Barriers & Facilitators who Impact Veterans’ Engagement with Mental Health Support

Research Paper Title

The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment.

Background

It is often claimed that military veterans are reticent to seek help for mental disorders, even though delayed treatment may impair recovery and impact the wellbeing of those close to the veteran.

This paper aims to explore the barriers and facilitators to accessing professional mental health support for three groups of veterans who met criteria for a probable mental health disorder and:

  1. Do not recognise a probable mental disorder;
  2. Recognise they are affected by a mental disorder but are not seeking professional support; or
  3. Are currently seeking professional mental health support.

Methods

Qualitative telephone interviews were conducted with 62 UK military veterans. Thematic analysis identified core themes along an illustrative journey towards professional mental health support.

Results

Distinct barriers and facilitators to care were discussed by each group of veterans depicting changes as veterans moved towards accessing professional mental health support. In contrast to much of the literature, stigma was not a commonly reported barrier to care; instead care-seeking decisions centred on a perceived need for treatment, waiting until a crisis event occurred. Whilst the recognition of treatment need represented a pivotal moment, the data identified numerous key steps which had to be surmounted prior to care-seeking.

Conclusions

As care-seeking decisions within this sample appeared to centre on a perceived need for treatment future efforts designed to encourage help-seeking in UK military veterans may be best spent targeting the early identification and management of mental health disorders to encourage veterans to seek support before reaching a crisis event.

Reference

Rafferty, L.A., Wessely, S., Stevelink, S.A.M. & Greenberg, N. (2021) The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment. European Journal of Pscyhotraumatology. 10(1).1700613. doi: 10.1080/20008198.2019.1700613.

Epigenetic Biotypes of Post-Traumatic Stress Disorder

Research Paper Title

Epigenetic biotypes of post-traumatic stress disorder in war-zone exposed veteran and active duty males.

Background

Post-traumatic stress disorder (PTSD) is a heterogeneous condition evidenced by the absence of objective physiological measurements applicable to all who meet the criteria for the disorder as well as divergent responses to treatments.

Methods

This study capitalised on biological diversity observed within the PTSD group observed following epigenome-wide analysis of a well-characterised Discovery cohort (N = 166) consisting of 83 male combat exposed veterans with PTSD, and 83 combat veterans without PTSD in order to identify patterns that might distinguish subtypes.

Results

Computational analysis of DNA methylation (DNAm) profiles identified two PTSD biotypes within the PTSD+ group, G1 and G2, associated with 34 clinical features that are associated with PTSD and PTSD comorbidities.

The G2 biotype was associated with an increased PTSD risk and had higher polygenic risk scores and a greater methylation compared to the G1 biotype and healthy controls.

The findings were validated at a 3-year follow-up (N = 59) of the same individuals as well as in two independent, veteran cohorts (N = 54 and N = 38), and an active duty cohort (N = 133). In some cases, for example Dopamine-PKA-CREB and GABA-PKC-CREB signaling pathways, the biotypes were oppositely dysregulated, suggesting that the biotypes were not simply a function of a dimensional relationship with symptom severity, but may represent distinct biological risk profiles underpinning PTSD.

Conclusions

The identification of two novel distinct epigenetic biotypes for PTSD may have future utility in understanding biological and clinical heterogeneity in PTSD and potential applications in risk assessment for active duty military personnel under non-clinician-administered settings, and improvement of PTSD diagnostic markers.

Reference

Yang, R., Gautam, A., Getnet, D., Daigle, B.J., Miller, S., Misganaw, B., Dean, K.R., Kumar, R., Muhie, S., Wang, K., Lee, I., Abu-Amara, D., Flory, J.D., PTSD Systems Biology Consortium, Hood, L., Wolkowitz, O.M., Mellon, S.H., Doyle 3rd, F.J., Yehuda, R., Marmar, C.R., Ressler, K.J., Hammamieh, R. & Jett, M. (2020) Epigenetic biotypes of post-traumatic stress disorder in war-zone exposed veteran and active duty males. Molecular Psychiatry. doi: 10.1038/s41380-020-00966-2. Online ahead of print.

What is the Prevalence of Psychological Disorders in the COVID-19 Epidemic in China?

Research Paper Title

Prevalence of psychological disorders in the COVID-19 epidemic in China: A real world cross-sectional study.

Background

This study aimed to explore the prevalence of psychological disorders and associated factors at different stages of the COVID-19 epidemic in China.

Methods

The mental health status of respondents was assessed via the Patient Health Questionnaire-9 (PHQ-9), Insomnia Severity Index (ISI) and the Generalised Anxiety Disorder 7 (GAD-7) scale.

Results

5,657 individuals participated in this study. History of chronic disease was a common risk factor for severe present depression (OR 2.2, 95% confidence interval [CI], 1.82-2.66, p < 0.001), anxiety (OR 2.41, 95% CI, 1.97-2.95, p < 0.001), and insomnia (OR 2.33, 95% CI, 1.83-2.95, p < 0.001) in the survey population. Female respondents had a higher risk of depression (OR 1.61, 95% CI, 1.39-1.87, p < 0.001) and anxiety (OR 1.35, 95% CI, 1.15-1.57, p < 0.001) than males. Among the medical workers, confirmed or suspected positive COVID-19 infection as associated with higher scores for depression (confirmed, OR 1.87; suspected, OR 4.13), anxiety (confirmed, OR 3.05; suspected, OR 3.07), and insomnia (confirmed, OR 3.46; suspected, OR 4.71).

Limitations

The cross-sectional design of present study presents inference about causality. The present psychological assessment was based on an online survey and on self-report tools, albeit using established instruments. The researchers cannot estimate the participation rate, since they cannot know how many potential subjects received and opened the link for the survey.

Conclusions

Females, non-medical workers and those with a history of chronic diseases have had higher risks for depression, insomnia, and anxiety. Positive COVID-19 infection status was associated with higher risk of depression, insomnia, and anxiety in medical workers.

Reference

Wang, M., Zhao, Q., Hu, C., Wang, Y., Cao, J., Huang, S., Li, J., Huang, Y., Liang, Q., Guo, Z., Wang, L., Ma, L., Zhang, S., Wang, H., Ahu, C., Luo, W., Guo, C., Chen, C., Chen, Y., Xu, K., Yang, H., Ye, L., Wang, Q., Zhan, P., Li, G., Yang, M.J., Fang, Y., Zhu, S. & Yang, Y. (2020) Prevalence of psychological disorders in the COVID-19 epidemic in China: A real world cross-sectional study. Journal of Affective Disorders. 281, pp.312-320. doi: 10.1016/j.jad.2020.11.118. Online ahead of print.

What is a Community Mental Health Service?

Introduction

Centre for Mental Health Services, also known as community mental health teams (CMHT) in the United Kingdom, support or treat people with mental disorders (mental illness or mental health difficulties) in a domiciliary setting, instead of a psychiatric hospital (asylum). The array of community mental health services vary depending on the country in which the services are provided. It refers to a system of care in which the patient’s community, not a specific facility such as a hospital, is the primary provider of care for people with a mental illness. The goal of community mental health services often includes much more than simply providing outpatient psychiatric treatment.

Community services include supported housing with full or partial supervision (including halfway houses), psychiatric wards of general hospitals (including partial hospitalisation), local primary care medical services, day centres or clubhouses, community mental health centres, and self-help groups for mental health.

The services may be provided by government organisations and mental health professionals, including specialised teams providing services across a geographical area, such as assertive community treatment and early psychosis teams. They may also be provided by private or charitable organisations. They may be based on peer support and the consumer/survivor/ex-patient movement.

The World Health Organisation (WHO) states that community mental health services are more accessible and effective, lessen social exclusion, and are likely to have fewer possibilities for the neglect and violations of human rights that were often encountered in mental hospitals. However, WHO notes that in many countries, the closing of mental hospitals has not been accompanied by the development of community services, leaving a service vacuum with far too many not receiving any care.

New legal powers have developed in some countries, such as the United States, to supervise and ensure compliance with treatment of individuals living in the community, known as outpatient commitment or assisted outpatient treatment or community treatment orders.

Brief History

Origins

Community mental health services began as an effort to contain those who were “mad” or considered “lunatics”. Understanding the history of mental disorders is crucial in understanding the development of community mental health services. As medical psychology developed as a science and shifted toward the treatment of the mentally ill, psychiatric institutions began to develop around the world, and laid the groundwork for modern day community mental health services.

Pre-Deinstitutionalisation

On 03 July 1946, US President Harry Truman signed the National Mental Health Act which, for the first time in the history of the United States, generated a large amount of federal funding for both psychiatric education and research. The passing of this Act eventually led to the founding of the National Institute of Mental Health (NIMH) in 1949. At the end of the 1940s and moving into the beginning of the 1950s, the governor of Minnesota Luther Youngdahl initiated the development of numerous community-based mental health services. He also advocated for the humane treatment of people in state institutions.

Deinstitutionalisation

Philippe Pinel played a large role in the ethical and humane treatment of patients and greatly influenced Dorothea Dix. Dix advocated the expansion of state psychiatric hospitals for patients who were at the time being housed in jails and poor houses. Despite her good intentions, rapid urbanisation and increased immigration led to a gross overwhelming of the state’s mental health systems and because of this, as the 19th century ended and the 20th century began, a shift in focus from treatment to custodial care was seen. As quality of care declined and psychotropic drugs were introduced, those with mental illnesses were reintroduced to the community, where community mental health services were designated as primary care providers.

Mental Health Movements

Reform MovementEraSettingFocus of Reform
Moral Treatment1800-1850AsylumHumane, restorative treatment
Mental Hygiene1890-1920Mental hospital or clinicPrevention, scientific orientation
Community Mental Health1955-1970Community mental health centreDeinstitutionalisation, social integration
Community Support1975-PresentCommunitiesMental illness as a social welfare problem (e.g. treatment housing, employment, etc.)

Post-Deinstitutionalisation

Following deinstitutionalisation, many of the mentally ill ended up in jails, nursing homes, and on the streets as homeless individuals. It was at this point in history that modern community mental health services started to grow and become influential. In 1955, following a major period of deinstitutionalisation, the Mental Health Study Act was passed. With the passing of this Act, the US Congress called for “an objective, thorough, nationwide analysis and re-evaluation of the human and economic problems of mental health.” Following Congress’ mandate, the Joint Commission on Mental Illness conducted numerous studies. For the next four years this Commission made recommendations to establish community mental health centres across the country. In 1963, the Community Mental Health Centres Act was passed, essentially kick-starting the community mental health revolution. This Act contributed further to deinstitutionalisation by moving mental patients into their “least restrictive” environments. The Community Mental Health Centres Act funded three main initiatives:

  • Professional training for those working in community mental health centres;
  • Improvement of research in the methodology utilised by community mental health centres; and
  • Improving the quality of care of existing programmes until newer community mental health centres could be developed.

That same year the Mental Retardation Facilities and Community Mental Health Centres Construction Act was passed. President John F. Kennedy ran part of his campaign on a platform strongly supporting community mental health in the United States. Kennedy’s ultimate goal was to reduce custodial care of mental health patients by 50% in ten to twenty years. In 1965, the Community Mental Health Act was amended to ensure a long list of provisions. First, construction and staffing grants were extended to include centres that served patients with substance abuse disorders. Secondly, grants were provided to bolster the initiation and progression of community mental health services in low-SES areas. Lastly, new grants were established to support mental health services aimed at helping children. As the 20th century progressed, even more political influence was exerted on community mental health. In 1965, with the passing of Medicare and Medicaid, there was an intense growth of skilled nursing homes and intermediate-care facilities that alleviated the burden felt by the large-scale public psychiatric hospitals.

20th Century

From 1965 to 1969, $260 million was authorised for community mental health centres. Compared to other government organisations and programmes, this number is strikingly low. The funding drops even further under Richard Nixon from 1970-1973 with a total of $50.3 million authorised. Even though the funding for community mental health centres was on a steady decline, deinstitutionalisation continued into the 1960s and 1970s. The number of state and county mental hospital resident patients in 1950 was 512,501 and by 1989 had decreased to 101,402. This continuing process of deinstitutionalisation without adequate alternative resources led the mentally ill into homelessness, jails, and self-medication through the use of drugs or alcohol. In 1975, Congress passed an Act requiring community mental health centres to provide aftercare services to all patients in the hopes of improving recovery rates. In 1980, just five years later, Congress passed the Mental Health Systems Act of 1980, which provided federal funding for ongoing support and development of community mental health programmes. This Act strengthened the connection between federal, state, and local governments with regards to funding for community mental health services. It was the final result of a long series of recommendations by Jimmy Carter’s Mental Health Commission. Despite this apparent progress, just a year after the Mental Health Systems Act was passed, the Omnibus Budget Reconciliation Act of 1981 was passed. The Omnibus Act was passed by the efforts of the Reagan administration as an effort to reduce domestic spending. The Act rescinded a large amount of the legislation just passed, and the legislation that was not rescinded was almost entirely revamped. It effectively ended federal funding of community treatment for the mentally ill, shifting the burden entirely to individual state governments. Federal funding was now replaced by granting smaller amounts of money to the individual states. In 1977, the National Institute of Mental Health (NIMH) initiated its Community Support Program (C.S.P.). The C.S.P.’s goal was to shift the focus from psychiatric institutions and the services they offer to networks of support for individual clients. The C.S.P. established the ten elements of a community support system listed below:

  • Responsible team.
  • Residential care.
  • Emergency care.
  • Medicare care.
  • Halfway house.
  • Supervised (supported) apartments.
  • Outpatient therapy.
  • Vocational training and opportunities.
  • Social and recreational opportunities.
  • Family and network attention.

This conceptualisation of what makes a good community programme has come to serve as a theoretical guideline for community mental health service development throughout the modern-day United States psychological community. In 1986, Congress passed the Mental Health Planning Act of 1986, which was a Federal law requiring that at the state government level, all states must have plans for establishing case management under Medicaid, improving mental health coverage of community mental health services, adding rehabilitative services, and expanding clinical services to the homeless population. More specifically, community mental health providers could now receive reimbursement for services from Medicare and Medicaid, which allowed for many of the centres to expand their range of treatment options and services. As the 1990s began, many positive changes occurred for people with mental illnesses through the development of larger networks of community-based providers and added innovations with regards to payment options from Medicare and Medicaid. Despite these advancements, there were many issues associated with the increasing cost of health care. Community mental health services moved toward a system more similar to managed care as the 1990s progressed. Managed care as a system focuses on limiting costs by one of two means: either keeping the total number of patients using services low or reducing the cost of the service itself. Despite the drive for community mental health, many physicians, mental health specialists, and even patients have come to question its effectiveness as a treatment. The underlying assumptions of community mental health require that patients who are treated within a community have a place to live, a caring family, or supportive social circle that does not inhibit their rehabilitation. These assumptions are in fact often wrong. Many people with mental illnesses, upon discharge, have no family to return to and end up homeless. While there is much to be said for the benefits that community mental health offers, many communities as a whole often harbour negative attitudes toward those with mental illnesses. Historically, people with mental illnesses have been portrayed as violent or criminal and because of this, “many American jails have become housing for persons with severe mental illnesses arrested for various crimes.” In 1999 the Supreme Court ruled on the case Olmstead v. L.C. The Court ruled that it was a violation of the Americans with Disabilities Act of 1990 to keep an individual in a more restrictive inpatient setting, such as a hospital, when a more appropriate and less restrictive community service was available to the individual.

21st Century and Modern Trends

In 2002, President George W. Bush increased funding for community health centres. The funding aided in the construction of additional centres and increased the number of services offered at these centres, which included healthcare benefits. In 2003, the New Freedom Commission on Mental Health, established by President Bush, issued a report. The report was in place to “conduct a comprehensive study of the United States mental health delivery system…” Its objectives included assessing the efficiency and quality of both public and private mental health providers and identifying possible new technologies that could aid in treatment. As the 20th century came to a close and the 21st century began, the number of patients diagnosed with a mental health or substance abuse disorder receiving services at community mental health centres grew from 210,000 to approximately 800,000. This nearly four-fold increase shows just how important community mental health centres are becoming to the general population’s wellbeing. Unfortunately, this drastic rise in the number of patients was not mirrored by a concomitant rise in the number of clinicians serving this population. The staggering new numbers of patients then are being forced to seek specialised treatment from their primary care providers or hospital emergency rooms. The unfortunate result of this trend is that when a patient is working with their primary care provider, they are more likely for a number of reasons to receive less care than with a specialised clinician. Politics and funding have always been and continue to be a topic of contention when it comes to funding of community health centres. Political views aside, it is clear that these community mental health centres exist largely to aid areas painfully under resourced with psychiatric care. In 2008, over 17 million people utilised community mental health centres with 35% being insured through Medicaid, and 38% being uninsured. As the 2000s continued, the rate of increase of patients receiving mental health treatment in community mental health centres stayed steady.

Purpose and Examples

Cultural knowledge and attitude is passed from generation to generation. For example, the stigma with therapy may be passed from mother to daughter. San Diego county has a diverse range of ethnicities. Thus, the population diversity in San Diego include many groups with historical trauma and trans-generational trauma within those populations. For example, witnesses of war can pass down certain actions and patterns of survival mechanism to generations. Refugee groups have trans-generational trauma around war and PTSD. Providing services and therapy to these communities is important because it affects their day-to-day lives, where their experiences lead to trauma or the experiences are traumatic themselves. Knowledge and access to mental health resources are limited in these multicultural communities. Government agencies fund community groups that provide services to these communities. Therefore, this creates a power hierarchy. If their missions do not align with each other, it will be hard to provide benefits for the community, even though the services are imperative to the wellbeing of its residents.

The combination of a mental illness as a clinical diagnosis, functional impairment with one or more major life activities, and distress is highest in ages 18-25 years old. Despite the research showing the necessity of therapy for this age group, only one fifth of emerging adults receive treatment. Psychosocial interventions that encourage self-exploration and self-awareness, such as acceptance and mindfulness-based therapies, is useful in preventing and treating mental health concerns. At the Centre for Community Counselling and Engagement, 39% of their clients are ages 1-25 years old and 40% are in ages 26-40 years old as well as historically underrepresented people of colour. The centre serves a wide range of ethnicities and socio-economic statuses in the City Heights community with counsellors who are graduate student therapists getting their Master’s in Marriage and Family Therapy or Community Counselling from San Diego State University, as well as post-graduate interns with their master’s degree, who are preparing to be licensed by the state of California. Counselling fees are based on household incomes, which 69% of the client’s annual income is $1-$25,000 essentially meeting the community’s needs. Taking into account of San Diego’s population, the clinic serves as an example of how resources can be helpful for multicultural communities that have a lot of trauma in their populations.

Future

On one hand, despite the field’s movement toward community mental health services, currently “insufficient empirical research exists regarding the effectiveness of community treatment programmes, and the evidence that does exist does not generalise to all types of community treatment.” In addition to the fact that community mental health’s overall success must be further evaluated, in the times when it has proved effective, very little research exists to help in understanding what exact aspects make it effective. Effective and insightful research will be crucial in not only evaluating, but also improving the techniques community mental health utilises. On the other hand, the demand for and necessity of community mental health is driving it into the future. With this seemingly unrelenting increase in the number of people experiencing mental health illnesses and the number of people reporting these problems, the question becomes what role community mental health services will play. In 2007, almost 5% of adults in the United States reported at least one unmet need for mental health care. Funding has historically been and continues to be an issue for both the organisations attempting to provide mental health services to a community and the citizens of the community who are so desperately in need of treatment. The community mental health system’s goal is an extremely difficult one and it continues to struggle against changing social priorities, funding deficits, and increasing need. Community mental health services would ideally provide quality care at a low cost to those who need it most. In the case of deinstitutionalisation, as the number of patients treated increased, the quality and availability of care went down. With the case of small, private treatment homes, as the quality of the care went up their ability to handle large numbers of patients decreased. This unending battle for the middle ground is a difficult one but there seems to be hope. For example, the 2009 Federal Stimulus Package and Health Reform Act have increased the funding for community health centres substantially. Undoubtedly as community mental health moves forward, there will continue to be a juggling act between clinical needs and standards, political agendas, and funding.

Elucidating the Epidemiology of Mental Disorders

Research Paper Title

WHO’s work on the epidemiology of mental disorders.

Background

The WHO programme on epidemiology of mental disorders started in the early 1960’s with a series of reviews of knowledge.

These were followed by activities aiming at four main goals:

  • The standardisation of psychiatric diagnosis, classification and statistics;
  • The development of standardised internationally applicable instruments for the assessment of mental patients and of variables relevant to the assessment of mental illness;
  • The conduct of epidemiological studies of mental disorders; and
  • The training relevant to the above goals.

The paper provides a description of the activities undertaken to achieve these goals and stresses the importance and usefulness of the collaboration of individuals, experts and institutions all over the world in this effort.

Reference

Sartorius, N. (2020) WHO’s work on the epidemiology of mental disorders. Social Psychiatry and Psychiatric Epidemiology. 28(4), pp.147-155. doi: 10.1007/BF00797316.

My SO Has Got Depression (2011)

Introduction

A husband is suffering from melancholia, and he wants to commit suicide. His wife, who is a cartoonist, forces him to quit his job for the therapy. The wife’s optimism influence the husband, and they live happily ever after.

Also known as Tsure ga utsu ni narimashite (original title), 丈夫得了抑郁症 (China, Mandarin, festival title), and ツレがうつになりまして。(Japanese).

Outline

Mikio (Masato Sakai) is a married man and works hard for the company where he is employed. Then one day Mikio is diagnosed with depression. Mikio’s wife is Haruko (Aoi Miyazaki). They have been married for 5 years. Haruko draws comics for work, but they do not sell well. She mainly relied on Mikio for support. Meanwhile, Haruko did not notice any changes in her husband. She begins to blame herself for not noticing any signs. Mikio’s depression derived from his work. His company has been pressing him to quit the company. After Mikio quits his job his condition improves, but the dynamics of their relationship changes.

Cast

  • Mitsuru Fukikoshi – Sugiura.
  • Kanji Tsuda – Kazuo Takazaki.
  • Hiroshi Inuzuka – Kawaji.
  • Tomio Umezawa – Takashi Mikami.
  • Ryosei Tayama – Kamo.
  • Ren Osugi – Yasuo Kurita (Haruko’s dad).
  • Kimiko Yo – Satoko Kurita (Haruko’s mom).
  • Hiroshi Yamamoto – Kimizuka.
  • Saburo Tamura – Tsuda.
  • Yuta Nakano – Obata.
  • Atsushi Mizutani.

Awards

2011 (36th) Hochi Film Awards – 29 November 2011 – Best Actor (Masato Sakai).

Trivia

  • Based on the manga “Tsure ga Utsu ni Narimashite” by female manga artist Tenten Hosokawa.
    • The manga also inspired the NHK 2009 drama “How Do I Cope with My Husband’s Depression?” (Tsure ga utsu ni narimashite, NHK, 2009).
  • Movie director Kiyoshi Sasabe planned directing the film for 4 years.
  • Filming began January 9th and is expected to finish early February.
  • Aoi Miyazaki & Masato Sakai previously worked together in the 2008 taiga drama “Atsuhime”.

Production & Filming Details

  • Director(s): Kiyoshi Sasabe.
  • Producer(s): Mitsuru Kurosawa, Naoya Kinoshita, Hirohumi Shigemura, Takashi Hirajo, Hideyuki Hukuhara, Tadayoshi Kubota, Tatsuya Kunimatsu, and Masaaki Usui.
  • Writer(s): Tenten Hosokawa (manga) and Takeshi Aoshima (screenplay).
  • Music: Mino Kabasawa.
  • Cinematography: Takeshi Hamada.
  • Editor(s): Eisuke Oohata.
  • Production:
    • Central Arts.
    • CineMove.
    • Gentosha.
    • IVS Television.
    • King Records.
    • Kinoshita Komuten.
    • TV Asahi.
    • The Yomiuri Shimbun.
    • Toei Video Company.
  • Distributor(s): Toei Company (Japan).
  • Release Date: 08 October 2011 (Kawasaki Shinyuri Film Festival).
  • Running Time: 121 minutes.
  • Rating: Unknown.
  • Country: Japan.
  • Language: English (subtitles) and Japanese.

Video Link

What is the Impact of Early Manifesting Disorders in the Frame of General Mental Morbidity & of the Effect of Intervention?

Research Paper Title

What happens to children and adolescents with mental disorders? Findings from long-term outcome research.

Background

Research on the long-term outcome of mental disorders originating in childhood and adolescence is an important part of developmental psychopathology.

Methods

After a brief sketch of relevant terms of outcome research, the first part of this review reports findings based on heterotypic cohort studies.

The major second part of this review presents findings based on long-term outcome studies dealing with homotypic diagnostic groups. In particular, the review focuses on the course and prognosis of ADHD, anxiety disorders, depression, conduct disorders, eating disorders, autism spectrum disorders, schizophrenia, and selective mutism.

Results

Findings mainly support the vulnerability hypothesis regarding mental disorders with early manifestation in childhood and adolescence as frequent precursors of mental disorders in adulthood.

Conclusions

The discussion focuses on the impact of early manifesting disorders in the frame of general mental morbidity and of the effect of interventions, which is not yet sufficiently discernible.

Reference

Steinhausen, H-C. (2020) What happens to children and adolescents with mental disorders? Findings from long-term outcome research [German]. Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie. 41(6), pp.419-431. doi: 10.1024/1422-4917/a000258.

Theoretical Assumptions & Mental Disorders

Research Paper Title

Should definitions for mental disorders include explicit theoretical elements?

Background

In this article the researchers argue that mental disorders have come to be defined according to a descriptive theory of meaning. In other words, mental disorders are defined according to superficial descriptive criteria that count as necessary and sufficient criteria for the inclusion of a particular instance under its corresponding class.

These descriptive criteria are allegedly theory independent, leading to the assumption that psychiatric symptoms are directly identified in an object-like fashion.

Against this view, the researchers hold that a descriptive theory of meaning is unable to offer a proper account of the meaning of mental disorders both due to its own internal limitations and to the specific nature of psychiatric phenomena.

Due to the hermeneutic structure of psychiatric practice, they argue that the identification and description of mental symptoms and disorders unavoidably depends on (frequently unacknowledged) theoretical assumptions.

Since there is no global consensus regarding these theoretical commitments, and due to the fact that these significantly affect the final picture the researchers hold with respect to each mental disorder, they believe that these commitments should be explicitly stated both in diagnostic argumentation and in theoretical discussions in order to maximise self- and mutual understanding.

Reference

Adan-Manes, J. & Ramos-Gorostiza, P. (2020) Should definitions for mental disorders include explicit theoretical elements? Psychopathology. 47(3), pp.158-166. doi: 10.1159/000351741. Epub 2013 Aug 30.

The Use of Complementary & Alternative Medicine in Mental Disorders

Research Paper Title

Mental disorders and the use of alternative medicine: results from a national survey.

Background

The study examined the relationship between mental disorders and the use of complementary and alternative medicine.

Methods

Data from a national household telephone survey conducted in 1997-1998 (N=9,585) were used to examine the relationships between use of complementary and alternative medicine during the past 12 months and several demographic variables and indicators of mental disorders. Structured diagnostic screening interviews were used to establish diagnoses of probable mental disorders.

Results

Use of complementary and alternative medicine during the past 12 months was reported by 16.5% of the respondents. Of those respondents, 21.3% met diagnostic criteria for one or more mental disorders, compared to 12.8% of respondents who did not report use of alternative medicine. Individuals with panic disorder and major depression were significantly more likely to use alternative medicine than those without those disorders. Respondents with mental disorders who reported use of alternative medicine were as likely to use conventional mental health services as respondents with mental disorders who did not use alternative medicine.

Conclusions

The researchers found relatively high rates of use of complementary and alternative medicine among respondents who met criteria for common mental disorders. Practitioners of alternative medicine should look for these disorders in their patients, and conventional medical providers should ask their depressed and anxious patients about the use of alternative medicine. More research is needed to determine if individuals with mental disorders use alternative medicine because conventional medical care does not meet their health care needs.

Reference

Unutzer, J., Klap, R., Sturm, R., Young, A.S., Marmon, T., Shatkin, J. & Wells, K.B. (2020) Mental disorders and the use of alternative medicine: results from a national survey. The American Journal of Psychiatry. 157(11), pp.1851-1857. doi: 10.1176/appi.ajp.157.11.1851.

Is the Association between Mental Disorders & Cardiovascular Disease Spurious or Real?

Research Paper Title

PsyCoLaus: mental disorders and cardiovascular diseases: spurious association?

Background

Cardio-vascular diseases (CVD), their well established risk factors (CVRF) and mental disorders are common and co-occur more frequently than would be expected by chance.

However, the mechanisms underlying this association are still poorly understood.

The main study questions of PsyCoLaus, the psychiatric arm of CoLaus, are:

  • Do mental disorders increase vulnerability to CVRF and CVD?
  • Do CVRF and CVD promote the development of mental disorders?
  • Do CVRF/ CVD and mental disorders share common pathogenetic processes?

The longitudinal project adds a comprehensive psychiatric evaluation to the CoLaus investigation.

A better understanding of the psychological, physiological and behavioural links underlying CVD/ CVRF and mental disorders will result in the development of more specific and efficient strategies of prevention and treatment for both psychiatric and CVD/CVRF, two major elements of burden of disease.

Reference

Preisig, M., Waeber, G., Mooser, V. & Vollenweider, P. (2020) PsyCoLaus: mental disorders and cardiovascular diseases: spurious association? Revue Medicale Suisse. 7(315), pp.2127-2129.