Could a short training intervention modify opinions about mental illness? A case study on French health professionals

Abstract Background In France, negative views on schizophrenia are pervasive, even among health professionals. Prior research suggests that the level of prejudice is lower when the illness is described with the example of a specific individual. This finding highlights the importance of designing local, targeted destigmatization campaigns. The present study aims to evaluate the benefits of a short intervention offering contact with psychiatric services users on reducing the stigma about mentally ill people, among a sample of Health Administrators and Students. Methods Data were collected before (Time 0) and after (Time 1) a short training intervention program proposed to a sample of 121 Health Services Administrators and Students. This four-day workshop explained the multiple causes of mental illness, the clinical implications of psychosis and various mental disorders, the subjective experience of mental illness and the legal evolutions of users’ rights. The intervention was strongly based on live testimonies from users. Using a French version of the Attitudes to Mental Illness scale, we compared attitudes before and after the training intervention among 58 trainees having answered our questionnaire at Time 0 and Time 1. Results After the training, a significantly lower endorsement of stigmatizing statements compared to baseline was found in one third (9 out of 27) of the items. These results plead for further research about the potential benefits of initiatives like this short intervention program on significantly reducing stigmatizing attitudes towards mentally ill people among Health Administrators and Students. Conclusions The present study highlights the importance of further studying the effect of targeted interventions that offer first hand contact with persons with mental illness

Associations between traumatic event experiences, psychiatric disorders, and suicidal behavior in the general population of Afghanistan: findings from Afghan National Mental Health Survey

Background The role of traumatic event exposure and psychiatric disorders as central risk factors for suicidal behavior has been established, but there are limited data in high conflict regions with significant trauma exposures such as Afghanistan. Methods A nationally representative, cross-sectional survey was conducted through systematic stratified random sampling in 8 regions of Afghanistan in 2017 (N = 4474). Well-validated instruments were used to establish trauma exposure, psychiatric disorders. Death preference, suicidal ideation, plan, and attempts were assessed. Results In the total sample, 2.2% reported suicidal ideation in the past 12 months, and 7.1% of respondents reported that they had suicidal ideation at some point in their lives; 3.4% reported a suicide attempt. Women were at higher risk than men. All traumatic event exposures were strongly associated with suicidal behavior. Respondents who reported experiencing sexual violence were 4.4 times more likely to report lifetime suicide attempts (95% CI 2.3–8.4) and 5.8 times more likely to report past 12-month suicidal ideation (95% CI 2.7–12.4). Associations were strong and significant for all psychiatric disorders related to suicidal behavior. Respondents who met criteria for major depressive episodes (OR = 7.48; 95% CI 4.40–12.72), generalized anxiety disorder (OR = 6.61; 95% CI 3.54–12.33), and PTSD (OR = 7.26; 95% CI 4.21–12.51) had the highest risk of past 12-month suicidal ideation. Conclusion Traumatic event exposures and psychiatric disorders increase risk of suicidal behavior in the Afghan general population; women are at high risk. Interventions to reduce trauma exposure, including expansion of a mental health workforce in the region, are critically important

Chinese version of Dominic Interactive – A self-report video game for assessing mental health in young children

ObjectivesAssess the validity of the Chinese version of the Dominic Interactive (DI), a 91-item, video-based diagnostic screening instrument for children that assesses four internalized disorders (phobias, separation anxiety disorder, generalized anxiety disorder, and major depressive disorder) and three externalized disorders (attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder).Methods(1) Compare DI-generated “probable” or “possible” diagnoses to diagnoses based on the Development and Well-Being Assessment (DAWBA) instrument in 113 psychiatric outpatients and 20 community controls. (2) Administer DI to 1,479 children from elementary schools in Tianjin.ResultsIn the validation sample, DI with DAWBA concordance was much greater for internalized disorders (mean Kappa = 0.56) than for externalized disorders (mean kappa = 0.11). The positive predictive value of DI diagnoses ranged from 0.96 (generalized anxiety disorder) to 25% (oppositional defiant disorder) and negative from 0.81 to 0.96. Using “probable” cuts provides better results. In the survey, prevalence of probable DI disorders ranged from 1.0% (conduct disorder) to 13.1% (phobias). Internal consistency of all DI items was excellent (Cronbach alpha = 0.93) and that of the seven subscales ranged from 0.64 (phobias) to 0.87 (major depressive disorder). In multilevel SEM analyses, SRMR (Standardized root mean square residual) or each of the seven diagnoses was below 0.08 and each coefficient of determination was below 0.60.ConclusionThe Chinese DI is a convenient method of screening common mental disorders in Chinese children mainly for internalized disorders, which are the most prevalent diagnoses in that population. However its high negative predictive values for externalized could be used for screening

An exploratory study of stakeholders' perceptions of how epidemiologic data can be utilized for policy in the field of mental health

The World Mental Health Survey Consortium, a World Health Organization and Harvard University collaboration, totaling 28 countries participated in a uniform randomized general population survey, making use of translated versions of the WHO Composite International Diagnostic Interview. One of the major purposes of the survey was to help inform policy decision makers regarding mental health. However many obstacles prevent the direct translation of survey data to policies. We report on an investigation of the mechanisms involved in the transformation of survey data into mental health policies. After conducting 11 interviews of individuals representing 12 countries that participated in the survey, we found that although governments did take an active role in the conduct of the survey, this did not necessarily translate into direct policy changes. A number of factors were noted to influence the adoption and implement ation of mental health policy changes from the survey data: the establishment of links between the research group and policymakers; the identification of costs of mental disorder; definition of clear solutions; and lastly the generation of political will. The range of countries included in this investigation has enabled comparisons in the use of evidence to influence policies in different contexts. Gaining an understanding of why some countries were successful and why others struggled in transforming survey results to policies may help to inform researchers of translational issues of research to mental health policies in the future.publishersversionpublishe

High and low suicidality in Europe: a fine-grained comparison of France and Spain within the ESEMeD surveys

Background: Suicidality risk-factors between countries with similar economic and religious background have been rarely compared, especially within genders. Methods: Lifetime prevalence of suicide ideation, plans, and attempts in the ESEMeD surveys were stratified on four separate groups: French women, Spanish women, French men, and Spanish men. Outcome odds-ratios (OR) were modelled within each group using logistic regression including demographic characteristics, lifetime mood/anxiety disorders, parental bonding, marital status, and health service-use. Results: Lifetime prevalence of suicide attempts was 3.4% in France (1.1% men, 5.4% women) and 1.5% in Spain (1.2% men, 1.7% women), with a significantly greater gender difference in France (p = 0.001). Regarding risk-factors, French women reported suicide attempt more commonly with authoritarian mothers (OR = 1.51; 95%CI = 1.04-2.18), unlike Spanish women (OR = 0.77; 95%CI = 0.51-1.15) (p < 0.001). Spanish men showed more than eight-times higher odds of suicide attempt with overprotecting mothers than French men (p = 0.03). General practitioner-(GP)-use was significantly protective of suicide attempt among Spanish women (OR = 0.08; 95%CI = 0.02-0.35) with no effect in French women (OR = 1.03; 95%CI = 0.54-2.00) (p = 0.01). No significant differences in the effect of marital status, any lifetime antidepressant use, mental disorders, or religiosity on suicide attempt were observed between France and Spain within gender-stratum. Limitations: Parental bonding is retrospective and potentially influenced by mental state. Response rate was considerably lower in France than in Spain. Conclusions: Suicidality risk-factors play different roles across genders between France and Spain. Parental bonding dimensions may be interpreted differently according to country, underlining cultural importance. As recommended by WHO, mental health decisions must involve GPs in conjunction with psychiatrists or psychologists

Schizophrenia and quality of life: a one-year follow-up in four EU countries

BACKGROUND: This article systematically monitors the quality of life (QOL) of patients with schizophrenia from seven different sites across four European countries: France, Ireland, Portugal and Spain. METHODS: A one-year prospective cohort study was carried out. Inclusion criteria for patients were: a clinical lifetime diagnosis of schizophrenia according to ICD-10 (F20) diagnostic criteria for research, age between 18 and 65 years and at least one contact with mental health services in 1993. Data concerning QOL were recorded in seven sites from four countries: France, Portugal, Ireland and Spain, and were obtained using the Baker and Intagliata scale. At baseline, 339 patients answered the QOL questionnaire. At one-year follow-up, Spain could not participate, so only 263 patients were contacted and 219 agreed to take part. QOL was compared across centres by areas and according to a global index. QOL was correlated with presence of clinical and social problems, needs for care and interventions provided during the one-year follow-up. RESULTS: We did not find any link between gender and QOL. There were some significant differences between centres concerning many items. What is more, these differences were relative: in Lisbon where the lowest level of satisfaction was recorded, people were satisfied with food but highly dissatisfied with finances, whereas in St Etienne, where the highest level of satisfaction was recorded, people were less satisfied with food when they were more satisfied with finances. The evolution in one year among those respondents who took part in the follow-up (excluding the subjects from Granada) showed different patterns depending on the items. CONCLUSION: The four countries have different resources and patients live in rather different conditions. However, the main differences as far as their QOL is concerned very much depend on extra-psychiatric variables, principally marital status and income

Parental Smoking in the Vicinity of Children and Tobacco Control Policies in the European Region

Objective: To ascertain patterns of parental smoking in the vicinity of children in Eastern and Western Europe and their relation to Tobacco Control Scale (TCS) scores. Methods: Data on parental smoking patterns were obtained from the School Child Mental Health Europe (SCMHE), a 2010 cross-sectional survey of 5141 school children aged 6 to 11 years and their parents in six countries: Germany, Netherlands, Lithuania, Romania, Bulgaria and Turkey ranked by TCS into three level categories toward tobacco control policies. Results: A slightly higher proportion of Eastern compared to Western European mothers (42.4 vs. 35.1%) were currently smoking in but the difference was not statistically significant after adjusting for maternal age and maternal educational attainment. About a fifth (19.3%) and a tenth (10.0%) of Eastern and Western European mothers, respectively, smoked in the vicinity of their children, and the difference was significant even after adjustment for potential confounders (p less than 0.001). Parents with the highest educational attainment were significantly less likely to smoke in the vicinity of their children than those with the lowest attainment. After control of these covariates lax tobacco control policies, compared to intermediate policies, were associated with a 50% increase in the likelihood of maternal smoking in the vicinity of children adjusted odds ratio (AOR) = 1.52 and 1.64. Among fathers, however, the relationship with paternal smoking and TCS seems more complex since strict policy increases the risk as well AOR = 1,40. Only one country, however belongs to the strict group. Significance: Tobacco control policies seem to have influenced maternal smoking behaviors overall to a limited degree and smoking in the vicinity of children to a much greater degree. Children living in European countries with lax tobacco control policies are more likely to be exposed to second hand smoking from maternal and paternal smoking

Gene × Environment interactions in autism spectrum disorders: role of epigenetic mechanisms.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Several studies support currently the hypothesis that autism etiology is based on a polygenic and epistatic model. However, despite advances in epidemiological, molecular and clinical genetics, the genetic risk factors remain difficult to identify, with the exception of a few chromosomal disorders and several single gene disorders associated with an increased risk for autism. Furthermore, several studies suggest a role of environmental factors in autism spectrum disorders (ASD). First, arguments for a genetic contribution to autism, based on updated family and twin studies, are examined. Second, a review of possible prenatal, perinatal, and postnatal environmental risk factors for ASD are presented. Then, the hypotheses are discussed concerning the underlying mechanisms related to a role of environmental factors in the development of ASD in association with genetic factors. In particular, epigenetics as a candidate biological mechanism for gene × environment interactions is considered and the possible role of epigenetic mechanisms reported in genetic disorders associated with ASD is discussed. Furthermore, the example of in utero exposure to valproate provides a good illustration of epigenetic mechanisms involved in ASD and innovative therapeutic strategies. Epigenetic remodeling by environmental factors opens new perspectives for a better understanding, prevention, and early therapeutic intervention of ASD

Health status of the advanced elderly in six european countries: results from a representative survey using EQ-5D and SF-12

<p>Abstract</p> <p>Background</p> <p>Due to demographic change, the advanced elderly represent the fastest growing population group in Europe. Health problems tend to be frequent and increasing with age within this cohort.</p> <p>Aims of the study</p> <p>To describe and compare health status of the elderly population in six European countries and to analyze the impact of socio-demographic variables on health.</p> <p>Methods</p> <p>In the European Study of the Epidemiology of Mental Disorders (ESEMeD), representative non-institutionalized population samples completed the EQ-5D and Short Form-12 (SF-12) questionnaires as part of personal computer-based home interviews in 2001-2003. This study is based on a subsample of 1659 respondents aged ≥ 75 years from Belgium (n = 194), France (n = 168), Germany (n = 244), Italy (n = 317), the Netherlands (n = 164) and Spain (n = 572). Descriptive statistics, bivariate- (chi-square tests) and multivariate methods (linear regressions) were used to examine differences in population health.</p> <p>Results</p> <p>68.8% of respondents reported problems in one or more EQ-5D dimensions, most frequently pain/discomfort (55.2%), followed by mobility (50.0%), usual activities (36.6%), self-care (18.1%) and anxiety/depression (11.6%). The proportion of respondents reporting any problems increased significantly with age in bivariate analyses (age 75-79: 65.4%; age 80-84: 69.2%; age ≥ 85: 81.1%) and differed between countries, ranging from 58.7% in the Netherlands to 72.3% in Italy. The mean EQ VAS score was 61.9, decreasing with age (age 75-79: 64.1; age 80-84: 59.8; age ≥ 85: 56.7) and ranging from 60.0 in Italy to 72.9 in the Netherlands. SF-12 derived Physical Component Summary (PCS) and Mental Component Summary (MCS) scores varied little by age and country. Age and low educational level were associated with lower EQ VAS and PCS scores. After controlling for socio-demographic variables and reported EQ-5D health states, mean EQ VAS scores were significantly higher in the Netherlands and Belgium, and lower in Germany than the grand mean.</p> <p>Conclusions</p> <p>More than two thirds of the advanced elderly report impairment of health status. Impairment increases rapidly with age but differs considerably between countries. In all countries, health status is significantly associated with socio-demographic variables.</p