Eco-emotions and Psychoterratic Syndromes: Reshaping Mental Health Assessment Under Climate Change.

Human activities like greenhouse gas emissions, pollution, and deforestation are largely responsible for climate change and biodiversity loss. The climate is a complex system and scientists are striving to predict, prevent, and address the aforementioned issues in order to avoid reaching tipping points. The threat to humankind is not only physical (ie, heat waves, floods, droughts) but also psychological, especially for some groups. Insecurity, danger, chaos, and an unstable system due to climate change have both short- and long-term psychological effects. In this scenario, the need for new psychological categories is emerging, namely, eco-emotions and psychoterratic syndromes which include eco-anxiety, ecological grief, climate worry, and climate trauma. This paper focuses on these new categories, presenting a summary of each one, including definitions, hypotheses, questions, and testological evaluations, as a useful tool to be consulted by researchers and clinicians and to help them in the therapeutic work. Also, this paper endeavors to distinguish between a psychological stress resulting in a positive outcome, such as pro-environmental behavior, compared to a stress that leads to a psychopathology. Prevention and intervention strategies including social and community support are fundamental to help cope with and mitigate the effect of climate change on mental health. In conclusion, the climate crisis has led to an enormous increase in research on climate change and its consequences on mental health. Researchers and clinicians must be prepared to assess this complex phenomenon and provide help to those who cannot cope with anxiety and climatic mourning.

The Risk of Antipsychotic Drugs on Breast Cancer: A Systematic Review and Meta-analysis.

Objectives: To investigate the association between the consumption of antipsychotic drugs and breast cancer. Methods: In this systematic review and meta-analysis study, relevant studies were extracted from different databases including PubMed, ScienceDirect, Cochrane, Medline, and additional sources. The selected studies were statistically analyzed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Of a total of 11 studies selected, five were case-control type and six were cohort type. The overall study quality was 6.7. Meta-analysis of the five case-control studies (which together had 81 766 breast cancer patients and 1 150 316 control participants) showed no significant association between the overall use of antipsychotic drugs and the incidence of breast cancer (odds ratio = 1.06; 95% CI: 0.94-1.19; p =0.36). Q-test results showed evidence of heterogeneity (p < 0.10) in the overall analysis. The I2 statistical assessment also show evidence of heterogeneity (I2> 75%). Conclusions: The use of antipsychotic drugs does not significantly increase the risk of breast cancer.

Prolonged grief disorder, posttraumatic stress disorder, and depression following traffic accidents among bereaved Balinese family members: Prevalence, latent classes and cultural correlates.

INTRODUCTION: Qualitative studies have described the rather unique styles of Balinese people to adjust to adversity. No quantitative research assessing psychopathology among bereaved individuals has been performed yet. This study estimated the prevalence of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD) and depression among bereaved individuals after traffic deaths in Bali and the relations between subgroups sharing the same symptoms and cultural, socio-demographic characteristics and posttraumatic growth (PTG). METHODS: In this cross-sectional study, 301 participants participated in questionnaire-interviews assessing PGD, PTSD, depression, PTG and cultural and socio-demographic characteristics. On average, the time since loss was 16 months. The purpose of the rituals was examined by a thematic qualitative analysis. We performed latent class analyses and subsequently calculated the odds ratios between membership of classes and characteristics with a multivariate 3step analysis. RESULTS: Prevalence rates of PGD (0%), PTSD (1%) and moderate depression (2%) were low. Most participants followed the bereavement rituals characteristic for Balinese culture. The purpose of these rituals was mainly the expression of caring for the deceased. We found a large resilient class (76%) and two smaller classes, one characterized by elevated PGD symptoms (11%) and one by elevated PTSD symptoms (13%). Loss of close kin was associated with membership of the PTSD class. CONCLUSIONS: Prevalence rates of PGD, PTSD and depression in the Balinese community were remarkably low. Participants appeared to be quite homogeneous in following religious and cultural habits. Aspects of the Balinese culture might protect bereaved individuals for developing mental health issues and could be used for an informed refinement of bereavement rituals in other cultures.

Determinants of Mental Health and Practice Behaviors of General Practitioners During COVID-19 Pandemic in Bali, Indonesia: A Cross-sectional Study.

PURPOSE: We aim to study the level of mental health distress and COVID-19 prevention in practice behaviors among general practitioners (GPs) in Bali, Indonesia, as well as their determinants. METHODS: We conducted a cross-sectional online survey. Survey recruitment material was disseminated by purposive snowballing through regional professional association as well as research team's personal acquaintances. The survey measured mental health status by DASS-21 questionnaire and practice behavior by a questionnaire based on WHO recommendations for hand hygiene and PPE use during the COVID-19 pandemic. We conducted multivariate analyses to identify independent determinants for mental health and practice behavior. RESULTS: Analyses included 635 (41.75%) of GPs in Bali. Mental health status was relatively good with prevalence of depression, anxiety, and stress of 13.2%, 19.7%, and 11% respectively, lower than previous studies in Indonesia and elsewhere. Practice behavior, however, was not considerably lower with only 65.4% and 32.1% reported consistent hand hygiene and recommended PPE use respectively. Routine optional PPE use was reported by 23.6% of respondents. Long working hours and fear of COVID-19 was identified as detrimental to mental health while consistent hand hygiene improved it. Meanwhile, workplace, work setting, and fear of COVID-19, were identified as determinants for PPE use. GPs working in primary health centers and private hospitals were also found to have less adherence to hand hygiene protocols. CONCLUSION: Our results showed relatively good mental health status along with inadequate infection prevention in practice behavior of GPs in Bali, Indonesia. Intervention should be made to improve practice behavior. Determinants of practice behavior identified in this study could help to pinpoint intervention targets.

Depression screening in Surabaya Indonesia: Urgent need for better mental health care for high-risk communities and suicide prevention for men.

OBJECTIVES: Despite its high prevalence and considerable burden, depression is not handled with the required urgency in Indonesia. Existing data from the government does not specifically note its prevalence and symptoms manifestation. This study screened depression in Surabaya, where the prevalence of mood disorder was reported to be higher than the national prevalence, in order to identify where action is most needed. METHODS: Cross-sectional study with non-random sampling. Participants consisted of samples from general population categorised as non-high-risk group, and prisoners, sex workers and drug users categorised as high-risk group. Depression screening was done using MINI-ICD10 self-rated depression questionnaire. Correlation between screening results and demographic data was analysed using chi-square test. RESULTS: Positive depression screening was significantly associated with grouping and educational background. High-risk group and participants with lower education background had significantly higher number of positive screening. Significantly higher proportion of participants in the high-risk group experience eight of the ten depression symptoms regardless of screening results. Higher proportion of depression positive male participants experienced suicidal/self-harm symptom. LIMITATIONS: This study used non-random sampling method, therefore the results may not fully represent the general population. The screening instrument used did not account for depression and symptoms severity. CONCLUSION: High-risk group with low educational background is in most urgent need of mental health help, and suicide prevention strategy is most needed for men.

The Indonesian Mental Health Act: psychiatrists' views on the act and its implementation.

In 2014, the Indonesian government passed the Mental Health Act (MHA) to address the country's complex mental health situation. The implementation of the MHA has been slow, and little is known about how the MHA is perceived by mental healthcare providers within local settings. This study aimed to obtain insight into psychiatrists' views on the MHA, including on how it affected their clinical practice and on challenges of translating the MHA into practice. The study was conducted in Bali, and 27 psychiatrists (15 men and 12 women) participated in a semi-structured interview. Thematic analysis indicated four overarching themes: raising the profile of mental health, developing a shared understanding of mental illness, integrating psychiatric practice with other services and views on implementation of the MHA into practice. Overall, the psychiatrists viewed the MHA as a step in the right direction to improve mental health services and to create awareness at local and national levels. However, there was consensus that the meaning of the MHA's concepts of mental problems and disorders were not compatible with psychiatric everyday practice or their patients' understandings. As a result, many assumed that the MHA was targeted at government and policy officials. Furthermore, there was a perceived lack of clarity on issues relating to collaborating with other services and unequal access to resources among regencies that impacted on their clinical practice in a negative way. Moreover, a few psychiatrists raised concerns that local beliefs and practices were not acknowledged in the MHA. According to the participants, mental health remained a highly political issue and without national support, mental health would remain a low priority. In conclusion, insights into providers' perspectives contribute to developing an evidence-base that can inform the implementation process of the MHA in Indonesia, and possibly elsewhere, into local level guidelines and regulations.

Mental health issues among indigenous communities and the role of traditional medicine.

INTRODUCTION: Mental health in indigenous communities is a relevant issue for the World Health Organization (WHO). These communities are supposed to live in a pure, clean and intact environment. Their real condition is far different from the imaginary; they are vulnerable populations living in difficult areas, exposed to pollution, located far from the health services, exposed to several market operations conducted to extract natural resources, facing criminal groups or illegal exploitation of land resources. These factors may have an impact on mental health of indigenous population. METHODS: We reviewed all papers available on PubMed, EMBASE and The Cochrane Library until December 2018. We focused on those factors affecting the changes from a traditional to a post-modern society and reviewed data available on stress-related issues, mental distress affecting indigenous/aboriginal communities and the role of Traditional Medicine (TM). We reviewed articles from different countries hosting indigenous communities. RESULTS: The incidence of mental distress and related phenomena (e.g. collective suicide, alcoholism and violence) among indigenous populations is affected by political and socio-economic variables. The mental health of these populations is poorly studied and described even if mental illness indicators are somewhat alarming. TM still seems to have a role in supporting affected people and may reduce deficiencies due to poor access to medical insurance/coverage, psychiatry and psychotherapy. It would be helpful to combine TM and modern medicine in a healthcare model to face indigenous populations' health needs. CONCLUSION: This review confirms the impact of societal changes, environmental threats and exploitation of natural resources on the mental health of indigenous populations. Global Mental Health needs to deal with the health needs of indigenous populations as well as psychiatry needs to develop new categories to describe psychopathology related to social variance as recently proposed by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5).

Treating the untreated: applying a community-based, culturally sensitive psychiatric intervention to confined and physically restrained mentally ill individuals in Bali, Indonesia.

This study identified, mapped and treated the clinical features of mentally ill people, who had been isolated and restrained by family and community members as a result of a functional failure of the traditional medical, hospital-based mental health model currently practiced in Indonesia. A 10-month epidemiological population survey was carried out in Karangasem regency of Bali, Indonesia. A total of 404,591 individuals were clinically interviewed, of which 895 individuals with mental health problems were identified, with 23 satisfying criteria of physical restraint and confinement. Of the latter, twenty were males; age range was 19-69 years, all diagnosed by the researchers with schizophrenia-spectrum disorder (ICD-10 diagnostic criteria). Duration of restraint ranged from 3 months to 30 years (mean = 8.1 years, SD = 8.3 years). Through the application of a holistic intervention model, all patients exhibited a remarkable recovery within 19 months of treatment. We conclude that the development of a community-based, culturally sensitive and respectful mental health model can serve as an optimum promoter of positive mental health outcomes.

Random number generation in bilingual Balinese and German students: preliminary findings from an exploratory cross-cultural study.

Verbal random number generation is a procedurally simple task to assess executive function and appears ideally suited for the use under diverse settings in cross-cultural research. The objective of this study was to examine ethnic group differences between young adults in Bali (Indonesia) and Kiel (Germany): 50 bilingual healthy students, 30 Balinese and 20 Germans, attempted to generate a random sequence of the digits 1 to 9. In Balinese participants, randomization was done in Balinese (native language L1) and Indonesian (first foreign language L2), in German subjects in the German (L1) and English (L2) languages. 10 of 30 Balinese (33%), but no Germans, were unable to inhibit habitual counting in more than half of the responses. The Balinese produced significantly more nonrandom responses than the Germans with higher rates of counting and significantly less occurrence of the digits 2 and 3 in L1 compared with L2. Repetition and cycling behavior did not differ between the four languages. The findings highlight the importance of taking into account culture-bound psychosocial factors for Balinese individuals when administering and interpreting a random number generation test.