O3.6. PREVALENCE OF AND RECOVERY FROM COMMON MENTAL DISORDERS INCLUDING PSYCHOTIC EXPERIENCES

Abstract Background Systematic reviews indicate that approximately one third of people with at-risk mental states for psychosis (ARMS) will transition to a psychotic disorder. Research in non-specialised services, such as primary care settings, has shown that far fewer make such a conversion. Nonetheless, psychotic experiences (PE) may also be linked to common mental disorders (CMD), particularly depression and anxiety, and still predict poor outcomes. Population studies modelling the co-occurrence of CMD and PE have found an underlying unitary psychopathological factor, with PE emerging towards its more severe end. We know little about the prevalence of and recovery from PE in primary mental health care, where most CMD are treated. One example of primary mental health care setting in England is the Improving Access to Psychological Therapies (IAPT) programme (https://www.england.nhs.uk/mental-health/adults/iapt/). The IAPT programme provides evidence-based psychological therapies for mild to moderate CMD across the UK National Health Service (NHS). IAPT services adhere to current diagnostic paradigms and, therefore, do not either measure or treat PE. We aimed to establish the prevalence of PE in a large sample of patients with CMD from the IAPT programme and compare recovery rates between patients with CMD and PE (CMD-P) and those without PE. Methods We used the Community Assessment of Psychic Experiences - Positive 15-item Scale (CAPE-P15) to determine the prevalence of PE in patients with CMD receiving treatment from IAPT services across England. We employed the CAPE-P15 threshold score of 1.47, which identifies individuals with ARMS, and also a lower threshold of 1.30, chosen as within one standard error of measurement, in order to explore threshold effects in the association between PE and recovery. Patient-reported measures of depression (PHQ-9) and anxiety (GAD-7) are routinely collected in IAPT services and determine ‘caseness’ before, during and after therapy. Using recovery rates (moving from ‘caseness’ to recovery) monitored nationally in the IAPT programme, we stratified patients according to the absence and presence of PE. Multi-group growth models estimated improvement trajectories for each group. Results 2,042 patients with CMD completed the CAPE-P15. The mean age was 39.8. The overall prevalence of CMD-P was 29.68% at CAPE-P15 threshold score for ARMS, i.e. 1.47, and 48.09% at threshold score 1.30. The overall recovery rate at threshold of 1.47 was 27.87% and 36.3% at 1.30. Recovery rates for those without PE were 58.92% and 62.43% for thresholds 1.47 and 1.30, respectively. Although patients with or without PE shared similar improvement trajectories, the initial severity of patients with CMD-P impeded their likelihood of recovery during treatment. Discussion At least one in four patients receiving treatment from IAPT services in primary care experience CMD-P. This significant group of people experience a lower recovery rate, with adverse implications not only for them but also for efficiency of services. Although recovery trajectories for this group showed improvement over therapy sessions, remittance of symptoms was insufficient to meet national IAPT standards of recovery. This patient group is not well-served by current interventions in primary care. This work forms part of a nation-wide NIHR research programme (TYPPEX; https://www.nihr.ac.uk/news/innovative-mental-health-study-launchesin-eastern-region) aiming to develop innovative therapies for people with CMD-P in primary care. Preliminary results related to feasibility and effectiveness of new therapeutic approaches will also be presented.

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Common Mental Disorders

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i3.6308 ◽

2012 ◽

Vol 9 (3) ◽

pp. 213-217

Author(s):

A Risal

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Mental Disorders ◽

Mental Health Care ◽

Mental Health Professionals ◽

Common Mental Disorders ◽

Economic Status ◽

Pathways To Care ◽

Middle Income

Common mental disorders are a group of distress states manifesting with anxiety, depressive and unexplained somatic symptoms typically encountered in community and primary care settings. Risk factors for these disorders are mainly lower socio-economic status, psychological illnesses, poor reproductive health, gender disadvantage and physical ill-health. WHO has recommended that treatment of all these disorders should be based in primary care to be more effective and accessible to all the community people. The structure of mental health care in primary care is generally understood in terms of the “pathways to care” model and it plays a major role in countries like ours where community-based mental health services do not exist. Both the psychological and pharmacological therapies are found to be equally effective for treating these disorders. Integration of mental health into primary care can be considered as the stepping stone in the way forward to tackle the barriers and problems in effective management of common mental disorders in the community. The acute shortage of mental health professionals and the relatively low levels of awareness about mental disorders make it mandatory that primary health care should remain the single largest sector for mental health care in low and middle income countries like ours.DOI: http://dx.doi.org/10.3126/kumj.v9i3.6308 Kathmandu Univ Med J 2011;9(3):213-7

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Training primary health care workers in mental health and its impact on diagnoses of common mental disorders in primary care of a developing country, Malawi: a cluster-randomized controlled trial

Psychological Medicine ◽

10.1017/s0033291713001141 ◽

2013 ◽

Vol 44 (3) ◽

pp. 657-666 ◽

Cited By ~ 42

Author(s):

F. Kauye ◽

R. Jenkins ◽

A. Rahman

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Developing Countries ◽

Primary Health Care ◽

Mental Disorders ◽

Intervention Study ◽

Common Mental Disorders ◽

Prevalence Rates ◽

Primary Health

BackgroundMental health problems are common in primary care, with prevalence rates of up to 40% reported in developing countries. The study aim was to evaluate the impact of a specially designed toolkit used to train primary health care (PHC) workers in mental health on the rates of diagnosed cases of common mental disorders, malaria and non-specific musculoskeletal pains in primary care in Malawi.MethodClinics with out-patient services in the designated district were randomly divided into control and intervention arms. Using a two-phase sampling process, Self-Reporting Questionnaire scores, data on diagnoses made by PHC workers and results of the Structured Clinical Interview for DSM-IV for depression were collected from 837 consecutively attending adult patients in the pre-intervention study and 2600 patients in the post-intervention study.ResultsThe point prevalence rates for probable common mental disorder and depression were 28.8% and 19%, respectively. Rates for both anxiety and depression diagnoses by PHC workers at baseline were 0% in both arms. Following training, there were significant differences between the two arms in the rates of diagnosed cases of depression [9.2% v. 0.5%, odds ratio (OR) 32.1, 95% confidence interval (CI) 7.4–144.3, p ⩽ 0.001], anxiety (1.2% v. 0%, p ⩽ 0.001) and malaria (31% v. 40%, OR 0.62, 95% CI 0.43–0.89, p = 0.01). The intervention arm had more cases diagnosed with depression and anxiety while the control arm had more cases diagnosed with malaria.ConclusionsTraining of PHC workers in mental health with an appropriate toolkit will contribute significantly to the quality of detection and management of patients seen in primary care in developing countries.

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Brazilian multicentre study of common mental disorders in primary care: rates and related social and demographic factors

Cadernos de Saúde Pública ◽

10.1590/0102-311x00158412 ◽

2014 ◽

Vol 30 (3) ◽

pp. 623-632 ◽

Cited By ~ 55

Author(s):

Daniel Almeida Gonçalves ◽

Jair de Jesus Mari ◽

Peter Bower ◽

Linda Gask ◽

Christopher Dowrick ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Mental Disorders ◽

Rio De Janeiro ◽

Common Mental Disorders ◽

Anxiety And Depression ◽

Porto Alegre ◽

Primary Health

Mental health problems are common in primary health care, particularly anxiety and depression. This study aims to estimate the prevalence of common mental disorders and their associations with socio-demographic characteristics in primary care in Brazil (Family Health Strategy). It involved a multicenter cross-sectional study with patients from Rio de Janeiro, São Paulo, Fortaleza (Ceará State) and Porto Alegre (Rio Grande do Sul State), assessed using the General Health Questionnaire (GHQ-12) and the Hospital Anxiety and Depression Scale (HAD). The rate of mental disorders in patients from Rio de Janeiro, São Paulo, Fortaleza and Porto Alegre were found to be, respectively, 51.9%, 53.3%, 64.3% and 57.7% with significant differences between Porto Alegre and Fortaleza compared to Rio de Janeiro after adjusting for confounders. Prevalence proportions of mental problems were especially common for females, the unemployed, those with less education and those with lower incomes. In the context of the Brazilian government's moves towards developing primary health care and reorganizing mental health policies it is relevant to consider common mental disorders as a priority alongside other chronic health conditions.

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Chinese perspectives on primary care for common mental disorders: Barriers and policy implications

International Journal of Social Psychiatry ◽

10.1177/0020764018776347 ◽

2018 ◽

Vol 64 (5) ◽

pp. 417-426 ◽

Cited By ~ 7

Author(s):

Kai Sing Sun ◽

Tai Pong Lam ◽

Dan Wu

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Mental Disorders ◽

Mental Health Care ◽

Primary Care Physicians ◽

Common Mental Disorders ◽

Chinese Patient ◽

Policy Implications ◽

World Health

Background: The World Health Organization (WHO) has called for integration of mental health into primary care for a decade. In Western countries, around 15% to 25% of patients with common mental disorders including mood and anxiety disorders seek help from primary care physicians (PCPs). The rate is only about 5% in China. Aims: This article reviews the Chinese findings on the barriers to primary care for common mental disorders and how they compared with Western findings. Methods: A narrative literature review was conducted, focusing on literature published from mid-1990s in English or Chinese. Patient, PCP and health system factors were reviewed. Results: Although Chinese and Western findings show similar themes of barriers, the Chinese have stronger barriers in most aspects, including under-recognition of the need for treatment, stigma on mental illness, somatization, worries about taking psychiatric drugs, uncertainties in the role, competency and legitimacy of PCPs in mental health care and short consultation time. Conclusion: Current policies in China emphasize enhancement of mental health facilities and workforce in the community. Our review suggests that patients’ intention to seek help and PCPs’ competency in mental health care are other fundamental factors to be addressed.

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The Use of Antidepressants, Anxiolytics, Sedatives and Hypnotics in Europe: Focusing on Mental Health Care in Portugal and Prescribing in Older Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17228612 ◽

2020 ◽

Vol 17 (22) ◽

pp. 8612

Author(s):

Marta Estrela ◽

Maria Teresa Herdeiro ◽

Pedro Lopes Ferreira ◽

Fátima Roque

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Disorders ◽

Mental Health Care ◽

Older Patients ◽

Common Mental Disorders ◽

Health Policies ◽

Depression And Anxiety ◽

Treatment Gap ◽

Mental Health Policies

(1) Background: Mental disorders are a growing concern in the 21st century. The most prevalent common mental disorders include depression and anxiety. It is predicted that half of the population will at some point in their lives experience one or more mental disorders. Although common mental disorders are highly prevalent, some of the most significant related problems are the wide treatment gap and the excessive use of antidepressants, anxiolytics and sedatives/hypnotics, especially among older patients. (2) Methods: This study aimed to analyze mental health care in Portugal, with a focus on the consumption of antidepressants, anxiolytics, sedatives and hypnotics among older patients. (3) Results: The use of antidepressants, anxiolytics, sedatives and hypnotics has increased overall across Europe. In Portugal, a downward trend of sedatives and hypnotics consumption can be observed. Anxiolytics and antidepressants, on the other hand, have been increasing. Patients aged ≥60 years old consume more than half of the aforementioned drugs. (4) Conclusions: Mental health policies should be designed to improve the conscientious use of antidepressants, anxiolytics, sedatives and hypnotics, particularly among older adults.

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Implementing mhGAP training to strengthen existing services for an internally displaced population in Pakistan

Global Mental Health ◽

10.1017/gmh.2017.1 ◽

2017 ◽

Vol 4 ◽

Cited By ~ 14

Author(s):

A. Humayun ◽

I. Haq ◽

F. R. Khan ◽

N. Azad ◽

M. M. Khan ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Disorders ◽

Primary Care Physicians ◽

Psychosocial Support ◽

Common Mental Disorders ◽

Care Staff ◽

Humanitarian Crisis ◽

Internally Displaced ◽

Primary Care Staff

Background.In 2014, over a million people were internally displaced after the launch of a military operation in North Waziristan, a tribal region on Pakistan's side of the Durand Line. Despite security concerns and restrictions, a collaborative mental health and psychosocial support initiative was undertaken in the district of Bannu. Monthly mental health camps were conducted for a period of 6 months by a multidisciplinary mental health team. The initiative also helped to assess mental health needs and plan training for primary care staff to strengthen existing resources.Methods.As part of this initiative, Mental Health Gap Action Programme (mhGAP) training was conducted for physicians and psychosocial staff in the affected district. This marked the first instance of implementing these guidelines in Pakistan following a humanitarian crisis. This paper describes the training process including the adaptation of the mhGAP curriculum, training of trainers, training workshops for primary care staff and an analysis of results of pre- and post-testing of their knowledge about common mental disorders using a 25-item questionnaire.Results.The gaps in knowledge of primary care physicians in recognizing and managing common mental disorders were clearly identified. The mean pre- and post-test scores of the participants were 15.43, 62% (p value 0.000, s.d. 4.05) and 19.48, 78% (p value 0.000, s.d. 3.13) respectively, which showed significant improvement.Conclusions.Despite the challenges of a humanitarian crisis, mhGAP guidelines can be successfully implemented to train primary care physicians in in low- and middle-income countries such as Pakistan. However, the dearth of primary care resources can hinder the complete integration of mental health services into primary healthcare.

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Primary Mental Health Care Part 2: Three European Primary Mental Health Care Examples as Basis for Change to the Irish System

10.53902/jpssr.2021.01.000509 ◽

2021 ◽

Vol 1 (2) ◽

Author(s):

Smith L

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Mental Health Care ◽

Health Care Systems ◽

Stepped Care ◽

Primary Mental Health Care ◽

Alternative Vision ◽

Care Approach ◽

Care Systems

The successes and limitations of primary mental health care systems in three countries outside of Ireland are examined in order to inform potential change for the Irish primary mental health care system. Systems currently at work within Scotland, England, and the Netherlands are outlined, all of which employ versions of the “stepped-care” approach to primary care. It is acknowledged that Ireland is attempting to modify primary care to include the stepped-care approach. However, there are significant limitations to the current Irish system. With the Scottish, English, and Dutch systems in mind, an alternative vision of primary mental health care for Ireland is suggested.

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Adherence to clinical guidelines in integration of mental health services into primary health care in Mbarara, southwestern Uganda: a medical records review

International Journal of Mental Health Systems ◽

10.1186/s13033-021-00488-6 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Edith K. Wakida ◽

Moses Ocan ◽

Godfrey Z. Rukundo ◽

Samuel Maling ◽

Peter Ssebutinde ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Primary Health Care ◽

Mental Health Services ◽

Mental Disorders ◽

Health Services ◽

Clinical Guidelines ◽

Common Mental Disorders ◽

Primary Health ◽

Southwestern Uganda

Abstract Background The Ugandan Ministry of Health decentralized mental healthcare to the district level; developed the Uganda Clinical Guidelines (UCG); and trained primary health care (PHC) providers in identification, management, and referral of individuals with common mental disorders. This was intended to promote integration of mental health services into PHC in the country. ‘Common mental disorders’ here refers to mental, neurological and substance use conditions as indicated in the UCG. However, the extent of integration of mental health into general healthcare remains unknown. This study aimed to establish the level of adherence of PHC providers to the UCG in the identification and management of mental disorders. Methods This was a prospective medical record review of patient information collected in November and December 2018, and March and April 2019 at two health centers (III and IV) in southwestern Uganda. Data (health facility level; sex and age of the patient; and mental disorder diagnosis, management) was collected using a checklist. Continuous data was analyzed using means and standard deviation while categorical data was analyzed using Chi-square. Multivariable logistic regression analysis was performed to establish predictors of PHC provider adherence to the clinical guidelines on integration of mental health services into PHC. The analysis was conducted at a 95% level of significance. Results Of the 6093 records of patients at the study health facilities during the study period, 146 (2.4%) had a mental or neurological disorder diagnosis. The commonly diagnosed disorders were epilepsy 91 (1.5%) and bipolar 25 (0.4%). The most prescribed medications were carbamazepine 65 (44.5%), and phenobarbital 26 (17.8%). The medicines inappropriately prescribed at health center III for a mental diagnosis included chlorpromazine for epilepsy 3 (2.1%) and haloperidol for epilepsy 1 (0.7%). Female gender (aOR: 0.52, 95% CI 0.39–0.69) and age 61+ years (aOR: 3.02, 95% CI 1.40–6.49) were predictors of a mental disorder entry into the HMIS register. Conclusion There was a noticeable change of practice by PHC providers in integrating mental health services in routine care as reflected by the rise in the number of mental disorders diagnosed and treated and entered into the modified paper based HMIS registers.

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Innovative Technology Based Interventions for Psychological Treatment of Common Mental Disorders

Journal of Clinical Medicine ◽

10.3390/jcm9103075 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3075

Author(s):

Tara Donker ◽

Annet Kleiboer

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Disorders ◽

Clinical Medicine ◽

Common Mental Disorders ◽

Psychological Treatment ◽

Evidence Base ◽

Innovative Technology ◽

Special Issue ◽

Technological Advances

The present Special Issue of Journal of Clinical Medicine includes a series of important papers that aim to further the evidence base of innovative technological advances in the screening and treatment of mental health, and to further our understanding of their implications for mental health care [...]

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