Does educational background explain inequalities in care service use for mental health problems in the Dutch general population?

OBJECTIVE: To investigate whether (1) education predicts the use of care services for mental health problems, independently of mental disorder and functional impairment and (2) education modifies the association between mental disorder and service use. METHOD: Predictors of service use were recorded at baseline, and service use itself at 12-month follow-up, in a representative sample (N=7076) of the Dutch population, using the Composite International Diagnostic Interview. RESULTS: People with more education were less likely to use primary care but more likely to use mental health care. The effects on both types of care remained significant after adjustment for mental disorder and functional impairment. Lower education tended to strengthen the association between mood or anxiety disorder and primary care use. CONCLUSION: Further research on inequalities in service use will benefit from additional explanatory analyses and from the inclusion of sociopsychological variables, like cost-benefit considerations in decisions to use services.     

Impact of shared mental health care in the general population on subjects’ perceptions of mental health care and on mental health status

Objective A community survey evaluated whether the development of a shared mental health care intervention had an impact on health care perceptions and mental health status of subjects with common mental health problems (MHP). Methods Adults <70 years old with common MHP (DSM-IV/CIDI-SF major depressive disorder, generalized anxiety or MHI-SF 36 psychic distress diagnoses), were randomly drawn from the general population in the intervention area (IA, n = 349) and in a control area (CA, n = 360), and evaluated twice at an interval of 18 months (percentage of follow-up: IA = 69.3%, CA = 71.9%, P = .44). CA and IA groups did not differ for the criteria of interest at baseline. Results At 18 months, compared to CA, IA reported significantly different help-seeking attitudes or behaviours (P = .02 for all subjects and .006 for subjects with current MHP) and greater general satisfaction with care (P = .03 for both). Remission rates and daily life functioning did not differ. Conclusions After 4 years of development of a mental health network based on a consultation-liaison model, Shared Mental Health Care was associated with greater satisfaction and access with care among subjects with common MHP. The association was not found with mental health status, but the study lacked power to adequately address the issues.     

Understanding ethnic differences in mental health service use for adolescents’ internalizing problems: the role of emotional problem identification

Although immigrant adolescents are at least at equal risk of developing internalizing problems as their non-immigrant peers, immigrant adolescents are less likely to use mental health care. The present study is the first to examine ethnic differences in problem identification to find explanations for this disparity in mental health service use. Specifically, the extent to which emotional problem identification mediates the relationship between immigrant status and mental health service use for internalizing problems in three immigrant populations in the Netherlands (i.e., Surinamese, Turkish, and Moroccan) was investigated. A two-phase design was used to include adolescents at risk for internalizing problems. Data were used from the second phase, in which 349 parents and adolescents participated (95 native Dutch, 85 Surinamese, 87 Turkish, and 82 Moroccan). Results indicated that mental health service use for internalizing problems is far lower among immigrant adolescents than among native Dutch adolescents, although differences between immigrant groups were also substantive. A lack of emotional problem identification was identified as an essential mediator in the relationship between immigrant status and mental health service use. Since the results suggest the low levels of problem identification in our immigrant samples may serve an explanatory role in the relationship between immigrant status and mental health service use, future research should aim at understanding these ethnic differences in problem identification.     

Does ethnicity affect need for mental health service among New Zealand prisoners?

OBJECTIVE: The National Study on Psychiatric Morbidity in New Zealand Prisons identified undiagnosed mental illness and unmet treatment needs for mentally disordered offenders. As approximately 50% of prisoners are of Maori and 8.3% Pacific Island ethnicity, we analyzed the data to determine if there were any differences in the rates of major mental disorders between ethnic groups. METHOD: A census of all female prisoners, all remand male prisoners and an 18% random sample of the sentenced male prisoners were interviewed employing the diagnostic interview for mental illness (CIDI-A), screening diagnostic interview for relevant personality disorders (PDQ) and suicide screening questions. Self-identified ethnicity was recorded. Ethnic groups were compared for sociodemographic variables, morbidity for mental disorder, treatment experience and suicidality. RESULTS: The ethnic groups were largely similar in age and current prevalence for mental disorders, although there was some evidence of differing sociodemographic factors, especially younger age among the Maori prisoners. Maori report fewer suicidal thoughts, but acted suicidally at the same rate as non-Maori. Treatment for mental disorder was less common among Maori and Pacific Island prisoners than others, both in prison and in the community. CONCLUSION: Criminogenic factors present in the developmental histories of prisoners might also increase the risk of mental disorders. Ethnic groups were not different in the rate at which they manifest mental disorders in the face of such factors. Younger prisoners were disproportionately more likely to be of Maori or Pacific Island ethnicity. Both prior to and after entry to prison, services must improve responsiveness to Maori and Pacific Island people.     

Do different psychotic experiences differentially predict need for care in the general population?

INTRODUCTION: The pathway from subclinical psychotic experiences to need for care may depend on type of psychotic experience, level of associated distress, and previous experience of psychosis. METHOD: In a general population sample with no previous Diagnostic and Statistical Manual of Mental Disorders , Revised Third Edition , psychotic disorder (n = 4722), 83 subjects displayed at least one psychotic experience. Within the group of 83, subjects with (n = 24) and without need for care (n = 59) were compared. Presence of psychotic experiences at younger ages had been assessed at earlier interviews. RESULTS: Of 7 different psychotic experiences, only hearing voices, nonverbal hallucinations, and passivity phenomena were significantly associated with need for care. These associations were largely explained by the distress associated with the psychotic experience, but whether individuals had had psychotic experiences at earlier ages did not matter. CONCLUSIONS: Different psychotic experiences differ in the associated level of need for care and the mediating role of distress. Longer prior exposure to psychosis may not influence the pathway from subclinical to clinical.     

What are the ethics of care in mental health disorders?

Psychiatry is undergoing a major crisis, on both an institutional as well as a clinical level. Numerous players involved in psychiatry feel in difficulty and are increasingly raising questions as to what direction and meaning to give to their practice. It is in such a context that ethics can help us to progress, reflect and build the future together. It is high time to create the specific basis of ethics in psychiatry.     

Does mental health history explain gender disparities in insomnia symptoms among young adults?

BackgroundInsomnia is the most commonly reported sleep disorder, characterized by trouble falling asleep, staying asleep, or waking up too early. Previous epidemiological data reveal that women are more likely than men to suffer from insomnia symptoms. We investigate the role that mental health history plays in explaining the gender disparity in insomnia symptoms.MethodsUsing logistic regression, we analyze National Health and Nutritional Examination Survey (NHANES) III interview and laboratory data, merged with data on sociodemographic characteristics of the residential census tract of respondents. Our sample includes 5469 young adults (ages 20–39) from 1429 census tracts.ResultsConsistent with previous research, we find that women are more likely to report insomnia symptoms compared to men (16.7% vs. 9.2%). However, in contrast to previous work, we show that the difference between women’s and men’s odds of insomnia becomes statistically insignificant after adjusting for history of mental health conditions (OR = 1.08, p > .05).ConclusionsThe gender disparity in insomnia symptoms may be driven by higher prevalence of affective disorders among women. This finding has implications for clinical treatment of both insomnia and depression, especially among women.     

Starving in the midst of plenty? A study of training needs for child and adolescent mental health service delivery in primary care

Current UK child mental health policy seeks to engage primary care personnel in improving service delivery under the heading of 'Comprehensive CAMHS' but little is known about the size of this resource, the sufficiency of its training or its commitment to children's mental health. We surveyed local health, education and social services agencies within a UK Unitary Authority just outside London, using both questionnaire and focus group methodologies: 150 primary care personnel were identified in 14 teams. Of these 122 participated in the questionnaire survey, and 60 took part in focus groups. There was, approximately, one such team member for every 30 children with a mental health problem. Respondents reported deficiencies in skills and knowledge, but wanted training and support to increase their involvement provided it related to their daily practice, professional roles, and was developed in accordance with local needs and resources. Lack of training and organization impedes the effective deployment of a potentially huge resource for children with mental health problems. This could be addressed by appropriately tailored training courses, combined with managerial work on systems and remits. Such a programme would be needed to realize the National Service Framework's concept of a 'comprehensive CAMHS'.     

Can psychiatry cross the quality chasm? Improving the quality of health care for mental and substance use conditions

In 2001, a seminal Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century, put forth a comprehensive strategy for improving the quality of U.S. health care. This strategy attained considerable traction within the overall U.S. health care system and subsequent attention in the mental health community as well. A new Institute of Medicine report, Improving the Quality of Health Care for Mental and Substance Use Conditions, examines the quality chasm strategy in light of the distinctive features of mental and substance use health care, including concerns about patient decision-making abilities and coercion into care, a less developed quality measurement and improvement infrastructure, lagging use of information technology and participation in the development of the National Health Information Infrastructure, greater separations in care delivery accompanied by more restrictions on sharing clinical information, a larger number of provider types licensed to diagnose and treat, more solo practice, and a differently structured marketplace. This article summarizes the Institute of Medicine's analysis of these issues and recommendations for improving mental and substance use health care and discusses the implications for psychiatric practice and related advocacy efforts of psychiatrists, psychiatric organizations, and other leaders in mental and substance use health care.     

What are the contributing factors for insomnia in the general population?

Lack of a systematic assessment of insomnia has led to large variations in its reported prevalence in the general population. This study aims to provide new guidelines to assess insomnia prevalence. A cross-sectional telephone survey using the Sleep-EVAL system was done with 24,600 general population-based subjects 15 years and older representative of general populations (France, the UK, Germany, Italy, Portugal, and Spain) consisting of 251,405,391 inhabitants. The overall participation rate was 81.0%. Within the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) symptomatology for insomnia, 27.2% (95% confidence interval: 26.6–27.8%) of the sample reported difficulty initiating sleep (DIS) (10.1%) or maintaining sleep (DMS) (disrupted sleep (DS): 18.0%; early morning awakening (EMA): 10.9%) or nonrestorative sleep (NRS) (8.9%) at least three times per week; 48.5% of them were concomitantly suffering of a DSM-IV sleep/mental disorder. A factor analysis identified several variables strongly related to each of the major factors of insomnia allowing: (1) The narrowing of the definition of insomnia: the prevalence of insomnia decreased to 16.8% with 64.5% of insomnia subjects having a DSM-IV sleep/mental disorder; (2) The identification of a sleep-deprived (voluntary or not) group without insomnia symptoms, representing 2.1% (1.9–2.3%) of the sample. Interestingly, the latter group closely matched the definition of insufficient sleep syndrome as described by the International Classification of Sleep Disorders (ICSD). Using more delineated criteria to assess insomnia increases the recognition of subjects complaining about sleep. Classifications should be amended to improve the correct identification of insomnia. Sleep-deprived subjects should also not be neglected.     

Change in the mental health field?

An analysis of the current roles of the federally funded community mental health center and the public mental hospital suggests that despite the rhetoric about a community mental health revolution, the mental health field has yet to undergo significant change. Ideological, political, economic, and structural barriers-characteristics of the field itself-impede such change outside, inside, and across the centers and hospitals. Recent court decisions on patients' rights, however, have the potential for moving the field into a period where bold new action actually can occur.Preparation of this paper was supported, in part, by Research Grant No. 1 R01 MH23646 from the National Institute of Mental Health. The authors thank Al Imershein, Kent Miller, and Elane Nuehring for helpful comments on an earlier draft.     

Did we learn something positive out of the COVID-19 pandemic? Post-traumatic growth and mental health in the general population

BackgroundWhen facing a traumatic event, some people may experience positive changes, defined as posttraumatic growth (PTG).MethodsUnderstanding the possible positive consequences of the pandemic on the individual level is crucial for the development of supportive psychosocial interventions. The present paper aims to: 1) evaluate the levels of PTG in the general population; 2) to identify predictors of each dimension of post-traumatic growth.ResultsThe majority of the sample (67%, N = 13,889) did not report any significant improvement in any domain of PTG. Participants reported the highest levels of growth in the dimension of “appreciation of life” (2.3 ± 1.4), while the lowest level was found in the “spiritual change” (1.2 ± 1.2). Female participants reported a slightly higher level of PTG in areas of personal strength (p < .002) and appreciation for life (p < .007) compared to male participants, while no significant association was found with age. At the multivariate regression models, weighted for the propensity score, only the initial week of lockdown (between 9-15 April) had a negative impact on the dimension of “relating to others” (B = −.107, 95% CI = −.181 to −.032, p < .005), while over time no other effects were found. The duration of exposure to lockdown measures did not influence the other dimensions of PTG.ConclusionsThe assessment of the levels of PTG is of great importance for the development of ad hoc supportive psychosocial interventions. From a public health perspective, the identification of protective factors is crucial for developing ad-hoc tailored interventions and for preventing the development of full-blown mental disorders in large scale.     

How does being female assist help-seeking for mental health problems?

OBJECTIVE: In Australia the prevalence of mental health problems does not vary by gender, but help-seeking and service utilization do. The aim of the present study was to examine a number of attitudinal factors that may influence help-seeking for mental health problems. METHOD: A cross-sectional community survey was conducted with a sample of 579 rural residents (57.9% female), who completed self-report measures assessing stoicism, alexithymia, perceived and personal stigma and the various facets of the personality trait of openness to experience. RESULTS: Men scored higher on measures of stoicism and personal stigma associated with mental health problems than women, and compared to women had lower scores on the facets of openness to experience. CONCLUSIONS: Higher rates of help-seeking for mental health problems by women may be due to lower levels of stoicism and personal stigma related to mental health problems in women compared to men.     

Another missed opportunity? Recognition of alcohol use problems by mental health providers

Alcohol use problems (AUPs) are prevalent among people seeking psychotherapy. Despite mandates from managed care companies to routinely screen for AUPs, little is known about the screening practices of providers or their ability to identify AUPs based on presenting symptoms. Participants (N = 117) read two case vignettes and suggested initial diagnoses and questions they would ask in order to clarify a diagnosis. Participants were more likely to ask about substance use and diagnose an AUP when the vignette contained explicit reference to the client's substance use as compared to a vignette where the signs of an AUP were more subtle. In both vignettes, a mental health problem was a more likely diagnosis than an AUP. Neither participant attributes nor personal or professional experiences with AUPs reliably shaped responses to the vignettes. The findings are discussed in light of their implications for future research and improved training in addictions for mental health providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

Lost in transition? Perceptions of health care among young people with mental health problems in Germany: a qualitative study

Background

The transitioning of young patients from child and adolescent to adult mental health services when indicated often results in the interruption or termination of service. The personal views of young service users on current clinical practice are a valuable contribution that can help to identify service gaps. The purpose of this qualitative study was to explore the perceptions of health care of young people with mental health problems in the transition age range (16–25 years), and to better understand health behaviour, care needs and the reasons for disengaging from care at this point in time.

Methods

Seven group discussions and three interviews were conducted with 29 young people in this age range. Discussions were audio-taped, transcribed verbatim and analysed following the reconstructive approach of R. Bohnsack’s documentary method.

Results

An overarching theme and nine subthemes emerged. Participants displayed a pessimistic and disillusioned general attitude towards professional mental health services. The discussions highlighted an overall concern of a lack of compassion and warmth in care. When they come into contact with the system they often experience a high degree of dependency which contradicts their pursuit of autonomy and self-determination in their current life stage. In the discussions, participants referred to a number of unmet needs regarding care provision and strongly emphasised relationship issues. As a response to their care needs not being met, they described their own health behaviour as predominantly passive, with both an internal and external withdrawal from the system.

Conclusions

Research and clinical practice should focus more on developing needs-oriented and autonomy-supporting care practice. This should include both a shift in staff training towards a focus on communicative skills, and the development of skills training for young patients to strengthen competences in health literacy.

     

Microbes and mental health: Can the microbiome help explain clinical heterogeneity in psychiatry?

Trillions of microbes cover the surfaces of our bodies and inhabit our gastrointestinal tract. In the past decade, research efforts examining the role of the microbiome in mental health have moved to the forefront of neuroscience and psychiatry. Based on a foundation of animal studies demonstrating the vital role for microbiota-brain communication in brain development, behavior, and brain function over the life span, clinical studies have started to consider the microbiome in psychiatric disorders. The composition, diversity and function of commensal microbes is influenced by genetic, lifestyle, and environmental factors. This review provides an overview of the factors contributing to individual differences in the microbiome, reviews recent work in psychiatric disorders, and considers what is needed to advance a better understanding of how the microbiome impacts mental health which may help us understand the heterogeneity observed in clinical psychiatric populations.