scholarly journals An Approach to Treating Depressive and Psychotic Illness in Indigenous Communities

2008 ◽  
Vol 14 (1) ◽  
pp. 17 ◽  
Author(s):  
Tricia Nagel ◽  
Gary Robinson ◽  
Thomas Trauer ◽  
John Condon
Keyword(s):  
Mental Health ◽  
Service Providers ◽  
Health Workers ◽  
Controlled Trial ◽  
Indigenous Communities ◽  
Northern Territory ◽  
Remote Communities ◽  
Problem Solving Therapy ◽  
Randomised Controlled ◽  
Indigenous Mental Health

This study is one of the activities of a multi-site research program, the Australian Mental Health Initiative (AIMhi), funded by the National Health and Medical Research Council. AIMhi in the Northern Territory collaborated with Aboriginal mental health workers and Northern Territory remote service providers in developing a range of resources and strategies to promote improved Indigenous mental health outcomes. A brief intervention that combines the principles of motivational interviewing, problem solving therapy and chronic disease self-management is described. The intervention has been integrated into a randomised controlled trial. Early findings suggest that the strategy and its components are well received by clients with chronic mental illness, and their carers, in remote communities.

Two-way approaches to Indigenous mental health literacy

2009 ◽  
Vol 15 (1) ◽  
pp. 50 ◽  
Author(s):  
Tricia M. Nagel ◽  
Carolyn Thompson ◽  
Gary Robinson ◽  
John Condon ◽  
Thomas Trauer
Keyword(s):  
Mental Health ◽  
Health Promotion ◽  
Health Workers ◽  
Participant Observation ◽  
Indigenous Communities ◽  
Mental Health Promotion ◽  
Story Telling ◽  
Remote Communities ◽  
Education And Care ◽  
Indigenous Mental Health

This study was designed to provide important new information about relapse prevention in Indigenous 1 people with chronic mental illness. It aimed to explore Indigenous mental health promotion with Aboriginal mental health workers (AMHW) in order to develop strategies for effective mental health intervention. The research was conducted in three remote Indigenous communities in the top end of the Northern Territory with AMHW. Assessment, psycho-education, and care-planning resources were developed with local AMHW through exploration of local Indigenous perspectives of mental health promotion. Qualitative research methods and an ethnographic approach were used to elicit information, and data included key informant interviews, participant observation, music, photography and story telling. The study confirms that Indigenous people in remote communities prefer to use story telling and local language, local artwork and local music to convey health information. It also confirms that family and local practitioners are key cultural informants and that indirect, holistic and ‘two-way’ messages are preferred.

Adverse Mental Health Effects of Cannabis Use in Two Indigenous Communities in Arnhem Land, Northern Territory, Australia: Exploratory Study

2005 ◽  
Vol 39 (7) ◽  
pp. 612-620 ◽  
Author(s):  
Alan R. Clough ◽  
Peter D'abbs ◽  
Sheree Cairney ◽  
Dennis Gray ◽  
Paul Maruff ◽  
...  
Keyword(s):  
Mental Health ◽  
Alcohol Use ◽  
Health Effects ◽  
Health Workers ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Northern Territory ◽  
Symptom Cluster ◽  
Cannabis Use ◽  
Mental Health Effects

Objective: We investigated adverse mental health effects and their associations with levels of cannabis use among indigenous Australian cannabis users in remote communities in the Northern Territory. Method: Local indigenous health workers and key informants assisted in developing 28 criteria describing mental health symptoms. Five symptom clusters were identified using cluster analysis of data compiled from interviews with 103 cannabis users. Agreement was assessed (method comparison approach, κ-statistic) with a clinician's classification of the 28 criteria into five groups labelled: ‘anxiety’, ‘dependency’, ‘mood’, ‘vegetative’ and ‘psychosis’. Participants were described as showing ‘anxiety’, ‘dependency’ etc., if they reported half or more of the symptoms comprising the cluster. Associations between participants' self-reported cannabis use and each symptom cluster were assessed (logistic regression adjusting for age, sex, other substance use). Results: Agreement between two classifications of 28 criteria into five groups was ‘moderate’ (64%, κ=0.55, p<0.001). When five clusters were combined into three, ‘anxietydependency’, ‘mood-vegetative’ and ‘psychosis’, agreement rose to 71% ( κ=0.56, p<0.001). ‘Anxiety-dependency’ was positively associated with number of ‘cones’ usually smoked per week and this remained significant when adjusted for confounders (p=0.020) and tended to remain significant in those who had never sniffed petrol (p=0.052). Users of more than five cones per week were more likely to display ‘anxiety-dependency’ symptoms than those who used one cone per week (OR=15.8, 1.8–141.2, p=0.013). A crude association between the ‘mood-vegetative’ symptom cluster and number of cones usually smoked per week (p=0.014) also remained statistically significant when adjusted for confounders (p=0.012) but was modified by interactions with petrol sniffing (p=0.116) and alcohol use (p=0.276). There were no associations between cannabis use and ‘psychosis’. Conclusions: Risks for ‘anxiety-dependency’ symptoms in cannabis users increased as their level of use increased. Other plausible mental health effects of cannabis in this population of comparatively new users were probably masked by alcohol use and a history of petrol sniffing.

scholarly journals Behavioural activation delivered by the non-specialist: phase II randomised controlled trial

2011 ◽  
Vol 198 (1) ◽  
pp. 66-72 ◽  
Author(s):  
David Ekers ◽  
David Richards ◽  
Dean McMillan ◽  
J. Martin Bland ◽  
Simon Gilbody
Keyword(s):  
Mental Health ◽  
Randomised Controlled Trial ◽  
Mental Health Professionals ◽  
Social Adjustment ◽  
Large Scale ◽  
Health Workers ◽  
Controlled Trial ◽  
Behavioural Activation ◽  
Cognitive Behaviour ◽  
Randomised Controlled

BackgroundBehavioural activation appears as effective as cognitive– behaviour therapy (CBT) in the treatment of depression. If equally effective, then behavioural activation may be the preferred treatment option because it may be suitable for delivery by therapists with less training. This is the first randomised controlled trial to look at this possibility.AimsTo examine whether generic mental health workers can deliver effective behavioural activation as a step-three high-intensity intervention.MethodA randomised controlled trial (ISRCTN27045243) comparing behavioural activation (n = 24) with treatment as usual (n = 23) in primary care.ResultsIntention-to-treat analyses indicated a difference in favour of behavioural activation of –15.79 (95% CI –24.55 to –7.02) on the Beck Depression Inventory–II and Work and Social Adjustment Scale (mean difference –11.12, 95% CI –17.53 to –4.70).ConclusionsEffective behavioural activation appears suitable for delivery by generic mental health professionals without previous experience as therapists. Large-scale trial comparisons with an active comparator (CBT) are needed.

scholarly journals Feasibility of Group Problem Management Plus (PM+) to improve mental health and functioning of adults in earthquake-affected communities in Nepal

2020 ◽  
Vol 29 ◽  
Author(s):  
M. Sangraula ◽  
E. L. Turner ◽  
N. P. Luitel ◽  
E. van ‘t Hof ◽  
P. Shrestha ◽  
...  
Keyword(s):  
Mental Health ◽  
Randomised Controlled Trial ◽  
Clinical Outcome ◽  
Health Workers ◽  
Controlled Trial ◽  
Family Members ◽  
Depression Symptoms ◽  
Problem Management ◽  
Randomised Controlled ◽  
Programme Staff

Abstract Aims Psychological interventions that are brief, acceptable, effective and can be delivered by non-specialists are especially necessary in low- and middle-income countries, where mental health systems are unable to address the high level of psychosocial needs. Problem Management Plus (PM+) is a five-session intervention designed for those impaired by psychological distress while living in communities affected by adversity. Individual PM+ has demonstrated effectiveness in reducing distress in Kenya and Pakistan, and a group version of PM+ (Group PM+) was effective for conflict-affected women in Pakistan. This paper describes a feasibility and acceptability trial of locally adapted Group PM+ for women and men in an earthquake-affected region of rural Nepal. Methods In this feasibility cluster randomised controlled trial, participants in the experimental arm were offered five sessions of Group PM+ and participants in the control arm received enhanced usual care (EUC), which entailed brief psycho-education and providing referral options to primary care services with health workers trained in the mental health Gap Action Programme Intervention Guide (mhGAP-IG). A mixed-methods design was used to assess the feasibility and acceptability of Group PM+. Feasibility was assessed with criteria including fidelity and retention of participants. Acceptability was assessed through in-depth interviews with participants, family members, programme staff and other stakeholders. The primary clinical outcome was depression symptoms assessed using the Patient Health Questionnaire (PHQ-9) administered at baseline and 8–8.5 weeks post-baseline (i.e. after completion of Group PM+ or EUC). Results We recruited 121 participants (83% women and 17% men), with equal allocation to the Group PM+ and EUC arms (1:1). Group PM+ was delivered over five 2.5–3 hour sessions by trained and supervised gender-matched local non-specialists, with an average attendance of four out of five sessions. The quantitative and qualitative results demonstrated feasibility and acceptability for non-specialists to deliver Group PM+. Though the study was not powered to assess for effectiveness, for all five key outcome measures, including the primary clinical outcome, the estimated mean improvement was larger in the Group PM+ arm than the EUC arm. Conclusion The intervention and trial procedures were acceptable to participants, family members, and programme staff. The communities and participants found the intervention to be beneficial. Because feasibility and acceptability were established in this trial, a fully powered randomised controlled trial will be conducted for larger scale implementation to determine the effectiveness of the intervention in Nepal.

scholarly journals Increasing demand for school counselling through a lay counsellor-delivered classroom sensitisation intervention: a stepped-wedge cluster randomised controlled trial in New Delhi, India

2021 ◽  
Vol 6 (6) ◽  
pp. e003902
Author(s):  
Rachana Parikh ◽  
Adriaan Hoogendoorn ◽  
Daniel Michelson ◽  
Jeroen Ruwaard ◽  
Rhea Sharma ◽  
...  
Keyword(s):  
Mental Health ◽  
Low Income ◽  
Mental Health Problems ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
New Delhi ◽  
Stepped Wedge ◽  
Whole School ◽  
Cluster Randomised ◽  
Randomised Controlled

IntroductionWe evaluated a classroom-based sensitisation intervention that was designed to reduce demand-side barriers affecting referrals to a school counselling programme. The sensitisation intervention was offered in the context of a host trial evaluating a low-intensity problem-solving treatment for common adolescent mental health problems.MethodsWe conducted a stepped-wedge, cluster randomised controlled trial with 70 classes in 6 secondary schools serving low-income communities in New Delhi, India.The classes were randomised to receive a classroom sensitisation session involving a brief video presentation and moderated group discussion, delivered by a lay counsellor over one class period (intervention condition, IC), in two steps of 4 weeks each. The control condition (CC) was whole-school sensitisation (teacher-meetings and whole-school activities such as poster displays). The primary outcome was the proportion of students referred into the host trial. Secondary outcomes were the proportion of students who met mental health caseness criteria and the proportion of self-referred adolescents.ResultsBetween 20 August 2018 and 9 December 2018, 835 students (23.3% of all students) were referred into the host trial. The referred sample included 591 boys (70.8%), and had a mean age of 15.8 years, SD=0.06; 194 students (31.8% of 610 with complete data) met mental health caseness criteria. The proportion of students referred in each trial conditionwas significantly higher in the IC (IC=21.7%, CC=1.5%, OR=111.36, 95% CI 35.56 to 348.77, p<0.001). The proportion of self-referred participants was also higher in the IC (IC=98.1%, CC=89.1%, Pearson χ2 (1)=16.92, p<0.001). Although the proportion of referred students meeting caseness criteria was similar in both conditions (IC=32.0% vs CC=28.1%), the proportion weighted for the total student population was substantially higher in the IC (IC=5.2%, CC=0.3%, OR=52.39, 95% CI 12.49 to 219.66,p<0.001).ConclusionA single, lay counsellor-delivered, classroom sensitisation session increased psychological help-seeking for common mental health problems among secondary school pupils from urban, low-income communities in India.Trial registration numberNCT03633916.

scholarly journals Digital cognitive–behavioural therapy for insomnia compared with digital patient education about insomnia in individuals referred to secondary mental health services in Norway: protocol for a multicentre randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e050661
Author(s):  
Håvard Kallestad ◽  
Simen Saksvik ◽  
Øystein Vedaa ◽  
Knut Langsrud ◽  
Gunnar Morken ◽  
...  
Keyword(s):  
Mental Health ◽  
Randomised Controlled Trial ◽  
Patient Education ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Group Differences ◽  
Post Intervention ◽  
Cognitive Behavioural ◽  
Randomised Controlled

IntroductionInsomnia is highly prevalent in outpatients receiving treatment for mental disorders. Cognitive–behavioural therapy for insomnia (CBT-I) is a recommended first-line intervention. However, access is limited and most patients with insomnia who are receiving mental healthcare services are treated using medication. This multicentre randomised controlled trial (RCT) examines additional benefits of a digital adaptation of CBT-I (dCBT-I), compared with an online control intervention of patient education about insomnia (PE), in individuals referred to secondary mental health clinics.Methods and analysisA parallel group, superiority RCT with a target sample of 800 participants recruited from treatment waiting lists at Norwegian psychiatric services. Individuals awaiting treatment will receive an invitation to the RCT, with potential participants undertaking online screening and consent procedures. Eligible outpatients will be randomised to dCBT-I or PE in a 1:1 ratio. Assessments will be performed at baseline, 9 weeks after completion of baseline assessments (post-intervention assessment), 33 weeks after baseline (6 months after the post-intervention assessment) and 61 weeks after baseline (12 months after the post-intervention assessment). The primary outcome is between-group difference in insomnia severity 9 weeks after baseline. Secondary outcomes include between-group differences in levels of psychopathology, and measures of health and functioning 9 weeks after baseline. Additionally, we will test between-group differences at 6-month and 12-month follow-up, and examine any negative effects of the intervention, any changes in mental health resource use, and/or in functioning and prescription of medications across the duration of the study. Other exploratory analyses are planned.Ethics and disseminationThe study protocol has been approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref: 125068). Findings from the RCT will be disseminated via peer-reviewed publications, conference presentations, and advocacy and stakeholder groups. Exploratory analyses, including potential mediators and moderators, will be reported separately from main outcomes.Trial registration numberClinicalTrials.gov Registry (NCT04621643); Pre-results.

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