bluuebunny/crossref_metadata_2025 huggingface dataset:
Socioeconomic and Psychosocial Stressors Contributing to General Adult Community Mental Health Recovery Service Referrals in Epsom, Surrey, a Retrospective Case Note Analysis
Authors: Fullerton Christine , Qazi Afaf
Published: August 2024

Aims

Referrals to secondary mental health services in the United Kingdom are at record levels. In the wake of the coronavirus pandemic and cost of living crisis, many experienced a deterioration in their social and financial circumstances. It is widely accepted that social determinants impact mental health and wellbeing. This analysis aimed to investigate socioeconomic and psychosocial stressors contributing to referrals to the Community Mental Health Recovery Service (CMHRS) for the general adult population in Epsom, Surrey.

Methods

This retrospective case note analysis focused on Single Point of Access (SPA) referrals made to CMHRS Epsom between 1st September 2022 and 1st September 2023. A random number generator was used to select a cross-section of 30 cases from 141 referrals. Following exclusion criteria, 29 cases were examined using an ICD–10 social determinants of health (Z55-Z65) lens. Finally, thematic analysis was used to identify key socioeconomic and psychosocial factors impacting referred patients.

Results

Patients were most commonly referred to CMHRS for presentations of suicidal ideation and self-harm (n = 13). Referrals were also related to symptoms of depression, anxiety and psychosis, the need for diagnostic clarity and for review of medication. All but one referral (n = 28) cited psychosocial stressors contributing to the patient’s presentation. Five key themes were identified. These were: current unemployment (n = 18), current housing and financial concerns (n = 18), ongoing social isolation (n = 19), relationship conflict and breakdown (n = 10) and a background of child sexual and physical abuse (n = 10). Protective factors, for those able to identify them, were exclusively linked to the patient’s social network (n = 22). Patients cited family members, friends, neighbours, the church and their pets as reasons to stay alive and accept support.

Conclusion

This analysis concluded that referrals to secondary mental health services in Epsom are significantly associated with a person's current and historical social circumstances. Policies and services which provide early intervention support with housing, employment and finances are vital in reducing the mental distress of at-risk individuals while also reducing pressure on mental health services. Reinforcing community and social support systems may be key in helping patients buffer psychosocial stress. Further study on this issue, involving a larger cohort, would be beneficial.
Suicide Prevention Intervention for Adults Presenting With Self-Harm in Pakistan: Cost-Effectiveness Analysis
Authors: Alvi Mohsin Hassan , Ashraf Tehmina , Gire Nadeem , Chaudhry Nasim , Husain Nusrat
Published: August 2024

Aims

Suicide is a serious global public health concern. Most suicide related deaths occur in low- and middle-income countries (LMICs) such as Pakistan. Self-harm is a major predictor of death by suicide and has cost implications both in terms of treatment and subsequent suicide. Therefore, culturally relevant interventions that have the potential to reduce self-harm in Pakistan may have major implications for the costs incurred by service provision and productivity losses due to illness or premature death. This trial investigated the clinical and cost effectiveness of the CMAP intervention verses enhanced treatment as usual (E-TAU) to reduce self-harm over 12 months in Pakistan.

Methods

Participants were recruited from emergency departments, primary care settings, medical units of participating hospitals and self-referral from community settings in Karachi, Lahore, Rawalpindi, Quetta and Peshawar. Eligible consented participants were assessed at baseline, 3- (end of intervention), 6-, 9- and 12-month post-randomization. Participants in the intervention arm received 6 one-to-one sessions of culturally adapted manual assisted psychological intervention (CMAP) over 3 months. The Client Service Receipt Inventory was used to record health service utilization, both formal and informal. Health related quality of life was measured using the EQ-5D-3L. The Thailand tariff value set (developed by the EuroQol Organization) was used to calculate quality-adjusted life year (QALY) because Thailand was deemed similar to Pakistan. The Incremental Cost Effectiveness Ratio (ICER) was calculated based on between arm differences in estimated cost and Quality Adjusted Life Years (QALYs) gains in the sampled population. Costs were converted to US dollars using the currency exchange rate on February 2024 (US$1 = PKR276)

Results

A total of 901 participants were randomized into either the CMAP arm (n = 440) or E-TAU arm (n = 461). Total QALY gained in the CMAP arm was 0.40 (95% CI: 0.36–0.45) and in the E-TAU arm was 0.33 (95% CI: 0.30–0.38) at 12-month post-randomization. The additional QALY gained due to CMAP intervention is 0.07. The difference in costs per participant between CMAP and TAU arms was US$59. The ICER for the CMAP versus E-TAU was US$843 per QALY gain.

Conclusion

Results revealed that the CMAP intervention is likely to be cost-effective compared with the E-TAU, given the cost-effectiveness threshold. These findings suggest that implementing culturally relevant self-harm and suicide prevention measures such as CMAP can lead to significant societal cost savings by preventing self-harm and suicides.
Stakeholder's Views on the Development of Mobile Application (TechCare) for Patients With First Episode With Psychosis: Qualitative Study
Authors: un Nisa Zaib , Gire Nadeem , Khoso Ameer Bukhsh , Cahudhry Imran B. , Husain Nusrat
Published: August 2024

Aims

Psychosis is one of the leading causes of disability. First Episode Psychosis (FEP) significantly impacts the long-term course of the disorder. While a majority of FEP service users show signs of ‘recovery' within 12 months of treatment, the early course involves frequent relapses, with up to 80% relapsing within five years. This elevates the risk of persistent psychotic symptoms, affecting cognitive, social, and occupational functioning. Medication, the core treatment, reduces relapse by 75%, necessitating additional psychosocial treatments. Mobile-based interventions are recognized for meeting families' needs in terms of information, guidance, and support. This paper explores stakeholder views on developing mobile interventions for those experiencing their first psychosis episode.

Methods

This qualitative paper was part of the TechCare app development process in which face-to-face interviews with patients (17), and 4 focus groups with health professionals were carried out. The qualitative interviews and focus groups explored the views of stakeholders on the need for mobile-based treatment, the structure of the application, the content of the application and barriers and challenges were also explored in detail. All the audio-recorded interviews were transcribed and analyzed through a framework approach.

Results

Qualitative analysis revealed three themes. The first theme centers on stakeholders' views about mobile-based treatment. Health professionals reported that app-based treatment enhances help-seeking behavior, reduces societal stigma, and aids in managing treatment and activities. The second theme focuses on suggestions for the Techcare application, emphasizing logical and easy-to-understand content, with a major focus on crisis management, hallucinations, and psycho-education about symptoms. Participants also highlighted the need for a section providing psycho-education for families. Carers emphasized the necessity of an activity plan in the app, including an activity log for medication management and activities. The third theme delves into barriers and challenges in app-based treatment, including difficulty levels and privacy concerns. Stakeholders stressed the importance of content in simple Urdu language for broader understanding.

Conclusion

In conclusion, mobile-based treatment contributes to reducing stigma, increasing awareness about the illness in its early stages, and facilitating the management of functional activities for patients. The insights gathered from stakeholders provide valuable guidance for the development of an effective and culturally sensitive mobile-based intervention for individuals experiencing FEP.
Acceptability and Effectiveness of Low Intensity Mental Health Services for Children and Young People Attending a General Hospital
Authors: Roach Anna , Groszmann Mike ,   The UCLH Psychological Medicine Team,   The Lucy Project Team
Published: August 2024

Aims

Despite the high prevalence of mental health disorders in children and young people (CYP) with long-term health conditions (LTCs), these difficulties are often overlooked and untreated. Previous research demonstrated the effectiveness of low intensity psychological support provided via a drop-in mental health centre in a single specialist paediatric hospital. The aim of this study is to determine the effectiveness and acceptability of accessible low intensity mental health services for CYP attending a general hospital.

Methods

This project was part of a wider prospective non-randomised single-arm multi-centre interventional study (Trial registration: ISRCTN15063954). CYP aged up to 25 years old with a LTC, who had been receiving care for their LTC for 6 months or more, and their parent/carer were eligible to be referred by their clinician or self-refer to the trial. The primary outcome is the difference in the total difficulties score on the Strengths and Difficulties Questionnaire (SDQ) reported by parent or CYP between baseline and 6 months. Interventions provided were: low intensity CBT, onward referral or signposting.

Results

53 families were recruited at this hospital which made up 44% of the total study sample (120 families). Patients recruited were made up of 34 females, 18 males and one young person who identified as non-binary. The mean age of the CYP was 16.13 years and they were living with a range of different LTCs including cancer, asthma and diabetes. At baseline the average self-reported and parent reported SDQ scores were within the “very high” range (21.52 and 22.03, respectively). All participants were offered an initial assessment within 3 weeks of consenting (average 19.6 days) and treatment began within a month. Qualitative feedback from families has identified how the service “fills a gap” between physical and mental health and their satisfaction with how “time-sensitive” support was available.

Conclusion

There is significant demand for this service and CYP living with different LTCs are accessing and utilising the service provided. This model of intervention allows timely access to evidence-based mental health support for CYP attending a general hospital for their physical health needs, compared with standard waiting times in other services.
Do Medical Students Adopt Problem-Focused or Emotion-Focused Coping Strategies?
Authors: Hawsawi Aisha , Nixon Elena , Nixon Neil
Published: August 2024

Aims

The pursuit of a career in medicine, while potentially rewarding, is undeniably accompanied by demanding challenges. These challenges encompass not only rigorous academic demands and long work hours but also contend with a competitive academic environment, conflicts in maintaining a study-life balance, and a multitude of other stressors unique to the medical profession. Amidst this backdrop, concerns are growing worldwide about the mental health challenges that medical students face as they start their careers in medicine. Coping can play a pivotal role in overcoming these challenges. This study explores how coping is associated with wellbeing aspects, i.e., anxiety and depression, as well as personality, and looks into the coping strategies adopted by medical students, specifically focusing on whether they predominantly employ problem-focused or emotion-focused coping. Additionally, it aims to explore contextual factors influencing students' coping strategies, which is crucial for informing wellbeing interventions and support services.

Methods

This study used a mixed-methods approach, employing quantitative data on coping, personality, stress, anxiety and depression and qualitative data from semi-structured interviews with preclinical and clinical year medical students at the University of Nottingham.

Results

Regression findings revealed that medical students primarily used emotion-focused over problem-focused coping. Interestingly, thematic analysis showed that medical students employ problem-focused coping strategies in rigorous, academically challenging and controllable situations such as upcoming exams; they prioritise structured study schedules, seek additional academic resources, and actively engage with faculty to enhance their understanding of complex topics; conversely, emotion-focused coping emerged prominently in the face of personal or interpersonal stressors, particularly in situations perceived as uncontrollable. In such instances, like unexpected setbacks or health concerns, students may acknowledge and express their emotions and engage in activities for emotional relief, including seeking wellbeing support.

Conclusion

The study reveals a dynamic interplay between problem-focused and emotion-focused coping strategies in medical students. Recognising that medical students tend to adopt different coping strategies in different situations, medical education systems should aim to develop or tailor existing resources to provide appropriate academic and wellbeing support.
Comparative Psychological Evaluation of Individuals With and Without Cleft Lip and Palate: A Systematic Review and Meta-Analysis
Authors: Eltayib Riham , Ibrahim Danya
Published: August 2024

Aims

This study sought to assess and compare the psychological well-being of both children and adults with cleft lip and palate (CLP) in contrast to those without CLP. The focus was on self-satisfaction regarding facial appearance, popularity among peers, and self-esteem.

Methods

This study was registered at the University of Dundee, including various study designs such as randomized controlled clinical trials, longitudinal, cross-sectional, and observational studies. Only studies concentrating on non-syndromic CLP in children and adults were considered. No limitations were set on age or language. Self-reports, including validated and unvalidated questionnaires, interviews, and observational/clinical assessments, were deemed suitable. Database searches were performed in Medline, Pubmed, Scopus, Cochrane, and Web of Science (January 2019). An electronic search yielded 334 results, with 74 articles meeting the inclusion criteria. After screening and risk of bias assessment, four articles were included in the qualitative analysis, three of which were included in the meta-analysis.

Results

The review encompassed four studies conducted in China, Japan, Sweden, and the United States, involving 442 participants (non-CLP control group n = 305, CLP group n = 137). While the majority of individuals with CLP did not exhibit significant psychological issues, certain challenges were noted, particularly concerning speech or hearing difficulties, depression, anxiety, and interpersonal relationships. Age did not seem to correlate with the occurrence or severity of psychological problems in CLP patients, with gender playing a significant role, as females tended to be more sensitive to facial appearance. The level of self-satisfaction was not statistically significant between the two groups (OR = 0.85) while the non-CLP group was more likely to rate themselves as being more popular among their peers (OR = 1.48). Also, the non-CLP group has higher self-esteem than CLP patients (OR = 1.05).

Conclusion

Limited evidence suggests that some individuals with cleft lip and palate may face psychological challenges, indicating a need for more structured approaches to assess the psychological well-being of CLP patients.
Gender Differences in the Emergence of Post-Traumatic Stress Disorder Following a Single Exposure to a Terrorist Related Crime: A Meta-Analysis
Authors: Khan Huma Riaz , Ibrahim Ahmed Usman
Published: August 2024

Aims

To quantify and evaluate the gender differences regarding the development of PTSD. This meta-analysis calculates (a) the difference between males and females who develop PTSD, and (b) the difference in gendered relative risk of PTSD development.

Methods

Study selection criteria included participant mean age above 18 years, single and direct exposure to a terrorism related traumatic event, and a confirmed diagnosis based on Diagnostic and Statistical Manual of Mental Disorders 5th edition. Data extraction included year and location of terrorist event, the total number of participants in the study, the total numbers of males and females diagnosed with PTSD, and time (in months) of diagnosis following the traumatic event. The number of males and females affected by PTSD was pooled using random effects inverse variance weighted meta-analysis and relative risks (95% confidence interval) were calculated.

Results

Twenty-seven studies met the inclusion criteria of which five had significant information to be included in the meta-analysis. The total number of males in the pooled sample size was 328, and the total number of females was 354 out which a total number of 34 males and 66 females met the PTSD criteria. The mean average of males and females affected by PTSD was 6 and 11, respectively. An independent samples Mann Whitney U test rejected the null hypothesis (p < 0.05) and concluded that the distribution of PTSD between males and females was significantly different. The meta-analysis found an overall relative risk of a diagnosis of PTSD in females to be 1.82 (95% CI 1.25–2.65) compared with males.

Conclusion

This meta-analysis found females to have an elevated risk of developing PTSD following a single terrorism traumatic event. The results of our study are supported by previously published research, which has found females to be at higher risks of developing PTSD. However, such research has proposed gender differences secondary to the types of stressful events experienced, which does not apply to our meta-analysis given the uniformity of the traumatic event we explore. Other factors, therefore, need investigating to understand this phenomenon.

We acknowledge that researching psychological consequences in communities affected by terrorism is complicated and limited by lack of healthcare access, trained clinicians, cultural diversity in the expression and articulation of a community's traumatic experience and of course, the instability of the ground fabric. Other limitations of the included studies are the binary of gender reporting, which limits a fuller understanding of a minoritized community.
Predictors of the Course of Post-Traumatic Stress Disorder After Physical Injury Over Two Years
Authors: Kim Jae-Min
Published: August 2024

Aims

The course of post-traumatic stress disorder (PTSD) is complex and remains an area of active investigation, as analyses aimed at identifying predictors of PTSD outcomes often produce variable and inconsistent results. This particular study delves into the progression and patterns of PTSD over a two-year period, focusing on individuals who are in the recovery phase from severe physical injuries. The research aims to understand the different trajectories that PTSD can take and to identify the factors that may influence these pathways, with the goal of enhancing our understanding and treatment of this challenging and multifaceted condition.

Methods

Patients were recruited from a trauma center at a university hospital in South Korea between June 2015 and January 2021. At baseline, 1142 patients underwent evaluations encompassing trauma and PTSD-related measures, socio-demographic characteristics, pre-trauma characteristics, and peri-trauma assessments. They were subsequently followed up for PTSD using the Clinician-administered PTSD Scale (CAPS) at 3, 6, 12, and 24 months. The analyzed sample consisted of 1014 patients who were followed up at least once after the baseline and 3-month evaluations. Latent class growth analysis was employed to identify distinct trajectory groups, and logistic regression models to ascertain predictors associated with each trajectory.

Results

The study identified five unique trajectories of PTSD progression among the patients: resilient, worsening/recovery, worsening, recovery, and chronic groups. The "worsening/recovery” trajectory, which indicates patients whose symptoms initially worsened but later improved, was predominantly associated with individuals who had experienced previous traumatic events and those who had sustained injuries from traffic accidents. On the other hand, the "worsening” trajectory, where patients' symptoms continuously deteriorated over time, was linked to individuals with higher education levels and elevated depressive symptoms. The "recovery” trajectory, characterized by a gradual improvement in symptoms, was more common in female patients and those with a history of childhood abuse, traffic-related injuries, a dissociative subtype of PTSD, and higher levels of anxiety and depressive symptoms. Lastly, the "chronic” trajectory, where patients experienced persistently severe symptoms, was predicted by the presence of a dissociative subtype of PTSD and heightened anxiety symptoms. These findings illustrate the diverse paths PTSD can take and highlight the importance of various factors in influencing these trajectories.

Conclusion

These findings highlighted the heterogeneity of PTSD symptom development and thus the importance of considering individual characteristics when assessing and addressing PTSD following severe physical injuries.
Point-of-Care Blood Testing in Severe Mental Illness: A Mixed-Methods Evaluation
Authors: Lyman Monty , Fanshawe Jack , Brewin Josh , Fanshawe Thomas , Turner Philip
Published: August 2024

Aims

There is a significant mortality gap between the general population and people with SMI. This is especially prominent in those with psychotic disorders, underpinned by an increased risk of cardiometabolic disease. Identifying patients at risk early in their psychotic disorder is of key importance to reduce this mortality gap. Despite the recognised importance of regular physical health assessments in this group, completion rates are suboptimal. Point-of-care testing (POCT) to screen for diabetes and hyperlipidaemia, providing a result from a fingerprick sample in under 10 minutes presents a potential solution to enhance delivery of physical health checks and improve health outcomes in a proactive manner.

We introduced POCT across EIP teams in Southeast of England and evaluated the impact on physical health check completion rates and the quality of clinician-patient interactions in EIP teams.

Methods

A stepped wedge study was performed, introducing Abbot Afinion-2 machines across 30 EIP teams in all eight Mental Health Trusts in South East England (2021–2022). Numbers of completed physical health checks, and HBA1C and lipids blood tests completed in six months before and six months after introduction of POCT were collected from individual patients. Data were compared with those from the South West, which acted as a control region. Data were analysed from National Clinical Audit of Psychosis (NCAP) over comparable date range (2021–2022) to corroborate the findings. Clinician questionnaires were administered at three timepoints (after training, two-months, and eight-months), capturing training experiences, device usability and impacts on patient interactions.

Results

In Southeast England, the rate and quality of physical health checks increased after introduction of POCT HbA1c testing OR 2.02 (95% CI 1.17 to 3.49), lipids 2.38 (1.43 to 3.97), and total completed health checks 3.61 (1.94 to 7.94). These increases were not seen in the Southwest region that did not introduce the machines. A post-hoc review of national audit data also showed a greater improvement of health checks in the intervention group compared with the comparator group over an overlapping timescale. Findings from the questionnaires evidenced improved patient engagement, clinician empowerment and the preference of POCT over traditional blood tests in this setting.

Conclusion

POCT is associated with improvements in the rate and quality of physical health checks, and this study emphasizes the potential of POCT in reducing health inequalities and enhancing holistic care for individuals living with severe mental illness.
ComPASSION: A Screening Tool for Type 1 Diabetes and Disordered Eating (T1DE)
Authors: Major Benjamin , Partridge Helen , Zaidman Sebastian , Nicholson Eveleigh , Figueiredo Carla
Published: August 2024

Aims

Background: In 2018, NHS England funded a one-year project of a combined approach for physical and mental health services to support those with type 1 diabetes and eating disorders – ComPASSION Project. Part of this project looked to develop a questionnaire screening tool to improve early recognition of those at risk of T1DE.

Aims: To assess the effectiveness of an adapted questionnaire in identifying patients at risk of T1DE in a routine diabetes clinic. To this end, we focussed on two main aspects:

1.

Discussion around weight and body image – patient discussion topic.

2.

Diabetes distress score.

Methods

Data from a modified questionnaire was collected retrospectively from diabetes clinics across two hospital sites July 2019–March 2020 with a total study size of 300 patients. Questionnaire responses from those with T1DE were compared with those without.

Results

The questionnaire screening tool is an effective screening tool identifying Type 1 diabetic patients at risk of disordered eating. Patients with T1DE were more likely to raise concerns regarding weight and/or body image. Diabetes distress scores were significantly greater in T1DE patients.

Conclusion

Healthcare professionals should be alert to patients with Type 1 diabetes at risk of disordered eating. Early identification of patients with T1DE is possible when using patient discussion topics and assessing the diabetes distress score. Further studies are needed to assess the effectiveness of this questionnaire screening tool on a larger population.
Gender Differences Amongst First-Time Admitted Psychiatric Inpatients in Palestine
Authors: Marzouqa Nizar , Alhroob Thaer , Alnammourah Wala , Awwad Asala , Oweina Layth
Published: August 2024

Aims

Bethlehem Psychiatric Hospital is the only psychiatric hospital in the West Bank. Gender differences aren't widely studied in medical Palestinian research, therefore, data on it is very scarce. This study aims to study gender-based patterns of clinical and demographic characteristics amongst patients admitted for the first time at Bethlehem Psychiatric Hospital over a year.

Methods

A retrospective cross-sectional study was conducted at the Bethlehem Psychiatric Hospital, reviewing the medical records of patients admitted for the first time between October 2022 and October 2023. First, data collection was conducted manually by residents transferring information from paper-based files to an Excel sheet. Next, sociodemographic and clinical variables were selected. Finally, the 21st version of IBM SPSS was used to analyze the role of gender factors.

Results

For the 140 patients admitted for the first time to the psychiatric hospital between October 2022 and October 2023, the majority (70%) were male, with a mean age of 31.6 for males and 35 for females.

Most variables showed no significant differences between male and female patients. Of the variables that showed significantly (p < 0.05) higher occurrence in male patients were imprisonment, physical aggression (78.6% of males, 61.9% of females), smoking (84.4% of males, 14.3% of females), and substance use (36.7% of males, 2.3% of females). However, length of stay, clozapine prescription, and parents' consanguinity were significantly higher in women.

Conclusion

This is the first study conducted about gender differences in Palestinian psychiatric inpatients. Some elements pointing to antisocial traits (like imprisonment and substance use) were more common in males, while women stayed longer at the hospital. Studying these measures and their etiology is crucial for better understanding and management.

There is a need for more research on gender differences, and Palestinian psychiatry as a whole, integrating social-economic, cultural, and medical views, to provide better equitable care for patients, and be able to advocate better for them.
Comparison of Temperament and Cognitive Function Between Basketball and Baseball Players
Authors: Kim Kun Jung , Han Doug Hyun , Kim Sun Mi , Min Kyung Joon
Published: August 2024

Aims

The purpose of this study was investigating the differences in temperament, personality, and cognitive function among athletes and non-athletes, as well as differences within athlete groups participating in different-paced sports like baseball and basketball.

Methods

A total of 57 professional basketball players, 51 professional baseball players, and 44 non-athletes subjected to temperament and characteristics inventory assessments and computerized neurocognitive function test. One-way analysis of variance (ANOVA) was employed to analyze the average differences in demographic characteristics, temperament, personality traits, and cognitive functions among the three groups, followed by Bonferroni post hoc tests. Comparisons between starters and non-starters within the athlete groups were conducted using the Mann–Whitney U test.

Results

In the analysis of temperament, the basketball and baseball player groups exhibited higher reward dependence and persistence compared with the control group. Additionally, in the assessment of personality traits, both basketball and baseball player groups scored higher in self-directedness and cooperativeness compared with the control group, whereas self-transcendence scores were lower. In cognitive ability assessments, baseball and basketball players outperformed the control group in emotional perception tests. Both baseball and basketball players showed lower card movement counts compared with the control group.

Conclusion

This study compared the differences in temperament, personality, and cognitive abilities between professional basketball and baseball players and non-athletes. These results provide valuable insights into the temperament, personality, and cognitive abilities of professional athletes, contributing important information for athlete development and coaching goals in the future.
Evaluation of the TRANSFORM Pilot Training Program for Community Health Workers and Traditional and Faith-Based Healers in Bangladesh
Authors: Soron Tanjir Rashid , Azmery Kazi Shammin , Akter Farzana , Rana Belaluzzaman , Rahman Maksudur
Published: August 2024

Aims

In the densely populated Korail slum of Bangladesh, there is a critical gap in mental health care provision and utilization that was revealed in our ethnographic study. We observed the pivotal role of Community Health Workers (CHWs), Medicine Sellers, and Traditional and Faith-Based Healers (TFHs) in the existing health care service delivery. Moreover, we explored the opportunity to collaborate with them to ensure universal access to biomedical care for serious mental disorders in this slum. As a part of this collaborative approach, we aimed to train these 4 key stakeholders through co-designed training programs that were codeveloped through extensive community engagement including 5 co-designing workshops and 2 writing workshops with them. Furthermore, we refined the initial training program by an expert committee and stakeholders. This training program was piloted to find out the acceptability, feasibility, impact, challenges and areas of improvement.

Methods

We followed mixed-methods approach to evaluate the 3-day pilot training with 20 participants at Mirpur, Dhaka. In quantitative part of evaluation we used a) pre and post test assessment that has been carefully designed to assess knowledge, skills, communication, attitudes and motivation, b) session specific questionnaire to find out feedback of the content, activities and time sensitivity of the session, anonymous feedback forms.

In the qualitative part, we conducted a) focus group discussions (FGDs) after completion of training with each group, b) observational notes from each session for deeper understanding.

Results

The pilot training engaged a diverse group of 20 participants and their age ranged from 24 to 52 years, representing 11 different organizations. Though most of the participants were working in the health sector for a long time, we found more than 10% of the participants believed there was no effective biomedical care for the serious mental disorder during pretesting. However, their perception changed during the training. The role playing and case scenario was the most engaging and enjoyable part. We found the participants considered their knowledge regarding the mental health increased up to 80% from their baseline. Our research team also found the increased number of referrals to the biomedical care from the community after the pilot training.

Conclusion

The increased motivation and sense of responsibility reported by participants underscore the training program's effectiveness and the experience and learning from this pilot helped us to further refinements of the training program for the traditional and faith based healer, community health workers and medicine to transform the mental health scenario in Bangladesh.
Menopause and Risk-Taking Behaviours: A Cross-Sectional, Online Survey
Authors: Reisel Dan , Kamal Aini , Glynne Sarah , Newson Louise
Published: August 2024

Aims

Limited data suggest that negative mood symptoms in the menopause transition may be associated with a higher prevalence of alcohol misuse and other risk-taking behaviours in menopausal women. Excessive alcohol consumption can exacerbate menopausal symptoms, reduce quality of life and is associated with chronic morbidity that overlaps with the consequences of long-term oestrogen deficiency (such as osteoporosis and cardiovascular disease). The aim of this survey was to explore the impact of mental ill-health on alcohol consumption and gambling habits in menopausal women.

Methods

We constructed an anonymous survey consisting of multiple-choice and free-text questions. The survey was distributed online via social media channels on the 22 August 2023 and was open for 6 weeks. All perimenopausal and menopausal women were invited to participate. Responses were collected using the Qualtrics survey platform and analysed in Excel for descriptive statistics.

Results

1,178 responses were submitted. One in three women reported drinking more alcohol during the perimenopause/menopause; 15% of women drink more than the recommended maximum of 14 units per week, and 24% (286) are spending up to £50 per week on alcohol. 70% (332) cited anxiety, stress, and/or depression as the reason for their increased alcohol consumption, whilst 29% (135) said they drank to alleviate menopause symptoms. Further, 5% (54) of respondents admitted gambling more since the onset of perimenopause/menopause; 43% (27) said it was due to anxiety, stress, and/or depression, whilst 13% (9) said they do so to help manage their menopause symptoms.

Conclusion

This anonymous, cross-sectional survey found evidence of an association between menopause and addiction. Increased awareness of this association should facilitate earlier recognition and more timely access to support and effective treatment for addiction, including hormone replacement therapy to treat menopausal symptoms that may underlie and/or exacerbate unhealthy lifestyle behaviours.
Efficacy of Transcranial Magnetic Stimulation (TMS) on Negative and Cognitive Symptoms in Schizophrenia – a Systematic Review and Meta-Analysis
Authors: Rudrappa Roopa , Cavanna Andrea , Rickards Hugh , Ul Haq Katshu Mohammad Zia
Published: August 2024

Aims

Traditional antipsychotic treatment improves positive symptoms in schizophrenia but has little impact on negative and cognitive symptoms. TMS is a non-invasive neuromodulation technique which has been suggested to impact negative and cognitive symptoms of schizophrenia. This systematic review critically appraised the research evaluating the effect of TMS on negative and cognitive symptoms of schizophrenia. Furthermore, we carried out a meta-analysis of randomised controlled trials of the effect of TMS on negative symptoms in schizophrenia.

Methods

Systematic review was carried out according to PRISMA guidelines. Cochrane Library, Ovid Medline, Science Direct and PubMed databases were searched for relevant studies using the search terms: “transcranial magnetic stimulation” OR “TMS” OR “repetitive transcranial magnetic stimulation” OR “r-TMS” OR “theta burst stimulation” OR “TBS” AND “negative symptoms” OR “cognitive dysfunction” OR “cognitive impairment” AND “schizophrenia” OR “psychosis”. Only randomised controlled trials evaluating the effect of TMS (rTMS or iTBS, intermittent theta burst) on negative and/or cognitive symptoms in schizophrenia were selected. Thirty-three studies were included in the systematic review. The Standardised mean difference (SMD) with 95% confidence interval (CI) was calculated for each study and pooled across studies using an inverse variance random effect model.

Results

Sixteen studies demonstrated significant improvement in negative symptoms with a superior effect of TMS compared with sham intervention. Eight studies showed improvement in certain domains of cognition and one study showed a delayed effect on negative symptoms. Studies which showed positive effects on negative symptoms have used similar TMS parameters such as 10 Hz over L-DLPFC (Left dorsolateral prefrontal cortex) except for a few studies. Ten studies reported negative results for negative and/or cognitive symptoms, TMS parameters and duration of treatment used varied among these studies. Overall, SMD for SANS (Scale for Assessment of Negative Symptoms) was 0.89 (95%CI: 0.46–1.32, P < 0.00001) and for PANSS-N (Positive and Negative Syndrome scale-negative) was 0.67 (95%CI: 0.22–1.12, P < 0.00001), both in favour of TMS. The heterogeneity of the included studies was high, I2- 85% for SANS and 92% for the PANSS-N subscale with a small to moderate risk of publication bias.

Conclusion

High-frequency rTMS is more effective than sham in improving negative and cognitive symptoms in schizophrenia. Our results suggest the need for well-designed randomised controlled trials with larger sample sizes and standard harmonised cognitive assessments to assess the effect of TMS on negative and cognitive symptoms to provide sufficient evidence for inclusion in routine clinical practice.
Technology Enabled Remote Monitoring in Schools(TERMS): A Case Study Series Using Parallel Testing in Clinical Settings and School Workshops
Authors: Sameem Hafeesa , Ahuja Alka , Johns Gemma , Simmons Mrs Vicky , John Oliver
Published: August 2024

Aims

The TERMS (Technology Enabled Remote Monitoring in Schools) project aimed to elucidate the operational dynamics of remote monitoring with bluetooth-enabled physical health monitoring devices. The focus was on measuring key parameters such as usage, perceived value, accuracy, and satisfaction among patients, their families, and healthcare staff. Additionally, we sought to explore the potential future integration of remote monitoring in educational settings through school site workshops.

Background

Digital healthcare has become an indispensable part of effective healthcare provision on a global level. Remote monitoring is the use of technology, to monitor patients outside of a clinical setting with the help of medical devices, questionnaires, and clinical dashboards, allowing clinicians to review the data to assist in clinical assessment and decision-making. While this method is already established for conditions like Diabetes and Asthma it is not for other conditions like ADHD. This is especially a challenge for the younger demographic.

Schools are pivotal for promoting student well-being and early interventions, leading to reduced negative outcomes like exclusion and school absence and enhanced academic attainment. The TERMS project strives to bridge the gap between education and healthcare by collaborating with schools and clinicians. This is in alignment with the digital and data strategy for health and social care in Wales as outlined by the Welsh Government(2023).

Methods

This study had 2 parts:

Clinical Site Testing:

Blue tooth-enabled clinical monitoring device readings were obtained after they were monitored first with traditional clinical monitoring devices. Additional qualitative feedback was also obtained.

Educational Workshops:

Workshops were carried out with students and teaching staff to collect qualitative and quantitative feedback on the remote monitoring equipment and patient-facing dashboard. This also set out to determine if remote monitoring in schools is feasible and how it could be implemented.

Results

A total of 47 clinical patient cases were included. The accuracy of the bluetooth-enabled device readings and those of traditional equipment were compared. Analysis of the qualitative data revealed useful domains and subdomains of opinions along with the user-friendliness of the software interface.

Conclusion

Overall, we have identified that patient and family perception of remote monitoring is positive, suggesting an improved/comparable level of care for their condition. Additionally, school workshops highlight that this service could be implemented within a school setting. As long as considerations were made for who would conduct the remote monitoring and what the role of the school would be.
Improving Communication Between the Community Learning Disability Team, Patients, Their Carers and Primary Care Services Within Aneurin Bevan University Health Board
Authors: Scanlon Kathleen , Richings Ceri , Howe Gareth
Published: August 2024

Aims

Recommendations from the NHS and the Royal College of Psychiatrists advise that patients receive a copy of all correspondence that is sent on to the GP. Often, within psychiatric services, letters are not routinely sent to patients.

To improve communication with patients and their carers, the Aneurin Bevan Learning Disability team have been writing letters directly to patients and sending a copy to the GP.

There is limited use of jargon, and the complexity of the language aims to reflect the individual's reading level.

This study aimed to gain feedback from local GPs on the new letter format to ensure effective communication between teams.

Methods

We contacted Primary Care Services in the local area to gain feedback on how our clinic letters were being processed, we were informed that letters are reviewed by an admin team and only sent on to GPs if there are specific tasks to action, meaning that many of our letters remain unread.

We identified 16 GP practices in the Torfaen and Monmouthshire area and sent a survey by email to gain feedback on the new correspondence style. The survey was sent out three times within a 12-month period.

Results

Of 16 GP practices just 6 responded, with just 1 GP stating that they had noticed a change in the letter style. 50% of GPs felt they received relevant information in the letters from the CLDT. The comments were largely positive with suggestions reflecting changes that have already been made. There is no feedback that suggests GPs feel they are not receiving adequate clinical information.

Conclusion

The lack of response may highlight how infrequently GPs are reviewing the letters from the CLDT confirming the importance of prioritising doctor–patient correspondence. The limited communication from GP to CLDT emphasises the need for improvement in liaison between secondary and primary care services.

The lack of negative feedback about the letters is encouraging. There is no feedback that suggests GPs feel they are not receiving adequate clinical information and clear feedback that GPs want clear and accessible information, particularly regarding specific actions for GPs.

A clear limitation of this work is the lack of response to our survey. Reviewing these letters from our team is a very small proportion of a GPs workload, more time may be needed to ensure GPs have had contact with our team and are able to provide more detailed feedback.
Personality Disorder and Crisis in the COVID-19 Pandemic
Authors: Sethi Amar , Howe Andrew
Published: August 2024

Aims

To identify if COVID-19 has changed the experience for patients under the care of Crisis Resolution Home Treatment teams (HTT).

To identify if COVID-19 altered the response for HTT patients in the context of Personality Disorder (PD).

To provide useful demographic and experiential information about patients using HTT with PD during crisis.

Methods

Data regarding the demographics of patients with personality disorders under the care of the Croydon crisis home treatment team were collected retrospectively for two, predetermined time windows. The first window was pre-COVID-19 (26/03/2019–25/03/2020) and the second window was during COVID-19 (26/03/2020–25/03/2021). The demographics of patients with personality disorder referred to the team during these two time periods included were compared.

Results

More patients with personality disorder were referred to the Croydon HTT during COVID-19 (n = 82) when compared with the window before (n = 58). The proportion of referred patients with Emotionally Unstable Personality Disorder (EUPD) was constant before and during COVID-19. The average length of stay reduced from 22.6 days before COVID-19 to 18.7 days during COVID-19. The proportion of rejected referrals to the HTT of patients with personality disorder increased during COVID-19. Finally, the proportion of BAME (Black, Asian, Minority Ethnicity) referrals of patients with personality disorder increased during COVID when compared with before, with this finding not being replicated in any other ethnic group.

Conclusion

Increased numbers of referrals may indicate worsening mental health in the community. This may have been compounded by an inability of community mental health teams and inpatient services to meet such an increase in demand for services. An overall reduction in inpatient admissions during COVID-19 supports this idea. There was a relatively larger drop in duration of admission for patient with personality disorder during COVID-19, when compared with all patients. This may be due to staff feeling unable to offer quick management for patients with personality disorder. Subsequently, staff may have selectively discharged such patients earlier. The rate of rejected referrals to the Croydon HTT was consistently higher than the acceptances both pre- and post- COVID-19. Therefore, HTT clinicians may feel unable to adequately treat PD.

In conclusion, the number of referrals to the HTT increased during COVID-19, however, with a reduced average duration of stay with HTT for patients. The rejection rates for personality disorder patients were consistently higher than for other patient groups, both before and during COVID-19. Additionally, the proportion of patients with personality disorder from BAME backgrounds increased during COVID-19.