Feasibility of implementing a culturally adapted Prolonged Grief Disorder scale in the mental healthcare system in Nepal

Abstract Background Nepali widows have a high prevalence of mental disorders, including prolonged grief disorder (PGD). Despite the considerable needs that Nepali widows have for mental health services, resources for mental health in Nepal are limited, amplifying the importance of accurate screening and diagnosis. The objective of this study was to explore the feasibility of implementing a culturally adapted Prolonged Grief Scale (PG-12/17-N) and provide actionable recommendations for its implementation. Methods Twenty-five mental health service providers in Kathmandu and Chitwan, Nepal were interviewed using a semi-structured guide based on selected constructs from the Consolidated Framework for Implementation Research. Qualitative data were inductively and deductively coded and analyzed to identify prominent themes. Results Providers reported that the main advantages of the scale were the need to identify widows at risk, cultural relevance, easy language, and inclusion of detailed and specific symptoms. Perceived weaknesses included the complexity in response options and scoring, length, item redundancy, overlap with depression symptoms, and lack of somatic symptoms. Providers discussed the need for training, supervision, and a referral and detection system required to implement the scale in Nepal. Further development of a brief version of the scale as a routine screener may facilitate detection and referral to care. Conclusion Based on the results showing need to address PGD in Nepali widows, further efforts are needed to increase awareness about PGD and develop evidence-supported treatments for PGD, after which screening could be made routine for widows.

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Long-term prevalence and predictors of prolonged grief disorder amongst bereaved cancer caregivers: A cohort study

Palliative & Supportive Care ◽

10.1017/s1478951518001013 ◽

2019 ◽

Vol 17 (5) ◽

pp. 507-514 ◽

Cited By ~ 2

Author(s):

Rachel D. Zordan ◽

Melanie L. Bell ◽

Melanie Price ◽

Cheryl Remedios ◽

Elizabeth Lobb ◽

...

Keyword(s):

Mental Health ◽

Palliative Care ◽

Psychological Health ◽

Linear Regression Analysis ◽

Population Based ◽

Anticipatory Grief ◽

Prolonged Grief Disorder ◽

Prolonged Grief ◽

Cancer Caregivers

AbstractContextThe short-term impact of prolonged grief disorder (PGD) following bereavement is well documented. The longer term sequelae of PGD however are poorly understood, possibly unrecognized, and may be incorrectly attributed to other mental health disorders and hence undertreated.ObjectivesThe aims of this study were to prospectively evaluate the prevalence of PGD three years post bereavement and to examine the predictors of long-term PGD in a population-based cohort of bereaved cancer caregivers.MethodsA cohort of primary family caregivers of patients admitted to one of three palliative care services in Melbourne, Australia, participated in the study (n= 301). Sociodemographic, mental health, and bereavement-related data were collected from the caregiver upon the patient's admission to palliative care (T1). Further data addressing circumstances around the death and psychological health were collected at six (T2,n= 167), 13 (T3,n= 143), and 37 months (T4,n= 85) after bereavement.ResultsAt T4, 5% and 14% of bereaved caregivers met criteria for PGD and subthreshold PGD, respectively. Applying the total PGD score at T4, linear regression analysis found preloss anticipatory grief measured at T1 and self-reported coping measured at T2 were highly statistically significant predictors (bothp< 0.0001) of PGD in the longer term.ConclusionFor almost 20% of caregivers, the symptoms of PGD appear to persist at least three years post bereavement. These findings support the importance of screening caregivers upon the patient's admission to palliative care and at six months after bereavement to ascertain their current mental health. Ideally, caregivers at risk of developing PGD can be identified and treated before PGD becomes entrenched.

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A Mobile App for Prolonged Grief among Bereaved Parents: Study Protocol for a Randomized Controlled Trial

10.1101/2021.04.23.21256003 ◽

2021 ◽

Author(s):

Rakel Eklund ◽

Maarten Eisma ◽

Paul Boelen ◽

Filip Arnberg ◽

Josefin Sveen

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Controlled Trial ◽

Intervention Group ◽

Mobile App ◽

Cognitive Behavioral ◽

Ethical Review ◽

Depression Symptoms ◽

Prolonged Grief ◽

Bereaved Parents

Introduction: Bereaved parents have elevated risk to develop mental health problems, yet, few studies have evaluated the effect of psychosocial interventions developed for bereaved parents. Cognitive behavioral therapy (CBT), both face-to-face or digitally delivered, has shown to be an effective intervention for prolonged grief symptoms. Self-help mobile apps offer various advantages and studies show improved mental health after app interventions. No app has yet been evaluated targeting prolonged grief in bereaved parents. Therefore, the aim of this planned study is to develop and examine the effectiveness of a CBT-based mobile app, called My Grief, in reducing symptoms of prolonged grief, as well as other psychological symptoms, in bereaved parents. Another aim is to assess users experiences and adverse events of My Grief. Methods and analysis: We will conduct a two-armed randomized waitlist-controlled trial. Parents living in Sweden, who lost a child to cancer between one and ten years ago, with elevated symptoms of prolonged grief, will be recruited to participate in the trial. The content of My Grief covers four main domains (Learn: Self-monitoring: Exercises: Get support) and builds on principles of CBT and the proven-effective PTSD Coach app. Participants in the intervention group will fill out online questionnaires at baseline and at 3, 6 and 12-months follow-ups, and the waitlist-controls at baseline and at 3 months. The primary outcome will be prolonged grief symptoms at the 3 months follow-up. Secondary outcomes are posttraumatic stress and depression symptoms, quality of life, and cognitive behavioral variables (i.e., avoidance, rumination, negative cognitions). Ethics and dissemination: Ethical approval has been received from the Swedish Ethical Review Authority (project no. 2021-00770). If the app is shown to be effective, the app will be made publicly accessible on app stores, so that it can benefit other bereaved parents. Trial registration: Clinicaltrials.gov, identifier: NCT04552717.

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A human right to be detained? Mental healthcare after ‘Savage’ and ‘Rabone'

The Psychiatrist ◽

10.1192/pb.bp.112.040980 ◽

2013 ◽

Vol 37 (9) ◽

pp. 294-296 ◽

Cited By ~ 1

Author(s):

Mohammad Shaiyan Rahman ◽

Nadya Wolferstan

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Service Providers ◽

Healthcare Providers ◽

Mental Healthcare ◽

Case Law ◽

Human Right ◽

Health Service Providers ◽

The Uk ◽

Suicidal Patients

SummaryThe UK courts have recently considered the management of suicidal patients in the cases of Savage and Rabone. As a result of these judgments, the case law has extended significantly the responsibilities of mental healthcare providers. In this article we discuss the repercussions of these landmark decisions which are likely to have significant consequences for mental health service providers in the UK.

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Does time heal all wounds?: the changing mental health of refugees over time

10.32920/ryerson.14649186 ◽

2021 ◽

Author(s):

Stephanie Nicole Fraser

Keyword(s):

Mental Health ◽

Service Providers ◽

Mental Healthcare ◽

Armed Conflicts ◽

Traumatic Experiences ◽

Future Research ◽

Psychological Interventions ◽

Health Changes ◽

The World ◽

Migration Factors

An increase of ongoing armed conflicts has resulted in substantial numbers of refugees around the world. The traumatic experiences refugees face can be detrimental to their mental health, further compounded by resettlement stressors upon arrival in Canada. This qualitative study incorporates an intersectional social determinants of health framework in order to understand the changes in mental health of refugees at different stages of a lifelong (re)settlement process. The findings of this study are informed by interviews with five service providers. Results indicated a number of salient post-migration factors that influence mental health in both the short and over the longer term for refugees and further elucidated the effects of a mutually-reinforcing relationship between resettlement stressors and trauma in mental health changes. Implications of the study findings reveal a critical need for a more psychosocial approach to be taken regarding refugee mental healthcare in future research as well as psychological interventions.

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Finding Strength in the Struggle

Handbook of Research on Leadership and Advocacy for Children and Families in Rural Poverty - Advances in Human Services and Public Health ◽

10.4018/978-1-7998-2787-0.ch009 ◽

2020 ◽

pp. 195-219

Author(s):

Loni Crumb ◽

Madeline Clark ◽

Susan M. Long

Keyword(s):

Mental Health ◽

Rural Communities ◽

Service Providers ◽

Rural Poverty ◽

Mental Healthcare ◽

People Of Color ◽

Future Research ◽

Health And Wellbeing ◽

Strength Based ◽

Health Disorders

Poverty is an intersectional issue, as children; women; men; people of color; people who identify as lesbian, gay, or transgender; and immigrant groups are all prone to experience the multifaceted impact of poverty. People who live in rural poverty are likely to experience more severe and persistent mental health disorders. This chapter provides an overview of how rural poverty impacts the mental health and wellbeing of diverse children and families. The authors discuss issues faced by residents living in rural poverty and provide multiple strength-based strategies that behavioral service providers can use to provide culturally relevant mental healthcare in impoverished rural communities. Lastly, the authors offer suggestions for future research.

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Finding Strength in the Struggle

Research Anthology on Mental Health Stigma, Education, and Treatment ◽

10.4018/978-1-7998-8544-3.ch057 ◽

2021 ◽

pp. 1012-1036

Author(s):

Loni Crumb ◽

Madeline Clark ◽

Susan M. Long

Keyword(s):

Mental Health ◽

Rural Communities ◽

Service Providers ◽

Rural Poverty ◽

Mental Healthcare ◽

People Of Color ◽

Future Research ◽

Health And Wellbeing ◽

Strength Based ◽

Health Disorders

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A paradigm shift: relationships in trauma-informed mental health services

BJPsych Advances ◽

10.1192/bja.2018.29 ◽

2018 ◽

Vol 24 (5) ◽

pp. 319-333 ◽

Cited By ~ 42

Author(s):

Angela Sweeney ◽

Beth Filson ◽

Angela Kennedy ◽

Lucie Collinson ◽

Steve Gillard

Keyword(s):

Mental Health ◽

Service Providers ◽

Mental Healthcare ◽

Organisational Change ◽

Public Health Issue ◽

List Type ◽

Service Users ◽

Department Of Health ◽

Trauma Informed ◽

Highly Correlated

SUMMARYTrauma-informed approaches emerged partly in response to research demonstrating that trauma is widespread across society, that it is highly correlated with mental health and that this is a costly public health issue. The fundamental shift in providing support using a trauma-informed approach is to move from thinking ‘What is wrong with you?’ to considering ‘What happened to you?’. This article, authored by trauma survivors and service providers, describes trauma-informed approaches to mental healthcare, why they are needed and how barriers can be overcome so that they can be implemented as an organisational change process. It also describes how past trauma can be understood as the cause of mental distress for many service users, how service users can be retraumatised by ‘trauma-uninformed’ staff and how staff can experience vicariously the service user's trauma and can themselves be traumatised by practices such as restraint and seclusion. Trauma-informed mental healthcare offers opportunities to improve service users' experiences, improve working environments for staff, increase job satisfaction and reduce stress levels by improving the relationships between staff and patients through greater understanding, respect and trust.LEARNING OBJECTIVES•Appreciate broad-based definitions of trauma•Gain an understanding of what trauma-informed approaches are and why they have emerged, including the potential for (re)traumatisation in the mental health system•Consider how to practise trauma-informed approaches, including in ‘trauma-uninformed’ organisations, and the potential barriers to and opportunities from doing soDECLARATION OF INTERESTA. S. is funded by a National Institute for Health Research (NIHR) Post-Doctoral Fellowship. This article presents independent research partially funded by the NIHR. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.

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Poor physical and mental health predicts prolonged grief disorder: A prospective, population-based cohort study on caregivers of patients at the end of life

Palliative Medicine ◽

10.1177/0269216320948007 ◽

2020 ◽

Vol 34 (10) ◽

pp. 1416-1424 ◽

Cited By ~ 1

Author(s):

Maja Krarup Lenger ◽

Mette Asbjoern Neergaard ◽

Mai-Britt Guldin ◽

Mette Kjaergaard Nielsen

Keyword(s):

Mental Health ◽

Health Status ◽

General Population ◽

Physical Health ◽

End Of Life ◽

Population Based ◽

Physical And Mental Health ◽

Prolonged Grief Disorder ◽

Prolonged Grief ◽

Sf 36

Background: The health of caregivers can be affected during end-of-life caregiving. Previous cross-sectional studies have indicated an association between poor health status and prolonged grief disorder, but prospective studies are lacking. Aim: To describe physical and mental health status in caregivers of patients at the end of life, and to investigate whether caregivers’ health status during caregiving predict prolonged grief disorder. Design: A population-based prospective survey was conducted. Health status was measured in caregivers during caregiving (SF-36), and prolonged grief disorder was assessed 6 months after bereavement (Prolonged Grief-13). We calculated mean scores of health status and explored the association with prolonged grief disorder using logistic regression adjusted for age, gender and education. Setting/participants: The health in caregivers of patients granted drug reimbursement due to terminal illness in Denmark in 2012 was assessed during caregiving and 6 months after bereavement ( n = 2125). Results: The SF-36 subscale ‘role-physical’ concerning role limitations due to physical health, the ‘mental health’ component score, and all ‘mental health’ subscales showed significantly worse health in the participants than in the general population. Both poor physical health (adjusted OR: 1.05 (95% CI: 1.04–1.07)) and poor mental health (adjusted OR: 1.09 (95% CI: 1.07–1.11)) predicted prolonged grief disorder. Conclusion: Caregivers scored lower on one physical subscale and all mental health measures than the general population. Prolonged grief disorder was predicted by poor physical and mental health status before bereavement. Future research is needed on the use of health status in systematic assessment to identify caregivers in need of support.

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Providing Care for Migrants and Refugees

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.165 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S35-S35

Author(s):

M. Schouler-Ocak

Keyword(s):

Mental Health ◽

Healthcare System ◽

Mental Health Professionals ◽

Asylum Seekers ◽

Mental Health Problems ◽

Service Providers ◽

Mental Healthcare ◽

Healthcare Services ◽

Common Mental Health Problems ◽

Refugees And Asylum Seekers

With growing globalisation and an increasing number of people on the move across boundaries, it has become vital that service providers, policy makers and mental health professionals are aware of the different needs of the patients they are responsible. One of the most fundamental barriers for migrants, refugees and asylum seekers in accessing health services are inadequate legal entitlement and, mechanisms for ensuring that they are well known and respected in practice. Access to the healthcare system is impeded by language and cultural communication problems. Qualified language and cultural mediators are not widely available, and moreover, are not regularly asked to attend. This can lead to misunderstandings, misdiagnosis and incorrect treatment, with serious consequences for the afflicted. The language barrier represents one of the main barriers to access to the healthcare system for people who do not speak the local language; indeed, language is the main working tool of psychiatry and psychotherapy, without which successful communication is impossible. Additionally, the lack of health literacy among the staff of institutions, which provide care for refugees and asylum seekers means that there is a lack of knowledge about the main symptoms of common mental health problems among these groups. The healthcare services, which are currently available, are not well prepared for these increasing specific groups. In dealing with ethnic minorities, including asylum seekers and refugees, mental healthcare professionals need to be culturally competent.In this talk, main models for providing mental health care for migrants and refugees will be presented and discussed.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Predictors of the Length of Stay of Psychiatric Inpatients: Protocol for a Systematic Review and Meta-Analysis

10.21203/rs.3.rs-40781/v2 ◽

2021 ◽

Author(s):

Farid Carranza ◽

Neri Alejandro Álvarez ◽

Andrea Muriel Contreras ◽

Andrea Fernanda Guerrero ◽

Natalia Sofía Tamayo ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Length Of Stay ◽

Service Providers ◽

Meta Analysis ◽

Mental Healthcare ◽

Psychiatric Inpatients ◽

Regression Coefficients ◽

Effect Sizes ◽

Point Estimate

Abstract Background: Length of stay (LOS) for inpatient psychiatric services is an important factor with serious drawbacks when it is extended more than needed. Impacts on economy, social functioning and stigma can hamper improvement and affect the patients’ experiences on future mental healthcare. Predictions of which patients have a higher chance for prolonged LOS have been extensively researched. Previous systematic reviews found consistent predictors of both longer and shorter LOS. However, they do not provide an estimate from the pooled effect sizes. Furthermore, to our knowledge, there are no meta-analysis on the influence of these factors. The primary objective of this study will be to provide point estimates on the effect sizes of all studied predictors of the LOS of psychiatric inpatients.Methods: We will conduct a systematic search in PubMed, MEDLINE, EMBASE and PsycINFO for observational studies evaluating the effect size of independent factors on the length of stay of psychiatric inpatients. Prospective and retrospective cohorts that assess the influence of predictors through the reporting of standardized regression coefficients will be included. We will provide a qualitative synthesis of the findings from each study and perform a meta-analysis from pooled regression coefficients that were adjusted for other variables or confounders in order to obtain a point estimate and confidence interval for all factors extracted from the included studies.Discussion: The results from this study may provide more accurate predictions for mental health institutions, psychiatrists, mental health service providers, patients, and families on the prognosis regarding the length of stay for needed inpatient care. This information may be used to anticipate individuals with a higher chance for prolonged hospitalization to plan the necessary interventions for these specific situations. Considering both the benefits and disadvantages of longer and shorter stays, the pooled estimates for independent factors may be used by mental healthcare providers and patients for informed decision-making. The results from this study will also update results presented in previous studies and identify the strengths and limitations from the current available evidence. Systematic Review Registration: PROSPERO ID CRD42020172840

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