Community-based mental health interventions in low- and middle-income countries: a qualitative study with international experts.

BACKGROUND: Mental health services are scarce in low- and middle-income countries (LMICs), and designing and implementing effective interventions can be difficult. The aim of this international study was to explore the key lessons for developing, implementing, and evaluating community-based mental health and well-being interventions in LMICs, with an additional focus on older adults. METHODS: Research and clinical experts in developing and implementing psychosocial community-based interventions in LMICs were interviewed remotely between October 2021 and January 2022. Participants were recruited via existing global health networks and via published literature searches. Participants were asked about their experiences of developing and implementing interventions, and about key barriers and facilitators during the process. Interviews lasted up to 45 min, and data were analysed using combined inductive and deductive thematic analysis. RESULTS: Sixteen global mental health experts participated. Five themes with different sub-themes were generated: Mechanisms and contexts; Barriers; Facilitators; Public and stakeholder involvement; Looking through an ageing lens. The development and delivery of mental health interventions in LMICs are facilitated through integration into existing health infrastructures and working with existing job roles as delivery agents. Public and stakeholder involvement are crucial at all stages of development through to implementation to focus on meeting local needs and sustaining participant motivation. Logistical barriers of transport, resources, and location need to be addressed, emphasising local sustainability. CONCLUSIONS: This study provides important insights for how the development, implementation, and evaluation of community-based mental health and well-being interventions in LMICs can be optimised, and can complement general guidance into complex interventions developments.

Community-based mental health and well-being interventions for older adults in low- and middle-income countries: a systematic review and meta-analysis.

BACKGROUND: Mental health support is often scarce in low- and middle-income countries (LMIC), with mental health stigmatised. Older adults are some of the most vulnerable members of society and may require specific types of mental health support. The aim of this mixed-methods systematic review and meta-analysis was to explore the types, components, and efficacy of psychosocial community-based mental health interventions for older adults (aged 60 + years) residing in LMIC. METHODS: Six databases were searched in August 2021. Studies published since 2000 were included if they collected primary quantitative or qualitative data on community-based interventions for improving mental health for older adults residing in LMICs, focusing on improving mental health and well-being outcomes. Full texts were screened by two researchers. RESULTS: From 24,378 citations identified, 40 studies met eligibility criteria. Across 12 countries, interventions were categorised into those focusing on (1) Established forms of psychological therapy; (2) Exercise; (3) Education; (4) Social engagement; (5) Multi-component. Most interventions were effective in reducing levels of depression, anxiety, and improving well-being, including reminiscence therapy, different types of socialising, and breathing and laughter exercises. Some interventions reported no benefits and those that did at times failed to report continued benefits at follow-up. Given the variations in intervention type and delivery, cultures, and outcome measures used, underpinning factors of intervention success or failure were difficult to establish. CONCLUSIONS: Psychosocial interventions for older adults in LMIC need to be adapted to local contexts depending on culture and population needs. Existing interventions and their components can be used as a foundation to produce adapted and multi-component interventions, to tackle growing and inadequate mental health care provision in LMIC. TRIAL REGISTRATION: The review protocol was registered on PROSPERO [CRD42021271404].

Understanding post-conflict mental health needs and co-producing a community-based mental health intervention for older adults in Colombia: a research protocol.

BACKGROUND: Older adults in Colombia have seen a number of stressful life events - including the Colombian armed conflict, forced misplacement and recently COVID-19. These events likely have had and are having a substantial impact on people's mental health and well-being, whilst mental health care provision in Colombia is not sufficient and often access is limited and unaffordable. Therefore, the aim of this study is to understand the impact of stressful life events on the mental health of older adults living in Colombia, and co-produce, pilot, and evaluate a community-based mental health intervention in Turbo. METHODS: This 3-year international mixed-methods study comprises of three phases: Phase I will explore the impact of stressful life events on the mental health of older adults living in Colombia, and their mental health needs, via quantitative needs assessments and qualitative interviews and focus groups; Phase II will involve synthesising the findings from Phase I as well as conducting a systematic review and qualitative interviews with experts into implementing mental health interventions in LMICs to co-produce a community-based mental health intervention with older adults and local community group leaders and care providers; Phase III will involve the piloting and evaluation of the mental health intervention via quantitative and qualitative assessments. Co-production and public involvement underpin each element of this project. DISCUSSION: Appropriate mental health care is as important as physical health care, but this study also looks at how we might integrate these findings into community-level public health initiatives for application both within Colombia and more widely in both LMICs and more developed countries. This study protocol will act as a guide for the development and adaptation of psychosocial mental health interventions in different cultures and contexts.

[Cerebral venous sinus thrombosis: Epidemiology, clinical characteristics, imaging and prognosis]. / Trombosis de senos venosos cerebrales: epidemiología, características clínicas, imaginología y pronóstico.

INTRODUCTION: Cerebral venous sinus thrombosis represents 0.5 - 1% of all cerebrovascular diseases. OBJECTIVE: The aim of this study was to determine the epidemiological, clinical, and imaging features of the disease, as well as the outcomes of patients with cerebral venous sinus thrombosis, and to explore the characteristics associated with unfavorable patient outcomes. MATERIALS AND METHODS: In this cross-sectional, retrospective study, the medical records of 37 patients with cerebral venous sinus thrombosis were analyzed. RESULTS: Eighty-six percent of the patients were women, and the mean patient age was 41 years. The most frequently reported symptom was headache (86.5%); headache was the single presenting symptom in 40.5% of the patients. Sixty-eight percent of the patients had at least one risk factor, the most frequent of which was obesity (24.3%). A total of 43.2% of the patients had no focal neurological findings. The most common finding on computerized tomography (CT) was hyperdense venous sinuses; on Magnetic Resonance Imaging (MRI), the most common finding was venous infarction. On average, 2.27±1.3 sinuses were involved; most frequently, the transverse venous sinuses were affected. The average hospital stay was 7.8±3.6 days. At hospital discharge, the outcomes were favorable in 92% of the patients, and the mortality rate was 5.4%. CONCLUSIONS: Cerebral venous sinus thrombosis is a different type of cerebrovascular disorder, with distinct epidemiology, risk factors, clinical presentations and functional outcomes. The diagnosis is based on clinical suspicion because of the unspecific clinical presentation of the disease.

Trombosis de senos venosos cerebrales: epidemiología, características clínicas, imaginología y pronóstico / Cerebral venous sinus thrombosis: Epidemiology, clinical characteristics, imaging and prognosis

Introducción. La trombosis de senos venosos cerebrales representa entre 0,5 y 1 % de las enfermedades cerebrovasculares en adultos, y sus factores de riesgo son diferentes a los del resto de dichas enfermedades. Objetivo. Determinar la epidemiología, las características clínicas e imaginológicas, así como los resultados en pacientes con trombosis de senos venosos cerebrales, y explorar los aspectos asociados con los puntajes desfavorables en la escala modificada de Rankin. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de corte transversal en el Instituto Neurológico de Colombia entre marzo de 2006 y junio de 2011, periodo en el que se analizaron las historias clínicas de 37 pacientes con diagnóstico confirmado por neuroimágenes. Resultados. El 86,5 % de los pacientes eran mujeres, con una edad promedio de 41 años. El síntoma más frecuente fue la cefalea (86,5 %), el cual se presentó como único síntoma en el 40,5 % de los casos. El 68 % tenía, por lo menos, un antecedente de riesgo para trombosis de senos venosos cerebrales, siendo el más frecuente la obesidad (24,3 %), seguido del uso de anticonceptivos hormonales (21,9 %). El examen neurológico fue normal en el 43,2 %. El hallazgo más frecuente en la tomografía fue la hiperdensidad de los senos venosos (33 %) y, en la resonancia magnética, el infarto venoso (37,5 %). El promedio de senos comprometidos fue de 2,27+1,3, siendo más frecuente el compromiso de los transversos. La estancia hospitalaria promedio fue de 7,8+3,6 días. El 92 % de los pacientes presentaba resultados funcionales favorables al dárseles de alta. La mortalidad hospitalaria fue de 5,4 % y se relacionó directamente con la trombosis de senos venosos cerebrales. Conclusiones. La trombosis de senos venosos cerebrales difiere de los otros tipos de enfermedad cerebrovascular en cuanto a su perfil epidemiológico, factores de riesgo, presentación clínica y pronóstico. Es una condición que exige un alto grado de sospecha diagnóstica, pues su presentación clínica es inespecífica.

Introduction: Cerebral venous sinus thrombosis represents 0.5 - 1% of all cerebrovascular diseases. Objective: The aim of this study was to determine the epidemiological, clinical, and imaging features of the disease, as well as the outcomes of patients with cerebral venous sinus thrombosis, and to explore the characteristics associated with unfavorable patient outcomes. Materials and methods: In this cross-sectional, retrospective study, the medical records of 37 patients with cerebral venous sinus thrombosis were analyzed. Results: Eighty-six percent of the patients were women, and the mean patient age was 41 years. The most frequently reported symptom was headache (86.5%); headache was the single presenting symptom in 40.5% of the patients. Sixty-eight percent of the patients had at least one risk factor, the most frequent of which was obesity (24.3%). A total of 43.2% of the patients had no focal neurological findings. The most common finding on computerized tomography (CT) was hyperdense venous sinuses; on Magnetic Resonance Imaging (MRI), the most common finding was venous infarction. On average, 2.27±1.3 sinuses were involved; most frequently, the transverse venous sinuses were affected. The average hospital stay was 7.8±3.6 days. At hospital discharge, the outcomes were favorable in 92% of the patients, and the mortality rate was 5.4%. Conclusions: Cerebral venous sinus thrombosis is a different type of cerebrovascular disorder, with distinct epidemiology, risk factors, clinical presentations and functional outcomes. The diagnosis is based on clinical suspicion because of the unspecific clinical presentation of the disease.