World Psychiatric Association-Asian Journal of Psychiatry Commission on Public Mental Health.

Although there is considerable evidence showing that the prevention of mental illnesses and adverse outcomes and mental health promotion can help people lead better and more functional lives, public mental health remains overlooked in the broader contexts of psychiatry and public health. Likewise, in undergraduate and postgraduate medical curricula, prevention and mental health promotion have often been ignored. However, there has been a recent increase in interest in public mental health, including an emphasis on the prevention of psychiatric disorders and improving individual and community wellbeing to support life trajectories, from childhood through to adulthood and into older age. These lifespan approaches have significant potential to reduce the onset of mental illnesses and the related burdens for the individual and communities, as well as mitigating social, economic, and political costs. Informed by principles of social justice and respect for human rights, this may be especially important for addressing salient problems in communities with distinct vulnerabilities, where prominent disadvantages and barriers for care delivery exist. Therefore, this Commission aims to address these topics, providing a narrative overview of relevant literature and suggesting ways forward. Additionally, proposals for improving mental health and preventing mental illnesses and adverse outcomes are presented, particularly amongst at-risk populations.

World Psychiatric Association-Asian Journal of Psychiatry Commission on Psychiatric Education in the 21st century.

Psychiatric practice faces many challenges in the first quarter of 21st century. Society has transformed, as have training requirements and patient expectations, underlining an urgent need to look at educational programmes. Meanwhile, awareness has grown around psychiatric disorders and there are evolving workforce trends, with more women going to medical school and specialising in psychiatry. Trainee psychiatrists carry different expectations for work-life balance and are increasingly becoming conscious of their own mental health. A tendency to see health as a commodity and the litigious nature of society has elicited additional pressures for healthcare professionals. Cartesian mind-body dualism has created further complexity and this can often be frustrating for patients and care-partners alike. In many cultures across Asia and beyond, patients can present with physical symptoms to express underlying psychological distress with increasing physical investigations. Simultaneously, in various countries, a shift from asylums to community-based interventions and then home treatments have changed psychiatric care in remarkable ways. These changes have added to pressures faced by mental healthcare professionals. However, trainees and other mental healthcare professionals continue to receive similar training as they did a generation ago. The tensions and differences in ideology/orientation between different branches of psychiatry have made responses to patient needs challenging. Recognising that it is difficult to predict the future, this World Psychiatric Association-Asian Journal of Psychiatry Commission makes recommendations that could help institutions and individuals enhance psychiatric education. This Commission draws from existing resources and recent developments to propose a training framework for future psychiatrists.

Prevalence of burnout in medical students in Guatemala: Before and during Covid-19 pandemic comparison.

Burnout is a syndrome consisting of physical, emotional, and mental exhaustion along with depersonalization and poor sense of personal accomplishment. Often related to work conditions. Several recent studies from around the world have shown high rates of burnout among medical students in different countries. In Guatemala City, we decided to assess levels of burnout in 2017 and then again in December 2020. In the first wave from one private medical school, we had a total of 159 respondents (response rate of 56.7%) and 132 (48.5%) in the second wave. Not surprisingly rates of burnout were higher during the pandemic even though response rate is lower. Surprisingly we found that rates of depersonalization had not increased, and levels of personal accomplishment had. These findings present a mixed picture of levels of burnout in Guatemala City. Further qualitative research is indicated to explore cultural differences in order to set up appropriate and suitable intervention strategies.

Prevalencia de trastorno depresivo en pacientes con diabetes mellitus en una institución privada en la ciudad de Guatemala

Introducción- La diabetes mellitus es una enfermedad que afecta a millones de personas alrededor del mundo y causa múltiples patologías. Actualmente se ha evidenciado una relación estrecha entre la diabetes mellitus y trastornos mentales, como la depresión. Se cree que al enfrentar la depresión como otra de las patologías causadas por la diabetes y se obtienen mejores resultados tratando adecuadamente la enfermedad y así lograr una mejor expectativa de vida. Objetivo: El objetivo de este trabajo es establecer la prevalencia de trastorno depresivo en pacientes con diabetes mellitus en una institución privada de la ciudad de Guatemala. Métodos: Estudio descriptivo de 77 personas con diagnóstico previo de diabetes mellitus usando el cuestionario de depresión de Beck como instrumento diagnóstico (1). Resultados: Se evidencio que la prevalencia de trastorno depresivo en pacientes con diagnóstico de diabetes mellitus es 30%. El nivel de depresión observado con más frecuencia es leve en un 43% y el nivel de depresión severo se observó en 13%. Se observó depresión en mayor porcentaje en el sexo femenino que masculino (35% vs. 23% respectivamente) y en pacientes mayores de 60 años (39%). Conclusiones Se estableció que la prevalencia de depresión en pacientes con diabetes mellitus es mayor que la observada en estudios previos. No se observó que fuera estadísticamente significativa la diferencia entre sexo y edad en los pacientes que padecen de depresión a pesar que los porcentajes son mayores en el sexo femenino y en sujetos mayores de 60 años

Introduction: Diabetes mellitus is a disease affecting millions of people worldwide and cause serious conditions. Recently a close relationship between diabetes and mental illness, like depression has been stressed. Maintaining a good control of diabetes will yield to better results treating depression with a better life expectancy. Objective: The main purpose of this study is to establish the prevalence of depressive disorder in patients with diabetes mellitus in a private institution in Guatemala City. Methods: Descriptive study of 77 subjects with diagnosis of diabetes mellitus evaluated in a private institution using Beck´s inventory for measuring depression. (1) Results: The prevalence of depressive disorder in patients diagnosed with diabetes mellitus was 30%. The level of depression observed more frequently was a mild form with 43%, and severe form was observed in 13% of patients. Depression was observed in a higher percentage in females than in males (35% vs. 23%), and in older than 60 years old (39%). Conclusion: The prevalence of depression in patients with diabetes mellitus was higher that the observed in recent studies. No difference found between sex and age and no statistically significance found. Depression can also be related with other factors such as socioeconomic, education, etc

Geopolitical factors and mental health I.

Natural and man-made disasters carry with them major burden and very often the focus is on immediate survival and management of resulting infectious diseases. The impact of disasters directly and indirectly on the well-being and mental health of those affected often gets ignored. The reasons are often stigma and lack of attention to mental health consequences. In addition, often the focus is on preventing the spread of infectious diseases such as waterborne or airborne diseases. This is further complicated by the fact that often aid agencies in offering aid tend to focus on communicable diseases and not on mental health of populations. This focus may reflect easily to measure outcomes in comparison with mental illnesses as the global burden of disease is likely to increase in the next few decades. There is an urgent need to apply the principles of social justice on social and health care policies, which will lead to elimination of stigma. In this article, we propose that the impact of mental illness as a result of disasters needs to be taken seriously in any planning and delivery of relief. Mental health is likely to be affected both directly and indirectly as a result of disasters and also likely to be influenced by ongoing factors such as poor housing, overcrowding and other social determinants. In addition to deliver equity between physical and mental illnesses, appropriate and adequate resources are needed so that identifiable needs can be met with clear outcomes.

Geopolitical factors, foreign aid and mental health II: Value for money.

In the previous accompanying paper, we described geopolitical factors which affect mental health of individuals who suffer directly and indirectly. These disasters whether they are natural or man-made often attract significant amounts of aid and resources - financial and human. In addition, those who offer foreign aid need to be aware of where and how the aid is being spent. In this paper, we propose that aid giving agencies give due attention to the impact the aid should have on mental health of recipients. Global mental health has become a movement, but concerns remain about its efficacy. Therefore, it is imperative that any aid given is given and utilised in a culturally appropriate and culturally sensitive way. In an interconnected and interlinked world, it is likely that when one country or nation is affected by disasters or trauma, it will impact upon others around both directly and indirectly. We present a new measurement tool-CAPE Vulnerability Index which can be used to identify most vulnerable communities so that international aid may be more appropriately targeted. We believe that this index may go some way in assisting governments and policymakers in ascertaining the impact of their aid on the emotional and mental health of individuals. We suggest that their needs to be a ring-fencing of aid to ensure that population mental health is protected and enhanced with a strategic approach inbuilt into the foreign policy the focus needs to shift towards public mental health.