Antidepressant use in 27 European countries: associations with sociodemographic, cultural and economic factors

Background Prescribing of antidepressants varies widely between European countries despite no evidence of difference in the prevalence of affective disorders. Aims To investigate associations between the use of antidepressants, country-level spending on healthcare and country-level attitudes towards mental health problems. Method We used Eurobarometer 2010, a large general population survey from 27 European countries, to measure antidepressant use and regularity of use. We then analysed the associations with country-level spending on healthcare and country-level attitudes towards mental health problems. Results Higher country spending on healthcare was strongly associated with regular use of antidepressants. Beliefs that mentally ill people are ‘dangerous’ were associated with higher use, and beliefs that they ‘never recover’ or ‘have themselves to blame’ were associated with lower and less regular use of antidepressants. Conclusions Contextual factors, such as healthcare spending and public attitudes towards mental illness, may partly explain variations in antidepressant use and regular use of these medications

Cash transfers and the mental health of young people: evidence from South Africa's child support grant

This study examines the longitudinal impact of the South African Child Support Grant (CSG) on risk for depression and life satisfaction among young people (15–19 years). We analysed data from the last three waves of the National Income Dynamics Study (NIDS), a nationally representative panel survey that took place every two years from 2008 to 2017. We used an instrumental variable (IV) approach that exploits multiple changes in age eligibility from 1998 to 2012. Depressive symptoms were assessed using an 8-item version of the Centre for Epidemiological Studies Depression Scale; participants who scored above 8 were considered at risk for depression. Life satisfaction was rated on a scale of 1 (‘very dissatisfied’) to 10 (‘very satisfied’); participants who scored 8 or above were classified as satisfied. We also examined impacts on educational deficit (≥2 years behind) and not being in education, employment or training (NEET) as secondary outcomes, as these are also important for mental health. Age eligibility strongly predicted CSG receipt at Wave 3. In instrumental variable models, CSG receipt did not influence the risk for depression (β = 0.10, SE = 0.10, p = 0.316), nor life satisfaction (β = −0.07, SE = 0.09, p = 0.420) at Wave 3, nor at Waves 4 or 5. Some improvements in educational deficit were observed at Wave 3 among CSG beneficiaries compared to non-beneficiaries. These results were robust to multiple specifications. CSG receipt did not improve the psychological wellbeing of adolescents and young adults, nor did it improve their education or employment outcomes. Our findings highlight the need to identify alternative social policies that address the root causes of youth social disadvantage, in conjunction with targeted approaches to improve the mental health of young South Africans living in poverty

How do child and adolescent mental health problems influence public sector costs? Interindividual variations in a nationally representative British sample.

Author's manuscript version. The final published version of the article is available from the publisher as an open access article via: DOI: 10.1111/jcpp.12327BACKGROUND: Policy and practice guidelines emphasize that responses to children and young people with poor mental health should be tailored to needs, but little is known about the impact on costs. We investigated variations in service-related public sector costs for a nationally representative sample of children in Britain, focusing on the impact of mental health problems. METHODS: Analysis of service uses data and associated costs for 2461 children aged 5-15 from the British Child and Adolescent Mental Health Surveys. Multivariate statistical analyses, including two-part models, examined factors potentially associated with interindividual differences in service use related to emotional or behavioural problems and cost. We categorized service use into primary care, specialist mental health services, frontline education, special education and social care. RESULTS: Marked interindividual variations in utilization and costs were observed. Impairment, reading attainment, child age, gender and ethnicity, maternal age, parental anxiety and depression, social class, family size and functioning were significantly associated with utilization and/or costs. CONCLUSIONS: Unexplained variation in costs could indicate poor targeting, inequality and inefficiency in the way that mental health, education and social care systems respond to emotional and behavioural problems.Department of Health (England)Wellcome Trus

Public knowledge, attitudes, social distance and reported contact regarding people with mental illness 2009-2015

Objective To investigate whether public knowledge, attitudes, desire for social distance and reported contact in relation to people with mental health problems have improved in England during the Time to Change (TTC) programme to reduce stigma and discrimination 2009–2015. Methods Using data from an annual face-to-face survey of a nationally representative sample of adults, we analysed longitudinal trends in the outcomes with regression modelling using standardised scores of the measures overall and by age and gender subgroups. Results There were improvements in all outcomes. The improvement for knowledge was 0.17 standard deviation units in 2015 compared to 2009 (95% CI 0.10, 0.23); for attitudes 0.20 standard deviation units (95% CI 0.14, 0.27) and for social distance 0.17 standard deviation units (95% CI 0.11, 0.24). Survey year for 2015 vs. 2009 was associated with a higher likelihood of reported contact (OR 1.32, 95% CI 1.13, 1.53). Statistically significant interactions between year and age suggest the campaign had more impact on the attitudes of the target age group (25–45) than those aged over 65 or under 25. Women's reported contact with people with mental health problems increased more than did men's. Conclusion The results provide support for the effectiveness of TTC

Coping with stigma and discrimination: evidence from mental health service users in England

Mental health stigma and discrimination are significant problems. Common coping orientations include: concealing mental health problems, challenging others and educating others. We describe the use of common stigma coping orientations and explain variations within a sample of English mental health service users. Cross-sectional survey data were collected as part of the Viewpoint survey of mental health service users’ experiences of discrimination (n = 3005). Linear regression analyses were carried out to identify factors associated with the three stigma coping orientations. The most common coping orientation was to conceal mental health problems (73%), which was strongly associated with anticipated discrimination. Only 51% ever challenged others because of discriminating behaviour, this being related to experienced discrimination, but also to higher confidence to tackle stigma. Although stigma coping orientations vary by context, individuals often choose to conceal problems, which is associated with greater anticipated and experienced discrimination and less confidence to challenge stigma. The direction of this association requires further investigation

About the Problem of Differentiation Between the Oaks Quercus pubescens Willd. and Quercus virgiliana. (Ten.) Ten.

U radu su prikazane razlike između srodnih maljavodlakavih hrastova Quercus pubescens i Q. virgiliana. Isto tako prikazana je njihova približna rasprostranjenost u Hrvatskoj, te mogućnost njihova razlikovanja na terenu. Istaknute su i poteškoće u uspješnom određivanju i prepoznavanju navedenih hrastova.In the work the morphological differences between the related downy hairy oaks Quercus pubescens and Q. virgiliana are analyzed. They occupy large areas especially in the Adriatic littoral of the Republic of Croatia, but they develop sporadically in its hinterland, too. The said oaks can be differentiated from each other by the morphology of their leaf, cupule and bark, by the arrangement of flowers on a short fruit shoot as well as by the appearance of their cupule. Q. pubescens has a leaf with 4–6 pairs of lateral lobes, and the petiole is 1–2 cm, maximum 3 cm, long. Its bark at the trunk base is shallowly longitudinally furrowed. All female flowers of the short, fruit shoot are sitting, placed terminally. All ripe acorns are sitting, placed terminally. The cupule covered with small, triangular scales arranged like tiles on a roof is smooth in appearance. Q. virgiliana has a leaf with 3–4 (-5) pairs of lateral lobes, and the petiole is more than 3 cm long. Its bark at the trunk base is deeply furrowed, on the cross cut like a cogwheel. The female flowers are arranged on a more or less long rachis, not longer than 10 cm, in the form of an ear, and the ears can be arranged both terminally and laterally in leaf axils. In the ear there are often clusters of several flowers. One or several ripe acorns are on a more or less long stalk, usually 1–2 cm long. At the top or sidewise on the cupule the remnant of the rachis can often be noticed in the form of a curved, dry extension. The cupule scales are verrucously swollen or protuberated, making the entire cupule verrucously wrinkled. In case of any deviation from the above parameters, as a rule the hybrids are involved

Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis:A systematic review

Stigma associated with mental illness can delay or prevent help-seeking and service contact. Stigma-related influences on pathways to care in the early stages of psychotic disorders have not been systematically examined. This review systematically assessed findings from qualitative, quantitative and mixed-methods research studies on the relationship between stigma and pathways to care (i.e. processes associated with help-seeking and health service contact) among people experiencing first-episode psychosis or at clinically defined increased risk of developing psychotic disorder. Forty studies were identified through searches of electronic databases (CINAHL, EMBASE, Medline, PsycINFO, Sociological Abstracts) from 1996 to 2016, supplemented by reference searches and expert consultations. Data synthesis involved thematic analysis of qualitative findings, narrative synthesis of quantitative findings, and a meta-synthesis combining these results. The meta-synthesis identified six themes in relation to stigma on pathways to care among the target population: ‘sense of difference’, ‘characterizing difference negatively’, ‘negative reactions (anticipated and experienced)’, ‘strategies’, ‘lack of knowledge and understanding’, and ‘service-related factors’. This synthesis constitutes a comprehensive overview of the current evidence regarding stigma and pathways to care at early stages of psychotic disorders, and illustrates the complex manner in which stigma-related processes can influence help-seeking and service contact among first-episode psychosis and at-risk groups. Our findings can serve as a foundation for future research in the area, and inform early intervention efforts and approaches to mitigate stigma-related concerns that currently influence recognition of early difficulties and contribute to delayed help-seeking and access to care

Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study

The aims of this paper are to: (i) explore the experiences of involvement of mental health service users, their caregivers, mental health centre heads and policy makers in mental health system strengthening in three low- and middle-income countries (LMICs) (Ethiopia, Nepal and Nigeria); (ii) analyse the potential benefits and barriers of such involvement; and (iii) identify strategies required to achieve greater service user and caregiver participation. A cross-country qualitative study was conducted, interviewing 83 stakeholders of mental health services. Our analysis showed that service user and caregiver involvement in the health system strengthening process was an alien concept for most participants. They reported very limited access to direct participation. Stigma and poverty were described as the main barriers for involvement. Several strategies were identified by participants to overcome existing hurdles to facilitate service user and caregiver involvement in the mental health system strengthening process, such as support to access treatment, mental health promotion and empowerment of service users. This study suggests that capacity building for service users, and strengthening of user groups would equip them to contribute meaningfully to policy development from informed perspectives. Involvement of service users and their caregivers in mental health decision-making is still in its infancy in LMICs. Effective strategies are required to overcome existing barriers, for example making funding more widely available for Ph.D. studies in participatory research with service users and caregivers to develop, implement and evaluate approaches to involvement that are locally and culturally acceptable in LMICs

Lean economies and innovation in mental health systems

Poor access to mental health care is widely reported, although it differs according to sociopolitical and economic contexts. In emerging economies, including Brazil, Russia, India, China, and South Africa (BRICS), there has been increased public investment in recent years, but rapid economic growth in these countries has now slowed. Precarious global transitions affect both the burden of mental health problems and demand for services. Innovations prompted by these transitions, in both high-income and low-income countries, could help meet population needs during times of economic shock, whether scarcity or affluence