This study investigates the association between protected characteristics and inequalities in mental health care in the UK. Multinomial regression was used to model the association between protected ...characteristics and self-reported distress. Data was extracted from waves 6–10 (2014–2019) of the UK Household Longitudinal Study. Two risk categories were constructed: “undiagnosed distress” referred to a General Health Questionnaire-12 (GHQ-12) score above “caseness” along with no history of mental health diagnosis; “diagnosis without self-report symptoms” referred to a GHQ-12 score consistently below “caseness” within the study time frame but having received a mental health diagnosis. Compared to people without a disability, people with a disability are at considerably greater risk of both undiagnosed distress (Relative risk ratios (RRR) 2.76; Confidence Interval (CI): 2.55, 2.99) and diagnosis without self-reported symptoms (RRR 3.61; CI: 2.80, 4.66). Likewise, women were more likely than men to report undiagnosed distress (RRR = 1.49; CI: 1.38,1.61) or a diagnosis without self-reported symptoms (RRR = 1.38; CI: 1.08, 1.76. Lesbian, gay, and bisexual people are at greater risk of undiagnosed distress compared with heterosexual people (RRR 1.42; CI: 1.19, 1.70). Adults aged 16–24 years were at greatest risk compared to all other age groups. People from a minority ethnic background had a reduced risk of diagnosis without self-report symptoms compared with people from a White ethnic background (RRR 0.34; CI: 0.20, 0.61). Education, employment and income variables moderated some of these associations. This is the first study to examine diagnosis without self-report symptoms alongside undiagnosed distress. Findings suggest that addressing inequality in mental health care requires increased understanding of the needs and strengths within different groups and to provide appropriate forms of social, medical or psychosocial intervention rather than a singular focus on increasing detection, diagnosis and treatment. People with a disability appear to be at greatest disadvantage, requiring greater attention in policy and practice.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Background
Globally, national guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research concerning ...patient experience of treatments. A review of patient experience research can provide a comprehensive overview of this important form of evidence and thus enable the voices and subjectivities of those affected by depression to have an impact on the treatments and services they are offered. This review aims to seek a comprehensive understanding of patient experiences of psychological therapies for depression using a systematic and rigorous approach to review and synthesis of qualitative research.
Method
PsychINFO, PsychARTICLES, MEDLINE, and CINAHL were searched for published articles using a qualitative approach to examine experiences of psychological therapies for depression. All types of psychological therapy were included irrespective of model or modes of delivery (e.g. remote or in person; group or individual). Each article was assessed following guidance provided by the Critical Appraisal Skill Programme tool. Articles were entered in full into NVIVO and themes were extracted and synthesized following inductive thematic analysis.
Results
Thirty-seven studies, representing 671 patients were included. Three main themes are described; the role of therapy features and setting; therapy processes and how they impact on outcomes; and therapy outcomes (benefits and limitations). Subthemes are described within these themes and include discussion of what works and what’s unhelpful; issues integrating therapy with real life; patient preferences and individual difference; challenges of undertaking therapy; influence of the therapist; benefits of therapy; limits of therapy and what happens when therapy ends.
Conclusions
Findings point to the importance of common factors in psychotherapies; highlight the need to assess negative outcomes; and indicate the need for patients to be more involved in discussions and decisions about therapy, including tailoring therapy to individual needs and taking social and cultural contexts into account.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In this volume, the editors examine the state of clinical governance in the Mental Health sector. Despite the often confusing wealth of literature on the subject, little, if any, refers specifically ...to psychological treatment services. Clinical Effectiveness in Psychotherapy and Mental Health provides a guide to learning about the different guidelines and evaluation methods. It focuses on three important contributions to clinically effective practice: clinical audit, outcome monitoring and evidence-based practice.
OBJECTIVES: To assess the feasibility of cognitive screening in older veterans presenting for routine primary care.
DESIGN: Quality improvement initiative.
SETTING: Seven Veterans Affairs Medical ...Centers.
PARTICIPANTS: Veterans aged 70 and older without a prior diagnosis of cognitive impairment.
MEASUREMENTS: Scores from 16 different versions of the Mini‐Cog, a 5‐point cognitive screen consisting of three‐word recall (0–3 points) with a clock‐drawing interference task (0 or 2 points). Five word lists were paired with three clock times and randomly ordered for presentation with the original Mini‐Cog version. The conventional dementia screening cut point was increased to maximize sensitivity; to pass, patients had to draw the clock correctly and recall at least two of three words (score 4 or 5/5).
RESULTS: Administering the Mini‐Cog took 90 to 180 seconds. Of 8,342 veterans approached, 8,063 (96.7%) agreed to be screened; 2,081 (25.8%) scored less than 4 out of 5. Scores declined with age, but age did not predict pass or fail. Different word lists produced different screen failure rates, ranging from 21.2% to 33.4%. Five dementia specialists were unable to distinguish harder from easier lists. Different clock times accounted for 2% or less of the difference in failure rates.
CONCLUSION: The Mini‐Cog was quick and well accepted by older veterans. Many with no prior documentation of cognitive impairment failed the screen. Failure rates varied with the word list used, revealing that even apparently minor changes in test items affect screen results. Additional study is needed to establish the value of cognitive screening in shaping primary care of older veterans.
Objectives
To assess the effect of screening on diagnosing cognitive impairment.
Design
Quality improvement initiative.
Setting
Seven Veterans Affairs Medical Centers.
Participants
Veterans aged 70 ...or older without a prior diagnosis of cognitive impairment.
Measurements
Veterans failing a brief cognitive screen (Mini‐Cog score <4/5) at a routine primary care visit were offered a further, comprehensive evaluation with an advance practice registered nurse trained in dementia care and integrated into the primary care clinic. Veterans completing the evaluation were reviewed in a consensus conference and assigned a diagnosis of dementia; cognitive impairment, no dementia; or no cognitive impairment. Total numbers of screens, associated scores (0–5), and the consensus diagnoses were tallied. New cognitive impairment diagnoses were also tracked for veterans who passed the screen but requested further evaluation, failed but declined further evaluation, or were not screened. Primary care provider satisfaction with the program also was assessed.
Results
Of 8,342 veterans offered screening, 8,063 (97%) accepted, 2,081 (26%) failed the screen, 580 (28%) agreed to further evaluation, and 540 (93%) were diagnosed with cognitive impairment, including 432 (75%) with dementia. For screen passes requesting further evaluation, 87% (103/118) had cognitive impairment, including 70% (82/118) with dementia. Screen failures declining further evaluation had 17% (259/1,501) incident cognitive impairment diagnosed through standard care, bringing the total newly documented cognitive impairment in all screens to 11% (902/8,063), versus 4% (1,242/28,349) in similar clinics without this program. Eighty‐two percent of primary care providers in clinics with this program agreed that it provided a useful service.
Conclusion
Screening combined with offering further evaluation increased new diagnoses of cognitive impairment in older veterans two to three times. Veterans accepted screening well, and providers found the program useful.
Recent studies of public law care proceedings within the family justice system in England and Wales suggest that up to a quarter of all mothers who appear in such proceedings will reappear within a ...subsequent—or recurrent—set of such proceedings within seven years. In the last decade, new interdisciplinary research spanning social work, clinical psychology and sociology has defined and investigated the previously hidden challenge and social costs of ‘recurrent care proceedings’ (RCP). This article adds to this new field by analysing the core values, practice and impact of three different local services in the northwest of England working with birth parents to reduce the risk of recurrent proceedings. The article combines data gathered from the three distinct services using a common evaluation framework co-produced by the authors working with service leads, practitioners and users. It explores how all three services are seeking to reduce the risk of recurrent care proceedings in their local areas without requiring women to use long acting reversible contraception (LARC) or other forms of contraception as a condition of accessing the service. It concludes that insights gained from these and cognate services can inform an emergent community of practice in the recurrent care field.
Between 2017 and 2020, the UN Special Rapporteur (SR) Dainius Puras published three reports that called for significant changes to organisation, funding and service provision in mental health care in ...ways that emphasise inclusive, rights‐oriented, democratic and sustainable community health services. This article aims to examine formal organisational responses to the UN mental health reports and consider the underlying arguments that either support or delegitimise the SR stance on the need for a paradigmatic shift towards a human rights‐based approach to mental health. By combining several different search strategies to identify organisational responses across the web, a total of 13 organisational responses were included in the analysis. Given the political nature of the responses, concepts from discourse theory were used to analyse the responses. The analysis showed how the responses articulated two binary positions and contesting articulations of good mental health care, which formed a backdrop for rejecting the SR reports in defence of psychiatry. The discussion elucidates how the responses tend to resemble previous ways in which critique has been dealt with mainly by ‘biological psychiatry’, but that the counter‐critical nature of the medical and psychiatric organisational responses remains in contrast to the broader reception within the UN community.
The forthcoming National Institute for Health and Care Excellence depression guideline reviews short-term outcomes for long-term depression. We present effect sizes for long-term outcomes in trials ...that report these data. Psychological therapies become more effective, whereas antidepressants become less effective over the long term. We review other forms of longitudinal research that support these findings.
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