Category: Mental Health

Conditional Cash Transfers & Mental Health

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Research Paper Title

The worse the better? Quantile treatment effects of a conditional cash transfer programme on mental health.

Background

Poor mental health is a pressing global health problem, with high prevalence among poor populations from low-income countries.

Existing studies of conditional cash transfer (CCT) effects on mental health have found positive effects.

However, there is a gap in the literature on population-wide effects of cash transfers on mental health and if and how these vary by the severity of mental illness.

Methods

The researchers use the Malawian Longitudinal Study of Family and Health containing 790 adult participants in the Malawi Incentive Programme, a year-long randomized controlled trial.

They estimate average and distributional quantile treatment effects and we examine how these effects vary by gender, HIV status and usage of the cash transfer.

Results

They find that the cash transfer improves mental health on average by 0.1 of a standard deviation.

The effect varies strongly along the mental health distribution, with a positive effect for individuals with worst mental health of about four times the size of the average effect.

These improvements in mental health are associated with increases in consumption expenditures and expenditures related to economic productivity.

Conclusions

Their results show that CCTs can improve adult mental health for the poor living in low-income countries, particularly those with the worst mental health.

Reference

Ohrnberger, J., Fichera, E., Sutton, M. & Anselmi, L. (2020) The worse the better? Quantile treatment effects of a conditional cash transfer programme on mental health. Health Policy and Planning. doi: 10.1093/heapol/czaa079. Online ahead of print.

What is the Evidence for the Effectiveness of Psychological Interventions for Adults with Anti-Social Personality Disorder?

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Research Paper Title

Psychological interventions for antisocial personality disorder.

Background

Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties. This review updates Gibbon 2010 (previous version of the review).

Therefore the purpose of this review was to evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD.

Methods

The researchers searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. They also searched reference lists and contacted study authors to identify studies.

Selection criteria concisted of randomised controlled trials of adults, where participants with an AsPD or dissocial personality disorder diagnosis comprised at least 75% of the sample randomly allocated to receive a psychological intervention, treatment-as-usual (TAU), waiting list or no treatment. The primary outcomes were aggression, reconviction, global state/functioning, social functioning and adverse events.

Data collection and analysis consisted of standard methodological procedures expected by Cochrane.

Results

This review includes 19 studies (eight new to this update), comparing a psychological intervention against TAU (also called ‘standard Maintenance'(SM) in some studies).

Eight of the 18 psychological interventions reported data on our primary outcomes. Four studies focussed exclusively on participants with AsPD, and 15 on subgroups of participants with AsPD. Data were available from only 10 studies involving 605 participants.

Eight studies were conducted in the UK and North America, and one each in Iran, Denmark and the Netherlands. Study duration ranged from 4 to 156 weeks (median = 26 weeks).

Most participants (75%) were male; the mean age was 35.5 years. Eleven studies (58%) were funded by research councils. Risk of bias was high for 13% of criteria, unclear for 54% and low for 33%. Cognitive behaviour therapy (CBT) + TAU versus TAU One study (52 participants) found no evidence of a difference between CBT + TAU and TAU for physical aggression (odds ratio (OR) 0.92, 95% CI 0.28 to 3.07; low-certainty evidence) for outpatients at 12 months post-intervention.

One study (39 participants) found no evidence of a difference between CBT + TAU and TAU for social functioning (mean difference (MD) -1.60 points, 95% CI -5.21 to 2.01; very low-certainty evidence), measured by the Social Functioning Questionnaire (SFQ; range = 0-24), for outpatients at 12 months post-intervention. Impulsive lifestyle counselling (ILC) + TAU versus TAU One study (118 participants) found no evidence of a difference between ILC + TAU and TAU for trait aggression (assessed with Buss-Perry Aggression Questionnaire-Short Form) for outpatients at nine months (MD 0.07, CI -0.35 to 0.49; very low-certainty evidence).

One study (142 participants) found no evidence of a difference between ILC + TAU and TAU alone for the adverse event of death (OR 0.40, 95% CI 0.04 to 4.54; very low-certainty evidence) or incarceration (OR 0.70, 95% CI 0.27 to 1.86; very low-certainty evidence) for outpatients between three and nine months follow-up. Contingency management (CM) + SM versus SM One study (83 participants) found evidence that, compared to SM alone, CM + SM may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI; range = 0 (no problems) to 1 (severe problems); MD -0.08, 95% CI -0.14 to -0.02; low-certainty evidence) for outpatients at six months. ‘Driving whilst intoxicated’ programme (DWI) + incarceration versus incarceration One study (52 participants) found no evidence of a difference between DWI + incarceration and incarceration alone on reconviction rates (hazard ratio 0.56, CI -0.19 to 1.31; very low-certainty evidence) for prisoner participants at 24 months.

Schema therapy (ST) versus TAU One study (30 participants in a secure psychiatric hospital, 87% had AsPD diagnosis) found no evidence of a difference between ST and TAU for the number of participants who were reconvicted (OR 2.81, 95% CI 0.11 to 74.56, P = 0.54) at three years. The same study found that ST may be more likely to improve social functioning (assessed by the mean number of days until patients gain unsupervised leave (MD -137.33, 95% CI -271.31 to -3.35) compared to TAU, and no evidence of a difference between the groups for overall adverse events, classified as the number of people experiencing a global negative outcome over a three-year period (OR 0.42, 95% CI 0.08 to 2.19).

The certainty of the evidence for all outcomes was very low. Social problem-solving (SPS) + psychoeducation (PE) versus TAU One study (17 participants) found no evidence of a difference between SPS + PE and TAU for participants’ level of social functioning (MD -1.60 points, 95% CI -5.43 to 2.23; very low-certainty evidence) assessed with the SFQ at six months post-intervention. Dialectical behaviour therapy versus TAU One study (skewed data, 14 participants) provided very low-certainty, narrative evidence that DBT may reduce the number of self-harm days for outpatients at two months post-intervention compared to TAU.

Psychosocial risk management (PSRM; ‘Resettle’) versus TAU One study (skewed data, 35 participants) found no evidence of a difference between PSRM and TAU for a number of officially recorded offences at one year after release from prison. It also found no evidence of difference between the PSRM and TAU for the adverse event of death during the study period (OR 0.89, 95% CI 0.05 to 14.83, P = 0.94, 72 participants (90% had AsPD), 1 study, very low-certainty evidence).

Conclusions

There is very limited evidence available on psychological interventions for adults with AsPD. Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition. No intervention reported compelling evidence of change in antisocial behaviour.

Overall, the certainty of the evidence was low or very low, meaning that we have little confidence in the effect estimates reported. The conclusions of this update have not changed from those of the original review, despite the addition of eight new studies. This highlights the ongoing need for further methodologically rigorous studies to yield further data to guide the development and application of psychological interventions for AsPD and may suggest that a new approach is required.

Reference

Gibbon, S., Khalifa, N.R., Cheung, N.H-Y., Vollm, B.A. & McCarthy, L. (2020) Psychological interventions for antisocial personality disorder. The Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD007668.pub3.

Depression and Pre-Clinical Dementia

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Research Paper Title

A cross-national study of depression in preclinical dementia: A COSMIC collaboration study.

Background

Depression commonly accompanies Alzheimer’s disease, but the nature of this association remains uncertain.

Methods

Longitudinal data from the COSMIC consortium were harmonized for eight population-based cohorts from four continents. Incident dementia was diagnosed in 646 participants, with a median follow-up time of 5.6 years to diagnosis. The association between years to dementia diagnosis and successive depressive states was assessed using a mixed effect logistic regression model. A generic inverse variance method was used to group study results, construct forest plots, and generate heterogeneity statistics.

Results

A common trajectory was observed showing an increase in the incidence of depression as the time to dementia diagnosis decreased despite cross-national variability in depression rates.

Conclusions

The results support the hypothesis that depression occurring in the preclinical phases of dementia is more likely to be attributable to dementia-related brain changes than environment or reverse causality.

Reference

Carles, S., Carriere, I., Reppermund, S., Davin, A., Guaita, A., Vaccaro, R., Ganguli, M., Jacobsen, E.P., Beer, J.C., Riedel-Heller, S.G., Roehr, S., Pabst, A., Haan, M.N., Brodarty, H., Kochan, N.A., Trollor, J.N., Kim, K.W., Han, J.W., Suh, S.W., Lobo, A., De La Camara, C., Lobo, E., Lipnicki, D.M., Sachdev, P.S., Ancelin, M-L., Ritchie, K. & for Cohrot Studies of Memory in an International Consortium (COSMIC). (2020) A cross-national study of depression in preclinical dementia: A COSMIC collaboration study. Alzheimer’s & Dementia. doi: 10.1002/alz.12149. Online ahead of print.

On This Day … 27 September

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People (Deaths)

  • 2004 – John E. Mack, American psychiatrist and author (b. 1929).

Background

John Edward Mack (04 October 1929 – 27 September 2004) was an American psychiatrist, writer, and professor and the head of the department of psychiatry at Harvard Medical School.

In 1977, Mack won the Pulitzer Prize for his book A Prince of Our Disorder on T.E. Lawrence.

As the head of psychiatry at Harvard Medical School, Mack’s clinical expertise was in child psychology, adolescent psychology, and the psychology of religion.

He was also known as a leading researcher on the psychology of teenage suicide and drug addiction, and he later became a researcher in the psychology of alien abduction experiences.

National Good Neighbour Day

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Introduction

National Good Neighbour Day is a national holiday in the United States celebrated on 26 September.

Background

In the early 1970s, Becky Mattson of Lakeside, Montana created National Good Neighbor Day as a day to connect with and recognise the importance of strong leaders.

On 22 September 1978, President Jimmy Carter signed Proclamation 4601 establishing 24 September 1978 as National Good Neighbour Day, stating that it should be observed “with appropriate ceremonies and activities.”

On 28 April 2004, the Senate passed a resolution by Montana Senator Max Baucus to designate 26 September as National Good Neighbour Day.

On This Day … 25 September

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People (Births)

  • 1962 – Kalthoum Sarrai, Tunisian-French psychologist and journalist (d. 2010).

People (Deaths)

  • 1958 – John B. Watson, American psychologist and academic (b. 1878).
  • 2005 – Urie Bronfenbrenner, Russian-American psychologist and ecologist (b. 1917).
  • 2005 – M. Scott Peck, American psychiatrist and author (b. 1936).
  • 2013 – Bennet Wong, Canadian psychiatrist and academic, co-founded Haven Institute (b. 1930).

Themes & Psychiatrists’ Use of Metaphor in Relation to Psychological Trauma

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Research Paper Title

A frog in boiling water? A qualitative analysis of psychiatrists’ use of metaphor in relation to psychological trauma.

Background

Tensions about the definition, diagnostics, and role of psychological trauma in psychiatry are long-standing. This study sought to explore what metaphor patterns in qualitative interviews may reveal about the beliefs of psychiatrists in relation to trauma.

Methods

A qualitative inquiry using systematic metaphor analysis of 13 in-depth interviews with Australian psychiatrists.

Results

Three themes were identified:

  1. A power struggle between people, trauma, and psychiatry;
  2. Trauma is not a medical condition; and
  3. Serving the profession to protect society.

Conclusions

Metaphors present trauma as a powerful force that people can manage in different ways. Psychiatrists may view trauma as a social rather than medical issue. Psychiatrists experience role pressure associated with trauma including incongruence with risk management expectations of their roles.

Reference

Isobel, S., McCloughen, A. & Foster, K. (2020) A frog in boiling water? A qualitative analysis of psychiatrists’ use of metaphor in relation to psychological trauma. Australasian Psychiatry. doi: 10.1177/1039856220946596. Online ahead of print.

What is the Exclusion Problem?

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Introduction

Traditionally conceived, the exclusion problem is faced by non-reductive materialist views which hold that mental causes are distinct from physical causes.

Many think that if materialism is true, then every physical effect must have a sufficient physical cause; but in that case the purportedly distinct mental causes can appear to be “excluded” as genuine causes because the physical causes “already” do all the “causal work”.

Exclusion can work both ways – some have argued that mental causes exclude physical causes – but most have thought that it is mental causes that are under threat.

Some have taken the exclusion argument to demonstrate the falsity of non-reductive materialism, but most have tried to defend non-reductive materialism by contending that the exclusion argument is unsound.

Key Works on the Subject

The exclusion argument was first proposed by Norman Malcolm (1968). After a brief flurry of interest in Malcolm’s argument (e.g. Goldman 1969; Martin 1971), discussion of the issue largely died off until Jaegwon Kim resurrected the exclusion argument and used it as the central component of his sustained critique of non-reductive materialism (1989; 1998; 2005).

Subsequent debates have had two main focal points: examining either the “horizontal” or “vertical” aspects of the non-reductive model (this distinction was first drawn in Donaldson 2019).

  • The horizontal approach concerns the nature of the mental-physical causal relation (e.g. Horgan 1997; Crisp & Warfield 2001; Kim 2007; Loewer 2007; List & Menzies 2009; Zhong 2014).
  • The vertical approach concerns the explaining of the holding of the mental-physical supervenience relation (e.g. Yablo 1992; Shoemaker 2007; Paul 2007; Walter 2007; Bennett 2008; Wilson 2009; Pereboom 2011).

An Introduction to the Subject

Sophie Gibb’s introduction to the volume she co-edited with Lowe and Ingthorsson (2013) is a good place to start, and that volume also contains much of the state of the art thinking on the exclusion problem.

Kim 2005, or Kim 2007 alongside Loewer 2007, are also a good way in.

Enyclopedia entries include Yoo 2007, Robb & Heil 2008 – although these survey the broader issue of mental causation, of which the exclusion problem is just one part.

References

  1. Exclusion Again.Karen Bennett – 2008 – In Jakob Hohwy & Jesper Kallestrup (eds.), Being Reduced: New Essays on Reduction, Explanation, and Causation. Oxford University Press. pp. 280–307.
  2. Kim’s Master Argument. [REVIEW] Thomas M. Crisp & Ted A. Warfield – 2001 – Noûs 35 (2):304–316.
  3. Vertical Versus Horizontal: What is Really at Issue in the Exclusion Problem?John Donaldson – 2019 – Synthese:1-16.
  4. Mental Causation and Ontology.Sophie Gibb, E. J. Lowe & R. D. Ingthorsson (eds.) – 2013 – Oxford: Oxford University Press.
  5. The Compatibility of Mechanism and Purpose.Alvin I. Goldman – 1969 – Philosophical Review 78 (October):468-82.
  6. Kim on Mental Causation and Causal Exclusion.Terence E. Horgan – 1997 – Philosophical Perspectives 11:165-84.
  7. Physicalism, or Something Near Enough.Jaegwon Kim – 2005 – Princeton University Press.
  8. Causation and Mental Causation.Jaegwon Kim – 2007 – In Brian P. McLaughlin & Jonathan D. Cohen (eds.), Contemporary Debates in Philosophy of Mind. Blackwell. pp. 227–242.
  9. The Myth of Non-Reductive Materialism.Jaegwon Kim – 1989 – Proceedings and Addresses of the American Philosophical Association 63 (3):31-47.
  10. Mind in a Physical World: An Essay on the Mind–Body Problem and Mental Causation.Jaegwon Kim – 1998 – MIT Press.
  11. Physicalism, or Something Near Enough.Jaegwon Kim – 2005 – Princeton University Press.
  12. Causation and Mental Causation.Jaegwon Kim – 2007 – In Brian P. McLaughlin & Jonathan D. Cohen (eds.), Contemporary Debates in Philosophy of Mind. Blackwell. pp. 227–242.
  13. Nonreductive Physicalism and the Limits of the Exclusion Principle.Christian List & Peter Menzies – 2009 – Journal of Philosophy 106 (9):475-502.
  14. Mental Causation, or Something Near Enough.Barry M. Loewer – 2007 – In Brian P. McLaughlin & Jonathan D. Cohen (eds.), Contemporary Debates in Philosophy of Mind. Blackwell. pp. 243–64.
  15. Mental Causation, or Something Near Enough.Barry M. Loewer – 2007 – In Brian P. McLaughlin & Jonathan D. Cohen (eds.), Contemporary Debates in Philosophy of Mind. Blackwell. pp. 243–64.
  16. The Conceivability of Mechanism.Norman Malcolm – 1968 – Philosophical Review 77 (January):45-72.
  17. On the Conceivability of Mechanism.Michael Martin – 1971 – Philosophy of Science 38 (March):79-86.
  18. Constitutive Overdetermination.L. A. Paul – 2007 – In J. K. Campbell, M. O’Rourke & H. S. Silverstein (eds.), Causation and Explanation. MIT Press. pp. 4–265.
  19. Consciousness and the Prospects of Physicalism.Derk Pereboom – 2011 – Oxford University Press.
  20. Mental Causation.David Robb & John Heil – 2008 – Stanford Encyclopedia of Philosophy.
  21. Physical Realization.Sydney Shoemaker – 2007 – Oxford University Press UK.
  22. Determinables, Determinates, and Causal Relevance.Sven Walter – 2007 – Canadian Journal of Philosophy 37 (2):217-244.
  23. Determination, Realization and Mental Causation.Jessica Wilson – 2009 – Philosophical Studies 145 (1):149-169.
  24. Mental Causation.Stephen Yablo – 1992 – Philosophical Review 101 (2):245-280.
  25. Mental Causation.Julie Yoo – 2007 – Internet Encyclopedia of Philosophy.
  26. Sophisticated Exclusion and Sophisticated Causation.Lei Zhong – 2014 – Journal of Philosophy 111 (7):341-360.

Mental Health Care, Policy, and COVID-19: The Renewed Role for Psychiatric and Addiction Nursing

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Research Paper Title

Mental Health Care, Policy, and COVID-19: The Renewed Role for Psychiatric and Addiction Nursing.

Background

Kovner (2020) has importantly highlighted the role that health care workers play in the 21st century to fight pandemics, such as the recent COVID-19 outbreak, in Canada and around the world. The heroic actions, determination, selflessness, and compassion of nurses and many health care providers worldwide have become the highlighted story of COVID-19 pandemic (Kovner, 2020). This is particularly significant, as 2020 has been called the Year of the Nurse and the Midwife by the World Health Organization and the International Council of Nurses to celebrate the birth of renowned nurse Florence Nightingale on her 200th anniversary. While this year has already signified the critical position of nurses in primary care, policy, and clinical practice, the role of psychiatric nurses and their contributions to primary care have often been overlooked by society, government policy makers, and many academics.

This is particularly true, as most provinces/states do not have dedicated bachelors’ degrees in psychiatric nursing, except for British Columbia (BC), Alberta, Saskatchewan, and Manitoba in Canada. Additionally, BC remains the only province/State in North America that has a fellowship program in Addiction nursing (Jozaghi & Dadakhah-Chimeh, 2018). Momentously, it was also the first province/state in North America to enact a provincial ministry dedicated to mental health and addiction (BC Gov News, 2017). This is remarkably significant in the current pandemic as many North American are asked to work from home, have been laid off, ordered to self-isolate, or practice social distancing. The cumulative effects of financial strain and self-isolation have already been reflected in a higher frequency of police calls for mental health and domestic assault cases in many provinces, territories, and states (Hong, 2020; Seebruch, 2020). The latest research also highlights a projected increase in suicide cases in North America linked to the COVID-19 pandemic (McIntyre & Lee, 2020). Self-isolation measures and the ongoing opioid crisis have also caused sharp increases in mortalities linked to synthetic opioids to their highest levels (Johnston, 2020). Finally, some researchers have warned about the potential misuse of alcohol during the current pandemic (Clay & Parker, 2020).

Therefore, the rise in mental health and domestic abuse calls, potential suicides, overdose deaths, and alcohol abuse serves as a reminder that COVID-19 is not our only health crisis. We must tackle and plan for the potential tsunami of mental health and addiction cases. While the Federal government in Canada has promised investment to improve long-term care, Kovner (2020) rightly pointed out that COVID-19 pandemic is about politics and policy and we similarly urge the governments and municipalities to invest to improve public health. More importantly, dedicated mental health care and training in psychiatric and addiction nursing is long overdue. We also recommend that cities, states, and federal housing agencies to increase funding for dedicated mental health and harm reduction programs during the current pandemic for people who have mental health or substance use disorders.

Reference

Dadakhah-Chimeh, Z. & Jozaghi, E. (2020) Mental Health Care, Policy, and COVID-19: The Renewed Role for Psychiatric and Addiction Nursing. Policy, Politics& Nursing Practice. doi: 10.1177/1527154420957305. Online ahead of print.

Risk Factors: Linking Hospitalisation, ED Visits & Mental Health Conditions

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Research Paper Title

Risk factors of hospitalisation for any medical condition among patients with prior emergency department visits for mental health conditions.

Background

This longitudinal study identified risk factors for frequency of hospitalisation among patients with any medical condition who had previously visited one of six Quebec (Canada) emergency departments (ED) at least once for mental health (MH) conditions as the primary diagnosis.

Methods

Records of n = 11,367 patients were investigated using administrative databanks (2012-13/2014-15). Hospitalisation rates in the 12 months after a first ED visit in 2014-15 were categorised as:

  • No hospitalisations (0 times);
  • Moderate hospitalisations (1-2 times); and
  • Frequent hospitalisations (3+ times).

Based on the Andersen Behavioural Model, data on risk factors were gathered for the 2 years prior to the first visit in 2014-15, and were identified as predisposing, enabling or needs factors. They were tested using a hierarchical multinomial logistic regression according to the three groups of hospitalisation rate.

Results

Enabling factors accounted for the largest percentage of total variance explained in the study model, followed by needs and predisposing factors. Co-occurring mental disorders (MD)/substance-related disorders (SRD), alcohol-related disorders, depressive disorders, frequency of consultations with outpatient psychiatrists, prior ED visits for any medical condition and number of physicians consulted in specialised care, were risk factors for both moderate and frequent hospitalisations.

Schizophrenia spectrum and other psychotic disorders, bipolar disorders, and age (except 12-17 years) were risk factors for moderate hospitalisations, while higher numbers (4+) of overall interventions in local community health service centres were a risk factor for frequent hospitalisations only.

Patients with personality disorders, drug-related disorders, suicidal behaviours, and those who visited a psychiatric ED integrated with a general ED in a separate site, or who visited a general ED without psychiatric services were also less likely to be hospitalised. Less urgent and non-urgent illness acuity prevented moderate hospitalisations only.

Conclusions

Patients with severe and complex health conditions, and higher numbers of both prior outpatient psychiatrist consultations and ED visits for medical conditions had more moderate and frequent hospitalisations as compared with non-hospitalised patients.

Patients at risk for frequent hospitalisations were more vulnerable overall and had important biopsychosocial problems.

Improved primary care and integrated outpatient services may prevent post-ED hospitalisation.

Reference

Penzenstadler, L., Gentil, L., Grenier, G., Khazaal, Y. & Fleury, M-J. (2020) Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions. BMC Psychiatry. 20(1), pp.431. doi: 10.1186/s12888-020-02835-2.