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Psychology › Social Psychology

Mental Health Treatment and Access

Works Count: 58387

Description

This cluster of papers explores the impact of stigma on mental health care, focusing on the prevalence, epidemiology, and global burden of mental disorders. It also delves into help-seeking behavior, public attitudes towards mental illness, and the challenges in accessing appropriate health services for individuals experiencing psychological distress.

Keywords

Stigma; Mental Disorders; Depression; Global Burden; Help-Seeking Behavior; Prevalence; Epidemiology; Public Attitudes; Health Services; Psychological Distress

“Mental health literacy”: a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment

1997-02-01
Anthony F. Jorm , Ailsa Korten , Patricia A. Jacomb +3 more
Objectives: To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments ("mental health literacy"). Design: A cross-sectional survey, in 1995, with structured interviews … Objectives: To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments ("mental health literacy"). Design: A cross-sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia. Participants: A representative national sample of 2031 individuals aged 18–74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette. Results: Most of the participants recognised the presence of some sort of mental disorder: 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%). When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so. Corresponding data for the schizophrenia vignette were: counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%). Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful, and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems). Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics. Conclusion: If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised. Further, public understanding of psychiatric treatments can be considerably improved.

Diagnostic and Statistical Manual of Mental Disorders

2012-01-20
Craig A. Harper
This chapter provides a brief critical overview of the Diagnostic and Statistical Manual of Mental Disorders This chapter provides a brief critical overview of the Diagnostic and Statistical Manual of Mental Disorders

Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative.

2007-10-01
Ronald C. Kessler , Matthias C. Angermeyer , James C. Anthony +7 more
Data are presented on the lifetime prevalence, projected lifetime risk, and age-of-onset distributions of mental disorders in the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Face-to-face community surveys … Data are presented on the lifetime prevalence, projected lifetime risk, and age-of-onset distributions of mental disorders in the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Face-to-face community surveys were conducted in seventeen countries in Africa, Asia, the Americas, Europe, and the Middle East. The combined numbers of respondents were 85,052. Lifetime prevalence, projected lifetime risk, and age of onset of DSM-IV disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI), a fully-structured lay administered diagnostic interview. Survival analysis was used to estimate lifetime risk. Median and inter-quartile range (IQR) of age of onset is very early for some anxiety disorders (7-14, IQR: 8-11) and impulse control disorders (7-15, IQR: 11-12). The age-of-onset distribution is later for mood disorders (29-43, IQR: 35-40), other anxiety disorders (24-50, IQR: 31-41), and substance use disorders (18-29, IQR: 21-26). Median and IQR lifetime prevalence estimates are: anxiety disorders 4.8-31.0% (IQR: 9.9-16.7%), mood disorders 3.3-21.4% (IQR: 9.8-15.8%), impulse control disorders 0.3-25.0% (IQR: 3.1-5.7%), substance use disorders 1.3-15.0% (IQR: 4.8-9.6%), and any disorder 12.0-47.4% (IQR: 18.1-36.1%). Projected lifetime risk is proportionally between 17% and 69% higher than estimated lifetime prevalence (IQR: 28-44%), with the highest ratios in countries exposed to sectarian violence (Israel, Nigeria, and South Africa), and a general tendency for projected risk to be highest in recent cohorts in all countries. These results document clearly that mental disorders are commonly occurring. As many mental disorders begin in childhood or adolescents, interventions aimed at early detection and treatment might help reduce the persistence or severity of primary disorders and prevent the subsequent onset of secondary disorders.

Mental health literacy

2000-11-01
Anthony F. Jorm
Background Although the benefits of public knowledge of physical diseases are widely accepted, knowledge about mental disorders (mental health literacy) has been comparatively neglected. Aims To introduce the concept of … Background Although the benefits of public knowledge of physical diseases are widely accepted, knowledge about mental disorders (mental health literacy) has been comparatively neglected. Aims To introduce the concept of mental health literacy to a wider audience, to bring together diverse research relevant to the topic and to identify gaps in the area. Method A narrative review within a conceptual framework. Results Many members of the public cannot recognise specific disorders or different types of psychological distress. They differ from mental health experts in their beliefs about the causes of mental disorders and the most effective treatments. Attitudes which hinder recognition and appropriate help-seeking are common. Much of the mental health information most readily available to the public is misleading. However, there is some evidence that mental health literacy can be improved. Conclusions If the public's mental health literacy is not improved, this may hinder public acceptance of evidence-based mental health care. Also, many people with common mental disorders may be denied effective self-help and may not receive appropriate support from others in the community.
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Schizophrenia: manifestations, incidence and course in different cultures A World Health Organization Ten-Country Study

1992-01-01
Assen Jablensky , Norman Sartorius , G. Ernberg +5 more
An abstract is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content. An abstract is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content.

Stigma as a Fundamental Cause of Population Health Inequalities

2013-03-14
Mark L. Hatzenbuehler , Jo C. Phelan , Bruce G. Link
Bodies of research pertaining to specific stigmatized statuses have typically developed in separate domains and have focused on single outcomes at 1 level of analysis, thereby obscuring the full significance … Bodies of research pertaining to specific stigmatized statuses have typically developed in separate domains and have focused on single outcomes at 1 level of analysis, thereby obscuring the full significance of stigma as a fundamental driver of population health. Here we provide illustrative evidence on the health consequences of stigma and present a conceptual framework describing the psychological and structural pathways through which stigma influences health. Because of its pervasiveness, its disruption of multiple life domains (e.g., resources, social relationships, and coping behaviors), and its corrosive impact on the health of populations, stigma should be considered alongside the other major organizing concepts for research on social determinants of population health.
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The PHQ-9: A New Depression Diagnostic and Severity Measure

2002-09-01
Kurt Kroenke , Robert L. Spitzer
and treatable mental disorders presenting in general medical as well as specialty settings. There are a number of case-finding instruments for detecting depression in primary care, ranging from 2 to … and treatable mental disorders presenting in general medical as well as specialty settings. There are a number of case-finding instruments for detecting depression in primary care, ranging from 2 to 28 items.1,2 Typically these can be scored as continuous measures of depression severity and also have established cutpoints above which the probability of major depression is substantially increased. Scores on these various measures tend to be highly correlated3, with little evidence that one measure is superior to any other.1,2,4

Short screening scales to monitor population prevalences and trends in non-specific psychological distress

2002-08-01
Ronald C. Kessler , Gavin Andrews , Lisa J. Colpe +5 more
Background. A 10-question screening scale of psychological distress and a six-question short-form scale embedded within the 10-question scale were developed for the redesigned US National Health Interview Survey (NHIS). Methods. … Background. A 10-question screening scale of psychological distress and a six-question short-form scale embedded within the 10-question scale were developed for the redesigned US National Health Interview Survey (NHIS). Methods. Initial pilot questions were administered in a US national mail survey ( N = 1401). A reduced set of questions was subsequently administered in a US national telephone survey ( N = 1574). The 10-question and six-question scales, which we refer to as the K10 and K6, were constructed from the reduced set of questions based on Item Response Theory models. The scales were subsequently validated in a two-stage clinical reappraisal survey ( N = 1000 telephone screening interviews in the first stage followed by N = 153 face-to-face clinical interviews in the second stage that oversampled first-stage respondents who screened positive for emotional problems) in a local convenience sample. The second-stage sample was administered the screening scales along with the Structured Clinical Interview for DSM-IV (SCID). The K6 was subsequently included in the 1997 ( N = 36116) and 1998 ( N = 32440) US National Health Interview Survey, while the K10 was included in the 1997 ( N = 10641) Australian National Survey of Mental Health and Well-Being. Results. Both the K10 and K6 have good precision in the 90th–99th percentile range of the population distribution (standard errors of standardized scores in the range 0·20–0·25) as well as consistent psychometric properties across major sociodemographic subsamples. The scales strongly discriminate between community cases and non-cases of DSM-IV/SCID disorders, with areas under the Receiver Operating Characteristic (ROC) curve of 0·87–0·88 for disorders having Global Assessment of Functioning (GAF) scores of 0–70 and 0·95–0·96 for disorders having GAF scores of 0–50. Conclusions. The brevity, strong psychometric properties, and ability to discriminate DSM-IV cases from non-cases make the K10 and K6 attractive for use in general-purpose health surveys. The scales are already being used in annual government health surveys in the US and Canada as well as in the WHO World Mental Health Surveys. Routine inclusion of either the K10 or K6 in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology.

What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies

2014-02-21
Sarah Clément , Oliver Schauman , Tanya Graham +7 more
Background Individuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic … Background Individuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic review addressed the overarching question: What is the impact of mental health-related stigma on help-seeking for mental health problems? Subquestions were: ( a ) What is the size and direction of any association between stigma and help-seeking? ( b ) To what extent is stigma identified as a barrier to help-seeking? ( c ) What processes underlie the relationship between stigma and help-seeking? ( d ) Are there population groups for which stigma disproportionately deters help-seeking? Method Five electronic databases were searched from 1980 to 2011 and references of reviews checked. A meta-synthesis of quantitative and qualitative studies, comprising three parallel narrative syntheses and subgroup analyses, was conducted. Results The review identified 144 studies with 90 189 participants meeting inclusion criteria. The median association between stigma and help-seeking was d = − 0.27, with internalized and treatment stigma being most often associated with reduced help-seeking. Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier. A detailed conceptual model was derived that describes the processes contributing to, and counteracting, the deterrent effect of stigma on help-seeking. Ethnic minorities, youth, men and those in military and health professions were disproportionately deterred by stigma. Conclusions Stigma has a small- to moderate-sized negative effect on help-seeking. Review findings can be used to help inform the design of interventions to increase help-seeking.
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An Ultra-Brief Screening Scale for Anxiety and Depression: The PHQ-4

2009-11-01
Kurt Kroenke , Robert L. Spitzer , Janet B. W. Williams +1 more

The de Facto US Mental and Addictive Disorders Service System

1993-02-01
Darrel A. Regier , William E. Narrow , Donald S. Rae +3 more
After initial interviews with 20,291 adults in the National Institute of Mental Health Epidemiologic Catchment Area Program, we estimated prospective 1-year prevalence and service use rates of mental and addictive … After initial interviews with 20,291 adults in the National Institute of Mental Health Epidemiologic Catchment Area Program, we estimated prospective 1-year prevalence and service use rates of mental and addictive disorders in the US population. An annual prevalence rate of 28.1% was found for these disorders, composed of a 1-month point prevalence of 15.7% (at wave 1) and a 1-year incidence of new or recurrent disorders identified in 12.3% of the population at wave 2. During the 1-year follow-up period, 6.6% of the total sample developed one or more new disorders after being assessed as having no previous lifetime diagnosis at wave 1. An additional 5.7% of the population, with a history of some previous disorder at wave 1, had an acute relapse or suffered from a new disorder in 1 year. Irrespective of diagnosis, 14.7% of the US population in 1 year reported use of services in one or more component sectors of the de facto US mental and addictive service system. With some overlap between sectors, specialists in mental and addictive disorders provided treatment to 5.9% of the US population, 6.4% sought such services from general medical physicians, 3.0% sought these services from other human service professionals, and 4.1% turned to the voluntary support sector for such care. Of those persons with any disorder, only 28.5% (8.0 per 100 population) sought mental health/addictive services. Persons with specific disorders varied in the proportion who used services, from a high of more than 60% for somatization, schizophrenia, and bipolar disorders to a low of less than 25% for addictive disorders and severe cognitive impairment. Applications of these descriptive data to US health care system reform options are considered in the context of other variables that will determine national health policy.

How stigma interferes with mental health care.

2004-10-01
Patrick W. Corrigan
Many people who would benefit from mental health services opt not to pursue them or fail to fully participate once they have begun. One of the reasons for this disconnect … Many people who would benefit from mental health services opt not to pursue them or fail to fully participate once they have begun. One of the reasons for this disconnect is stigma; namely, to avoid the label of mental illness and the harm it brings, people decide not to seek or fully participate in care. Stigma yields 2 kinds of harm that may impede treatment participation: It diminishes self-esteem and robs people of social opportunities. Given the existing literature in this area, recommendations are reviewed for ongoing research that will more comprehensively expand understanding of the stigma-care seeking link. Implications for the development of antistigma programs that might promote care seeking and participation are also reviewed.

Twelve-Month Use of Mental Health Services in the United States

2005-06-01
Philip S. Wang , Michael Lane , Mark Olfson +3 more
Background: Dramatic changes have occurred in mental health treatments during the past decade.Data on recent treatment patterns are needed to estimate the unmet need for services.Objective: To provide data on … Background: Dramatic changes have occurred in mental health treatments during the past decade.Data on recent treatment patterns are needed to estimate the unmet need for services.Objective: To provide data on patterns and predictors of 12-month mental health treatment in the United States from the recently completed National Comorbidity Survey Replication.Design and Setting: Nationally representative faceto-face household survey using a fully structured diagnostic interview,

The PHQ-8 as a measure of current depression in the general population

2008-08-28
Kurt Kroenke , Tara W. Strine , Robert L. Spitzer +3 more

The Structure of Common Mental Disorders

1999-10-01
Robert F. Krueger
<h3>Background</h3> This report presents the results of confirmatory factor analyses of patterns of comorbidity among 10 common mental disorders in the National Comorbidity Survey, a national probability sample of US … <h3>Background</h3> This report presents the results of confirmatory factor analyses of patterns of comorbidity among 10 common mental disorders in the National Comorbidity Survey, a national probability sample of US civilians who completed structured diagnostic interviews. <h3>Methods</h3> Patterns of comorbidity among<i>DSM-III-R</i>mental disorders were analyzed via confirmatory factor analyses for the entire National Comorbidity Survey sample (N=8098; age range, 15-54 years), for random halves of the sample, for men and women separately, and for a subsample of participants who were seeing a professional about their mental health problems. Four models were compared: a 1-factor model, a 2-factor model in which some disorders represented internalizing problems and others represented externalizing problems, a 3-factor variant of the 2-factor model in which internalizing was modeled as having 2 subfactors (anxious-misery and fear), and a 4-factor model in which the disorders represented separate affective, anxiety, substance dependence, and antisocial factors. <h3>Results</h3> The 3-factor model provided the best fit in the entire sample. This result was replicated across random halves of the sample as well as across women and men. The substantial empirical intercorrelation between anxious-misery and fear (0.73) suggested that these factors were most appropriately conceived as subfactors of a higher-order internalizing factor. In the treatment sample, the 2-factor model fit best. <h3>Conclusions</h3> The results offer a novel perspective on comorbidity, suggesting that comorbidity results from common, underlying core psychopathological processes. The results thereby argue for focusing research on these core processes themselves, rather than on their varied manifestations as separate disorders.

Lifetime Prevalence of Specific Psychiatric Disorders in Three Sites

1984-10-01
Lee N. Robins
• Lifetime rates are presented for 15<i>DSM-III</i>psychiatric diagnoses evaluated in three large household samples on the basis of lay interviewers' use of the Diagnostic Interview Schedule. The most common diagnoses … • Lifetime rates are presented for 15<i>DSM-III</i>psychiatric diagnoses evaluated in three large household samples on the basis of lay interviewers' use of the Diagnostic Interview Schedule. The most common diagnoses were alcohol abuse and dependence, phobia, major depressive episode, and drug abuse and dependence. Disorders that most clearly predominated in men were antisocial personality and alcohol abuse and dependence. Disorders that most clearly predominated in women were depressive episodes and phobias. The age group with highest rates for most disorders was found to be young adults (aged 25 to 44 years). Correlates with race, education, and urbanization are presented.

Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health Surveys

2004-06-01
Koen Demyttenaere , Ronny Bruffaerts , José Posada-Villa +7 more
ContextLittle is known about the extent or severity of untreated mental disorders, especially in less-developed countries.ObjectiveTo estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth … ContextLittle is known about the extent or severity of untreated mental disorders, especially in less-developed countries.ObjectiveTo estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative.Design, Setting, and ParticipantsFace-to-face household surveys of 60 463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia.Main Outcome MeasuresThe DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview.ResultsThe prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country.ConclusionsReallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.
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The global burden of mental disorders: An update from the WHO World Mental Health (WMH) Surveys

2009-03-01
Ronald C. Kessler , Sergio Aguilar‐Gaxiola , Jordi Alonso +5 more
Abstract Aims - The paper reviews recent findings from the WHO World Mental Health (WMH) surveys on the global burden of mental disorders. Methods - The WMH surveys are representative … Abstract Aims - The paper reviews recent findings from the WHO World Mental Health (WMH) surveys on the global burden of mental disorders. Methods - The WMH surveys are representative community surveys in 28 countries throughout the world aimed at providing information to mental health policy makers about the prevalence, distribution, burden, and unmet need for treatment of common mental disorders. Results - The first 17 WMH surveys show that mental disorders are commonly occurring in all participating countries. The inter-quartile range (IQR: 25th-75th percentiles) of lifetime DSM-IV disorder prevalence estimates (combining anxiety, mood, externalizing, and substance use disorders) is 18.1–36.1%. The IQR of 12-month prevalence estimates is 9.8–19.1%. Prevalence estimates of 12-month Serious Mental Illness (SMI) are 4–6.8% in half the countries, 2.3–3.6% in one-fourth, and 0.8–1.9% in one-fourth. Many mental disorders begin in childhood-adolescence and have significant adverse effects on subsequent role transitions in the WMH data. Adult mental disorders are found to be associated with such high role impairment in the WMH data that available clinical interventions could have positive cost-effectiveness ratios. Conclusions - Mental disorders are commonly occurring and often seriously impairing in many countries throughout the world. Expansion of treatment could be cost-effective from both employer and societal perspectives
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Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis

2011-12-19
Laura Manea , Simon Gilbody , Dean McMillan
<h3>Background:</h3> The brief Patient Health Questionnaire (PHQ-9) is commonly used to screen for depression with 10 often recommended as the cut-off score. We summarized the psychometric properties of the PHQ-9 … <h3>Background:</h3> The brief Patient Health Questionnaire (PHQ-9) is commonly used to screen for depression with 10 often recommended as the cut-off score. We summarized the psychometric properties of the PHQ-9 across a range of studies and cut-off scores to select the optimal cut-off for detecting depression. <h3>Methods:</h3> We searched Embase, MEDLINE and PsycINFO from 1999 to August 2010 for studies that reported the diagnostic accuracy of PHQ-9 to diagnose major depressive disorders. We calculated summary sensitivity, specificity, likelihood ratios and diagnostic odds ratios for detecting major depressive disorder at different cut-off scores and in different settings. We used random-effects bivariate meta-analysis at cutoff points between 7 and 15 to produce summary receiver operating characteristic curves. <h3>Results:</h3> We identified 18 validation studies (<i>n</i> = 7180) conducted in various clinical settings. Eleven studies provided details about the diagnostic properties of the questionnaire at more than one cut-off score (including 10), four studies reported a cut-off score of 10, and three studies reported cut-off scores other than 10. The pooled specificity results ranged from 0.73 (95% confidence interval [CI] 0.63–0.82) for a cut-off score of 7 to 0.96 (95% CI 0.94–0.97) for a cut-off score of 15. There was major variability in sensitivity for cut-off scores between 7 and 15. There were no substantial differences in the pooled sensitivity and specificity for a range of cut-off scores (8–11). <h3>Interpretation:</h3> The PHQ-9 was found to have acceptable diagnostic properties for detecting major depressive disorder for cut-off scores between 8 and 11. Authors of future validation studies should consistently report the outcomes for different cut-off scores.
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The validity of two versions of the GHQ in the WHO study of mental illness in general health care

1997-01-01
David Goldberg , Richard Gater , Norman Sartorius +4 more
Background . In recent years the 12-item General Health Questionnaire (GHQ-12) has been extensively used as a short screening instrument, producing results that are comparable to longer versions of the … Background . In recent years the 12-item General Health Questionnaire (GHQ-12) has been extensively used as a short screening instrument, producing results that are comparable to longer versions of the GHQ. Methods . The validity of the GHQ-12 was compared with the GHQ-28 in a World Health Organization study of psychological disorders in general health care. Results are presented for 5438 patients interviewed in 15 centres using the primary care version of the Composite International Diagnostic Instrument, or CIDI-PC. Results . Results were uniformly good, with the average area under the ROC curve 88, range from 83 to 95. Minor variations in the criteria used for defining a case made little difference to the validity of the GHQ, and complex scoring methods offered no advantages over simpler ones. The GHQ was translated into 10 other languages for the purposes of this study, and validity coefficients were almost as high as in the original language. There was no tendency for the GHQ to work less efficiently in developing countries. Finally gender, age and educational level are shown to have no significant effect on the validity of the GHQ. Conclusions . If investigators wish to use a screening instrument as a case detector, the shorter GHQ is remarkably robust and works as well as the longer instrument. The latter should only be preferred if there is an interest in the scaled scores provided in addition to the total score.

The Composite International Diagnostic Interview

1988-12-01
Lee N. Robins
The Composite International Diagnostic Interview (CIDI), written at the request of the World Health Organization/US Alcohol, Drug Abuse, and Mental Health Administration Task Force on Psychiatric Assessment Instruments, combines questions … The Composite International Diagnostic Interview (CIDI), written at the request of the World Health Organization/US Alcohol, Drug Abuse, and Mental Health Administration Task Force on Psychiatric Assessment Instruments, combines questions from the Diagnostic Interview Schedule with questions designed to elicit Present State Examination items. It is fully structured to allow administration by lay interviewers and scoring of diagnoses by computer. A special Substance Abuse Module covers tobacco, alcohol, and other drug abuse in considerable detail, allowing the assessment of the quality and severity of dependence and its course. This article describes the design and development of the CIDI and the current field testing of a slightly reduced "core" version. The field test is being conducted in 19 centers around the world to assess the interviews' reliability and its acceptability to clinicians and the general populace in different cultures and to provide data on which to base revisions that may be found necessary. In addition, questions to assess International Classification of Diseases, ninth revision, and the revised DSM-III diagnoses are being written. If all goes well, the CIDI will allow investigators reliably to assess mental disorders according to the most widely accepted nomenclatures in many different populations and cultures.

The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI)

2004-06-01
Ronald C. Kessler , T. Bedirhan Üstün
Abstract This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of … Abstract This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH‐CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio‐demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12‐month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer‐assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper‐and‐pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD‐10 and DSM‐IV criteria. Elaborate CD‐ROM‐based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection. Copyright © 2004 Whurr Publishers Ltd.
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Depression Is a Risk Factor for Noncompliance With Medical Treatment

2000-07-24
M. Robin DiMatteo , Heidi S. Lepper , Thomas W. Croghan
Background: Depression and anxiety are common in medical patients and are associated with diminished health status and increased health care utilization.This article presents a quantitative review and synthesis of studies … Background: Depression and anxiety are common in medical patients and are associated with diminished health status and increased health care utilization.This article presents a quantitative review and synthesis of studies correlating medical patients' treatment noncompliance with their anxiety and depression.Methods: Research on patient adherence catalogued on MEDLINE and PsychLit from January 1, 1968, through March 31, 1998, was examined, and studies were included in this review if they measured patient compliance and depression or anxiety (with nϾ10); involved a medical regimen recommended by a nonpsychiatrist physician to a patient not being treated for anxiety, depression, or a psychiatric illness; and measured the relationship between patient compliance and patient anxiety and/or depression (or provided data to calculate it).Results: Twelve articles about depression and 13 about anxiety met the inclusion criteria.The associa-tions between anxiety and noncompliance were variable, and their averages were small and nonsignificant.The relationship between depression and noncompliance, however, was substantial and significant, with an odds ratio of 3.03 (95% confidence interval, 1.96-4.89).Conclusions: Compared with nondepressed patients, the odds are 3 times greater that depressed patients will be noncompliant with medical treatment recommendations.Recommendations for future research include attention to causal inferences and exploration of mechanisms to explain the effects.Evidence of strong covariation of depression and medical noncompliance suggests the importance of recognizing depression as a risk factor for poor outcomes among patients who might not be adhering to medical advice.

Assessment of Social Adjustment by Patient Self-Report

1976-09-01
Myrna M. Weissman
Current emphasis on early case finding, outpatient care, and on longitudinal studies of asymptomatic patients has focused attention on the community adjustment of psychiatric patients. Thus, simple and inexpensive methods … Current emphasis on early case finding, outpatient care, and on longitudinal studies of asymptomatic patients has focused attention on the community adjustment of psychiatric patients. Thus, simple and inexpensive methods such as self-report scales, which allow the routine assessment of patient adjustment, are potentially useful. The derivation and testing of such a method, the Social Adjustment Scale Self-Report, is described. This scale covers the patient's role performance, interpersonal relationships, friction, feelings and satisfaction in work, and social and leisure activities with the extended family, as a spouse, parent, and member of a family unit. Self-report results based on 76 depressed outpatients were comparable to those obtained from relatives as well as by a rater who interviewed the patient directly.

Lifetime Co-occurrence of DSM-III-R Alcohol Abuse and Dependence With Other Psychiatric Disorders in the National Comorbidity Survey

1997-04-01
Ronald C. Kessler
<h3>Objective:</h3> To study patterns of co-occurrence of lifetime<i>DSM-III-R</i>alcohol disorders in a household sample. <h3>Methods:</h3> Data came from the National Comorbidity Survey (NCS), a nationally representative household survey. Diagnoses were based … <h3>Objective:</h3> To study patterns of co-occurrence of lifetime<i>DSM-III-R</i>alcohol disorders in a household sample. <h3>Methods:</h3> Data came from the National Comorbidity Survey (NCS), a nationally representative household survey. Diagnoses were based on a modified version of the Composite International Diagnostic Interview. <h3>Results:</h3> Respondents with lifetime<i>NCS/DSM-III-R</i>alcohol abuse or dependence had a high probability of carrying at least 1 other lifetimeNCS/<i>DSM-III-R</i>diagnosis. Retrospective reports have suggested that most lifetime co-occurring alcohol disorders begin at a later age than at least 1 other NCS/<i>DSM-III-R</i>disorder. Earlier disorders are generally stronger predictors of alcohol dependence than alcohol abuse and stronger among women than men. Lifetime co-occurrence is positively, but weakly, associated with the persistence of alcohol abuse among men and of alcohol dependence among both men and women. <h3>Conclusions:</h3> Caution is needed in interpreting the results due to the fact that diagnoses were made by nonclinicians and results are based on retrospective reports of the age at onset. Within the context of these limitations, though, these results show that alcohol abuse and dependence are often associated with other lifetime<i>DSM-III-R</i>disorders and suggest that, at least in recent cohorts, the alcohol use disorders are usually temporally secondary. Prospective data and data based on clinically confirmed diagnoses are needed to verify these findings.

The paradox of self-stigma and mental illness.

2002-01-01
Patrick W. Corrigan , Amy C. Watson
Published narratives by persons with serious mental illness eloquently describe the harmful effects of stigma on self-esteem and self-efficacy. However, a more careful review of the research literature suggests a … Published narratives by persons with serious mental illness eloquently describe the harmful effects of stigma on self-esteem and self-efficacy. However, a more careful review of the research literature suggests a paradox; namely, personal reactions to the stigma of mental illness may result in significant loss in self-esteem for some, while others are energized by prejudice and express righteous anger. Added to this complexity is a third group: persons who neither lose self-esteem nor become righteously angry at stigma, instead seemingly ignoring the effects of public prejudice altogether. This article draws on research from social psychologists on self-stigma in other minority groups to explain this apparent paradox. We describe a situational model of the personal response to mental illness stigma based on the collective representations that are primed in that situation, the person's perception of the legitimacy of stigma in the situation, and the person's identification with the larger group of individuals with mental illness. Implications for a research program on the personal response to mental illness stigma are discussed.

Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): A critical review

1994-01-01
Hans‐Ulrich Wïttchen

Public conceptions of mental illness: labels, causes, dangerousness, and social distance.

1999-09-01
Bruce G. Link , Jo C. Phelan , Michaeline Bresnahan +2 more
The authors used nationwide survey data to characterize current public conceptions related to recognition of mental illness and perceived causes, dangerousness, and desired social distance.Data were derived from a vignette … The authors used nationwide survey data to characterize current public conceptions related to recognition of mental illness and perceived causes, dangerousness, and desired social distance.Data were derived from a vignette experiment included in the 1996 General Social Survey. Respondents (n = 1444) were randomly assigned to 1 of 5 vignette conditions. Four vignettes described psychiatric disorders meeting diagnostic criteria, and the fifth depicted a "troubled person" with subclinical problems and worries.Results indicate that the majority of the public identifies schizophrenia (88%) and major depression (69%) as mental illnesses and that most report multicausal explanations combining stressful circumstances with biologic and genetic factors. Results also show, however, that smaller proportions associate alcohol (49%) or drug (44%) abuse with mental illness and that symptoms of mental illness remain strongly connected with public fears about potential violence and with a desire for limited social interaction.While there is reason for optimism in the public's recognition of mental illness and causal attributions, a strong stereotype of dangerousness and desire for social distance persist. These latter conceptions are likely to negatively affect people with mental illness.

The PHQ-9

2001-09-01
Kurt Kroenke , Robert L. Spitzer , Janet B. W. Williams
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Resources for mental health: scarcity, inequity, and inefficiency

2007-09-01
Shekhar Saxena , Graham Thornicroft , Martín Knapp +1 more

The size and burden of mental disorders and other disorders of the brain in Europe 2010

2011-09-01
Hans‐Ulrich Wïttchen , Frank Jacobi , Jürgen Rehm +7 more
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No health without mental health

2007-09-01
Martin Prince , Vikram Patel , Shekhar Saxena +4 more

Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

2004-06-01
Jordi Alonso , M. C. Angermeyer , Sebastian Bernert +7 more
Objective: To describe the 12‐month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries. Method: A representative random sample of non‐institutionalized inhabitants from Belgium, France, … Objective: To describe the 12‐month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries. Method: A representative random sample of non‐institutionalized inhabitants from Belgium, France, Germany, Italy, the Netherlands and Spain aged 18 or older ( n = 21425) were interviewed between January 2001 and August 2003. DSM‐IV disorders were assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview (WMH‐CIDI). Results: Fourteen per cent reported a lifetime history of any mood disorder, 13.6% any anxiety disorder and 5.2% a lifetime history of any alcohol disorder. More than 6% reported any anxiety disorder, 4.2% any mood disorder, and 1.0% any alcohol disorder in the last year. Major depression and specific phobia were the most common single mental disorders. Women were twice as likely to suffer 12‐month mood and anxiety disorders as men, while men were more likely to suffer alcohol abuse disorders. Conclusion: ESEMeD is the first study to highlight the magnitude of mental disorders in the six European countries studied. Mental disorders were frequent, more common in female, unemployed, disabled persons, or persons who were never married or previously married. Younger persons were also more likely to have mental disorders, indicating an early age of onset for mood, anxiety and alcohol disorders.

Collaborative Care Management of Late-Life Depression in the Primary Care Setting

2002-12-11
Jürgen Unützer , Wayne Katon , Christopher M. Callahan +7 more
ContextFew depressed older adults receive effective treatment in primary care settings.ObjectiveTo determine the effectiveness of the Improving Mood–Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression.DesignRandomized … ContextFew depressed older adults receive effective treatment in primary care settings.ObjectiveTo determine the effectiveness of the Improving Mood–Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression.DesignRandomized controlled trial with recruitment from July 1999 to August 2001.SettingEighteen primary care clinics from 8 health care organizations in 5 states.ParticipantsA total of 1801 patients aged 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%).InterventionPatients were randomly assigned to the IMPACT intervention (n = 906) or to usual care (n = 895). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depresssion, Problem Solving Treatment in Primary Care.Main Outcome MeasuresAssessments at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life.ResultsAt 12 months, 45% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P&lt;.001). Intervention patients also experienced greater rates of depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P&lt;.001), more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P&lt;.001), lower depression severity (range, 0-4; between-group difference, −0.4; 95% CI, −0.46 to −0.33; P&lt;.001), less functional impairment (range, 0-10; between-group difference, −0.91; 95% CI, −1.19 to −0.64; P&lt;.001), and greater quality of life (range, 0-10; between-group difference, 0.56; 95% CI, 0.32-0.79; P&lt;.001) than participants assigned to the usual care group.ConclusionThe IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.

Grand challenges in global mental health

2011-07-01
Pamela Y. Collins , Vikram Patel , Sarah S. Joestl +7 more
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Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys

2007-09-01
Philip S. Wang , Sergio Aguilar‐Gaxiola , Jordi Alonso +7 more
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Validation and Utility of a Self-report Version of PRIME-MD&lt;SUBTITLE&gt;The PHQ Primary Care Study&lt;/SUBTITLE&gt;

1999-11-10
Robert L. Spitzer
The Primary Care Evaluation of Mental Disorders (PRIME-MD) was developed as a screening instrument but its administration time has limited its clinical usefulness.To determine if the self-administered PRIME-MD Patient Health … The Primary Care Evaluation of Mental Disorders (PRIME-MD) was developed as a screening instrument but its administration time has limited its clinical usefulness.To determine if the self-administered PRIME-MD Patient Health Questionnaire (PHQ) has validity and utility for diagnosing mental disorders in primary care comparable to the original clinician-administered PRIME-MD.Criterion standard study undertaken between May 1997 and November 1998.Eight primary care clinics in the United States.Of a total of 3000 adult patients (selected by site-specific methods to avoid sampling bias) assessed by 62 primary care physicians (21 general internal medicine, 41 family practice), 585 patients had an interview with a mental health professional within 48 hours of completing the PHQ.Patient Health Questionnaire diagnoses compared with independent diagnoses made by mental health professionals; functional status measures; disability days; health care use; and treatment/referral decisions.A total of 825 (28%) of the 3000 individuals and 170 (29%) of the 585 had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those of independent mental health professionals (for the diagnosis of any 1 or more PHQ disorder, kappa = 0.65; overall accuracy, 85%; sensitivity, 75%; specificity, 90%), similar to the original PRIME-MD. Patients with PHQ diagnoses had more functional impairment, disability days, and health care use than did patients without PHQ diagnoses (for all group main effects, P<.001). The average time required of the physician to review the PHQ was far less than to administer the original PRIME-MD (<3 minutes for 85% vs 16% of the cases). Although 80% of the physicians reported that routine use of the PHQ would be useful, new management actions were initiated or planned for only 117 (32%) of the 363 patients with 1 or more PHQ diagnoses not previously recognized.Our study suggests that the PHQ has diagnostic validity comparable to the original clinician-administered PRIME-MD, and is more efficient to use.

The World Health Organization Composite International Diagnostic Interview short‐form (CIDI‐SF)

1998-11-01
Ronald C. Kessler , Gavin Andrews , Daniel K. Mroczek +2 more
Abstract Data are reported on a series of short‐form (SF) screening scales of DSM‐III‐R psychiatric disorders developed from the World Health Organization's Composite International Diagnostic Interview (CIDI). A multi‐step procedure … Abstract Data are reported on a series of short‐form (SF) screening scales of DSM‐III‐R psychiatric disorders developed from the World Health Organization's Composite International Diagnostic Interview (CIDI). A multi‐step procedure was used to generate CIDI‐SF screening scales for each of eight DSM disorders from the US National Comorbidity Survey (NCS). This procedure began with the subsample of respondents who endorsed the CIDI diagnostic stem question for a given disorder and then used a series of stepwise regression analyses to select a subset of screening questions to maximize reproduction of the full CIDI diagnosis. A small number of screening questions, between three and eight for each disorder, was found to account for the significant associations between symptom ratings and CIDI diagnoses. Summary scales made up of these symptom questions correctly classify between 77% and 100% of CIDI cases and between 94% and 99% of CIDI non‐cases in the NCS depending on the diagnosis. Overall classification accuracy ranged from a low of 93% for major depressive episode to a high of over 99% for generalized anxiety disorder. Pilot testing in a nationally representative telephone survey found that the full set of CIDI‐SF scales can be administered in an average of seven minutes compared to over an hour for the full CIDI. The results are quite encouraging in suggesting that diagnostic classifications made in the full CIDI can be reproduced with excellent accuracy with the CIDI‐SF scales. Independent verification of this reproduction accuracy, however, is needed in a data set other than the one in which the CIDI‐SF was developed. Copyright © 1998 Whurr Publishers Ltd.

Diagnostic and Statistical Manual of Mental Disorders

2013-06-11
Janet B. W. Williams , Michael B. First
The fifth edition of the <italic>Diagnostic and Statistical Manual of Mental Disorders</italic> of the American Psychiatric Association is referred to as DSM-5<italic>™</italic>. DSM-5’s early predecessor, DSM-III, differed considerably from the … The fifth edition of the <italic>Diagnostic and Statistical Manual of Mental Disorders</italic> of the American Psychiatric Association is referred to as DSM-5<italic>™</italic>. DSM-5’s early predecessor, DSM-III, differed considerably from the first two editions. Its innovative incorporation of specified diagnostic criteria had a major impact on the field of mental health. In DSM-5, these criteria have been further updated to reflect the important gains in our understanding of mental disorders.

Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States

1994-01-01
Ronald C. Kessler
This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a … This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States.The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview.Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status.The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.

The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013

2014-03-19
Zachary Steel , Claire Marnane , Changiz Iranpour +4 more
Background: Since the introduction of specified diagnostic criteria for mental disorders in the 1970s, there has been a rapid expansion in the number of large-scale mental health surveys providing population … Background: Since the introduction of specified diagnostic criteria for mental disorders in the 1970s, there has been a rapid expansion in the number of large-scale mental health surveys providing population estimates of the combined prevalence of common mental disorders (most commonly involving mood, anxiety and substance use disorders). In this study we undertake a systematic review and meta-analysis of this literature. Methods: We applied an optimized search strategy across the Medline, PsycINFO, EMBASE and PubMed databases, supplemented by hand searching to identify relevant surveys. We identified 174 surveys across 63 countries providing period prevalence estimates (155 surveys) and lifetime prevalence estimates (85 surveys). Random effects meta-analysis was undertaken on logit-transformed prevalence rates to calculate pooled prevalence estimates, stratified according to methodological and substantive groupings. Results: Pooling across all studies, approximately 1 in 5 respondents (17.6%, 95% confidence interval:16.3–18.9%) were identified as meeting criteria for a common mental disorder during the 12-months preceding assessment; 29.2% (25.9–32.6%) of respondents were identified as having experienced a common mental disorder at some time during their lifetimes. A consistent gender effect in the prevalence of common mental disorder was evident; women having higher rates of mood (7.3%:4.0%) and anxiety (8.7%:4.3%) disorders during the previous 12 months and men having higher rates of substance use disorders (2.0%:7.5%), with a similar pattern for lifetime prevalence. There was also evidence of consistent regional variation in the prevalence of common mental disorder. Countries within North and South East Asia in particular displayed consistently lower one-year and lifetime prevalence estimates than other regions. One-year prevalence rates were also low among Sub-Saharan-Africa, whereas English speaking counties returned the highest lifetime prevalence estimates. Conclusions: Despite a substantial degree of inter-survey heterogeneity in the meta-analysis, the findings confirm that common mental disorders are highly prevalent globally, affecting people across all regions of the world. This research provides an important resource for modelling population needs based on global regional estimates of mental disorder. The reasons for regional variation in mental disorder require further investigation.
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Cross-national epidemiology of DSM-IV major depressive episode

2011-07-26
Evelyn J. Bromet , Laura Helena Andrade , Irving Hwang +7 more
Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present … Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low- to middle-income countries in the World Mental Health Survey Initiative. Major depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults. The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2:1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low- to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed. MDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.
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Prevalence and Treatment of Mental Disorders, 1990 to 2003

2005-06-15
Ronald C. Kessler , Olga Demler , Richard G. Frank +6 more
Although the 1990s saw enormous change in the mental health care system in the United States, little is known about changes in the prevalence or rate of treatment of mental … Although the 1990s saw enormous change in the mental health care system in the United States, little is known about changes in the prevalence or rate of treatment of mental disorders.We examined trends in the prevalence and rate of treatment of mental disorders among people 18 to 54 years of age during roughly the past decade. Data from the National Comorbidity Survey (NCS) were obtained in 5388 face-to-face household interviews conducted between 1990 and 1992, and data from the NCS Replication were obtained in 4319 interviews conducted between 2001 and 2003. Anxiety disorders, mood disorders, and substance-abuse disorders that were present during the 12 months before the interview were diagnosed with the use of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Treatment for emotional disorders was categorized according to the sector of mental health services: psychiatry services, other mental health services, general medical services, human services, and complementary-alternative medical services.The prevalence of mental disorders did not change during the decade (29.4 percent between 1990 and 1992 and 30.5 percent between 2001 and 2003, P=0.52), but the rate of treatment increased. Among patients with a disorder, 20.3 percent received treatment between 1990 and 1992 and 32.9 percent received treatment between 2001 and 2003 (P<0.001). Overall, 12.2 percent of the population 18 to 54 years of age received treatment for emotional disorders between 1990 and 1992 and 20.1 percent between 2001 and 2003 (P<0.001). Only about half those who received treatment had disorders that met diagnostic criteria for a mental disorder. Significant increases in the rate of treatment (49.0 percent between 1990 and 1992 and 49.9 percent between 2001 and 2003) were limited to the sectors of general medical services (2.59 times as high in 2001 to 2003 as in 1990 to 1992), psychiatry services (2.17 times as high), and other mental health services (1.59 times as high) and were independent of the severity of the disorder and of the sociodemographic characteristics of the respondents.Despite an increase in the rate of treatment, most patients with a mental disorder did not receive treatment. Continued efforts are needed to obtain data on the effectiveness of treatment in order to increase the use of effective treatments.
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Diagnostic and Statistical Manual of Mental Disorders(DSM)

2008-01-01
Frederick T. L. Leong
Title: Diagnostic and statistical manual of mental disorders (DSM-5) Author: American Psychiatric Association Editors of Croatian Edition: Vlado Jukic, Goran Arbanas ISBN: 978-953-191-787-2 Publisher: Naklada Slap, Jastrebarsko, Croatia Number of … Title: Diagnostic and statistical manual of mental disorders (DSM-5) Author: American Psychiatric Association Editors of Croatian Edition: Vlado Jukic, Goran Arbanas ISBN: 978-953-191-787-2 Publisher: Naklada Slap, Jastrebarsko, Croatia Number of pages: 936Diagnostic and statistical manual of mental disorders is a national classification, but since its third edition it became a worldwide used manual. [1] It has been published by the American Psychiatric Association and two years ago the fifth edition was released. [2] Croatian was among the first languages this book was translated to. [3] DSM-5 was translated by psychiatrists and psychologists, mainly from the University hospital Vrapce and published by the Naklada Slap publisher.DSM has always been more publicly debated than the other main classification - the International Classification of Diseases (ICD). [4] The same happened with this fifth edition. Even before it was released, numerous individuals, organizations, groups and associations were publicly speaking about the classification, new diagnostic entities and changing criteria. [5]Although there is a tendency of authors of both DSM and ICD to synchronize these two classifications and to make them more harmonized with each new edition, there are several differences among them. While ICD covers all the diseases, disorders and reasons for making a contact with the health system, DSM covers only mental disorders. Other disorders (medical conditions, as they are named in DSM-5) are not included, except in situations when they lead to a development of a mental disorder. The other main difference is that DSM is more operational zed, and gives criteria for each of the disorders, listing how many criteria have to be met to make a diagnosis of a particular disorder, and what excluding criteria are.Due to the fact that it is used all around the globe and since it has become the most used manual, it is sometimes said that DSM is a psychiatric Bible. [6]Some critics of DSM say that it stigmatizes people and that in each edition it includes more diagnostic entities. It is true that in each edition of DSM there are more disorders listed, but this is due to the fact that medicine is a developing area and new insights are made every year, so some disorders are separated into different subtypes or subgroups and different new diagnoses, giving the impression more behaviour are being pathologized. The intention of the authors was to make more homogenous groups. But, the truth is that, compared with ICD, it is more difficult to get a diagnosis in DSM, than in ICD, with the same clinical presentation. [7] DSM requires functional impairment or distress to pathologize behaviour, while in ICD this criterion is not present in every case.During the process of developing DSM-5 there was an open public discussion. [2] For over a year any person was able to participate in the discussion about future criteria, inclusion or exclusion of diagnostic entities from DSM. More than 21000 letters was sent to the authors. This was the unprecedented way of developing a classification that ICD now tries to follow in preparation of its 11th edition.As a direct consequence of such an open and wide discussion, some new disorders were included (e.g. hoarding disorder), some were excluded even though they were included during the proposal period (e.g. hypersexual disorders), some were heavily debated (e.g. narcissistic personality disorder). [8-10]As previously mentioned, DSM and ICD systems try to harmonize more. There were more non-American authors included in DSM-5 than ever before and some of the experts in the field were in the task force of DSM-5 and ICD-11. [2, 11]What is new in DSM-5, compared to DSM-IV. The organization of the chapters has been changed, so now the flow of the disorders follow life cycle. The book starts with neurodevelopmental disorders, followed by schizophrenia, bipolar and depressive disorders, and closing with neurocognitive disorders. …

Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care

1994-12-14
Robert L. Spitzer
<h3>Objective.</h3> —To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians. <h3>Design.</h3> —Survey; criterion … <h3>Objective.</h3> —To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians. <h3>Design.</h3> —Survey; criterion standard. <h3>Setting.</h3> —Four primary care clinics. <h3>Subjects.</h3> —A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians. <h3>Main Outcome Measures.</h3> —PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/ referral decisions. <h3>Results.</h3> —Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the<i>Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition</i>. The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, κ=0.71; overall accuracy rate=88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures,<i>P</i>&lt;.005). Nearly half (48%) of 287 patients with a PRIME-MD diagnosis who were somewhat or fairly well-known to their physicians had not been recognized to have that diagnosis before the PRIME-MD evaluation. A new treatment or referral was initiated for 62% of the 125 patients with a PRIME-MD diagnosis who were not already being treated. <h3>Conclusion.</h3> —PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research. (<i>JAMA</i>. 1994;272:1749-1756)

Social Class and Mental Illness: A Community Study

2007-10-01
August B. Hollingshead , Fredrick C. Redlich
Class and Mental Illness: A Community Study. By August B. Hollingshead and Fredrick C. Redlich. Price, $7.50. Pp. 442. John Wiley & Sons, Inc., 440 Fourth Ave., 1958. The ten-year … Class and Mental Illness: A Community Study. By August B. Hollingshead and Fredrick C. Redlich. Price, $7.50. Pp. 442. John Wiley & Sons, Inc., 440 Fourth Ave., 1958. The ten-year collaborative research directed by Hollingshead, a sociologist, and Redlich, a psychiatrist, has already produced some twenty-five papers; and the general drift of their work is very well known. But in Social Class and Mental Illness most of the major data of their project are given for the first time in detail. (A second volume, entitled Social Class, Family Dynamics, and Mental Illness, by Jerome Myers and Bertram Roberts, will soon be published.) The entire project represents trends of capital importance that are affecting the nature and destiny of psychiatry. One trend is the sociologizing of psychiatric research\p=m-\meaningthe incorporation of sociological perspectives into the study of mental disease and its treatment. The parallel and conjoint researches of sociologists and psychiatrists have supported the movement toward a social psychiatry, itself a close relative of what has come to be called, rather broadly, of course, milieu therapy. All of this increasing emphasis upon the possible (its supporters claim, the actual) importance of social factors in mental illness is itself linked with the continuous change in the position of psychiatry itself as a profession. If psychiatry were a stationary profession,

The Lancet Commission on global mental health and sustainable development

2018-10-01
Vikram Patel , Shekhar Saxena , Crick Lund +7 more
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Prevalence of mental disorders in China: a cross-sectional epidemiological study

2019-02-18
Yueqin Huang , Yu Wang , Hong Wang +7 more

Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

2022-01-10
The mental disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were depressive disorders, anxiety disorders, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, … The mental disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were depressive disorders, anxiety disorders, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, eating disorders, idiopathic developmental intellectual disability, and a residual category of other mental disorders. We aimed to measure the global, regional, and national prevalence, disability-adjusted life-years (DALYS), years lived with disability (YLDs), and years of life lost (YLLs) for mental disorders from 1990 to 2019.In this study, we assessed prevalence and burden estimates from GBD 2019 for 12 mental disorders, males and females, 23 age groups, 204 countries and territories, between 1990 and 2019. DALYs were estimated as the sum of YLDs and YLLs to premature mortality. We systematically reviewed PsycINFO, Embase, PubMed, and the Global Health Data Exchange to obtain data on prevalence, incidence, remission, duration, severity, and excess mortality for each mental disorder. These data informed a Bayesian meta-regression analysis to estimate prevalence by disorder, age, sex, year, and location. Prevalence was multiplied by corresponding disability weights to estimate YLDs. Cause-specific deaths were compiled from mortality surveillance databases. The Cause of Death Ensemble modelling strategy was used to estimate death rate by age, sex, year, and location. The death rates were multiplied by the years of life expected to be remaining at death based on a normative life expectancy to estimate YLLs. Deaths and YLLs could be calculated only for anorexia nervosa and bulimia nervosa, since these were the only mental disorders identified as underlying causes of death in GBD 2019.Between 1990 and 2019, the global number of DALYs due to mental disorders increased from 80·8 million (95% uncertainty interval [UI] 59·5-105·9) to 125·3 million (93·0-163·2), and the proportion of global DALYs attributed to mental disorders increased from 3·1% (95% UI 2·4-3·9) to 4·9% (3·9-6·1). Age-standardised DALY rates remained largely consistent between 1990 (1581·2 DALYs [1170·9-2061·4] per 100 000 people) and 2019 (1566·2 DALYs [1160·1-2042·8] per 100 000 people). YLDs contributed to most of the mental disorder burden, with 125·3 million YLDs (95% UI 93·0-163·2; 14·6% [12·2-16·8] of global YLDs) in 2019 attributable to mental disorders. Eating disorders accounted for 17 361·5 YLLs (95% UI 15 518·5-21 459·8). Globally, the age-standardised DALY rate for mental disorders was 1426·5 (95% UI 1056·4-1869·5) per 100 000 population among males and 1703·3 (1261·5-2237·8) per 100 000 population among females. Age-standardised DALY rates were highest in Australasia, Tropical Latin America, and high-income North America.GBD 2019 showed that mental disorders remained among the top ten leading causes of burden worldwide, with no evidence of global reduction in the burden since 1990. The estimated YLLs for mental disorders were extremely low and do not reflect premature mortality in individuals with mental disorders. Research to establish causal pathways between mental disorders and other fatal health outcomes is recommended so that this may be addressed within the GBD study. To reduce the burden of mental disorders, coordinated delivery of effective prevention and treatment programmes by governments and the global health community is imperative.Bill & Melinda Gates Foundation, Australian National Health and Medical Research Council, Queensland Department of Health, Australia.
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Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study

1994-12-14
Robert L. Spitzer
<h3>Objective.</h3> —To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians. <h3>Design.</h3> —Survey; criterion … <h3>Objective.</h3> —To assess the validity and utility of PRIME-MD (Primary Care Evaluation of Mental Disorders), a new rapid procedure for diagnosing mental disorders by primary care physicians. <h3>Design.</h3> —Survey; criterion standard. <h3>Setting.</h3> —Four primary care clinics. <h3>Subjects.</h3> —A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians. <h3>Main Outcome Measures.</h3> —PRIME-MD diagnoses, independent diagnoses made by mental health professionals, functional status measures (Short-Form General Health Survey), disability days, health care utilization, and treatment/ referral decisions. <h3>Results.</h3> —Twenty-six percent of the patients had a PRIME-MD diagnosis that met full criteria for a specific disorder according to the<i>Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition</i>. The average time required of the primary care physician to complete the PRIME-MD evaluation was 8.4 minutes. There was good agreement between PRIME-MD diagnoses and those of independent mental health professionals (for the diagnosis of any PRIME-MD disorder, κ=0.71; overall accuracy rate=88%). Patients with PRIME-MD diagnoses had lower functioning, more disability days, and higher rates of health care utilization than did patients without PRIME-MD diagnoses (for all measures,<i>P</i>&lt;.005). Nearly half (48%) of 287 patients with a PRIME-MD diagnosis who were somewhat or fairly well-known to their physicians had not been recognized to have that diagnosis before the PRIME-MD evaluation. A new treatment or referral was initiated for 62% of the 125 patients with a PRIME-MD diagnosis who were not already being treated. <h3>Conclusion.</h3> —PRIME-MD appears to be a useful tool for identifying mental disorders in primary care practice and research. (<i>JAMA</i>. 1994;272:1749-1756)

Cultural Adaptation and Psychometric Properties of the 8-item Patient Health Questionnaire (PHQ-8) to Screen for Depression in Southwestern Madagascar

2025-06-25
Hervet J. Randriamady , Manasi Sharma , Rocky E. Stroud +7 more | Cambridge Prisms Global Mental Health

Mental illness in rural communities - perspective from Sudan

2025-06-25
Aseel Magzoub | Education for Health

Undercounts of people with serious mental illness using the Washington Group Short Set questions

2025-06-25
Jean P. Hall , Kathleen C. Thomas , Bryan P. McCormick +1 more | Frontiers in Psychiatry
Background Accurately counting Americans with mental health conditions is essential to support program development and appropriate resource allocations, which are often based on prevalence data. Multiple federal surveys use the … Background Accurately counting Americans with mental health conditions is essential to support program development and appropriate resource allocations, which are often based on prevalence data. Multiple federal surveys use the Washington Group Short Set (WG-SS) questions to identify people with disabilities, including those with mental health conditions. However, the WG-SS questions miss many people with mental illnesses, under-representing this population in US federal survey data. Hence, we sought to explore the degree to which people with serious mental illness are missed. Methods We used data from the 2020 National Survey on Health and Disability to assess the rates that respondents with self-reported serious mental illness (SMI) conditions, i.e., major depression, bipolar disorder, schizophrenia, and schizoaffective disorder (n=263), were missed as disabled by the WG-SS questions. Results Using the three WG-SS questions suggested by the Washington Group to capture people with mental illnesses, 66.2%, 88.6%, and 96.6% of respondents with SMI were characterized as non-disabled; 58.2% were characterized as non-disabled across the three questions combined. Discussion Previous research demonstrated that the WG-SS questions missed almost 60% of respondents with any mental illness. However, the Washington Group states that its question set better captures people with more severe disabilities, so this study focused only on respondents with serious mental illnesses and only on questions that the Washington Group suggests capture people with psychosocial disabilities. Conclusion Results indicate that the WG-SS questions miss large percentages of even those with the most severe mental illnesses, who therefore may be substantially undercounted in US federal surveys using these questions. In turn, public mental health programs may be substantially underfunded.

Understanding barriers in supporting service users with complex post-traumatic stress disorder: a pilot survey

2025-06-24
Martin Robinson , Christine A. Courtois | European journal of psychotraumatology
Background: Experiences of complex trauma and complex post-traumatic stress disorder (CPTSD) may be associated with barriers to effective intervention for service users and providers.Objective: This investigation sought to identify barriers … Background: Experiences of complex trauma and complex post-traumatic stress disorder (CPTSD) may be associated with barriers to effective intervention for service users and providers.Objective: This investigation sought to identify barriers to intervention and support for individuals with CPTSD and their service providers.Method: A pilot survey on barriers to services for CPTSD was distributed to members of the International Society for Traumatic Stress Studies (ISTSS) Complex Trauma Special Interest Group (CTSIG). A total of 28 respondents provided quantitative ratings of potential barriers to CPTSD intervention and support, and qualitative opinion based on respondents' clinical and research experience. Quantitative data underwent descriptive analyses, and qualitative data were analysed using an inductive content analysis approach.Results: The majority of potential CPTSD-related barriers in this survey were perceived as 'usually' or 'almost always' barriers for service users and providers. The results highlighted CPTSD-related stigma/misunderstanding, inability to drive systemic change, and accessibility of resources as the most significant barriers to effective CPTSD intervention faced by service providers. The main perceived barriers facing individuals with CPTSD were access to supports and services, dissatisfaction with previous intervention(s), and availability of personal and resources. Qualitative remarks indicated relevant barriers in identification and recognition of CPTSD, availability of training, treatment challenge, misdiagnosis, vulnerability due to CPTSD experiences, structural barriers, and symptom-related difficulties.Conclusion: These findings extend our understanding of expert opinion related to CPTSD intervention barriers, and offer indicative directions for future research. Extension of these results is needed to integrate the opinions of more diverse expert groups.

Empowering Dementia Care Partners: How Self-Efficacy Influences Anxiety and Depression

2025-06-24
Scott E. Wilks , Catherine M. Lemieux , Laura Ainsworth +3 more | Illness Crisis & Loss
Care partners often struggle with confidence in managing their own health. The mediating effect of self-efficacy on a care partner's mental health and social loneliness was explored. Standardized measures assessed … Care partners often struggle with confidence in managing their own health. The mediating effect of self-efficacy on a care partner's mental health and social loneliness was explored. Standardized measures assessed loneliness, care partner self-efficacy, depression, and anxiety. Participants included 95 care partners who completed a survey measuring anxiety, depression, loneliness, and self-efficacy. Direct effects in the first mediation model were significant for loneliness on self-efficacy; self-efficacy on anxiety; and loneliness on anxiety. The indirect mediation effect of loneliness on anxiety through self-efficacy was significant. Direct effects in the second mediation model were significant for loneliness on self-efficacy; self-efficacy on depression; and loneliness on depression. Indirect mediation effects of loneliness on depression through self-efficacy were significant. Findings showed self-efficacy's buffering function on depression and anxiety. The current study underscores the need to educate and train providers on the importance of ADRD care partner self-efficacy when addressing their mental health and isolation.

Feasibility and acceptability of CoMUni: a social media- based intervention to increase mental health help seeking in UK undergraduate students

2025-06-24
Natalie Wilde , David Foxcroft , Emma Davies | Advances in Mental Health

Exploring Police Training Models for Addressing Mental Illness in Rural Communities

2025-06-24
Chunghyeon Seo , Joseph A. Winn | Community Mental Health Journal

Protocol for developing a model to promote the mental health of nurses caring for mental healthcare users at mental health institutions in Limpopo province, South Africa

2025-06-23
Annikie V. Hobyane , Hilda N. Shilubane , Tinyiko Nelly Rikhotso | PLoS ONE
The nurses as front liners caring for mental health care users (MHCUs) at mental health institutions are susceptible to adverse physical and psychological effects as a result of hostile behaviors … The nurses as front liners caring for mental health care users (MHCUs) at mental health institutions are susceptible to adverse physical and psychological effects as a result of hostile behaviors of mentally ill patients. Most nurses suffer from stress that is caused by management's lack of support, working overtime, lack of recognition by supervisors, and lack of skills and knowledge on how to handle aggressive mental health care users. The present study aims to develop a model to promote the mental health of nursing staff providing care to individuals with mental disorders at mental health institutions. Phase 1, the empirical face, will employ a qualitative, exploratory, and descriptive design focusing on nurses' experiences caring for MHCUs and their views on improving their mental health. Information will be gathered using unstructured individual interviews with nurses purposefully sampled at selected mental health institutions. The study will apply procedures to safeguard trustworthiness and moral principles during the study. Phase 2 will focus on developing a model, and in phase 3, the developed model will be validated. The findings of the study will determine recommendations.

Mental Health Stigma and Help-Seeking Behaviors Among Primary Healthcare Physicians in Oman

2025-06-23
Tharaya Al-Hashemi , Tamadhir Al-Mahrouqi , Salim Al‐Huseini +7 more | International Journal of Environmental Research and Public Health
Background: In Oman, primary healthcare physicians (PHPs) are often the first point of contact in the healthcare system. Understanding the prevalence and impact of stigma among these professionals is crucial … Background: In Oman, primary healthcare physicians (PHPs) are often the first point of contact in the healthcare system. Understanding the prevalence and impact of stigma among these professionals is crucial to fostering a supportive work environment and promoting access to mental health care. This study evaluated mental health stigma and its association with help-seeking behaviors among PHPs in Muscat, Oman. Methods: A cross-sectional analytical study was conducted from March to May 2023 using cluster random sampling to recruit 191 PHPs. Participants completed a structured questionnaire that evaluated demographic and clinical characteristics, help-seeking behaviors, and perceived stigma. The PPSS developed for this study underwent expert review, pilot tests, and reliability analysis. Data were analyzed using descriptive statistics, Chi-square tests, and multivariate logistic regression, with a significance set at p &lt; 0.05. Results: Most of the participants were women (78.5%), aged 30–39 years (49.7%), and Omani nationals (71.2%). More than half (57.6%) reported experiencing depressive episodes, yet only 21.8% sought professional help. High levels of stigma were associated with reluctance to seek professional mental health support, and 24.6% of participants preferred not to seek help at all. Those in the stigma group were significantly more likely to rely on family or friends for support (adjusted OR = 2.873; 95% CI = 1.345–6.138; p = 0.006). Common barriers to help-seeking included a lack of belief in the effectiveness of treatment (23.0%) and concerns about confidentiality (19.9%). Conclusions: Mental health stigma remains a widespread problem among primary healthcare physicians in Oman, influencing their behavior and preferences. Interventions to reduce stigma and address barriers to mental health care, such as enhanced confidentiality safeguards and treatment skepticism, are critical to improving physician well-being and healthcare delivery. This study can inform policy and training programs aimed at improving physician well-being and patient care.

Supplemental Material for Do Posttreatment Increases in Social Recovery Capital Mediate the Relationship Between Lower Internalizing Symptoms and Less Substance Use?

2025-06-23
| Psychology of Addictive Behaviors

Comparative study on school-based mental health literacy in three Asian countries

2025-06-23
Fumiko Shibuya , Masahide Usami , Marian Danille C. Santillan +7 more | Tropical Medicine and Health
Mental health literacy is essential for the recognition, management, and prevention of mental disorders among school-aged children. However, few studies have examined the implementation status of school-based mental health literacy … Mental health literacy is essential for the recognition, management, and prevention of mental disorders among school-aged children. However, few studies have examined the implementation status of school-based mental health literacy in Asian countries. This study aims to compare the approaches taken by the Philippines, Indonesia, and Japan in managing school-based mental health literacy through curriculum-related policies. The collected documents of this study analyzed both policies (formulated from 2000 to 2023) and curricula (from grade 1 to grade 12) that were adapted to the deductive content analysis methods. Policies were analyzed using the policy triangle framework (Walt and Gilson in Health Policy Plan 9:353-370, 1994) and mapped using the review points (Margaretha et al. in Front Psychiatry 14:1126767, 2023). Curricula were analyzed using the definition of mental health literacy (Jorm in Am Psychol 67:231-243, 2012). This study focused on mental health laws and policies in the Philippines, Indonesia, and Japan, highlighting their success in addressing the needs of adults and school-aged children. By considering each country's unique socio-cultural contexts and basic educational approaches, this study identified diverse strategies and methodologies in addressing mental health challenges. Using a common analytic framework, this study collected and analyzed policies and curricula on mental health literacy from the three countries (Philippines, 22; Indonesia, 9; and Japan, 6). The basic education curricula developed by their respective Ministries of Education were used. This study highlights two key findings on school-based mental health literacy. First, mental health literacy is incorporated into health and physical education in Japan, health, values education and homeroom guidance in the Philippines, and religious education in Indonesia. Second, while the Philippines and Indonesia implement mental health education based on established policies, Japan lacks a core mental health literacy policy but has developed and implemented related curricula through its course of study guidelines. The curriculum analysis identified a specific challenge: a lack of "first aid skills to support others who are developing a mental disorder or are in a mental health crisis". This study revealed the partial implementation of mental health literacy education in the Philippines, Indonesia, and Japan. The Philippines offers a nearly comprehensive curriculum on mental health literacy (grades 1-12), Japan incorporates it into health education (grades 5-10), and Indonesia integrates it into religious education (grades 1-12). While the Philippines and Indonesia align with mental health policies, Japan relies on its national curriculum without a core policy. A key challenge was indicated involving teachers, guidance counselors, or school health personnel as key actors to support students with mental disorders or those potentially at risk, as well as to handle emergency cases of mental disorders in schools. Recommendations include systematic monitoring of the implementation of school-based mental health policies, collaboration with UN agencies to align with international standards while incorporating culturally tailored strategies for each country.

Psychiatry at crossroads yet again: social policies must lead the way

2025-06-22
Antonio Ventriglio | International Review of Psychiatry

New MH care services launched by national recovery center

2025-06-20
Valerie A. Canady | Mental Health Weekly
Taking into account Indiana's low ranking in national studies in overall mental health, including prevalence of mental illness and access to care, national leaders in addiction recovery treatment this month … Taking into account Indiana's low ranking in national studies in overall mental health, including prevalence of mental illness and access to care, national leaders in addiction recovery treatment this month announced the expansion of the state's Recovery Centers of America's Indianapolis facility with the addition of mental health residential and outpatient treatment services.

MH patients describe ED experiences when seeking medical care

2025-06-20
Valerie A. Canady | Mental Health Weekly
Research focusing on the experiences of people with mental health or substance use disorders seeking medical care in a hospital emergency room found that many experience stigma and described health … Research focusing on the experiences of people with mental health or substance use disorders seeking medical care in a hospital emergency room found that many experience stigma and described health care providers as “dismissive,” “rushed” and “unprofessional.”

The Impact of Enhanced Behavioral Health Services on Total Healthcare Costs Among US Employers: A Site-Level Analysis of 19 Cohort Studies

2025-06-20
Matt Hawrilenko , Casey Smolka , Emily Ward +3 more | Journal of health economics and outcomes research
Background: The return on investment (ROI) of mental health care is a critical metric in an era of cost-conscious healthcare decision-making. However, selective reporting of positive study results may inflate … Background: The return on investment (ROI) of mental health care is a critical metric in an era of cost-conscious healthcare decision-making. However, selective reporting of positive study results may inflate ROI estimates. Objective: To quantify the mean and variation in employer-level ROI outcomes for a comprehensive behavioral health benefit program. Methods: Data were obtained from 19 employer-specific studies conducted between May 2023 and December 2024. Sources included medical claims data spanning 12 months pre- and post-program launch, and program billing records of clinical and nonclinical costs. Studies were included if they were conducted by a single behavioral health benefit where the full sample of studies was known. The population included 19 US employers where employees and dependents received up to 12 free psychotherapy or medication management sessions. All studies used the same inclusion and exclusion criteria, retrospective matched cohort design, and difference-in-differences analysis. Data were abstracted following PRISMA guidelines. ROI was estimated using a difference-in-differences model to control for baseline medical spending and pooled using inverse variance weighting with a random effects structure. The primary outcome was the ROI multiple, defined as the ratio of gross per-member-per-month savings to total program spending. Results: The meta-analysis included 42 148 participants (14 645 program users and 27 503 matched controls) across a range of employer sizes and industries. The pooled ROI multiple was 2.3 (95% CI, 1.9-2.8), corresponding to net savings of 159permemberpermonth(95 111-$207). Significant heterogeneity was observed (I² = 67.8%; t² = 0.646; P < .001). A sensitivity analysis including nonclinical costs yielded a pooled ROI of 1.8. Conclusion: This meta-analysis, the largest of its kind, demonstrates that a centralized behavioral health benefit can consistently generate net savings across varied employer settings. These findings provide robust evidence to support the adoption of comprehensive mental health programs as an effective strategy for reducing overall medical spending in employer-sponsored health plans.

Self-management strategies and care needs of patients with persistent depressive disorder and their informal caregivers: a multi-perspectives qualitative interview study

2025-06-20
Ericka C. Solis , Ingrid V. E. Carlier , Noëlle G. A. Kamminga +1 more | Frontiers in Psychiatry
Introduction When patients with persistent depressive disorder (PDD) respond insufficiently to available evidence-based treatments, depression treatment guidelines recommend psychiatric rehabilitation through self-management. Preferably, the intervention should involve the patient’s informal … Introduction When patients with persistent depressive disorder (PDD) respond insufficiently to available evidence-based treatments, depression treatment guidelines recommend psychiatric rehabilitation through self-management. Preferably, the intervention should involve the patient’s informal caregiver. Methods To gain insight into the healthcare needs of PDD patients and their caregivers and to facilitate the implementation of a self-management program, we conducted individual semi-structured interviews with 28 PDD patients and 9 informal caregivers regarding their self-management/coping and needs. Transcripts were analyzed with Grounded Theory using three sensitizing concepts (PDD experience, self-management/coping, needs). Results Patients had 9 main themes and caregivers had 11 main themes. Patients and caregivers shared 9 main themes, pertaining to powerlessness, patients’ identity changes, shame/stigma, relationship dissatisfaction, family suffering, self-management attitudes, self-management strategies, coping support, and coping complications. While self-management attitudes of patients were mixed, those of caregivers were positive. Care needs of both groups centered on psychoeducation and communication skills development. Caregivers reported urgently needing support in dealing with patients’ suicidal behavior. Discussion Our findings underscore the profound burden of PDD on both patients and their informal caregivers. We strongly recommend that healthcare professionals encourage and facilitate the development of self-management in depressed patients early in the treatment process and involve informal caregivers, particularly within suicide prevention strategies. Clinical Trial Registration https://onderzoekmetmensen.nl/en/trial/55681 , Netherlands Trial Register Identifier NL5818.

Psychological Burden and Coping Strategies Among Pakistani Adults: A Cross-Sectional Survey Study

2025-06-20
Madeeha Malik , H. K. Ur Rehman , Azhar Hussain +5 more | Epidemiologia
Background/Objectives: Mental health conditions represent a growing global health concern, disproportionately impacting populations in low- and middle-income countries like Pakistan. Limited epidemiological data, coupled with recent socioeconomic and environmental disruptions, … Background/Objectives: Mental health conditions represent a growing global health concern, disproportionately impacting populations in low- and middle-income countries like Pakistan. Limited epidemiological data, coupled with recent socioeconomic and environmental disruptions, has intensified the need for current insights into psychological burden and coping capacities in the Pakistani population. Methods: A descriptive, cross-sectional survey was conducted from January to May 2023 among 400 community-dwelling adults attending outpatient departments in Islamabad and Rawalpindi. A structured 75-item questionnaire incorporating validated tools (PHQ-9, GAD-7, WHO-5, CSES, and SRQ-20) was used to assess depression, anxiety, well-being, coping self-efficacy, and mental distress. Descriptive statistics, χ2 and Fisher’s exact tests, and Spearman’s rank correlation (rs) analyses were performed using IBM SPSS 22.0. Results: Most respondents were male (73.0%), aged 25–34 (60.0%), and urban-dwelling (80.0%). Clinically relevant depression and anxiety were observed in 57.0% and 19.5% of participants, respectively; 38.0% reported mental distress. Conversely, 76.5% demonstrated fair-to-good coping efficacy and 51.0% had high well-being scores. Younger age (≤34 years), higher income, urban residence, and male gender were associated with significantly better mental health outcomes. Strong positive correlation was found between PHQ-9 and GAD-7 scores (rs = 0.672), and moderate negative correlations were found between GAD-7 and WHO-5 (rs = −0.496), and PHQ-9 and WHO-5 (rs = −0.310). Conclusions: Our findings highlight the significant psychological burden among urban Pakistani adults, alongside promising levels of resilience and coping self-efficacy. These results emphasize the urgent need for early, culturally adapted mental health screening and intervention programs in outpatient settings. Integrating such strategies into primary care, particularly for vulnerable subgroups like women, older adults, and those with lower income could facilitate timely diagnosis, improve outcomes, and reduce stigma surrounding mental health.

Mind the Gap: a Retrospective Study of Discrepancies in Self-Reported and Administrative Database-Identified Mental Health Issues in Slovenia

2025-06-19
Matej Vinko , Andreja Kukec , Lijana Zaletel‐Kragelj | Slovenian Journal of Public Health
ABSTRACT Background This study assessed discrepancies between self-reported and administrative data sources in identifying mental health issues in Slovenia, and investigated associated socio-demographic factors. Methods Data were linked from the … ABSTRACT Background This study assessed discrepancies between self-reported and administrative data sources in identifying mental health issues in Slovenia, and investigated associated socio-demographic factors. Methods Data were linked from the 2019 Slovenian European Health Interview Survey (EHIS; n=9,900) and national health administrative databases capturing inpatient hospitalisations, outpatient prescription drugs and mental health-related sick leave. Mental health issues were identified in EHIS by self-report and in administrative databases using diagnostic codes and medication claims. Socio-demographic factors were obtained from EHIS. Discrepancies were assessed and multinomial logistic regression was used to analyse the association between these factors and the source of case identification. Results Of the 9,900 EHIS respondents, 1,336 (13.5%) self-reported mental health issues, while 1,675 (16.9%) were identified in administrative databases. Only 613 individuals (4.6% of the total sample) were identified in both sources. Older age was associated with being identified in both data sources and administrative data only compared to not being identified. Females and unemployed persons were more likely than males and employed persons to be identified as having mental health issues, regardless of the data source. Compared to those with primary education or lower, individuals with higher education were less likely to be identified in administrative data only or in both data sources. Conclusions discrepancies exist between self-reported and administrative data sources in identifying mental health issues. Discrepancies are associated with socio-demographic factors and may lead to different interpretations of population mental health. This study underscores the importance of cautiously interpreting self-reported and administrative health data in public health.

Stigmatising attitudes towards people with mental disorders in a survey of older Japanese adults before the COVID-19 pandemic

2025-06-19
Kumiko Yoshioka , Alyssia Rossetto | Aging & Mental Health
This study investigates stigmatising attitudes towards depression and schizophrenia in a sample of Japanese adults aged 70-79. One thousand participants completed an online survey in 2017. They were randomly assigned … This study investigates stigmatising attitudes towards depression and schizophrenia in a sample of Japanese adults aged 70-79. One thousand participants completed an online survey in 2017. They were randomly assigned to read a vignette of a person experiencing either major depression or chronic schizophrenia, then answered questions regarding discrimination by others in the community, personal and perceived stigma, and preference for social distance. Participants had more stigmatising attitudes towards the vignette of the person experiencing schizophrenia. They most often endorsed statements indicating they would not employ someone, or vote for a politician, with a mental disorder. Participants perceived that other people were more likely to hold stigmatising attitudes than themselves. Regarding social distance, participants were most unwilling to have the person marry into their family or move next door to them. Substantial minorities of older Japanese adults hold stigmatising attitudes towards people with mental disorders, particularly towards those experiencing schizophrenia, and for statements assessing desire for social distance. Anti-stigma efforts targeted at older Japanese adults might usefully focus on destigmatising schizophrenia, promoting the social inclusion and competence of people with mental disorders, and developing social contact interventions to reduce desire for social distance.

Effectiveness of barber-facilitated “Doing What Matters in Times of Stress” intervention among urban literate youths in Western Kenya: A cluster randomised trial

2025-06-18
Protus Musotsi , Phiona Koyiet , Harriet Musimbi +5 more | PLOS Global Public Health
Youth with mental health disorders are a growing concern in Kenya, yet services are inaccessible. “Doing What Matters in Times of Stress (DWM)” is a scalable self-help intervention that can … Youth with mental health disorders are a growing concern in Kenya, yet services are inaccessible. “Doing What Matters in Times of Stress (DWM)” is a scalable self-help intervention that can be delivered by lay providers. However, its effectiveness in low-resource, non-humanitarian settings is unknown. We evaluated the effectiveness of barber-facilitated DWM intervention in reducing psychological distress, while improving functioning and resilience among literate urban youths in Western Kenya. This cluster randomised trial involved 15 barbers in intervention group and 15 in the waiting-list control. Barbers were from 30 barbershops in Bungoma and Kitale towns, aged 18–30 years and literate in English. Using mental health-themed music as an entry point, barbers recruited youth aged 18–29 years, fluent in English, and had mild or moderate psychological distress and functioning difficulties. Intervention participants received DWM guide and/or audios, supported by barbers through three individual sessions. Waiting-list control participants received the intervention after five weeks. Outcome measures included Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7), Perceived Stress Scale (PSS-10) and psychological outcome profiles (PSYCHLOPS). We analysed data using cumulative ordinal multilevel models. Between 31 st July 2023–27 th January 2024, 330 eligible youths were enrolled (n = 158, from 11 intervention arm barbers and n = 172 from 10 control barbers). Post-intervention, intervention group youth had 95%, 82% and 71% lower odds of higher depression (AOR = 0.05, 95% CI 0.02-0.10, p &lt; 0.001), anxiety (AOR = 0.18, 95% CI 0.09–0.34, p &lt; 0.001) and stress (AOR = 0.29, 95% CI 0.12–0.71, p = 0.007), respectively. They also had 86% lower odds of higher self-identified problem severity scores (AOR = 0.14, 95% CI = 0.08 -0.27, p &lt; 0.001) and 4.3 times higher odds of higher resilience levels (AOR = 4.33, 95% CI 2.00–9.36, p &lt; 0.001). DWM effectively reduced psychological distress and improved resilience among youths. Barbershops are promising community places for mental health promotion. Long-term, multi-site studies are required to assess outcome sustainability and scalability. Trial registration : Pan African Clinical Trials Registry PACTR202306502042812

Development and evaluation of a training module for people with lived experience of mental illness using social contact strategy for stigma reduction: A study protocol

2025-06-18
Gurucharan Bhaskar Mendon , Santosh Loganathan , Maya Semrau +1 more | PLoS ONE
Social contact strategy or social contact based anti-stigma intervention, where a person with lived experience (PWLE) of mental illness shares his/her lived experiences with the target group, has been found … Social contact strategy or social contact based anti-stigma intervention, where a person with lived experience (PWLE) of mental illness shares his/her lived experiences with the target group, has been found to be effective in reducing stigma and discrimination. A culturally appropriate social contact based anti-stigma intervention training module would be helpful in training PWLE. Since there is no culturally appropriate training module available in India, there is a need to develop a training module for PWLE of mental illness to deliver a social contact based anti-stigma intervention. Thus, the proposed mixed-methods study aims to develop and test the efficacy of a training module for PWLE of mental illness, using social contact strategy to reduce stigma and discrimination towards people with mental illness amongst undergraduate students. The proposed study will be carried out in three phases; Phase-I: formative work will be conducted using an explorative research design. After a formative and extensive literature review, the culturally appropriate training module will be developed and subsequently reviewed and validated by mental health experts and service users. Phase-II: PWLE of mental illness will be trained using the developed manual adopting a case series design. Phase-III: To test the efficacy of the training, a quasi-experimental research design will be used, in which the target group’s knowledge, attitudes and behaviour towards mental illness will be assessed pre- and post and at three-month follow-up. Socio-demographic data will be analysed using descriptive statistics. Qualitative data (Phase-I and Phase-III) will be analysed through thematic analysis. Based on normality distribution, a parametric test like RMANOVA or an equivalent non parametric test will be adopted during phase III for efficacy testing. In addition, the outcomes amongst the PWLE, i.e., self-stigma and self-esteem, will be assessed and use of the training module will be analysed using thematic analysis.

Stigma experience and coping strategies in stroke survivors: a qualitative study

2025-06-18
Lina Song , Xiaofei Sun , C.L. Cassandra Li +3 more | Frontiers in Psychology
Aim To investigate the true experiences of stigma and changes in stroke survivors and explore how they manage their symptoms. Background Stroke is a serious disease that threatens human health … Aim To investigate the true experiences of stigma and changes in stroke survivors and explore how they manage their symptoms. Background Stroke is a serious disease that threatens human health with increasing mortality and disability rates. Declining self-care ability and excessive external dependence can easily lead to stigma. However, there is a lack of studies on real stigma experiences and coping styles among stroke survivors. Design A descriptive qualitative study. Methods Fourteen participants were recruited across inpatient stroke settings in China. Semi-structured face-to-face interviews were conducted with participants to collect data. Audio-recorded data were transcribed. The data were analyzed using the seven-step Colaizzi method for phenomenological analysis, adhering to the principles of Phenomenological research methodology. The study adheres to SRQR EQUATOR checklist. Findings Fourteen semi-structured interviews were conducted, revealing three main themes and ten sub-themes: (1) Non-adaptive emotion regulation in response to stigma, including sub-themes of remorse, shame, sadness, perceived disaster, depression, and reduced self-worth; (2) Adaptive emotion regulation in response to stigma, including positive reappraisal, positive adjustment, acceptance, and support systems; (3) Origins of stigma, including sources such as relatives, friends, oneself, and medical staff. Conclusion The findings have the potential to inform the development and implementation of strategies to reduce the experience of stigma in early-stage clinical settings. Medical professionals must prioritize the comprehensive examination of genuine instances of stigma encountered by stroke survivors. Timely identification of stigma is imperative to mitigate the risk of patients adopting inaccurate beliefs and maladaptive coping mechanisms post-stroke. Strategies aimed at diminishing stigma should consider personal, familial, policy-related, societal, institutional, and environmental dimensions.

Impact of lifestyle in chronic pain and depression: a propensity score analysis in UK biobank

2025-06-18
H. W. Casey , Helen R. Wright , Josiah King +7 more | Wellcome Open Research
<ns3:p>Background Chronic pain and depression are prevalent global health burdens that frequently co-occur, leading to worse outcomes than either condition alone. Current treatments are frequently inadequate, particularly for comorbid chronic … <ns3:p>Background Chronic pain and depression are prevalent global health burdens that frequently co-occur, leading to worse outcomes than either condition alone. Current treatments are frequently inadequate, particularly for comorbid chronic pain and depression. Identifying contributing lifestyle factors could help inform more effective interventions and improve our understanding of disease pathophysiology. Methods This study aimed to identify contributing factors for both conditions by assessing the effects of seven lifestyle-related variables (using counterfactual analysis to account for confounding) within the UK Biobank. Chronic pain and depression were analysed as separate disorders and within nominal comorbidity groups (neither disorder, each disorder in isolation and both disorders combined), in full and sex-specific samples. Results Insufficient sleep (full sample: odds ratio (OR) =1.645, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub>&lt;</ns3:italic>0.001, female sample: OR=1.693, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub> </ns3:italic>=0.002) and loneliness (full sample: OR=3.397, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub> </ns3:italic>&lt;0.001, female sample: OR=3.196, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub> </ns3:italic>&lt;0.001, male sample: OR=3.798, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub> </ns3:italic>&lt;0.001) were associated with increased risk of depression. Obesity (full sample: OR=1.379, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub>&lt;</ns3:italic>0.001, female sample: OR=1.467, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub>&lt;</ns3:italic>0.001, male sample: OR=1.308, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub>=</ns3:italic> 0.005) was associated with an increased risk of chronic pain. In nominal outcomes, insufficient sleep (full sample: OR=1.828, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub> </ns3:italic>&lt;0.001, female sample: OR=1.845, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub>&lt;</ns3:italic>0.001, male sample: OR=1.847, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub>=</ns3:italic>0.013) and loneliness (full sample: OR=3.488, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub>&lt;</ns3:italic>0.001, female sample: OR=3.388, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub>&lt;</ns3:italic>0.001, male sample: OR=3.782, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub>&lt;</ns3:italic>0.001) were associated with an increased risk of comorbid chronic pain and depression. Additionally, loneliness was also associated with an increased risk of depression without chronic pain (full sample: OR=2.812, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub> </ns3:italic>=0.003, male sample: OR=3.467, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub>=</ns3:italic>0.014) and obesity was associated with an increased risk of chronic pain without depression (full sample: OR=1.333, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub>&lt;</ns3:italic>0.001, female sample: OR=1.399, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub> </ns3:italic>=0.002, male sample: OR=1.281, <ns3:italic>P<ns3:sub>Adjusted</ns3:sub> </ns3:italic>=0.018). Conclusions By identifying lifestyle-related risk factors with potential causal impacts on chronic pain, depression and their comorbidity, these findings enhance our understanding of disease pathophysiology and highlight potential markers and targets of more accurate diagnoses and non-therapeutic interventions.</ns3:p>

Editorial Note: Depressive symptoms and associated factors among HIV positive patients attending public health facilities of Dessie town: A cross-sectional study

2025-06-18
| PLoS ONE

Psychiatric Morbidity Among Medical Clinic Attendees at a Tertiary Care Hospital in Sri Lanka During the Economic Crisis

2025-06-18
Shamila De Silva , Dileepa Senajith Ediriweera , Aruni Hapangama | Research Square (Research Square)
<title>Abstract</title> <italic>Background</italic> Chronic physical illnesses such as diabetes and hypertension are risk factors for psychiatric morbidity among medical clinic attendees. Failure to identify psychiatric morbidity results in a significant financial … <title>Abstract</title> <italic>Background</italic> Chronic physical illnesses such as diabetes and hypertension are risk factors for psychiatric morbidity among medical clinic attendees. Failure to identify psychiatric morbidity results in a significant financial burden on the healthcare system and on individuals by increasing hospital visits and needless investigations. The Sri Lankan population has been undergoing unprecedented health, political and economic issues since 2019, potentially worsening the mental health of many individuals. This study aims to detect the prevalence of psychiatric morbidity (depression, anxiety, and stress) among medical clinic attendees at a tertiary care hospital in Sri Lanka, and explore associated sociodemographic and medical factors. <italic>Methods</italic> Conducted at the North Colombo Teaching Hospital, Ragama, this descriptive cross-sectional study involved 350 participants who provided informed consent. An interviewer-administered questionnaire collected sociodemographic and medical data, complemented by DASS-21 scale for screening depression, anxiety, and stress. Data analysis was performed using SPSS, employing descriptive statistics, Chi-square tests, and Pearson correlation. <italic>Results</italic> Of 350 participants 203 (58%) were females; 195 (55.7%) were aged 60 years or more. Anxiety was present in 10.0%(95%CI:6.9%-13.1%), depression in 22.6%(95%CI:18.2%-26.9%) and stress in 9.7%(95%CI:6.6%-12.8%). Patients with anxiety had a higher number of comorbidities than those without (P=0.011), as did patients with stress (P=0.038). Patients with hypertension were more likely to have depression than those without (26% vs 17%, P=0.041). Participants with anxiety and depression were likely to have higher monthly expenses for medications and to be on medications for psychiatric illnesses. Those with inadequate income, not living in their own house and unable to pay debts were likely to have depression. For every additional comorbidity, odds ratio (OR) of having anxiety increased by 1.45(95%CI:1.09–1.96). Females had OR of having anxiety 2.83(95%CI:1.24-7.19). For every additional comorbidity, OR of having stress increased by 1.51(95%CI:1.14–2.03). For every Rs.1000 increase in monthly expenditure, OR of having depression increased by 1.06(95%CI:1.01–1.12). <italic>Conclusion</italic> The study highlights a concerning prevalence of psychiatric disorders among medical clinic attendees, particularly among those with multiple comorbidities and socio-economic challenges. There is an urgent need for effective mechanisms to identify and address these mental health issues within this vulnerable population.

Strained patient-provider relationship, unmotivated workforce, financial constraints, and stigma: Multiple challenges in integrating mental health care within Vietnam’s methadone clinics

2025-06-18
Nguyễn Thu Trang , Nguyen Huu Anh , Hán Đình Hòe +7 more | Journal of Ethnicity in Substance Abuse
This study examined current mental health practices in methadone treatment in Vietnam. We conducted 23 interviews with participants with methadone experiences (n = 12), methadone physicians (n = 6), counselors … This study examined current mental health practices in methadone treatment in Vietnam. We conducted 23 interviews with participants with methadone experiences (n = 12), methadone physicians (n = 6), counselors (n = 5), and one focus group with family members. Mental health issues were primarily identified through casual observation, on-site support was limited, and referrals to psychiatric care were rarely pursued. Four factors shaped this situation: (1) a strained patient-provider relationship; (2) an inadequately trained, unstable, unmotivated workforce; (3) participants' financial constraints; and (4) mental health stigma and misconception. Addressing system-level factors to enforce treatment guidelines and improve provider working conditions is critical to improving care quality.

THE EFFECT OF THE PSYCHIATRIC AND MENTAL HEALTH NURSING COURSE ON MENTAL HEALTH LITERACY IN NURSING STUDENTS: A QUASI-EXPERIMENTAL STUDY

2025-06-17
Ahmet Göktaş | İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi
In the literature, it is suggested that curriculum programs should be updated, sufficient content should be added to the psychiatric and mental health nursing course, and training programs should be … In the literature, it is suggested that curriculum programs should be updated, sufficient content should be added to the psychiatric and mental health nursing course, and training programs should be organized to improve students' mental health literacy. This study aimed to determine the effect of the psychiatric and mental health nursing course on mental health literacy among nursing students. This study was conducted as a quasi-experimental study with 69 nursing students. The mean age of the students was 21.97±1.14 and 79.7% were female. It was found that the posttest mean scores of the mental health literacy scale and its sub-scales were significantly higher than the pretest mean scores. It is recommended to add sufficient content to the psychiatric and mental health nursing course and support it with clinical practice. In places where there are no units on mental health for the implementation of the course, consultation-liaison psychiatric nursing practice enables students to put the information they receive in the course into practice and increases the mental health literacy level.

Self-stigma of individuals with alcohol dependence in Turkey: A qualitative study

2025-06-17
Seval Cuceler Yalmancıoglu , Mualla Yılmaz | Journal of Ethnicity in Substance Abuse
This study aims to determine the self-stigma of individuals with alcohol dependence in Turkey. In this study, a qualitative research approach and content analysis were used. Also, the phenomenological design … This study aims to determine the self-stigma of individuals with alcohol dependence in Turkey. In this study, a qualitative research approach and content analysis were used. Also, the phenomenological design was implemented, which is one of the qualitative research approaches. The study group of the research consisted of 37 alcohol-dependent individuals receiving inpatient treatment in an addiction treatment center (AMATEM) in Turkey. The data for this study were collected between January 14 and May 22, 2020. Two main themes emerged: 1) Opinions of Alcohol-Dependent Individuals on Themselves 2) Opinions of Society on Alcohol-Dependent Individuals. Also, seven sub-themes emerged regarding these themes. This study determined the self-stigmatization of alcohol-dependent individuals, their regrets, and the effect of culture and Islamic religion on self-stigmatization. At the research, alcohol-dependent individuals stated that they stigmatized, despised, and loathed themselves and alcohol consumers in general. In line with these results, combatting against social stigma toward alcohol-dependent individuals and providing the individuals stigmatizing themselves (self-stigma) or addicted to alcohol with training on alcohol dependence and stigma prevention are recommended.

Pathways to mental health services across local health systems in sub-Saharan Africa: Findings from a systematic review

2025-06-17
Samuel Adeyemi Williams , Mamadu Baldeh , Abdulai Jawo Bah +3 more | PLoS ONE
Globally, over 280 million individuals suffer from mental disorders, and almost 85% in low-resource settings do not receive any therapy. In sub-Saharan Africa (SSA), many patients are forced to either … Globally, over 280 million individuals suffer from mental disorders, and almost 85% in low-resource settings do not receive any therapy. In sub-Saharan Africa (SSA), many patients are forced to either live with untreated mental illness or seek care from traditional or religious leaders due to the high treatment cost. This literature review identifies pathways to access mental health services and proposed a collaborative model for care across SSA. We systematically searched five electronic databases (Embase and MEDLINE via OVID, CINAHL, PsycINFO, and Global Index Medicus) using the following search terms, ‘pathways to care’, ‘mental disorders,’ and ‘sub-Saharan Africa’ for primary studies reporting on pathways to care for mental disorders in SSA. There were no restrictions on the study’s date. Overall, the electronic database search produced 3399 search results, of which we retrieved 194 articles for full-text screening and 29 studies included in the analysis. This study finds that traditional and faith-based healers play an integral role in the pathway to care; more than 70% used traditional and religious healers as the first point of care for mental health care. The median duration for the delay in seeking treatment in a health facility was six months. Patients who sought care from traditional and faith healers were found to have experienced the most prolonged delay without treatment. Age, gender, level of education, marital status, and geographical location were some of the factors associated with the pathway choice. Patients who sought care from traditional and faith healers as the first point of care were found to have experienced the most extended delay without treatment when they arrived at the hospital. The study proposes and recommends a new model for collaboration between biomedical, traditional and faith-based healers that focuses on education through training and adopting a new referral framework.

Community pharmacists’ perceptions of mental health care: A qualitative study on stigma and barriers

2025-06-17
Nadia Saleh , Mai Rizik , Mohammed Zawiah +1 more | Journal of Health Psychology
This study aimed to explore the stigma, barriers, and improvements needed for providing effective mental health care in community pharmacies in Jordan. A qualitative study was conducted through semi-structured interviews … This study aimed to explore the stigma, barriers, and improvements needed for providing effective mental health care in community pharmacies in Jordan. A qualitative study was conducted through semi-structured interviews with 20 community pharmacists. The interviews were conducted in December 2024. Thematic analysis was applied to identify themes. A total of 20 pharmacists were interviewed. Pharmacists reported significant stigma among patients with mental health disorders, often due to societal pressures. However, within the pharmacy environment, pharmacists showed minimal stigma and demonstrated empathy. Key barriers identified included communication challenges, particularly the lack of privacy. Proposed improvements focused on enhancing education and training through workshops and continuous professional development. Community pharmacists play a critical role in mental health care but face challenges such as stigma, communication issues, and knowledge gaps. Addressing these barriers through better training could significantly enhance the ability of pharmacists to provide effective mental health support.

Key components of successful intersectoral collaboration in mental health promotion

2025-06-17
Nina Tamminen , Outi Wallin , Kirsti Kasila +2 more | Journal of Public Mental Health
Purpose This paper aims to describe the factors that ensure successful intersectoral collaboration in mental health promotion. Design/methodology/approach This descriptive study was conducted in the southwest area of Finland in … Purpose This paper aims to describe the factors that ensure successful intersectoral collaboration in mental health promotion. Design/methodology/approach This descriptive study was conducted in the southwest area of Finland in collaboration with participants from one wellbeing services county, municipalities, non-governmental organisations and local educational institutions. Altogether, 28 participants provided data in six focus group interviews. This data was analysed using thematic analysis method. Findings Five key components of successful intersectoral collaboration in mental health promotion were identified: recognition of the importance and value of collaboration, commitment and support from leaders and decision makers, structures for intersectoral collaboration, communication and dialogue and dissemination of collaboration outcomes and continuity of best practices. Originality/value Intersectoral collaboration is needed for successful implementation of strategies and measures to promote mental health and strengthen mental wellbeing. The identification of five key components for intersectoral collaboration provides a valuable framework that can inform future mental health promotion initiatives.

Direct Outreach Meetings Increase Primary Care Utilization of Psychiatry Access Programs

2025-06-16
Matthew D. Jandrisevits , Michelle Broaddus , Rosa Kim +2 more | The Journal of Behavioral Health Services & Research

Perceptions of electronic health records by minority ethnic groups in mental health: A systematic literature review

2025-06-16
Ammarah Ikram , Sahdia Parveen , Eleftheria Vaportzis | medRxiv (Cold Spring Harbor Laboratory)
The implementation of Electronic Health Records (EHRs) in mental health contexts has been slow. Reasons for this include concerns from health care professionals regarding the collection of sensitive information and … The implementation of Electronic Health Records (EHRs) in mental health contexts has been slow. Reasons for this include concerns from health care professionals regarding the collection of sensitive information and the stigma associated with mental health services. Despite the low uptake of EHRs, the benefits include patients feeling empowered and in control of their own treatment. However, minority ethnic groups often access mental health services through crisis pathways and have been found to disengage with EHRs. The aim of this review was to explore minority ethnic groups' perceptions of the utility of mental health EHRs and establish perceived barriers and facilitators to access. MEDLINE, CINAHL, EMBASE, Scopus, PsycINFO, PubMed and Web of Science were searched. Included papers mentioned minority ethnic groups from the 37 listed countries on the Organisation for Economic Co-operation and Development, and included service users, clients or patients accessing EHRs in mental healthcare settings. Papers were required to be published between 2009 - 2025. Eight papers met all criteria for inclusion, and three themes emerged: Limited English proficiency as a barrier, Lack of access to technology and Perceived impact of EHRs on access to care. Barriers to access EHRs with limited English proficiency, no access to technology, and stigma was a significant issue for minority ethnic groups due to concerns of who has access to the electronic health data. Benefits of accessing EHRs included easier and efficient access to records. EHRs are critical for modern health systems and further work is required to improve EHRs usage in mental health systems for minority ethnic groups.

Understanding stigma: The experiences of people with drug-sensitive pulmonary tuberculosis in Rawalpindi, Pakistan

2025-06-16
Renato T. Stein , Anil Fastenau , Hanna Åman +4 more | PLoS ONE
Introduction Tuberculosis (TB) is a major global health problem and Pakistan is ranked fifth among the 30 high-burden countries in the world. TB-related stigma affects health seeking behaviour and treatment … Introduction Tuberculosis (TB) is a major global health problem and Pakistan is ranked fifth among the 30 high-burden countries in the world. TB-related stigma affects health seeking behaviour and treatment adherence, increasing disease transmission and worsening health outcomes. This study aimed to explore experiences of stigma among people with TB (PWTB) in Rawalpindi to help inform targeted stigma reduction interventions that could improve health seeking behaviour, treatment adherence and the mental well-being of PWTB in Pakistan. Methodology In-depth interviews were conducted with 15 people with pulmonary drug sensitive TB from Rawalpindi, Pakistan. For assessing emerging themes, an inductive themed analysis approach was used. Next, a deductive approach was applied by analysing and interpreting the data against the Health Stigma and Discrimination Framework. Results TB- related stigma among participants was driven by fear of infection, which in some cases was due to misconceptions surrounding TB transmission as well as social judgement and gender norms. Stigma manifested through: anticipated and perceived stigma in the form of non-disclosure and fear of social exclusion; enacted stigma among friends and family, in the workplace and healthcare settings; and internalised stigma, The negative outcomes of stigma that resulted for some participants included non- adherence and social exclusion, in the form of loss of marriage prospects and employment. Conclusion This study confirms that TB-related stigma persists in Pakistan, impacting he well-being, medication adherence and treatment outcomes of PWTB. The distinct drivers, manifestations and outcomes of stigma in Rawalpindi Pakistan uncovered from this study, supported by previous research, can help inform targeted stigma reduction interventions such as public education programmes.

Pilot outcomes and exploration of treatment mechanisms using a culturally adapted version of the unified protocol for transdiagnostic treatment of emotional disorders to improve mental health symptoms, alcohol misuse, functional outcomes, and sleep quality in emergency responders

2025-06-16
Eric C. Meyer , Sheila Roth , Elizabeth Coe +2 more | Frontiers in Health Services
Introduction Emergency responders encounter frequent trauma and myriad occupational hazards, contributing to concerning rates of posttraumatic stress disorder (PTSD) and related mental health symptoms. These symptoms are each strongly linked … Introduction Emergency responders encounter frequent trauma and myriad occupational hazards, contributing to concerning rates of posttraumatic stress disorder (PTSD) and related mental health symptoms. These symptoms are each strongly linked with neuroticism/negative emotionality (NNE). Thus, an emotion-focused, transdiagnostic, skills-based treatment approach seems to be a strong match for this population. We sought to address barriers to mental health treatment for emergency responders, including stigma, logistical barriers, and lack of provider knowledge regarding emergency response culture by delivering treatment via telehealth by providers trained in emergency response culture. Methods In an uncontrolled pilot trial, we delivered the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to 30 emergency medical service, police, and fire service personnel. Results The large majority (80.0%) completed treatment. Working Alliance Inventory scores were high. Large improvements occurred at post-treatment and one-month follow-up in PTSD symptom severity (Hedges' g = 1.1 at post-treatment; g = 1.3 at follow-up), depression ( g = 1.3; 1.3), anxiety ( g = 1.1; 1.0), functional impairment ( g = 1.2; 1.1), and quality of life ( g = .89; .81). Small-to-medium sized improvements occurred in sleep quality ( g = .42; .69) and engagement in values-consistent behavior ( g = .34; .77). There were large, theory-consistent improvements during treatment in NNE ( g = 1.1), difficulties in emotion regulation ( g = .94), and experiential avoidance ( g = 1.1), and large associations between changes in these mechanistic variables and improved treatment outcomes. Discussion We summarize our cultural adaptation process aimed at maximizing fit of the UP with emergency responders and recommend additional, controlled research examining the UP in trauma exposed populations. Clinical Trial Registration NCT05357586.

Enhancing Medical Student Confidence in Managing Patients with Mental Health Crises and Patients in Law Enforcement Custody

2025-06-16
Miguel Ángel Hernández Navarro , Max Berger , Stephen Villa +2 more | Western Journal of Emergency Medicine

Challenges of caring for complex, vulnerable patients: how psychiatric nurses experience caring for people with co-occurring psychiatric and addiction disorders

2025-06-15
Natalie Finch | Evidence-Based Nursing

Taking efficacious treatments for posttraumatic stress beyond the bedside: Exploration of successes and challenges in training community and lay providers across the globe

2025-06-15
Anu Asnaani , Lily A. Brown , Bita Ghafoori +2 more | Journal of Traumatic Stress
Abstract Although there is considerable data to support the efficacy of several treatments for trauma‐related disorders, the traumatic stress field continues to struggle with adequate implementation and uptake of such … Abstract Although there is considerable data to support the efficacy of several treatments for trauma‐related disorders, the traumatic stress field continues to struggle with adequate implementation and uptake of such treatments in real‐world settings, which greatly contributes to persistent health disparities in these disorders. Task‐shifting, or the ability to train frontline providers in evidence‐based treatments for psychological disorders following traumatic events in various local and global community settings, may be one avenue to improve the translatability, scalability, and sustainability of effective traumatic stress treatments. In this paper, we describe a range of implementation and training efforts to bring efficacious treatments for trauma‐related disorders beyond the bedside and directly into the communities that could benefit the most. Our descriptions cover the training methodologies utilized and the fidelity measurement of efforts to train frontline providers in several distinct global settings, namely Chile, Portugal, Greece, the Caribbean, and Somaliland. In addition, we describe a large‐scale, city‐wide implementation and evaluation of providers’ fidelity to evidence‐based traumatic stress treatment within a major U.S. city for further exemplification around how task‐shifting can happen at a larger, systemic, top‐down level. In our descriptions, we also critically examine the challenges our teams have encountered when doing such work and highlight successful strategies that could facilitate the reduction of inequities in traumatic stress treatment worldwide.

Stigma as a major barrier to human rights in health-care assessment: evaluating the psychometric properties of the substance use stigma mechanism scale

2025-06-14
Mahvia Gull , Muhammad Aqeel , Aniqa Kanwal | International Journal of Human Rights in Healthcare
Purpose Stigma against people suffering from substance use disorders contributes to health disparities and impedes health-care and human rights efforts. There is substantive evidence to show that substance use stigma … Purpose Stigma against people suffering from substance use disorders contributes to health disparities and impedes health-care and human rights efforts. There is substantive evidence to show that substance use stigma threatens the societal values of diversity, equality and inclusion, is a barrier to mental health and well-being and contributes to successful treatment and screening. It is a cultural phenomenon that varies by context, country and region. The majority of stigma instruments were developed in the west, resulting in a lack of instruments that are culturally relevant for the eastern context. This study aims to discuss the psychometric properties of cross-culturally adapted stigma measurement scales for the Urdu-speaking community. Design/methodology/approach The Urdu version was prepared using the standard back-translation method. The sample, selected through the purposive sampling method, is comprised of 200 adults with an age range of 18–60 years. The Cronbach’s alpha reliability and validity of the substance use stigma mechanism scale (SU-SMS) were assessed through exploratory factor analysis and Pearson correlation analyses. Findings Preliminary analysis revealed that the overall instrument had good internal consistency (Urdu SU-SMS α = 0.92; English SU-SMS α = 0.92) as well as test–retest correlation coefficients for 15 days ( r = 0.95). The factor loading of all items ranged from 0.61 to 0.99, which explained the significance level and indicated the model’s overall goodness of fit. Originality/value This study investigates the effects of stigma associated with substance use disorders on human dignity, rights and language. Cross-cultural settings for health prevention, assessment and theory pay insufficient attention to stigma within the Urdu-speaking community, but this indigenous cross-cultural instrument can provide a new perspective.

Assessment of Perceptions of Nursing Undergraduates towards Mental Health Practices

2025-06-13
Algamdii Alya | Clinical Journal of Nursing Care and Practice
Background: Undergraduate nursing students, like the general population, are not devoid of negative attitudes relating to mental health. As future manpower, undergraduate nursing students need to be trained in a … Background: Undergraduate nursing students, like the general population, are not devoid of negative attitudes relating to mental health. As future manpower, undergraduate nursing students need to be trained in a manner that inspires confidence in the way they perceive and handle mentally ill persons. Aim: This study aimed to investigate undergraduate students' perceptions and attitudes toward mental health practices. Methods: The study adopted a cross-sectional descriptive design approach. A self-reported questionnaire was prepared and sent to 140 undergraduate nursing students studying at King Saud University. A total of 128 students took part in the study by filling out self-reported questionnaires. Results: Undergraduate nursing students have a positive perception and attitude (social relationships) towards people living with mentally ill persons in three of the five Attitudes towards Mental Illness (AMI) categories investigated. AMI1 (18.93), AMI2 (9.55), AMI3 (16.88), AMI4 (8.34), AMI5 (9.82), Average AMI (62.98). Conclusion: Undergraduate nursing students hold unjustified views regarding people with mental illness, which leads to negative attitudes held throughout their studies and professional practice. As future manpower, it is important that psychiatric training is reformed to offer undergraduate nursing students comprehensive skills necessary for future practice.

Health Care Use, Care Settings, and Location of Death for People With Schizophrenia in Long-Term Care.

2025-06-13
Katie Dover , Jess G. Fiedorowicz , David H. Kirkwood +7 more | PubMed

Life and Stigma Experiences of Individuals With Substance Use Disorder: A Qualitative Study

2025-06-13
Esra Albal , Gül Dıkeç , Gökhan Umut | Addicta The Turkish Journal on Addictions

Use of Online Tools for Mental Health Among Racially and Ethnically Diverse College Students: Mixed Methods Study

2025-06-13
Sarah A. Hamza , Yesenia Aguilar Silvan , Lauren C. Ng | JMIR Human Factors
Background Anxiety and depression symptoms have been rising among college students, with many increasingly meeting the criteria for 1 or more mental health problems. Due to a rise in internet … Background Anxiety and depression symptoms have been rising among college students, with many increasingly meeting the criteria for 1 or more mental health problems. Due to a rise in internet access and lockdown restrictions associated with the COVID-19 pandemic, online mediums, such as teletherapy, repositories for mental health information, discussion forums, self-help programs, and online screening tools, have become more popular and used by college students to support their mental health. However, there is limited information about individual-level factors that lead college students to use these online tools to support their mental health. Objective This mixed methods study aimed to examine the associations between demographics, symptom severity, mental health literacy, stigma, attitudes, and self-efficacy and the use of online tools to seek psychological information and services among racially and ethnically diverse college students. This study also aimed to qualitatively characterize types of online tools used, reasons for using tools or lack thereof, and perceived helpfulness of tools. Methods Undergraduate students (N=123) completed validated measures and provided open-ended descriptions of the types of online tools they used to seek psychological information and services and their reasons for using those tools. Logistic regression analyses were used to test associations of online tool use to seek mental health information and hypothesized predictors. Descriptive statistics were conducted to examine online tool types, reasons for using online tools, and helpfulness explanations. Results In total, 49.6% (61/123) of the participants used online tools (eg, search engines) to seek mental health information, while 30.1% (37/123) used online tools (eg, medical websites) to seek mental health services. Mental health literacy (P=.002; odds ratio 1.14, 95% CI 1.05-1.24) was associated with greater use of online tools to seek mental health information. None of the hypothesized variables predicted online tool use to seek mental health services. In total, 82% (50/61) of participants who sought information found online tools somewhat helpful, while 49% (18/37) of participants who sought services found online tools very helpful. Of the students who did not use online tools to seek information, 19% (12/62) reported it was because they did not know which online tools to use and 31% (19/62) stated they would be encouraged to use online tools if it was recommended by professionals, therapists, family, or friends. Of the students who did not use online tools to seek services, 33% (28/86) reported it was because they did not think mental health help was necessary. Conclusions These findings highlight the use of online tools to provide mental health information and connect to professional services, suggesting that online tools are widely used to access mental health support.