Mental Health Matters

COVID-19 and the Role of Primary Care in Suicide Prevention

Published on 09/02/2020 by Andrew Marshall1 Comment

Research Paper Title

Role of Primary Care in Suicide Prevention During the COVID-19 Pandemic.

Background

Primary care providers have an important role in suicide prevention, knowing that among people who die by suicide, 83% have visited a primary care provider in the prior year, and 50% have visited that provider within 30 days of their death, rather than a psychiatrist.

The psychosocial impact of the coronavirus disease 2019 pandemic poses increased risk for suicide and other mental health disorders for months and years ahead.

This article focuses on screening tools, identification of the potentially suicidal patient in the primary care setting, and a specific focus on suicide prevention during widespread, devastating events, such as a pandemic.

Reference

Nelson, P.A. & Adams, S.M. (2020) Role of Primary Care in Suicide Prevention During the COVID-19 Pandemic. The Journal for Nurse Practitioners. doi: 10.1016/j.nurpra.2020.07.015. Online ahead of print.

On This Day … 01 September

Published on 09/01/2020 by Andrew Marshall1 Comment

Events

1939 – Adolf Hitler signs an order to begin the systematic euthanasia of mentally ill and disabled people.
2004 – Random Acts of Kindness Day (New Zealand).

Aktion T4

Aktion T4 was a postwar name for mass murder by involuntary euthanasia in Nazi Germany. The name T4 is an abbreviation of Tiergartenstraße 4, a street address of the Chancellery department set up in early 1940, in the Berlin borough of Tiergarten, which recruited and paid personnel associated with T4. Certain German physicians were authorised to select patients “deemed incurably sick, after most critical medical examination” and then administer to them a “mercy death” (Gnadentod). In October 1939, Adolf Hitler signed a “euthanasia note”, backdated to 01 September 1939, which authorised his physician Karl Brandt and Reichsleiter Philipp Bouhler to implement the programme.

The killings took place from September 1939 until the end of the war in 1945; from 275,000 to 300,000 people were killed in psychiatric hospitals in Germany and Austria, occupied Poland and the Protectorate of Bohemia and Moravia (now the Czech Republic). The number of victims was originally recorded as 70,273 but this number has been increased by the discovery of victims listed in the archives of the former East Germany. About half of those killed were taken from church-run asylums, often with the approval of the Protestant or Catholic authorities of the institutions.

The Holy See announced on 02 December 1940 that the policy was contrary to divine law and that “the direct killing of an innocent person because of mental or physical defects is not allowed” but the declaration was not upheld by some Catholic authorities in Germany. In the summer of 1941, protests were led in Germany by the Bishop of Münster, Clemens von Galen, whose intervention led to “the strongest, most explicit and most widespread protest movement against any policy since the beginning of the Third Reich”, according to Richard J. Evans.

Several reasons have been suggested for the killings, including eugenics, racial hygiene, and saving money. Physicians in German and Austrian asylums continued many of the practices of Aktion T4 until the defeat of Germany in 1945, in spite of its official cessation in August 1941. The informal continuation of the policy led to 93,521 “beds emptied” by the end of 1941. Technology developed under Aktion T4 was taken over by the medical division of the Reich Interior Ministry, particularly the use of lethal gas to kill large numbers of people, along with the personnel of Aktion T4, who participated in Operation Reinhard. The programme was authorised by Hitler but the killings have since come to be viewed as murders in Germany. The number of people killed was about 200,000 in Germany and Austria, with about 100,000 victims in other European countries.

And now something slightly more positive.

Random Acts of Kindness Day

Random Acts of Kindness Day is a day to celebrate and encourage random acts of kindness.

“It’s just a day to celebrate kindness and the whole pay it forward mentality”, said Tracy Van Kalsbeek, executive director of the Stratford Perth Community Foundation, in 2016, where the day is celebrated on 04 November 4.

It is celebrated on 01 September in New Zealand and on 17 February in the US.

Background

The Random Acts of Kindness Foundation (RAK) was founded in 1995 in the US.
It is a non-profit headquartered in Denver, Colorado.
Random Acts of Kindness (RAK) day began in 2004 in New Zealand.

What is a Random Act of Kindness

A random act of kindness is a nonpremeditated, inconsistent action designed to offer kindness towards the outside world.

Suggested Activities

Pay for the person behind you in the drive-thru.
Let someone go ahead of you in line.
Buy extra at the grocery store and donate it to a food pantry.
Buy flowers for someone (postal worker, grocery store clerk, bus driver, etc.).
Help someone change a flat tire.
Post anonymous sticky notes with validating or uplifting messages around for people to find.
Compliment a colleague on their work.
Send an encouraging text to someone.
Take muffins to work.
Let a car into the traffic ahead of you.
Wash someone else’s car.
Take a gift to new neighbors and introduce yourself.
Pay the bus fare for the passenger behind you.

Website

https://www.randomactsofkindness.org/

Does COVID-19 Fear, Mental Health, and Substance Misuse Conditions among University Social Work Students Ignore Nationality?

Published on 09/01/2020 by Andrew Marshall1 Comment

Research Paper Title

COVID-19 Fear, Mental Health, and Substance Misuse Conditions Among University Social Work Students in Israel and Russia.

Background

In December 2019, cases of pneumonia of unknown etiology but with acute respiratory distress syndrome (ARDS) and other serious complications were reported in Wuhan, Hubei Province, China. One month later, a novel coronavirus was identified by the Chinese Centre for Disease Control and Prevention (CDC) from the throat swab sample of a patient and was subsequently named “COVID-19” by the World Health Organisation (WHO) (Nanshan et al. 2020). At the end of June 2020, approximately 500,000 deaths worldwide have been linked to COVID-19 (Johns Hopkins University of Medicine 2020).

Following many cases reported by Chinese authorities, the WHO declared the new coronavirus pneumonia epidemic a public health emergency of international concern. Among the early virus characteristics reported were strong human-to-human transmission and fast transmission speed, mainly spread through respiratory droplets and contact (Nanshan et al. 2020). In response, Chinese authorities moved to a strategy of regional blockade aimed to stop the spread of the epidemic (Chen et al. 2020) as well as quarantine. “Quarantine” is one of the oldest and most effective tools of controlling communicable disease outbreaks. It means the restriction of movement among people presumed to have been exposed to a contagious disease but are not ill, either because they did not become infected or because they are still in the incubation period. The second tool that is widely used to prevent the spread of the pandemic is “social distancing.” It is designed to reduce interactions between people in a community where individuals may be infectious but have not yet been identified, and hence not yet isolated (Burdorf et al. 2020).

Once countries dealing with COVID-19 implemented quarantine and social distancing, the need for social workers and other health care professionals greatly increased due to mental health problems experienced by the general public. Studies have found that widespread outbreaks of infectious diseases, such as COVID-19, are associated with psychological distress and mental illness (Bao et al. 2020). Such conditions include stress, anxiety, depression, insomnia, anger, fear, stigma (Lin 2020; Pakpour and Griffiths 2020; Torales et al. 2020), and substance misuse (Baillie et al. 2010) on individual, family, community, and national levels (Harper et al. 2020; Kang et al. 2020). Older adults, especially with chronic health conditions, have been identified as extremely vulnerable to COVID-19. However, those dealing with the infection, such as medical and allied health personnel including those affiliated with social work, have received considerable attention for their “front line” efforts combating this disaster.

Israel and Russia pursue a similar policy to combat the COVID-19: strict quarantine or self-isolation, the abolition of all events with a large number of people, the closure of schools and universities, the cessation of aviation and railway travel and closed borders, the mandatory use of masks, etc. At the end of June 2020, there were 22,800 confirmed cases and 314 deaths in Israel and in Russia, 626,779 cases and 8958 deaths (JHUM 2020). Based on the dearth of information about student mental health during the COVID-19 pandemic (Grubic et al. 2020), The researchers hypothesized fear, mental health, and substance misuse among university students are similar regardless of nationality. For this purpose, social work students from Israel and Russia were studied.

Reference

Yehudai, M., Bendar, S., Gritsenko, V., Konstantinov, V., Reznik, A. & Isralowitz, R. (2020) COVID-19 Fear, Mental Health, and Substance Misuse Conditions Among University Social Work Students in Israel and Russia. International Journal of Mental Health Addiction. 1–8.
doi: 10.1007/s11469-020-00360-7 [Epub ahead of print].

What are the Challenges to Engaging in Late-Life Mental Health Research?

Published on 08/31/2020 by Andrew Marshall1 Comment

Research Paper Title

Engaging in Late-Life Mental Health Research: a Narrative Review of Challenges to Participation.

Background

This narrative review seeks to ascertain the challenges older patients face with participation in mental health clinical research studies and suggests creative strategies to minimise these obstacles.

Recent Findings

Challenges to older adults’ engagement in mental health research include practical, institutional, and collaboration-related barriers applicable to all clinical trials as well as more personal, cultural, and age-related patient barriers specific to geriatric mental health research.

Universal research challenges include:

Institutional barriers of lack of funding and researchers, inter-researcher conflict, and sampling bias;
Collaboration-related barriers involving miscommunication and clinician concerns; and
Practical patient barriers such as scheduling issues, financial constraints, and transportation difficulties.

Challenges unique to geriatric mental health research include:

Personal barriers such as no perceived need for treatment, prior negative experience, and mistrust of mental health research;
Cultural barriers involving stigma and lack of bilingual or culturally matched staff; and
Chronic medical issues and concerns about capacity.

Summary

Proposed solutions to these barriers include increased programmatic focus on and funding of geriatric psychiatry research grants, meeting with clinical staff to clarify study protocols and eligibility criteria, and offering transportation for participants.

To minimise stigma and mistrust of psychiatric research, studies should devise community outreach efforts, employ culturally competent bilingual staff, and provide patient and family education about the study and general information about promoting mental health.

Reference

Newmark, J., Gebara, M.A., Aizenstein, H. & Karp, J. (2020) Engaging in Late-Life Mental Health Research: a Narrative Review of Challenges to Participation. Current Treatment Options in Psychiatry. doi: 10.1007/s40501-020-00217-9. Online ahead of print.

What are the Challenges of Mental Healthcare during COVID-19?

Published on 08/28/2020 by Andrew Marshall1 Comment

Research Paper Title

Current and Future Challenges in the Delivery of Mental Healthcare during COVID-19.

Background

The USA is in the midst of the COVID-19 pandemic.

The researchers assess the impact of COVID-19 on psychiatric symptoms in healthcare workers, those with psychiatric comorbidities, and the general population.

They highlight the challenges ahead and discuss the increased relevance of telepsychiatry.

Methods

The researchers analysed all available literature available as of 25 March 2020, on PubMed, Ovid Medline, and PsychInfo.

They utilised the MeSH term “covid AND (psychiatry OR mental health)” and included all articles.

Duplicates were removed resulting in 32 articles, of which 19 are cited. Four additional references are included to examine suicide data. During the review process, an additional 7 articles were identified which are also included.

Results

Frontline healthcare workers are currently experiencing increased psychiatric symptoms and this is more severe in females and nurses. Non-frontline healthcare workers, as well as the general population, are experiencing vicarious traumatisation.

People with psychiatric comorbidities, and the general population, face increased psychiatric symptom burden. Migrant workers, the elderly, children, and the homeless may be disproportionately impacted. Suicide rates may be impacted.

Conclusions

The COVID-19 pandemic has resulted in a severe disruption to the delivery of mental healthcare.

Psychiatric facilities are facing unprecedented disruptions in care provision as they struggle to manage an infected population with comorbid psychiatric symptoms.

Telepsychiatry is a flawed but reasonable solution to increase the availability of mental healthcare during COVID-19.

Reference

Gautam, M., Thakrar, A., Akinyemi, E. & Mahr, G. (2020) Current and Future Challenges in the Delivery of Mental Healthcare during COVID-19. SN Comprehensive Clinical Medicine. 1-6. doi: 10.1007/s42399-020-00348-3. Online ahead of print.

Can We Use Telehealth to Reach Underserved Veterans?

Published on 08/27/2020 by Andrew Marshall1 Comment

Research Paper Title

The Impact of Co-occurring Anxiety and Alcohol Use Disorders on Video Telehealth Utilisation Among Rural Veterans.

Background

Co-occurring anxiety and alcohol use disorders lead to poorer treatment outcomes for both disorders.

Compounding risk for poor outcomes related to these disorders, individuals living in rural areas face barriers receiving evidence-based mental health treatment.

Video to home telehealth (VTH) has been implemented broadly within the Veterans Health Administration to improve access to care for rural veterans. However, VTH may not be utilised equally across disorders and comorbidities, including co-occurring anxiety and alcohol use disorders, potentially contributing to gaps in care that are not available in person.

Methods

A cohort of veterans who received at least one VTH mental health visit between fiscal years 2016-2019 was compiled from VA administrative data.

Multilevel linear growth curve models were used to examine growth in VTH use over time among veterans with anxiety only, alcohol use disorder only, and co-occurring disorders.

Results

Fixed effects were significant for both time and diagnosis group and a significant interaction between time and group.

For each subsequent fiscal year, the percentage of total MH visits that were VTH increased for all groups but less so for those with co-occurring anxiety and alcohol use diagnoses.

Conclusions

Despite VTH being an important tool to reach underserved rural veterans, rural veterans with AUD and co-occurring anxiety and AUD are at risk for not receiving care using this modality.

Findings suggest that veterans with co-occurring anxiety and AUD are especially at risk for being underserved, given that a major goal of VTH is to increase access to mental health services.

Reference

Ecker, A.H., Amspoker, A.B., Hogan, J.B. & Lindsay, J.A. (2020) The Impact of Co-occurring Anxiety and Alcohol Use Disorders on Video Telehealth Utilization Among Rural Veterans. Journal of Technology in Behavioral Science. 1-6. doi: 10.1007/s41347-020-00150-x. Online ahead of print.

The Same or Different? Precision vs Personalised Psychiatry

Published on 08/25/2020 by Andrew Marshall1 Comment

Research Paper Title

‘Precision’ or ‘personalised’ psychiatry: different terms – same content?

Background

Due to the increased lifetime prevalence and personal, social, and economic burden of mental disorders, psychiatry is in need of a significant change in several aspects of its clinical and research approaches.

Over the last few decades, the development of personalised/precision medicine in psychiatry focusing on tailored therapies that fit each patient’s unique individual, physiological, and genetic profile has not achieved the same results as those obtained in other branches, such as oncology.

The long-awaited revolution has not yet surfaced.

There are various explanations for this including imprecise diagnostic criteria, incomplete understanding of the molecular pathology involved, absence of available clinical tools and, finally, the characteristics of the patient.

Since then, the co-existence of the two terms has sparked a great deal of discussion around the definition and differentiation between the two types of psychiatry, as they often seem similar or even superimposable.

Generally, the two terminologies are used indiscriminately, alternatively, and/or separately, within the same scientific works.

In this paper, an overview is provided on the overlap between the application and meaning of the terms ‘precision psychiatry’ and ‘personalised psychiatry’.

Reference

Perna, G., Cuniberti, F. Dacco, S., Grassi, M. & Caldirola, D. (2020) ‘Precision’ or ‘personalized’ psychiatry: different terms – same content? Fortschritte der Neurologie-Psychiatre. doi: 10.1055/a-1211-2722. Online ahead of print.

PLA Navy Personnel in Relation to Attitudes & Barriers to Mental Healthcare

Published on 08/24/2020 by Andrew Marshall1 Comment

Research Paper Title

Attitudes and perceived barriers to mental healthcare in the People’s Liberation Army Navy: study from a navy base.

Background

The People’s Liberation Army (PLA, China) Navy is increasingly conducting military operations other than war overseas. Factors such as confrontations with pirates, special environments and long sailing times have resulted in mental health problems. However, the navy’s actual utilisation of mental health services is low.

This study examined members’ rate of willingness to seek help and the factors that act as barriers to willingness to seek mental health services in the PLA Navy.

Methods

This cross-sectional study was conducted at the Zhoushan Base, operated by the East Sea Fleet, between March 2019 and April 2019.

The researchers distributed a 12-item questionnaire to examine participants’ attitudes and perceived barriers to mental healthcare. They recruited 676 navy personnel. Participants’ willingness to seek help if they had mental health problems was also assessed.

Results

The response rate was 99%. A total of 88.44% of the sample reported being willing to seek help. Univariate analysis suggested that those not willing to seek help were more likely to agree with the items, ‘Mental healthcare does not work’ and ‘My unit leadership might treat me differently’ and all organisational barriers, and they were more likely to have concerns about ’embarrassment’ and ‘being weak’ than those willing to seek help.

After controlling for demographic characteristics, binary logistic regression analyses confirmed that a lack of knowledge regarding the location of mental health clinics and being perceived as weak were the main factors preventing participants’ willingness from seeking help.

Conclusions

Extensive efforts to decrease organisational barriers and stigma towards mental healthcare should be a priority for researchers and policymakers to improve the usage of mental health services.

Psychoeducation aimed at de-stigmatising mental health problems should be delivered and the accessibility and availability of mental health services should be increased.

Reference

Gu, R-P., Liu, X.R> & Ye, X.F. (2020) Attitudes and perceived barriers to mental healthcare in the People’s Liberation Army Navy: study from a navy base. BMJ Military Health. doi: 10.1136/bmjmilitary-2019-001396. Online ahead of print.

Linking New Interests & Activities with Anxiety & Depression in Retirement for Navy Veterans

Published on 08/21/2020 by Andrew Marshall1 Comment

Research Paper Title

The impact of socio-demographic features on anxiety and depression amongst navy veterans after retirement: a cross-sectional study.

Background

Retirement from work may trigger various changes in everyday life that affect mental health.

The current cross-sectional study, conducted with 231 veterans, examines the relationship between socio-demographic features and both anxiety and depression in navy veterans after retirement.

Methods

Spielberg’s State-Trait Anxiety Inventory (STAI) was used for anxiety assessment, and the Beck Depression Inventory (BDI) was used for depression assessment.

The analysis was performed with the Statistical Package for Social Sciences (SPSS), version 20.0.

Results

It was found that the mean score of state anxiety was 41 and trait anxiety, 38.

Severe depression was found in 6.5% of the veterans, moderate in 8.3% and mild in 21.7%.

The presence of a serious health problems was an independent predictor of both anxiety and depression’s more serious symptoms.

Conclusions

Inversely, the stability in terms of retirement choice was negatively related to depression, while the development of new interests and activities after retirement was negatively related to both anxiety and depression.

Further, life satisfaction after retirement was a predictor of lower current anxiety levels among veterans.

Reference

Georgantas, D., Tsounis, A., Vidakis, I., Malliarou, M. & Sarafis, P. (2020) The impact of socio-demographic features on anxiety and depression amongst navy veterans after retirement: a cross-sectional study. BMC Rsearch Notes. 13(1), pp.122. doi: 10.1186/s13104-020-04966-x.