To explore longitudinal changes in the importance of mental and behavioural disorders and their subgroups among people receiving disability pension in Iceland in the period 1990 to 2007.
Estimation of the incidence of disability pension was based on national demographic data and information from the national disability register which includes the main diagnoses causing disability.
The share of mental and behavioural disorders among new recipients of disability pension increased from 14 to 30% for women and 20 to 35% men. There was a marked increase in the incidence of disability due to disorders related to the use of alcohol and other psychoactive substances, mood disorders, disorders of psychological development and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. The proportion of mental and behavioural disorders as the primary diagnosis among new recipients of disability pension increased.
The most likely explanation for the changes we observe is alteration in social conditions leading to a lower threshold for seeking disability pension for mental disorders.
The Mental Health (Care and Treatment) (Scotland) Act 2003 introduced the role of the Named Person, who can be nominated by service users to protect their interests if they become subject to compulsory measures and replaces the Nearest Relative. If no nomination is made, the primary carer or nearest relative is appointed the Named Person. The views of professionals involved in the development and implementation of the provisions were unknown.
To describe the perceptions of mental health officers and policy makers involved in the development and implementation of the new provisions.
Sixteen professionals were interviewed to explore their perceptions of and experiences with the Named Person provisions. Data were analysed using Thematic Analysis.
Perceptions of the Named Person provisions were generally favourable but concerns were expressed over low uptake; service users' and carers' lack of understanding of the role; and potential conflict with human rights legislation over choice and information sharing.
Legislation should be amended to allow the choice of no Named Person and the prevention of information being shared with the default appointed Named Person. Removal of the default appointment should be considered.
The General Health Questionnaire (GHQ, Goldberg & Hillier, 1979 , Psychological Medicine, 9, 139-145) is a self-administered questionnaire used to measure non-psychotic psychiatric disorders. There is a study using a Portuguese version of this questionnaire (n = 60) including a group of inpatients with infectious diseases (Ribeiro & Antunes, 2003 , Revista Portuguesa de Psicossomática, 5(1), 37-45), but there are no larger studies in non-clinical Portuguese population.
The primary aim of the study was to confirm the psychometric properties of the Portuguese version of the GHQ-28 among 171 Portuguese adults in non-clinical settings.
The Portuguese version of the GHQ-28 was administered to 171 adult subjects of Portuguese general population.
The Portuguese version of the GHQ-28 has an internally consistent measure Cronbach's α 0.922 for the GHQ-28 total scale. For the subscale somatic symptoms Cronbach's α was 0.825; for the subscale Anxiety/ Insomnia, Cronbach's α was 0.873; for the subscale Social dysfunction Cronbach's α was 0.873 and for the subscale Severe Depression was 0.838. Four factors were extracted using factor analysis: somatic symptoms (items 1-7); anxiety/insomnia (items 8-14); psychosocial dysfunction (items 15-21); and severe depression (items 22-28).
The findings suggest that the GHQ-28 is a suitable screening instrument for adult Portuguese population in non-clinical settings.
To assess mental health service use after one year and to determine what kinds of people prefer to seek mental health (MH) care for mental or emotional problems? Is MH service helpful to moderate post-traumatic stress disorder (PTSD) symptom? What are the relationships among potential traumatic events (PTEs) experiences, MH services utilization and PTSD symptoms?
A systematic random sample of 2300 people in 19 severely affected counties from the 5.12 Chinese earthquake was interviewed with a 90.4% response rate. The PTSD scale was based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.
There was a clear trend that the people who had a higher education level (OR = 2.952, P < 0.01**) and who had a higher monthly income (OR = 5.425, P < 0.01**) were more likely to seek MH services. The PTSD patients who had sought MH services and those who had not sought MH services were 182 and 653, respectively (29.8% of MH sample and 44.3% of non-MH sample).
MH services utilization was related to PTSD possibility decreasing. PTEs experiences were also related to MH services utilization and increased PTSD symptoms, so psychological intervention will continue to be an important aspect in post-disaster MH care.
Despite a preference for economic evaluations to measure outcomes in terms of quality-adjusted life years, generic measures of outcome are rarely used in mental health research involving young people.
To explore the validity and responsiveness of the EQ-5D measure of health-related quality of life in adolescents with major depression.
Data came from a clinical trial involving adolescents with persistent major depression (n = 199). Construct validity was tested using socio-demographic constructs and baseline clinical outcome scores. To assess convergent validity, correlation between EQ-5D and clinical outcome scores was tested. To assess responsiveness, the mean change in EQ-5D scores of participants categorised as improved versus not improved on clinical outcome measures was tested.
Significant differences in mean EQ-5D score were found for co-morbidity and three of four severity measures but not gender, age, treatment history or suicide attempts. Mean EQ-5D scores were significantly correlated with all clinical outcome measures, although relationships were moderate or weak. A change in mean EQ-5D score was significantly related to clinical assessments of improvement on all outcome measures.
Results provide initial evidence to support the relevance of the EQ-5D in adolescents with major depression, but this evidence is weak. Replication studies are needed to assess the generalisability of these findings.
This article presents the results of an audit of self-harming across three women's units over a period of 6 years. All three units use a positive risk-taking approach to self-harm whereby the risk that this behaviour presents is considered in an effort to reduce actual harm.
To explore patterns and frequency of self-harm across three units within a women's service.
Incidents of deliberate self-harm were collected from incident forms completed across the units from 2004 to 2009.
Frequency graphs show a reduction of self-harm over the course of admission, and parametric analyses show that there was a significant difference in the frequency of self-harm during the first and last 3 months of admission.
These results are discussed within a psychoanalytical framework, with particular reference to relational security and the value of positive risk-taking.
Organised abuse (where multiple adults conspire to sexually abuse multiple children) has been one of the most controversial issues in debates over mental health practice with survivors of child sexual abuse.
The aim of this paper is to summarise and analyse the available prevalence data pertinent to organised abuse and to identify the challenges that organised abuse poses for mental health policy and practice.
Prevalence studies of sexual abuse based on community and clinical samples were reviewed for findings pertinent to organised abuse. Key indicators of organised abuse were selected and summarised on the basis of their association with the known characteristics of organised abuse. The literature regarding the health impacts of these indicators was also reviewed.
A minority of people reporting contact sexual abuse in the community report experiences indicative of organised abuse. These indicators are elevated in particular settings and they are associated with poor mental and physical health.
Organised abuse is rare but it is associated with poor mental and physical health outcomes. There is currently no source of integrated care for adults with histories of organised abuse. Many survivors end up in prison or homeless, chronically disabled by illness, or dead.
The improving access to psychological therapy (IAPT) initiative aims to provide widespread evidence-based psychological treatments for common mental health problems in the UK. Individual services have implemented National Institute for Clinical Excellence guidelines in various ways; some provide group-based therapy, whilst others do not.
The study investigates how patients and staff experience group-based therapy, what they find helpful and where improvements can be made.
Forty-five semi-structured interviews were undertaken with staff and patients in three IAPT services. Framework analysis was used to analyse comments relating to patient experience in group-based treatment.
The study found that patients can feel isolated with their symptoms and group-based interventions can normalise the illness, reducing stress. Individuals experience benefits and, in some cases, difficulties, in different ways. Some patients hear of the strategies that others have found useful, and observe others' progress, which may bring hope for their own recovery.
IAPT group-based interventions appear to aid recovery in different ways to one-to-one therapy, by normalising mental illness and increasing social contact. Greater understanding of the factors operating in group-based interventions might increase attendance and recovery facilitated by IAPT group interventions.
External validity is central to pragmatic trials. Recruitment of a 'representative' sample is fundamental to this. However, recruitment is a complex process, requiring, first researcher access to eligible participants. Questions have been asked about the match between study samples and real-world clinical patients and the impact this has on generalisability of findings.
Using interview and observational data from a grounded theory process evaluation of a multicentre trial, we investigated factors influencing referral.
We found evidence of a fundamental disjunction between research and clinical practice manifested in varying 'filtering' processes. Organisational culture and the knowledge and attitudes of service providers regarding research generally and specifically in this RCT resulted in exclusion of very many potentially eligible participants.
These findings have policy and practical implications and highlight the need for development of genuinely collaborative partnerships between the research and clinical communities. Importantly, we suggest that the CONSORT recommendations be further refined to identify the potential study population.
There is a paucity of service research on the effectiveness of short-term mental health clinics.
To outline the development of the Urgent Consultation Clinic (UCC), an inter-professional, short-term, mental health program in a general hospital, and to evaluate the effectiveness of the UCC from a quality improvement perspective.
Participants (n = 143) completed a battery of validated measures assessing psychological and physical symptoms, quality of life, life satisfaction, and satisfaction with services at three time-points. Inter-professional team members rated participants' overall functioning and severity of mental health problems at intake and termination.
The median time from referral to initial UCC visit was 12 days. A significant decline in the severity of mental health symptoms was observed, with 87% of participants reporting clinically elevated symptoms at intake compared to 71% at termination. Significant improvements were observed in life satisfaction, overall functioning, and mental quality of life. Sixty-nine percent of participants rated the quality of services as good or excellent.
The UCC model of care contributed to improved access to psychiatric evaluation and short-term treatment. This inter-professional model could be applied to other health care settings to meet the needs of patients requiring acute psychiatric services.
Concerns have been raised about inpatient mental health care. An accreditation model can improve compliance with standards associated with improved quality of health care.
To explore the effects of a standards-based, peer review, accreditation model on standards of care in acute inpatient wards and explore how staff achieved change.
Quality of care was assessed by independent peer review against evidence-based standards in an accreditation process. Staff from the 11 wards receiving subsequent accreditation were interviewed to find out what processes had enabled accreditation.
Sixteen wards enrolled: four achieved immediate and 11 subsequent accreditation. The most common reasons for initial failure of accreditation were lack of psychological therapies or 1:1 time for patients, and presence of ligature points. Ward staff perceived the accreditation process improved communication, gave power to negotiate for resources, clear guidance how to practice, rewarded good practice and led to additional unrelated improvements in care.
Acute wards need to attend to basic safety and provide talking treatments (both formal psychotherapy and basic time spent with patients). An accreditation, peer-reviewed, standards-based process can enable staff to feel confident about improvements in the quality of care.
Abstract Despite the global prevalence of mental illness and its negative effects on the economy in terms of healthcare spending, many affected individuals do not receive timely or adequate treatment due to stigmatization of such disorders in their communities. Being labeled as mentally ill can have detrimental consequences in several cultures. In Kuwait, the stigma associated with visiting the country's main provider of mental health services, the Psychological Medicine Hospital, is an obstacle for many seeking professional help for mental health. Cultural acceptance of visiting the local primary care clinic, however, allows frequent contact with primary care physicians who often find themselves frustrated at their inability to provide psychiatric services because it is not part of their training. The refusal of the patient to be referred to a stigmatized institution further increases the challenges of treating such patients for these physicians. The integration of mental health care into general health services is a concept encouraged by the World Health Organization's 2001 World Health Report and should be considered in order to overcome this dilemma. Such integrated care would serve as a cost-effective solution to facilitating the treatment of these individuals and reducing the stigma associated with mental disorders through education.
Self-harm in custody is a well-researched phenomenon. This is particularly true for women in prison who demonstrate disproportionately high rates of self-harm. Despite the growing body of prison research, there has been a lack of service user involvement (SUI). Aims To outline the first use of SUI in a custodial setting in developing care pathways for self-harm.
A participatory action research approach was used to engage women prisoners and staff.
Participants were able to identify strengths and weaknesses of current care pathways and offer suggestions for service development based upon their experience of receiving and delivering care.
The authors conclude that despite participatory approaches being in their infancy in prisons the engagement of service users when aimed at effecting positive change can be successful.
Improving vocational rehabilitation in line with the current evidence base is an area of considerable interest. Aims To describe the strategies used by a multidisciplinary team in the initial stages of a participatory action research (PAR) approach to improving a vocational rehabilitation service.
A literature review and PAR process were completed. One hundred and fifteen participants engaged in multifaceted data collection and analysis, building consensus around key principles for a new vocational rehabilitation service.
A synthesis of our literature review and PAR process was developed into a set of principles for practice which we plan to implement across the service.
We have developed methodologies in interdisciplinary collaborations spanning statutory and non-statutory services. We have developed a set of principles for practice and detailed plans for implementation are being drawn up to inform provision in the future.
People with a diagnosis of bipolar disorder experience mood fluctuation from depression to mania, and their support needs may differ during these fluctuations.
To investigate support needed during periods of mania and depression, and when 'going up' or 'going down'.
Five service user researchers were supported in a reflexive-collaborative approach to undertake and analyse semi-structured interviews with 16 people with a diagnosis of bipolar disorder and 11 people providing informal support.
Support needs differed when becoming manic or depressed. When manic, people needed a calming approach and encouragement to avoid overly stimulating activities. When depressed, positive activity and engaging in everyday life routines were helpful. Three core themes determined the effectiveness of support: (1) being listened to with active engagement through affirmation and encouragement, (2) empowerment through development of personal coping and self-management strategies, and (3) early action and understanding of early warning signs to respond to developing crises and protect wellbeing.
Periods of depression or mania, and lesser 'ups' and 'downs', all require different support needs. Active listening and engagement, facilitating empowerment and appropriate early action are crucial elements of effective support.
The psychological benefits of exercise are repeatedly and consistently reported in the literature. Various forms of exercise, varying in duration and intensity, yield comparably positive changes in affect, which sheds doubt on the significance of exercise characteristics in the acute mental health benefits resulting from physical activity.
Based on research evidence, it is argued that the placebo effect may play a key role in the subjective exercise experience. This report is aimed at highlighting those aspects of the extant literature that call for the reconsideration of the placebo effect in the understanding of the acute mental benefits of physical activity.
Method and results:
This narrative review focuses on research evidence demonstrating that the duration and intensity of physical activity are not mediatory factors in the mental health benefits of acute exercise. Current research evidence pointing to the roles of expectancy and conditioning in the affective benefits of exercise calls for the reconsideration of the placebo effect.
The present evaluation concludes that new research effort ought to be invested in the placebo-driven affective beneficence of exercise.
A review of the literature on measuring the concept of stigma related to caring for a relative with mental illness yielded no instrument appropriate for use in Jordan.
To translate and culturally modify the stigma-devaluation scale (SDS) into Arabic, and to test the reliability, content and construct validity of the Arabic version of the SDS.
The SDS was translated into the Arabic language, modified and culturally adapted by a translation model. Estimation of internal consistency was used to assess the reliability of the SDS. Construct validity was determined by confirmatory factor analysis (CFA). Measurements of content validity and reading level of the Arabic SDS were included. The Arabic SDS was evaluated in a sample of 164 family caregivers in Jordan.
Content validity index was determined to be 1.0. Reading level of the Arabic SDS was deemed to be at a sixth grade level or higher. Cronbach's alpha coefficient of the Arabic SDS total scale was 0.87. The results of the CFA revealed that the factor structure of the SDS had a satisfactory fit.
This study provided psychometric evidence that the modified Arabic SDS is valid and conceptually consistent with the content of the original English SDS.
Dialectical behaviour therapy (DBT), a skill-based cognitive behavioural treatment, is increasingly used in the treatment of borderline personality disorder (BPD).
The study examined service users' perspective on the effectiveness of an adapted DBT programme, delivered within a community adult mental health setting.
Semi-structured interviews and focus groups were conducted with eight participants with a diagnosis of BPD about their experience of the programme.
Thematic analysis focused on two key themes: evaluation of therapy and treatment impact. Therapy-specific factors and personal challenges emerged as important themes. Treatment impact raised issues relating to a renewed sense of identity and changes in daily life.
The study describes the positive and negative experiences of service users with BPD attending an adapted DBT programme.
The Practitioner Health Programme (PHP) is a service set up to provide expert assessment and support to health professionals with mental and physical health problems affecting their ability to work.
The aim of this article is to examine the demographic and clinical characteristics of doctor-patients utilising PHP.
We report on scores for the CORE-OM, the Work and Social Adjustment Scale and the FAST for the first 200 patients seen by PHP.
Prevalent conditions included depression and alcohol dependence. Patients with co-morbid disorders showed severe distress and impairment of functioning. Ages ranged between 24 and 67, with 33.5% of the cohort aged between 30 and 39. Patients aged below 50 showed greater impairment of social functioning.
The needs of doctors are profound, with young doctors particularly vulnerable. Measures should be put in place to ensure that doctors at an early stage of their careers are aware of help available to them. The results highlight the importance of a service such as PHP.
The Practitioner Health Programme (PHP) was developed to provide expert assessment and support to practitioners (doctors and dentists) with mental and physical health problems affecting their ability to work.
This paper examines the treatment outcomes of the practitioner-patients utilising PHP.
We assessed outcomes on consecutive patients using the PHP. The Clinical Outcomes in Routine Evaluation Outcome Measure and the Work and Social Adjustment Scale were completed at initial assessment, 8- and 26-week follow-up. We also report the percentages of practitioner-patients off work at each interval, and examine global improvement and satisfaction scores for both follow-up intervals.
Two hundred practitioner-patients entered PHP due to a mental health or substance abuse problem and subsequently completed questionnaires at baseline; 102 patients returned questionnaires after 8 weeks and 95 returned questionnaires after 26 weeks. Results suggested that patients reported less distress and less impairment of functioning at 8 and 26 weeks. Scores for satisfaction and global improvement were consistently high.
The PHP is providing a valuable service to practitioner-patients, significantly helping to decrease levels of distress and improve work and social functioning.
In psychiatry's transformation from primarily an asylum-based profession to a community-oriented profession, false positive diagnoses that mistakenly classify normal intense reactions to stress as mental disorders became a major challenge to the validity of psychiatric diagnosis. The shift to symptom-based operationalized diagnostic criteria in DSM-III further exacerbated this difficulty because of the contextually based nature of the distinction between normal distress and mental disorder, which often display similar symptoms. The problem has particular urgency because the DSM's symptom-based criteria are often applied in studies and screening instruments outside of the clinical context and by non-mental-health professionals.
To consider, through selected examples, the degree of concern, systematicity and thoroughness - and the degree of success - with which recent revisions of the DSM have attended to the challenge of avoiding false positive diagnoses.
Conceptual analysis of selected criteria sets, with a focus on possible counterexamples to the claim that DSM criteria imply disorder.
Psychiatry has so far failed to systematically adjust its diagnostic practices to confront the problem of false positives. Flaws in criteria, which can be recognized immediately by lay people, remain unaddressed or are addressed on a hit-or-miss random basis years after the flaw has been introduced, even though the issue is purely conceptual and is not sensitive to any new research information.
We examined rates of medication non-adherence in 172 referrals to a crisis resolution home treatment service; we then explored any association between pattern of adherence and the treatment interventions recommended.
Thirty percent of crisis referrals (95% confidence intervals (CI) 24%, 38%) reported sub-optimal medication adherence in the preceding month. These individuals were significantly more likely to have a dual diagnosis (odds ratio 2.9, 95% CI 1.4, 5.9) and assessment was significantly more likely to be followed by admission (odds ratio 2.5; 95% CI 1.0, 6.2); non-adherence remained a significant predictor of admission when the odds were adjusted for confounders (odds ratio 1.18; 95% CI 1.0, 1.3).
Clinicians need to proactively identify and manage non-adherence as it is a potentially preventable trigger of relapse often present for months rather than days prior to the index crisis referral. Non-adherence is a meaningful target for improving clinical and cost-effectiveness of general adult mental health services.
Medication non-adherence has far-reaching consequences. Before utilising specialized interventions to target this problem, there is a need to improve the detection, understanding and management of non-adherence in routine clinical practice.
Aims and method:
This study explored whether a 1-day workshop targeting attitudes, skills and knowledge about medication adherence could modify any aspect of clinical practice of mental health professionals.
Five workshops were held with 134 participants. Baseline general knowledge in all professional groups was poor and interventions used not ideal. Post-workshop knowledge improved significantly. At 3-month follow-up, participants reported identifying more new cases of non-adherence and use of more effective strategies. Lack of time and support were identified as persisting barriers to change.
It is possible to raise awareness, teach a model and simple techniques to effect change in clinical practice. This brief training was well received, although ongoing support is required to increase interventions for as well as identification of individuals at risk of medication non-adherence.
The DSM classification of an adjustment disorder is frequently criticized for not being well differentiated from other disorders.
A possible reason for this is the vague definition of the term adjustment in social science literature. Hence, the current paper discusses the definition of adjustment and its implications for understanding maladjustment.
Differential definitions of the terms adjustment, adaptation, socialization and coping are outlined, leading to the proposition that each one of them represents a different type of demand that is imposed on an individual who encounters a transitional event. Moreover, the four types of demands might be the possible sources of maladjustment.
Helping people in transition requires an identification of the source, or combination of sources, that have led to the adjustment problem first, followed by the implementation of an adequate helping approach.
Stigmatizing attitudes against anorexia nervosa (AN) may act as barriers to treatment.
Evaluated college students' perceptions of AN as compared to major depressive disorder (MDD).
One-hundred two female undergraduates read vignettes describing targets with mild or severe MDD or AN, then rated biological, vanity, and self-responsibility attributions; feelings of admiration, sympathy, and anger; and behavioral dispositions toward coercion into treatment, imitation, and social distance.
AN was perceived more negatively than MDD in terms of vanity attributions, self-responsibility attributions, and feelings of anger, but more positively in terms of admiration and imitation.
This research demonstrates stigma-related mixed messages received by individuals with AN, which might be useful in improving eating disorders mental health literacy.
On the eve of reform of the 1983 Mental Health Act (MHA), little is known about how decisions to admit people under its powers are made.
To describe non-clinical and extra-legal influences on professionals' decisions about compulsory admission to psychiatric hospital.
Participant-observation of MHA assessments, including informal and depth interviews with the practitioners involved, and follow-up interviews with the people who had been assessed.
A candidate patient's chance of being sectioned is likely to increase when there are no realistic alternatives to in-patient care. This typically occurs when staff have insufficient time to set such alternatives in place and are unsupported by other professionals in doing this. Outcomes may also be affected by local operational norms and the level of professional accountability for specific MHA decisions.
Non-clinical and extra-legal factors explain some of the geographical variation in MHA admission rates. If compulsion is to be used only in the 'last resort', administrators and policy makers should look beyond legislative change to matters of resource allocation and service organisation.
The quality of admission clerking to psychiatry wards will influence initial management of patients suffering from mental illness. Incomplete clerking may put patient safety at risk.
We sought to assess the completeness of clerking to general adult psychiatry wards and to evaluate whether the introduction of an admission booklet would improve clerking.
We analysed the completeness of clerking to general adult psychiatric wards by trainee doctors. Using an audit approach, the first phase assessed completeness of clerking when trainee doctors used continuation sheets to document the clerking in a free-hand manner. Thereafter, we developed a standardised admission booklet to document the clerking and assessed completeness of clerking in the second phase.
The admission booklet significantly improved the completeness of clerking. Notable improvements were seen in multiple components of history taking and initial management, particularly in documenting risk to self and others.
Improving clerking by use of an admission booklet can lead to more informed management decisions particularly in regard to the patients' physical health and clinical risk management. This may consequently improve patient safety and help trainees communicate important aspects of the case to seniors and the wider multi-disciplinary team.