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1.
An. psicol ; 40(2): 199-218, May-Sep, 2024. tab, ilus
Artículo en Inglés, Español | IBECS | ID: ibc-232715

RESUMEN

La comorbilidad es más la regla que la excepción en salud mental y, sobre todo, en el caso de la ansiedad y la depresión. Los modelos transdiagnósticos estudian los procesos subyacentes para mejorar el tratamiento y la comprensión de la salud mental. Objetivo: Esta revisión sistemática busca evidencias sobre los factores de riesgo transdiagnósticos para la ansiedad y la depresión en la población clínica diagnosticada de estas condiciones psicopatológicas, analizando los diferentes tipos o categorías de factores identificados. Método: Se registró una revisión sistemática en PROSPERO (número de registro CRD42022370327) y se diseñó de acuerdo con las guías PRISMA-P. La calidad del estudio fue evaluada por dos revisores independientes con conocimiento del campo para reducir el posible sesgo. Resultados: Cincuenta y tres artículos fueron examinados y las variables transdiagnósticas fueron agrupadas en tres categorías: psicológicas, biológicas y socioculturales. Conclusiones: La categoría más estudiada fue la de variables psicológicas, en especial los procesos cognitivos, afecto negativo y neuroticismo, intolerancia a la incertidumbre, sensibilidad a la ansiedad. Los factores biológicos y socioculturales requieren más estudio para sustentar su enfoque transdiagnóstico.(AU)


Comorbidity is more the rule than the exception in mental health, specifically in the case of anxiety and depression. Transdiagnostic models studied the underlying processes to improve mental health treat-ment and understating. Objective:This systematic review searchs for evi-dence on transdiagnostic risk factors for anxiety and depression in the clin-ical population diagnosed with these psychopathological conditions, by an-alysing the different types or categories of factors identified.Methods:A sys-tematic review was registered in PROSPERO (registration number CRD42022370327) and was designed according to PRISMA-P guidelines. Two independent reviewers with field knowledge assessed the study quality to reduce bias.Results: Fifty-three articles were examined, and the transdi-agnostic variables were grouped into three categories: psychological, bio-logical, and sociocultural.Conclusions:The most studied category was that of psychological variables, especially cognitive processes, negative affect, and neuroticism, intolerance of uncertainty, anxiety sensitivity. Biological and sociocultural factors require more study to support their transdiagnos-tic approach.(AU)


Asunto(s)
Humanos , Masculino , Femenino , Salud Mental , Factores de Riesgo , Ansiedad , Depresión , Psicopatología , Trastornos Mentales
2.
Eur J Gen Pract ; 30(1): 2357780, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38832626

RESUMEN

BACKGROUND: Worldwide, there are concerns about declining mental health of children and young people (CYP). OBJECTIVES: To examine trends in GP consultation rates for psychosocial problems and the impact of the COVID-19 pandemic. METHODS: We performed a population-based cohort study using electronic GP records of CYP (0-24 years) living in the Rotterdam metropolitan area between 2016 and 2021. We calculated monthly consultation rates for psychosocial problems, stratified by age group and sex. We used negative binomial models to model the pre-COVID-19 trend, and estimate expected rates post-COVID-19 onset. We modelled the effect of COVID-19 infection rate and school closure on consultation rates per sex and age group. RESULTS: The cohort increased from 64801 to 92093 CYP between January 2016 and December 2021. Median age was 12.5 years and 49.3% was female. Monthly consultation rates increased from 2,443 to 4,542 consultations per 100,000 patient months over the six years. This trend (RR 1.009, 95%CI 1.008-1.011) started well before the COVID-19 pandemic. Consultation rates of adolescent girls and young women increased most strongly. Between March and May 2020, there was a temporary reduction in consultation rates, whereupon these returned to expected levels. COVID-19 infection rate and school closures showed small but significant associations with consultation rates for psychosocial problems but this did not affect the overall trend. Although consultation rates for psychosocial problems increased, this increment was stable over the entire study period. CONCLUSION: The COVID-19 pandemic did not significantly increase consultation rates for psychosocial problems in CYP. The consultation rates increased, especially in adolescent girls and young women.


CYP' consultation rates for psychosocial problems within general practice almost doubled between 2016 and 2021 in the Rotterdam metropolitan area, the Netherlands.This increase was steady over time and was not affected by the COVID-19 pandemic.Consultation rates in general practice for psychosocial problems increased most strongly in adolescent girls and young women.


Asunto(s)
COVID-19 , Derivación y Consulta , Humanos , Femenino , Adolescente , COVID-19/epidemiología , Niño , Masculino , Países Bajos/epidemiología , Preescolar , Lactante , Adulto Joven , Derivación y Consulta/estadística & datos numéricos , Estudios de Cohortes , Trastornos Mentales/epidemiología , Recién Nacido , Medicina General/estadística & datos numéricos
3.
PLoS One ; 19(6): e0303079, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38833458

RESUMEN

How did mental healthcare utilization change during the COVID-19 pandemic period among individuals with pre-existing mental disorder? Understanding utilization patterns of these at-risk individuals and identifying those most likely to exhibit increased utilization could improve patient stratification and efficient delivery of mental health services. This study leveraged large-scale electronic health record (EHR) data to describe mental healthcare utilization patterns among individuals with pre-existing mental disorder before and during the COVID-19 pandemic and identify correlates of high mental healthcare utilization. Using EHR data from a large healthcare system in Massachusetts, we identified three "pre-existing mental disorder" groups (PMD) based on having a documented mental disorder diagnosis within the 6 months prior to the March 2020 lockdown, related to: (1) stress-related disorders (e.g., depression, anxiety) (N = 115,849), (2) serious mental illness (e.g., schizophrenia, bipolar disorders) (N = 11,530), or (3) compulsive behavior disorders (e.g., eating disorder, OCD) (N = 5,893). We also identified a "historical comparison" group (HC) for each PMD (N = 113,604, 11,758, and 5,387, respectively) from the previous year (2019). We assessed the monthly number of mental healthcare visits from March 13 to December 31 for PMDs in 2020 and HCs in 2019. Phenome-wide association analyses (PheWAS) were used to identify clinical correlates of high mental healthcare utilization. We found the overall number of mental healthcare visits per patient during the pandemic period in 2020 was 10-12% higher than in 2019. The majority of increased visits was driven by a subset of high mental healthcare utilizers (top decile). PheWAS results indicated that correlates of high utilization (prior mental disorders, chronic pain, insomnia, viral hepatitis C, etc.) were largely similar before and during the pandemic, though several conditions (e.g., back pain) were associated with high utilization only during the pandemic. Limitations included that we were not able to examine other risk factors previously shown to influence mental health during the pandemic (e.g., social support, discrimination) due to lack of social determinants of health information in EHR data. Mental healthcare utilization among patients with pre-existing mental disorder increased overall during the pandemic, likely due to expanded access to telemedicine. Given that clinical correlates of high mental healthcare utilization in a major hospital system were largely similar before and during the COVID-19 pandemic, resource stratification based on known risk factor profiles may aid hospitals in responding to heightened mental healthcare needs during a pandemic.


Asunto(s)
COVID-19 , Trastornos Mentales , Servicios de Salud Mental , Aceptación de la Atención de Salud , Humanos , COVID-19/epidemiología , COVID-19/psicología , Masculino , Femenino , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Adulto , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Servicios de Salud Mental/estadística & datos numéricos , Pandemias , Registros Electrónicos de Salud , Anciano , SARS-CoV-2 , Massachusetts/epidemiología , Adulto Joven , Adolescente
4.
Transl Psychiatry ; 14(1): 237, 2024 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-38834543

RESUMEN

To advance the emergence of circadian-based therapies, this study characterized how psychiatric symptoms fluctuate across the day and vary between individuals. Using a dimensional approach, we determined how chronotype relates to 13 psychiatric traits, and modeled the temporal development of symptoms throughout the day using generalized additive mixed effects models. In this preregistered study, a subclinical sample completed 13 psychiatric trait scales and a chronotype scale at baseline (N = 515, n = 404 women, 109 men, n = 2 non-binary, M age = 32.4 years, range 18-77), followed by 22 psychiatric symptoms and behaviors rated repeatedly between ~08:00-00:00 (n = 410). Key findings are that 11 out of 13 psychiatric traits were associated with being an evening-type, ranging from depression to obsessive comulsive disorder, social anxiety, and delusional ideation, while only mania was associated with being a morning-type. Four distinct psychiatric trait factors were identified, each predicting worse symptom levels throughout the day. Fatigue-related symptoms exhibited strong time-of-day changes with evening-types experiencing worse fatigue in the morning and morning-types in the evening. Evening-types had considerably lower drive and motivation than morning-types from morning to early evening. Evening-types also had more pronounced negative emotional symptoms and ADHD-type symptoms in the evening, particularly among those high in psychiatric trait factors. These findings identified important research targets that hold promise for improving mental health outcomes, such as strategies to boost morning motivation. Furthermore, the results emphasize the relevance of incorporating circadian factors, including chronotype, into translational psychiatric research and interventions.


Asunto(s)
Ritmo Circadiano , Humanos , Masculino , Femenino , Adulto , Ritmo Circadiano/fisiología , Persona de Mediana Edad , Adolescente , Adulto Joven , Anciano , Trastornos Mentales/psicología , Trastornos Mentales/fisiopatología , Salud Mental , Escalas de Valoración Psiquiátrica , Cronotipo
5.
BMC Psychiatry ; 24(1): 417, 2024 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-38834965

RESUMEN

BACKGROUND: Polypharmacy is common in older adults with psychiatric disorders, but no consensus has reached about the reliable indicators evaluating the benefits and risks of drug-drug interactions (DDIs) in polypharmacy. We aimed to identify indicators suitable for evaluating the clinical significance of DDIs in polypharmacy in older adults with psychiatric disorders. METHODS: The online tools were used to distribute and collect the questionnaires. The Delphi method was applied to analyze experts' opinions. The degree of authority and coordination of experts were analyzed using the coefficient of variation, coefficient of coordination, expert's judgment factor, familiarity with the study content factor, and Kendall coordination coefficient. Statistical analysis was conducted using the IBM SPSS® Statistics Package version 26.0. RESULTS: After three rounds of expert consultation, five primary and eleven secondary indicators were identified. The primary "pharmacodynamic indicator" included "severity of adverse drug reactions", "duration of adverse drug reaction", "symptom relief", "time to onset of symptomatic relief", "number of days in hospital", and "duration of medication". The secondary "pharmacokinetic indicator" contained "dosage administered" and "dosing intervals". The primary "patient tolerance indicator" contained one secondary indicator of "patient tolerability". The primary indicator "patient adherence" contained one secondary indicator of "patient adherence to medication". The primary indicator "cost of drug combination" contained one secondary indicator of "readmission". These indicators were used to determine the clinical significance of DDIs during polypharmacy. CONCLUSIONS: The clinical significance of drug combinations should be taken into account when polypharmacy is used in the elderly. The five primary indicators and eleven secondary indicators might be preferred to evaluate their risks and benefits. Medication management in this population requires a multidisciplinary team, in which nurses play a key role. Future research should focus on how to establish efficient multidisciplinary team workflows and use functional factors to assess DDIs in polypharmacy for psychiatric disorders.


Asunto(s)
Técnica Delphi , Interacciones Farmacológicas , Trastornos Mentales , Polifarmacia , Humanos , Trastornos Mentales/tratamiento farmacológico , Anciano , Masculino , Femenino , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Persona de Mediana Edad , Encuestas y Cuestionarios , Relevancia Clínica
6.
PLoS One ; 19(6): e0304527, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38838025

RESUMEN

BACKGROUND/AIMS: Primary and review studies show that supported employment interventions showed promise in assisting people with severe mental illness (SMI) in achieving successful employment and health-related outcomes. This umbrella review synthesises evidence from across review studies on supported employment interventions for individuals with SMI, to identify key findings and implementation challenges in relation to five key outcomes: (1) employment, (2) quality of life, (3) social functioning, (4) clinical/service utilisation, and (5) economic outcomes. METHODS: A systematic search of eleven databases and registers (CINAHL, Cochrane, EmCare, JBI EBP, ProQuest, PsycINFO, PubMed, Scopus, and Web of Science, and Prospero and Campbell) was conducted to identify meta-analyses and systematic reviews on supported employment interventions for individuals with SMI, peer reviewed and published in English. Quality assessment and data extraction were performed using standardised Joanna Briggs Institute (JBI) tools. A mixed-methods synthesis approach was employed to integrate both quantitative and qualitative evidence. RESULTS: The synthesis of 26 review studies primarily focused on the Individual Placement and Support (IPS) model among various supported employment interventions. Overall, combining supported employment with targeted interventions such as neurocognitive therapy and job-related social skill training showed a positive effect on employment (including job retention) and non-employment outcomes (e.g., health, quality of life, social functioning) relative to standard forms of supported employment for people with SMI. Contextual factors (intervention fidelity, settings, systemic barriers) were important considerations for intervention implementation and effectiveness. DISCUSSION: Significant overlap of primary studies across 26 review studies exposed considerable variations in interpretation and conclusions drawn by authors, raising questions about their reliability. High volume of overlap reporting from the USA on IPS interventions in review studies is likely to have biased perceptions of effectiveness. There is no one-size-fits-all solution for supporting individuals with SMI in obtaining and maintaining employment. Tailoring strategies based on individual needs and circumstances appears crucial to address the complexity of mental health recovery. We propose creating centralised registries or databases to monitor primary studies included in reviews, thus avoiding redundancy. OTHER: This umbrella study was registered with PROSPERO (No. CRD42023431191).


Asunto(s)
Empleos Subvencionados , Trastornos Mentales , Calidad de Vida , Humanos , Trastornos Mentales/terapia , Trastornos Mentales/rehabilitación
7.
JMIR Hum Factors ; 11: e53406, 2024 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-38837191

RESUMEN

BACKGROUND: Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medication side effects, and improving overall health outcomes. Digital technology is increasingly used to promote fitness, lifestyle, and physical health among the general population. However, using these interventions to promote physical health within mental health care requires a nuanced understanding of the factors that affect their adoption and implementation. OBJECTIVE: Using a qualitative design, we explored the attitudes of mental health care professionals (MHCPs) toward digital technologies for physical health with the goal of illuminating the opportunities, development, and implementation of the effective use of digital tools for promoting healthier lifestyles in mental health care. METHODS: Semistructured interviews were conducted with MHCPs (N=13) using reflexive thematic analysis to explore their experiences and perspectives on using digital health to promote physical health in youth mental health care settings. RESULTS: Three overarching themes from the qualitative analysis are reported: (1) motivation will affect implementation, (2) patients' readiness and capability, and (3) reallocation of staff roles and responsibilities. The subthemes within, and supporting quotes, are described. CONCLUSIONS: The use of digital means presents many opportunities for improving the provision of physical health interventions in mental health care settings. However, given the limited experience of many MHCPs with these technologies, formal training and additional support may improve the likelihood of implementation. Factors such as patient symptomatology, safety, and access to technology, as well as the readiness, acceptability, and capability of both MHCPs and patients to engage with digital tools, must also be considered. In addition, the potential benefits of data integration must be carefully weighed against the associated risks.


Asunto(s)
Personal de Salud , Trastornos Mentales , Investigación Cualitativa , Humanos , Trastornos Mentales/terapia , Trastornos Mentales/psicología , Femenino , Masculino , Personal de Salud/psicología , Personal de Salud/educación , Adulto , Adolescente , Actitud del Personal de Salud , Promoción de la Salud/métodos , Estilo de Vida , Adulto Joven
8.
J Am Acad Psychiatry Law ; 52(2): 225-234, 2024 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-38824424

RESUMEN

In recent decades, there has been increasing biomedical and public understanding of the role of autoimmunity in neuropsychiatric illness. Popular media have highlighted patients with psychiatric illnesses who were eventually diagnosed with autoimmune neuropsychiatric illnesses such as anti- N-methyl-D-aspartate receptor encephalitis. Coverage of these cases has often drawn attention to the effects of misdiagnosis or delayed diagnosis of such diseases in psychiatric patients. Autoimmune encephalitis can have varied presentations and often involves evaluation and management from multiple medical specialties. As a result, there remains considerable uncertainty regarding how courts might gauge the legal standard of care with regard to psychiatric workup of new-onset psychiatric symptoms, and the degree to which autoimmune encephalitis must be considered. In this article we provide a brief overview of autoimmune encephalitis and autoimmune psychosis, including current diagnostic approaches to these conditions. We review case law regarding the standard of care for psychiatric disorders caused by general medical conditions. Finally, we provide a medicolegal perspective on the responsibilities of psychiatrists and other mental health professionals in the evaluation of possible autoimmune encephalitis.


Asunto(s)
Encefalitis , Humanos , Encefalitis/diagnóstico , Nivel de Atención/legislación & jurisprudencia , Enfermedades Autoinmunes/diagnóstico , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Enfermedad de Hashimoto/diagnóstico , Encefalitis Antirreceptor N-Metil-D-Aspartato/diagnóstico , Trastornos Psicóticos/diagnóstico
9.
J Appl Res Intellect Disabil ; 37(4): e13266, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38863266

RESUMEN

BACKGROUND: Prader-Willi syndrome (PWS) is commonly associated with intellectual disability, but also with a specific behavioural phenotype and a high predisposition to psychiatric comorbidity. This study examines the psychiatric care situation of people with PWS. METHOD: A structured online questionnaire was administered to carers of people with PWS living in Germany, asking about demographic, diagnostic and treatment parameters as well as personal experiences. RESULTS: Of 77 people with PWS, 44.2% had at least one psychiatric comorbid diagnosis. The main reasons for seeking psychiatric care were emotional outbursts and aggressive behaviour. 34.9% reported that they were currently seeking psychiatric care without success. However, 32.5% of PWS had been treated with psychotropic medication, mainly antipsychotics. CONCLUSIONS: Psychiatric comorbidity appears to be undertreated in PWS, especially in the ambulatory setting. Uncertainty among mental health care providers may also lead to frequent off-label use of psychotropic medications.


Asunto(s)
Comorbilidad , Trastornos Mentales , Síndrome de Prader-Willi , Humanos , Síndrome de Prader-Willi/tratamiento farmacológico , Masculino , Femenino , Adulto , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Adulto Joven , Alemania/epidemiología , Adolescente , Psicotrópicos/uso terapéutico , Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud
10.
Open Biol ; 14(6): 240063, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38864245

RESUMEN

Frontotemporal lobe abnormalities are linked to neuropsychiatric disorders and cognition, but the role of cellular heterogeneity between temporal lobe (TL) and frontal lobe (FL) in the vulnerability to genetic risk factors remains to be elucidated. We integrated single-nucleus transcriptome analysis in 'fresh' human FL and TL with genetic susceptibility, gene dysregulation in neuropsychiatric disease and psychoactive drug response data. We show how intrinsic differences between TL and FL contribute to the vulnerability of specific cell types to both genetic risk factors and psychoactive drugs. Neuronal populations, specifically PVALB neurons, were most highly vulnerable to genetic risk factors for psychiatric disease. These psychiatric disease-associated genes were mostly upregulated in the TL, and dysregulated in the brain of patients with obsessive-compulsive disorder, bipolar disorder and schizophrenia. Among these genes, GRIN2A and SLC12A5, implicated in schizophrenia and bipolar disorder, were significantly upregulated in TL PVALB neurons and in psychiatric disease patients' brain. PVALB neurons from the TL were twofold more vulnerable to psychoactive drugs than to genetic risk factors, showing the influence and specificity of frontotemporal lobe differences on cell vulnerabilities. These studies provide a cell type resolved map of the impact of brain regional differences on cell type vulnerabilities in neuropsychiatric disorders.


Asunto(s)
Lóbulo Frontal , Trastornos Mentales , Psicotrópicos , Lóbulo Temporal , Humanos , Psicotrópicos/farmacología , Lóbulo Frontal/metabolismo , Lóbulo Frontal/patología , Lóbulo Temporal/metabolismo , Lóbulo Temporal/patología , Trastornos Mentales/genética , Trastornos Mentales/metabolismo , Neuronas/metabolismo , Receptores de N-Metil-D-Aspartato/metabolismo , Receptores de N-Metil-D-Aspartato/genética , Predisposición Genética a la Enfermedad , Perfilación de la Expresión Génica , Transcriptoma , Regulación de la Expresión Génica , Esquizofrenia/genética , Esquizofrenia/metabolismo , Trastorno Bipolar/genética , Trastorno Bipolar/metabolismo
11.
Comput Biol Med ; 177: 108685, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38838557

RESUMEN

The intersection of Artificial Intelligence (AI) and perinatal mental health research presents promising avenues, yet uncovers significant challenges for innovation. This review explicitly focuses on this multidisciplinary field and undertakes a comprehensive exploration of existing research therein. Through a scoping review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, we searched relevant literature spanning a decade (2013-2023) and selected fourteen studies for our analysis. We first provide an overview of the main AI techniques and their development, including traditional methods across different categories, as well as recent emerging methods in the field. Then, through our analysis of the literature, we summarize the predominant AI and ML techniques adopted and their applications in perinatal mental health studies, such as identifying risk factors, predicting perinatal mental health disorders, voice assistants, and Q&A chatbots. We also discuss existing limitations and potential challenges that hinder AI technologies from improving perinatal mental health outcomes, and suggest several promising directions for future research to meet real needs in the field and facilitate the translation of research into clinical settings.


Asunto(s)
Inteligencia Artificial , Salud Mental , Humanos , Femenino , Embarazo , Atención Perinatal/métodos , Trastornos Mentales
12.
Turk Psikiyatri Derg ; 35(2): 95-101, 2024.
Artículo en Inglés, Turco | MEDLINE | ID: mdl-38842151

RESUMEN

OBJECTIVE: Access to psychiatry services in Kashmir is challenging because of active enduring conflict, insecurity and a fundamental role played by the traditional health workers. We aimed to assess the main pathways to mental health services in Kashmir, India. METHODS: This cross-sectional hospital-based study was performed from March 2012 to June 2017 in the outpatient psychiatry department at a psychiatric disease hospital in Kashmir. A convenience sampling method was used to select newly referred patients to the services. A survey was developed to collect information on demographic data and the main pathways for patients when seeking care for mental disorders. RESULTS: A total of 518 patients were interviewed. About half of the respondents (48.8 %) attended clinical consultation from a general pathway like a physician or a neurologist, while 31.8% were visiting a psychiatrist for a significant psychiatric disorder. For some patients (17.8%), their initial pathway to mental health services is traditional healers. CONCLUSION: The current study revealed different pathways to seeking psychiatric care in Kashmir India. Further studies are needed to address the treatment gap and ways to improve access to mental health services for the Kashmir population.


Asunto(s)
Trastornos Mentales , Servicios de Salud Mental , Derivación y Consulta , Humanos , India , Trastornos Mentales/terapia , Estudios Transversales , Femenino , Masculino , Adulto , Persona de Mediana Edad , Adolescente , Adulto Joven , Accesibilidad a los Servicios de Salud , Encuestas y Cuestionarios
13.
Turk Psikiyatri Derg ; 35(2): 87-94, 2024.
Artículo en Inglés, Turco | MEDLINE | ID: mdl-38842150

RESUMEN

OBJECTIVE: Although Syrian refugees have high rates of mental health problems due to war trauma, little is known on their degree of need for and contact with mental health services. Using a population sample of Syrian refugees living in Ankara, we assessed the perceived need for and contact with mental health services, as well as the barriers to access these services. METHOD: This was a cross-sectional mixed-method study of 420 Syrian refugees living in Ankara city center, using face to face interviews administered at the respondents' home by trained, Arabic-speaking interviewers. PTSD and depression were assessed using Harvard Trauma Questionnaire and Beck Depression Inventory, respectively. RESULTS: Of all the refugees in our sample, 14,8% (N=62) stated that they felt the need for mental healthcare since arriving in Turkey. The actual number contacting any mental health service was very low (1,4%, N=6). The most important barriers to accessing mental health services were reported by the respondents to be language problems and lack of information on available mental health services. Service providers and policymakers also reported similar topics as the most important barriers: low awareness about mental health problems, daily living difficulties, and language and cultural barriers. Multivariate analyses revealed that presence of medical or mental disorders and female gender predicted the perceived need for contacting services. CONCLUSION: Our results show that, although refugees report high rates of mental health problems, the perceived need for and actual contact with services are very low. To address this treatment gap, and to provide adequate care for refugees with mental health problems, common barriers (language and awareness) should be identified and dealt with.


Asunto(s)
Accesibilidad a los Servicios de Salud , Servicios de Salud Mental , Refugiados , Humanos , Refugiados/psicología , Siria/etnología , Femenino , Masculino , Estudios Transversales , Adulto , Turquía , Persona de Mediana Edad , Adulto Joven , Encuestas y Cuestionarios , Adolescente , Trastornos por Estrés Postraumático/psicología , Trastornos Mentales/terapia
14.
BMJ Open ; 14(6): e085808, 2024 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-38851230

RESUMEN

INTRODUCTION: There is a lack of distinct and measurable outcomes in psychiatric and/or mental health nursing which negatively impacts guiding clinical practice, assessing evidence-based nursing interventions, ensuring future-proof nursing education and establishing visibility as a profession and discipline. Psychiatric and/or mental health nursing struggle to demonstrate patient-reported outcomes to assess the effectiveness of their practice. A systematic review that summarising patient-reported outcomes, associated factors, measured nursing care/interventions and used measurement scales of psychiatric and/or mental health nursing in the adult population in acute, intensive and forensic psychiatric wards in hospitals will capture important information on how care can be improved by better understanding what matters and what is important to patients themselves. This review can contribute to the design, planning, delivery and assessment of the quality of current and future nursing care METHODS AND ANALYSIS: This protocol follows the Cochrane methodological guidance on systematic reviews of interventions and The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. The search strategy will be identified by consultations with clinical and methodological experts and by exploring the literature. The databases Ovid MEDLINE, CINAHL, EMBASE, APA PsychARTICLES, Web of Science and Scopus will be searched for all published studies. Studies will be screened and selected with criteria described in the population, intervention, control and outcomes format after a pilot test by two researchers. Studies will be screened in two stages: (1) title and abstract screening and (2) full-text screening. Data extraction and the quality assessment based on the Johanna Briggs Institute guidelines will be conducted by two researchers. Data will be presented in a narrative synthesis. ETHICS AND DISSEMINATION: No ethical approval is needed since all data are already publicly accessible. The results of this work will be published in a peer-reviewed scientific journal. PROSPERO REGISTRATION NUMBER: CRD42023363806.


Asunto(s)
Medición de Resultados Informados por el Paciente , Enfermería Psiquiátrica , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Humanos , Trastornos Mentales/terapia , Trastornos Mentales/enfermería
15.
JMIR Ment Health ; 11: e56529, 2024 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-38861302

RESUMEN

Recent breakthroughs in artificial intelligence (AI) language models have elevated the vision of using conversational AI support for mental health, with a growing body of literature indicating varying degrees of efficacy. In this paper, we ask when, in therapy, it will be easier to replace humans and, conversely, in what instances, human connection will still be more valued. We suggest that empathy lies at the heart of the answer to this question. First, we define different aspects of empathy and outline the potential empathic capabilities of humans versus AI. Next, we consider what determines when these aspects are needed most in therapy, both from the perspective of therapeutic methodology and from the perspective of patient objectives. Ultimately, our goal is to prompt further investigation and dialogue, urging both practitioners and scholars engaged in AI-mediated therapy to keep these questions and considerations in mind when investigating AI implementation in mental health.


Asunto(s)
Inteligencia Artificial , Empatía , Humanos , Psicoterapia/métodos , Trastornos Mentales/terapia , Trastornos Mentales/psicología
16.
Am J Occup Ther ; 78(4)2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38861552

RESUMEN

IMPORTANCE: Veterans receiving inpatient psychiatric services with limitations in activities of daily living (ADLs) benefit from occupational therapy, yet disparities in access are unknown. OBJECTIVE: To investigate whether ADL limitations, an indicator of occupational therapy need, was associated with inpatient psychiatric occupational therapy utilization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics. DESIGN: Secondary analysis of VHA data. Modified Poisson regression modeled occupational therapy utilization as a function of ADL limitations, facility characteristics, and covariates. Interactions estimated whether the relationship between ADL limitations and occupational therapy utilization differed across facility characteristics. SETTING: VHA inpatient psychiatric setting. PARTICIPANTS: Veterans receiving VHA inpatient psychiatric care from 2015 to 2020 (N = 133,844). OUTCOMES AND MEASURES: Occupational therapy utilization. RESULTS: Veterans with ADL limitations were more likely to receive occupational therapy. Veterans receiving care in facilities with higher complexity and greater inpatient psychiatric care quality were more likely to receive occupational therapy. Additionally, Black veterans were less likely to receive occupational therapy relative to their White, non-Hispanic counterparts. Interactions indicated that the extent to which ADL limitations drove access to occupational therapy utilization was weaker within facilities with higher complexity and care quality. CONCLUSIONS AND RELEVANCE: Veterans with ADL limitations were more likely to access inpatient psychiatric occupational therapy, suggesting that such services are generally allocated to veterans in need. However, findings indicate disparities in access across patient-level (e.g., Black race) and facility-level (e.g., facility complexity) factors, informing efforts to eliminate barriers to accessing these valuable services. Plain-Language Summary: This is the first study, to our knowledge, to examine disparities in access to inpatient psychiatric occupational therapy in the Veterans Health Administration (VHA). The study findings show that access to inpatient psychiatric occupational therapy is partly driven by the needs of the patient. However, nonclinical factors, such as a patient's race and the characteristics of the facility at which they receive care (complexity, number of psychiatric beds available, and the quality of psychiatric care), are also important drivers of access. Identifying factors influencing access to these valuable services is the first step in developing strategies that reduce barriers to access for veterans in need.


Asunto(s)
Actividades Cotidianas , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Terapia Ocupacional , United States Department of Veterans Affairs , Humanos , Estados Unidos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Veteranos , Pacientes Internos , Trastornos Mentales/rehabilitación , Anciano , Servicios de Salud Mental/estadística & datos numéricos
17.
Transl Psychiatry ; 14(1): 246, 2024 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-38851761

RESUMEN

Acute COVID-19 infection can be followed by diverse clinical manifestations referred to as Post Acute Sequelae of SARS-CoV2 Infection (PASC). Studies have shown an increased risk of being diagnosed with new-onset psychiatric disease following a diagnosis of acute COVID-19. However, it was unclear whether non-psychiatric PASC-associated manifestations (PASC-AMs) are associated with an increased risk of new-onset psychiatric disease following COVID-19. A retrospective electronic health record (EHR) cohort study of 2,391,006 individuals with acute COVID-19 was performed to evaluate whether non-psychiatric PASC-AMs are associated with new-onset psychiatric disease. Data were obtained from the National COVID Cohort Collaborative (N3C), which has EHR data from 76 clinical organizations. EHR codes were mapped to 151 non-psychiatric PASC-AMs recorded 28-120 days following SARS-CoV-2 diagnosis and before diagnosis of new-onset psychiatric disease. Association of newly diagnosed psychiatric disease with age, sex, race, pre-existing comorbidities, and PASC-AMs in seven categories was assessed by logistic regression. There were significant associations between a diagnosis of any psychiatric disease and five categories of PASC-AMs with odds ratios highest for neurological, cardiovascular, and constitutional PASC-AMs with odds ratios of 1.31, 1.29, and 1.23 respectively. Secondary analysis revealed that the proportions of 50 individual clinical features significantly differed between patients diagnosed with different psychiatric diseases. Our study provides evidence for association between non-psychiatric PASC-AMs and the incidence of newly diagnosed psychiatric disease. Significant associations were found for features related to multiple organ systems. This information could prove useful in understanding risk stratification for new-onset psychiatric disease following COVID-19. Prospective studies are needed to corroborate these findings.


Asunto(s)
COVID-19 , Trastornos Mentales , SARS-CoV-2 , Humanos , COVID-19/psicología , COVID-19/complicaciones , COVID-19/epidemiología , Masculino , Femenino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Anciano , Fenotipo , Síndrome Post Agudo de COVID-19 , Comorbilidad , Registros Electrónicos de Salud , Adulto Joven , Factores de Riesgo , Adolescente
18.
BMC Public Health ; 24(1): 1473, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38824499

RESUMEN

OBJECTIVES: The aim of this study was to investigate associations between exposure to work-related violence/threats and harassment, and future sickness absence (SA) due to common mental disorders (CMDs), taking familial factors (shared genetics and early-life environment) and neuroticism into account. METHODS: The study sample included 8795 twin individuals from the Swedish Twin Project of Disability Pension and Sickness Absence (STODS), including survey data from the Study of Twin Adults: Genes and Environment (STAGE). Self-reported work-related violence and/or threats as well as work-related harassment (including bullying) and national register data on SA due to CMDs were analyzed using standard logistic regression, and conditional logistic regression among complete twin pairs discordant on exposures. Individuals were followed for a maximum of 13 years. Interactions between neuroticism and exposures were assessed using both multiplicative and additive interaction analyses. RESULTS: Exposure to work-related violence/threats was associated with higher odds of SA due to CMDs when adjusting for age, sex, marital status, children, education, type of living area, work characteristics, and symptoms of depression and burnout (OR 2.11, 95% CI 1.52-2.95). Higher odds of SA due to CMDs were also found for exposure to harassment (OR 1.52, 95% CI 1.10-2.11) and a combined indicator of exposure to violence/threats and/or harassment (OR 1.98, 95% CI 1.52-2.59), compared with the unexposed. Analyses of twins discordant on exposure, using the unexposed co-twin as reference, showed reduced ORs. These ORs were still elevated but no longer statistically significant, potentially due to a lack of statistical power. No multiplicative interaction was found between neuroticism and exposure to work-related violence/threats, or harassment. However, a statistically significant additive interaction was found between neuroticism and exposure to violence/threats, indicating higher odds of SA due to CMDs in the group scoring lower on neuroticism. CONCLUSIONS: Exposure to work-related offensive behaviors was associated with SA due to CMDs. However, the results indicated that these associations may be partly confounded by familial factors. In addition, an interaction between exposure and neuroticism was suggested. Thus, when possible, future studies investigating associations and causality between offensive behaviors at work and mental health-related outcomes, should consider familial factors and neuroticism.


Asunto(s)
Trastornos Mentales , Neuroticismo , Ausencia por Enfermedad , Humanos , Masculino , Femenino , Suecia/epidemiología , Adulto , Ausencia por Enfermedad/estadística & datos numéricos , Estudios Prospectivos , Persona de Mediana Edad , Trastornos Mentales/epidemiología , Violencia Laboral/estadística & datos numéricos , Violencia Laboral/psicología , Acoso Escolar/psicología , Acoso Escolar/estadística & datos numéricos
19.
Front Public Health ; 12: 1271215, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38827611

RESUMEN

Background: Emerging definitions of health have suggested a shift in focus to one's ability to manage their health condition, function, and social determinants of health. The construct of health for youths with mental health and substance use disorders (MHSU) is complex and multi-dimensional with interplay between biological, behavioral, and social conditions. Expanding definitions of health is crucial in the measurement of health and evaluation of integrated youth services (IYS) systems for people with MHSU disorders. Hence, it is critical to understand the construct of health from the perspective of a young person living with a MHSU disorder. Methods: This study was conducted using inductive thematic analysis. Three focus groups were conducted from July to August 2017. Results: A total of 22 youths (17-24 years) took part in this study. Results showed that health is a multidimensional construct situated in the ecosystem of a person's environment. Health can be understood from two macro themes: Individual health and Determinants of health. It consisted of physical health, mental health, day-to-day functioning, and being in control of your own health condition. Systemic and social factors were factors that influenced the state of health. Conclusion: This study contributes to a conceptualization of good health in youth with MHSU disorders. This conceptualization can aid in the development of more accurate measures of health and functioning and the evaluation of mental health services for youth with MHSU.


Asunto(s)
Grupos Focales , Investigación Cualitativa , Trastornos Relacionados con Sustancias , Humanos , Adolescente , Femenino , Masculino , Adulto Joven , Estado de Salud , Salud Mental , Determinantes Sociales de la Salud , Trastornos Mentales
20.
Front Public Health ; 12: 1327315, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38827616

RESUMEN

Background: Substantial research evidence supports the correlation between mental disorders and sepsis. Nevertheless, the causal connection between a particular psychological disorder and sepsis remains unclear. Methods: For investigating the causal relationships between mental disorders and sepsis, genetic variants correlated with mental disorders, including anorexia nervosa (AN), attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD), posttraumatic stress disorder (PTSD), schizophrenia (SCZ), and tourette syndrome (TS), were all extracted from the Psychiatric Genomics Consortium (PGC). The causal estimates and direction between these mental disorders and sepsis were evaluated employing a two-sample bidirectional MR strategy. The inverse variance weighted (IVW) method was the primary approach utilized. Various sensitivity analyses were performed to confirm the validity of the causal effect. Meta-analysis, multivariable MR, and mediation MR were conducted to ensure the credibility and depth of this research. Results: The presence of AN was in relation to a greater likelihood of sepsis (OR 1.08, 95% CI 1.02-1.14; p = 0.013). A meta-analysis including validation cohorts supported this observation (OR 1.06, 95% CI 1.02-1.09). None of the investigated mental disorders appeared to be impacted when sepsis was set as the exposure factor. Even after adjusting for confounding factors, AN remained statistically significant (OR 1.08, 95% CI 1.02-1.15; p = 0.013). Mediation analysis indicated N-formylmethionine levels (with a mediated proportion of 7.47%), cystatin D levels (2.97%), ketogluconate Metabolism (17.41%) and N10-formyl-tetrahydrofolate biosynthesis (20.06%) might serve as mediators in the pathogenesis of AN-sepsis. Conclusion: At the gene prediction level, two-sample bidirectional MR analysis revealed that mental disorder AN had a causal association with an increased likelihood of sepsis. In addition, N-formylmethionine levels, cystatin D levels, ketogluconate metabolism and N10-formyl-tetrahydrofolate biosynthesis may function as potential mediators in the pathophysiology of AN-sepsis. Our research may contribute to the investigation of novel therapeutic strategies for mental illness and sepsis.


Asunto(s)
Análisis de la Aleatorización Mendeliana , Trastornos Mentales , Sepsis , Humanos , Trastornos Mentales/genética , Femenino
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