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Understanding the acceptability of e-mental health – attitudes and expectations towards computerised self-help treatments for mental health problems

April 18, 2014 Comments off

Understanding the acceptability of e-mental health – attitudes and expectations towards computerised self-help treatments for mental health problems
Source: BMC Psychiatry

Background
E-mental health and m-mental health include the use of technology in the prevention, treatment and aftercare of mental health problems. With the economical pressure on mental health services increasing, e-mental health and m-mental health could bridge treatment gaps, reduce waiting times for patients and deliver interventions at lower costs. However, despite the existence of numerous effective interventions, the transition of computerised interventions into care is slow. The aim of the present study was to investigate the acceptability of e-mental health and m-mental health in the general population.

Methods
An advisory group of service users identified dimensions that potentially influence an individual’s decision to engage with a particular treatment for mental health problems. A large sample (N = 490) recruited through email, flyers and social media was asked to rate the acceptability of different treatment options for mental health problems on these domains. Results were analysed using repeated measures MANOVA.

Results
Participants rated the perceived helpfulness of an intervention, the ability to motivate users, intervention credibility, and immediate access without waiting time as most important dimensions with regard to engaging with a treatment for mental health problems. Participants expected face-to-face therapy to meet their needs on most of these dimensions. Computerised treatments and smartphone applications for mental health were reported to not meet participants’ expectations on most domains. However, these interventions scored higher than face-to-face treatments on domains associated with the convenience of access. Overall, participants reported a very low likelihood of using computerised treatments for mental health in the future.

Conclusions
Individuals in this study expressed negative views about computerised self-help intervention and low likelihood of use in the future. To improve the implementation and uptake, policy makers need to improve the public perception of such interventions.

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Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments

April 1, 2014 Comments off

Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments
Source: BMC Psychiatry

Background
To date, our ability to accurately identify patients at high risk from suicidal behaviour, and thus to target interventions, has been fairly limited. This study examined a large pool of factors that are potentially associated with suicide risk from the comprehensive electronic medical record (EMR) and to derive a predictive model for 1–6 month risk.

Methods
7,399 patients undergoing suicide risk assessment were followed up for 180 days. The dataset was divided into a derivation and validation cohorts of 4,911 and 2,488 respectively. Clinicians used an 18-point checklist of known risk factors to divide patients into low, medium, or high risk. Their predictive ability was compared with a risk stratification model derived from the EMR data. The model was based on the continuation-ratio ordinal regression method coupled with lasso (which stands for least absolute shrinkage and selection operator).

Results
In the year prior to suicide assessment, 66.8% of patients attended the emergency department (ED) and 41.8% had at least one hospital admission. Administrative and demographic data, along with information on prior self-harm episodes, as well as mental and physical health diagnoses were predictive of high-risk suicidal behaviour. Clinicians using the 18-point checklist were relatively poor in predicting patients at high-risk in 3 months (AUC 0.58, 95% CIs: 0.50 – 0.66). The model derived EMR was superior (AUC 0.79, 95% CIs: 0.72 – 0.84). At specificity of 0.72 (95% CIs: 0.70-0.73) the EMR model had sensitivity of 0.70 (95% CIs: 0.56-0.83).

Conclusion
Predictive models applied to data from the EMR could improve risk stratification of patients presenting with potential suicidal behaviour. The predictive factors include known risks for suicide, but also other information relating to general health and health service utilisation.

Mobile phone text message reminders of antipsychotic medication: is it time and who should receive them? A cross-sectional trust-wide survey of psychiatric inpatients

February 3, 2014 Comments off

Mobile phone text message reminders of antipsychotic medication: is it time and who should receive them? A cross-sectional trust-wide survey of psychiatric inpatients
Source: BMC Psychiatry

Background
Poor adherence to antipsychotic medication is a widespread problem, and the largest predictor of relapse in patients with psychosis. Electronic reminders are increasingly used to improve medication adherence for a variety of medical conditions, but have received little attention in the context of psychotic disorders. We aimed to explore the feasibility and acceptability of including short message service (SMS) medication reminders in the aftercare plan of service users discharged from inpatient care on maintenance antipsychotic medication.

Methods
We conducted a cross-sectional, trust-wide survey in the inpatient units of the Oxleas National Health Service (NHS) Foundation Trust in the UK between June 29 and August 3, 2012. Using a self-report questionnaire and the Drug Attitude Inventory, we examined inpatient attitudes towards antipsychotic drugs, past adherence to antipsychotic medication, frequency of mobile phone ownership, and interest in receiving SMS medication reminders upon discharge from the ward. Predictors of a patient’s interest in receiving electronic reminders were examined using simple logistic regression models.

Results
Of 273 inpatients, 85 met eligibility criteria for the survey, showed decisional capacity, and agreed to participate. Of the 85 respondents, over a third (31-35%) admitted to have forgotten to take/collect their antipsychotic medication in the past, and approximately half (49%) to have intentionally skipped their antipsychotics or taken a smaller dose than prescribed. Male patients (55%), those with negative attitudes towards antipsychotics (40%), and those unsatisfied with the information they received on medication (35%) were approximately 3 to 4 times more likely to report past intentional poor adherence. The large majority of respondents (80-82%) reported having a mobile phone and knowing how to use SMS, and a smaller majority (59%) expressed an interest in receiving SMS medication reminders after discharge. No variable predicted a patient’s interest in receiving electronic reminders of antipsychotics.

Conclusions
Automatic SMS reminders of antipsychotic medication were acceptable to the majority of the survey respondents as an optional service offered upon discharge from inpatient care. Automatic electronic reminders deserve further investigation as a flexible, minimally invasive, cost-effective and broadly applicable tool that can potentially improve antipsychotic adherence and clinical outcomes.

Impaired social decision making in patients with major depressive disorder

January 30, 2014 Comments off

Impaired social decision making in patients with major depressive disorder
Source: BMC Psychiatry

Background
Abnormal decision-making processes have been observed in patients with major depressive disorder (MDD). However, it is unresolved whether MDD patients show abnormalities in decision making in a social interaction context, in which decisions have actual influences on both the self-interests of the decision makers per se and those of their partners.

Methods
Using a well-studied ultimatum game (UG), which is frequently used to investigate social interaction behavior, we examined whether MDD can be associated with abnormalities in social decision-making behavior by comparing the acceptance rates of MDD patients (N = 14) with those of normal controls (N = 19).

Results
The acceptance rates of the patients were lower than those of the normal controls. Additionally, unfair proposals were accepted at similar rates from computer partners and human partners in the MDD patients, unlike the acceptance rates in the normal controls, who were able to discriminatively treat unfair proposals from computer partners and human partners.

Conclusions
Depressed patients show abnormal decision-making behavior in a social interaction context. Several possible explanations, such as increased sensitivity to fairness, negative emotional state and disturbed affective cognition, have been proposed to account for the abnormal social decision-making behavior in patients with MDD. This aberrant social decision-making behavior may provide a new perspective in the search to find biomarkers for the diagnosis and prognosis of MDD.

Impact of a mobile phone and web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: a randomised controlled trial

November 21, 2013 Comments off

Impact of a mobile phone and web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: a randomised controlled trial
Source: BMC Psychiatry

Background
Mobile phone-based psychological interventions enable real time self-monitoring and self-management, and large-scale dissemination. However, few studies have focussed on mild-to-moderate symptoms where public health need is greatest, and none have targeted work and social functioning. This study reports outcomes of a CONSORT-compliant randomised controlled trial (RCT) to evaluate the efficacy of myCompass, a self-guided psychological treatment delivered via mobile phone and computer, designed to reduce mild-to-moderate depression, anxiety and stress, and improve work and social functioning.

Method
Community-based volunteers with mild-to-moderate depression, anxiety and/or stress (N = 720) were randomly assigned to the myCompass program, an attention control intervention, or to a waitlist condition for seven weeks. The interventions were fully automated, without any human input or guidance. Participants’ symptoms and functioning were assessed at baseline, post-intervention and 3-month follow-up, using the Depression, Anxiety and Stress Scale and the Work and Social Adjustment Scale.

Results
Retention rates at post-intervention and follow-up for the study sample were 72.1% (n = 449) and 48.6% (n = 350) respectively. The myCompass group showed significantly greater improvement in symptoms of depression, anxiety and stress and in work and social functioning relative to both control conditions at the end of the 7-week intervention phase (between-group effect sizes ranged from d = .22 to d = .55 based on the observed means). Symptom scores remained at near normal levels at 3-month follow-up. Participants in the attention control condition showed gradual symptom improvement during the post-intervention phase and their scores did not differ from the myCompass group at 3-month follow-up.

Conclusions
The myCompass program is an effective public health program, facilitating rapid improvements in symptoms and in work and social functioning for individuals with mild-to-moderate mental health problems.

Interactions between risky decisions, impulsiveness and smoking in young tattooed women

November 4, 2013 Comments off

Interactions between risky decisions, impulsiveness and smoking in young tattooed women
Source: BMC Psychiatry

Background
According to previous studies, one of the common problems of everyday life of persons with tattoos is risky behavior. However, direct examination of the decision making process, as well as factors which determine women’s risk-taking decisions to get tattoos, have not been conducted. This study investigates whether risk taking decision-making is associated with the self-assessment impulsiveness in tattooed women.

Methods
Young women (aged 18–35 years) with (N = 60) and without (N = 60) tattoos, performed the Iowa Gambling Task (IGT), as a measure of decision-making processes, as well as completing the Barratt Impulsivity Scale (BIS-11).

Results
Tattooed women showed significantly higher scores in the BIS-11 and preference for disadvantageous decks on the IGT compared to non-tattooed women. There was no significant correlation between risky decision-making in the IGT and BIS-11 impulsivity measures. A significantly higher rate of smoking was observed in the tattooed women. However, the analysis did not reveal a group effect after adjustment for smoking in the IGT and the BIS-11 measures.

Conclusions
The present study was specifically designed to resolve questions regarding associations between impulsiveness and risky decision-making in tattooed women. It shows that in tattooed women, risky decisions are not a direct result of their self-reported impulsiveness. Smoking does not explain the psychometric differences between tattooed women and controls.

Self-assessed mental health problems and work capacity as determinants of return to work: a prospective general population-based study of individuals with all-cause sickness absence

October 17, 2013 Comments off

Self-assessed mental health problems and work capacity as determinants of return to work: a prospective general population-based study of individuals with all-cause sickness absence
Source: BMC Psychiatry

Background
Mental health problems are common in the work force influence work capacity and sickness absence. The aim was to examine self-assessed mental health problems and work capacity as determinants of time until return to work (RTW).

Methods
Employed women and men (n=6140), aged 19–64 years, registered as sick with all-cause sickness absence between February 18 and April 15, 2008 received a self-administered questionnaire covering health, and work situation(response rate 54%). Demographic data was collected from official registers. This follow-up study included 2502 individuals. Of these, 1082 were currently off sick when answering the questionnaire. Register data on total number of benefit compensated sick-leave days in the end of 2008 were used to determine the time until RTW. Self-reported persistent mental illness, the WHO (Ten) Mental Well-Being Index and self-assessed work capacity in relation to knowledge, mental, collaborative and physical demands at work were used as determinants. Multinomial and binary logistic regression analyses were used to estimate odds ratios with 95% confidence intervals (CI) for the likelihood of RTW.

Results
The likelihood of RTW (>=105 days) was higher among those with persistent mental illness OR=1.75 (95 % CI, 1.21-2.52) and those with low mental well-being OR= 2.18 (95% CI, 1.69-2.82) after adjusting for age and gender. An analysis of employee who were off sick when they answered the questionnaire, the likelihood of RTW (>=105 days) was higher among those who reported low capacity to work in relation to knowledge, mental, collaborative and physical demands at work. In a multivariable analysis, the likelihood of RTW (>=105 days) among those with low mental well-being remained significant OR=1.93 (95% CI 1.46-2.55) even after adjustment for all dimensions of capacity to work.

Conclusion
Self-assessed persistent mental illness, low mental well-being and low work capacity increased the likelihood of prolonged RTW. This study is unique because it is based on new sick-leave spells and is the first to show that low mental well-being was a strong determinant of RTW even after adjustment for work capacity. Our findings support the importance of identifying individuals with low mental well-being as a way to promote RTW.

Psychological distress and quality of life in older persons: relative contributions of fixed and modifiable risk factors

October 17, 2013 Comments off

Psychological distress and quality of life in older persons: relative contributions of fixed and modifiable risk factors
Source: BMC Psychiatry

Background
With a rapidly ageing population and increasing life expectancy, programs directed at improving the mental health and quality of life (QOL) of older persons are extremely important. This issue may be particularly relevant in the aged-care residential sector, where very high rates of depression and poor QOL are evident. This study aims to investigate the fixed and modifiable risk factors of psychological distress and QOL in a cohort of Australians aged 60 and over living in residential and community settings.

Methods
The study examined the relationship between demographic, health and lifestyle factors and the outcome variables of self-reported QOL and psychological distress (K10 scores) based on data from 626 Australians aged 60 and over from the 45 and Up Study dataset. Univariate and multivariate regression analyses (performed on a subset of 496) examined risk factors related to psychological distress and QOL adjusting for age and residential status.

Results
Significant psychological distress was experienced by 15% of the residential sample and 7% of the community sample and in multivariate analyses was predicted by older age, more functional limitations, more time spent sleeping and lower levels of social support (accounting for 18.2% of the variance). Poorer QOL was predicted by more functional limitations and greater levels of psychological distress. Together these variables accounted for 35.0% of the variance in QOL ratings.

Conclusions
While psychological distress was more common in residential settings, programs targeting modifiable risk factors have the potential to improve QOL and reduce psychological distress in older persons living in both residential and community settings. In particular, promoting health and mobility, optimising sleep-wake cycles and increasing social support may reduce levels of psychological distress and improve QOL.

Ethnicity and suicide attempt: analysis in bipolar disorder and schizophrenia

October 10, 2013 Comments off

Ethnicity and suicide attempt: analysis in bipolar disorder and schizophrenia
Source: BMC Psychiatry

Background
Evidence is mixed as to whether White Europeans are at a higher risk for suicide attempts or completions compared to other ethnic groups. The present analysis assessed whether risk for suicide attempt was associated with White European ethnicity in 907 subjects with schizophrenia or bipolar disorder.

Methods
Subjects were diagnosed using the Structured Clinical Interview for DSM-IV, and ethnicity was determined by self-report. Subjects were recruited from psychiatric care centers in Toronto, Canada. Logistic regression correcting for clinical covariates like age, gender and diagnosis, was used in this study.

Results
We found no difference in suicide attempter status in white and non-white subjects who were diagnosed with schizophrenia and bipolar disorder.

Conclusion
Our study does not support the evidence that White-European patients in North America are at higher risk for suicide attempt compared to non-European descent subjects. However, this result has to be replicated in larger studies in patients with these disorders.

Distinctive emotional responses of clinicians to suicide-attempting patients – a comparative study

September 24, 2013 Comments off

Distinctive emotional responses of clinicians to suicide-attempting patients – a comparative study
Source: BMC Psychiatry

Background
Clinician responses to patients have been recognized as an important factor in treatment outcome. Clinician responses to suicidal patients have received little attention in the literature however, and no quantitative studies have been published. Further, although patients with high versus low lethality suicidal behaviors have been speculated to represent two distinct populations, clinicians’ emotional responses to them have not been examined.

Methods
Clinicians’ responses to their patients when last seeing them prior to patients’ suicide attempt or death were assessed retrospectively with the Therapist Response/Countertransference Questionnaire, administered anonymously via an Internet survey service. Scores on individual items and subscale scores were compared between groups, and linear discriminant analysis was applied to determine the combination of items that best discriminated between groups.

Results
Clinicians reported on patients who completed suicide, made high-lethality attempts, low-lethality attempts, or died unexpectedly non-suicidal deaths in a total of 82 cases. We found that clinicians treating imminently suicidal patients had less positive feelings towards these patients than for non-suicidal patients, but had higher hopes for their treatment, while finding themselves notably more overwhelmed, distressed by, and to some degree avoidant of them. Further, we found that the specific paradoxical combination of hopefulness and distress/avoidance was a significant discriminator between suicidal patients and those who died unexpectedly non-suicidal deaths with 90% sensitivity and 56% specificity. In addition, we identified one questionnaire item that discriminated significantly between high- and low-lethality suicide patients.

Conclusions
Clinicians’ emotional responses to patients at risk versus not at risk for imminent suicide attempt may be distinct in ways consistent with responses theorized by Maltsberger and Buie in 1974. Prospective replication is needed to confirm these results, however. Our findings demonstrate the feasibility of using quantitative self-report methodologies for investigation of the relationship between clinicians’ emotional responses to suicidal patients and suicide risk.

Perceived humiliation during admission to a psychiatric emergency service and its relation to socio-demography and psychopathology

September 12, 2013 Comments off

Perceived humiliation during admission to a psychiatric emergency service and its relation to socio-demography and psychopathology
Source: BMC Psychiatry

Background
There is a lack of empirical studies of patients’ level of humiliation during the hospital admission process and its implications for the clinical setting. We wanted to explore associations between self-rated humiliation and socio-demography and psychopathology in relation to admission to a psychiatric emergency unit.

Methods
Consecutively admitted patients (N = 186) were interviewed with several validated instruments. The patients self-rated humiliation by The Cantril Ladder, and 35% of the sample was defined as the high humiliation group.

Results
Final multivariate analysis found significant associations between compulsory admission, not being in paid work, high scores on hostility, and on entitlement, and high levels of humiliation. No significant interactions were observed between these variables, and the narcissism score was not a confounder concerning humiliation.

Conclusions
High level of humiliation during the admission process was mainly related to patient factors, but also to compulsory admission which should be avoided as much as possible protecting the self-esteem of the patients.

Understanding psychiatric institutionalization: a conceptual review

June 19, 2013 Comments off

Understanding psychiatric institutionalization: a conceptual review

Source: BMC Psychiatry

Background

Since Goffman’s seminal work on psychiatric institutions, deinstitutionalization has become a leading term in the psychiatric debate. It described the process of closure or downsizing of large psychiatric hospitals and the establishment of alternative services in the community. Yet, there is a lack of clarity on what exactly the concept of institutionalization means in present-day psychiatry. This review aims to identify the meaning of psychiatric institutionalization since the early 1960s to present-day.

Method

A conceptual review of institutionalization in psychiatry was conducted. Thematic analysis was used to synthesize the findings.

Results

Four main themes were identified in conceptualizing institutionalization: bricks and mortar of care institutions; policy and legal frameworks regulating care; clinical responsibility and paternalism in clinician-patient relationships; and patients’ adaptive behavior to institutionalized care.

Conclusions

The concept of institutionalization in psychiatry reflects four distinct themes. All themes have some relevance for the contemporary debate on how psychiatric care should develop and on the role of institutional care in psychiatry.

Malingering and PTSD: Detecting malingering and war related PTSD by Miller Forensic Assessment of Symptoms Test (M-FAST)

June 7, 2013 Comments off

Malingering and PTSD: Detecting malingering and war related PTSD by Miller Forensic Assessment of Symptoms Test (M-FAST)

Source: BMC Psychiatry

Background

Malingering is prevalent in PTSD, especially in delayed-onset PTSD. Despite the attempts to detect it, indicators, tools and methods to accurately detect malingering need extensive scientific and clinical research. Therefore, this study was designed to validate a tool that can detect malingering of war-related PTSD by Miller Forensic Assessment of Symptoms Test (M-FAST).

Methods

In this blind clinical diagnosis study, one hundred and twenty veterans referred to War Related PTSD Diagnosis Committee in Iran in 2011 were enrolled. In the first step, the clients received Psychiatry diagnosis and were divided into two groups based on the DSM-IV-TR, and in the second step, the participants completed M-FAST.

Results

The t-test score within two groups by M-FAST Scale showed a significant difference (t = 14.058, P < 0.0001), and 92% of malingering war-related PTSD participants scored more than 6 and %87 of PTSD group scored less than 6 in M-FAST Scale.

Conclusions

M-FAST showed a significant difference between war-related PTSD and malingering participants. The >=6 score cutoff was suggested by M-FAST to detect malingering of war-related PTSD.

Mental health affects future employment as job loss affects mental health: findings from a longitudinal population study

May 28, 2013 Comments off

Mental health affects future employment as job loss affects mental health: findings from a longitudinal population study
Source: BMC Psychiatry

Background

Workforce participation is a key feature of public mental health and social inclusion policies across the globe, and often a therapeutic goal in treatment settings. Understanding the reciprocal relationship between participation and mental health has been limited by inadequate research methods. This is the first study to simultaneously examine and contrast the relative effects of unemployment on mental health and mental health on employment status in a single general population sample.

Method

Data were from working-age respondents (20 to 55 years at baseline) who completed nine waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey (N=7176). Cross-lagged path analyses were used to test the lagged and concurrent associations between unemployment and mental health over time, adjusting for sociodemographic characteristics.

Results

Mental health was shown to be both a consequence of and risk factor for unemployment. Thus, the poorer mental health observed amongst people who are not working is attributable to both the impact of unemployment and existing mental health problems. While the strength of these two effects was similar for women, the results for men suggested that the effect of unemployment on subsequent mental health was weaker than the effect of mental health on subsequent risk of unemployment.

Conclusion

Disentangling the reciprocal links between mental health and workforce participation is central to the development and success of clinical goals and health and social policies that aim to promote either aspect. This study demonstrates that both effects are important and supports concurrent responses to prevent a cycle of disadvantage and entrenched social exclusion.

Safety of antidepressants in adults aged under 65: protocol for a cohort study using a large primary care database.

May 15, 2013 Comments off

Safety of antidepressants in adults aged under 65: protocol for a cohort study using a large primary care database

Source: BMC Psychiatry

Background

Antidepressants are among the most commonly prescribed drugs in primary care in England and their use is increasing. This is largely due to longer durations of treatment of depression. Observational studies have shown some differences in adverse outcomes associated with different antidepressant drugs but relatively little is known about their relative safety particularly with long term use. The primary aim of this study is to determine the relative and absolute risks of pre-defined adverse events comparing different classes of antidepressant drugs in adults aged under 65 years and diagnosed with depression.

Methods/design

The study will identify a cohort of patients with a first recorded diagnosis of depression between 1/1/2000 and 31/07/2011, and made between the ages of 20 to 64 years using a large primary care database (QResearch). Patients will be followed up until 1/08/2012. Details of all prescriptions for antidepressants in patients in the cohort will be extracted, including the date of each prescription, the type of antidepressant drug, the dose and total quantity prescribed. Prospectively recorded data will be used to ascertain information on adverse outcomes that occurred during follow-up and after entry into the cohort. These are: all-cause mortality, suicide, attempted suicide/self-harm, sudden death, antidepressant overdose/poisoning, myocardial infarction, stroke/transient ischaemic attack, cardiac arrhythmia, epilepsy/seizures, upper gastrointestinal bleeding, falls, fractures, adverse drug reactions and motor vehicle crashes. Cox proportional hazard models will be used to estimate the association of the outcomes with class of antidepressant drug adjusting for potential confounding variables. The analyses will also examine associations by duration and dose and with the most frequently prescribed individual antidepressant drugs. Self-controlled case series analyses will be used to estimate the relative incidence of the outcomes of interest for defined time periods of antidepressant use.

Discussion

The results of this study will help to establish the relative safety and balance of risks for different antidepressant drugs in people aged under 65.

Typology of persons with severe mental disorders

May 15, 2013 Comments off

Typology of persons with severe mental disorders

Source: BMC Psychiatry

Background

Persons with severe mental disorders (PSMD) form a highly heterogeneous group. Identifying subgroups sharing similar PSMD profiles may help to develop treatment plans and appropriate services for their needs. This study seeks to establish a PSMD typology by looking at individual characteristics and the amount and adequacy of help received.

Methods

The study recruited a sample of 352 persons located in south-western Montreal (Quebec, Canada). Cluster analysis was used to create a PSMD typology.

Results

Analysis yielded five clusters: 1. highly functional older women with mood disorders, receiving little help from services; 2. middle-aged men with diverse mental disorders and alcohol abuse, receiving insufficient and inadequate help; 3. middle-aged women with serious needs, mood and personality disorders and suicidal tendencies, living in autonomous apartments, and receiving ample but inadequate help; 4. highly educated younger men with schizophrenia, living in autonomous apartments, and receiving adequate help; and 5. older poorly educated men with schizophrenia, living in supervised apartments, with ample help perceived as adequate. Marked differences were found between men and women, between users diagnosed with schizophrenia and others, and between persons living in supervised or autonomous apartments.

Conclusion

Our study highlights the existence of parallel subgroups among PSMD related to their socio-demographic status, clinical needs and service-use profiles, which could be used to focus more appropriate interventions. For mental health service planning, it demonstrates the relevance of focusing on individuals showing critical needs who are affected by multiple mental disorders (especially when associated with alcohol abuse), and often find help received as less adequate.

Predictors of psychiatric disorders in combat Veterans

May 8, 2013 Comments off

Predictors of psychiatric disorders in combat Veterans

Source: BMC Psychiatry

Background

Most previous research that has examined mental health among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combatants has relied on self-report measures to assess mental health outcomes; few studies have examined predictors of actual mental health diagnoses. The objective of this longitudinal investigation was to identify predictors of psychiatric disorders among Marines who deployed to combat in Iraq and Afghanistan.

Methods

The study sample consisted of 1113 Marines who had deployed to Iraq or Afghanistan. Demographic and psychosocial predictor variables from a survey that all Marines in the sample had completed were studied in relation to subsequent psychiatric diagnoses. Univariate and multivariate logistic regression were used to determine the influence of the predictors on the occurrence of psychiatric disorders.

Results

In a sample of Marines with no previous psychiatric disorder diagnoses, 18% were diagnosed with a new-onset psychiatric disorder. Adjusting for other variables, the strongest predictors of overall psychiatric disorders were female gender, mild traumatic brain injury symptoms, and satisfaction with leadership. Service members who expressed greater satisfaction with leadership were about half as likely to develop a mental disorder as those who were not satisfied. Unique predictors of specific types of mental disorders were also identified.

Conclusions

Overall, the study’s most relevant result was that two potentially modifiable factors, low satisfaction with leadership and low organizational commitment, predicted mental disorder diagnoses in a military sample. Additional research should aim to clarify the nature and impact of these factors on combatant mental health.

Young men’s attitudes and behaviour in relation to mental health and technology: implications for the development of online mental health services.

April 24, 2013 Comments off

Young men’s attitudes and behaviour in relation to mental health and technology: implications for the development of online mental health services.

Source: BMC Psychiatry

Background

This mixed-methods study was designed to explore young Australian men’s attitudes and behaviour in relation to mental health and technology use to inform the development of online mental health services for young men.

Methods

National online survey of 486 males (aged 16 to 24) and 17 focus groups involving 118 males (aged 16 to 24).

Results

Young men are heavy users of technology, particularly when it comes to entertainment and connecting with friends, but they are also using technology for finding information and support. The focus group data suggested that young men would be less likely to seek professional help for themselves, citing a preference for self-help and action-oriented strategies instead. Most survey participants reported that they have sought help for a problem online and were satisfied with the help they received. Focus group participants identified potential strategies for how technology could be used to overcome the barriers to help-seeking for young men.

Conclusions

The key challenge for online mental health services is to design interventions specifically for young men that are action-based, focus on shifting behaviour and stigma, and are not simply about increasing mental health knowledge. Furthermore, such interventions should be user-driven, informed by young men’s views and everyday technology practices, and leverage the influence of peers.

The production and recognition of psychiatric original articles published in languages other than English

March 26, 2013 Comments off

The production and recognition of psychiatric original articles published in languages other than English

Source: BMC Psychiatry

Background

Whereas the most influential journals in psychiatry are English language journals, periodicals published in other languages serve an important purpose for local communities of clinicians and researchers. This study aimed at analyzing the scientific production and the recognition of non-English general psychiatry journals.

Methods

In a cohort study, the 2009 volume of ten journals from Brazil (1), German language countries (5), France (2), Italy (1), and Poland (1) was searched for original articles. Patterns of citations to these articles during 2010 and 2011 as documented in Web of Science were analyzed.

Results

The journals published 199 original articles (range: 4–46), mostly observational studies. Half of the papers were cited in the following two years. There were 246 citations received, or an average of 1.25 cites per article (range: 0.25-4.04). Many of these citations came from the local community, that is, from the same authors and journals. Citations by other periodicals and other authors accounted for 36% [95%-CI: 30%-42%], citations in English sources for 33% [28%-39%] of all quotations. There was considerable heterogeneity with regard to citations received among the ten journals investigated.

Conclusion

Non-English language general psychiatry journals contribute substantially to the body of research. However, recognition, and in particular recognition by the international research community is moderate.

The psychosocial difficulties in brain disorders that explain short term changes in health outcomes

March 20, 2013 Comments off

The psychosocial difficulties in brain disorders that explain short term changes in health outcomes

Source: BMC Psychiatry

Background

This study identifies a set of psychosocial difficulties that are associated with short term changes in health outcomes across a heterogeneous set of brain disorders, neurological and psychiatric.

Methods

Longitudinal observational study over approximately 12 weeks with three time points of assessment and 741 patients with depression, bipolar disorders, multiple sclerosis, parkinson’s disease, migraine, traumatic brain injury and stroke. The data on disability was collected with the checklist of the International Classification of Functioning, Disability and Health. The selected health outcomes were the Short Form 36 and the World Health Organization Disability Assessment Schedule. Multilevel models for change were applied controlling for age, gender and disease severity.

Results

The psychosocial difficulties that explain the variability and change over time of the selected health outcomes were energy and drive, sleep, and emotional functions, and a broad range of activities and participation domains, such as solving problems, conversation, areas of mobility and self-care, relationships, community life and recreation and leisure.

Conclusions

Our findings are of interest to researchers and clinicians for interventions and health systems planning as they show that in addition to difficulties that are diagnostic criteria of these disorders, there are other difficulties that explain small changes in health outcomes over short periods of time.

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