Evolution of Mental Health Online Strategies from the Early Stage of the COVID-19 Pandemic to the Pre-Vaccination Period

Background: The COVID-19 outbreak and its consequent quarantines, containment measures and social distancing imposed by authorities worldwide has caused an increase of psychological responses such as depression, abuse use, insomnia, post-traumatic stress symptoms, anger, anxiety, grief or confusion. This situation has fostered the implementation of new strategies like remote therapy to maintain the continuity of mental health (MH) care. Several international organizations (World Health Organization, the United Nations and the American Psychiatric Association) are focused on addressing the recovery from the COVID-19 pandemic, ensuring availability of emergency MH services, strengthening social cohesion, reducing the isolation, and promoting psychological support, as well as protecting human rights. This research aims to assess the evolution of online MH strategies and recommendations to cope with psychological impact of COVID-19 since early stages of the pandemic to pre-vaccination period. Methods: A sample of 24 online documents was analysed to assess their structural evolution from April 2020 to June 2021. Each document was analysed separately by two researchers. The questionnaire, developed by Almeda et al. (2021), was used to assess the content of these documents. This instrument consists of 39 items organized in seven domains (D) D1) Symptoms, D2) Mental disorders, D3) COVID-19 general information, D4) MH strategies and MH topics, D5) MH strategies and MH-related topics, D6) MH recommendations and MH topics and D7) MH recommendations and MH-related topics. To assess the structural evolution of the document in the selected periods, a T-Student for related samples was used. Results: Statistically significant differences with a negligible effect size were found in D1+D2 domains (t(23) = 3, p = 0.006, d = 0.18). An increasing concern on bereavement, sleeping problems and loneliness symptoms has been highlighted together with a greater interest on schizophrenia, bipolar disorder, chronic pain and obsessivecompulsive disorder. Statistically significant differences with negligible size effect were also found when the questions related to COVID-19 have been analysed (D3-D7;t(23) = 2.24, p = 0.035, d = 0.19). All COVID-19 information items have increased (D3) as also happened in most of the MH strategies and MH-related topics (80%;D5). In D7, D4 and D6 domains, a small increase in the information provided is highlighted. From an international point of view, England, Australia, New Zealand and Mexico are the countries with the highest rate of improvement in their strategies, followed by Ireland and Spain with small improvements. Finally, the information in the online documents of the rest of the countries remains stable. Conclusions: Online MH strategies and recommendations have improved during the pandemic period only in specific countries, especially in Mexico. Due to the high rate of mortality, bereavement has played a key role in the set of symptoms included. Globally speaking, the analysed countries are making efforts to address MH remotely, as it is evidenced in their online strategies

Use of a decision support system for benchmarking analysis and organizational improvement of regional mental health care:Efficiency, stability and entropy assessment of the mental health ecosystem of Gipuzkoa (Basque Country, Spain)

Decision support systems are appropriate tools for guiding policymaking processes, especially in mental health (MH), where care provision should be delivered in a balanced and integrated way. This study aims to develop an analytical process for (i) assessing the performance of an MH ecosystem and (ii) identifying benchmark and target-for-improvement catchment areas. MH provision (inpatient, day and outpatient types of care) was analysed in the Mental Health Network of Gipuzkoa (Osakidetza, Basque Country, Spain) using a decision support system that integrated data envelopment analysis, Monte Carlo simulation and artificial intelligence. The unit of analysis was the 13 catchment areas defined by a reference MH centre. MH ecosystem performance was assessed by the following indicators: relative technical efficiency, stability and entropy to guide organizational interventions. Globally, the MH system of Gipuzkoa showed high efficiency scores in each main type of care (inpatient, day and outpatient), but it can be considered unstable (small changes can have relevant impacts on MH provision and performance). Both benchmark and target-for-improvement areas were identified and described. This article provides a guide for evidence-informed decision-making and policy design to improve the continuity of MH care after inpatient discharges. The findings show that it is crucial to design interventions and strategies (i) considering the characteristics of the area to be improved and (ii) assessing the potential impact on the performance of the global MH care ecosystem. For performance improvement, it is recommended to reduce admissions and readmissions for inpatient care, increase workforce capacity and utilization of day care services and increase the availability of outpatient care services

Modelling the balance of care:Impact of an evidence-informed policy on a mental health ecosystem

Major efforts worldwide have been made to provide balanced Mental Health (MH) care. Any integrated MH ecosystem includes hospital and community-based care, highlighting the role of outpatient care in reducing relapses and readmissions. This study aimed (i) to identify potential expert-based causal relationships between inpatient and outpatient care variables, (ii) to assess them by using statistical procedures, and finally (iii) to assess the potential impact of a specific policy enhancing the MH care balance on real ecosystem performance. Causal relationships (Bayesian network) between inpatient and outpatient care variables were defined by expert knowledge and confirmed by using multivariate linear regression (generalized least squares). Based on the Bayesian network and regression results, a decision support system that combines data envelopment analysis, Monte Carlo simulation and fuzzy inference was used to assess the potential impact of the designed policy. As expected, there were strong statistical relationships between outpatient and inpatient care variables, which preliminarily confirmed their potential and a priori causal nature. The global impact of the proposed policy on the ecosystem was positive in terms of efficiency assessment, stability and entropy. To the best of our knowledge, this is the first study that formalized expert-based causal relationships between inpatient and outpatient care variables. These relationships, structured by a Bayesian network, can be used for designing evidence-informed policies trying to balance MH care provision. By integrating causal models and statistical analysis, decision support systems are useful tools to support evidence-informed planning and decision making, as they allow us to predict the potential impact of specific policies on the ecosystem prior to its real application, reducing the risk and considering the population’s needs and scientific findings

Modelling mental healthcare improvement in highly integrated care systems: the case of the Basque Country (Spain)

Currently there is growing interest in providing integrated mental health care between hospital (acute residential care) and community-based services (… and other health systems). Mental health systems are complex due to the high disorder prevalence, socio-economic burden, stigma associated, and high gap of unmet population needs. Mental health can be considered an ecosystem related to, at least, physical health and social services ones. Decision support systems are robust tools for guiding and improving planning and management of health ecosystems by integrating methods like Bayesian networks. These models identify critical variables, domains and constructs and their corresponding causal relationships. The objective of this research is to design an integrated and integral theoretical Bayesian network for guiding mental health planning and management, and in consequence, improving mental health care delivery

Impact of the workforce allocation on the technical performance of mental health services: the collective case of Helsinki-Uusimaa (Finland)

Background Long-term mental health (MH) policies in Finland aimed at investing in community care and promoting reforms have led to a reduction in the number of psychiatric hospital beds. However, most resources are still allocated to hospital and community residential services due to various social, economic and political factors. Despite previous research focussing on the number and cost of these services, no study has evaluated the emerging patterns of use, their technical performance and the relationship with the workforce structure. Objective The purpose of this study was to observe the patterns of use and their technical performance (efciency) of the main types of care of MH services in the Helsinki-Uusimaa region (Finland), and to analyse the potential rela‑ tionship between technical performance and the corresponding workforce structure. Methods The sample included acute hospital residential care, non-hospital residential care and outpatient care services. The analysis was conducted using regression analysis, Monte Carlo simulation, fuzzy inference and data envelopment analysis. Results The analysis showed a statistically signifcant linear relationship between the number of service users and the length of stay, number of beds in non-hospital residential care and number of contacts in outpatient care services. The three service types displayed a similar pattern of technical performance, with high relative technical efciency on average and a low probability of being efcient. The most efcient acute hospital and outpatient care services integrated multidisciplinary teams, while psychiatrists and nurses characterized non-hospital residential care. Conclusions The results indicated that the number of resources and utilization variables were linearly related to the number of users and that the relative technical efciency of the services was similar across all types. This suggests homogenous MH management with small variations based on workforce allocation. Therefore, the distribution of workforce capacity should be considered in the development of efective policies and interventions in the southern Finnish MH system

Raising awareness and combatting digital gender based violence through service-learning

Digital Gender Based Violence (DGBV) is a growing social problem and affects especially younger people. DGBV describes any kind of Gender Based Violence (GBV) related with new Information and Communication Technologies. To combat DGBV we designed the teaching innovation project "Digital gender-based violence: learning from feminisms" aiming to contribute to the eradication of digital sexist violence in order to promote healthy digital relationships. The project is part of the broader Service Learning project of the University of Barcelona “Sharing Ideas – University goes to High school”: In the classes at University, students will learn the curriculum specific content, to develop a workshop to be implemented in short sessions with high school students.We implement the project at the University of Barcelona in the subjects Social Control (6 ECTS, compulsory) and Sociology of Genders (3 ECTS, optional) of the Sociology Bachelor. Beside the high schools, the project also involves the feminist third sector organization Alia complementing the university students’ training on DGBV. The different actors involved underline the inter-institutional character of the project. The project is a special Service Learning experience as it applies feminist research and teaching methodologies, emphasizing social transformation of gender inequalities.For our project, we share our research results on DGBV with our students in order to enable them to identify and recognize what are DGBV and why they occur. Therefor we expose our own research answering the following questions: what profiles are most affected? What are the profiles of the aggressors? What are the survivors’ reactions on DGBV and how do they evaluate them? For the introductory sessions, we count with the support of the third sector association Alia. The main objective of these activities is to raise the awareness of existing DGBV between adolescents and young people. In addition, we aim to share tools to protect themselves from DGBV as well as to deal with DGBV in order to finally eradicate DGBV.We wonder if the project achieves its goals: Do university students acquire new content at class? Are the contents we provide university students with helpful in order to prepare the workshops at school? What are the additional contents and competences acquired during the workshops at school? Do the high school students benefit from the workshop in terms of contents and competences? We also assess gender differences taking into account gender and paying specially attention to non-binary identified persons. In order to assess these research questions, we consider observation of the sessions, students’ reflections (qualitative) as well as a quantitative questionnaire

Standardised description of health and social care:A systematic review of use of the ESMS/DESDE (European Service Mapping Schedule/Description and Evaluation of Services and DirectoriEs)

Background: Evidence-informed planning and interpretation of research results both require standardised description of local care delivery context. Such context analysis descriptions should be comparable across regions and countries to allow benchmarking and organizational learning, and for research findings to be interpreted in context. The European Service Mapping Schedule (ESMS) is a classification of adult mental health services that was later adapted for the assessment of health and social systems research (Description and Evaluation of Services and DirectoriEs - DESDE). The aim of the study was to review the diffusion and use of the ESMS/DESDE system in health and social care and its impact in health policy and decision-making. Method: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (1997–2018). Results: Out of 155 papers mentioning ESMS/DESDE, 71 have used it for service research and planning. The classification has been translated into eight languages and has been used by seven international research networks. Since 2000, it has originated 11 instruments for health system research with extensive analysis of their metric properties. The ESMS/DESDE coding system has been used in 585 catchment areas in 34 countries for description of services delivery at local, regional and national levels. Conclusions: The ESMS/DESDE system provides a common terminology, a classification of care services, and a set of tools allowing a variety of aims to be addressed in healthcare and health systems research. It facilitates comparisons across and within countries for evidence-informed plannin

Impact of IPDE-SQ personality disorders on the healthcare and societal costs of fibromyalgia patients: A cross-sectional study

Background: Data is lacking on comorbid personality disorders (PD) and fibromyalgia syndrome (FMS) in terms of prevalence, and associated healthcare and societal costs. The main aim of this study was to assess the prevalence of PD in FMS patients and to analyse whether the presence of comorbid PD is related to worse functional impairment and greater healthcare (medical visits, drug consumption, and medical tests) and societal costs. Methods: A cross-sectional study was performed using the baseline data of 216 FMS patients participating in a randomized, controlled trial carried out in three primary health care centres situated in the region of Barcelona, Spain. Measurement instruments included the International Personality Disorder Examination - Screening Questionnaire (IPDE-SQ), the Fibromyalgia Impact Questionnaire (FIQ), the Client Service Receipt Inventory (CSRI), and a socio-demographic questionnaire. Results: Most patients (65 %) had a potential PD according to the IPDE-SQ. The most prevalent PD were the avoidant (41.4 %), obsessive-compulsive (33.1 %), and borderline (27 %). We found statistically significant differences in functional impairment (FIQ scores) between FMS patients with potential PD vs non-PD (59.2 vs 51.1; p < 0.001). Multivariate regression analyses revealed that higher FIQ total scores and the presence of potential PD were related to more healthcare costs (primary and specialised care visits). Conclusions: As expected, PD are frequent comorbid conditions in patients with FMS. Our results suggest that the screening of comorbid PD in patients with FMS might be recommendable in order to detect potential frequent attenders to primary and specialised care

A Comparison of Mental Health Care Systems in Northern and Southern Europe : A Service Mapping Study

Mental health services (MHS) have gone through vast changes during the last decades, shifting from hospital to community-based care. Developing the optimal balance and use of resources requires standard comparisons of mental health care systems across countries. This study aimed to compare the structure, personnel resource allocation, and the productivity of the MHS in two benchmark health districts in a Nordic welfare state and a southern European, family-centered country. The study is part of the REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care) project. The study areas were the Helsinki and Uusimaa region in Finland and the Girona region in Spain. The MHS were mapped by using the DESDE-LTC (Description and Evaluation of Services and Directories for Long Term Care) tool. There were 6.7 times more personnel resources in the MHS in Helsinki and Uusimaa than in Girona. The resource allocation was more residential-service-oriented in Helsinki and Uusimaa. The difference in mental health personnel resources is not explained by the respective differences in the need for MHS among the population. It is important to make a standard comparison of the MHS for supporting policymaking and to ensure equal access to care across European countries.Peer reviewe

Effects of temperature, food type and food concentration on the grazing of the calanoid copepod Centropages chierchiae

Laboratory experiments were conducted to study the combined effect of temperature (8, 13, 19 and 24C), food type and food concentration on the grazing rates of the adult stages of the calanoid copepod Centropages chierchiae. As prey, the diatom Phaeodactylum tricornutum and the dinoflagellate Gymnodinium sp. (both ca. 15 m cell diameter) were used at a range of carbon concentrations similar to the ones experienced in nature (6.4 to 393.8 C L-1). Ingestion rates increased linearly with food concentration and did not differ between prey types. When comparing the effect of temperature, highest clearance and ingestion rates were obtained at 19C, whereas no difference was observed among the other temperatures. Daily rations varied between 1.2 and 183.5 body carbon day(1). Additional experiments were conducted to study the selective feeding behaviour of C. chierchiae when offered a mixture of different prey types. Selective feeding was dependent on food concentration; at low food levels, large cells were selected (Ditylum brightwellii), whereas at medium and high food concentrations no clear selection patterns were observed. In contrast to other studies, no positive selection of dinoflagellates over other algal food was found.Portuguese Science and Technology Foundation (FCT) under project VITAL [PTDC/MAR/111304/2009]; project MODELA [FCT PTDC/MAR/098643/2008]; FCT [SFRH/BPD/38332/2007, SFRH/BD/28198/2006]; Spanish Ministry of Economy and Competitively [CTM2011-23480]; European Community [227799]info:eu-repo/semantics/publishedVersio