Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 163.249
Filtrar
1.
Biol Psychiatry ; 93(5): 405-418, 2023 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-36725140

RESUMEN

Findings from numerous laboratories and across neuroimaging modalities have consistently shown that exogenous administration of cytokines or inflammatory stimuli that induce cytokines disrupts circuits and networks involved in motivation and motor activity, threat detection, anxiety, and interoceptive and emotional processing. While inflammatory effects on neural circuits and relevant behaviors may represent adaptive responses promoting conservation of energy and heightened vigilance during immune activation, chronically elevated inflammation may contribute to symptoms of psychiatric illnesses. Indeed, biomarkers of inflammation such as cytokines and acute phase reactants are reliably elevated in a subset of patients with unipolar or bipolar depression, anxiety-related disorders, and schizophrenia and have been associated with differential treatment responses and poor clinical outcomes. A growing body of literature also describes higher levels of endogenous inflammatory markers and altered, typically lower functional or structural connectivity within these circuits in association with transdiagnostic symptoms such as anhedonia and anxiety in psychiatric and at-risk populations. This review presents recent evidence that inflammation and its effects on the brain may serve as one molecular and cellular mechanism of dysconnectivity within anatomically and/or functionally connected cortical and subcortical regions in association with transdiagnostic symptoms. We also discuss the need to establish reproducible methods to assess inflammation-associated dysconnectivity in relation to behavior for use in translational studies or biomarker-driven clinical trials for novel pharmacological or behavioral interventions targeting inflammation or its effects on the brain.


Asunto(s)
Trastorno Bipolar , Trastornos Mentales , Humanos , Encéfalo , Inflamación , Citocinas , Imagen por Resonancia Magnética
2.
BMJ Open ; 13(2): e067736, 2023 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-36725097

RESUMEN

OBJECTIVES: This population-based observational study explores the associations between individual-level and neighbourhood-level indices of active living with inpatient mental healthcare use among adults with an underlying chronic cardiometabolic condition. DESIGN AND SETTING: Data from the 2013-2014 Canadian Community Health Survey were linked longitudinally to hospital records from the 2013/2014‒2017/2018 Discharge Abstract Database and to a geocoded measure of active living environments (ALE). Relationships between individuals' leisure-time physical activity and neighbourhood ALE with risk of hospital admission for mental health disorders were assessed using multivariable Cox regressions. PARTICIPANTS: A national cohort was identified from the survey data of 24 960 respondents aged 35 years and above reporting having been diagnosed with diabetes, hypertension and/or heart disease. OUTCOME MEASURE: Potentially avoidable hospitalisation for a mood, anxiety or substance use disorder over a 5-year period. RESULTS: More than half (52%) of adults aged 35 years and above with a cardiometabolic disease were physically inactive in their daily lives, and one-third (34%) resided in the least activity-friendly neighbourhoods. The rate of being hospitalised at least once for a comorbid mental disorder averaged 8.1 (95% CI: 7.0 to 9.3) per 1000 person-years of exposure. Individuals who were at least moderately active were half as likely to be hospitalised for a comorbid mental health problem compared with those who were inactive (HR: 0.50 (95% CI: 0.38 to 0.65)). No statistically discernible associations between neighbourhood ALE and hospitalisation risks were found after controlling for individuals' behaviours and characteristics, including in separate models stratified by age group and by sex. CONCLUSIONS: The evidence base to support prioritisation of interventions focusing on the built environment favouring mental health-promoting physical activity among higher-risk adults at the population level, independently of individual-level behaviours and characteristics, remains limited.


Asunto(s)
Hipertensión , Trastornos Mentales , Humanos , Adulto , Canadá/epidemiología , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Ejercicio Físico , Estudios de Cohortes , Hospitalización , Características de la Residencia
3.
BMC Public Health ; 23(1): 219, 2023 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-36726107

RESUMEN

INTRODUCTION: Psychotic experiences (PEs) are associated with increased risk of later mental disorders and so could be valuable in prevention studies. However, to date few intervention studies have examined PEs. Given this lack of evidence, in the current study a secondary data analysis was conducted on a clustered-randomized control trial (RCT) of 3 school based interventions to reduce suicidal behaviour, to investigate if these may reduce rates of PEs, and prevent PE, at 3-month and 1-year follow-up. METHODS: The Irish site of the Saving and Empowering Young Lives in Europe study, trial registration (DRKS00000214), a cluster-RCT designed to examine the effect of school-based interventions on suicidal thoughts and behaviour. Seventeen schools (n = 1096) were randomly assigned to one of three intervention arms or a control arm. The interventions included a teacher training (gate-keeper) intervention, an interactive educational (universal-education) intervention, and a screening and integrated referral (selective-indicative) intervention. The primary outcome of this secondary data-analysis was reduction in point-prevalence of PEs at 12 months. A second analysis excluding those with PEs at baseline was conducted to examine prevention of PEs. Additional analysis was conducted of change in depression and anxiety scores (comparing those with/without PEs) in each arm of the intervention. Statistical analyses were conducted using mixed-effects modelling. RESULTS: At 12-months, the screening and referral intervention was associated with a significant reduction in PEs (OR:0.12,95%CI[0.02-0.62]) compared to the control arm. The teacher training and education intervention did not show this effect. Prevention was also observed only in the screening and referral arm (OR:0.30,95%CI[0.09-0.97]). Participants with PEs showed higher levels of depression and anxiety symptoms, compared to those without, and different responses to the screening and referral intervention & universal-education intervention. CONCLUSIONS: This study provides the first evidence for a school based intervention that reduce & prevent PEs in adolescence. This intervention is a combination of a school-based screening for psychopathology and subsequent referral intervention significantly reduced PEs in adolescents. Although further research is needed, our findings point to the effectiveness of school-based programmes for prevention of future mental health problems.


Asunto(s)
Trastornos Mentales , Adolescente , Humanos , Europa (Continente) , Instituciones Académicas , Ansiedad
4.
Neurosurg Focus ; 54(2): E6, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36724523

RESUMEN

OBJECTIVE: Concussions are a form of mild traumatic brain injury (mTBI) that most commonly occur after blunt trauma to the head and may result in temporary loss of consciousness. These patients are typically comanaged by neurocritical care specialists, neurologists, and neurosurgeons depending on the severity of disease. The purpose of this study was twofold: 1) evaluate how patient demographic characteristics impact the development of novel psychiatric disorders (NPDs) after mTBI; and 2) develop screening recommendations to identify patients with NPDs. METHODS: The authors used data from the 2010-2019 National Readmissions Database of the Healthcare Cost and Utilization Project. Patients who were readmitted for mTBI within a year of their first admission between 2010 and 2019 were identified (n = 206,070). The association between patient demographic characteristics and the emergence of NPDs after mTBI was examined using multivariable binomial regression analysis. Density plots were used to examine diagnostic patterns for NPDs. RESULTS: The mean ± SD age of all patients was 50.9 ± 26.2 years, and 43.9% of patients were female. Overall, an additional 818 (0.40%) patients were reported to have novel suicidal ideation (SI), 3866 (1.9%) novel depression, 3449 (1.7%) novel anxiety, and 88 (0.043%) novel homicidal ideation (HI) after mTBI. Younger age (OR 0.9775, 95% CI 0.9705-0.9848, p < 0.0001) and reduced Charlson Comorbidity Index (CCI) score (OR 0.9155, 95% CI 0.8539-0.9774, p = 0.010) may predict novel SI, and female sex (OR 0.7464, 95% CI 0.6026-0.9214, p = 0.0069) may be inversely related to novel SI after mTBI. Also, multivariable analysis found that female sex (OR 1.1774, 95% CI 1.0654-1.3016, p = 0.0014) and Medicare/Medicaid insurance type (OR 0.9381, 95% CI 0.8983-0.9797, p = 0.0039) may predict novel anxiety after mTBI. Similarly, younger age (OR 0.9956, 95% CI 0.9923-0.9989, p = 0.0096), higher CCI score (OR 1.0363, 95% CI 1.0099-1.0629, p = 0.0062), and Medicare/Medicaid insurance type (OR 0.9386, 95% CI 0.8998-0.9789, p = 0.0032) may predict novel depression. Lastly, female sex (OR 0.3271, 95% CI 0.1467-0.6567, p = 0.0031) and increased median income (OR 0.8829, 95% CI 0.7930-0.9944, p = 0.049) were inversely proportional to novel HI after mTBI. The median time to diagnosis of NPD was 69.5 days for depression, 66.5 days for anxiety, 70.0 days for SI, and 66.5 days for HI. CONCLUSIONS: Numerous patient demographic factors are significant predictors of the development of NPDs after mTBI and concussion. Screening for NPDs within 3 weeks and 3 months after mTBI may identify most patients at risk for developing novel postconcussive psychiatric conditions, including anxiety, depression, HI, and SI. Further studies are warranted to understand how patient demographic characteristics should dictate medical management and screening after mTBI and concussion.


Asunto(s)
Conmoción Encefálica , Trastornos Mentales , Humanos , Femenino , Anciano , Estados Unidos , Adulto Joven , Adulto , Persona de Mediana Edad , Masculino , Conmoción Encefálica/complicaciones , Conmoción Encefálica/diagnóstico , Conmoción Encefálica/epidemiología , Estudios Retrospectivos , Medicare , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/etiología , Ansiedad
5.
Neurosurg Focus ; 54(2): E8, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36724525

RESUMEN

Surgical techniques targeting behavioral disorders date back thousands of years. In this review, the authors discuss the history of neurosurgery for psychiatric disorders, starting with trephination in the Stone Age, progressing through the fraught practice of prefrontal lobotomy, and ending with modern neurosurgical techniques for treating psychiatric conditions, including ablative procedures, conventional deep brain stimulation, and closed-loop neurostimulation. Despite a tumultuous past, psychiatric neurosurgery is on the cusp of becoming a transformative therapy for patients with psychiatric dysfunction, with an ever-increasing evidence base suggesting reproducible and ethical therapeutic benefit.


Asunto(s)
Estimulación Encefálica Profunda , Trastornos Mentales , Neurocirugia , Psicocirugía , Humanos , Estimulación Encefálica Profunda/métodos , Trastornos Mentales/cirugía , Procedimientos Neuroquirúrgicos/métodos
6.
South Med J ; 116(2): 176-180, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36724532

RESUMEN

OBJECTIVES: A large number of people cannot afford healthcare services in the United States. Researchers have studied the impact of lack of affordability of health care on the outcomes of various physical conditions. Mental health disorders have emerged as a major public health challenge during the past decade. The lack of affordability of health care also may contribute to the burden of mental health. This research focuses on the association between financial barriers to health care and mental health outcomes in the US state of Tennessee. METHODS: We used cross-sectional data contained in the 2019 US Behavioral Risk Factor Surveillance System (BRFSS). We extracted data for the state of Tennessee, which included 6242 adults aged 18 years or older. Multinomial regression analyses were conducted to test the association between not being able to see a doctor with the number of mentally unhealthy days during the past month. We coded the outcome as a three-level variable, ≥20 past-month mentally unhealthy days, 1 to 20 past-month mentally unhealthy days, and 0 past-month mentally unhealthy days. The covariates examined included self-reported alcohol use, self-reported marijuana use, and other demographic variables. RESULTS: Overall, 11.0% of participants reported ≥20 past-month mentally unhealthy days and 24.0% reported 1 to 20 past-month mentally unhealthy days. More than 13% of study participants reported they could not see a doctor because of the cost in the past 12 months. The inability to see a doctor because of the cost of care was associated with a higher risk of ≥20 past-month mentally unhealthy days (relative risk ratio 3.18; 95% confidence interval 2.57-3.92, P < 0.001) and 1 to 19 past-month mentally unhealthy days (relative risk ratio 1.94; 95% confidence interval 1.63-2.32, P < 0.001). CONCLUSIONS: Statistically significant associations were observed between the inability to see a doctor when needed because of cost and increased days of poorer mental health outcomes. This research has potential policy implications in the postcoronavirus disease 2019 era with healthcare transformation and significant financial impact.


Asunto(s)
Accesibilidad a los Servicios de Salud , Trastornos Mentales , Adulto , Humanos , Estados Unidos , Tennessee/epidemiología , Estudios Transversales , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Sistema de Vigilancia de Factor de Riesgo Conductual , Evaluación de Resultado en la Atención de Salud
11.
BMC Psychiatry ; 23(1): 82, 2023 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-36721128

RESUMEN

BACKGROUND: Research suggests that employment is an important factor for recovery and improved quality of life for people with mental illnesses. Mental health professionals often serve as gatekeepers for employment interventions, yet little is known about their expectations about employment for people with mental illness in Norway. The purpose of this study is to examine mental health professionals' expectations and efforts to include employment for people with moderate to severe mental illness in treatment settings. METHODS: Two hundred seven mental health professionals were recruited from municipal mental health services, specialized clinics, social media, and professionals' networks across Norway. Participants completed a survey package comprising demographic questions, current practices and a revised version of the self-reported measure Expectations for the Employability of People with Serious Mental Illness (EESMI), a validated measure consisting of three subscales. RESULTS: Results suggested overall favorable expectations of employment for people with moderate to severe mental illness. Analyses revealed that patients participating more frequently in collaborative meetings predicted more favorable expectations about employment among mental health professionals compared to less frequent meetings. In addition, findings suggest that psychiatrist hold more negative expectations about employment in comparison to the other educational groups. Lastly, more than half of mental health professionals reported that they have integrated discussions about employment, and routines to address work-oriented activity in consultations with patients, however, there are substantial variations in routines for addressing work or work-oriented activity as a topic in consultations with patients. CONCLUSIONS: These results suggest that efforts are being made to integrate employment in treatment settings for people with mental illness in Norway; however, more work is needed to remove barriers and facilitate evidence-based approaches.


Asunto(s)
Trastornos Mentales , Salud Mental , Humanos , Motivación , Calidad de Vida , Empleo , Trastornos Mentales/terapia
12.
Cad Saude Publica ; 38(12): e00022122, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36651416

RESUMEN

Violence is a major social problem in Brazil, with severe repercussions on the health care sector. Primary health care professionals, especially community health workers (CHWs), are at high risk of violence at facilities and in the socially vulnerable area where they work. This study analyzed the relationships between adverse working conditions and dimensions of localized violence on the prevalence of common mental disorders (CMD) among CHWs in Fortaleza, a state capital in Northeastern Brazil. Information was collected with a self-report questionnaire containing items on sociodemographic data, work-related violence, psychoemotional signs and symptoms (Self-Reporting Questionnaire-20), mental health care, and absence from work due to general or mental health issues. Based on the responses of 1,437 CHWs, the prevalence of CMD (32.75%) was associated with perceived, witnessed, or suffered violence in the work area. In the hierarchical analysis, CMD were associated with age, sex, religious identity, years of experience as a CHW with the Family Health Strategy (FHS), work neighborhood, activities in the community, considering the lack of bonding with families as an obstacle, having suffered domestic violence, use of medication for emotional dysregulation, identifying the neighborhood as violent, considering violence a physical or mental health determinant, and identifying impunity as a cause of violence. Thus, the work and mental health of CHWs were significantly affected by violence dimensions. Our findings are relevant to the adoption of strategies to mitigate the effects of violence on the work and mental health of CHWs.


Asunto(s)
Violencia Doméstica , Trastornos Mentales , Humanos , Salud Mental , Brasil/epidemiología , Agentes Comunitarios de Salud , Trastornos Mentales/epidemiología
13.
Artículo en Inglés | MEDLINE | ID: mdl-36673705

RESUMEN

In view of disease-related threats, containment measures, and disrupted healthcare, individuals with pre-existing mental illness might be vulnerable to adverse effects of the COVID-19 pandemic. Previous reviews indicated increased mental distress, with limited information on peri-pandemic changes. In this systematic review, we aimed to identify longitudinal research investigating pre- to peri-pandemic and/or peri-pandemic changes of mental health in patients, focusing on the early phase and considering specific diagnoses. PsycINFO, Web of Science, the WHO Global literature on coronavirus disease database, and the Cochrane COVID-19 Study Register weresearched through 31 May 2021. Studies were synthesized using vote counting based on effect direction. We included 40 studies mostly from Western, high-income countries. Findings were heterogeneous, with improving and deteriorating mental health observed compared to pre-pandemic data, partly depending on underlying diagnoses. For peri-pandemic changes, evidence was limited, with some suggestion of recovery of mental distress. Study quality was heterogeneous; only few studies investigated potential moderators (e.g., chronicity of mental illness). Mental health effects on people with pre-existing conditions are heterogeneous within and across diagnoses for pre- to peri-pandemic and peri-pandemic comparisons. To improve mental health services amid future global crises, forthcoming research should understand medium- and long-term effects, controlling for containment measures.


Asunto(s)
COVID-19 , Trastornos Mentales , Humanos , COVID-19/epidemiología , Salud Mental , Pandemias , Cobertura de Afecciones Preexistentes , SARS-CoV-2 , Trastornos Mentales/epidemiología
14.
Artículo en Inglés | MEDLINE | ID: mdl-36673814

RESUMEN

Common mental health and musculoskeletal disorders (CMDs and MSDs) are two of the most significant causes of non-participation in employment amongst working age adults. BACKGROUND: This case study fills an important gap in the scientific literature on reintegration back to work after sickness absence due to CMDs and MSDs. It particularly examines the return to work (RTW) experiences of sick-listed employees to understand the facilitators and barriers of sustainable RTW. METHODS: Using a realist evaluation approach within a qualitative inquiry, perceptions of employees were explored to provide in-depth understanding of what, how and under what circumstances sustainable RTW can be enabled for employees absent on a short- or long-term basis. Repeat face-to-face semi-structured interviews were conducted with 22 participants (15 women and 7 men, aged 30-50 years and sick-listed with MSDs and CMDs) who were recruited using purposive sampling. Data was thematically analysed. RESULTS: A total of 2 main codes and 5 subcodes were developed and grouped into three theoretical abstractions. As a result of validating the context, mechanism, and outcome configurations with accounts of participants, all three initial theories explaining the most prominent mechanisms that either facilitates or impedes a sustainable RTW for people with CMDs and MSDs were justified. CONCLUSIONS: Our findings reveal the active role of line managers on the RTW outcomes of returning employees. However, line-manager's competence and ability to effectively support and implement appropriate RTW strategies suited to employees' hinges on working in alignment with key stakeholders and returning employees.


Asunto(s)
Trastornos Mentales , Enfermedades Musculoesqueléticas , Masculino , Adulto , Humanos , Femenino , Reinserción al Trabajo/psicología , Salud Mental , Ausencia por Enfermedad , Empleo , Trastornos Mentales/psicología
15.
Artículo en Inglés | MEDLINE | ID: mdl-36673831

RESUMEN

BACKGROUND: The extent and nature of sexual abuse (SA) and its consequences in psychiatry are still poorly described in adolescence. OBJECTIVE: This article describes the frequency of SA reported in an adolescent population hospitalized in psychiatry, and assesses its links with the severity of mental disorders and the medical issues of these adolescents. METHODS: The study includes 100 patients for whom SA has been mentioned, among all patients aged 13 to 17 years old hospitalized for about 4 years. The characteristics of sexual abuse were correlated with the medical severity of the patients, as well as the number, the duration of their hospitalization(s), and the time until disclosure. RESULTS: The results show the central place of SA in adolescent psychiatry, with a prevalence of 28.5% and a cumulative hospital stay which is five times longer than average. Correlations have been observed between the number of suicide attempts and the number of abuses reported. The medical severity of patients is significantly increased when the named aggressor is an adult. The number of hospitalizations is positively correlated with the number of reported abuses, as well as with the intrafamilial and adult status of the perpetrator. Finally, an early age of onset, repeated abuse, and the intrafamilial nature of the abuse are associated with a longer time to disclosure. CONCLUSIONS: The severity of adolescent psychiatric situation is statistically in favor of a history of SA, which should therefore be actively explored during care.


Asunto(s)
Abuso Sexual Infantil , Trastornos Mentales , Delitos Sexuales , Adulto , Adolescente , Humanos , Niño , Psiquiatría del Adolescente , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Intento de Suicidio/psicología , Hospitalización , Abuso Sexual Infantil/psicología
16.
Soc Sci Med ; 318: 115634, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36621085

RESUMEN

Research shows mental health is impacted by poor-quality physical and social-environmental conditions. Subsequently state-led redevelopment/regeneration schemes focus on improving the physical environment, to provide better social-environmental conditions, addressing spatial and socioeconomic inequities thus improving residents' health. However, recent research suggests that redevelopment/regeneration schemes often trigger gentrification, resulting in new spatial and socioeconomic inequalities that may worsen health outcomes, including mental health, for long-term neighborhood residents. Using the right to the city and situating this within the framework of accumulation by dispossession and capitalist hegemony, this paper explores the potential mechanisms in which poor mental health outcomes may endure in neighborhoods despite the implementation of redevelopment/regeneration projects. To do so, we explored two neighborhoods in the city of Glasgow - North Glasgow and East End - and conducted a strong qualitative study based on 25 in-depth semi-structured interviews with key stakeholders. The results show that postindustrial vacant and derelict land spaces and socioeconomic deprivation in North and East Glasgow are potential mechanisms contributing to the poor mental health of its residents. Where redevelopment/regeneration projects prioritize economic goals, it is often at the expense of social(health) outcomes. Instead, economic investment instigates processes of gentrification, where long-term neighborhood residents are excluded from accessing collective urban life and its (health) benefits. Moreover, these residents are continually excluded from participation in decision-making and are unable to shape the urban environment. In summary, we found a number of potential mechanisms that may contribute to enduring poor mental health outcomes despite the existence of redevelopment/regeneration projects. Projects instead have negative consequences for the determinants of mental health, reinforcing existing inequalities, disempowering original long-term neighborhood residents and only providing the "right" to the unhealthy deprived city. We define this as the impossibility to benefit from material opportunities, public spaces, goods and services and the inability to shape city transformations.


Asunto(s)
Disparidades en el Estado de Salud , Trastornos Mentales , Determinantes Sociales de la Salud , Humanos , Ciudades/epidemiología , Ambiente , Investigación Cualitativa , Características de la Residencia , Escocia/epidemiología , Trastornos Mentales/epidemiología
17.
Artículo en Inglés | MEDLINE | ID: mdl-36674394

RESUMEN

Although previous studies have examined the impact of long working hours on mental health in China, they have not addressed the initial value and reverse causality issues. To bridge this gap in the literature, I conducted a dynamic longitudinal analysis to investigate the association between long working hours and the risk of mental illness nationwide. Using three-wave longitudinal data from the China Family Panel Studies conducted in 2014, 2016, and 2018, I adopted dynamic regression models with lagged long working hours variables to examine their association with the risk of mental illness. The results indicate that long working hours have positive and significant (p < 0.01 or p < 0.05) associations with the risk of mental illness (OR: 1.12~1.22). The effect is more significant for women, white-collar workers, and employees in micro-firms, compared with their counterparts (i.e., men, pink- and blue-collar workers, employees of large firms, and self-employed individuals). The results provide empirical evidence of the effects of long working hours on mental health in China, confirming the need to enforce the regulations regarding standard working hours and monitor regulatory compliance by companies, as these factors are expected to improve mental health.


Asunto(s)
Trastornos Mentales , Salud Mental , Masculino , Humanos , Femenino , Trastornos Mentales/epidemiología , Empleo , China/epidemiología
18.
Medicine (Baltimore) ; 102(3): e32610, 2023 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-36701729

RESUMEN

The purpose of this study was to assess if behavior and emotional function, as measured by the Pearson Behavioral Assessment Survey for Children, Second Edition (BASC-2) in patients and parents, changes with differing treatment protocols in patients with adolescent idiopathic scoliosis (AIS). One previous study showed abnormal BASC-2 scores in a substantial number of patients diagnosed with AIS; however, no study has assessed how these scores change over the course of treatment. AIS patients aged 12 to 21 years completed the BASC-2. The 176-item questionnaire was administered to subjects at enrollment, assessing behavioral and emotional problems across 16 subscales of 5 domains: school problems, internalizing problems, inattention/hyperactivity, emotional symptoms index, and personal adjustment. Parents were given an equivalent assessment survey. Surveys were administered again after 2 years. Subject treatment groups (bracing, surgery, and observation) were established at enrollment. Patients were excluded if they did not complete the BASC-2 at both time points. Forty-six patients met the inclusion criteria, with 13 patients in the surgical, 20 in the bracing, and 13 in the observation treatment groups. At enrollment, 26% (12/46) of subjects with AIS had a clinically significant score in 1 or more subscales, and after 2 years 24% (11/46) of subjects reported a clinically significant score in at least 1 subscale (P = .8). There were no significant differences in scores between enrollment and follow-up in any treatment group. Similar to what was reported in a previous study, only 36% (4/11) of patients had clinically significant scores reported by both patient and parent, conversely 64% (7/11) of parents were unaware of their child's clinically significant behavioral and emotional problems. Common patient-reported subscales for clinically significant and at-risk scores at enrollment included anxiety (24%; 11/46), hyperactivity (24%; 11/46), attention problems (17%; 8/46), and self-esteem (17%; 8/46). At 2-year follow-up, the most commonly reported subscales were anxiety (28%; 13/46), somatization (20%; 9/46), and self-esteem (30%; 14/46). Patients with AIS, whether observed, braced or treated surgically, showed no significant change in behavior and emotional distress over the course of their treatment, or compared with each other at 2-year follow-up.


Asunto(s)
Trastornos Mentales , Escoliosis , Niño , Humanos , Adolescente , Escoliosis/cirugía , Escoliosis/psicología , Emociones , Encuestas y Cuestionarios , Cognición
19.
BMC Health Serv Res ; 23(1): 86, 2023 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-36703119

RESUMEN

BACKGROUND: Stigma associated with mental health challenges is a major barrier to service seeking among youth. Understanding how stigma impacts service-seeking decisions from the perspectives of youth remains underexplored. Such research is necessary to inform effective stigma reduction. OBJECTIVE: This study aims to understand how stigma influences service seeking among youth with mental health challenges. METHODS: Qualitative inquiry was taken using youth engagement, underpinned by pragmatism. Data were collected via 4 virtual focus groups with 22 purposively selected youth participants with lived experience of mental health challenges in Ontario, Canada. Focus group guides were developed collaboratively among research team members, including youth co-researchers. Data were analyzed inductively using reflexive thematic analysis. RESULTS: Three main themes were constructed from the data: point of entry into the system, being biomedicalized or trivialized, and paving the way for non-stigmatizing services. Initial contact with the mental healthcare system was seen to be affected by stigma, causing participants to delay contact or be refused services if they do not fit with an expected profile. Participants described a constant negotiation between feeling 'sick enough' and 'not sick enough' to receive services. Once participants accessed services, they perceived the biomedicalization or trivialization of their challenges to be driven by stigma. Lastly, participants reflected on changes needed to reduce stigma's effects on seeking and obtaining services. CONCLUSION: A constant negotiation between being 'sick enough' or 'not sick enough' is a key component of stigma from the perspectives of youth. This tension influences youth decisions about whether to seek services, but also service provider decisions about whether to offer services. Building awareness around the invisibility of mental health challenges and the continuum of wellness to illness may help to break down stigma's impact as a barrier to service seeking. Early intervention models of care that propose services across the spectrum of challenges may prevent the sense of stigma that deters youth from accessing and continuing to access services.


Asunto(s)
Trastornos Mentales , Servicios de Salud Mental , Humanos , Adolescente , Ontario , Salud Mental , Estigma Social , Investigación Cualitativa , Trastornos Mentales/terapia , Trastornos Mentales/psicología
20.
BMC Psychiatry ; 23(1): 72, 2023 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-36703121

RESUMEN

BACKGROUND: The fear and lack of understanding of mental illness can lead to stigma. The stigma of mental illness affects not only individuals who suffer from it, but also the caregivers. Stigma among caregivers can lead to delay in seeking care, poor adherence to treatment and a high risk of relapse. Caregivers of patients with mental illness are at an increased risk of distress due to the burden to stigma and caregiving burden. An increase in caregivers' burden can lead to a reduction in caregivers' involvement. There is a relationship between caregivers' involvement, burden, and affiliated stigma. The present study examined the mediating role of affiliated stigma in the relationship between caregivers' burden and involvement among informal caregivers of hospital-admitted patients with mental illness in Uganda. METHODS: A cross-sectional study was conducted among 428 informal caregivers (mean age: 39.6 years [SD±14.6]; females = 62.1%). Information was collected regarding sociodemographic characteristics, affiliated stigma, and the involvement and burden of informal caregivers. RESULTS: The findings indicate that affiliated stigma serves as a full mediator between the caregiver's roles and involvement (ß=15.97, p<0.001). Being female increased the caregivers' burden of caregiving (ß= -0.23, p<0.001). CONCLUSION: The findings in the present study suggest that intervention to address affiliated stigma among caregivers of patients with mental illness should be incorporated into mainstream mental health care to reduce the caregiving burden.


Asunto(s)
Cuidadores , Trastornos Mentales , Humanos , Femenino , Adulto , Masculino , Cuidadores/psicología , Estudios Transversales , Estigma Social , Pacientes Internos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...