An analysis of the nature of depressive phenomena in primary health care utilising multivariate statistical techniques

The nature of depressive phenomena in primary health care was explored with data obtained from three primary health care clinics situated in the periphery of the city of Calcutta in India. The Self-Reporting Questionnaire (SRQ) and the Screening for Depression Questionnaire (SDQ-9) were used as the first stage and the Clinical Interview Schedule (CIS) and the Hamilton Rating Scale for Depression (Hamilton) as the second stage instruments respectively. Health workers with limited training administered the first stage instruments to consecutive adult clinic attenders. Principal components analysis followed by multiple linear regression analysis and discriminant function analysis were applied to the data. It was concluded that depressive phenomena in primary health care settings were largely undifferentiated in nature.     

The Effects of the European Early Promotion Project Training on Primary Health Care Professionals

This chapter explores the effects of the European Early Promotion project training on primary health care professionals, with regard to their knowledge, self-efficacy and ability to identify need in families, and to their satisfaction with the training received. A quasi-experimental group comparison design was developed, in which an Intervention and a Comparison group were assessed twice: the Intervention group before and after the special EEPP training and the Comparison at the same time interval but without the training. Overall results show a tendency for the Intervention group to improve in knowledge and perceived self-efficacy, and a significant improvement in their accuracy of need identification in families, compared with the Comparison group. These results were more prominent in Greece, Serbia and the UK than in Finland and Cyprus, whereas training satisfaction was high in all sites. The results are discussed in terms of their implications for early intervention as well as for training PHCPs to conduct preventative and promotional work with families.     

Innovations in Practice: Child and adolescent psychiatrists and primary care – innovative models of consultation in the United States

Background: There is a severe shortage of child and adolescent psychiatrists (CAPs) in the United States, an increasingly recognized high prevalence of mental disorders in young people, and widely supported goals to provide more mental health services in the primary care setting. Method: A number of innovative, state‐wide or more local, publically funded programs have been developed in the United States over the last several years to respond to these challenges and to provide CAP consultation to primary care physicians (PCPs) who wish to address the mental health disorders of their patients in the primary care setting. Results: A number of these programs and their approaches to consultation are described. An example of a clinical scenario that might be addressed using this model of CAP/PCP collaboration is offered. Conclusions: An innovative model of consultation to PCPs from CAPs appears able to facilitate the treatment of many young people with mental health disorders in the primary care setting.     

Provision of Mental Health Services in South African Substance Abuse Treatment Facilities

To date, South African research has not examined mental health service provision in substance abuse treatment facilities, even though these services improve client retention and treatment outcomes. To describe the extent to which substance abuse treatment facilities in Gauteng and KwaZulu-Natal provinces provide clients with mental health services during the course of treatment and to compare mental health service provision in these settings by type of facility and staff composition. Cross-sectional audits of substance abuse treatment facilities were conducted in Gauteng and KwaZulu-Natal provinces. Data were collected using the Treatment Services Audit Questionnaire. A response rate of 84% was obtained. Few treatment facilities provide clients with access to mental health services. Inpatient facilities are more likely than outpatient facilities to provide clients with access to mental health services. Facilities with for-profit ownership status are more likely than facilities with non-profit status to provide access to mental health care. Based on the above findings, a number of recommendations are made to increase the provision of mental health services during the course of substance abuse treatment.     

Preliminary outcome study on assertive community treatment in Japan

Aims: The beneficial effects of assertive community treatment (ACT), which has been widely acclaimed as being successful in several foreign countries, must also be objectively evaluated with respect to the transition from inpatient to community‐based mental health treatment in Japan. This was the first study that examined effects of the ACT program in Japan using pre/post design data of the pilot trial of the ACT program in Japan project. Methods: The study included 41 subjects hospitalized at Kohnodai Hospital, National Center of Neurology and Psychiatry between May 2003 and April 2004 for severe mental illness and who met inclusion criteria for entry regarding age, diagnosis, residence, utilization of mental health services, social adjustment, and ability to function in daily activities. All subjects provided informed consent for study participation and were followed for 1 year after hospital discharge. Results: Comparison of the number of days and frequency of inpatient psychiatric hospitalization and frequency of emergency psychiatric visits between the 1‐year period before hospitalization and 1‐year period after hospital discharge showed a significant decrease in number of days and frequency of hospitalization. Comparison at 1 year after discharge with baseline showed no change in satisfaction with overall quality of life or Brief Psychiatric Rating Scale scores, but the Global Assessment of Functioning score significantly increased, and the antipsychotic dose (chlorpromazine equivalent) significantly decreased. Conclusion: Despite some limitations in methodology and conclusions, this study suggests that ACT enables persons with severe mental illness to live for longer periods in the community, without worsening of symptoms, decreased social function, or deterioration in quality of life.     

The History of Community Mental Health Treatment and Rehabilitation for Persons with Severe Mental Illness

The authors review the evolution of the treatments for persons with severe mental illnesses over the past 40 years in three areas: pharmacological and other somatic treatments, psychosomatic treatments, and rehabilitation. Current treatments are based on a much stronger evidence base, are more patient-centered, and are more likely to target autonomy and recovery.     

Training,attitudes and practice of district health workers in Kenya

BACKGROUND: The 1994 mental health policy in Kenya was rooted in the concepts of Primary Health Care articulated at Alma Ata, and required that mental health care be decentralized to all levels of the health care system, and delivered by all cadres of health staff rather than just mental health specialists. However, effective implementation of this policy was likely to be influenced by the degree to which the training, attitudes and practice of health staff was consistent with and supportive of the mental health policy. OBJECTIVE: This article therefore reports a study conducted in 1997, which examined the training, attitudes and practice of district level health staff in relation to mental health care and compared them with the national mental health policy of 1994. METHOD: A semi-structured questionnaire was sent to the medical superintendents of all district hospitals in Kenya, for distribution to respondents from each cadre of health staff. A total of 148 health workers from 28 districts out of 44 eligible districts (63%) responded. RESULTS: District health workers did not think general health workers ought to manage most psychiatric patients, even if they were capable of doing so, preferring a system where these patients were managed by specialists and were not admitted into general wards. They also tended to equate mental illness with psychosis. CONCLUSION: Despite their training in mental health care and their theoretical knowledge of the principles of Primary Health Care, the attitude and mental health care practice of most health workers were in keeping with a more medical model of health care, emphasising pharmacological treatment and expecting psychiatric patients to conform to the standard Sick Role. This orientation, being at variance with the orientation of the 1994 mental health policy, may have contributed to difficulties in implementation of the policy.     

Determinants of subjective quality of life in patients attending community-based mental health services. The South-Verona Outcome Project 5

OBJECTIVE: Investigate the relationship of various domains of quality of life (QoL) with socio-demographics, clinical and social characteristics, service use and satisfaction in a representative sample of patients in contact with the South-Verona community mental health service. METHOD: Measures included: Lancashire Quality of Life Profile (LQOLP), demographics, diagnosis and service utilization data from the Case Register, Brief Psychiatric Rating Scale (BPRS), Disability Assessment Schedule (DAS), Global Assessment of Functioning (GAF) and Verona Service Satisfaction Scale (VSSS). Analyses were conducted using a block-stratified multiple regression model. RESULTS: Demographics, diagnosis, psychopathology, disability, functioning and service use together explained different amounts of variance in each LQOLP domain, but always less than 14%. VSSS explained more variance than any other indicator in health (13.1%), social relations (12.1%), leisure/participation (9.1%), and general wellbeing (9.0%). CONCLUSION: Different domains of QoL are predicted by different indicators. In some important domains, self-perceived satisfactory and effective care might have an impact on the QoL of patients.     

Cross-sectional 7-year follow-up of anxiety in primary care patients

We describe the longitudinal patterns of anxiety symptoms and mental health treatment among patients recruited from a primary care clinic, and provide a naturalistic view of anxiety symptoms, disorders, and treatment at two time periods 7 years apart. Study participants were originally identified in a primary care setting in 1992 as positive but untreated for the presence of anxiety and/or depressive symptoms and disorders. Data were collected through telephone interviews assessing current psychological status for anxiety and depression symptoms, disorders, and general functioning and well being. There were no planned interventions. Participants were re-interviewed after 7 years. Two hundred seventy-one of the identified 1992 population of 784 patients were followed up by interview in 1999. Comparisons of the scores demonstrated that respondents were less symptomatic in 1999 than in 1992, with 45% of respondents reporting no symptoms whatsoever at follow-up. Severity of symptom status in 1992 was indicative of follow-up symptom severity. Most respondents (68%) had not received mental health treatment over the 7 years, largely because they wanted to handle problems on their own. This study demonstrates the tendency of anxiety to remain or reappear years after originally identified, with 55% of patients reporting symptoms after 7 years. Initially untreated and underdiagnosed anxiety is associated with continued impairment in functional status and quality of life and continued underrecognition and undertreatment.