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What are the Historical Contexts to Communicating Mental Health?

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Research Paper Title

Introduction: historical contexts to communicating mental health.

Abstract

Contemporary discussions around language, stigma and care in mental health, the messages these elements transmit, and the means through which they have been conveyed, have a long and deep lineage.

Recognition and exploration of this lineage can inform how we communicate about mental health going forward, as reflected by the 9 papers which make up this special issue.

The researchers introduction provides some framework for the history of communicating mental health over the past 300 years. They show that there have been diverse ways and means of describing, disseminating and discussing mental health, in relation both to therapeutic practices and between practitioners, patients and the public. Communicating about mental health, they argue, has been informed by the desire for positive change, as much as by developments in reporting, legislation and technology.

However, while the modes of communication have developed, the issues involved remain essentially the same. Most practitioners have sought to understand and to innovate, though not always with positive results. Some lost sight of patients as people; patients have felt and have been ignored or silenced by doctors and carers. Money has always talked, for without adequate investment services and care have suffered, contributing to the stigma surrounding mental illness.

While it is certainly ‘time to talk’ to improve experiences, it is also time to change the language that underpins cultural attitudes towards mental illness, time to listen to people with mental health issues and, crucially, time to hear.

Reference

Wynter, R. & Smith, L. (2017) Introduction: historical contexts to communicating mental health. Medical Humanities. 43(2), pp.73-80. doi: 10.1136/medhum-2016-011082.

Measuring Functional Independence using the interRAI Child and Youth Mental Health Assessment System.

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Research Paper Title

Examining the Structure of a New Pediatric Measure of Functional Independence Using the interRAI Child and Youth Mental Health Assessment System.

Background

Activities of daily living (ADL) are key to daily living and adjustment. A number of ADL scales have been developed and validated to examine functional performance in the paediatric population; however, most of these scales are limited to specific groups.

The purpose of this research was to test the plausibility of developing and validating a hierarchical versus additive ADL summary scale for children and youth using the interRAI Child Youth Mental Health (ChYMH) assessment system.

Methods

Data from 8980 typically developing children (mean age 12.02 years) and 655 children with developmental disabilities (mean age 11.9 years) was used to develop ADL summary scales. Patterns among the data were analysed and, unlike with adult populations, a hierarchical scale did not capture ADL performance and mastery.

Results

Two new ADL additive summary scales for children and youth were developed to measure ADL skills within this group.

Reference

Stewart, S.L., Morris, J.N., Asare-Bediako, Y.A. & Toohey, A. (2019) Examining the Structure of a New Pediatric Measure of Functional Independence Using the interRAI Child and Youth Mental Health Assessment System. Developmental Neurorehabilitation. 1-8. doi: 10.1080/17518423.2019.1698070. [Epub ahead of print].

Mental Health Needs & Visits: Rural vs Urban Residents

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Research Paper Title

Rural Residents With Mental Health Needs Have Fewer Care Visits Than Urban Counterparts.

Background

Analysis of a nationally representative sample of adults with mental health needs shows that rural residents have fewer ambulatory mental health visits than their urban counterparts do.

Even among people already on prescription medications for mental health conditions, rural-urban differences are large.

Reference

Kirby, J.B., Zuvekas, S.H., Borsky, A.E. & Ngo-Metzger, Q. (2019) Rural Residents With Mental Health Needs Have Fewer Care Visits Than Urban Counterparts. Health Affairs (Project Hope). 38(12), pp.2057-2060. doi: 10.1377/hlthaff.2019.00369.

International Volunteer Day (IVD)

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The 05 December is International Volunteer Day (IVD), more formally known as The International Volunteer Day for Economic and Social Development.

It is an international observance mandated by the United Nations (UN) General Assembly in 1985.

It offers an opportunity for volunteer-involving organisations and individual volunteers to promote volunteerism, encourage governments to support volunteer efforts and recognise volunteer contributions to the achievement of the Sustainable Development Goals (SDGs) at local, national and international levels.

International Volunteer Day is celebrated by many non-governmental organisations, civil society, and the private sector, among others. It is also marked and supported by the United Nations Volunteers (UNV) programme.

UNV coordinates a campaign to promote IVD every year, building on the impact volunteers have in communities, nationally and globally for peace and development.

In 2018, the focus of IVD was not only to celebrate volunteerism in all its facets, but also to highlight the role that volunteers play in building resilient communities.

It is worth noting that current estimates equate the global volunteer workforce to 109 million full-time workers:

  • 30% of volunteering that takes place formally through organisations, associations and groups;
  • 70% occurs through informal engagement between individuals; and
  • Overall, 60% of the informal volunteers are women.

I currently volunteer for a mental health charity in Fife, Scotland, Express Group (Fife).

The Experience of Sexual Minority Men & Mental Healthcare in Toronto, Canada

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Research Paper Title

Mental health and structural harm: a qualitative study of sexual minority men’s experiences of mental healthcare in Toronto, Canada.

Background

Compared to the general population, sexual minority men report poorer mental health outcomes and higher mental healthcare utilisation.

However, they also report more unmet mental health needs.

Methods

To better understand this phenomenon, the researchers conducted qualitative interviews with 24 sexual minority men to explore the structural factors shaping their encounters with mental healthcare in Toronto, Canada.

Interviews were analysed using grounded theory.

Results

Many participants struggled to access mental healthcare and felt more marginalised and distressed because of two interrelated sets of barriers.

  • The first were general barriers, hurdles to mental healthcare not exclusive to sexual minorities. These included:
    • Financial and logistical obstacles;
    • The prominence of psychiatry and the biomedical model; and
    • Unsatisfactory provider encounters.
  • The second were sexual minority barriers, obstacles explicitly rooted in heterosexism and homophobia sometimes intersecting with other forms of marginality. These included:
    • Experiencing discrimination and distrust; and
    • Limited sexual minority affirming options.

Discussions of general barriers outweighed those of sexual minority barriers, demonstrating the health consequences of structural harms in the absence of overt structural stigma.

Conclusions

Healthcare inaccessibility, income insecurity and the high cost of living are fostering poor mental health among sexual minority men.

Research must consider the upstream policy changes necessary to counteract these harms.

Reference

Gaspar, M., Marshall, Z., Rodrigues, R., Adam, B.D., Brennan, D.J., Hart, T.A. & Grace, D. (2019) Mental health and structural harm: a qualitative study of sexual minority men’s experiences of mental healthcare in Toronto, Canada. Culture, Health, & Sexuality. 1-17. doi: 10.1080/13691058.2019.1692074. [Epub ahead of print].

The Effects of Childhood Trauma on Increased Cortisol Levels in Patients with Glucocorticoid Resistance

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Research Paper Title

Childhood Trauma, HPA Axis Activity and Antidepressant Response in Patients with Depression.

Background

Childhood trauma is among the most potent contributing risk factors for depression and is associated with poor treatment response.

Hypothalamic-pituitary-adrenal (HPA) axis abnormalities have been linked to both childhood trauma and depression, but the underlying mechanisms are poorly understood.

The present study aimed to investigate the link between childhood trauma, HPA axis activity and antidepressant response in patients with depression.

Methods

As part of the Wellcome Trust NIMA consortium, 163 depressed patients and 55 healthy volunteers were included in this study.

Adult patients meeting Structured Clinical Interview for Diagnostic and Statistical Manual Version-5 criteria for major depression were categorised into subgroups of treatment responder (n=42), treatment non-responder (n=80) and untreated depressed (n=41) based on current depressive symptom severity measured by the 17-item Hamilton Rating Scale for Depression and exposure to antidepressant medications established by Antidepressant Treatment Response Questionnaire. Childhood Trauma Questionnaire was obtained.

Baseline serum C-reactive protein was measured using turbidimetric detection. Salivary cortisol was analysed at multiple time points during the day using the ELISA technique. Glucocorticoid resistance was defined as the coexistence of hypercortisolemia and inflammation.

Results

The results show that treatment non-responder patients had higher exposure to childhood trauma than responders.

No specific HPA axis abnormalities were found in treatment non-responder depressed patients.

Untreated depressed showed increased diurnal cortisol levels compared with patients on antidepressant medication, and higher prevalence of glucocorticoid resistance than medicated patients and controls.

The severity of childhood trauma was associated with increased diurnal cortisol levels only in individuals with glucocorticoid resistance.

Conclusions

The researchers argue their findings suggest that the severity of childhood trauma experience contributes to a lack of response to antidepressant treatment.

The effects of childhood trauma on increased cortisol levels are specifically evident in patients with glucocorticoid resistance and suggest glucocorticoid resistance as a target for the development of personalised treatment for a subgroup of depressed patients with a history of childhood trauma rather than for all patients with resistance to antidepressant treatment.

Reference

Nikkheslat, N., McLaughlin, A.P., Hastings, C., Zajkowska, Z., Nettis, M.A., Mariani, N., Enache, D., Lombardo, G., Pointon, L., Cowen, P.J., Cavanagh, J., Harrison, N.A., Bullmore, E.T., Pariante, C.M., Mondelli, V. & NIMA Consortium. (2019) Childhood Trauma, HPA Axis Activity and Antidepressant Response in Patients with Depression. Brain, Behavior, and Immunity. pii: S0889-1591(19)30702-0. doi: 10.1016/j.bbi.2019.11.024. [Epub ahead of print].

Do Pregnant & Postpartum Women in OUD Treatment have the Potential to Benefit from Access to PSS throughout their Perinatal Period?

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Research Paper Title

Peer support specialists and perinatal opioid use disorder: Someone that’s been there, lived it, seen it.

Background

Perinatal opioid use disorder (OUD) has increased drastically since 2000 and is associated with myriad adverse outcomes.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends using peer support services to promote sustained remission from substance use disorders (SUDs).

Integrating peer support specialists into perinatal OUD treatment has the potential to improve maternal and child health.

However, there is limited published research on the experiences of pregnant and parenting women with peer support specialists during SUD treatment.

The purpose of this study was to:

  1. Describe experiences of perinatal women undergoing OUD treatment with peer support specialists; and
  2. Describe recommendations for improving or enhancing peer support services.

Methods

For this qualitative descriptive study, the researchers conducted two focus groups in a private location in a clinic that serves postpartum women with OUD (N = 9) who were parenting a child under the age of 5.

The focus groups were voice recorded, professionally transcribed, and analyzed in MAXQDA using content analysis.

Results

Four themes emerged from the data:

  1. Feeling Supported by Peer Support Specialists;
  2. Qualities of an ‘Ideal’ Peer Support Specialist;
  3. Strategies to Improve Interactions with Peer Support Specialists; and
  4. Importance of Communication Across the Perinatal Period.

Participants reported that PSSs had a strong, positive impact on their recovery.

Postpartum women report overall positive experiences receiving peer support services during their pregnancy and postpartum period.

However, participants offered suggestions to improve their interactions with PSSs, such as clarifying the boundaries between peer supporters and clients.

Conclusions

Pregnant and postpartum women in OUD treatment have the potential to benefit from access to PSS throughout their perinatal period.

Future research is needed to determine the impact of PSS on sustained recovery for perinatal women with OUD.

Reference

Fallin-Bennett, A., Elswick, A. & Ashford, K. (2019) Peer support specialists and perinatal opioid use disorder: Someone that’s been there, lived it, seen it. Addictive Behaviors. 102:106204. doi: 10.1016/j.addbeh.2019.106204. [Epub ahead of print].

Comparing the Effectiveness of Prompt Mental Health Care to Treatment as Usual

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Research Paper Title

Effectiveness of Prompt Mental Health Care, the Norwegian Version of Improving Access to Psychological Therapies: A Randomized Controlled Trial.

Background

The innovative treatment model Improving Access to Psychological Therapies (IAPT) and its Norwegian adaptation, Prompt Mental Health Care (PMHC), have been evaluated by cohort studies only. Albeit yielding promising results, the extent to which these are attributable to the treatment thus remains unsettled.

Therefore the objective of this research was to investigate the effectiveness of the PMHC treatment compared to treatment as usual (TAU) at 6-month follow-up.

Methods

A randomised controlled trial with parallel assignment was performed in two PMHC sites (Sandnes and Kristiansand) and enrolled clients between November 9, 2015 and August 31, 2017. Participants were 681 adults (aged ≥18 years) considered for admission to PMHC due to anxiety and/or mild to moderate depression (Patient Health Questionnaire [PHQ-9]/Generalised Anxiety Disorder scale [GAD-7] scores above cutoff). These were randomly assigned (70:30 ratio; n = 463 to PMHC, n = 218 to TAU) with simple randomisation within each site with no further constraints. The main outcomes were recovery rates and changes in symptoms of depression (PHQ-9) and anxiety (GAD-7) between baseline and follow-up. Primary outcome data were available for 73/67% in PMHC/TAU. Sensitivity analyses based on observed patterns of missingness were also conducted. Secondary outcomes were work participation, functional status, health-related quality of life, and mental well-being.

Results

A reliable recovery rate of 58.5% was observed in the PMHC group and of 31.9% in the TAU group, equalling a between-group effect size of 0.61 (95% CI 0.37 to 0.85, p < 0.001). The differences in degree of improvement between PMHC and TAU yielded an effect size of -0.88 (95% CI -1.23 to -0.43, p < 0.001) for PHQ-9 and -0.60 (95% CI -0.90 to -0.30, p < 0.001) for GAD-7 in favour of PMHC. All sensitivity analyses pointed in the same direction, with small variations in point estimates. Findings were slightly more robust for depressive than anxiety symptoms. PMHC was also more effective than TAU in improving all secondary outcomes, except for work participation (z = 0.415, p = 0.69).

Conclusions

The PMHC treatment was substantially more effective than TAU in alleviating the burden of anxiety and depression. This adaptation of IAPT is considered a viable supplement to existing health services to increase access to effective treatment for adults who suffer from anxiety and mild to moderate depression. A potential effect on work participation needs further examination.

Reference

Knapstad, M., Lervik, L.V., Sæther, S.M.M., Aarø, L.E. & Smith, O.R.F. (2019) Effectiveness of Prompt Mental Health Care, the Norwegian Version of Improving Access to Psychological Therapies: A Randomized Controlled Trial. Psychotherapy and Psychosomatics. 1-16. doi: 10.1159/000504453. [Epub ahead of print].