bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Depression Amongst Adult Hemophilia Patients Registered With Hemophilia Foundation of Zambia
Authors: Darji Dhruv 
Published: August 2024

AimsMain ObjectiveTo assess the prevalence of depression (major depression) amongst adult hemophilia patients in Zambia.Specific Objectives
1.To assess the prevalence of depression amongst adult hemophilia patients in Zambia using the Patient Health Questionnaire 9 (PHQ9) tool to screen for/diagnose depression.2.To determine risk factors, amongst hemophilia patients, to developing depression.3.To ascertain factors that significantly associate with depression amongst adult patients with hemophilia in Zambia.MethodsThis was a quantitative cross-sectional study, conducted by administering the study questionnaire to collect data on demographic characteristics, clinical characteristics and the Patient Health Questionnaire – 9. A total of 59 adult patients with Hemophilia in Zambia, registered under the Hemophilia Foundation of Zambia were interviewed through the questionnaire. The data were analyzed using STATA 14. Descriptive analyses were done on the data, responses on PHQ-9 were totaled to assess for the prevalence of depression. Depression was defined as PHQ-9 ≥ 5; Major Depression as PHQ-9 ≥ 10. Pearson Chi-2 test was done to assess for associations and a logistic regression model was created to show the relationship between significant risk factors (independent variables) and depression.Results59 participants were interviewed in this study. They were all male with an average age of 24.77 years from various parts of Zambia. 91.53% of the patients reported to have Hemophilia A, while 8.47% had Hemophilia B, there were no patients with Hemophilia C. The average PHQ-9 score was 8.66. 83.04% of participants had depressive symptoms (PHQ > 5); 44.06% having major depression and only 16.96% of the participants reported no depression. Number of painful bleeding episodes (OR = 2.063; P = 0.048) and difficulty in performing daily activity (OR = 4.311; P = 0.008) were significantly associated with a higher risk for major depression.ConclusionThere was a high prevalence of major depression (44.06%) amongst adult patients with hemophilia registered under the Hemophilia Foundation of Zambia. Hence there is need for addition of mental health care to the multidisciplinary management of adults with hemophilia for improved health outcomes due to the high prevalence of depression amongst this group. Additionally, patients who suffer many painful bleeding episodes must be prioritized candidates for mental health care.
Exploring Pathways to Autism Spectrum Diagnosis in Adulthood
Authors: Dufour Isabelle , Brodeur Sébastien , Chiu Yohann , Dubé Émilie , Couture Mélanie 
Published: August 2024

AimsAutism spectrum is a neurodevelopmental condition usually diagnosed in early childhood. The broadened diagnostic criteria of the DSM–5 (2013) have led to an increasing number of autism spectrum diagnoses of individuals requiring lower levels of support. Barriers to diagnosis, especially in adults, include the complexity of differential diagnosis with co-occurring psychiatric disorders. This study explored the various pathways of psychiatric diagnosis preceding an autism spectrum diagnosis in adulthood.MethodsThis retrospective cohort study was extracted from health-administrative data from Quebec (Canada) and included all adults with a first recorded autism spectrum diagnosis between 2010 and 2017 (index date). A Trajectory of psychiatric Diagnoses (TDx) was defined as a succession of categorical states, each corresponding to a medical record of a psychiatric diagnosis. These TDx were analysed from 2002 to 2017, using a state sequence analysis with trimester as time units. For each trimester, we defined the following diagnoses in order of priority: 1) autism spectrum, 2) intellectual disability (ID), 3) schizophrenia, 4) bipolar disorder (BP), 5) depressive disorder (DD), 6) anxiety disorder (AD), 7) attention-deficit/hyperactivity disorder (ADHD), and 8) other psychiatric disorders. The simple Hamming metric was used to measure the dissimilarity between TDx, followed by a hierarchical cluster analysis to categorise similar trajectories.ResultsThe study cohort included 2799 adults diagnosed with autism spectrum between 2010 and 2017. Several psychiatric disorders were recorded during the study period, including AD (77.5%), DD (58.0%), schizophrenia (49.4%), BP (48.3%) and ID (33.2%). Results revealed 5 distinct types of TDx. Types 1 and 2, shared by 63.8% and 17.6% of the cohort respectively, represented individuals in younger age groups with similar characteristics, but with very different sequences of psychiatric diagnoses. Slight or sharp increases in diagnoses were observed around 2010, predominantly associated to autism spectrum in Type 1, and to schizophrenia and AD in Type 2. Individuals in Type 4 (6%) were little different from Types 1 and 2, but the TDx showed high prevalence of diagnoses of ID, DD, AD and ADHD, decreasing progressively around the diagnosis of autism. Types 3 and 5 (9.0% and 3.6%), representing middle-aged/older groups, displayed distinctive trajectories of high healthcare use, almost entirely associated with schizophrenia (Type 3), and BD (Type 5).ConclusionThis study proposes a complementary examination of the multiple pathways to diagnosis experienced by autistic adults, highlighting the need for further investigation into co-occurring psychiatric disorders.
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

AimsReferrals 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.MethodsThis 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.ResultsPatients 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.ConclusionThis 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

AimsSuicide 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.MethodsParticipants 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)ResultsA 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.ConclusionResults 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

AimsPsychosis 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.MethodsThis 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.ResultsQualitative 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.ConclusionIn 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

AimsDespite 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.MethodsThis 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.Results53 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.ConclusionThere 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

AimsThe 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.MethodsThis 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.ResultsRegression 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.ConclusionThe 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

AimsThis 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.MethodsThis 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.ResultsThe 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).ConclusionLimited 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.