The mental health of parturients 1-2 months after delivery was assessed. The study was carried out using a questionnaire between September and November 1992 in connection with the postpartum visits of mothers to the maternity health care center. The need for psychological help was assessed using a 12-item questionnaire (General Health Questionnaire), according to which 28% of the subjects needed psychological help. These mothers did not differ from the others in terms of age, marital status, education, or financial situation. Nor was the need for psychological help associated with health habits, with traumatic life events or conflicts during childhood and adolescence, or with delivery-related factors. Mothers needing psychological help were more depressed and considered the social support they were receiving to be inadequate more often than the others. These women also more often reported marital problems during pregnancy and after delivery. None of the mothers had sought help because of mental health problems. It is concluded that antenatal and postnatal clinics should pay more attention to the mental health of mothers.
Population surveys were conducted, examining nonpsychotic psychiatric symptoms, life events, and problems in community living in Primrose, a community experiencing rapid growth in anticipation of the construction of a heavy oil extraction plant, and in Wolf Creek, a stable rural town. Psychiatric symptom levels were lower in the boom town than in Wolf Creek, but the Primrose symptom levels were comparable to those in Saskatchewan. More life events were experienced by Primrose residents who, despite lower symptom levels, had seen their physician more often for minor illnesses. The complaints about living in the town of Primrose matched those of boom town residents from elsewhere. There was no evidence to support the popular view that living in a boom town creates more nonpsychotic psychiatric symptomatology. The higher proportion of the boom town population using physician services for minor illnesses, the higher level of life events reported, and the high frequency of reported problems for families living in the boom town support suggestions that stress is associated with these conditions.
BACKGROUND: Mentally retarded persons have high prevalences of psychiatric disorders and often receive little professional help for them. MATERIAL AND METHODS: From a total of 48 mentally retarded inhabitants in a local community, 28 were selected on the basis of possible psychiatric problems. A psychiatrist diagnosed the persons and gave advice based on personal observation, contact with caregivers, and all available documentation. RESULTS: The estimated levels of functioning were adjusted for 19 persons. 32 new psychiatric diagnoses were detected. Milieu changes were recommended for 25 persons, and 26 changes in psychotropic medication were recommended. INTERPRETATION: Although the procedure is workintensive, the results justify the described approach.
The Quebec Child Mental Health Survey (QCMHS) was conducted in 1992 on a representative sample of 2400 children and adolescents aged 6 to 14 years from throughout Quebec. Prevalences of nine Axis-I DSM-III-R (American Psychiatric Association, 1987) mental health disorders were calculated based on each informant (for 6-11-year-olds: child, parent, and teacher; for 12-14-year-olds: child and parent). Informant parallelism allows the classification of results of the demographic variables associated with disorders in the logistic regression models. This strategy applies to group variables (correlates of disorders) whereas informant agreement applies to individual diagnoses. Informant parallelism implies that results for two informants or more are in the same direction and significant. In the QCMHS, informant parallelism exists for disruptive disorders, i.e. in two ADHD regression models (child and parent) higher rates among boys and young children, and in three oppositional/conduct disorders regression models (child, parent, and teacher) higher rates among boys. No informant parallelism is observed in the logistic regression models for internalizing disorders, i.e. the patterns of association of demographic variables with anxiety and depressive disorders vary across informants. Urban-rural residence does not emerge as a significant variable in any of the logistic regression models. The overall 6-month prevalences reach 19.9% according to the parent and 15.8% according to the child. The implications of the results for policy makers and clinicians are discussed.
BACKGROUND: Co-operation between mental health care units and the social services is important in the case of people with social problems who also suffer from mental health problems. However, participation of patients and their families in the treatment process, and co-operation between them and the professionals, are also important. Communication between the professionals, patients and their family members, and the professionals is a crucial factor for co-operation. AIMS AND OBJECTIVES: The aim of this study was to elucidate the experiences and importance of co-operation for the patients. The data consisted of interviews with 22 mental health patients who were also clients of municipal social services. METHOD: The grounded theory approach was used, focusing on the informants' experiences of the integrated network and family-oriented model for co-operation. RESULTS: The findings indicate the importance of the participation of patients and their social networks in psychiatric care or the treatment process. Meetings should be characterized by open and reflexive discussions with all participants' points of view being included, so that fruitful co-operation is possible. However, some negative experiences were also reported, all of which were connected with the professionals' behaviour. CONCLUSIONS: Trust and honesty are essential elements in relations between professionals and psychiatric patients, but it cannot be assumed that they will develop naturally. It is the professionals' responsibility to adjust their behaviour so that these elements can be created in a mutual process between patients and professionals. Multidisciplinary teams are a necessity in family-oriented co-operation between psychiatry and social services, and in a satisfactory caring process. RELEVANCE TO CLINICAL PRACTICE: Nurses' work is often individually oriented and nurses are ruled by routines in their work. The mental health caring process should be seen as a shared process between the patient, his/her human environment and professionals for which nurses need skills to their interaction with patients and their social network.
Mental health of parents and their quality of life is likely to be affected when a child in the family has a psychiatric disorder. The purpose of this study is to assess quality of life and mental health of parents of referred children waiting for service at the only child psychiatric service in Iceland, with reassessment at least 3 months after first attendance to the service. In order to do so, 208 parents of 123 children waiting for psychiatric care were sent the Icelandic Quality of Life (IQL), the General Health Questionnaire (GHQ-30) and the CAGE screen for alcoholism. For reassessment, responders in the first phase were assessed again with the IQL and GHQ-30, at least 3 months after initiation of child psychiatric interventions. A total of 120 of the 208 parents (58%) responded in the first phase of the study, 49 fathers and 71 mothers. The mean (+/- s, standard deviation) standardized IQL T-score was for the fathers 51+/- 7.5 but significantly lower for the mothers or 45 +/-11.5 (P = 0.001) compared to normal sample of same-age women (T-scores of 50 are normal). Nearly 55% of women compared with 26% of men were psychiatric cases, scoring 5 or higher on the GHQ. According to a CAGE score of 2 and above 16% of fathers and 14% of mother abused alcohol. No significant change occurred in parents GHQ-30 or IQL before and after initiation of treatment. We conclude that mothers of children with mental disorders have poor quality of life, and high prevalence of mental disorders; hence child psychiatry clinics need to ensure that mothers receive appropriate care along with the child.
We investigated the postpartum mental health of 139 mothers, 4-8 weeks after delivery and 2 years later. The sample consisted of mothers who attended a maternity center for a routine health check-up 1-2 months after delivery. The occurrence of mental disorders was assessed using a 12-item General Health Questionnaire (GHQ). The occurrence of mental disorders (> 2 on the GHQ) was 28.1% in the initial check-up and 19.4% 2 years later. Mental health improved in 27 mothers (19%) but remained impaired (i.e. cases) in 12 (9%). Mental health was normal in 85 mothers (61%) during both examinations. Factors predicting chronicity of mental disorder on univariate analysis were poor financial situation, poor social support, problems with a partner and life events perceived as stressful during follow-up. Those with continuing mental-health problems had more psychiatric problems than the others before pregnancy. Most (92%) of these subjects had not become pregnant again. Using a logistic-regression analysis, independent factors predicting chronicity of mental-health problems were the high Zung score (Odds Ratio (OR) 1.4, 95% confidence interval (CI) 1.16-1.65) and a deterioration in relationship with a partner during pregnancy (OR 29, 95% CI 1.83-460). On the other hand, a low Zung score (OR 1.3, 95% CI 1.14-1.44) after delivery predicted recovery from mental disorder. A postpartum mental disorder usually resolves spontaneously. However, mental symptoms sometimes persist. The postpartum mental-health of mothers should be assessed, and treatment provided, if necessary.
OBJECTIVES: We compared rates of mental health problems and use of mental health care across multiple racial and ethnic groups using secondary data from a large, nationally representative survey. METHODS: We pooled cross-sectional data from the 2001-2003 National Surveys on Drug Use and Health. Our sample included 134,875 adults classified as white, African American, American Indian/Alaskan Native, Asian, Mexican, Central and South American, Puerto Rican, other Hispanic-Latino, or those with multiple race and ethnicities. For each group, we estimate the past year probability of: (1) having 1 or more mental health symptoms in the past year, (2) having serious mental illness in the past year, (3) using mental health care, (4) using mental health care conditional on having mental health problems, (5) reporting unmet need for mental health care, and (6) reporting unmet need for mental health care conditional on having mental health problems. RESULTS: We found significantly higher rates of mental health problems and higher self-reported unmet need relative to whites among American Indian/Alaskan Natives and lower rates of mental health problems and use of mental health care among African American, Asian, Mexican, Central and South American, and other Hispanic-Latino groups. These differences generally were robust to the inclusion of clinical and socio demographic covariates. CONCLUSIONS: Overall, our study shows wide variation in mental health morbidity and use of mental health care across racial and ethnic groups in the United States. These results can help to focus efforts aimed at understanding the underlying causes of the differences we observe.
The authors used data from the Canadian Community Health Survey: Mental Health and Well-Being to estimate and compare perceived effectiveness of mental health care provided by general practitioners/family doctors (GP/FDs), by mental health specialists among those who visited GP/FDs, and by mental health specialists-only in the past 12 months (N=2,859). The authors found that, in Canada, perceived effectiveness of mental health care provided by GP/FDs did not significantly differ from that provided by mental health specialists. Using services from both GP/FDs and mental health specialists and taking psychotropic medication improved perceived effectiveness of care.
Although the general hospital remains an important place for stabilizing crises, most services for mental illnesses are provided in outpatient/community settings. In the absence of comprehensive data at the community level, data that are routinely collected from general hospitals can provide insights on the performance of mental health services for people living with mental illness or poor mental health. This article describes three new indicators that provide a snapshot on the performance of the mental health system in Canada: self-injury hospitalization rate, 30-day readmission rate for mental illness and percentage of patients with repeat hospitalizations for mental illness. Findings suggest a need for the early detection and treatment of mental illnesses and for optimal transitions between general hospitals and community services.
Mental health is an emerging priority for health surveillance. It has not been determined that the existing data sources can adequately meet surveillance needs. The objective of this project was to explore the use of telephone surveys as a means of collecting supplementary surveillance information. A computer-assisted telephone interview was administered to 5,400 subjects in Alberta. The interview included a set of brief, validated measures for evaluating mental disorder prevalence and related variables. The individual subject response rate was 78 percent, but a substantial number of refusals occurred at the initial household contact. The age and sex distribution of the study sample differed from that of the provincial population prior to weighting. Prevalence proportions did not vary substantially across administrative health regions. There is a potential role for telephone data collection in mental health surveillance, but these results highlight some associated methodological challenges. They also draw into question the importance of regional variation in mental disorder prevalence--which might otherwise have been a key advantage of telephone survey methodologies.
For persons with mental illness and addictions, comprehensive assessment of their strengths, preferences and needs is central to person-centred care planning. In this study, the validity of the Mental Health Assessment Protocols (MHAPs) embedded in the Resident Assessment Instrument Mental Health instrument (the mandated assessment system for Ontario adult inpatient psychiatry) is examined, and triggering rates are compared in inpatient and community-based mental health settings. The sample is based on adults admitted to a psychiatric facility (n = 963) and to community mental health programmes (n = 1505) participating in the study. An international panel of mental health experts further evaluated study results. Among the 27 MHAPs, all but one had sensitivity rates above 80%, and the specificity was over 80% for 74% of the MHAPs. The expert panel found that the MHAPs worked well and could be used to support mental health care. The present study found that the MHAPs are valid measures, though more complex triggering algorithms capable of differentiating individuals based on outcomes were suggested to enhance their clinical relevance to care planning. Further, the use of compatible instrumentation in community-based mental health settings was promoted to enhance continuity of care.
To examine (1) whether there is any consistency among medical schools in mental health services provided and (2) how these services are perceived by student affairs deans, mental health service providers, and the students themselves.
Questionnaires were sent in October 1991 to the student affairs dean (or director), the individual responsible for student mental health services, and a student representative in each of the 126 U.S. and Canadian medical schools. Data were sought regarding personnel, individuals served, location, hours, administration, funding, confidentiality, administrative referrals, and respondents' suggestions for improvement. Possible differences among the three groups of respondents were tested by chi-square.
Responses were received from 75 student affairs deans, 53 mental health providers, and 30 students. There was much diversity among schools in services provided, especially in the areas of administration and funding. Although perceptions of the three respondent groups were often the same, they differed significantly in a number of areas. Suggestions for improvement of services involved funding, personnel, hours, confidentiality and privacy, specialty services, preventive and support programs, and visibility. The suggestion most frequently made by the students was for increased information and visibility.
The differences among schools coupled with the differing perceptions within schools indicate a need for a comprehensive consideration of what kinds of mental health services are needed and how they can best be made accessible to a diverse body of students experiencing a variety of academic and personal challenges.
The purpose of this study is to estimate the percentage of mental health problems in a pediatric outpatient Norwegian clinic. We used the Strengths and Difficulties Questionnaire to screen for mental health problems. Families of children aged 4-11 took part in the study, and 380 out of 982 possible families consented to take part, and 349 families contributed with questionnaire data. The main referral reasons for the patients were asthma, eneuresis and stomach pain. Mothers reported that 17.4% of boys and 17.8% of girls displayed mental clinical problems. The prevalence of problems did not differ significantly between somatic diagnostic groups. Although the study has low participation, it underlines the necessity of screening all pediatric patients for mental health problems. Future research in pediatric clinics should include factors of psychology because pediatric problems are not caused by somatics alone.
Managing complex change initiatives can be a risky and controversial task. Hargrove and Glidew's (1990) model of "impossible jobs" defines typical obstacles: constituency conflict, perceptions of client legitimacy, respect for professional authority, and the strength of the agency myth. The author uses this model to describe his experiences while implementing major changes within British Columbia's community mental health system and provincial psychiatric hospital. Coping strategies include coalition building, public education, meaningful stakeholder participation, systemic feedback, mutual aid, and staff development.
We evaluated dominance-submissiveness between co-twins and its relationship to mental health in a cohort study of 419 twins followed from pregnancy to 22-30 years of age. Dominance-submissiveness between co-twins was assessed from three separate perspectives: physical dominance, psychological dominance, and verbal dominance. Depressive, nervous, and psychosomatic symptoms were analyzed in different twin groups. In the physical domain, males were more commonly dominant than females at school age and in adulthood. Before and at school age, girls were more dominant than boys in the psychological and verbal domains, as well as in total dominance. These differences disappeared in adulthood, and 81% of adult twins felt themselves equal to their co-twin in total dominance. Submissiveness in the psychological domain seemed to be associated with increased depressiveness, nervous complaints and psychosomatic symptoms in males of male-female twin pairs. Verbally submissive males in same-sex twin pairs had more depression and psychosomatic symptoms. Among females of same-sex twin pairs, submissiveness in the psychological domain was most clearly associated with depressive symptoms, whereas psychological or verbal dominance-submissiveness among females from male-female twin pairs was not associated with symptoms. Psychologically dominant males and females of same-sex twin pairs expressed greater nervousness than did their co-twins. We conclude that being submissive, especially in the psychological domain, to a female twin partner seems to be stressful, whereas it is easier, especially for females, to be submissive to a male twin partner.
11 informants who were mourning relatives or friends who had died during the last five years were interviewed by a priest, who asked about their relationship to the deceased, their participation in funeral rituals and their experience of their own mourning process. The respondents endorsed the following scales: SCL-90 Depression subscale, Intrinsic, Extrinsic and Quest Scales, Doctrinal Orthodoxy Scale, Liberal Belief Scale, Moral Conservatism Index and Humanistic Mortality Scale. Each respondent was evaluated hermeneutically in a pastoral-clinical way, and the whole material was treated statistically. The extrinsic person uses his religion to attain comfort, security, and social acceptance, and it is not deeply integrated in his personality. The extrinsic religious orientation correlated positively with a prolonged mourning process and depression. It can be tentatively concluded that extensive participation in funeral rituals seems to prevent a prolonged mourning process and resulting depression.
The relation between "poverty and mental health" has long been established. However, the dynamic underlying the relation between social and psychic processes has received much less attention. This article presents certain preliminary results of research whose aim is to promote the emergence of the multiple dimensions behind the problematic of mental health in social conditions characterized by extreme poverty. In addition, the authors base their approach on the assumption that human beings, even underprivileged, are very active players, and explore the strategies that are hereby developed in order to maintain or recover their equilibrium.