Severe and common mental disorders and risk of hospital admissions for Ambulatory Care Sensitive Conditions (ACSCs): prospective cohort study using UK Biobank

Background People with mental disorders have an excess chronic disease burden. One mechanism to potentially reduce the public health and economic costs of mental disorders is to reduce preventable hospital admissions. Ambulatory care sensitive conditions (ACSCs) are a defined set of chronic and acute illnesses not considered to require hospital treatment if patients receive adequate primary healthcare. We examined the relationship between both severe and common mental disorders and risk of emergency hospital admissions for ACSCs and factors associated with increased risk. Methods Baseline data from England (N=445,814) were taken from UK Biobank, which recruited participants aged 37-73 years during 2006 to 2010, and were linked to hospital admission records up to 31st December 2019. Participants were grouped into those who had a history of either schizophrenia, bipolar disorder, depression or anxiety, or no record of mental disorder. Cox proportional hazard models (for the first admission) and Prentice, Williams and Peterson Total Time models (PWP-TT, which account for all admissions) were used to assess the risk (using hazard ratios (HR)) of hospitalisation for ACSCs among those with mental disorders compared to those without, adjusting for factors in different domains, including sociodemographic (e.g. age, sex, ethnicity), socioeconomic (e.g. deprivation, education level), health and biomarkers (e.g. multimorbidity, inflammatory markers), health-related behaviours (e.g. smoking, alcohol consumption), social isolation (e.g. social participation, social contact) and psychological (e.g. depressive symptoms, loneliness). Results People with schizophrenia had the highest risk of hospital admission for ACSCs compared to those with no mental disorder (HR=4.40, 95% CI: 4.04 - 4.80). People with bipolar disorder (HR=2.48, 95% CI: 2.28 - 2.69) and depression or anxiety (HR=1.76, 95% CI: 1.73 - 1.80) also had higher risk. Associations were more conservative when accounting for all admissions. Although adjusting for a range of factors attenuated the observed associations, they still persisted, with socioeconomic and health-related variables contributing most. Conclusions People with severe mental disorders had highest risk of preventable hospital admissions, with the risk also elevated amongst those with depression and anxiety. Ensuring people with mental disorders receive adequate ambulatory care is essential to reduce the large health inequalities experienced by these groups.

Prevalence of common mental disorders in adult Syrian refugees resettled in high income Western countries: a systematic review and meta-analysis

Background The immense social upheaval and ongoing humanitarian crisis created by the 2011 war in Syria has forced millions of civilians to flee their homeland, many of whom seek refugee status in Western nations. Whilst it is known that the prevalence of mental illness is higher within refugee populations, this systematic review and meta-analysis aims to pool the prevalence rates of common mental disorders (namely posttraumatic stress disorder, depression and generalized anxiety disorder) in adult Syrian refugees resettled in high income Western countries. Methods Seven electronic databases (Medline, PsychInfo, CINAHL, PTSDpubs, SCOPUS, PubMed and Embase) were searched up to the 31st of December 2020. Using pre-determined inclusion and exclusion criteria, relevant articles were screened by title and abstract, and later by full text. A meta-analysis was used to estimate the prevalence rates for each mental illness. Results Eleven studies met the eligibility criteria for the systematic review. Nine of these studies had a low-moderate risk of bias and were included in the meta-analysis. Of the 4873 refugees included in the meta-analysis, the total pooled prevalence rate of having any of the three mental disorders was 33% (CI 95%, 27-40%), 40% for anxiety (CI 95%, 31-50%), 31% for depression (CI 95%, 20-44%) and 31% for PTSD (CI 95%, 22-41%). A meta-regression revealed that the total pooled prevalence rate for having any of the three mental disorders was not influenced by age, host country, duration in host country, educational or marital status. Conclusions Despite significant study heterogeneity, the prevalence rates of common mental disorders in adult Syrian refugees resettled in high-income Western countries are significantly higher than reported rates in the general population.

Peer-led counselling with problem discussion therapy for adolescents living with HIV in Zimbabwe: A cluster-randomised trial

Background Adolescents living with HIV have poor virological suppression and high prevalence of common mental disorders (CMDs). In Zimbabwe, the Zvandiri adolescent peer support programme is effective at improving virological suppression. We assessed the effect of training Zvandiri peer counsellors known as Community Adolescent Treatment Supporters (CATS) in problem-solving therapy (PST) on virological suppression and mental health outcomes. Methods and findings Sixty clinics were randomised 1:1 to either normal Zvandiri peer counselling or a peer counsellor trained in PST. In January to March 2019, 842 adolescents aged 10 to 19 years and living with HIV who screened positive for CMDs were enrolled (375 (44.5%) male and 418 (49.6%) orphaned of at least one parent). The primary outcome was virological nonsuppression (viral load ≥1,000 copies/mL). Secondary outcomes were symptoms of CMDs measured with the Shona Symptom Questionnaire (SSQ ≥8) and depression measured with the Patient Health Questionnaire (PHQ-9 ≥10) and health utility score using the EQ-5D. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using logistic regression adjusting for clinic-level clustering. Case reviews and focus group discussions were used to determine feasibility of intervention delivery. At baseline, 35.1% of participants had virological nonsuppression and 70.3% had SSQ≥8. After 48 weeks, follow-up was 89.5% for viral load data and 90.9% for other outcomes. Virological nonsuppression decreased in both arms, but there was no evidence of an intervention effect (prevalence of nonsuppression 14.7% in the Zvandiri-PST arm versus 11.9% in the Zvandiri arm; AOR = 1.29; 95% CI 0.68, 2.48; p = 0.44). There was strong evidence of an apparent effect on common mental health outcomes (SSQ ≥8: 2.4% versus 10.3% [AOR = 0.19; 95% CI 0.08, 0.46; p < 0.001]; PHQ-9 ≥10: 2.9% versus 8.8% [AOR = 0.32; 95% CI 0.14, 0.78; p = 0.01]). Prevalence of EQ-5D index score <1 was 27.6% versus 38.9% (AOR = 0.56; 95% CI 0.31, 1.03; p = 0.06). Qualitative analyses found that CATS-observed participants had limited autonomy or ability to solve problems. In response, the CATS adapted the intervention to focus on empathic problem discussion to fit adolescents’ age, capacity, and circumstances, which was beneficial. Limitations include that cost data were not available and that the mental health tools were validated in adult populations, not adolescents. Conclusions PST training for CATS did not add to the benefit of peer support in reducing virological nonsuppression but led to improved symptoms of CMD and depression compared to standard Zvandiri care among adolescents living with HIV in Zimbabwe. Active involvement of caregivers and strengthened referral structures could increase feasibility and effectiveness. Trial registration Pan African Clinical Trials Registry PACTR201810756862405.

Edinburgh Postnatal Depression Scale (EPDS) for screening for depression in the first year post delivery in a low-resourced rural setting in Kenya

Postnatal depression is one of the most common mental disorders among postnatal mothers and may have severe consequences for mothers and their children. Locally validated screening tools that can be self- or lay interviewer-administered are required to identify at-risk women, especially in settings with no mental health specialists. This study aimed to assess the validity and reliability of a culturally adapted version of the Edinburgh Postnatal Depression Scale (EPDS) in a local dialect (Kamba) in a Kenyan setting. Trained research assistants administered the local-language version of self-report scales (EPDS) to a sample of 544 Kamba-speaking women. The same scale was re-administered to the same research participants two weeks later by the same research assistants. The test scores were compared with an external ‘gold standard’ according to the DSM-IV criteria Mini-International Neuropsychiatric Interview for adults (MINI-Plus). The EPDS had an area under the curve (AUC) of 0.867 with 95% C.I of 0.836 to 0.894, with a cut-off point of ≥11, sensitivity of 81.0% (95% C.I 70.6–89.0) and specificity of 82.6% (95% CI 78.8–85.9). The positive predictive value (PPV) and negative predictive value (NPV) were 44.1% and 96.2%, respectively. The internal reliability was 0.852 and the test-retest reliability was 0.496. The EPDS showed good utility in detecting depressive disorder in Kamba-speaking postnatal women. It does not have to be administered by mental health workers (who are few in low- and middle-income countries); rather, this can be done by a trained lay interviewer.

Psychological Distress in Men during the COVID-19 Pandemic in Brazil: The Role of the Sociodemographic Variables, Uncertainty, and Social Support

Objective: To analyze the relationships between sociodemographic variables, intolerance to uncertainty (INT), social support, and psychological distress (i.e., indicators of Common Mental Disorders (CMDs) and perceived stress (PS)) in Brazilian men during the COVID-19 pandemic. Methods: A cross-sectional study with national coverage, of the web survey type, and conducted with 1006 Brazilian men during the period of social circulation restriction imposed by the health authorities in Brazil for suppression of the coronavirus and control of the pandemic. Structural equation modeling analysis was performed. Results: Statistically significant direct effects of race/skin color (λ = 0.268; p-value < 0.001), socioeconomic status (SES) (λ = 0.306; p-value < 0.001), household composition (λ = 0.281; p-value < 0.001), PS (λ = 0.513; p-value < 0.001), and INT (λ = 0.421; p-value < 0.001) were evidenced in the occurrence of CMDs. Black-skinned men with higher SES, living alone, and with higher PS and INT levels presented higher prevalence values of CMDs. Conclusions: High levels of PS and INT were the factors that presented the strongest associations with the occurrence of CMDs among the men. It is necessary to implement actions to reduce the stress-generating sources as well as to promote an increase in resilience and the development of intrinsic reinforcements to deal with uncertain threats.

Development of a Screening Tool for Common Mental Disorders Among General Hospital Inpatients in China

Background: Depression and anxiety disorders are common conditions among general hospital inpatients, but are believed to be under-recognized in China.Methods: A short, practical questionnaire termed the happiness index scale (HIS) was developed for screening co-morbid mental disorders in non-psychiatric clinical settings. The HIS was completed by 1,005 non-psychiatric inpatients in a general hospital in China. The reliability and validity of the HIS were then assessed.Results: The HIS comprised eight items which loaded onto four dimensions: (a) sleep quality; (b) suicidal tendency; (c) depression; and (d) anxiety. These dimensions explained 84.2% of the total variance. Confirmatory factor analysis showed reasonably good fit of the four-factor model (χ2/df = 1.27, p &lt; 0.001, goodness-of-fit index = 0.95, comparative fit index = 0.99, root-mean-square error of approximation = 0.008). The correlation coefficients between each item and the corresponding factor were all &gt; 0.5. Cronbach's α of the entire scale was 0.83, indicating good internal consistency. The area under the ROC curve was 0.95 compared with the original 31-item scale. Using the optimal cut-off score of HIS (mild happiness), the sensitivity and specificity were 0.933 and 0.882, respectively.Conclusions: The new HIS scale is a practical screening tool composed of eight items covering the four most common and important dimensions of mental disorder. The HIS exhibited good reliability and specificity. The HIS is potentially suitable for large-scale screening in busy non-psychiatric clinical settings in China. Further verification using larger samples is warranted.