Month: July 2020

Is There a Mental Health Crisis among Canadian Postsecondary Students?

Published on by Andrew Marshall1 Comment

Research Paper Title

Mental Health among Canadian Postsecondary Students: A Mental Health Crisis?

Background

Recent reports express concerns about a mental health crisis among postsecondary students. These assertions, however, often arise from surveys conducted in postsecondary settings that lack the broader context of a referent group. The objectives of this study were:

  • To assess the mental health status of postsecondary students 18 to 25 years old from 2011 to 2017; and
  • To compare the mental health status of postsecondary students to nonstudents.

Methods

Prevalence was estimated for a set of mental health outcomes using seven annual iterations of the Canadian Community Health Survey (2011 to 2017). Logistic regression was used to derive odds ratio estimates comparing mental health status among postsecondary students and nonstudents, adjusting for age and sex. Random effects metaregression and meta-analyses techniques were used to evaluate trends in prevalence and odds ratio estimates over time.

Results

Over the study period, the prevalence of perceived low mental health, diagnosed mood and anxiety disorders, and past-year mental health consultations increased among female students, whereas binge drinking decreased among male students. With the exception of perceived stress, the odds of experiencing each mental health outcome were lower among postsecondary students compared to nonstudents.

Conclusions

These findings do not support the idea that postsecondary students have worse mental health than nonstudents of similar age. The perception of a crisis may arise from greater help-seeking behaviour, diminishing stigma, or increasing mental health literacy. Regardless, the observance of these trends provide an opportunity to address a previously latent issue.

Reference

Wiens, K., Bhattarai, A., Dores, A., Pedram, P., Williams, J.V.A., Bulloch, A.G.M. & Patten, S.B. (2020) Mental Health among Canadian Postsecondary Students: A Mental Health Crisis? Canadian Journal of Psychiatry. 65(1), pp.30-35. doi: 10.1177/0706743719874178. Epub 2019 Sep 4.

Changing Attitudes & Stigma toward Mental Health in Nursing Students

Published on by Andrew Marshall2 Comments

Research Paper Title

Attitudes and stigma toward mental health in nursing students: A systematic review.

Background

This systematic review seeks to ascertain whether mental health-specific education reduces stigmatising attitudes in nursing students.

Methods

A systematic review of the literature was performed.

Results

Thirteen studies met the inclusion criteria.

Most of the results show an improvement in attitudes toward mental health, both in theory and clinical experience, but a greater improvement toward these stigmatising attitudes was observed in clinical placements than in theory.

Conclusions

Mental-health-specific training seems to improve perceptions toward mental health.

Clinical placement underpins theory, leading to a decrease in negative attitudes and stigma regarding mental health.

Reference

Palou, R.G., Vigue, G.P. & Tort-Nasarre, G. (2020) Attitudes and stigma toward mental health in nursing students: A systematic review. Perspectives in Psychiatric Care. 56(2), pp.243-255. doi: 10.1111/ppc.12419. Epub 2019 Jul 28.

Could Programmes to Improve Mental Health Literacy Facilitate Formal as well as Informal Help-seeking among Unemployed Persons with Mental Health Problems?

Published on by Andrew Marshall1 Comment

Research Paper Title

Mental health literacy and help-seeking among unemployed people with mental health problems.

Background

Unemployed people with mental health problems often do not use available mental health services.

Help-seeking may depend on knowledge, recognition and attitudes associated with mental health – a concept referred to as mental health literacy (MHL).

Therefore the aim of this study was to investigate the influence of MHL on help-seeking intentions and behaviours among unemployed individuals with mental health problems.

Methods

A total of 301 unemployed individuals with mental health problems were recruited mainly from employment agencies in Southern Germany.

MHL was assessed by the Mental Health Knowledge Schedule (MAKS), the Depression Literacy Scale (DLS), and the Depression with Suicidal Thoughts Vignette.

Help-seeking intentions and behaviours were measured using the General Help-Seeking Questionnaire (GHSQ).

Associations between MHL and help-seeking intentions and behaviours were tested using regression analyses and structural equation modelling (SEM).

Results

All three MHL scales were significantly positively associated with help-seeking intentions and behaviors.

In their SEM model, greater MHL was significantly associated with increased intentions and behaviours to seek help from health professionals (formal help) and from family and friends (informal help).

Conclusions

Among unemployed persons with mental health problems, programmes to improve MHL could facilitate formal as well as informal help-seeking.

Future research should examine the efficacy of MHL-interventions to increase help-seeking.

Reference

Waldmann, T., Staiger, T., Oexle, N. & Rusch, N. (2020) Mental health literacy and help-seeking among unemployed people with mental health problems. Journal of Mental Health (Abingdon, England). 29(3), pp.270-276. doi: 10.1080/09638237.2019.1581342. Epub 2019 Mar 12.

Is Having a Mental Health Disorder Associated with Spending More on other Medical Conditions?

Published on by Andrew Marshall1 Comment

Research Paper Title

Association of Mental Health Disorders With Health Care Spending in the Medicare Population.

Background

The degree to which the presence of mental health disorders is associated with additional medical spending on non-mental health conditions is largely unknown.

Therefore, the purpose of this study was to determine the proportion and degree of total spending directly associated with mental health conditions vs spending on other non-mental health conditions.

Methods

This retrospective cohort study of 4 358 975 fee-for-service Medicare beneficiaries in the US in 2015 compared spending and health care utilisation among Medicare patients with serious mental illness (SMI; defined as bipolar disease, schizophrenia or related psychotic disorders, and major depressive disorder), patients with other common mental health disorders (defined as anxiety disorders, personality disorders, and post-traumatic stress disorder), and patients with no known mental health disorders. Data analysis was conducted from February to October 2019.

Exposure: Diagnosis of an SMI or other common mental health disorder.

Main outcomes and measures: Risk-adjusted, standardised spending and health care utilisation. Multi-variable linear regression models were used to adjust for patient characteristics, including demographic characteristics and other medical co-morbidities, using hospital referral region fixed effects.

Results

Of 4,358,975 Medicare beneficiaries, 987,379 (22.7%) had an SMI, 326,991 (7.5%) had another common mental health disorder, and 3,044,587 (69.8%) had no known mental illness.

Compared with patients with no known mental illness, patients with an SMI were younger (mean [SD] age, 72.3 [11.6] years vs 67.4 [15.7] years; P < .001) and more likely to have dual eligibility (633 274 [20.8%] vs 434 447 [44.0%]; P < .001).

Patients with an SMI incurred more mean (SE) spending on mental health services than those with other common mental health disorders or no known mental illness ($2024 [3.9] vs $343 [6.2] vs $189 [2.1], respectively; P < .001).

Patients with an SMI also had substantially higher mean (SE) spending on medical services for physical conditions than those with other common mental health disorders or no known mental illness ($17 651 [23.6] vs $15 253 [38.2] vs $12 883 [12.8], respectively; P < .001), reflecting $4768 (95% CI, $4713-$4823; 37% increase) more in costs for patients with an SMI and $2370 (95% CI, $2290-$2449; 18.4% increase) more in costs for patients with other common mental health disorders.

Among Medicare beneficiaries, $2,686,016,110 of $64,326,262,104 total Medicare spending (4.2%) went to mental health services and an additional $5,482,791,747 (8.5%) went to additional medical spending associated with mental illness, representing a total of 12.7% of spending associated with mental health disorders.

Conclusions

In this study, having a mental health disorder was associated with spending substantially more on other medical conditions.

These findings quantify the extent of additional spending in the Medicare fee-for-service population associated with a diagnosis of a mental health disorder.

Reference

Figueroa, J.F., Phelan, J., Orav, E.J., Patel, V. & Jha, A.K. (2020) Association of Mental Health Disorders With Health Care Spending in the Medicare Population. JAMA Network Open. 3(3):e201210. doi: 10.1001/jamanetworkopen.2020.1210.

Linking Prenatal Antidepressant Use & Risk of Adverse Neonatal Outcomes

Published on by Andrew Marshall1 Comment

Depression is common among pregnant women and, untreated, is associated with morbidity in both mother and child.

But what about the risks of treatment?

A large database study from the US, with information on the timing, dose, and type of antidepressant treatment in pregnancy, identifies a dose dependent increase in risk for newborn respiratory distress and a small increase in risk of preterm birth in those taking higher doses.

CBT: Is It Remotely Effective!

Published on by Andrew Marshall3 Comments

Perhaps because cognitive behavioural therapy (CBT) is effective in such a wide range of conditions, availability is often limited.

However, it is beginning to look as if CBT works equally well when delivered remotely.

In a three month trial in a primary care setting in Sweden, internet delivered CBT was no worse than face-to-face CBT for patients with high levels of anxiety about their health.

Regardless of how it was delivered, CBT produced benefits not only for hypochondriasis but for general anxiety and depression too.

What is the Current Situation School Mental Health in ASEAN Countries?

Published on by Andrew Marshall1 Comment

Research Paper Title

Current Situation and Comparison of School Mental Health in ASEAN Countries.

Background

School-based mental health interventions are considered to have potential for the promotion of mental health in developing countries.

The researchers held a workshop to discuss the promotion of mental health in schools in southeast Asian countries.

This review report aimed to summarise the current situation of school mental health in Association of Southeast Asian Nations (ASEAN) countries as reported by their representatives in this workshop.

Methods

To summarise the current situation of ASEAN countries in relation to school mental health, the researchers qualitatively analysed the content of the discussions from four perspectives:

  1. Laws and regulations;
  2. Mental health services;
  3. Teacher training on mental health; and
  4. Mental health education for students.

Results

With regard to school mental health laws and regulations, this report could not provide clear conclusions because the laws were reported through the personal understanding of the public officers.

The results show that mental health services in schools are centred on professionals such as guidance counsellors, although the coverage varied among the different ASEAN countries.

Conclusions

Only Singapore conducted mental health training for teachers in a comprehensive way, and the number of people who were actually trained in other countries was very limited.

Cambodia, Malaysia, Myanmar, Philippines, Singapore, and Thailand included mental health education for students in health education or life skills subjects.

Reference

Nishio, A., Kakimoto, M., Bermardo, T.M.S. & Kobayashi, J. (2020) Current Situation and Comparison of School Mental Health in ASEAN Countries. Pediatrics International: Official Journal of the Japan Pediatrics Society. 62(4), pp.438-443. doi: 10.1111/ped.14137.

Psychological Distress & Loneliness

Published on by Andrew Marshall1 Comment

In a survey of almost 1,500 US adults, McGinty and colleagues (2020) studied levels of psychological distress using the Kessler scale and levels of loneliness.

They compared the distress levels with national data from 2018. In 2018, the prevalence of serious psychological distress was 3.9%. In April 2020 it was 13.6%.

The authors note a worrying implication of these findings – that, since the Kessler scale is predictive of serious mental illness, the distress during the pandemic could transfer to longer term psychiatric disorders.

This is not outside the realms of possibility, especially since the social and economic impact of the pandemic is expected to be felt for years to come.

The authors should be commended both for their methodology and for their upfront discussion of its limitations – namely the potential for sampling bias.

People might have been more likely to respond to such a survey in April 2020 compared with 2018; therefore, the 2020 figures could be an overestimate.

Reference

McGinty, E.E., Presskreischer, R., Han, H. & Barry, C.L. (2020) Psychological Distress and Loneliness Reported by US Adults in 2018 and April 2020. JAMA. 324(1), pp.93-94. doi:10.1001/jama.2020.9740.

How Mental Health Services are Adapting to Provide Care in the Pandemic

Published on by Andrew Marshall1 Comment

Emma Wilkinson, writing in the British Medical Journal (BMJ), talks to healthcare workers who are trying to ensure that vulnerable psychiatric patients do not get sidelined by covid-19 and finds that some changes may become permanent.

As the NHS rapidly ramped up critical care capacity to deal with the surge of severely ill covid-19 patients, other specialties quickly had to rethink how to manage routine care while
avoiding face-to-face contact with patients when possible. For mental health services this has meant a host of changes, the biggest being the rapid adoption of video and phone
consultations – an approach that had rarely been used in a field where relationships and trust between clinicians and patients are vital, and where body language and eye contact are a key part of assessment.

You can read the rest of the article @ https://www.bmj.com/content/bmj/369/bmj.m2106.full.pdf.

Reference

Wilkinson, E. (2020) How Mental Health Services are Adapting to Provide Care in the Pandemic. BMJ 2020;369:m2106.