investigate how day centre attendees differed from non-attendees regarding different aspects of social interaction and to investigate how occupational factors, including day centre attendance, and previously known predictors were related to social interaction in the study sample as a whole.
Methods: A total of 93 day centre attendees and 82 non-attendees with psychiatric disabilities were examined regarding social interaction, subjective perception of occupation, activity level, sense of self-mastery and socio-demographic and clinical variables. Data were analysed with non-parametric statistics, mainly logistic regression.
Results: Social support was mainly provided by informal caregivers such as family members. The day centre attendees had more social relations but did not experience better quality or closeness in their relationships than non-attendees. Important factors for social interaction were subjective perceptions of daily occupation, being married/cohabiting, self-mastery and severity of psychiatric symptoms.
Conclusion: Alternative ways of enhancing social interactions in the community is needed, targeting the group’s feeling of satisfaction and value in daily life together with self-mastery.
Background: Combat soldiers often encounter moral dilemmas during operational deployment, especially when an armed engagement is situated within a civilian setting. The study of moral dilemmas and posttraumatic stress disorder (PTSD) has mostly focused on the impact of war atrocities and moral injury. However, the relationship between moral attitudes and different combat-related pathologies has not been thoroughly addressed by quantitative studies.
Aims: We aimed to assess the relationship between combatant’s moral attitudes, severity of PTSD symptoms and mixed lateral preference.
Methods: Data on moral objection, PTSD severity and lateral preference were collected in a right-handed non-pathologic sample (n = 147) of reserve combat troops in the Israel Defense Forces (IDF).
Results: Nearly one-fifth (19.7%) of the reserve personnel who served in the occupied territories have reported high moral objection to the commands they were expected to act upon. This group of participants exhibited more PTSD symptoms and higher levels of mixed lateral preference. Multiple linear regression analyses revealed a mediating role of moral objection in the relationship between PTSD symptoms severity and lateral preference.
Conclusions: Our findings suggest that moral objection has significant implications on combatant’s psychological and organic well-being. The findings highlight the need to include moral attitudes in research and clinical practice among combat personnel and veterans.
Background: The stigma of mental illness can be a barrier to effective medication management in the community pharmacy setting. This article explored mental health consumers’ or caregivers’ experiences of stigma in Australian community pharmacies.
Materials: Semi-structured interviews and focus groups were conducted with a purposive sample of consumers or caregivers (n = 74). Interview transcripts were analysed using a general inductive approach.
Discussion: Stigma presented a barrier to effective mental health management. Self-stigma impeded consumers’ community pharmacy engagement. Positive relationships with knowledgeable staff are fundamental to reducing stigma.
Conclusions: Findings provide insight into the stigma of mental illness in community pharmacies.
Background and aims: In Italy, the reform of the mental health system in 1978 should have drastically changed the provision of care and pathways of patients seeking to obtain it. The aim of this article is to examine the current pathways to psychiatric care in Italy.
Methods: We used a method developed in the World Health Organization international collaborative studies to investigate pathways to care in 15 Italian mental health centers. We recruited 420 patients with a psychiatric illness and explored the care pathways they took to reach to psychiatric services and the delays from the onset of illness to reaching psychiatric care.
Results: The majority of patients (33.8%) had direct access to mental health care, whereas the others arrived to a specialist in psychiatry through general hospitals (20.3%), general practitioners (33.0%) or private practitioners (9.8%). The main diagnosis for referral was neurotic disorder (36.6%), followed by affective disorder (35.4%) and psychotic disorder (11.5%). The delay from onset of illness to psychiatric care was greater for patients with psychotic disorders than for those with affective and neurotic disorders. The most frequently prescribed treatments were pharmacotherapy (56%), psychological support (8%), and psychotherapy (7.0%); 15% of the patients received no treatment.
Conclusions: Our multicenter study shows that although general practitioners and hospital doctors are still the main referral point for mental health care, a greater proportion of patients are first seen in private settings or directly reach mental health centers, compared to previous surveys conducted in Italy. However, a stronger collaboration of psychiatrists with general practitioners and psychologists is still needed.
Background: The symptoms of somatoform disorders are very distressing to the sufferer as well as pose significant burden on the health-care delivery system. Although the nature of symptoms is physical, the underlying mechanisms are not clearly understood.
Objective: The purpose of this study was to assess the explanatory models of patients with somatoform disorders presenting to a tertiary care hospital in Northern India.
Method: A total of 99 consecutive adult patients (≥18 years) with diagnosis of somatoform disorders according to the International Classification of Diseases–10th Revision (ICD-10) were evaluated for their explanatory models using the causal models section of Explanatory Model Interview Catalogue (EMIC).
Results: The mean age of the study sample was 36.52 years, and the mean duration of illness was 59.39 ± 57.68 months. The most common clinical diagnosis was that of persistent somatoform pain disorder. The most common explanations given belonged to the category of psychological factors (68.7%) followed by weakness (67.7%), social causes (51%) and karma–deed–heredity (53.5%) category. The mean number of etiological categories reported were 2.6 (standard deviation (SD) = 1.7). Among the various specific causes, the commonly reported explanations by one half of the sample in decreasing order were general weakness (63.6%), mind–thoughts–worry category (59.6%) and loneliness (53.5%). The mean number of specific etiologies was 4.9 (SD = 3.83).
Conclusion: Most of the patients with somatoform disorder attribute their symptoms to psychological factors. It also becomes imperative to understand the physical symptoms in somatoform disorders from the sociocultural aspects of patients.
Background: The relationship between personality temperaments, academic achievement and specialty interest is important because of its implications in career counseling.
Aim: To assess the effect of personality on academic performance and career selection and to study the impact of some sociodemographic factors on academic achievement and career choice of medical graduates.
Methodology: A total of 436 medical graduates of Ain Shams medical school were approached, out of which 331 participated. They were given a sociodemographic questionnaire, and the Temperament and Character Inventory–Revised (TCI-R; 240) for personality construct; they had to answer questions about academic achievement, ranking, scores and choice of medical specialty.
Results: Novelty seeking (NS1, NS2 and NS3) and self-transcendence (ST1 and ST2) were correlated with graduation ranking, (r = .2, p = .00; r = .15, p = .009; r = .16, p = .005; r = .12, p = .003; r = .14, p = .02; r = .17, p = .004; r = .13, p = .03, respectively), that is, lower NS and ST had better academic outcome. Only high school score was associated with better achievement (p = .00). In specialty selection, females were significantly overrepresented in pediatrics and clinical pathology, whereas males were significantly predominating surgical specialties except for obstetrics and gynecology (p = .00). Students choosing patient-centered specialties had higher reward dependence (RD), persistence (PS) and cooperativeness (C); those choosing clinical pathology had highest harm avoidance (HA), whereas those choosing radiology had lowest HA and those choosing surgery had significantly higher self-directedness (SD3).
Conclusion: Personality impacts academic achievement and specialty choice with other factors as gender and previous scholastic performance.
Background: Preventive coping refers to efforts that are taken to reduce the likelihood of experiencing, or lessen the impact of, stress in the future.
Aims: The present investigation explored the use of preventive strategies in daily life among people with severe mental illness, and examined the association between types of preventive strategies used and end-of-day mood.
Methods: Participants included 27 adults diagnosed with severe mental illness who completed up to 20 daily interviews each (375 interviews were completed in total), which assessed preventive coping and end-of-day mood.
Results: The most commonly (across participants) and frequently (within participant days) endorsed preventive strategies were accessing social support and engaging in activities/hobbies. Participants tended to have less positive mood at end-of-day on days in which either no, or more passive, strategies were used.
Conclusions: Findings supported that preventive strategies are frequently used by members of this population, and that accessing social support and engaging in activities/hobbies are the most frequently used preventive strategies. Findings also suggest that the use of no or more passive preventive strategies was associated with less positive mood at end of day.
Background: There is little objective evidence to support the use of community treatment orders (CTOs) from randomized controlled trials. Qualitative research indicates more negative than positive responses to the use of CTOs. Nonetheless, the use of CTOs is growing internationally. There is no research to identify for whom CTOs may be a positive experience.
Aim: To assess patients’ perspectives of CTOs, assessing for correlates with clinical and demographic variables.
Methods: Patients currently or previously subject to a CTO were assessed quantitatively to identify their experience. Demographic data, the experience of coercion, views of detention, satisfaction with care, social functioning and psychopathology were correlated using SPSS.
Results: Fifty-three per cent of patients felt that they were, on balance, better off when treated informally in the community. Patients described greater coercion and less satisfaction with care when subject to a CTO. These factors, and being in employment, identified patients whom felt harmed by CTOs 61% of the time.
Conclusions: This paper highlights that more than half of patients under a CTO consider it negatively. This group is identified by patients who work, experience coercion and are unsatisfied with care. This has implications for the application of CTOs.
Background: There are few studies investigating the influence of the development on mental health of minorities in China.
Aims: To follow up the prevalence, natural course and prognosis of schizophrenia in Jinuo people, the last group to be recognized as a ‘national minority’ in China, every 10 years since 1979.
Methods: From 1979 to 2009, 15%–19% of Jinuo residents were evaluated by random cluster sampling and followed up every 10 years using the Chinese version of the Composite International Diagnostic Interview (CIDI) as the screening tool and the International Classification of Diseases (ICD) as diagnostic criteria tool.
Results: There were no significant differences for the lifetime prevalence and current prevalence of schizophrenia across the three decades. Neither were there any significant differences for the prognosis of schizophrenia; however, at least half the patients had deteriorated or had residual symptoms in the follow-up. PANSS symptoms were significantly different according to different illness duration.
Conclusions: During the three decades, there was no increasing trend for schizophrenia prevalence in Jinuo society; however, the prognosis of schizophrenia was not optimistic. In the natural, untreated status, schizophrenia patients with an illness duration of more than 20 years had more serious symptoms.
Background: Immigrants have higher rates of suicidal behaviour in comparison to the indigenous population.
Aims: To describe the characteristics of foreign nationality suicide completers and search for differences between them and native Greeks. This is the first study focused on immigrant suicide victims in Greece.
Methods: Data were collected for all recorded cases of completed suicide for the two-year period November 2007 to October 2009 at the Athens Department of Forensic Medicine, the largest, by far, of its kind in Greece covering approximately 35% of the country’s population. The material was collected using the method of psychological autopsy as well as from the victims’ forensic records.
Results: Nearly 10% of Greece’s 11 million population are of foreign nationality. Approximately half of them live in Athens and its suburbs, an area where 35% of Greece’s population lives. In our sample, 15.8% of the suicide victims were of foreign nationality (53 cases): 41 men (77.4%) and 12 women (22.6%). Higher suicide rates were found for citizens of Kuwaiti (9.1%), Somali (6.7%) and Afghan (0.9%) nationality (immigrant communities with very few members); the lower suicide rates were for individuals of Egyptian (0.01%), Ukrainian (0.01%) and Albanian (0.006%) nationality (the Albanian immigrant community is the largest in Greece). In comparison to their Greek counterparts, immigrant victims were younger (mean age 38.7 vs 54.9 years, p < .001) more often unemployed (p = .007) and with a history of alcohol abuse (p < .001). The main suicide method used by immigrants was hanging (p < .001) while for Greeks it was jumping from a height.
Conclusions: Individuals who belong to small national communities seem to have the highest risk of dying by suicide. Immigrant suicide victims differ from the indigenous population in several parameters. Our data could help define the most vulnerable of them and apply more effective suicide prevention strategies.
Background: The loss of social support is one of the major risk factors for suicide. However, there are few empirical studies that have examined how a person’s suicide ideation relates to their social support.
Aims: To examine the relationship between social support and suicidal ideation.
Methods: Self-report questionnaires were sent to 2,200 randomly selected adults in Japan. The questionnaire inquired the participants about the severity of suicidal ideation, the details of current perceived social support and their degree of satisfaction with this social support. Social support and related indicators were compared among three groups of participants that varied in severity of suicidal ideation.
Results: People in the group that had suicide ideation during their lives reported receiving significantly less support from their family and had greater feelings of dissatisfaction with that support than those in the other groups. Furthermore, people who had suicide ideation during the month immediately preceding the survey reported providing less support to their family, relatives or friends, as well as receiving less support from family than other groups, and having stronger feelings of dissatisfaction with social support.
Conclusion: Our study identified a strong relationship between the severity of suicidal ideation and perceived social support.
Background: Acute and transient psychotic disorders (ATPDs) are relatively under-researched. There is therefore a dearth of information on the disorders especially in developing countries, where they have been shown to be relatively common.
Aim: To describe the socio-demographic and clinical characteristics of patients with ATPD, as well as to examine the factors that are associated with early recovery in patients with ATPD in a developing country.
Methods: A review of 124 cases of untreated first episode of ATPD that presented at the University College Hospital, Ibadan, Nigeria over a five-year period.
Results: Of the new cases that presented at the psychiatry department of the hospital, 10.1% were ATPDs. There was no significant difference between the proportions of males and females presenting at the hospital (50.8% vs 49.2%). Mean age at presentation was 29.5 (SD = 9.6) years, while the mean duration of illness before presentation was 7.3 (SD = 6.1) days. Female gender was significantly associated with earlier recovery (p = .047).
Conclusion: ATPDs are common in developing countries. The epidemiology in developing countries is probably different from that of the developed countries.
Background: There has been no study carried out to assess health service utilization by people with common mental disorder (CMD) in Malawi.
Aim: The aim of the study was to evaluate health service utilization patterns of patients with CMD in primary health care (PHC) clinics.
Methods: The study was conducted in two PHC clinics in one of the 28 districts in Malawi. Face-to-face interviews with the Self-Reporting Questionnaire (SRQ-20) were conducted in a sample of 323 PHC attendees aged 18 years and older who attended the PHC clinics for any reason.
Results: The prevalence of probable CMD in the sample was 20.1%. People with probable CMD had a higher mean number of health facility visits in the previous three months compared to those without probable CMD (1.6 vs 1.19, p = .02).
Conclusion: The study reveals high utilization of health services for people with CMD in the PHC setting. There is a need for PHC workers to improve skills in diagnosing patients with CMD to make PHC services more effective by reducing re-attendance and improving patient outcomes.
Background: Chronic pain is a sensory and emotional experience that causes significant disturbances to a patient’s life as well as to their family. Whether the family environment is affected by chronic pain and, in turn, affects the patients’ pain experience has yet to be investigated. The interaction between patients and spouses has been assessed using the expressed emotion (EE) construct, a tool previously described in the field of mental health. For schizophrenia and other psychiatric illnesses, a correlation exists between family EE and patients’ outcomes.
Aims: The main objective of this study was to observe the presence of EE among relatives of chronic spinal pain patients and to evaluate its correlation with their symptoms.
Methods: A prospective observational study was conducted on 54 patients and their spouses currently seen at the Chronic Pain Unit of Hospital Clinic of Barcelona. The following variables were recorded: age, gender, pain score, quality of life and EE.
Results: Data showed that a considerable proportion of spouses were rated as high EE. There was an association between EE and patients’ quality of life, and the level of EE predicted some other variables of patients’ quality of life.
Conclusion: The EE level of spouses of chronic pain patients affects the patients’ quality of life and thus the way that they experience their pain.
Background: Association between education and desire for social distance from people with mental illness is unclear.
Aims: (1) Is there an association between education and social distance from people with a depression or schizophrenia? (2) Can this association be explained by beliefs about causes of and emotional reactions to the mental disorders? (3) Are there differences between the two mental disorders?
Methods: Analyses are based on a telephone survey in two large German cities (Hamburg and Munich, N = 2,014, response rate 51%). Vignettes with typical signs and symptoms suggestive of depression and schizophrenia were presented. Respondents were asked about beliefs about causes of the mental disorders, their emotional reactions and their desire for social distance.
Results: Lower education is significantly associated with a stronger tendency for social distance in the case of depression but not in case of schizophrenia, when age and gender are controlled. In case of depression, the association decreases when beliefs about possible causes are additionally controlled. In terms of schizophrenia, associations between education and social distance become stronger when emotional reactions are introduced.
Conclusions: Our results underline that campaigns aimed at reducing stigma and social distance should consider specific emotional reactions and information needs of people with low education regarding different mental disorders.
Background and Aim: The CES-D is a commonly used self-report assessment for depressive symptomatology. However, its psychometric properties have not been evaluated in Fiji. This study aims to evaluate the reliability and validity of English language and Fijian vernacular versions in ethnic Fijian adolescent schoolgirls.
Methods: As part of the HEALTHY Fiji study, ethnic Fijian female adolescents (N = 523) completed the CES-D. Participants selected to respond in English or the local vernacular. Reliability (internal consistency, item-total score correlation, and test-retest estimates), validity (associations with other proxies for depression) and factor structure were assessed. Evaluations considered differences between language versions.
Results: In this sample, the CES-D had a Cronbach’s α of 0.81 and item-total score correlation coefficients ranged between 0.2 and 0.63. One week test-retest reliability (ICC(2)) was 0.57. CES-D scores were higher among individuals who endorsed feelings of depression and suicidality compared to those who did not. ROC analyses of the CES-D versus binary depression and suicidality variables produced AUCs around 0.70 and did not support a discrete cut-off for significant disturbance. Findings were similar across the two language groups.
Conclusions: The CES-D has acceptable reliability and validity among ethnic Fijian female adolescents in English and in the Fijian vernacular language. Findings support its utility as a dimensional measure for depressive symptomatology in this study population. Further examination of its clinical utility for case finding for depression in Fijian school-based and community populations is warranted.
Background: Therapists seeing poor clients may ask if countries with greater income equality have less mental illness. If so, how should therapists respond?
Material: A review of epidemiological studies, theories of inequality and democratic reform movements in psychiatry and psychology leads to four arguments.
Discussion: (1) Increasing income equality improves the health of societies. (2) An elite opposes greater equality, partly by persuading the majority to consent to the existing order. (3) Therapists may inadvertently help in this persuasive effort. (4) However, therapists in democratic traditions create systems of care that support movements for greater income equality.
Background and Aims: While a number of negative health outcomes have been associated with bullying in childhood, we are not aware of any studies examining relationships between bullying in childhood, and pain symptoms and pain perception in adulthood – the focus of the present study.
Methods: Using a cross-sectional consecutive sample and a self-report survey methodology, we examined among 243 primary-care outpatients a history of being bullied in childhood (yes/no) in relationship to three pain ratings (now, past month, past year) and catastrophic thoughts and feelings about pain as assessed by the Pain Catastrophizing Scale (PCS).
Results: Being bullied in childhood was statistically significantly associated with present pain ratings (p < .001) as well as pain ratings over the past month and the past year (p < .01), and with the total score on the PCS as well as each of its sub-scales (i.e. rumination, magnification, helplessness) (p < .001).
Conclusions: Being bullied in childhood is associated with higher reported levels of pain at various time points as well as greater levels of self-reported catastrophic thoughts and feelings about pain. Importantly, the methodology of this study does not allow for the examination of a causal relationship.
Background: To investigate whether duration of residence (DOR) impacts dementia literacy in Chinese Americans aged 40–64.
Material: A total of 151 Chinese Americans answered a self-administered, true/false survey assessing knowledge of dementia symptoms, treatment, cause and prognosis. Two groups were dichotomized and compared based on DOR in the USA.
Discussion: DOR did not greatly impact the understanding of dementia between respondents with a < 20-year versus a ≥ 20-year DOR. Both groups exhibited deficiencies in recognizing the symptoms of dementia.
Conclusion: Gaps in dementia knowledge reflect a stigma surrounding mental illness among Chinese Americans, and impact the seeking of professional care.
Background: Stigma is a major obstacle to the treatment and recovery of people with mental illness. In Nigeria, there is a dearth of information on internalization of stigma and its effect on treatment outcome measures such as quality of life.
Aim and objectives: The aim of the study was to assess self-stigma among patients with schizophrenia attending a psychiatric hospital outpatient clinic, and the relationship of self-stigma to the socio-demographic, clinical characteristics and quality of life of the patients.
Method: Two hundred and fifty-six consecutive outpatient attendees of the Neuropsychiatric Hospital, Aro, Abeokuta in Nigeria with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis of schizophrenia were recruited for the study. The diagnosis of schizophrenia was established with the Structured Clinical Interview Schedule for DSM-IV Axis I disorder (SCID), while item 17 of the Present State Examination was used to ascertain the presence of insight into the illness. The subjects were interviewed with a socio-demographic questionnaire, the Internalized Stigma of Mental Illness (ISMI) scale, the Brief Psychiatric Rating Scale (BPRS) and the World Health Organization’s Quality of Life (WHOQOL-Bref) questionnaire.
Results: The mean age of the subjects was 39.5 (SD = 10.6) years with males constituting 52.0% of the sample. High self-stigma was found in 18.8% of the subjects. The socio-demographic and clinical correlates of high self-stigma found using univariate analysis were low educational level (2 = 22.69, p < .001), unemployment (2 = 15.9, p < .001), low income (2 = 25.03, p < .001), source of income (2 = 12.52, p = .007) and severity of psychopathology (t = 8.245, p < .001). High self-stigma was associated with poor quality of life in all the domains of WHOQOL-Bref.
Conclusion: This study revealed that self-stigma was common among subjects with schizophrenia. It is associated with poor treatment outcome, highlighting the need to incorporate stigma intervention strategies into mental health care delivery.
Background: Caregiver burden has been associated with caregivers’ mental disorders and need for support and information. However, the lack of quantitative studies and formal interventions aiming to lower burden levels in this population reflect the current negligence regarding this important issue.
Aim: To identify burden levels and associated factors in caregivers of young adults with bipolar and unipolar mood disorder.
Method: This is a cross-sectional study nested within a population-based cross-sectional study with young adults. Caregiver burden was assessed through the Burden Interview. Information about caregiver mental disorders (Axis I) and alcohol abuse were obtained through the Mini International Neuropsychiatric Interview (MINI) and the Cut-Down, Annoyed, Guilty and Eye-Opener (CAGE) questionnaire, respectively.
Results: Caregiver burden was associated to caregiver’s mood and anxiety disorders, suicide risk and being the caregiver of young adults with depression disorder and bipolar disorder. Also, burden was higher among caregivers of bipolar individuals. When excluding the control group from the analysis, only mood and anxiety disorders remained associated to caregiver burden.
Conclusions: Caregivers are affected by the young adult’s disorder even before a diagnosis has been given, with serious impairments in their lives. Thus, this is a subject in need of designing relevant strategies aiming to provide them with care.
Background: In recent decades there has been an increasing interest in cognitive deficits in schizophrenia. However, only a few studies have examined the impact of psychosocial support on the prevention of cognitive deterioration in patients who suffer from schizophrenia.
Aim: The aims of the present study are: (1) to confirm the presence of cognitive deficits among patients with schizophrenia; (2) to explore any correlations between such deficits and a range of clinical and/or demographic characteristics of the patients; and (3) to investigate any association between cognitive deficits and psychosocial support.
Method: A total of 118 patients with schizophrenia (the patient group) and 102 healthy volunteers (the control group) had a cognitive assessment using a battery of neuropsychological tests. The patients were allocated to one of the following groups: (1) patients under routine outpatient follow-up; or (2) patients receiving or having recently received intensive psychosocial support, in addition to follow-up. This included daily participation in vocational and recreational activities provided by dedicated mental health day centers. The findings of the neuropsychological testing of individuals in all groups were compared, after controlling for clinical or demographic factors.
Results: The scores in the neuropsychological tests were lower overall in the patients group compared to healthy volunteers. Within the patients group, those receiving/having received psychosocial support had higher scores compared to those on routine follow-up alone. There were no significant differences between patients currently receiving psychosocial support and those having received it in the past. Lower education, age and illness duration (but not severity of positive or negative symptoms) were factors associated with lower test scores.
Conclusions: The study provides some evidence that psychosocial support may be beneficial for the cognitive functioning of patients with schizophrenia and this benefit may be a lasting one.
Background: Latin Americans represent one of the fastest-growing immigrant populations in Canada. But very little is known about their mental health.
Aims: This paper reviews the literature on the mental health of Latin American immigrants to Canada. The paper also identifies potential areas to expand the research agenda.
Method: Twenty-five papers were identified by a comprehensive electronic search undertaken in medical- and humanities-related databases.
Results: Results are reported in three sections: (1) the rates of mental illness; (2) the risk factors that affect mental health; and (3) the access and barriers to care and services. Findings indicate that despite the diversity of immigration from Latin America to Canada, much of the information on mental health focuses on Central American refugees. The most frequently examined risk factor is displacement as a consequence of political persecution and torture in the home country. Access to mental health services in this population seems to be limited by cultural differences and language barriers.
Conclusion: New research on this topic should reflect the growing diversity and heterogeneity of the Latin American population in Canada.
Background: Few studies have investigated user involvement initiatives in whole organizations. The aim was to explore the experiences of professionals and user representatives taking part in the implementation of a user involvement plan.
Materials: A qualitative study in a mental health hospital included interviews and observational data.
Discussion: Three different stories emerged. The first described the implementation as a success. The second described the implementation as a success, but after overcoming several obstacles. The third described that the development plan had limited impact.
Conclusions: Close attention should be made to decision-making and resource allocation when implementing user involvement.
Background: Different studies have shown similar or even lower mortality among homeless persons with compared to homeless persons without a severe mental disorder.
Aims: To clarify the association between presence of a psychiatric diagnosis and mortality among the socially marginalized.
Methods: The Public Mental health care (PMHc) is a legal task of the municipal authority aiming at prevention and intervention in case of (imminent) homelessness among persons with a serious shortage of self-sufficiency. The data of PMHc clients (N=6,724) and personally matched controls (N=66,247) were linked to the registries of Statistics Netherlands and analysed in a Cox model.
Results: The increased mortality among PMHc clients, compared to the general population (HR=2.99, 95%-CI: 2.63-3.41), was associated with a broad range of death causes. Clients with a record linkage to the Psychiatric Case Registry Middle Netherlands (‘PMHc+’) had an increased risk of suicide (HR=2.63, 0.99-7.02, P=0.052), but a lower risk of natural death causes (HR=0.71, 0.54-0.92, P=0.011), compared to clients without this record linkage (‘PMHc-’). Compared to controls, however, ‘PMHc-’ clients experienced substantially increased risks of suicide (HR=3.63, 1.42-9.26, P=0.007) and death associated with mental and behavioural disorders (ICD-10 Ch.V) (HR=7.85, 3.54-17.43, P<0.001).
Conclusion: Psychiatric services may deliver an important contribution to the prevention of premature natural death among the socially marginalized.
Background: Understanding of mental illness in sub-Saharan Africa has remained under-researched in spite of the high and increasing neuropsychiatric burden of disease in the region.
Aims: This study investigated the causal beliefs that the Igbo people of south-eastern Nigeria hold about schizophrenia, with a view to establishing the extent to which the population makes psychosocial, biological and supernatural attributions.
Method: Multi-stage sampling was used to select participants (N = 200) to which questionnaires were administered.
Results: Mean comparison of the three causal models revealed a significant endorsement of supernatural causation. Logistic regressions revealed significant contributions of old age and female gender to supernatural attribution; old age, high education and Catholic religious denomination to psychosocial attributions; and high education to biological attributions.
Conclusions: It is hoped that the findings would enlighten, augment literature and enhance mental health care service delivery.
Preventive psychiatry is a branch of psychiatry that aims at health promotion, protection from specific mental illnesses, early diagnosis, effective treatment, disability limitation and rehabilitation. Prevention of neuropsychiatric illnesses as compared to other illnesses is particularly important as they run a chronic course and cause substantial disability. Preventive measures have been found to be effective in reducing incidence and disability in a wide range of mental illnesses such as depression, psychosis, anxiety and conduct disorders. The need of the hour is to translate advances in our understanding of mental illness into effective intervention programmes for the prevention of mental illness and the promotion of positive mental health.
Background: Only a few studies have evaluated the similarities and differences between clinicians’ and caregivers’ rating of burden of caring for a person with chronic mental illness.
Aim: To compare clinician-rated and caregiver-rated burden in a population of patients with either schizophrenia or bipolar disorder, using two different scales to measure caregiver burden.
Methodology: Caregivers of patients with schizophrenia (n = 65) or bipolar disorder (n = 57) completed the Hindi version of the Involvement Evaluation Questionnaire (Hindi-IEQ) by themselves. Clinicians rated the burden on the Family Burden Interview Schedule (FBI) based on semi-structured interview with the same caregivers.
Results: Both total objective and subjective burden on the FBI (clinician ratings) demonstrated significant positive correlations with the total Hindi-IEQ (caregiver ratings) scores. Most areas of burden on the FBI correlated positively with the tension and the worrying-urging II subscales, as well as the total Hindi-IEQ scores. According to clinicians, a significantly higher percentage of caregivers of patients with schizophrenia were experiencing a moderate to severe degree of subjective burden; objective burden in this group was also significantly higher in the domains of effect on the mental health of caregivers. Contrastingly, caregivers of patients with bipolar disorder judged burden to be higher in this group than schizophrenia.
Conclusions: There were many areas of agreement as well as some significant discrepancies between clinicians’ and caregivers’ assessment of burden in this population of patients. This suggests that a comprehensive evaluation of burden should include assessments by both clinicians and caregivers of patients.
Purpose: To describe changes to mental health services using systems thinking.
Method: Structured standardized quality of life assessment (Manchester Short Quality of Life Assessment: MANSA) was used to establish service user priorities for changes to service provision (part of a process known as check in systems thinking). Current service performance in these priority areas was identified, and changes to service arrangements were planned, implemented and monitored by task and finish (T&F) groups (making use of a process known as flow in systems thinking).
Results: 81 MANSA assessments were completed at the check stage (by NM). Work finances and leisure activities emerged as service user priority areas for change, and T&F groups were established with representation of all sectors and service users. Ways to make improvements were observed, planned and implemented by T&F groups (the flow stage).
Conclusion: The systems approach reveals how services and quality of life have been changed for patients in Wrexham. Further generalizable research is needed into the potential benefits of using systems thinking in mental health service evaluation.
Objective: To investigate whether people with schizophrenia experience discrimination when using health care services.
Methods: A cross-sectional survey in 27 countries in centres affiliated to the INDIGO Research Network, using face-to-face interviews with 777 participants with schizophrenia (62% male and 38% female). We analysed the data related to health issues, including health care, disrespect of mental health staff, and also personal privacy, safety and security, starting a family, pregnancy and childbirth. Discrimination was measured by the Discrimination and Stigma Scale (DISC), which consists of 36 items comprising three sub-scales: positive experienced discrimination; negative experienced discrimination; and anticipated discrimination.
Results: More than 17% of patients experienced discrimination when treated for physical health care problems. More than 38% of participants felt disrespected by mental health staff, with higher ratings in the post-communist countries.
Conclusions: Mental health service providers have a key role in decreasing stigma in their provision of health care, and by doing more against stigmatizing and discriminating practices on the therapeutic and organizational level. This will require a change of attitudes and practices among mental and physical health care staff.
On 1 September 1967, the Nobel Prize-winning civil rights leader Martin Luther King Jr. delivered a speech entitled ‘The role of the behavioral scientist in the civil rights movement’ to the American Psychological Association (APA, 1999; King, 1968). With eloquence and passion, Martin Luther King championed the civil rights struggle and spoke to the interests of his audience. He stressed how behavioural scientists could and should support the civil rights movement. King’s eloquent and passionate speech is still relevant today – explaining how psychologists and other mental health professionals could help address today’s pressing social issues.
Background: The chronic course of schizophrenia typically results in severe social, vocational and functional impairment, interferes with patients’ autonomy, reduces quality of life and increases disability.
Aims: The aim of our study was: (1) to assess social and functional impairment in schizophrenia outpatients from the Czech Republic and Slovakia; and (2) to examine a relationship between functioning and antipsychotic treatment and demographic variables.
Methods: Schizophrenia outpatients in a stable phase of illness, treated with current antipsychotic medication for a minimum of one month, were enrolled for the study. Demographic and medication data were recorded. The Personal and Social Performance (PSP), Subjective Well-Being under Neuroleptics (SWN) and Clinical Global Impressions (CGI) scales were administered.
Results: The total number of study subjects was 926. Most PSP values were within the interval of moderate impairment. Functional performance correlated positively with subjective satisfaction with medication and negatively with symptom severity. Higher education predicted better functioning on PSP. The best performance was associated with a stable relationship and a useful work role. Patients who showed the best level of functioning were more likely to be treated with antipsychotic monotherapy. No difference among drugs in monotherapy was found in subjective satisfaction.
Conclusions: The PSP values of stable schizophrenia outpatients indicated a moderate degree of impairment. Improvement of functional capacity remains one of the unmet needs of schizophrenia patients.
Background: Family interventional programmes are effective adjuncts to pharmacotherapy in patients with schizophrenia. Modification in content of such programmes in response to local challenges is considered important, but has not been fully explored in Africa.
Aims: To assess the feasibility and acceptability of an interventional family study for people with schizophrenia and their families in a socially deprived urban community in South Africa and to explore the contextual factors that could influence implementation of the intervention.
Method: A psychiatric nurse facilitated semi-structured interviews with four multi-family groups, each comprising adult outpatients with schizophrenia and their caregivers. Six sessions were held per group. Thematic analysis was applied.
Results: Three themes emerged: stigma and abuse; substance abuse comorbidity and caregiver burden of multiple stressors. Many of these stressors relate to the challenges of an impoverished urban environment.
Conclusions: Multi-family groups with a psycho-educational and behaviour modification frame are acceptable. Negative symptoms are seen as protective in areas of community violence. Modification of traditional models of family therapy to include factors related to poverty, violence, caregiver burden, stigma and limited health care access should be considered in this setting.
Background and aim: Lack of cultural adaptation may risk or worsen mental illness among immigrants, and interfere with assessment and treatment. Language proficiency (LP) seems essential for access to foreign environments, and the limited research concerning its effects on mental health care encouraged this preliminary study.
Methods: We reviewed clinical records of all immigrant psychiatric patients hospitalized at the University of Foggia in 2004–09 (N = 85), and compared characteristics of patients with adequate versus inadequate LP.
Results: Subjects (44 men, 41 women; aged 35.7±10.0 years) represented 3.62±0.94% of all hospitalizations in six years. (2004–09). Most (60.0%) had emigrated from other European countries. Many were diagnosed with a DSM-IV unspecified psychosis (40.0%) or adjustment disorder (18.8%), and 45.9% were in first-lifetime episodes. Average comprehension and spoken LP was considered adequate in 62.4% and inadequate in 37.6%. In multivariate modelling, adequate LP was more prevalent among women, emigration from another European country, receiving more psychotropic drugs at hospitalization, and having entered Italy legally.
Conclusion: Findings support an expected importance of LP among immigrant psychiatric inpatients, and encourage language assessment and training as part of the comprehensive support of such patients, especially men.
Background: Literature on mental disorders in migrants is constantly increasing. Only a few studies describe psychopathological dimensions in migrants over their nosographic diagnoses; however, there is a growing literature about the greater utility of a categorical-dimensional approach, rather than a solely categorical approach, in the understanding of mental disorders. The aim of this paper is to describe the phenomenology of mental disorders in migrants referred to the Transcultural Psychiatric Team of Bologna (BoTPT), by analysing the psychopathological dimensions that underlie their clinical diagnoses.
Methods: We recruited all migrants who attended the BoTPT between May 1999 and July 2009. The psychopathological assessment was conducted with the Association for Methodology and Documentation in Psychiatry (AMDP) and clinical diagnoses were formulated according to ICD-10. We proceeded through a two-step analysis: (1) comparing the prevalence rates of psychopathological symptoms across diagnoses; then (2) conducting a factor analysis to assess how those symptoms configure psychopathological dimensions and how these dimensions underlie clinical diagnoses.
Results: As expected, we found significant associations between diagnoses and the prevalence of their core psychopathological symptoms. Factor analysis revealed a strong polymorphism of the psychopathological presentation of mental disorders and unexpectedly showed that in each diagnostic cluster, the first extracted factor was not composed of core symptoms.
Conclusions: A mixed categorical-dimensional approach seems to improve the description of the psychopathology among migrants, as it adds relevant information regarding psychopathological dimensions useful to the understanding of the peculiar clinical expressivity of our patients.
Aims: To generate a short version of a newly developed inventory that adopted the conceptual framework of the Substance Abuse and Mental Health Services Administration (SAMHSA) consensus statement on recovery.
Methods: Through Rasch analysis, this paper presents how this recovery inventory (SAMHSA-RIC), with its original 111 items, can be reduced to a much shorter version with only 41 items.
Results: Although internal consistency is slightly lowered because of item reduction, the short version maintains satisfactory and significant correlations with quality of life measures. Overall, the canonical correlation between the scale and WHOQOL-BREF was virtually the same, with only a 0.2% decrease.
Conclusions: SAMHSA-RIC (short version) has strong potential to become a general tool for evaluating rehabilitative services for persons with persistent and severe mental illness. A validation study of the short version with clinical samples is warranted.
Background: Pathway studies highlight the help-seeking behaviours of patients with physical and mental illness. A number of these studies have been completed in other countries, but there have been few reports from China. Therefore, this study was planned to explore the characteristics of the help-seeking pathways of patients with mental illness from rural regions of China through the mental health professionals and treatment at the General Hospital of the People’s Liberation Army (PLAGH).
Methods: The pathway diagrams were documented for 203 subjects with various mental disorders using the translated version of the World Health Organization (WHO) pathway encounter form. The patterns of help-seeking and durations were analysed, and the 2 test and Mann-Whitney U test were employed as needed.
Results: On average, each patient consulted 3.6 caregivers. The vast majority of patients first visited local secondary general hospitals (SGHs) (35.5%, 2 = 41.93, p < .0001) or local tertiary general hospitals (TGHs) (32%, 2 = 36.21, p < .0001); however, 75.4% of them had not received professional diagnosis and treatment. The patients who first contacted the psychiatric service, finally reached the PLAGH, because of poor treatment or the high cost of medical care.
Conclusion: The subjects first seek the help of various sources before attending PLAGH due to a lack of awareness of the treatment services and the fear of the stigma associated with mental disorders. The primary care, even the local general hospital, did not act as a gatekeeper to psychiatric services.
Background: As many patients with severe mental illness (SMI) who have complex needs are difficult to engage, outreach mental health services are needed to engage them into treatment. The extent to which these services exist in large European cities is unknown.
Methods: Experts in 29 European countries were sent a structured questionnaire containing two case vignettes of difficult-to-engage patients (a first-episode psychosis patient and a homeless chronic schizophrenia patient). The type and quality of outpatient care was assessed and related to several national indices.
Results: The questionnaire was returned by experts from 22 countries (76%) representing 92% of the EU population. Six countries (21%) had a systematic method for detecting difficult-to-engage patients. The most important route whereby such patients entered the mental health system was through informal care; the most important reasons for entering it were the level of psychiatric symptoms, nuisance and violence. Assertive outreach was available in nine countries (41%), with coverage ranging from a few teams (sometimes for a specific target group) to most of the country. The case vignettes showed that outpatient care for these difficult-to-engage patients varied widely. In seven (30%) of the 22 countries, a hospital would take no action if such patients who had been admitted voluntarily discharged themselves prematurely. On a scale of 0–10, the experts’ mean scores regarding the quality of outpatient care for patients with SMI in general were 5.2 (SD = 1.9) and 3.2 (SD = 2.2) in difficult-to-engage ones. Explorative analyses showed that the quality of outpatient care for difficult-to-engage patients was associated with gross national income and the number of psychiatrists per capita.
Conclusions: Outpatient mental health services for difficult-to-engage SMI patients varied widely among European countries; experts judged their overall quality to be poor. It is now important to achieve consensus on a minimum European standard for the quality of care for such patients.
Background: Exhibitions of art by people with experience of mental illness are increasingly being staged to improve awareness of mental health issues in the general community and to counter the stigma of mental illness. However, few exhibitions have incorporated research to ascertain their actual effectiveness.
Method: This paper reports the results of a study that considered the responses of 10,000 people after they viewed exhibitions of art produced by people with experience of mental illness. These works were selected from the Cunningham Dax Collection, one of the world’s most extensive collection of artworks by people with experience of mental illness and/or psychological trauma.
Results: More than 90% of respondents agreed with three propositions that the exhibitions helped them: (1) gain a better understanding of mental illness; (2) gain a more sympathetic understanding of the suffering of people with mental illness; and (3) appreciate the ability and creativity of people with mental illness.
Conclusion: The results suggest that exhibitions can successfully promote mental health literacy and contribute to positive attitudes towards people with experience of mental illness. This paper explores these findings and raises questions about how the presentation of artworks in an exhibition influences their effectiveness in mental health promotion.
Background: A deeper engagement into medical decision-making is demanded by treatment guidelines for patients with affective disorders. There is to date little evidence on what facilitates active behaviour of patients with depression. In general medicine ‘question prompt sheets’ (QPSs) have been shown to change patients’ behaviour in the consultation and improve treatment satisfaction but there is no evidence for such interventions for mental health settings.
Aims: To study the effects of a QPS on active patient behaviour in the consultation.
Methods: Randomized controlled trial (involving N = 100 outpatients with depression) evaluating the effects of a QPS on patients’ behaviour in the consultation.
Results: The QPS showed no influence on the number of topics raised by patients (p = .13) nor on the external rater’s perception of ‘Who made the decisions in today’s consultation?’ (p = .50).
Conclusions: A QPS did not change depressed patients’ behaviour in the consultation. More complex interventions might be needed to change depressed patients’ behaviour within an established doctor–patient dyad. Patient seminars addressing behavioural aspects have been shown to be effective in other settings and may also be feasible for outpatients with affective disorders.
Background: Compared to the general population, people with severe mental illness (SMI) have a higher risk of developing cardiovascular disease (CVD). Authors of clinical guidelines advise annual screening for CVD risk factors with appropriate lifestyle counselling. There are seven recommended elements of this health check: blood pressure, body mass index (or waist circumference), blood glucose, serum cholesterol, diet advice, exercise recommendations and smoking cessation guidance.
Aim: To establish whether training practice nurses increases the proportion of patients with SMI who are screened for CVD risk factors and given lifestyle advice in primary care.
Method: A before-and-after audit of 400 patients on the SMI registers in five primary care centres in Northampton, England.
Results: Following the training, the proportion of patients with SMI who received all elements of the health check significantly increased (pre-training: n = 33, 8%, 95% CI = 6–11; post-training: n = 60, 15%, 95% CI = 12–19; RR = 1.82, 95% CI = 1.22–2.72, p = .01).
Conclusion: Training practice nurses about CVD prevention in people with SMI may be effective in increasing the proportion of patients in this group who receive a comprehensive health check.
Background: Income inequality is associated with numerous negative health outcomes. There is evidence that ecological-level socio-environmental factors may increase risk for schizophrenia.
Aims: The aim was to investigate whether measures of income inequality are associated with incidence of schizophrenia at the country level.
Method: We conducted a systematic review of incidence rates for schizophrenia, reported between 1975 and 2011. For each country, national measures of income inequality (Gini coefficient) along with covariate risk factors for schizophrenia were obtained. Multi-level mixed-effects Poisson regression was performed to investigate the relationship between Gini coefficients and incidence rates of schizophrenia controlling for covariates.
Results: One hundred and seven incidence rates (from 26 countries) were included. Mean incidence of schizophrenia was 18.50 per 100,000 (SD = 11.9; range = 1.7–67). There was a significant positive relationship between incidence rate of schizophrenia and Gini coefficient (β = 1.02; Z = 2.28; p = .02; 95% CI = 1.00, 1.03).
Conclusions: Countries characterized by a large rich–poor gap may be at increased risk of schizophrenia. We suggest that income inequality impacts negatively on social cohesion, eroding social capital, and that chronic stress associated with living in highly disparate societies places individuals at risk of schizophrenia.
Objective: Existing measures of needs in severe mental illness have been developed mainly from professionals’ viewpoints and are Eurocentric. Our aim was to standardize a measure of the needs of people with schizophrenia across several cultures and based on users’ own viewpoints.
Method: An instrument to measure needs, based on qualitative data on users’, carers’ and professionals’ views, was tested in 164 people with schizophrenia or related psychoses in six countries. Participants underwent face-to-face interviews, one third of which were repeated 30 days later. Principal axis factoring and Promax rotation evaluated scale structure; Horn’s parallel combined with bootstrapping determined the number of factors; and intra-class correlation assessed test-retest reliability.
Results: The instrument contained four factors: (1) health needs; (2) work and leisure needs; (3) existential needs; and (4) needs for support in daily living. Cronbach’s α for internal consistency was 0.81, 0.81, 0.77 and 0.76 for factors 1–4 and 0.81 for the scale as a whole. Correlation between factors was of moderate range for the first three factors (0.41–0.50) and low for the fourth factor (0.14–0.29). Intra-class correlation coefficient for test-retest reliability was 0.74 (0.64–0.82) for the whole scale. Mean item score on needs for support in daily living was lower than for the other factors.
Conclusions: The MARISTÁN Scale of Needs evaluates needs from the patient perspective and it is a valid instrument to measure the needs of people with severe mental illness across cultures.
The birthplace of the specialty of psychiatry was in the asylum, which was created to divert patients from workhouses where the most disadvantaged and destitute people with mental illness were to be found. The current welfare reforms are endangering the welfare and livelihood of the most disadvantaged of our patients. These reforms in the authors’ opinion are related more to the historical cycle of societal attitude to homeless people than to seeing them as the undeserving poor. This is particularly true since the current economic crisis was not caused by the poor, so it is very unfair that our poorest patients should suffer most as a result of the welfare reforms.
Background and Aims: Peer support workers are an emerging workforce within the mental health system in Hong Kong. The purposes of this paper were to describe the development of a peer support training programme and to evaluate its outcome from the perspectives of both trainees and the users of services that they provided.
Method: The curriculum consisted of six weeks of coursework on the recovery approach and a 24-week paid internship at the Warmline telephone service. We gathered feedback from 22 Warmline users. Eighteen trainees were also assessed using the three recovery-related psychosocial measures and qualitative methods.
Results: The Warmline service provided by peer support trainees lessened the isolation of service users and raised their hopes. Compared to the baseline, the peer support trainees scored marginally higher on the psychosocial measures at the end of the training. At post-training evaluation, peer support trainees said that they had gained in knowledge, were more hopeful about their own recovery, and had developed mutually supportive relationships among themselves and with their supervisors.
Conclusion: The programme shows potential benefits for both Warmline service users and trainees. Future studies should compare different training methods and examine the implementation of peer support services in a non-western cultural context.
Background: The assessment of patients’ needs is an essential element of psychiatric health care planning and evaluation. Not much interest has been paid to the study of psychiatric patients’ needs in Poland so far.
Aims: To assess the relation between inpatients’ and their key carers’ perception of needs in a Polish sample.
Methods: Out of 324 inpatients invited to take part in the study, 60 sets were finally included. Patients and their carers were examined by means of CANSAS to rate patients’ and carers’ perception of needs.
Results: The mean number of general needs indicated by patients themselves was 7.11 (± 2.98), and those indicated by carers equalled 9.53 (± 3.92). The more unmet needs identified by the patient, the more met and general needs of the patient identified by their carer (r = .27, p = .03; r = .38, p = .02, respectively). The more general needs perceived by the patient themself, the higher the indicator of unmet and general needs scored by their carer (r = .32, p = .01; r = .39, p = .001, respectively).
Conclusions: There is a significant association between the inpatients’ and their carers’ perception of needs. Patients’ perspective should serve as a high priority in developing treatment plans.
Background: Recent immigrants have better mental health than the natives (‘immigration advantage’). Biculturals have better mental health than the monoculturals (‘biculturalism paradox’).
Material: Mexican immigrants have lower rates of psychopathology than the US population. This is less true for Cubans and not true for Puerto Ricans. The ‘advantage’ also occurs in other groups. Biculturals have better mental health and endorse both cultures.
Discussion: The theory of demoralization predicts that borrowing values from both cultures and applying them judiciously are more conducive to mental health than indiscriminately subscribing to either culture.
Conclusion: The findings are consistent with the theory of demoralization.
Background: Data from Turkey on prevalence of personality disorders (PD) in the normal population are sparse.
Aims: The present study conducted in a community sample aimed to investigate personality disorders in terms of prevalence, associated risk factors and personality dimensions.
Methods: A stratified sampling procedure allowed us to compose a sample consisting of 774 participants residing in Aydin, Turkey. The DSM-IV and ICD-10 Personality Questionnaire (DIP-Q) and the Temperament and Character Inventory (TCI) were used to assess PDs and personality dimensions, respectively.
Results: Roughly 20% of the participants received a PD diagnosis. Among the individual PD categories, schizotypal and obsessive-compulsive PDs were the most prevalent diagnoses. Participants with PD were more likely to have higher self-directedness and cooperativeness scores. These risk factors and personality dimensions were most strongly associated with the cluster B disorders.
Conclusion: New versions of the diagnostic systems should include schizotypal, obsessive-compulsive and cluster B PDs as separate diagnostic categories, and impaired self-directedness as well as cooperativeness as a general diagnostic criterion for the sake of backward and forward compatibility of the research in this field.
Background: In response to the significant contribution of mental health problems to the global burden of disease, the World Health Organization (WHO, 2008) renewed its call for the integration of mental health services within primary care. The operationalization of this within resource-constrained settings such as rural Malawi, however, presents a challenge, not least the cultural acceptance of approaches to responding to psychological distress.
Aim: This study reports on the development, implementation and evaluation of a mental health care training programme for 271 health surveillance assistants (HSAs) designed to overcome such challenges.
Method: A structured evaluation of the impact of training on HSAs’ provision of mental health care was undertaken.
Results: Results demonstrated a statistically significant positive effect on HSAs’ knowledge and confidence in providing care and analysis of patient records revealed considerable mental health care and health promotion activity wherein HSAs initiated a new dialogue with the community on mental health and human rights concerns.
Conclusion: The HSAs’ focus on the psychosocial concerns of individuals’ ‘distress’ and ‘risk’ prepared the way for a practical set of culturally sensitive and therapeutic interventions and offers a potential path towards increasing the capacity of primary care mental health provision that is responsive to local understandings and experiences of distress.
Background: People with mental health problems are known to be socially excluded but the contribution of pre-morbid characteristics, symptoms and needs, and the impact on quality of life is unknown.
Aims: To investigate change in social inclusion after the development of a psychotic Illness and factors associated with this.
Methods: A cross-sectional community survey of people with psychosis was carried out in three areas of London. Five domains of social inclusion (social integration, consumption, access to services, productivity, political engagement) were assessed prior to the onset of illness and currently using the Social Inclusion Questionnaire User Experience. Quality of life, symptoms and needs were also assessed using standardized measures. Factors associated with change in social inclusion were investigated using multiple regression.
Results: Productivity and social integration among the 67 participants reduced after the onset of psychosis. Older age at onset and longer duration of illness were associated with greater reduction in productivity. Less reduction in social integration was associated with greater quality of life. Participants reported barriers to social inclusion that were directly related to symptoms of their illness, low confidence and poor self-esteem.
Conclusions: A greater focus on interventions that can facilitate the occupation and the social networks of people with psychosis is required. Interventions that tackle ‘self-stigma’ may also prove useful in mitigating the social exclusion experienced by people with psychosis.
Background: During the past decade, the mental health consumer movement has drawn the attention of mental health providers, researchers and policy makers to the concept of recovery. Traditionally, recovery primarily refers to the remission of symptoms. Nowadays, recovery is also regarded in a sense that all individuals, even those with severe psychiatric disabilities, can improve. Accordingly, recovery for people with severe mental illness refers to hope and optimism, empowerment, regained control and increased self-esteem, illness self-management and engagement in meaningful daily activities (Corrigan, Giffort, Rashid, Leary & Okeke, 1999; Jacobson & Greenley, 2001; Leamy, Bird, le Boutillier, Williams & Slade, 2011; van Gestel-Timmermans, Brouwers, van Assen, Bongers & van Nieuwenhuizen, 2012). Little empirical research, however, has been done and instruments to measure recovery are scarce.
Aims: In the current study, the psychometric properties of the Dutch version of the Mental Health Recovery Measure (MHRM) are explored. Convergent and divergent validity of the MHRM was assessed using standardized measures of hope (Hope Herth Index (HHI)), recovery-promoting professional competence (Recovery Promoting Relationships Scale (RPRS)) and general physical health and well-being (RAND Measure of Health-Related Quality of Life (RAND-36)).
Methods: A factor analysis was conducted and Cronbach’s α of the MHRM scales was assessed. The construct validity was assessed by computing the intercorrelations of the MHRM, HHI, RPRS and RAND-36.
Results: Data were available for 212 patients: 70 patients completed the MHRM, HHI and RAND 36 and 142 filled out the MHRM and RPRS. Exploratory factor analysis resulted in an interpretable three-factor solution. Cronbach’s α ranged from 0.86 to 0.94. The convergent validity of the instrument was satisfactory; the divergent validity was less clear.
Conclusions: This study offers evidence to suggest that the Dutch version of the MHRM is a reliable measure (in terms of internal consistency) with a generally acceptable convergent and divergent validity. Further research is needed to clarify the extent to which the MHRM is sensitive enough to capture the individual recovery process of patients.
Background: No population-based studies have directly compared the long-term health and mental health outcomes of conflict- versus non-conflict-affected communities from the same ethnic background.
Aims: To identify and compare levels of psychiatric morbidity between a traumatized and non-traumatized civilian community; to investigate the long-term impact of mass violence.
Methods: Double-stratified community surveys in Siem Reap and Surin provinces were conducted by highly qualified Cambodian interviewers using culturally validated survey instruments with known psychometric properties. These included Cambodian versions of the Hopkins Symptom Checklist-25, the Harvard Trauma Questionnaire and the Medical Outcome Study Short Form.
Results: Siem Reap and Surin respondents experienced 12,266 and 621 major trauma events, respectively; 745 (76.2%) Siem Reap respondents and six (0.6%) Surin respondents reported torture events; 499 (49.5%) Siem Reap respondents and 203 (19.7%) Surin respondents met the clinical threshold for depression (OR 4.01, 95% CI 3.29–4.88); 204 (20.6%) Siem Reap respondents and 23 (2.2%) Surin respondents met the clinical threshold for post-traumatic stress disorder (PTSD) (OR 11.39, 95% CI 7.3–17.7). The MOS physical disability was higher in Siem Reap versus Surin respondents (74 (7.5%) vs 13 (1.3%), 2 = 47.4 df = 1, p < .001). Health status was poorest among Siem Reap respondents when compared with Surin respondents (mean score 1.59 vs 0.59, respectively; t = 19.85 df = 2018, p < .001). Path analysis reveals that recent and past extreme violence are associated with the health and mental health status of the Siem Reap community.
Conclusion: After 25 years, the Khmer civilian population that experienced the Pol Pot genocide continues to suffer psychiatric morbidity and poor health.
Objective: Compulsory admission to a psychiatric hospital is associated with a three- to fourfold increase in the risk of another compulsory admission. Given the rising numbers of civil detentions in the Netherlands and other European countries, it is important to understand the mechanism behind this association. Our aim is to study the links between opinions about prior psychiatric treatment, insight, service engagement and the risk of (new) civil detentions.
Methods: We took a random sample of 252 from the 2,682 patients consecutively coming into contact with two psychiatric emergency teams in Amsterdam between September 2004 and September 2006. We recorded socio-demographic and clinical characteristics, and information about prior involuntary admissions. We interviewed the patients using the Verona Service Satisfaction Scale (Verona-EU), the Birchwood Insight Scale and the Service Engagement Scale. During a two-year follow-up period we noted their use of mental health care facilities.
Results: Patients with a satisfactory score on the Verona-EU had significantly lower odds for civil detentions during follow-up compared to patients with a dissatisfactory score on this scale (OR = 0.3). Level of insight did not influence the risk of detention during follow-up. Furthermore, of the 131 patients admitted involuntarily the year before, one-third looked back on their involuntary admission with unambiguous satisfaction.
Conclusion: More satisfaction with prior treatment seems to reduce the risk of civil detention remarkably. Low levels of satisfaction seem to be mainly dependent on a history of previous involuntary admission. These findings seem to open up a new perspective for diminishing the risk of (new) civil detention by trying to enhance satisfaction with treatment, especially for patients under detention.
Background: Medically unexplained symptoms (MUS) are common in primary care across cultures, accounting for high consultations with multiple providers and unnecessary investigations. Cognitive behavioural therapy (CBT) is efficacious for MUS and reduces physical symptoms, psychological distress and disability. Two intervention trials by the author and his group remain the only reported trials from the developing world.
Material: A treatment package was designed by modifying a CBT model. The modifications were innovative use of locally relevant appropriate language and strategies that were simple enough while conforming to the CBT principles. The aim was to convey the principles of CBT to people using simple techniques – using metaphor. These are described in the paper as generic metaphors that could be used to explain the CBT principles and specific ones for patients with MUS.
Discussion: Metaphor is an effective clinical tool. The author’s clinical experience and patients’ feedback suggest that these metaphors are helpful in conveying the CBT principles to patients. To develop metaphors appealing to the client and effective clinically, carrying out qualitative research among patients’ explanatory model is an important prerequisite. The generic and MUS-specific metaphors reported here should be tried in other cultural and clinical settings and evaluated. Further systematic work including qualitative work for consensus evaluation among CBT experts as well as opinion on user-friendliness of these techniques tested among CBT practitioners will be needed.
Background: High-quality health services include both safe care as well as involving service users in treatment and decision-making.
Material: The aim was to explore how mental health service users perceive the relationship between safe care on the one hand and increased influence and decision-making on the other. This was a qualitative study of 15 User Interviewing User evaluation reports, including 417 service users.
Discussion: Safe and predictable care was essential in poor illness phases, while increased influence and independence were more important in better phases.
Conclusions: High-quality services are flexible enough to adjust to users’ varying symptoms and needs.
Background: Very few studies have evaluated the quality of life (QOL) of caregivers of schizophrenia patients. The aim of this paper is to study the QOL, including the spirituality, religiousness and personal beliefs (SRPB) facets, of primary caregivers of patients with schizophrenia using the WHOQOL-BREF and WHOQOL-SRPB scales. Additionally an attempt was made to study the relationship between QOL with coping and burden in caregivers.
Method: One hundred primary caregivers of patients with schizophrenia completed the WHOQOL-BREF and WHOQOL-SRPB scales. They were also assessed on the Family Burden Interview Schedule and Coping Checklist.
Results: There were no significant associations of clinical variables and perceived burden with any of the WHOQOL-BREF domains and various WHOQOL-SRPB facets. There was a significant positive correlation between WHOQOL-BREF and various facets of WHOQOL-SRPB. There was a significant negative correlation between coercion as a coping strategy and the spiritual strength facet of WHOQOL-SRPB. Seeking social support as a coping strategy had a negative correlation with all domains of WHOQOL-BREF, whereas avoidance and use of problem-focused coping had no correlation with any of the domains of WHOQOL-BREF. Collusion as a coping skill had a negative correlation with the domains of physical health, social relationships and environment and the total WHOQOL-BREF score. Coercion as a coping strategy had a negative correlation with the general health and environment domains of WHOQOL-BREF.
Conclusions: Findings of the present study suggest that there is a positive correlation between WHOQOL-BREF domains and WHOQOL-SRPB facets, which indicates that SRPB forms an integral component of the concept of QOL. Further, the QOL of caregivers is influenced by the coping skills used to deal with stress arising due to a patient’s illness.
Background and aims: Increasingly positive attitudes have been reported among young people in China towards mental illness, but little is known about Chinese medical students’ attitudes towards psychiatry, psychiatric services and patients.
Methods: We administered a bilingual survey to Wuhan University medical students in the final years of their clinical training. Primary outcomes were composite scores on a 21-item attitudes toward psychiatry (ATP) survey and the number of correct responses to diagnostic questions following a series of three clinical case vignettes.
Results: Mean composite score on the ATP items was 78/105 (SD = 9.6), representing overall positive attitudes among the students. Female gender and having learned about more psychiatric disorders were positively associated with a higher mean ATP score and remained so after adjustment for relevant covariates.
Conclusions: Chinese medical students reported positive attitudes towards psychiatry, openness with regard to psychiatric services, and respect for psychiatric patients. Learning about a broad spectrum of psychiatric diagnoses and greater clinical contact with patients may improve overall attitudes of Chinese medical students towards psychiatry and their ability to make accurate diagnoses.
Aims: This ecological comparison study explored temporal trends since 1985 in age-adjusted suicide and homicide rates for older male adults (over the age of 65) resident in the EU and the Russian Federation.
Methods: The data were extracted from the World Health Organization’s (WHO) European mortality database.
Results: Older men resident in the Russian Federation had a higher risk of dying a violent death (by homicide and by suicide) than their younger compatriots (relative risks (RR) ranging from 1.13 to 1.31). Conversely, in the EU, older men had a higher risk of dying from suicide (RRs of 1.52 for men over the age of 65 and 3.27 for men over the age of 75) and a lower risk of being victims of homicide (RRs ranging between 0.84 and 0.89) than their younger compatriots.
Conclusions: The European region is characterized by great inequalities in rates of violent deaths among the elderly.
Background: In a health-care service with the emphasis on improvement related to functioning and well-being, the communication process between patient and professionals is essential. There is a lack of research on this matter.
Aim: The aim was to investigate, in a group of severely mentally ill persons, whether the use of a simple communication tool could influence the sense of empowerment, satisfaction with care, therapeutic alliance and unmet needs.
Method: The study had a cluster randomized design. The intervention was a communication tool (2-COM) applied in two teams during one year. In a comparison group of two other teams, the treatment was as usual. At baseline, after six months, and after one year, assessments were made.
Results: After one year the 2-COM groups seemed to have a larger reduction in unmet needs compared to the treatment-as-usual group. However, there were large problems with attrition in the study, and it was not possible to draw relevant conclusions.
Conclusions: The methodological problems were substantial, and the study may be considered as a pilot study. In a main study the researchers ought to take control over the selection of patients on the basis of the experiences from this study.
Background: Several studies have reported an inverse correlation between general population and elderly suicide rates and antidepressant prescribing rates. Correlations between general population and elderly suicide rates and prescribing rates of other psychotropic drugs have also been reported. All studies of elderly suicide rates have used data over a decade old.
Methods: The relationship between elderly suicide rates and prescription rates of psychotropic drugs by the broad British National Formulary (BNF) categories, for individual psychotropic drug groups within the BNF categories (e.g. SSRIs), and for individual psychotropic drugs was examined over a 12-year period (1995–2006) using Spearman’s rank correlation. All data were ascertained from the archives of the National Statistics Office.
Results: There was an absence of significant correlations between elderly suicides rates and rates of prescriptions of psychotropic drugs in the broad BNF categories, individual psychotropic drug groups and individual psychotropic drugs.
Discussion: The findings may be due to methodological flaws. However, if they are genuine, then the following approaches require consideration to further reduce suicide rates: (1) development of strategies to ensure continued prescription of psychotropic drugs at the current level; (2) development of strategies to improve non-pharmacological measures, including improved mental health services provision for older people, improved assessment of suicide risk, increased availability of psychosocial interventions and restricting the availability of methods of suicide; and (3) development of strategies to implement improvement in distal risk (e.g. societal socio-economic status) and protective (e.g. societal educational attainment) factors for suicide at a societal level.
Background: The literature describes psychiatric treatment of ultra-orthodox Jews as complex and challenging, in light of this community’s unique characteristics and the ideological gap between ultra-orthodox patients and secular professionals. Recent data indicate that patient-centred culturally sensitive care contributes to the treatment outcomes among cultural minorities.
Aims: To examine the effect of the level of a physician’s religiosity and cultural sensitivity, as perceived by ultra-orthodox Jewish psychiatric patients, as well as the treatment venue (i.e. the distance of the treatment facility from the patients’ community) on treatment outcomes (working alliance, medical adherence and the patients’ social adaptation).
Methods: The sample included 38 ultra-orthodox Jewish men and women receiving psychiatric treatment at the Lev Hasharon Mental Health Centre. The participants completed questionnaires about the physician’s religiousness and cultural sensitivity, working alliance, medical adherence and social adaptation.
Results: Working alliance was positively related to the treatment location, meaning that patients were more committed and involved in the treatment when it took place in a facility distanced from their community. Working alliance was also correlated with medical adherence. Regression analysis revealed that the doctor’s acquaintance with religion and cultural sensitivity predicted patients’ reported social adaptation level.
Conclusions: In contrary to common perceptions, ultra-orthodox patients are not necessarily reluctant to be treated by secular physicians. These patients prefer a discreet treatment far from their community’s public eye. Their perception of a doctor who acknowledges and respects their religiosity positively affects the way that they perceive their social functioning. Culturally sensitive treatment enables patients to feel respected and acknowledged through their sociocultural affiliation, and not only through their disorder. It seems essential to train physicians about the importance of culturally sensitive treatment with this population.
Background: Family members experience stigma via their connection with the affected member. Family stigma contains stereotypes of blame, shame and contamination.
Aim: To establish the tendency towards stigmatization of family members of a person with autistic spectrum disorders (ASD) by a sample of the general public of Belgrade.
Methods: The sample encompassed 181 participants, of various ages and levels of education, and of different, self-assessed levels of knowledge about autism. The structure of stigmatization of family members of a person with ASD was explored applying the Family Stigma Questionnaire (FSQ) and the Level of Familiarity Questionnaire (LFQ).
Results: Analysis of the obtained results established that scores indicating the tendency towards stigmatization were most pronounced for variables connected to blame for deterioration of the condition of the person with autism, contamination of the individual family members by the condition, and to feeling pity for family members of a person with ASD. Statistically significant differences were established when the FSQ scores stigmatizing parents and siblings were compared. Significant differences in stigmatizing stereotypes were established according to gender and level of education, and according to the self-assessment of knowledge about autism and the level of previous contact to persons with mental disorders.
Conclusion: Anti-stigma programmes are important especially bearing in mind that participants who self-evaluated as having the least knowledge about ASD demonstrated the highest tendency towards stigmatizing the parents of a person suffering from ASD, and those of lower education demonstrated the highest tendency towards stigmatizing the family members.
Purpose: Living in disadvantaged urban areas is associated with poor mental health. The purpose of this study was to assess which social characteristics were associated with psychological distress within a disadvantaged, multi-ethnic neighbourhood of Berlin.
Methods: The study was conducted in an area of Berlin with the highest rates of unemployment and highest density of migrants. A total of 143 participants aged 18–57 years were included from a random sample. The social characteristics educational level, employment status, marital status, living alone, per-capita income and background of migration were collected. Psychological distress was assessed using the General Health Questionnaire GHQ-28; scores ≥ 5 indicated psychological distress corresponding to psychiatric caseness.
Results: Psychological distress was found in 40.6% (n = 58) of the sample. Psychological distress was associated with younger age (OR = 0.95, 95% CI = 0.92–0.98, p = .004), female gender (OR = 3.51, 95% CI = 1.55–7.92, p = .003) and living alone (OR = 3.88, 95% CI = 1.58–9.52, p = .003), but not with background of migration, low educational level or with unemployment.
Conclusions: Young age and female gender may predispose for psychological distress in disadvantaged areas. Living alone could be a social indicator of poor mental health within disadvantaged urban areas. The directionality of the association is unclear. Background of migration, low income and educational level do not seem to be associated with poor mental health within those areas.
Aims: The aim of the present study was to investigate potential differences between suicide decedents who had contact with a psychologist or psychiatrist before committing suicide and those individuals who had not had previous contact with a mental health professional prior to ending their lives.
Methods: Psychological autopsy interviews (N = 396) were conducted for individuals who died by suicide between 1997 and 2007 in South Tirol, Italy.
Results: The study found that suicide decedents known to mental health professionals were more frequently women and more frequently unemployed or with unstable employment. These decedents were significantly more likely than those unknown to mental health professionals to have a family history of mental illness, one or more past suicide attempts, and more frequent substance abuse, and likely to have frequent alcohol abuse. They more often had visited a physician in the last four weeks before dying and more frequently complained about psychological symptoms. In the prediction of group membership, individuals whom were known to mental health professionals prior to their suicidal act were 3 times more likely to have a family history of mental illness, 5.8 times more likely to have one past suicide attempt, 9.7 times more likely to have two or more past suicide attempts and 3.5 times more likely to have visited a physician in the four weeks prior to their death.
Conclusion: Our findings indicate that suicide decedents who had contact with mental health services can be distinguished from those who were not known to mental health professionals.
Background: Mental illness is a significant contributor to global disease burden and this is expected to increase over the coming decades. Traditionally mental illness has not been well understood by the general public, resulting in poor attitudes towards persons with mental illness and stigmatization. Such conditions are common in the Caribbean where less than 5% of the health budget is allocated to mental illness.
Aims: To assess knowledge and attitudes towards mental illness among college students within the English-speaking Caribbean.
Methods: A self-report questionnaire was adapted from previous studies designed to measure knowledge and attitudes of mental illness. Students were sampled from the University of the West Indies campuses in Jamaica, Barbados and Trinidad & Tobago.
Results: Responses were collected from 673 persons with a response rate of 84%. While participants were agreed that particular diseases were mental illnesses, overall knowledge scores were low. Knowledge was higher among those persons who knew someone with a mental illness. Attitude scores were suggestive of stigmatization, with drug abuse and schizophrenia seen in a particularly poor light.
Conclusions: These results suggest that widespread educational campaigns need to be implemented across the region, designed to both increase knowledge about mental illness and reduce discrimination towards persons suffering with mental illness.
Aims: To examine if divorce is associated with an increased risk of psychiatric disorder.
Methods: A register-based cohort study of all married or divorced individuals aged 45–54 in Sweden in 2006. After exclusion of 129,669 individuals with a history of psychiatric care in 1987–2005, we followed 703,960 persons for psychiatric disorder during 2007, measured as psychiatric inpatient care, outpatient care and use of psychotropic medication. Marital trajectories were taken into consideration. Data were analysed using Poisson regression.
Results: Divorced women and men had a higher risk for psychiatric inpatient care compared to married (ORwomen = 3.2, 95%CI = 1.6–6.3, ORmen = 3.3, 95%CI = 2.0–5.4). The longer the marriage, the lower the risk for psychiatric disorders. Lower educational level increased the risk for psychiatric inpatient care.
Conclusions: In conclusion, our study supports both the selection hypothesis, linking healthy individuals to long and stable marriages, and the social causation hypothesis, linking the stress of recent divorce to increased psychiatric disorder for both women and men.
Backgound: In developing countries, little is known about public recognition and beliefs about treatment of severe mental disorders, both emergent key elements in reducing stigma and the gap of treatment of such patients. It has been proposed that they may be related to gender and perception of patient’s aggressiveness and/or dangerousness.
Aims: To assess mental illness recognition and beliefs about treatment of schizophrenia, and to determine their relationship with perception of patient’s aggressiveness/dangerousness and gender of the perceiver in a community sample of Mexico City.
Methods: A convenience sample of 1038 subjects responded to a questionnaire that assesses all variables after reading a vignette of a patient with paranoid schizophrenia.
Results: Women were 1.88 times more likely to recognize the presence of mental illness and considered psychiatric interventions as the most adequate treatment of symptoms. In contrast, non-psychiatric interventions were more often considered by men (64.7%). Responders who recognize mental illness were more likely to perceive the patient as dangerous, which was related to the suggestion of more restrictive interventions.
Conclusions: It is necessary to direct special efforts to increase mental health literacy among men. The general public needs objective information about aggression and dangerousness in anti-stigma campaigns among developing countries similar to Mexico.
Aim: The study explored the socio-demographic, clinical and legal profile of forensic psychiatric inpatients in an attempt to improve the existing mental health services for prisoners within the prison and in psychiatric hospitals.
Methodology: A chart review of 135 forensic psychiatric inpatients admitted between January 2005 and December 2009 was done. A structured data-extraction tool was used for data collection and a descriptive approach for analyses.
Results: Subjects were referred either directly from prison (62.2%) or from court (37.8%) for diagnosis, treatment or certification. References to the Mental Health Act 1987, charges and inclusion of first investigation report and behavioural observation report was lacking in most. The majority of prisoners (85.7%) were under trial, murder being the most common charge. Psychiatric diagnosis was made in 90.3%, the most common being psychosis. Substance use (nicotine, alcohol, cannabis) and high-risk behaviours were also common.
Conclusion: There is a need to streamline the procedure of referral and to sensitize the referral authorities about the Mental Health Act and mental illnesses, and the need to enclose first investigation reports and behavioural observation reports. De-addiction services and facilities need to be established within prison premises so that the inmates get the benefit of treatment at the earliest opportunity.
Background: Several studies show an association between a long duration of untreated illness (DUI) and poor outcome in schizophrenic patients. DUI, in turn, may be influenced by different variables including specific illness-related factors as well as access to local psychiatric services.
Aims: The purposes of the present study were to detect differences in terms of DUI among schizophrenics coming from different geographic areas and to evaluate differences in DUI across diagnostic sub-types.
Method: One hundred and twenty-five (125) schizophrenic patients of the Psychiatric Clinic of Milan (n = 51) and Moscow (n = 74) were enrolled. SCID-I was administered to all patients and information about DUI was obtained by consulting clinical charts and health system databases, and by means of clinical interviews with patients and their relatives. DUI was defined as the time between the onset of illness and the administration of the first antipsychotic drug. One-way analyses of variance (ANOVAs) were performed to find eventual differences in terms of DUI across diagnostic sub-types.
Results: Italian patients showed a longer DUI (M = 4.14 years, SD = 4.95) than Russians (M = 1.16 years, SD = 1.43) (F = 24.03, p < .001). DUI was found to be longer in paranoid schizophrenics (M = 3.47 years, SD = 4.19) compared to catatonic patients (M = 0.96 years, SD = 0.94) (F = 3.56, p = .016).
Conclusions: The results of the present study suggest that the different schizophrenic sub-types may differ in terms of DUI, likely due to different clinical severity and social functioning. Studies with larger samples are needed to confirm the data of the present study.
Background: Women prisoners are known to suffer from an accumulation of factors known to increase the risk for several major health problems. This study examines the prevalence of adverse childhood experiences (ACE) and the relationship between such experiences and suicide attempts and drug use among incarcerated women in Norway.
Methods: A total of 141 women inmates (75% of all eligible) were interviewed using a structured interview guide covering information on demographics and a range of ACE related to abuse and neglect, and household dysfunction. The main outcome variables were attempted suicide and adult drug abuse.
Results: Emotional, physical and sexual abuse during childhood was experienced by 39%, 36% and 19%, respectively, and emotional and physical neglect by 31% and 33%, respectively. Looking at the full range of ACE, 17% reported having experienced none, while 34% reported having experienced more than five ACEs. After controlling for age, immigrant background and marital status, the number of ACEs significantly increased the risk of attempted suicide and current drug abuse.
Conclusion: The associations observed between early life trauma and later health risk behaviour indicate the need for early prevention. The findings also emphasize the important role of prison health services in secondary prevention among women inmates.
Background: Intercultural differences influence acute inpatient psychiatric care systems.
Aims: To evaluate characteristics of acute inpatient care in a German and a Japanese hospital.
Method: Based on a sample of 465 admissions to the Psychiatric State Hospital Regensburg (BKR) and 91 admissions to the Hirakawa Hospital (HH) over a six-month period in 2008, data from the psychiatric basic documentation system (BADO) were analysed with regard to socio-demographic characteristics, treatment processes and outcome indicators.
Results: Schizophrenia and related psychosis was the most common diagnosis in both hospitals. Cases at the BKR were admitted more quickly after onset of the present episode. Global Assessment of Psychosocial Functioning (GAF) ratings at admission were lower at the HH. Most admissions to both hospitals received psychopharmacological treatment, but more at the HH received psychotherapy. Length of stay was significantly longer at the HH (75 days) than at the BKR (28 days). Admissions to the HH were more improved with regard to GAF and clinical global impression (CGI).
Conclusions: Acute admissions in Germany provide intensive care with short hospitalization as crisis intervention. For acute admissions in Japan, comprehensive care for severe mental illness precedes emergency admissions and achieves greater improvement with longer hospitalization.
Background: Physical comorbidities and substance use are commonly reported in patients with mental disorders.
Aim: To examine somatic comorbidity in patients with substance use disorders (SUD) compared to patients with mental disorders but no SUD.
Methods: Lifetime prevalence data on mental and physical health status were collected from inpatients in 12 mental health care facilities in five different countries. Differences in somatic comorbidity were examined by means of logistic regression analysis controlling for age and gender.
Results: Of 2,338 patients, 447 (19%) had a primary or secondary SUD diagnosis. In comparison to patients with other mental disorders, patients with SUD had a higher prevalence of infectious and digestive diseases but a lower prevalence of endocrine, nutritional and metabolic disorders. Patterns of physical comorbidities differed according to type of substance used (alcohol use – cardiovascular; tobacco use – respiratory, neoplasms; cannabinoid use – injuries; opioid use – infectious, digestive; benzodiazepine use – endocrine, nutritional, metabolic; stimulants – urogenital).
Conclusions: SUD are related to specific somatic health risks while some of our findings point to potentially protective effects. The widespread prescription of benzodiazepines requires research on physical health effects. Early detection of SUD and their integration into programmes targeting physical comorbidity should be a priority in organizing mental health care.
Background: Public beliefs concerning the causes of mental disorders are important in their effective treatment. The relative importance of public beliefs related to the etiology of mental disorders among Chinese populations and their relationship to other attitudes to mental disorders are poorly understood.
Aims: To investigate the endorsement of beliefs related to the etiology of mental disorders in Macau, in particular, traditional Chinese beliefs, and to explore their relationship to general attitudes towards mental disorders.
Methods: A survey of 361 members of the public measured attitudes towards 32 possible causes of mental disorders as well as contact with and social distance from individuals with a mental disorder.
Results: The results indicated that traditional Chinese beliefs were ranked with relatively low importance compared with psychosocial causes. Traditional beliefs related to two underlying factors and were significantly higher in participants with lower education levels. There was a significant negative correlation between endorsement of traditional beliefs and contact with individuals with a mental disorder and a significant positive correlation between endorsement of traditional beliefs and desired social distance from individuals with a mental disorder.
Conclusion: Factors underlying traditional Chinese beliefs concerning the causes of mental disorders are associated with more negative attitudes towards individuals with a mental disorder, with such beliefs more strongly endorsed by those with relatively lower education levels.
Aims: There is a scarcity of data on mental health problems among Sudanese internally displaced persons (IDPs). This study aims to assess the prevalence of mental disorders of IDPs in Sudan, and to determine and compare the association between mental disorders and socio-demographic variables between the rural and urban long-term IDP populations.
Methods: This cross-sectional study was implemented in two IDP areas in Central Sudan. Data were collected during face-to-face interviews using structured questionnaires to assess socio-demographic factors and the Mini International Neuropsychiatric Interview (MINI) to determine psychiatric diagnoses. A total of 1,876 adults were enrolled from both study areas.
Results: The overall prevalence of having any mental health disorder in the IDP population was 52.9%. The most common disorders were major depressive disorder (24.3%), generalized anxiety disorder (23.6%), social phobia (14.2%) and post-traumatic stress disorder (12.3%). Years of displacement and education were associated with different mental disorders between the two areas, and there were no gender differences in prevalence of mental disorders in either area.
Conclusion: This study shows high prevalence rates of mental disorders in both urban and rural IDP populations in Sudan, indicating a need to explore the circumstances for these high rates and to develop appropriate responses.
Aims: Victimization through being bullied in childhood is traditionally associated with subsequent internalizing symptoms, but some literature suggests otherwise. In this study, we examined a history of being bullied in relationship to 21 externalized aggressive behaviours in adulthood.
Methods: Using a cross-sectional approach and a self-report survey methodology, we examined a history of being bullied in childhood in relation to 21 aggression variables in a consecutive sample of 342 internal medicine outpatients.
Results: In comparison with the not bullied, participants who reported having been bullied in childhood had a statistically significantly greater overall number of self-reported aggressive behaviours. Longer duration of being bullied was statistically significantly correlated with a greater number of reported aggressive behaviours. With regard to individual behaviours, four were statistically significantly associated with being bullied: hitting walls; intentionally breaking things; getting into fist fights; and pushing/shoving a partner.
Conclusions: While relationships between bullying in childhood and subsequent internalizing symptoms have been well established, the present study indicates that bullying in childhood is also associated with externalizing/aggressive behaviours in adulthood.
Background: The husbands of women with schizophrenia have been variously characterized in the psychiatric literature as abusive, burdened and ill. The aim of this paper is to summarize what has been written about these three perspectives.
Method: The search terms ‘schizophrenia’, ‘mental illness’, ‘marriage’, ‘spouse’, ‘partner’, ‘caregiver’, ‘caregiving’, ‘burden’, ‘assortative mating’ and ‘domestic abuse’ were entered into PubMed and Google Scholar. Criteria for inclusion of articles were relevance to the three identified themes of abuse, burden and mental illness in husbands of women with schizophrenia. The results show considerable variation, some of it cultural, with partial evidence for all three characterizations.
Conclusion: There is a need for support and psychoeducation programmes that are specifically designated for spouses and that address their special concerns.
Background and aims: There is a dearth of studies investigating the prevalence and factors associated with unmet needs in people with schizophrenia from low- and middle-income countries. We aimed to study prevalence and risk factors for unmet need.
Method: A case-control study design was employed. One hundred and one (101) consecutive patients attending a psychiatric hospital were assessed using Camberwell Assessment of Need Short version (CANSAS) and Positive and Negative Syndrome Scale (PANSS). Multivariate analysis was employed to adjust for confounders.
Results: The majority of patients had many unmet needs. These unmet needs were significantly associated with lower education, poverty and persistent psychopathology on multivariate analysis.
Conclusion: Unmet needs are associated with poverty, lower education and persistent psychopathology. There is a need to manage unmet needs, in addition to addressing psychopathology and poverty.
Introduction: Continuity of care has been demonstrated to be important for service users and carer groups have voiced major concerns over disruptions of care. We aimed to assess the experienced continuity of care in carers of patients with both psychotic and non-psychotic disorders and explore its association with carer characteristics and psychological well-being.
Methods: Friends and relatives caring for two groups of service users in the care of community mental health teams (CMHTs), 69 with psychotic and 38 with non-psychotic disorders, were assessed annually at three and two time points, respectively. CONTINUES, a measure specifically designed to assess continuity of care for carers themselves, was utilized along with assessments of psychological well-being and caregiving.
Results: One hundred and seven carers participated. They reported moderately low continuity of care. Only 22 had had a carer’s assessment and just under a third recorded psychological distress on the GHQ. For those caring for people with psychotic disorders, reported continuity was higher if the carer was male, employed, lived with the user and had had a carer’s assessment; for those caring for people with non-psychotic disorders, it was higher if the carer was from the service user’s immediate family, lived with them and had had a carer’s assessment.
Conclusion: The vast majority of the carers had not had a carer’s assessment provided by the CMHT despite this being a clear national priority and being an intervention with obvious potential to increase carers’ reported low levels of continuity of care. Improving continuity of contact with carers may have an important part to play in the overall improvement of care in this patient group and deserves greater attention.
Background: Since the Mental Health Reform Law 1978/180, in Italy mental hospitals have been progressively closed and a community-centred psychiatric care oriented to rehabilitation began. After almost 35 years, the de-institutionalization process is now complete. However, psychosocial interventions in the community are provided only rarely, although a specific mental health professional, the psychiatric rehabilitation technician, has been established in Italy.
Material: Training courses and the education of psychosocial rehabilitation technicians have been analysed and the university degree has been described. Moreover, the practical and theoretical skills needed at the end of the training course have been discussed.
Discussion: Psychiatric rehabilitation technicians are trained to perform multidisciplinary rehabilitative and educational interventions for people with severe mental disorders and their carers. They represent an innovative professional workforce in mental health care, not yet established outside Italy, whose role and activities are essential in a community-based mental health system model.
Conclusion: The skills needed for properly performing psychosocial interventions are not available in other mental health professionals and it is not possible that these interventions, which require in-depth training, are performed by professionals with a different background. It is advisable that psychiatric rehabilitation technicians become an integral and permanent component of an efficient community psychiatric staff.
Background: Literature about experiences of mental illness among ethnic minority has tended to focus on first-generation migrants. This study fills that gap by exploring experiences among highly acculturated Chinese-American patients with mental illness.
Materials: Twenty-nine participants completed semi-structured interviews based on Kleinman’s explanatory model, which were audio-taped, transcribed and coded for qualitative analysis.
Discussion: Beliefs about the causes of mental illness included biological factors, head trauma and personal losses. Issues relating to stigma and shame were also discussed.
Conclusion: Highly acculturated ethnic minority patients may ascribe to a biomedical model at the same time as ascribing to culture-specific beliefs.
Background: Bullying in childhood is ubiquitous and associated with a number of identified negative outcomes in both childhood and adulthood. However, the relationship between being bullied in childhood and religious/spiritual status in adulthood has never been explored.
Method: Using a cross-sectional sample of 324 consecutive internal medicine outpatients and a survey methodology, we examined relationships between ‘When you were growing up, were you ever a victim of bullying?’ and (1) self-perceived extent of religiosity/spirituality and (2) religiosity/spirituality as assessed by scores on the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12).
Results: While bullying status in childhood was not related to either the self-perceived extent of religiosity or spirituality, it did evidence negative statistically significant relationships with seven of 12 FACIT-Sp-12 scales, as well as the overall composite score.
Conclusions: According to these data, bullying in childhood is associated with lower religious/spiritual well-being in adulthood; however, this study was not designed to examine a causal relationship.
Background: Research has seldom considered social capital at the individual, household and administrative area level simultaneously and examined its association with mental health.
Aim: The main purpose of this study was to examine the association between social capital and mental health while controlling for various confounders at multiple levels using multi-level analysis and operationalizing social capital at the individual, household and administrative area level.
Methods: This study used cross-sectional data from the 2010 Seoul Welfare Panel Study conducted by the Seoul Welfare Foundation (participation rates for the household and household members were 87.6% and 87.5%, respectively).
Results and conclusions: The main finding of this study was that organizational participation (B = 0.132, p < .001) and perceived helpfulness (B = 0.129, p < .001) were positively associated with mental health. This study also found that perceived helpfulness was positively associated with mental health (B = 0.070, p < .001). However, it did not find a significant association between the contextual level of social capital and mental health. The results indicate that the different dimensions of social capital may act differently to mental health depending on the level.
Background: Studies about stress disorders following a disaster have mainly been based on single-event trauma with little emphasis on multiple traumas.
Aims: This study investigated the prevalence and predictors of stress disorders following two earthquakes in China.
Methods: Subjects were randomly sampled from 11 villages in rural China. A total of 624 subjects were administered with the 12-item General Health Questionnaire (GHQ-12), Symptom Checklist -90-R (SCL-90-R), Coping Style Scale and Social Support Rating Scale. This was followed by a structural clinical interview using the Chinese translation of the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV-TR axis 1 disorders (SCID-I-P) for acute stress disorder (ASD) and post-traumatic stress disorder (PTSD).
Results: The prevalence of ASD and PTSD was 15% and 29%, respectively. Regression analysis indicated that high intensity of trauma exposure, lower educational level, subjective feeling of economic status and psychological stress after the first earthquake significantly predicted the outcome of PTSD.
Conclusions: The study suggested that the prevalence of stress disorders in two earthquakes were higher than that experienced in a single disaster. The intensity of trauma exposure, low educational level, bad subjective feeling of economic status, and psychological stress after the first earthquake could be used to identify survivors at risk of developing PTSD in two earthquakes.
Background: Evidence suggests a much higher prevalence of postpartum depression in South Asia than in ‘western’ contexts.
Aim: To conduct a rapid systematic review of evidence on the association between social relationships and postpartum depression in South Asia.
Methods: Five databases were searched to identify relevant studies. Studies meeting the selection and quality criteria were analysed and integrated in a narrative review.
Results: Nine mostly quantitative studies were included in the review. Low support and poor relationships with the husband and parents-in-law were associated with postpartum depression, although associations were weakened in multivariate analyses. The different dimensions of support have not yet been systematically investigated and the likely complex interrelationships between social relationship risk factors are not yet well understood.
Conclusions: Findings mirror those from ‘western’ contexts, showing the key role of social relationships in the aetiology of postpartum depression. Yet, they also reinforce the hypothesis that the social and cultural context influences the association. The importance of relationships with the extended family, as well as the husband, in South Asia is highlighted. Further research is recommended to develop an understanding of these relationships to better inform interventions.
Background: There is currently a gap in our knowledge of how eating disorder symptomatology is impacted by spirituality and religiosity. To date, studies examining the role of ethnicity in women’s self-reported levels of eating disorder symptomatology have neglected the roles of spirituality and religiosity.
Aims: This study addresses this gap in the literature by investigating ethnicity, spirituality, religiosity, body shame, body mass index (BMI) and age in relation to eating disorder symptomatology in women.
Methods: A representative non-clinical sample of ethnically diverse Canadian women (N = 591) was surveyed.
Results: Younger women, particularly those with higher body shame, BMI and lower spirituality, reported more eating disorder symptomatology. Hispanic and Asian women had higher body shame and lower BMI compared to white women. Spirituality was more strongly related to eating disorder symptomatology than religiosity.
Conclusions: This is the first study identifying interactive relationships between ethnicity, spirituality, body shame, BMI and age on eating disorder symptomatology in women. Particularly significant is that higher spirituality was related to a lower level of eating disorder symptomatology. These findings have important implications for treatment and women’s physical and psychological health and wellness.
Background: Therapeutic communities (TCs) are becoming increasingly widespread as a form of treatment for entrenched mental health problems, particularly addictions and personality disorders, and are equally used in educational, prison and learning disability settings. Despite growing evidence for their effectiveness, little research has been conducted to establish how TCs work to produce positive outcomes. We hypothesize that there are two specific factors that in combination contribute to TC effectiveness: the promotion of a sense of belongingness and the capacity for responsible agency. Although both factors are found in other therapeutic approaches and are important to the psychosocial aspects of psychiatric care more generally, we argue that their combination, extent and emphasis are unique to TCs.
Material: Drawing on social and experimental psychology, we: (1) review research on a sense of belongingness and the capacity for responsible agency; (2) establish the mechanisms by which TCs appear to promote them; (3) draw lessons for TC practice; and (4) suggest why they may contribute to positive outcome.
Discussion: A sense of belongingness is correlated with improved self-esteem and overall well-being. The capacity for responsible agency is central to behavioural change. TCs are typically used in fields where positive outcome requires both personal growth and behavioural change. We suggest that TCs are uniquely placed to demand such growth and change of their members because the sense of belongingness engendered by TC methods protects against the risks engendered by this demand.
Conclusion: Empirically informed, evidence-driven research is necessary to understand how TCs work and how TC practice can be improved. This understanding may offer lessons for the improvement of psychosocial aspects of psychiatric care more generally.
Aim: All too often, efficacious psychosocial evidence-based interventions fail when adapted from one culture to another. International translation requires a deep understanding of the local culture, nuanced differences within a culture, established service practices, and knowledge of obstacles and promoters to treatment implementation. This research investigated the following objectives to better facilitate cultural adaptation and translation of psychosocial and mental health treatments in Arab countries: (1) identify barriers or obstacles; (2) identify promoting strategies; and (3) provide clinical and research recommendations.
Methods: This systematic review of 22 psychosocial or mental health studies in Middle East Arab countries identified more barriers (68%) than promoters (32%) to effective translation and adaptation of empirically supported psychosocial interventions.
Results: Identified barriers include obstacles related to acceptability of the intervention within the cultural context, community and system difficulties, and problems with clinical engagement processes. Whereas identified promoter strategies centre on the importance of partnering and working within the local and cultural context, the need to engage with acceptable and traditional intervention characteristics, and the development of culturally appropriate treatment strategies and techniques.
Conclusions: Although Arab cultures across the Middle East are unique, this article provides a series of core clinical and research recommendations to assist effective treatment adaptation and translation within Arab communities in the Middle East.
Background: This study examines the psychosocial outcomes of women discharged from the Vlore Psychiatric Hospital in Albania.
Methods: The study was designed as a controlled, not randomized, follow-up study. It included 16 women diagnosed with psychosis who were discharged from a psychiatric hospital to live in group homes in the community. The control group included 20 women diagnosed with psychosis who lived at the psychiatric hospital while awaiting discharge. All subjects were assessed twice using the HoNOS-Rome tool, at the start of the study (T0) and 12 months later (T1).
Results: Both groups showed an improvement in the HoNOS total score between T0 and T1 (p < .001). This improvement was significantly larger in the Home group compared to the Hospital group (p = .014). An item-level analysis indicated a significantly greater improvement in the Home group on items 11 (autonomy), 12 (work), 16 (family) and 18 (goals).
Conclusions: Projects for social inclusion of people suffering from psychosis must design living spaces that offer viable alternatives to psychiatric hospitals. This study also documents the efforts in the Vlore region of Albania to follow European standards of mental health care.
Background: Community-based mental health services may be impaired by stigmatization and social distance towards persons with mental illness. Little is known about the impact of education on the attitude of volunteers for mental health programmes. This study aimed to examine the effect of an educational programme on the attitude of community volunteers towards mental illness.
Methods: Thirty-one volunteers for a community mental health programme completed the Familiarity with Mental Illness Questionnaire and a modified version of the Bogardus Social Distance Scale (Bogardus, 1925) before and after an educational programme.
Results: At the end of the educational session, perceived dangerousness was significantly reduced and attitude (social distance) towards persons with mental illness showed significant improvement.
Conclusion: Attitudes of community volunteers towards persons with mental illness improve with educational programmes. This may lead to improved treatment and care of individuals who are mentally ill.
Background: Stress-related mental ill health and its disorders are considered by the World Health Organization (WHO) to be the new world epidemic and their prevalence rates seem to be increasing worldwide.
Aims: To examine and identify sub-populations at risk for psychological discomfort in Northern Ireland and map the relative impact of potential predictors.
Methods: A sample of 4,638 respondents to the NIHSW-2001 survey was analysed with latent class analysis and latent class factorial analysis. Latent class multinomial logistic regression assessed the impact of a range of predictors on class membership.
Results: Five sub-populations were differentiated. All subgroups at risk for anxiety and depression were characterized as being younger and female. Disability and adverse life events were strong predictors of risk. Long-standing illness and housing worries were predictors of medium and high risk membership. The effect of civil unrest was significant only for the medium-risk subgroup; marital status and income did not affect group membership.
Conclusions: Because all five subgroups showed a different probability, but a similar profile of endorsing GHQ-12 items, it could be hypothesized that an underlying continuum dimension of anxiety and depression is present in the Northern Irish population.
Background: The major suicide method in rural China today is ingestion of agricultural pesticides.
Aim: This study is to investigate the characteristics of Chinese rural young suicides who died of pesticide ingestion.
Methods: A sample of 392 suicides from rural China was studied using the psychological autopsy method, and data were analysed for demographic characteristics, the suicide method used, mental disorder and psychological characteristics.
Results: Suicides by pesticide ingestion were enacted more because of impulsiveness and tended to demonstrate less mental illness than those suicides using other means in rural China.
Conclusions: Accessibility, high toxicity and lethality of the pesticides were risk factors for the suicides of people without a mental disorder in rural China. The use of pesticides is a rational choice and the safe storage of these kinds of farming chemicals should be controlled to prevent certain suicides.
Background and Aims: Immigrants in Europe appear at higher risk of psychiatric coercive interventions. No studies have investigated this issue in Italy. The aim of this study is to investigate whether the use of physical restraint, compulsory admission and other treatment characteristics differ in immigrated and Italian-born patients admitted to a psychiatric intensive care unit.
Methods: One hundred first-generation immigrant patients were compared to 100 age-, gender- and diagnosis-matched Italian-born patients. Subjects were diagnosed according to DSM-IV-TR and rated on the Clinical Global Impression – Severity Scale and the Global Assessment of Functioning. Clinical data and treatment characteristics were collected.
Results: Immigrant patients were more likely to be physically restrained as compared to Italian-born patients (11% vs 3%; 2 = 4.92; p = 0.027; RR = 3.67; 95% CI = 1.05–12.7). No differences in the proportion of involuntary treatment were found. Immigrant patients did not receive higher doses of antipsychotics or benzodiazepines, but they had a longer stay in the hospital.
Conclusions: The higher rate of physical restraint among migrants may reflect cultural, ethnic and language differences leading to communication problems between immigrant patients and mental health professionals. Since coercive interventions can be harmful, specific strategies to prevent this phenomenon in immigrants are needed.
Background: As well as an improvement in community services, the de-institutionalization of patients receiving long-term psychiatric care can lead to marginally staffed mental health services, more homelessness, rising admission rates and more people in prison cells. It is assumed that an imbalance between community and hospital care for chronic patients puts pressure on crisis services.
Aims: In this study, the central question is whether patients receiving long-term psychiatric care in Amsterdam do indeed put pressure on the city’s emergency mental health services. We compare the pressure exerted by this group with the pressure resulting from the use of these services by all registered patients.
Methods: Data were taken from the client registration systems of three mental health organizations in Amsterdam in the period from 2000 to 2004. Inclusion criteria for long-term psychiatric patients were age above 19 years and uninterrupted receipt of mental health care for a minimum of two successive years.
Results: Annually, 6%–8% of all non-long-term patients experienced a crisis outside office hours in the period under investigation; this was 4%–6% for long-term patients. The non-long-term patients accounted for 83% of crisis contacts outside office hours over the entire study period, with long-term patients accounting for 17%.
Conclusions: The assumption that crises are more prevalent in long-term patients in the community seems to be an example of stigmatization rather than an observation based on fact.
Background: Eating disorders is a particular problem for university students. However, little is known about this problem among medical students who often have high stress.
Aims: The aims of this study were to describe the changes in eating attitudes and eating disorders from 2006 to 2008 in a medical student sample, and to compare the gender differences of eating attitudes and body mass index (BMI, kg/m2) with this sample.
Methods: This study was conducted in Changsha city, Mainland China. Self-reported questionnaires, including the Eating Attitudes Test (EAT) and Eating Disorders Assessment Questionnaire (CETCA), were employed to examine the changes in eating attitudes and eating disorders from 2006 to 2008 in a medical student sample (N = 500).
Results: Self-reported findings suggest that tentative eating disorders prevalence was 0.90% (anorexia nervosa (AN): 0; bulimia nervosa (BN): 4 females) in 2006 and 1.44% (AN: 1 male; BN: 1 male and 3 females) in 2008 of the full sample. The present data showed that 2.26% (2 males and 9 females) in 2006 and 2.47% (4 males and 6 females) in 2008 of all students obtained scores greater than 20 on the EAT-26 indicative of distorted eating attitudes and behaviour. Male students kept lower distorted eating attitudes and behaviours than female students, while female students kept a lower BMI than male students in both 2006 and 2008. However, there were no statistically significant changes in eating attitudes, distorted eating attitudes and CETCA in either male or female students from 2006 to 2008.
Conclusions: The results of this study suggest that there were no statistically significant changes from 2006 to 2008 in eating attitudes, distorted eating attitudes and CETCA. However, females showed significantly higher eating disorders and distorted eating attitudes compared to males in both 2006 and 2008. This study is furthering our understanding of eating disorders in a Chinese cultural context.
Background: In contrast to extensive research on psychiatric patients’ dangerousness, very few studies have examined their victimization.
Aim: The aim of our study is to record reported victimization of seriously mentally ill outpatients in Greece and compare them with healthy controls.
Method: We interviewed 150 severely mentally ill outpatients and a matched group of healthy controls using a semi-structured interview. This recorded incidents of victimization and perceived discrimination during the previous year. Logistic regression models were used to examine the influence of demographic parameters on both victimization and discrimination.
Results: In this study 59.3% of patients and 46.0 % of controls (p = .02) reported being victims of a criminal act at least once and 52.0% of patients and 24.0 % of controls (p < .001) reported experiencing discrimination during the previous year. Patients, in comparison to controls, were more likely to report being victims of any kind of victimization (OR = 1.85, 95% CI = 1.07–3.21), of assault/threat (OR = 4.62, 95% CI = (2.32–9.19) and of discrimination (OR = 3.34, 95% CI = (2.1–5.62). In addition, patients reported experiencing higher distress in assault/threat crime compared to controls (p = .03).
Conclusions: Patients with serious mental illness are more likely than the general population to report being victims of criminal acts and experiencing discrimination.
Background: Stigmatizing attitudes can impair the quality of life of people with mental health problems. Psychiatric hospitalization can generate stigma. Are some approaches to care less stigmatizing than others?
Aims: This study was designed to replicate findings from Flanders, Belgium in an English context, investigating how ward size and treatment approach affected service users’ expectations and experiences of stigma.
Methods: The translated Belgian questionnaire was administered to 70 service users in 15 inpatient adult mental health settings in central England. Adjustments were made to the multivariate analysis in light of the smaller sample size, in order to replicate the original equation as closely as possible.
Results: Neither ward size nor individualized care proved significant in the smaller English sample, which was subject to the risk of type II error. Across two models, self-rejection correlated with age (negatively), social rejection and stigma expectations.
Conclusions: This analysis shows that attempts to translate evidence about psychiatric inpatient services must take into account differences between the settings, populations and models of care. Expectations as well as outcomes of stigma may be relevant when assessing the impact of psychiatric hospital treatment on individual patients.
Background: Existing studies of depression and family functioning have used western samples to examine how depression and impaired family functioning are related, and to explore levels of discrepancy between depressed patients and their family members. The purpose of the current study is to explore these questions in a Chinese sample.
Method: This study examined the association between family functioning and depression in a Chinese sample of 60 depressed patients and their family members and 60 non-clinical controls and their family members. The study evaluated levels of agreement between family members on a self-report measure of family functioning (Family Assessment Device) using reliability statistics. It also compared families’ self-reported family functioning to that of a trained observer using an observational rating scale (McMaster Clinical Rating Scale).
Results: Results indicate poorer family functioning among Chinese families with a depressed family member, high to moderate agreement between patients and family members, moderate to low agreement between non-clinical participants and their family members, and moderate correlations between subjective and objective ratings of family functioning in a mainland Chinese sample.
Conclusions: As in other cultures, depression is associated with impaired family functioning in Chinese families. There is good agreement between family members and a trained evaluator about the family impairments. The Family Assessment Device and the McMaster Clinical Rating Scale are useful for assessing family functioning in Chinese families.
Aims: To explore the association between MMORPG addiction and mental health status, and between self-control ability and mental health status among young male MMORPG players in Hanoi, Vietnam.
Methods: In this cross-sectional study, 10 computer game rooms were randomly selected out of 77 in five communes in Hanoi. From these game rooms, 350 MMORPG players were purposively recruited as a study group, of whom 344 completed the questionnaire. In the same five communes, 344 non-players were selected as a control group. An online game addiction scale, a self-control scale and the Vietnamese SRQ-20 were used to measure the degree of MMORPG addiction, self-control ability and level of mental disorders.
Results: MMORPG players had significantly higher mental disorders scale scores than non-players (p < .001). The strongest positive correlation was detected between MMORPG addiction scale scores and mental disorders scale scores (r = 0.730, p < .001). Self-control scale scores were negatively associated with mental disorders scale scores (r = –0.345, p < .001). The average amount of money spent on games per month, MMORPG addiction scale score and self-control scale score were considered the best predictors of a higher mental disorders scale score.
Conclusion: Young, male MMORPG players with higher addiction scores were more likely to have higher mental disorders scale scores, and such mental status was negatively associated with the level of self-control in Hanoi, Vietnam. Closer attention should be paid to prevent mental disorders among MMORPG players.
Aims: Many patients have stigma about depression, which may inhibit treatment seeking. However, most previous research in this area has been conducted in outpatient samples. The current study investigated self-stigma and its relationship with treatment beliefs in depressed patients receiving psychiatric hospital treatment.
Method: The sample consisted of 55 hospitalized patients with depressive disorders who completed measures of self-stigma, medication beliefs, psychotherapy beliefs and depression.
Results: Multiple regression analyses controlling for demographic variables demonstrated that higher depression severity was associated with increased self-stigma related to treatment and having depression. Higher self-stigma about treatment was associated with more negative beliefs about psychiatric medications, but more positive beliefs about psychotherapy. In contrast, self-stigma about depression was associated with negative beliefs about medications, but not psychotherapy.
Conclusions: Psychiatric hospital treatment, particularly in the USA, emphasizes medication treatment while de-emphasizing evidence-based psychosocial interventions. Individuals with negative views about psychiatric medications and positive views about the value of psychotherapy have higher treatment self-stigma, which may discourage them from seeking hospital treatment when needed or negatively affect their treatment response.
Background: New research is continually improving the comprehension of bipolar disorder (BD). However, many challenges remain to be addressed, such as understanding the health care practices (HCPs) chosen by bipolar patients and the determinants of seeking treatment.
Material: Using a qualitative approach, we studied the HCPs of six patients with BD through focused interviews.
Discussion: Even patients who report using primarily allopathic care usually test out and combine different HCPs.
Conclusion: Pathways to care in BD are composed of a combination of HCPs because patients need to develop a stock of potential treatment alternatives to deal with the suffering involved in living with BD.
Background: Existing knowledge about the cultural beliefs of black and minority ethnic (BME) communities in the UK regarding stigma and mental illness is limited.
Material: Data were collected in 10 focus groups, five with service users and five with laypersons, from BME communities in London.
Discussion: Thematic analysis identified that cultural beliefs regarding mental illness reflect four different voices present within the BME communities.
Conclusion: The study revealed that cultural beliefs influencing both relationships with family and, consequently, help-seeking for individuals with mental illness must be considered in the development of anti-stigma interventions and when engaging communities around mental healt.
Background: While numerous past reviews of psychological autopsy (PA) studies have examined the relationship between mental disorder and suicide, there has been little systematic investigation of suicide occurring in the absence of any identifiable psychiatric condition.
Aim: This article reviews available literature on the topic by considering Axis I, sub-threshold, mild disorders and personality disorders.
Method: We conducted a systematic review of PA studies from 2000 onwards. Studies included in the review had to clearly describe the proportion of suicide cases without a classifiable mental disorder or sub-threshold condition.
Results: Up to 66.7% of suicide cases remained without diagnosis in those studies that only examined Axis I disorders (n = 14). Approximately 37.1% of suicide cases had no psychiatric condition in research papers that assessed personality and Axis I disorders (n = 9), and 37% of suicides had no Axis I, sub-threshold/mild conditions (n = 6). In general, areas in China and India had a higher proportion of suicides without a diagnosis than studies based in Europe, North America or Canada.
Conclusion: Variation in the proportion of suicide cases without a psychiatric condition may reflect cultural specificities in the conceptualization and diagnosis of mental disorder, as well as methodological and design-related differences between studies.
Background: The psychiatric advance statement (PAS) is a document that outlines the preferences of patients in their future treatment. Formulating and writing a PAS has not been studied in low- and middle-income (LAMI) countries.
Aim: To study the feasibility of writing a PAS in an Indian population.
Methods: Patients’ diagnosed with schizophrenia or schizoaffective psychosis attending the outpatient clinic at the Schizophrenia Research Foundation (SCARF) or its community centres in 2011 were screened using the study criteria. After obtaining informed consent, stratified sampling was used to derive the final sample.
Results: Most patients consented to participate in the study (122/123 patients). Following interviews with research assistants, 93 patients were assessed to have the capacity to write a PAS and 92 completed one. The patients were mostly able to complete the PAS on their own. Major themes included choice of treatment facility, type of treatment and nomination of others to take decisions on their behalf. A third of the sample were either from rural areas or not exclusively urban. At the time of the study, about 45% of the sample was rated as being symptomatic.
Conclusion: Psychotic patients with a long-term illness, a third of them from non-urban areas, were able to write a valid PAS.