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.
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.
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.
The purpose of this paper is to describe a participatory action research process on the development of a professional practice model of mental health nurses in mental health promotion in a comprehensive school environment in the city of Oulu, Finland. The developed model is a new method of mental health promotion for mental health nurses working in comprehensive schools. The professional practice model has been developed in workshops together with school staff, interest groups, parents and students. Information gathered from the workshops was analysed using action research methods. Mental health promotion interventions are delivered at three levels: universal, which is an intervention that affects the whole school or community; selective, which is an intervention focusing on a certain group of students; and indicated, which is an individually focused intervention. All interventions are delivered within the school setting, which is a universal setting for all school-aged children. The interventions share the goal of promoting mental health. The purposes of the interventions are enhancing protective factors, reducing risk factors relating to mental health problems and early identification of mental health problems as well as rapid delivery of support or referral to specialized services. The common effect of the interventions on all levels is the increase in the experience of positive mental health.
The purpose of this study was to test the applicability of a standardized procedure for assessing Icelandic children's behavior/emotional problems and competencies, and to identify differences related to demographic variables. This study focuses upon the method of using the Child Behavior Checklist by Achenbach to estimate the self-reported prevalence by parents and adolescents of emotional and behavior problems in children from 2-16 years of age and self-reported prevalence of adolescents from 11-18 years, selected at random from the general population, both in urban and rural areas. The information was obtained by mailing lists with a letter to parents of children 2-10 years of age. The lists for adolescents 11-18 years of age were distributed by teachers in school. Those adolescents who were not in school received the lists by mail at their homes. The Child Behavior Checklists used for analyses were completed by 109 parents of 2-3 year old children; 943 parents of 4-16 year old children, and 546 non-referred adolescents from the general population. The rate of response was lowest for the youngest age group (47%), but increasing to 62% with increasing age of the child. The response rate among the adolescents answering the Youth Self Report was 64%. Comparisons are presented with the Child Behavior Checklist for this study with Dutch, American, French, Canadian, German and Chilean samples and show striking similarities in four of these countries in behavior/emotional problems reported. The present study prevalence data behavior/emotional problems in Icelandic children from the general population from 4-16 year olds for 943 children is 17.5 (boys 19.1; girls 15.).
The authors' goal was to investigate factors protective of the mental health of refugees, with a particular focus on time splitting and suppression of the past.
Structured interviews covering premigration and postmigration stresses, personal and social resources, and mental health were given to 1,348 Southeast Asian refugees resettled in Vancouver, British Columbia, and to a comparison sample of 319 residents of Vancouver. Both groups of subjects also performed a task designed to measure orientation toward past, present, and future.
Compared with resident Canadians, refugees were more likely to exhibit an atomistic time perspective in which past, present, and future are split. Temporal atomism and avoidance of nostalgia were associated with a lower risk of depression than were other time perspectives.
Under conditions of extreme adversity, time splitting and suppression of the past may be adaptive strategies, mitigating the risk of depression.
This study investigated the mental health of Portuguese children in Canada. Preliminary work involved a survey of professionals serving the Portuguese community and the translation and assessment of a standardized child behaviour checklist. Forty-five Portuguese children and 45 non Portuguese children referred to a children's mental health centre were compared on demographic and family indicators and their referral source. There were similar proportions of boys and girls in the two groups, similar types of services were requested, and they had similar treatment histories. The Portuguese children were older at the time of referral and were more likely to be referred by educational agencies than the non Portuguese children. Portuguese families appeared to experience different stresses than non Portuguese families. Implications of these findings for the provision of culturally sensitive interventions for Portuguese children and their families are discussed.
Analysis of the Quebec Health survey identified those Quebec industrial sectors and professions in which workers are at risk of higher psychological distress and lower psychological well-being. Risk levels were measured by odds ratio, controlling for: health status, sex, social support and stressful life events. Results show that those at risk are blue collar workers and less qualified workers of traditional sectors. Lower job latitude could explain those results. Results show that risk of mental health problems is significantly higher in the following industrial sectors: leather, chemicals, paint and varnish industries; urban bus transport and taxi; shoe, clothing and textile retail stores; department stores; restaurant services; insurance and public administration (excluding defence). Risk of mental health problems is higher in the following professions road transport (excluding truck drivers); textile, leather, fur manufacturing and repairing; housekeeping and maintenance; painters, tapestry-workers, insulation and waterproofing, food and beverages sector; data processors; editors and university professors.