Stigma and discrimination related to mental illness in low- and middle-income countries

Aims.This paper aims to provide an overview of evidence from low- and middle-income countries (LAMICs) worldwide to address: the nature of stigma and discrimination, relevant context-specific factors, global patterns of these phenomena and their measurement and quantitative and qualitative evidence of interventions intended to reduce their occurrence and impact. The background to this study is that the large majority of studies concerned with identifying effective interventions to reduce stigma and discrimination originate in high-income countries (HICs). This paper therefore presents such evidence from, and relevant to, LAMICs.Methods.Conceptual overview of the relevant peer-reviewed and grey literature on stigma and discrimination related to mental illness in LAMICs are available in English, Spanish, French and Russian.Results.Few intervention studies were identified related to stigma re-education in LAMICs. None of these addressed behaviour change/discrimination, and there were no long-term follow-up studies. There is therefore insufficient evidence at present to know which overall types of intervention may be effective and feasible and in LAMICs, how best to target key groups such as healthcare staff, and how far they may need to be locally customised to be acceptable for large-scale use in these settings. In particular, forms of social contacts, which have been shown to be the most effective intervention to reduce stigma among adults in HICs, have not yet been assessed sufficiently to know whether these methods are also effective in LAMICs.Conclusion.Generating information about effective interventions to reduce stigma and discrimination in LAMICs is now an important mental health priority worldwide.Key words: Discrimination, evidence-based psychiatry, health service research, mental illness stigma     

Suicide prevention in military organizations

Suicide is an important public health problem in the demographic group that forms the bulk of military populations, namely young and middle-aged men. Suicide in the military also has special significance: certain aspects of military service can lead to serious mental disorders that increase the risk of suicidal behaviour. Moreover, military organizations have control over a broad range of factors (notably the direct delivery of mental health care) that could mitigate suicide risk. This article will review the literature on suicide risk in military organizations to answer the important question: Are military personnel at increased risk for suicide? Next, Mann et al.'s (2005) model for specific suicide preventive interventions in civilian settings will be reviewed and then expanded, with an emphasis on identifying special opportunities for suicide prevention in military organizations, including: 1) organizational interventions to mitigate work stress; 2) selection, resilience training, and risk factor reduction; 3) interventions to overcome barriers to care; and 4) systematic quality improvement efforts in mental health care. Finally, the evidence behind comprehensive suicide prevention programmes will be reviewed, with a special focus on the US Air Force's benchmark programme.     

Promoting the Social and Emotional Health of Primary School-Aged Children: Reviewing the Evidence Base for School - Based Interventions

Schools are key settings for promoting the social and emotional health and well-being of children. This study investigated the effectiveness of interventions to improve the social and emotional well-being of primary school-aged children. The protocol development stage of the proposed systematic review identified related and comparable research reviews, indicating a more useful review of reviews. Eight reviews of intervention effectiveness covering 322 primary studies were reviewed. The majority examined classroom-based interventions. Greater effectiveness results from a sustained focus on the promotion of mental health, on self-esteem and coping outcomes within the broad school climate, and on replicating positive impacts rather than the prevention of mental health problems. Conclusions are limited by short duration of studies, lack of detail of interventions, identified outcomes and socio-demographic data, and the relationship between processes and outcomes. This study has clearly shown how crucial carefully designed studies are in understanding strategies with potential to impact on the mental health and well-being of children.     

Telemental health and web-based applications in children and adolescents

The authors conducted a review of the literature with regard to child and adolescent mental health intervention, from which they identified 20 unique publications and 12 separate interventions. These interventions encompassed depression, anxiety, substance abuse, eating disorders, and mental health promotion. Studies were heterogeneous, with a wide range of study designs and comparison groups creating some challenges in interpretation. However, modest evidence was found that Internet interventions showed benefits compared with controls and preintervention symptom levels. Interventions had been developed for a range of settings, but tended to recruit middle-class participants of European ethnicity. Internet interventions showed a range of approaches toward engaging children and incorporating parents and peers into the learning process.     

MindMatters, a whole-school approach promoting mental health and wellbeing

OBJECTIVE: MindMatters is an innovative, national mental health promotion program which provides a framework for mental health promotion in Australian schools. Its objectives are to facilitate exemplary practice in the promotion of whole-school approaches to mental health promotion; develop mental health education resources, curriculum and professional development programs which are appropriate to a wide range of schools, students and learning areas; trial guidelines on mental health and suicide prevention and to encourage the development of partnerships between schools, parents, and community support agencies to promote the mental wellbeing of young people. METHOD: A team of academics and health education professionals, supported by a reference group of mental health experts, developed MindMatters. The program was piloted in 24 secondary schools, drawn from all educational systems and each State and Territory in Australia. The pilot program was amended and prepared for dissemination nationally. RESULTS: The program provides a framework for mental health promotion in widely differing school settings. The teacher professional development dimension of the program is central to enhancing the role of schools in broad population mental health promotion. CONCLUSIONS: Promoting the mental health and wellbeing of all young people is a vital part of the core business of teachers by creating a supportive school environment that is conducive to learning. Teachers need to be comfortable and confident in promoting and teaching for mental health. Specific, targeted interventions, provided within a whole-school framework, address the needs of the minority of students who require additional support.     

Prevalence and characteristics of mental disorders in jails and prisons

PURPOSE OF REVIEW: The published literature from 2004 on mental disorders in jails and prisons was reviewed. RECENT FINDINGS: A number of important studies on prisoner suicide, older prisoners, prison medical services and inmate mental health are highlighted, which provide useful potential interventions to improve the care of mentally ill prisoners. Relevant pieces on ethical issues are also discussed. SUMMARY: Despite increasing prison populations worldwide and robust evidence that serious mental disorders are common in inmates in Western countries, many key issues in the treatment of mentally disordered prisoners remain unanswered. In addition, the evidence base on the nature and prevalence of mental disorders in prisoners in non-Western countries remains small.     

Dialectical behavior therapy in the Asia‐Pacific Rim region

Background: Borderline personality disorder (BPD) contributes to suicide‐related morbidity and mortality and requires more intensive psychotherapeutic resources due to its high mental health service usage. Accessibility to an evidence‐based treatment program is a cornerstone to support patients with BPD and part of broader suicide prevention efforts as well as improving their quality of life. Aims: In this article, the authors aim to discuss and review available dialectical behavior therapy (DBT) and DBT‐informed services of selected countries in the Asia‐Pacific Rim, namely Singapore, Malaysia, and Mexico. Materials & Methods: We contacted providers of different services and gathered information on the process of setting up the service and adapting the treatment, in addition to reviewing the available literature published in the countries. Results: To date, there have been a pair of DBT‐informed services in Singapore, four in Malaysia, and several in Mexico with a few of them offering standard DBT. Different efforts have been put in place to increase the accessibility to training and also the number of DBT practitioners. Discussion: Important considerations during the process of setting up new services include the use of domestic examples and local language that are contextually appropriate for the local community. Selected challenges faced in common include shortage of workforce, affordability of training programs, and the need for language adaptation with or without translation. Conclusion: Further long‐term evaluation of locally adapted DBT‐informed mental health services will help to elucidate the effectiveness and efficacy of the program which will potentially serve as a guide for other resource‐scarce regions.     

Review of mental health promotion interventions in schools

Purpose

The prevalence of mental disorders amongst children and adolescents is an increasing global problem. Schools have been positioned at the forefront of promoting positive mental health and well-being through implementing evidence-based interventions. The aim of this paper is to review current evidence-based research of mental health promotion interventions in schools and examine the reported effectiveness to identify those interventions that can support current policy and ensure that limited resources are appropriately used.

Methods

The authors reviewed the current state of knowledge on school mental health promotion interventions globally. Two major databases, SCOPUS and ERIC were utilised to capture the social science, health, arts and humanities, and education literature.

Results

Initial searches identified 25 articles reporting on mental health promotion interventions in schools. When mapped against the inclusion and exclusion criteria, 10 studies were included and explored. Three of these were qualitative and seven were quantitative.

Conclusions

A range of interventions have been tested for mental health promotion in schools in the last decade with variable degrees of success. Our review demonstrates that there is still a need for a stronger and broader evidence base in the field of mental health promotion, which should focus on both universal work and targeted approaches to fully address mental health in our young populations.

     

Peer-based health interventions for people with serious mental illness: A systematic literature review

Health interventions delivered by peer specialists or co-facilitated by peer specialists and health professionals can help improve the physical health of people with serious mental illness (SMI). Yet, the quality of the studies examining these health interventions and their impact on health outcomes remains unclear. To address this gap, we conducted a systematic literature review of peer-based health interventions for people with SMI. We rated the methodological quality of studies, summarized intervention strategies and health outcomes, and evaluated the inclusion of racial and ethnic minorities in these studies. We used the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to conduct our systematic literature review. Electronic bibliographic databases and manual searches were used to locate articles that were published in English in peer-reviewed journals between 1990 and 2015, described peer-based health interventions for people with SMI, and evaluated the impact of the interventions on physical health outcomes. Two independent reviewers used a standardized instrument to rate studies' methodological quality, abstracted study characteristics, and evaluated the effects of the interventions on different health outcomes. Eighteen articles were reviewed. Findings indicated that the strength of the evidence generated from these studies is limited due to several methodological limitations. Mixed and limited intervention effects were reported for most health outcomes. The most promising interventions were self-management and peer-navigator interventions. Efforts to strengthen the evidence of peer-based interventions require a research agenda that focuses on establishing the efficacy and effectiveness of these interventions across different populations and settings.     

Insomnia as a Precipitating Factor in New Onset Mental Illness: a Systematic Review of Recent Findings

Purpose

We aimed to systematically review recent publications (01/2014–03/2017) with longitudinal designs allowing for the assessment of the prospective risk of insomnia on new onset mental illness in key conditions: anxiety, depression, bipolar disorder, posttraumatic stress disorder, substance use disorders, and suicide.

Recent Findings

A literature yielded 1859 unique articles meeting search criteria were identified; 16 articles met all selection criteria and reviewed with some studies reporting on more than one mental health outcome. Overall, the review supports the hypothesis that insomnia is a predictor of subsequent mental illness.

Summary

The evidence is strongest for an insomnia-depression relationship. The new studies identified and reviewed add to a modest number of publications supporting a prospective role of insomnia in new onset mental illness in three areas: anxiety disorders, bipolar disorder, and suicide. The few selected new studies focused on SUD were mixed, and no studies focused on PTSD were identified that met the selection criteria. Treatment of insomnia may also be a preventive mental health strategy.

     

Suicidal behavior sociocultural factors in developing countries during COVID-19

ObjectivesSociocultural factors in the aftermath of any pandemic can play a role in increasing suicidal behavior like suicidal ideation, suicidal attempts, or suicide. The authors discuss the risk and predisposing factors for suicidal ideation among mental health patients in four developing countries (Bangladesh, Colombia, India and Pakistan), this aims to grasp the heterogeneity of these motivators and to elaborate specific interventions regarding suicide in the COVID-19 pandemic.MethodsWe searched PubMed, Medline, and Google Scholar through March, 2021 for articles using a combination of the keywords and generic terms for suicide, suicide ideation, COVID-19, developing countries, low-middle-income countries, Sociocultural factors, Suicidal behavior, predisposing factors and predictive factors, for articles in English language only, and without publication time restriction.ResultsThis narrative review summarizes the sociocultural risk and predisposing factors for suicidal behavior in developing countries during the COVID-19 pandemic. The findings reveal those factors such as fear of being infected, growing economic pressure, lack of resources due to lockdown are mostly responsible in the four countries for the current increase in suicides. There are a few cultural differences that are specified in the narrative.ConclusionThe COVID-19 pandemic is a public health challenge, in which prevention and intervention of suicidal behavior have been suboptimal, especially in low-middle-income countries. Based on literature results, we provide practical suggestions (e.g., reducing infodemic, specialized helplines, improving mental health services availability) in order to tackle main challenges of suicide prevention, such as lack of adequate manpower, fragile health system and poverty.     

《上海精神医学》的发展方向

全球精神卫生的发展表明了中低收入国家需要在努力改善精神病学的学术和实践水平的国际舞台上发出他们自己的声音。在过去的10到15年的时间里,中国的精神病学及其研究得到了迅速的发展,     

A Model for Multidisciplinary Peer Review and Supervision of Behavioral Health Clinicians

The authors describe a semi-annual program formultidisciplinary peer review and supervision that is inuse at two rural adult and child mental health and drugand alcohol service agencies. The program incorporates semiannual chart reviews andface-to-face discussions held with each clinician by amultidisciplinary supervisory group. Several qualityimprovement issues addressed by this program aredescribed, including improved communication, improvedclinical diagnosis, the establishment of serviceparameters, more appropriate referrals for psychiatricand other medical care, and improved clinician skills. The program represents an inexpensive approachto peer review and supervision that can incorporateuniversity-based consultants, improve quality of care,improve clinicians' skills, and be readily applied by clinical supervisors to most behavioralhealth settings.     

Ethnic minority elders: are they neglected in published geriatric psychiatry literature?

ABSTRACTBackground: The population size of the elderly from ethnic minority groups in many developing countries is rapidly increasing. The authors perceived a paucity of publications in the geriatric psychiatry literature pertaining to ethnic minority elders.Methods: A study examining the proportion of research publications pertaining to ethnic minority elders in two leading geriatric psychiatry journals, International Psychogeriatrics and International Journal of Geriatric Psychiatry, was undertaken.Results: The main findings were: (1) overall only 7.6% of the publications examined ethnic minority elders; (2) only 5.1% of publications were exclusively of ethnic minority elderly groups; and, (3) only 2.5% of publications included ethnic minority elderly groups in their overall sample.Conclusions: Findings from studies, such as epidemiological studies of risk factors for mental disorders in old age and randomized controlled studies of treatment interventions, which exclude ethnic minority elders, cannot be assumed to apply to these groups. Researchers, research institutions, funding organizations and policy-makers should acknowledge the rising numbers of ethnic minority elders and recognize the importance of using ethnic minority-specific research data in the planning of culturally sensitive services and mental health promotion programs.     

Evidence-based mental health care and implementation science in low- and middle-income countries

Although the evidence base for what to do about the mental health gap in low- and middle-income countries (LAMICs) has improved significantly over the last decade, mental health care in LAMICs still provide services to only a small minority of people with mental disorders. The problem is how to translate the relevant body of scientific knowledge into routine practice. It is clear from over two decades of research that the creation of evidence-based guidelines is necessary but not sufficient for evidence-based practice, whether in high- or low-income settings. In this Editorial, I discuss whether the recent development of 'implementation science' may offer an opportunity towards effective guideline implementation in low- and medium-income settings, so that clinical practice is more often based on evidence that does lead to patient benefit.     

Review of Suicide Prevention Programs: Massachusetts,United States,in Comparison with Seoul

Suicide is a tragedy that has massive impact on society. In order to prevent suicide, active government intervention is necessary. The suicide rate in Seoul is rapidly increasing and is more than five times higher than that in the state of Massachusetts (MA) during the last decade, especially in the elderly. The suicide prevention program of MA is one of the most effective suicide prevention programs in the United States. The program views suicide as a preventable public health problem, and emphasizes treatment of depression and de-stigmatization of mental health illnesses to prevent suicide. Also, through active collaboration with mental health professionals, they try to identify at-risk populations and help them to get medical interventions. The program also actively collaborates with the regional coalition program and the Samaritans in taking care of the elderly, and supports the elderly in feeling worthwhile after retirement by helping them to work for communities as volunteers. For its part, the Seoul suicide prevention program puts more emphasis on "life respect culture" and "emotional support to high risk individuals by regular visiting". The annual budget of the Seoul suicide prevention program is one-quarter and that for mental health is about one-twentieth that of MA. Considering the high suicide rate and lower mental health service usage in Seoul, it is crucial to raise awareness of depression and decrease the stigma on mental illnesses. Furthermore, educational efforts with long-term investment in research on suicide are necessary.     

Mental health and psychosocial support in humanitarian settings: a public mental health perspective

Aims.To discuss the potential usefulness of a public health approach for ‘mental health and psychosocial support’ (MHPSS) interventions in humanitarian settings.Methods.Building on public mental health terminology in accordance with recent literature on this topic and considering existing international consensus guidelines on MHPSS interventions in humanitarian settings, this paper reflects on the relevance of the language of promotion and prevention for supporting the rationale, design and evaluation of interventions, with a particular focus on populations affected by disasters and conflicts in low- and middle-income countries.Results.A public mental health approach and associated terminology can form a useful framework in the design and evaluation of MHPSS interventions, and may contribute to reducing a divisive split between ‘mental health’ and ‘psychosocial’ practice in the humanitarian field. Many of the most commonly implemented MHPSS interventions in humanitarian settings can be described in terms of promotion and prevention terminology.Conclusions.The use of a common terminology across health, protection, education, nutrition and other relevant sectors providing humanitarian interventions has the potential to allow for integration of MHPSS activities in one overall framework, with diverse humanitarian practitioners working to achieve a common goal.Key words: Humanitarian settings, low- and middle-income countries, mental health psychosocial support, public health     

Suicide and its prevention among older adults.

OBJECTIVE: To review the research on the epidemiology, risk and resiliency, assessment, treatment, and prevention of late-life suicide. METHOD: I reviewed mortality statistics. I searched MEDLINE and PsycINFO databases for research on suicide risk and resiliency and for randomized controlled trials with suicidal outcomes. I also reviewed mental health outreach and suicide prevention initiatives. RESULTS: Approximately 12/100,000 individuals aged 65 years or over die by suicide in Canada annually. Suicide is most prevalent among older white men; risk is associated with suicidal ideation or behaviour, mental illness, personality vulnerability, medical illness, losses and poor social supports, functional impairment, and low resiliency. Novel measures to assess late-life suicide features are under development. Few randomized treatment trials exist with at-risk older adults. CONCLUSIONS: Research is needed on risk and resiliency and clinical assessment and interventions for at-risk older adults. Collaborative outreach strategies might aid suicide prevention.