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1.
Npj Ment Health Res ; 3(1): 9, 2024 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-38609473

RESUMO

In the Democratic Republic of the Congo (DRC), the prevalence of mental health issues could be greater than in other low-income and middle-income countries because of major risk factors related to armed conflicts and poverty. Given that mental health is an essential component of health, it is surprising that no systematic evaluation of mental health in the DRC has yet been undertaken. This study aims to undertake the first systematic review of mental health literacy and service provision in the DRC, to bridge this gap and inform those who need to develop an evidence base. This could support policymakers in tackling the issues related to limited mental health systems and service provision in DRC. Following Cochrane and PRISMA guidelines, a systematic (Web of Science, Medline, Public Health, PsycINFO, and Google Scholar) search was conducted (January 2000 and August 2023). Combinations of key blocks of terms were used in the search such as DRC, war zone, mental health, post-traumatic stress disorder (PTSD), anxiety, depression, sexual violence, war trauma, resilience, mental health systems and service provision. We followed additional sources from reference lists of included studies. Screening was completed in two stages: title and abstract search, and full-text screening for relevance and quality. Overall, 50 studies were included in the review; the majority of studies (n = 31) were conducted in the Eastern region of the DRC, a region devastated by war and sexual violence. Different instruments were used to measure participants' mental health such as the Hopkins Symptoms Checklist (HSCL-25), The Harvard Trauma Questionnaire, Patient Health Questionnaire (PHQ-9); General Anxiety Disorder (GAD-7), and Positive and Negative Symptoms Scale (PANSS). Our study found that wartime sexual violence and extreme poverty are highly traumatic, and cause multiple, long-term mental health difficulties. We found that depression, anxiety, and PTSD were the most common problems in the DRC. Psychosocial interventions such as group therapy, family support, and socio-economic support were effective in reducing anxiety, depression, and PTSD symptoms. This systematic review calls attention to the need to support sexual violence survivors and many other Congolese people affected by traumatic events. This review also highlights the need for validating culturally appropriate measures, and the need for well-designed controlled intervention studies in low-income settings such as the DRC. Better public mental health systems and service provision could help to improve community cohesion, human resilience, and mental wellbeing. There is also an urgent need to address wider social issues such as poverty, stigma, and gender inequality in the DRC.

2.
BMC Psychiatry ; 24(1): 160, 2024 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-38395842

RESUMO

BACKGROUND: When an individual is detained in hospital it is important that they maintain contact with their family, friends and communities as these can be helpful for their well-being and recovery. Maintaining these relationships is also important to unpaid carers (family or friends), but they can be strained by carers' instigation of, or compliance with, the involuntary detention. Section 17 of the Mental Health Act (1983) in England and Wales allows for temporary leave from hospital, from an hour in the hospital grounds to going home for a few days. However, carers are not always involved in decisions around statutory s.17 leave, even where they are expected to support someone at home. This study aimed to explore how practice can be improved to better involve and support carers around s.17 leave. METHODS: Semi-structured interviews and focus groups were held with 14 unpaid carers and 19 mental health practitioners, including four Responsible Clinicians, in three sites in England in 2021. The research explored views on what works well for carers around s.17 leave, what could be improved and the barriers to such improvements. Transcripts were analysed using reflexive thematic analysis. RESULTS: Three themes were identified in the analysis: the need for carer support and the challenges surrounding provision; challenges with communication, planning and feedback around s.17 leave; and inconsistency in involving carers around s.17 leave. Permeating all themes was a lack of resources presenting as under-staffing, high demands on existing staff, and lack of time and capacity to work and communicate with carers. CONCLUSION: Implications include the need for more funding for mental health services for both prevention and treatment; staff training to increase confidence with carers; and standardised guidance for practitioners on working with carers around s.17 leave to help ensure consistency in practice. The study concluded with the production of a 'S.17 Standard', a guidance document based on the research findings consisting of 10 steps for practitioners to follow to support the greater involvement and support of carers.


Assuntos
Cuidadores , Serviços de Saúde Mental , Humanos , Cuidadores/psicologia , Saúde Mental , Inglaterra , Hospitais
3.
Trials ; 24(1): 652, 2023 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-37803385

RESUMO

BACKGROUND: New treatments are needed for people with treatment-resistant depression (TRD), who do not benefit from anti-depressants and many of whom do not recover fully with psychological treatments. The Community Navigator programme was co-produced with service users and practitioners. It is a novel social intervention which aims to reduce loneliness and thus improve health outcomes for people with TRD. Participants receive up to 10 individual meetings with a Community Navigator, who helps them to map their social world and set and enact goals to enhance their social connections and reduce loneliness. Participants may also access group meet-ups with others in the programme every 2 months, and may be offered modest financial support to enable activities to support social connections. METHODS: A researcher-blind, multi-site, 1:1 randomised controlled trial with N = 306 participants will test the effectiveness of the Community Navigator programme for people with TRD in secondary community mental health teams (CMHTs). Our primary hypothesis is that people who are offered the Community Navigator programme as an addition to usual CMHT care will be less depressed, assessed using the PHQ-9 self-report measure, at 8-month, end-of-treatment follow-up, compared to a control group receiving usual CMHT care and a booklet with information about local social groups and activities. We will follow participants up at end-of-treatment and at 14 months, 6 months after end-of-treatment follow-up. Secondary outcomes include the following: loneliness, anxiety, personal recovery, self-efficacy, social network, social identities. We will collect data about health-related quality of life and service use to investigate the cost-effectiveness of the Community Navigator programme. DISCUSSION: This trial will provide definitive evidence about the effectiveness and cost-effectiveness of the Community Navigator programme and whether it can be recommended for use in practice. The trial is due to finish in August 2025. TRIAL REGISTRATION: Prospectively registered on 8th July 2022 at: ISRCTN13205972.


Assuntos
Serviços Comunitários de Saúde Mental , Humanos , Adulto , Depressão/terapia , Solidão , Qualidade de Vida , Ansiedade/psicologia , Análise Custo-Benefício , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Ann Gen Psychiatry ; 22(1): 8, 2023 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-36915120

RESUMO

BACKGROUND: Leisure activities can improve quality of life in the general population. For people with psychosis, negative symptoms (e.g. being unmotivated, difficulty in sticking with activities) are often a barrier to engaging in social leisure activities. However, we do not know if participation in leisure activities is associated with quality of life in this group and, whether psychosocial interventions should aim to increase leisure activities. AIM: This study investigates participation in social leisure activities of people with psychosis and whether their participation is associated with better quality of life. METHODS: A cross-sectional survey was conducted in 6 NHS mental health trusts. Adults aged 18-65 (N = 533) with a diagnosis of a psychosis-related condition (ICD-10 F20-29) were recruited from outpatient secondary mental health services. Several measures were used including an adapted version of the Time Use Survey (TUS), the Social contacts assessment (SCA) and Manchester Short Assessment of Quality of Life (MANSA). A Structural Equation Model (SEM) was used to explore the relationships between participation in leisure activities and quality of life, and whether social contacts mediated the link. RESULTS: Participants attended an average of 2.42 (SD = 1.47) leisure activities in the last 7 days. Their quality of life increased with the number of leisure activities they attended. Participation in leisure activities was positively associated with quality of life in people with psychosis (B = 0.104, SE = 0.051, p = 0.042, 95% CI [0.003 to 0.204]). Leisure activities predicted social contacts, but the link between social contacts and the quality of life was not significant. After controlling for sociodemographic factors, being female and unemployed were negatively linked with quality of life (B = - 0.101, SE = 0.048, p = 0.036, 95% CI [- 0.196 to - 0.006; B = - 0.207, SE = 0.050, p = 0.001, 95% CI [- 0.305 to - 0.108, respectively]. CONCLUSION: People with psychosis who attend more leisure activities have a higher quality of life. Quality of life was lower amongst female and unemployed participants who attended leisure activities. Intervention which helps improve participation in leisure activities may be beneficial for people with psychosis. Trial registration number ISRCTN15815862.

5.
J Ment Health ; : 1-17, 2022 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-35532039

RESUMO

BACKGROUND: Unpaid carers of adult mental health inpatients often lack support for their well-being and feel excluded from decisions about patient care. AIMS: This scoping review aimed to: synthesise the peer-reviewed literature evaluating the outcomes of brief interventions for unpaid carers of adult mental health inpatients, identify transferable lessons for evidenced-informed practice, and establish future research priorities. METHODS: PRISMA scoping review guidelines were followed to search 12 databases using predefined search terms. Two reviewers independently screened papers and applied exclusion/inclusion criteria. Studies were included if they evaluated the impact or outcomes of interventions. Two reviewers extracted data and assessed study quality. Data were synthesised to categorise types of interventions and evidence for their outcomes. RESULTS: 16 papers met the inclusion criteria, and five types of interventions were identified: those that aimed to (1) increase carer involvement in inpatient care; (2) facilitate organisational change to increase carer support and involvement; (3) provide carers with support; (4) deliver psychoeducation and offer support; and (5) reduce carer stress and improve coping skills. CONCLUSIONS: Whilst evidence of intervention effectiveness was promising, the quality of studies was generally weak. More research is needed to develop an evidence-informed approach to supporting carers during inpatient stays.

6.
BMC Psychiatry ; 22(1): 302, 2022 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-35484521

RESUMO

BACKGROUND: Poor social circumstances can induce, exacerbate and prolong symptoms of mental health conditions, while having a mental health condition can also lead to worse social outcomes. Many people with mental health conditions prioritise improvement in social and functional outcomes over reduction in clinical symptoms. Interventions that improve social circumstances in this population should thus be considered a priority for research and policy. METHODS: This rapid evidence synthesis reports on randomised controlled trials of interventions to improve social circumstances across eight social domains (Housing and homelessness; money and basic needs; work and education; social isolation and connectedness; family, intimate and caring relationships; victimisation and exploitation; offending; and rights, inclusion and citizenship) in people with mental health conditions. Economic evaluations were also identified. A comprehensive, stepped search approach of the Cochrane library, MEDLINE, Embase, PsycINFO, Web of Science and Scopus was conducted. RESULTS: One systematic review and 102 randomised controlled trials were included. We did not find RCT evidence for interventions to improve family, intimate and caring relationships and only one or two trials for each of improving money and basic needs, victimisation and exploitation, and rights, inclusion and citizenship. Evidence from successful interventions in improving homelessness (Housing First) and employment (Individual Placement and Support) suggests that high-intensity interventions which focus on the desired social outcome and provide comprehensive multidisciplinary support could influence positive change in social circumstances of people with mental health conditions. Objective social isolation could be improved using a range of approaches such as supported socialisation and social skills training but interventions to reduce offending showed few benefits. Studies with cost and cost-effectiveness components were generally supportive of interventions to improve housing and vocational outcomes. More research is needed to ensure that social circumstances accompanied by high risks of further exacerbation of mental health conditions are adequately addressed. CONCLUSIONS: Although there is a large body of literature examining how to support some aspects of life for people with mental health conditions, more high-quality evidence is required in other social domains. Integration into mental health services of interventions targeting social circumstances could significantly improve a number of social outcomes.


Assuntos
Pessoas Mal Alojadas , Transtornos Mentais , Serviços de Saúde Mental , Humanos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Saúde Mental , Isolamento Social/psicologia
7.
BMJ Open ; 12(4): e057530, 2022 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-35393321

RESUMO

INTRODUCTION: The launch of the Movement for Global Mental Health brought long-standing calls for improved mental health interventions in low-and middle-income countries (LMICs) to centre stage. Within the movement, the participation of communities and people with lived experience of mental health problems is argued as essential to successful interventions. However, there remains a lack of conceptual clarity around 'participation' in mental health interventions with the specific elements of participation rarely articulated. Our review responds to this gap by exploring how 'participation' is applied, what it means and what key mechanisms contribute to change in participatory interventions for mental health in LMICs. METHODS AND ANALYSIS: A realist review methodology will be used to identify the different contexts that trigger mechanisms of change, and the resulting outcomes related to the development and implementation of participatory mental health interventions, that is: what makes participation work in mental health interventions in LMICs and why? We augment our search with primary data collection in communities who are the targets of global mental health initiatives to inform the production of a programme theory on participation for mental health in LMICs. ETHICS AND DISSEMINATION: Ethical approval for focus group discussions (FGDs) was obtained in each country involved. FGDs will be conducted in line with WHO safety guidance during the COVID-19 crisis. The full review will be published in an academic journal, with further papers providing an in-depth analysis on community perspectives on participation in mental health. The project findings will also be shared on a website, in webinars and an online workshop.


Assuntos
Países em Desenvolvimento , Saúde Mental , COVID-19 , Humanos , Renda , Pobreza
8.
Community Ment Health J ; 58(7): 1338-1345, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35079917

RESUMO

This paper explores the subjective experiences of mental health practitioners, people with psychosis and carers, on social isolation and community integration of people with psychosis. Focus groups and one-to-one interviews with 80 adult participants across three sites in the UK were conducted. Audio recordings were transcribed and analysed using thematic analysis. Participants commented on various aspects that may cause social isolation or enable community integration, including institutional factors (lack of resources, hospitalisation impact), illness symptoms (e.g., paranoia; over-pathologising vs individual choice), stigma (particularly the psychosis label), and the importance of communities that foster agency and embrace change. Hospitalisation maybe be a cause for isolation and psychiatric wards should consider allowing for socialisation as a therapeutic tool. Initiatives should consider the social fabric of our communities, socioeconomic inequalities and stigmatisation. Building communities that are accepting, kind and flexible can create opportunities that could lead to independence from mental health services.


Assuntos
Serviços de Saúde Mental , Transtornos Psicóticos , Adulto , Cuidadores/psicologia , Humanos , Saúde Mental , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Isolamento Social
9.
Int J Community Wellbeing ; 5(1): 179-195, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34723113

RESUMO

The NHS Plan is introducing social prescribing link workers into GP surgeries in England. The link workers connect people to non-health resources in the community and voluntary sector, with the aim of meeting individual needs beyond the capacity of the NHS. Social prescribing models focus on enhancing individual wellbeing, guided by the policy of universal personalised care. However, they largely neglect the capacity of communities to meet individual need, particularly in the wake of a decade of austerity. We propose a model of community enhanced social prescribing (CESP) which has the potential to improve both individual and community wellbeing. CESP combines two evidence-informed models - Connected Communities and Connecting People - to address both community capacity and individual need. CESP requires a literacy of community which recognises the importance of communities to individuals and the importance of engaging with, and investing in, communities. When fully implemented the theory of change for CESP is hypothesised to improve both individual and community wellbeing.

10.
Soc Psychiatry Psychiatr Epidemiol ; 57(9): 1907-1915, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34791516

RESUMO

PURPOSE: People with psychosis are vulnerable to social isolation, which is associated with worse clinical outcomes. In general populations, people living in areas with higher population density have more social contacts, while those living in more socially deprived and fragmented areas are less satisfied with their relationships. We assessed whether and how neighbourhood factors are associated with social contacts and satisfaction with friendships for people with psychosis. METHODS: We carried out a cross-sectional study including people with psychosis aged 18-65 years in urban and rural sites in England. Population density and social deprivation and fragmentation indexes were described within Lower Level Super Output Areas (LSOA). Their associations with participants' social contacts and satisfaction with friendships were tested with negative binomial and ordinal regression models, respectively. RESULTS: We surveyed 511 participants with psychotic disorders. They had a median of two social contacts in the previous week (interquartile range [IQR] = 1-4), and rated satisfaction with friendships as 5 out of 7 (Manchester Short Assessment of Quality of Life; IQR = 4-6). Higher population density was associated with fewer social contacts (Z-standardised relative risk [RR] = 0.88; 95% CI = 0.79-0.99, p = 0.03), but not with satisfaction with friendships (RR = 1.08; 95% CI = 0.93-1.26, p = 0.31). No associations were found for social contacts or satisfaction with friendships with social deprivation or fragmentation indexes. CONCLUSIONS: Clinicians in urban areas should be aware that their patients with psychosis are more socially isolated when more people live around them, and this could impact their clinical outcomes. These findings may inform housing programmes.


Assuntos
Características da Vizinhança , Transtornos Psicóticos , Estudos Transversais , Humanos , Transtornos Psicóticos/epidemiologia , Qualidade de Vida , Isolamento Social
11.
Schizophr Res ; 240: 46-51, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34923207

RESUMO

Many people with psychosis have few social contacts which can significantly reduce quality of life. While the symptoms of psychosis are thought to contribute to social isolation, they could also lead to the perception that patients are uninterested in increasing their social contacts or in socialisation interventions. Hence, those who most need support to reduce isolation may be less likely to receive it. Despite this, studies have yet to identify the characteristics of patients who do and do not want to increase their social contacts. A cross-sectional study was conducted with 548 participants with psychosis in community mental health teams across England, covering urban and rural areas. Logistic regression analysis was used to determine predictors of wanting to vs. not wanting to increase social contacts. Content analysis was used to explore reasons. The majority (68%) of participants reported a desire for more social contacts, which was significantly associated with lower quality of life. While people with lower quality of life were more likely to express a desire for more contacts, they were less likely to feel confident in increasing them. Reasons for not wanting to increase contacts were related either to perceived barriers or to feeling content with current circumstances. It may be concluded that people with psychosis who have a lower quality of life and little confidence in socialising have a greater desire for more social contacts. Hence, contrary to traditional beliefs, they are likely to be motivated to engage with support to reduce isolation if it is offered.


Assuntos
Transtornos Psicóticos , Qualidade de Vida , Estudos Transversais , Inglaterra/epidemiologia , Humanos , Transtornos Psicóticos/epidemiologia , Isolamento Social
12.
BMJ Open ; 11(12): e050627, 2021 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-34903539

RESUMO

INTRODUCTION: People with psychosis tend to have smaller social networks than both people in the general population and other people with long-term health conditions. Small social networks are associated with poor quality of life. Preliminary evidence suggests that coaching patients to increase their social contacts may be effective. In this study, we assessed whether structured social coaching improves the quality of life of patients with psychosis (primary outcome) compared with an active control group, receiving information on local social activities. METHODS AND ANALYSIS: A structured social coaching intervention was developed based on the literature and refined through stakeholder involvement. It draws on principles from motivational interviewing, solution focused therapy and structured information giving. It is provided over a 6-month period and can be delivered by a range of different mental health professionals. Its effectiveness and cost-effectiveness are assessed in a randomised controlled trial, compared with an active control group, in which participants are given an information booklet on local social activities. Participants are aged 18 or over, have a primary diagnosis of a psychotic disorder (International Classification of Disease: F20-29) and capacity to provide informed consent. Participants are assessed at baseline and at 6, 12 and 18 months after individual randomisation. The primary outcome is quality of life at 6 months (Manchester Short Assessment of Quality of Life). We hypothesise that the effects on quality of life are mediated by an increase in social contacts. Secondary outcomes are symptoms, social situation and time spent in social activities. Costs and cost-effectiveness analyses will consider service use and health-related quality of life. ETHICS AND DISSEMINATION: National Health Service REC London Hampstead (19/LO/0088) provided a favourable opinion. Findings will be disseminated through a website, social media, scientific papers and user-friendly reports, in collaboration with a lived experience advisory panel. TRIAL REGISTRATION NUMBER: ISRCTN15815862.


Assuntos
Tutoria , Transtornos Psicóticos , Adolescente , Análise Custo-Benefício , Humanos , Transtornos Psicóticos/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Medicina Estatal
13.
Health Soc Care Community ; 29(6): 1936-1947, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33662171

RESUMO

The efficacy of crisis planning in mental health services is contested. As recovery and self-management are core to Early Intervention in Psychosis (EIP) services and the Care Programme Approach (CPA), the views of EIP practitioners of the most useful aspects of crisis planning can inform this vital aspect of practice. We conducted a mixed methods study using a national cross-sectional survey (n = 70) and semi-structured interviews (n = 12) with EIP practitioners in England in 2019. Data were analysed using non-parametric tests and thematic analysis. A Joint Crisis Plan (JCP) template was used as a benchmark to judge current practice by (Sutherby et al., 1999; Henderson et al., 2004; Thornicroft et al., 2013). The most useful crisis plan themes identified by practitioners included early warning signs, triggers and helpful treatments, although not all elements were considered useful. Additionally, the interviews identified that collaboration with clients, carers and other services; personalisation; and self-management were all considered important in effective crisis planning. The practitioners also identified barriers to effective crisis planning, such as the electronic records system, lack of time and lack of available service provision. The research highlighted the important aspects of EIP and was significant in impacting the service and wider EIP network further. While crisis planning is a significant part of EIP, it does not appear to be consistently applied in practice. Fully implementing collaborative crisis planning in EIP services may require changes to policy, practice and local systems to ensure that crisis planning is as effective as possible.


Assuntos
Serviços de Saúde Mental , Transtornos Psicóticos , Autogestão , Estudos Transversais , Intervenção Educacional Precoce , Humanos , Transtornos Psicóticos/terapia
14.
Artigo em Inglês | MEDLINE | ID: mdl-33233789

RESUMO

In India, cardiovascular disease (CVD), with hypertension as its foremost risk factor, has the highest prevalence rate of non-communicable diseases (NCDs) and a rising mortality. Previous research has found a clustering of behavioural and social risks pertaining to NCDs, though the latter are infrequently addressed in public health interventions in India. This paper reaches toward the development of a social intervention to address social determinants of NCD relating to hypertension and diabetes. We used Theory of Change (ToC) as a theoretical approach to programme design. Mixed methods were used, including qualitative interviews with community members (n = 20), Accredited Social Health Activists (n = 6) and health professionals (n = 8), and a stakeholder workshop (n = 5 participants). The recruitment of participants from one local area in Kerala enabled us to map service provision and gain a holistic understanding of how to utilise the existing workforce to target social risk factors. The findings suggest that social interventions need to focus on ensuring health behaviour information reaches all parts of the community, and that those with more social risk factors are identified and supported to engage with treatment. Further research is required to test the resulting intervention model.


Assuntos
Diabetes Mellitus , Hipertensão , Doenças não Transmissíveis , Determinantes Sociais da Saúde , Humanos , Índia/epidemiologia , Doenças não Transmissíveis/epidemiologia
15.
BMC Cardiovasc Disord ; 20(1): 327, 2020 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641078

RESUMO

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality in India. Social and behavioural factors are strongly interrelated in the prevention and control of CVD. The ability to make lifestyle changes to control hypertension and diabetes (major risk factors for CVD) is determined by factors such as education, gender, caste, poverty, and urbanicity. This study aimed to improve our understanding of the inter-relationship of social and behavioural factors in the management of elevated serum glucose and high blood pressure and co-morbid mental health conditions. METHODS: A population-based catchment area cross sectional survey was conducted in Kerala, India. Data were collected from residents aged over 30 years (n = 997) using standardized tools and clinical measures. We performed latent class analysis incrementally to extract homogeneous latent classes of individuals based on their responses to social and behavioural risk factors in the survey. Using structural equation models, we assessed the mediating effect of depression and anxiety, and social or behavioural risk factors, on management of high blood pressure and raised serum glucose levels. RESULTS: The prevalence of high blood pressure and blood glucose in the sample was 33 and 26% respectively. Latent class analysis found three clusters of risk factors. One had a predominance of behavioural characteristics, another of social risk factors and the third was a low risk group. Age, female sex, and marital status had an effect on high blood pressure and high glucose, though were mediated by mental health, social and behavioural risk factors. CONCLUSIONS: Interventions to improve the management of risk factors for CVD need to address social risk factors and be sensitive to the needs of population sub-groups that may require additional support to access health services. An integration of social and health services may be required to achieve this.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/terapia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/terapia , Estilo de Vida , Saúde Mental , Comportamento de Redução do Risco , Determinantes Sociais da Saúde , Adulto , Idoso , Ansiedade/epidemiologia , Ansiedade/psicologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Área Programática de Saúde , Comorbidade , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Inquéritos Epidemiológicos , Fatores de Risco de Doenças Cardíacas , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Proteção , Medição de Risco
16.
BMJ Open ; 10(6): e035590, 2020 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-32595154

RESUMO

OBJECTIVES: The purpose of this study is to examine the existing literature of the major social risk factors which are associated with diabetes, hypertension and the comorbid conditions of depression and anxiety in India. DESIGN: Scoping review. DATA SOURCES: Scopus, Embase, CINAHL Plus, PsycINFO, Web of Science and MEDLINE were searched for through September 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies reporting data on social risk factors for diabetes or hypertension and depression or anxiety in community-based samples of adults from India, published in English in the 10 years to 2019, were included. Studies that did not disaggregate pooled data from other countries were excluded. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted study aims; methods; sample size and description; demographic, social and behavioural risk factors and a summary of findings from each paper. Risk factors were synthesised into six emergent themes. RESULTS: Ten studies were considered eligible and included in this review. Nine presented cross-sectional data and one was a qualitative case study. Six themes emerged, that is, demographic factors, economic aspects, social networks, life events, health barriers and health risk behaviours. CONCLUSIONS: Literature relating to the major social risk factors associated with diabetes, hypertension and comorbid depression and anxiety in India is sparse. More research is required to better understand the interactions of social context and social risk factors with non-communicable diseases and comorbid mental health problems so as to better inform management of these in the Indian subcontinent.


Assuntos
Depressão/epidemiologia , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Fatores Sociais , Doença Crônica , Comorbidade , Humanos , Índia/epidemiologia
17.
BMC Psychiatry ; 20(1): 29, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996175

RESUMO

BACKGROUND: People with psychosis experience more social isolation than any other diagnostic group and have smaller social networks than the general population. This isolation can have a detrimental effect on quality of life. No direct, standardised interventions have been developed to specifically target this issue. Stakeholders input appears crucial in the process of developing such an intervention. This study aimed to identify the main considerations when developing an intervention aiming to reduce social isolation in people with psychosis. METHODS: Focus groups and individual interviews were conducted with patients, carers and mental health staff. Data was thematically analysed. RESULTS: Thirty four patients with psychosis, 26 carers of people experiencing psychosis and 22 mental health professionals participated in the study. Suggested aspects to be considered in a novel intervention were: i) finding and training the right staff member; ii) discussing negative social attitudes and patients' previous negative experiences, iii) addressing personal ambivalence; iv) establishing how best to provide information about social activities; v) facilitating access to social activities, vi) striking a balance between support and independence. CONCLUSION: The suggestions identified can help to develop more targeted approaches to reduce social isolation within this patient group. A patient-centred approach and generic communication skills appear to be underpinning most of the helpful elements identified, whilst specific techniques and skills can help to overcome negative past experiences and motivational barriers.


Assuntos
Cuidadores/psicologia , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Isolamento Social/psicologia , Rede Social , Participação dos Interessados/psicologia , Adulto , Idoso , Feminino , Grupos Focais/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia
18.
Int J Soc Psychiatry ; 66(1): 41-48, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31580173

RESUMO

BACKGROUND: Evidence-based strategies for treating mental health conditions need to be scaled up to address the mental health treatment gap in low- and middle-income countries. Most medical and psychological interventions for the treatment of mental health conditions have been developed and evaluated in high-income countries. However, the imperative of scaling up such interventions potentially ignores local realities, and may also discredit or replace local frameworks for responding to distress. AIMS: This article aims to develop a framework for the cultural adaptation of social interventions which are developed within, and draw upon, local contexts, to ensure they are acceptable, feasible and effective. METHOD: A case study approach is used to discuss the feasibility of developing and adapting psychosocial interventions which are embedded in local knowledge, values and practices. RESULTS: The first case study introduces yoga as an alternative and/or complementary, and culturally relevant, approach for people experiencing mental health conditions in India. The second case study is a cross-cultural adaptation of a psychosocial intervention from the United Kingdom to fit the local idioms of distress and service context in Sierra Leone, as the country battled with the Ebola outbreak. We use these case studies to develop a Cultural Adaptation Framework, which recognises that people and their mental health are products of their culture and society, to inform the future development, adaptation and evaluation of sociocultural interventions for people experiencing mental health conditions in low- and middle-income countries. CONCLUSION: The Cultural Adaptation Framework can be used to ensure interventions are culturally relevant and responsive to local conditions prior to evaluating in experimental studies.


Assuntos
Competência Cultural , Transtornos Mentais/terapia , Psicoterapia , Características Culturais , Países em Desenvolvimento , Prática Clínica Baseada em Evidências , Acessibilidade aos Serviços de Saúde , Humanos , Índia , Serviços de Saúde Mental , Modelos Psicológicos , Serra Leoa , Yoga
19.
Br J Psychiatry ; 212(5): 308-317, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28982657

RESUMO

BACKGROUND: Connectedness is a central dimension of personal recovery from severe mental illness (SMI). Research reports that people with SMI have lower social capital and poorer-quality social networks compared to the general population.AimsTo identify personal well-being network (PWN) types and explore additional insights from mapping connections to places and activities alongside social ties. METHOD: We carried out 150 interviews with individuals with SMI and mapped social ties, places and activities and their impact on well-being. PWN types were developed using social network analysis and hierarchical k-means clustering of this data. RESULTS: Three PWN types were identified: formal and sparse; family and stable; and diverse and active. Well-being and social capital varied within and among types. Place and activity data indicated important contextual differences within social connections that were not found by mapping social networks alone. CONCLUSIONS: Place locations and meaningful activities are important aspects of people's social worlds. Mapped alongside social networks, PWNs have important implications for person-centred recovery approaches through providing a broader understanding of individual's lives and resources.Declaration of interestNone.


Assuntos
Transtorno Bipolar , Satisfação Pessoal , Transtornos Psicóticos , Esquizofrenia , Capital Social , Participação Social , Apoio Social , Adulto , Idoso , Análise por Conglomerados , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
PLoS One ; 12(9): e0184377, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28886163

RESUMO

INTRODUCTION: Police officers frequently come into contact with individuals with mental health problems. Specialist training in this area for police officers may improve how they respond to individuals with mental health problems; however, evidence to support this is sparse. This study evaluated the effectiveness of one bespoke mental health training package for frontline police officers relative to routine training. DESIGN: Pragmatic, two-armed cluster randomised controlled trial in one police force in England. Police stations in North Yorkshire were randomised with frontline police officers receiving either a bespoke mental health training package or routine training. The primary outcome was the number of incidents which resulted in a police response reported to the North Yorkshire Police control room up to six months after delivery of training. Secondary outcomes included: likelihood of incidents using Section 136 of the Mental Health Act; likelihood of incidents having a mental health tag applied; and number of individuals with a mental health warning marker involved in incidents. The appropriateness of mental health tags applied to a random sample of incidents was checked by an independent mental health professional. Routinely collected data were used. RESULTS: Twelve police stations were recruited and randomised (Intervention group n = 6; Control group n = 6), and 249 officers received the bespoke mental health training intervention. At follow-up, a median of 397 incidents were assigned to trial stations in the intervention group, and 498 in the control group. There was no evidence of a difference in the number of incidents with a police response (adjusted incidence rate ratio (IRR) 0.92, 95% CI 0.61 to 1.38, p = 0.69), or in the number of people with mental health warning markers involved in incidents (adjusted IRR 1.39, 95% CI 0.91 to 2.10, p = 0.13) between the intervention and control groups up to six months following the intervention; however, incidents assigned to stations in the intervention group were more likely to have a mental health tag applied to them than incidents assigned to control stations (adjusted odds ratio 1.41, 95% CI 1.16 to 1.71, p = 0.001). The review of 100 incidents suggests that there may be incidents involving individuals with mental health issues that are not being recorded as such (Kappa coefficient 0.65). There was no statistically significant difference in the likelihood of Section 136 of the Mental Health Act being applied to an incident. CONCLUSIONS: The bespoke one day mental health training delivered to frontline officers by mental health professionals did not reduce the number of incidents reported to the police control room up to six months after its delivery; however training may have a positive effect on how the police record incidents involving individuals with mental health problems. Our trial has shown that conducting pragmatic trials within the police setting is feasible and acceptable. There is a wealth of routinely collected police data that can be utilised for research and further collaboration between police forces and academia is encouraged. TRIAL REGISTRATION: ISRCTN (ISRCTN11685602). The authors confirm that all ongoing and related trials for this drug/intervention are registered.


Assuntos
Capacitação em Serviço , Pessoas Mentalmente Doentes , Polícia/educação , Relações Profissional-Paciente , Comunicação , Inglaterra , Humanos , Características de Residência
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