ABSTRACT

Background

Despite their high prevalence and significant burden, mental disorders remain grossly under-diagnosed and under-treated. In low-and-middle-income countries, such as Mali, integrating mental health services into primary care is the most viable way of closing the treatment gap. The aim of this study was to assess the effects of a mental health e-learning program on the knowledge, attitudes and practices of primary healthcare professionals in Mali.

Methods

An e-learning platform including 12 interactive modules was used to train 46 healthcare professionals. Changes in knowledge, attitudes and practices, as well as in satisfaction with knowledge and in ability to diagnose and manage patients were evaluated by comparing data collected pre and post e-learning.

Outcomes

Knowledge and practices scores increased significantly post e-learning for all modules, except the practices score for anxiety disorders. Similarly, scores regarding satisfaction with knowledge and ability to diagnose and manage patients increased significantly, and more so than the knowledge and practices scores. Changes in attitudes however were not significant.

Conclusion

Despite the difficult conditions of implementation in isolated areas of rural Mali, preliminary results suggest a positive effect of the e-learning.

ABSTRACT

Background

Amid a youth mental health crisis, community-based early intervention services have shown promising outcomes. Understanding the specific factors that predict clinical outcomes is crucial for enhancing intervention efficacy, yet these factors remain insufficiently understood.

Aim

This study examined the individual and service-related factors associated with reliable improvement for young people (n = 4565) aged 12–25 years attending a brief primary care youth talk therapy mental health service across 14 sites.

Methods

Reliable improvement was measured using the clinical outcomes in routine evaluation (YP-CORE and CORE-10) measure at baseline and follow up. Poisson regression was used to identify individual and service-related factors associated with reliable improvement.

Results

Higher initial distress levels predicted increased levels of reliable improvement (adjusted risk ratios ranged from 235.7 to 415.1, p < 0.001), indicating that this intervention is particularly effective for individuals with higher initial distress levels. Conversely, extended wait times negatively affected therapeutic outcomes for young people aged 12–16, with waiting times exceeding 60 days associated with lower likelihoods of improvement (adjusted risk ratio = 89.2 for > 60 days, p < 0.01). Waiting times did not significantly impact individuals aged 17–25. Attending nine or more sessions was associated with a lower likelihood of reliable improvement.

Conclusion

This study underscores the critical importance of minimising wait times for young people and the importance of tailored approaches to early intervention services. Addressing these factors can enhance the efficacy of early intervention services and better support the mental well-being of young people.

Early Intervention in Psychiatry, Volume 19, Issue 1, January 2025.

ABSTRACT

Aims

Research on family functioning in psychosis has typically focused on specific family-related factors and their impact on symptomatology, finding strong associations between high expressed emotion and poor outcomes, especially in those with long-term illness. The objective of this review is to examine the impact of a broad range of family-related factors and their relationship with clinical, social, occupational and relational outcomes in first-episode psychosis (FEP).

Method

A systematic search of databases PsycInfo, Pubmed, Embase and CINHAL between 1990 and August 2023 was completed. In total, 1408 articles were screened, and study quality was assessed using the JBI critical appraisal checklists for analytical cross-sectional studies and cohort studies. A narrative synthesis approach was used to analyse the data.

Results

Of the 1408 identified articles, 80 full-text articles were screened. Fifteen studies were included for data extraction. The objectives and scope of the selected studies varied considerably. Studies consisted of cross-sectional and prospective cohort designs. Participants consisted of FEP patients and family members, with the patient age range varying from 15.9 to 30.8 (MD = 24.5). Significant associations were identified between family factors (high EE, family environment and carer burden) and symptom and social outcomes.

Discussion

While findings emphasised the significant impact of family factors on symptomatic and social outcomes, the literature had significant limitations due to the absence of underlying theoretical models and understanding of the dynamics of distress in families within FEP. Future research should seek to develop a model accounting for such processes.

ABSTRACT

Aim

This study aimed to examine patient perceived reasons for thinking about suicide among individuals with first-episode psychosis (FEP).

Methods

Participants completed a baseline assessment followed by 28 days of ecological momentary assessment (EMA). Baseline measures assessed lifetime suicidal ideation and reasons for thinking about suicide. EMA items assessed real-time suicidal ideation and reasons for thinking about suicide.

Results

The average number of lifetime reasons for thinking about suicide was 11.47 ± 5.99, with the most commonly endorsed reasons being to get away or escape (81.6%), to stop bad feelings (71.1%), and to relieve feelings of aloneness, emptiness or isolation (57.9%). Only 31.6% of participants endorsed positive symptoms as a lifetime reason for thinking about suicide. EMA results were consistent with lifetime data. Participants typically endorsed multiple reasons (2.15 ± 0.71), with the desire to escape and to stop bad feelings being the most commonly endorsed items. Psychosis was endorsed as a reason for thinking about suicide during 16.3% of instances of ideation during EMA.

Conclusion

These findings highlight the multi-faceted nature of suicide risk in psychosis. Interestingly, positive symptoms were not frequently endorsed as reasons for thinking about suicide from the patient's perspective. Further research is needed to identify when and for whom positive symptoms contribute to suicide risk. Additionally, our results identify important risk factors for further study, namely the desire to escape and/or stop bad feelings.