Co-morbid drug and alcohol and mental health issues in a rural New South Wales Area Health Service

Objective: In 2003 the New South Wales (NSW) Centre for Rural and Remote Mental Health (CRRMH) conducted an analysis of co‐morbid drug and alcohol (D&A) and mental health issues for service providers and consumers in a rural NSW Area Health Service. This paper will discuss concerns raised by rural service providers and consumers regarding the care of people with co‐morbid D&A and mental health disorders. Design: Current literature on co‐morbidity was reviewed, and local area clinical data were examined to estimate the prevalence of D&A disorders within the mental health service. Focus groups were held with service providers and consumer support groups regarding strengths and gaps in service provision. Setting: A rural Area Health Service in NSW. Participants: Rural health and welfare service providers, consumers with co‐morbid D&A and mental health disorders. Results: Data for the rural area showed that 43% of inpatient and 20% of ambulatory mental health admissions had problem drinking or drug‐taking. Information gathered from the focus groups indicated a reasonable level of awareness of co‐morbidity, and change underway to better meet client needs; however, the results indicated a lack of formalised care coordination, unclear treatment pathways, and a lack of specialist care and resources. Discussion: Significant gaps in the provision of appropriate care for people with co‐morbid D&A and mental health disorders were identified. Allocation of service responsibly for these clients was unclear. It is recommended that D&A, mental health and primary care services collaborate to address the needs of clients so that a coordinated and systematic approach to co‐morbid care can be provided.     

Causes of death of adults and elderly and healthcare-seeking before death in rural Bangladesh

The health system of a country needs to be adjusted to patterns of morbidity and mortality to mitigate the income-erosion consequences of prolonged ill-health and premature death of adults. Population-based data on mortality by cause are a key to modifying the health system. However, these data are scarce, particularly for rural populations in developing countries. The objectives of this study were to determine the burdens of health due to major causes of death obtained from verbal autopsy of adults and the elderly and their healthcare-seeking patterns before death in a well-defined rural population. There were 2,397 deaths--613 were among adults aged 15-59 years and 1,784 among the elderly aged 60+ years--during 2003-2004 in the health and demographic surveillance area in Matlab, a rural area of Bangladesh. Trained interviewers interviewed close relatives of the deceased using a structured verbal-autopsy questionnaire to record signs and symptoms of diseases/conditions that led to death and medical consultations before death. Two physicians independently assigned the underlying causes of deaths with disagreements resolved by a third physician. The physicians were able to assign a specific cause in 91% of the cases. Rates and proportions were used for estimating the burden of diseases by cause. Of all deaths of adults and the elderly, communicable diseases accounted for 18% and non-communicable diseases for 66%, with the proportion of non-communicable diseases increasing with age. Leading non-communicable diseases were diseases of the circulatory system (35%), neoplasms (11%), diseases of the respiratory system (10%), diseases of the digestive system (6%), and endocrine and metabolic disorders (6%), all of which accounted for 68% of deaths. Injury and other external causes accounted for another 5% of the deaths. During terminal illness, 31% of the adults and 25% of the elderly sought treatment from medical doctors, and 14% of the adults and 4% of the elderly died in healthcare facilities. The findings suggest that the health managers and policy-makers of Bangladesh should recognize the importance of prevention and management of chronic diseases and place it on the health agenda for rural people.     

Prevalence of mental disorders in an urban area in Brazil

OBJECTIVE: To detect the prevalence of mental disorders among the elderly residents of an urban area. METHODS: A sample of 327 elderly residents (60 years and older) of the city of Montes Claros, in northern Minas Gerais, was selected by means of probabilistic sampling, in multiple strata, within a homogeneous stratum. The sample unit was the home. Mental disorders were determined by means of the Short Psychiatric Evaluation Schedule (SPES). Univariate analysis was done via the chi-squared test and multivariate analysis via logistical regression. RESULTS: The estimated prevalence of mental disorders was 29.3%. Their presence was associated with female sex, number of illnesses, functional capacity and place of residence (shantytown/non-shantytown). CONCLUSIONS: Comparing the results with other community studies, the prevalence of mental disorders among the elderly in the urban area of Montes Claros was high and was associated with multiple illnesses, incapacity and poverty. This reality is a matter for concern because of its impact on quality of life relating to this population's health, and on healthcare services over the next few decades.     

Low birth weight in offspring of women with depressive and anxiety symptoms during pregnancy: results from a population based study in Bangladesh

Background  

There is a high prevalence of antepartum depression and low birth weight (LBW) in Bangladesh. In high- and low-income countries, prior evidence linking maternal depressive and anxiety symptoms with infant LBW is conflicting. There is no research on the association between maternal mental disorders and LBW in Bangladesh. This study aims to investigate the independent effect of maternal antepartum depressive and anxiety symptoms on infant LBW among women in a rural district of Bangladesh.     

绍兴市1991年与2001年精神疾病患病率调查

目的　了解 1 991年与 2 0 0 1年绍兴市人群中精神疾病的患病率及社区精神卫生服务状况。方法　采用线索调查与逐户调查相结合 ,对市区、农村共 339651人口进行调查 ,并与 1 991年的相关资料进行对照。结果　 1 991年与 2 0 0 1年精神疾病终生患病率分别为 1 0 .1 7‰和 1 3 .85‰ ,时点患病率分别为 9.51‰和 1 2 .77‰ ,≥ 1 5岁人口的时点患病率为 1 1 .70‰和 1 4 .60‰ ,神经症、酒依赖、药物依赖的患病率上升明显 (χ2 分别为 1 2 5 .72、1 0 1 .0 7、8.97,P <0 .0 1 )。各类疾病中神经症、精神分裂症、精神发育迟滞居前三位。城市精神疾病患者的劳动能力、经济状况、就医条件、监护情况均好于农村。结论　绍兴市 1 0年间精神疾病患病率呈上升趋势 ,与经济、社会、文化发展相关的精神疾病患病率升高明显。城、乡精神卫生社区服务发展不平衡 ,农村精神疾病防治工作应予加强     

Prevalence of common mental disorders in a population covered by the Family Health Program (QUALIS) in São Paulo, Brazil

The prevalence of common mental disorders has increased in many countries. Cases are often not identified and adequately treated because traditional health care services are rarely prepared to deal with this problem. The Family Health Program (FHP) has been implemented in Brazil since 1995-1996 and provides a new primary health care model with the potential for better care for these patients. This study investigates common mental disorders prevalence according to FHP coverage and associated socio-demographic factors. A large health and health care survey was conducted from January to March 2001 in areas partly covered by the FHP in a peripheral area of the city of Sao Paulo and included common mental disorders screening in 2,337 individuals > 15 years of age. There was no significant difference in common mental disorders prevalence according to FHP. Common mental disorders prevalence was significantly higher among females (PR = 1.34), elderly (PR = 1.56), and individuals with lower income (PR = 2.64) or less schooling (PR = 2.83). Common mental disorders was associated with indicators of social disadvantage, implying the need to focus on specific health problems and risk groups to improve the impact of care.     

Are 'Village Doctors' in Bangladesh a curse or a blessing?

Background  

Bangladesh is one of the health workforce crisis countries in the world. In the face of an acute shortage of trained professionals, ensuring healthcare for a population of 150 million remains a major challenge for the nation. To understand the issues related to shortage of health workforce and healthcare provision, this paper investigates the role of various healthcare providers in provision of health services in Chakaria, a remote rural area in Bangladesh.     

Profile of home nursing clients with mental health diagnoses: Epidemiological analysis of Australian community home nursing data

Mental health is an important part of overall health status and mental ill health is common within the community. There is, however, little information relating to the mental health status of those in the community accessing services such as home nursing. The aim of this study is to profile mental health diagnoses and service use of persons accessing a community home nursing service. Retrospective data analysis was conducted of routinely collected administrative data from a service providing community home nursing in metropolitan Melbourne, Australia in 2014. Mental health diagnoses extracted from care records were International Classification of Disease code of 291–299 (Version‐9) or F10‐F99 (Version‐10). Past‐year prevalence for mental health diagnoses was 17%; lower than overall Australian prevalence (20%) and prevalence displayed in healthcare settings (25%–36%). The most prevalent class were mood [affective] disorders (7.8%), followed by neurotic, stress‐related and somatoform disorders (4.8%). Schizophrenia, schizotypal and delusional disorders prevalence (2.5%) were more than twice that in the population (0.3%–1.0%). Those with a mental health diagnosis received between 40%‐80% more visits than those without. These data demonstrate that the profile of mental health disorders in this population is complex, and that those with a mental health diagnosis experience higher care burden than those without. These findings will inform service planning and provision into the future.     

Primary care treatment for child and adolescent neuropsychiatric conditions in remote rural Punjab, Pakistan - a cross-sectional survey

Background Pakistan is one of the most populous regions of the world. Previous work has demonstrated that there is reliance on traditional healthcare systems when seeking psychiatric care; however, there is a lack of information on help seeking for child and adolescent population. The aim of this study was to describe types of treatments and families’ perceptions of the effectiveness of those treatments for childhood neuropsychiatric disorders in remote rural Punjab. Method Cross‐sectional survey of consecutive attendees at an advertised mental health consultation day in a remote rural area. Results The effectiveness of these treatments, as rated by patients and their families, was variable, with highest reported effectiveness for general practitioner treatments. In families with a past history of care from a general practitioner, those who had epilepsy reported treatments to be more effective than those with mental retardation. Carers and users described consulting five different types of primary healthcare practitioners that used both physical and psychotherapeutic treatments. Conclusions There is considerable variation in treatments available for child and adolescent neuropsychiatric disorders in remote rural areas of Punjab, a large proportion of which are considered ineffective by the users and carers. This highlights the need to develop effective interventions for child and adolescent neuropsychiatric conditions that can be administered by primary health workers. Our data suggest that the need for this is greatest for mental retardation.     

Association between smoking and mental disorders: Results from an Australian National Prevalence Survey

OBJECTIVE: To assess the prevalence of mental disorders according to smoking status. METHOD: Data were taken from the National Survey of Mental Health and Wellbeing of Adults which was conducted by the Australian Bureau of Statistics in 1997. This survey involved a household sample of 10,641 adults aged 18+. The Composite International Diagnostic Interview was used to assess affective, anxiety and substance use disorders over the previous 12 months. RESULTS: Smoking was found to be strongly associated with all categories of mental disorders, but the association varied by age. In people aged 18-39, current smokers had the highest prevalence of mental disorders, never smokers the lowest, and former smokers were in between. In the 40-59 age group, the results were similar, except that former smokers were more similar to never smokers. However, in the 60+ age group, smoking status was not associated with affective or anxiety disorders, and it was associated with substance use disorders only in males. CONCLUSIONS: The study confirmed that there is a strong relationship between mental disorders and smoking. However, the effect is age specific, being much stronger in younger adults than in the elderly. This age group effect could be due to a cohort difference in motivation for taking up smoking. IMPLICATIONS: Public health efforts to reduce the prevalence of smoking need to take account of the strong relationship between smoking and mental disorders.     

The prevalence of common mental disorders in urban slums with displaced persons in Colombia]

OBJECTIVES: To investigate the prevalence of common mental disorders in groups with a high percentage of families who have been displaced by armed conflict and political instability and are living in urban slum areas on the outskirts of Sincelejo, a city in the department of Sucre, Colombia. METHODS: A cross-sectional study was conducted, with two-stage random cluster sampling, in slum neighborhoods of Sincelejo that contain a high percentage of displaced persons. A household survey of persons 18 years old or older was used to determine the presence of common mental disorders-psychosomatic disorders, anxiety, and depression-in the population studied. A score of 7 or more on the first 20 questions of the Self-Reporting Questionnaire (SRQ) of the World Health Organization was used to determine the presence of a common mental disorder. We searched for associations among the studied variables (age group, gender, type of health care card, and length of residence in the neighborhood) and among those variables and the score on the SRQ. The chi-square test was used, with statistical significance set at 0.05. Logistic regression was carried out with all the related variables. RESULTS: The prevalence of common mental disorders in the adult population of the neighborhoods studied was 27.2% (95% confidence interval (95% CI)=24.0% to 30.0%); 13.6% (95% CI=11.4% to 16.1%) of the population surveyed had problems with excessive alcohol consumption. There was an association between the prevalence of common mental disorders and the type of health care card used (odds ratio=1.66 for persons using the health care card for displaced persons versus persons using other types of health care cards). In addition, there was an association between the prevalence of common mental disorders and gender (OR=1.78 for women); this association remained after adjusting for other explanatory variables. CONCLUSIONS: Using the study criteria (type of health care card and length of time living in the slum area), it was difficult to separate the displaced persons from other persons living in the same slum areas, and thus to measure the prevalence of common mental disorders among just the displaced persons. The prevalence of common mental disorders in the urban population studied showed a statistical association with the type of health care card, which in turn determined the level of access to public health services. This association between the type of health care card held and the prevalence of common mental disorders is strong enough to justify providing mental health care services to persons who have the health care card for displaced persons.     

Utilisation of postnatal care in Bangladesh: evidence from a longitudinal study

Utilisation of health services is a complex behavioural phenomenon. Empirical studies of preventive and curative services in Bangladesh have often showed that the use of health services is related to the availability, quality and cost of services, as well as to social structure, health beliefs and personal characteristics of the users. The present paper attempts to examine factors associated with the utilisation of healthcare services during the postnatal period in Bangladesh by using prospective data from a survey on maternal morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERT). Both bivariate and multivariate analyses of the data confirmed that the mother's age at marriage had a significant and positive impact on the utilisation of quality healthcare services. The husband's occupation also showed a strong impact on healthcare utilisation, indicating higher use of quality care for postpartum morbidity by wives of business and service workers. The bivariate analysis showed that the number of pregnancies prior to the index pregnancy and desired pregnancies are significantly associated with the utilisation of postpartum healthcare. However, the results of this study were inconclusive on the influence of other predisposing and enabling factors, such as maternal education, the number of previous pregnancies, the occupation of the husband, antenatal care visits during pregnancy and access to health facilities. Multivariate logistic regression estimates did not show any significant impact of these factors on the use of maternal healthcare.     

Implications of health care provision on acute lower respiratory infection mortality in Bangladeshi children

This study uses a geographic information system to evaluate the effects of health care provision on acute lower respiratory infection (ALRI) mortality in very young children in rural Bangladesh. Since 1988, an ALRI control program has been operating in a rural area of Bangladesh in an effort to decrease morbidity and mortality of children suffering from ALRI. ALRI-specific mortality data for very young children (<2 years of age) were obtained from a surveillance system of the area from 1988 to 1993. The ALRI mortality data were aggregated by clusters of households called baris. In order to avoid bias in the population size of haris, spatial moving averages of ALRI-specific death rates were calculated. The relationships between ALRI death rates and several environmental and health service provision variables were measured using regression analysis. The results show that the ALRI mortality rate was 54% lower in the community-based ALRI control program area than in a comparison area where there was no intervention. Greater access to allopathic practitioners was related to lower ALRI mortality rates while access to indigenous practitioners was related to higher mortality. In conclusion, the benefit of the community-based ALRI control program, using a simple case management strategy and improved access to allopathic practitioners, should be replicated in other rural areas of Bangladesh in an effort to reduce child ALRI mortality.     

Prolonged breastfeeding in Bangladesh: indicators of inadequate feeding practices or mothers'' response to children''s poor health?

The association between breastfeeding and diarrhoeal morbidity was examined in a prevalence study of 5502 children aged 6-71 months from rural and urban Bangladesh. Breastfeeding was found to be associated with reduced prevalence of diarrhoea. This association was most pronounced at the age of six months and declined linearly to zero at approximately 30 months of age; thereafter, breastfeeding was increasingly associated with diarrhoeal illness. The linear association was found only among those children who have no access to modern health services and information, when controlling for urban and rural differences. The literature provides two opposing explanations for the positive association of prolonged breastfeeding with diarrhoeal illness. The first explanation suggests that breastfeeding can be seen as mothers' response to children's poor health. The second explanation incriminates sub-optimal child feeding practices, characterised by prolonged breastfeeding and inadequate quality and quantity of complementary foods, as the cause of malnutrition and diarrhoea. Further studies are needed to identify which explanation is correct, given the public health implications in terms of children's survival, growth and development.     

Prevalence of psychological distress, anxiety and depression in rural communities in Australia

OBJECTIVE: To describe the prevalence of psychological distress, depression and anxiety in three Australian rural settings and to identify the levels of risk by gender and age. DESIGN AND SETTING: Three cross-sectional surveys in the Greater Green Triangle area covering the south-east of South Australia (Limestone Coast), and south-west (Corangamite Shire) and north-west (Wimmera) of Victoria. PARTICIPANTS: A total of 1563 people, aged 25-74 years, randomly selected from the electoral roll. MAIN OUTCOME MEASURES: Psychological distress assessed by the Kessler 10, and anxiety and depression assessed by the Hospital Anxiety and Depression Scale. RESULTS: The prevalence of psychological distress was 31% for both men and women with two-thirds reporting moderate and one-third high levels of psychological distress. The prevalence of depression and anxiety was approximately 10%. The highest rate of psychological distress, anxiety and depression occurred in the 45-54 years age group. There were no consistent gender or area differences in the prevalence of psychological distress, depression or anxiety. CONCLUSIONS: A third of the rural population reported psychological distress, with the highest prevalence observed in middle-aged men and women. Thus, health professionals should attend not only to physical health, but also to mental health status in this age group. It is also important to target prevention strategies at the 20% who reported moderate levels of psychological distress in order to prevent the development of more serious conditions.     

Nurses’ perceptions of mental healthcare in primary-care settings in Kenya

Kenya maintains an extraordinary treatment gap for mental health services because the need for and availability of mental health services are extraordinarily misaligned. One way to narrow the treatment gap is task-sharing, where specialists rationally distribute tasks across the health system, with many responsibilities falling upon frontline health workers, including nurses. Yet, little is known about how nurses perceive task-sharing mental health services. This article investigates nurses’ perceptions of mental healthcare delivery within primary-care settings in Kenya. We conducted a cross-sectional study of 60 nurses from a public urban (n?=?20), private urban (n?=?20), and public rural (n?=?20) hospitals. Nurses participated in a one-hour interview about their perceptions of mental healthcare delivery. Nurses viewed mental health services as a priority and believed integrating it into a basic package of primary care would protect it from competing health priorities, financial barriers, stigma, and social problems. Many nurses believed that integrating mental healthcare into primary care was acceptable and feasible, but low levels of knowledge of healthcare providers, especially in rural areas, and few specialists, would be barriers. These data underscore the need for task-sharing mental health services into existing primary healthcare in Kenya.     

The use of outpatient mental health services in the United States and Ontario: the impact of mental morbidity and perceived need for care.

OBJECTIVES: This study compared the associations of individual mental health disorders, self-rated mental health, disability, and perceived need for care with the use of outpatient mental health services in the United States and the Canadian province of Ontario. METHODS: A cross-sectional study design was employed. Data came from the 1990 US National Comorbidity Survey and the 1990 Mental Health Supplement to the Ontario Health Survey. RESULTS: The odds of receiving any medical or psychiatric specialty services were as follows: for persons with any affective disorder, 3.1 in the United States vs 11.0 in Ontario; for persons with fair or poor self-rated mental health, 2.7 in the United States vs 5.0 in Ontario; for persons with mental health-related disability. 3.0 in the United States vs 1.5 in Ontario. When perceived need was controlled for, most of the between country differences in use disappeared. CONCLUSIONS: The higher use of mental health services in the United States than in Ontario is mostly explained by the combination of a higher prevalence of mental morbidity and a higher prevalence of perceived need for care among persons with low mental morbidity in the United States.     

Employee psychological distress and treated prevalence by indices of rurality

Objective: Although there is population data on the prevalence and treated prevalence of mental disorders by urban‐rural indices, there is a lacuna of information pertaining to employees. This paper examines the prevalence and treated prevalence of psychological distress in employees by urban‐rural indicators. Methods: Cross‐sectional employee Health and Performance at Work Questionnaire responses (n=78,726 from 58 large companies) are interrogated by indices of remoteness (Accessibility/Remoteness Index of Australia), psychological distress (Kessler 6) and treatment‐seeking behaviours for mental health problems. Results: The overall prevalence of moderate or high psychological distress in employees was 35.2%. The prevalence varied only slightly (maximum to minimum difference of 4.6%) by rural/remote indices. Overall treatment‐seeking behaviour for psychological distress was low (22.5%). The percentage of employees seeking treatment for high levels of psychological distress was the lowest in very remote regions (15.1%). Conclusion: Very remote employees are less likely to access mental health treatments and may be an employee subgroup that would benefit from specific employer health interventions aimed to increase treatment‐seeking behaviours. Implications: Employees in very remote Australia could benefit from specific interventions aimed to increase mental health awareness/literacy.     

广东地区围绝经期综合征患病状况及其影响因素

目的 :了解广东地区围绝经期综合征的患病情况及其影响因素。方法 :采用统一的调查问卷 ,对广东省 9个地区的 44 89例 4 0～ 6 5岁围绝经期妇女进行调查。结果 :在 4 4 89例被调查者中 ,出现围绝经期综合征者 30 5 7例 ,发生率为 6 8.1% ,其中以心理症状、躯体症状为主 ,分别为 85 .9%、86 .0 % ,最为痛苦的是失眠 ,肌肉、骨关节疼痛 ,烦躁 ,头晕。性欲下降情况农村高于城市 ,而心理症状、血管舒缩症状、泌尿生殖系统症状城市高于农村。躯体症状、性欲下降情况随着年龄的增加患病率相应增加 ,5 1～ 6 0岁为患病高峰。心理症状、躯体症状、性欲下降情况、泌尿生殖系统症状随着月经的改变而逐渐升高。未怀孕者的心理症状、躯体症状、血管舒缩症状、性欲下降均高于曾怀孕者 ,泌尿生殖道症状在足月妊娠、人工流产、早产者的患病机率高。患病与年龄、职业、婚姻状况、文化程度、家庭人口、经济收入、孕产次、月经、是否服用激素等密切相关。出现围绝经期综合征后就医者仅占 2 8.8% ,农村高于城市 ,分别为 31.5 % ,2 6 .6 %。结论 :应加强围绝经期妇女的保健工作 ,尤其是心理保健 ,以减少躯体疾病的发生 ,缓解围绝经期症状 ,提高生活质量。     

Unravelling the extent of inequalities in health across urban and rural areas: Evidence from a national sample in England

Studies of inequalities in health between rural and urban settings have produced mixed and sometimes conflicting results, depending on the national setting of the study, the level of geographic detail used to define rural areas and the health indicators studied. By focusing on morbidity data from a national sample of individuals, this study aims to examine the extent of inequalities in health between urban and rural areas, as well as inequalities in health across rural areas of England. Multilevel analyses for poor self-rated health, overweight and obesity, and common mental disorders are reported for a sample of 30,776 individuals aged 18 years and older (obtained from the Health Survey for England years 2000–2003 combined) and distributed across 3645 small areas classed in four categories: two groups of urban areas (Greater London area or ‘other cities’) and two types of rural settings (semi-rural areas or villages). Results show that rural dwellers were significantly less likely than residents of urban areas to report their health as being fair or poor and to report common mental disorders, independent of their socio-demographic characteristics. However, as for urban settlements, there were significant variations in health across semi-rural areas and across villages, indicating the presence of health inequalities within rural settings in England. These inequalities were not fully explained by the individual composition of the areas or by the available measures of area socioeconomic conditions, indicating that in rural contexts more specific factors may have significance for health. Different policies and services for health promotion and care may need to be targeted to different types of rural areas.