The role of time perspective and acculturative stress on adaptive and maladaptive stress coping strategies of Puerto Ricans living in the island of Puerto Rico and the state of Connecticut in mainland United States.

We assessed the role of Time Perspective (TP) and acculturative stress on adaptive and maladaptive coping strategies, across healthy and treatment-seeking Puerto Ricans living in the island of Puerto Rico (PR), as well as at the state of Connecticut in mainland United States (US). Participants were comprised of 197 adults from the island of PR, as well as 138 adults from Connecticut. TP was measured through five categories assessed by the Zimbardo TP Inventory (Past Positive, Past Negative, Present Fatalistic, Present Hedonistic, and Future), the Deviation from a Balanced Time Perspective-revisited (DBTPr) coefficient, and the Deviation from the Negative Time Perspective (DNTP) coefficient. Acculturative stress was measured with the Acculturative Distress Scale. Adaptive and maladaptive stress-coping were measured through the Brief COPE Inventory. DNTP predicted adaptive coping, whereas acculturative stress, Present Hedonistic, and DBTPr predicted maladaptive coping. Puerto Ricans living in Connecticut engaged more often in maladaptive coping than those in PR. Acculturative stress partially mediated the influence of DBTPr on maladaptive coping. DNTP mediated the influence of state on adaptive coping. DBTPr and acculturative stress totally mediated the influence of state on maladaptive coping. These findings suggest that assessing TP, levels of acculturative stress, and coping strategies could assist in tailoring evidence-based interventions to the specific needs of Puerto Rican populations. Doing so could be effective in promoting a Balanced Time Perspective, reducing acculturative stress, increasing adaptive coping, and improving mental as well as physical health, on Puerto Ricans living in PR or mainland US.

Addressing psychiatric care in conflict zones: recommendations for the Arab region.

The Arab world has struggled with conflict and political turmoil for several decades, rendering its already underdeveloped mental healthcare system unable to serve the psychiatric needs of victims of violence and trauma, with consequences that extend far beyond the cessation of hostilities. This role has become incumbent on international relief agencies, which have expanded mental health programmes in countries of conflict and refuge. Although their intervention has overall been positive, their mission is usually short term, leaving countries unable to maintain these advantages when the funding ends. The authors advocate for a sustainable framework that emphasises a larger role for regional and local actors. Expertise that is culturally and socially grounded could take the initiative in research, training and deployment in collaboration with non-governmental organisations, allowing for comprehensive development of the mental health sector.

Psychological torture: Characteristics and impact on mental health.

Torture has been illegal in most of Europe and the United States for over a century but persisted in other parts of the world. The changing geopolitical landscape has led to its resurgence in recent years. The public rejection of traditional forms of torture that rely on the infliction of physical pain has paradoxically increased the reliance on psychological methods of torture. This critical commentary aims to define and characterize psychological torture (PT) while exploring practical, legal, ethical and therapeutic implications relevant to clinicians and policymakers. Psychological torture comes in a range of forms. It is being increasingly justified and adopted by legitimate authorities in the name of national security. The emphasis on the avoidance of physical pain leads to the assumption that PT does not produce the levels of suffering and harm that are associated with physically violent forms of torture. This same assumption has allowed for the implication of mental health professionals in theorizing and providing legitimacy for the actions of perpetrators. Psychological torture is still poorly defined with limited understanding of its long-term psychiatric impact on those who are subjected to it. The role of mental health professionals in preventing or addressing psychological torture remains ambiguous and needs to be reinforced.

Training Residents in High-Value, Cost-Effective Care: a National Survey of Psychiatry Program Directors.

OBJECTIVE: The goal of this study was to explore how prepared psychiatry programs are to teach residents to practice resource management and high-value, cost-effective care. METHODS: An anonymous online survey was sent to 187 psychiatry training directors between July and September 2015. RESULTS: Forty-four percent of training directors responded to the survey. While most training directors who responded (88%) agreed that that graduate medical education has a responsibility to respond to the rising cost of health care, fewer than half agreed that that their faculty members consistently model cost-effective care (48%), that residents have access to information regarding the cost of tests and procedures (32%), and that residents are prepared to integrate the cost of care with available evidence when making medical decisions (44%). Only 11% reported providing training in resource management. Barriers cited to teaching cost-effective care included a lack of information regarding health care costs (45%), a lack of time (24%), a lack of faculty with relevant skills (19%), and competing training demands and priorities (18%). Training directors also noted a lack of available curricular resources and assessment tools (21%). Another 12% cited concerns about cost containment overriding treatment guidelines. Ninety percent of training directors agreed that they would be interested in resources to help teach high-value, cost-effective care. CONCLUSIONS: Most psychiatry programs do not provide formal training in resource management but are interested in resources to teach high-value, cost-effective care. Curricula for residents and faculty may help meet this need.

Mental Health in Lebanon's Triple-Fold Crisis: The Case of Refugees and Vulnerable Groups in Times of COVID-19.

Lebanon's management of the COVID-19 pandemic is largely being maneuvered amid the country's escalating triple fold crisis. As the country continues to grapple with political stagnation, a dwindling economy and currency, all while working through an ongoing refugee crisis, mental health in times of Coronavirus in Lebanon remains unaddressed. This piece explores the effects of this triple fold crisis upon the mental health of the country's refugees and most vulnerable groups, and provides room for discussions on the potential benefits of telemental health as an intervention in low-income and conflict settings. Although the implementation of TMH services in Lebanon among vulnerable communities in times of COVID-19 is not a priority, this piece insists it would ultimately fill a substantial mental health gap during the country's ongoing difficult transitory period.

Integration of Primary Care and Psychiatry: A New Paradigm for Medical Student Clerkships.

BACKGROUND: Public health crises in primary care and psychiatry have prompted development of innovative, integrated care models, yet undergraduate medical education is not currently designed to prepare future physicians to work within such systems. AIM: To implement an integrated primary care-psychiatry clerkship for third-year medical students. SETTING: Undergraduate medical education, amid institutional curriculum reform. PARTICIPANTS: Two hundred thirty-seven medical students participated in the clerkship in academic years 2015-2017. PROGRAM DESCRIPTION: Educators in psychiatry, internal medicine, and pediatrics developed a 12-week integrated Biopsychosocial Approach to Health (BAH)/Primary Care-Psychiatry Clerkship. The clerkship provides students clinical experience in primary care, psychiatry, and integrated care settings, and a longitudinal, integrated didactic series covering key areas of interface between the two disciplines. PROGRAM EVALUATION: Students reported satisfaction with the clerkship overall, rating it 3.9-4.3 on a 1-5 Likert scale, but many found its clinical curriculum and administrative organization disorienting. Students appreciated the conceptual rationale integrating primary care and psychiatry more in the classroom setting than in the clinical setting. CONCLUSIONS: While preliminary clerkship outcomes are promising, further optimization and evaluation of clinical and classroom curricula are ongoing. This novel educational paradigm is one model for preparing students for the integrated healthcare system of the twenty-first century.

Attitudes Towards Implementation of Store-and-Forward Telemental Health in Humanitarian Settings: Survey of Syrian Healthcare Providers.

BACKGROUND: Store-and-forward (S&F) telemedicine is thought to be most applicable in humanitarian settings. Unlike other kinds of telemental health (TMH), S&F requires engagement and active participation from healthcare providers in submitting text or audio-video clinical material for consultations. To implement such consultative systems there is a need to gauge providers' attitudes towards this technology. MATERIALS AND METHODS: An electronic survey was sent to Syrian healthcare providers (physicians and nonphysicians) who are affiliated with humanitarian nongovernmental organizations managing Syrians affected by war. After a description of what TMH and S&F are, participants were asked about their attitudes towards such services. RESULTS: Fifty-two providers responded to the electronic survey. Only results from providers inside Syria (n = 30) are presented. The majority of respondents had no experience with TMH. Half of the providers believed that mental healthcare can be provided through S&F and that there would be a benefit from such services. Respondents reported that cultural (68%), financial (84%), and technical (80%) barriers do exist for such services. When asked, providers believed that patients would agree to be audiotaped (58%) for the purpose of S&F compared with being videotaped (15%) (p = 0.007). CONCLUSIONS: Electronic surveys of healthcare workers in humanitarian settings are feasible. Providers in the Syrian humanitarian setting have little experience in TMH; however, they are open to using an S&F service while acknowledging cultural, financial, and technical barriers to the implementation.

Teaching Collaborative Care in Primary Care Settings for Psychiatry Residents.

BACKGROUND: Job descriptions for psychiatrists will change significantly over the next decade, as psychiatrists will be called on to work as caseload consultants to the primary care team. OBJECTIVE: The purpose of this pilot study was to examine the effects of an American Association of Directors of Psychiatric Residency Training-approved collaborative care curriculum on caseload consulting skills among psychiatry residents. METHODS: In 2014, 46 psychiatry residents (5 postgraduate year 1s, 10 postgraduate year 2s, 22 postgraduate year 3s, and 9 postgraduate year 4s) from 5 academic psychiatry residency programs in the New England area were given the 2-hour pilot collaborative care curriculum. Participants were asked to complete an anonymous survey at both the beginning and the end of the workshop to rate their comfort level in aspects of collaborative care psychiatry (7 items from SBP4 psychiatry milestones) based on a Likert scale (1-not at all, 2-slightly, 3-moderately, and 4-extremely). Paired t-test was used to examine the difference between pretest and posttest results of residents participating in the workshop. RESULTS: The pretest mean score for the group was 2.9 (standard deviation = 0.44), whereas the posttest mean was 3.51 (standard deviation = 0.42), p < 0.0001. Only 15% (n = 7) of residents reported having some form of primary care or ambulatory specialty care consultation experience while in training. CONCLUSION: This brief collaborative care curriculum significantly improved resident confidence in milestone criteria related to population health and case-based consultations.

Pilot assessment and survey of Syrian refugees' psychological stress and openness to referral for telepsychiatry (PASSPORT Study).

BACKGROUND: Given the scarcity of mental health resources available for refugees in areas of conflict, it is imperative to investigate interventions that would be accepted by the refugees. MATERIALS AND METHODS: In this study we surveyed 354 Syrian refugees using the HADStress screening tool and asked about their openness to referral to psychiatry and telepsychiatry. RESULTS: Of the surveyed sample, 41.8% had scores on HADStress that correlate to posttraumatic stress disorder. However, only 34% of the whole sample reported a perceived need to see a psychiatrist, and of those only 45% were open to telepsychiatry. CONCLUSIONS: Women, those who were bilingual, and those with positive HADStress status were less likely to accept telepsychiatry; however, this finding did not reach statistical significance. This study reports a partial acceptance of Syrian refugees for telepsychiatric services despite the high prevalence of psychological stress.

The neglected role of resource manager in residency training.

OBJECTIVE: The goal of this study was to investigate residency training in the four roles of systems-based practice: patient care advocate, team member, information integrator, and resource manager. METHODS: The authors surveyed 457 psychiatry residents and fellows across 12 programs from April 2009 to November 2010. Residents were asked to rate the extent in which they were encouraged to perform behaviors consistent with systems-based practice. RESULTS: Approximately 52% residents (n=237) completed the survey. Differences in the average Likert ratings for the four roles were significant [F (3, 4,021)=122.152, p<0.001]. Residents were more likely to report routine encouragement to function as a team member (82%, OR=7.2, 95% CI=4.7-11.0), information integrator (77%, OR=5.4, 95% CI=3.6-8.1), or patient care advocate (74%, OR=4.6, 95% CI=3.1-6.8) compared to resource manager (38%). CONCLUSIONS: Based upon this study, residency training in resource management is relatively limited compared to other aspects of systems-based practice.

The association between depressive disorders and health care utilization: results from the São Paulo ageing and health study (SPAH).

BACKGROUND: Although depressive disorders are associated with increased health care utilization in the elderly living in high-income countries, few studies have examined this relationship in Latin America. METHOD: The present study is part of the São Paulo Ageing and Health Study, a population-based epidemiological study of mental disorders in 2072 low-income adults ≥ 65 years old living in São Paulo, Brazil. Depressive disorders defined as major depressive disorder (MDD) and clinically relevant depressive symptoms (CRDS) were assessed with the Geriatric Mental State and the Neuropsychiatric Inventory. We examined the association between depressive disorders/symptoms and health care utilization (outpatient visits, hospital admissions and medication use in the past 3 months) using count models. RESULTS: The prevalence of MDD and CRDS was 4.9% and 21.4%, respectively. In the fully adjusted model, older adults with MDD were 36% more likely to have one more outpatient visit (RM: 1.36, 95% CI: 1.11-1.67), while older adults with CRDS were 14% more likely to have one more outpatient visit (RM: 1.14, 95% CI: 1.02-1.28). Elderly individuals with MDD had a prevalence of hospital admissions in the previous 3 months that was twice that of those without depression (PR=2.02, 95% CI: 1.09-3.75). Significant differences were not found for medication use. CONCLUSION: Among low-income older adults living in Brazil, those with MDD are more likely to have a recent hospital admission and outpatient service use than those without depression. Future studies are needed to examine the effectiveness of depression treatments for this population in order to both decrease the burden of illness as well as to minimize health care utilization related to depression.