scholarly journals Resolving the paradox of increased mental health expenditure and stable prevalence

2019 ◽  
Vol 53 (9) ◽  
pp. 844-850 ◽  
Author(s):  
Graham N Meadows ◽  
Ante Prodan ◽  
Scott Patten ◽  
Frances Shawyer ◽  
Sarah Francis ◽  
...  
Keyword(s):  
Mental Health ◽  
Help Seeking ◽  
Depressive Disorders ◽  
Psychological Treatment ◽  
Antidepressant Medication ◽  
Simulation Modelling ◽  
Psychological Treatments ◽  
Self Help ◽  
Comprehensive Service ◽  
Mental Health Expenditure

A doubling of Australian expenditure on mental health services over two decades, inflation-adjusted, has reduced prevalence of neither psychological distress nor mental disorders. Low rates of help-seeking, and inadequate and inequitable delivery of effective care may explain this partially, but not fully. Focusing on depressive disorders, drawing initially on ideas from the work of philosopher and socio-cultural critic Ivan Illich, we use evidence-based medicine statistics and simulation modelling approaches to develop testable hypotheses as to how iatrogenic influences on the course of depression may help explain this seeming paradox. Combined psychological treatment and antidepressant medication may be available, and beneficial, for depressed people in socioeconomically advantaged areas. But more Australians with depression live in disadvantaged areas where antidepressant medication provision without formal psychotherapy is more typical; there also are urban/non-urban disparities. Depressed people often engage in self-help strategies consistent with psychological treatments, probably often with some benefit to these people. We propose then, if people are encouraged to rely heavily on antidepressant medication only, and if they consequently reduce spontaneous self-help activity, that the benefits of the antidepressant medication may be more than offset by reductions in beneficial effects as a consequence of reduced self-help activity. While in advantaged areas, more comprehensive service delivery may result in observed prevalence lower than it would be without services, in less well-serviced areas, observed prevalence may be higher than it would otherwise be. Overall, then, we see no change. If the hypotheses receive support from the proposed research, then implications for service prioritisation and delivery could include a case for wider application of recovery-oriented practice. Critically, it would strengthen the case for action to correct inequities in the delivery of psychological treatments for depression in Australia so that combined psychological therapy and antidepressant medication, accessible and administered within an empowering framework, should be a nationally implemented standard.

scholarly journals Implementing Psychological Interventions Through Nonspecialist Providers and Telemedicine in High-Income Countries: Qualitative Study from a Multistakeholder Perspective

10.2196/19271 ◽  
2020 ◽  
Vol 7 (8) ◽  
pp. e19271
Author(s):  
Daisy Radha Singla ◽  
Sasha Lemberg-Pelly ◽  
Andrea Lawson ◽  
Nika Zahedi ◽  
Tyla Thomas-Jacques ◽  
...  
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Mental Health Professionals ◽  
Psychological Treatment ◽  
Primary Objective ◽  
Anxiety Symptoms ◽  
High Income ◽  
Barriers And Facilitators ◽  
Psychological Treatments ◽  
Stakeholder Groups

Background Task sharing has been used worldwide to improve access to mental health care, where nonspecialist providers—individuals with no formal training in mental health—have been trained to effectively treat perinatal depressive and anxiety symptoms. Little formative research has been conducted to examine relevant barriers and facilitators of nonspecialist providers and the use of telemedicine in treatment service delivery. Objective The primary objective of this study was to examine the main barriers and facilitators of nonspecialist provider–delivered psychological treatments for perinatal populations with common mental health disorders, such as depression and anxiety, from a multistakeholder perspective. Methods This study took place in Toronto, Canada. In total, 33 in-depth interviews were conducted with multiple stakeholder groups (women with lived experience and their significant others, as well as health and mental health professionals). Qualitative data were quantified to estimate commonly endorsed themes within and across stakeholder groups. Results Psychological treatments delivered by nonspecialist providers were considered acceptable by the vast majority of participants (30/33, 90%). Across all stakeholder groups, nurses (20/33, 61%) and midwives (14/33, 42%) were the most commonly endorsed cadre of nonspecialist providers. The majority of stakeholders (32/33, 97%) were amenable to nonspecialist providers delivering psychological treatment via telemedicine (27/33, 82%), although concerns were raised about the ability to establish a therapeutic alliance via telemedicine (16/33, 48%). Empathy was the most desired characteristic of a nonspecialist provider (61%). Patient and patient advocate stakeholders were more likely to emphasize stigma as an important barrier to accessing psychological treatments (7/12, 58%), compared to clinicians (2/9, 22%) and spouses (1/5, 20%). Clinician stakeholders were more likely to emphasize the importance of ensuring nonspecialist providers were trained to deliver psychological treatments (3/9, 33%), compared to other stakeholder groups. Conclusions These results can inform the design, implementation, and integration of nonspecialist-delivered interventions via telemedicine for women with perinatal depressive and anxiety symptoms in high-income country contexts.

scholarly journals Who seeks Internet-based interventions for depression in Brazil?

2021 ◽  
Vol 38 ◽  
Author(s):  
Rodrigo Teixeira LOPES ◽  
Maria Adriana SVACINA ◽  
Juan Martín GÓMEZ-PENEDO ◽  
Andrés ROUSSOS ◽  
Björn MEYER ◽  
...  
Keyword(s):  
Mental Health Professionals ◽  
Help Seeking ◽  
Depressive Disorders ◽  
Comorbid Conditions ◽  
Psychological Treatments ◽  
Face To Face ◽  
Remote Areas ◽  
Symptoms Of Depression ◽  
Screening Questionnaires ◽  
Flexible Schedules

Abstract Specific psychological treatments for depressive disorders delivered on the Internet have shown effectiveness and presented advantages over face-to-face treatments (potentially less expensive, flexible schedules, available in remote areas). This paper aims to describe the characteristics of those who sought help from an online self-guided intervention for depression and to explore hypotheses about predictors of enrollment to the program. Based on a sample of 282 of individuals who filled in screening questionnaires, we verified that the respondents were mainly female, were on average 34.36 years old, were primarily recruited through Facebook, had been previously diagnosed by mental health professionals, presented moderate self-efficacy perception, and had moderately severe symptoms of depression. Respondents who reported comorbid conditions were more likely to attend enrollment interviews, and being in treatment or not did not influence attendance. Such characterization may provide strategies to reach more people and to optimize the design of interventions targeting help-seeking depressed individuals in Brazil.

scholarly journals Relationship between obesity and health problems in help-seeking military veterans

2019 ◽  
pp. jramc-2019-001155
Author(s):  
Victoria Williamson ◽  
A Rossetto ◽  
D Murphy
Keyword(s):  
Mental Health ◽  
General Population ◽  
Physical Health ◽  
Help Seeking ◽  
Mental Health Problems ◽  
Psychological Treatment ◽  
Mental Healthcare ◽  
Armed Forces ◽  
Health Problems ◽  
Physical And Mental Health

BackgroundUK Armed Forces (UK AF) veterans may be particularly vulnerable to obesity and its comorbid physical and mental health problems.AimTo examine the relationship between body mass index (BMI), physical health problems, mental health disorders and sociodemographic characteristics in UK AF veterans engaged in psychological treatment.MethodsInformation regarding veteran BMI, demographic characteristics, physical health conditions and mental health problems was collected and analysed using univariate and multivariate regression analyses. Rates of veteran obesity were also compared with the UK general population.ResultsOf the 384 help-seeking veterans, 37.5% (n=151) were overweight (BMI 26–30) and 35.5% (n=143) were obese. Obesity in help-seeking male veterans was two to four times higher than that of the general population of UK. Higher scores on measures of anger and common mental health problems were significantly associated with greater BMI. Problems with physical systemic functioning and mobility were also significantly associated with greater BMI.ConclusionsThe results indicate that treatment-seeking UK AF veterans exhibit higher levels of obesity compared with the general population, and clinically significant physical and mental comorbidities. The findings highlight a need for mental health services to offer treatments that effectively integrate physical and mental healthcare in the treatment of people with mental health problems.

What to do about depression? Help-seeking and treatment recommendations of the public

2011 ◽  
Vol 20 (2) ◽  
pp. 163-169 ◽  
Author(s):  
A. Holzinger ◽  
H. Matschinger ◽  
M.C. Angermeyer
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Help Seeking ◽  
Treatment Options ◽  
Antidepressant Medication ◽  
Structured Interview ◽  
First Century ◽  
The Public ◽  
Treatment Of Depression

Aims.Several population studies on beliefs about depression carried out in western countries during the 1990s have shown that the public clearly favors psychotherapy over antidepressant medication. The present study examines whether this phenomenon still exists at the end of the first decade of the twenty-first century.Materials and Methods.In 2009, a telephone survey was conducted among the population of Vienna aged 16 years and older (n = 1205). A fully structured interview was administered which began with the presentation of a vignette depicting a case of depression fulfilling the diagnostic criteria of DSM-IV for a moderate depressive episode.Results.Psychotherapists were most frequently endorsed as source of professional help. Antidepressant medication still was more frequently advised against than recommended. Respondents familiar with the treatment of depression tended to be more ready to recommend to seek help from mental health professionals and to endorse various treatment options, particularly medication.Conclusion.At the end of the first decade of this century, there still exists a large gap between the public's beliefs and what mental health professionals consider appropriate for the treatment of depression. Therefore, further effort to improve the public's mental health literacy seems necessary.

Public awareness of psychological problems in Pakistan

2020 ◽  
Vol 25 (1) ◽  
pp. 35-45
Author(s):  
Waqar Husain ◽  
Fayyaz Ahmed Faize
Keyword(s):  
Mental Health ◽  
Large Scale ◽  
Psychological Treatment ◽  
Public Awareness ◽  
Well Being ◽  
Psychological Problems ◽  
Content Type ◽  
Self Help ◽  
Health Practitioners ◽  
Income Data

Purpose Awareness of psychological problems is essential to address the problems adequately. It also contributes positively in the overall psychosocial well-being of a society. The rates of mental health literacy have been investigated in many countries and have been found to be lower than expected. The purpose of this study was to explore public awareness of psychological problems and psychological treatment in Pakistan. Design/methodology/approach The current study explored the latest levels of public awareness of psychological problems in the country by involving 3,500 respondents from five major cities. The sample of the study was sufficiently rich to represent Pakistanis based on gender, age, education, profession and income. Data were gathered from 3,500 respondents through interviews and a self-respondent questionnaire. Findings The study revealed that the awareness of psychological problems in Pakistan was 36 per cent. Several significant variations were also found based on different demographic factors. The study also revealed that 42.17 per cent of the respondents were aware of psychotherapy as a possible way of treating psychological problems followed by their awareness of social support (17.29 per cent), medicine (16.74 per cent), supernatural practices (6.29 per cent), religious practices (5.60 per cent) and self-help (3.57 per cent). Practical implications As a result of the findings of unsatisfactory levels of public awareness of psychological problems, this paper has implications for mental health practitioners and policymakers to play their active part in improving the situation. Originality/value The current study is the first large-scale study in the country.

scholarly journals Guided self-help in primary care mental health

2007 ◽  
Vol 191 (3) ◽  
pp. 206-211 ◽  
Author(s):  
Nagina Khan ◽  
Peter Bower ◽  
Anne Rogers
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Research ◽  
Personal Experience ◽  
Help Seeking ◽  
Qualitative Studies ◽  
Explanatory Framework ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Depression Management

BackgroundThere is a gap between the supply of trained cognitive – behavioural therapists to treat depression and demand for care in the community. There is interest in the potential of self-help interventions, which require less input from a therapist. However, the design of effective self-help interventions is complex. Qualitative research can help to explore some of this complexity Aims The study aimed to identify qualitative studies of patient experience of depression management in primary care, synthesise these studies to develop an explanatory framework, and then apply this framework to the development of a guided self-help intervention for depression.MethodA meta-synthesis was conducted of published qualitative research.ResultsThe synthesis revealed a number of themes, including the nature of personal experience in depression; help-seeking in primary care; control and helplessness in engagement with treatment; stigma associated with treatment; and patients' understandings of self-help interventions.ConclusionsThis meta-synthesis of qualitative studies provided a useful explanatory framework for the development of effective and acceptable guided self-help interventions for depression.

Psychological treatment of depression in children and adolescents

1998 ◽  
Vol 173 (4) ◽  
pp. 291-298 ◽  
Author(s):  
Richard Harrington ◽  
Jane Whittaker ◽  
Philp Shoebridge
Keyword(s):  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Preventive Intervention ◽  
Psychological Treatment ◽  
Behavioural Therapy ◽  
Psychological Interventions ◽  
Psychological Treatments ◽  
Literature Searches ◽  
Cognitive Behavioural ◽  
Treatment Of Depression

BackgroundThis paper reviews research on the psychological treatment of depression in children.MethodManual and computer literature searches were performed.ResultsThe most promising psychological interventions for depression in children are individual rather than family therapies. Cognitive – behavioural therapy seems to be an effective treatment for depressive symptoms and mild depressive disorders. It may also be a useful preventive intervention, though this remains to be conclusively demonstrated. There have been no systematic studies comparing psychological treatments with medication.ConclusionsStudies comparing psychological treatments and medication are now required.

scholarly journals Characterizing individuals accessing mental health services in the UAE: a focus on youth living in Dubai

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Mariapaola Barbato ◽  
Shaikha Al Hemeiri ◽  
Shorouk Nafie ◽  
Baraa A. Dhuhair ◽  
Nadia T. Dabbagh
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Child Psychiatry ◽  
Help Seeking ◽  
Depressive Disorders ◽  
Treatment Seeking ◽  
Pathways To Care ◽  
Self Harm ◽  
Psychotic Features

Abstract Background Most mental health issues develop during adolescence, therefore identifying youth mental health needs and pathways to care is critical to improve prevention. To date, studies have typically focused on Western samples, while the impact of cultural diversity on perception of health and illness, and pathways to care, remain poorly understood. To address the shortage of studies conducted in the Arab world, and particularly in the United Arab Emirates (UAE), the present investigation aims to identify the characteristics of youth accessing mental health services in Dubai. Methods Data was collected retrospectively from patients’ records at Rashid Hospital Child Psychiatry Service. Information collected included demographics, life stressors, symptoms duration, main diagnosis, and presence/absence of psychotic features in patients’ symptomatology. The relationship between demographic and clinical variables was explored using Chi-square tests and negative binomial regression models. Results The sample included 99 treatment-seeking young patients (mean age 15.3; SD = 1.7); 47.5 % were Emirati (UAE national) and 52.5 % were non-Emirati patients. In our treatment-seeking youth sample Depressive disorders represented the most frequent diagnosis, followed by Bipolar and related disorders, Anxiety and stress related disorders, and Schizophrenia and psychotic disorders. Compared to Emirati patients, non-Emirati patients were more likely to report relationships with friends as a source of stress. Female help-seekers, compared to males, were more likely to report stressful relationships with family members, and to receive a diagnosis of Depressive disorders. The duration of symptoms before seeking help was significantly predicted by family stress, gender, self-harm behavior, a symptomatology with psychotic features, and a diagnosis of Anxiety disorders. Conclusions The present study contributes to characterizing youth accessing mental health services at Rashid Hospital’s Child Psychiatry service in Dubai. An overall prevalence of poor family functioning among help-seeking youth, and the importance of peer support for expatriate youth were highlighted. Gender differences in perceived stressors, diagnoses and help-seeking behavior suggest the need to promote help-seeking among young boys. While presentation with psychotic features seems to lead to quicker access to medical care, self-harm and anxiety appear to delay help-seeking. The potential implications of our results for promoting youth wellbeing in the region are discussed.

scholarly journals Adolescents’ perceived barriers and facilitators to seeking and accessing professional help for anxiety and depressive disorders: a qualitative interview study

2021 ◽  
Author(s):  
Jerica Radez ◽  
Tessa Reardon ◽  
Cathy Creswell ◽  
Faith Orchard ◽  
Polly Waite
Keyword(s):  
Mental Health ◽  
Young People ◽  
Help Seeking ◽  
Depressive Disorders ◽  
Qualitative Interviews ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Social Evaluation ◽  
Professional Help ◽  
Qualitative Interview Study

AbstractAnxiety and depressive disorders are the most common mental health disorders in adolescents, yet only a minority of young people with these disorders access professional help. This study aims to address this treatment gap by improving our understanding of barriers and facilitators to seeking/accessing professional help as perceived by adolescents with anxiety/depressive disorders identified in the community. Twenty-two adolescents, aged 11–17 years, who met diagnostic criteria for a current anxiety and/or depressive disorder were identified through school-based screening. In-depth qualitative interviews were conducted one-to-one with each adolescent and adolescents’ parents were interviewed separately for the purpose of data triangulation. Data were analysed using reflexive thematic analysis. We identified four themes capturing adolescent perceived barriers and facilitators to seeking/accessing professional help for anxiety and depressive disorders: (1) making sense of difficulties, (2) problem disclosure, (3) ambivalence to seeking help, and (4) the instrumental role of others. Barriers/facilitators identified within each theme reflect important developmental characteristics of adolescence, such as a growing need for autonomy and concerns around negative social evaluation. At the same time, the results highlight adolescents’ dependency on other people, mainly their parents and school staff, when it comes to successfully accessing professional help for their mental health difficulties. This study identifies a number of barriers/facilitators that influence help-seeking behaviour of adolescents with anxiety and/or depressive disorders. These factors need to be addressed when targeting treatment utilisation rates in this particular group of young people.

scholarly journals Implementing Psychological Interventions Through Nonspecialist Providers and Telemedicine in High-Income Countries: Qualitative Study from a Multistakeholder Perspective (Preprint)

2020 ◽  
Author(s):  
Daisy Radha Singla ◽  
Sasha Lemberg-Pelly ◽  
Andrea Lawson ◽  
Nika Zahedi ◽  
Tyla Thomas-Jacques ◽  
...  
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Mental Health Professionals ◽  
Psychological Treatment ◽  
Primary Objective ◽  
Anxiety Symptoms ◽  
High Income ◽  
Barriers And Facilitators ◽  
Psychological Treatments ◽  
Stakeholder Groups

BACKGROUND Task sharing has been used worldwide to improve access to mental health care, where nonspecialist providers—individuals with no formal training in mental health—have been trained to effectively treat perinatal depressive and anxiety symptoms. Little formative research has been conducted to examine relevant barriers and facilitators of nonspecialist providers and the use of telemedicine in treatment service delivery. OBJECTIVE The primary objective of this study was to examine the main barriers and facilitators of nonspecialist provider–delivered psychological treatments for perinatal populations with common mental health disorders, such as depression and anxiety, from a multistakeholder perspective. METHODS This study took place in Toronto, Canada. In total, 33 in-depth interviews were conducted with multiple stakeholder groups (women with lived experience and their significant others, as well as health and mental health professionals). Qualitative data were quantified to estimate commonly endorsed themes within and across stakeholder groups. RESULTS Psychological treatments delivered by nonspecialist providers were considered acceptable by the vast majority of participants (30/33, 90%). Across all stakeholder groups, nurses (20/33, 61%) and midwives (14/33, 42%) were the most commonly endorsed cadre of nonspecialist providers. The majority of stakeholders (32/33, 97%) were amenable to nonspecialist providers delivering psychological treatment via telemedicine (27/33, 82%), although concerns were raised about the ability to establish a therapeutic alliance via telemedicine (16/33, 48%). Empathy was the most desired characteristic of a nonspecialist provider (61%). Patient and patient advocate stakeholders were more likely to emphasize stigma as an important barrier to accessing psychological treatments (7/12, 58%), compared to clinicians (2/9, 22%) and spouses (1/5, 20%). Clinician stakeholders were more likely to emphasize the importance of ensuring nonspecialist providers were trained to deliver psychological treatments (3/9, 33%), compared to other stakeholder groups. CONCLUSIONS These results can inform the design, implementation, and integration of nonspecialist-delivered interventions via telemedicine for women with perinatal depressive and anxiety symptoms in high-income country contexts.

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