A Review of Substance Use Disorder Treatment in Developing World Communities

Background: As global health endeavors increasingly encompass efforts to prevent and treat mental illness in the developing world, it is important to build a base of knowledge of existing treatment models and experimental outcomes. Objective: This article reviews the current literature on substance use disorder treatment in countries with a high, medium, or low Human Development Index according to the 2011 United Nations Development Programme Report. Methods: We searched the databases PubMed, PsycINFO, and Global Health using search terms such as 'substance abuse treatment developing countries', 'addiction developing nations', and 'alcohol abuse developing countries'. Opinion pieces and articles published before 1994 were excluded. Thirty relevant articles (excluding those reviewed for background information) were identified. Findings: Comprehensive overviews of treatment models were markedly absent from the current literature. However, existing research highlights specific areas of need, which may serve as a guide for future research and program development. Conclusions: In light of the evident need for treatment of substance use disorder in developing countries, future research would do well to blend inquiry with practice. Although further investigation is needed to fully understand the specific needs of developing world populations, assisting those populations should be a primary goal

An Ethical Framework for Global Psychiatry

Existing literature addresses the ethical considerations of global health work and how medical school curricula can help prepare students for them, but little has been written regarding an ethical approach to global psychiatry. In this paper we summarize prominent ethical issues that arise in global health psychiatry in order to provide a foundation for a framework in global health psychiatry. These issues include obtaining informed consent in the face of language barriers, diagnosing and treating for mental illnesses while navigating communities where such conditions are heavily stigmatized, and justifying the cessation of proving care to current patients for the sake of providing care to new patients abroad. To help prepare psychiatrists and students for work that engages these issues, we propose a multi-step process to assist the practicing global psychiatrist in recognizing ethical dilemmas and evaluating potential courses of action based on their respective ethical merits

Ongoing Mental Health Concerns in Post-3/11 Japan

Background: The triple disaster that struck the Tohoku region on March 11, 2011, has had massive psychiatric, social, and physical effects on the people of Japan. A staggering loss of life and property, as well as an ongoing nuclear disaster, has dramatically affected the ability of the country to recover. Objective: In an effort to better understand the current social, health, and mental health needs of the region affected by the disaster and to share lessons from 9/11, a group of 9/11 survivors and doctors from the Icahn School of Medicine at Mount Sinai traveled to sites throughout the Fukushima, Miyagi, and Iwate prefectures. Methods: A qualitative analysis was performed on transcripts of the cultural and medical exchanges, which occurred on this trip to identify relevant themes about the problems confronting the recovery effort almost 3 years after the disaster. Findings: Significant themes that emerged included a crippling radiation anxiety, a considerable stigma toward addressing mental health care, and a shortage of mental health care throughout the region, as well as ongoing psychiatric symptoms such as insomnia, anxiety, and alcohol misuse. Conclusions: These issues continue to complicate the recovery effort but suggest avenues for future interventions

Piloting Self-Help Groups for Alcohol Use Disorders in Saint Vincent/Grenadines

Background: Although alcohol consumption is recognized as a global problem, little research to date explores treatment options for alcohol use disorders in developing nations. Given the scarce mental health resources available in Saint Vincent and the Grenadines, community self-help programming for alcohol use disorders could potentially provide an important complement to the existing mental health services. Objective: The aim of this study was to gather baseline data on knowledge and attitudes toward alcohol consumption among community members, and subsequently, to pilot self-help rehabilitation programs for alcohol use disorders, while determining factors that affect the feasibility and sustainability of such programs. Methods: Focus groups were conducted in 3 communities to discuss community perceptions of alcohol use and the feasibility of self-help programs. Focus group findings guided the development and implementation of the self-help groups. A postintervention focus group was held to determine the effectiveness and community-wide effect of the self-help programs. Findings: Focus group participants agreed that alcohol consumption was a problem in Saint Vincent, leading to underage drinking and violence. Suggestions to encourage self-help meeting attendance included organizing group activities and providing visuals to illustrate alcohol's effects on health. Self-help group members were surveyed about their group experience. Of the 35 members surveyed, 77% said the group was very helpful, and 91% indicated that they would attend again. Postintervention focus group participants stated that individuals had reduced alcohol consumption after attending at least 1 self-help meeting. Conclusions: Elements that contributed to the sustainability of self-help groups included strong local leadership from district health nurses as well as willingness of participants to seek support. However, efforts need to be made to increase community awareness of alcohol use disorders and its associated dangers. Our results suggested self-help programs to address alcohol use disorders are a feasible intervention in Saint Vincent that warrants further development, dissemination, and exploration

Children’s Knowledge of Sexual Abuse Prevention in El Salvador

Background: Child sexual abuse (CSA) remains a global health problem that must be addressed. In a country with limited resources such as El Salvador, we sought an alternative way to disseminate CSA prevention information to elementary school children. Objective: The aim of this study was to evaluate the effectiveness of a child sexual abuse (CSA) prevention exhibit at a children's museum. Methods: We asked 189 children to answer a questionnaire about CSA prevention before entering a museum exhibit on the subject and then asked 59 different children to answer the questionnaire after visiting the exhibit. Findings: Children's knowledge scores on CSA prevention significantly improved after visiting the exhibit ('P' < .012). Conclusions: A museum exhibit that addresses CSA prevention is an effective way of communicating CSA prevention to children

The role of religion in the longer-range future, April 6, 7, and 8, 2006

This repository item contains a single issue of the Pardee Conference Series, a publication series that began publishing in 2006 by the Boston University Frederick S. Pardee Center for the Study of the Longer-Range Future. This conference that took place during April 6, 7, and 8, 2006. Co-organized by David Fromkin, Director, Frederick S. Pardee Center for the Study of the Longer-Range Future, and Ray L. Hart, Dean ad interim Boston University School of TheologyThe conference brought together some 40 experts from various disciplines to ponder upon the “great dilemma” of how science, religion, and the human future interact. In particular, different panels looked at trends in what is happening to religion around the world, questions about how religion is impacting the current political and economic order, and how the social dynamics unleashed by science and by religion can be reconciled.Carnegie Council on Ethics and International Affair

Knowledge of and Attitudes Toward Clinical Depression Among Health Providers in Gujarat, India

Background: Clinical depression is a major leading cause of morbidity and mortality but it is oftentimes overlooked and undertreated. The negative perception and lack of understanding of this condition prevents millions of people from seeking appropriate and on-time medical help, leading to distress and increased burden for affected people and their families. The implementation of public education campaigns and training of non-psychiatric health professionals on mental health and clinical depression has been neglected in several countries, including India, which is the second most populous country in the world with a population of more than 1.2 billion people, almost one-fifth of the world's population. Objective: This study sought to explore the knowledge and attitudes toward the diagnosis and treatment of clinical depression in nonpsychiatric health care providers in Vadodara, Gujarat, India. Methods: A cross-sectional survey was conducted over a 4-week period In Gujarat, India among resident physicians and community health workers about their knowledge and views on clinical depression. Findings: We found considerable stigma and misinformation about depression especially among health care workers in India. Most of the community health workers had a great deal of difficulty when defining clinical depression, and a large majority said that they never heard about depression or its definition and although the overwhelming majority of respondents did not believe that clinical depression results from a punishment from God (82% disagreed or strongly disagreed with this belief) or evil spirits (77.5%), a much smaller proportion disagreed with the assertions that depression was either solely due to difficult circumstances (38.2%) or that sufferers only had themselves to blame (47.2%). Meanwhile, only 32.6% disagreed with the position that clinical depression is a sign of weakness and 39.4% disagreed with the statement that suicide was a sign of weakness. Conclusions: Our findings underscore the considerable public health priority facing India’s policymakers and planners to better educate more non-psychiatric physicians and community health workers to identify, understand, and respond to early signs of mental illnesses, especially clinical depression

Cosmological vacuum selection and metastable susy breaking

We study gauge mediation in a wide class of O'Raifeartaigh type models where supersymmetry breaking metastable vacuum is created by gravity and/or quantum corrections. We examine their thermal evolution in the early universe and the conditions under which the susy breaking vacuum can be selected. It is demonstrated that thermalization typically makes the metastable supersymmetry breaking cosmologically disfavoured but this is not always the case. Initial conditions with the spurion displaced from the symmetric thermal minimum and a small coupling to the messenger sector can result in the realization of the susy breaking vacuum even if the reheating temperature is high. We show that this can be achieved without jeopardizing the low energy phenomenology. In addition, we have found that deforming the models by a supersymmetric mass term for messengers in such a way that the susy breaking minimum and the susy preserving minima are all far away from the origin does not change the conclusions. The basic observations are expected to hold also in the case of models with an anomalous U(1) group.Comment: 28 pages, 4 figures, plain Latex, journal versio

Enduring Mental Health Morbidity and Social Function Impairment in World Trade Center Rescue, Recovery, and Cleanup Workers: The Psychological Dimension of an Environmental Health Disaster

Background The World Trade Center (WTC) attacks exposed thousands of workers to hazardous environmental conditions and psychological trauma. In 2002, to assess the health of these workers, Congress directed the National Institute for Occupational Safety and Health to establish the WTC Medical Monitoring and Treatment Program. This program has established a large cohort of WTC rescue, recovery, and cleanup workers. We previously documented extensive pulmonary dysfunction in this cohort related to toxic environmental exposures. Objectives Our objective in this study was to describe mental health outcomes, social function impairment, and psychiatric comorbidity in the WTC worker cohort, as well as perceived symptomatology in workers’ children. Methods Ten to 61 months after the WTC attack, 10,132 WTC workers completed a self-administered mental health questionnaire. Results Of the workers who completd the questionnaire, 11.1% met criteria for probable post-traumatic stress disorder (PTSD), 8.8% met criteria for probable depression, 5.0% met criteria for probable panic disorder, and 62% met criteria for substantial stress reaction. PTSD prevalence was comparable to that seen in returning Afghanistan war veterans and was much higher than in the U.S. general population. Point prevalence declined from 13.5% to 9.7% over the 5 years of observation. Comorbidity was extensive and included extremely high risks for impairment of social function. PTSD was significantly associated with loss of family members and friends, disruption of family, work, and social life, and higher rates of behavioral symptoms in children of workers. Conclusions Working in 9/11 recovery operations is associated with chronic impairment of mental health and social functioning. Psychological distress and psychopathology in WTC workers greatly exceed population norms. Surveillance and treatment programs continue to be needed