Conditions for the Successful Integration of an eHealth Tool "StopBlues" Into Community-Based Interventions in France: Results From a Multiple Correspondence Analysis.

BACKGROUND: For over a decade, digital health has held promise for enabling broader access to health information, education, and services for the general population at a lower cost. However, recent studies have shown mixed results leading to a certain disappointment regarding the benefits of eHealth technologies. In this context, community-based health promotion represents an interesting and efficient conceptual framework that could help increase the adoption of digital health solutions and facilitate their evaluation. OBJECTIVE: To understand how the local implementation of the promotion of an eHealth tool, StopBlues (SB), aimed at preventing psychological distress and suicide, varied according to local contexts and if the implementation was related to the use of the tool. METHODS: The study was nested within a cluster-randomized controlled trial that was conducted to evaluate the effectiveness of the promotion, with before and after observation (NCT03565562). Data from questionnaires, observations, and institutional sources were collected in 27 localities where SB was implemented. A multiple correspondence analysis was performed to assess the relations between context, type of implementation and promotion, and use of the tool. RESULTS: Three distinct promotion patterns emerged according to the profiles of the localities that were associated with specific SB utilization rates. From highest to lowest utilization rates, they are listed as follows: the privileged urban localities, investing in health that implemented a high-intensity and digital promotion, demonstrating a greater capacity to take ownership of the project; the urban, but less privileged localities that, in spite of having relatively little experience in health policy implementation, managed to implement a traditional and high-intensity promotion; and the rural localities, with little experience in addressing health issues, that implemented low-intensity promotion but could not overcome the challenges associated with their local context. CONCLUSIONS: These findings indicate the substantial influence of local context on the reception of digital tools. The urban and socioeconomic status profiles of the localities, along with their investment and pre-existing experience in health, appear to be critical for shaping the promotion and implementation of eHealth tools in terms of intensity and use of digital communication. The more digital channels used, the higher the utilization rates, ultimately leading to the overall success of the intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-020-04464-2.

Emerging public health challenges during the COVID-19 pandemic in Malawi: A review.

The ongoing COVID-19 pandemic has posed new and has aggravated already existing public health challenges in Malawi and worldwide. Having a better understanding of these challenges can help facilitate the identification of solutions and designing further public health interventions and policies for effective management of the COVID-19 pandemic. This article presents an overview of the situation of COVID-19 in Malawi and identifies emerging public health challenges that the country is facing amidst this pandemic. It is based on a review of relevant key policy documents, reports, and publications. Some of the key emerging challenges identified in Malawi are worsening population health and socio-economic status; health system challenges like inadequate financing and human resources, disruption of essential health services; a rise in mental health conditions and suicide rates; teenage pregnancies and early marriages; and changes in some health policies. The findings point to the need to invest more in strategies for health promotion, health system strengthening and avoiding disruptions and recovery of services. These should include COVID-19 vaccination promotion campaigns, improvement of the public health surveillance system, strengthening the health workforce, implementation of health financing strategies, procurement of adequate essential medicines and supplies, and strengthening of youth-friendly reproductive health services, community health services and community engagement. These will ensure that the health system in Malawi is well-equipped to deliver resilient, sustainable and quality health services amidst and beyond the COVID-19 pandemic thereby promoting progress toward the achievement of Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) in Malawi.

School-based interventions to promote adolescent health: A systematic review in low- and middle-income countries of WHO Western Pacific Region.

BACKGROUND: In the World Health Organization Western Pacific Region (WHO WPRO), most adolescents enroll in secondary school. Safe, healthy and nurturing school environments are critical for adolescent health and development. Yet, there were no systematic reviews found on the efficacy of school-based interventions among adolescents living in low and middle income countries (LMIC) in the Region. There is an urgent need to identify effective school-based interventions and facilitating factors for successful implementation in adolescent health in WPRO. METHODS: For this systematic review, we used five electronic databases to search for school-based interventions to promote adolescent health published from January 1995 to March 2019. We searched RCT and non-RCT studies among adolescents between 10 to 19 years old, done in LMIC of WHO WPRO, and targeted health and behaviour, school environment and academic outcomes. Quality of studies, risk of bias and treatment effects were analyzed. Effective interventions and implementation approaches were summarized for consideration in scale-up. RESULTS: Despite a broad key term search strategy, we identified only eight publications (with 18,774 participants). Most of the studies used knowledge, attitudes and behaviours as outcome measures. A few also included changes in the school policy and physical environment as outcome measures while only one used BMI, waist circumference and quality of life as their outcome measures. The topics in these studies included: AIDS, sexual and reproductive health, de-worming, nutrition, obesity, tobacco use, and suicide. Some interventions were reported to be successful in improving knowledge, attitudes and behaviours, but their impact and scale were limited. The interventions used by the different studies varied from those that addressed a single action area (e.g. developing personal skills) or a combination of action areas in health promotion, e.g. developing a health policy, creating a supportive environment and developing personal skills. No intervention study was found on other important issues such as screening, counseling and developing safe and nurturing school environments. CONCLUSIONS: Only eight school-based health interventions were conducted in the Region. This study found that school-based interventions were effective in changing knowledge, attitudes, behaviors, healthy policies and environment. Moreover, it was clarified that policy support, involving multiple stakeholders, incorporating existing curriculum, student participation as crucial factors for successful implementation.

The Implementation of Mental Health Policies and Practices in Schools: An Examination of School and State Factors.

BACKGROUND: Poor mental health outcomes persist among adolescent youth. Secondary schools play a critical role in fostering positive mental health by implementing policies and practices grounded in evidence. The factors associated with implementation, however, are unclear. This study examines which school- and state-level factors are associated with improved implementation of mental health policies and practices at secondary schools across the United States. METHODS: US Centers for Disease Control and Prevention data stemming from 3 datasets (School Health Policies and Practices, School Health Profiles, and Youth Risk Behavior Surveillance System) surveys were integrated and analyzed. RESULTS: Health educator certification, school use of data during school improvement planning, presence of a health/safety coordinator, presence of a health council and state-provided health educator professional development in mental health and suicide prevention were each significantly positively associated with schools' implementation of mental health policies and practices. CONCLUSIONS: To promote improved implementation of mental health policies and practices in schools and provide better support for youth mental health outcomes, the use of certified health educators and health-related supports should be considered. State health and education agencies should undertake evaluations of its mental health practices to ensure the assistance they offer to schools is evidence based.

[The risk of death by suicide in the Colombian population 2000-2013]. / Riesgo de muerte por suicidio en población Colombiana 2000-2013.

The scope of this article is to analyze the risk of death by suicide in Colombia based on the covariables of sex, age group, year, region and/or department from 2000 to 2013. The databases of deaths by suicide and population projections of DANE were used. A longitudinal and analytical study was conducted. From 2000 to 2013, annual trends of deaths by suicide by means of modeling of covariables were established and risk estimates were collected. The Poisson regression model (PRM) was used. IRR was used according to the MRP with a level of significance of (P <0.05). Colombians between the years 2000-2013, male, 15 to 34 years old, from the Central and Eastern regions and from the Departments of Vaupés, Huila and Quindío were those with the highest risk of death by suicide. The suicide rate decreased slightly as the years went by. The highest risk of suicide occurred among men of productive age, older adults, and in underdeveloped regions. Colombia requires a mental health policy that implements strategies for primary care, health promotion and disease prevention, aimed at promoting the quality of life, detection of suicidal ideation, treatment and rehabilitation of these people from a comprehensive rights and care approach.

Analizar el riesgo de muerte por suicidio en Colombia, a partir de covariables sexo, grupo etario, año, región y/o departamento de 2000 a 2013. Se utilizaron las bases de datos de muertes por suicidio y proyecciones poblacionales del DANE. Se realizó un estudio longitudinal y analítico. De 2000 a 2013, se establecieron las tendencias anuales de muertes por suicidio por covariables mediante modelación y se recogieron estimaciones de riegos Se utilizó el modelo de regresión de Poisson (MRP). Se emplearon IRR según el MRP con nivel de significancia (P < 0,05). Los colombianos entre los años 2000-2013, de sexo masculino, de 15 a 34 años, de las regiones Central y Oriental y de los Departamentos de Vaupés, Huila y Quindío fueron los que mayor riesgo tuvieron de morir por suicidio. La tasa de suicidios fue levemente decreciente conforme pasaron los años. El mayor riesgo de suicidio ocurrió en hombres en edad productiva, adultos mayores y en regiones poco desarrolladas. Colombia requiere una política de salud mental que implemente estrategias de atención primaria, promoción de la salud y prevención de la enfermedad, orientadas a fomentar la calidad de vida, detección de ideación suicida, tratamiento y rehabilitación a estas personas desde el enfoque de derechos y atención integral.

Problematizing Men's Suicide, Mental Health, and Well-Being.

BACKGROUND: The Province of Quebec, Canada (PQ), witnessed a drastic rise in suicide among adult men between 1990 and 2000, followed by a continuous drop since then. At the end of the 1990s, men's suicide became recognized as a social issue, leading to implementation of gender-responsive strategies focusing on positive aspects of masculinity. Many of these strategies received positive assessments. AIMS: This article offers a critical overview of the evolution of social responses to men's suicide in PQ. METHOD: We highlight elements of success with examples of interventions targeting men directly, professionals who work with men, and natural support networks of men. RESULTS: Results and discussion suggest the benefits to shift towards salutogenic, gender-transformative approach to men's suicide prevention. CONCLUSION: Closing remarks question the current gaps and upcoming challenges in suicide prevention among men.

Riesgo de muerte por suicidio en población Colombiana 2000-2013 / The risk of death by suicide in the Colombian population 2000-2013

Resumen Analizar el riesgo de muerte por suicidio en Colombia, a partir de covariables sexo, grupo etario, año, región y/o departamento de 2000 a 2013. Se utilizaron las bases de datos de muertes por suicidio y proyecciones poblacionales del DANE. Se realizó un estudio longitudinal y analítico. De 2000 a 2013, se establecieron las tendencias anuales de muertes por suicidio por covariables mediante modelación y se recogieron estimaciones de riegos Se utilizó el modelo de regresión de Poisson (MRP). Se emplearon IRR según el MRP con nivel de significancia (P < 0,05). Los colombianos entre los años 2000-2013, de sexo masculino, de 15 a 34 años, de las regiones Central y Oriental y de los Departamentos de Vaupés, Huila y Quindío fueron los que mayor riesgo tuvieron de morir por suicidio. La tasa de suicidios fue levemente decreciente conforme pasaron los años. El mayor riesgo de suicidio ocurrió en hombres en edad productiva, adultos mayores y en regiones poco desarrolladas. Colombia requiere una política de salud mental que implemente estrategias de atención primaria, promoción de la salud y prevención de la enfermedad, orientadas a fomentar la calidad de vida, detección de ideación suicida, tratamiento y rehabilitación a estas personas desde el enfoque de derechos y atención integral.

Abstract The scope of this article is to analyze the risk of death by suicide in Colombia based on the covariables of sex, age group, year, region and/or department from 2000 to 2013. The databases of deaths by suicide and population projections of DANE were used. A longitudinal and analytical study was conducted. From 2000 to 2013, annual trends of deaths by suicide by means of modeling of covariables were established and risk estimates were collected. The Poisson regression model (PRM) was used. IRR was used according to the MRP with a level of significance of (P <0.05). Colombians between the years 2000-2013, male, 15 to 34 years old, from the Central and Eastern regions and from the Departments of Vaupés, Huila and Quindío were those with the highest risk of death by suicide. The suicide rate decreased slightly as the years went by. The highest risk of suicide occurred among men of productive age, older adults, and in underdeveloped regions. Colombia requires a mental health policy that implements strategies for primary care, health promotion and disease prevention, aimed at promoting the quality of life, detection of suicidal ideation, treatment and rehabilitation of these people from a comprehensive rights and care approach.

National Suicide Prevention, Local Mental Health Resources, and Suicide Rates in Japan.

BACKGROUND: Suicide rates in Japan are relatively high in OECD countries. A national fund to help local authorities implement suicide prevention programs was launched in 2009. The national suicide prevention project was transferred from the Cabinet Office to the Ministry of Health, Labor, and Welfare on April 2016, with a greater focus on mental health promotion by local governments. AIMS: The aim of the present study was to (a) identify local authorities' implementation of suicide prevention programs in terms of local health policies, and (b) examine the associations between local health resources and suicide rates in Japan. METHOD: We investigated the types of programs implemented under the fund, and correlations with authorities' sociodemographic characteristics and mental health and welfare resources. RESULTS: A majority of authorities implemented general suicide prevention programs. More focused programs addressing issues such as mental health in the workplace, alcohol problems, and attempted suicide were less frequently implemented. There were significantly fewer suicides in health regions with a higher ratio of psychiatrists to residents or a lower ratio of psychiatric beds. LIMITATIONS: A causal relationship between suicide rates and characteristics of local authorities cannot be inferred from the data. CONCLUSION: A community mental health system that operated in parallel to the current system may result in fewer inpatients and a reduction in Japan's suicide rate.

"If We Want to Get Men in, Then We Need to Ask Men What They Want": Pathways to Effective Health Programing for Men.

In Ireland, men's health is becoming a priority. In line with global trends, indicators of poor mental health (including rates of depression and suicide) are increasing alongside rates of unemployment and social isolation. Despite the growing awareness of men's health as a national priority, and development of the first National Men's Health Policy in the world, there is still a concern about men's nonengagement with health services. Health and community services often struggle to appropriately accommodate men, and men commonly avoid health spaces. A growing body of literature suggests that a persistent lack of support or resources for service providers contributes to their inability to identify and meet men's unique health needs. This study aims to provide further insight into the ways in which this gap between men and health services can be closed. Semistructured, qualitative interviews were conducted with nine project partners ( n = 9) of a successful men's health program in Dublin. Interviews captured reflections on what processes or strategies contribute to effective men's health programs. Findings suggest that gender-specific strategies-especially related to community-engagement and capacity building-are necessary in creating health programs that both promote men's health and enable men to safely and comfortably participate. Moreover, including men in all aspects of the planning stages helps ensure that programs are accessible and acceptable for men. These findings have been operationalized into a user-driven resource that illustrates evidence-informed strategies and guiding principles that can be used by practitioners hoping to engage with men.

Contribution of the Nordic School of Public Health to the public mental health research field: a selection of research initiatives, 2007-2014.

The field of public mental health has been defined by an expert group convened by the Nordic School of Public Health (NHV) as encompassing the experience, occurrence, distribution and trajectories of positive mental health and mental health problems and their determinants; mental health promotion and prevention of mental disorders; as well as mental health system policies, governance and organization. The mental health priorities of the Nordic Council of Ministers in 2010 signalled a mutual Nordic exchange of knowledge in the following thematic areas: child and adolescent mental health; working life and mental health; mental health in older people; strengthening the role of primary care in mental health service provision; stronger involvement of users and carers; and reduction of use of coercion in psychiatric care. Efforts to realize these priorities included commissioning the Nordic Research Academy for Mental Health, an NHV-based network of research institutions with a common interest in mental health research across the Nordic countries, to develop, organize and follow-up projects on public mental health. The research initiatives included mental health policy analysis, register-based research and research focused on the users' perspective in a Nordic context, as well as EU-level research policy analysis. The public mental health research conducted at the NHV highlighted the complexity of mental health and emphasized that the broad determinants of mental health need to be increasingly addressed in both public health research and practice. For example, health promotion actions, improved access to health care, a healthy alcohol policy and prevention of suicides and violence are all needed to reduce the life expectancy gap - a red flag indicator of public health inequalities. By exchanging knowledge and best practice, the collaboration between the Nordic countries contributes to the welfare of the region. The expertise and traditions developed at the NHV are of significant importance in this work.

School-based suicide prevention: content, process, and the role of trusted adults and peers.

Suicide is a leading cause of preventable death in youth, and numerous curricula and other prevention and intervention programs have been developed in the last 15 years. Comprehensive suicide prevention planning should include the 4 components of health promotion, prevention/education, intervention, and postvention. School-based suicide prevention and mental health education programs have become more common as an efficient and cost-effective way to reach youth. Process considerations that are based on the principles of therapeutic engagement with patients and families can provide mental health professionals with strategies that can assist education professionals, students, and the larger school community simultaneously.

Public mental health: the time is ripe for translation of evidence into practice.

Public mental health deals with mental health promotion, prevention of mental disorders and suicide, reducing mental health inequalities, and governance and organization of mental health service provision. The full impact of mental health is largely unrecognized within the public health sphere, despite the increasing burden of disease attributable to mental and behavioral disorders. Modern public mental health policies aim at improving psychosocial health by addressing determinants of mental health in all public policy areas. Stigmatization of mental disorders is a widespread phenomenon that constitutes a barrier for help-seeking and for the development of health care services, and is thus a core issue in public mental health actions. Lately, there has been heightened interest in the promotion of positive mental health and wellbeing. Effective programmes have been developed for promoting mental health in everyday settings such as families, schools and workplaces. New evidence indicates that many mental disorders and suicides are preventable by public mental health interventions. Available evidence favours the population approach over high-risk approaches. Public mental health emphasizes the role of primary care in the provision of mental health services to the population. The convincing evidence base for population-based mental health interventions asks for actions for putting evidence into practice.

[Suicide Rates and Suicide Prevention in Women of Turkish Origin in Berlin]. / Suizidraten und Suizidprävention bei Berliner Frauen mit türkischem Migrationshintergrund.

Suicidality in female Turkish immigrants is higher as compared to that of native-born women of the same age. The analysis of the national mortality registry in Germany reported a 2-fold suicide risk in the target group compared to German women of the same age. A population-based multi-modal intervention project was conducted. Suicidal crisis were analysed in focus groups and guided the development of the intervention module. The intervention consisted of a public awareness campaign, a telephone hotline, and the training of key persons. All parts of the intervention were subsequently evaluated. Suicide attempts of the target group that were presented at all emergency units in Berlin were registered. In a population-based interview survey the aim was to elicit central sociodemographic and psychosocial variables that may influence distress and help-seeking behaviour in women of Turkish origin.

Identifying and Referring Youths at Risk for Suicide Following Participation in School-Based Gatekeeper Training.

Gatekeeper training is a core strategy of the Garrett Lee Smith Memorial Suicide Prevention Act of 2004. Using data gathered from school-based gatekeeper trainings implemented by GLS grantees, this analysis examines training and gatekeeper factors associated with (1) identification and referral patterns and (2) services at-risk youths receive. Time spent interacting with youths was positively correlated with the number of gatekeeper identifications and knowledge about service receipt. Gatekeepers who participated in longer trainings identified proportionately more at-risk youths than participants in shorter trainings. Most gatekeeper trainees referred the identified youths to services regardless of training type.

Are there mental health differences between francophone and non-francophone populations in manitoba?

OBJECTIVE: Francophones may experience poorer health due to social status, cultural differences in lifestyle and attitudes, and language barriers to health care. Our study sought to compare mental health indicators between Francophones and non-Francophones living in the province of Manitoba. METHODS: Two populations were used: one from administrative datasets housed at the Manitoba Centre for Health Policy and the other from representative survey samples. The administrative datasets contained data from physician billings, hospitalizations, prescription drug use, education, and social services use, and surveys included indicators on language variables and on self-rated health. RESULTS: Outside urban areas, Francophones had lower rates of diagnosed substance use disorder (rate ratio [RR] = 0.80; 95% CI 0.68 to 0.95) and of suicide and suicide attempts (RR = 0.59; 95% CI 0.43 to 0.79), compared with non-Francophones, but no differences were found between the groups across the province in rates of diagnosed mood disorders, anxiety disorders, dementia, or any mental disorders after adjusting for age, sex, and geographic area. When surveyed, Francophones were less likely than non-Francophones to report that their mental health was excellent, very good, or good (66.9%, compared with 74.2%). CONCLUSIONS: The discrepancy in how Francophones view their mental health and their rates of diagnosed mental disorders may be related to health seeking behaviours in the Francophone population. Community and government agencies should try to improve the mental health of this population through mental health promotion and by addressing language and cultural barriers to health services.

Mental health and psychiatric care in Bolivia: what do we know?

BACKGROUND: Recently Bolivia has implemented a universal health system, but their mental health policy is still emerging. OBJECTIVES: To investigate the current state of the mental health care system in Bolivia and discuss challenges for structuring a coordinated network of services that can effectively meet the needs of the Bolivian population. METHODS: This review was conducted by searching for scholarly articles through the databases Lilacs, Medline OPS, HISA and IBECS REPIDISCA via the search portal in the Virtual Health Library - NLM (http://www.bireme.br). RESULTS: Bolivia has a National Mental Health Plan that is intended to guide mental health promotion, prevention, treatment and rehabilitation of mental illness, but the resources for this area of health are limited. There are 1.06 psychiatrists and 0.46 psychologists per 100, 000 inhabitants. Information on psychiatric morbidity in Bolivia and the impact of mental disorders on the global burden of disease is scarce. Admission statistics reported by psychiatric hospitals in the country show that the main cause of hospitalization is substance abuse (30%). Alcohol consumption is responsible for 90% of these admissions, in addition to being a major cause of deaths in traffic and one of the main risk factors for domestic violence. Almost one in two women in Bolivia (47%) experienced some form of violence from their partner in the last year. Nineteen percent of women living with a partner reported being physically abused, while 7% were sexually abused by their partners. Isolated studies report that suicide rates are disproportionately high in Bolivia. CONCLUSIONS: Although there is a shortage of epidemiological data in Bolivia, it is clear the impact of alcohol addiction in psychiatric admissions, domestic violence and traffic accidents. Violence against women and suicides are important issues to be tackled. Among the proposed strategies to afford human resources for mental health in Bolivia, "task shifting", the delegation of tasks to non-specialists should be extensively adopted in the country to improve mental health care.

CDC Grand Rounds: Evidence-based injury prevention.

Approximately 5.8 million persons die from injuries each year, accounting for 10% of all deaths worldwide. In the United States, 180,000 persons die each year from injuries, making the category the country's leading cause of death for those aged 1-44 years and the leading cause of years of potential life lost before age 65 years. Injuries also result in 2.8 million hospitalizations and 29 million emergency department visits each year in the United States. Motor vehicle crashes, falls, homicides, suicides, domestic violence, child maltreatment, and other forms of intentional and unintentional injury affect all strata of society, with widespread physical, mental, and reproductive health consequences. Injuries and violence affect not only individuals, but also families and communities, producing substantial economic and societal burdens related to health-care costs, work loss, and disruption of education. The estimated annual U.S. cost in medical expenses and lost productivity resulting from injuries is $355 billion.

Introducing the Policy Research Project of the Korean Neuropsychiatric Association / 신경정신의학

Mental health policy influences the mental health system and promotion in the medium and longer term. Thus, many countries develop a mental health plan suitable for their countries. In 2012, the suicide rate in Korea was 28.1 per 100000 persons, representing a nine-year high among countries in the Organization for Economic Co-operation and Development. In addition, suicide rates in Korea increase as a function of age. For example, the prevalence of suicide per 100000 persons is 19.3 among people in their 20 s and 83.2 among those in their 70 s, respectively. Another important mental health issue in Korea is a need for 'positive psychiatry', which generally aims to improve mental health and psychiatric conditions, not only in patients with psychiatric illnesses but also in the general population. As the definition of mental health is being broadened, psychiatrists should expand their range of activities and collaborate more with other professional and civic groups. Psychiatrists belonging to various institutions, such as mental health groups, clinics, mental health hospital, and general hospital, also need to find ways to expand the importance of their roles. Given the growing responsibilities for the mental health policy, the Policy Research Institute of the Korean Neuropsychiatric Association planned eight review articles on the mental health of Korea in the medium and longer term.