Making strides in women’s mental health care delivery in rural Ethiopia: demographics of a female outpatient psychiatric cohort at Jimma University Specialized Hospital (2006–2008)

This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health care for women requires concerted efforts by multiple stake holders. Using our results, we advance concrete and practical suggestions for improving women’s mental health in rural Ethiopia. We point out that the health care system needs to be responsive, allowing for change starting with gender rights, so that rural women have access to basic mental health services

Capacity Building in Global Mental Health: Professional Training

We suggest that the optimal approach to building capacity in global mental health care will require partnerships between professional resources in high-income countries and promising health-related institutions in low- and middle-income countries. The result of these partnerships will be sustainable academic relationships that can educate a new generation of in-country primary care physicians and, eventually, specialized health professionals. Research capabilities will be an essential educational component to inform policy and practice, and to ensure careful outcome measurements of training and of intervention, prevention, and promotion strategies. The goal of these academic centers of excellence will be to develop quality, in-country clinical and research professionals, and to build a productive environment for these professionals to advance their careers locally. In sum, this article discusses human capacity building in global mental health, provides recommendations for training, and offers examples of recent initiatives. (Harv Rev Psychiatry 2012;20:47–57.

Adjuvant therapy with minocycline for schizophrenia (The MINOS Trial): study protocol for a double-blind randomized placebo-controlled trial

Background: Schizophrenia is understood to be a heterogeneous brain condition with overlapping symptom dimensions. The negative symptom dimension, with its protean cognitive manifestations, responds poorly to treatment, which can be a particular challenge in countries where clozapine therapy is not available. Preliminary data indicate that minocycline may be beneficial adjunct in the treatment of schizophrenia: positive, negative, and cognitive symptoms. In this study we aim to assess the efficacy of adjunctive minocycline to alleviate symptoms of schizophrenia in patients who have failed to respond to a therapeutic trial of antipsychotic medications. Methods: The study is a parallel group, double-blind, randomized, placebo-controlled trial. Participants will be adults (aged 18 years and above) with first episode or relapse episode of schizophrenia of under 5 years’ duration. Patients who failed to show adequate therapeutic response to at least one antipsychotic medication given for a minimum of 4 weeks will be recruited from a psychiatry hospital in Addis Ababa and a psychiatry clinic in Butajira, Ethiopia. A total of 150 participants (75 in each arm) will be required to detect a five-point mean difference between the intervention arms adjusting for baseline symptom severity, at 90% power and 95% confidence. Patients in the intervention arm will receive minocycline (200 mg/day orally) added on to the regular antipsychotic medications participants are already on. Those in the placebo arm will receive an inactive compound identical in physical appearance to minocycline. Intervention will be offered for 12 weeks. Diagnosis will be established using the operational criteria for research (OPCRIT). Primary outcome measure will be a change in symptom severity measured using the positive and the negative syndrome scale for schizophrenia (PANSS). Secondary outcome measures will include changes in severity of negative symptoms, proportion achieving remission, and level of functioning. Whether changes are maintained post intervention will also be measured (PANSS). Key assessment for the primary outcome will be conducted at the end of trial (week 12). One post-intervention assessment will be conducted 4 weeks after the end of intervention (week 16) to determine sustainability of change. Trial registration Clinicaltrials.gov identifier: NCT01809158

The African Global Mental Health Institute: Increasing capacity, inclusivity and translation of psychiatric research and care

The largest treatment gap for mental, neurological and substance use (MNS) disorders to date exists in Sub-Saharan Africa (e.g., South Africa, Malawi, Nigeria).  While efforts have been made to reduce the global burden of MNS disorders, there remain significant barriers to delivery of equitable mental health care in Africa and the diaspora. These barriers are deeply rooted in a lack of research structures to inform care delivery, few outlets to train in-country mental health professionals, and limited involvement of policymakers in translation of research findings. Given the demonstrated need across domains of research, education, service delivery and policy in Africa, it is in the purview of global leaders and mental health professionals to build the infrastructure necessary to make systematic, targeted strides to develop each of these areas. With this conceptual framework in mind, over fifty global leaders, psychiatrists, mental health professionals and advocates with expertise in cultural psychiatry convened at a global conference in Cape Town, South Africa in 2016 to establish the African Global Mental Health Institute (AGMHI). The AGMHI is an organizational effort that aims to reduce the global burden of mental illness through research, education and training, service delivery, and policy. Aligned with mental health initiatives posited by the World Health Organization (WHO) and the World Bank, the AGMHI represents an opportunity to explore and understand cultural nuance among populations in Africa and the diaspora. This article focuses on the AGMHI’s targeted strategies in the following actions: 1) bolstering training and education programs for clinicians and/or researchers in Africa and the diaspora to increase human capacity for mental health; 2) conducting and disseminating inclusive, culturally-relevant research (e.g., research that involves community stakeholders in its design and conduct) to meet the urgent need for a culturally-relevant evidence base;  3) identifying key stakeholders to promote sustainable mental health care and inform policy; and 4) fostering local and global collaborations (e.g., engaging local and national governments, non-governmental organizations (NGO), academic institutions, etc.) to share methods of improving access to mental health services. In concert with empirical data, these strategies were devised by members of the AGMHI, which is comprised of international leaders with decades of expertise in global psychiatry. While the MNS disorder treatment gap remains at large, the AGMHI believes these specific strategies are a step toward reducing the treatment gap and enhancing mental health care access globally

A mental health needs assessment of children and adolescents in post-conflict Liberia: results from a quantitative key-informant survey

Between 1989 and 2004, Liberia experienced a devastating civil war that resulted in widespread trauma with almost no mental health infrastructure to help citizens cope. In 2009, the Liberian Ministry of Health and Social Welfare collaborated with researchers from Massachusetts General Hospital to conduct a rapid needs assessment survey in Liberia with local key informants (n = 171) to examine the impact of war and post-war events on emotional and behavioral problems of, functional limitations of, and appropriate treatment settings for Liberian youth aged 5–22. War exposure and post-conflict sexual violence, poverty, infectious disease and parental death negatively impacted youth mental health. Key informants perceived that youth displayed internalizing and externalizing symptoms and mental health-related functional impairment at home, school, work and in relationships. Medical clinics were identified as the most appropriate setting for mental health services. Youth in Liberia continue to endure the harsh social, economic and material conditions of everyday life in a protracted post-conflict state, and have significant mental health needs. Their observed functional impairment due to mental health issues further limited their access to protective factors such as education, employment and positive social relationships. Results from this study informed Liberia's first post-conflict mental health policy

Global mental health: the role of collaboration during the COVID-19 pandemic

T32 MH116140 - NIMH NIH HHSPublished versio

Impactos da microcefalia no brasil e no mundo: revisão sistemática e meta-análise/ Impacts of microcephaly in brazil and the world: systematic review and meta-analysis

A microcefalia apresenta etiologia complexa e multifatorial, sendo identificada pela medida do Perímetro Cefálico (PC) menor que dois desvios-padrões da média específica para o sexo e idade gestacional. A infecção trouxe diversas consequências psicossociais e econômicas. Portanto, é de fundamental importância a compreensão dos impactos gerados no Brasil e no mundo. O objetivo do estudo é conhecer os impactos da microcefalia no Brasil e no mundo. Trata-se de um estudo de revisão sistemática seguida de metanálise. O período de busca foi realizado durante o mês de junho de 2020, contemplando os artigos das bases de dados: PUBMED, SCOPUS e Web of Science. Utilizou-se artigos nos idiomas inglês, português e espanhol, com período de publicação dos últimos 5 anos (2015-2020), utilizando os descritores em MESH: Microcephaly, “Zika Virus”, “Health Impact Assessment”, fazendo uso do operador booleano AND. A análise apresenta um efeito final de 0,79 com IC de 0,66 a 0,88 o que representa um tamanho de efeito médio pela interpretação estatística. Portanto, é crucial compreender os impactos que patologia gera, para que assim sejam implementadas mais políticas públicas voltadas para melhora da qualidade de vida dos pacientes e família, assim como para a sociedade como um todo