Developing mental health indicators in England

OBJECTIVES: This paper reports on the construction of a set of indicators for mental health and the publication of a report for England's Chief Medical Officer. The report was the seventh in a series of reports aimed at initiating public health action to improve health at a regional level in England. STUDY DESIGN: Observational study using routine data. METHODS: A set of over 80 indicators was constructed by an expert group. These indicators were then populated from routine datasets. Commentary was provided on each indicator in the report. RESULTS: A small team compiled this large set of indicators from routine data working in a public health observatory in one region of England. CONCLUSIONS: It is possible to produce a large array of indicators about mental health. The conclusion from examining these indicators is that there are many unexplained differences in mental health across the regions of England. Many of these indicators are closely linked to deprivation. Some indicators show a lack of difference across the country, and in many instances, service provision is inconsistent and does not always relate to need. In some cases, there was a worrying absence of data, e.g. data on ethnicity and the mental health of offenders.     

Theoretical accounts on deinstitutionalization and the reform of mental health services: a critical review

This article offers a comprehensive critical review of the most popular theoretical accounts on the recent processes of deinstitutionalization and reform of mental health services and their possible underlying factors, focusing in the sharp contrast between the straightforward ideas and models maintained by mainstream psychiatry and the different interpretations delivered by authors coming from the social sciences or applying conceptual tools stemming from diverse social theories. Since all these appraisals tend to illuminate only some aspects of the process while obscuring others, or do not fit at all with some important points of the actual changes, it is concluded that the quest for an adequate explanation is far from having been completed. Finally, some methodological and conceptual strategies for a renewed theoretical understanding of these significant transformations are also briefly discussed, including a comprehensive empirical evaluation of the facts, the consideration of the shifting social values and needs involved in mental health care provision and the historical analysis of deinstitutionalization policies within the framework of the broader social and cultural trends of the decades following World War II.     

The effect of food insecurity on mental health: panel evidence from rural Zambia

A growing number of studies show support for a positive association between food insecurity and poor mental health in developing countries. Few of these studies, however, explore the relationship statistically employing longitudinal data. This study combines ethnography with randomly sampled household-level panel data (two waves) collected in 2009 to examine the association between food insecurity and mental health in rural Zambia. Mental health was measured using the Self-Reporting Questionnaire and food insecurity was assessed utilizing a modified 7-item scale based on local coping strategies used during food shortages. A multilevel linear regression model was employed with repeated measures nested within individuals (N = 280 observations) living in 81 households nested within 16 villages. Regression results confirm the postulated positive association between poor mental health and food insecurity. Food insecurity during the dry season, the time of year in rural Zambia when many households are typically food secure, had a subsequent greater effect on mental health than food insecurity during the rainy season. The difference in the effect was statistically significant at the five-percent level. In a country where mental health care resources are severely lacking, policy and applied efforts aimed at improving access to key agricultural resources, thereby increasing agricultural output, could potentially produce beneficial mental health outcomes.     

Migration and mental health: Evidence from a natural experiment

People migrate to improve their well-being. Yet a large literature suggests that migration can be a stressful process, with potentially negative impacts on mental health. However, to truly understand the effect of migration one must compare the mental health of migrants to what their mental health would be had they stayed in their home country. The existing literature is not able to do this. New Zealand allows a quota of Tongans to immigrate each year with a random ballot used to choose amongst the excess number of applicants. Experimental estimates of the mental health effects of migration are obtained by comparing the mental health of migrants who were successful applicants in the random ballot to the mental health of those who applied to migrate under the quota, but whose names were not drawn. Migration is found to lead to improvements in mental health, particularly for women and those with poor mental health.     

Beyond symptoms: defining primary care mental health clinical assessment priorities, content and process

The assessment of undifferentiated psychological distress is a daily aspect of primary care practice. Primary care practitioners' underlying values influence the priorities, process and content of assessment. Currently there is a lack of definition of these values in primary care clinical mental health assessment. This paper presents the case for adopting the philosophical values and principles of holistic transdisciplinary generalism to influence practice worldwide. Furthermore, it raises awareness of current constraints on practice, including an overreliance on the psychiatric paradigm of care and resulting criteria-based diagnoses. Finally, the paper seeks to promote discussion among primary care practitioners and researchers globally about how to define primary care clinical mental health assessment priorities, process and content.     

婴儿期不同养育方式对青少年期心理健康的影响

目的探讨婴儿期养育方式对青少年期综合心理健康状况及其相关方面的影响。方法采用一般情况问卷(自拟)、青少年自评量表(YSR)、青少年生活事件自评量表(ASLEC)对66名婴儿期采用隔代养育的青少年(研究组)和67名婴儿期采用亲子养育的青少年(对照组)进行测评。结果多元方差分析显示,两种养育方式的青少年综合心理健康无差异,(Wilks’λ=0.881,F=1.85,P=0.0660.05);控制了婴儿期主要养育人受教育年限和生活事件混杂因素影响后进行多元协方差分析,结果显示亲子养育青少年社交方面优于隔代养育青少年(2.54±0.24vs3.44±0.25,F=6.38,P=0.0130.05)。结论养育方式对青少年综合心理健康的远期影响有限,应当加强隔代养育儿童社交方面的培养。     

AIDS treatment and mental health: Evidence from Uganda

Increased access to antiretroviral therapy (ART) in developing countries over the last decade is believed to have contributed to reductions in HIV transmission and improvements in life expectancy. While numerous studies document the effects of ART on physical health and functioning, comparatively less attention has been paid to the effects of ART on mental health outcomes. In this paper we study the impact of ART on depression in a cohort of patients in Uganda entering HIV care. We find that 12 months after beginning ART, the prevalence of major and minor depression in the treatment group had fallen by approximately 15 and 27 percentage points respectively relative to a comparison group of patients in HIV care but not receiving ART. We also find some evidence that ART helps to close the well-known gender gap in depression between men and women.     

Mental health system reform in Moldova: Description of the program and reflections on its implementation between 2014 and 2019

In 2014, the Republic of Moldova started a systematic process of reforming its mental health system, implementing priority actions set out in the National Mental Health Programme. The reform entailed a service delivery re-design, instituting mechanisms for collaboration across health and social sectors, and revision of the policy framework. Outcomes of the first 4 years of the reform included: 1) the establishment of a network of mental health services in 4 pilot districts embedding mental health diagnosis, treatment and referral in primary and specialized mental healthcare; 2) creation of an enabling policy environment at the national and district level; and 3) strengthened community support and acceptance of mental health issues. Objectives of the first Phase were achieved and the reform is now in its second Phase (2018–2022). The implementation strategy in Phase 1 focused efforts on 4 pilot districts, whereas Phase 2 harnesses lessons learned from Phase 1 and facilitates local leaders and actors to scale-up the model to all 32 districts and municipalities in Moldova. Ownership over the reform process shifted from project-led in Phase 1 to national and local government-led in Phase 2. We reflect on the process and contents of the mental health reform, discuss lessons learned and implementation challenges encountered. We conclude with learning points for policymakers and researchers considering mental health reform in other countries.     

Homeless and runaway youth mental health issues: No access to the system

Data from a center for homeless and runaway youth are presented in order to summarize the major mental health problems faced by these youth. This article also identifies indicators related to behavioral and environmental variables that may help in the development of intervention and prevention strategies for this population.     

基于德尔菲法的乡镇卫生院精神卫生服务绩效评价指标体系研究

目的 构建乡镇卫生院精神卫生服务绩效评价指标体系,为乡镇卫生院精神卫生服务绩效评估提供客观参考。方法 结合我国和广西相关政策,通过文献分析法及专家访谈法,初步构建评价指标体系,采用Delphi法经2轮专家咨询,确定绩效评价指标及其权重系数。结果 2轮咨询专家积极系数分别为87.5%和100%,总体权威系数为（0.84±0.01）;2轮指标总体协调系数分别为0.221、0.267（P均＜0.001）。最终构建的评价指标体系包括:一级指标3项,按权重从小到大的指标依次为结构（0.3472）、过程（0.3282）、结果（0.3247）;二级指标11项;三级指标49项。结论 该研究基于Delphi法构建的乡镇卫生院精神卫生服务绩效评价指标体系,能较为客观地评估乡镇卫生院精神卫生服务水平。     

家政服务人员岗前心理健康与生存质量调查

目的调查家政服务人员入职前的心理健康状况及其生存质量,为下一步针对性开展心理健康教育提供科学依据。方法以某家政公司976名岗前家政服务人员为研究对象,以症状自评量表（SCL-90）评定其心理健康状况,以世界卫生组织生存质量评定量表简版评定其生存质量。结果 SCL-90筛查阳性者占9.2%。年龄与SCL-90的人际关系、偏执、精神病性等多个因子存在负相关,相关系数分别为-0.085~-0.161（P〈0.01）。SCL-90筛查阳性者中,40岁及以下者的生存质量环境领域得分高于40岁以上者,差异有统计学意义。SCL-90各因子与生存质量各领域得分全部存在负相关,P值均〈0.01。结论家政从业人员岗前整体心理健康水平较好,40岁及以下者较40岁以上者生存质量更高。     

大庆油田员工心理健康促进方案构建的研究

目的探讨适用于油田企业的员工心理健康促进方案的运作模式及其内容,了解员工生活与心理压力的来源与类型,规划构建有关心理健康教育课程。方法采用问卷调查方法,自行设计调查问卷,在大庆油田有限责任公司员工内采用分层抽样方法抽取3 000人作为调查对象。收集调查对象对心理健康促进的看法及需求并对资料进行统计分析。结果有效问卷2 760份,全体研究对象都认为现代企业关注员工心理健康很重要;受调查对象压力总体感觉比较大及以上者占33.59%,员工压力来源的排序依次为经济压力、生活压力、人际关系压力、职业发展压力、婚姻情感压力及内部竞争压力;员工需要获得的专业帮助依次为情绪管理、压力管理、有效沟通技巧、适应技巧、子女教育与亲子关系、心理调整技巧及职业规划设计;大庆油田员工心理健康促进方案以员工心理健康评价、心理卫生教育训练为主,辅以员工个别心理咨询。结论对大庆石油员工进行心理卫生教育是必要的。     

Area social fragmentation, social support for individuals and psychosocial health in young adults: evidence from a national survey in England

This paper uses national survey data for young adults in England to explore empirically the relationships between social fragmentation in communities (measured for geographical areas), social support experienced by individuals from their immediate social circle, and psychosocial health of young adults. After reviewing previous research about these associations, we adopted an empirical approach to these questions, which was innovative in using data on area social fragmentation from a different source to the survey data on individuals. Also, we have examined the relevance for mental health of interactions between individual social support and area social fragmentation, as well as their independent associations with health. To test these ideas empirically, we present a statistical analysis, using survey data from the national Health Survey for England on young people aged 16-24 years, linked to a geographical indicator of social fragmentation, derived from the population census and with a measure of material poverty. The outcome variable was distress measured by the General Health Questionnaire (GHQ). In a logistic regression model that controls for grouping of individuals within areas we included data on individuals' sex, ethnic group, employment status, social class and educational level. Controlling for these indicators, we demonstrate that risk of individual distress (indicated by GHQ score of 3+) was significantly and positively associated with area social fragmentation and there was a significant association with social support received within the individual's immediate social circle, which was negative ('protective'). An index of material poverty in one's area of residence did not predict individual distress. There was no evidence that social support was more 'protective' in areas of greatest social fragmentation. We also note that while being in employment was associated with better mental health in this sample, higher educational level was associated with worse average levels of distress (controlling for age). We consider some of the policy implications of the findings.     

Working conditions and mental health: Results from the CARESUN study

The authors conducted a work-related stress surveillance study in 2013 on 6,558 public-sector employees in Italy, examining how they perceived their jobs, via the Job Content Questionnaire, and their mental health status, via the General Health Questionnaire 12 (GHQ-12). Of the 2,094 employees completing the questionnaires, 60% were male, 52% had a medium-level education, and 76% had a medium-level job. Three hundred and eighty-five employees (18%) had a GHQ-12 score >3 and were classified as GHQ-12 cases: these were more often female (54%), medium-to-highly educated (54%), and had more often reported health problems over the previous year (51%). Thus, GHQ-12 cases represented a significant percentage of the examined population, indicating that work-related stress surveillance programs are needed for the planning of psychosocial interventions aimed at the reintegration of individuals with mental health problems.     

Distal determinants of mental health conditions (MHC) for asylum-seeking children in Greece: A health system enhancement study

Mental health conditions (MHC) of asylum-seeking children in Greece are dire, but still recovering from the financial crisis, Greece cannot afford the cost of mental health treatments. We were motivated to understand the root causes of these mental health problems to explore the possibilities for prevention. We developed our inferences in four ways: (1) secondary analyses of thirty-nine semi-structured informational interviews conducted with national and international aid organizations and healthcare providers; (2) secondary analyses of nine interviews with asylum seekers; (3) direct observation during six refugee camp visits from June 1 to July 28, 2017; and (4) a literature review to develop a diagnostic tree of causal outcomes.Results revealed eight proximal causes: chronic stress, trauma, at-risk population without protection and assistance, the large number of vulnerable groups, feeling of insecurity, feeling of lacking control, a lack of autonomy, and feeling helpless and hopeless. We identified sixty-nine distal determinants of adverse MHC beneath the proximal causes. Too numerous and too diverse to treat effecvively with limited resources, these root causes of MHC were thematically grouped into: laws and regulations, capacity and resources, accountability and standards, prioritization, bias and stigma, and displacement. Using a common health systems framework, we developed strategic policy approaches to target the root causes, which could prevent ill-health while saving time and resources.     

中国疾病预防控制中心公共卫生援外人员心理健康状况的研究

目的了解公共卫生援外人员心理健康状况及其影响因素。方法2018年7月至2019年7月,对中国疾病预防控制中心“援塞拉利昂固定生物安全实验室第二期技术援助项目”的第3、4批队伍全体成员共21人,分别在行前、到塞拉利昂3个月、6个月、回国后1个月应用症状自评量表(SCL-90)、一般情况及影响因素调查表进行调查和评价。结果部分公共卫生援外人员出现阶段性的心理异常反应(SCL-90总分>160分)。SCL-90总分在队员出发前往塞拉利昂后上升,到塞拉利昂3个月时达最高峰,然后下降至行前水平,呈现低-高-低的趋势。敌对、偏执因子的得分呈现低-高-低-高的趋势。在时间节点的类别中,SCL-90总分分布差异无统计学意义(P>0.05),强迫因子得分分布差异有统计学意义(P<0.05)。结论公共卫生援外队员整体心理健康状况较好。各界应采取相应措施保护并持续关注援外人员的心理健康发展。     

精神病院政府补偿机制的选择：以辽宁省为例

精神病人是社会弱势群体,精神病院又是医疗卫生服务机构中的薄弱机构,为提高精神病院对精神病人的有效治疗和管理能力,建议各级政府从经济政策上给予有力支撑,建立和完善合理的补偿机制。     

The impact of poor health on academic performance: New evidence using genetic markers

This paper examines the influence of health conditions on academic performance during adolescence. To account for the endogeneity of health outcomes and their interactions with risky behaviors we exploit natural variation within a set of genetic markers across individuals. We present evidence that specific genetic markers have good statistical properties to identify the impacts of ADHD, depression and obesity. These markers help reveal a new dynamism from poor health to lower academic achievement with substantial heterogeneity in their impacts across genders. Our investigation further exposes the considerable challenges in identifying health impacts due to the prevalence of comorbid health conditions, with clear implications for the health economics literature.     

Vulnerability and mental health

Abstract

The vulnerability of children has long been recognized in terms of their development needs and the importance of protecting their physical health. The extent, severity and impact of their mental health problems, including the particular vulnerabilities associated with such problems in both childhood and through to adult life, have been less of a public health priority. Vulnerabilities come in many forms, all of which may impact on the mental health and wellbeing of children and may do so in complex ways. These include the diversity of family structures, of cultures, of childrearing practices, the influence of developmental trajectories, experiences of illness and disability in child or parent and multiple strengths, resilience and protective factors. In understanding the patterns and sources of vulnerability, several themes need to be taken into account. Advocacy is also a central issue. Children do not have a political voice. The most vulnerable children from the most vulnerable families are rarely heard. This brings a responsibility for all, in terms of advocacy, engagement with their issues and recognition and building of their strengths and hearing their voices in all these matters.