Mental Health in low-and middle income countries (LMICs): Going beyond the need for funding

Despite being globally recognised as an important public health issue, mental health is still less prioritised as a disease burden in many Low-and Middle-Income Countries (LMICs). More than 70% of the global mental health burden occurs in these countries. We discussed mental health issues in LMICs under themes such as abuse and mental illness, cultural influence on mental health, need for dignity in care, meeting financial and workforce gaps and the need for national health policy for the mental health sector. We highlighted that although mental health education and health care services in most LMICs are poorly resourced; there is an urgent need to address issues beyond funding that contribute to poor mental health. In order to meet the increasing challenge of mental health illness in LMICs, there is a need for effort to address cultural and professional challenges that contribute to poor mental health among individuals. We have a notion that mental health should be integrated into primary health care in LMICs. Creating awareness on the impact of some cultural attitudes/practices will encourage better uptake of mental health services and increase the ease when discussing mental health issues in these countries which can contribute to reducing the poor mental health in LMICs

The Impact of Spousal Migration on the Mental Health of Nepali Women: A Cross-Sectional Study.

Spousal separation, lack of companionship, and increased household responsibilities may trigger mental health problems in left-behind female spouses of migrant workers. This study aimed to examine mental ill-health risk in the left-behind female spouses of international migrant workers in Nepal. A cross-sectional survey was carried out in the Nawalparasi district. Study areas were purposively chosen; however, participants were randomly selected. Nepali versions of the 12-item General Health Questionnaire (GHQ), Beck Depression Inventory (BDI), and Connor-Davidson Resilience Scale (CD-RISC) were used. Mental ill-health risk was prevalent in 3.1% of the participants as determined by GHQ. BDI identified mild or moderate depression in 6.5% of the participants with no one having severe depression. In bivariate analysis, a high frequency of communication with the husband was associated with lower mental ill-health risk and depression, as well as increasing resilience. Reduced return intervals of husbands and a high frequency of remittance were also associated with a low GHQ score. In a multiple regression model, adjusting for potential confounding variables, participants who communicated with their husbands at least once a day had a greater mean CD-RISC score (i.e., high resilience against mental ill-health risk) compared to those who did so at least once a week; a mean difference of 3.6 (95% CI 0.4 to 6.9), P = 0.03. To conclude, a low mental ill-health risk was found in the female spouses of migrants

Could therapeutic diaries support recovery in psychiatric intensive care?

Despite growing literature surrounding the use of patient diaries in intensive care units within the general healthcare setting and the positive effects these may have on a patient’s psychological recovery from such an admission; no studies exist examining the effects of similar patient diaries in psychiatric intensive care units when used with people experiencing an acute exacerbation of psychosis. This paper hypothesises the potential positive effects of diaries kept for patients in psychiatric intensive care units. In the development of strategies to help people in psychiatric crisis understand and manage their own distress and psychological trauma, diaries may be helpful for the prevention of further psychological problems and aid recovery post discharge. Research is required to consider the possible effects of therapeutic diaries and the role of the multidisciplinary team in keeping these within psychiatric intensive care settings

Ethical conduct of nursing research

Editoria

Achieving Culturally Competent Mental Health Care: A Mixed-Method Study drawing on the Perspectives of UK Nursing Students

Purpose This study aimed to examine the degree of cross-cultural competency amongst UK mental health student nurses, and the care delivery challenges arising from their internalised cultural assumptions. Design and Methods This study adopted a mixed-methods design. Participants were final year nursing students in the UK. Findings The results revealed participants had a moderate level of cultural awareness and competency but highlighted many challenges to providing cross-cultural care arising from the meanings, enablers and values they attributed to culturally competent mental health care. Practice Implications As cultural competency is considered an essential characteristic of effective nursing care, greater attention should be paid to how student nurses assimilate cultural awareness in order to develop confidence in their day-to-day practice

Libido as a motivator for starting and restarting non-prescribed anabolic androgenic steroid use among men: a mixed-methods study

Anabolic Androgenic Steroids (AAS) are commonly used for their anabolic effects and potential detrimental consequences are well documented. Most studies focus on the motivations of increased muscle development and report increased libido as a secondary motivation. This paper aims to explore users’ reports of libido as a motivator for starting and restarting AAS use. This mixed-methods study comprised questionnaires with 133 adult male AAS users (38% of selected increased libido as motivation for using), and 23 semi-structured interviews with a sub-sample. Thematic analysis identified four interlinked themes: increased libido as a motivation for starting/re-starting AAS; increased libido/sexual performance as a beneficial effect; mixed experiences with physicians regarding libido changes and hypogonadism and reduced sexual functioning and fertility after AAS cessation. Increased libido was identified as a benefit by 90% but motivations for use changed over time. Reasons for AAS use included mitigating the effects of aging particularly linked to the concept of virility. AAS as self-medication for low testosterone needs further investigation as does the idea of hegemonic masculinity as a reinforcing driver for AAS use. This study highlights the need to consider how AAS users’ views of medical support impact on self-medication choices