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As refugees and asylum seekers are at high risk of developing mental disorders, we assessed the effectiveness of Self-Help Plus (SH + ), a psychological intervention developed by the World Health Organization, in reducing the risk of developing any mental disorders at 12-month follow-up in refugees and asylum seekers resettled in Western Europe.
Refugees and asylum seekers with psychological distress (General Health Questionnaire-12 ⩾ 3) but without a mental disorder according to the Mini International Neuropsychiatric Interview (M.I.N.I.) were randomised to either SH + or enhanced treatment as usual (ETAU). The frequency of mental disorders at 12 months was measured with the M.I.N.I., while secondary outcomes included self-identified problems, psychological symptoms and other outcomes.
Of 459 participants randomly assigned to SH + or ETAU, 246 accepted to be interviewed at 12 months. No difference in the frequency of any mental disorders was found (relative risk [RR] = 0.841; 95% confidence interval [CI] 0.389–1.819; p-value = 0.659). In the per protocol (PP) population, that is in participants attending at least three group-based sessions, SH + almost halved the frequency of mental disorders at 12 months compared to ETAU, however so few participants and events contributed to this analysis that it yielded a non-significant result (RR = 0.528; 95% CI 0.180–1.544; p-value = 0.230). SH + was associated with improvements at 12 months in psychological distress (p-value = 0.004), depressive symptoms (p-value = 0.011) and wellbeing (p-value = 0.001).
The present study failed to show any long-term preventative effect of SH + in refugees and asylum seekers resettled in Western European countries. Analysis of the PP population and of secondary outcomes provided signals of a potential effect of SH + in the long-term, which would suggest the value of exploring the effects of booster sessions and strategies to increase SH + adherence.
Accumulating evidence suggests beneficial effects of media stories featuring individuals mastering their suicidal crises, but effects have not been assessed for psychiatric patients.
We randomized n = 172 adult psychiatric patients (n = 172, 97.1% inpatients) to read an educative article featuring a person mastering a suicidal crisis (n = 92) or an unrelated article (n = 80) in a single-blind randomized controlled trial. Questionnaire data were collected before (T1) and after exposure (T2) as well as 1 week later (study end-point, T3). The primary outcome was suicidal ideation as assessed with the Reasons for Living Inventory; secondary outcomes were help-seeking intentions, mood, hopelessness, and stigmatization. Differences between patients with affective versus other diagnoses were explored based on interaction tests.
We found that patients with affective disorders (n = 99) experienced a small-sized reduction of suicidal ideation at 1-week follow up (mean difference to control group [MD] at T3 = −0.17 [95% CI −0.33, −0.03], d = −0.15), whereas patients with nonaffective diagnoses (n = 73) experienced a small-sized increase (T2: MD = 0.24 [95% CI 0.06, 0.42], d = 0.19). Intervention group participants further experienced a nonsustained increase of help-seeking intentions (T2: MD = 0.53 [95% CI 0.11, 0.95], d = 0.19) and a nonsustained deterioration of mood (T2: MD = −0.14 [95% CI −0.27, −0.02], d = −0.17).
This study suggests that patients with affective disorders appear to benefit from media materials featuring mastery of suicidal crises. More research is needed to better understand which patient groups are at possible risk of unintended effects.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
This paper presents data obtained in a one-day census investigation in five European countries (Austria, Hungary, Romania, Slovakia, Slovenia). The census forms were filled in for 4191 psychiatric inpatients. Concerning legal status, 11.2% were hospitalised against their will (committed) and 21.4% were treated in a ward with locked doors. There was only a small correlation between commitment and treatment in a locked ward. More frequent than treatment of committed patients in locked wards was treatment of committed patients in open wards (Austria, Hungary) and treatment of voluntary patients in closed wards (Slovakia, Slovenia). Concerning employment, 27.7% of patients aged 18–60 held a job before admission. The vast majority of patients (84.8%) had a length of stay of less than 3 months. A comparison of these data with the results of a study performed in 1996 and using the same method shows a decrease of rates of long-stay patients. In 1996 the rates of employment were significantly higher in Romania (39.3%) and Slovakia (42.5%) compared to Austria (30.7%). These differences disappeared in 1999 due to decreasing rates of employment in Romania and Slovakia. The numbers of mental health personnel varies between types of institution (university or non-university) and countries, being highest in Austria and lowest in Romania. A considerable increase in the numbers of staff was found in Slovakia.
Most studies investigating the problems and needs of schizophrenia patients’ carers include only one care-giving relative - mostly the patients’ mothers.
The compare needs of mothers and fathers of patients with schizophrenia.
101 sets of parents of patients suffering from schizophrenia were included in this study. They were assessed by means of the “Carers’ Needs Assessment for Schizophrenia”.
Compared to fathers, mothers reported significantly more often problems concerning stress due to earlier life events and burn-out. Mothers required some interventions such as individual psychoeducation or family counselling more than twice as often than fathers. Overall, mothers reported more problems and needs than fathers. The number of mothers’ problems was predicted by not living with a partner and a shorter duration of the patients’ illness (DUPI). The number of mothers’ needs was predicted by patients’ psychiatric symptoms, not living with a partner and a shorter DUPI. Among fathers we could not identify any predictors, neither for problems nor for needs.
Parents of schizophrenic patients have various problems handling their child's illness and therefore need professional support. Overall, mothers reported more problems and needs for interventions than fathers. The differences between mothers’ and fathers’ problems and needs indicate the importance of considering the carer's gender in clinical work.
Non-adherence of medication still is a major problem among patients suffering from bipolar disorders.
Previous studies focused mainly on possible side-effects, attitudes and subjective well-being. Most scales concerning this issue have been developed by psychiatric experts and based on their knowledge not on the patients points of view.
The purpose of this study was to find out what kind of drug effects the patients themselves want.
2 focus-groups with 13 patients and In-depth interviews with 15 mania patients were conducted to collect information about subjective burden and symptoms of the illness. Content analyses of the transcriptions were performed and the results were used to develop a first draft of the questionnaire.
The final German test version consists of 32 items and is called “The Subjective Mania Scale”. The study of content-validity showed that all SMS items were considered to be important by more than 50% of the sample. Test-retest reliability and sensitivity to change were evaluated. All SMS-items showed a significant change between time-point 1 and 3.
The SMS-rating scale is a feasible, reliable and valid instrument for clinical trials among mania patients.
The purpose of this study was to investigate disability among patients suffering from schizophrenia and to identify predictors of disability.
101 patients from different types of psychiatric services in Vienna and diagnosed with schizophrenia according to ICD-10 were included. They were investigates by means of 36-Item self-administered version of the WHO Disability Assessment Schedule II (WHO-DAS-II) and the PANSS-scale. Patients’ mothers and fathers were asked to fill in the Family Problem Questionnaire.
The mean total score of the WHO-DAS-II was 74.1 (SD 21.9). When using weighted sub-scores the highest disability scores were found for social contacts, participation in society and household (means 2.58, 2.57 and 2.51 respectively). Using logistic regression, overall disability was positively associated with patient's age, overall severity of symptoms (PANSS) and number of previous hospital admissions. Overall disability was not associated with duration of illness and or patient's gender. The subjective burden experienced by patients’ fathers and mothers were increased by reduced social contacts and impaired participation in society, while we could not find an association with other domains of patient's disability (understanding, mobility, self-care, household).
This study shows that schizophrenia results in disability in several domains. Family caregivers’ burden was predominantly increased by social consequences of schizophrenia.
To investigate caregiving and its consequences among fathers and mothers of the same patients suffering from schizophrenia.
101 patients as well as both parents were investigated using the “Carers' Needs Assessment for Schizophrenia”, the “Beck Depression Inventory”, the “Involvement Evaluation Questionnaire” and the “Family Problem Questionnaire”.
The mean number of days fathers lived together with the patients was not significant from that of the mothers, but the average duration (hours per week) of contact with the patient was significantly higher for mothers than for fathers. Among 40% of the sample, fathers and mothers spend an equal amount of time caring for the patient. Mothers reported significantly more often problems than fathers concerning stress due to earlier life events and burn-out. Mothers needed some interventions such as individual psychoeducation or family counselling more than twice as often as fathers. Mothers reported overall higher numbers of problems and needs for intervention than fathers. The overall score of caregivers' involvement did not differ significantly between fathers and mothers. The mothers' objective burden was significantly higher than the fathers' objective burden, but parents did not show differences concerning subjective burden. Using the “Beck Depression Inventory”, mothers were more often depressed than fathers.
This study shows that often fathers and mothers spend an equal amount of time caring for the patient. The differences found between mothers and fathers should be considered when planning services for family caregivers.
Depression is among the main risk factors for suicide. The Geriatric Depressions Scale (GDS-30, GDS-15) is depression screening instrument specifically developed for the elderly.
Objectives and aims
To provide a systematic review of the screening accuracy of both GDS versions.
An electronic search was performed using Medline, Embase, Cinahl, Psyndex and Cochrane library. The selection and examination of papers was done by two reviewers independently. The following studies were excluded: number of depression cases less than 10, no clear case criterion, phone version, psychiatric samples.
Of 173 papers which were read and examined, only 42 papers were included. For both GDS versions similar mean validity indices were found (GDS-30: sensitivity 0.753, specificity 0.770; GDS-15: sensitivity 0.805, specificity 0.750). Using pooled samples we could not find significant differences between the two versions of the GDS. Using comparative studies based on identical samples, both GDS versions showed significantly better validity indices than the “Yale-1-question” screen, but did not differ from the CES-D. Frequently, essential information about research methods was not given. When methods were reported, the differing methods (e.g. concerning blinding, cut-off values, sampling procedures) limit the comparability of primary studies.
In general, the GDS seems to be sufficient for depression screening. While early recognition of depression is essential for identifying persons at risk for suicide, the GDS does not explicitly focus on this problem.
Originally, the General Health Questionnaire (= GHQ) was designed to detect mental disorders among general medical outpatients and in community. The aim of the present survey is to compare the criterion validity indices of three different GHQ versions among general hospital inpatients when using different scoring methods.
The GHQ-30 was filled in by inpatients prior to the research interview. For psychiatric case-identifiation the Clinical Interview Schedule was performed by three research psychiatrists.
The final sample consisted of 993 inpatients. When comparing the three different GHQ-versions, no significant differences were found in OMR and ROC-AUC as well as in sensitivity (0,612–0,701) and specificity (0,601–0759). When comparing the four scoring methods no significant differences were found in sensitivity. By contrast, OMR and specificity showed better indices for the 20 item and 12 item GHQ versions when using the bimodal and modified Lickert scoring method. Further, the Lickert scoring method showed no significant differences to the other scoring methods for the GHQ-30, where as the modified Lickert and the bimodal method showed lower OMR and higher specificity compared to the chronic method.
Due to the results of this survey, the future use of the chronic scoring method for the GHQ has to be questioned when used for general hospital inpatients.
What do carers of schizophrenia patients need during first contact with psychiatric services?
The aim of the present study was to analyse the problems and needs for interventions among caregivers of patients with schizophrenia who were the first time in contact with psychiatric services.
93 family caregivers of schizophrenia patients and 93 schizophrenia patients were investigated during the first contact with psychiatric services. The ‘Carer’s Needs Assessment for Schizophrenia” (CNA-S) and PANNS were used for investigation.
The most frequent problems of caregivers of first contact patients with schizophrenia were insufficient information on psychiatric disorder and concerns about the patient’s future. Further, the intervention ‘individual psychoeducation” was needed significantly more often among caregivers of first contact patients than among those having been previously in contact with psychiatric services.
Carers being the first time in contact with psychiatric services need some specific interventions significantly more often than later.
A variety of interventions are available to supportthe caregivers of dementia patients. For the purpose of service planning, we developed aninstrument to assess the needs of dementia caregivers and whether these needsare met. Another aim was to investigate aspects of reliability and validity ofthis new instrument.
Thedevelopment of this instrument ('Carers’ Needs Assessment for Dementia” =CNA-D) wasbased on in-depth interviews and a focus group. The combined inter-rater and test-retest reliabilitywas investigated among 45 dementia caregivers. For analyzing concurrent validity correlations of the CNA-D with the ”ZaritBurden Inventory' were used. Content validity wasinvestigated by performing a separate survey among 40 caregivers and 40 professionals.
The CNA-D is asemi-structured research interview including 18 problem areas. For each ofthese problem areas, the CNA-D offers several possible interventions. Therelevance of the problem areas and the interventions (contentvalidity) wasconfirmed by the majority of the study participants. Significant positiveassociations were found between the total score of the 'Zarit Burden Inventory'on the one hand, and the number of problems and the number of unmet needsaccording to the CNA-D on the other hand. The agreement between the interviewerswas 'excellent” (i.e. kappa above 0.75) in 73.7% of the problem areas and in69.9% of the interventions.
These results suggest that the CNA-D is both validand reliable. The CNA-D seems to be able to comprehensively assess the needs ofdementia caregivers
Most studies on the consequences of psychiatric illnesses for caregiver relatives of patients involve only one relative, predominantly a parent and most often the patient’s mother. Studies that focus on the gender-specific differences between caregiver relatives are very sparse. In order to rule out possible differences in the level of burden depending on the particular patient both parents of the same patients were included in this study.
To analyse the differences in the level of burden put on mothers and fathers of patients diagnosed with schizophrenia according to ICD-10. To analyse the correlation between the unmet needs of caregivers and the level of burden put on them.
Both parents of 101 patients with schizophrenia were included in this study. The different aspects of caregivers’ burden were assessed by means of the 'Involvement Evaluation Questionnaire”. Unmet needs of caregivers were assessed with the 'Carers’ Needs Assessment for Schizophrenia”.
Mothers showed significantly higher scores in the dimensions 'Tensions” and 'Urging” than fathers. Multiple linear regression analysis showed positive correlation between unmet needs and the level of burden in both mothers and fathers.
Unmet needs of caregiving parents of patients suffering from schizophrenia are in correlation with higher levels of burden. The differences between mothers and fathers in the level of burden indicate the importance of considering the caregiver´s gender in clinical work.