Pandemics and pre-existing mental illness: A systematic review and meta-analysis.

INTRODUCTION: Pandemics are known to affect mental health of the general population and various at-risk groups like healthcare workers, students and people with chronic medical diseases. However, not much is known of the mental health of people with pre-existing mental illness during a pandemic. This systematic review and meta-analysis investigates, whether people with pre-existing mental illness experience an increase in mental health symptoms and experience more hospitalizations during a pandemic. MATERIALS AND METHODS: A systematic search was conducted in the EMBASE, OVID-MEDLINE and PsycINFO databases to identify potentially eligible studies. Data were extracted independently and continuous data were used in calculating pooled effect sizes of standardized mean difference (SMD) using the random-effects model. RESULTS: Of 1791 records reviewed 15 studies were included. People with pre-existing mental illness have significantly higher psychiatric symptoms, anxiety symptoms and depressive symptoms compared to controls during a pandemic with pooled effect sizes (SMD) of 0.593 (95% confidence interval (CI) 0.46 to 0.72), 0.616 (95% CI 0.49 to 0.73) and 0.597 (95% CI 0.38 to 0.80) respectively. Studies also found a reduction in psychiatric hospitalizations and utilization of psychiatric services during pandemics. CONCLUSION: The review highlights the need for mental health services to address the increased mental health symptoms in people with pre-existing mental illnesses during a pandemic. Future research should focus on better designed controlled studies of discrete illness groups, so as to provide a robust basis for policy makers to plan appropriate level of support and care for people with mental illness during a pandemic.

An acute in-patient psychiatric service for 16- to 17-year-old adolescents in the UK: a descriptive evaluation.

Aims and method The need for an age-appropriate in-patient service for 16- to 17-year-olds led to the development of a 6-bed acute admissions unit in a non-metropolitan county in the UK. We provide a descriptive evaluation of the first 2 years of its operation. All admissions from April 2010 to March 2012 were reviewed, clinical details systematically recorded and descriptively analysed. Results Ninety-seven young people were admitted during this period (a third were compulsorily detained under the Mental Health Act 1983). The average length of stay was 3-4 weeks. The most common presenting complaints were self-harm and low mood, usually in the context of life events and childhood adversity. Nearly half had substance misuse and other risk-taking behaviours. A third presented with psychotic symptoms. Adjustment and anxiety disorders were most common, followed by alcohol/substance use disorders, depressive illnesses and psychotic illnesses. Comorbidity was the rule rather than the exception. Most patients improved by the time of discharge. Clinical implications The unit provides an accessible and effective age-appropriate service and is likely to constitute an important component of the comprehensive child and adolescent mental health service strategy in the county.

Psychosocial correlates, psychological distress, and quality of life in patients with medically unexplained symptoms: a primary care study in Karachi, Pakistan.

OBJECTIVE: To examine the psychosocial correlates and association of psychological distress and quality of life (QOL) in patients with medically unexplained symptoms (MUS) compared to those with medically explained symptoms (MES) in a primary care setting in Karachi, Pakistan. METHODS: A cross-sectional study of 472 patients attending GP clinics between March and August 2009 in Karachi. Participants completed questionnaires to assess demographic details, somatic symptoms, anxiety, depression, and QOL. The patients' GP recorded whether the presenting complaint was medically unexplained or medically explained. RESULTS: MUS subjects in our study were more educated, had better social support and fewer financial problems, were less depressed and had a better QOL than subjects who had medically explained symptoms (non-MUS). Both groups (MUS and non-MUS) were comparable in terms of anxiety and number of somatic symptoms, but non-MUS subjects were more depressed than the MUS group. In a regression analysis, the number of somatic symptoms and lower levels of anxiety predicted poorer QOL in this sample. Whether these symptoms were medically explained (or not) did not seem to contribute significantly to the QOL. CONCLUSION: Our findings confirm that even in the developing world, patients with MUS are common among primary care attendees. However, patients with MUS in urban Karachi, Pakistan may differ from Western MUS subjects in the role of stress, support, and anxiety in their presentation, and may be reflective of a conceptually different group of difficulties.

Medical professionalism education for psychiatry trainees: does it meet standards?

OBJECTIVE: Developing professionalism is an important part of a doctor's training. Developing professional attributes is an expected part of postgraduate psychiatry training, as indicated by the curriculum. It is unknown whether this requirement is being met. Our aim was to explore whether psychiatry trainees are meeting current standards of professionalism education. METHODS: This audit and evaluation was investigated using an online survey, inviting trainees from three National Health Service Trusts in North West England. Invitations were sent by email with a link to an online survey. RESULTS: The results suggest that current standards are not being met. Trainees value professionalism education and feel it is important. However, there is a lack of formal teaching and a lack of adequate educational opportunities: 25% of trainees get any formal teaching and 78% feel this teaching is not adequate. There is also a concern that 20% of supervisors are not considered good role models. CONCLUSIONS: Recommendations to address this educational gap are presented. Recommendations include making time in trainees' academic programmes for formal educational activities for professionalism development, and further exploration of why some supervisors are not considered good role models for professionalism.

Multidimensional scale of perceived social support: psychometric properties in a South Asian population.

AIM: The Multidimensional Scale of Perceived Social Support (MSPSS) was developed to assess perceived social support, and has been widely used in Western samples. We attempted to translate and adapt this scale into the Urdu language, and herewith report on its psychometric properties in a rural Pakistani setting. METHODS: The study sample consisted of 325 antenatal women who were registered with 'Lady Health Workers' in the Kallar Circle of Rawalpindi district. The subjects were assessed pre- and postnatally with measures of psychiatric distress, and social support and depression, respectively (using a guided structured interview). RESULTS: MSPSS scores were inversely related to measures of psychiatric distress and depression, thus supporting the construct validity of the MSPSS as a measure of social support. The internal consistency (Cronbach's alpha) of MSPSS was 0.92. Unlike previous research using the MSPSS in Western studies, the factor analysis revealed a single-factor solution that accounted for 53% of the variance. CONCLUSIONS: The Urdu translation of the MSPSS was found to have good construct validity, and internal consistency. However, the findings suggest that women in the study population perceived social support as a unitary construct, as opposed to a tri-dimensional one as identified in Western samples.