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Mental health systems in countries: Where are we now?
Abstract
More than 85% of the world's population lives in 153 low-income and middle-income countries (LAMICs). Although country-level information on mental health systems has recently become available, it still has substantial gaps and inconsistencies. Most of these countries allocate very scarce financial resources and have grossly inadequate manpower and infrastructure for mental health. Many LAMICs also lack mental health policy and legislation to direct their mental health programmes and services, which is of particular concern in Africa and South East Asia. Different components of mental health systems seem to vary greatly, even in the same-income categories, with some countries having developed their mental health system despite their low-income levels. These examples need careful scrutiny to derive useful lessons. Furthermore, mental health resources in countries seem to be related as much to measures of general health as to economic and developmental indicators, arguing for improved prioritisation for mental health even in low-resource settings. Increased emphasis on mental health, improved resources, and enhanced monitoring of the situation in countries is called for to advance global mental health.
... Probability of positive outcomes can further increase with the integration of services. 4 There is well-documented neglect of mental health all over the world. In most countries and most of the times it happens at the level of health care policy making and planning by allocating inadequate resources to psychiatric services. ...
... Pak J Med Sci July -August 2023 Vol. 39 No.4 www.pjms.org.pk 3 ...
... Pak J Med Sci July -August 2023 Vol. 39 No.4 www.pjms.org.pk 5 ...
Many people with Schizophrenia lack the resources and access to mental health services especially in low and middle income countries. Integration of mental health into primary care services can be a cost effective way of reducing the disability associated with Schizophrenia. Our aim was to review the studies conducted on role of Primary care physicians in management of Schizophrenia in low and middle income countries. PRISMA guidelines were followed and we registered the study protocol at PROSPERO. Four Electronic Databases (Medline, Psycinfo, CINAHL and Embase) were searched in May 2022. Relevant articles after search were 504 of which 61 full text were examined. A total of 20 studies were included in the final review comprising of observational, experimental and qualitative studies. Most studies reported on abilities of Primary care physicians including their knowledge, perceptions, skills and competencies in identifying and management of Schizophrenia and related Psychosis. Findings suggest that there is considerable amount of stigma, lack of awareness and social support about people diagnosed with Schizophrenia. Significant improvement was observed in diagnosis and management of schizophrenia by Primary care physicians who received appropriate training by experts in the field. This review suggests that appropriate training of General practitioners in diagnosing and treating schizophrenia can help in reduction of huge Treatment Gap in Schizophrenia. They can also be utilised in delivering psycho social interventions to improve overall quality of patient care.
... How then do decision makers choose which interventions to prioritize in LMICs where chronic government under-investment in mental healthcare persists [5,6]? Economic evaluations of youth mental interventions, in addition to efficacy examinations, are needed to inform important policy, practice, and research decisions by policymakers, practitioners, researchers, and other mental health professionals interested in investing limited resources wisely. ...
Background
Low- and middle-income countries (LMICs) have the highest socio-economic burden of mental health disorders, yet the fewest resources for treatment. Recently, many intervention strategies, including the use of brief, scalable interventions, have emerged as ways of reducing the mental health treatment gap in LMICs. But how do decision makers prioritize and optimize the allocation of limited resources? One approach is through the evaluation of delivery costs alongside intervention effectiveness of various types of interventions. Here, we evaluate the cost-effectiveness of Shamiri, a group– and school–based intervention for adolescent depression and anxiety that is delivered by lay providers and that teaches growth mindset, gratitude, and value affirmation.
Methods
We estimated the cost-effectiveness of Shamiri using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines for economic evaluations. Changes in depression and anxiety were estimated using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder questionnaire (GAD-7) at treatment termination and 7-month follow-up using two definitions of treatment benefit. Cost-effectiveness metrics included effectiveness-cost ratios and cost per number needed to treat.
Results
Base case cost assumptions estimated that delivering Shamiri cost $15.17 (in 2021 U.S. dollars) per student. A sensitivity analysis, which varied cost and clinical change definitions, estimated it cost between $48.28 and $172.72 to help 1 student in Shamiri, relative to the control, achieve reliable and clinically significant change in depression and anxiety by 7-month follow-up.
Conclusions
Shamiri appears to be a low-cost intervention that can produce clinically meaningful reductions in depression and anxiety. Lay providers can deliver effective treatment for a fraction of the training time that is required to become a licensed mental health provider (10 days vs. multiple years), which is a strength from an economic perspective. Additionally, Shamiri produced reliable and clinically significant reductions in depression and anxiety after only four weekly sessions instead of the traditional 12–16 weekly sessions necessary for gold-standard cognitive behavioral therapy. The school setting, group format, and economic context of a LMIC influenced the cost per student; however, broader conclusions about the cost-effectiveness of Shamiri have yet to be determined due to limited economic evaluations of mental health programs in LMICs.
Trial registration
This study was registered prior to participant enrollment in the Pan-African Clinical Trials Registry (PACTR201906525818462), registered 20 Jun 2019, https://pactr.samrc.ac.za/Search.aspx.
... Seventh, only one included study was conducted in a low-income status country. This is notable as family members, including siblings, in developing nations are likely to have higher caregiving responsibilities and less access to professional support due to under-resourced mental health sectors (Jacob et al., 2007). Finally, it was beyond the scope of this study to examine differences in siblings' experiences based on the category of mental illness in the qualitative analysis. ...
Background:
Family members of people with mental illness (MI) may experience a host of psychological adversities such as increased stress, burden, and reduced wellbeing. However, relatively little is known about siblings. This study aimed to characterise the experience of distress (viz. depressive and anxiety symptoms), burden, and wellbeing in siblings of people with MI.
Methods:
Studies reporting on quantitative measures of depression, anxiety, burden, or wellbeing in siblings; and/or qualitative findings on siblings' experience were eligible. The literature search was conducted up until 20th October 2022.
Results:
Sixty-two studies comprising data from 3744 siblings were included. The pooled mean percentage of depressive symptoms fell in the mild range at 15.71 (k = 28, N = 2187, 95% CI 12.99-18.43) and anxiety symptoms fell in the minimal range at 22.45 (k = 16, N = 1122, 95% CI 17.09-27.80). Moderator analyses indicate that siblings of people with a schizophrenia spectrum disorder experience greater depressive symptoms than siblings of people with other types of MI (β = -16.38, p < 0.001). Qualitative findings suggest that individuals may be particularly vulnerable during their siblings' illness onset and times of relapse. Limited communication, confusion about MI, and the need to compensate may contribute to siblings' distress and/or burden. Siblings' experience of wellbeing and caregiving were closely related.
Conclusion:
This review highlights the complex psychological experience of siblings and the need for greater research and clinical support for this important yet often overlooked cohort.
... Given the complexity of care coordination required for optimal pediatric craniopharyngioma care, these tumors are often best managed in highly specialized tertiary care centers frequently unavailable in resource-poor settings. Unfortunately, the majority of the global population including children resides in LMICs, where access to high quality pediatric surgical care is limited [13]. The challenging nature of pediatric craniopharyngioma management even in well-resourced settings further complicates the care of LMIC patients. ...
Introduction
Pediatric craniopharyngioma is a complex pathology, with optimal management involving a multidisciplinary approach and thoughtful care coordination. To date, no studies have compared various treatment modalities and outcomes described in different global regions. We conducted a comprehensive systematic review to compare demographics, clinical presentation, treatment approach and outcomes of children diagnosed with craniopharyngioma globally.
Methods
A systematic review was conducted in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms included “craniopharyngioma” and country-specific terms. Inclusion criteria included full-text studies published between 2000–2022, primarily examining pediatric patients 18-years old or younger diagnosed with craniopharyngioma, and reporting management and outcomes of interest. Data extracted included country of origin, demographical data, initial presentation and treatment modality, and outcomes. Descriptive statistics and between-group comparisons based on country of origin were performed.
Results
Of 797 search results, 35 articles were included, mostly originating from high-income countries (HIC) (n = 25, 71.4%). No studies originated from low-income countries (LIC). When comparing HIC to middle-income countries (MIC), no differences in patient demographics were observed. No differences in symptomatology at initial presentation, tumor type, surgical approach or extent of surgical resection were observed. HIC patients undergoing intracystic therapy were more likely to receive bleomycin (n = 48, 85.7%), while the majority of MIC patients received interferon therapy (n = 10, 62.5%). All MIC patients undergoing radiation therapy underwent photon therapy (n = 102). No statistically significant differences were observed in postoperative complications or mean follow-up duration between HIC and MIC (78.1 ± 32.2 vs. 58.5 ± 32.1 months, p = 0.241).
Conclusion
Pediatric craniopharyngioma presents and is managed similarly across the globe. However, no studies originating from LICs and resource-poor regions examine presentation and management to date, representing a significant knowledge gap that must be addressed to complete the global picture of pediatric craniopharyngioma burden and management.
... In Nepal, the health system is overstretched due to the high burden of other diseases, low availability of trained health workers and financial resources, political instability, and poor governance and accountability. This mirrors the situation of other LMICs with mental health funding reported to be only a small proportion of the health budget which may be an average of 2.1% in lower-middle-income countries and 1% in low-income countries [6]. Some literature report corruption, poor governance, weak implementation of regulations, and lack of political commitment, as key factors that undermine equitable and effective healthcare services in countries like Nepal [7]. ...
Background
The burden of mental health problems and inequalities in healthcare has emerged as critical issues, in Nepal. Strengthened citizen-driven social accountability (SA) is an effective strategy for building equitable health systems and providing quality healthcare services to all, yet SA in mental health is an under-researched area in Nepal.
Objective
This study explores changes in mental health service delivery in the re-configured federal health system and discusses the functioning and effectiveness of SA in the federalized context of Nepal.
Method
This case study research used a qualitative approach to data collection. We conducted Key Informant Interviews (KIIs), and Focus Group Discussions (FGDs) with local stakeholders including people with experience of mental health problems. The audio-recorded interviews and discussions were transcribed and analyzed using a thematic content method.
Results
A total of 49 participants were recruited, and 17 participated in interviews and 32 participated in six focus group discussions. From the data, eight themes emerged: Policy challenges in mental health, Governance and service delivery, Tokenism in the application of social accountability processes, Weak role of key actors in promoting accountability, Complaints and response, Discriminatory health and welfare system, Public attitudes and commitment towards mental health, and No differences experienced by the change to a federal system. It was found that existing health policies in Nepal inadequately cover mental health issues and needs. The prevailing laws and policies related to mental health were poorly implemented. There is a lack of clarity at different levels of government about the roles and responsibilities in the delivery of mental health services. Poor intra- and inter-governmental coordination, and delays in law-making processes negatively impacted on mental health service delivery. SA mechanisms such as social audits and public hearings exist within government health systems, however, application of these in mental health services was found poor. Rights-holders with mental health problems had not experienced any change in the provision of healthcare services for them even after the federalization.
Conclusion
Mental health is insufficiently addressed by the health policies in Nepal, and SA mechanisms appeared to be rarely institutionalized to promote good governance and provide effective healthcare services to vulnerable populations. The provision of more equitable services and honest implementation of SA tools may foster greater accountability and thereby better service delivery for people with mental health problems.
... [2]. With 85% of the world's population in the low-and middle-income countries (LMICs), they contribute disproportionately to the global disease burden [3] with more than 80% of Persons With Mental Illness (PWMI) residing in these countries [4]. Among other mental health disorders, depression and anxiety continue to be the leading causes of disease burden globally (ranked 13th and 24th leading causes of DALYs, respectively) and LMICs are expected to have depression as the third leading cause of disease burden by 2030 [5]. ...
India comprises around 18% of the world’s population and contributes a major proportion to the global burden of mental disorders. In recognition, the Hon’ble Union Finance Minister of India in the Union Budget 2022 announced India’s first National Tele Mental Health Programme, i.e. Tele Mental Health Assistance and Networking Across States (Tele MANAS). Tele MANAS envisions to work as a
comprehensive, integrated, and inclusive 24X7 tele-mental health facility in each State and Union Territory (UT) in India with the aim to provide universal access to equitable, accessible, affordable, and quality mental health care through 24X7 tele-mental health counselling services as a digital component of the National
Mental Health Programme (NMHP) with assured linkages. Launched on October 10, 2022, on World Mental Health Day, the Government of India (GoI) is unquestionably making a remarkable contribution towards raising awareness of mental health disorders worldwide and mobilizing efforts in support of mental health to advance global mental health.
... In Brazil, a national mental health policy was legislated in 2001, driven by the Psychiatric Reform movement, which advocated for a community model of care. Since then, there have been several changes in the implementation of territorial services and clinical practices based on psychosocial care, leading the Brazilian experience to occupy a prominent place in the field of global mental health (JACOB et al., 2007;ALMEIDA, 2019). ...
This is a methodological study for the development and validation of the Multidimensional Instrument for Evaluating of the Implementation of Psychosocial Care Network (IMAI-RAPS) in Minas Gerais (MG)/Brazil. The study was carried out in three stages: evaluability study, development of the IMAIRAPS, application of the Delphi Technique for content and appearance validation of the questions. The analysis of official documents, literature review and a structured engagement with program members were carried out to clarify its operationalization and focus on the central aspects to be evaluated. A theoreticallogical model of RAPS was built according to the Donabedian triad: structure, process and result and organized into: Minimum Units (Mental Health Care and Psychosocial Rehabilitation), Connectivity (Network Articulation), Integration (Governance and Management of the Care), Normativity (Mental Health Policy and Participation and Social Control), Subjectivity and Structure (Services, Logistics System and Health Education). The IMAI-RAPS was derived from this model, which was validated by 44 experts in the field, indicating the approach of relevant, useful and viable questions for evaluating the structure and process of implementing the program in MG. The use of the Delphi Technique made it possible for the developed products to be marked out by Psychosocial Care Network scholars or professionals from different regions of the country, increasing the analytical power of the tool.
... No Brasil, a construção de uma política nacional de saúde mental teve origem na década de 1980, impulsionada pelo movimento da Reforma Psiquiátrica, apostando em um modelo comunitário de assistência. Desde então, constatam-se diversas mudanças ligadas a implementação de serviços territoriais e práticas clínicas baseadas na atenção psicossocial, levando a experiência brasileira a ter um lugar de destaque no campo da saúde mental global (JACOB et al, 2007;ALMEIDA, 2019). ...
Resumo Trata-se de um estudo metodológico para desenvolvimento e validação do Instrumento Multidimensional para Avaliação da Implantação da RAPS (IMAI-RAPS) em Minas Gerais (MG)/Brasil. O estudo foi executado em três etapas: estudo de avaliabilidade, desenvolvimento do IMAI-RAPS, aplicação da Técnica Delphi para validação de conteúdo e aparência das questões. Foram realizados a análise de documentos oficiais, revisão da literatura e um engajamento estruturado com membros do programa para esclarecer sua operacionalização e focalizar os aspectos centrais a serem avaliados. Um modelo teórico-lógico da RAPS foi construído de acordo com a tríade donabediana: estrutura, processo e resultado e organizado em: Unidades Mínimas (Assistência à Saúde Mental e Reabilitação Psicossocial), Conectividade (Articulação da Rede), Integração (Governança e Gestão do Cuidado), Normatividade (Política de Saúde Mental e Participação e Controle Social), Subjetividade e Estrutura (Serviços, Sistema Logístico e Educação em Saúde). Desse modelo derivou-se o IMAI-RAPS que foi validado por 44 experts da área indicando a abordagem de questões relevantes, úteis e viáveis para avaliação da estrutura e processo de implantação do programa em MG. A utilização da Técnica Delphi possibilitou que os produtos desenvolvidos fossem balizados por estudiosos ou profissionais da RAPS de diversas regiões do país aumentando o poder analítico da ferramenta.
... The restructured healthcare model was based on prior work carried out in countries with larger resources, and it aimed to shift the focus from hospital care to care in the community and primary healthcare services, placing the user and the protection of their human rights at the heart of its mission [2]. Since then, several changes based on the provision of psychosocial care have occurred relating to the setting up of services and clinical practices in the different regions, leading the Brazilian deinstitutionalization experience to have a prominent place in the field of global mental health [3,4]. ...
In recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a community mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of this care network in Minas Gerais, the second most populous state of Brazil, generating indicators that can enhance the strategic management of the public health system in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas Gerais was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of services like ‘Family Health Strategy,’ ‘Expanded Family Health Center,’ and ‘Psychosocial Care Centers’ but a lack of ‘Beds in General Hospitals’ destinated to mental health care, ‘Unified Electronic Medical Records’ and ‘Mental Health Training Activities for Professionals.’ In the process dimension, adequate implementation of actions such as ‘Multidisciplinary and Joint Care,’ ‘Assistance to Common Mental Disorders by Primary Health Care,’ ‘Management of Psychiatric Crises in Psychosocial Care Centers,’ ‘Offer of Health Promotion Actions,’ and ‘Discussion of Cases by Mental Health Teams’ point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of ‘Psychosocial Rehabilitation Actions,’ ‘Productive Inclusion,’ ‘User Protagonism,’ ‘Network Integration,’ and practical activities for the effectiveness of collaborative care. We found a better implementation of the mental health care network in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of mental health care networks are scarce throughout the Brazilian territory, a fact also found in Minas Gerais, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management.
... How then do decision makers choose which interventions to prioritize in LMICs where chronic government under-investment in mental healthcare persists [5][6] ? Economic evaluations of youth mental interventions, in addition to e cacy examinations, are needed to inform important policy, practice, and research decisions by policymakers, practitioners, researchers, and other mental health professionals interested in investing limited resources wisely. ...
Background: Low- and middle-income countries (LMICs) have the highest socio-economic burden of mental health disorders, yet the fewest resources for prevention. Recently, many intervention strategies — including the use of brief, scalable interventions— have emerged as ways of reducing the mental health treatment gap in LMICs. But how do decision makers prioritize and optimize the allocation of limited resources? One approach is through the evaluation of delivery costs alongside intervention effectiveness of various types of interventions. Here, we evaluate the cost-effectiveness of Shamiri, a group– and school–based intervention for adolescent depression and anxiety that is delivered by lay-provider and that teaches growth mindset, gratitude, and value affirmation.
Methods: We estimated the cost-effectiveness of Shamiri using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines for economic evaluations. Changes in depression and anxiety were estimated at treatment termination and 7-month follow-up using a standard definition and reliable and clinically significant change definition of treatment benefit. Cost-effectiveness metrics included effectiveness-cost ratios and cost per number needed to treat.
Results: Base case cost assumptions estimated that delivering Shamiri cost $15.17 (in 2021 U.S dollars) per student. A sensitivity analysis, which varied cost and clinical change definitions, estimated it cost between $48.28 and $172.72 to help 1 student in Shamiri, relative to the control, achieve reliable and clinically significant change in depression and anxiety by 7-month follow-up.
Conclusions: Shamiri appears to be a low-cost intervention that can produce clinically meaningful reductions in depression and anxiety. Lay providers can deliver effective treatment for a fraction of the time that is required to become a licensed mental health provider (10 days vs. multiple years), which is a strength from an economic perspective. Additionally, Shamiri produced reliable and clinically significant reductions in depression and anxiety after only 4 weekly sessions instead of the traditional 12-16 weekly sessions necessary for gold-standard cognitive behavioral therapy. The cost per “treated” student is acceptable relative to other school-based adolescent mental health interventions that have ranged from $52 to $56,500 per student with a successful outcome.
Trial registration: This study was registered prior to participant enrollment in the Pan-African Clinical Trials Registry (PACTR201906525818462), registered 20 Jun 2019, https://pactr.samrc.ac.za/Search.aspx.
... To contextualise issues related to delineating priorities for mental health research in LAMI countries, it is important to remain cognisant of the many barriers to research in poorly resourced settings with scarce financial, human and technical resources. 29,30 Although data on the number of mental health researchers and research funding in LAMI countries are not readily available, the ratio of scientists per 1000 population in LAMI countries is under 0.5, in contrast to high-income countries where the ratio is over 2. Similarly, LAMI countries invest less than 1% of their gross domestic product in research and development compared with 2% in high-income countries. 31 Thus, in addition to a major revision of priorities in mental health research, efforts would be needed to increase resources (e.g. ...
... This international difference in the burden of mental health disease is due to a combination of factors. In low-income and middle-income country, adequate and quality mental health infrastructure [28], mental health services are not provided equitably to people with mental disorders [29][30][31], persons with serious mental illness in less-developed countries do not receive treatment [32].Besides, most of these countries lack prevention of mental disorders [33].A research pointed out that, 32% of 191 countries did not have a speci ed budget for mental health. Many countries from Africa (79%) and the South East Asia (63%)spent less than 1% of their total health budget on mental health [34]. ...
Background
Mental illness had been a worldwide concern. Global Mental Health (GMH) had become a movement to fight for Global health inequality. In low-income country, mental health infrastructure and services are not provided equitably to people with mental disorders.
Methods
We used the data of global burden of 204countries from 1990 to 2019 in Global Burden of Disease database. The Years Lived with Disability (YLDs) due to mental disorders was treated as an indicator of national mental health. By using the GBD Results Tool toolkit provided by the Institute of Health Measurement and Evaluation, we retrieved and visualized the data in global burden of disease data. In addition, we used correlation analysis to analyze the correlation between the burden of mental illness and the level of national development.
Results
It is found that, mental health had been a global issue which showing a gradual upward trend. There is a significant positive and moderate correlation between national development and the burden of mental disorder. The better the national development, the higher the YLDs Rate caused by mental disorders. The burden of mental illness in low-income countries is not high, but the rate of increase is relatively fast, while the burden of mental illness in low- and middle-income countries is relatively high, but the rate of decrease is apparent.
Conclusions
Although there is a positive correlation between the national development level and the national burden of mental illness, the study found that the burden of mental disorders (as measured by YLD’s) in developed countries was high and declining, compared to developing countries where the burden was lower but growing. It is high time to notice that mental health had been a global issue. Global mental health movement should be done to narrow the gap between different countries, especially in developing countries.
... Finally, this project was conducted in a specific and predominantly rural region of Ethiopia, and different interventions may be best suited to address emotional and psychosocial needs of PLWH in different settings. However, this study's findings have relevance for a number of locations, especially resource-limited and rural settings where formal mental health services and mental health professionals may be limited and difficult to access [57][58][59]. For example, in one Ethiopian district, rural residents with severe mental disorders, especially those who lived more than three hours from a health facility, were less likely to access care [57]. ...
People living with HIV face multiple psychosocial challenges. In a large, predominantly rural Ethiopian region, 1799 HIV patients new to care were enrolled from 32 sites in a cluster randomized trial using trained community support workers with HIV to provide individual health education, counseling and social support. Participants received annual surveys through 36 months using items drawn from the Centre for Epidemiologic Studies Depression Scale-10, Medical Outcome Study Social Support Survey, and HIV/AIDS Stigma Instrument-PLWA. At 12 months (using linear mixed effects regression models controlling for enrollment site clustering), intervention participants had greater emotional/informational and tangible assistance social support scores, and lower scores assessing depression symptoms and negative self-perception due to HIV status. A significant treatment effect at 36 months was also seen on scores assessing emotional/informational social support, depression symptoms, and internalized stigma. An intervention using peer community support workers with HIV to provide individualized informational and psychological support had a positive impact on the emotional health of people living with HIV who were new to care.
(ClinicalTrials.gov protocol ID: 1410S54203, May 19, 2015).
... We will make inferences about which behavioral phenotypes are most predictive and evaluate their time-delayed impact upon mood at different time lags. Granger causality [30] is a quantitative framework for assessing the relationship between time series, and has been widely used in econometrics, neuroscience, and genomics to study the temporal causal relations among multiple economic events [30,31] directional interactions of neurobiological signals [32][33][34] and gene time-course expression levels [35][36][37], respectively. Given two time series and , the temporal structure of the data is used to assess whether the past values of , are predictive of future values of , beyond what the past of can predict alone; if so, is said to Granger cause . ...
Objective: This study proposes to identify and validate weighted sensor stream signatures that predict near-term risk of a major depressive episode and future mood among healthcare workers in Kenya.
Approach: The study will deploy a mobile app platform and use novel data science analytic approaches (Artificial Intelligence and Machine Learning) to identifying predictors of mental health disorders among 500 randomly sampled healthcare workers from five healthcare facilities in Nairobi, Kenya.
Expectation: This study will lay the basis for creating agile and scalable systems for rapid diagnostics that could inform precise interventions for mitigating depression and ensure a healthy, resilient healthcare workforce to develop sustainable economic growth in Kenya, East Africa, and ultimately neighboring countries in sub-Saharan Africa. This protocol paper provides an opportunity to share the planned study implementation methods and approaches.
Conclusion: A mobile technology platform that is scalable and can be used to understand and improve mental health outcomes is of critical importance.
... No Brasil, a formação da Política Nacional de Saúde Mental (PNSM) se iniciou em 1980 com o objetivo de criar um modelo comunitário de assistência (Coelho et al., 2022). Durante esse período, diversos avanços com relação à implementação de serviços territoriais e às práticas adotadas na atenção psicossocial, levaram o Brasil a um lugar de destaque dentre os modelos adotados no resto do mundo (Jacob et al., 2007). ...
A dependência química é um grave problema para a saúde, é uma patologia sem cura que é caracterizada pelo seu caráter progressivo e que afeta em todos os âmbitos de diversos brasileiros. Assim, levando-se em consideração a caracterização de tal patologia e a escassez de estudos acerca do papel efetivo da Rede de Atenção Psicossocial (RAPS) para a recuperação desses pacientes, faz-se crucial o entendimento dos impactos dessa rede. Objetivos: Compreender e analisar o papel da RAPS na recuperação de dependentes químicos. Metodologia: Trata-se de uma revisão integrativa acerca da atuação da RAPS na recuperação de dependentes químicos. Utilizou-se a estratégia PICO para a elaboração da pergunta norteadora. Ademais, realizou-se o cruzamento dos descritores “Rede de Atenção Psicossocial; “Dependência Química”; “Importância” e em inglês: “Chemical Dependency” e “Drug Users” nas seguintes bases de dados: Biblioteca Virtual de Saúde (BVS); Scientific Eletronic Library Online (SCIELO) e PubMed. Resultados e Discussão: A partir dos 11 estudos selecionados, nota-se que a inexistência de uma rede de apoio pode interferir diretamente na recuperação e reinserção de dependentes químicos. Conclusão: Após essa revisão, ressalta-se a importância do fortalecimento da RAPS e maior destinação de recursos para sua melhor atuação.
... 5,6 Second, resource limitations in LMICs often limit funding for mental healthcare: although LMICs are home to over 80% of the world's population, only 20% of global spending on mental health care occurs in LMICs. 7,8 Third, most interventions are developed and tested in highincome countries, and may lack cultural relevance for youth living in other parts of the world. 2,9 Fourth, most LMICs have a limited number of mental health professionals to deliver interventions; for example, the World Health Organization found that LMICs have 0.1 psychiatrists per 100,000, whereas high-income countries have 1. ...
Objective:
Because most youth psychotherapies are developed and tested in high-income countries, relatively little is known about their effectiveness or moderators in low- and middle-income countries (LMICs). To address this gap, we conducted a meta-analysis of randomized controlled trials (RCTs) testing psychotherapies for youth with multiple psychiatric conditions in LMICs, and we tested candidate moderators.
Method:
We searched nine international databases for RCTs of youth psychotherapies in LMICs published through January 2021. The RCTs targeted elevated symptoms of youth anxiety (including post-traumatic stress disorder [PTSD] and obsessive compulsive disorder [OCD]), depression, conduct, and attention problems. Using robust variance estimation, we estimated the pooled effect sizes (Hedges g) at post-treatment and follow-up for intervention versus control conditions.
Results:
Of 5,145 articles identified, 34 (with 43 treatment-control comparisons and N=4176 participants) met methodological standards and were included. The overall pooled g with winsorized outliers was 1.01 (95% CI=0.72 1.29, p<.001) at post-treatment and 0.68 (95% CI=0.29 1.07, p=.003) at follow-up. Interventions delivered by professional clinicians significantly outperformed those delivered by lay-providers (g=1.59 vs. 0.53). Interventions developed non-locally were more effective if not adapted to local contexts than if adapted locally (g=2.31 vs. 0.66), highlighting a need for further research on effective adaptations. Significant risk of bias was identified.
Conclusion:
Overall pooled effects of youth psychotherapies in LMICs were markedly larger than those in recent comparable non-LMIC meta-analyses, which have shown small-to-medium effects for youth psychotherapies. Findings highlight the potential benefits of youth psychotherapies in LMICs as well as a need for more RCTs and improved study quality.
... This study aimed to explore the mental health and well-being of Ukrainian refugees and IDPs as well as explore the protective role of the family in enhancing resilience. Results of the initial analyses conducted on our sample in the centre of Przemysl in Poland and in Lviv are consistent with findings in the literature indicating the occurrence of a variety of psychological symptoms and syndromes in populations in conflict situations [30]. Indeed, the majority of the sample in both Poland and Lviv reported high or very high levels of anxiety, depression, anger, and sleep disturbances. ...
A growing body of research highlights how communities traumatized by conflict and displacement suffer from long-term mental and psychosocial illnesses. The Russian army’s attack on Ukraine has resulted in an estimated 10 million people being internally or externally displaced from Ukraine, of whom more than 3.8 million have left Ukraine to seek refuge elsewhere in Europe. Soleterre has decided to launch an intervention to provide psychological support to Ukrainian refugees and IDPs, aimed at containing war trauma, assessing the severity of symptoms, and enabling those affected to receive psychological support. The intervention model envisioned the administration of an intake form to provide a rapid collection of qualitative and quantitative information for those arriving in Poland or Lviv from Ukraine. Our results showed how most of the samples reported high or very high levels of anxiety, depression, and sleep disturbances. Moreover, results highlighted how being close to families or being able to keep in touch with them work as a protective factor in enhancing resilience, as well as a support network. These findings underscored the importance of re-thinking our perception of “family” in a broader sense, considering the new facets it can take on in post-conflict situations.
... 1,3 Globally, there is high variability in the systems supporting the delivery of mental healthcare in the general population. 4 A mental healthcare system comprises 'all the organisations, people, and actions whose primary intent is to promote, restore or maintain [mental] health'. 5 The system is therefore more than mental health facilities; it includes the workforce, medicines and relevant legislation. ...
This paper compares across six nations the mental health systems available to prisoners with the highest acuity of psychosis and risk combined with the lowest level of insight into the need for treatment. Variations were observed within and between nations. Findings highlight the likely impact of factors such as mental health legislation and the prison mental health workforce on a nation's ability to deliver timely and effective treatment close to home for prisoners who lack capacity to consent to treatment for their severe mental illness. The potential benefits of addressing the resulting inequalities are noted.
... Mental disorders entail a wide range of clinical entities, including bipolar disorder, psychosis such as schizophrenia, depression, developmental disorders such as autism, dementia (World Health Organization 2019), anxiety-mood disorders, and substance abuse disorders (Steel et al. 2014;Seedat et al. 2009). There are 153 low-and middle-income countries (LMICs), with approximately 85% of the world's population (Jacob et al. 2007). Around 80% of those living in LMICs suffer from mental disorders, with substance abuse disorders and mental illness contributing to 16.6% and 8.8% of total disease burden, respectively (World Health Organization 2008a). ...
Mental health services are defined as “the means by which effective interventions for mental health are delivered.” The effectiveness of these interventions is determined by how mental health services are organized within different sociocultural, economic, and political contexts. Mental disorders impose a significant health and economic burden on low- and middle-income countries (LMICs) due to many challenges. This entry will discuss various aspects of mental health services delivery in LMICs and the pharmacists’ roles in such healthcare services. Also, this entry will discuss the challenges of pharmacists’ engagement in the delivery of mental health services in LMICs and will elaborate on important and feasible solutions for capacity building.
... De hecho, este conjunto de indicadores tiene aplicación al producir evidencia sobre un escenario de salud y sus tendencias, con base en la experiencia, para identificar poblaciones con mayores necesidades de salud, establecer riesgo epidemiológico e identificar áreas críticas. De esta forma, es una herramienta importante que contribuye a establecer políticas y sus prioridades, a mejorar la calidad de los servicios, a adecuar protocolos y medidas de atención que puedan brindar información para programas de promoción de la SM, además contribuye a la prevención y al tratamiento de la enfermedad con rehabilitación psicosocial de casos crónicos, en busca de un mejor servicio que cubra las necesidades de la población (49)(50)(51) . ...
Resumen Objetivo: proponer indicadores de salud mental para la gestión de la Red de Atención en Salud Mental, a partir de la convergencia de uso en países con organización pública de salud. Método: análisis exploratorio de los indicadores que adoptan y utilizan estos países, a partir del análisis detallado de sus respectivos documentos normativos, considerando las directrices de la Organización Mundial de la Salud. Después de seleccionar los indicadores, se sugirió adoptar la Matriz de Salud Mental para desarrollarlos y aplicarlos en la Red Brasileña de Atención Psicosocial. Respetando los criterios de inclusión y exclusión de los indicadores estudiados, la matriz fue construida en dos dimensiones: geográfica (nacional/regional, local, individual) y temporal (entrada, proceso y resultados). Resultados: el análisis indica que 41 indicadores presentaron evidencia de uso. Todos fueron posicionados en la Matriz de Salud Mental, y contribuyeron como métrica para analizar la finalidad de los servicios de salud mental, en los niveles y fases de cada dimensión. Conclusión: los indicadores seleccionados, distribuidos en diferentes dimensiones de la Matriz de Salud Mental, están disponibles para ser utilizados tanto en la gestión y en la práctica clínica, como en estudios científicos y, en un horizonte futuro, para definir políticas de salud mental.
... Indeed, this set of indicators has application in producing evidence on a health scenario and its trends, based on experience, to identify populations with greater health needs, establish epidemiological risk and identify critical areas. In this way, it contributes as an important tool to establish policies and their priorities, to improve the quality of the services and to adapt care protocols and measures that can provide diverse information for MH promotion programs, as well as prevention and treatment of diseases with psychosocial rehabilitation of the chronic cases, seeking to better meet the needs of the population (49)(50)(51) . ...
Objective: to propose Mental Health Indicators aimed at management
of the Mental Health Care Network, starting with convergence of
their use, in countries with public health organization. Method: an
exploratory analysis of the indicators adopted and used in these
countries, from the detailed analysis of their respective normative
documents, considering the World Health Organization guidelines.
After selection of the indicators, the Mental Health Matrix was
adopted as a suggestion for their development and application in
the Brazilian Psychosocial Care Network. The matrix was prepared
in two dimensions, respecting the inclusion and exclusion criteria for
the indicators studied, as follows: geographical (national/regional,
local, individual), and time (entry, process and results). Results:
the analysis indicates 41 indicators that presented diverse evidence
regarding their use. All were allocated in the Mental Health Matrix,
contributing as a metric to analyze the purpose of the Mental Health
services, in the levels and phases of each dimension. Conclusion: the
indicators selected, distributed in the different Mental Health Matrix
dimensions, are being made available for their use in management
and in the clinical practice, as well as for scientific studies and, in the
future, to be used as definers of Mental Health policies.
... This study found that grip strength and depression were negatively correlated in older adults, which can be extended from India to other LAMICs. Given that LAMICs carry a greater burden of depression, accounting for more than 80% of total years of disability globally (World Health Organization, 2017), these disorders account for less than 2% of the health budget in these countries (Jacob et al., 2007). Therefore, special attention is required for the grip strength level of elderly individuals so that the occurrence of depressive symptoms can be prevented and blocked at an early stage. ...
Background
The association between grip strength and depression in elderly individuals in low- and middle-income countries (LMICs) has rarely been studied. This study aims to explore the relevance of grip strength and depression in the elderly population using data from a national large-scale population.Methods
This study was conducted using data from seniors over 60 years old in wave 1 of the Longitudinal Aging Study in India (LASI). Grip strength is the maximum of three measurements by the dynamometer. Depression symptoms were assessed using 10 items on the Center for Epidemiologic Studies Depression Scale (CESD-10) with a 10-point boundary. Multivariate linear regression analysis, non-linear analysis, subgroup analysis, interaction tests and sensitivity analysis were performed.ResultsThere were 27,343 participants in this study, including 19,861 participants with low grip strength and 7,482 participants with normal grip strength. The results revealed that grip strength and depression were negatively correlated in elderly individuals after adequate adjustment for confounding factors [odds ratio (OR) = 1.237, 95% confidence interval (CI) 1.172–1.305, p < 0.00001]. The results remained stable after adjusting for all confounding factors (OR = 1.090, 95% CI 1.030–1.155, p = 0.00307). Regression analysis showed that physical activity (PA), comorbidities and cognition may have an impact on the correlation between grip strength and depression symptoms. Smooth curve fit suggested that grip strength and depressive symptoms were linearly related. The interaction test results of gender in the relationship between grip strength and depression were significant (p for interaction < 0.05).Conclusion
Grip strength and depression were negatively correlated in older Indians, and larger prospective studies are needed in the future to determine this association.
... There is a scarcity of trained health care providers in India [16] with less than one psychiatrist per million citizens in rural India [17]. The availability of psychologists, social workers, and psychiatry nurses is even smaller, pointing to the need for training primary health care staff to close the treatment gap [18]. ...
Abstract Background Depression is common among primary care patients in LMIC but treatments are largely ineffective. In this cluster-randomized controlled trial, we tested whether depression outcomes are different among recipients of a collaborative care model compared to enhanced standard treatment in patients with co-morbid chronic medical conditions. Methods We conducted a cluster randomized controlled trial among participants 30 years or older seeking care at 49 primary health centers (PHCs) in rural Karnataka, diagnosed with major depressive disorder, dysthymia, generalized anxiety disorder, or panic disorder on the MINI-International Neuropsychiatric Interview plus either hypertension, diabetes, or ischemic heart disease. From a list of all PHCs in the district, 24 PHCs were randomized a priori to deliver collaborative care and 25 PHCs enhanced standard treatment. The collaborative care model consisted of a clinic-based and a community-based component. Study assessment staff was blinded to treatment arm allocation. The primary outcome was the individual-level PHQ-9 score over time. Results Between May 2015 and Nov 2018, 2486 participants were enrolled, 1264 in the control arm, and 1222 in the intervention arm. They were assessed at baseline, 3, 6 and 12 months. The mean PHQ-9 depression score was around 8.5 at baseline. At each follow-up PHQ-9 scores were significantly lower in the intervention (5.24, 4.81 and 4.22 at respective follow-ups) than in the control group (6.69, 6.13, 5.23, respectively). A significant time-by-treatment interaction (p
... Children and young people are exposed to witnessing violence and forced to participate in violence (Machel, 1996). In African contexts of armed conflict, high rates of depression, anxiety and post-traumatic stress reactions have been reported in war-affected children (Bayer et al., 2007;Betancourt et al., 2012) However, it is essential to note that untreated mental disorders are significantly high in low and middle-income countries-upward of 70%, especially in children (Gore et al., 2011;Patel et al., 2007;Jacob et al., 2007). In part, the figure is explained in terms of lack of mental health resources but also lack of trained health care professionals who can recognise and diagnose mental health disorders as well as barriers to seeking help such as stigma. ...
As Shultz et al. (2014) suggested, “in the annals of forced migration, Colombia is notable for the high overall numbers of internally displaced persons” (p. 475). Unfortunately, Colombia is easily associated with this phenomenon, which does not occur merely due to the action of certain violent groups, but rather is due to more complex dynamics that require an informed approach from different angles. In general, the analyses focus on the socio-political, economic, and military aspects. In this chapter, however, we want to highlight two elements: health care for displaced people and migrants, on the one hand, and the need to recognize the ethical-moral dimension that underlies the problem of displacement, on the other.
In the following lines, we will present a general picture of forced displacement in Colombia from a global perspective on this problem to point out the particularities of the Colombian case. Figures on the phenomenon and the elements that make this situation an ethical-political problem of great dimensions will be presented, proposing elements from bioethics that help consider the problem, especially concerning the health needs of this population and the differential care that, therefore, is required.
... XX wieku nastąpił proces "otwierania drzwi" szpitali psychiatrycznych. Zaczęto zwracać uwagę na leczenie pacjenta bliżej miejsca zamieszkania, bliżej rodziny [Jacob, Sharan, Mirza, Garrido-Cumbrera, Seedat, Mari, Sreenivas, Saxena 2007, ss. 1061-1077. ...
The concepts of “strategy” or “strategic planning” have traditionally been associated with the military context or with the business environment. The question arises
whether they can serve as effective instruments for development of higher education
institutions as well. An attempt of an analysis of the mission statements and strategies of some of the well-established, high-ranked higher schools in Poland was made.
The findings show that, although it is difficult to estimate to what extent Polish higher
schools treat their mission statements and strategic plans as the sources of competitive
advantage and not just marketing tools, the process of implementing strategic thinking
in higher schools in Poland has already started.
... Por lo tanto, se debe esperar que los trastornos mentales expliquen un número importante de consultas o solicitudes de atención en los servicios de salud, a tal punto que cerca de un sexto de los adultos colombianos requirió tratamiento por psiquiatría en el contexto hospitalario (Minsalud-Colciencias, 2015). Los servicios en salud mental en el ámbito hospitalario toman aproximadamente el 80 % de los recursos destinados a los cuidados en atención mental en los países de bajos y medianos ingresos alrededor del mundo (Jacob et al, 2007;Saxena et al, 2011). ...
Introducción:
la escala de conocimiento en salud mental (MAKS) y la escala de trastorno mental: actitudes de los médicos (MICA) son herramientas para explorar estigma-discriminación relacionado con los trastornos mentales. Las traducciones en español están disponibles; sin embargo, se desconoce la consistencia interna de estos instrumentos.
Objetivo:
explorar la consistencia interna y la correlación entre MAKS y MICA en estudiantes de medicina.
Materiales y métodos:
se diseñó un estudio psicométrico. Una muestra de 507 estudiantes, con edades comprendidas entre 18 y 39 años (M=21,0; DE =2,9), 56,5 % eran mujeres, 65,3 % estudiaban en una universidad privada y 50,1 % tomaban cursos básicos de medicina. Los participantes completaron el MAKS y el MICA, que son escalas de 12 y 16 ítems, respectivamente. Ambas escalas ofrecen opciones de respuesta tipo Likert, desde totalmente de acuerdo hasta totalmente en desacuerdo.
Resultados:
se calculó la consistencia interna (alfa de Cronbach y omega de McDonald) y la correlación entre MAKS y MICA. MAKS mostró alfa de Cronbach de 0,62 y omega de McDonald de 0,77 y MICA presentó alfa de Cronbach de 0,51 y omega de McDonald de 0,33. La reproducibilidad de la MICA r=0,44 y CCI de 0,61 y la de la MAKS r =0,44 y CCI de 0,60.
Conclusión:
se concluye que la MAKS presenta aceptable consistencia interna y reproducibilidad; sin embargo, la MICA muestra un pobre desempeño. Se recomienda utilizar MAKS para medir la discriminación de estigma relacionada con trastornos mentales entre estudiantes de medicina en Santa Marta, Colombia. Los ítems de la versión en español de la MICA necesitan una revisión sólida.
... Prior work has demonstrated that individuals with first episode psychosis often have several clinical contacts before they receive accurate diagnoses and effective treatment Cabassa et al., 2018;Marino et al., 2020). While many factors likely contribute to these findings, the difficult nature of eliciting psychotic symptoms from patients coupled with the relative scarcity of specialist psychiatric providers who can readily conduct diagnostic interviews (Jacob et al., 2007;Satiani et al., 2018) undoubtably complicate pathways to care for individuals with psychosis. These avoidable treatment delays have immediate adverse effects on the quality of life of individuals with psychotic illness and are associated with potential danger to patients and those around them (Addington et al., 2015a;Fusar-Poli et al., 2013;Marshall et al., 2005;Nielssen et al., 2012). ...
Despite significant advances in early-intervention services for psychosis, delays in identifying patients continue to impede the delivery of prompt and effective treatments. We sought to develop and preliminarily validate a self-administered psychosis implicit association task (P-IAT) as a screening and diagnostic support tool for identifying individuals with psychotic illness in community settings. The P-IAT is a response latency task, designed to measure the extent to which individuals implicitly associate psychosis-related terms with the “self.” The P-IAT was administered to 57 participants across 3 groups: healthy controls (N=19), inpatients hospitalized with active psychosis (N=19), and outpatients with psychotic disorders (N=19). Mean D-scores (the output of the task) differed significantly between the illness groups and healthy controls (Mann-Whitney U=138, p<.001). A receiver operating curve was plotted to assess the performance of D-scores in predicting a psychosis diagnosis, yielding an area under the curve of 0.81. When participant D-scores exceeded -0.24, the test achieved a specificity of 100% (sensitivity: 47%), with all 18 participants scoring above this threshold belonging to the illness groups. The discriminant performance of the P-IAT suggests its potential to augment existing screening instruments and inform referral decision making, particularly in settings with limited access to specialist providers.
... The development of a National Mental Health Policy (PNSM in Portuguese) in Brazil started in the 1980s, driven by social movements and staking on a community care model. There have been several advances linked to the improvement of territorial services and clinical practices based on psychosocial care in the last 30 years, leading the Brazilian performance into a prominent rank in the field of global mental health 3 . ...
The present study aims at analyzing the regionalization of the services carried out by the Psychosocial Care Network (RAPS in Portuguese) in the state of Minas Gerais (MG) in Brazil, yielding indicators that may enhance the SUS strategic management towards the strengthening of the psychosocial care provided by the state. It is a cross-sectional study, based on the data collected in May 2019 from government websites, considering the state’s Macro-Regions and Health Regions as units of analysis. Indicators of service coverage in relation to the population in accordance to normative parameters determined by the Ministry of Health for a better understanding of the effective coverage were produced, and a general indicator (iRAPS) of the supply of services in this network in Minas Gerais state was validated. The outcomes allow a detailed analysis of the structural aspect of the RAPS in MG and unveil the development of a robust network. However, important regional heterogeneities were noticed and also a lack of services aiming at specific populations providing assistance 24 hours a day, which weakens the proper access to RAPS in several parts of the state. Higher values of iRAPS were found in health regions with low socioeconomic development and low general offer of health services, a fact that differs from the national scenario, which may imply state policy investments aiming at offering RAPS within the state hinterland areas.
... No Brasil, a construção de uma Política Nacional de Saúde Mental (PNSM) teve origem na década de 1980, impulsionada por movimentos sociais, apostando em um modelo comunitário de assistência. Nos últimos 30 anos, constatamse diversos avanços ligados à implementação de serviços territoriais e às práticas clínicas baseadas na atenção psicossocial, levando a experiência brasileira a ter um lugar de destaque no campo da saúde mental global 3 . ...
Resumo Objetivou-se analisar a regionalização dos serviços da Rede de Atenção Psicossocial (RAPS) em Minas Gerais (MG), Brasil, gerando indicadores que possam potencializar a gestão estratégica do SUS no fortalecimento da atenção psicossocial do estado. É um estudo transversal, realizado a partir de dados coletados em maio de 2019 em sites governamentais, tendo as Macrorregiões e Regiões de Saúde do estado como unidades de análise. Foram produzidos indicadores da cobertura de serviços em relação à população, de acordo com parâmetros normativos estipulados pelo Ministério da Saúde, para melhor compreensão da cobertura efetivada e validou-se um indicador geral (iRAPS) da oferta dos serviços dessa rede em MG. Os resultados encontrados possibilitam uma análise detalhada do aspecto estrutural da RAPS em MG e demonstram a implantação de uma rede robusta. Entretanto, percebem-se importantes heterogeneidades regionais e também uma carência de serviços voltados para populações específicas e com funcionamento 24 horas, o que fragiliza o adequado acesso à RAPS em diversos territórios do estado. Foram encontrados maiores valores do iRAPS nas regiões de saúde com baixo desenvolvimento socioeconômico e baixa oferta geral de serviços de saúde, fato que difere do cenário nacional.
... There is a global gap in CAMHS, especially in the LMICs where 85% of the world population lives (Kumar et al., 2021). The 153 LMICs have limited financial resource allocation, inadequate manpower and infrastructure for mental health services (Jacob et al., 2007). Greater than 40% of the world's population are youth 24-years-old or younger; a quarter of disability-adjusted life years (DALYs) for mental disorders and substance abuse are borne by this age group (Global Burden of Disease Collaborative Network, 2017). ...
The dearth of child and adolescent mental health services (CAMHS) is a global problem. Integrating CAMHS in primary care has been offered as a solution. We sampled integrated care perspectives from colleagues around the world. Our findings include various models of integrated care namely: the stepped care model in Australia; shared care in the United Kingdom (UK) and Spain; school-based collaborative care in Qatar, Singapore and the state of Texas in the US; collaborative care in Canada, Brazil, US, and Uruguay; coordinated care in the US; and, developing collaborative care models in low-resource settings, like Kenya and Micronesia. These findings provide insights into training initiatives necessary to build CAMHS workforce capacity using integrated care models, each with the ultimate goal of improving access to care. Despite variations and progress in implementing integrated care models internationally, common challenges exist: funding within complex healthcare systems, limited training mechanisms, and geopolitical/policy issues. Supportive healthcare policy, robust training initiatives, ongoing quality improvement and measurement of outcomes across programs would provide data-driven support for the expansion of integrated care and ensure its sustainability.
This research was on the importance of accessibility to community-based mental health platforms for adolescents, views and perspectives from Life in the Light a community mental health care centre in the city of Bulawayo in Zimbabwe. The primary purpose of the research study was to show the positive outcomes of access to community-based mental health care. This was critical, especially within the backdrop of the deficit in mental health care access in the nation of Zimbabwe. The research sought to highlight this limited access to mental health and the social-structural factors which make it so. Grassroots-level attitudes on mental health access were also discussed as how they play out in the lack of investment and limitations to access and also how increased access was beneficial to the adolescents who had it. The research took a qualitative approach, taking a phenomenological paradigm since it sought to highlight the view, perspectives and experiences of adolescents who had accessed mental health care. The target population of this research was 30 participants and a sample size of 10 adolescents from Life in the Light was used. Semi-structured interviews were used as instruments in the collection and extraction of data on the positive effects of easily accessible community-based counselling services. The data was then analysed using thematic analysis in order to efficiently capture the views and perspectives of the adolescents at Life in the Light between the ages of 13-19. The data collected highlighted the issues that restrict access from stigmatisation to a shortage of mental health care access in general. The research also showed that adolescents who were engaged in community-based therapy were happier and more productive afterwards. It was also apparent that there needs to be a significant increase in investment in mental health services.
Interventions to treat substance use disorders (SUDs) and other mental health disorders (MHDs) in prison settings vary in both availability and effectiveness across contexts. Furthermore, incomplete characterization of intervention efficacy and/or effectiveness impacts the ability to know whether an intervention with demonstrated effectiveness in one setting will be effective in another setting. We systematically reviewed the literature for studies of interventions for SUDs and other MHDs conducted in prison settings, and synthesized the identified interventions and identified evidence gaps. Search strategies yielded 9,599 articles published between January 1, 2010, and December 31, 2020. A total of 82 articles were identified as eligible with interventions presented for SUDs ( n = 52), for MHDs ( n = 23), and for SUDs/MHDs ( n = 7). Findings point to a narrow range of interventions of demonstrated effectiveness and to important gaps in the evidence-base for which high-quality research, particularly in low- and middle-income settings, is needed.
Objective:
To describe the trends in use of antidepressants (ADs), atypical antipsychotics (AAPs), and benzodiazepines (BZDs) among high-, middle-, and low-income countries.
Methods:
A cross-sectional time-series analysis by country from July 2014 to December 2019 utilizing IQVIA's Multinational Integrated Data Analysis database was conducted. Population-controlled rates of use were calculated in number of standard units of medications per drug class per population size. The United Nations' 2020 World Economic Situation and Prospects was used to group countries into high-, middle-, and low-income. Percent change in rates of use per drug class was calculated from July 2014 to July 2019. Linear regression analyses were conducted to assess the predictability of percent change in use utilizing a country's baseline rate of use per drug class and economic status as predictor variables.
Results:
A total of 64 countries were included: 33 high-, 6 middle-, and 25 low-income. Average baseline rates of use for ADs in high-, middle-, and low-income countries were 2.15, 0.35, and 0.38 standard units per population size, respectively. For AAPs, rates were 0.69, 0.15, and 0.13, respectively. For BZDs, rates were 1.66, 1.46, and 0.33, respectively. Average percent changes in use for ADs by economic status were 20%, 69%, and 42%, respectively. For AAPs, they were 27%, 78%, and 69%, respectively. For BZDs, they were -13%, 4%, and -5%, respectively. Some associations were found demonstrating that as a country's economic status increases, percent change of AD (p = 0.916), AAP (p = 0.23), and BZD (p = 0.027) use decreases. Similarly, as baseline rate of use for ADs and AAPs increases, percent change in use decreases with p-values of 0.026 and 0.054, respectively. For BZDs, as baseline rate of use increases, percent change in use increases (p = 0.038).
Conclusions:
High-income countries have a higher rate of treatment utilization compared to low- and middle-income countries (LMICs) with treatment utilization increasing in all countries of interest.
Background: Culture-compatible interventions are important for the success of mental health programs in different communities. The Thinking Healthy Program (THP) proposed by WHO is an evidence-based intervention for the treatment of prenatal depression that requires adaptation in any country or culture.
Methods: The THP was translated in two copies by two translators of Iranian origin with academic education in English. A panel of experts was held to perform content and face validations. A systematic review was conducted, the strategies of the program were presented using nominal group technique, and a pre-test was performed. Finally, both the mothers and peers were asked for their opinions through open-ended questions.
Results: Some terms were changed and some images were modified. Sexual health content and a training session about natural childbirth were added. Most of the mothers and peers considered the program acceptable and understandable and the images appropriate, and suggested expanding the program to all health care centers.
Conclusion: The Persian version of the THP seems to have adequate validity to be used in Iran.
Objective
This study aimed to evaluate the factor structure of the Depression Anxiety and Stress Scale (DASS‐21) among caregivers of young children in Southeastern Europe.
Background
The DASS‐21 is a widely used measure in prevention and intervention research with families. Studies regarding the scale's psychometric properties among caregivers, particularly from non‐Western countries, are limited and additional research is required.
Method
The DASS‐21 was administered to N = 835 primary caregivers from North Macedonia, the Republic of Moldova, and Romania. Competing models were tested with confirmatory factor analysis (CFA). Measurement invariance was assessed using multigroup CFA (MGCFA). Bifactor dimensionality and reliability indices were used to evaluate the validity of the composite and subscale scores.
Results
A tripartite bifactor model with two specific factors (depression and anxiety) and one general factor (negative affectivity) represented the data well. This model showed cross‐country configural and partial metric invariance. Dimensionality and reliability indices supported a unidimensional interpretation of the measure, with the general negative affectivity factor accounting for a substantial share of the variance (82%) compared to the specific factors of depression (10%) and anxiety (8%).
Conclusion
The tripartite model best represented the data. Configural and partial metric invariance were verified for this model. Dimensionality and reliability indices, however, indicate that the DASS‐21 functions best as a general measure of negative affectivity.
Implications
Future intervention studies involving caregivers from Southeastern Europe should consider using the DASS‐21 as an overall measure of negative affectivity and utilize the composite score instead of the subscale scores.
In recent years, the reality of global migration has brought the lack of understanding of mental health needs across different cultures into sharp focus. Psychology programs are not up to date on global issues and are often experienced as inadequate in preparing graduates to meet the challenges of society today. The field of education and training in psychology has hardly evolved since the last two decades. On the other hand, the mental health needs arising locally and globally require a knowledge base and a set of skills future psychologists need to have in order to be able to work and grow professionally. In addition, most psychologists in the western world are bound, at some point in their career, to be in contact with immigrants or refugees to offer them services and be a source of support for such a vulnerable population. Also, the field of psychology is witnessing more movement among psychologists than ever before, whereby many professionals move to another country, to work, volunteer, gain or provide training, consult and much more. This requires a certain level of preparation, which psychologists need to be aware of and ready to engage in before and after they move. This article highlights different psychology programs around the world that include global mental health in their programs. It discusses essential aspects and skills that psychologists need to learn to be prepared to work globally with various populations and to expand their skills beyond service providing to more management and policy work. Topics such as human rights and social justice, advocacy, health management and policymaking are addressed as important competencies to be gained during the education and training of future psychologists.
Suicide has been a concern of the society since a long time. Recently, suicide as a whole has been increasing. In general, suicide is attempted by all types of people. It can be attempted by any person despite their age, gender, caste, religion, class, nationality etc. In India, we have come across suicide by women due to dowry, sexual abuse etc. We have seen suicide by farmers who are financially stressed and more. Suicidal thoughts can come across anyone's minds and can have number of factors affecting the person. In India, especially student suicide has been drastically increasing. Student in this study means a person studying in an educational institution in India and limited to the age group of 13 to 25 years. This also includes the students of the same age group, who are not studying in educational institutions but preparing for entrance examinations to get into one. There are numerous reasons why a student might take this step. It can go from exam fear to the number of circumstantial experiences. The material used for reference includes analysis and statistics from (WHO) World Health Organization, (NCRB) National crime records bureau, (IPC) Indian penal code etc. Information from websites of newspapers such as, The Hindu, Indian express etc. This study talks about the various factors leading to suicidal thoughts, which includes coronavirus pandemic to mental and physical abuse, how the pandemic and other experiences the students go through can affect them. Further, out of the mentioned factors, few important ones that need instant attention have been explained in detail. How to prevent suicide? And Who can prevent suicide? What is the role of students' guardian or parents in preventing suicidal thoughts that might occur? How can educational institutions contribute to prevention? This paper also answers questions like what has been the pattern of student suicide in India, before and during the pandemic. The legal status of suicides in India has also been discussed, which brings the question of decriminalizing suicides. Whether decriminalizing will decrease the number of deaths from suicide or not. Further, talks about the sociologist, Emile Durkheim's view on student suicide and which type of suicide is student suicide according to his theory. Various articles and journals have been mentioned in the study to discuss the matter in detail. This project's idea is to make people aware of this issue, which is slowly becoming the new normal. The project takes the reader from introduction of suicide, to factors affecting suicide, to how to prevent it. The study should be used to understand what student suicide is, and to realize how much it needs our attention.
Background:
Globally, mental health disorders rank as the greatest cause of disability. Low and middle-income countries (LMICs) hold a disproportionate share of the mental health burden, especially as it pertains to depression. Depression is highly prevalent among those with non-communicable diseases (NCDs), creating a barrier to successful treatment. While some treatments have proven efficacy in LMIC settings, wide dissemination is challenged by multiple factors, leading researchers to call for implementation strategies to overcome barriers to care provision. However, implementation strategies are often not well defined or documented, challenging the interpretation of study results and the uptake and replication of strategies in practice settings. Assessing implementation strategy fidelity (ISF), or the extent to which a strategy was implemented as designed, overcomes these challenges. This study assessed fidelity of two implementation strategies (a 'basic' champion strategy and an 'enhanced' champion + audit and feedback strategy) to improve the integration of a depression intervention, measurement based care (MBC), at 10 NCD clinics in Malawi. The primary goal of this study was to assess the relationship between the implementation strategies and MBC fidelity using a mixed methods approach.
Methods:
We developed a theory-informed mixed methods fidelity assessment that first combined an implementation strategy specification technique with a fidelity framework. We then created corresponding fidelity indicators to strategy components. Clinical process data and one-on-one in-depth interviews with 45 staff members at 6 clinics were utilized as data sources. Our final analysis used descriptive statistics, reflexive-thematic analysis (RTA), data merging, and triangulation to examine the relationship between ISF and MBC intervention fidelity.
Results:
Our mixed methods analysis revealed how ISF may moderate the relationship between the strategies and MBC fidelity. Leadership engagement and implementation climate were critical for clinics to overcome implementation barriers and preserve implementation strategy and MBC fidelity. Descriptive statistics determined champion strategy fidelity to range from 61 to 93% across the 10 clinics. Fidelity to the audit and feedback strategy ranged from 82 to 91% across the 5 clinics assigned to that condition. MBC fidelity ranged from 54 to 95% across all clinics. Although correlations between ISF and MBC fidelity were not statistically significant due to the sample of 10 clinics, associations were in the expected direction and of moderate effect size. A coefficient for shared depression screening among clinicians had greater face validity compared to depression screening coverage and functioned as a proximal indicator of implementation strategy success.
Conclusion:
Fidelity to the basic and enhanced strategies varied by site and were influenced by leadership engagement and implementation climate. Champion strategies may benefit from the addition of leadership strategies to help address implementation barriers outside the purview of champions. ISF may moderate the relationship between strategies and implementation outcomes.
Introduction:
Anti, peri and postnatal depression is known to affect the relationship between infants and their mothers adversely. Previous studies have identified barriers and facilitators, reported by women and HCPs, related to the identification and management of anti, peri and postnatal depression. However, these studies considered the experiences of women separately from those of the healthcare professionals, even though their experiences of anti, peri and postnatal depression are interconnected. Additionally, there is a lack of research among people living in the Middle East, including Oman, which has one of the highest rates of anti, peri and postnatal depression globally.
Aim:
This study aimed to explore the views and experiences of HCPs and service users relating to anti, peri and postnatal depression from the Middle East perspective.
Method:
A qualitative descriptive study using semi-structured interviews was conducted. This study took place at the Family Medicine and Community Clinic at University Hospital and three selected primary healthcare centres in Muscat, between May 2020 and February 2021. Purposive sampling was used: 15 HCPs with 2-20 years of clinical experience in anti, peri and postnatal primary care and 13 pregnant patients plus 2 post-birth patients were interviewed. Audio-recordings were transcribed verbatim, and the anonymized transcripts were then entered into the qualitative data management software, NVIVO 12.
Results:
A thematic approach was used to analyse the data. Four themes were identified in the data, namely: 1) making sense of anti, peri and postnatal depression; 2) how to deal with anti, peri and postnatal depression; 3) barriers to addressing anti, peri and postnatal depression in primary anti, peri and postnatal care settings; 4) bridging the gap: facilitators in detecting and managing anti, peri and postnatal depression.
Conclusions:
Improving the identification and management of anti, peri and postnatal depression in primary healthcare systems will require a whole-system approach, with interventions at the patient, practice and comprehensive primary care team levels.
In recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of the RAPS in Minas Gerais (MG), the second most populous state of Brazil, generating indicators that can enhance the strategic management of the SUS in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of ‘Family Health Strategy (ESF),’ ‘Expanded Family Health Center (NASF),’ and ‘Psychosocial Care Centers (CAPS)’ but a lack of ‘Beds in General Hospitals (LHG),’ ‘Unified Electronic Medical Records’ and ‘Mental Health Training Activities for Professionals’. In the process dimension, adequate implementation of actions such as ‘Multidisciplinary and Joint Care,’ ‘Assistance to Common Mental Disorders by Primary Health Care,’ ‘Management of Psychiatric Crises in CAPS,’ ‘Offer of Health Promotion Actions,’ and ‘Discussion of Cases by Mental Health Teams’ point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of ‘Psychosocial Rehabilitation Actions,’ ‘Productive Inclusion,’ ‘User Protagonism,’ ‘Network Integration,’ and practical activities for the effectiveness of collaborative care. We found a better implementation of RAPS in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of RAPS are scarce throughout the Brazilian territory, a fact also found in MG, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management.
Much of the research on posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) has been conducted in high-income countries (HICs). However, PTSD and AUD commonly co-occur (PTSD + AUD) are both associated with high global burden of disease, and disproportionately impact those in low- and middle-income countries (LMICs). This narrative review attempts to synthesize the research on prevalence, impact, etiological models, and treatment of PTSD + AUD drawing from research conducted in HICs and discussing the research that has been conducted to date in LMICs. The review also discusses overall limitations in the field, including a lack of research on PTSD + AUD outside of HICs, issues with measurement of key constructs, and limitations in sampling strategies across comorbidity studies. Future directions are discussed, including a need for rigorous research studies conducted in LMICs that focus on both etiological mechanisms and on treatment approaches.
Humanitarian crises such as forced displacement have broad impacts on individuals, families, and communities. This chapter provides an overview of mental health and psychosocial guidelines and frameworks in the humanitarian field. Its aim is to distill the complexity of relevant knowledge needed by social workers, including key terminology and core principles in providing mental health and psychosocial support in humanitarian settings. The chapter also provides an overview of humanitarian response frameworks, guidelines, and best practices put forth by the United Nations High Commissioner for Refugees (UNHCR), the World Health Organization (WHO), the International Organization for Migration (IOM), Inter-Agency Standing Committee (IASC), and other leading bodies in the field. The critical importance of advocacy, coordination, and collaboration among stakeholders is discussed.KeywordsTermsPrinciplesAssessmentResearchM & EInclusionSustainabilityPolicyAdvocacy
Mental illness accounts directly for 14% of the global burden of disease and significantly more indirectly, and recent reports recognise the need to expand and improve mental health delivery on a global basis, especially in low and middle income countries. This text defines an approach to mental healthcare focused on the provision of evidence-based, cost-effective treatments, founded on the principles of sharing the best information about common problems and achieving international equity in coverage, options and outcomes. The coverage spans a diverse range of topics and defines five priority areas for the field. These embrace the domains of global advocacy, systems of development, research progress, capacity building, and monitoring. The book concludes by defining the steps to achieving equality of care globally. This is essential reading for policy makers, administrators, economists and mental health care professionals, and those from the allied professions of sociology, anthropology, international politics and foreign policy.
COVID-19 was first reported in China's Wuhan city of Hubei province in late 2019. The World Health Organization (WHO) declared it a global public health emergency and a global pandemic respectively in quick succession as it spread so fast across the world. In this chapter, the authors analyze its effects on Zambia by focusing on among others, the economy, education, family interactions, culture, and psychosocial wellbeing of Zambia and how the government responded to minimize the effects. They find that preventive measures were not fully adhered to in many places partly because the government did not enforce a total lockdown as many other countries did although learning institutions, drinking places, church gatherings, funeral processions, and other social gatherings such as weddings were all suspended. They note that government responses to the pandemic preserved lives but also worsened the economic slowdown. They conclude that the pandemic exposed the deficiencies in the healthcare and social protection systems and inequality in the country but enhanced digitalization.
Objective:
to propose Mental Health Indicators aimed at management of the Mental Health Care Network, starting with convergence of their use, in countries with public health organization.
Method:
an exploratory analysis of the indicators adopted and used in these countries, from the detailed analysis of their respective normative documents, considering the World Health Organization guidelines. After selection of the indicators, the Mental Health Matrix was adopted as a suggestion for their development and application in the Brazilian Psychosocial Care Network. The matrix was prepared in two dimensions, respecting the inclusion and exclusion criteria for the indicators studied, as follows: geographical (national/regional, local, individual), and time (entry, process and results).
Results:
the analysis indicates 41 indicators that presented diverse evidence regarding their use. All were allocated in the Mental Health Matrix, contributing as a metric to analyze the purpose of the Mental Health services, in the levels and phases of each dimension.
Conclusion:
the indicators selected, distributed in the different Mental Health Matrix dimensions, are being made available for their use in management and in the clinical practice, as well as for scientific studies and, in the future, to be used as definers of Mental Health policies.
Proper treatment of developmental disabilities requires health workers to have adequate knowledge of etiology and referral procedures. There is a dearth of research on knowledge of developmental disabilities among health workers in Ghana. The purpose of this study was to document knowledge about developmental disorders, causes, and referral procedures among health workers. Researchers used a successive free-listing method to interview 37 health workers. Developmental disabilities which present with physical symptoms were the most salient disorders identified among health workers, while learning disabilities and attention deficit disorder were largely overlooked. The most commonly listed developmental disabilities were cerebral palsy, Down syndrome, and autism spectrum disorder. Respondents had limited knowledge about the causes of and referral resources for developmental disabilities. Results show the need for continuing medical education, public awareness, and enhanced resources to support the identification and care of children with developmental disabilities in Ghana.
Nigeria is a huge country. It covers an area of 924 000 km ² on the west coast of Africa. It has a population of about 110 million, which means that every one in six Africans is a Nigerian. It is a country of diverse ethnicity, with over 200 spoken languages, even though three of those are spoken by about 60% of the population. Administratively, it is divided into 36 states and operates a federal system of government, with constitutional responsibilities allocated to the various tiers of government – central, state and local. There are two main religions, Islam (predominantly in the north) and Christianity (predominantly in the south). However, a large proportion of the people still practise traditional religions exclusively or in addition to either Islam or Christianity.
Uganda is a landlocked developing country in East Africa with an estimated population of 24.8 million people (2002 census). At independence (in 1962) Uganda was a very prosperous and stable country, with enviable medical services in the region. This, however, was destroyed by a tyrant military regime and the subsequent civil wars up to 1986, when the current government took over the reigns of power.
The delivery of health care in Canada is shaped by a number of variables – geography, legislation, federal structure, location and culture.
Albania, situated in the western Balkans, has an area of 28 748 km ² and a population of 3 069 275 (year 2001), almost one-third of whom are aged 0–14 years. Life expectancy is estimated to be 70.4 years for both sexes (World Health Organization, 2003 a ). According to the World Health Organization's classification, Albania is a country with low child and low adult mortality rates. The nation's total expenditure on health in 2001 amounted to 3.7% of gross domestic product.
Relative to its economic indicators, Sri Lanka has a high health status. The life expectancy in the year 2001 was 70.7 years for males and 75.4 years for females. Maternal and infant mortality rates have shown a downward trend over the past half century and now are around 2.3 per 10 000 live births and 16 per 1000 live births, respectively. These trends are mainly due to the high literacy rate and comparatively large investments made in health and social welfare.
The Republic of Belarus (ROB) covers 207 600 km ² and has a population of about 10 million (Ministry of Statistics and Analysis, 2005). It was a member state of the former Soviet Union until it gained independence in 1991. Belarus is located between Poland, Lithuania and Latvia in the west, Russia in the east, and Ukraine in the south. Seventy-two per cent of the population live in an urban environment and 28% in rural areas. The average life span for men is 63 years and for women 75 years (Ministry of Public Health, 2005).
Thailand is located in Southeast Asia and covers an area of 513 115 km ² . In 2006 its population was approximately 64 million. The major nationality is Thai. About 80% of the total population live in rural areas. The country is composed of 76 provinces, divided into a total of 94 districts and 7159 sub-districts.
Spain covers an area of some 506 000 km ² and has a population of just over 41 million. It is a high-income country (according to World Bank criteria) and devotes 7.5% of its gross domestic product to health.
Papua New Guinea is an independent commonwealth in the South Pacific, lying just north of Australia and sharing its western border with Indonesia. The population of Papua New Guinea is 5.2 million, of whom 87% live in rural areas (2000 census) (National Statistics Office, 2003). The country has a very rich culture; for example, there are over 800 distinct language groups (although Papua New Guinea has less than 0.1% of the world's population, it is home to over 10% of the world's languages).
The State of Qatar is a peninsula overlooking the Arabian Gulf, with an area of 11400 km ² . The Al Thani family has ruled the country since the mid-1800s. The population of just over 860000 is of a multi-ethnic nature, and predominantly resides in the capital, Doha. Only about 20% of the population is Qatari. Around 73% of the population are between the ages of 15 and 64 years. Life expectancy at birth is 74.8 years for males and 73.8 years for females. The literacy rate is 94.9% for men and 82.3% for women. Arabic is the official language and English is a common second language. The economy is dominated by oil and natural gas, and the country has one of the highest per capita incomes in the world. The per capita government expenditure on health is $574 (international dollars), which is among the highest in the region.
Bermuda comprises a group of small islands in the Atlantic Ocean, situated approximately 1000 km east of the USA. It is a self-governing crown dependency of the UK. It is the third richest country in the world, with average wages per head of US$41 495 in 2000. Its economy is based on a flourishing offshore insurance industry and tourism.
The Islamic Republic of Iran is located in the Middle East between the Caspian Sea and the Persian Gulf. Iran's total land area is 1 648 000 km ² . Its total population in 2003 was about 68 920 000 (UNICEF, 2003). The population growth rate is 1.41%. Of the total population, 60.4% live in urban and 39.6% in rural areas (Yasamy et al , 2001).
Ukraine, at 603 700 km ² , has the second largest landmass in Europe. It has a population of about 47.4 million. Ukraine is a lower-middle-income country with a gross national income per capita of US$1260 (World Bank, 2002).
Chile has approximately 600 psychiatrists for its 15 million people. Although in the capital city, Santiago, the provision (per capita) is twice as high as in the rest of the territory, it is possible to see over the past decade a progressive increase in the number of these specialists in the other main cities. There are no more than 50 child psychiatrists and several cities have no local resource in this sub-speciality.
The profound political, social and economic changes that occurred after the end of communist rule in Central Europe in 1989 had a profound influence on Czech psychiatry. In the socialist Czechoslovakia the healthcare system was fully owned, financed and organised by the state, in so-called regional institutes of healthcare. These had obligatory catchment areas of about 100 000 inhabitants and comprised in-patient as well as out-patient care facilities, including psychiatry. The main trends after 1989 were decentralisation of the healthcare system, rapid privatisation, especially of out-patient services, and financing through the newly established health insurance corporations.
Afghanistan's historic strategic position between the great civilisations of India, Persia and Central Asia has made it from the very beginning both a crossroads for trade and cultural exchange and an almost continuous battlefield. In the years since the Soviet invasion in 1979 the country has become the stage of an ongoing complex humanitarian emergency. The period of Soviet occupation was characterised by massive human rights violations. The Soviet army and its allies were involved in indiscriminate bombardments and targeted executions, while the mujahedeen were involved in guerrilla warfare. The USSR was forced to withdraw in 1989 and the remnants of Afghanistan's communist regime were defeated in 1992.
Jordan, one of the most recently established countries in the Middle East, was part of the Ottoman Empire. It was declared a political entity known as Transjordan under the mandate of the British government in 1923, until it gained independence and was declared a Kingdom in 1946. In 1950, Transjordan and the West Bank were united and assumed the current name of the Hashemite Kingdom of Jordan. The next major change for the Kingdom came in 1967, when the occupation of the West Bank and Gaza Strip by Israeli forces caused a massive influx of migrants to the East Bank.
The Philippines, known as the Pearl of the Orient, is an archipelago of 7107 islands, bounded on the west by the South China Sea, on the east by the Pacific Ocean, on the south by the Sulu and Celebes Sea, and on the north by the Bashi Channel. The northernmost islands are about 240 km south of Taiwan and the southernmost islands approximately 24 km from Borneo. The country has a total land area of some 300 000 km ² . It is divided into three geographical areas: Luzon, Visayas and Mindanao. It has 17 regions, 79 provinces, 115 cities, 1495 municipalities and 41 956 barangays (the smallest geographic and political unit). It has over 100 ethnic groups and a myriad of foreign influences (including Malay, Chinese, Spanish and American).
The Republic of Turkey has a population of 67.4 million (year 2000) and covers 783 563 km ² ; administratively it is divided into 81 provinces. A few national statistics from 2000 are: infant death rate 41.9/1000; life expectancy at birth 68 years; unemployment rate 6.6%; gross national product (GNP) per capita US$2965; and adult literacy rate 87.32% (females 80.64%; males 93.86%) (State Statistics Institute, 2003).
The prevalence of mental illnesses in Finland generally reflects global trends, with a clear increase in the occurrence of depression and anxiety. At any time, between 4% and 9% of the population of 5.2 million suffer from major depressive disorders. Some 10–20% of the population experience depression during their lifetime. Bipolar depressive disorders affect 1–2% and schizophrenia 0.5–1.5% of the population. The prevalence of alcoholism is 4–8%.
For over a thousand years, the Hippocratic system of medicine prevailed in Europe. It went into oblivion during the Dark Ages, when there was a reversion to the demoniacal theories of mental illness. Hippocrates’ works survived, however, in the library at Alexandria, where they were translated into Arabic. These and other classical works were retranslated into Latin and Greek from the 12th century on, ushering in the Renaissance.
Mongolia is a country with an approximate area of 1.5 million km ² . Its population is 2.5 million, nearly 90% of whom are ethnically Mongolian. Khalkh Mongols form the largest subgroup (approximately 79% of the population); the next largest subgroup is the Kazakhs (5.3%), followed by smaller groups such as Tuvins, Uzbeks, Uighurs, Russian and Chinese. The population is young, with 35.9% under the age of 15 years. The official language is Mongolian. Just under half the population live in rural areas and around a fifth live a nomadic life. About 80% of the land area is suitable for agriculture, mostly for animal husbandry.
The Bolivarian Republic of Venezuela covers 916 445 km ² ; to the north is the Caribbean Sea, to the south-east the Amazonian region and the plains of Brazil and Colombia, and to the west the Andes and the Colombian Guajira peninsula. Its estimated population (2004) is 25 226 million, which is concentrated along the north coastal area, where the population density exceeds 200 inhabitants per km ² ; most of the territory remains almost inhabited (fewer than 6 inhabitants per km ² ), in particular the border areas. The population is mainly urban: 70% live in cities with more than 50 000 inhabitants.
Azerbaijan is a nation with a Turkic population which regained its independence after the collapse of the Soviet Union in 1991. It has an area of approximately 86 000 km ² . Georgia and Armenia, the other countries comprising the Transcaucasian region, border Azerbaijan to the north and west, respectively. Russia also borders the north, Iran and Turkey the south, and the Caspian Sea borders the east. The total population is about 8 million. The largest ethnic group is Azeri, comprising 90% of the population; Dagestanis comprise 3.2%, Russians 2.5%, Armenians 2% and others 2.3%.
Italian psychiatry is probably more debated than known in the international arena. Law 180 of 1978, which introduced a radical community psychiatry system, has drawn worldwide attention and debate, with comments ranging from the enthusiastic to the frankly disparaging (Mosher, 1982; Jones et al , 1991). More recently, this interest was marked by a well-attended symposium ‘Lessons Learned from Italian Reforms in Psychiatry’ held at the 2003 annual meeting of the Royal College of Psychiatrists in Edinburgh.
The Korean peninsula is located between China and Japan. After the Second World War, the Republic of Korea was established in the southern half of the Korean peninsula. South Korea has a total area of 98 480 km ² and a population of 48 598 175 (July 2004 estimate). The per capita gross domestic product (GDP), in terms of purchasing power parity, is US$17 700 (2003 estimate) (Central Intelligence Agency, 2004). The illiteracy rate (among those aged over 15 years) is 1.9% (0.7% for males and 3% for females) (2003 estimate). Life expectancy at birth is 75.6 years (72.0 years for males and 79.5 years for females) and the infant mortality rate is 7.2 per 1000 births (2004 estimate). The unemployment rate is 3.4% (2003 estimate). The proportion of the population aged 65 and over is currently 8.7% (2004 estimate) (Korea National Statistics Office, 2003). Over 40% of the total Korean population (i.e. some 20 million) lives in Seoul and its vicinity. South Korea is highly urbanised and modernised. Besides central government, local government is based on seven metropolitan cities and nine provinces.
Ethiopia, in the Horn of Africa, is one of the ancient independent nations of the world and has a rich diversity of peoples and cultures. The country covers 1.1 million km ² (Central Statistical Authority, 2000 a ). It has a population of about 70 million people (Central Statistical Authority, 2002), 80 different ethnic groups and some 200 dialects. Ethiopia is the second most populous nation in sub-Saharan Africa, after Nigeria (Hailemariam & Kloos, 1993). Forty-eight per cent of the population are under 15 years of age and over 80% live in rural areas (Central Statistical Authority, 1995). Islam and Christianity are the main religions.
The Maltese Islands are located in the Mediterranean Sea and have a total area of 316 km ² . They consist of three inhabited islands – Malta (the largest of the group), Gozo and Comino – and two uninhabited islands – Filfla and Cominotto. Malta is a democratic republic. Since its independence in 1964, Malta has played a more significant part in international relations. It became a member of the Commonwealth, the United Nations, the World Health Organization and several other organisations. In May 2004, Malta also became a member of the European Union.
Brazil is a country with 170 000 000 inhabitants (census for the year 2000), of whom 138 000 000 live in urban areas. The illiteracy rate, that is, people over 15 years of age who cannot write or read even a simple message, is 13.4%. About 25.6% of the population live on a family income less than half the minimum wage (1999 figures). Brazil's gross internal revenue is R$564 800 per capita (1998 figures, about US$1680 today).
The Republic of Trinidad and Tobago is the most southerly of the Caribbean island states. Trinidad is just 14 km from the coast of Venezuela. Trinidad covers an area of 4828 km ² while Tobago, the sister isle, has an area of 300 km ² . The total population is approximately 1.3 million; 40.3% of the population is of East Indian descent, 39.6% of African descent, 18.4% mixed and 1.7% belong to other ethnic groups (Central Statistical Office, 2001). St Ann's Hospital in Port of Spain, the capital, was established in 1900 and is the country's only psychiatric hospital. There are two general hospitals, one in the north, at Port of Spain, and the other in the south, at San Fernando.
Malaysia is a tropical country in the heart of South East Asia, at the crossroads of the ancient east–west sea trade routes. Although independent from British colonial rule only in 1957, it has a recorded history dating back to at least the first century CE, when the region was already the source of valuable mineral and forest produce that found markets in China, India and further west.
Iraq is known to be the cradle of civilisation — a country with a rich history. Present-day Iraq occupies the greater part of the ancient land of Mesopotamia, the plain between the Euphrates and Tigris rivers. Some of the world's greatest ancient civilisations arose in this area, and Iraq possesses a huge number of historical monuments and archaeological sites.
Malawi is a country with an approximate area of 118 000 km ² . Its population is estimated at 13 million and the gender ratio (men per hundred women) is 98. The proportion of the population under the age of 15 years is 47% and the proportion above the age of 60 years is 5%. The literacy rate is 75.5% for men and 48.7% for women (World Health Organization, 2005).
Following a 10-year war of liberation (fought by the Mau Mau against the British), Kenya attained full independence from colonial rule in 1963. For 10 years the country enjoyed rapid economic growth (6–7% per annum) but this slowed steadily to near stagnation in the 1990s. Poor governance, abuse of human rights, internal displacements of citizens, large numbers of refugees from neighbouring countries and the AIDS pandemic conspired to reduce Kenyans’ life expectancy to 47 years (in the UK it is presently 77 years). Some 42% of the population now live below the poverty line, and 26% of Kenyans exist on less than US$1 per day. The annual per capita income in Kenya is US$360 (in the UK it is $24 000) (World Bank, 2002). AIDS currently has an estimated prevalence rate of 12%. In large parts of rural Kenya many sexually active adults are unable to work, and elderly grandparents are left to look after orphaned children (some already infected with HIV), as they struggle to deal with their own grief for the loss of many of their own children. In December 2002 a new government was elected, which gives some grounds for optimism in an otherwise bleak situation.
French psychiatry is currently facing a period of profound change, as many of what were considered its most specific characteristics and traditions have been called into question. It is therefore difficult to draw a profile of French psychiatry, because it has to take into account a radical splitting between, on the one hand, what is still the common profile of most French psychiatrists and, on the other, the new model imposed by stakeholders and policy makers who want French psychiatry to take on a more Anglo-Saxon profile, with evidence-based practice coming to the fore, for instance.
Lebanon is a western Asian country with an area of 10 452 km ² and a population of around 4 million (excluding the 10 million Lebanese immigrants worldwide). It has approximately 60 psychiatrists, mostly concentrated in the capital, Beirut, although a trend for decentralisation is currently observed. The number of psychiatrists is steadily increasing as postgraduate training centres have been established during the past decade. There are, however, few sub-specialists, owing to a lack of adequate training programmes.
Australia, a vast continent of 7 700 000 km ² (including the island state of Tasmania), is roughly the size of Western Europe or mainland USA, but with a population of only 20.2 million (2004 estimate), mainly concentrated in coastal areas.
Lithuania is a country with an approximate area of 65 000 km ² . Its population is 3.422 million, and the gender ratio (expressed as men per 100 women) is 87. The proportion of the population under the age of 15 years is 18%, and the proportion above the age of 60 years is 20%. The literacy rate is 99.6% for both men and women. The country is in the higher middle-income group (by World Bank 2004 criteria).
Few countries (if any) have experienced the abundance of material welfare Norway has had for the last decades. The report of the Organisation for Economic Co-operation and Development (OECD) for 2004 places Norway on the very top of the list of ‘best countries to live in’. One might therefore expect that mental disorders would not thrive in Norway, but this is not so.
Romania is now in a period of transition from communism to democracy. Geographically, Romania, like other Eastern European countries, is on the border between the Western world and the Middle East and Asia; until December 1989 it was behind the ‘Iron Curtain’.
Brazilian scientific output exhibited a 4-fold increase in the last two decades because of the stability of the investment in research and development activities and of changes in the policies of the main funding agencies. Most of this production is concentrated in public universities and research institutes located in the richest part of the country. Among all areas of knowledge, the most productive are Health and Biological Sciences. During the 1998-2002 period these areas presented heterogeneous growth ranging from 4.5% (Pharmacology) to 191% (Psychiatry), with a median growth rate of 47.2%. In order to identify and rank the 20 most prolific institutions in these areas, searches were made in three databases (DataCAPES, ISI and MEDLINE) which permitted the identification of 109,507 original articles produced by the 592 Graduate Programs in Health and Biological Sciences offered by 118 public universities and research institutes. The 20 most productive centers, ranked according to the total number of ISI-indexed articles published during the 1998-2003 period, produced 78.7% of the papers in these areas and are strongly concentrated in the Southern part of the country, mainly in Sao Paulo State.
The People's Republic of Bangladesh is located in South Asia. The total land area of Bangladesh is 147570 km ² . Its total population in 2001 was about 123 million. The population growth rate is 1.47%; of the total population, 75% live in rural areas and 25% in urban areas (Bangladesh Bureau of Statistics, 2000).
Israel is a multicultural society in a state of permanent change. The population, of about 6.5 million, comprises the following religious groupings: Jews (77.5%), Muslims (15.3%), Christians (2.1%), Druzes (1.7%) and others (3.4%). The organisation of and the approaches used by the country's health services have been determined by this sociocultural plurality, and also by a continuous influx of immigrants (among whom, 882 600 and 44 200 arrived from countries of the former USSR and Ethiopia, respectively, between 1990 and 2001), as well as by the precarious security situation (the country has seen several wars with its neighbours in addition to the long-standing conflict with the Palestinians). The patterns of care of the population reflect both Western psychiatry and traditional systems. Because of such complexity, the present brief overview is necessarily selective.
OBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41% (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5% of the budget in 1995 and 49% in 2005, and the expenses with community services and medication have increased 15% each. As a whole, the expenses in mental health decreased by 26.7% (2.66 to 1.95 US$ per capita). CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged.