Month: July 2020

Advancing E-Mental Health in Canada

Published on by Andrew Marshall1 Comment

Research Paper Title

Advancing E-Mental Health in Canada: Report From a Multistakeholder Meeting.

Background

The need for e-mental health (electronic mental health) services in Canada is significant.

The current mental health care delivery models primarily require people to access services in person with a health professional.

Given the large number of people requiring mental health care in Canada, this model of care delivery is not sufficient in its current form. E-mental health technologies may offer an important solution to the problem.

This topic was discussed in greater depth at the 9th Annual Canadian E-Mental Health Conference held in Toronto, Canada.

Themes that emerged from the discussions at the conference include:

  1. The importance of trust, transparency, human centredness, and compassion in the development and delivery of digital mental health technologies;
  2. An emphasis on equity, diversity, inclusion, and access when implementing e-mental health services;
  3. The need to ensure that the mental health workforce is able to engage in a digital way of working; and
  4. Co-production of e-mental health services among a diverse stakeholder group becoming the standard way of working.

Reference

Strudwick, G., Impey, D., Torous, J., Krausz, R.M. & Wiljer, D. (2020) Advancing E-Mental Health in Canada: Report From a Multistakeholder Meeting. JMIR Mental Health. 7(4), pp.e19360. doi: 10.2196/19360.

Can Probiotics Improve Mental Health Outcomes in Pregnant Women with Obesity?

Published on by Andrew Marshall1 Comment

Research Paper Title

Probiotics and Maternal Mental Health: A Randomised Controlled Trial among Pregnant Women with Obesity.

Background

Poor maternal mental health has been associated with a myriad of pregnancy and child health complications.

Obesity in pregnancy is known to increase one’s risk of experiencing poor maternal mental health and associated physical and mental health complications.

Probiotics may represent a novel approach to intervene in poor mental health and obesity.

Methods

The reseaschers conducted this pre-specified secondary analysis of the Healthy Mums and Babies (HUMBA) randomised controlled trial to investigate whether probiotics would improve maternal mental health outcomes up to 36 weeks of pregnancy.

Two-hundred-and-thirty pregnant women with obesity (BMI ≥ 30.0 kg/m2) were recruited and randomised to receive probiotic (Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12, minimum 6.5 × 109 CFU) or placebo capsules.

Depression, anxiety, and functional health and well-being were assessed at baseline (120-176 weeks’ gestation) and 36 weeks of pregnancy.

Results

Depression scores remained stable and did not differ between the probiotic (M = 7.18, SD = 3.80) and placebo groups (M = 6.76, SD = 4.65) at 36 weeks (p-values > 0.05).

Anxiety and physical well-being scores worsened over time irrespective of group allocation, and mental well-being scores did not differ between the two groups at 36 weeks.

Conclusions

Probiotics did not improve mental health outcomes in this multi-ethnic cohort of pregnant women with obesity.

Reference

Dawe, J.P., McCowan, L.M.E., Wilson, J., Okesene-Gafa, K.A.M. & Serlachius, A.S. (2020) Probiotics and Maternal Mental Health: A Randomised Controlled Trial among Pregnant Women with Obesity. Scientific Reports. 10(1), pp.1291. doi: 10.1038/s41598-020-58129-w.

What is the Effect of Urbanisation on Mental Health?

Published on by Andrew Marshall1 Comment

Research Paper Title

Urbanisation and emerging mental health issues.

Background

Rapid urbanisation worldwide is associated to an increase of population in the urban settings and this is leading to new emerging mental health issues.

This narrative mini-review is based on a literature search conducted through PubMed and EMBASE.

Methods

A total of 113 articles published on the issue of urban mental health have been selected, cited, reviewed, and summarised.

Results

There are emerging evidences about the association between urbanisation and mental health issues.

Urbanisation affects mental health through social, economic, and environmental factors.

It has been shown that common mental syndromes report higher prevalence in the cities.

Social disparities, social insecurity, pollution, and the lack of contact with nature are some of recognised factors affecting urban mental health.

Conclusions

Further research studies and specific guidelines should be encouraged to help policy makers and urban designers to improve mental health and mental health care facilities in the cities; additional strategies to prevent and reduce mental illness in the urban settings should be also adopted globally.

Reference

Ventriglio, A., Torales, J., Castaldelli-Maia, J.M., De Berardis, D. & Bhugra, D. (2020) Urbanization and emerging mental health issues. CNS Spectrums. 1-8. doi: 10.1017/S1092852920001236. Online ahead of print.

Proposing Principles for Designing the Built Environment of Mental Health Services

Published on by Andrew Marshall1 Comment

Research Paper Title

Principles for designing the built environment of mental health services.

Background

Although there is an increasing amount of literature on the key principles for the design of mental health services, the contribution of the built environment to outcomes for the service user is a largely neglected area.

To help address this gap, the authors present evidence that highlights the pivotal role of evidence-based architectural design in service users’ experience of mental health services.

They propose six important design principles to enhance the care of mental health service users.

Drawing on research into the delivery of mental health services and best-practice approaches to their architectural design, they outline a holistic conceptual model for designing mental health services that enhance treatment outcomes and experiences, provide benefits to families and the community, and promote community resilience.

In this Personal View, they argue that the design of mental health services needs to extend across disciplinary boundaries to integrate evidence-informed practice across individual, interpersonal, and community levels.

Reference

Liddicoat, S., Badcock, P. & Killackey, E. (2020) Principles for designing the built environment of mental health services. Lancet Psychiatry. doi: 10.1016/S2215-0366(20)30038-9. Online ahead of print.

What Does the Czech Republic Spend on Mental Health Care, and Where?

Published on by Andrew Marshall1 Comment

Research Paper Title

Expenditures on Mental Health Care in the Czech Republic in 2015.

Background

Expenditures on mental health care in the Czech Republic are not being published regularly, yet they are indispensable for evaluation of the ongoing reform of Czech mental health care.

The main objective of this study is to estimate the size of these expenditures in 2015 and make a comparison with the last available figures from the year 2006.

Methods

The estimation is based on an OECD methodology of health accounts, which structures health care expenditures according to health care functions, provider industries, and payers.

The expenditures are further decomposed according to diagnoses, and inputs used in service production.

Results

The amount spent on mental health care in 2015 reached more than 13.7 billion Czech korunas (EUR 501.6 million), which represented 4.08% of the total health care expenditures.

This ratio is almost identical with the 2006 share (4.14%).

There are no significant changes in the relative expenditures on mental health care and in the structure of service provision.

Conclusions

The Czech mental health care system remains largely hospital based with most of all mental health care expenditures being spent on inpatient care.

Future developments in the expenditures will indicate the success of the current effort to deinstitutionalise mental health care.

Reference

Broulikova, H.M., Dlouhy, M. & Winkler, P. (2020) Expenditures on Mental Health Care in the Czech Republic in 2015. The Psychiatric Quarterly. 91(1), pp.113-125. doi: 10.1007/s11126-019-09688-3.

Do Adults Experiencing Mental Illness & Homelessness follow Distinct Stigma & Discrimination Group Trajectories based on their Mental Health-problems?

Published on by Andrew Marshall1 Comment

Research Paper Title

Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness.

Background

Stigma and discrimination toward individuals experiencing homelessness and mental disorders remain pervasive across societies. However, there are few longitudinal studies of stigma and discrimination among homeless adults with mental illness.

This study aimed to identify the two-year group trajectories of stigma and discrimination and examine the predictive role of mental health characteristics among 414 homeless adults with mental illness participating in the extended follow-up phase of the Toronto At Home/Chez Soi (AH/CS) randomised trial site.

Methods

Mental health-related perceived stigma and discrimination were measured at baseline, one, and two years using validated scales.

Group-based-trajectory modelling was used to identify stigma and discrimination group trajectory memberships and the effect of the Housing First treatment (rent supplements and mental health support services) vs treatment as usual on these trajectories.

The associations between mental health-related characteristics and trajectory group memberships were also assessed using multinomial logistic regression.

Results

Over two-years, three group trajectories of stigma and discrimination were identified.

For discrimination, participants followed a low, moderate, or increasingly high discrimination group trajectory, while for stigma, participants followed a low, moderate or high stigma group trajectory.

The Housing First treatment had no significant effect on discrimination or stigma trajectories groups.

For the discrimination trajectories, major depressive episode, mood disorder with psychotic features, alcohol abuse, suicidality, severity of mental health symptoms, and substance use severity in the previous year were predictors of moderate and increasingly high discrimination trajectories.

History of discrimination within healthcare setting was also positively associated with following a moderate or high discrimination trajectory.

For the stigma trajectories, substance dependence, high mental health symptoms severity, substance use severity, and discrimination experiences within healthcare settings were the main predictors for the moderate trajectory group; while substance dependence, suicidality, mental health symptom severity, substance use severity and discrimination experiences within health care setting were also positive predictors for the high stigma trajectory group.

Ethno-racial status modified the association between having a major depression episode, alcohol dependence, and the likelihood of being a member of the high stigma trajectory group.

Conclusions

This study showed that adults experiencing mental illness and homelessness followed distinct stigma and discrimination group trajectories based on their mental health-problems.

There is an urgent need to increase focus on strategies and policies to reduce stigma and discrimination in this population.

Reference

Mejia-Lancheros, C., Lachaud, J., O’Campo, P., Wiens, K., Nisenbaum, R., Wang, R., Hwang, S.W. & Stergiopoulos, V. (2020) Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PLoS One. 15(2), pp.e0229385. doi: 10.1371/journal.pone.0229385. eCollection 2020.

Can High-Intensity Interval Training Improve Physical & Mental Health Outcomes?

Published on by Andrew Marshall1 Comment

Research Paper Title

Can high-intensity interval training improve physical and mental health outcomes? A meta-review of 33 systematic reviews across the lifespan.

Background

High-intensity-interval-training (HIIT) has been suggested to have beneficial effects in multiple populations across individual systematic reviews, although there is a lack of clarity in the totality of the evidence whether HIIT is effective and safe across different populations and outcomes.

The aim of this meta-review was to establish the benefits, safety and adherence of HIIT interventions across all populations from systematic reviews and meta-analyses.

Methods

Major databases were searched for systematic reviews (with/without meta-analyses) of randomised & non-randomised trials that compared HIIT to a control.

Thirty-three systematic reviews (including 25 meta-analyses) were retrieved encompassing healthy subjects and people with physical health complications.

Results

Evidence suggested HIIT improved cardiorespiratory fitness, anthropometric measures, blood glucose and glycaemic control, arterial compliance and vascular function, cardiac function, heart rate, some inflammatory markers, exercise capacity and muscle mass, versus non-active controls.

Compared to active controls, HIIT improved cardiorespiratory fitness, some inflammatory markers and muscle structure.

Improvements in anxiety and depression were seen compared to pre-training.

Additionally, no acute injuries were reported, and mean adherence rates surpassed 80% in most systematic reviews.

Conclusions

Thus, HIIT is associated with multiple benefits.

Further large-scale high-quality studies are needed to reaffirm and expand these findings.

Reference

Martland, R., Mondelli, V., Gaughran, F. & Stubbs, B. (2020) Can high-intensity interval training improve physical and mental health outcomes? A meta-review of 33 systematic reviews across the lifespan. Journal of Sports Sciences. 38(4), pp.430-469. doi: 10.1080/02640414.2019.1706829. Epub 2019 Dec 31.

Outlining Tele-Mental Health & In-Person Care

Published on by Andrew Marshall1 Comment

Research Paper Title

Use of Tele-Mental Health in Conjunction With In-Person Care: A Qualitative Exploration of Implementation Models.

Background

Although use of tele-mental health services is growing, there is limited research on how tele-mental health is deployed.

This project aimed to describe how health centres use tele-mental health in conjunction with in-person care.

Methods

The 2018 Substance Abuse and Mental Health Services Administration Behavioural Health Treatment Services Locator database was used to identify community mental health centres and federally qualified health centres with telehealth capabilities.

Maximum diversity sampling was applied to recruit health centre leaders to participate in semi-structured interviews.

Inductive and deductive approaches were used to develop site summaries, and a matrix analysis was conducted to identify and refine themes.

Results

Twenty health centres in 14 states participated. All health centres used telepsychiatry for diagnostic assessment and medication prescribing, and 10 also offered therapy via telehealth.

Some health centres used their own staff to provide tele-mental health services, whereas others contracted with external providers. In most health centres, tele-mental health was used as an adjunct to in-person care.

In choosing between tele-mental health and in-person care, health centres often considered patient preference, patient acuity, and insurance status or payer.

Although most health centres planned to continue offering tele-mental health, participants noted drawbacks, including less patient engagement, challenges sharing information within the care team, and greater inefficiency.

Conclusions

Tele-mental health is generally used as an adjunct to in-person care.

The results of this study can inform policy makers and clinicians regarding the various delivery models that incorporate tele-mental health.

Reference

Uscher-Pines, L., Raja, P., Qureshi, N., Huskamp, H.A., Busch, A.B. & Mehrotra, A. (2020) Use of Tele-Mental Health in Conjunction With In-Person Care: A Qualitative Exploration of Implementation Models. Psychiatric Services (Washington, D.C.). 71(5), pp.419-426. doi: 10.1176/appi.ps.201900386. Epub 2020 Jan 30.

Could an ‘Apple a Day’ Keep the (Mental Health) Doctor Away?

Published on by Andrew Marshall1 Comment

Research Paper Title

Fruit and vegetables intake in adolescents and mental health: a systematic review.

Background

The proper nutrition is indicated as a factor of a potential importance for the mental health early in life span, and among the potential products, which may influence, there are fruit and vegetables.

Therefore the purpose of this study was to conduct a systematic review of the observational studies analysing the association between the fruit and vegetables intake and the mental health in adolescents.

Methods

On the basis of PubMed and Web of Science databases, the papers presenting human studies and published in English until June 2019, analysing the association between intake of fruit and/ or vegetables, as well as related products (e.g. juices) and the mental health were included to the systematic review, while they analysed a group of adolescents.

Results

Based on the conducted systematic review, 17 studies were indicated as those which assess the influence of fruit and vegetables intake on the mental health in adolescents. For the assessment of mental health, diverse variables were taken into account, including positive (happiness, self-esteem), neutral (health-related quality of life, mental health status), and negative ones (loneliness, general difficulties, feeling worried, anxiety, stress and distress, depressive symptoms, depression, suicidal behaviours).

Conclusions

Based on the conducted systematic review of observational studies, it may be indicated that in a groups of adolescents there was a positive association between intake of fruit and vegetable products and mental health.

Especially beneficial for general mental health in adolescents, were such products as green vegetables, yellow vegetables and fresh fruit.

Reference

Glabska, D., Guzek, D., Groele, B. & Gutkowska, K. (2020) Fruit and vegetables intake in adolescents and mental health: a systematic review. Roxzniki Pantstwowego Zakladu Higieny. 71(1), pp.15-25. doi: 10.32394/rpzh.2019.0097.

Examining National Trends in the Care of Different Mental Health Problems & in Different Treatment Settings among Adolescents

Published on by Andrew Marshall1 Comment

National Trends in Mental Health Care for US Adolescents.

Background

The prevalence of adolescent depression and other internalising mental health problems has increased in recent years, whereas the prevalence of externalising behaviours has decreased. The association of these changes with the use of mental health services has not been previously examined.

Therefore, the purpose of this study was to examine national trends in the care of different mental health problems and in different treatment settings among adolescents.

Methods

Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analysed from July 20 to December 1, 2019.

Time trends in 12-month prevalence of any mental health treatment or counselling in a wide range of settings were examined overall and for different:

  • Sociodemographic groups;
  • Types of mental health problems (internalising, externalising, relationship, and school related); and
  • Treatment settings (inpatient mental health, outpatient mental health, general medical, and school counselling).

Trends in the number of visits and nights in inpatient settings were also examined.

Results

A total of 47,090 of the 230,070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years.

The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002).

Internalising problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalising problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions.

During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counselling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001).

Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased.

Conclusions

This study’s findings suggest that the growing number of adolescents who receive care for internalising mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Reference

Mojtabai, R. & Olfson, M. (2020) National Trends in Mental Health Care for US Adolescents. JAMA Psychiatry. 77(7), pp.1-12. doi: 10.1001/jamapsychiatry.2020.0279. Online ahead of print.

Research Paper Title

National Trends in Mental Health Care for US Adolescents.

Background

The prevalence of adolescent depression and other internalising mental health problems has increased in recent years, whereas the prevalence of externalising behaviours has decreased. The association of these changes with the use of mental health services has not been previously examined.

Therefore, the purpose of this study was to examine national trends in the care of different mental health problems and in different treatment settings among adolescents.

Methods

Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analysed from July 20 to December 1, 2019.

Time trends in 12-month prevalence of any mental health treatment or counselling in a wide range of settings were examined overall and for different:

  • Sociodemographic groups;
  • Types of mental health problems (internalising, externalising, relationship, and school related); and
  • Treatment settings (inpatient mental health, outpatient mental health, general medical, and school counselling).

Trends in the number of visits and nights in inpatient settings were also examined.

Results

A total of 47,090 of the 230,070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years.

The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002).

Internalising problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalising problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions.

During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counselling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001).

Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased.

Conclusions

This study’s findings suggest that the growing number of adolescents who receive care for internalising mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Reference

Mojtabai, R. & Olfson, M. (2020) National Trends in Mental Health Care for US Adolescents. JAMA Psychiatry. 77(7), pp.1-12. doi: 10.1001/jamapsychiatry.2020.0279. Online ahead of print.