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dre cummings discusses Meek Mill’s 2018 song, “Trauma,” as a way to enter the debate about the psychological effects of growing up racial minority in poverty-stricken environments. In “Trauma,” Meek Mill deftly describes the Adverse Childhood Experiences (ACEs) that marred his own individual upbringing, then expresses the trauma’s faced by African American communities the nation over. Recent powerful research indicates that the more ACEs a child faces while growing up, the more likely that such trauma will cause negative health outcomes in those individuals as adults. Meek Mill makes it clear in “Trauma” that African American children that grow up in US urban centers face a dramatic number of ACEs throughout their young lives. This chapter, using “Trauma’s” framework, will not only acknowledge the built-in Adverse Childhood Experiences for those that grow up poor and black in America, but also argues that the criminal justice system itself, particularly law enforcement culture in the United States, stands as an Adverse Childhood Experience in and of itself.
Climate change poses an existential threat to our planet and our health. We explore the intersections of climate change and mental health which has been under-recognised to date. Climate change can affect mental health directly through the effects of extreme weather events such as heat, drought and flooding, and indirectly through increasing rates of migration and inequality. Vulnerable individuals with neuropsychiatric disorders will be particularly at risk. Emerging evidence is also showing effects of air pollution on brain development. Mitigation efforts related to reducing carbon emissions will have both direct and indirect effects on mental health. A further consideration demonstrated by the COVID-19 pandemic is that the spread of infectious disease can have substantial effects on the mental health of the population. With climate change and biodiversity loss, pandemics could recur in the future with increasing frequency. It is now essential that mental health professionals be equipped as agents for climate action.
Military personnel deployed to combat and peacekeeping missions are exposed to high rates of traumatic events. Accumulating evidence suggests an important association between deployment and the development of other mental health symptoms beyond post-traumatic stress disorder.
This study examined the prevalence of agoraphobia, anxiety, depression, and hostility symptoms in a cohort of Dutch ISAF veterans (N = 978) from pre-deployment up to 10 years after homecoming. The interaction of potential moderating factors with the change in mental health symptoms relative to pre-deployment was investigated at each time point.
The probable prevalence of agoraphobia, anxiety, depression, and hostility symptoms significantly increased over time to respectively 6.5, 2.7, 3.5, and 6.2% at 10 years after deployment. Except for hostility symptoms, the probable prevalence at 10 years after deployment was the highest compared to all previous follow-up assessments. Importantly, less perceived social support after returning from deployment was found as a risk factor for all different mental health symptoms. Unit support was not associated with the development of mental health problems.
This study suggests a probable broad and long-term impact of deployment on the mental health of military service members. Due to the lack of a non-deployed control group, causal effects of deployment could not be demonstrated. Continued effort should nevertheless be made in the diagnosis and treatment of a wide range of mental health symptoms, even a decade after deployment. The findings also underscore the importance of social support after homecoming and its potential for the prevention of long-term mental health problems.
Many countries did not have alternative healthcare arrangements during their initial COVID-19 lockdowns. This is surprising as partial and full lockdowns have been previously used to manage terrorism and the SARS outbreak of 2002-2003. This paper examines how lockdowns disrupt normal healthcare services and discusses countermeasures that can be used during lockdowns regardless of the emergency that engendered them. Solutions are discussed pragmatically with front-line clinicians, healthcare managers, and policymakers in mind. Mental health services are used as a case in point with generalizable lessons for other healthcare specialties.
Although patient and carer involvement in research is well-developed in many countries, this area has been largely overlooked in South-East European countries.
To explore experiences of patients participating in newly set up lived experience advisory panels (LEAPs) within a European Commission funded, large-scale, multi-country mental health research project that focused on improving treatment of individuals with psychosis.
Twenty-one mental health patients were individually interviewed across five countries: Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia. Topic guides covered the experience of participating in LEAPs and their sustainability. Data were analysed by framework analysis.
Seven themes were identified about participating in LEAPs: predominantly positive evaluation, high levels of participant motivation, therapeutic benefits for participants, few challenges, various future perspectives, positive appraisal of the research project and mixed reflections on mental healthcare. Overall, patients’ experiences were positive and enabled them to feel empowered. Patients expressed interest in remaining involved in advisory panels. Additionally, they felt that they could potentially contribute to the work of non-government organisations.
This study is among the few studies exploring patient participation in research projects, and the first such study conducted in South-East European countries. Patients are highly motivated for this engagement, which has the potential to empower them to take on new social roles. Significant efforts at the national level are needed in each country, to make patient involvement in research standard practice.
Health and social care workers (HSCWs) are at risk of experiencing adverse mental health outcomes (e.g. higher levels of anxiety and depression) because of the COVID-19 pandemic. This can have a detrimental effect on quality of care, the national response to the pandemic and its aftermath.
A longitudinal design provided follow-up evidence on the mental health (changes in prevalence of disease over time) of NHS staff working at a remote health board in Scotland during the COVID-19 pandemic, and investigated the determinants of mental health outcomes over time.
A two-wave longitudinal study was conducted from July to September 2020. Participants self-reported levels of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and mental well-being (Warwick-Edinburgh Mental Well-being Scale) at baseline and 1.5 months later.
The analytic sample of 169 participants, working in community (43%) and hospital (44%) settings, reported substantial levels of depression and anxiety, and low mental well-being at baseline (depression, 30.8%; anxiety, 20.1%; well-being, 31.9%). Although mental health remained mostly constant over time, the proportion of participants meeting the threshold for anxiety increased to 27.2% at follow-up. Multivariable modelling indicated that working with, and disruption because of, COVID-19 were associated with adverse mental health changes over time.
HSCWs working in a remote area with low COVID-19 prevalence reported substantial levels of anxiety and depression, similar to those working in areas with high COVID-19 prevalence. Efforts to support HSCW mental health must remain a priority, and should minimise the adverse effects of working with, and disruption caused by, the COVID-19 pandemic.
Recently, military leaders have tackled twin crises: soaring rates of suicide and rising levels of divorce among service personnel and veterans. Suicide prevention programs run alongside interventions to buttress couples. Many researchers have posited a correlation between relationship failure and lethal self-harm, with some military commanders identifying Dear Johns as the commonest cause of suicide. This chapter excavates a long tradition of associating Dear John letters with servicemen’s deaths by suicide. But it also scrutinizes the hypothesis that failed relationships, particularly those ended by letter, are the primary cause of suicide. More complex understandings of both why relationships fail under wartime pressure and why some service personnel have taken their own lives, are required. The chapter argues that military studies tend to underestimate the challenges deployment poses to intimate partnerships. By treating the couple as a self-contained unit whose dysfunctions emerge from within, researchers have often emphasized the psychological damage spouses do to service personnel, minimizing the emotional havoc war wreaks on those in its orbit.
The focus of this chapter is the role of the nurse in optimising child and youth mental health. An overview of mental disorders experienced during childhood and adolescence is followed by a discussion of mental health promotion for children and young people. Although the lifetime prevalence of eating disorders is very low, they are common, and nurses play an important role in the care of those affected children and young people admitted to hospital for treatment. The chapter looks specifically at how nurses can help support children and young people with eating disorders, and also considers the effects of digital technologies on the mental health of young people growing up in today's society. The importance of working closely with the parents and families of children and young people disabled by mental illness and the services available to them is emphasised throughout the chapter.
Empirical knowledge on what specific aspects of mental health are associated with spirituality is limited, and explanations for the mechanisms underlying this association is scarce. Furthermore, there is limited research on this association among individuals from non-Christian religious backgrounds and non-Western countries. The current study examined relations between spirituality and aspects of mental health in 1,544 adolescents from diverse religious backgrounds in two Eastern countries, India and the United Arab Emirates (UAE). Additionally, we examined mediating and moderating factors. Adolescents (58% female) ages 11–15 years completed a questionnaire on aspects of their mental health, spirituality, and self-control abilities. Results showed that spirituality had a significant positive association with life satisfaction and a significant negative association with internalizing problems, but a non-significant relation with externalizing problems, controlling for age, gender, and socioeconomic status. Self-control completely mediated the association between spirituality and life satisfaction, and this mediational relation was only present for adolescents from the UAE. Results support prior research suggesting positive associations between spirituality and adaptive mental health outcomes and extend these findings to adolescents from diverse religious backgrounds in non-Western countries. These findings have important clinical and policy implications for supporting the role of spirituality in an adolescent’s life.
We aimed to explore personal factors in use of rehabilitation counseling and mental health services by Māori adults. Participants were three Māori adults (females = 2, residing in major urban settings, age range 45–50 years old; male = 1, residing in a rural setting, age range = 25–30 years old). Thematic analysis yielded the following findings: (a) a preference of Māori service providers who understand whānau culture, (b) an understanding of whakapapa or the family structure as an integral source of social support as counselors are planning for treatment, (c) establishing and maintaining trusting relationships within the Māori community by non-Māori counselors, (d) having financial difficulties when attempting to access rehabilitation resources, (e) limited access to health care facilities and services or lack of information about the services available, and (f) a general mistrust of government operated systems. Rehabilitation and mental health services with Māori should address personal cultural and systemic exclusion factors for better service engagement.
In this paper, we consider changes to memorial practices for mental health service users during the asylum period of the mid-nineteenth up to the end of the twentieth century and into the twenty-first century. The closing of large asylums in the UK has been largely welcomed by professionals and service-users alike, but their closure has led to a decrease in continuous and consistent care for those with enduring mental health challenges. Temporary and time-limited mental health services, largely dedicated to crisis management and risk reduction have failed to enable memory practices outside the therapy room. This is an unusual case of privatised memories being favoured over collective memorial activity. We argue that the collectivisation of service user memories, especially in institutions containing large numbers of long-stay patients, would benefit both staff and patients. The benefit would be in the development of awareness of how service users make sense of their past in relation to their present stay in hospital, how they might connect with others in similar positions and how they may connect with the world and others upon future release. This seems to us central to a project of recovery and yet is rarely practised in any mental health institution in the UK, despite being central to other forms of care provision, such as elderly and children's care services. We offer some suggestions on how collective models of memory in mental health might assist in this project of recovery and create greater visibility between past, present and future imaginings.
Globally, adolescent self-harm rates remain high, while help-seeking behaviour remains low. School staff are in a position to facilitate access to appropriate care for young people who self-harm (YPS-H), but little is known about gatekeepers’ attributions of self-harm or whether these attributions influence the support they provide. This study investigates the perceived functions of self-harm reported by potential gatekeepers and examines how these compare to the self-reported functions of self-harm in young people; 386 students from postgraduate teaching (n = 111), school counselling (n = 37), and undergraduate psychology (n = 238) programs completed a survey regarding their beliefs about YPS-H, which included the Inventory of Statements about Self-Harm. Responses were compared to those of 281 young people attending treatment at a suicide prevention program who completed the same measure. Preservice teachers, school counsellors and psychology students endorsed all functions of self-harm at a higher rate than treatment-seeking young people themselves. In particular, they endorsed interpersonal functions to a greater extent than the clinical reference group. The potential effect of greater endorsement of interpersonal influence as a function of self-harm gatekeeper’s responding to YPS-H is discussed.
Sexual orientation is considered from Savin-Williams’ continuum perspective, and gender and sexual orientation are both conceptualized from a fluid, rather than a categorical viewpoint. A Minority Stress Model is applied to the experience of LGBTQ+ communities, whereby stress reactions relate to concerns about one’s safety, discrimination, oppression, and internalized oppression, among many other negative mental and physical health outcomes. Proximal and distal stressors are presented in conjunction with the Minority Stress Model and applied to several domains illustrating community gaps and interventions in academic, legislative, religious, economic, medical, social, and social-environmental realms. Key policies are presented supporting greater rights for LGBTQ+ communities. Despite these advances, significant gaps remain with regard to responsiveness to the needs of LGBTQ+ communities. A case study highlights adverse effects and policy regarding conversion therapy.
The chapter examines current trends in the prevalence of mental health issues for American college students. The use of mental health services is discussed, along with insights into barriers to treatment and harm-reduction efforts. The chapter closes with recommendations for future directions in addressing mental health challenges across campuses in the United States.
The many implications of the concept of wellness across history and geocultural dimensions are examined before arriving at a contemporary and generally accepted definition. The role of culture and its different components is carefully examined as an active engine of wellness, making it clear that the impact of such components vary in connection with the context and nature of societies in the different world regions: Africa, Asia, Europe, America, and Australia/ New Zealand. Consensus around the main features of wellness is the objective of an extensive discussion section that examines specific and broad terminologies in the global health and global mental health scenarios. This leads to the notion of a Culture of Health, articulated as both the main support of wellness across cultures, and as an expression of the human rights movement applied to health issues around the world. Wellness represents as well a prominent objective of public health policies advocating multidisciplinary and integrated approaches to health and mental health, strengthened by a substantial cultural context and cultural perspectives.
As of 2020, close to 1 billion people are living with mental disorders. The COVID-19 pandemic has revealed and intensified the shortcomings in guaranteeing the right to mental health, particularly of the marginalized. The article discusses the international human rights framework with the endeavour of highlighting the non-derogability of the right and the obligations imposed on States in pursuance of it. By discussing the Indian experience the article exemplifies that, despite greater normative clarity, practice has not been brought into conformity in most States, resulting in pre-existing lacunae being amplified during the pandemic. The article proceeds to outline recommendations for States to consider by treating India as a global reference. The overarching conclusion is that while the pandemic has made it even more apparent that the implementation of the rights-framework is deficient, it has also provided an opportunity to advance which can only be availed by operationalizing this framework.
Previous studies have shown a negative impact of the COVID-19 pandemic and its associated sanitary measures on mental health, especially among adolescents and young adults. Such a context may raise many concerns about the COVID-19 pandemic long-term psychological effects. An analysis of administrative databases could be an alternative and complementary approach to medical interview-based epidemiological surveys to monitor the mental health of the population. We conducted a nationwide study to describe the consumption of anxiolytics, antidepressants and hypnotics during the first year of the COVID-19 pandemic, compared to the five previous years.
A historic cohort study was conducted by extracting and analysing data from the French health insurance database between 1 January 2015 and 28 February 2021. Individuals were classified into five age-based classes. Linear regression models were performed to assess the impact of the COVID-19 pandemic period on the number of drug consumers, in introducing an interaction term between time and COVID-19 period.
Since March 2020, in all five age groups and all three drug categories studied, the number of patients reimbursed weekly has increased compared to the period from January 2015 to February 2020. The youngest the patients, the more pronounced the magnitude.
Monitoring the consumption of psychiatric medications could be of great interest as reliable indicators are essential for planning public health strategies. A post-crisis policy including reliable monitoring of mental health must be anticipated.