Cross-national variations in reported discrimination among people treated for major depression worldwide : the ASPEN/INDIGO international study

No study has so far explored differences in discrimination reported by people with major depressive disorder (MDD) across countries and cultures. To (a) compare reported discrimination across different countries, and (b) explore the relative weight of individual and contextual factors in explaining levels of reported discrimination in people with MDD. Cross-sectional multisite international survey (34 countries worldwide) of 1082 people with MDD. Experienced and anticipated discrimination were assessed by the Discrimination and Stigma Scale (DISC). Countries were classified according to their rating on the Human Development Index (HDI). Multilevel negative binomial and Poisson models were used. People living in ‘very high HDI’ countries reported higher discrimination than those in ‘medium/low HDI’ countries. Variation in reported discrimination across countries was only partially explained by individual-level variables. The contribution of country-level variables was significant for anticipated discrimination only. Contextual factors play an important role in anticipated discrimination. Country-specific interventions should be implemented to prevent discrimination towards people with MDD

Listening to the subjective experiences of patients with first-episode psychosis. Relationship of self-rated and clinician-rated psychopathology with subjective quality of life and needs

Background: I disturbi psicotici sono la pi\uf9 invalidanti di tutte le malattie mentali. I professionisti e gli utenti dei servizi mostrano opinioni e priorit\ue0 divergenti sulla cura. I pazienti sono pi\uf9 concentrati sugli aspetti relativi all'integrazione sociale nella comunit\ue0, mentre i clinici, sulla gestione della malattia, sui deficit associati alla diagnosi e il trattamento. L\u2019accordo medico- paziente sul processo di cura porta a migliori risultati clinici. Lo studio va ad analizzare il livello di psicopatologia valutato dal clinico e dal paziente e il loro rapporto con la qualit\ue0 di vita e la necessit\ue0 di cura, in un campione di pazienti all\u2019esordio psicotico. Metodi: Nel contesto dello studio multicentrico GET UP, a 92 pazienti sono state somministrate un set di scale che vanno ad analizzare la valutazione oggettiva e soggettiva dei sintomi (utilizzando rispettivamente scala PANSS e la scala PSYRATS), la valutazione della qualit\ue0 di vita (utilizzando la scala WHOQoL Bref) e i bisogni di cura (utilizzando la scala CAN). La valutazione \ue8 stata eseguita al basale e a 9 mesi di follow-up. Risultati: Sono presenti diversi livelli di accordo tra una valutazione oggettiva e soggettiva del livello di gravit\ue0 sintomatologica. Per quanto riguarda gli aspetti dell\u2019allucinazione uditiva \ue8 emerso un buon/moderato accordo tra i pazienti e medici, mentre per quanto riguarda le convinzioni deliranti \ue8 stato rilevato un moderato/scarso accordo tra paziente e medico. L\u2019accordo tra lo staff ed il paziente sulla valutazione dei sintomi non sembra avere un grande impatto sulla qualit\ue0 della vita, con l'eccezione di alcuni settori specifici. Per quanto concerne l\u2019accordo tra medico e paziente sulla valutazione sintomatologica ed i bisogni di cura, questo studio ha evidenziato che quando \ue8 presente uno scarso accordo tra il personale e il paziente, questi ultimi hanno un maggior numero di bisogni insoddisfatti. Per quel che concerne le convinzioni deliranti, invece, quando \ue8 presente uno scarso accordo tra il paziente e il medico, i pazienti dichiarano di avere pi\uf9 esigenze nei confronti dei servizi. La presenza di un accordo moderato sulla valutazione dei sintomi deliranti, sembra essere connesso ad un miglioramento dei bisogni di base e sociali. Conclusione: una delle grandi sfide per i servizi di salute mentale \ue8 quella di sviluppare migliori metodi per aumentare l\u2019accordo tra il personale medico e pazienti, non solo per la valutazione dello stato psicopatologico, ma anche per le decisioni rispetto al trattamento e alla sua pianificazione. La qualit\ue0 soggettiva della vita ed i bisogni di cura rappresentano alcune promettenti misure sia di processo che di esito nei soggetti all\u2019esordio psicotico. La misurazione di questi fattori ha importanti implicazioni per la pianificazione e lo sviluppo del trattamento, in particolare dal punto di vista della potenziale generalizzabilit\ue0 di obiettivi terapeutici.Backgroung: Psychotic disorders are the most disabling of all mental illnesses. Professionals and service users display divergent opinions and prioritize different aspects of care. Patients are more focused on aspects related to social integration in the community and their psychosocial performance, whereas staff on the illness, its management and deficits associated with diagnosis and treatment. When clinicians and patients agree about the care process, it is easier to obtain better clinical outcomes. The study compared clinician-rated and patient-rated psychopathology and analyzed their relationship with subjective quality of life and need for care in a sample of first episode psychotic patients. Methods: In the context of the multi-center GET UP study, 92 patients were assessed for both clinician and self rated psychopathology (by using respectively PANSS scale and PSYRATS scale), and asked to report their subjective quality of life (by using the WHO QoL Bref scale) and need for care (by using CAN). Assessment were performed at baseline and at 9 months follow up. In order to explore the associations between psychopathology and subjective quality of life, bivariate correlations were preformed. Results: Different levels of agreement between staff and patient evaluation of symptoms\u2019 seriousness are present. For auditory hallucination a good or moderate agreement between patients and clinicians is found, while for delusional beliefs a moderate or low agreement between patients and clinicians is detected. The staff-patient agreement on symptoms\u2019 seriousness seems to not to have a great impact on the quality of life area, with the exception of some specific domains (physical domain and satisfaction with information). As concern the effect of staff-patient agreement on symptoms\u2019 seriousness and need for care, this study highlighted that when a poor agreement between staff and patient assessment of auditory hallucination is present, patients have an higher number of unmet need. For delusional beliefs, instead, when a poor agreement between patient and clinician rated delusion and unusual thought content is present, patients declare to have more needs towards services. Patients with a moderate agreement with clinician about the evaluation of delusional symptoms, seem to have an improvement of basic met needs and social needs. Conclusion: A great challenge to mental health services is to develop better methods of increasing consensus between staff and patients not only in evaluating the psychopathological status, but also in share the treatment decision and planning. Staff may increase consensus by obtaining more feedback from users about the extent to which services are meeting their needs. Subjective quality of life and needs represent some promising measures of both process and outcome in FEP subjects. Measurement of these factors has important implications for treatment planning and delivery, particularly from the point of view of potential generalizability to broader treatment goals such as recovery and staying well

Social capital and reported discrimination among people with depression in 15 European countries

Purpose Social capital is a protective factor for mental health. People with depression are vulnerable to discrimination and its damaging impact. No previous studies have explored the link between social capital and experienced or anticipated discrimination in people with depression. This study aims to test the hypothesis that levels of self-reported discrimination in people with depression are inversely associated with social capital levels. Method A total of 434 people with major depression recruited in outpatient settings across 15 European countries participated in the study. Multivariable regression was used to analyse relationships between discrimination and interpersonal and institutional trust, social support and social network. Results Significant inverse association was found between discrimination and social capital in people with major depression. Specifically, people with higher levels of social capital were less likely to have elevated or substantially elevated levels of experienced discrimination. Conclusions Higher level of social capital may be closely associated with lower level of experienced discrimination among patients with major depression. It is important to explore these associations more deeply and to establish possible directions of causality in order to identify interventions that may promote social capital and reduce discrimination. This may permit greater integration in society and more access to important life opportunities for people with depression. Keywords: Depression, Social capital, Discrimination, Social support, Multisite stud

Social capital and reported discrimination among people with depression in 15 European countries

Social capital is a protective factor for mental health. People with depression are vulnerable to discrimination and its damaging impact. No previous studies have explored the link between social capital and experienced or anticipated discrimination in people with depression. This study aims to test the hypothesis that levels of self-reported discrimination in people with depression are inversely associated with social capital levels.status: publishe

Feasibility and Effectiveness of a Multi-Element Psychosocial Intervention for First-Episode Psychosis: Results From the Cluster-Randomized Controlled GET UP PIANO Trial in a Catchment Area of 10 Million Inhabitants.

Integrated multi-element psychosocial interventions have been suggested to improve the outcomes of first-episode psychosis (FEP) patients, but they have been studied primarily in experimental settings and in nonepidemiologically representative samples. Thus, we performed a cluster-randomized controlled trial, comparing an integrated multi-element psychosocial intervention, comprising cognitive behavioral therapy, family intervention, and case management, with treatment as usual (TAU) for FEP patients in 117 community mental health centers (CMHCs) in a large area of northern Italy (10 million inhabitants). The randomized units (clusters) were the CMHCs, and the units of observation the patients (and, when available, their family members). The primary hypotheses were that add-on multicomponent intervention: (1) results in greater improvements in symptoms, as assessed with positive and negative syndrome scale and (2) reduces in-hospital stay, based on days of hospitalization over the 9-month follow-up. Four hundred and forty-four FEP patients received the intervention or TAU and were assessed at baseline and 9 months. Based on the retention rates of patients (and families) in the experimental arm, multi-element psychosocial interventions can be implemented in routine mental health services. Regarding primary outcomes, patients in the experimental arm showed greater reductions in overall symptom severity, while no difference could be found for days of hospitalization. Among the secondary outcomes, greater improvements were detected in the experimental arm for global functioning, emotional well-being, and subjective burden of delusions. No difference could be found for service disengagement and subjective burden of auditory hallucinations. These findings support feasibility and effectiveness of early interventions for psychosis in generalist mental health services