The challenges of integration in health care research

The team approach in neuroscience patient care results in health care professionals interacting on a daily basis. However, the collaboration of health care disciplines in research is limited. The barrier to research integration among disciplines may be related to the diverse views of the quantitative and qualitative paradigms. Health care research is challenged by both the variety of health professionals and differing research paradigms. Patients will benefit from integrated health care research with a coordinated research agenda and efficient use of resources.     

Disaster Mental Health Epidemiology: Methodological Review and Interpretation of Research Findings

Worldwide, disasters are increasing in frequency and severity. Mental health consequences of disasters are extensive, and knowledge of anticipated mental health effects is needed for effective disaster response. Difficulties inherent in conducting disaster research have limited the understanding of research findings. This article presents and interprets disaster mental health research findings in the context of research methods. A brief history of the disaster mental health research field is provided, and the presentation of findings is ordered into topical areas of disaster mental health consequences and timing and prediction of mental health outcomes. Results of different studies varied greatly by several main characteristics of research methods, especially methods of psychiatric assessment, sampling and exposure group determination, and consideration of confounding variables. In conclusion, many complexities in conducting disaster mental health research have limited the understanding and interpretation of available knowledge needed to inform efforts to plan and carry out effective mental health responses to disasters. Thoughtful interpretation of findings in the context of research design and methods is vital to accurate understanding of the types, prevalence, and predictors of anticipated mental health effects of disasters. A wealth of knowledge from disaster mental health research has accumulated in recent decades, but more research is still needed to resolve inconsistent findings through methodological refinements.     

Translational research in multiple sclerosis

Translational research has become a challenge for the health care administration and Neurology Departments. The need to incorporate the results of basic research into the clinical setting and, vice versa, the orientation of basic research from the knowledge arising from clinical research, implies a new way of looking at the research concept. It also makes it necessary to reconsider the clinical health care and research infrastructures together with a need to define the functions health care neurologists and their involvement in the research tasks. Multiple sclerosis, due to its heterogeneous character, that is, clinical, pathogenic and pathological, is a paradigm of how translational research should help to improve knowledge of the clinical phenomena and to elaborate the therapeutic proposals based on said knowledge.     

Den nordiska planeringsgruppen för psykiat risk hälso-och sjukvårdsforskning

Lehtinen V. The Nordic planning group on psychiatric health services research.

The motivation for and activities of a special Nordic planning group for psychiatric health services research are described in the article. The reorganization and development of the mental health service is a key issue in all Nordic countries. There exists a great need for research as a basis for this development. A close Nordic cooperation in this field is clearly motivated by the fact that the structure of the mental health service and its development show both common and different traits in a very interesting manner in the various countries. The planning group started in 1986, and so far it has had six meetings. The group started by collecting information on the existing psychiatric health services research in the Nordic countries. A comparative document on the organization of the mental health service in these countries is in preparation. The group has also been active in research training by organizing a joint Nordic 8-day course on psychiatric health services research. A second course was held in June 1989. Furthermore, the group organized a symposium on its theme during the Nordic Congress of Psychiatry in Reykjavik in August 1988. A special symposium on the role of relatives in health service is planned, together with another Nordic planning group for general health services research. Further support for the psychiatric health services research in the Nordic countries is needed also in the future.     

Adapting evidence-based mental health treatments in community settings: preliminary results from a partnership approach

This article describes the application of a university-community partnership model to the problem of adapting evidence-based treatment approaches in a community mental health setting. Background on partnership research is presented, with consideration of methodological and practical issues related to this kind of research. Then, a rationale for using partnerships as a basis for conducting mental health treatment research is presented. Finally, an ongoing partnership research project concerned with the adaptation of evidence-based mental health treatments for childhood internalizing problems in community settings is presented, with preliminary results of the ongoing effort discussed.     

Translating knowledge to practice: optimizing the use of guidelines

Guidelines support health care decision-making but continue to be underused, therefore more research is needed on how they can be better developed and implemented. The same is true of mental health care, for which there is recent growing interest in improving care delivery and associated outcomes by optimizing the use of mental health care guidelines. This editorial describes the key concepts from accumulated research on guideline implementation to suggest a number of avenues for research on implementation of mental health care guidelines.     

Research priorities in mental health

Setting research priorities becomes necessary when the demand for research funds outstrips the supply; because it is impossible to do everything some topics must be chosen as more promising and pertinent than others. This paper proposes a scheme for estimating the relative merits of different branches of research within the whole field of mental health. The scheme for assessing the claims of each area is based upon three factors: the need for research in a particular topic (using data about prevalence of disorders; the costs attributable to disorders; and the like); the possibilities of doing good science; the estimated time to a clinical payoff. It is argued that reasonable assessments of these three factors can be combined to give a relative weight to any particular research area. The judgements of relative weight can be progressively improved as more data becomes available. The argument is put that one way to obtain more funds for mental health research overall is to improve the ordering of the different areas within the field of mental health. Once mental health has its house in order it will be better equipped to make the case for mental health research.     

Factors that influence state funding for mental health research

A 50-state survey was conducted to identify the extent of and the factors associated with states' funding of mental health research. Of the 49 states responding, 28 funded mental health research. Funds for research represented about .3 percent of total state expenditures for mental health. More populous states were more likely to fund mental health research. A moderately high correlation was found between state funding for research and federal research funding, and a modest but statistically significant correlation was found between state funding for research and total state expenditures for mental health. No correlation was found between state mental health research funding and state per capita mental health expenditures. Political environments supportive of mental health research were characterized by budget stability, articulate and committed leaders, and active citizen advocacy.     

Applying evidence to patient care: From population health to individual patient values

What are the health status and health needs of people with epilepsy? How do clinicians and patients choose between alternative interventions for the same condition? Are health interventions used effectively in the community, and do they improve health? How can we translate findings from regulatory clinical trials to the real world? These and similar questions are the subject of applied translational research. This evolving and broad-ranging area of research involves the application of basic sciences such as epidemiology, biostatistics, economics, and behavioral science to the assessment of health, health interventions, and outcomes. However, despite its palpable importance, applied translational research remains underfunded and underutilized. Using their own innovative research as a prototype, two young and promising investigators provide insights not only into the enormous potential but also the gaps and hurdles of two specific areas of applied translational research, i.e., clinical decision analysis and health services research. The message is clear that if we are to understand and improve the health of people with epilepsy in clinics, hospitals, and communities, we must substantially increase research capacity to address the many gaps that thwart our progress in applied research in epilepsy.This article is part of a Special Issue entitled “The Future of Translational Epilepsy Research”.     

Cultural psychiatry and epidemiology: researching the means, methods and meanings

This article describes my developing interest in cultural psychiatry. This is both a challenging and yet a privileged opportunity to reflect on my research and clinical work over the last 25 years. I describe cultural and interpersonal influences on my thinking and interests, and the development of my research career moving from health services research of specialist services, to primary care research to public mental health research. Specifically, social and cultural influences on risks and responses to mental illness are discussed, as are pathways to care, the recognition of mental illness, and public health and cultural psychiatry research.     

Interdisciplinary research framework for multisectoral mental health policy development

This paper proposes an interdisciplinary research framework for developing mental health policy in countries where a multisectoral approach to population mental health is not yet on the policy agenda. The proposed mental health policy research framework contains two structural elements: research on the policy content and policy process dimensions. The content dimension defines mental health policy as being a multisectoral policy encompassing positive mental health for all, the prevention and treatment of mental disorders, and the social and human rights consequences of poor mental health. The process dimension is based on the cyclical model of policy processes as described by Kingdon’s theory of agenda-setting and Rochefort’s analysis of the factors which affect mental health policy-making. The framework presents an innovative approach to researching mental health policy, bringing a more interdisciplinary focus and an explicit emphasis on policy-making.     

Developing partnerships in mental health to bridge the research-practitioner gap

PURPOSE. An overview of approaches used in contemporary mental health research to consider when coordinating research agendas is presented. Connections between the research–practice gap and evidence‐based practice are explored. Collaboration, as a key concept and practice, is investigated particularly in relation to community and consumer participation in mental health research. CONCLUSIONS. Non‐commensurate belief systems, inadequate infrastructure, and institutional tendencies maintain the status quo and constitute significant impediments to widespread planned and integrated research programs. PRACTICE IMPLICATIONS. Communication and trust building between researchers and practitioners is central to developing effective collaborations that can deliver more effective health care.     

Reducing the scarcity in mental health research from low and middle income countries: a success story from Sri Lanka

There is an enormous inequity in global health as well as research. Less than 10% of research funds are spent on the diseases that account for 90% of the global disease burden. This case study of north-south, south-south collaborations in Sri Lanka is a classic example of the issues faced by mental health researchers in low and middle income countries (LMICs). In this paper, work carried out by the Institute of Psychiatry (IoP), King's College London and the Institute for Research and Development (IRD) partnership since 1997 in Sri Lanka is presented to show an example of a successful private research institution based in a LMIC as a product of south-south and north-south collaboration in mental health research. The evidence of scarcity of mental health research and resources is overwhelmingly abundant in the context of Sri Lanka. IRD-IoP partnership showcases a successful north-south partnership with equality and efficiency. It has moved beyond start-up phase and has become a sustainable initiative in terms of funding, collaboration, research output and policy impact. International funding agencies, academics, and other bodies need to address sustaining such initiatives as priorities in reducing scarcity and inequity in mental health research in developing countries.     

A Future Research Agenda for Digital Geriatric Mental Healthcare

The proliferation of mobile, online, and remote monitoring technologies in digital geriatric mental health has the potential to lead to the next major breakthrough in mental health treatments. Unlike traditional mental health services, digital geriatric mental health has the benefit of serving a large number of older adults, and in many instances, does not rely on mental health clinics to offer real-time interventions. As technology increasingly becomes essential in the everyday lives of older adults with mental health conditions, these technologies will provide a fundamental service delivery strategy to support older adults’ mental health recovery. Although ample research on digital geriatric mental health is available, fundamental gaps in the scientific literature still exist. To begin to address these gaps, we propose the following recommendations for a future research agenda: 1) additional proof-of-concept studies are needed; 2) integrating engineering principles in methodologically rigorous research may help science keep pace with technology; 3) studies are needed that identify implementation issues; 4) inclusivity of people with a lived experience of a mental health condition can offer valuable perspectives and new insights; and 5) formation of a workgroup specific for digital geriatric mental health to set standards and principles for research and practice. We propose prioritizing the advancement of digital geriatric mental health research in several areas that are of great public health significance, including 1) simultaneous and integrated treatment of physical health and mental health conditions; 2) effectiveness studies that explore diagnostics and treatment of social determinants of health such as “social isolation” and “loneliness;” and 3) tailoring the development and testing of innovative strategies to minority older adult populations.     

Evaluative research in community mental health

This paper compares evaluative research to program evaluation by defining and describing each. A case example using the scientific design and methodology of evaluative research to evaluate a specific community mental health program is also presented. Project design is discussed in light of the awareness that the mental health needs of communities do not always bend to fit the requisite of precise scientific procedure. Some ideas on methodological considerations reflect that normal research tools can be useful to achieve a valid study. Implications for the application of evaluative research to community mental health needs are also identified.     

Active involvement of people with intellectual disabilities in health research – A structured literature review

Actively involving people with intellectual disabilities (ID) in health research, also known as inclusive health research, is increasingly popular. Currently, insight into experiences of this type of research is scarce. To gain insight into this topic, a structured literature review was conducted focussing on (1) existing theories, (2) inclusive methods, (3) added value and (4) barriers and facilitators. Literature published between January 2000 and January 2014 was included covering keywords related to ID and inclusive health research. Searches were performed in Pubmed, CINAHL, PsycINFO, EMBASE and MEDLINE databases, resulting in 26 included papers. Papers were quality assessed and analysed using qualitative data analysis software. Four theories were often simultaneously addressed: participatory research, emancipatory research, inclusive research and Arnstein's ladder. Barriers and facilitators could be divided into preparing, undertaking and finalising phases of research. Authors indicated that their motivation to conduct inclusive health research was based on demands by policy and funding bodies or was based on ethical considerations (i.e., ethical notions and giving people with ID a voice). Upon completion, authors perceived increased quality and validity of their research and several benefits for stakeholders (i.e., people with ID, researchers and healthcare professionals). Overall, there was consistency in their perception of the most important aspects of inclusive health research. Based on the analysis of included papers, four recommendations of inclusive health research with people with ID were found. Inclusive health research should be: (1) tailoring to the specific study; (2) anticipating all stakeholders; (3) considering its added value; and (4) providing insight into its process.     

Measuring sexual health: preliminary development of a sexual health inventory

The sexual health model is a conceptual framework that posits 10 key components of healthy human sexuality. An initial scale was developed to measure the sexual health as conceptualized by Robinson et al. Building on that research, this article describes the exploratory factor analysis examining the underlying structure of the sexual health model as measured by the sexual health inventory. A shorter-efficient sexual health inventory is presented that might be helpful in research and clinical settings. These preliminary findings reaffirm that the sexual health inventory is measurable and has statistical validity.     

Research,empiricism and clinical practice in low-income countries

Mental health problems are relevant for every country. They are particularly important for low-income countries which face a high burden of illness due to infectious disease, greater socio-economic disparities, and have limited resources for mental health care. There is a great mismatch in the areas of mental health research, practice, policy and services in comparison to developed countries. There have been a few studies that have investigated major mental health problems prevailing in these countries but missed out significant health problems. Studies have tended to be more donor driven and conducted in tertiary centres. The low priority accorded to mental health by the policy makers, scarcity of human resources, lack of culture-specific study instruments, lack of support from scientific journals have been some of the impediments to mental health research in these countries. In addition, lack of community participation and absence of sound mental health policies have deprived the vast majority of the benefit of modern psychiatric treatments. Recently, with increase in collaboration in research, availability of treatment including low-priced psychotropics, and a growing emphasis on the need for mental health policy in some low-income countries, the bleak scenario is expected to change.     

Posttraumatic stress disorder, hostility, and health in women: A review of current research

A large body of evidence indicates that hostility is related to increased morbidity and mortality and evidence is growing that posttraumatic stress disorder (PTSD) is associated with poorer health outcomes. The majority of this research, however, has been conducted in male samples. As a result, the connections between PTSD and hostility and the ramifications of these variables on health in women are less clear. We review the current literature examining PTSD, hostility, and health in women and discuss possible mechanisms underlying the relationship between PTSD and hostility on health outcomes in the context of a proposed theoretical model. Although the current literature suggests that hostility and PTSD are related to health in women, more rigorous, focused research is lacking. A number of suggestions for future research are provided.     

Research priorities in mental health,Part 2: an evaluationof the current research effort against stakeholders' priorities

OBJECTIVE: To examine the current distribution of mental health research in Australia and compare this with the priorities of various stakeholder groups. METHOD: A content analysis was carried out on a year's worth of published articles and a year's worth of competitive research grants. A questionnaire for stakeholders was developed in which respondents were asked to rate priorities for research using the same categories. Questionnaires were sent to mental health researchers,members of panels that evaluate mental health research grant applications,general practitioners, psychiatrists, clinical psychologists, mental health nurses, mental health consumer and carer advocates, and members of the National Mental Health Working Group. RESULTS: Different groups of stakeholders tended to have differing perspectives on research priorities, with some major differences between committees that evaluate research grants and consumer and carer groups. Different stakeholder groups also tended to obtain their information about research from different sources. However, there were also a number of areas of agreement. When different research topics are considered,the following tended to be under-researched: affective disorders,suicide, primary care and community settings, prevention and promotion,evaluation of services, Aboriginal and Torres Strait Islander peoples,and socially and economically disadvantaged people. CONCLUSIONS: It is of concern that committees that evaluate research are guided by different values from consumers and carers in setting priorities. Nevertheless, there is consensus across stakeholder groups that a number of areas should be a high priority.