Showing papers in "International Review of Psychiatry in 2011"
TL;DR: At mid-point in a national roll-out of the Improving Access to Psychological Therapies programme progress is generally in line with expectation, and a large number of people who would not otherwise have had the opportunity to receive evidence-based psychological treatment have accessed, and benefited from, the new IAPT services.
Abstract: The Improving Access to Psychological Therapies (IAPT) programme is a large-scale initiative that aims to greatly increase the availability of NICE recommended psychological treatment for depression and anxiety disorders within the National Health Service in England. This article describes the background to the programme, the arguments on which it is based, the therapist training scheme, the clinical service model, and a summary of progress to date. At mid-point in a national roll-out of the programme progress is generally in line with expectation, and a large number of people who would not otherwise have had the opportunity to receive evidence-based psychological treatment have accessed, and benefited from, the new IAPT services. Planned future developments and challenges for the programme are briefly described.
628 citations
TL;DR: The prevalence, distribution, and consequences of personality disorders, and potential risk factors for their development are reviewed; primary and secondary prevention strategies are needed to reduce the individual and societal burdens from personality disorders in the community.
Abstract: Community studies conducted over the past decade have greatly increased our knowledge of the epidemiology of personality disorders. Here, we review the prevalence, distribution, and consequences of personality disorders, and potential risk factors for their development. An estimated 6-10% of individuals in the community have a personality disorder. The prevalence of personality disorders varies across sociodemographic groups, being higher, for example, in those who are separated or divorced and those who have dropped out of high school. Personality disorders are strongly associated with Axis I disorders in the community, including mood disorders, anxiety disorders, and alcohol and other substance use disorders, as well as with functional impairment. Personality disorders also are associated with medical service use and medical morbidity and mortality, especially related to cardiovascular disease. Individuals in the community with personality disorders are more likely to have a history of criminal arrest, interpersonal violence, and suicidal behaviours. Childhood adversities, especially abuse and neglect, are potential risk factors for the development of personality disorders. Additional prospective studies are needed to elucidate potential precursors and consequences of personality disorders. Furthermore, primary and secondary prevention strategies are needed to reduce the individual and societal burdens from personality disorders in the community.
134 citations
TL;DR: A review of the literature published between 2001 and 2010 assessing the impact of deployments to Iraq and Afghanistan on spouses of military personnel found longer deployments, deployment extensions and PTSD in military personnel were found to be associated with psychological problems for the spouse.
Abstract: Deployment has well documented psychological consequences for military personnel. To fully understand the human cost of war, the psychosocial impact of separation and homecoming of military personnel on their families must also be considered. Recent arduous confl icts in Iraq and Afghanistan make understanding the impact of war on spouses topical and pertinent. Widespread psychological morbidity and social dysfunction have been reported in spouses of military personnel who have been deployed to combat zones such as Vietnam, with diffi culties most acute for spouses of military personnel with post-traumatic stress disorder (PTSD). A review of the literature published between 2001 and 2010 assessing the impact of deployments to Iraq and Afghanistan on spouses of military personnel was conducted. A total of 14 US-based studies were identifi ed which examined psychological morbidity, help seeking, marital dysfunction and stress in spouses. Longer deployments, deployment extensions and PTSD in military personnel were found to be associated with psychological problems for the spouse. Methodological differences in the studies limit direct comparisons. Recommendations for future research are outlined. The needs of spouses of military personnel remain an important issue with implications for service provision and occupational capability of both partners.
132 citations
TL;DR: It is suggested that young single males and those who have undergone particularly stressful experiences are at greatest risk of misusing alcohol, and raised questions about the place of alcohol in military culture.
Abstract: Traditionally alcohol has been used by the military to cope with the intense stress of battle but also as a way of mediating the transition from the heightened experience of combat to routine safety. The use of alcohol has divided medical opinion. Some doctors viewed it as wholly harmful to both social and occupational function and to health, while others argued that alcohol had a specific role in lifting morale, aiding unit cohesion and protecting soldiers from adjustment disorders. Although alcoholism has always been identified as incompatible with military service, the effects of habitual heavy drinking among military personnel are less well understood. Recent studies have suggested that young single males and those who have undergone particularly stressful experiences are at greatest risk of misusing alcohol. These associations, observed in the aftermath of recent conflicts in Iraq and Afghanistan, have again raised questions about the place of alcohol in military culture.
126 citations
TL;DR: Researchers found an increase in emotional and behavioral problems in children when a parent was deployed and parental psychopathology was most consistently identified as a risk factor for childhood emotional and Behavioral disorders in the research.
Abstract: The aim of this review is to evaluate what is known about the impact on children of parental deployment to Iraq or Afghanistan. We searched for relevant studies with a minimum sample size of 50 which were published between 2003 and 2010 using Google Scholar, MEDLINE, PubMed, PsycINFO and Web of Science. Bibliographies of retrieved articles were also searched. Nine US-based studies were identified for inclusion in the review, five were cross-sectional, two were longitudinal and two were analyses of routinely collected data. Researchers found an increase in emotional and behavioral problems in children when a parent was deployed. Several mediating factors were identified, such as the family demographics and the number and duration of parental deployments. Parental psychopathology was most consistently identified as a risk factor for childhood emotional and behavioral disorders in the research. Limitations of the current research and subsequent recommendations for future research are also outlined.
105 citations
TL;DR: Perceived discrimination and homesickness are not associated with psychopathology in the Spanish context, suggesting that cultural congruity plays a key role in the relationship between immigration and mental health.
Abstract: This study explores acculturative stress as a risk factor for depressive and anxiety disorders as well as their symptomatology. It is hypothesized that perceived discrimination and general psychosocial stress will show the greatest association with psychopathology. The sample consists of 414 Latin American immigrant primary care patients in Barcelona. The instruments used are: the Barcelona Immigration Stress Scale (BISS) to evaluate acculturative stress, the Goldberg Anxiety and Depression Scale (GADS) for anxiety and depression symptoms, the Mini International Neurological Interview (MINI), a semi-structured interview, to detect psychiatric pathology, and a questionnaire for sociodemographic and attitudinal characteristics. The most elevated levels of acculturative stress were observed in the factors homesickness and general psychosocial stress. Acculturative stress is associated with depression and anxiety. With the covariants controlled, intercultural contact stress and general psychosocial stress maintain the relationship. Acculturative stress constitutes a risk factor for both depression and anxiety. General psychosocial stress and intercultural contact stress are related to psychopathology. Perceived discrimination and homesickness are not associated with psychopathology in the Spanish context, suggesting that cultural congruity plays a key role in the relationship between immigration and mental health.
104 citations
TL;DR: A methodology for developing outcome measures for use in large studies entirely from the perspective of mental health service users is described, starting with a participatory and qualitative methodology and proceeding to psychometric testing.
Abstract: It is becoming increasingly recognized that conventionally derived outcome measures in mental health research are problematic. This is both because of the methodology used and because a ‘good’ outcome is framed from the perspective of clinicians and researchers. This paper describes a methodology for developing outcome measures for use in large studies entirely from the perspective of mental health service users. It is a mixed methods model starting with a participatory and qualitative methodology and proceeding to psychometric testing. At all stages, the researchers are themselves mental health service users. In the first phase of the model, focus groups are convened comprising people who have received the treatment or service being measured. The focus groups meet twice resulting in a draft mixed-methods questionnaire devised from thematic analysis of the focus group data. This is then taken to expert panels, again comprising individuals who have received the treatment or service being evaluated for refi...
96 citations
TL;DR: Analysis of data gathered after the last fire in northern Israel among adolescents aged 12–18 belonging to three cultural groups and the pattern of personal versus community SOC in explaining stress reactions indicates that personal SOC was the strongest predictor of stress reactions in all cultures.
Abstract: The salutogenic theory considers sense of coherence (SOC) as a cross-cultural concept (), meaning that in all cultures and at all stages of coping with a stressor, a person with a strong SOC is at an advantage in preventing tension from being transformed into stress. However, in seeking to understand how the SOC works, it is culture which seems to define which resources are appropriate. The aim of our paper is to examine this theoretical assumption of Antonovsky. Data on personal and community SOC as well as on stress reactions were gathered after the last fire in northern Israel (December 2010) among adolescents aged 12–18 belonging to three cultural groups (Jews, Druze, Muslims). We compared the pattern of personal versus community SOC in explaining stress reactions in the three cultures. Results indicate that personal SOC was the strongest predictor of stress reactions in all cultures. Community SOC, however, played a significant role mainly for Druze. Results are discussed relating to Antonovs...
95 citations
TL;DR: Significant findings include an appreciation for the role combat plays in the development of mental disorders, including PTSD and traumatic brain injury, and efforts to understand the determinants, prevention, recognition, and treatment of combat-related mental disorders.
Abstract: Although documentation that war infl icts psychological casualties dates back to the American Civil War and earlier, most research began after the Vietnam confl ict, when studies focused on post-traumatic stress disorder (PTSD). With ongoing confl icts in Iraq and Afghanistan, there has been signifi cant research to illuminate the epidemiology of war-related psychological casualties. Signifi cant fi ndings include an appreciation for the role combat plays in the development of mental disorders, including PTSD and traumatic brain injury (TBI). Recent research has endeavoured to understand and improve psychological resilience to temper potentially adverse mental health effects of military service in the theatre of combat operations. Over 2 million US service members have now deployed and returned over 3 million times to the Iraq and Afghanistan confl icts. Mental health providers in the Departments of Defense and Veterans Affairs healthcare systems have consequently observed steep increases in mental health service use among these personnel. The Departments have responded aggressively to bolster staffi ng levels, increase capacity, improve available services, and anticipate future needs. Scientists and clinicians continue efforts to understand the determinants, prevention, recognition, and treatment of combat-related mental disorders.
89 citations
TL;DR: How personality, temperament, and personality disorders are increasingly conceptualized as overlapping entities is summarized, followed by the various ways in which personality traits may relate to Axis I conditions causally, with methods for distinguishing between them.
Abstract: Personality and psychopathology are increasingly recognized as tightly linked domains of study, despite historical and theoretical divisions. In this paper, we discuss the history of these divisions, models of inter-relations between personality and psychopathology, and selected examples from the literature demonstrating personality/psychopathology inter-relations in clinical and community populations. We begin by summarizing how personality, temperament, and personality disorders are increasingly conceptualized as overlapping entities. We next address relationships between personality traits and common mental illnesses/symptoms (e.g. internalizing and externalizing problems). Then we discuss the various ways in which personality traits may relate to Axis I conditions causally, with methods for distinguishing between them. We conclude with a more in-depth example, relating personality traits to schizophrenia.
82 citations
TL;DR: Current state of knowledge regarding the prevalence and course of post-traumatic stress disorder in past and present members of the defence forces is reviewed, with particular reference to the challenges posed by this population in a treatment setting.
Abstract: Although symptoms characteristic of post-traumatic stress disorder (PTSD) have been noted in military personnel for many centuries, it was not until 1980 that the disorder was formally recognized and became the focus of legitimate study. This paper reviews our current state of knowledge regarding the prevalence and course of this complex condition in past and present members of the defence forces. Although rates vary across conflicts and countries, there is no doubt that PTSD affects substantial numbers of personnel and results in considerable impairment in functioning and quality of life. The paper goes on to discuss recent attempts to build resilience and to promote adjustment following deployment, noting that there is little evidence at this stage upon which to draw firm conclusions. Finally, effective treatment for PTSD is reviewed, with particular reference to the challenges posed by this population in a treatment setting.
TL;DR: The results of this review indicate that rTMS is effective in reducing the level of cravings for smoking, alcohol, and cocaine when applied at high frequencies to the dorsolateral prefrontal cortex (DLPFC).
Abstract: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that is now being tested for its ability to treat addiction. This review discusses current research approaches and results of studies which measured the therapeutic use of rTMS to treat tobacco, alcohol and illicit drug addiction. The research in this area is limited and therefore all studies evaluating the therapeutic use of rTMS in tobacco, alcohol or illicit drug addiction were retained including case studies through NCBI PubMed ( http://www.ncbi.nlm.nih.gov ) and manual searches. A total of eight studies were identified that examined the ability of rTMS to treat tobacco, alcohol and cocaine addiction. The results of this review indicate that rTMS is effective in reducing the level of cravings for smoking, alcohol, and cocaine when applied at high frequencies to the dorsolateral prefrontal cortex (DLPFC). Furthermore, these studies suggest that repeated sessions of high frequency rTMS over the DLPFC may be most effective in reducing the level of smoking and alcohol consumption. Although work in this area is limited, this review indicates that rTMS is a promising modality for treating drug addiction.
TL;DR: An overview of TMS in the context of child and adolescent psychiatry is provided, recent therapeutic and neurophysiological studies are discussed, and relevant ethical considerations are examined.
Abstract: Transcranial magnetic stimulation (TMS) is emerging as a new treatment and neurophysiological research tool for psychiatric disorders. Recent publications suggest that this modality will also serve as a treatment and research tool in child and adolescent psychiatry. Current reports on therapeutic trials of repetitive transcranial magnetic stimulation (rTMS) in adolescents have primarily focused on depression. However, other pilot work involves the treatment of attention-deficit/hyperactivity disorder (ADHD), autism and schizophrenia. Neurophysiological studies typically utilize single and paired-pulse TMS paradigms which index cortical excitability and inhibition. Initial studies have focused on ADHD, autism, and depression. General knowledge regarding TMS among child and adolescent psychiatrists is lacking. The aim of this review is to provide an overview of TMS in the context of child and adolescent psychiatry, discuss recent therapeutic and neurophysiological studies, and examine relevant ethical considerations.
TL;DR: A qualitative review of randomized controlled trials (RCTs) of psychosocial interventions for personality disorders underscored the dearth of treatment research for many of these personality disorders.
Abstract: Personality disorders are widely prevalent among those seeking mental health services, resulting in substantial distress and a heavy burden on public assistance and health resources. We conducted a qualitative review of randomized controlled trials (RCTs) of psychosocial interventions for personality disorders. Articles were identified through searches of electronic databases and classified based on the focus of the psychological intervention. Data regarding treatment, participants and outcomes were identified. We identified 33 RCTs that evaluated the efficacy of various psychosocial treatments. Of these studies, 19 focused on treatment of borderline personality disorder, and suggested that there are several efficacious treatments and one well-established treatment for this disorder. In contrast, only five RCTs examined the efficacy of treatments for Cluster C personality disorders, and no RCTs tested the efficacy of treatments for Cluster A personality disorders. Although other personality disorders, especially Cluster A, place heavy demands on public assistance, and in spite of recommendations that psychosocial interventions should be the first line of treatment for these disorders, our review underscored the dearth of treatment research for many of these personality disorders. We highlight some obstacles to such research and suggest directions for future research.
TL;DR: Recommendations largely correspond in five areas across guidelines, whereas discrepancies or vagueness exist in two areas due to newly emerging (drug choice) or still restricted evidence (duration of antipsychotic treatment).
Abstract: Treatment guidelines provide evidence-based recommendations to assist practitioners in specific clinical situations. They are a major tool to assure and enhance treatment quality and to overcome existing disparities. However, guideline quality itself varies and needs to be considered. Based on a former review, schizophrenia guidelines with high methodological quality were identified and examined regarding updated versions. Five guidelines were selected, of which three updates have been newly evaluated with the AGREE instrument. In addition, clinical content regarding seven core topics in schizophrenia treatment decisions was compared. Guideline quality on average is good, with highest AGREE scores for the NICE guideline. Updating of the German guideline resulted in noticeable quality improvements. Regarding content, recommendations largely correspond in five areas across guidelines, whereas discrepancies or vagueness exist in two areas due to newly emerging (drug choice) or still restricted eviden...
TL;DR: The US strategic defence policy has undergone dramatic changes in the last two decades, with more recent changes having placed increased demands on members of the reserve components as mentioned in this paper. But these changes have not always met the standards for mobilization and deployment.
Abstract: The US strategic defence policy has undergone dramatic changes in the last two decades, with more recent changes having placed increased demands on members of the reserve components. Rapid and often unexpected call-ups of reserves for operational missions, both domestic and international, required meeting standards for mobilization and deployment. Standards were in place but not necessarily met. Mobilizations pointed to several areas of unpreparedness; at first, obvious areas, such as members being physically unfit, inadequately trained and improperly equipped and less than competent unit leaders; and later, less obvious areas, in particular, emergent personal adjustment problems. During these mobilizations, unique consequences of stressors on individual reservists were evident, including worries about family and civilian job during deployment, adjustments to returning and reintegration, post-deployment post-traumatic stress disorder and related symptoms, and now suicide. Some have explained these...
TL;DR: This article will review the literature on suicide risk in military organizations to answer the important question: Are military personnel at increased risk for suicide?
Abstract: Suicide is an important public health problem in the demographic group that forms the bulk of military populations, namely young and middle-aged men. Suicide in the military also has special significance: certain aspects of military service can lead to serious mental disorders that increase the risk of suicidal behaviour. Moreover, military organizations have control over a broad range of factors (notably the direct delivery of mental health care) that could mitigate suicide risk. This article will review the literature on suicide risk in military organizations to answer the important question: Are military personnel at increased risk for suicide? Next, Mann et al.'s (2005) model for specific suicide preventive interventions in civilian settings will be reviewed and then expanded, with an emphasis on identifying special opportunities for suicide prevention in military organizations, including: 1) organizational interventions to mitigate work stress; 2) selection, resilience training, and risk factor reduction; 3) interventions to overcome barriers to care; and 4) systematic quality improvement efforts in mental health care. Finally, the evidence behind comprehensive suicide prevention programmes will be reviewed, with a special focus on the US Air Force's benchmark programme.
TL;DR: In this paper, the authors discuss the ethical implications regarding changes to personal identity that arise from the therapeutic use of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) technologies.
Abstract: Neurotechnology provides means to engage micro- and macrostructural networks of the brain to both mitigate the manifestations of several neurological and psychiatric disorders, and alter cognition and motoric activity. Such capacity also generates questions of how these interventions may affect personal identity. This paper discusses the ethical implications regarding changes to personal identity that arise from the therapeutic use of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) technologies. In addition, we raise the question of whether changes in personal identity, as a side effect of these interventions, are ethically acceptable and whether such alterations of personality foster patients' sense of well-being and autonomy. First, we provide a series of case vignettes that afford an overview of the ways that various neurological interventions can affect personal identity. Second, we offer a brief working definition of personal identity in order to delineate an ethical framework that we deem necessary for the responsible use of neurostimulation technologies. In so doing, we argue that neurostimulation therapy, as a doctoring act, should be directed, and adherent to goals of restoring and/or preserving patients' personal identity. To this end, we offer an ethical framework that we believe enables sound decisions about the right and good use of TMS and DBS.
TL;DR: The current review addresses the link between behavioural inhibition and the risk for developing anxiety disorders by reviewing the contribution of extrinsic and intrinsic factors to the development of anxiety in behaviourally inhibited children.
Abstract: Behavioural inhibition is a stable temperamental trait that is identifiable during infancy and toddlerhood and is characterized by fearful reactivity to novelty. Children identified as behaviourally inhibited have been shown to be at increased risk for developing anxiety disorders such as social phobia. The current review addresses the link between behavioural inhibition and the risk for developing anxiety disorders. Research suggests that this risk may be modulated by a number of extrinsic and intrinsic factors. Extrinsic factors include particular parental beliefs, parenting styles, and childrearing contexts. Intrinsic factors include executive function capacities such as attention bias, attention shifting, inhibitory control, and self-monitoring. In the present paper we review the contribution of these factors to the development of anxiety in behaviourally inhibited children.
TL;DR: In this article, the authors synthesize the available data on the neurocognitive effects of magnetic seizure therapy (MST) and conclude that MST has little to no adverse cognitive effects.
Abstract: Magnetic seizure therapy (MST) is a novel neurotherapeutic intervention in development for the treatment of major affective disorders. Like other neurotherapeutic strategies such as electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS), a primary interest will be to monitor the associated neurocognitive effects. Thus, the purpose of this systematic review was to synthesize the available data on the neurocognitive effects of MST. The authors performed two independent literature searches with the following terms terms: MST, magnetic, magnetic seizure therapy, depression, neurocognition, cognitive, preclinical. We included in this review a total of eleven articles that mentioned MST and neurocognition in the abstract. The articles were divided into three methodological domains that included virtual computer simulations, preclinical studies, and clinical investigations. Collectively, the available evidence suggests MST has little to no adverse cognitive effects. Specifically, virtual computer simulations found the magnetic field was localized to grey matter, and preclinical studies found no neurocortical or neurocognitive sequelae. Clinical investigations found MST to be associated with rapid reorientation and intact anterograde and retrograde memory. Future investigations using translational methods are warranted to confirm these findings and to further determine the effects of MST on neurocognitive functions.
TL;DR: Investigation of why people with a first episode of psychosis choose or decline to participate in mental health research found reasons for research participation identified included a desire to help others, curiosity, and positive experiences with clinicians.
Abstract: The aim of this study was to investigate why people with a first episode of psychosis choose or decline to participate in mental health research, using a qualitative study design. Participants were recruited via referrals from the Genetics and Psychosis (GAP) study. A total of 26 individuals with a first-episode of psychosis (nine of whom declined participation in the GAP study and 17 who participated) were individually interviewed and asked about their attitudes towards mental health research participation. Thematic analysis of interview transcripts was used to determine dominant themes and sub-themes on what constituted barriers and facilitators to participation. Reasons for research participation identified included a desire to help others, curiosity, and positive experiences with clinicians. Decisions to participate or not were also influenced by practical issues, including the timing of the approach, researchers' communication skills and whether individuals had concerns that it may be potentially harmful to their health. Other barriers to participation included patients' conceptualizations of mental health problems and the influence of other inpatients. Information on barriers and facilitators to recruitment in mental health research could inform recruitment strategies, thereby maximizing recruitment rates and minimizing the risk of selection biases.
TL;DR: VNS and deep brain stimulation are neurostimulation treatments for TRD and the evidence supporting the clinical utility of these therapies is reviewed.
Abstract: Antidepressant treatments, including pharmacotherapy and psychotherapy, do not result in remission for the majority of patients with major depressive disorder The high prevalence of treatment resistant depression (TRD) poses a significant issue for patients as well as both societal and economic costs Due to the limited efficacy of existing therapies in this sub-population, alternative somatic treatments are being explored Both vagus nerve stimulation (VNS) and deep brain stimulation (DBS) are neurostimulation treatments for TRD While VNS has Food Drug Administration approval as an adjunctive therapy for MDD, DBS is still in the experimental stages This article will review the evidence supporting the clinical utility of these therapies
TL;DR: The team ombuds model, a didactic model, will be presented to promote mental health with special regard to SOC and transcultural competences within the formal educational system.
Abstract: During the past 30 years, salutogenesis and sense of coherence have been well researched in various disciplines, such as psychology, sociology and medical sciences. However, only a few studies have focused on transcultural and educational work contexts. A strong sense of coherence (SOC) is associated with a positive school performance, achievement, success, the ability to manage conflicts and transcultural competences and well-being. However, interventions on how to increase SOC and transcultural competences within the educational field have rarely been addressed. This article aims at contributing theoretically to the void in literature on didactic and educational interventions in educational and particularly school systems to promote SOC and transcultural competence. The team ombuds model, a didactic model, will be presented to promote mental health with special regard to SOC and transcultural competences within the formal educational system.
TL;DR: Some of the key issues that complicate therapeutic contact and communication are explored, and means by which to strengthen key components of the therapeutic relationship are outlined.
Abstract: Although research has demonstrated that mental health services function with patients from different cultural backgrounds, a variety of culture- and race-related factors can result in services being of lower quality than that which occurs when the clinician and patient are from the same culture. The provision of culturally competent care requires many institutional and organizational adaptations that lie beyond the control of most mental health professionals. The therapeutic relationship, however, remains a key factor of mental healthcare that can be attended to by individual therapists. The therapeutic relationship plays an important role in almost every therapeutic approach, and has been increasingly recognized as representing a means to the provision of quality intercultural and interracial treatment. At the same time, a host of cultural and racial factors relating to both the patient and clinician can compromise the development of the therapeutic relationship. This paper will explore some of the key issues that complicate therapeutic contact and communication, and will outline means by which to strengthen key components of the therapeutic relationship.
TL;DR: An integrative framework of acculturation and salutogenesis is provided that helps to integrate inconsistent findings in the migrant mental health literature and some implications for future research activities are summarised.
Abstract: During the last two decades, the number of international migrants worldwide has constantly risen. In this context, cross-cultural dimensions of psychological disorders receive increased attention, especially depression, anxiety and post-traumatic stress disorders among the migrant population. In this paper we propose a theoretical framework for the understanding of migrant mental health. This framework combines elements from Berry's acculturation model and Antonovsky's salutogenic theory. The former illustrates the main factors that affect an individual's adaptation in a new cultural context. The term acculturative stress denotes unresolved problems resulting from intercultural contact that cannot be overcome easily by simply adjusting or assimilating. The latter specifies the relationship between culturally associated stress and mental health more distinctive, introducing the concepts of generalized resistance resources and sense of coherence that determine mental health outcomes of migrants duri...
TL;DR: This article focuses on two themes: how changes in sampling have influenced the nature of the inferences drawn from the survey-based surveillance data and how the ability to utilize different forms of data has served to strengthen the programme.
Abstract: Mental health advisory teams (MHATs) conduct comprehensive mental health surveillance of US service members in combat environments. Since 2003, six teams have deployed to Iraq and four have deployed to Afghanistan, and results have played a key role influencing behavioural health policy. The repeated deployments of the teams have provided opportunities for processes to be refined, and this refinement has led to a scientifically rigorous and replicable approach. In this article we focus on two themes. The first theme is how changes in sampling have influenced the nature of the inferences drawn from the survey-based surveillance data. The second theme is how the ability to utilize different forms of data has served to strengthen the programme. Focusing on these two themes provides a way to discuss key findings, recommendations and limitations while also interspersing practical observations intended to help inform the design of broad-scale, in-theatre mental health surveillance efforts. We believe that future surveillance efforts should build on the lessons of the MHATs and attempt to replicate the more rigorous sampling methods; nonetheless, we also strive to convey that large surveillance efforts are valuable even if they cannot be executed with random sampling.
TL;DR: SOC can be regarded as a protective factor for depression in patients with Turkish migration background in Germany and in local Turkish patients, and multiple regression analyses have demonstrated SOC to be the strongest predictor for depressiveness.
Abstract: The present study explores sense of coherence (SOC) levels in two clinical samples (outpatients with neurotic disorders) with the same Turkish cultural background in comparison to the German reference values as well as the association between SOC and depression and the protective role of SOC. A total of 96 Turkish patients in Germany (36.67 ± 9.52 years) as well as 60 local Turkish patients (38.57 ± 10.15 years) have been examined for SOC measured with the Sense of Coherence scale (SOC-29) and depression with the Beck Depression Inventory (BDI). Both samples scored significantly lower for SOC compared to the normal Turkish and German population and to German subjects with psychiatric symptoms (p < 0.001) but did not differ significantly from each other. Negative significant correlations were found between SOC and the degree of depressiveness in both groups (immigrants: r = -0.59, p < 0.001; Turks: r = -0.51, p < 0.001). Multiple regression analyses including SOC, age, gender, education, marital and employment status have demonstrated SOC to be the strongest predictor for depressiveness. SOC can be regarded as a protective factor for depression in patients with Turkish migration background in Germany and in local Turkish patients. However, further studies are needed to clarify if the concept SOC can be used adequately in collectivistic cultures as, for example, the Turkish one.
TL;DR: An examination of the UK literature on the mental health consequences of deployment of armed forces personnel to Iraq and Afghanistan finds that post-traumatic stress disorder is low in the UK Armed Forces, but deployment to Iraq or Afghanistan is associated with an increased risk of PTSD for reserve personnel.
Abstract: Concerns about the mental health of military personnel deployed to Iraq and Afghanistan has led to a new generation of research. This review is an examination of the UK literature on the mental health consequences of deployment of armed forces personnel to Iraq and Afghanistan. As yet, deployment to Iraq or Afghanistan has not been associated with a general increase in mental health problems for the UK Armed Forces. However, research has highlighted certain problems that continue to need to be addressed. Whilst, the rate of post-traumatic stress disorder (PTSD) is low in the UK Armed Forces (1.6-6%), deployment to Iraq or Afghanistan is associated with an increased risk of PTSD for reserve personnel. In contrast to PTSD, the rate of alcohol misuse is high in the UK Armed Forces (between 16-20%), and has been associated with deployment to Iraq or Afghanistan for regular personnel. As the UK military engagement in Afghanistan continues and more personnel are deployed, the demand for help from military health services, the NHS and the service charities will increase.
TL;DR: It is suggested that interviewers’ experiences of mental health problems broadly do not impact on quantitative data collected in structured interviews about discrimination.
Abstract: User involvement in research is widely valued, but evidence of its impact in quantitative research is lacking. We investigate whether survey responses are affected by interviewers' experience of mental health problems. We hypothesized that when the interviewer has experienced mental health problems, participants would be more likely to consent to participate, leave fewer items unanswered, report higher levels of discrimination and express greater satisfaction with the interview. The study was nested within a telephone survey of service users' experiences of discrimination. Participants were randomly assigned to three groups: peer disclosing, peer non-disclosing and non-peer interviewers, where 'peer interviewers' have personal experience of mental health problems. Analyses explored the impact on response rate, number of unanswered questions, reported discrimination and interview experience. No difference was found in prevalence of discrimination reported to interviewers. A significantly lower response rate was attained in the peer-disclosing group (5% compared to 6.5%, p = 0.005). Significantly fewer questions were left unanswered in the peer-disclosing group (Mean = 0.07 compared to 0.4, p = 0.004). Findings suggest that interviewers' experiences of mental health problems broadly do not impact on quantitative data collected in structured interviews about discrimination. Disclosure of peer status prior to consent may have affected recruitment.
TL;DR: Understanding patients’ and caregivers’ conceptions of personal identity in the context of disease and treatment is important not only for the informed consent process, but also for questions of public policy.
Abstract: A range of implantable brain-interfacing devices (IBIDs) is currently in use and development for the treatment of movement disorders and disorders of mood, behaviour and thought. These include cochlear implants, deep brain stimulation (DBS), prosthetic limbs, and optogenetic interventions (the combined use of genetics and optics to control individual cells). While implantable non-brain devices, such as implantable cardioverter defibrillators, began receiving US Food and Drug Administration approval in 1980, the development of IBIDs is recent, with the approval of DBS for Parkinson's disease in 1997. The expansion in use of IBIDs from neurological to psychiatric conditions is even more recent, with current trials underway for a range of disorders including depression, OCD, addiction, Alzheimer's disease and Tourette's syndrome. Emerging applications of existing IBIDs and new devices in development differ from currently approved devices and applications in two potentially crucial ways: 1) They target conditions traditionally seen as psychiatric; and/or 2) They target and modify functions or traits tied closely to agency, personal identity and personhood. As such, understanding patients' and caregivers' conceptions of personal identity in the context of disease and treatment is important not only for the informed consent process, but also for questions of public policy.