Tag: Mental Health

Mental Health & Social Support

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Everyone requires a social network to satisfy the human need to be cared for, accepted, and emotionally supported, particularly in times of stress.

Research has shown that strong social support may significantly improve recovery from both physical and mental illnesses.

Changes in society have diminished the traditional support once offered by neighbours and families.

As an alternative, self-help groups and mutual aid groups have sprung up throughout the country.

Some self-help groups, such as Alcoholics Anonymous and Narcotics Anonymous, focus on addictive behaviour.

Others act as advocates for certain segments of the population, such as the disabled and older people, or provide support for family members of people who have a severe mental illness.

Timely Referrals from Primary Care to Specialty Mental Health, and Back

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Research Paper Title

Provider perspectives on a clinical demonstration project to transition patients with stable mental health conditions to primary care.

Background

Research to improve access to mental healthcare often focuses on increasing timely referrals from primary care (PC) to specialty mental health (SMH).

However, timely and appropriate transitions back to PC are indispensable for increasing access to SMH for new patients.

Methods

The researchers developed and implemented a formalised process to identify patients eligible for transition from SMH to PC.

The FLOW intervention was piloted at a Veterans Health Administration community-based outpatient clinic. Qualitatively examine provider perspectives regarding patient transitions at initiation and termination of the FLOW project.

Sixteen mental health providers and three PC staff completed qualitative interviews about the benefits and drawbacks of FLOW at initiation. Ten mental health providers and one PC staff completed interviews at 12-month follow-up. Primary benefits anticipated at initiation were that FLOW would increase access to SMH, provide acknowledgement of veterans’ recovery, and differentiate between higher and lower intensity mental health services.

Results

SMH providers reported additional perceived benefits at 12-month follow-up, including:

  • Decreased stress over their caseloads; and
  • Increased ability to deliver efficient, effective treatment.

Anticipated drawbacks at initiation were that veterans would get inconsistent care, PC could not offer the same level of care as SMH, and veterans might view transition as a rejection by their SMH provider.

Perceived drawbacks were similar at 12-month follow-up, but there was less frequent endorsement.

Conclusions

Findings highlight need for sustained and frequent provider education regarding:

  1. The appropriate characteristics of individuals eligible for transition; and
  2. Established procedures to ensure care coordination during and after transition.

Reference

Fletcher, T.L., Johnson, A.L., Kim, B., Yusuf, Z., Benzer, J. & Smith, T. (2019) Provider perspectives on a clinical demonstration project to transition patients with stable mental health conditions to primary care. Translational Behavioral Medicine. pii: ibz172. doi: 10.1093/tbm/ibz172. [Epub ahead of print].

Would a Clinical Staging Tool be useful in Clinical Practice to Predict Disease Course in Anxiety Disorders?

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Research Paper Title

A clinical staging approach to improving diagnostics in anxiety disorders: Is it the way to go?

Background

Clinical staging is a paradigm in which stages of disease progression are identified; these, in turn, have prognostic value.

A staging model that enables the prediction of long-term course in anxiety disorders is currently unavailable but much needed as course trajectories are highly heterogenic.

This study therefore tailored a heuristic staging model to anxiety disorders and assessed its validity.

Methods

A clinical staging model was tailored to anxiety disorders, distinguishing nine stages of disease progression varying from subclinical stages (0, 1A, 1B) to clinical stages (2A-4B).

At-risk subjects and subjects with anxiety disorders (n = 2352) from the longitudinal Netherlands Study of Depression and Anxiety were assigned to these nine stages.

The model’s validity was assessed by comparing baseline (construct validity) and 2-year, 4-year and 6-year follow-up (predictive validity) differences in anxiety severity measures across stages.

Differences in depression severity and disability were assessed as secondary outcome measures.

Results

Results showed that the anxiety disorder staging model has construct and predictive validity.

At baseline, differences in anxiety severity, social avoidance behaviours, agoraphobic avoidance behaviours, worrying, depressive symptoms and levels of disability existed across all stages (all p-values < 0.001).

Over time, these differences between stages remained present until the 6-year follow-up.

Differences across stages followed a linear trend in all analyses: higher stages were characterised by the worst outcomes.

Regarding the stages, subjects with psychiatric comorbidity (stages 2B, 3B, 4B) showed a deteriorated course compared with those without comorbidity (stages 2A, 3A, 4A).

Conclusions

A clinical staging tool would be useful in clinical practice to predict disease course in anxiety disorders.

Reference

Bokma, W.A., Batelaan, N.M., Hoogendoorn, A.W., Penninx, B.W. & van Balkom, A.J. (2019) A clinical staging approach to improving diagnostics in anxiety disorders: Is it the way to go? The Australian & New Zealand Journal of Psychiatry. doi: 10.1177/0004867419887804. [Epub ahead of print].

The Ill Effect of Problematic Neighbourhood Environments on Spousal/Partner Relationships & Mental Health and Psychological Well-being

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Research Paper Title

Perceived neighbourhood disorder and psychological distress among Latino adults in the United States: Considering spousal/partner relationship.

Background

It has been well-established that neighbourhood disorder and disadvantage are detrimental to mental health and psychological well-being.

There has been growing research interest in minority stress issues, however, less is known about how perceived neighbourhood disorder matters for psychological well-being among Latino adults in the United States.

Methods

Analysing data from National Latino Asian American Study, 2002-2003, the present study investigates the relationships among perceived neighbourhood disorder, spousal/partner relationships (i.e., spousal/partner strain and support), and psychological distress.

Results

The findings indicated that perceived neighbourhood disorder and spousal/partner strain were positively associated with increased psychological distress, whereas spousal/partner support had no protective effect against psychological distress.

Moreover, mediation analysis showed that the association between perceived neighbourhood disorder and psychological distress was partially mediated by spousal/partner strain (i.e., 15.13%), not spousal support.

Finally, moderation analysis revealed that the presence of spousal/partner strain exacerbated the relationship between perceived neighbourhood disorder and psychological distress. Conversely, the absence of spousal/partner strain appeared to buffer the adverse impact of neighbourhood disorder on psychological distress.

Conclusions

These findings highlighted the ill effect of problematic neighbourhood environments on the quality of the spousal/partner relationship and subsequently Latino’s psychological well-being.

Reference

Kwon, S. (2019) Perceived neighborhood disorder and psychological distress among Latino adults in the United States: Considering spousal/partner relationship. Journal of Community Psychology. doi: 10.1002/jcop.22288. [Epub ahead of print].

Health Policies: Consider the Direct & Indirect Cross-effects between Mental Health & Physical Health

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Research Paper Title

The relationship between physical and mental health: A mediation analysis.

Background

There is a strong link between mental health and physical health, but little is known about the pathways from one to the other.

The researchers analyse the direct and indirect effects of past mental health on present physical health and past physical health on present mental health using lifestyle choices and social capital in a mediation framework.

Methods

They use data on 10,693 individuals aged 50 years and over from six waves (2002-2012) of the English Longitudinal Study of Ageing.

Mental health is measured by the Centre for Epidemiological Studies Depression Scale (CES) and physical health by the Activities of Daily Living (ADL).

Results

The researchers find significant direct and indirect effects for both forms of health, with indirect effects explaining 10% of the effect of past mental health on physical health and 8% of the effect of past physical health on mental health.

Physical activity is the largest contributor to the indirect effects.

There are stronger indirect effects for males in mental health (9.9%) and for older age groups in mental health (13.6%) and in physical health (12.6%).

Conclusions

Health policies aiming at changing physical and mental health need to consider not only the direct cross-effects but also the indirect cross-effects between mental health and physical health.

Reference

Ohrnberger, J., Fichera, E. & Sutton, M. (2017) The relationship between physical and mental health: A mediation analysis. Social Science & Medicine (1982). 195, pp.42-49. doi: 10.1016/j.socscimed.2017.11.008. Epub 2017 Nov 8.

Providing a Starting Point for Discussions, Dialogue, and Further Study Regarding Mental Health Research for Indigenous Peoples around the World

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Research Paper Title

The mental health of Indigenous peoples in Canada: A critical review of research.

Background

Many scholars assert that Indigenous peoples across the globe suffer a disproportionate burden of mental illness.

Research indicates that colonialism and its associated processes are important determinants of Indigenous peoples’ health internationally.

In Canada, despite an abundance of health research documenting inequalities in morbidity and mortality rates for Indigenous peoples, relatively little research has focused on mental health.

This paper provides a critical scoping review of the literature related to Indigenous mental health in Canada.

Methods

searched eleven databases and two Indigenous health-focused journals for research related to mental health, Indigenous peoples, and Canada, for the years 2006-2016.

Over two hundred papers are included in the review and coded according to research theme, population group, and geography.

Results

Results demonstrate that the literature is overwhelmingly concerned with issues related to colonialism in mental health services and the prevalence and causes of mental illness among Indigenous peoples in Canada, but with several significant gaps.

Mental health research related to Indigenous peoples in Canada overemphasises suicide and problematic substance use; a more critical use of the concepts of colonialism and historical trauma is advised; and several population groups are underrepresented in research, including Métis peoples and urban or off-reserve Indigenous peoples.

Conclusions

The findings are useful in an international context by providing a starting point for discussions, dialogue, and further study regarding mental health research for Indigenous peoples around the world.

Reference

Nelson, S.E. & Wilson, K. (2017) The mental health of Indigenous peoples in Canada: A critical review of research. Social Science & Medicine (1982). 176, pp.93-112. doi: 10.1016/j.socscimed.2017.01.021. Epub 2017 Jan 18.

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.

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].