Process and outcomes evaluation of smartphone applications for Bipolar Disorder: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Iona Tatham ◽  
Ellisiv Clarke ◽  
Kelly Grieve ◽  
Pulkit Kaushal ◽  
Jan Smeddinck ◽  
...  
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Scoping Review ◽  
Best Practice ◽  
Energy Levels ◽  
Health Science ◽  
Solid Base ◽  
Type I ◽  
Comprehensive Overview ◽  
Outcomes Evaluation

BACKGROUND Mental Health Applications (MHAs) provide opportunities for accessible, immediate and innovative approaches to better understand mental health disorders especially those with high burden such as Bipolar Disorder (BD). Many MHAs have been developed but few have had their effectiveness evaluated. OBJECTIVE This systematic scoping review explores current process and outcome measures of MHAs for BD (MHA-BD) with an aim to provide a comprehensive overview of current research. This will identify best practice for evaluating MHA-BDs and provide a solid base for future studies whilst also aiding professionals on MHA selection in BD. METHODS A systematic literature search of the health science databases PsycINFO, Medline, Embase, EBSCO, Scopus and Web of Science was undertaken up to January 2021 to narratively assess how other studies had evaluated MHAs for BD. RESULTS A total of 3342 articles were identified, and 12 were included. Across all studies, 507 participants were studied, 376 with BD Type I or II. Data from 372 participants were analysed. Of the 507, the mean age of participants in 11 of the studies was 36.5 years, with 302 being females. The final study did not collect age data. The most widely employed validated outcome measure were YMRS used 8 times, HDRS-17 & HAMD were both applied three times and ASRM, QID and FAST used twice, while CISS, EQ-5D, GAD-7, IDS-C, MASS, MDI, Morisky-Green 8-item, PSS and WHOQOL-BREF were all utilised once. Subjective markers were also measured in 9 different studies, 6 of which used MONARCA. Mood and energy levels were the most commonly utilised subjective markers, being used 4 four times each. Eleven of the 12 studies discussed the various confounding factors and barrier to MHA-BD usage. CONCLUSIONS Reported low adherence rates, usability challenges and privacy concerns act as barriers to usage of MHA-BD. Moreover, as MHA evaluation is itself developing, so must guidance for clinicians in how to aid patient choices in m-Health. These obstacles could be ameliorated by incorporating co-production and co-design using participatory patient approaches during the development and evaluation stages of MHA-BD. Further, including qualitative aspects in trials that examine patient experience of both mental ill health and the MHA itself could result in a more patient-friendly, fit-for-purpose MHA-BD. CLINICALTRIAL Not applicable

Is the use of long-acting injectable antipsychotic extended in the outpatient treatment of bipolar disorder? A brief description

2017 ◽  
Vol 41 (S1) ◽  
pp. S424-S425
Author(s):  
L. Niell ◽  
J. Rodríguez ◽  
R.A. Baena ◽  
I. Alberdi-Paramo ◽  
G. Montero ◽  
...  
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Health Center ◽  
Treatment Guidelines ◽  
Mental Health Center ◽  
Mood Stabilizer ◽  
Mood Stabilizers ◽  
Type I ◽  
Regular Treatment ◽  
Long Acting

AimsObtain and analyze information on treatment guidelines, with particular emphasis on the use of antipsychotics, in patients diagnosed with bipolar disorder I and bipolar disorder II who are treated at a mental health center in a district of Madrid (Spain) under the conditions of habitual clinical practice.Then, compare with recently published literature.MethodsWe performed a descriptive study of a sample of 100 patients diagnosed with bipolar disorder (type I and type II) at any stage of the disease who receive regular treatment in a mental health center in a district of Madrid. Information regarding the treatment used, especially the use of antipsychotics (either in a single therapy or in combination with other drugs such as mood stabilizers, antidepressants, hypnotics or anxiolytics), was collected retrospectively from the data obtained from the medical record.ResultsNinety-four percent of patients are taking mood stabilizer treatment (68% lithium, 24% valproate, 1% and 1% carbamazepine and lamotrigine). Four percent take lithium and valproate in combination. Forty-eight percent of patients are taking some antipsychotic (atypical about 90%). Of these, only 10% in injectable form, and 5% take both oral and injectable antipsychotics.ConclusionsThe diminished use of injectable antipsychotics, well below recent publications, draws the attention. You can probably explain this low proportion of injectable medication because we are generally dealing with stable patients with a long-term disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Bethany Kotlar ◽  
Emily Gerson ◽  
Sophia Petrillo ◽  
Ana Langer ◽  
Henning Tiemeier
Keyword(s):  
Mental Health ◽  
Maternal Health ◽  
Pregnant Women ◽  
Scoping Review ◽  
Maternal Mental Health ◽  
Epidemiological Studies ◽  
Anxiety And Depression ◽  
Comprehensive Overview ◽  
Middle Income ◽  
Middle Income Countries

Abstract Introduction The Covid-19 pandemic affects maternal health both directly and indirectly, and direct and indirect effects are intertwined. To provide a comprehensive overview on this broad topic in a rapid format behooving an emergent pandemic we conducted a scoping review. Methods A scoping review was conducted to compile evidence on direct and indirect impacts of the pandemic on maternal health and provide an overview of the most significant outcomes thus far. Working papers and news articles were considered appropriate evidence along with peer-reviewed publications in order to capture rapidly evolving updates. Literature in English published from January 1st to September 11 2020 was included if it pertained to the direct or indirect effects of the COVID-19 pandemic on the physical, mental, economic, or social health and wellbeing of pregnant people. Narrative descriptions were written about subject areas for which the authors found the most evidence. Results The search yielded 396 publications, of which 95 were included. Pregnant individuals were found to be at a heightened risk of more severe symptoms than people who are not pregnant. Intrauterine, vertical, and breastmilk transmission were unlikely. Labor, delivery, and breastfeeding guidelines for COVID-19 positive patients varied. Severe increases in maternal mental health issues, such as clinically relevant anxiety and depression, were reported. Domestic violence appeared to spike. Prenatal care visits decreased, healthcare infrastructure was strained, and potentially harmful policies implemented with little evidence. Women were more likely to lose their income due to the pandemic than men, and working mothers struggled with increased childcare demands. Conclusion Pregnant women and mothers were not found to be at higher risk for COVID-19 infection than people who are not pregnant, however pregnant people with symptomatic COVID-19 may experience more adverse outcomes compared to non-pregnant people and seem to face disproportionate adverse socio-economic consequences. High income and low- and middle-income countries alike faced significant struggles. Further resources should be directed towards quality epidemiological studies. Plain English summary The Covid-19 pandemic impacts reproductive and perinatal health both directly through infection itself but also indirectly as a consequence of changes in health care, social policy, or social and economic circumstances. The direct and indirect consequences of COVID-19 on maternal health are intertwined. To provide a comprehensive overview on this broad topic we conducted a scoping review. Pregnant women who have symptomatic COVID-19 may experience more severe outcomes than people who are not pregnant. Intrauterine and breastmilk transmission, and the passage of the virus from mother to baby during delivery are unlikely. The guidelines for labor, delivery, and breastfeeding for COVID-19 positive patients vary, and this variability could create uncertainty and unnecessary harm. Prenatal care visits decreased, healthcare infrastructure was strained, and potentially harmful policies are implemented with little evidence in high and low/middle income countries. The social and economic impact of COVID-19 on maternal health is marked. A high frequency of maternal mental health problems, such as clinically relevant anxiety and depression, during the epidemic are reported in many countries. This likely reflects an increase in problems, but studies demonstrating a true change are lacking. Domestic violence appeared to spike. Women were more vulnerable to losing their income due to the pandemic than men, and working mothers struggled with increased childcare demands. We make several recommendations: more resources should be directed to epidemiological studies, health and social services for pregnant women and mothers should not be diminished, and more focus on maternal mental health during the epidemic is needed.

scholarly journals Chronic-Care-Management Programs for Multimorbid Patients with Diabetes in Europe: A Scoping Review with the Aim to Identify the Best Practice

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Julia Heike Brettel ◽  
Ulf Manuwald ◽  
Henriette Hornstein ◽  
Joachim Kugler ◽  
Ulrike Rothe
Keyword(s):  
Scoping Review ◽  
Chronic Care ◽  
Best Practice ◽  
Chronically Ill ◽  
Comprehensive Overview ◽  
Patients With Diabetes ◽  
Primary Care Sector ◽  
European Health ◽  
In The Beginning ◽  
Multimorbid Patients

Aim. This scoping review is aimed at providing a current descriptive overview of care programs based on the chronic care model (CCM) according to E. H. Wagner. The evaluation is carried out within Europe and assesses the methodology and comparability of the studies. Methods. A systematic search in the databases PubMed, Embase, and MEDLINE via OVID was conducted. In the beginning, 2309 articles were found and 48 full texts were examined, 19 of which were incorporated. Included were CCM-based programs from Belgium, Cyprus, Germany, Italy, Switzerland, and the Netherlands. All 19 articles were presented descriptively whereof 11 articles were finally evaluated in a checklist by Rothe et al. (2020). In this paper, the studies were tabulated and evaluated conforming to the same criteria. Results. Due to the complexity of the CCM and the heterogeneity of the studies in terms of setting and implementation, a direct comparison proved difficult. Nevertheless, the review shows that CCM was successfully implemented in various care situations and also can be useful in single practices, which often dominate the primary care sector in many European health systems. The present review was able to provide a comprehensive overview of the current care situation of chronically ill patients with multimorbidities. Conclusions. A unified nomenclature concerning the distinction between disease management programs and CCM-based programs should be aimed for. Similarly, homogeneous quality standards and a Europe-wide evaluation strategy would be necessary to identify best practice models and to provide better care for the steadily growing number of chronically multimorbid patients.

scholarly journals Scoping review protocol documenting cancer outcomes and inequalities for adults living with intellectual and/or developmental disabilities

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032772
Author(s):  
Morgan Stirling ◽  
Janice Linton ◽  
Hélène Ouellette-Kuntz ◽  
Shahin Shooshtari ◽  
Julie Hallet ◽  
...  
Keyword(s):  
Developmental Disabilities ◽  
Scoping Review ◽  
Health Science ◽  
Cancer Outcomes ◽  
Contributing Factors ◽  
Comprehensive Overview ◽  
Scoping Reviews ◽  
Education Levels ◽  
Review Protocol ◽  
Meta Analyses

IntroductionThere is increasing attention on the cancer burden for adults with intellectual and developmental disabilities (IDD). Emerging evidence suggests there are differences in cancer experiences and outcomes for individuals living with IDD, from risk through survivorship. These differences may be attributed to features of the IDD, such as cognitive deficits and communication, as well as social determinants of health-like lower education levels and ableism. However, there is no comprehensive overview of the literature quantifying these potential disparities and describing the influencing factors. In this paper, we describe a scoping review protocol to systematically review published literature on cancer for adults with IDD. The purpose of this review is to identify differences in cancer risk, stage at diagnosis, treatment and survival along the cancer continuum for adults with IDD and outline potential contributing factors creating these disparities.Methods and analysisWe will follow Arksey and O’Malley’s expanded framework for scoping reviews to conduct this review. We will systematically search electronic databases for peer-reviewed, published journal articles to identify appropriate studies in collaboration with a health science librarian. Two reviewers will independently review titles and abstracts followed by a full-text review to determine whether it meets inclusion criteria. A data chart for collecting and sorting information will be developed in consultation with the team. Results will be collated and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews: PRISMA-Scoping Reviews. Extracted information will be summarised quantitatively and qualitatively to meet review objectives.Ethics and disseminationThis scoping review will employ a methodology to identify literature related to cancer outcomes and experiences for adults with IDD. Results will be disseminated to relevant stakeholders who care for and support individuals with IDD at local, provincial and national levels and through publishing findings. By highlighting the disparities in the cancer system and gaps in the research, this scoping review can provide direction for future action.

scholarly journals Collaborative Involvement of Indigenous Youth in the Design and Evaluation of Digital Mental Health Interventions: A Scoping Review Protocol

2020 ◽  
Author(s):  
Josie Povey ◽  
Buaphrao Raphiphatthana ◽  
Michelle Torok ◽  
Tricia Nagel ◽  
Fiona Shand ◽  
...  
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Full Text ◽  
Best Practice ◽  
Data Extraction ◽  
Grey Literature ◽  
Health Interventions ◽  
Indigenous Youth ◽  
Mental Health Interventions ◽  
Review Protocol

Abstract Background: Indigenous youth worldwide are at greater risk of developing mental health concerns due to ongoing inequity and disadvantage. Digital mental health solutions are identified as a potential approach to improving access to mental health treatment for Indigenous youth, with evidence of acceptability and effectiveness beginning to emerge. Although collaborative design, development and evaluation is widely recognised as necessary to improving the acceptability of these tools, there is limited evidence to guide engagement of Indigenous youth in these processes. The objective of this scoping review is to map evidence regarding the collaborative involvement of Indigenous youth in the design and/or evaluation of digital mental health interventions. Methods: Scoping review methodology includes six stages, 1) identifying research question; 2) identifying relevant studies; 3) developing a study selection and data extraction method; 4) charting the data; 5) collating, summarising and reporting results. Additionally, Step 6) consultation, engages a male and female Indigenous health researcher in reviewing protocols, analysis and findings, enhancing credibility and ensuring findings are informed by Indigenous worldviews. Searches for relevant literature are undertaken in the following databases: EBSCOhost databases (Academic Search Premiere, Computer and Applied Science complete, CINAHL Plus with Full text, MEDLINE with full text, APA PsychArticles, Psychology and Behavioural Sciences collection, APA PsychInfo), PubMed, and Scopus. In addition, Infomit and Google (limited to the first 200 results) are searched for grey literature. All primary studies and grey literature in English that meet eligibility criteria are included. Data, including; study methods, methodologies, digital mental health program details, participant information and engagement and reporting processes are extracted and included for analysis. Data extraction variables are guided by the Consolidated Criteria for Strengthening Reporting of Health Research (CONSIDER statement). This statement provides a best practice checklist for reporting research involving Indigenous peoples. This scoping review protocol has been registered with Open Science Framework (available via osf.io/2nkc6).Discussion: To date, there are no reviews which critically analyse engagement of Indigenous youth in the development and evaluation of youth-specific digital mental health interventions. This review will aim to fill that gap and appraise alignment of current practice with best practice guidelines to inform future research. It will highlight appropriate strategies for the engagement of youth in collaborative processes, providing guidance for health practitioners, policy makers, and researchers working in the field of Indigenous youth and digital mental health.

scholarly journals Effects of the Covid-19 Pandemic on Maternity Staff in 2020 – A Scoping Review

2021 ◽  
Author(s):  
Nadine Schmitt ◽  
Elke Mattern ◽  
Eva Cignacco ◽  
Gregor Seliger ◽  
Martina König-Bachmann ◽  
...  
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Subjective Effects ◽  
Obstetric Care ◽  
Moral Dilemmas ◽  
Physical Contact ◽  
Main Topic ◽  
Evidence Based ◽  
Post Traumatic Stress ◽  
Comprehensive Overview

Abstract In the spring of 2020, the SARS-CoV-2 virus caused the Covid-19 pandemic, bringing with it drastic changes and challenges for health systems and medical staff. Among the affected were obstetricians and midwives, whose close physical contact with pregnant women, women who recently gave birth, and their children was indispensable. In the obstetric setting, births cannot be postponed, and maternity staff had to adapt to assure obstetric safety while balancing evidence-based standards with the new challenges posed by the pandemic. This scoping review gives a comprehensive overview of the effecs the Covid-19 pandemic had on maternity staff. We followed the evidence-based approach described by Arksey & O’Malley: we searched several databases for English and German articles published between January 2020 and January 2021 that discussed or touched upon the effects the pandemic had on maternity staff in OECD countries and China.We found that structural challenges caused by the crisis and its subjective effects on maternity staff fell into two main topic areas. Structural challenges (the first main topic) were divided into five subtopics: staff shortages and restructuring; personal protective equipment and tests; switching to virtual communication; handling women with a positive SARS-CoV-2 infection; and excluding accompanying persons. The pandemic also strongly affected the staff’s mental health (the second main topic.) Attempting to meet challenges posed by the pandemic while afraid of contamination, suffering overwork and exhaustion, and struggling to resolve ethical-moral dilemmas had severe negative subjective effects. Several studies indicated increased depression, anxiety, stress levels, and risk of post-traumatic stress symptoms, although the crisis also generated strong occupational solidarity.Care for pregnant, birthing, and breast-feeding women cannot be interrupted, even during a pandemic crisis that requires social distancing. Maternity staff sometimes had to abandon normal standards of obstetric care and were confronted with enormous challenges and structural adjustments that did not leave them unscathed: their mental health suffered considerably. Researchers should study maternity staff’s experiences during the pandemic to prepare recommendations that will protect staff during future epidemics.

scholarly journals Effects of the Covid-19 pandemic on maternity staff in 2020 – a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nadine Schmitt ◽  
Elke Mattern ◽  
Eva Cignacco ◽  
Gregor Seliger ◽  
Martina König-Bachmann ◽  
...  
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Subjective Effects ◽  
Obstetric Care ◽  
Moral Dilemmas ◽  
Physical Contact ◽  
Main Topic ◽  
Evidence Based ◽  
Post Traumatic Stress ◽  
Comprehensive Overview

AbstractIn the spring of 2020, the SARS-CoV-2 virus caused the Covid-19 pandemic, bringing with it drastic changes and challenges for health systems and medical staff. Among the affected were obstetricians and midwives, whose close physical contact with pregnant women, women who recently gave birth, and their children was indispensable. In the obstetric setting, births cannot be postponed, and maternity staff had to adapt to assure obstetric safety while balancing evidence-based standards with the new challenges posed by the pandemic. This scoping review gives a comprehensive overview of the effecs the Covid-19 pandemic had on maternity staff. We followed the evidence-based approach described by Arksey & O’Malley: we searched several databases for English and German articles published between January 2020 and January 2021 that discussed or touched upon the effects the pandemic had on maternity staff in OECD countries and China. We found that structural challenges caused by the crisis and its subjective effects on maternity staff fell into two main topic areas. Structural challenges (the first main topic) were divided into five subtopics: staff shortages and restructuring; personal protective equipment and tests; switching to virtual communication; handling women with a positive SARS-CoV-2 infection; and excluding accompanying persons. The pandemic also strongly affected the staff’s mental health (the second main topic.) Attempting to meet challenges posed by the pandemic while afraid of contamination, suffering overwork and exhaustion, and struggling to resolve ethical-moral dilemmas had severe negative subjective effects. Several studies indicated increased depression, anxiety, stress levels, and risk of post-traumatic stress symptoms, although the crisis also generated strong occupational solidarity. Care for pregnant, birthing, and breast-feeding women cannot be interrupted, even during a pandemic crisis that requires social distancing. Maternity staff sometimes had to abandon normal standards of obstetric care and were confronted with enormous challenges and structural adjustments that did not leave them unscathed: their mental health suffered considerably. Researchers should study maternity staff’s experiences during the pandemic to prepare recommendations that will protect staff during future epidemics.

scholarly journals Process and outcomes evaluation of smartphone applications for Bipolar Disorder: A Scoping Review (Preprint)

10.2196/29114 ◽  
2021 ◽  
Author(s):  
Iona Tatham ◽  
Ellisiv Clarke ◽  
Kelly Grieve ◽  
Pulkit Kaushal ◽  
Jan Smeddinck ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Scoping Review ◽  
Smartphone Applications ◽  
Outcomes Evaluation

scholarly journals Effects of the Covid-19 pandemic on maternity staff in 2020 – a scoping review

2021 ◽  
Author(s):  
Nadine Schmitt ◽  
Elke Mattern ◽  
Eva Cignacco ◽  
Gregor Seliger ◽  
Martina König-Bachmann ◽  
...  
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Subjective Effects ◽  
Obstetric Care ◽  
Moral Dilemmas ◽  
Physical Contact ◽  
Main Topic ◽  
Evidence Based ◽  
Post Traumatic Stress ◽  
Comprehensive Overview

Abstract In the spring of 2020, the SARS-CoV-2 virus caused the Covid-19 pandemic, bringing with it drastic changes and challenges for health systems and medical staff. Among the affected were obstetricians and midwives, whose close physical contact with pregnant women, women who recently gave birth, and their children was indispensable. In the obstetric setting, births cannot be postponed, and maternity staff had to adapt to assure obstetric safety while balancing evidence-based standards with the new challenges posed by the pandemic. This scoping review gives a comprehensive overview of the effecs the Covid-19 pandemic had on maternity staff. We followed the evidence-based approach described by Arksey & O’Malley: we searched several databases for English and German articles published between January 2020 and January 2021 that discussed or touched upon the effects the pandemic had on maternity staff in OECD countries and China. We found that structural challenges caused by the crisis and its subjective effects on maternity staff fell into two main topic areas. Structural challenges (the first main topic) were divided into five subtopics: staff shortages and restructuring; personal protective equipment and tests; switching to virtual communication; handling women with a positive SARS-CoV-2 infection; and excluding accompanying persons. The pandemic also strongly affected the staff’s mental health (the second main topic.) Attempting to meet challenges posed by the pandemic while afraid of contamination, suffering overwork and exhaustion, and struggling to resolve ethical-moral dilemmas had severe negative subjective effects. Several studies indicated increased depression, anxiety, stress levels, and risk of post-traumatic stress symptoms, although the crisis also generated strong occupational solidarity. Care for pregnant, birthing, and breast-feeding women cannot be interrupted, even during a pandemic crisis that requires social distancing. Maternity staff sometimes had to abandon normal standards of obstetric care and were confronted with enormous challenges and structural adjustments that did not leave them unscathed: their mental health suffered considerably. Researchers should study maternity staff’s experiences during the pandemic to prepare recommendations that will protect staff during future epidemics.

scholarly journals Indicators for Public Mental Health: A Scoping Review

2021 ◽  
Vol 9 ◽  
Author(s):  
Diana Peitz ◽  
Christina Kersjes ◽  
Julia Thom ◽  
Heike Hoelling ◽  
Elvira Mauz
Keyword(s):  
Mental Health ◽  
Focus Group ◽  
Scoping Review ◽  
International Institutions ◽  
Public Mental Health ◽  
Future Research ◽  
Comprehensive Overview ◽  
Medline Search ◽  
Population Mental Health ◽  
Comprehensive Compilation

Background: To monitor population mental health, the identification of relevant indicators is pivotal. This scoping review provides a comprehensive overview of current indicators representing the various fields of public mental health core topics. It was conducted as a first step to build up a Mental Health Surveillance for Germany.Methods: We conducted a systematic MEDLINE search via PubMed. This search was supplemented by an extensive examination of the websites of relevant national as well as international institutions in the context of public mental health and an additional internet search via Google. To structure the data, an expert-based focus group identified superordinate topics most relevant to public mental health to which the identified indicators could be assigned to. Finally, the indicator set was screened for duplicates and appropriate content to arrive at a final set.Results: Within the various search strategies, we identified 13.811 records. Of these records, a total of 365 records were processed for indicator extraction. The extracted indicators were then assigned to 14 topics most relevant to public mental health as identified by the expert-based focus group. After the exclusion of duplicates and those indicators not meeting criteria of specificity and target group, the final set consisted of 192 indicators.Conclusion: The presented indicator set provides guidance in the field of current concepts in public mental health monitoring. As a comprehensive compilation, it may serve as basis for future surveillance efforts, which can be adjusted and condensed depending on the particular monitoring focus. Our work provides insights into established indicators included in former surveillance work as well as recent, not yet included indicators reflecting current developments in the field. Since our compilation mainly concludes indicators related to mental health in adults, it should be complemented with indicators specific to children and adolescents. Furthermore, our review revealed that indicators on mental health promotion and prevention are underrepresented in current literature of public mental health and should hence be focused on within future research and surveillance.

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