Vietnamese Americans' attitudes toward seeking mental health services: Relation to cultural variables

This study examined the relation between culturally based variables and attitudes toward seeking mental health services among a community sample of Vietnamese Americans ( N = 148) with at least 8 years' residence in the United States (U.S.). Variables included Stigma, Traditional Beliefs about Mental Illness, Help‐Seeking Preferences, Problem Prioritizing, and Disclosure. The results indicated that Disclosure, Help‐Seeking Preferences, and Problem Prioritizing were significant predictors of attitudes. Greater willingness to disclose, greater preference for professional resources over family/community resources, and higher priority placed on mental/emotional health concerns over other concerns were each associated with more favorable attitudes toward seeking mental health services. Stigma and Traditional Beliefs about Mental Illness did not appear to be significant predictors. Implications of the findings are discussed. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 213–231, 2005.     

Anxiety disorders in a public mental health system: clinical characteristics and service use patterns

BACKGROUND: Anxiety disorders are among the most common forms of psychiatric disorder, yet few investigations have examined the prevalence or service use of clients with anxiety disorders in the public mental health sector. METHODS: We examined demographics, clinical information, and service use in clients with anxiety disorders enrolled in San Diego County Adult and Older Adult Mental Health Services in fiscal 2002-2003. RESULTS: Almost 15% of the sample had a diagnosis of an anxiety disorder based on administrative billing data. Most anxiety disorder clients had additional psychiatric diagnoses, most commonly depression. Clients with both anxiety disorders and depression were more likely than those with anxiety or depression alone to use emergency psychiatric services and outpatient services than those with depression alone. Those with anxiety disorders alone used more outpatient services than those with depression alone. LIMITATION: Data were taken from an administrative database. CONCLUSIONS: Data indicate that anxiety disorders are not uncommon in public mental health settings and are associated with higher utilization of outpatient mental health services.     

Predicting change in problem behavior from child and family characteristics and stress in referred children and adolescents

A three-wave longitudinal study design with two 6-month intervals was used to examine the stability and change in Internalizing, Externalizing, and Total Problem behavior among children and adolescents referred to outpatient mental health services. Our results indicated high stabilities for parent ratings of child psychopathology across a 1-year interval. Additionally, we found decreases in the level of problem behavior. Interindividual differences in change were found for Total Problems and Externalizing behavior but not for Internalizing. While both the child's temperament and intelligence level and family relations were related to the initial level of parent-rated problem behavior, only intermediary stressful life events had an influence on the rate of change of child psychopathology.     

A qualitative investigation to inform yoga intervention recruitment practices for racial/ethnic minority adolescents in outpatient mental health treatment

ObjectiveYoga is recognized as an effective approach to improving overall physical and mental health; however, there may be perceived barriers to yoga participation, particularly among populations most at risk for mental health issues. We conducted qualitative formative research to help inform recruitment practices for a future study and to specifically understand the barriers and facilitators to engagement in yoga practice among racial/ethnic minority adolescents, as well as adolescents in outpatient mental health treatment.MethodsQualitative data were collected at a community health clinic that serves low income families in southeastern Florida. Using semi structured interviews with racial and ethnic minority adolescents between 12 and 17 years old, participants were asked about beliefs and perceptions about yoga, as well as recommendations on recruiting peers. A thematic analysis approach was used to identify and examine common themes.ResultsTwenty interviews were conducted and eight major themes emerged from the data. Themes were grouped as (1) Facilitators to recruitment and (2) Barriers to recruitment.InterpretationAdvertising free yoga that emphasizes the social, physical, and mental benefits can help assuage negative perceptions of yoga and promote the advantages of yoga among teenagers. Having recruitment materials and modalities that highlight inclusivity of all genders and physical abilities in the yoga classes are also important in facilitating participation. Understanding perceptions of yoga, as well as perceived barriers and facilitators, among racially/ethnically diverse adolescents in outpatient mental health treatment, can assist recruitment efforts, increase yoga intervention participation, and ultimately, improve mental health outcomes for underserved populations.     

地方高校学生焦虑与应付方式的关系

目的:调查当前地方性高校学生的焦虑心理现状,分析焦虑的影响因素,同时探讨其与应付方式的关系,以提高其身心健康水平。方法:对181名在校大学生采用随机抽样的方法,运用应付方式问卷和烦恼心理问卷进行测量。结果:1学生焦虑状况整体处于"轻微"到"中等程度"之间;2"缺乏自信"焦虑因子上,班委显著低于非班委人员(F=4.847,P=0.029);无睡眠困扰者焦虑水平最低(P0.05);学习成绩处于及格水平附近者的焦虑水平最高(P0.05);3焦虑各因子与应对方式相关显著(P0.05),解决问题和幻想解释了"前途迷茫"变异程度的18.4%(R2=0.184);自责、解决问题和退避解释"缺乏自信"变异程度的23.1%(R2=0.231);解决问题和退避解释"经济压力"变异程度的10.3%(R2=0.103)。结论:地方高校学生焦虑程度适中,心理状况良好;焦虑的积极应对与消极应对方式并存,来自"前途迷茫"的焦虑主要采用解决问题和幻想的应付方式,"缺乏自信"采用自责、解决问题和退避,"经济压力"采用解决问题和退避的应付方式。     

Adolescent life events and adult mental health 5–9 years after referral for acute psychiatric outpatient treatment

Knowledge is needed of mental health in relation to life events of former acute child and adolescent outpatients at risk of suicide. The present study describes the long‐term mental health outcome of young adults who as children or adolescents were referred to outpatient psychiatry for mental health problems, and identifies putative mental health statistical outcome predictors at follow‐up, with focus on life events. One hundred patients referred to treatment at child and adolescent outpatient clinics in Nordland County, Norway, during 1990–1994 were interviewed face to face, 5–9 years after referral. At follow‐up, life events at young age were associated with the mental health status in spite of referral and acute psychotherapeutic intervention. There was a general effect of life events at young age, affecting a large number of mental health variables. Childhood and adolescence difficulties were highly correlated, indicating a possible continuation of effects from childhood to adolescence. Copyright © 2004 John Wiley & Sons, Ltd.     

Outpatient mental health care, self-help groups, and patients' one-year treatment outcomes

OBJECTIVE: To examine the association between the duration and amount of outpatient mental health care, participation in self-help groups, and patients' casemix-adjusted one-year outcomes. METHODS: A total of 2,376 patients with substance use disorders, 35% of whom also had psychiatric disorders, were assessed at entry to treatment and at a one-year follow-up. Information about the duration and amount of outpatient mental health care was obtained from a centralized health services utilization database. RESULTS: Patients who obtained regular outpatient mental health care over a longer interval and patients who attended more self-help group meetings had better one-year substance use and social functioning outcomes than did patients who were less involved in formal and informal care. The amount of outpatient mental health care did not independently predict one-year outcomes. CONCLUSIONS: The duration of outpatient mental health care and the level of self-help involvement are independently associated with less substance use and more positive social functioning. The provision of low intensity treatment for a longer time interval may be a cost-effective way to enhance substance abuse and psychiatric patients' long-term outcomes.     

Hospital planning for weapons of mass destruction incidents

As terrorists attacks increase in frequency, hospital disaster plans need to be scrutinized to ensure that they take into account issues unique to weapons of mass destruction. This paper reports a review of the literature addressing hospital experiences with such incidents and the planning lessons thus learned. Construction of hospital disaster plans is examined as an ongoing process guided by the disaster planning committee. Hospitals are conceived as one of the components of a larger community disaster planning efforts, with specific attention devoted to defining important linkages among response organizations. This includes the public health authorities, political authorities, prehospital care agencies, and emergency management agencies. A review is completed of six special elements of weapons of mass destruction incidents that should be addressed in hospital disaster plans: incident command, hospital security, patient surge, decontamination, mental health consequences, and communications. The paper closes with a discussion of the importance of training and exercises in maintaining and improving the disaster plan.     

Introducing Mother Baby Connections: a model of intensive perinatal mental health outpatient programming

Perinatal mental health problems, experienced by 15–20% of women, are a significant public health issue associated with adverse effects among childbearing women; yet only 20–25% receive adequate treatment. There has been a recent proliferation of intensive perinatal day treatment programs in the United States. To meet this need in the greater Philadelphia area, we introduce Mother Baby Connections (MBC), an innovative interdisciplinary, attachment-focused, intensive, outpatient perinatal mental health program recently launched at Drexel University. The purpose of this paper is to (1) present an overview of MBC, its theoretical framework for services, and its evidence-based components, highlighting the unique factors that differentiate this program from traditional outpatient treatment, and (2) present clinical outcome data utilizing scores from reliable and valid scales, including enrollment to discharge outcomes from 20 months of MBC operation. In sum, outcomes for 20 predominantly minority women with complete measures showed significant improvements in maternal depression symptom severity, maternal functioning, birth trauma symptoms, perceived stress, parenting stress, and emotional regulation. Effect sizes were medium to large (i.e., 0.42–2.00). We conclude that MBC is a viable model for tailored intensive outpatient treatment to foster maternal mental health and functioning during the perinatal period.     

大学生自助式心理健康教育的实验研究

目的探讨自助式心理健康教育对大学生健康信念、健康行为和健康水平的影响。方法运用自然教学实验对实验组和控制组(两组样本均为60人)进行45个学时教学,采用健康信念、健康行为调查问卷和GHQ-20量表对两组被试进行前后测试。结果两组被试的健康信念、健康行为和健康水平均得到改善,但实验组被试的改进更加明显,尤其是在自我肯定等积极心理品质方面。结论自助式心理健康教育的实效性优于常规心理健康教育方法。     

Relationship between the social and demographic characteristics of post-sentence offenders and the outcomes of forensic psychiatric referrals

Examined the relationship between the social and demographic characteristics of post-sentence offenders (N = 240) and outcome of outpatient forensic psychiatric referrals using multiple regression analysis. The referral process was divided into three stages: Decision to refer, compliance with referral, and outcome of referral, and the following research questions were explored: (1) whether there were differences between the social and demographic characteristics of offenders who were referred by court order of the sentencing judge and those referred by their probation officer; (2) the the relationship between socioeconomic status and completion of referral; (3) the relationship between socioeconomic status and recommendation for further mental health services; and (4) the relationship between source of referral and recommendation for mental health services. Results suggest that the relationship between social and demographic variables and the offender's interaction with a forensic mental health system is markedly different from the voluntary clients and mental health resources studied in earlier research.     

河北省2001年与2008年精神卫生资源调查与分析

目的 通过对河北省精神卫生资源7年前后对比,分析精神卫生服务资源发展状况,为制定省内精神卫生发展规划提供依据.方法 分别调查了2001年和2008年全省精神卫生资源状况,分层抽取34所机构,对不同指标进行动态对照分析.结果 ①全省精神卫生机构由67所增加到116所,分布依然不均f②省市级机构年门诊人次分别增加了77.6...     

不同背景大学生应对方式与心理健康的差异

目的探讨不同背景下大学生应对方式以及心理健康水平的差异．以及心理健康的影响因素。方法采用应对方式问卷、心理症状自评量表（SCL-90）和自编的一般背景调查问卷封250名在校大学生进行调查。结果在性别、专业、家庭所在地、是否独生子女各不同背景下大学生应对方式及心理健康水平存在显着性差异。应对方式与心理健康存在相关．多元逐步回归分析表明．幻想、自责、解决问题三应对方式因子对心理健康有显着影响。结论心理健康教育应加强对大学生应对方式的培养．应特别注重幻想、自责、解决问题三个因子。     

An evaluation of large group CBT psycho-education for anxiety disorders delivered in routine practice

OBJECTIVE: To determine the clinical utility and acceptability of a brief CBT psycho-educational course delivered in an NHS psychotherapy service. METHODS: All patients referred, found suitable for CBT, and who had an anxiety disorder, were invited to enrol in a psycho-education course, delivered in an outpatient mental health clinic by two mental health nurses with post-registration training in CBT. There were up to 24 patients in each course. Outcome measures used were CORE-OM and Fear Questionnaire administered pre-course and at 12-week follow-up and Client Satisfaction Questionnaire administered post-course. RESULTS: One-hundred and ninety one patients were referred. Of these 120 remained in contact with the service to the follow-up meeting. Ninety-seven patients were discharged at the follow-up point and 92 requested further individual psychotherapy. A number of patients made a clinical and reliable change as measured by CORE-OM and Fear Questionnaire. One-hundred and two patients completed the CSQ-8 reporting high satisfaction with the intervention. CONCLUSIONS: The intervention appears to be helpful for a number of patients and largely acceptable for most patients that attend. PRACTICE IMPLICATIONS: Large group psycho-educational interventions for anxiety disorders could be increasingly used as a method of delivering low intensity treatments within a stepped care model of the treatment of anxiety disorders. The intervention is relatively simple to deliver and potentially could be delivered by primary care clinicians.     

Predicting patient deterioration in youth mental health services: community mental health vs. managed care settings

Objective: To examine differences across a community mental health system and a private managed care system in the accuracy of a warning system designed to identify youth at risk for deterioration in mental health services. Design: Longitudinal outcome data from the Youth Outcome Questionnaire (Y‐OQ) were examined using multilevel modeling for 2,310 youth ages 4–17 who received outpatient treatment. Results: The warning system correctly identified 69% of cases that ultimately ended in deterioration in the community mental health setting, compared to 61% in the managed care setting. The overall hit rate (overall accuracy in classifying cases as deteriorators/non‐deteriorators) was the same in the two settings (75%). Conclusions: Results are consistent with previous research demonstrating that patient‐focused warning systems can be reasonably accurate in identifying youth cases at risk for treatment failure. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–17, 2011.     

Postpartum psychiatric emergency visits: a nested case-control study

Mental health conditions are one of the most common reasons for postpartum emergency department (ED) visits. Characteristics of women using the ED and their mental health service use before presentation are unknown. We characterized all women in Ontario, Canada (2006–2012), who delivered a live born infant and had a psychiatric ED visit within 1 year postpartum (n?=?8728). We compared those whose ED visit was the first physician mental health contact since delivery to those who had accessed mental health services on specific indicators of marginalization hypothesized to be associated with lower likelihood of mental health contact prior to the ED visit. For 60.4 % of women, this was the first physician mental health contact since delivery. The majority were presenting with a mood or anxiety disorder, and only 13.6 % required hospital admission. These women were more likely to have material deprivation and residential instability than women with contact (Q5 vs. Q1 aORs 1.30, 95 % CI 1.12–1.50; 1.17, 95 % CI 1.01–1.36), to live in rural vs. urban areas (aOR 1.58, 95 % CI 1.38–1.80), and to be low vs. high income quintile (aOR 1.18, 95 % CI 1.01–1.38). The frequent use of ED services as the first point of contact for mental health concerns suggests that interventions to improve timely and equitable access to effective outpatient postpartum mental health care are needed. Marginalized women are at particularly high risk of not having accessed outpatient services prior to an ED visit, and therefore, future research and interventions will specifically need to consider the needs of this group.     

THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS’ EXPERIENCES OF MENTAL HEALTH TREATMENT

Clinicians and researchers have pointed to the need for culturally sensitive mental health interventions. Yet it has not been determined if the inclusion of cultural elements affects the way mental health clients experience services. This study examined 102 clients who had received mental health treatment from outpatient mental health clinics to investigate whether culturally related elements involving race and ethnicity were important to clients and whether they were related to client satisfaction and perceived treatment outcomes. Ethnic minority clients generally felt that issues regarding race and ethnicity were more important than did White clients. When these elements were considered important but were not included in their care, clients were less satisfied with treatment. Consistent with the notion of cultural responsiveness, these findings provide empirical evidence that culturally relevant aspects of the mental health service experience are salient to ethnic minority clients and can affect how they respond to services.     

Annual cost of managing bipolar disorder to the UK healthcare system

Introduction:

Bipolar disorder is a common illness characterized by recurrent episodes of pathological disturbances of mood. The aim of this study was to estimate the annual cost associated with bipolar disorder to the UK healthcare system (National Health Service).

Methods:

A retrospective observational study was conducted. Primary care resource use was estimated using the IMS Disease Analyzer, a nationally representative sample of general practitioner (GP) practices. Two sources of data from the NHS Information Centre were used to assess resource use in secondary care and in outpatient and community mental health. The number of bed days and day attendances for patients hospitalized was obtained from the Hospital Episode Statistics (HES). This was supplemented with Mental Health Minimum Dataset (MHMDS) to quantify outpatient and community mental health face-to-face contacts. Resource use was examined between 01 April 2007 and 31 March 2008.

Results:

The annual NHS cost of bipolar disorder was estimated to be £342 million at 2009/2010 prices. Hospitalizations accounted for 60%, outpatient and community mental health 26.7%, and medication in primary care 7.4% of the overall direct costs of care.

Limitations:

This study may be confounded by the absence of a control group. This study was limited to an assessment of direct healthcare costs only, not the wider societal cost of bipolar disorder.

Conclusions:

The direct medical cost of managing bipolar disorder in the UK healthcare system is considerable. Therapeutic strategies that optimize community-based management, prevention of recurrence and hospitalization could reduce the economic burden of this illness.     

心理因素与门诊服务利用的关系

目的:探索心理因素与门诊服务利用的关系。方法:采用分层整群随机抽样方法抽取样本,利用自制调查问卷和Kessler10量表进行访谈式调查。结果:共调查威海市15岁及以上居民11652人。占威海市总人口的4.72‰。(1)居民两周患病检出率为10.4%(其中农村地区为10.9%,城市地区为7.7%),两周就诊率平均为4.8%(其中农村地区为5.0%,城市地区为4.1%);63.6%的患者就诊时选择基层医疗机构;(2)单因素和多因素分析结果显示,影响门诊服务利用的主要心理因素是K10分值,其高分组(30~50)的OR值=2.258(95%CI:1.265-4.032)。结论:心理健康状况差与两周就诊率高相关。     

Quality of life in depression: An important outcome measure in an outpatient cognitive–behavioural therapy group programme?

Studies have shown that psychiatric patients have significantly impaired quality of life (QOL) in comparison to community samples who are not suffering a mental illness. Despite an increase in research in the mental health field, there still remains little consensus as to the merit of using such questionnaires within a mental health population. There is a concern that QOL is redundant with affective state and symptomatology. We investigated the usefulness of the Quality of Life Enjoyment and Satisfaction Questionnaire‐short form (QLESQ‐SF) in a depressed outpatient sample receiving time‐limited, standardized group cognitive–behavioural therapy. QLESQ‐SF ratings were examined at admission and 10‐week endpoint in an intention‐to‐treat (N = 212) and completers (N = 164) sample. QLESQ‐SF ratings and symptom ratings (Beck Depression Inventory‐II; Beck Anxiety Inventory) improved significantly over time. Hierarchical regression analyses revealed that, although affective state and change in symptomatology were significantly correlated with QOL and change in QOL, a large proportion of variance was unexplained. These results are inconsistent with the theory of measurement redundancy. QOL appears to be a useful measure that provides additional treatment outcome information distinct from affective state and symptomatology. Copyright © 2009 John Wiley & Sons, Ltd.