Khat use and mental illness: a critical review

Khat has been used as a stimulant plant in many parts of Africa and the Arabian Peninsula for centuries. Its current use among particular migrant communities in Europe and elsewhere has caused alarm among policy makers and health care professionals. In the United Kingdom, the debate over the psychiatric and social implications of khat use has led to a demand for stricter legal control of this stimulant plant. This paper (a) provides a historical overview of khat use, and (b) reviews the evidence for the existence of a causal link between khat use and mental illness. To do so, we undertook a detailed search of social and medical science databases for case reports, qualitative and quantitative articles on khat use and mental illness from 1945 to 2006. The validity and reliability of the studies that met our inclusion criteria were examined. Lastly, although highlighting health concerns about khat use we suggest that the debate about this popular drug in migrant populations carries elements of a 'moral panic'. There is a need for improved research on khat use and its possible association with psychiatric disorders.     

Explaining non-help-seeking amongst young adults with mental distress: a dynamic interpretive model of illness behaviour

Mental disorder is common amongst young adults and is associated with many adverse outcomes. Data, however, indicate that young adults are particularly unlikely to seek help for such distress. This paper describes a qualitative study of 23 young adults (aged 16 to 24 years) with mental distress. Interviewing was used to obtain detailed narratives of illness behaviour and to explore reasons for non-help-seeking. Help-seekers and non-help-seekers were interviewed. The findings allowed development of an explanatory model - the cycle of avoidance (COA) - which contributes towards attempts to provide a dynamic understanding of help-seeking behaviour. Dominant approaches tend to be deterministic and static and to account for non-help-seeking in terms of 'barriers' to care, which although easily translated into targets for policy intervention, are superficial representations of complex issues. The COA conceptualises help-seeking as a circular process and offers a model of 'non-help-seeking' in which lay conceptions of mental distress, the social meanings attached to 'help-seeking' and treatment, and the purposeful action of individuals, assume central importance. Although derived in the context of young adulthood and mental distress, this model may have wider applicability as a theoretical template for explaining non-help-seeking in other age groups and conditions, and other illness behaviours.     

Khat (Catha edulis) Chewing during Pregnancy in Yemen: Findings from a National Population Survey

Aims This study examines the prevalence of khat chewing among women during pregnancy and some of the risk factors for this habit in Yemen. Methods Survey data on 7,343 ever-married women from the Yemen Demographic and Maternal and Health Survey (YDMHS), conducted in 1997 are used. Women who had a live birth during the 5 years preceding the survey were asked if they chewed khat during each of their pregnancies (=1) or not (=0). Associations between chewing khat and socio-demographic risk factors were assessed using odds ratios from binary logistic regression models. Results About 40.7% of women surveyed reported chewing khat while pregnant during the 5 years before the survey. Old age, no education, rural residence, living in mountainous regions, and low wealth were significant risk factors for chewing khat. Conclusions Khat chewing during pregnancy is highly prevalent in Yemen. Socio-economically disadvantaged women were more likely to chew khat than other women.     

重性精神疾病患者肇事肇祸情况干预效果评估

目的 了解海宁市社区重性精神疾病患者肇事肇祸的现状及对比。方法 2010年9—11月对海宁市3 370例在册的重性精神疾病患者进行肇事肇祸危险性评估,并对肇事肇祸危险性评估等级≥1级的1 074例患者进行早期多部门联合干预,于2011年10—12月再次对1 074例患者进行肇事肇祸危险性评估并进行对比分析。结果 干预前后危险性评估1、2、3、4级人数差异均有统计学意义（P<0.05）;干预前后危险性评估≥1级的患者住院次数、监护人变化及服药情况差异有统计学意义（P<0.01）;干预前有肇事肇祸者198例（18.44%）,其中精神分裂症患者最多,为164例（82.83%）;干预后有肇事肇祸者76例（7.18%）,其中精神分裂症患者最多,为64例（84.20%）;干预前后肇事肇祸发生的次数及不良后果程度比较差异均有统计学意义（P<0.05）;干预前后有肇事肇祸的患者住院次数、服药情况差异有统计学意义（P<0.05）;干预前后有肇事肇祸者与无肇事肇祸者疾病种类、年龄、文化程度、病程、监护人变化以及服药依从性比较差异均有统计学意义（P<0.05）。结论 社区重性精神疾病患者的肇事肇祸现状通过政府、卫生、财政、民政、残联等多部门共同的监护和管治,肇事肇祸现状得到明显改善。     

Community perceptions of mental distress in a post-conflict setting: A qualitative study in Burundi

There is scant documentation of the mental health characteristics of low-income communities recovering from armed conflict. To prepare for quantitative health surveys and health service planning in Burundi, we implemented a qualitative study to explore concepts related to mental distress and coping among adults. Mental distress was defined as problems related to feelings, thinking, behaviour and physical stress. Using free listing and key informant interviews with a range of community members, we triangulated data to identify salient issues. Thirty-eight free list respondents and 23 key informants were interviewed in 5 rural communities in Burundi using 2 interview guides from the WHO Toolkit for Mental Health Assessment in Humanitarian Settings. Based on these interviews, we identified four locally defined idioms/terms relating to mental distress: ihahamuka (anxiety spectrum illnesses), ukutiyemera (a mix of depression and anxiety-like syndrome), akabonge (depression/grief-like syndrome) and kwamana ubwoba burengeje (anxiety-like syndrome). Mental distress terms were perceived as important problems impacting community development. Affected individuals sought help from several sources within the community, including community leaders and traditional healers. We discuss how local expressions of distress can be used to tailor health research and service integration from the bottom up.     

成都市重性精神疾病社区防治现况调查

目的了解成都市社区精神卫生服务及重性精神疾病社区防治工作开展情况。方法采用两阶段分层抽样方式,选取6个区县共16家社区卫生服务中心/乡镇卫生院进行问卷调查。结果不同圈层的重性精神疾病患者管理率、重性精神疾病患者规范管理率、管理患者肇事肇祸率及管理患者体检率等指标有较大差异。结论 （1）社区卫生服务中心在管理的规范性方面普遍好于乡镇卫生院,但乡镇卫生院在工作总量和工作的扎实程度上好于社区卫生服务中心;（2）一、三圈层工作开展情况好于二圈层。     

Interorganisational cooperation and its effects on community rehabilitation for people with severe mental disorders in Beijing,China: A case study

A national comprehensive management pilot project for mental health has been implemented in China to provide integrated care for people with severe mental disorders through strengthened cooperation among government organisations and between government and other relevant social organisations. The promotion of community rehabilitation has been included as a key part of this pilot program. The present study took the AD district of Beijing as a case study to examine interorganisational cooperation and its effects on community rehabilitation in a real-world setting. Interviews were conducted with 14 frontline workers, including 7 mental health workers from community health centres and 3 staff and 4 social workers working in rehabilitation centres. Five officials from relevant health and social welfare departments and a social work organisation were also interviewed. Experiences in Beijing revealed that interorganisational cooperation helped to build a multiagency workforce furnished with basic mental health knowledge at the community level, which rendered it possible for frontline workers to provide fundamental follow-up services, pilot the case management model of service provision and increase the provision of psychosocial rehabilitation services within the poorly resourced context of Chinese mental healthcare. Moreover, the engagement of social organisations provided bottom-up pressure to innovate through the active bringing forward of new ideas concerning cooperation and service delivery. However, differences in professional authority and commitment were observed. Health department officials and health professionals seemed to exercise a dominant role as compared to social welfare department officials and social workers. Future policy making should motivate social welfare department officials to improve social care for people with severe mental disorders. Social workers require training to improve their knowledge of mental health matters, and social organisations need greater latitude to strengthen their influence over the development of community rehabilitation services for people with severe mental disorders.     

Describing depression: ethnicity and the use of somatic imagery in accounts of mental distress

Past research has suggested that there are significant differences in the prevalence and progress of anxiety and depression in different ethnic groups in England and that patterns of help seeking also differ. In parallel, research has also reported distinctive differences in the language and representations of mental distress across different ethnic groups. Differences both in the expression of depression and underlying conceptual models of mental health and illness may be part of the explanation for different patterns of help seeking, as the accounts people give of their experience of health and illness, including the meaning they attach to symptoms and signs for example, have been shown to be an important mediator of the action they take to protect their health or to respond to ill health. In this paper we will use evidence from recent mixed-method research with people of Pakistani origin and white people living in a locality in northwest England to explore the constructions and representations of mental distress, and in particular the physical imagery and 'somatic metaphors' of narratives used by our respondents, and consider how these data might illuminate debates about the experience of mental ill health and help-seeking practices.     

Social comparison of distress and mental health help-seeking in the US general population

The role of social comparison of distress in the mental health help-seeking process remains largely unexplored. The aim of this study was to examine the association of socially compared distress with mental health help-seeking and perceived need for mental health care in a population sample. In 36,679 adult participants of the 2003 US National Survey on Drug Use and Health, data on 12-month help-seeking and perceived unmet need for care were compared between participants who described themselves as more worried, nervous or anxious than others vs. participants who described themselves as no more worried, nervous or anxious than others. Compared to participants who described themselves as no more worried, nervous or anxious, than others, those who described themselves as more worried, nervous or anxious were significantly more likely to seek professional help (adjusted odds ratio=1.84) or to perceive an unmet need for such help (adjusted odds ratio=1.44). It is concluded that social comparison of distress is a significant correlate of mental health help-seeking and perceived unmet need for such help. Individual variations in social comparison of distress may partly explain the discrepancy between need-as measured by non-compared distress-and help-seeking in the general population.     

Fear and Shame: using theatre to destigmatise mental illness in an Australian Macedonian community

In the article entitled ‘Fear and Shame: using theatre to destigmatise mental illness in an Australian Macedonian community’ by Blignault et al., an incorrect year was used. Page 124, col. 2, para 3, line 3 should read: When asked who they would contact for help if someone they knew was showing signs of mental illness, 84% of the overall sample nominated health workers or services in 2009 compared to 60% in 2003 (see Table 5).     

Nutrition and mental health research in Australia and New Zealand: A review of progress and directions for the future

This review summarises nutrition and mental health research in Australia and New Zealand between 1986 and 2006. The method used to identify papers for inclusion was a search of computerised databases: Medline, Cinahl and Meditext 1986–2006, with subsequent bibliographical review. Key search words were nutrition, diet, mental disorder, mental illness, weight, physical health, Australia and New Zealand. Inclusion criteria included: English language, original data in peer reviewed journals, and examination of some component of nutrition in people with a mental illness. The review of thirteen papers found that the evidence base for dietetic practice in mental health has developed through small assessment and interventional research, often with multidisciplinary collaboration. Future research should include quality and outcome measures with intersectoral partnerships. Dietitians are well positioned to lead and participate in mental health research and to implement research findings to improve the nutritional status of this vulnerable group.     

The quality of care provided to patients with chronic non-communicable diseases: a retrospective multi-setup study in jimma zone, southwest ethiopia

Background

Chronic Non-Communicable Diseases are among the major causes of morbidity and mortality worldwide. However, access to and quality of health care for patients is very low in developing countries including Ethiopia. Hospitals and Health Centers are the main sources of health care for such patients in Ethiopia. In this study we assessed the quality of care patients with Chronic Non-Communicable Diseases received in hospital and health center setups.

Methods

A retrospective multi-setup study was conducted in Jimma University Specialized Hospital and four Health Centers in Jimma Zone from February to March 2010. A total of 52 process indicators of quality covering three disease conditions: Diabetes, Hypertension and Epilepsy were measured by reviewing randomly selected medical records. Quality of care was measured as a proportion of recommended components of care actually provided to patients. And also outcome and structural measures were assessed to supplement process measures of quality.

Results

Six hundred seventy four medical records were reviewed. Recommended care components were actually provided to patients in 35.1% (95% CI:34.1%, 36.0%), 38.5% (95% CI:37.5%, 39.5%) and 60.1% (95% CI:59.3%, 61.0%) of times on which patients were eligible, among patients with Diabetes, Hypertension and Epilepsy, respectively. After case mix adjustment, it was found that 45.9% (95% CI:45.4%, 46.5%) of recommended components of care was actually provided to patients. This was 45.1% (95% CI:44.4%, 45.8%) in the hospital and 30.5% (95% CI:29.7%, 31.3%) in the health centers. Among patients for whom outcome data was available, optimal level of disease control was achieved only for 47 (30.5%), 40 (38.5%) and 193 (52.9%) of patients with Diabetes, Hypertension and Epilepsy, respectively.

Conclusion

The quality of care provided to patients with Chronic Non-Communicable Diseases is very low in both settings though it is relatively better in Jimma University Specialized Hospital. Therefore, a continuous process of quality improvement is recommended in both settings.     

The mental health workforce in the community: a comparison of national Community Psychiatric Nursing and Approved Social Work survey results

In the past it has not been possible to compare the distribution and workload of two of the main professional groups providing mental health care in the community, community psychiatric nurses (CPNs) and approved social workers (ASWs) because no adequate national data were available. Two recent surveys permit a limited degree of comparison between the characteristics of the two national workforces and the present paper summarizes the comparison which can be made from the two different data sets, in terms of the numbers of staff and rates per head of population, number of clients seen, caseload variations and training. Training for, and provision of, out-of-hours services by ASWs are more uniform, but there is much less variation per head of population in the numbers of CPNs than ASWs across the UK. The CPNs are almost certainly working with more people with serious mental illness. There is some suggestion, which needs further research, that, in numerical terms, there might be an element of substitution of one discipline for another in different regions of the country.     

Parenting a young person with mental health problems: temporal disruption and reconstruction

The article explores the experiences of parents living with a young person with mental health problems. Qualitative interviews were conducted with 25 parents (18 mothers and 7 fathers) whose child had a diagnosed psychiatric condition. It is argued that the parents engaged in a form of narrative reconstruction of their dual roles as parents and carers as they tried to make sense of the illness in their lives by reconstructing their past, present and future experiences. The concept 'responsibility' was threaded through the parents' narratives and is discussed in relation to three key dimensions - moral responsibility; causal responsibility; and responsibility for self. It is argued that the moral imperative to care for their child was the dominant theme in the parents' narratives but that this was challenged by their lack of knowledge of psychiatric conditions; their interactions with healthcare professionals; their relationships with their child; and their difficulties in coping with the extended parental responsibility that arose from their caring role.     

嚼槟榔与口腔癌关系的病例对照研究

目的 分析口腔癌发病的危险因素,并进一步探讨嚼槟榔与口腔癌的关系。 方法 采用以医院为基础的1:1病例对照研究方法,对2014年在湘潭市某综合医院确诊的口腔癌病例及同期该院其他科室就诊的非口腔疾病、非肿瘤病人共100对进行问卷调查。采用条件logistic回归对资料进行分析,计算OR值及95%CI,并分析嚼槟榔与吸烟、饮酒的交互作用。 结果 单因素条件logistic回归分析结果:吸烟(OR=3.441,95%CI:1.671～7.001,P=0.001)、饮酒(OR=3.010,95%CI:1.497～6.063,P=0.002)、嚼槟榔(OR=3.340,95%CI:1.423～7.844,P=0.006)是口腔癌的危险因素;而多因素条件logistic回归分析结果:吸烟(OR=2.700,95%CI:1.289～5.656,P=0.008)、饮酒(OR=2.257,95%CI:1.071～4.756,P=0.032)是口腔癌的危险因素,但未发现嚼槟榔(OR=2.070,95%CI:0.790～4.758,P=0.139)能独立升高口腔癌的发病风险。交互作用分析结果:嚼槟榔与吸烟(OR_相乘交互=0.696,95%CI:0.140～1.465,P=0.658)、饮酒(OR_相乘交互=1.416,95%CI:0.318～6.300,P=0.648)间不存在相乘交互作用。相加交互作用:嚼槟榔与吸烟之间不存在相加交互作用,相对超危险度比(RERI)的95%CI(-1.573～2.225),归因比(AP)的95%CI(-0.364～0.514)包括0,且交互作用指数(S)的95%CI (0.589～2.087)包括1。但嚼槟榔与饮酒之间存在相加交互作用,嚼槟榔且饮酒患口腔癌的危险性是不嚼槟榔不饮酒的5.034倍,RERI为2.263、AP为0.449、S为2.275。 结论 嚼槟榔、吸烟、饮酒都是口腔癌的主要危险因素。嚼槟榔与饮酒存在相加交互作用,可增加饮酒患口腔癌的发病风险。     

The outcomes of partnerships with mental health service users in interprofessional education: a case study

This paper reports findings from a 5-year evaluation (1998-2003) of a postqualifying programme in community mental health in England which made a sustained attempt to develop partnerships with service users. Users were involved in the commissioning of the programme and its evaluation, as trainers and as course members. The evaluation employed mixed methods to assess: learners' reactions to user-trainers and users as course members; changes in knowledge, attitudes and skills; and changes in individual and organisational practice. Data were collected from participant observation of training, 23 individual and 18 group interviews with students and their managers (n=13), and student ratings of knowledge and skills at the beginning and end of the programme (n=49). The quality of care provided by students was rated by service users (n=120) with whom they worked, using a user-defined questionnaire. The quality of care, and mental health and quality of life outcomes were compared to those for two comparison groups (n=44) in areas where no training had taken place. In general, the students reported positive learning outcomes associated with the partnership orientation of the programme, and learning directly from and with service users. A higher proportion of programme users reported good user-centred assessment and care planning, and showed greater improvement in life skills compared to the comparators. This case study provides evidence of the value of partnership working with service users in interprofessional postqualifying education in mental health. The success is attributed to the design of the programme and the responsiveness of the programme board, which included service users. It may provide a useful model for programmes elsewhere and for other user groups. The case study itself provides a possible model for the systematic evaluation of partnerships with users in education and training.     

A primary mental health-care model for rural Australia: outcomes for doctors and the community

ABSTRACT: To address the high rate of depression and suicide in rural Australia requires a multifaceted approach to educate the community, improve the skills of health workers and provide user-friendly patient counselling. The present paper describes a model that covers each of these aspects and details the outcomes with respect to the doctors and the community. Improved awareness in the community of mental illness and the availability of treatment, decreasing the stigma of such a diagnosis, and increasing the skills and reducing the isolation of doctors in rural areas who treat mental illness were all positive benefits from this cost-effective way of providing mental health care in a primary setting. The adoption of this model in all primary care settings is advocated.