Population mental health refers to the distribution of mental health and wellness, as well as psychiatric disorders, within and across societies. In the first two decades of the 21st century, mental ...illness and psychiatric disorders in the United States and across the world are looming large as a cause of morbidity and mortality, and are far more often discussed in the public arena than before. Although psychiatric disorders have been recognized for generations as contributing to individual and societal burden, awareness of their impact on individuals, their families, and society, as well as the associated costs, is stronger than ever. Actions informed by best available evidence can no longer be postponed.Both by their frequency and consequences, psychiatric disorders affect societal health as measured by numerous health, social, and economic indicators. In this issue, we hope to shed light on the emerging challenges for improving population mental health. Psychiatric disorders, and their underlying mental health and wellness dimensions, remain among the most disabling health conditions worldwide, with significant burdens on individuals and societies (Vigo et al. Estimating the true global burden of mental illness. Lancet Psychiatry. 2016 ;3(2):171-178.).
Full text
Available for:
CEKLJ, FSPLJ, ODKLJ, UL, VSZLJ
Background Psychiatric disorder and psychological distress are increasingly recognized as risk factors for coronary heart disease (CHD). Elucidation of the mechanisms of these associations has ...implications for prevention. This study aims to confirm the association between psychological distress and CHD and examine if it could be explained by other factors such as health behaviours, social isolation and low control at work. Methods A prospective occupational cohort study of London-based civil service employees (Whitehall II Study) with baseline data collected from 1985–1988 with a 5-year follow-up. The participants were male and female middle-aged civil servants working in 20 Government Departments; 73% of eligible employees attended baseline screening. Psychological distress measured by the General Health Questionnaire (GHQ) at baseline was used to predict incidence of self-reported CHD and possible and probable electrocardiographic (ECG) abnormalities during follow-up. Results In men, baseline psychological distress was associated with an increased incidence of overall self-reported CHD (odds ratios OR = 1.83, 95% CI : 1.5–2.3) and ECG abnormalities (OR = 1.51, 95% CI : 1.1–2.1), after adjustment for age, employment grade and length of follow-up. In women, baseline psychological distress was also associated with an increased incidence of CHD (OR = 1.60, 95% CI : 1.2–2.1), but not with ECG abnormalities. Adjustment for health behaviours, marital status, social networks and work characteristics reduced the risks for incident CHD by 12% in men and by 10% in women; for ECG abnormalities these adjustments increased the risk in men by 16% and had little effect in women. Conclusions The experience of psychological distress confers increased risk of CHD in men that is not explained by health behaviours, social isolation or work characteristics. The increased risk of CHD associated with psychological distress is not consistently demonstrated in women.
We describe the development of an online fidelity questionnaire for early intervention in psychosis (EIP) services, to be used in population-level research, and that can be completed using ...self-reports from EIP staff.PURPOSEWe describe the development of an online fidelity questionnaire for early intervention in psychosis (EIP) services, to be used in population-level research, and that can be completed using self-reports from EIP staff.A review of key literature sources on the components of EIP services was used to identify those components eligible for inclusion in the questionnaire. A modified Delphi approach, using experts in EIP services, was used to select the most important components to include in the questionnaire. To pilot test the questionnaire, two EIP staff members completed one fidelity questionnaire each, and a third questionnaire was completed by an external rater. Responses from the three sources were compared and used to revise the fidelity questionnaire.METHODSA review of key literature sources on the components of EIP services was used to identify those components eligible for inclusion in the questionnaire. A modified Delphi approach, using experts in EIP services, was used to select the most important components to include in the questionnaire. To pilot test the questionnaire, two EIP staff members completed one fidelity questionnaire each, and a third questionnaire was completed by an external rater. Responses from the three sources were compared and used to revise the fidelity questionnaire.Twenty-two experts from England and Canada responded to two Delphi rounds, identifying the top 25 most important EIP service components. Some evidence-based components were not rated as highly as some non-evidence-based components. Pilot testing showed that the EIP staff rated fidelity higher than the external rater. Several questions were removed and/or revised based on the pilot study findings.RESULTSTwenty-two experts from England and Canada responded to two Delphi rounds, identifying the top 25 most important EIP service components. Some evidence-based components were not rated as highly as some non-evidence-based components. Pilot testing showed that the EIP staff rated fidelity higher than the external rater. Several questions were removed and/or revised based on the pilot study findings.Fidelity instruments are limited by the available evidence and the personal experiences of experts used to develop them. As such, fidelity instruments and EIP services should continually be updated to reflect new knowledge. The online fidelity questionnaire was a simple and efficient way to collect data. Future evaluations of the fidelity questionnaire need to ensure that externally collected fidelity data are comprehensive and accurate.CONCLUSIONSFidelity instruments are limited by the available evidence and the personal experiences of experts used to develop them. As such, fidelity instruments and EIP services should continually be updated to reflect new knowledge. The online fidelity questionnaire was a simple and efficient way to collect data. Future evaluations of the fidelity questionnaire need to ensure that externally collected fidelity data are comprehensive and accurate.
Fast, easy, and cost-effective methods are needed for fidelity assessment, quality improvement initiatives, and population-based studies in Early Intervention for Psychosis (EIP) services. Having an ...online questionnaire assessing the fidelity of EIP services, completed by staff self-reports, and having evidence of reliability and validity, could fill that gap. We assess the reliability and validity of the Early Intervention for Psychosis Services Fidelity Questionnaire (EIPS-FQ), developed in Part I of this set of papers.PURPOSEFast, easy, and cost-effective methods are needed for fidelity assessment, quality improvement initiatives, and population-based studies in Early Intervention for Psychosis (EIP) services. Having an online questionnaire assessing the fidelity of EIP services, completed by staff self-reports, and having evidence of reliability and validity, could fill that gap. We assess the reliability and validity of the Early Intervention for Psychosis Services Fidelity Questionnaire (EIPS-FQ), developed in Part I of this set of papers.A convenience sample of 10 EIP teams in England was used. Two staff members completed online questionnaires assessing recent and past fidelity. An external rater completed the same questionnaire for the two time periods, using a random sample of patient medical records, program documentation, and interviews with staff. The intra-class correlation coefficient (ICC) was calculated to assess inter-rater reliability. Validity was assessed using Bland-Altman plots, absolute mean differences, and the ICC.METHODSA convenience sample of 10 EIP teams in England was used. Two staff members completed online questionnaires assessing recent and past fidelity. An external rater completed the same questionnaire for the two time periods, using a random sample of patient medical records, program documentation, and interviews with staff. The intra-class correlation coefficient (ICC) was calculated to assess inter-rater reliability. Validity was assessed using Bland-Altman plots, absolute mean differences, and the ICC.The fidelity score measuring recent fidelity ranged from 54.2 to 82.7, out of a possible 100. The ICC assessing reliability of the fidelity score was 0.40 (95% CI: 0.0-0.81). The ICCs for the fidelity sub-category scores ranged from 0 to 0.76. Two sub-categories, comprehensive assessments and family involvement and intervention, had low ICCs, regardless of period examined.RESULTSThe fidelity score measuring recent fidelity ranged from 54.2 to 82.7, out of a possible 100. The ICC assessing reliability of the fidelity score was 0.40 (95% CI: 0.0-0.81). The ICCs for the fidelity sub-category scores ranged from 0 to 0.76. Two sub-categories, comprehensive assessments and family involvement and intervention, had low ICCs, regardless of period examined.This first attempt at validating the EIPS-FQ has demonstrated that the reliability of the EIPS-FQ is moderate/low, and therefore requires modification prior to use. The next iteration of the fidelity questionnaire will clarify or remove items which had very low fidelity and add evidence-based components not identified in the Delphi exercise.CONCLUSIONSThis first attempt at validating the EIPS-FQ has demonstrated that the reliability of the EIPS-FQ is moderate/low, and therefore requires modification prior to use. The next iteration of the fidelity questionnaire will clarify or remove items which had very low fidelity and add evidence-based components not identified in the Delphi exercise.
The aging, non-demented brain undergoes several physiological changes, some of which may affect cognitive function. The goal of the present study was to examine the associations between subcortical ...and periventricular white matter hyperintensities (WMHs), cortical and subcortical atrophy, and cognitive function (episodic memory, word fluency, attention, and perceptual, cognitive, and motor speed). This was done within a European collaborative study, Cardiovascular Determinants of Dementia (CASCADE), in which magnetic resonance imaging (MRI) was performed on community-dwelling individuals. The study includes 1254 persons from eight European study centers, ranging between 64 and 76 years of age (
M 69.4
±
3.3; 55% men). When demographics (age, education, and sex), study center, and concurrent brain changes had been adjusted for, periventricular WMHS predicted lower performance in word fluency and the Stroop test (time), and subcortical atrophy predicted lower performance in motor speed and the Stroop test (errors). The findings are consistent with findings from lesion and functional neuroimaging studies.
We addressed whether repeated job strain and low work social support increase the risk of major depressive disorder (MDD).
We used work characteristics from Karasek's Job Strain model, measured on 3 ...occasions over 10 years in a cohort of 7732 British civil servants, to predict subsequent onset of MDD with the Composite International Diagnostic Interview.
Repeated job strain was associated with increased risk of MDD (odds ratio OR = 2.19; 95% confidence interval CI = 1.48, 3.26; high job strain on 2 of 3 occasions vs none) in a fully adjusted model. Repeated low work social support was associated with MDD (OR = 1.61; 95% CI = 1.10, 2.37; low work social support on 2 of 3 occasions vs none). Repeated job strain remained associated with MDD after adjustment for earlier psychological distress.
Demonstration of an increased association for repeated job strain adds to the evidence that job strain is a risk factor for depression. Recognition and alleviation of job strain through work reorganization and staff training could reduce depression in employees.
Full text
Available for:
CEKLJ, FSPLJ, ODKLJ, UL, VSZLJ
In this article we have provided a perspective on the importance and value of youth mental health services for society and argued that advancing youth mental health services should be the number one ...priority of health services in Canada. Using the age period of 12–25 years for defining youth, we have provided justification for our position based on scientific evidence derived from clinical, epidemiological and neurodevelopmental studies. We have highlighted the early onset of most mental disorders and substance abuse as well as their persistence into later adulthood, the long delays experienced by most help seekers and the consequence of such delays for young people and for society in general. We have also provided a brief review of the current gross inadequacies in access and quality of care available in Canada. We have argued for the need for a different conceptual framework of youth mental disorders as well as for a transformation of the way services are provided in order not only to reduce the unmet needs but also to allow a more meaningful exploration of the nature of such problems presenting in youth and the best way to treat them. We have offered some ideas based on previous work completed in this field as well as current initiatives in Canada and elsewhere. Any transformation of youth mental health services in Canada must take into consideration the significant geographic, cultural and political diversity across the provinces, territories and indigenous peoples across this country.
It is important that the effects of work on mental health are investigated when work practices are changing rapidly and there is decreasing job security. This has been examined in the Whitehall II ...Study, a cohort study of 6895 male and 3413 female, London-based civil servants, aged 35–55 years at baseline in 1985. Work characteristics were measured by modified Karasek indices in a self-report questionnaire. Psychiatric disorder was measured by the 30-item General Health Questionnaire (GHQ). In longitudinal analyses in men and women, high work social support predicted lower GHQ scores, and high job demands predicted higher GHQ scores at follow-up. High work social support and high skill discretion were protective against taking short spells of psychiatric sickness absence. The protective effects of social support at work and the potential risk of job demands have implications for management, job design, training, and further research.
The prevalence of fatigue as a presenting complaint and as a symptom is evaluated in French general practice patients. The data for a sample of 3784 persons 18-64 years-of-age who were seen by 367 ...general practitioners were examined for fatigue as a presenting complaint, diagnosis, and reported symptoms of persistent fatigue. Gender, age, and socio-professional category were considered as potential risk correlates. At least one of the symptoms of persistent fatigue was reported by 41.2% of the patients, but only 7.6% had presented with fatigue to the doctor. Women reported more symptoms of fatigue than men, but they were only slightly more likely to present with, or be diagnosed with fatigue; women were more frequently diagnosed with depression. There was a strong relationship between the symptoms of depression as measured by the Center for Epidemiologic Studies-Depression Scale (CES-D) and fatigue, but fatigue was neither sensitive nor specific for the diagnosis of depression. Age and fatigue as a presenting complaint and diagnosis were strongly associated for men. After adjusting for sex and age, we found that lower social classes were less likely to be diagnosed as fatigued, though they were more likely to report symptoms of fatigue.
McIlwaine et al discuss the study by Jones et al which offers a qualitative exploration of matters relating to transfers between early intervention service for psychosis (EIP) (also known as ...coordinated specialty care CSC in the US) and subsequent care, as well as their implementation. On the basis of 144 interviews with diverse stakeholders, the authors carefully identified and described the logistics behind transfers, service fidelity to recommended guidelines, and the subjective experience of transfers from both clinician and client perspectives. Their work highlights several additional points that warrant further reflection.
PDF
