The role of religious advisors in mental health care in the World Mental Health surveys.

OBJECTIVES: To examine the role of religious advisors in mental health care (MHC) according to disorder severity, socio-demographics, religious involvement and country income groups. METHODS: Face to face household surveys in ten high income (HI), six upper-middle income (UMI) and five low/lower-middle (LLMI) income countries totalling 101,258 adults interviewed with the WMH CIDI plus questions on use of care for mental health problems and religiosity. RESULTS: 1.1% of participants turned to religious providers for MHC in the past year. Among those using services, 12.3% used religious services; as much as 30% in some LLMI countries, around 20% in some UMI; in the HI income countries USA, Germany, Italy and Japan are between 15 and 10% whenever the remaining countries are much lower. In LLMI 20.9% used religious advisors for the most severe mental disorders compared to 12.3 in UMI and 9.5% in HI. For severe cases most of religious providers use occurred together with formal care except in Nigeria, Iraq and Ukraine where, respectively, 41.6, 25.7 and 17.7% of such services are outside any formal care. Frequency of attendance at religious services was a strong predictor of religious provider usage OR 6.5 for those who attended over once a week (p < 0.0001); as seeking comfort "often" through religion in case of difficulties OR was 3.6 (p = 0.004) while gender and individual income did not predict use of religious advisors nor did the type of religious affiliation; in contrast young people use them more as well as divorced and widowed OR 1.4 (p = 0.02). Some country differences persisted after controlling for all these factors. CONCLUSIONS: Religious advisors play an important role in mental health care and require appropriate training and collaboration with formal mental healthcare systems. Religious attitudes are strong predictors of religious advisors usage.

Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1).

BACKGROUND: This paper is a part of the work of the group that carried out the report "The state of the mental health in Europe" (European Commission, DG Health and Consumer Protection, 2004) and deals with the mental health issues related to the migration in Europe. METHODS: The paper tries to describe the social, demographical and political context of the emigration in Europe and tries to indicate the needs and (mental) health problems of immigrants. A review of the literature concerning mental health risk in immigrant is also carried out. The work also faces the problem of the health policy toward immigrants and the access to health care services in Europe. RESULTS: Migration during the 1990s has been high and characterised by new migrations. Some countries in Europe, that have been traditionally exporters of migrants have shifted to become importers. Migration has been a key force in the demographic changes of the European population. The policy of closed borders do not stop migration, but rather seems to set up a new underclass of so-called "illegals" who are suppressed and highly exploited. In 2000 there were also 392,200 asylum applications. The reviewed literature among mental health risk in some immigrant groups in Europe concerns: 1) highest rate of schizophrenia; suicide; alcohol and drug abuse; access of psychiatric facilities; risk of anxiety and depression; mental health of EU immigrants once they returned to their country; early EU immigrants in today disadvantaged countries; refugees and mental health. Due to the different condition of migration concerning variables as: motivation to migrations (e.g. settler, refugees, gastarbeiters); distance for the host culture; ability to develop mediating structures; legal residential status it is impossible to consider "migrants" as a homogeneous group concerning the risk for mental illness. In this sense, psychosocial studies should be undertaken to identify those factors which may under given conditions, imply an increased risk of psychiatric disorders and influence seeking for psychiatric care. COMMENTS AND REMARKS: Despite in the migrants some vulnerable groups were identified with respect to health problems, in many European countries there are migrants who fall outside the existing health and social services, something which is particularly true for asylum seekers and undocumented immigrants. In order to address these deficiencies, it is necessary to provide with an adequate financing and a continuity of the grants for research into the multicultural health demand. Finally, there is to highlight the importance of adopting an integrated approach to mental health care that moves away from psychiatric care only.

Psychometric evaluation of a new instrument in Spanish to measure self-care requisites in patients with schizophrenia.

PURPOSE: The purpose of this study was to develop and validate a new instrument in Spanish designed to measure self-care requisites in patients with schizophrenia treated in the community. DESIGN AND METHODS: The first phase was conducted to develop the questionnaire through a panel of experts and evaluate for content validity. Psychometric evaluation was then conducted with a consecutive sample of 341 patients. FINDINGS: The scale demonstrated good internal consistency and stability over time. The discriminant and convergent validity was satisfactory. The confirmatory factor analysis showed that the theoretical model fits the self-care requisites proposed by Orem's nursing theory from which it originated. PRACTICE IMPLICATIONS: This scale is a valid and reliable instrument for use in clinical practice, guiding the nurse in developing the most appropriate care plan for each patient.

Recreational drugs and HIV in Europe: current use of recreational drugs and principal HIV guidelines related recommendations.

INTRODUCTION: Recreational drug consumption has been associated with both higher rates of risk activities related to HIV transmission and also worse adherence and management of HIV patients under HAART treatment. Moreover, relevant interactions may be present in patients under HAART treatment. Our aim is to present the European trends of drug consumption per country and age groups and assess the way drug consumption is addressed in general HIV guidelines. MATERIALS AND METHODS: Last 12-month prevalence drug use was obtained from the European Monitoring Centre for Drugs and Drug Addiction for the four most consumed drugs (cannabis, cocaine, amphetamines, ecstasys). Consumption rates were collected and analyzed by country and age. Principal HIV guidelines were assessed to identify the degree of incorporation of drug use issues at three levels: transmission risk, adherence to the HAART and management of interactions. GUIDELINES: (a) WHO; (b) EACS; (c) BHIVA; (d) US DHHS; (e) IAS-USA; (f) GESIDA; (g) French CPG; (h) Italian CPG. RESULTS: Data on drugs of abuse consumption was obtained from 29 European countries, with results showing relevant drug utilization in Europe. Cannabis was the most frequent drug across all countries, with 10 countries over 5% of prevalence over the last year. Other drugs prevalence accounted for about 0.5-1%, reaching up to: 2.1% for cocaine in Spain, 1.4% for ecstasy in the Netherlands and 1.1% for amphetamines in Estonia. 15-24 and 25-34 years old subgroups had the highest prevalence, although notable use of cannabis and cocaine was also found in the 35-44 and 45-54 subgroups. From the eight guidelines assessed, six considered recreational drugs at any point. Recommendations for specific drugs were given in 50% of the guidelines. From those guidelines addressing drug consumption: three assessed risk habits which related to transmission risk, six appraised issues on adherence to HAART and five comprised data on interactions between recreational drugs and HAART. Additionally, five guidelines mentioned drugs in the context of other issues, such as sexual dysfunction or HIV-associated neurocognitive impairment. CONCLUSIONS: Use of recreational drugs is frequent in Europe, not only in the younger population but also in other unexpected older subgroups. The scarce information found in the guidelines has a potential implication for patients and clinicians; therefore, there is a need to include specific recommendations about the clinical management of people living with HIV who use recreational drugs.

[Cooperation between primary care and mental health services]. / Cooperación entre atención primaria y servicios de salud mental.

PURPOSE: To find out the current coordination/cooperation level of primary care (PC) with the adult mental health centres (AMHC), the addiction treatment centres (ATC) and children and adolescent mental health centres (CAMHC) of Catalonia (Spain). Differences in coordination between urban and non-urban areas were also evaluated. DESIGN: Cross-sectional descriptive study. SETTING: Eighty PC centres representing the seven health regions of Catalonia. PARTICIPANTS: Selection was by means of a multi-staged and stratified sampling method. A total of 356 of the 618 PC physicians who agreed to participate completed a survey evaluating different aspects of coordination with the specialised mental health services. RESULTS: The PC physicians indicated that the availability of AMHC was worse than that provided by ACT and CAMHC. However, the reports on the state of the referred patients and the training courses in mental health offered by the AMHC were more frequent. There were no significant differences in availability or training in mental health between urban and non-urban areas. CONCLUSIONS: The cooperation between the PC and the specialised mental health services of Catalonia is optimal in some aspects, but patient waiting time needs to be reduced for first visits to the AMHC and training activities offered by the CAMHC and the ACT need to be increased.