Educational and Training Interventions Aimed at Healthcare Workers in the Detection and Management of People With Mental Health Conditions in South and South-East Asia: A Systematic Review

Background: To bridge significant mental health treatment gaps, it is essential that the healthcare workforce is able to detect and manage mental health conditions. We aim to synthesise evidence of effective educational and training interventions aimed at healthcare workers to increase their ability to detect and manage mental health conditions in South and South-East Asia.Methods: Systematic review of six electronic academic databases from January 2000 to August 2020 was performed. All primary research studies were eligible if conducted among healthcare workers in South and South-East Asia and reported education and training interventions to improve detection and management of mental health conditions. Quality of studies were assessed using Modified Cochrane Collaboration, ROBINS-I, and Mixed Methods Appraisal Tools and data synthesised by narrative synthesis. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A review protocol was registered with the PROSPERO database (CRD42020203955).Findings: We included 48 of 3,654 screened articles. Thirty-six reported improvements in knowledge and skills in the detection and management of mental health conditions. Training was predominantly delivered to community and primary care health workers to identify and manage common mental health disorders. Commonly used training included the World Health Organization's mhGAP guidelines (n = 9) and Cognitive Behavioural Therapy (n = 8) and were successfully tailored and delivered to healthcare workers. Digitally delivered training was found to be acceptable and effective. Only one study analysed cost effectiveness. Few targeted severe mental illnesses and upskilling mental health specialists or offered long-term follow-up or supervision. We found 21 studies were appraised as low/moderate and 19 as high/critical risk of bias.Interpretation: In low resource country settings, upskilling and capacity building of primary care and community healthcare workers can lead to better detection and management of people with mental health disorders and help reduce the treatment gap.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42020203955.

Digital health interventions for the management of mental health in people with chronic diseases: a rapid review

ObjectiveDetermine the effectiveness of digital mental health interventions for individuals with a concomitant chronic disease.DesignWe conducted a rapid review of systematic reviews. Two reviewers independently conducted study selection and risk of bias evaluation. A standardised extraction form was used. Data are reported narratively.InterventionsWe included systematic reviews of digital health interventions aiming to prevent, detect or manage mental health problems in individuals with a pre-existing chronic disease, including chronic mental health illnesses, published in 2010 or after.Main outcome measureReports on mental health outcomes (eg, anxiety symptoms and depression symptoms).ResultsWe included 35 reviews, totalling 702 primary studies with a total sample of 50 692 participants. We structured the results in four population clusters: (1) chronic diseases, (2) cancer, (3) mental health and (4) children and youth. For populations presenting a chronic disease or cancer, health provider directed digital interventions (eg, web-based consultation, internet cognitive–behavioural therapy) are effective and safe. Further analyses are required in order to provide stronger recommendations regarding relevance for specific population (such as children and youth). Web-based interventions and email were the modes of administration that had the most reports of improvement. Virtual reality, smartphone applications and patient portal had limited reports of improvement.ConclusionsDigital technologies could be used to prevent and manage mental health problems in people living with chronic conditions, with consideration for the age group and type of technology used.

COVID-19-related prescribing challenge in intellectual disability

Background The COVID-19 pandemic and associated restrictions are expected to affect the mental health of the population, especially people with intellectual disability and/or autism spectrum disorder, because of a variety of biological and psychosocial reasons. Aims This study aimed to estimate if COVID-19 restrictions are associated with a change in number of total consultations carried out by psychiatrists and prescription of psychotropic medication in people with intellectual disability and/or autism spectrum disorder, within a community intellectual disability service. Method A quantitative observational study was conducted, involving retrospective and prospective data collection before and during lockdown. Data was collected on a spreadsheet and emailed to all psychiatrists working within the Coventry and Warwickshire Partnership NHS Trust-wide community intellectual disability service. Variables included total consultations, medication interventions, types of medications used, multidisciplinary team input and clinical reasons for medication interventions. Data was analysed separately for child and adolescent mental health services (CAMHS) and adult intellectual disability teams, and for the whole service. Results During the lockdown period, total consultations in the community intellectual disability service increased by 19 per week and medication interventions increased by two per week. Multidisciplinary team input increased in CAMHS from 0.17 to 0.71 per week and in adult intellectual disability from 5.7 to 6.5 per week. Hypnotics and benzodiazepines were the most commonly prescribed psychotropic medications during the lockdown period. Conclusions COVID-19-related lockdown resulted in an increase in medication interventions, total consultations and involvement of multidisciplinary teams to manage mental health and behavioural issues in people with intellectual disability and/or autism spectrum disorder.

Characteristics of Confidence and Preparedness in Paramedics in Metropolitan, Regional, and Rural Australia to Manage Mental-Health-Related Presentations: A Cross-Sectional Study

Mental-health-related presentations account for a considerable proportion of the paramedic’s workload in prehospital care. This cross-sectional study aimed to examine the perceived confidence and preparedness of paramedics in Australian metropolitan and rural areas to manage mental-health-related presentations. Overall, 1140 paramedics were surveyed. Pearson chi-square and Fisher exact tests were used to compare categorical variables by sex and location of practice; continuous variables were compared using the non-parametric Mann–Whitney and Kruskal–Wallis tests. Perceived confidence and preparedness were each modelled in multivariable ordinal regressions. Female paramedics were younger with higher qualifications but were less experienced than their male counterparts. Compared to paramedics working in metropolitan regions, those working in rural and regional areas were generally older with fewer qualifications and were significantly less confident and less prepared to manage mental health presentations (p = 0.001). Compared to male paramedics, females were less confident (p = 0.003), although equally prepared (p = 0.1) to manage mental health presentations. These results suggest that higher qualifications from the tertiary sector may not be adequately preparing paramedics to manage mental health presentations, which signifies a disparity between education provided and workforce preparedness. Further work is required to address the education and training requirements of paramedics in regional and rural areas to increase confidence and preparedness in managing mental health presentations.

“Companion, friend, four-legged fluff ball”: The power of pets in the lives of LGBTQ+ young people experiencing homelessness

Experiences of homelessness are challenging for lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) young people. LGBTQ+ young adults without stable housing endure mental health struggles stemming from multiple structural disadvantages. In navigating stressors, LGBTQ+ young people may develop bonds with companion animals, or pets. Demonstrating the diverse ways LGBTQ+ young adults manage mental health challenges while homeless, we qualitatively analyzed the narratives of 17 LGBTQ+ young adults (18–25) surrounding their pet relationships. Participants emphasized the positive power of pets in their lives to help offset stressors. These findings illustrate how marginalized young people manage their mental health through informal resources. Incorporating companion animals could potentially enhance services for LGBTQ+ youth experiencing marginalization.

Honamli Goats Breed in South of Turkey I- Serum Mineral Analysis

The objectivity of this study was to investigate some blood minerals and parameters in Honamli goats reared under semi-intensive conditions. 90 goats (2-4 ages) in different three herds kept under similar manage mental conditions were chosen as research materials in Teke Border of Antalya Province. Serum Ca 6.786±0.206 mg/dL, P 4.094±0.173 mg/dL, Cl 111.105±0.582 mmol/L, K 4.519±0.066 mmol/L, Mg 2.161±0.05 mg/dL, Na 148.047±0.508 mmol/L, Fe 110.706±2.510 μg/dL, UIBC 155.025±4.333 μg/dL and Tp 7.055±0.120 g/dL were determined by Roche Diagnostics, Cobas 8000 modular analyser series, immunoassay. After then, total iron- binding capacity (TIBC), transferrin (Tf), transferrin saturation (TSAT) and Ca++ levels were calculated from each other using different biochemical formulas. Ratios between the some minerals were calculated and presented in the text. Also, very high significant differences (P

Beyond clicks and downloads: a call for a more comprehensive approach to measuring mobile-health app engagement

Downloading a mobile health (m-health) app on your smartphone does not mean you will ever use it. Telling another person about an app does not mean you like it. Using an online intervention does not mean it has had an impact on your well-being. Yet we consistently rely on downloads, clicks, ‘likes’ and other usage and popularity metrics to measure m-health app engagement. Doing so misses the complexity of how people perceive and use m-health apps in everyday life to manage mental health conditions. This article questions commonly used behavioural metrics of engagement in mental health research and care, and proposes a more comprehensive approach to measuring in-app engagement.