RESUMEN
Background: Stigma related to mental illness (and its treatment) is prevalent worldwide. This stigma could be at the structural or organizational level, societal level (interpersonal stigma), and the individual level (internalized stigma). Vulnerable populations, for example, gender minorities, children, adolescents, and geriatric populations, are more prone to stigma. The magnitude of stigma and its negative influence is determined by socio-cultural factors and macro (mental health policies, programs) or micro-level factors (societal views, health sectors, or individuals' attitudes towards mentally ill persons). Mental health stigma is associated with more serious psychological problems among the victims, reduced access to mental health care, poor adherence to treatment, and unfavorable outcomes. Although various nationwide and well-established anti-stigma interventions/campaigns exist in high-income countries (HICs) with favorable outcomes, a comprehensive synthesis of literature from the Low- and Middle-Income Countries (LMICs), more so from the Asian continent is lacking. The lack of such literature impedes growth in stigma-related research, including developing anti-stigma interventions. Aim: To synthesize the available mental health stigma literature from Asia and LMICs and compare them on the mental health stigma, anti-stigma interventions, and the effectiveness of such interventions from HICs. Materials and Methods: PubMed and Google Scholar databases were screened using the following search terms: stigma, prejudice, discrimination, stereotype, perceived stigma, associate stigma (for Stigma), mental health, mental illness, mental disorder psychiatric* (for mental health), and low-and-middle-income countries, LMICs, High-income countries, and Asia, South Asian Association for Regional Cooperation/SAARC (for countries of interest). Bibliographic and grey literature were also performed to obtain the relevant records. Results: The anti-stigma interventions in Asia nations and LMICs are generalized (vs. disorder specific), population-based (vs. specific groups, such as patients, caregivers, and health professionals), mostly educative (vs. contact-based or attitude and behavioral-based programs), and lacking in long-term effectiveness data. Government, international/national bodies, professional organizations, and mental health professionals can play a crucial in addressing mental health stigma. Conclusion: There is a need for a multi-modal intervention and multi-sectoral coordination to mitigate the mental health stigma. Greater research (nationwide surveys, cultural determinants of stigma, culture-specific anti-stigma interventions) in this area is required.
RESUMEN
BACKGROUND: The unique aspects of the global situation with respect to the 2019 novel coronavirus disease (COVID-19) pandemic places a significant burden on health and mental health services. During this period, there has been an increased demand in mental health-care services, whose prepandemic access was lower than necessary in many developing countries and is currently limited by international social distancing recommendations and protocols. AIM: This study aims to determine the effectiveness of teleconsultation use to increase access to mental health services, provided by volunteer staff during the quarantine of the COVID-19 pandemic in the Dominican Republic. MATERIALS AND METHODS: A special telephone service was enabled, organized by different governmental and private entities, in addition, it was published a list of telephone numbers of a team of volunteers consisting of 598 psychologists and seventy psychiatrists, who interacted from March 25 to May 17 with people who needed their help using calls, video calls, and electronic messaging services. After providing mental healthcare, each volunteer completed an online form to record relevant consultation data provided with a total of 6800 interventions to date. RESULTS: Nearly 67.3% of the interventions were requested by women. About 77.8% were adults between the ages of 18 and 59. 27.1% of the interventions were requested by people who worked as health personnel. Forty-six percent of the interventions were requested by people living in the province of Santo Domingo and 4.8% by people living outside the country. Of the interventions, 43% reported anxiety, 26%, sleep problems, 15%, depression, and 2% reported behaviors related to suicide. Of all the interventions, 5.3% required referral to a crisis intervention unit for face-to-face follow-up. CONCLUSIONS: The enablement of this teleconsultation model and the number of interventions made during this period of the COVID-19 pandemic, suggests that access to mental healthcare in the Dominican Republic has increased. Problems with anxiety, sleep, and depression are common during the COVID-19 pandemic. Only a small group of patients have needed to be referred for face-to-face care, demonstrating that teleconsultation has been an effective tool.
