Acceptability of a role for community health workers in integrated mental health care for perinatal depression: a qualitative study from Surabaya, Indonesia

Abstract Background: Integrated antenatal care in Indonesia has the potential to extend the role of community health workers (CHWs) to include the identification of perinatal depression in the community and referral to primary health care (PHC) centres, which is an example of task-sharing. This study aimed to examine the acceptability of this type of task-sharing in perinatal depression in Surabaya.Methods: Semi-structured interviews were conducted with participants from four PHC stakeholder groups. 62 participants were recruited from PHC centres, villages and integrated health service posts, the district health office, and one hospital. Data were analysed using framework analysis.Results: More than ninety percent of participants accepted or conditionally accepted task-sharing in perinatal depression. Acceptability was influenced by the perceived benefits of task-sharing, the convenience of the service delivery, the existence of cases of perinatal depression perceived by stakeholders, personal characteristics of CHWs, and the scope of their responsibility within existing tasks. Acceptability was limited by stigma of mental health problems, confidentiality, CHWs’ perceived self-capacity, lack of confidence in CHWs’ competencies, and the objectives of task-sharing in depression identification.Conclusion: Results indicate the need to enhance CHWs’ knowledge about perinatal depression and the needs of users, and CHWs’ competencies in identifying depression. Stigma influences potential health service users’ attitudes to mental health services and help-seeking and help-providing behaviours among service providers, and can reduce motivation to use and to provide services.</jats:p

Evaluation of the acceptability and usefulness of an information website for caregivers of people with bipolar disorder

BACKGROUND: Bipolar disorder is associated with extreme mood symptoms, disability and suicide risk. Close family or friends often have a primary role in supporting an adult with bipolar disorder. However, not all support is helpful and there is little publicly accessible evidence-based information to guide caregivers. Caregiver burden increases the risk of caregiver depression and health problems. To help fill the information gap, expert clinicians, caregivers and consumers contributed to the development of guidelines for caregivers of adults with bipolar disorder using the Delphi consensus method. This paper reports on an evaluation of the acceptability and usefulness of the online version of the guidelines, http://www.bipolarcaregivers.org. METHODS: Visitors to the website responded to an initial online survey about the usefulness of the information (N=536). A more detailed follow-up feedback survey was emailed to web users who were adult caregivers of adults with bipolar disorder a month later (N=121). The feedback was analyzed quantitatively and qualitatively to establish user appraisals of the online information, whether and how caregivers applied the information and ways it could be improved. RESULTS: The majority of users (86.4% to 97.4%) found the various sections of the website useful. At follow-up, nearly 93% of caregivers reported that the information was relevant to them and 96% thought it would help others. Most respondents said that the information was supportive and encouraged adaptive control appraisals. However, a few respondents who were experiencing complex family problems, or who cared for a person with severe chronic bipolar disorder did not appraise it as positively. Nevertheless, over two-thirds of the caregivers reported using the information. Optional interactive features were recommended to maximize benefits. CONCLUSIONS: Overall, http://www.bipolarcaregivers.org was appraised positively and used. It appears useful to close family and friends seeking basic information and reassurance, and may be an inexpensive way to disseminate guidelines for caregivers. Those who care for people with more severe and chronic bipolar disorder, or who have complex family problems might benefit from more specialized interventions, suggesting the importance of a stepped-care approach to supporting caregivers. The potential of evidence-based, collaboratively developed information websites to enhance caregiver and consumer outcomes merits further investigation

Mental health literacy as a function of remoteness of residence: an Australian national study

<p>Abstract</p> <p>Background</p> <p>Although there have been many population studies of mental health literacy, little is known about the mental health literacy of people who reside in rural areas. This study sought to determine the impact of remoteness on public knowledge of depression and schizophrenia.</p> <p>Methods</p> <p>The mental health literacy of residents of major cities, inner regional, and outer-remote (including outer regional, remote, and very remote) regions were compared using data from a 2003–04 Australian national survey of the mental health literacy of 3998 adults. Measures included the perceived helpfulness of a range of professionals, non-professionals and interventions, and the causes, prognosis, and outcomes after treatment for four case vignettes describing depression, depression with suicidal ideation, early schizophrenia and chronic schizophrenia. Participant awareness of Australia's national depression initiative and depression in the media, their symptoms of depression and exposure to the conditions depicted in the vignettes were also compared.</p> <p>Results</p> <p>Mental health literacy was similar across remoteness categories. However, inner regional residents showed superior identification of the disorders depicted in the suicidal ideation and chronic schizophrenia vignettes. They were also more likely to report having heard of Australia's national depression health promotion campaign. Conversely, they were less likely than major city residents to rate the evidence-based treatment of psychotherapy helpful for depression. Both inner regional and outer-remote residents were less likely to rate psychologists as helpful for depression alone. The rural groups were more likely to rate the non-evidence based interventions of drinking and painkillers as helpful for a depression vignette. In addition, outer-remote residents were more likely to identify the evidence based treatment of antipsychotics as harmful for early schizophrenia and less likely to endorse psychiatrists, psychologists, social workers and general practitioners as helpful for the condition.</p> <p>Conclusion</p> <p>Mental health awareness campaigns in rural and remote regions may be most appropriately focused on communicating which interventions are effective for depression and schizophrenia and which mental health and other professionals are trained in the best-practice delivery and management of these. There is also a need to communicate to rural residents that alcohol and pain relievers are not an effective solution for depression.</p

Social determinants of mental health service utilization in Switzerland

OBJECTIVES: To investigate whether mental health services utilization in Switzerland is equitably distributed (i.e., predicted only by the need of a person). METHODS: Data on 17,789 participants of the Swiss Health Survey 2012 (≥15 years) was analysed. Logistic regression analyses were conducted to predict: having been in treatment for a psychological problem; having used psychotropic medication; having had medical treatment for depression; and having visited a psychologist or psychotherapist. Need (depression severity and risky alcohol consumption) and socio-demographic variables were used as independent variables. RESULTS: Depression severity was the strongest predictor for using mental health services. In contrast, risky alcohol consumption was not associated with an increased likelihood of using mental health services. After adjusting for need, the following groups were less likely to use (some of) the mental health services: males, young people, participants who (almost) work full-time, single/unmarried, non-Swiss people and those living in rural areas. Education and income were not significantly associated with the outcomes in the adjusted analyses. CONCLUSIONS: Some socio-demographic subgroups are less likely to use mental health services despite having the same need

Reluctance to seek professional help among suicidal people: results from the Swiss Health Survey

OBJECTIVES: To investigate whether help-negation (not accepting or accessing available helping resources) among suicidal people can also be found in a Swiss sample. METHODS: Data on 16,640 participants (aged 15 and older) from the Swiss Health Survey 2012 was analyzed. Logistic regression analyses were conducted to study the association between suicidality (categorized into "not at all"; "several days"; and "more than half of the days") and currently being in treatment for depression (covariates: depression and socio-demographic variables). RESULTS: Less than 1/3 of the participants with the highest level of suicidality were currently in treatment (males: 27.0 %; females: 29.6 %). Participants who were experiencing suicidality for several days were more likely to be in treatment relative to non-suicidal people. However, people with the highest level of suicidality did not differ from the other two groups in regard to treatment frequency. Help-negation was particularly pronounced among males and young people (15-24-year olds). CONCLUSIONS: The reluctance to seek professional help is problematic because treatment might reduce the risk of suicide

Non-participation in epidemiological school-based surveys: using mixed methods to study predictors and modes of justification for (non-)participation at the school level

Response rates in epidemiological studies have generally been decreasing over the past decades. However, when the target group consists of adolescents and young adults, school-based surveys have hitherto been able to mitigate this problem: This age group can be reached relatively easy in the school context (e.g., as compared to reaching them by phone) with very low refusal rates at the student level. However, the present study used a mixed-methods approach and suggests that schools at the organizational level have meanwhile become the problematic bottleneck for school-based surveys, as they increasingly reject requests for study participation. The current article provides insights into promising means for counteracting this trend. Researchers are advised to offer flexible timeframes for schools’ participation and to involve institutional gatekeepers who are endorsing their study. Furthermore, researchers, funding agencies, and schools would benefit from joint regional survey coordination systems. Such means will be crucial for the representativeness of future school-based epidemiological surveys

Parental factors associated with depression and anxiety in young people : A systematic review and meta-analysis

Background There is a burgeoning and varied literature examining the associations between parental factors and depression or anxiety disorders in young people. However, there is hitherto no systematic review of this complex literature with a focus on the 12–18 years age range, when the first onset for these disorders peaks. Furthermore, to facilitate the application of the evidence in prevention, a focus on modifiable factors is required. Methods Employing the PRISMA method, we conducted a systematic review of parental factors associated with depression and anxiety disorders in young people which parents can potentially modify. Results We identified 181 articles altogether, with 140 examining depression, 17 examining anxiety problems, and 24 examining both outcomes. Stouffer's method of combining p values was used to determine whether associations between variables were reliable, and meta-analyses were conducted to estimate the mean effect sizes of associations between each parental factor and outcome. Limitations Limitations include sacrificing micro-level detail for a macro-level synthesis of the literature, not systematically reviewing moderators and mediators, the lack of generalizability across cultures and to younger or adult children, and the inability to conduct a meta-analysis on all included studies. Conclusions Parental factors with a sound evidence base indicating increased risk for both depression and anxiety include less warmth, more inter-parental conflict, over-involvement, and aversiveness; and for depression additionally, they include less autonomy granting and monitoring