The Syndemic Approach in relation to Clinical Practice and Research in Psychiatry

The syndemic framework goes beyond the concept of comorbidity and considers how diseases interact within their wider environmental context, along with social and political factors, to mutually exacerbate negative outcomes. The syndemic approach enhances the way mental disorders are understood in terms of their aetiology, treatment and prognosis and therefore influences the direction of clinical practice, policy development and research priorities in the field of psychiatry. Using a syndemic framework to develop mental health policy globally can help address the mental health “treatment gap” in countries where resources are limited. In Russia, identified syndemics have been of particular relevance to mental disorders and further research using a syndemic framework will continue to build upon the strong background of integrated mental healthcare currently provided.

Barriers and facilitators to implementing a mobile intervention with task shifting in the treatment of depressive symptoms in people with diabetes and / or hypertension in Brazil: A study protocol using the CFIR.

Background: Task-shifting and eHealth have been proposed as ways of approaching the mental health treatment gap in low and middle-income countries (LMIC). The Latin America Treatment & Innovation Network in Mental Health (LATIN-MH) developed CONEMO (Emotional Control), a behavioral intervention used to treat depressive symptoms in a sample of patients with diabetes and hypertension in Sao Paulo, Brazil. The intervention uses task shifting and is delivered via a smartphone app. The effectiveness of this intervention was tested in two randomized trials in these countries. Aim: This paper aims to present the protocol for a study that will explore perceived barriers and facilitators to implementing this intervention to help future scale-up. Methods: We will conduct qualitative research with users of the CONEMO intervention and health professionals who participated directly and indirectly in the trial in Brazil. We will use semi-structured interviews, and we will adopt the Consolidated Framework for Implementation Research (CFIR) for data analysis. Discussion: Task-shifting and eHealth are potentially important tools to help decrease the mental health treatment gap in Latin America. This study will increase our understanding of the factors which may facilitate or hinder the implementation of mobile behavioral mental health interventions, using task-shifting, within LMICs. Findings could be used in future design and planning to facilitate successful implementation and treatment. Registration in Clinical Trials (www.clinical.trials.gov) NCT028406662

Reforming Undergraduate Psychiatry Training in Ukraine

In Ukraine, mental health problems are common yet the mental health services available are still old fashioned and based on healthcare approaches used in the Soviet Union, providing mainly inpatient services and rudimentary community services. The World Health Organization (WHO) introduced the Mental Health Gap Action Programme (mhGAP) to reduce the mental health treatment gap all over the world and 2 years later introduced the WHO mhGAP-Intervention Guide (mhGAP-IG), version 2.0 (2016) as not only an educational tool, but also an evidence based guideline to scale up services for mental, neurological and substance use (MNS) conditions with an objective to reduce gap between available health systems capacity and resources for mental health. The main aim of this paper is to describe reforms of undergraduate psychiatry training in Ukraine using Kyiv Medical University as a case example. Kyiv Medical University (KMU) is the first university in Ukraine to introduce the mhGAP-IG in Ukraine. The revised psychiatry curricula in KMU aims to strengthens the evidence based teaching practices, to put emphasis on community orientated mental health care, and to use interactive teaching methods that the university hopes will attract more future doctors to psychiatry and ideally contribute towards the reduction of the mental health treatment-gap in Ukraine.

Mental health treatment gap in adults of Russian, Somali, and Kurdish origin in Finland

Background Migration affects migrating persons’ health in many levels. Populations of migrant origin, and in particular refugees, are known to have an increased risk of mental ill health. Previous research from Finland has shown that the prevalence of mental health symptoms is significantly higher among Russian origin women and Kurdish origin men and women than in the general population. Building on prior research, we explore the prevalence of perceived need for mental healthcare among Russian, Somali, and Kurdish origin populations and compare this to the general population in Finland. Additionally, we present prevalence of mental health treatment gap in these groups. Methods We used data from the Finnish Migrant Health and Wellbeing Study (n = 1404) and the Health 2011 Survey (n = 1459). Prevalence was calculated using predicted margins (95% confidence level). P-value of less than 0.05 was considered significant. Mental health treatment gap was examined by constructing a combined variable of perceived need for mental health services and prevalence of service use. Results The perceived need for mental health services was higher in Kurdish origin persons (16%) and lower in Somali origin persons (<1%) than in the general population (8%). Both Kurdish origin men (11%) and women (20%) expressed more need for mental health services than men (4%) and women (11%) in the general population. The mental health treatment gap was highest in Russian origin women (10%) and Kurdish origin women (10%) and men (8%). For the general population, the treatment gap was only 1% (men 2 %, women <1%). Conclusions Untreated mental health problems are unjust, problematic and can be a source of great human suffering. Evidence from Finland shows that especially persons of Kurdish origin experience a mental health treatment gap. To expand coverage and reduce inequalities in health services, national development projects (e.g. PALOMA) have been launched to improve mental healthcare. Key messages Perceived need for mental health services is more common among certain foreign-born populations than the general population in Finland; this is in line with prior research on mental health symptoms. Untreated mental health problems are unjust, problematic and can be a source of great human suffering; evidence of mental health treatment gap should lead to improved access to mental health services.