Evidence-based prevention practice in mental health: what is it and how do we get there?

A substantial number of children in the United States suffer from mental health problems. These children enter into adulthood at a disadvantage and often continue to experience mental health problems as adults. Historically, much less attention has been paid to prevention of mental health problems than to treatment and rehabilitative services. In recent years, however, great strides have been made in developing and evaluating prevention interventions in the area of mental health. Nevertheless, the study of prevention still lags behind clinical treatment research in identifying and disseminating effective programs and interventions. The following article draws on the work of numerous prevention scholars to develop a conceptual framework of evidence-based prevention practice in the area of mental health. Suggestions for how researchers, policy makers, and service providers can contribute to the development of evidence-based prevention practice in mental health are considered.     

The variation of the stress–mental health relationship by ethnicity and gender

Population-based studies have consistently shown a higher frequency of stress and mental health problems (MHPs) among women than among men, and among immigrants than among the ethnic majority. However, little is known about ethnic variation and gender differences among immigrants. This study aimed to explore the variation of the stress–mental health relationship by gender and ethnicity. Logistic regression analyses were conducted on data from 2349 participants including Danes, and Lebanese, Pakistani and Turks – first generation of immigrants in Denmark. The results showed similarities and differences between women and men and between ethnic groups. The risk of developing MHPs was higher among women than among men and the gender difference was significant in all immigrants groups but not in Danes. Although the stress exposure is higher among women and immigrants, gender and ethnic differences in mental health are better explained by cultural dimensions and circumstances in peoples' life.     

Who comes first? The role of the prefrontal and parietal cortex in cognitive control

Cognitive control processes enable us to adjust our behavior to changing environmental demands. Although neuropsychological studies suggest that the critical cortical region for cognitive control is the prefrontal cortex, neuro-imaging studies have emphasized the interplay of prefrontal and parietal cortices. This raises the fundamental question about the different contributions of prefrontal and parietal areas in cognitive control. It was assumed that the prefrontal cortex biases processing in posterior brain regions. This assumption leads to the hypothesis that neural activity in the prefrontal cortex should precede parietal activity in cognitive control. The present study tested this assumption by combining results from functional magnetic resonance imaging (fMRI) providing high spatial resolution and event-related potentials (ERPs) to gain high temporal resolution. We collected ERP data using a modified task-switching paradigm. In this paradigm, a situation where the same task was indicated by two different cues was compared with a situation where two cues indicated different tasks. Only the latter condition required updating of the task set. Task-set updating was associated with a midline negative ERP deflection peaking around 470 msec. We placed dipoles in regions activated in a previous fMRI study that used the same paradigm (left inferior frontal junction, right inferior frontal gyrus, right parietal cortex) and fitted their directions and magnitudes to the ERP effect. The frontal dipoles contributed to the ERP effect earlier than the parietal dipole, providing support for the view that the prefrontal cortex is involved in updating of general task representations and biases relevant stimulus-response associations in the parietal cortex.     

Why are religious individuals more obsessional? The role of mental control beliefs and guilt in Muslims and Christians

Background and objectives

The cognitive-behavioural perspective on obsessions recognizes that certain cultural experiences such as adherence to religious beliefs about the importance of maintaining strict mental control might increase the propensity for obsessional symptoms via the adoption of faulty appraisals and beliefs about the unacceptability and control of unwanted intrusive thoughts. Few studies have directly investigated this proposition, especially in a non-Western Muslim sample.

Method

In the present study high religious, low religious and religious school Canadian Christian and Turkish Muslim students were compared on measures of OCD symptoms, obsessive beliefs, guilt, religiosity, and negative affect.

Results

Analysis revealed that religiosity had a specific relationship with obsessional but not anxious or depressive symptoms in both samples, although the highly religious Muslim students reported more compulsive symptoms than highly religious Christians. In both samples the relationship between religiosity and obsessionality was mediated by importance/control of thoughts and responsibility/threat beliefs as well as generalized guilt.

Limitations

The sample composition was limited to non-clinical undergraduates and only two major religions were considered without recognition of denominational differences.

Conclusions

These findings indicate that the tendency for highly religious Christians and Muslims to experience greater obsessionality is related to their heightened sense of personal guilt and beliefs that they are responsible for controlling unwanted, threatening intrusive thoughts.     

What is duty/triage? Understanding the role of duty/triage in an area mental health service

OBJECTIVE: To describe the duty/triage system within one urban area mental health service in Australia and to investigate the factors that affect the decision to organize a comprehensive assessment. METHOD: Data was collected from 3 months of duty/triage information and key informant interviews. Policies and procedures related to duty/triage were reviewed. Quantitative and qualitative analyses were conducted. RESULTS: Two thousand, six hundred and three contacts with duty/triage occurred over a -3-month period. Half of these were related to patients new to the service. Most contacts were self-referrals or referrals from a carer. Few referrals came through the primary health care sector. New patients were more likely to be assessed if the referral was presented in technical language and if it was initiated by a health professional, particularly a general practitioner, emergency department or other mental health service. Assessment was less likely if the patient or carer initiated the referral, if the problem was presented in vague or non-technical terms, if there was a drug or alcohol problem or if the person refused care. CONCLUSIONS: A substantial number of potential patients contact a duty/triage worker every day. However, there is little interaction with the primary care sector, limited documentation of risk and a lack of consistency in the documented reasons for the service response. Further investigation is needed of the conditions conducive to consistent quality decision making at the point of entry to a specialist mental health service.     

The role of the hippocampus in long-term memory: is it memory store or comparator?

Several attempts have been made to reconcile a number of rival theories on the role of the hippocampus in long-term memory. Those attempts fail to explain the basic effects of the theories from the same point of view. We are reviewing the four major theories, and shall demonstrate, with the use of mathematical models of attention and memory, that only one theory is capable of reconciling all of them by explaining the basic effects of each theory in a unified fashion, without altogether sacrificing their individual contributions. The key issue here is whether or not a memory trace is ever stored in the hippocampus itself, and there is no reconciliation unless the answer to that question is that there is not. As a result of the reconciliation that we are proposing, there is a simple solution to several outstanding problems concerning the neurobiology of memory such as: consolidation and reconsolidation, persistency of long term memory, novelty detection, habituation, long-term potentiation, and the multifrequency oscillatory self-organization of the brain.     

Mental health problems and marital disruption: is it the combination of husbands and wives’ mental health problems that predicts later divorce?

BACKGROUND: Divorce has been established as an adverse social consequence of mental illness. There is, however, little research that has considered how the mental health of both spouses may interact to predict relationship disruption. The aim of the current study was to use data from a large population-based survey to examine whether the combination of spouses' mental health problems predicts subsequent marital dissolution. METHODS: Prospective analysis of data from a longitudinal national household survey. 3,230 couples were tracked over 36 months, with logistic regression models used to determine whether the mental health problems of both spouses at wave 1 (determined by the SF36 mental health subscale) predicted subsequent relationship dissolution. RESULTS: Couples in which either men or women reported mental health problems had higher rates of marital disruption than couples in which neither spouse experienced mental health problems. For couples in which both spouses reported mental health problems, rates of marital disruption reflected the additive combination of each spouse's separate risk. Importantly, these couples showed no evidence of a multiplicative effect of mental illness on rates of subsequent divorce or separation. CONCLUSIONS: The results do not support the notion that a combination of mental health problems in both spouses uniquely predicts marital dissolution. Rather, there is an additive effect of individual mental health problems on the risk of dissolution.     

‘Whether you like it or not people with mental problems are going to go to them’: A qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana

Limited research has been conducted to explore the factors that support or obstruct collaboration between traditional healers and public sector mental health services. The first aim of this study was to explore the reasons underpinning the widespread appeal of traditional/faith healers in Ghana. This formed a backdrop for the second objective, to identify what barriers or enabling factors may exist for forming bi-sectoral partnerships. Eighty-one semi-structured interviews and seven focus group discussions were conducted with 120?key stakeholders drawn from five of the ten regions in Ghana. The results were analysed through a framework approach. Respondents indicated many reasons for the appeal of traditional and faith healers, including cultural perceptions of mental disorders, the psychosocial support afforded by such healers, as well as their availability, accessibility and affordability. A number of barriers hindering collaboration, including human rights and safety concerns, scepticism around the effectiveness of ‘conventional’ treatments, and traditional healer solidarity were identified. Mutual respect and bi-directional conversations surfaced as the key ingredients for successful partnerships. Collaboration is not as easy as commonly assumed, given paradigmatic disjunctures and widespread scepticism between different treatment modalities. Promoting greater understanding, rather than maintaining indifferent distances may lead to more successful co-operation in future.     

A longitudinal study of the use of mental health services by persons with serious mental illness: do Spanish-speaking Latinos differ from English-speaking Latinos and Caucasians?

OBJECTIVE: Reports of mental health care use by Latinos compared to Caucasians have been mixed. To the authors' knowledge, no large-scale studies have examined the effects of language on mental health service use for Latinos who prefer Spanish compared to Latinos who prefer English and to Caucasians. Language is the most frequently used proxy measure of acculturation. The authors used the administrative database of a mental health system to conduct a longitudinal examination of mental health service use among Spanish-speaking versus English-speaking Latinos and Caucasians with serious mental illness. METHOD: There were 539 Spanish-speaking Latinos, 1,144 English-speaking Latinos, and 4,638 Caucasians initiating treatment for schizophrenia, bipolar disorder, or major depression during 2001-2004. Using multivariate regressions, the authors examined the differences among the groups in the type of service first used. The authors also examined the probability of use of each of four types of mental health services and the intensity of outpatient treatment. RESULTS: Spanish-speaking Latinos differed from both English-speaking Latinos and Caucasians on most measures. Compared to patients in the other groups, the Spanish-speaking Latinos were less likely to enter care through emergency or jail services and more likely to enter care through outpatient services. There were no group differences in the proportion that stayed in treatment or used inpatient hospitalization. CONCLUSIONS: This study suggests that for Latinos, preferred language may be more important than ethnicity in mental health service use. Future studies comparing mental health use may need to differentiate between Spanish- and English-speaking Latinos.     

Who uses mental health services in Australia? An analysis of data from the National Survey of Mental Health and Wellbeing

OBJECTIVE: This study sought to identify sociodemographic and psychological measures associated with utilisation of mental health services in Australia, using information collected through the 1997 National Survey of Mental Health and Wellbeing. METHOD: Twenty-one potential predictor variables were selected from the National Survey. Predisposing and enabling factors included age, sex, marital status, labour force status, geographical location and level of education. Predictor variables measuring need for services included the General Health Questionnaire score, a neuroticism scale, diagnoses of affective, anxiety and substance-abuse disorders from the Composite International Diagnostic Interview, and self-identified depression, anxiety and substance abuse. Simple and multiple logistic regressions were undertaken to identify predictor variables associated with use of mental health services from general practitioners, psychiatrists, psychologists and other health professionals. RESULTS: General practitioners were the most commonly reported providers of mental health services with 76% of those receiving any mental health care reporting using this type of service. Using multiple logistic regression, the predictor variables most associated with use of mental health services were measures of the need for such services, such as psychological distress and mental disorder. After controlling for need variables, the sociodemographic variables associated with using services provided by any health professional were being female, level of education and being separated. Living in a remote area was associated with lower use of specialist services, but not with general practitioner services. Older age was associated with less use of psychologists and other health professionals. Income and having a usual language other than English did not affect service use. CONCLUSIONS: The factors most strongly related to Australians' use of mental health services are their having a diagnosed affective, anxiety or substance-abuse disorder and their self-identifying as having depression or anxiety. Although there are regional inequalities in levels of utilisation of mental health services, these are seen more with specialist services than with those provided by general practitioners.     

Religiosity and decreased risk of substance use disorders: is the effect mediated by social support or mental health status?

Objective  

The negative association between religiosity (religious beliefs and church attendance) and the likelihood of substance use disorders is well established, but the mechanism(s) remain poorly understood. We investigated whether this association was mediated by social support or mental health status.     

Older patients’ in Sweden and their experience of the emotional support received from the registered nurse – a grounded theory study

Objectives: This study intends to explore older patients’ experiences of the emotional support received from registered nurses (RNs). We also aimed to gain deeper knowledge about the process of how getting the support they need is managed by the patient.

Methods: The study was conducted using the grounded theory method. Data were collected by interviewing 18 patients between 80 and 96 years old.

Results: Reasons why older patients experienced the emotional support received from the RN are reflected in the categories ‘Meets my needs when I am irresolute’, ‘Meets my needs when I am vulnerable’ and ‘Meets my needs when I am in need of sympathy’. Reasons to the emotional support resulted in that patients experienced ‘A sense of being able to hand over’, which is therefore the core category of this study.

Conclusion: Older patients’ experiences of emotional support are about obtaining relief. Patients were active participants and had strategies for which they wanted to share their emotions with the RN. In order to develop participatory care for older patients, we need more knowledge about how emotional support can be used as a nursing intervention.     

The confounding of race and geography: how much of the excess stroke mortality among African Americans is explained by geography?

INTRODUCTION: The excess stroke mortality among African Americans and Southerners is well known. Because a higher proportion of the population living in the 'Stroke Belt' is African American, then a portion of the estimated excess risk of stroke death traditionally associated with African-American race may be attributable to geography (i.e., race and geography are 'confounded'). In this paper we estimate the proportion of the excess stroke mortality among African Americans that is attributable to geography. METHODS: The numbers of stroke deaths at the county level are available from the vital statistics system of the US. A total of 1,143 counties with a population of at least 500 whites and 500 African Americans were selected for these analyses. The black-to-white stroke mortality ratio was estimated with and without adjustment for county of residence for those aged 45-64 and for those aged 65 and over. The difference in the stroke mortality ratio before versus after adjustment for county provides an estimate of the proportion of the excess stroke mortality inappropriately attributed to race (that is in fact attributable to geographic region). RESULTS: For ages 45-64, the black-to-white stroke mortality ratio was reduced from 3.41 to 3.04 for men, and from 2.82 to 2.60 for women, suggesting that between 10 and 15% of the excess mortality traditionally attributed to race is rather due to geography. Over the age of 65, the black-to-white stroke mortality ratio was reduced from 1.31 to 1.27 for men, and from 1.097 to 1.095 for women, suggesting that between 2 and 13% of the excess mortality attributed to black race is actually attributable to geography. The reductions of all the four age strata gender groups were highly significant. DISCUSSION: These results suggest that a significant, although relatively small, proportion of the excess mortality traditionally attributed to race is rather a factor of geography.     

The role of APOE-?4 and beta amyloid in the differential rate of recovery from ECT: a review

Individual biological differences may contribute to the variability of outcomes, including cognitive effects, observed following electroconvulsive treatment (ECT). A narrative review of the research literature on carriage of the apolipoprotein E ɛ4 allele (APOE-ɛ4) and the protein biomarker beta amyloid (Aβ) with ECT cognitive outcome was undertaken. ECT induces repeated brain seizures and there is debate as to whether this causes brain injury and long-term cognitive disruption. The majority of ECT is administered to the elderly (over age 65 years) with drug-resistant depression. Depression in the elderly may be a symptom of the prodromal stage of Alzheimer''s disease (AD). Carriage of the APOE-ɛ4 allele and raised cerebral Aβ are consistently implicated in AD, but inconsistently implicated in brain injury (and related syndromes) recovery rates. A paucity of brain-related recovery, genetic and biomarker research in ECT responses in the elderly was found: three studies have examined the effect of APOE-ɛ4 allele carriage on cognition in the depressed elderly receiving ECT, and two have examined Aβ changes after ECT, with contradictory findings. Cognitive changes in all studies of ECT effects were measured by a variety of psychological tests, making comparisons of such changes between studies problematic. Further, psychological test data-validity measures were not routinely administered, counter to current testing recommendations. The methodological issues of the currently available literature as well as the need for well-designed, hypothesis driven, longitudinal studies are discussed.     

The associations between self-reported sleep duration and adolescent health outcomes: What is the role of time spent on Internet use?

ObjectiveThis study aimed to examine the associations of self-reported sleep duration with adolescent health outcomes, taking into account time spent on Internet use.MethodsWe used data from the 2008–2009 Korea Youth Behavioral Risk Factor Survey, a cross-sectional online survey of middle and high school students aged 13–18 years in South Korea (N = 136,589) to examine the associations of self-reported sleep duration with four mental and physical health measures, e.g. self-report of depressive symptoms, suicidal ideation, weight status, and self-rated health. The binary logit and generalized ordered logit models controlled for time spent on Internet use for non-study purposes and other factors.ResultsShorter self-reported sleep duration was associated with a higher likelihood of reporting depressive symptoms, suicidal ideation, and overweight or obese status, and a lower likelihood of reporting better self-rated health, even after accounting for time spent on Internet use. Excessive Internet use was found to be an independent risk factor for these outcomes.ConclusionsAmong in-school adolescents in South Korea, shorter sleep duration and excessive Internet use are independently and additively associated with multiple indicators of adverse health status. Excessive Internet use may have not only direct adverse health consequences, but also have indirect negative effects through sleep deprivation.