Category: Mental Health

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.

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.

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.

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.

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.