“Best Before”: On Women, Ageism, and Mental Health

Introduction: Our world has changed over the last decades, and one of the dramatic changes has been the increase in human life expectancy. Due to important life-saving breakthroughs, the current life expectancy for the world in 2024 is 73.33 years; and female global life expectancy is 76.0 years. This trend manifests one of the greatest achievements of human society, which, however, reveals issues that humanity has yet to address. One of them is the place and role of women over 40 in modern society. Purpose: This paper aims to unveil gendered ageism and to identify its negative impact on women’s mental health. Methodology: We conducted a systematic search in the main electronic databases, such as PubMed, Scopus, Web of Science, and Google Scholar.  Relevant studies were identified using search terms: women over 40, aging, gendered ageism, mental health, wellbeing, beauty standards, youthfulness, age stereotypes, multiple discrimination, inequity, identity, sexuality, social exclusion, intersectionality. The authors used phenomenological philosophical, hermeneutic, and inductive approaches, as well as the interpretive research paradigm. Review and Discussion: Constant anxiety about aging, attempts to turn back time, desperate cosmetic battles that women are involved in are far from just a tribute to fashion or female vanity, but also an attempt to come out of the shadows, to overcome the boundaries of female limited space, and to make a woman visible. However, women’s grand entrance onto the big stage faces gendered ageism that forces women over 40 feel excluded in society and life by making them invisible. Despite certain changes in public consciousness over the role of women in society, we still live in a men’s world. The centuries-old subordination of women to men, cultural ideas about the “perfect” female face, body, age, weight, compliance with which is a “pass” to the world of success, or, according to evolutionary psychologists, a “mechanism” that promotes survival, crystallize in various disorders, thereby undermining women’s mental health, downplaying the value of wisdom, knowledge and life experience, and eroding women’s self-esteem. Conclusion: Aging is a natural and inevitable process, and old age is a significant part of life, which can be filled with joy, achievements of small and big goals, dissemination of accumulated experience and wisdom. Unfortunately, these wonderful aspirations are hindered by ageism – one of the last socially acceptable prejudices. Inducing age stereotypes and perpetuating internalized ageism, our social environment maintains discrimination of women over 40 in workplace, social settings, and private sphere that has detrimental consequences for women’s mental and physical health. Therefore, combating ageism and sexism and eliminating age discrimination is essential to support older women’s health and wellbeing. Both women and men share the responsibility to progress towards true equity that will help women around the world achieve success on their own terms and reach their full potential. Life journey of every woman is a way of self-discovery and self-development, in which the various aspects of a woman’s personality come together to create unique integrity of body, mind, and spirit. To fully realize the potential of half of humanity, it is necessary to dismantle the systems that maintain inequities, as well as to raise up and empower women of all ages, colors, abilities to assert themselves and be respected in both public and private spheres, to accept reality and move on, to feel comfortable and confident in their own skin, to do wonders for everyone on our planet, and to know that every woman matters

From treatment to social reintegration: : principles of medical and psychological support of veterans (on example of the Russian-Ukrainian war)

Introduction: Analyzing numerical data from different countries around the world that have experience of participating in wars and resolving their consequences, it is important to consider the wide range of war effects on all spheres of society. This influence is discussed in the context of economic, political, state-building, demographic, and other spheres. Special attention is given to analyzing the consequences of this impact on individuals returning from war. These consequences are diverse and include physical and psychological problems, job loss, social exclusion, and other challenges that require an integrated approach to effectively address them. Purpose: To analyze the main principles of medical and psychological rehabilitation of combat veterans, having conducted a comprehensive analysis of their links and constituent elements, and to consider possible ways of their implementation. Methodology: We conducted a systematic search in the main electronic medical databases such as: PubMed, Scopus, Web of Science and Google Scholar until January 2024. We used theoretical methods such as systematic, bibliosemantic and retrospective, comparative analysis and generalization of the publication data of the conducted studies that considered links, components, principles and possible ways of their implementation in the field of medical and psychological rehabilitation of combat veterans. Relevant studies were identified by key words: war or combat veterans, rehabilitation, reintegration, psychoeducation, hub. Results: The research revealed complex challenges in the system of medical and psychological rehabilitation of military veterans, including post-traumatic stress disorder, physical injuries, social isolation and limited resources. The analysis identified key principles important to the planning and implementation of rehabilitation programs, including individualization, comprehensiveness, accessibility, and integration. The results highlighted the importance of a systems approach and collaboration between various parties concerned for the effective implementation of the veterans’ rehabilitation system. The study suggests specific ways of the identified principles implementation. Understanding the modality of the medical and psychological rehabilitation system is a key aspect in improving the quality of rehabilitation and providing adequate support to veterans. In order to achieve these goals, a hierarchy of therapeutic goals was created determining the modalities of the medical and psychological rehabilitation system. Conclusion: Effective medical and psychological rehabilitation for combat veterans should be based on the systematic organization of care, recognizing the importance of each component in ensuring coordination, efficiency and quality of services. Establishing clear therapeutic goals forms the basis for comprehensive psychological support, contributing to veterans’ self-esteem, mental health, and social integration, ultimately enhancing their overall well-being and quality of life

Syndemic Burden: Bridging the gap between Tuberculosis and Mental Health Care for Integrated Patient-Centered Solutions – a comprehensive review

Introduction: Mental health issues are prevalent, yet their treatment remains inadequate. Tuberculosis presents substantial mental health challenges. Their co-occurrence is a frequent phenomenon. However, the integration of mental health professionals or services is not a common practice. Purpose: To review the evidence about the relation between tuberculosis and mental health, and its consequences concerning the implementation of policies and services. Methodology: We conducted a comprehensive review using the MeSH terms "Tuberculosis" and "Mental Health" on PubMed, spanning from 2011 to December 2021. We identified and assessed systematic reviews, regular reviews, scoping review and meta-analyses for their appropriateness and relevance. Results: A total of 341 studies were accessed for eligibility and 19 studies were included. Mental disorders and tuberculosis are frequent comorbidities. Their relation is commonly described as “syndemic”. Shared risk factors, social vulnerabilities, and upstream social determinants are prevalent in both conditions. There is a potential for the integration of both conditions into policy and service organization. Conclusions: Mental disorders treatment gap could be shortened by addressing mental health problems among TB patients. The WHO Global End TB Strategy prioritizes integrated patient-centered care, and fostering collaborative partnerships between tuberculosis and mental health services could enhance its implementatio

Harvard Medical School Global Mental Health: Trauma and Recovery Course: What is the Global Impact? Three Year’s Results

Purpose: This paper describes and documents an innovative blended learning Global Mental Health: Trauma and Recovery certificate training course. This course combines a two-week face-to-face training in Orvieto, Italy with a five-month follow-up online virtual training as a learning experience for global health care practitioners. Continuing medical education (CME) accreditation is offered upon completion. This course utilized an innovative blended learning model with a community of practice approach, a combination of lectures and discussions, and online in-depth group case study discussions. Methodology: Data was collected by self-reported anonymous evaluation by participants of three continuous years of the CME Global Mental Health: Trauma and Recovery certificate training course sponsored by Harvard Medical School. One hundred fifty-five participants (n= 39 in 2011; n = 57 in 2012; n=59 in 2013) underwent a pre- and post-course evaluation to determine sustained confidence in performing medical and psychiatric care to traumatized patients and communities, as well as to determine their learning of the Global Mental Health Action Plan (GMHAP). Results: Over the course of three independent years, a total of 155 participants were evaluated. There was evidence for significant improvement in their confidence levels in all clinical areas (diagnosis; treatment of trauma; use of psychotropic medication) when comparing baseline to completion of the six-month course. All ten dimensions of the GMHAP and nine medical and psychiatric aspects of treatment revealed significant improvement in confidence levels. Regression analysis also indicated similar results after the adjustment of demographic covariates. Physicians and participants with mental health and social work background had significantly higher confidence. Participants who were MD’s or psychiatrists had higher confidence in most of the categories of confidence except for self-care, understanding culture, collaboration, and policy and financing. The model showed no difference in learning based upon gender and level of development of country of origin. Conclusion: The evaluation of this blended learning CME program provides evidence of significant enhancement of clinical practice and planning skills in health care practitioners working with highly traumatized patients and communities worldwide. This successful training over the past 18 years has gone far to achieve the health and mental health capacity building as requested by the Ministers of Health from post-conflict societies in the historic Rome meeting in 2004

The Psychometric Properties of the Environmental Worry Index

Introduction: Environmental-related hazards are a global problem; consequently, an Environmental Worry Index (EWI) was developed; however, the psychometric properties of this scale in the Spanish population are unavailable. Purpose: The objective of this study was to adapt and examine the psychometric properties of an Environmental Worry Inventory (EWI) in a Spanish-speaking student population.Methodology: This study adopted a cross-sectional design. It used a snowball sampling technique to collect data using the compact questionnaire comprise of EWI, Climate Anxiety Scale (CAS), and Big Five Inventory (BFI-15) from 251 participants in 2023 among students of Autonomous University of Ciudad Juárez (UACJ), Juárez, Mexico.Results: Results of exploratory factor analysis (EFA), the Kaiser-Meyer-Olkin (KMO=0.891) and Bartlett's Test of Sphericity (p < 0.001) showed adequate data. Confirmatory factor analysis (CFA; ?2 (5) = 78,595, CFI = 0.94, and RMSEA=0.078) demonstrated adequate goodness of fit. EWI was associated with CAS, and neuroticism dimension of BFI-15. It has an acceptable overall Cronbach Alpha coefficient (? = 0.890); the two subscale factors’ reliability coefficients ranged from .80 to .89. Conclusion: The study concluded that EWI is reliable, valid and recommended for use among Mexicans especially the Spanish speaking students

Will Including Health at COP28 Mean Transformation of Global Mental Health Action? And will Mental Health Professionals transform to help achieve it? Research Note

Introduction: For the first time COP28 have included Public Health in their climate change discussions. Given progress on climate change has many hurdles, from domestic, economic and corporate pressures, it is pertinent to explore what impact this inclusion might have and what specific challenges there might be in relation to global mental health.Purpose: This positioning paper considers whether the implication of the inclusion of Health at COP28 might bring about transformation in the way Global Mental Health is addressed. It also considers how it might transform how mental health professionals, but also all others involved in working with people with mental health issues, transform mental health. The paper considers challenges to be faced going forward and potential solutions. The author acknowledges they are sharing their position on this subject, but in doing so, hopes to generate wider discussion.Methodology: As this is a positioning paper, data has been derived from the argument and counter argument within the paper. Therefore, there is a possibility of the risk of bias. Results: Plans to improve mental health globally have focused on replicating a Western, Global North model. Despite over 10 years of the WHO Mental Health Action Plan, there continues to be a growing mental health pandemic, worsened by Covid-19. Mental ill- health is caused by multiple factors, many are national, regional and even localized. The Western Global North model does not factor this in sufficiently to bring about improvement.Conclusion: This paper evaluated whether by including ‘Health’ at the recent COP28, it would help transform Global Mental Health. What became clear, after reviewing previous policies and action plans, was that significant change and improvement had not occurred. Policy makers and professionals approach needs to focus on preventing mental ill-health rather than treating after the event. Additionally, decolonisation of policies and professionals education is required to co-create sustainable resilience with people/communities and reduce mental ill-health

Well-being of mental health workers during the Russian-Ukrainian War

Introduction: While the detrimental impact of the Russian-Ukrainian War on mental health of Ukrainian population has been well-documented, less attention has been given to mental health workers (MHWs) providing mental health support services amid the war. Purpose: To examine levels of domain-specific well-being in Ukrainian MHWs; identify and quantify the relative importance of factors associated with well-being; and examine interactions of risk and protective factors in relation to each well-being domain. Methodology: A convenience sample of 178 MHWs completed a survey that assessed their well-being, and sociodemographic, war-related, mental health, and psychosocial characteristics. Results:  Lower levels of mental health difficulties such as anxiety and posttraumatic stress symptoms, and higher levels of psychosocial factors such as higher optimism, gratitude, and presence and search for meaning were associated with higher well-being. MHWs with high levels of protective psychosocial factors were more likely to report higher well-being even in the presence of mental health difficulties. Conclusions: Results of this study provide insight into the levels and correlates of multiple well-being domains among Ukrainian MHWs amid the ongoing war. They further suggest that interventions to mitigate mental health difficulties and bolster protective psychosocial factors may help promote well-being in this populatio

Personality and Health in Military Context: A Study of Combatants and Injured Servicemen

Introduction: The ongoing conflict in Ukraine has placed significant mental and physical health burdens on military personnel, including both elite combat troops and injured servicemen in rehabilitation. Understanding the factors that influence their health outcomes is crucial for developing effective support and intervention strategies. Purpose: This study aims to analyse the relationships between negative indicators of mental and physical health (PTSD symptoms and somatic complaints) and personal characteristics (resilience, self-efficacy, and Big Five personality traits) in two distinct samples of military personnel: elite combat troops and injured servicemen in rehabilitation. By comparing these groups, the study seeks to understand how personal characteristics influence health outcomes and whether the impact differs based on the context of military service. Methodology: The study involved 180 Ukrainian military personnel (all men) divided into two groups: 149 elite combat troops and 31 injured combatants in rehabilitation. Participants completed self-report measures assessing PTSD symptoms, physical complaints, resilience, self-efficacy, and personality traits. Descriptive statistics (means, standard deviations, ranges, skewness, and kurtosis) were computed, and independent samples t-tests and Cohen’s d were calculated to determine differences between the groups. Pearson's bivariate correlations and Z-tests were conducted to examine relationships between health indicators and personal characteristics. Multiple linear regression analysis (using the forward method) was performed to construct prognostic models for mental and physical health outcomes. Results: Injured combatants exhibited significantly higher levels of PTSD symptoms, exhaustion, and various physical complaints compared to elite combat troops. In contrast, elite combat troops showed higher levels of resilience, self-efficacy, extraversion, and emotional stability. Regression models highlighted self-efficacy, resilience, and emotional stability as key predictors of reduced PTSD symptoms and physical complaints, with varying predictive values across the two groups. Conclusion: The study underscores the importance of personal characteristics in mitigating the negative health impacts of combat exposure within the global mental health landscape. Tailored interventions enhancing resilience, self-efficacy, and emotional stability are crucial, particularly for injured combatants. Future research should employ longitudinal designs and larger samples to further understand the dynamics of these relationships and support the well-being of military personnel on a global scale. By addressing these critical areas, we can develop more effective strategies to support the mental health and recovery of those affected by combat and conflict worldwide

FAMILY BONDING IN CONFINEMENT OF THE COVID-19 PANDEMIC: A SYSTEMATIC REVIEW

Introduction: Due to the demands of the COVID-19 pandemic, the family became the primary setting in which people were confined. As a result, the family bond during confinement is an important phenomenon to study. Purpose: The purpose of this systematic review was to determine if the family bond would influence the changes in mental health brought on by confinement and the COVID-19 pandemic. Methodology: The methodological were a Systematic Review using the PRISMA model in the search engines Web of Science, Scopus, PubMed, PSYINFO, Taylor and Francis, Sciendo, Academic Search Ultimate, and Medline between September 2021 and April 2022. NOS (Newcastle-Ottawa Scale) was utilized. Results: Concerning the search results, it was possible to identify seven relevant studies for analysis: four on the variables associated with psychological well-being during the pandemic and two on the perceived changes in emotional state during the pandemic. Conclusions: the effects of confinement on mental health are characterized by an increase in negative emotions, heightened perceptions of stress, anxiety, and depression, and altered sleep patterns. Concerning the influence of the family bond on mental health, it was discovered that when the bond is perceived as positive and strong, that is, the individual perceives that their basic, social, and affective needs are covered, it becomes a protective factor for mental health, regulating the manifestation of stress, favoring the manifestation of positive emotions over negative ones, and becoming emotionally supportive

Exploring the Feasibility of Integrating Mental Health into a Family Planning Program in low-resource settings

Introduction: Mental health challenges remain a pressing issue, underscored by the glaring gap between the elevated demand and the scarce resources. Research has highlighted the effectiveness of integrating mental health services with primary care services, particularly in low-resource settings. Purpose: The objective of this research was to evaluate the perceived implications and feasibility of integrating basic mental health services into an existing community-based family planning initiative in Pakistan. By adopting a community-driven and co-produced methodology, our study not only ensured a deeper resonance with local needs but also paved the way for a sustainable and transformative uptake of mental health services in low-resource settings. This co-produced strategy, anchored in mutual collaboration and shared expertise with the community, promises a more holistic, enduring, and adaptive integration of essential health services within community frameworks.Methodology: This study utilized a qualitative research approach to obtain a comprehensive understanding of the program's feasibility and potential for expansion. Interview tools and guides, tailored to the regional language, were developed by the Research Associate to gather insights from the lady health workers involved in delivering the intervention, as well as from the clients. Overall, our team conducted 24 interviews, of which 9 were with the lady health workers and 15 with clients. The interviews were facilitated by the Research Associate and a Psychologist.Results: Utilizing the socio-ecological model, we thematically analyzed factors at individual, interpersonal, and community levels that support or hinder the integration of mental health services with existing community-based programmes. We also examined the intervention's impact on its users and the healthcare providers.Our analysis underscores the significant potential of integrating mental health services into existing community-based health programmes, such as family planning, in low-resource settings. Predominant themes highlighted women's willingness to use these services, influenced by strong relationships and trust in the lady health workers, ease of access to services, and community support. Identified barriers to integration included prevailing poverty, a preference for direct financial incentives in addition to counseling, confidentiality concerns in tight-knit communities, and the lingering stigma surrounding mental health.Conclusion: Our findings highlight the value of community collaboration in healthcare, particularly in low-resource settings. The co-production approach blends professional guidance with local insights, fostering community ownership and enhancing program sustainability. As the first to merge mental health with family planning in Pakistan, our research suggests that future health initiatives can greatly benefit from community-driven methods, leading to more sustainable and transformative health outcomes